How Hard Is It to Stop Antidepressants?
In this podcast (episode #435) and blog, I talk to clinical researcher and fellow at University College London Dr. Mark Horowitz on his own experience on psychiatric medication, the many myths surrounding antidepressants, safely withdrawing from psychiatric drugs, and so much more!
Mark works in London as a Clinical Research Fellow in the NHS and an Honorary Clinical Research Fellow at UCL while training as a psychiatry. As well as his work in this field, he has also completed a PhD in the neurobiology of depression and the pharmacology of antidepressants at the Institute of Psychiatry, Psychology and Neuroscience at King’s College London.
But Mark does more than study psychiatric medications. As he notes, “At the same time as researching the way in which antidepressants worked I have also been taking this medication since I was a medical student. It was not until 15 years later that I tried to come off this medication as I wondered whether it was responsible for the fatigue which had led to me being diagnosed with the sleep disorder, narcolepsy. When I tried to come off this antidepressant over 4 months I received a very abrupt education into antidepressant withdrawal symptoms. I experienced insomnia, panic attacks, dizziness, anxiety and low mood. This was nothing like the Woody Allen-level neurosis that had led me to start them in the first place – and I had experienced nothing like it before.
It was also something that I had not been taught about at medical school or in psychiatry training. I soon learnt by reading the academic literature available that the psychiatrists and academics at the institution I had studied at and others like them around the world had little helpful to say about withdrawal effects from antidepressants – they recommended stopping the drugs over 2 to 4 weeks, and reported that the symptoms were mild and brief.
Many prominent academics with close ties to pharmaceutical companies attacked academics and patients who complained of trouble coming off their antidepressants, accusing them of malingering, or seeking legal payments. Instead, the place where I found the most useful advice was online peer-support websites (especially Surviving Antidepressants) filled with people trying to come off their antidepressants. There I found people describing the exact same symptoms I had experienced: like me, their symptoms were neither mild, nor brief. And this was not a handful of people – instead I found tens of thousands of people with near identical complaints. None seemed to be malingerers, in it for a buck or ignorant – they all had been told by doctors that there would be no major issue in coming off their medication and all had been given unhelpful advice by their doctors to come off in just a few weeks.
Even more helpfully for me, these online groups described a better way to come off antidepressants: going down by small amounts, that become smaller and smaller as the total dose got lower, and going down to very tiny amounts before completely stopping. I am using this method to come off the antidepressant I have been on for so many years, as well as the other psychiatric drugs I ended up being prescribed, in what I now see as a prescribing cascade, where adverse effects led to more medications. Reducing my medication has greatly improved the tiredness, problems with memory and concentration that have plagued me for years (and for which I was given psychiatric and neurological explanations).”
Indeed, based on his research and experience, Mark has written an excellent paper about how to come off antidepressants that was published in The Lancet Psychiatry and widely reported. He also works with other doctors and the public how to teach people how to safely taper off antidepressants and other psychiatric medications based on his own personal and professional experiences, and the realization that he has been “misled on how difficult it is to stop psychiatric medications”. Mark has dedicated his career to “re-evaluating the other information he has taken for granted about psychiatric medications, how they work, what they are treating and what their long-term effects might be” and helping people who are suffering find ways to heal and be at peace within their own minds.
Mark is also one of the authors of the groundbreaking study on the serotonin depression myth that recently made headlines around the world. As mentioned in my interview with journalist and mental health advocate Robert Whitakerand my interview with psychiatrist, researcher and professor Dr. Joanna Moncrieff, the chemical imbalance theory has been around for a long time. From the 1970s, drug companies and many mental health professionals have largely marketed psychiatric drugs as anti-psychotic, anti-depressive, or anxiolytic (anti-anxiety)—cures combating a particular disease, notwithstanding the lack of evidence for chemical imbalances or other pathologies related to mental illness. This was recently highlighted in the groundbreaking systematic review study led by Dr. Mike Horowitz, Dr. Joanna Moncrieff and their team.
As they note in their study on the serotonin theory of depression (alongside many other mental health professionals and advocates), the chemical imbalance approach is shaped by the assumption that symptoms of depression and other mental health issues are caused by a brain chemical abnormality, and that psychotropics like anti-depressants help rectify this abnormality and improve mental health. Even though this hypothesis dominates the way we think about mental health, we have no evidence that it is the best way to understand mental issues, as Mark and his team point out. First, there is no strong evidence that mental struggles like depression, for example, is associated with any particular biochemical abnormality. Moreover, we do not know if the drugs we use work in this way, i.e. correcting biochemical imbalances. This is due to the fact that the mental health drugs we use are psychoactive. They cross the blood-brain barrier and change the normal state of the brain, which means they can change our feelings, thoughts, perceptions and even behaviors, just in the same way a substance like alcohol can (as Dr. Moncrieff discussed in our interview).
As Mark, Joanna and the other authors of the study note in their article in the journal Molecular Psychiatry, “the main areas of serotonin research provide no consistent evidence of there being an association between serotonin and depression, and no support for the hypothesis that depression is caused by lowered serotonin activity or concentrations”. If we do not have good evidence that psychiatric medications like antidepressants do not work by correcting or reversing a chemical imbalance in the brain that causes depression, it is important that we review the way we use their drugs, many of which may even cause chemical imbalances in the brain, and can have many negative side effects (like the ones Mark himself experienced) that, unfortunately, are often just assumed to be the result of the mental condition returning.
This is why he is passionate about helping people safely withdraw from these medications. As Mark notes, there is actually very little official guidance on how to stop psychiatric medication safely. There has been very little research on this subject, although, thankfully, this is changing, not least through the work done by Mark and other professionals like him.
The key thing to understand about withdrawal is that“no one should stop their antidepressant medication abruptly—this can be dangerous and is known to cause withdrawal effects, which can be severe and long-lasting in some people, especially those using the medications long-term. If anyone is considering this choice…discuss it with your doctor and, if you go ahead, to undertake a gradual and supported reduction as advised by recent Royal College of Psychiatry guidance.”
There are ways to withdraw from psychiatric drugs safely, which Mark has written extensively about including in a recent paper about how to come off antidepressants, although this should always be done under the guidance of an appropriate medical professional. When withdrawing, there are several key points to consider:
- Come off psychiatric medication SLOWLY.
- Go down in SMALL AMOUNTS. It is very important to understand that very small amounts of any kind of psychiatric medication can have large effects on the brain.
- It is important to note that with psychiatric drugs you can reduce higher doses a lot quicker than lower doses. For lower levels, people often use tapering strips or liquids to reduce the drug by very small amounts over time. This is why it is important to make smaller and smaller reductions over time as you get down to lower doses (by proportion), based on the effect these doses have on the brain.
- It is necessary to take a flexible approach as everyone’s situation and past history is different, and avoid switching between certain drugs as much as possible.
- There are different ways to decrease doses, which should be done under the guidance of a medical professional. These include dividing tablets, using a liquid version of the drug and a syringe, and using compounding pharmacies to order smaller doses or tapering strips.
There are also great sources of information like Mad in America, Rxisk, ISEPP and other patient-run websites (like the kind Mark mentions) that seek to provide people with helpful information and address all parts of the human experience, not just our biology.
For more on psychiatric medications, withdrawal and mental health, listen to my podcast episode with Dr. Mark Horowitz (episode #435), and check out his amazing work!
If you enjoy listening to my podcast, please consider leaving a 5-star review and subscribing. And keep sharing episodes with friends and family and on social media. (Don’t forget to tag me so I can see your posts!).
You can now also join me on Patreon for exclusive, ad-free content! Sign up for a membership level that suits you, and receive access to ad-free exclusive bonus podcasts. These episodes will include more targeted, step-by-step guides for specific mental health issues AND some fun, more personal podcasts about topics like my favorite skincare products and favorite books, as well as live Q&As, fan polls and requests, and exclusive digital downloads!
This podcast is sponsored by:
Everlywell. Their at-home lab tests and vitamins and supplements can help you get the knowledge and support you need, so you can become a healthier you. Everlywell is digital healthcare designed for you — all at an affordable and transparent price. With over thirty at-home lab tests, you’ll be able to choose the test that makes the most sense for you to get the answers you need, like the Women’s Health Test or Food Sensitivity Test. Here’s how it works: Everlywell ships products straight to you with everything needed in one package. To take your at-home lab test, simply collect your sample and use the included prepaid shipping label to mail your test back to a certified lab. Your physician-reviewed results get sent to your phone or device in just days! And, you can share the results with your primary care physician to help guide next steps. If you ordered vitamins and supplements, you can start adding them to your daily routine right away. And, for listeners of the show, Everlywell is offering a special discount of twenty percent off an at-home lab test at everlywell.com/drleaf.
Noom. Whatever your reason is for wanting to make a health change, Noom is ready to help. Their psychology-based approach empowers you with the knowledge and support to build lasting results. Whatever your health goals are, Noom’s flexible, non-restrictive program focuses on progress instead of perfection. Indeed, they know progress isn’t a straight line, and off-days are totally okay. Noom will help you get back on track no matter what happens! Plus their program is grounded in science! The team at Noom have published more than 30 peer-reviewed scientific articles that inform users, practitioners, scientists, and the public about their methods and effectiveness. Stay focused on what’s important to you with Noom’s psychology-based approach. Sign up for your trial today at Noom.com/DRLEAF. And check out Noom’s first ever book, The Noom Mindset, a deep dive into the psychology of behavior change. Available for pre-order wherever books are sold!
Pique Tea’s Liposomal Vitamin C. Natural collagen production starts to slow down in our 20s, and I am in my 50s now, so this product has become an important part of my daily routine. Why? Vitamin C is vital in the production of collagen and plays a key role in keeping our skin plump, supple and glowing as we age. Pique’s Liposomal Vitamin C is maximized for absorption to support healthy collagen levels for healthy skin and provide immune support (especially with cold and flu season upon us!). It is full of antioxidants from organic elderberry superfood complex that can help Smooth and brighten skin and Combat hyperpigmentation and sun spots/sun damage from inside out! I love that it makes a great addition to my skincare routine, especially since I already use a topical Vitamin C serum, and that it only has 7 clean ingredients. It’s the beauty/wellness shot I look forward to taking every day - delicious and nutritious! Plus it is Non-GMO, non-soy, and has no refined sugars or preservatives. For a Limited Time Special Offer Get 15% off and free shipping on your first month’s supply of Daily Radiance by going to piquelife.com/drleaf.
Podcast Highlights
3:55 Why Mark is passionate about mental health
6:10 Psychiatric drug withdrawal is often misunderstood or overlooked
8:00 Mark’s own experiences with psychiatric medication & withdrawal
14:45 How survivor-run sites are helping people suffering from psychiatric drug withdrawal
17:26 There is very little guidance on ho two stop psychiatric medication safely
22:00 Why the withdrawal process is so hard for so many people
23:00 Why it is important to withdraw from psychiatric medication gradually & under the guidance of a medical professional
28:00 How psychiatric medications affect the brain & body
32:38 Why some people mistake drug withdrawal for a return of their condition
33:28 What withdrawal symptoms from psychiatric medications like antidepressants can look like
41:20 The power of awareness & acceptance + how our experiences can shape us & help us grow
45:00 Research on how common withdrawal effects from medications are
47:16, 54:13 How to safely withdraw from psychiatric medications
58:53 Why we should be careful when it comes to drugs like esketamine
Switch On Your Brain LLC. is providing this podcast as a public service. Reference to any specific viewpoint or entity does not constitute an endorsement or recommendation by our organization. The views expressed by guests are their own and their appearance on the program does not imply an endorsement of them or any entity they represent. If you have any questions about this disclaimer, please contact info@drleaf.com.
This podcast and blog are for educational purposes only and are not intended as medical advice. We always encourage each person to make the decision that seems best for their situation with the guidance of a medical professional.