I was recently asked by a friend what I made of some of the responses by the President of the Royal College of Psychiatrists on the potential for antidepressants to cause dependence and withdrawal.
I replied that I was somewhat uncertain what to make of the responses that I had come across. I am not on social media and I am always wary of gauging anyone without really knowing them.
So these were some of my thoughts, which may, or may not, add up to something:
• Based on my experience of colleagues around me in psychiatry, Professor Wendy Burn is saying what I generally hear: that the prevailing view is that SSRIs are generally not harmful, have few long term side effects, and that dependence and withdrawal are issues confined to relatively few. I noted that one commentator said: “If, as Wendy suggests, it’s taken Twitter to open her eyes regarding severe drug withdrawal then maybe she’s been missing signs of withdrawal with her patients, assuming instead that her patient’s illness is returning. SSRI withdrawal mimics depressive symptoms”.
• As Psychiatrists we generally see the most severely affected patients. It is also the case that we rarely follow up in the longer term i.e. when somebody is better they will generally be discharged. This means that we have neither a longitudinal nor overall population view.
• If Professor Wendy Burn represents the prevailing outlook amongst psychiatrists and prescribers, and I think that she may do, why might this be the case? I guess there may be a number of reasons:
(1) As psychiatrists we are taught that we are more “objective” than patients seeking our help (patients are “merely” subjective). So we have comments like this by Professor Wendy Burn which include the word “believe”: “Yes I believe some people are having problems.” And “I have been prescribing these drugs for over 30 years and majority of patients have found them helpful. Plus have seen family and friends benefit. Haven’t seen addiction (unlike benzos). Why would I stop using them?”
(2) Psychiatrists generally have a goal to diagnose (and in my opinion to label far too much in pathological terms). It is generally considered that giving a diagnosis is “empowering” but my experience of labelling was the opposite. I was sometimes reduced to one word, and that word invariably did not include Peter.
(3) An overly narrow consideration of evidence. One commentator said to Professor Wendy Burn: “Should you not be looking at the wider evidence base such as the many reports of severe withdrawal difficulties. You are the President, you made a public statement re withdrawal for which there is no evidence. You therefore dismissed all the concerns being raised by patients.”
(4) A lack of awareness in prescribers on the scale of vested interests providing “evidence” and the extensive marketing this as “Continuing Medical Education”.
(5) Disproportionate reliance on quantitative evidence over qualitative experience.
(6) Professional and institutional denial. I am certain that healthcare workers find considerations that their interventions may have caused harm as difficult to contemplate and even harder to openly acknowledge. Defensiveness is a very human reaction.
(7) The legal and wider consequences of accepting that prescribed harm is happening and may be more prevalent than currently considered
(8) Society. The human need for simple and quick fixes, alongside existential fears and a general need to reduce the complex to the impossibly simple.