DR. MAX PEMBERTON on Royal College of Psychiatry decision on serious side effects of antidepressants
This day has been coming for a long time. The medical world has finally been awakened by major problems – highlighted by the tireless campaign of this newspaper – about how we treat depression.
Antidepressants are a lifesaver for millions of people. Last year more than 70 million NHS recipes were written in England alone.
There is no doubt that this class of drugs can benefit people with moderate to severe depression, helping them cope and ultimately solve the problem.
However, there is a proportion of patients for whom stopping medication causes horrible withdrawal symptoms. Yet their voices – and those of doctors who support them and who have seen the symptoms – were silenced or ignored.
The consensus was that withdrawal symptoms, if they existed, & # 39; mild & # 39; and would last a week or two.
This day has been coming for a long time. The medical world has finally been awakened by major problems – highlighted by the tireless campaign of this newspaper – about how we treat depression. File image
This was an insult to thousands of people who, as one of my patients described it, were "through hell and back" & # 39; in an attempt to empty the pills.
I have seen patients jerking violently in front of me because of the electric & # 39; zap & # 39; sensations they get – a common withdrawal phenomenon – yet they told me their GPs thought it was & # 39; everything in the spirit & # 39;
That will now change as the Royal College of Psychiatrists (RCPsych) – of which I am a member – finally accepts that withdrawal can be associated with & # 39; serious & # 39; side effects that are weeks or & # 39; longer & # 39; last.
Royal College will also lobby with the National Institute for Health and Care Excellence (NICE), the NHS body that monitors best practices, changes guidelines and has patients advise on potential problems before they begin.
Getting to this point has not been easy. It is an undisputed victory for The Mail's two-year campaign, Save The Prescription Pill Victims, which demands recognition of the magnitude of the problem.
WE WILL, I think, look back on this as a dark period, and the reluctance of the medical establishment to acknowledge the suffering caused is shameless.
In my opinion, it is reminiscent of the benzodiazepine scandal, a group of sedative drugs including Valium, which doctors have given to everyone since the 1960s.
They became joking & # 39; mother & # 39; s little helper & # 39; mentioned because they were seen as a special panacea for stressed housewives who were stuck with children at home.
However, they were far from the magic bullet that doctors and patients have made the pharmaceutical industry believe.
We discovered that patients could build up a tolerance that needed higher and higher doses to control their symptoms. And if they quit, they ran the risk of & # 39; rebound anxiety & # 39; making them even more nervous than ever before.
The Royal College of Psychiatrists (RCPsych) – of which I am a member – finally accepts that withdrawal may be accompanied by & # 39; serious & # 39; side effects from weeks to & # 39; longer & # 39 ;. File image
Even today we have to deal with the consequences, with tens of thousands still being addicted and dealing with side effects for decades after they have been prescribed.
Like antidepressants, patients and some doctors were worried about these drugs, but they were lightly discharged.
Will the problems associated with modern antidepressants be equally serious? I hope not, but there is a great need for patient training, and the late recognition by RCPsych of the problems they can cause offers a perfect opportunity.
Patients should be aware that when they stop taking the pills their symptoms may return – they may become anxious, nervous, withdrawn or suicidal. These are not withdrawal symptoms, but rather indications that the drugs effectively treated an underlying disease.
For other patients, it is undoubtedly true that their bodies will have difficulty adjusting to stopping medication.
I am often asked if this means that antidepressants are addictive. Simply put, the answer is no. Patients do not feel a strong urge to continue using them in the same way as some people do with, for example, cocaine, heroin or alcohol.
But the withdrawal symptoms can be so severe that some patients are too scared to stop.
This is a subtle but important difference and I believe that the medical establishment has been hiding behind this for years. No, antidepressants are not addictive, but it is insincere to claim that they are easy to stop.
It is important to repeat that many people have no problems getting rid of these pills. And the risk of withdrawal symptoms is certainly not a reason to prevent you from taking the medication if they are really needed.
The lesson here is simple: doctors must listen to their patients – to take their experience of symptoms seriously – and to adjust the initiation and stopping of medication to the needs of an individual.
Part of the problem is that the vast majority of mental health problems are managed in primary care – not least because of the unacceptably long waiting time in most areas to see a psychiatrist.
I have a lot of sympathy for GPs who may have 10 minutes to solve complex problems and patients who are often upset. However, prescribing an antidepressant must be carefully considered and most general practitioners have little or no psychiatric training and lack the knowledge to manage the circumstances with which they are confronted.
They often do not understand how slowly patients may need to be weaned from their medication.
Usually the doses are halved and then stopped. Nevertheless, studies show the great success with the use of small dose reductions during weeks and months. Why is this routine not a practice?
There is also the problem of repeat prescriptions for antidepressants that can go on for months or years without questions.
I am particularly concerned about those who have started taking medication that does not really need it. They can have mild depression, or social problems such as relationship problems or problems at work that no pill can hope to solve.
Others may suffer from personality disorders whose symptoms can mimic depression, but for which antidepressants are largely ineffective.
B UT DOCTORS eagerly write prescriptions because they think it can't hurt to try them without establishing a clear clinical need. In which other part of medicine would this be acceptable?
More emphasis should also be placed on alternative treatments for managing depression for those patients who could benefit – for example, conversation therapies such as cognitive behavioral therapy (CBT).
This has the advantage that it helps people to change the way they think about their problems and offers them mental strategies to deal with them, rather than simply masking their feelings with a pill – and it does not pose a risk of side effects or withdrawal symptoms.
I hope that the RCPsych's decision on these drugs will bring about a real change in the way we – doctors and patients – view them.
There is absolutely no shame in taking antidepressants, but it is only good that patients know the risks, as well as the benefits, and today the start of a change is good.
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