The man who runs this, Brian, in my view deserves a knighthood. Following the suicide of his son after taking citalopram, he set up this site and every day trawls through newspapers and coroners inquests finding cases of suicide and homicide where antidepressants may be the cause. He now has over 4500 cases, and he and his wife campaign relentlessly for wider understanding of these drugs.
If you think adverse drug reactions from antidepressants are rare, just visit this site. SSRI Stories is a collection of over 6,000 stories that have appeared in the media (newspapers, TV, scientific journals) in which prescription drugs were mentioned and in which the drugs may be linked to a variety of adverse outcomes including violence, suicides and homicides.
Surviving Antidepressants is a peer support group.
Run by UK antidepressant campaigner Bob Fiddaman, whose story if featured in The Pill that Steals Lives and on this site. Related, in the main, to GlaxoSmithKline's activities and Seroxat. Bob and 100 other Seroxat sufferers are taking Glaxo to court in the UK's first ever class action against a drug company. There is nothing Bob doesn't know about drug company cover ups and he is also a mine of information on how to withdraw, having done it himself.
Psychiatrist. Psychopharmacologist. Scientist. Author. Blog that is updated daily and offers reader debate. Professor David Healy needs no introduction to anyone who knows anything about antidepressants. He is this country's leading expert on antidepressant induced psychosis and has been an expert witness on most high profile cases where antidepressants have been thought to be the cause of homicides, violence and suicide.
RxISK is a free, independent drug safety website to help you weigh the benefits of any medication against its potential dangers.
Council for evidence based psychiatry exists to communicate evidence of the potentially harmful effects of psychiatric drugs to the people and institutions in the UK that can make a difference. It was set up by Luke Montagu, who stopped taking antidepressants some years ago but still suffers horrendous side effects. His story is featured in The Pill That Steals Lives. The site is a mine of information and as Luke is a filmmaker, there are a number of beautifully shot films made by him about people whose lives have been affected by psychiatric drugs.
Features research, articles, studies and personal experiences relating to antidepressants.
This website gives up to date information about psychiatric mediation and the withdrawal process. It has been created by people who have gone through it themselves and come out the other side.
Leading mental health charity in England and Wales, working “to create a better life for people with experience of mental distress”.
The governments Medicines and Healthcare Products Regulatory Agency where you are supposed to report adverse drug reactions. Unfortunately only around 1-10% of adverse drug reactions are reported via their yellow card system. This means its jolly hard to get an idea of how many cases there are. If there is someone reading this who wants to take up a cause, how about getting the MHRA to distribute their yellow cards everywhere and making sure GP's and the general public fill them in.
Uk charity giving a voice to patients and those bereaved due to ADR’s or severe withdrawal effects.
Medication-Induced Suicide Prevention and Education Foundation in Memory of Stewart Dolin is a non profit organization dedicated to honoring the memory of Stewart Dolin and other victims of akathisia by raising awareness of akathisia. Their story is featured in The Pill That Steals Lives.
A global independent network of researchers, professionals, patients, carers and people interested in health. Contributors from more than 130 countries work together to provide research and information that is free from commercial sponsorship. Its through the Cochrane that we get to here the real story of what goes on in drug trials, rather than just hearing about what the drug companies want us to know.
Campaigning group to get all drug trials published. If you want to be properly informed, not just about psychiatric drugs but all drugs, then please join this campaign.
Provides news of psychiatric research, original journalism articles, and a forum for an international group of writers. Run by award winning author Robert Whitaker whose book Mad in America is a must read (see below).
Provides up to date information on drug recalls and side effects
BOOKS TO READ AND FILMS TO WATCH
In November 2013, me and my kids, Lily and Oscar, who were 11 and 12 at the time, began a journey to understand how a year of my life had been stolen by psychiatric drugs.
We read many books and watched many films. Here are some of our favourites:
First up, was Dying for a Cure by Rebekah Beddoe from Australia. We were gobsmacked. The similarities between what happened to her and to me were staggering. You can read all about her story in the Stolen Lives section on this site.
I'm now lucky to have Rebekah as a great friend and support. Her book is available from Amazon. She is visiting me in the summer for my book launch. Hurrah!
Next up were two books by leading world expert on antidepressants Professor David Healy. He also is my superhero because he constantly stands up to the drug companies, trawling through unpublished data and acting as expert witness for people who have killed on antidepressants. His two seminal books, Let them Eat Prozac and The Antidepressant Era are not for the fainthearted. They are packed with info, read these and you will know everything there is to know about the history of antidepressants.My favourite bit is when he talks about a healthy volunteer study he did on 20 colleagues who he gave Zoloft (sertraline). Two became suicidal and psychotic, and the symptoms lasted days after the experiment finished. It gives a lie to the drug companies claims that people who become suicidal were sick anyway. These were healthy professionals who he worked with.
If you are in any doubt that antidepressants can cause people to become gun wielding maniacs, then John Cornwell's The Power to Harm is the book for you. It charts how a 48 year old print worker, Joseph Wesbecker, went on a killing spree and gunned down 20 colleagues, then turned the gun on himself, after taking Prozac and reportedly becoming psychotic. The following intrigue during the court case is fascinating. Eli Lily tried to buy off the injured victims and relatives of those killed by secretly offering them a huge amount of money. Interesting to note that by the time the case came to court there were a further 170 claims relating to Prozac.
Best books for understanding claims we have all been persuaded we are mentally ill are James Davies Cracked and Robert Whitaker's Anatomy of an Epidemic. Did you know that in 1950 1 in 1000 people were mentally ill, now its 1 in 4. These authors (and many others) believe psychiatrists (who are usually paid by drug companies), keep making up disorders like social anxiety disorder, hair pulling disorder, and there is now even a caffeine withdrawal disorder. And guess what the treatment is.....
One of my absolute favourite books is Deadly Medicines and Organised Crime by award winning writer Peter Gotzsche, director of the Cochrane Centre. I can't think of a better book that exposes how pharma lie skewer their drug trials and manipulate the data so we, the public, really don't have a clue what is really going on. Did you know that antidepressants are only tested for 6 to 8 weeks by the drug industry themselves? And that they only have to publish two trials to get a drug licensed and they can bury the rest.? Thanks to the Cochrane, though, who look at all the trials and all the data, we get a picture of what is really going on. His blog is Here.
For a great inside look at how pharmaceutical reps work, then Gwen Olsen's Confessions of an RX Drug Pusher is an excellent read. Her story is tarnished with personal tragedy. Her niece was taking psychiatric drugs and killed herself by setting fire to herself. The family are convinced it was caused by the multiple drugs she was taking. Not surprisingly, Gwen has now devoted herself to exposing the industry she once worked for.
Another story of almost unimaginable personal tragedy, is Dear Luise by Dorrit Cato Christtenson from Denmark. Its written by the mother of a girl who got caught up in a nightmare of over medication and incarceration in psychiatric hospitals. Eventually she died age 32 but tragically knew it was the medication that was killing her.
Two books that cast doubt on whether the drugs work at all are Irving Kirsch's seminal book The Emperor's New Drugs where he publishes his research that shows antidepressants are no more effective than a placebo. Also Joanna Moncrieffs The Myth of the Chemical Cure and The Bitterest Pills, in which she exposes the lie that psychiatric drugs correct chemical imbalances. These book argue that all the drugs do is create altered mental states which aren't a long term solution.
Psychiatrist Peter Breggin's Your Drug May Be Your Problem offers advice on how to taper off psychiatric medications. I couldn't put down his book Medication Madness in which he gives case after case of people who have committed acts of homicide, suicide and violence on medications.
And now for films....
A real tear jerker is Kevin Miller's Letters from Generation RX. Its a feature documentary where there are countless tales of people who have killed themselves and others on antidepressants.
Who Cares in Sweden is a wonderful and thought provoking trilogy of films on antidepressants made by an independent filmmaker
Available on Itunes, a really good watch.
If you are in any doubt as to how hard it is to come off antidepressants when you have been on them for a while, then watch this film by American filmmaker Phil Lawrence as he tries to withdraw. Its painful....
Panorama ran a series of investigative reports called the Secrets of Seroxat and are a great expose of how Glaxo Smithkline Beacham suppressed information showing kids became suicidal on their drug Seroxat (also known as Paxil and paroxetine). They had an unprecedented response from people (including adults) who had suffered. Here is the link to one of their reports.
How to Withdraw from Antidepressants
If you decide that the pills are not for you, and you would like to come off them, Professor David Healy has kindly allowed me to publish his withdrawal protocol. This will help you cope with the sometimes overwhelming problems of coming off these drugs.
WARNING: People who have been prescribed antidepressants should not suddenly stop taking their medication. Gradual tapering is advisable. Anyone considering altering the dosage of their medication, or withdrawing from it, needs to seek medical advice first.
DAVID HEALY MD FRCPsych
N WALES DEPT of PSYCHOLOGICAL MEDICINE
SSRI stands for selective serotonin reuptake inhibitor. This does not mean these drugs are selective to the serotonin system or that they are in some sense pharmacologically “clean”. It means they have little effects on the norepinephrine/noradrenaline system. There are 8 Serotonin reuptake inhibitors on the market:
UK Trade Name US Trade Name
Fluoxetine Prozac Prozac
Paroxetine Seroxat Paxil
Sertraline Lustral Zoloft
Citalopram Cipramil Celexa
Escitalopram Cipralex Lexapro
Fluvoxamine Faverin Luvox
Venlafaxine Effexor Efexor
Duloxetine Cymbalta Cymbalta
Venlafaxine in doses up to 150mg is an SSRI. Over 150 mg it also inhibits noradrenaline reuptake. Duloxetine is a potent serotonin reuptake inhibitor but not selective to the serotonin system.
SSRI withdrawal symptoms break down into two groups.
The first group may be unlike anything you have had before:
- Dizziness - “when I turn to look at something I feel my head lags behind”. Electric Head - which includes a number of strange brain sensations -“its almost like the brain is having a version of goose pimples”
- Electric Shock-like Sensations - Zaps - like being prodded with a cattle prod Other Strange Tingling or Painful Sensations
- Nausea, Diarrhoea, Flatulence
- Muscle Spasms/ Tremor
- Dreams, including Agitated Dreams or other Vivid Dreams
- Hallucinations or other visual or auditory disturbances Sensitivity to noises or visual stimuli
The second group are symptoms which may lead you or your physician to think that all you have are features of your original problem. These include: Depression and Anxiety - these are the commonest 2 withdrawal symptoms Labile Mood - emotions swinging wildly
- Fatigue/ Malaise - Flu-like Feelings Insomnia or Drowsiness
- Feelings of Unreality
- Feelings of being Hot or Cold Change of Personality
- More generally there is an intolerance of stress.
- Any difficulties present may wax and wane and this can be demoralising.
Is This Withdrawal?
There are three ways to distinguish SSRI withdrawal from the nervous problems that the SSRI might have been used to treat in the first instance.
First if the problem begins immediately on reducing or halting a dose or begins within hours or days or perhaps even weeks of so doing then it is more likely to be a withdrawal problem.
If the original problem has been treated and you are doing well, then on discontinuing treatment no new problems should show up for several months or indeed several years.
Second if the nervousness or other odd feelings that appear on reducing or halting the SSRI (sometimes after just missing a single dose) clear up when you are put back on the SSRI or the dose is put back up, then this also points towards a withdrawal problem rather than a return of the original illness. When original illnesses return, they take a long time to respond to treatment. The relatively immediate response of symptoms on discontinuation to the reinstitution of treatment points towards a withdrawal problem.
Third the features of withdrawal may overlap with features of the nervous problem for which you were first treated - both may contain elements of anxiety and of depression. However withdrawal will also often contain new features not in the original state such as pins and needles, tingling sensations, electric shock sensations, pain and a general flu-like feeling.
Before starting to withdraw, it should be noted that many people will have no problems on withdrawing. Some will have minimal problems, which may peak after a few days before diminishing. Symptoms can remain for some weeks or months. Others will have greater problems, which can be helped by the management plan outlined below.
Finally however there will be a group of people who are simply unable to stop whatever approach they take. Some others will be able to stop but will find problems persisting for months or years afterwards. It is important to recognise this latter possibility in order to avoid punishing yourself. Specialist help may make a difference for some people in these two groups, if only to provide possible antidotes to attenuate the problems of ongoing SSRIs such as loss of libido.
How To Withdraw
If there are any hints of problems on withdrawal from SSRIs, the management of withdrawal is something to be done in consultation with your physician. You may wish to show this to your doctor. Over-rapid withdrawal may be medically hazardous, particularly in older persons.
Many doctors suggest you withdraw by taking one pill every other day for a few weeks before stopping. There is no guideline that advocates this or evidence that supports it and the approach is misguided.
One of the first steps to consider is getting a liquid formulation of your antidepressant. This can be done by asking your doctor to approach the local primary care pharmacist who can make an application to one of the specialist companies such as Martindale’s or Rosemount that can make up a liquid formulation of almost any antidepressant you might be on - see below.
There are 2 theories about what leads to dependence and withdrawal that dictate slightly differing management plans.
One theory is that the relatively short half life of paroxetine and venlafaxine make these two drugs more problematic. This leads to a withdrawal strategy that advocates switching from paroxetine or other drugs to fluoxetine.
The second is that paroxetine and venlafaxine are relatively more potent serotonin reuptake inhibitors and this theory leads to a switch to less potent serotonin reuptake inhibitors such as citalopram or one of the older antidepressants such as imipramine.
Either approach is facilitated by having access to treatment in liquid form.
Paroxetine, fluoxetine and imipramine come in liquid form and anyone having difficulties with withdrawal should insist on access to the liquid form of one of these drugs or a special formulation of the drug they are on.
1A Convert to a liquid form of the drug you are on. If this is paroxetine 20mg then reduce by a comfortable amount in weekly steps - see below. This may mean reducing as little as 1 mg per week and being prepared to stop and stabilize if things get too difficult. For some people depending on the drug and their own physiology, there may be a need to go very slowly, others may be able to go faster.
The Reduced Potency Approach
1A Taking this approach, the best option is to change to Imipramine 100mg. This comes in 25mg and 10 mg tablets and also in liquid form. It is the first serotonin reuptake inhibitor. It is much less potent than the SSRIs, and has been used widely for children for a range of problems.
1B Another option is to have a mixture of 50 mg imipramine with 10 mg paroxetine or fluoxetine.
The Half-Life Approach
1A Convert the dose of SSRI you are on to an equivalent dose of Prozac liquid. Seroxat/Paxil 20mg, Efexor 75mg, Cipramil/Celexa 20mgs, Lustral/ Zoloft 50mgs are equivalent to 20mg of Prozac liquid. The rationale for this is that Prozac has a very long half-life, which helps to minimise withdrawal problems. The liquid form permits the dose to be reduced more slowly than can be done with pills.
One drawback to this approach is that some people become agitated on switching to fluoxetine in which cases one option is take a short course of diazepam until this settles down. This agitation might be caused by exposure to fluoxetine or because for some people the substitution does not cover withdrawal from their original drug. If the agitation gets better when the dose of fluoxetine is reduced then its more likely to be caused by fluoxetine, if it gets worse, then it is more likely to be linked to withdrawal.
1B Yet another option is to change from paroxetine or whatever the original drug was to a mixture of half the previous dose of the original drug and the other half in the form of fluoxetine. The next step is to reduce gradually the dose of the original drug and after that to reduce the fluoxetine.
2 Stabilise on one of these options for up to 4 weeks before proceeding.
3 For uncomplicated withdrawal, it may be possible to then drop the dose by a quarter.
4 If there has been no problem with step 2, a week or two later, the dose can be reduced to half of the original.
Alternatively if there has been a problem with the original drop, the dose should be reduced by 1 mg amounts in weekly or two weekly decrements.
5 From a dose of fluoxetine 10mgs liquid or tablets or imipramine 10mg tablets or liquid, consider reducing by 1mg every week over the course of several weeks - or months if need be. (a syringe is helpful in reducing the dose evenly).
6 If there are difficulties at any particular stage the answer is to wait at that stage for a longer period of time before reducing further.
Complexities of Withdrawal
Some people are extremely sensitive to withdrawal effects. If there are problems with step 1 above, return to the original dose and from there reduce as tolerated.
Withdrawal and dependence are physical phenomena. But some people can get understandably phobic about withdrawal particularly if the experience is literally shocking. If you think you have become phobic, a clinical psychologist or nurse therapist may be able to help manage any phobic element.
Self-help support groups can be invaluable. Join one. If there is none nearby, consider setting one up. There will be lots of others with a similar problem.
An alternate approach is to substitute St John’s Wort or an antihistamine for the SSRI, as these both have serotonin reuptake inhibiting properties. If a dose of 3 tablets of St John’s Wort is tolerated instead of the SSRI, this can then be reduced slowly - by one pill per fortnight or even per month or by halving tablets.
If withdrawal problems appear to ease off and then come back, it is worth checking whether this was because the affected person was co-incidentally treating themselves with something like St John’s Wort or an antihistamine.
Some people for understandable reasons may prefer this approach. But it needs to be noted that St John’s Wort and the antihistamines come with their own set of problems.
While SSRI withdrawal may not be a problem for some people, for others it can last months and indeed years - possibly 2-4 years. Even if it endures for months/years, it does seem likely to clear up in the long run.
In the case of enduring problems, being active is probably important. An enduring problem is likely to be underpinned by some brain change that can only be reversed by encouraging activity in that brain area through physical and mental activity. Gentle but regular exercise and involvement in activities rather than withdrawal seems more likely to stimulate silenced brain areas back into life.
If it seems impossible to withdraw and the option is to stabilise on an SSRI for the foreseeable future, at this point there is no clear indicator as to whether there is a best SSRI to stabilise on. In terms of ongoing problems paroxetine, sertraline, venlafaxine and duloxetine are associated with a high frequency of problems on withdrawal and on this basis seem poor fall-back options. Fluoxetine is associated with proportionally the greatest frequency of reports of drug seeking or “addictive” behaviours, and is problematic from this point of view. By default this leaves citalopram as a fallback option.
Companies have tried to label withdrawal problems as discontinuation problems or discontinuation syndromes, because of the negative perceptions linked to the term withdrawal.
The problems posed by withdrawal may stabilise to the point where you can get on with life. But whether it is or is not possible to withdraw, it is important to note ongoing problems and to get your physician or someone to report them if possible to the appropriate bodies - such as the FDA/MHRA. New health problems such as diabetes or raised blood lipid levels may have a link to prior or ongoing treatment. If your doctor won’t report these problems, you should if you live in a place where this can be done.
There are clear effects on the heart from SSRIs and from some there are likely to be cardiac problems during the post-withdrawal period. Such problems if they occur should be noted and recorded. SSRIs can also increase the risks of haemorrhage, especially if combined with aspirin, and of fractures.
SSRIs are well-known to impair sexual functioning. The conventional view has been that once the drug is stopped, functioning comes back to normal.
There are indicators however that this may not be true for everyone. If sexual functioning remains abnormal, this should be brought to the attention of your physician, who will hopefully report it.
Withdrawal may reveal other continuing problems, similar to the ongoing sexual dysfunction problem, such as memory or other problems. It is important to report these. The best way to find a remedy is to bring the problem to the attention of as many people as possible.
The single most important group who need to be aware of all these issues are women of child-bearing years. A very large number of pregnancies happen in an unplanned fashion and are several weeks advanced before the woman is aware of the situation. SSRIs, and paroxetine in particular, are now clearly linked to a number of problems in pregnancy, among which are an increased frequency of birth defects, an increased rate of miscarriage, premature birth, low birth weight, a neonatal withdrawal syndrome and pulmonary hypertension in the newborn infant.
One of the biggest problems of SSRI dependence involves women who are on treatment and unable to stop who wish to become pregnant. Getting off an SSRI at present seems more difficult for women than men, even with the incentive of wishing to become pregnant.
1. Rosemont Pharmaceuticals (Tel 0113 244 1999)
Amitriptyline 10mg/5ml, 25mg/5ml, 50mg/5ml
Dosulepin 25mg/5ml, 75mg/5ml
2. Cardinal Health, Martindale (Tel 0800 137 627)
This manufacturer will prepare any antidepressant on request.
3. Large chain pharmacies like Boots or Rowlands may have their own supplier of liquid formulations.
THE ABOVE INFORMATION HAS BEEN KINDLY PROVIDED TO THIS SITE BY PROFESSOR DAVID HEALY.
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