Position statement: frequency of withdrawal reactions

Following the publication of the Royal College of Psychiatrists Position Statement on antidepressants and depression there was widespread news coverage supported by Expert Statements by Professor Allan Young and Professor John Geddes.

Dr Sameer Jauhar in offering public support of the position statement was concerned about the media coverage:

“I do not understand how and why people make up numbers like this. Every individual is important- you don’t need to give erroneously high numbers to highlight the problem”.

Dr Jauhar, with Dr Joseph Hayes as co-author, were cited in the position statement. These authors have criticized the research methodology of Professor James Davies and Professor John Read on the frequency of withdrawal reactions. The Mental Elf  has stated that Hayes and Jauhar “set the record straight on antidepressant withdrawal”.

In a recent paper “Antidepressants, withdrawal and addiction: where are we now?” Jauhar et al claim that the frequency of withdrawal reactions for paroxetine (probably the worst drug in respect to withdrawal) is only 23%. However this withdrawal rate of 23% for paroxetine is flawed because it is based on 3 short-term (12-24 weeks) efficacy studies with carefully pre-selected, unrepresentative samples. Most importantly, timing of drug discontinuation was not randomised. In another study by Rosenbaum et al. participants were on paroxetine for about 12 months on average, which is much more representative of real-world practice than the short-term trials analyzed by Jauhar et al.  In this study, 66% of patients experienced a withdrawal reaction in the paroxetine arm (vs. 60% for sertraline and 14% for fluoxetine). In a study by Michelson et al using similar methodology and length of treatment before discontinuation (mean: 16 months) largely confirmed the high incidence of withdrawal symptoms after discontinuation of paroxetine vs. active treatment (57% vs. 6%)

It would seem then that the incidence rate of  withdrawal reactions for paroxetine is, in reality, much higher than the 23% quoted by Jauhar et al.

Following the publication of this paper one of the co-authors, Professor David Nutt said “here is the definitive overview of antidepressant withdrawal just out today”. Professor Allan Young is another co-author and his recent expert view for the Science Media Centre began “[these] so called withdrawal reactions . . . “. Last year Professor Young, as President of the British Association for Psychopharmacology awarded Dr Jauhar the Senior Clinical Award. BAP has recently confirmed that Dr Jauhar has won another award for this year.

Rhiannon Cosslett, a Guardian Columnist, in a piece titled “I know antidepressant withdrawal symptoms are real. Why didn’t doctors?” recently said:

“It is too easy to simply state that doctors need to listen more to patients in cases such as these. Proper research needs to be conducted. But it is telling that patient stories weren’t enough to bring about change to prescribing and withdrawal guidelines: that has happened only because clinicians such as Professor David Taylor, who also happened to be a patient, have experienced withdrawal and studied it as a result. Taylor told the New Yorker that had he not suffered withdrawal, he probably would have accepted the standard guidelines.”

The lack of research on the effects of withdrawal by pharmaceutical companies rushing their medicines out into the world is also undoubtedly a factor. As is the minimising by drugs companies of such research that does exist – ‘highlight the benign nature of discontinuation symptoms, rather than quibble about their incidence,’ read one internal memo seen by the New Yorker.” 

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