14 June 2026.
Comment by Peter Scott-Gordon in relation to Dr Aftab’s Substack piece:
Thank you Dr Aftab for your thoughts in this complex area. You have summarised your substack piece as asking the following questions about “protracted withdrawal.”
(1) Given the standard understanding of withdrawal in pharmacology, how well does this conceptualization apply to protracted cases?
(2) Given the loose/speculative definitions and given the difficulties of causal inference, what sort of overlap should we expect in self-attribution of protracted withdrawal and conditions like CFS and FND?
I would like to make some comments on your questions and the conclusions you come to based on my own experience as a retired NHS psychiatrist and somebody who has been prescribed an antidepressant and found it difficult to stop. I am offering this as a statement so that others might feel enabled to share their perspectives. It is not my intention or wish to get involved in further discussion on this subject myself.
I agree that there is more than the conventional understanding of withdrawal being described for some people after stopping antidepressants. I have experienced protracted symptoms myself. I also agree that hyperbolic tapering is not the whole answer. I am also well aware that some people can stop antidepressants without any ill-effects.
However, I am less certain that longstanding mainstream theories of neuronal level changes and transmitter function should be considered sufficient to form the basis of any pharmacological understanding of the effects of long-term exposure to antidepressants. As an example of where theories have had to be re-examined, I am aware of growing uncertainty in relation to the amyloid cascade in the pathogenesis of dementia.
It is important to acknowledge the scale of prescribing of antidepressants. In the UK this is now nearly 1 in 4 adults. This was not made sufficiently clear in your piece. We do not at this stage know accurately the numbers of people [of the 1 in 4 taking an antidepressant] who will have problems, and sometimes very severe consequences, on stopping their medication. Studies so far have shown variation in the percentage of individuals who report ill-effects when stopping antidepressants. Even if the most conservative figure is used, the number of people faced with harmful effects from stopping antidepressants will be large.
The 1990s Defeat Depression Campaign stated that the prevalence of clinical depression was 1 in 20 and that a significant number of treatable cases were being missed. With nearly 1 in 4 adults in the UK taking an antidepressant we cannot keep ignoring the possibility that quite a lot of people find that they have problems stopping their antidepressant, so keep taking it. It is not a plausible explanation that all these people need to continue taking them to prevent relapse of clinical depression. The numbers just do not match.
You express concerns that some people are mis-associating symptoms of Chronic Fatigue Syndrome [CFS] or Functional Neurological Disorder [FND] for harmful consequences of stopping antidepressants. My understanding is that there remains significant scientific uncertainty in relation to the pathogenesis of conditions such as CFS and FND. Given this, it is premature to present this conclusion with any degree of confidence.
Even as a doctor and retired psychiatrist I feel disempowered to say all of this to you. The psychiatric establishment can come across as highly defensive regarding ill-effects of antidepressants. Your influential position and work with senior psychiatrists across the world are therefore likely to deter many from sharing their thoughts and experiences. The medical profession needs to be careful to listen to the voices of all people. I am concerned that psychiatry risks doing the very opposite. Rather, there seems to be considerable effort to suggest that many of those struggling to get off antidepressants, or who have been harmed by antidepressants, may be suffering from ‘Iatrogenic harm identity’. Is this not an example of pre-determinism? Is this not an example of stigma?