The analysis of this paper by Dr Joseph Hayes and Dr Sameer Jauhar established methodological flaws and errors in data extraction and concluded that it is “difficult to accept the findings with any confidence.”
The Mental Elf stated that Hayes and Jauhar have “set the record straight on antidepressant withdrawal”.
The authors of this original review paper have since offered a reply – including a wish for all to work together in improving understanding of this issue. I agree, there needs to be room for all under the umbrella of understanding:
“While waiting for the prescribing professions to conduct better studies we hope that all concerned, including those guilty of denial and minimisation in the past, can now work together to acknowledge what thousands of people with direct experience have been trying to tell their doctors for years, to provide full information to people contemplating starting antidepressants, and to lobby for support for the millions trying to withdraw from them.”
Ben Goldacre stated: “Good blog post. But I’d prefer it if the authors did a systematic review themselves. Important issue, lots of patients. I hope this response is only a holding blog. Peer review has a role but is mainly a slow irrelevant circus.”
The sociologist and biologist Patrick Geddes, long since dead, once affirmed his view:
Room under the umbrella (some thoughts):
As a wide reader I have always been drawn to the metaphor of the umbrella. The quote that I have used in the title of this blog comes from “No one writes to the Colonel” by Gabriel García Márquez.
I must be honest, I feel uneasy about sharing my thoughts on this subject, and perhaps I am not alone in feeling uneasy. However I have a determination to be true to who I am: a questioning doctor and somebody who has lived with antidepressant dependence and withdrawal.
Hayes and Jauhar state that recognition of withdrawal symptoms from antidepressants in the scientific literature is “not new”. This may be the case, but has this “scientific recognition” correlated, as it should, to the actual experience of those who have been taking antidepressants?
In terms of recognition in the clinical setting, I am even less sure about this. As Hayes and Jauhar point out there may be confusion about what is termed “relapse” and what may be withdrawal symptoms as a result of becoming dependent on an antidepressant. Alistair Campbell recently described his experience, concluding that he has “definitely become dependent” on his antidepressant:
Hayes and Jauhar expressed concerns that this published review on antidepressant withdrawal was “heavily featured in the media” but make no mention of the clarion call, seemingly coordinated by the Science Media Centre, on the publication of this Lancet meta-analysis:
The reporting of this meta-analysis carried headlines such that “more people should get pills to beat depression” and that it “finally puts to bed the controversy on antidepressants”. Neither the authors nor the experts giving their reaction mentioned, at least in what I read and watched, that the studies included were on average only 8-12 weeks in duration. There was also no discussion of potential harms associated with antidepressants: such as dependence or withdrawal.
Recently published Scottish Government figures have confirmed that almost 1 in 5 of our population are now taking antidepressants. The prescribing rates have increased year-on-year for the last decade: this would seem to reflect the reality that antidepressants are being taken far longer than available evidence can offer scientific support for. It is reasonable then to question how “realistic” such prescribing is?
I share in the determination for science, as Robert K Merton once described, to be “disinterested”. Hayes and Jauhar rightly question ideological or intellectual conflicts of interests. These potential conflicts apply to all academics and scientists. Jauhar argued otherwise in a paper co-authored with the President of the British Association of Psychopharmacology.
I have campaigned for Sunshine legislation for much of the last decade. My argument is based on robust evidence confirming that competing financial interests can lead to doctors recommending worse treatments for patients.
The Editor-in-Chief of the BMJ has recently stated that “paid opinion leaders are a blot on medicine’s integrity, and we should make them a thing of the past.”
Here are some of the paid opinion leaders in British Psychiatry:
I have written to a number of UK bodies who have a leadership role in healthcare to ask whether they support Sunshine legislation or not? I have had limited responses so far but have received this from the Science Media Centre. I have also spoken to one of the Managing Directors of Minervation Ltd (Mental Elf) who asked for more time to consider this question “because to be honest [he did] not know much about it”.
In the section, “Implications for practice” Hayes and Jauhar conclude:
“Whilst withdrawal effects are high for certain drugs (paroxetine, venlafaxine), when stopped abruptly, this happens very rarely in clinical practice and guidelines are in placed to address this. Furthermore, if people do experience withdrawal symptoms, there are treatments available, such as cross-titrating to a drug with a longer half-life, less likely to cause withdrawal, such as fluoxetine, followed by tapered withdrawal.”
This has not been my experience as an NHS psychiatrist of 25 years. It has also not been my personal experience. However, one senior member of the Royal College of Psychiatrists has stated publicly that for antidepressant withdrawal: “there already is a solution – switch to fluoxetine.” If this is the case one wonders why this issue has led to petitions to both the Scottish Parliament and the Welsh Assembly?
I want to close with this thought from “The Muse” by Jessie Burton: