Guardian: Royal College of Psychiatrists accepts re-adjustment in guidelines for patients coming off Anti-Depressants.

[Ryder]

It’s something of a relief to see before you, written down in black and white, what you have known to be true for a long time: in this case, that antidepressant withdrawal symptoms aren’t, well, all in your head. In a significant shift in position, the Royal College of Psychiatrists now accepts that it has not paid enough attention to patients suffering from severe withdrawal symptoms when coming off antidepressants.

Antidepressants: Please, PLEASE, do not just abandon your meds!

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Patients are to be warned by doctors when they are prescribed the drugs just how hard it can be to come off them. Some will have been on them for years. They will have tried to wean themselves off and been so alarmed by withdrawal symptoms – mistaking them for a return of symptoms of their mental health condition – that they have given up the struggle. They will now be advised to use a gradual tapering-off process.

 

This will not come as news to members of the online antidepressant withdrawal communities which have sprung up in response to a lack of clinical support for patients coming off their tablets. Desperate patients have been reduced to using a micropipette to measure out doses, while others use pill cutters.

 

The new stance by the Royal College follows a Lancet Psychiatry paper co-authored by David Taylor, the director of pharmacy and pathology at the Maudsley Hospital in London, who has himself experienced withdrawal, describing it in a recent New Yorker article as a “strange and frightening and torturous” experience that lasted six weeks. “Although the withdrawal syndrome can be differentiated from recurrence of the underlying disorder, it might also be mistaken for recurrence, leading to long-term unnecessary medication,” reads the paper. Despite current guidelines recommending a taper of two to four weeks, “tapers over a period of months and down to doses much lower than minimum therapeutic doses have shown greater success in reducing withdrawal symptoms”.

 

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 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. I’ve come off antidepressant medication several times, having suffered depression when I was in my early 20s and PTSD later. The symptoms I experienced included panic attacks, dizziness, headaches, irrational fury, dramatic mood swings, suicidal thoughts and exhaustion. Luckily, I have a doctor in my family, who, after my ill-judged initial attempt to go cold turkey ended in hospital, recommended that I take it slowly by cutting my pills in half and reducing down to every other day, then every three days and so on. I am now drug-free and fine, but it was no picnic: not for me, and not for the people I love, who had to be around me. Recently, I was shown a letter I had written while going through withdrawal. Tear it up, I said. I was not in my right mind.

 

One in six adults in England takes antidepressant medication: 7.3 million people in 2017-8 were given a prescription, 70,000 of whom were under 18. These pills are often prescribed in consultations taking less than 10 minutes. Friends have described watching GPs Google antidepressant medication before prescribing. Patients in the throes of withdrawal and in desperate need of support are left languishing, with no appointments available.An underfunded NHS, including mental health services, is not equipped to cope.

 

None of this is to say that antidepressants are bad, that they cannot be transformative, or give people back their lives. I am grateful for what they have done for me in times of profound distress but I wish I had known the nature of the journey that I would be embarking on; that stopping the train because you want to get off would be such a nightmare.

 

Why, when the health of so many people is at stake, did it take so long to listen to patients?

 

Written in the Guardian: https://www.theguardian.com/commentisfree/2019/may/30/antidepressant-withdrawal-symptoms-doctors-side-effects

[Donnam]

This is too late smart. I appreciate the doctor who experienced the withdrawals

for speaking up but it is only because he has had the experience that he is. Otherwise he would have supported that things are not that bad but now he knows. 

You should not be allowed to prescribe antidepressants unless you take them just long enough for your body to need them and then experience what patients etoxperience. This will increase an understanding to those who prescribe them like candy

[William]

Yes. This is front page of the Daily Mail. Fantastic! Although 6 years to late for me. Life has been ruined! 

[Ryder]

18 hours ago, William said:

Yes. This is front page of the Daily Mail. Fantastic! Although 6 years to late for me. Life has been ruined! 

 

You have yet to come to the end of your taper. Come to the end of your taper and then you can tell your story.

[William]

I’m not tapering. I had an adverse reaction, kindled my CNS & had no choice but to cold turkey. 6 years on, still nowhere near healed 

[AlanC]

That's quite the U-Turn from the Royal College of Psychiatrists.

 

It's cold comfort for those of us who were taken off too fast by our doctors and now can't reinstate, but at least it should help stop more people ending up in that particular hell.

[Altostrata]

The actual announcement from Royal College of Psychiatrists is here https://www.rcpsych.ac.uk/news-and-features/latest-news/detail/2019/05/29/rcpsych-calls-on-nice-to-update-its-antidepressant-withdrawal-advice

[VincentV]

On 5/31/2019 at 11:59 AM, AlanC said:

 

It's cold comfort for those of us who were taken off too fast by our doctors and now can't reinstate, but at least it should help stop more people ending up in that particular hell.

 

Amen. It is cold comfort, but actually acknowledged and listened to by doctors when i say this isnt my depression, its the result of that medication will mean a lot to me. 

[Ryder]

Everything happens for a reason. It's up to organisations and its members, such as SA, to make sure this doesn't happen to future generations, kids, grandkids, family etc.

 

Yes, years have been lost and you wanted recognition. Now you got it.

 

Its high tide you guys do something positive about this to voice it to others. And to continue your own journey to come of your own meds.

[powerback]

On ‎6‎/‎4‎/‎2019 at 4:37 PM, Ryder said:

Everything happens for a reason. It's up to organisations and its members, such as SA, to make sure this doesn't happen to future generations, kids, grandkids, family etc.

 

Yes, years have been lost and you wanted recognition. Now you got it.

 

Its high tide you guys do something positive about this to voice it to others. And to continue your own journey to come of your own meds.

I agree Ryder.i challenged my GP last year[not the first time] he's comeback was "I don't know what you do with these drugs at home " .Don't challenge them in regards these drugs its a waste of time and energy ,we need to find a better way .

 

[Onmyway]

This is great news but I am afraid that it is not reaching the GPs. Today I went to my GP practice to request a refill of the liquid citalopram of which I take 1.6 mg. The doctor flat out refused. He said it wasn't a therapeutic dose and the drug cost 8 times more than the regular (generic) citalopram and I was being a burden on the NHS. (I just checked the cost to the NHS and it is 5.21 pounds while  y copay is around 8 pounds, so it is completely covered by my copay). We had this argument for about 15 min. 

GP: If you want to get off, get off, this is subtherapeutic dose

Patient: I did get off and had horrible wd and then reinstated. There is a Lancet article that talks about tapering at 10% etc., so now I am tapering off.

GP: OK, taper if you want but you can take the pill every other day and every 3 days, it has a long half life of over 3 days. 

Patient: No, it does not. Citalopram has a half life of around 34 hours. You are thinking of prozac, I am not on prozac. 

GP: All SSRIs have long half lives. 

Patient: That's not true. Paxil has a half life of less than 24 hours and causes interdose withdrawal effects. There were lawsuits over this. 

GP: 1.6 mg is homeopathic

Patient: It is what my body needs.

GP: I have a roomful of people and no time to argue with you. 

But continued to argue with me over the next 5 min in the same vein. 

 

I had no problem with the previous doctor in the same practice and that was before these new publications. I worry that this will not get to the GP practices soon enough. The other day, while I was waiting for an appointment overheard 2 people requested refills for cipralex (citalopram) on the phone and in person in a matter of 30 min. This epidemic has to stop. I wish I knew how to help do it.  

 

[AlanC]

9 hours ago, Onmyway said:

Today I went to my GP practice to request a refill of the liquid citalopram of which I take 1.6 mg. The doctor flat out refused. He said it wasn't a therapeutic dose and the drug cost 8 times more than the regular (generic) citalopram and I was being a burden on the NHS. (I just checked the cost to the NHS and it is 5.21 pounds while  y copay is around 8 pounds, so it is completely covered by my copay).

 

I can't say I'm surprised since this is pretty much the same response I got from my doctor: I was effectively told the liquid was a one-off and, since I wasn't going to cooperate with what she wanted me to do (a higher dose of a more powerful antidepressant), I could forget about any further help.

 

But the argument about cost is ridiculous. We pay £9 for each prescription item. A bottle of the liquid lasts 16 weeks once opened and contains 15ml of 40mg/ml, so if you're taking 1.6mg it would expire before you'd used all of it. Plus 4 prescriptions would cover more than a year. Of course, generic Citalopram 10mg is just £0.86 for 4 weeks supply...

[Onmyway]

2 hours ago, AlanC said:

 

I can't say I'm surprised since this is pretty much the same response I got from my doctor: I was effectively told the liquid was a one-off and, since I wasn't going to cooperate with what she wanted me to do (a higher dose of a more powerful antidepressant), I could forget about any further help.

 

But the argument about cost is ridiculous. We pay £9 for each prescription item. A bottle of the liquid lasts 16 weeks once opened and contains 15ml of 40mg/ml, so if you're taking 1.6mg it would expire before you'd used all of it. Plus 4 prescriptions would cover more than a year. Of course, generic Citalopram 10mg is just £0.86 for 4 weeks supply...

 

When he told me about the cost I thought he was talking about it costing £80 or so. What was my surprise when I found it wasn't! 

I strongly suspect that he is seriously pro-SSRI and is annoyed at me claiming that I have withdrawal effects. He denied the nausea could be wd and wanted to investigate it further. I have never had nausea in my life before without a direct cause such as eating bad food except when I tried prozac for a few days many years back. Yes, let's waste my tme, NHS money and countless probing with instruments to show that the nausea is indeed wd related. I am very weary of  medical interventions, being a health researcher and knowing the risks of mistakes etc. so am not going to go on a wild goose chase when I am sure what it is. The only other thing that it could be is from anxiety but it had never been a symptom for me with anxiety before and it is there when I am not actually anxious - i.e. no palpitatons or ruminations though anxiety does exacerbate it a bit. 

 

I am, however, appalled that he was suggesting that I take the drug every 3 days. First of all he was wrong about the half-life of citalopram. Then half-life is one thing that people get hung up on and it is important when you do drug testing etc. But when you are in wd and at  such low doses, you want to maintain as consistent a concentration as possible so dosing every 3 days is just ridiculous.  And the half life we know is an average of multiple people's metabolism of the drug. I used to get vivid dreams when I missed even one dose of citalopram. 

 

I am fantasizing about writing a letter to the GP about how wrong he is, including the price quote for citalopram, the Lancet article (SA recommendations would not convince him), the Royal College of Psychiatrists and a bunch of other articles (he also denies SSRI increase the risk of birth defects). The fantasizing is my way of ruminating and getting into emotional spirals, so perhaps I should let this go. Will work on it. 

 

Alan, I am new to the UK and I did, in the end, get the prescription but is it possible to switch to a different GP practice if one GP refuses? Did you manage to get yours? 

 

 

 

[AlanC]

Onmyway, I thought it'd be more appropriate to reply to your question about changing doctors on your introduction thread.

 

The crucial thing now will be whether the NICE will accept the changes recommended by the Royal College of Psychiatrists and by Davies and Read when they review their guidelines later this year. If they do then it should become much harder for doctors to continue denying the problems these drugs can cause.

[Onmyway]

I went to the Royal College of Psychiatrists web site to look for what their current blurb is on antidepressants and it seems like it's under review so there is nothing. My expectation is that they will say that these withdrawal effects exist for a few patients but the majority are OK. I can't imagine consultations with GPs will go well as the GPs refuse to believe their patients. The few short term studies show that not everybody is in the same position in terms withdrawal and they give no indication of what happens to those who have taken them for decades or have been polydrugged as many have been. 

[Altostrata]

The announcement is under recent news or press releases.