The myth that antidepressants are addictive has been debunked: they are a vital tool in psychiatry | Carmine M Pariante

Yo I’ve been prescribing antidepressants since 1991. Like most medications, they are imperfect tools: They have side effects and don’t work for everyone. Some patients report negative effects or that their depression does not improve and may need to switch to a different antidepressant. For those who do help, antidepressants certainly improve depression and reduce the risk of suicide.

Very rarely in my clinical practice do patients complain that they cannot stop their medication because of the symptoms they experience when they try. Unpleasant physical or emotional experiences for a few days or a couple of weeks after stopping antidepressants, yes: dizziness, headache, nausea, insomnia, irritability, vivid dreams, electrical sensations or rapid mood changes. But patients who could not arrest The antidepressant because of these symptoms? In my 33 years of clinical practice, I can remember them on the fingers of one hand.

That is why I have been skeptical – like what I believe to be the majority of psychiatrists, psychiatric organizations and clinical guidelines – of the claims in some scientific articles and the media that “millions of people are addicted.” to antidepressants.”

“Addiction” means that users crave the substance and cannot stop using it compulsively, as is the case with opioids or illicit drugs. However, there is no desire or compulsion for antidepressants, and our clinical experience tells us that only a small minority of people experience disabling symptoms when they stop taking them. The largest study ever conducted on the subject has confirmed this.

This analysis, in which I was not involved, looks at 79 previous studies, covering more than 16,000 people who stopped taking antidepressants, and compares them with more than 4,000 people who stopped taking a placebo. Pharmaceutical companies were not involved in this new analysis, although some of the data analyzed came from industry-funded trials.

The most important finding is that the proportion of people who stop antidepressants and experience severe discontinuation symptoms (which would likely require restarting the antidepressant) is 1 in 30 to 35 patients: much, much lower than the previous figure of about 1 in every 4 patients. .

Even more fascinating is that about 1 in 3 patients who stop antidepressants experience some (non-severe) discontinuation symptoms, but so do 1 in 6 patients who stop placebo. This indicates that some of the symptoms of antidepressant discontinuation are probably not the result of stopping antidepressants as such, but rather the attribution of some symptoms, especially now that there is an expectation that such symptoms will occur.

Of course, I am not suggesting that people who stop taking antidepressants are making up symptoms, or that the symptoms are “all in the mind” (a useless expression that serves no purpose, by the way). Rather, the symptoms are real, but may not be related to stopping antidepressants, but are mistakenly attributed to this.

So where does the discrepancy between the alarming numbers above and this new study come from? Previous studies used less robust scientific research designs, because they did not include comparisons with a placebo, or used a study design that preferentially attracted people who wanted to volunteer their experience of the symptoms of stopping antidepressants, skewing the results. For example, online surveys are more likely to attract people who stopped taking antidepressants and experienced symptoms than those who stopped taking antidepressants with little discomfort.

This previous research, although less robust, had the positive effect of drawing attention to the debate about discontinuing antidepressants. This new study is not perfect and in the coming weeks and months there will be debate about the quality of the data and analyzes presented. However, this work represents some of the best research available on this crucial topic.

Therefore, doctors should now present these more accurate rates of discontinuation symptoms when discussing antidepressants with their patients. And people who have been advised by their doctor to start taking an antidepressant (indicating that they have significant depression that is affecting their lives) should be reassured by the very low incidence of serious discontinuation symptoms. People who have been taking antidepressants for some time (six to nine wellness months if it’s the first time, longer if it’s the second or third time) should talk to their doctors about stopping them. If they decide to do so, they should reduce it slowly over two to four months, being aware that not all the unpleasant sensations and emotions they experience are due to stopping the medication. For the small minority who may experience severe discontinuation symptoms, a reintroduction of the antidepressant followed by an even slower taper is needed.

People will make different decisions through an informed conversation with their doctor. Some will decide that antidepressants are not for them. Some will decide that they do not want to stop taking the antidepressant. Many factors will influence these decisions, but at least the now debunked myth that antidepressants are addictive will no longer be one of those factors.

  • Carmine M Pariante is Professor of Biological Psychiatry at King’s College London. Her research funding comes mainly from UK and EU charities and governments. Any additional research funding from industry is publicly declared in the relevant scientific articles.

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