By Angela Bischoff, March 1, 2005.
In The Antidepressant Solution (2005), Dr. Joseph Glenmullen gives a step-by-step guide to safely overcoming antidepressant withdrawal, dependence and addiction.
Research has shown that when patients stop antidepressants cold turkey they have high rates of withdrawal reactions, which vary depending on the particular drug, but generally affect between 60% and 78% of users! With 40-50 million people on antidepressant drugs worldwide, withdrawal and dependence have become major problems.
A study published in 1997 found that 70% of family doctors were unaware of antidepressant withdrawal even though they write the majority of prescriptions for these drugs. Drug companies still don’t adequately advise doctors of potential withdrawal reactions (nor other adverse reactions such as agitation). In fact, these drugs are advertised as “non habit-forming” or “not associated with dependence or addiction” even though both anecdotal evidence and company clinical trials prove otherwise. In Europe they can’t advertise this but they can in North America, where the FDA supported drug companies’ marketing ploy to change the term to “discontinuation” – while the user suffers the same withdrawal effects, which can be serious and even life-threatening.
Antidepressant withdrawal symptoms are divided into two main categories: psychiatric and physical symptoms. The psychiatric symptoms of antidepressant withdrawal include depressed mood, low energy, crying uncontrollably, anxiety, insomnia, irritability, agitation, impulsivity, hallucinations or suicidal and violent urges. The physical symptoms of antidepressant withdrawal include disabling dizziness, imbalance, nausea, vomiting, flu-like aches and pains, sweating, headaches, tremors, burning sensations or electric shock-like zaps in the brain.
Almost all patients who have been on antidepressants for more than one month should use a tapering program to go off the drugs, which Glenmullen is careful to note should be under doctor’s supervision. Also, your specific dosage reductions may need to be adjusted depending on your constitution. Everyone is different and will respond differently to the drug as well as to the withdrawal of the drug.
To reduce both the incidence and severity of withdrawal reactions, a conservative rule of thumb is a dosage reduction every month. For example, it is suggested that one taper off Remeron this way: if you start at 45 mg, reduce down to 30 mg for a full month, down to 15 mg for a full month, down to 7.5 mg for a full month, and finally 0.
Children are much more vulnerable than adults to antidepressant withdrawal reactions. Smaller dosage reductions and closer monitoring is recommended.
It is not recommended to skip dosages as a way of tapering; this can result in roller coaster episodes of withdrawal symptoms. Blunting withdrawal symptoms with other pharmaceutical drugs (i.e., pain killers) is also not recommended because it distorts and obscures the true stress the body is undergoing, a valuable gauge. Even after patients no longer need antidepressants to treat their original psychiatric conditions, their brain cells need time to readjust or readapt to stopping the drugs, and that takes time.
The fact that antidepressant withdrawal can mimic a patient’s original psychiatric condition is a cruel irony. Doctors and patients need to be well-informed about distinguishing antidepressant withdrawal from depressive relapse. This can be done by (a) noticing when the reaction occurs, (b) knowing that physical reactions are generally withdrawal reactions, (c) noticing if the symptoms peak and then clear in the predicted time frame and (d) noticing if the symptoms disappear quickly if the patient is given a test dose of the antidepressant.
How is it that physicians and the public have not been warned about probable withdrawal? Clearly, pharmaceutical companies have protected their profits, and regulatory agencies haven’t demanded the right data. Studies for drug approval are typically six to eight weeks, even though most patients are on these drugs for years or decades. Pharmaceutical companies note that dependence has “not been systematically studied.”
Withdrawal, dependence and addiction have historically been the death knell for psychiatric drugs, so that would explain why drug companies refused to study this adverse reaction. But it doesn’t explain why the regulatory agencies, such as the US FDA and Health Canada, have let them get away with it, to the peril of millions of users.