Antidepressant Withdrawal Welsh Senedd Debate
Editorial Note: For context see Welsh Government Response to Withdrawal Petition. The image is of Janet Finch-Saunders. The cover image is of the Senedd building.
Debate on the Petitions Committee Report: Petition P-05-784 Prescription drug dependence and withdrawal—recognition and support
Motion NDM7053 Janet Finch-Saunders
To propose that the National Assembly for Wales:
Notes the report of the Petitions Committee on Petition P-05-784 Prescription drug dependence and withdrawal—recognition and support, which was laid in the Table Office on 21 March 2019.
Motion moved.
Janet Finch-Saunders AM15:45:31
Thank you. Diolch, Deputy Presiding Officer. I’m delighted to open my first debate as Chairman of the Petitions Committee. I’d like to thank the clerking team, the legal team, and my fantastic committee members for all the support and assistance that I’ve received in my position as Chairman. I’d also like to thank those who continually send in fantastic petitions to this committee.227
Today’s debate is about a petition submitted by Stevie Lewis, which calls for better recognition and improved support for people adversely affected by dependence on prescription medication. I would like to personally thank Stevie Lewis for bringing the petition forward. She provided powerful—and often highly personal—evidence in support of the petition, and we are very grateful. I would also like to thank everyone who provided evidence to us. These included our health boards, professional bodies such as the Royal Pharmaceutical Society Wales and a number of people with personal experiences of prescription drug dependence and withdrawal. All of this evidence was invaluable to the Committee and has influenced a rather promising Government response.228
The petition calls for greater action to be taken to recognise the issues relating to prescription drug dependence and for improved support services to be available to people adversely affected by dependence on and withdrawal of prescription medications, especially antidepressants. This is when people who take prescription medication become dependent upon those very same medications, even when they have used that medication exactly as prescribed. Most concerning is that patients can also experience symptoms when they seek to reduce their dosage or stop taking medications entirely. These symptoms can sometimes be severe and debilitating. Indeed, the petition highlights specific concerns relating to antidepressants and benzodiazepines. Stevie Lewis has highlighted her own personal experience of being prescribed an SSRI antidepressant. After several unsuccessful attempts to stop taking the drug, she discovered she was physically dependent upon it. In her own words, she experienced a ‘long and crippling withdrawal’ before eventually stopping the medication after 17 years. Stevie Lewis’s testimony is not unique. It is echoed by many people who responded to an invitation by the Petitions Committee for people affected to share their experiences with us.229
I want to state at this point that these medications can have a positive impact for many people who are prescribed them. The committee is not suggesting that all prescribing of these medications is problematic—far from it. Rather, it is vitally important that patients have access to the right information and support, certainly at the beginning of their treatment, and also when they want to reduce or stop taking this medication. Also, medical professionals need to ensure that they sufficiently discuss approaches and therapies with patients that are considering an SSRI and are trying to manage their difficulties with mental health. I echo the aspirations of the Royal Pharmaceutical Society that patients should feel empowered when making decisions regarding their care.230
Now, I would like to focus on the committee’s findings and recommendations for the remainder of this contribution. Recognition of prescription drug dependence. Firstly, the petition calls for greater recognition of the issue of prescription drug dependence, particularly amongst policy makers and health professionals. This includes acknowledgement of the scale and impact of this issue and acceptance of the types of medications that can cause dependence and withdrawal issues. The committee was aware that it is not universally accepted that antidepressants are one of these medications. However, the experiences of the petitioner and others are evidence that dependence does exist and that many people do face difficulties in stopping their use of antidepressants.231
15:50
Janet Finch-Saunders AM15:50:00
We welcome the Welsh Government’s positive responses to our report, and I would like to thank the Minister for his recognition in doing that, and especially the recognition that antidepressants are associated with withdrawal symptoms in some cases. The petitioner has described this and other acknowledgements in the Minister’s response as an enormous step forward.232
The petitioner also expressed concern that policy and treatment for prescription drug dependence is placed under the umbrella of substance misuse. We agree that this is not appropriate, and services designed for treating drug and alcohol addiction are unlikely to be the best place to support people dependent upon prescription medication. We recommended that the Welsh Government should clearly distinguish between such issues in the future and should also identify specific actions to prevent and support those affected by prescription drug dependence. We welcome the Minister’s acceptance of this recommendation.233
Guidance. The committee also considered the professional guidance covering antidepressant prescribing. Concerns were raised with us about the potential of overprescribing and a lack of advice for people seeking to reduce their dosage. We recommended that the Welsh Government should further emphasise guidance about these matters, including that antidepressants should not be routinely prescribed for mild depression. In response, we note that the Minister has committed to ensure that NICE guidelines, which are currently under review, will be circulated widely within Wales. However, I am slightly concerned that this does not go far enough. We believe that the Welsh Government has a role in ensuring that health professionals adopt a more consistent approach to prescribing antidepressants and providing advice to patients. The petitioner has also proposed that further training materials may be required if the NICE guidelines are substantially revised.234
There are two other recommendations that I want to address this afternoon in terms of monitoring. The Petitions Committee has called on the Welsh Government to introduce a national prescribing indicator for antidepressants. This would improve the information about prescribing patterns available to health boards and the Welsh Government. We also believe that this information would enable the Government to better understand the scale of any problems and would support improved targeting of other types of treatments for depression, such as psychological therapies. We are disappointed that the Government has rejected this recommendation. In his response, the Minister recognises the importance of improving prescribing patterns. Therefore, given he does not consider a national prescribing indicator to be the correct approach, we would welcome his clarification as to how the Government intends to monitor this.235
Finally, the committee received a number of positive references to the prescribed medication support service run by Betsi Cadwaladr health board. Through this, therapists work with GPs and pharmacists to carry out face-to-face assessments of patients and they produce personal programmes. These will sometimes include tapering advice and withdrawal support. Within Wales, this targeted support is unique and appears to be a low-cost intervention. Therefore, we recommended that the Welsh Government should explore the potential of a national roll-out of this service. The Minister’s response indicates that he considers this to be the responsibility of local health boards to take forward. However, several health boards expressed to us that they would welcome greater opportunities to learn from best practice in relation to how they can best support patients. I continue to believe that the Government should take a greater leadership role in this regard. So, as is envisioned by the Royal Pharmaceutical Society, individuals that have inadvertently become dependent on prescribed medications—that they then have access to timely and appropriate support to clinical and psychological therapies in their own areas without fear of judgment and conflation of prescribed dependence and substance misuse.236
In conclusion, Llywydd, it was clear to the Petitions Committee that prescribed drug dependence is a serious issue and one that has not always received the attention or recognition that it deserves. I certainly hope that this is a starting point for change and I certainly look forward to listening to the the other comments made by Members of the Senedd here today in this afternoon’s debate. Diolch yn fawr.237
15:55
May I thank Janet Finch-Saunders and her committee for this very impressive and important piece of work? I have to say that it’s often my experience that the work in the Petitions Committee is amongst some of the most important things that this Assembly does—the way in which our system empowers the voice of citizens to be heard directly. One of the most positive things I think I’ve heard today is what Janet Finch-Saunders has just told us about the petitioner’s response to the whole of this process, because that multiplied many times, of course, grows a faith in this as a democracy that really listens to people and takes their concerns on board.238
Reading the report was a very personal experience for me, because many years ago, we had an experience in my own family of a family member who became dependent on medicine that had been prescribed because of mental health issues. We went through a process that felt like taking a family member through the horrible cold turkey that you see of heroin withdrawal. Now, this was back in the very early 1980s and what disturbed me, I think, was to read in the report that some of these problems still persist—that there are still some issues about the appropriateness of providing, that there are some issues about the understanding around the potential of some of these medications to develop a dependency. And it is really important that these issues are addressed. I’m very grateful to the petitioner for her individual courage in bringing these issues to the Assembly’s attention, and I’m sure that all of us, including the Minister, appreciate the courage that it must have taken to speak so openly.239
I’d just like to respond to a couple of particular points. One is a very important need, which obviously the committee Chair has already touched on, about making a difference between the right sort of services to support somebody who has developed an addiction either to illegal drugs or to alcohol and people who have become dependent on prescribed medications. The paths that people will have taken that have got them into those unfortunate situations will be very, very different and the help that they need and the support that they need will also therefore be different. And I think the important points that are made about not conflating the language—these are things that we all need to take on board. I feel I need to think about that in terms of my own personal discourse and the way I might talk about some of these issues.240
Like Janet Finch-Saunders, I want to come to recommendation 6, which the Welsh Government has rejected. I appreciate the reasons that the Minister has given, but I’d appreciate it if he could inform us today about how the concerns that lie behind that recommendation are to be addressed if they’re not to be put on the list of drugs targeted for drug reduction. It is really, really important that we do acknowledge that these medications, as Janet Finch-Saunders has said, can make a huge positive difference for people, but they can also, of course, create difficulties, and people must know, when they are having those medications prescribed, what the options are and potentially what the risks are, and they must have support to manage those risks.241
I also wanted to make a reference to recommendation 7, which the Minister has accepted in principle, but has said that it should be a matter for local health boards. I think what I would put to the Minister—and it’s a point that was raised by Members across this Chamber—is that we’re not always very good in Wales about seeing something that works well in one place and replicating it and learning from it elsewhere. Now, I can’t claim, as an individual, to be sufficiently familiar with this particular model, though I’ve obviously read what the report has had to say and I’ve heard what Janet Finch-Saunders has had to say. But given that the health boards are asking for some strong national leadership on this, I wonder if the Minister can say a little bit more—having accepted in principle, which I take to read that he’s accepting in principle that there is a need for some more national guidance—whether he would ask his officials to look again at that model and see if it could be effectively replicated elsewhere. It may be that it isn’t suitable. It may be that, for geographical reasons or whatever, it wouldn’t work particularly well perhaps in more urban environments, but when we have this level of knowledge, I think it’s a good idea to pick up and run with it. And that approach, of course, fits with some of the work that the Minister himself is trying to achieve through the transformation fund, which is all about developing good models that can then be effectively delivered elsewhere.242
The extent to which, of course, some of these antidepressants do cause dependency is still a matter of debate, but I think it’s very important that we create a culture of honesty around this, and the fact that a medication can create a dependency is not a reason not to use it, it’s a reason to use it with care. We use morphine to manage extreme pain relief in hospitals all the time, but when that is being prescribed, the people prescribing it know the potential risks, the people taking it know the potential risks, and the management system around it is there to prevent danger. I really think that we need, with these substances, which were, of course, sold to us as safe antidepressants—well, I think we know that there cannot be a medication that affects one’s emotional well-being that is entirely safe, and we need to ensure that when people are making decisions about treatment, they are making them effectively.243
I will end, Llywydd, as I can see my time is running out, just by saying that this is in some way reflective to me of the problems we have with our mental health services—that we know that many of the people who are being treated with these medications are being treated with these medications because there are no suitable talking therapies that might actually be much better. I’d urge, therefore, the Minister to look at dealing with this particular issue in that wider context, of which I know he is aware. We know that mental health services across Wales are not consistent; we know that talking therapies are available to some and not to others. Many of the people perhaps facing this difficult situation should never have had to take this medication in the first place if better alternatives had been available. I look forward hearing the Minister’s response and to Janet Finch-Saunders’s summing up of the debate and others’ contributions. Diolch yn fawr.244
16:00
The Minister for Health and Social Services, Vaughan Gething.245
Minister for Health and Social Services
Diolch, Llywydd. I’m very happy to take the opportunity to respond to the Petitions Committee’s report and the debate today. Tackling dependence on prescription-only and over-the-counter medicines remains a priority for this Government. The budget for substance misuse has increased to almost £53 million a year to provide a range of services and actions to respond to all forms of drug use, including prescription and over-the-counter medicines. We’ve also ensured prescribers across Wales have comprehensive guidance and advice in this area, so we are happy to note the motion today and we accept or accept in principle all but one of the recommendations, as Janet Finch-Saunders has set out.246
The committee’s recommendations are very much in line with the work already under way, which is led by both the Welsh Government and our partners across the national health service and area planning boards, bringing in a wider range of partners, including members of the third sector and the police.247
Recommendation 1, which seeks recognition around prescription drug dependence in both national policy and strategy, I’m pleased to give that recognition and outline the support that is already in place and work under way. I agree with the need to distinguish between substance misuse and dependence. So, our 2019-22 substance misuse delivery plan, which we’ll be consulting upon in the coming months, will make that distinction clear. In recognition of this, our work in responding to the issues of prescription drug dependence going forward will be overseen jointly by our pharmacy and prescribing as well as our substance misuse teams within the Government. Research is being undertaken at the University of South Wales, and the Welsh Government aims to gain a better understanding of the causes, characteristics and consequences of prescription and over-the-counter medications. That work will inform policy and identify best practice for us in the delivery of treatment and, hopefully, we expect this should lead to the development of a treatment framework on this issue.248
Turning to recommendation 2, the Government recognises SSRI and SNRI antidepressants are in some cases of discontinuation associated with withdrawal symptoms, and they can be consistent with symptoms of inadvertent dependence. We also know that some antidepressants are more likely to cause symptoms than others, but this is a complex issue where caution should be exercised so we don’t conflate the problems of dependence with those of discontinuation. Our position reflects the evidence that indicates discontinuation effects can be minimised through the structured tapering of those medicines, overseen with the support of the prescribing clinician. 249
In recommendations 3 and 4, I know clarity is sought on the guidance on not routinely prescribed medication and on the tapering of prescription medicines. As Janet Finch-Saunders set out, current guidance from NICE advises prescriptions and antidepressants are generally not recommended for mild depression, but they’re more likely to be effective for moderate to severe cases of depression. And those guidelines are, of course, being reviewed, and we will ensure those guidelines, which are expected in February next year, 2020, are circulated widely to clinicians in Wales for their adoption. I understand that the Royal College of Psychiatrists are planning to issue a new position statement on antidepressants and depression, including specific reference to how best to manage discontinuation. We will, of course, work with the Royal College of Psychiatrists in Wales, which will be making recommendations specific to Wales.250
Recommendation 5 requested an update on our actions in responding to recommendation 8 of the Health and Social Care Committee’s inquiry into alcohol and substance misuse, which was published in August 2015. I can confirm that the All Wales Therapeutics and Toxicology Centre has produced or contributed to a range of relevant guidance and good practice on prescription-only and over-the-counter medicines since that inquiry. I provided a list of that comprehensive work to the committee. I can also confirm specific action relating to the recommendations of the former advisory panel on substance misuse were included in the substance misuse delivery plan that just ended last year. The recommendations made in the advisory panel’s ‘A report on: Harms Relating to Prescription Only Analgesics’, published in December last year, are being taken into account in the drafting of the new delivery plan for 2019-22.251
As you’ve heard, I don’t accept recommendation 6. Depression is a common, recurrent and, in some cases, debilitating illness. For many people with depression, prescribing an antidepressant will be a safe and effective treatment option. We believe that a national prescribing indicator that intends to reduce prescribing could have the unintended consequence of discouraging the appropriate use of antidepressant medication and result in some patients not starting treatment and others stopping prematurely. We know that such medications can have an effective role to play in managing depression. Our interest is in the appropriate prescription and management of medication. I’d be concerned that targeting those for wholesale reduction would not lead to a positive outcome for the person. We remain of the view that improvements to prescribing practice, patient review and safe tapering will achieve the desired outcomes outlined by the committee that we share in terms of the outcome and the impact on the person. Alternative psychosocial treatment options, such as counselling, should of course be available and considered. Our investment to improve access to and the range of psychological therapies in Wales continues to increase. We are also testing new approaches to improve access to non-clinical support to improve mental health through, for example, our social prescribing projects.252
And, as you know, I’ve agreed recommendation 7 in principle. I recognise and applaud the work of the Betsi Cadwaladr prescription medication support service, but I’m not convinced of the need for a national programme based upon that particular service. I continue to believe that that should be addressed at a local level in response to local needs as part of the needs assessments of area planning boards to ensure that the issue is considered including ensuring that local drug treatment services engage with general practice to provide additional support when needed. There are different but positive approaches across Wales—for example, in Aneurin Bevan on tramadol reduction. Rather than endorse one approach across the country, I expect that practice to be shared between different area planning boards to understand what further improvement can be made. Patients should of course in the first instance be supported by their clinician appropriately, whether that is by prescribing medication and indeed the regular monitoring of any side-effects and providing support for safe tapering of the medication.253
We of course recognise that sharing information and best practice in relation to drug dependence will improve support for patients as proposed in recommendation 8, and our All Wales Medicines Strategy Group has a key role to play in this, and we’ll continue to work with them to share best practice and drive improvements.254
Recommendation 9 is for NHS Wales, but I very much support all opportunities for the NHS to benefit more from pharmacists’ expertise. We’ll have more to say on that in the coming weeks and months. I encourage health boards, trusts and primary care clusters to work more consistently with pharmacists to support patients. Our pharmacists have a vital role in providing medication reviews and professional advice, including crucially, in light of this report, helping patients end prescribed treatment.255
In response to recommendation 10, my officials will work with DAN 24/7 to evaluate if further training on prescription-only medication is required for staff and to ensure the website includes content on dependence on these medicines.256
I’d like to close by thanking both the Petitions Committee for their work and all those people who gave evidence, but most importantly to put on record my gratitude to Stevie Lewis, whose personal experience has brought to our attention the difficulties that can arise when withdrawing from prescribed medication.257
16:10
Janet Finch-Saunders to reply to the debate. Janet Finch-Saunders.258
Janet Finch-Saunders AM16:10:17
Diolch, Llywydd, and I would like to thank the Minister for what was actually a very detailed and quite a positive response, which is heartwarming for me as Chairman on our committee, but also for Stevie, who actually brought this petition forward because of their own experiences. I would also like to thank Members for their contributions and, in particular, Helen Mary Jones, who gave an excellent contribution as always. You spoke with much personal experience—your own life experiences with a member of your own family—and you also, very ably, provided us with recognition of the different approaches that are needed, and to avoid conflation between prescription drug dependence and substance abuse. I agree with you. I cannot see any earthly reason why, especially a health board that’s been in special measures for four years, where they can be seen to have, and it’s proven that they have a good model to be working, why the Minister actually leading those special measures isn’t convinced that perhaps the roll-out of those to where there isn’t this good practice in evidence, where that can’t be provided at the moment, to certainly help other health boards and help other individuals like Stevie with their concerns. 259
I would just—. In your response, though, you didn’t touch on this, so I would like, even if you write to me at a later date on this, Minister, if you could give some further guidance that the Welsh Government could give to ensure that you will fulfill a leadership role and, by doing that, endorse the proposed model from the Royal Pharmaceutical Society that effective communication is now required between pharmacists and GPs, from the initial administering of medication to reduced dosages. How does your Government intend to monitor and vocalise the requirements of pharmacists and the pharmaceutical industry in ensuring the safe use of prescription drugs? I’d also like to know a little bit more about what support services will be made available across Wales going forward, in this regard, so I would really like you to write to me on that.260
In conclusion, though, Llywydd, I would like to thank Stevie Lewis and everyone who has worked very hard in bringing forward this very important issue to our attention. I do hope that this debate, and indeed the work of the petitions process as a whole, has been a positive experience, and I do hope that the Welsh Government will give further consideration to the additional points raised this afternoon and that action is taken to provide better advice and support to people affected by prescription drug dependence in the future.261
As I mentioned, I am very pleased by the number of recommendations that you have agreed to in principle: a large number of those—only one, really, that we beg to differ on. But to me, recommendations in principle are only as good as the actual action that is carried out afterwards. So, thank you again, Minister, and thank you, Members. Diolch yn fawr.262
Y Llywydd / The Llywydd16:13:33
The proposal is to note the committee’s report. Does any Member object? The motion is therefore agreed in accordance with Standing Order 12.36.263
Motion agreed in accordance with Standing Order 12.36.
Comments
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recovery&renewal Retweeted
Michael P. Hengartner, PhD @HengartnerMP 1h
Some interesting thoughts on the annual meeting of the American Psychiatric Association and aggressive drug company marketing
very funny…
Being in a crowd of 15,000 psychiatrists is a weird experience. You realize that all psychiatrists look alike in an indefinable way. The men all look balding, yet dignified. The women all look maternal, yet stylish. Sometimes you will see a knot of foreign-looking people huddled together, their nametags announcing them as the delegation from the Nigerian Psychiatric Association or the Nepalese Psychiatric Association or somewhere else very far away. But however exotic, something about them remains ineffably psychiatrist.
https://slatestarcodex.com/2019/05/22/the-apa-meeting-a-photo-essay/
Michael P. Hengartner, PhD @HengartnerMP 23m
„Well, it turns out that having 15,000 psychiatrists in one building sparks a drug company feeding frenzy that makes piranhas look sedate by comparison.“ And they invest so much in marketing because it pays off! Ever wondered why health care spending is so high in the USA?
A good bit of history, with Professor John Read …
https://www.madintheuk.com/2018/10/millions-at-risk-from-antidepressant-withdrawal-new-review-concludes/
Antidepressant Dependence Discussed at the Seat of Welsh Government – Video
By
James Moore
21/12/2018
https://www.madintheuk.com/2018/12/antidepressant-dependence-welsh-government/
It can’t be repeated often enough …
Parts 1 and 2,
Wendy Burn @wendyburn
Dungeons and Back Alleys: The Fate of the Mentally Ill in America | Psychiatric Times. I saw this firsthand in San Francisco.
https://www.psychiatrictimes.com/couch-crisis/dungeons-and-back-alleys-fate-mentally-ill-america
Looking ‘back in anger’ is no way to produce results, but, psychiatrists are psychiatrists …
What about Neuroleptic (wrongly described as “antipsychotic”) drug withdrawal?
While a person consumes these drugs they can silently develop more serious problems which can “explode” to the surface on drug withdrawal; the problems often getting misdiagnosed as relapse.
Successful Neuroleptic drug withdrawal can lead to complete recovery from “Schizophrenia”, and a return to long term productivity. This has actually been the case for many (non researched) people.
Robert Whitaker has described the period of Neuroleptic Drug Withdrawal as one of “High Anxiety”. Its the way a person negotiates this period that determines the success or failure.
It’s a lot easier to to come off Strong Psychiatric Drugs and remain well with genuine help, than to have to do the whole thing on your own.
Psychologist and Expert Dr Rufus May has very good advice on coming off Neuroleptic Drugs and surviving. Medical Doctor, Dr Terry Lynch is also Expert on Neuroleptic Drug Withdrawal and Complete Recovery from “Schizophrenia” , with the help of Straightforward Psychotherapy.
Prof. Peter Gøtzsche @PGtzsche1 May 5
Forced drugging with antipsychotics is against the law: decision in Norway http://bit.ly/2Woiv37 We need to fight against these serious violations of human rights. I have provided expert testimony for law suits in six countries and am willing to help. #psychiatry
Forced Drugging with Antipsychotics is Against the Law: Decision in Norway
By
Peter Gøtzsche, MD
May 4, 2019
https://www.madinamerica.com/2019/05/forced-drugging-antipsychotics-against-law/
“end of the road” …
SUSANA Survey
https://holeousia.com/2019/05/28/susana-survey/
Marion Brown 1 min ago Reply
Thank you for compiling this comment Peter – and for writing to Mental Elf and Andrea Cipriani. There are many people who have attempted this new SUSANA survey, disseminated widely on Twitter over the holiday weekend, and have been dismayed and concerned at its clearly apparent flaws..
Peter Gordon asks ‘Is it ethical? -Re SUSANA study -Peter Gordon has followed up his e mail of yesterday with another one today with copies published on his blog HOLE OUSIA
To Cipriani and Tomlin;- ‘since I sent my open letter to you (of yesterday) that neither of you has acknowledged despite requesting a read receipt, the introduction explaining the basis, purpose and goals of the SUSANA study has been significantly changed.
There seems to be no explanation to those invited to participate in the study why such significant changes have been made. There is also no explanation to those many hundreds who have already completed the survey. Is this ethical?……Can the scientific board inform all potential participants the evidence that validates this recently added statement/explanation – ‘of course there are important side effects that are rare or less common such as suicidality, withdrawal symptoms , numbness etc’.
The Mental Elf @Mental_Elf May 24
Have YOU ever experienced side-effects from taking antidepressants? If the answer is “YES”, we really want your views in the #SUSANAsurvey
Senator Stan Kutcher @StanKutcher
Replying to @Mental_Elf
There are placebo and nociebo effects from all medications. Separating these from medication based effectiveness and from medication based adverse effects is complex and requires proper methods to do so @AllenFrancesMD @CoyneoftheRealm
Andrea Cipriani @And_Cipriani May 24
Yes, exactly what we’re doing in our @officialNIHR research project: using all available high quality data + the best methodological approaches + patients & clinicians’ views to understand effects of antidepressants (efficacy/tolerability/acceptability) and personalise treatment
James Moore @jf_moore
Academic psychiatry bemoans the fact that not enough research has been done to understand #antidepressant withdrawal, it then releases what it claims to be the ‘most comprehensive survey of AD side effects ever carried out’. Are withdrawal effects listed….nope. #MoreThan2Weeks
James Moore @jf_moore
Replying to @ReadReadj
Not only that John, credit to @benzosarebad who spotted that the survey introductory text was amended to add this….
Of course, there are important side effects that are rare or less common (such as suicidality, withdrawal symptoms, numbness, etc) and we will include all of these side effects in our analysis (we haven’t asked people to rank these as they are so important that we decided a priori to include them in the final list of side events).
http://clinicalepidemio.fr/proceed2/en/
So please can the Scientific Board for the SUSANA study inform all potential participants the evidence that validates this recently added statement/explanation: “Of course, there are important side effects that are rare or less common (such as suicidality, withdrawal symptoms, numbness, etc)” – Peter Gordon
Despite increased antidepressant prescriptions in recent years, reductions in suicides or all-cause mortality did not occur. [1][13]
Recent evidence reveals that administered antidepressants actually increase suicide risks by 2-5 times. [2][3][4][5][6][9]
A recent meta-analysis, level I evidence, clearly demonstrated that SSRIs double the risk of suicide and violence in adults. [4]
https://www.bmj.com/content/365/bmj.l2356/rapid-responses
NICE guidance on depression: 35 health organisations demand “full and proper” revision
https://www.bmj.com/content/365/bmj.l2356
…after extensive criticism.
Campaigning persuades Royal College of Psychiatrists to change its position on antidepressant withdrawal
By admin on 30/05/2019 in News, Psychiatric drugs
https://cepuk.org/2019/05/30/royal-college-psychiatrists-call-update-nice-antidepressant-guidelines-following-cep-campaign/
Following campaigning by CEP, the APPG for Prescribed Drug Dependence and numerous members of the #prescribedharm community, the Royal College of Psychiatrists has today changed its position on antidepressant withdrawal. It has issued a revised policy statement updating its guidance to doctors, and calls upon NICE to update its guidelines as well.
Anti-depressants CAN ruin lives: Major U-turn as psychiatrists say millions of patients MUST be warned over severe side effects
For years side effects of withdrawing from antidepressants were branded ‘mild’
But Royal College of Psychiatrists have now changed position to ‘severe’
UK prescribes more antidepressants than any other western country
https://www.dailymail.co.uk/news/article-7084025/Royal-College-Pyschiatrists-warn-doctors-anti-depressants-dangerous-effects.html
For years, health officials have played down the difficulty of withdrawing from antidepressants, insisting side-effects were ‘mild’ and last no more than a week or two. But in a new ‘position statement’ published today, the Royal College admits some patients experience ‘severe’ side effects which can last weeks or even months.
Professor Wendy Burn, president of the Royal College of Psychiatrists, said: ‘As psychiatrists, we are duty-bound to take on board the concerns of patients who’ve experienced more severe and long-lasting side effects of these medications.
In a major U-turn …
DR MAX PEMBERTON: Never again must victims of the over-prescribing of anti-depressants be silenced or ignored
https://www.dailymail.co.uk/news/article-7084029/DR-MAX-PEMBERTON-Royal-College-Psychiatry-decision-severe-effects-anti-depressants.html
This was an insult to thousands of people who have, as one patient of mine described it, ‘been through hell and back’ in trying to wean themselves off the pills.
I have seen patients jerking violently in front of me from the electric ‘zap’ sensations they are getting — a common withdrawal symptom — yet they told me their GPs dismissed it as ‘all in the mind’.
That will now change as the Royal College of Psychiatrists (RCPsych) — of which I am a member — finally accepts that withdrawal can be associated with ‘severe’ side-effects lasting weeks or ‘longer’.
SARAH VINE: I’m STILL stuck on anti-depressants, which is why I know the U-turn on medical guidance hasn’t come a moment too soon
https://www.dailymail.co.uk/news/article-7084027/SARAH-VINE-Royal-College-Psychiatry-decision-severe-effects-antidepressants.html
With; The Pill That Steals Lives …
recovery&renewal Retweeted
Helen McArdle @HMcArdleHT 27m
U-turn as psychiatrists say patients should be warned of antidepressant withdrawal risk
https://www.heraldscotland.com/news/17673220.antidepressants-u-turn-as-psychiatrists-say-patients-should-be-warned-of-withdrawal-risk/?ref=twtrec
recovery&renewal Retweeted
Royal College of Psychiatrists @rcpsych 2h
Call for patients to be warned over potential antidepressant withdrawal symptoms
https://www.itv.com/news/2019-05-30/call-for-patients-to-be-warned-over-potential-antidepressant-withdrawal-symptoms/
John Read @ReadReadj 2h
John Read Retweeted John Read
RCP FINALLY ADOPTS AN EVIDENCE-BASED APPROACH. Their report contradicts the opinions (Times, Feb, 2018) of their President, Dr Burn, and the Chair of their Psychopharmacology Committee, Dr Baldwin (paid by numerous drug companies). This u-turn is a very important step forward.
recovery&renewal Retweeted
James Moore @jf_moore 22m
Replying to @rcpsych @DrAdrianJames @BBCr4today
Dr. Adrian James said on Radio 4 that withdrawal was mild and self limiting and not the real story, but that the real story was that not enough people are getting antidepressant drugs. Seems at odds with the @CEP_UK Press Release.
Definitely got the media rolling …
NIHS should be reviewing the funding application by Cipriani and co. surely? And stopping continuation of the study.
Adrian James registrar and public relations man for the college of psychiatrists on R4 Today program (6am – on SOUNDS starts at 2.40 on the red line) -para phrased -‘doctors need an honest discussion with people who consult them ‘ Word honest used twice at least, Honestly it is time for the college to resign en masse preferably, all the secrets and lies won’t be ended after they are taking credit but are being forced being forced to ‘call for changes’ as they have disingenuously put it.
re Change.org which gives the whole list – ‘The college of psychiatrists is specifically calling for the following changes….
It would be hard to believe that having this petition in the Senedd (Welsh Parliament) and having it publicised on the blog for all to see their shame ,hasn’t rocked their boat –
Song by Bob Dylan :- Times they are a-changin’ (parts left out just as it’s very long )
Times they are a-changin
Come gather round people wherever you roam And admit that the waters Around you have grown And accept that soon You’ll be drenched to the bone If you’re time to you is worth savin Then you better start swimmin Or you’ll sink like a stone
For the times they are a-changin’………..For the wheels still in spin And there’s no tellin who that it’s namin’ For the loser now will be later to win
For the times they are a- changin………..And the present now will later be past The order is rapidly fadin
The times they are a-changin.
The meat of the matter …
Many of us have read today’s news articles published in several “mainstream” media outlets. Backslapping has ensued amongst those responsible for this apparent “U-turn”. Today’s media exposé isn’t really an exposé, not when adverse effects, which include suicidality and suicide have intentionally been omitted in today’s articles and in the Royal College of Psychiatrists (RCPsych) new “position paper.”
Those who died avoidable SSRI-induced akathisia deaths are also apparently invisible ghosts.
https://fiddaman.blogspot.com/2019/05/royal-college-of-psychiatrists-in.html#.XO_u-chKhdg
‘Trust me, there will be more …
From Stevie Lewis
Petitions Committee welcomes change in antidepressant prescription guidelines
The National Assembly’s Petitions Committee has welcomed the announcement by the Royal College of Psychiatrists that it is updating its guidance on prescribing anti-depressants.
Janet Finch-Saunders, Chair of the Petitions Committee, said:
“The Committee welcomes the move by the Royal College of Psychiatrists and is pleased our report on the issue of Prescription Drug dependency (PDD) had played a part in changing attitudes.
“Antidepressants and other prescription medications can be a lifeline to many people. However, there is a growing body of opinion that it can be difficult to stop using some medications and that not enough advice is available to patients at the outset.
“What is clear is that we need to do more to improve the support and information that is available to people who are prescribed these medications.
“Today’s announcement by the Royal College of Psychiatrists is a positive step towards that and we are now looking for other organisations and health services to follow suit.”
ENDS
This is all great news, but where is any mention about the devastating sexual side effects that can persist for years, decades and may be permanent?
They always seem to miss out about the PSSD in these U turn acknowledgements about antidepressants.
Wendy Burn Retweeted
Royal College of Psychiatrists Wales @RCPsychWales 10h
. @RCPsychWales welcomes the position statement from @rcpsych on Antidepressants and Depression and has highlighted several recommendations specific to Wales
https://www.rcpsych.ac.uk/members/devolved-nations/rcpsych-in-wales/latest-news/rcpsych-wales'-additional-welsh-specific-recommendations-for-position-statement-(ps04-19)-antidepressants-and-depression
RCPsych Wales’ additional, Welsh specific recommendations for Position Statement (PS04/19) Antidepressants and Depression
The Royal College of Psychiatrists Wales welcomes the Position Statement on Antidepressants and Depression (PS04/19) issued by the Royal College of Psychiatrists and offers the following, additional Welsh specific recommendations:
Welsh Government should invest further in alternatives to antidepressants for people with depression
Welsh Government should offer updated, evidence based, prescribing advice on antidepressant, withdrawal and tapering at the earliest opportunity to help people come of antidepressants with as few issues as possible.
Welsh Government should commission further research into the rates and behaviours of antidepressant prescribing to Children and Young people.
Full “Position Statement”
https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/position-statements/ps04_19—antidepressants-and-depression.pdf?sfvrsn=ddea9473_5
John Read @ReadReadj 17h
John Read Retweeted Lucy Johnstone #FBPE
Nice one Lucy. I expect Simon W and his gang got half way through writing their usual ‘anti-psychiatry’ ‘pill-shaming’ diatribe before realising they were writing to the Royal College.
Welsh (verb), specific …
re Position statement on antidepressants and depression May 19 by college of psychiatrists.
There’s the usual blah stating the blindingly obvious in the 1st chapter designed to portray the college as benign and incredibly! being unaware of until now ,of the evidence they have been denying or sitting on – (but noisy whoopy cushions are catching them out ) –
– if I was a GP I would be pretty angry about the many refrences to need for greater training and awareness for them but no mention of their own biased advice until now when the work of campaigners cannot be silenced any longer.
They are still not being honest about the range of adverse symptoms – Akathisia gets no mention nor does loss of sexual feeling for women although erectile dysfunction is mentioned, nor do they mention the loss of emotional pleasure in life in general. There are masses of evidence available published by people which it would seem negligent not to have trawled through already.
Worryingly after stating that ADs should not be used for youngsters (or very rarely) fluoxetine, sertralin and escitopram are recommended .Connection with suicide is denied, rather lack of help seeking is blamed.
They quote Cipriani who has just been exposed re the SUSANA study (above) ‘The most recent analysis conducted by Cipriani et al and including 116,477 patients found that all 21 antidepressants were significantly efficatious than placebo in reducing depressive symptom severity (2018) .
re The coalition of 35 health orgs demand full and proper revision of NICE guidelines – although they are promoting their own cause (led by psychotherapy researcher) who says NICE ‘engaged with us appropriately’ whatever that means ,they include a parliamentary group and say guidelines should include an emphasis on ‘patients’ experience. The next revision of guidelines is 2020 with consultation open from 2nd Oct – 13 Nov. So we shall have to see which piper calls the tune. The college has actually admitted that ‘it is worth noting that high no’s of industry sponsored research can effect the picture of AD efficacy – but no inclusion in their ‘call for change’ for obligations to publish their data. Or for a person without interests in pharmacology companies to be given the position of psychopharmacologist in the college of psychiatry.
Royal College of Psychiatrists Changes Position on Antidepressant Withdrawal
https://www.madinamerica.com/
Thanks to campaigning efforts by the Council for Evidence-based Psychiatry, the Royal College of Psychiatrists has dramatically changed its position on antidepressant withdrawal. In a major U-turn, they call for changes to NICE guidelines and withdrawal support services. This development has gained much media coverage including pieces in The Times, Daily Mail and Guardian.
Christopher Lane Ph.D.
Antidepressant Guidelines to Tighten in the UK
Welcome policy change also reveals scale of the problem.
https://www.psychologytoday.com/gb/blog/side-effects/201905/antidepressant-guidelines-tighten-in-the-uk
With all the evidence now amassed, the decades’ long delay in updating prescribing guidelines for such widely prescribed medication raises urgent questions about a profession-wide failure to recognize the scale of the problem.
“More than 15 million Americans have taken the medications for at least five years,” notes Carey, “a rate that has almost more than tripled since 2000,” according to a New York Times analysis of federal data.
Christopher Lane @christophlane
Prescribing guidelines for antidepressants are about to be tightened in the UK. Why the changes? And what took them so long?
See;- David Healy blog 28th january 2019
Open letter to David Haslam , NICE
In the BBC Panorama segments below, which aired in Britain on October 3, 2004, David Healy says we may come to see GSK’s masking of data about these withdrawal symptoms as “one of the biggest medical scandals ever.”
Senior pharmaceutical regulators in the UK acknowledge they were “disgusted” and “horrified” by the deliberate withholding of information.
The President of the Royal College of Psychiatrists, Dr. Mike Shooter, argues that the deception “has serious implications for the whole of psychiatry; it has serious implications for the whole of medicine.”
An investigative body in Britain met to consider whether to indict the drug maker on criminal charges.
https://www.christopherlane.org/the-paxil-papers/
Taken on Trust …
In their ‘call for change’ the college has admitted in writing in the published document that ‘it is worth noting that high numbers of industry sponsored research can effect the picture ADs efficacy’. Adrian James registrar, has made the college look very devious indeed by this incredible claim to ignorance of what the research-evidence they promote was/is based on.
A tiny corner of the ‘antidepressant’ scandal has at last been uncovered, with the absurdly-delayed admission that these potent, poorly-understood, fantastically profitable drugs can cause hideous withdrawal symptoms.
The problem is that many people, who have been prescribed them, fervently want to believe that they are effective. So they are the loudest defenders of them. This keeps us from discussing the growing evidence that they do not in fact work significantly better than dummy pills – as shown by the drug companies’ own research, which they have been forced to cough up by Freedom of Information requests.
And it means I am pelted with insults when I point out the alarming numbers of people who take these drugs and inexplicably kill or harm themselves or others. I wish you’d listen to me now. But, as usual, I fear I shall have to wait years before everyone catches on. And in that time many will suffer needlessly.
https://hitchensblog.mailonsunday.co.uk/
Saying that withdrawal symptoms can last months instead of weeks is a step in the right direction, but it is simply not enough!
For a lot of people withdrawal symptoms last years, and often many years; not months! For a significant minority they last decades, and may never go away, i.e permanent.
This “U turn” acknowledgement that the withdrawal from antidepressants can be longer and more severe than thought is still quite an underestimation of the what is actually happening. I know of enough people who have been severely damaged by these drugs, to know that it is often more than 3-6 months of suffering. It is often many years of suffering, and sometimes over a decade.
I will never be happy until the full truth comes out, and it is acknowledged that withdrawal symptoms can often last years, sometimes decades, and occasionally they may be permanent.
Nothing less than the full truth is good enough!
I totally agree with you Spruce – now we’ve got a foot in the door, let’s keep pushing until the door is wide open.
I hope that door can be pushed open Mary H, i really do.
I don’t feel it is an exaggeration to say that what these drugs have done to so many people, is a crime against humanity.
I totally agree they can last year’s not a couple off months maybe for the lucky ones
The benzodiazipine crisis was a dress rehearsal…. Campaigners, denial of the pills harms, denial of dependence and withdrawal. Behind closed doors there are hundreds of thousands seriously hurt, hurting, damaged, their voices now silence.
If you Google Benzodiazipine Experts, the Internet too is silent… Apparently there are none… The benzo Crisis was buried….. In an age of Social Media when Professors and Peasants can connect…. ‘Let them eat Prozac, Effexor, Sertraline etc… Can well and truly be spat back at the ignorant purveyors of poison
Two Years Tapering an Antidepressant – A Life-Changing Experience That I Didn’t Want
By
James Moore
05/06/2019
https://www.madintheuk.com/2019/06/two-years-tapering-an-antidepressant/
We all know James.
How I feel for his struggle.
He has used his struggle wisely and courageously.
Doing the MiA Podcasts and talking with so many, James is completely grounded, intelligent, compassionate, giving, and, it is a wonder he has done this, on his good days …
On his bad days, well, we know the complete disablement that coming off psychotropic medications can bring.
How is James to climb out of this?
It was different for me when I experienced Seroxat withdrawal in 2002.
I knew strange things were going on with doctors not accepting me and my struggle and I knew instinctively that my Seroxat withdrawal was callously dismissed.
I knew that because I had a situation from which I could not look back from.
However, instinctively, the following year, I was determined to get off it, the psychiatrist by then having doubled me up to 40 mg.
How lucky to have a new young, instinctively, bright, psychiatrist who talked to the Hospital Pharmacist who then developed a year long plan of reduction by pill and liquid over one year.
This really worked, it really did.
Sadly, at the last ml., from Seroxat, all hell let loose again.
If it wasn’t for my mother, aged 82, living with us, for over three months, whilst I was bed-bound and psychotic, I doubt I could have achieved the ultimate – off it …
James is to all and extents and purposes, alone with this.
He has his family, his friends, the support of all of us, but, he is the one, sometimes returning to bed because he can’t stand it any more.
Its different for me because I knew what Seroxat was capable of and I was determined that Seroxat was gone gone, gone
This position that James is in, could go on for years. Oscillating between good days and bad days.
He has a wife, he has a child, he has responsibilities.
He can’t do, what I did, and my mum did.
All I can say to James, is, you know exactly where you are with this.
You understand it completely.
I wish I could wave the fairy wand and make it easier for James.
But, that doesn’t help, does it?
Ultimately, James wants off it.
But, honestly, is this high-price of trying to get off it, worth it?
Sometimes, I wonder.
Caught in this trap, sometimes, even I, think was it worth it; if you function taking a pill-a-day, are your thoughts with the awful and dreadful chemicals coursing through your veins, are your thoughts with pharmaceutical companies making a profit out of you, are you worth less than you were before, it is really a struggle trying to answer all these questions …
James Moore 43 mins ago
Dr. Gordon is a man of the highest moral and ethical standards and has spent many years putting his patients first and listening to their needs. To read that psychiatry should single out one of its own for truth telling is alarming. Psychiatric drugs can help but they can also harm, so it is vital that we have an honest and unadulterated debate about benefit vs harm. This includes speaking out about withdrawal effects. Psychiatry needs many more like Peter Gordon and to spend less time defending guild interests.
News
4 hrs ago
Psychiatrist Peter Gordon claims Royal College ‘gaslighted’ him in antidepressant row
https://www.heraldscotland.com/news/17692699.psychiatrist-peter-gordon-claims-royal-college-gaslighted-him-in-antidepressant-row/?ref=twtrec
Exclusive by Helen McArdle
The married father-of-two had been originally prescribed the medication to alleviate anxiety and later spent more than a year very slowly reducing his dose.
Despite this, stopping Seroxat triggered his only episode of depression and left him feeling suicidal.
Dr Gordon, an NHS doctor for 26 years, resumed taking the antidepressant and said he is too scared to try stopping again.
The Herald, Scotland …
“This did not feel a comfortable thing to share in a national newspaper but I felt it was important to do this.”
https://holeousia.com/2019/07/02/it-is-by-living-that-we-learn/
The Mental Elf @Mental_Elf
The general public fill evidence vacuums with bad science, says @WesselyS, or rather the journalists do, with controversial theories given by non-experts (Prof Malcolm Bellish) that sell newspapers #RCPsychIC
Oooomph…