Why do scores of sufferers taking antidepressants get hooked for all times?

It was the news that many had been waiting for. Earlier this month, world-renowned medical journal The Lancet published a study that ‘proved’ antidepressants were not as risky as feared.

Reports prior to this suggested as many as half of patients suffered debilitating withdrawal symptoms when trying to stop taking the pills, including dizziness, headaches, nausea, insomnia and bizarre electric-shock-like ‘brain zaps’.

But the new research claimed that just one in six patients suffered this, while only one in 35 experienced symptoms that could be described as severe.

‘The hysteria about antidepressant addiction was unwarranted,’ commented Professor David Nutt, a mental health expert at Imperial College London and former Government adviser, on X/Twitter.

Meanwhile, in a Guardian newspaper article, Professor Carmine Pariante, a leading psychiatry expert at King’s College London, claimed that ‘the myth that antidepressants are addictive has been debunked’.

However, not all patients – or experts – agree. Some psychiatrists have raised serious concerns about the accuracy of the study, which they argue underplays the severity of antidepressant withdrawal symptoms.

A number of academics have even written to The Lancet warning that the study could put patients at risk of harm.

The joint letter, which has been shared with this newspaper, argues: ‘This [study] will lure patients and clinicians into unwarranted complacency about the difficulties of coming off antidepressants.’

Last week, Dr Ellie Cannon, The Mail on Sunday’s resident GP columnist, wrote that, having read the new study, she was pleased to hear that the pills were much less addictive than feared.

Dr Cannon, who has publicly spoken of her own antidepressant use and the fact that she has suffered from withdrawal symptoms when stopping, added that she would be glad to reassure patients. However, scores of readers responded saying they had been hit by withdrawal.

They reported a terrifying catalogue of symptoms, including uncontrollable crying, panic attacks, intrusive thoughts, crippling insomnia and even attempted suicide.

Some even claimed they were ‘trapped’ on antidepressants – because the severity of withdrawal symptoms made coming off them impossible.

Shockingly, one reader who was prescribed antidepressants after being mugged and stabbed said that weaning himself off them had proved even more traumatic than the attack.

With more than eight million people in the UK on antidepressants, experts on both sides of the debate agree it is crucial to find out the truth: just how frequent are antidepressants’ withdrawal symptoms?

The most common type of antidepressants used on the NHS are selective serotonin reuptake inhibitors – SSRIs – which are thought to affect levels of serotonin, a chemical ‘messenger’ in the brain linked to mood, emotion and sleep. The drugs – offered either as tablets or liquid form – are also given to patients with anxiety, obsessive-compulsive disorder and chronic pain.

While effective, there has been growing concern over side-effects. Last month, the UK’s medicines regulator announced it was opening an investigation into the safety of 30 of the most common antidepressants, which have been linked to hundreds of cases of suicide and self harm.

The Medicines and Healthcare products Regulatory Agency (MHRA) said the review would begin next month.

However, while the link between taking the drugs and these dangerous side-effects is still uncertain, experts say it has been known for some time that many patients struggle to come off antidepressants.

Specialists suspect withdrawal symptoms occur due to a sudden change in serotonin levels caused by stopping the drugs. These uncomfortable physical and mental effects tend to subside when patients restart taking antidepressants – which is why people often described being ‘hooked’ on the drugs or ‘addicted’.

NHS guidance cautions patients against suddenly stopping taking antidepressants because, it argues, this can trigger anger, headaches, low mood, sleeplessness and the sensation of being zapped like an electric shock. And, in 2020, the Royal College of Psychiatrists recommended that, to avoid this issue, patients slowly reduce their dose over several months or longer.

Experts say this highly cautious approach was the result of a 2019 UK study which concluded that 56 per cent of patients on the medication would experience withdrawal symptoms when they stopped taking it. The study, published in the medical journal Addictive Behaviours, said it was ‘not uncommon for people to experience withdrawal for months’.

However, many experts argue the researchers overstated the problem. They included data from several online surveys – which researchers typically consider to be poor quality evidence because anyone can take part. ‘There were a lot of holes in the previous review,’ say Dr Sameer Jauhar, a consultant psychiatrist at King’s College London. ‘It was scare story stuff that was not based on proper evidence.’

In the latest study, German researchers analysed data from 79 clinical trials involving more than 20,000 patients – some of whom had been treated with antidepressants and others with a placebo.

These sorts of trials are considered the highest quality medical evidence. The results showed that antidepressant withdrawal symptoms affected just 15 per cent of patients, but some experts are concerned by this figure.

In nearly half of the trials which were analysed, patients had only been on the drugs for three months or less. However, around four million people in the UK have been on them for more than two years, while two million have been using antidepressants for five years or more.

The longer that patients take antidepressants, the more likely it is that they will experience problems coming off them, the experts pointed out.

‘This is a serious weakness which is not acknowledged in the paper,’ says Tony Kendrick, professor of primary care at the University of Southampton.

‘Severe discontinuation symptoms would not usually be expected to arise after only a few weeks of antidepressant use.’

These worries are shared by mental health charity Mind, which says it was ‘important to note some of the review’s limitations, such as lots of the studies involved being short-term’ and added that ‘further research’ was needed.

Experts also point out that many of the trials analysed were designed to find out the safety and effectiveness of antidepressants – not to spot withdrawal.

‘Many studies relied on people reporting these symptoms spontaneously; they didn’t go out of their way to track them,’ says Joanna Moncrieff, professor of critical and social psychiatry at University College London.

‘So it’s very much likely to be an under-reported problem.’

Moreover, experts say there are specific concerns about one of the trials included in the review – a Japanese study which accounts for about a tenth of the patient data.

‘A Japanese doctor looked back through the notes of patients in his clinic and categorised them into having withdrawal or not,’ says Prof Moncrieff. ‘He found very low rates – but he didn’t say anything about his methods or how he has defined withdrawal.’

The study authors say they followed the highest standard of academic guidelines when choosing the studies for their review.

Prof Moncrieff, one of the four academics who has written to the Lancet Psychiatry to raise concerns about the study, added: ‘This review is misleading. It’s been interpreted as reassurance that antidepressants don’t cause significant withdrawal problems and therefore people shouldn’t be put off taking them. What worries me is that patients will be misinformed that withdrawal problems are not that significant on the basis of these studies.’

Other experts acknowledge the limitations of the study, but defended its findings. ‘The quality of the evidence in this review is very good with the caveat that it doesn’t involve longer-term trials,’ says Dr Jauhar.

One patient who has struggled to come off antidepressants is Caroline Petrie, 58, from Edinburgh, who was prescribed citalopram in August 2019.

‘A lot of difficult things happened, one after another, including a health scare,’ says the former career adviser. ‘Things felt out of control.’

She says she was told there would be no problem coming off antidepressants as long as it was gradual. However, after several weeks of taking citalopram, the mother-of-two was struggling to sleep and believed her anxiety had increased. She decided to stop taking the pills. ‘I tapered myself off over two weeks, taking a tablet every other day, then every third day, before stopping completely,’ she says.

‘But within a couple of days of stopping, everything got so much worse. My anxiety was through the roof, I had feelings of fear and panic, and a sense of impending doom.

‘Every time I tried to sleep, I would be jolted awake. Out of nowhere I had massive crying spells. I was worried about being on my own. I’d never experienced any of these things before. It was like being in a living hell.’

After a month, she was persuaded by a doctor to begin another antidepressant, mirtazapine, which she is still battling to come off, several years later.

She added: ‘Doctors are not educated about withdrawal and what it looks like.’

Experts agree that, regardless of the frequency of withdrawal symptoms, it is important to warn patients of the risk of these uncomfortable effects.

‘In the UK there are millions of people who are taking antidepressants,’ says Dr Jauhar.

‘Even if only one per cent of them got severe withdrawal, that would be a significant number of people who need treatment.

‘So it’s really important that people know there are risks.’

Experts say that patients who have been taking the drugs for an extended period of time – for example, more than two years – should take particular care when they decide to stop using them.

However, others say that one of the main reasons patients should take care when coming off the drugs is that their depression might return.

Robert Howard, professor of old age psychiatry at University College London, says: ‘If my patients are having no issues with the drugs, I don’t see any reason they should come off them.’

Pills helped me cope as a mum

For Lucy Nicholls there is no doubt at all – antidepressants have helped her cope with the pressures of being a young mother and rediscover her enjoyment of life.

The 20-year-old from Plymouth spent her teenage years suffering from poor mental health, and in 2019 was prescribed the antidepressant duloxetine for depression and obsessive-compulsive disorder. She said: ‘It definitely helped me. I was really depressed beforehand.

‘I didn’t see the point in anything, I didn’t want to talk to people, I didn’t want to do anything, I didn’t want to leave my room.

‘It just gave me motivation. I didn’t feel so sad all the time or feel that there wasn’t any point in anything. I started to enjoy things again – like art and nature.’

In 2021, soon after the birth of her son Mason, Lucy’s GP suggested that she stop taking the medication.

‘I didn’t notice any side-effects from coming off it,’ she says. However, a year later, Lucy began to feel low again and decided to go back on the antidepressants.

‘It’s been a year now and I’m feeling a lot better. I’m not sure if I would have got this far without medication – it’s helped me a lot.’