Literally Indescribable: Are Antidepressants Addictive!!

Before that, Michael was an educated, successful professional, financially secure, living life to the fullest. He loved working out at the gym, played competitive sports at a high level, and sang in choirs. He also was meticulous about taking care of his health. He never smoked, drank alcohol, or took drugs of any kind.

Michael’s troubles began after he accepted a new position that required him to spend long hours working. He developed arm pain and so sought medical attention for it.

The doctor told him the pain was due to a chemical imbalance, and it was just a matter of finding the right drug for him. So he prescribed, in quick succession, amitriptyline, venlafaxine, nortriptyline, and clonazepam. None of these drugs helped, and he didn’t stay on any of them for more than a couple of weeks.

Three months after he stopped the drugs, Michael began experiencing inexplicable bouts of tearfulness and agitation. He says he never had any psychological problems before this. He went back to the doctor and said “There’s something wrong with me, but I don’t know what it is.” Michael’s doctor prescribed Paxil.

“I had no idea that [this drug] was the sister of Prozac,” Michael told me. “If I had known something like that I would have ran a mile.”

Michael asked the doctor, “Is it addictive?” “No,” the doctor assured him. “Any side effects?” “You might experience a slight weight gain.”

Michael started on Paxil, but the drug left him emotionally numb. After a year, he complained to his doctor, who said “Okay—just don’t take it anymore.” The doctor did not offer any tapering advice, nor any warning of possible withdrawal effects.

Michael stopped the drug, but three months later he was affected, once again, by bouts of tearfulness and agitation. He went back to his doctor and pleaded “There’s something wrong with me. I don’t know what it is. Maybe I need this drug.” So the doctor renewed his prescription.

“There was no clinical assessment, no discussion, nothing,” Michael recalls.

Michael stayed on Paxil for eight more years. He tried a couple of times to kick the drug, but every time he was plagued with withdrawal symptoms. Whenever he went on vacation, he always made sure to take Paxil in his carry-on bag, because even a couple of days without the drug could be debilitating.

Michael finally decided to kick the Paxil for good. He announced his intentions to his doctor, who again offered no advice on tapering off the drug safely. So Michael devised his own tapering plan. Over the course of eight months, he cut the dose down from twenty milligrams to ten to five.

The results were disastrous. For the first time in his life, Michael became suicidal. For hours every morning all he was able to do was to lie in bed in a fetal position, trembling, sweating profusely. He also suffered from vomiting, diarrhea, and uncontrollable crying. He went back to the doctor, pleading “I’m in a very dark place. I don’t understand it. Tell me what you know about this drug you’ve been giving me.” The doctor asserted Michael had depression. When he replied, “That’s nonsense!” he was then referred to a psychiatrist.

“I didn’t want to go,” Michael recalls. “It was very obvious to me that I was dealing with people that were very ignorant concerning the pills they were pushing. They had no idea what they’d done to me.” But he went anyway to the psychiatrist, who told him it was okay to quit the Paxil cold turkey.

Then things got worse.

Brain Sloshing
Are antidepressants addictive?

The official answer to that question is “No.” Both the National Institute for Health and Clinical Excellence (NICE) and the American Psychiatric Association (APA) are in agreement on that point. The 2009 NICE guidelines for management of depression in adults inform readers that “antidepressants are not associated with addiction” and urges prescribers to inform patients of “the fact that addiction does not occur with antidepressants.” The 152-page APA guidelines for the treatment of patients with major depressive disorder uses the word “addiction” only once: “Common misconceptions about antidepressants (e.g., they are addictive) should be clarified.”

Both the NICE guidelines and the APA guidelines did refer to something called “discontinuation syndrome,” which includes flu-like symptoms such as nausea, headache, light-headedness, chills, and body aches, as well as neurological symptoms such as paresthesia, insomnia, and electric shock-like phenomena (commonly known as “brain zaps”), but these were characterized as transient and self-limiting:

“Symptoms are usually mild and self-limiting over about 1 week…” (NICE 2009).

“These symptoms typically resolve without specific treatment over 1-2 weeks.” (APA 2010).

Is this correct? John Read, a professor of clinical psychology at the University of East London, along with his colleague James Davies, surveyed the literature in order to determine the prevalence of withdrawal symptoms among users who discontinued antidepressants.

And of course, withdrawal symptoms are defined as those which appeared only after the drug is discontinued. The reappearance of symptoms that were present before the drug was started is not considered withdrawal, but rather the resurgence of the underlying condition.

Drs. Read and Davies found that studies show anywhere from 27% to 86% of those who discontinued antidepressants experienced withdrawal symptoms, and nearly half of those experiencing such effects endorsed the most extreme withdrawal severity rating offered.

What about the claim that withdrawal symptoms typically resolved after one or two weeks? Drs. Read and Davies found 10 studies which contained data on the length of withdrawal symptoms. Seven of these found that a significant portion of patients experience withdrawal symptoms for longer than two weeks, and withdrawal periods lasting for several months or more are not uncommon. One study found the mean duration for SSRI withdrawal symptoms was more than 90 weeks.

Drs. Read and Davies filed a Freedom of Information Act request to determine the basis for the 2009 NICE statement on that withdrawal symptoms usually are mild and self-limiting over about one week. NICE replied that the 2009 statement was inherited from a 2004 version of the guidelines, which stated:

“[Withdrawal] symptoms are not uncommon after discontinuing an antidepressant and that they will pass in a few days.”

And what was the basis for this statement? It turns out this earlier statement was based on two pieces of research, neither of which, upon examination, provided any evidence for the one-week claim.

These symptoms may be far from benign. A study of antidepressant withdrawal symptoms reported on the internet forum “Surviving Antidepressants” found a dizzying variety of complaints, including neurological (dizziness, ringing in the ears, burning sensations, sensitivity to light), psychological (suicidality, anger, insomnia, obsessive thoughts, poor concentration and memory, depersonalization, paranoia, terrifying dreams), gastrointestinal (constipation, diarrhea, acid reflux), cardiovascular (palpitations, chest pain, racing heart, skipped beats, high blood pressure), musculoskeletal (muscle weakness, aches and pains), psychosexual/genitourinary (difficulty urinating, erectile dysfunction, “numb penis”), and “other” (recurring infections, bad skin, hives).

Some of these complaints are literally indescribable in standard medical terminology: “vision lagging behind eye movements,” “head like cotton balls stuffed in,” “brain sloshing.”

In September of 2018, the All-Party Parliamentary Group for Prescribed Drug Dependence released its survey of 319 antidepressant users. Among the most startling findings:

64% of patients claimed not to have received any information from their prescribing doctors on the risks or side effects of antidepressants
25% were given no advice at all on how to withdraw from antidepressants
47% experienced withdrawal symptoms that lasted for more than one year
On a scale of 1 to 10, the average reported severity of withdrawal symptoms was nine
30% reported being out of work indefinitely because of antidepressant withdrawal symptoms
But perhaps even more unsettling were the respondents’ personal accounts of what antidepressant withdrawal has done to their lives. A sampling:

“I am unable to work, communicate, or basically function on any level that makes life worth living.”

“I exist as a shadow of the person I once was.”

“I cannot function to do simple tasks like make a cup of tea let alone leave the house to go to work.”

Many respondents claimed that their doctors just denied the very nature of the problem:

“I was told that ‘discontinuation syndrome’ could only have lasted a few weeks so I didn’t know what I was talking about.”

Others were told they were experiencing a relapse:

“The psychiatrists simply waived my story out of hand as impossible, saying that ‘It was just the old illness coming back’ even though I’ve NEVER experienced ANYTHING even remotely approaching this.”

“I was told it was just the anxiety and depression coming back but I have never experienced anything even close.”

“[It was] written off as my ‘original condition’ returning, and proof that I needed the medication like a diabetic needs insulin.”

Despite being told otherwise, the respondents were adamant that their withdrawal symptoms were different from the original problems which led them to take the drugs in the first place:

“The withdrawal has been far worse than the depression ever was.”

“Depression and despair ten times worse than I ever experienced before commencing on the drug.”

“This is far worse than anything I ever experienced before I went on the drug.”

Many of the respondents reported the withdrawal effects went on for years after discontinuing the drugs:

“It has gotten a little easier with time but even after 5 years of being off venlafaxine I am still not right.”

“It is just over 3 years since I stopped and I don’t think I am really over it now… I think my brain and body have been permanently damaged…”

“Seven years on after the last dose of the drug, I am still not the same person I was before starting Seroxat.”

Some of them found themselves unable to kick the drugs, and gave up entirely:

“I can only withdraw for a limited time because the symptoms are too severe to tolerate. I have tried several times to come off unsuccessfully.”

“I don’t want to be on these drugs anymore as they have too many side effects and I don’t believe they better the quality of my life, but I can’t stop.”

So why do the authorities say that antidepressants are not addictive?

A Semantic Quibble
Let’s hit the rewind button and go back to 2002, when BBC’s Panorama aired the documentary “Secrets of Seroxat.” (Seroxat is one of the trade names for paroxetine, the same drug which in the United States is marketed by GlaxoSmithKline as Paxil.) Viewers learned the story of Helen Kelsall, a young woman who began taking Seroxat for anxiety and experienced terrible withdrawal symptoms when she tried to kick the drug. These symptoms included headaches, muscle pain, sweating, tremors, nausea, balance problems,