Torment that isn’t all in the mind . . .

The young woman I saw in out-patients was clutching a newspaper cutting. ‘Just wait till I show my GP — I kept telling him I wasn’t making it up,’ she told me firmly.

‘I want him to say sorry for not believing me!’

helena (not her real name) had been referred to the clinic because she desperately wanted to come off antidepressant medication but was struggling because of the side-effects of withdrawal.

This week, she’d spotted reports of research published in the journal Lancet Psychiatry about the symptoms some people on long-term antidepressants suffer when they try to come off them.

For years, people like helena have been dismissed. The official view, as outlined in guidelines from Nice (the National Institute for health and Clinical Care excellence) is that withdrawal symptoms are mild, self-limiting and last a week or less.

Yet I know that many patients report a wildly different experience. As they start to come off antidepressants — the usual regimen involves halving the dose initially before it is stopped — severe symptoms kick in.

These include anxiety, dizziness, sleep problems and unpleasant sensations that patients describe as ‘like electric shocks’.

Now we have scientific proof of the potency of these drugs on the brain. The Lancet report reviewed brain scans and found that even low doses of antidepressant drugs have a significant effect.

The report was clear that contrary to what we’ve been told, withdrawal symptoms from antidepressants can be enduring and severe. It also acknowledged that these symptoms are often a reason why people go back on medication after trying to stop.

The report also highlighted Dutch research showing how people can be weaned off the medication successfully by reducing the dose by tiny amounts over weeks and months.

helena had started taking antidepressants two years ago when she was an undergraduate. A lively, outgoing student, she suddenly became withdrawn, lost her appetite, started sleeping during the day and no longer pursued

her favourite hobbies of swimming and horse riding. She described her anxiety as a constant feeling that something awful was going to happen.

her mother encouraged her to see her GP, and he prescribed antidepressants and a short course of talking therapy. This is pretty much textbook treatment for depression and anxiety.

helena improved rapidly and within a few months was back to her usual self. her family and friends breathed a sigh of relief.

She graduated, got a great job and embarked on a serious relationship. With her depression now a distant memory, she asked her GP if she could stop the drugs. he agreed.

By the time she saw me, she had been trying to get off the pills for over a year but could not cope with the side-effects. her GP was unsympathetic and she was beside herself. her story is far from unique. I’ve seen hundreds of patients like helena. OF

CourSe, many people don’t have any problems, and it is also important to emphasise that these drugs are literally lifesavers for some. The potential for severe withdrawal symptoms is not a reason to avoid taking them.

however, the Lancet findings are a reminder that as doctors we must listen to our patients, observe them and tailor our approach to individual need.

I’ve seen patients sitting in front of me suddenly jerking violently from the ‘zap’ sensations associated with coming off antidepressants. Yet they say that their GPs — who’ve seen it, too — have dismissed it as ‘all in the mind’.

This is another example of the discrimination that those with mental health problems face routinely. Their concerns are ignored as further evidence of them being ‘neurotic’.

Part of the problem is that the vast majority of mental health problems are managed in primary care. Few GPs, however, have the training in psychiatry to cope.

But the biggest problem, as I see it, is that too many GPs fail to appreciate how slowly patients need to be weaned off these antidepressant drugs.

I’ve worked with many patients who tell me that after being on high doses, on their doctors’ orders they’ve dramatically reduced the dose or even gone cold turkey. Severe side- effects have then overwhelmed them.

When I’ve put them back on the original dose then slowly weaned them off, they’ve been fine.

NICe guidelines on antidepressants are soon to be rewritten, and it’s likely they will now take into account the difficulty of stopping such medication.

Millions of patients have been vindicated. The medical profession owes them an apology.