I have had many doctors ask questions about this subject at seminars I have run on Stress, Anxiety and Depression. Finally, it is being debated robustly by American Psychiatrists and the findings are interesting, indicating that some (not all) patients have difficulties coming off these helpful drugs. The challenge remains to help identify the patients most likely to have difficulties, and my approach is always, while we wait for clarity on that issue let us encourage all patients to practise safe “protocols” when they decide to come off the drugs.
The problem we presently have, which has not been acknowledged and debated to date is that when people find difficulties coming off the medication, they tend to stay on it and if it’s a “clone” (generic) it tends to stop being clinically useful after about two years and so may open the door to further problems. I was clinically observing what I called “slippage” with the generics over twenty years ago and this enabled me to act and encourage GPs to monitor patients on them, especially if they continued taking the medication beyond the two-year point. One doctor’s brother who was referred to me was suicidal in the 3rd winter as the level of efficiency of the medication was clearly slipping in its effectiveness.
Our body will get used to things, and the Anti-Depressant medications are no exception to that general rule. When the body is comfortable with the new serotonin levels it doesn’t like them being changed by withdrawal and so symptoms may worsen when the drugs are withdrawn.
One Study authors noted in Psychiatric Times on the 13th February this year that problems coming off the medications are, “now understood to be potentially more common, complex, severe, and long lasting than previously acknowledged in clinical guidelines”. They also note that “discontinuation can trigger a complex multi-systemic syndrome”. They note these may be Neuralgic, GIT distress, Flu-like, and raised anxiety-depression levels.
Anti-depressant medication use in the USA has tripled in the last 30 years and 60% of patients are taking them for more than 2 years. The patient who has had difficulty withdrawing from them has often been dismissed as a problem in the past, but is now seen as describing real symptoms, which should have been expected, given that the Primal Brain will feel the withdrawal of medication that has assisted as a potential threat to survival.
There are now clear guidelines for tapering off, and it’s not just a linear taper. The Maudsley Deprescribing Guidelines, 2024, are very precise and have been found useful, and others have identified that its best to come off in Spring, as Serotonin levels naturally rise, and any lowering of medication be done in association with increased nature exposure, exercise and optimal nutrition through the process. Once again those “lifestyle” factors are central.
Dr John C McEwan
At Monarch Psychology Rooms, Greenlane