Content provided in partnership with

Antidepressant dependency - Rx News

Healthfacts, April, 1998 by Arthur Aaron Levin

Although much has been written questioning the efficacy and safety of antidepressant drugs, RxNews was, until now, unaware of the problems relating to withdrawal. But a new report authored by a colleague, Charles Medawar, raises concerns that the widespread enthusiasm about Prozac and similar antidepressants may be trapping people in a "web" of dependence (1997, The International Journal of Risk and Safety in Medicine, Volume 10).

Most Popular Articles in Health: Fuel your workout: exercisers who eat before they work out have more energy ...; Soothe a dry, itchy scalp: 5 easy expert solutions; Cocktails and calories: Beer, wine and liquor calories can really add up. ...; The sour truth about apple cider vinegar - evaluation of therapeutic use; The, six best supplements you've never heard of: these secret weapons can ...; More »

After reviewing published studies and personal accounts, Medawar, who is director of the London-based consumer advocacy group Social Audit, concludes that the newer antidepressants known as serotonin re-uptake inhibitors (SSRIs) can cause significant problems of dependence and withdrawal. And, he claims, doctors are ignoring these problems with SSRIs (Prozac, Paxil and Zoloft are brand names). He also suggests that "depression is fast developing as an iatrogenic [treatment caused] disease and that, however much they are part of the solution, antidepressant drugs seem much more implicated in the problem of depression than is supposed."

Because symptoms of SSRI withdrawal are often mistaken for a recurrence of depression, people are at risk of being unnecessarily prescribed more antidepressants. This potential for a drug treatment "merry go round" is not an insignificant problem given the widespread use of SSRIs and the belief that they are safer than older drugs. Additionally, mental and public health agencies have stepped up campaigns to diagnose and treat the millions of people they estimate are clinically depressed. The rapid growth of managed care compounds the risk. The Wall Street Journal has reported complaints from psychotherapists who say that managed care plans often overuse drugs to treat depression and other mental illnesses, in order to avoid higher-cost talk therapy.

A team of French and American psychiatrists researching antidepressant withdrawal concluded that "it is a frequent and often under-diagnosed phenomenon ... Withdrawal from antidepressants can produce transient changes in mood, affect, appetite and sleep, which might be incorrectly diagnosed as indicating a patient is having a relapse" (April 1996, CNS Drugs). According to the Journal of Clinical Psychiatry researchers at Massachusetts General Hospital in Boston found, "Symptoms of discontinuation may be mistaken for physical illness or relapse into depression; misdiagnosing the symptoms may lead to unnecessary, costly tests and treatment."

Medawar suggests that to fully appreciate the risk of ignoring SSRI dependence we need only look back to the enthusiastic acceptance of the "feel good" anti-anxiety drugs. First marketed in the 1960's, the benzodiazepines (Ativan, Valium and Xanax are some brands) were promoted as safer than older drugs. "With hindsight," he reminds us, "it is clear that the evidence of benzodiazepine dependence was there all the time, though not revealed and/or obscured: blindness, bias and self-interest all played their part and wishful thinking too. Given the widespread assumption (until the mid-1980's) that benzodiazepines presented virtually no risk of dependence, doctors rather assumed that people took them for years because they really worked."

Medawar is right on the money. A survey of physician knowledge, reported in a 1997 issue of the Journal of Clinical Psychiatry (58 Suppl 7:28-30), found that over two-thirds of non-psychiatrists and over a quarter of psychiatrists were unaware of the risks for discontinuation problems.

The FDA-approved SSRI drug label doesn't even acknowledge any problems with drug dependence. Prozac's label, for example, advises that the drug "has not been systematically studied, in animals or humans, for its potential for abuse, tolerance or physical dependence. pre-marketing clinical experience with Prozac did not reveal any tendency for withdrawal syndrome."

Given the high incidence of withdrawal problems during discontinuation, RxNews believes the FDA should require a change in drug labeling that more accurately reflects the accumulating evidence of dependency.

Antidepressant dependency - Rx News

Healthfacts, April, 1998 by Arthur Aaron Levin

Find Research Guides for:

Find Featured Titles for: Reference

Most Popular Articles in Health

Most Popular Publications in Health