A recent Mad in America Webinar on Antidepressant Dysregulation Syndromes introduced the idea that tapering might not be the only way to solve some of the problems SSRI antidepressants can cause. Tapering supporters give the impression tapering is the only legitimate way to go, leaving little or no room for the possibility that antidotes might help.
Quite aside from tapering supporters, others are cautious about looking for a quick fix to a problem that an SSRI quick fix has caused.
And I get nervous when people start drawing boxes about what SSRIs have caused at various receptors. These boxologists then claim to have worked out logically something that is almost certain to help. It rarely does and boxology of this sort has led to the deaths of people with PSSD.
The antidotes outlined below are not based on biobabble or boxology. They arise from the experience of people given a medicine for other reasons who then noticed there was an unexpected benefit happening in real life as opposed to an on-paper solution.
Acetazolamide
Psychiatric Drugs Explained has listed Acetazolamide since its first publication in 1993. Acetazolamide is what you might call an atypical anticonvulsant. Most anticonvulsants inhibit sodium currents or act on the GABA system, some do both. Acetazolamide does neither.
It is a Carbonic Anhydrase Inhibitor. Two other anticonvulsants share a carbonic anhydrase inhibiting action with it – Topiramate and Zonisamide.
While listing it in PDE, I had never seen Acetazolamide used. There was mention that people took it to prevent altitude sickness. This very recently led to my finding that there is evidence SSRIs can make altitude sickness worse, or at altitude they seem to stop working well.
This fits with another well known use for Acetazolamide. It is a treatment for acute glaucoma – the kind that SSRIs can cause. SSRIs it seems can increase the pressure in an eyeball, which is what glaucoma means. They do this by increasing fluid production in the eye. Glaucoma can cause blindness so it is something of an ocular emergency.
Increased fluid production is not in itself an emergency. The most common cause of glaucoma is a blockage to the drainage system of the eye and this can lead to an acute emergency. The SSRI problem is more insidious. Raised pressure over time can affect vision, cause blurred vision and perhaps lead to retinal tears without causing an acute crisis.
SSRIs and many antipsychotics are carbonic anhydrase activators. Activating Carbonic Anhydrase can lead to a build up of fluid in confined spaces – like eyeballs . A build up of fluid in the cerebrospinal canal is linked to what is called Benign Intracranial Hypertension. BIH is not always completely benign.
SSRI-triggered fluid build up is not like the fluid build up in Heart Failure or Edema, where diuretics like Furosemide can help tremendously. Furosemide is not a treatment for the local fluid build up that happens in eyes and that Acetazolamide can treat. Acetazolamide meanwhile has weak general diuretic properties and is not used to treat Heart Failure the way Furosemide is.
RxISK’s interest in Acetazolamide as an antidote stems from two reporters telling us that it had improved their SSRI induced visual problems and reporting that it seemed helpful for what is called Visual Vertigo and Vestibular Migraine
Acetazolamide and Akathisia
RxISK’s interest in Acetazolamide is two-fold. The fact that it appears for some people to offer some benefits in a number of SSRI triggered problems, and as medicines go it is generally viewed as having a benign side effect profile, is one interest.
An additional interest stems from the fact Acetazolamide seems to help some conditions that seem linked to akathisia. Raised eyeball pressure gives rise to an uncomfortable gritty feeling, which could be viewed as an eyeball akathisia.
Another akathisia like state is Pre-Menstrual Tension, which is linked to fluid retention. SSRI companies have tried to convert this into a new illness Pre-Menstrual Dysphoric Disorder – PMDD – and claim their drugs can treat this nightmarish condition. The emotional muting that SSRIs cause can be of some help but as regards the irritability, or akathisic element of this condition, which is traditionally linked to aggression, the clinical trial data suggest SSRIs significantly increase aggressive episodes.
In contrast, Acetazolamide appears a good treatment for PMDD, especially in women who do not show a good response to SSRIs.
Finally, there is also a possible benefit for Acetazolamide in Persistent Genital Arousal Disorder (PGAD). This is essentially a state of genital akathisia, leading to repeated distressing and unwanted orgasms. SSRI withdrawal, especially during the peri-menopausal period, is its most common trigger.
The distress PGAD causes leads women to contemplate clitoridectomies and other drastic procedures to alleviate the problem, which perhaps gives some indication as to the severity of the condition and why it seems reasonable to view it as an akathisia related state. Akathisia is such an uncomfortable state that it is the leading cause of death by suicide and a common trigger to homicides and aggression.
Recently a woman with confirmed PGAD has reported significant benefit from Mounjaro – tirzepatide – Eli Lilly’s version of Ozempic/Wegovy. Mounjaro injections last several weeks and while they last she is symptom free but as the injection wears off the symptoms return.
A fascinating feature to this is that Mounjaro – Tirzepatide – and Ozempic – Semaglutide – are Carbonic Anhydrase Inhibitors like Acetazolamide.
Can anyone on Mounjaro/Zepbound or Ozempic/Wegovy who has PGAD get in touch and let us know more.
Can anyone who has been put on any of these drugs who has had akathisia also get in touch and let us know – did these drugs make any difference to your akathisia?
Another fascinating aspect to all this is that the original drug that caused and brought akathisia to everyone’s attention as the akathisia was so intense it led to suicides, was a drug working on the serotonin system called reserpine which was derived from the roots of this Rauwolfia Serpentina plant.
Reserpine is a carbonic anhydrase activator and it blocks the anticonvulsant action of Acetazolamide.
Alcohol is a carbonic anhydrase inhibitor and in the form of red wine appears to relieve akathisia
Rather than use alcohol in their clinical trials to mask the akathisia caused by SSRIs, companies have used Benzodiazepines. Benzodiazepines are carbonic anhydrase inhibitors.
RxISK has run many posts on Akathisia – trying to bring it to the attention of the wider world. Here are some of them.
- Akathisia Challenge
- Akathisia Anthem
- Akathisia Depression and Suicide
- 500 Drugs that Cause Akathisia
We have liaised closely with groups like The Medication Induced Suicide Prevention and Education Foundation in Memory of Stuart Dolin – MISSD – set up by Wendy Dolin and run by an impressive group of people whose lives have all been touched by the catastrophes akathisia can visit on families.
At the risk of sounding like I’m indulging in the Boxology and Biobabble I condemned above, it does look like there might be a chink of light here to establish what underpins akathisia. It was described first 70 years ago and we are no nearer working out what happens in us when we get akathisic. Perhaps because everyone is looking in the brain and this is the wrong place. See Madness, Normality and Dysregulation.
When Bruce Springsteen called it ‘an endless, irritating angst embedded in his bones’ he may have been more accurate than he thought. There is a thin skin that covers bones – the periosteum – and fluid collecting in the confined space underneath this, somewhere where it should not be, may be exactly the kind of thing that gives rise to akathisia.
Finding out what is going on might enable us to ease if not cure the problem for those affected. Of course it might also make it possible for Lilly and other companies to run trials on their drugs and hide the problem even more effectively than they have done in the past. .
Lithium Gluconate
Several weeks ago RxISK wrote to large number of people, who have reported visual problems, including visual snow and a range of other problems suggesting that Lithium in a very low dose might be a helpful treatment for SSRI linked visual problems – See Visual Snow, Visual Blur and Visual Weird.
We did so on the basis of research brought to our attention that Lithium might have effects to stimulate the production of new cells linked to the cornea of the eye which might conceivably repair some SSRI induced corneal and perhaps other eye damage.
Reports from Norway suggested that Lithium can stimulate stem cells into activity. This is consistent with Lithium’s ability to increase white cell counts – something it is often prescribed for in people being treated for cancer where their chemotherapy risks wiping out their white cells.
But another action of Lithium has now come into the frame. It has long been known to be a diuretic and is usually given in the morning for this reason. Lithium can also treat glaucoma but while it reduces fluid pressure in the eye at present the researchers are not talking about carbonic anhydrase.
When we put the idea of using lithium to RxISK reporters several asked what dose and others asked would lithium orotate, which is available over the counter work?
At Mad in America’s Antidepressant Dysregulations Webinar, C – an attendee, said that Lithium Gluconate had stopped her akathisia stone dead. She had benzodiazepine withdrawal linked akathisia and had discovered Lithium Gluconate from French articles on its use for benzodiazepine withdrawal – See Stopping Benzodiazepines. She tried it and it worked.
There is in fact a French industry of giving Lithium Gluconate or Lithium Oligosol for irritability. This comes very close to the original use of Lithium in spa waters in the nineteenth century aimed at promoting a sense of wellbeing. The original 7 UP was a carbonated lithium water. The dose of these compounds is of the order of 10 mg per day – very very very low compared to the doses used in mental health for bipolar disorder, which range up to 1000 mg per day or more.
SSRIs and Brain Damage
The focus of the Dysregulation Webinar was on the difficulties people can have getting off SSRIs. One of the questions asked was whether these difficulties point to a withdrawal syndrome or brain damage? I was leaning toward saying that even with grim conditions like PSSD, which can look like damage, there are recoveries and windows of recovery.
Another of our RxISK reporters got in touch to say we had badly downplayed the damage these drugs can do. He had a diagnosed encephalopathy with Brain Scans and EEGs to show the damage.
We have a post about this – Could your Stimulant or Antidepressant cause Dementia? Which said they could.
Among the earliest problems noted with SSRIs was that they could cause low sodium. Most cases were mildly low but even so these could lead to confusion. Some were extremely low and this risked cardiac arrest and other problems.
A story emerged that attempting to correct these very low sodium levels too quickly could lead to Osmotic Demyelination. The low sodium led to increased fluid in cells and replacing sodium dragged fluid out of cells. This made sense but in fact is wrong. We do not know what causes osmotic demyelination.
The Demyelination affects the midbrain mostly – the area around the Pons – but it can happen elsewhere and gives rise to what are called white-matter intensities. The white area in the middle of the brain just above the dark area shows what can happen. The link to the Pons area has led to this condition also being called Central Pontine Myelinolysis.
This is unquestionably damage and badly affects and can kill some people. The original story was that it only happened to older people – which perhaps reduced the importance of the problem. But some years ago a mother of a relatively young girl was in touch describing how it had killed her daughter. We hoped she would write up the story but she never did. There have been other cases involving young women that have come our way since and they are heart breaking.
While restoring sodium too quickly with all the changes in fluid balance that go with that is not the cause of the damage, Osmotic Demyelination brings home the story that these drugs act on the water in us and the salts like sodium that are in our bodily fluids.
For the researchers among our readers and contributors, on whom we depend for everything that RxISK finds out, between the Acetazolamide issues above and the Osmotic Demyelination below, this post contains a lot of detail, all of which deserves further chasing.
There are for instance 10 different isoforms of carbonic anhydrase – and likely only some of these are important for people on SSRIs or antipsychotics – which ones? It feels like there is a door slightly ajar here that with a good push might open onto a room with some interesting secrets.
Tim says
I don’t know if this is in any way related to what was written above but in the early years of my PSSD alcohol was able to strongly restore sexual functions and reduce anhedonia. The red wine felt effective at times. I no longer react to alcohol in any way.
Dr. David Healy says
T
Thanks for this. We need as many observations like this as we can get
D
annie says
Leaving a week long stay in a mental hospital because I was off my head from stopping Seroxat after six weeks of horrendous withdrawal and restarting Seroxat in desperation of what to do, I had been stabilised with Diazepam, at my request, as no psychiatrist was available. Leaving with no one having the wit to supply me with Diazepam, and then driving with a sudden onset of suicidal ideation. I was desperate to go home, but my whole self was overtaken with visions of how to prevent myself from getting there. It was bizarre how real the visions were but I did not act on them. At home I was completely displaced. I was in some surreal place where I had no feelings, no emotions, no sense of time or place. I didn’t react to anything, hardly spoke. It was like I was behind a screen, like I had disappeared in to a third dimension. Old habits die hard, I guess, as dinner was being cooked for us, I was offered a glass of wine. Mine was always a dry white. It hardly took any time at all, as we three sat at the table, we all started talking about going away for a few days.
The switch was flicked. All that had passed seemed forgotten. It was like it had never happened. The weird drive home, being locked away for a week, all seemed gone.
We all went to bed. I was under a complete misapprehension that I was completely ok.
But waking up suddenly, in the dark, I leapt out of bed and ripped through a series of blood-curdling actions, that somehow, amazingly, I survived.
All the investigations taking place in Antidotes for Akathisia and Dysregulation are so vital to unlocking the secrets, amongst others the Secrets of Seroxat.
Antidep Effects reposted
MISSD@MISSDFoundation
How is it that an ingredient in the first version of 7-Up might help alleviate symptoms of #akathisia and #SSRI w/drawal?
This intriguing article about treatments being explored is a must read: https://rxisk.org/antidotes-for-akathisia-and-dysregulation/
@RxISK
Pinot Grigio/7-Up –
Missd it. How is it…?
Barbara says
Annie,
Do you still wake with that extreme feeling? I know so many people who have some variation of that awakening response, but no accepted explanation that I’ve seen in nearly 15 years of it
On SA, it’s thought to be a rebound of the cortisol awakening response. I’ve had it every day since I tapered Pristiq in 2010-11, but all cortisol tests show very LOW cortisol. Dysregulated sugar has also been suggested, but not proven to my knowledge.
I don’t have the classic akathisia presentation, but I know people who do and it is brutal upon awakening. It takes several hours to abate.
If I could get this calmed down, I might be slightly “ok”, but this Groundhog Day event is unbearable.
My apologies for the tangent.
annie says
Barbara,
Not at all – your tangent is interesting.
That extreme feeling?
Anyone who has been through the violent thuggery of Seroxat, and whether we call it Akathisia or not, will maintain some sort of ‘extreme feeling’ for the rest of their lives.
Well-known parents of deceased children from these drugs, will have ‘extreme feelings’ until the day they themselves die.
Akathisia seems to have no known boundaries, some people’s idea of Akathisia from one to the next.
The massive fall-out from doctor’s letting me down, to our cataclysmic reaction shortly afterwards left me and my child and our dog fending for ourselves light years away from our ‘life on the loch-side’. I had to bust a gut to earn something to keep us afloat. From corridors, those endless corridors, of bedding piled up outside of hotel doors for someone to shake duvets, to acres and acres of weeding, to polishing people’s picture frames on top of their grand pianos. A far cry from the life as a business exec.
I was forcing my body to extreme lengths when I was lucky if my child would eat a pot noodle. The dog ate more.
Responsibility came at a price.
Years and years of this, as well as trying to litigate; it was the ‘extreme feeling’ that kept me going.
Sometimes you have to let the ‘extreme feeling’ work for you.
Tais says
Doctor, thank you for the article but what to do with akathisia?
I have it since February, off of the causative drug since mid of April. I had normal hours when it was suddenly completely away. Whithout any clear reason. Did anyone experience this? Now I don’t have any good hour anymore…
How to heal? I’m afraid of using any drug… I have two very little children…
Tais says
Are there any evidence about links between adhd and akathisia? I had adhd as child and couldn’t sit still. Now I have akathisia after neuroleptika, it started after three month taking it and doesn’t go away since 5 month after stopping.
Dr. David Healy says
T
This is a great question – both ADHD and akathisia involve fidgetiness. And I once thought people with ADHD might be more likely to get akathisia but having given antipsychotics to healthy volunteers with various personality types I don’t now think this. I think anyone can get akathisia and it is very much a bodily thing.
In response to your other question. Akathisia can become semi-chronic. One thread running through some of the treatments that seem to help is they make us slightly more acidic and slightly less basic. It is beginning to look like inhaling Carbon Dioxide might help – it’s an old fashioned treatment for panic attacks. Adding vinegar to salads might help. And I guess avoiding antacids – anything that introduces bicarbonates into the mix.
But of course all of this must be done with care and in low dose and done over time rather than trying to readjust the body too quickly – over rapid corrections have a less than perfect history
D
Tais says
Thank you.
I heard from an osteopath about a patient with symptoms compared to akathisia who healed after a dialysis. Do you think it may somehow help?
Dr. David Healy says
I have no idea
D
Tais says
Thank you. I understand that akathisia usually has two components- the motoric and the internal terror. My internal terror ended suddenly two month after start of akathisia at its own, I still took the causative drug. Now I have the motoric component only although it seems to be not that pronounced. I don’t need to constantly pace but can’t sit or stand still.
Should the increase the acidic level help to calm this terror but not the motoric restlessness?
I’m sorry for so many questions but there is no information for chronic cases at all.
Dr. David Healy says
There is no point asking me – I depend on people like you to test these things out and report back so I can tell the next person who asks what seems to be the best option
The problem you and everyone else has is we knew nothing and still know very little about these pills when doctors started putting everyone on them. The only people doing any research are those now on them
D
Kevin says
Akathisia is interesting. 2 weeks after my last dose of Lexapro. I went through a crash for a week where I couldn’t get out of bed. I went completely numb. after sweats and shivers.
Then all I felt was terror inside of me and my skin crawelled with anxiety.
I went through 2 months of this before it started to lift. Now 10 months later I can see my emotions are turning back on and mental clarity is improving. It’s like a long slow re-awakening. I lasted 3 weeks in that state before I turn to cannabis. It did help to dial down the anxiety and numb me out. sadly I did become addicted to it and quitting was difficult.
It seems the distraction was a help. Plus the next day numbing effect helped.. Trade off is it was hard on my mental health and mood while using it.
annie says
‘As the former deputy health editor of this newspaper, and currently health editor of its sister website MailOnline, I know where to go for trusted medical advice. I know my way around clinical research papers and have some of the world’s top mental health experts on speed dial.’
It doesn’t take long to see how many mistaken ‘illusions’ have been popped in to ‘All about Eve’ …
Head start : ‘a sudden boost of chemicals [in the brain]’
EVE SIMMONS: Anti-depressants made me feel like I was going mad and couldn’t cope with another day of living. Here’s what to do if the same thing happens to you
By Eve Simmons For The Mail On Sunday
Published: 11:49, 28 September 2024 | Updated: 13:03, 28 September 2024
https://www.dailymail.co.uk/health/article-13899357/EVE-SIMMONS-Anti-depressants-mad-day-living.html
It’s 2am and I’m wide awake, scrolling frantically through TikTok for videos posted by strangers about the antidepressant I’m on. I type ‘first two weeks on antidepressants feeling like I’m going mad’ into the search bar, hoping to find someone who’d been through something similar and recovered.
Would I ever feel normal again?
I started taking the pills three weeks prior to this. It followed an episode of acute anxiety – a problem I’ve struggled with at various points in my life. About two-and-a-half weeks in, I started to feel really odd.
The best way I can describe it is a sense of being detached from my body. I struggled to concentrate on anything – even episodes of Love Island, which normally take my mind off the day’s stresses.
I was intermittently consumed by panic and constantly aware of my heartbeat.
As the former deputy health editor of this newspaper, and currently health editor of its sister website MailOnline, I know where to go for trusted medical advice. I know my way around clinical research papers and have some of the world’s top mental health experts on speed dial.
But in this case, I was stumped – no doctor I spoke to and nothing I read seemed to be able to offer tangible advice.
I had little choice but to turn to social media for answers – and, to some extent, I found them. But I couldn’t help think that I shouldn’t be like this.
I thought of this last week when an ongoing row reignited between experts over antidepressant safety.
In one corner there are psychiatrists who claim that disturbing side effects have been hugely underplayed. In the other are those who insist these problems are rare, minor and transient, and that any doctors who disagree are scaremongering.
On Wednesday, some of the anti-antidepressant camp wrote to medical journal The Lancet claiming that withdrawal symptoms – hallucinations, insomnia and worsening anxiety – hit up to half of patients taking the pills. This is vastly more than previous research, published earlier this year, suggested.
I’ve written about my mental health in these pages before – I take a pro-pills stance, based on my overall positive experience.
The best evidence shows that antidepressants improve about half of patients’ symptoms.
And they work for me. I was first prescribed them at 15, when I was suddenly hit by inexplicable, incessant anxiety, but only needed them for less than a year and stopped without any issues.
I took them again in my 20s, and for a third time aged 30, in 2022. It was then that I first suffered negative effects.
Within two weeks I developed the sensation of dissociation – the feeling of the body being separate from the mind. It was so bad, I had to take time off work.
But this mostly evaporated within another week or so, and I carried on taking the tablets.
I believe they left me better equipped to deal with life’s rich tapestry, including an unpleasant divorce. And I said this all publicly. There was backlash, mostly from people who’d suffered side effects and claimed that I was minimising the harms. But I stuck to my guns, even winning an award from the British Association for Psychopharmacology for my pro-medication articles.
I came off the pills after 18 months, again with no issue.
But this summer the anxiety returned – I found myself lying awake at night plagued by terror, struggling to breathe.
I feared that I was teetering on the edge of a psychotic episode, and that I needed medication again. This time, though, I found myself questioning whether I was right to be such an advocate for antidepressants.
I started taking the lowest possible dose of escitalopram, a common antidepressant.
There was a brief period of relief, but by the end of the month I was terrified of everything. The world around me felt unsafe, and my thoughts told me I couldn’t cope with another day of living.
Thankfully, I was already on annual leave from work. I spent the best part of a week moving between my bed and the sofa, scouring the internet for research that would support my suspicion – my desperate hope – that my experience was a temporary side effect and I wasn’t going mad.
But what I came across was universally vague. The drugs can cause ‘anxiety and agitation’ as well as ‘sedation’ in the first few weeks. The NHS simply says antidepressants can ‘cause problems at first, which generally improve’.
I contacted the psychiatrist who’d written the prescription. ‘It is difficult,’ she texted me, along with some confusing instructions to slowly come off the drugs if I continued to feel bad.
This, I felt, raised more questions. If I pushed on, would it pass? Or was it a warning that something was going seriously wrong? If I stopped, would my anxiety return?
I emailed a trusted contact – a world-leading expert in mental health treatment – who said ‘it is complicated’ and suggested I speak to my psychiatrist.
So I did what every health journalist warns readers not to – I turned to TikTok for advice. But what I saw was surprisingly reassuring. Hundreds of people, mostly in America, were talking about similar experiences. They spoke of their brains feeling ‘two steps behind’ their body, or like a ‘f****** zombie’.
For one girl, the medication ‘made the line between reality and a dream-like world very thin’. It all rang true – I wasn’t the only one.
Meanwhile, on website Reddit, hundreds of posts document antidepressant side effects in detail: disabling insomnia; panic attacks; suicidal thoughts; and, as one user put it, ‘feeling like you’re in absolute hell’.
But, reassuringly, the overwhelming majority said these eased within the first three months – and reported an overall improvement in their mental health.
A common theme was shock – no one warned them starting on the drugs would be so hard.
So why aren’t experts talking about this?
‘When you first start taking antidepressants, you get a sudden boost of chemicals [in the brain] which can cause unpleasant symptoms for some people,’ says Dr Sameer Jauhar, a consultant psychiatrist at King’s College London.
‘Over time the brain tends to adapt to this, which reduces these symptoms.’
But just how many suffer from this is unclear.
One 2018 study, based on surveys involving more than 1,000 patients, showed up to half of those taking the most common antidepressant – selective serotonin reuptake inhibitors (SSRIs) –reported feeling suicidal as a result of it. Feeling ‘foggy or detached’ was noted by three quarters, while feeling ‘emotionally numb’ and ‘less happy’ was also mentioned.
‘For some people, the side effects are mild,’ says Prof John Read, psychologist at the University of East London and author of the study. ‘But for lots of people, they aren’t. How can we be prescribing a mental health drug that makes people feel suicidal?
‘Even if it’s only for a few weeks, that is still enough for a person to kill themselves.’
But other experts say Prof Read’s research is not a reliable indicator of the scale of the problem. It is based on patients reporting their own symptoms – which can be difficult to separate between the mental health condition itself and side effects of the drug.
For reasons such as this, ‘self-reported’ data is considered the lowest-quality form of scientific evidence.
However, the highest form – controlled clinical trials conducted by doctors – have not offered answers, either.
There are no reliable figures from this sort of research to tell us how many patients suffer early psychiatric problems. As for what exactly those problems are, researchers seldom elaborate further than ‘severe, mild or non-existent’.
In 2019, health chiefs updated official guidance to acknowledge that withdrawal symptoms after coming off antidepressants may be ‘severe and lengthy’. The change was, in part, sparked by a groundswell of patient reports collected by University College London’s Prof Joanna Moncrieff – a psychiatrist and vocal critic of antidepressants.
To say she has been lambasted by the medical establishment would be an understatement – and, to her credit, she’s stuck to her guns.
The debate has rumbled on with little common ground being found, so where are patients like me supposed to turn for reliable information?
Ideally, your GP would be the first port of call. But one 2019 survey found that only a third felt confident about their knowledge of antidepressant side effects.
When I called my GP to seek help for my meltdown, he said ‘some anxiety’ was to be expected. He prescribed diazepam, also known as Valium, and said he’d call back in a week to check on me, but never did.
Some people, Dr Jauhar says, are at higher risk of side effects from SSRIs due to ‘being more sensitive to fluctuating levels of serotonin’ – the brain chemical linked to mood that the drugs help regulate.
People who suffer bipolar disorder, a type of depression that can cause extreme periods of lows and mania, are prone to this. Extra care needs to be taken if prescribing SSRIs to this group.
Both Prof Read and Dr Jauhar agree on one thing: more in-depth research is needed.
But, thankfully, there is pleasing data on one important detail. In all of the studies I’ve looked at, severe side effects are short-lived for most people.
In one US trial of 400 patients newly on SSRIs, a fifth suffered severe anxiety. For two thirds, this symptom resolved within two weeks. Large-scale reviews have found only around one in ten patients find side effects so unbearable that they have to come off the pills.
What is unequivocal is this: antidepressants are life-saving. A 2013 University College London paper found that, of 81 suicides studied, 75 per cent of victims were unmedicated.
Once again, my period of madness lasted only a fortnight. I still take the pills today. I feel myself again, and far less anxious than before.
So I guess my mantra remains stick with the pills, if you can. If you can’t, don’t just quit – speak to your doctor about alternatives.
For confidential support, call Samaritans on 116123, visit a Samaritans branch or go to samaritans.org.
‘All about Eve’, a great film with Bette Davis (1950) …
Harriet Vogt says
It should also be noted that – this journalist – a familiar advocate for the benefits of antidepressants – has just been awarded the ‘BAP Public Communications Prize for Non-Members. In recognition of the sterling public education activities whose efforts closely align with the overarching aims of BAP’.
Dr Jauhar praised her reportage as ‘balanced’. Uncharitably, I’ve always perceived it as incoherent, perhaps deliberately so.
One of two disturbing paragraphs in this journalistic potpourri (mot juste – adding a pleasant smell to a room) was this:
‘When I called my GP to seek help for my meltdown, he said ‘some anxiety’ was to be expected. He prescribed diazepam, also known as Valium, and said he’d call back in a week to check on me, but never did.’
How many patients in ‘this period of madness’, as she called it, try or succeed in taking their own lives – because they have neither been properly consented nor monitored by their (for the majority) GP? The NICE guidance on suicidality and its management is clear – so why isn’t this legal and ethical obligation being delivered?
The other disturbing para was obviously: “What is unequivocal is this: antidepressants are life-saving. A 2013 University College London paper found that, of 81 suicides studied, 75 per cent of victims were unmedicated’.
I’ve hunted and can’t find this paper. So many unanswered questions about these poor souls – not least of all, how many of the 75 had been medicated in the past?
David delivered relative risk figures nearly 20 years ago 2.0-2.5 x vs placebo
https://pubmed.ncbi.nlm.nih.gov/16194787/
The same level of risk emerged from Michael Hengartner’s relatively recent study too, as you will all know:
‘Adults who start treatment with antidepressants for depression are 2.5 times more likely to attempt suicide when compared to placebo, according to new research published today in the journal Psychotherapy and Psychosomatics.
The study found that approximately 1 in every 200 people who start treatment will attempt suicide due to the pharmacologic effects of the drug. This number is significant given around 7.4 million people were prescribed antidepressants in England alone last year, and given international estimates which suggest around 1 in 20 suicide attempts will end in death.’
https://karger.com/pps/article-pdf/88/4/247/3482471/000501215.pdf
The legal and ethical debate around this Saturday’s MiA webinar –‘Antidepressants and Homicide’ will be important. How legal and ethical is it to print risk diminishing tripe in the most read online newspaper brand is another relevant question.
annie says
Very good, Harriet. Succinctly put.
The Scottish Daily Mail is very inconsistent in their reporting. One minute it’s all about Katinka Newman and Peter Gordon and the next minute they report on a lot of flaky stuff.
This is the Daily Mail view about Eve. Headlined above her recent article.
Eve Simmons is an award-winning health journalist with a dogged determination to sniffing out fake health news – especially when it comes to diet.
Formerly the deputy health editor at the Mail on Sunday in the UK, continues to work on vital and entertaining reports on her specialist subjects in the US which include mental health, disability and eating disorders. And she’s not afraid to dress up like a fool and try the latest fitness fad…for the good of journalism.
‘For the good of journalism’, says it all.
Selling newspapers, and online, grabbing stories like Katinka’s makes you worry about if any principles are involved when there is very little consistency from their health and science writers..
Presumably Eve has a ‘unique selling point’?
Harriet Vogt says
Thanks, Annie – extreme irritation makes for terse writing.
Most likely ‘All about Eve’ – apt , it’s only ever all about her – will have written her own ‘blurb’. ‘Vital and entertaining reports’. (Head in hands at this point).
Ofc what this faux cheery garbage about antidepressants tells us – is how cosily familiar and welcome they have become throughout our culture.
Contrast the debilitation you have endured. Contrast 1:200 will attempt suicide; contrast 1:20 suicide attempts end in death. Contrast immeasurable risk of PSSD. Contrast the No 1 health condition in England – ‘anxiety’, No 4 (just behind CVD) ‘depression’. And so on and on.
Let us hope that Labour’s weasel – ( led by Wesley Weaselton, a stuffed toy) – getting people back to healthy work, rather than honestly acknowledging mass medicalisation and drug disablement – acts as an excuse for change.
annie says
I commented years and years and years ago, when ‘Wes – stuffed toys’ were making all their overtures and banging the drum for antidepressants that there was very little in the way of rebuttal.
I expect the charade to continue, now we have explosions of ADHD, Adult ADHD, and all the other ‘disorders’ bandied about. The desire to medicate has now gone full- pelt aided and abetted by the do-gooders. The young are gobbling them up like there is no tomorrow with little to no warnings of PSSD and being hooked for life.
I sincerely hope that you are right, and the Folly of their Ways is exposed as more and more of today’s youth, and younger, are dumped on, using the various Benefits Systems who co-operate with them.
No one is in charge of this catastrophic state of affairs, as the Daily Mail continues to display some pretty famous adults exposing their ‘frailties’ and boosting the ‘pill-industry’ even more.
When Dexter and Romain died, I found it very difficult to make any peace, and as Katinka’s website shows, and Vincent and Yoko’s website shows, and as Dan’s website shows, and as MISSD website shows, there is no Cold Comfort Pharm –
Billiam James, the artist, amongst us, summed it up completely with pictorials –
We are descending into a ‘not real’ delusion…
Harriet Vogt says
‘PERHAPS BECAUSE EVERYONE IS LOOKING IN THE BRAIN AND THIS IS THE WRONG PLACE?’
This does feel like a bit of a Kuhnian moment.
Just as your Drug (Iatrogenic) Dysregulation Syndrome finally makes sense of the enduring adverse effects of SSRIs on the body, where most of the serotonin lives, this resonated with me – a keen student of akathisia, never a sufferer:
‘When Bruce Springsteen called it ‘an endless, irritating angst embedded in his bones’ he may have been more accurate than he thought. There is a thin skin that covers bones – the periosteum – and fluid collecting in the confined space underneath this, somewhere where it should not be, may be exactly the kind of thing that gives rise to akathisia.’
More to the point, I sent your blog to Jill Nickens, Founder of the Akathisia Alliance https://akathisiaalliance.org/. Jill not only campaigns to drive awareness of akathisia, like the wonderful MISSD team – she has suffered with akathisia herself – for years and still does, it’s chronic – so has been motivated to research it deeply and is regularly involved with akathisia support groups.
Jill plans to contact you directly, but the bottom line comment she made to me was, ‘David Healy’s theory is really interesting and makes a lot of sense’
As I mentioned to you, she was interviewed by Dr Drew the other day, (as I’m sure you will have been), a useful 2m audience for any cause. https://open.spotify.com/episode/0fLkC83pYkItIp7zssXiQP
He was totally upfront about akathisia’s consistent misdiagnosis by his medical peers and the difficulties of finding any treatment that has lasting benefit. He talked about using zyprexa (eek), benzos etc., but the positive effects were short lived – so basically didn’t touch the sides. He also mentioned phenobarbital as a treatment he had considered but not tried. I have no idea.
The key point about your periosteum theory seems to me to be that it’s testable, as well as making intuitive sense. Expect Dr Drew would be interested too.
On the boxology front (fabulous addition to the lexicon of nonsense), this is one of the most intelligent overviews of akathisia I’ve ever found, especially the sections of why it is so commonly misdiagnosed, analysing both patient and clinician factors (some overlap with your/Dee’s latest paper on the obstacles to quantifying the risk of PSSD). https://www.psychiatrypodcast.com/psychiatry-psychotherapy-podcast/episode-111-akathisia
It’s really intelligent – until you get to the ‘mechanism’ section – when, to my scientifically uneducated mind, it turns into neurotransmitter bingo – or boxology – or even ‘bollocksology’ (Margaret McCartney’s tart addition to the lexicon):
• ‘The pathophysiology behind akathisia in duloxetine and other SNRIs/SSRIs is through its serotonergic effects on the nigrostriatal pathway which leads to a decrease in dopamine release (Salem et al., 2017).’
• It then details Neurotransmitter Patterns Associated with Akathisia in terms of relative signal transduction – sort of like morse code.
This is the type of tic-tac-toe conceptualisation that always leads me, albeit a scientific simpleton, to think of psychiatry as an irredeemable category error. Given that, unlike you, so many psychiatrists seem to understand neither the effects of the drugs they administer, nor the human beings to whom they administer them (conflating symptom clusters with reified ‘illnesses’), is this a life enhancing specialty? I’m sure we could do better for our patients.