DR MAX: Here are the methods to come back off anti-depressants safely

Antidepressants save lives. There’s no doubt about that. They are an effective treatment for moderate and severe depression and can be of incredible benefit for people suffering other crippling mental health conditions, such as anxiety and OCD.

As with all medications, however, they can have side effects and don’t work for all. But the biggest worry, for me, is that many people are started on them when they don’t really need them.

They may have mild depression, or social issues such as relationship difficulties or problems at work that no pill could hope to fix. Yet doctors dish them out thinking that there’s no harm in trying them anyway. And that’s a problem.

Antidepressants aren’t without down sides — and I’m not just talking about side effects, such as drowsiness. More problematic is the difficulty some people have in stopping taking them.

This isn’t because they are ‘addictive’. The body doesn’t crave them in the way it does an addictive substance. Rather, when they are stopped abruptly, the body takes time to adjust back, and during this process, really nasty symptoms can arise.

This is called ‘discontinuation syndrome’ and can include dizziness, headache, nausea, insomnia, ‘electric shock’-type sensations and irritability.

A recent study looked at how common this was and found one in six people who stop antidepressants will experience some of these symptoms.

What makes me sad is that, with careful planning and proper care, I suspect the number would be much lower.

Too often doctors fail to appreciate how slowly patients need to be weaned off these pills. I’ve seen many patients who have complained of withdrawals after being on high doses and then having them suddenly stopped. When I’ve put the patient back up to the original dose and then slowly weaned them off, they’ve been fine.

Choosing to start an anti-depressant has to involve a very careful weighing of the pros and cons and it’s only right that patients know about the risks.

GPs too often engage in a tick-box exercise that ends in a hasty prescription. Some people find it so hard to get off the drug later on, they give up and resign themselves to a lifetime of antidepressants, leading to feelings of failure.

Doctors have known about these problems for years yet, until recently, the medical establishment, including official bodies such as the National Institute for Health and Care Excellence (NICE), denied they existed or downplayed them.

This created a sense that patients were just making a fuss about nothing and studies over the years suggested they were having their medication stopped too abruptly as a result.

While patients coming off these pills usually have their dose halved, and then stopped, a Dutch study showed great success in weaning people off medication by using tiny reductions in dose over weeks and months. Yet it was met with silence from the medical bodies and NHS.

It was only an epic campaign by this paper, which lasted several years, that made those in power finally sit up and listen.

The Government, NHS, public health bodies and the Royal College of Psychiatrists all eventually acknowledged that coming off antidepressants too quickly was a problem and something needed to be done.

New guidelines were issued by NICE last year, and every doctor is now alerted to the fact that it can be difficult to wean patients off these drugs, and care must be taken before prescribing them.

Yet still many doctors don’t really appreciate the symptoms patients can experience when they stop taking the pills.

We need to acknowledge that, for some people, ending a reliance on the drugs is an unremarkable process but, for others, it can be almost impossible due to the awful side effects.

So, what do you do if you want to stop taking antidepressants and are worried?

It’s important to acknowledge that when some people stop taking the medication, their symptoms of anxiety or depression do return — they can become jittery, withdrawn or even suicidal.

This isn’t a discontinuation symptom, but evidence that the antidepressant was treating an underlying illness that has re-emerged. But for those who do experience discontinuation symptoms, be reassured that you are perfectly justified in asking the doctor for a slower reduction in dosage.

I’ve had a small number of patients who have used liquid forms of an antidepressant, so they can reduce it by just a tiny amount each week. But this is rarely necessary. Most of the time a slightly slower rate of reduction is all that’s needed.

As in all medical problems, it needs the doctor to take it seriously first. Sometimes short courses of other medications can take the edge off symptoms.

All GPs have access to mental health services for advice if they need help in reducing antidepressants slowly — and you should insist that they ask for help from a psychiatrist if they aren’t sure how to manage discontinuation symptoms.

I hate the idea that people who need antidepressants are worrying about the risks of discontinuation syndrome. I also hate the thought that people who don’t need the medication in the first place are having to go through it unnecessarily.

We all need more education around these powerful drugs.

If you want to stop your child using their phone so much, a new study has found the answer: put down your own handset. I’ve been saying this for years! If you want your children to behave in a certain way, then be a role model.

Why Kim’s wrong on therapy

Reality TV star Kim Kardashian, 43, says she has never had therapy — because she has ‘super supportive friends’. But this is rather missing the point of therapy.

The premise of it is that you can open up in a way that you can never do with friends.

A good therapist will ensure that you do not feel judged. They give you unconditional positive regard, but also challenge you in a way that a friend never could.

That’s not to say that friends aren’t important for our mental wellbeing.

But there are times when we need support from someone who deliberately leaves their own baggage at the door.

This is precisely what a therapist does and, alas, not even the best of friends can replicate it.

The DJ Chris Evans, 58, has celebrated a year of being sober after his skin cancer battle, saying that after his diagnosis, he realised that alcohol ‘took the shine off’ his life.

It often takes something serious to make us re-evaluate our lifestyle. It’s then that we can appreciate what we have, see issues that have been present for many years and what we need to do to change. 

I’ve seen this so often with patients who have a health scare. They give up alcohol, stop smoking, start eating healthily, spend more time with loved ones. The sad thing is that it sometimes comes too late for the change to be of benefit.

Dr Max prescribes… More fibre

A study has found the rise of cases of bowel cancer among young people may be linked to their diets not including enough fibre and containing too much sugar. 

This causes the growth of a bacteria in the gut that is thought to be the cause of cancer cells forming. Eating more fibre — oats, cereals, fruit, vegetables, seeds and nuts — can reduce the risk.