Withdrawing From Antidepressants Proves Harrowing for Some
over the past decade, and health officials in January began a nationwide review of prescription drug dependence and withdrawal.
In New Zealand, where prescriptions are also at historic highs, a survey of long-term users found that withdrawal was the most common complaint, cited by three- quarters of them.
And in America, nearly 25 million adults, like Ms. Toline, have been on antidepressants for at least two years, a 60 percent increase since 2010.
The drugs have helped millions of people ease depression and anxiety, and are widely regarded as milestones in psychiatric treatment. Many, perhaps most, people stop the medications without significant trouble. But the rise in longtime use is also the result of an unanticipated and growing problem: Many who try to quit say they cannot because of withdrawal symptoms they were never warned about.
Some scientists long ago anticipated that a few patients might experience withdrawal symptoms if they tried to stop — they called it “discontinuation syndrome.” Yet withdrawal has never been a focus of drug makers or regulators, who felt antidepressants could not be addictive and did far more good than harm.
The drugs initially were approved for short-term use, following studies lasting about two months. Even today, there is little data on long-term use.
“Some people are essentially being parked on these drugs for convenience’s sake because it’s difficult to tackle the issue of taking them off,” said Dr. Anthony Kendrick, a professor of primary care at the University of Southampton in Britain.
With government funding, he is developing online and telephone support to help practitioners and patients. “Should we really be putting so many people on antidepressants long-term when we don’t know if it’s good for them, or whether they’ll be able to come off?” he said.
Antidepressants were originally prescribed for episodic mood problems, to be taken for six to nine months, enough to get through a crisis
ater studies suggested that longer-term use could prevent a return of depression in some, but those trials rarely lasted more than two years.
Today, adults over 45, women and whites are more likely to take antidepressants than younger adults, men and minorities. And usage is increasing in older adults.
Still, it is not at all clear that everyone on an open- ended prescription should come off it. Most doctors agree that some users benefit from a lifetime prescription, but disagree over how many.
Antidepressants commonly cause emotional numbing, sexual problems like a lack of desire or erectile dysfunction, and weight gain. Some long- term users report a creeping unease about daily drug use.
“We’ve come to a place, at least in the West, where it seems every other person is depressed and on medication,” said Edward Shorter, a historian of psychiatry at the University of Toronto.
Drug manufacturers do not deny that some patients suffer harsh withdrawal symptoms.
“The likelihood of developing discontinuation syndrome varies by individuals, the treatment and dosage prescribed,” said Thomas Biegi, a . spokesman for Pfizer, the maker of Zoloft and Effexor.
Drugmaker Eli Lilly, referring to two popular drugs, said in a statement the company “remains committed to Prozac and Cymbalta and their safety and benefits.”
The few studies that have been published suggest that it is harder to get off some medications than others. This is due to the drugs’ half-life.
Brands with a relatively short halflife, like Effexor and Paxil, appear to cause more symptoms more quickly than those that stay in the system longer, like Prozac.
In one study, Eli Lilly had people taking Zoloft, Paxil or Prozac stop abruptly, for about a week. Half of those on Paxil had serious dizziness; 42 percent, confusion; and 39 percent, insomnia.
Among patients who stopped taking Zoloft, 38 percent had severe irritability; 29 percent experienced dizziness; and 23 percent, fatigue. The symptoms resolved once they resumed taking the pills.
Those on Prozac experienced no initial spike in symptoms when they stopped, but this result was not surprising. It takes Prozac several weeks to wash out of the body entirely, so one week’s interruption is not a test of withdrawal. In a study of Cymbalta, people in withdrawal experienced two to three symptoms on average. The most common were dizziness, nausea, headache and paresthesia — electric- shock sensations in the brain that many people call brain zaps. Most of these symptoms lasted longer than two weeks.
Dozens of people interviewed said the drugs often relieved mood problems, at first. After a year or so, it wasn’t clear whether the medication was having any effect.
Yet quitting was far harder, and stranger, than expected.
“It took me a year to come completely off — a year,” said Dr. Tom Stockmann, 34, a psychiatrist in East London, who experienced confusion, vertigo and brain zaps when he stopped taking Cymbalta after 18 months. He began removing a few beads of the drug in the capsule each day to taper off — the only way out, he decided. “I knew some people experienced withdrawal reactions,” Dr. Stockmann said, “but I had no idea how hard it would be.”
Robin Hempel, 54, a mother of four who lives in New Hampshire, began taking the antidepressant Paxil 21 years ago for severe premenstrual syndrome on the recommendation of her gynecologist.
“He said, ‘Oh, this little pill is going to change your life,’ ” she said. “Well, did it ever.”
The drug blunted her PMS symptoms, she said, but also caused her to gain nearly 20 kilos in nine months.
Quitting was nearly impossible. Ms. Hempel succeeded, in 2015, by tapering over months to 10 milligrams, then five, down from 20 milligrams and “finally all the way down to particles of dust,” after which she was bedridden for three weeks with dizziness, nausea and crying spells.
“Had I been told the risks of trying to come off this drug, I never would have started it,” Ms. Hempel said. “A year and a half after stopping, I’m still having problems. I’m not me right now; I don’t have the creativity, the energy. She — Robin — is gone.”
For now, people who haven’t been able to quit just by following a doctor’s advice are turning to microtapering: making tiny reductions over nine months, a year, two years — whatever it takes.
“It has taken a long, long time to get anyone to pay attention to this issue,” said Luke Montagu, a founder of the London- based Council for Evidence-Based Psychiatry, which pushed for Britain’s review of prescription drug addiction and dependence.
Mr. Montagu said, “You’ve got this huge parallel community that’s emerged, largely online, in which people are supporting each other though withdrawal and developing best practices largely without the help of doctors.”