DR MAX THE MIND DOCTOR: The antidepressent torment that ISN’T all in the mind
The young woman I saw in out-patients was clutching a newspaper cutting. ‘Just wait till I show my GP — I kept telling him I wasn’t making it up,’ she told me firmly.
‘I want him to say sorry for not believing me!’
Helena (not her real name) had been referred to the clinic because she desperately wanted to come off antidepressant medication but was struggling because of the side-effects of withdrawal.
This week, she’d spotted reports of research published in the journal Lancet Psychiatry about the symptoms some people on long-term antidepressants suffer when they try to come off them.
NICE guidelines on antidepressants are soon to be rewritten, and it’s likely they will now take into account the difficulty of stopping such medication. Millions of patients have been vindicated [File photo]
For years, people like Helena have been dismissed. The official view, as outlined in guidelines from Nice (the National Institute for Health and Clinical Care Excellence) is that withdrawal symptoms are mild, self-limiting and last a week or less.
Yet I know that many patients report a wildly different experience. As they start to come off antidepressants — the usual regimen involves halving the dose initially before it is stopped — severe symptoms kick in.
These include anxiety, dizziness, sleep problems and unpleasant sensations that patients describe as ‘like electric shocks’.
Now we have scientific proof of the potency of these drugs on the brain. The Lancet report reviewed brain scans and found that even low doses of antidepressant drugs have a significant effect.
Yet I know that many patients report a wildly different experience. As they start to come off antidepressants — the usual regimen involves halving the dose initially before it is stopped — severe symptoms kick in [File photo]
The report was clear that contrary to what we’ve been told, withdrawal symptoms from antidepressants can be enduring and severe.
It also acknowledged that these symptoms are often a reason why people go back on medication after trying to stop.
The report also highlighted Dutch research showing how people can be weaned off the medication successfully by reducing the dose by tiny amounts over weeks and months.
Helena had started taking antidepressants two years ago when she was an undergraduate.
A lively, outgoing student, she suddenly became withdrawn, lost her appetite, started sleeping during the day and no longer pursued her favourite hobbies of swimming and horse riding.
She described her anxiety as a constant feeling that something awful was going to happen.
Her mother encouraged her to see her GP, and he prescribed antidepressants and a short course of talking therapy. This is pretty much textbook treatment for depression and anxiety.
Helena improved rapidly and within a few months was back to her usual self. Her family and friends breathed a sigh of relief.
She graduated, got a great job and embarked on a serious relationship. With her depression now a distant memory, she asked her GP if she could stop the drugs. He agreed.
By the time she saw me, she had been trying to get off the pills for over a year but could not cope with the side-effects. Her GP was unsympathetic and she was beside herself. Her story is far from unique. I’ve seen hundreds of patients like Helena.
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Of course, many people don’t have any problems, and it is also important to emphasise that these drugs are literally lifesavers for some. The potential for severe withdrawal symptoms is not a reason to avoid taking them.
However, the Lancet findings are a reminder that as doctors we must listen to our patients, observe them and tailor our approach to individual need.
I’ve seen patients sitting in front of me suddenly jerking violently from the ‘zap’ sensations associated with coming off antidepressants. Yet they say that their GPs — who’ve seen it, too — have dismissed it as ‘all in the mind’.
This is another example of the discrimination that those with mental health problems face routinely. Their concerns are ignored as further evidence of them being ‘neurotic’.
The report was clear that contrary to what we’ve been told, withdrawal symptoms from antidepressants can be enduring and severe. It also acknowledged that these symptoms are often a reason why people go back on medication after trying to stop [File photo]
Part of the problem is that the vast majority of mental health problems are managed in primary care. Few GPs, however, have the training in psychiatry to cope.
But the biggest problem, as I see it, is that too many GPs fail to appreciate how slowly patients need to be weaned off these antidepressant drugs.
I’ve worked with many patients who tell me that after being on high doses, on their doctors’ orders they’ve dramatically reduced the dose or even gone cold turkey. Severe side-effects have then overwhelmed them.
When I’ve put them back on the original dose then slowly weaned them off, they’ve been fine.
NICE guidelines on antidepressants are soon to be rewritten, and it’s likely they will now take into account the difficulty of stopping such medication.
Millions of patients have been vindicated. The medical profession owes them an apology.
According to a survey by Lady Gaga’s charity, the Born This Way Foundation, most young people are struggling with their mental health. The study of 2,000 children aged 4 to 13 found that 55 per cent were stressed and a third felt sad.
Well hang on a minute, feeling sad or stressed isn’t having a mental illness, it’s life.
Surveys like this do more harm than good. They incorrectly portray normal distress as mental illness.
It does those with a genuine mental health problem a great disservice, and helps to perpetuate unrealistic expectations of what life should be like: always rosy and fine.
We all know that life is tough and it’s normal to feel down sometimes. That is what we should be teaching children.
A&E rule really hit the target
I am not usually a fan of targets, since they tend to reinforce the box-ticking culture that pervades the NHS today.
However, I am concerned that the Government this week quietly announced scrapping the A&E target that all patients should be seen within four hours.
Such targets are now an embarrassment politically, as few have been met in the past four years.
Now these patients will languish in A&E departments and no one will know, let alone care. The target protected those who are too often ignored — and now they are even more vulnerable [File photo]
It’s likely that the four-hour target in A&E will be kept for emergency cases such as heart attacks, with the aim of treatment within an hour. But such acute conditions aren’t the problem — they are usually recognised as life-threatening and dealt with promptly anyway.
Scrapping the four-hour target will disproportionately affect those with mental health problems.
They’ve long been the victims of breaches — suicidal people stuck in A&E for many hours until a bed in a psychiatric hospital is found — but at least the rule meant everyone knew about it.
The management would be alerted and after 12 hours, if no bed had been found, then the Chief Executive was called as the hospital risked financial penalties.
Now these patients will languish in A&E departments and no one will know, let alone care. The target protected those who are too often ignored — and now they are even more vulnerable.
Gender gap? It’s men who fare worse
Let’s talk about the ‘gender health gap’ — because everyone else seems to be. Are women really discriminated against in healthcare provision because it is inherently male-focused?
Feminist critics point to the fact that fewer women participate in clinical trials, which means the results disproportionately relate to men. As a result, drug doses are based on the average male weight and body composition.
There is also some evidence to suggest that women are less likely to complain of pain in case they are seen as ‘hysterical’ or a ‘hypochondriac’.
Men die on average nearly four years earlier than women. I doubt if there is any clearer evidence of inequality than that stark statistic. It equates to millions of male years of life lost each generation compared to women [File photo]
Such observations detract from the reality — and it isn’t what you think. Yes, there is a horrific gender health gap but it’s this.
Men die on average nearly four years earlier than women. I doubt if there is any clearer evidence of inequality than that stark statistic.
It equates to millions of male years of life lost each generation compared to women.
Men are more likely to die from all the common cancers that affect both sexes. And more men die now from prostate cancer (11,819 according to Prostate Cancer UK 2018 figures) than breast cancer each year (11,442).
Yet since 2002, breast cancer has attracted more than double the investment for research and treatment than has prostate cancer.
When it comes to mental health, men are significantly more likely to kill themselves than women, but less likely to receive treatment for depression or anxiety.
They are also more likely to drink or use drugs.
Can you imagine the outcry and claims of medical misogyny if it was the other way around?
The evidence is clear: it’s men, not women, who are getting a raw deal in healthcare.
Ministers plan to ban adverts for junk food before the 9pm watershed in an attempt to tackle childhood obesity.
What a waste of time. The idea that foods are ‘good’ or ‘bad’ goes against everything we should be teaching youngsters — and some adults — about a balanced diet.
There is no such thing as good or bad food; just healthy and unhealthy quantities of certain foods. And banning something just makes it all the more appealing to young minds.
There is already a means of stopping children from bingeing on sugar-rich and fatty treats. It’s called parental discipline.
Surely, it’s the job of Mum and Dad, not the Government, to ensure children are eating properly.
Dr Max prescribes… Watching documentary Far from the Tree
This moving and life-affirming documentary, based on the award- winning book by writer and professor of psychology Andrew Solomon, is a study of parental love and acceptance.
It explores how parents with children who are different from them — because they have autism, or dwarfism, for example — learn to accept them for who they are.
I watched it this week and was blown away. Check it out on Amazon Prime, YouTube and Google Play.
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