Email from Marion Brown
PE01651 – Prescribed drug dependence and withdrawal
I wanted to let you know that our Scottish petition seems to be gathering a very remarkable and powerful collection of published ‘evidence’ of patient experiences especially – and from all over the world!
The petitions clerks are being kept busy with ‘processing’ these and uploading to the petition webpage – and there are many more yet to come….
The meeting on 18 January – with Maureen Watt (Minister for MH) and John Mitchell (PMO and Psychiatry adviser to Govt.) giving evidence – left me feeling stunned. I wonder if you saw anything of it? Only now am I beginning to see that our petition webpage is actually a tremendously valuable (and indeed unusual) collection of formally published evidence… and steadily gathering more evidence as we proceed.
Here is the webpage to date:
If you wish to see the 18 January evidence session this is the link (with further link to transcript)
Our petition was second on agenda – starts about 90 mins in. The first item was extremely relevant too.
A quote from your own submission (Ref 1651/CC) was used in a formal question: Here is transcript:
Could you comment on whether you accept the following statements that were given to us in evidence? The first statement is:
“Ten per cent of the population of Scotland takes an antidepressant on prescription. Of those between 80 and 90% are on treatment for more than a year – many for over a decade.”
Is that because it is good treatment, or because people are dependent?
The second statement is:
“At present rates of antidepressant use among adolescents in Scotland, especially among women, is rocketing. These drugs are or are on their way to being the most commonly used prescription drugs by Scottish adolescents.”
Do you recognise and agree with those statements?
I do not recognise much of that. Antidepressants are certainly a commonly used medication. The guidance for treating depression says that if someone who is experiencing their first depression goes on antidepressants and the medication works for them, they should stay on it for six months before they come off it. If they have a recurrence of the depression, they should stay on the medication for two years. That guidance is internationally accepted and based on evidence.
For effective treatment of people with depression, if people respond to the drugs, they should be on them for that sort of timescale. They are not effective if they are used only for a month or for two months.
I grant that the study that was done on the prescribing of antidepressants is now six years old, but it indicated that the longer and more appropriate periods of time were being applied by GPs. It was new prescriptions of antidepressants and what happened to them that were being examined.
We now have a deadline of 15 February for the next tranche of submissions – if they are to be considered in advance of planning the next Petition Committee hearing (date as yet unscheduled).
If you – and /or anyone else that you know of who may be interested – would like to make a (further) submission (send to firstname.lastname@example.org – max 3 A4 pages and quoting ref: PE01651 in subject line) this would be welcomed.
It would seem that our Scottish petition is building to a very valuable resource for research – if you know of anyone interested in this area of research?
Where linked to healthcare or someone who has been put on antidepressant or related psychotropic drug, go on the website above and make a submission. You can be from anywhere in the world.
In the case of someone previously on treatment and disabled by withdrawal effects it might be simply to say for instance that there is the extra indignity of being deemed well and fit to work because you have come off treatment when in fact you might be quite incapable of work because of withdrawal effects. The committee needs to answer questions like – should I continue damaging myself in order to get further independence payments.
Ten per cent of the population of Scotland takes an antidepressant on prescription. Of those between 80 and 90% are on treatment for more than a year – many for over a decade. When the latest antidepressants were introduced around 1990 the recommendation was that they would be used for 3-6 months. Apologists for the drugs say treatment for over a year is a good thing. Its not. Its caused by dependence and it continues because so many people attempting to stop feel so bad they continue with treatment.
The marketing of these drugs targeted women of child-bearing years, although companies knew from the start the drugs were likely to lead to dependence and to birth defects, from major organ defects to behaviour abnormalities such as autistic spectrum disorder.
While treatments can be helpful, the evidence for true benefits when used in general practice is missing. The drugs are now the most commonly used medications by women in their teens and early twenties, the child-bearing years, and in these age groups there is no evidence for benefit. Because of the dependence the drugs cause, many young women are trapped into pregnancies in which their unborn babies are exposed to a teratogen because stopping is so difficult. There is no benefit to the woman for the most part or her child in any instance.
For all too many, women in particular, antidepressants turn out to be a gateway drug, into treatment with mood-stabilizers and other drugs or for antidepressant induced alcoholism or antidepressant induced osteoporosis or other conditions.
There is a pressing need to understand antidepressant dependence – how to avoid it and how best to manage it.
At present rates of antidepressant use among adolescents in Scotland, especially among women, is rocketing. These drugs are or are on their way to being the most commonly used prescription drugs by Scottish adolescents. There is no evidence of efficacy to support this use and compelling evidence for harms, especially self-harm.
Linked into the above, there is a further factor to bear in mind which is that pretty well the entire literature on these drugs is ghost-written, with the brief of the ghost-writers being to produce good marketing copy. There is no access to any of the data behind studies that may have been undertaken on these drugs, some of which have been conducted in Scotland. The MHRA have not seen the raw data and the Scottish Parliament cannot get access to the data behind these studies should Parliament request it. You should judge any comments of doctors or others apparently supporting the use of antidepressants against this background.
In response to MB’s request above I will be making a further submission. Post-SSRI sexual dysfunction (PSSD) is highly relevant here. In the case of the antidepressants, PSSD is a legacy effect. It commonly appears on withdrawal. It is likely only one of several legacy effects. Akathisia can also occur as a legacy effect.
In promoting research on PSSD and persistent genital arousal disorder (PGAD), the RxISK Prize is also looking at dependence and withdrawal as well as akathisia and suicide. It is quite likely that the changes that give rise to enduring sexual dysfunction give rise to enduring withdrawal also and that the onset of post antidepressant PGAD maps onto post antidepressant akathisia and suicidality.
So raising concerns about dependence and withdrawal effects is a way to go for anyone suffering from PSSD and PGAD. And contributing to the RxISK Prize is something to consider for anyone trying to find an answer to the problems of dependence and akathisia.
There is a significant difficulty for anyone suffering from PSSD and PGAD in this respect. Few sufferers want to lose the cloak of anonymity. If anyone has any brainwaves in respect of this petition – ways to expose Scottish ministers and their advisers to the horrors of PSSD or PGAD – we’d love to hear them. This would be a good place to get these concerns on the record.
To clarify – The Scottish Parliament petitions clerks are accepting written submissions by email to email@example.com – max approx 3 normal pages of text and quoting ref: PE 01651 in subject line
The petitions clerks check over all submissions – and publish once they have checked with sender by email (this can take a while) about any details that may need clarified or anonymised.
These are the official ‘rules’ http://email.rxisk.org/c/
The clerks are helpful … though say that it is taking a little while to work their way through submissions, according to the rules they have to comply with. There is a phone number UK 0131 348 5254 for enquiries about submissions.