It always surprises me that while most medics admit that all drugs can have serious adverse effects, when there is an actual victim, consumption of the drug is often supposedly viewed as coincidental. Although antidepressant Patient Information Leaflets and drug regulatory warnings stress of an increased risk of suicidality and aggression when taking these drugs, the continuous victim-denial by the drug industry and leading Key Opinion Leaders (KOPs) is disheartening to say the least.
It seems there is another growing furore surrounding antidepressants; this time its their addictive nature, with consumers’ experiencing withdrawal effects at odds with medical professionals who continuously express that antidepressants do not cause addiction. An article today in the Limerick Leader expressed concerns on the high rate of antidepressant users. It quoted Irish TD (member of Parliament), Maurice Quinlivan, as saying: “People working locally here on drug awareness groups in Limerick tell me that it can be much harder to get young people off of these prescription drugs than heroin as it can be that addictive.” Similarly, on Sky News yesterday, Danny Lee-Frost, head of enforcement at the MHRA (U.K. drug regulator), clarified antidepressant-addiction in no uncertain terms, stating:
“The sleeping pills and antidepressants are a lot more dangerous – They are a lot more addictive, in fact they are highly addictive – That’s the reason why they are prescription only. That changes the game completely – People have committed [sic] suicide as the ultimate resort to try and get off as these are fiercely addictive once you start taking them.”
Indeed, that the ‘newer’ antidepressants (SSRIs) can be highly addictive has been known for many years and per Peter C. Gøtzsche (Cochrane scientist):
“They surely are [addictive] and it is no wonder because they are chemically related to and act like amphetamine. Happy pills are a kind of narcotic on prescription. The worst argument I have heard about the pills not causing dependency is that patients do not require higher doses. Shall we then also believe that cigarettes are not addictive? The vast majority of smokers consume the same number of cigarettes for years.”
15 years ago Dr David Healy spoke of paroxetine withdrawal. He said:
“it was clear from early on that the company [GSK] had recognised that people who had been on this drug even for a relatively brief periods of time could go through withdrawal when they halt it. And they ran healthy volunteer trials to look at this further and found that in some instances up to 85% of the volunteers who had been on this drug for only two or three weeks had withdrawal problems when they halted.”
However, despite experts such as Gøtzsche, Healy and Lee-Frost leaving us in little doubt that antidepressants can indeed be addictive, there seems to be little consensus among medical professionals. Indeed, in Ireland medics have continuously denied that SSRI antidepressants are in any way addictive, with one Irish GP proclaiming on radio – “the drugs themselves are not dangerous, they’re not addictive, they’re not even dangerous at high levels of overdose”. (Notably, not only are SSRI antidepressants addictive, they can also be fatal in overdose; but that’s another story.) Likewise, speaking at a meeting hosted by the drug company Lundbeck, Professor Casey from the Irish College of Psychiatry, said “The outcome for those who get treatment is very good. It is also important to be aware too that antidepressants are not addictive”.
How can it be that addiction-denial is still commonplace when MHRA, Cochrane and psycho-pharmacological experts are expressing the opposite? And why? Adverse effect denial raises issues of consent and autonomy, neither of which are fulfilled if a consumer doesn’t know what he or she is consenting to. Indeed, rather than antidepressants being innocuously-sounding ‘happy pills’, per McHenry, 2006, attempts to reduce or discontinue SSRIs can cause ‘severe adverse events, such as jolting electric zaps (paraesthesia); confusion; headaches; vomiting; dizziness; nausea; worsening depression; insomnia; irritability; emotional lability, including suicidality, and agitation that, when severe, can resemble a manic episode’. All that, without even delving into the issue that most consumers will have antidepressant-induced sexual problems, ranging from vaginal-dryness to male-impotence.
Part of the problem stems from the word ‘addiction’, which medics seem to have an aversion to, especially when it relates to drugs they widely-prescribe. According to a 2003 WHO report on drug dependence, 3 SSRIs are ‘among the 30 highest-ranking drugs in the list of drugs for which drug dependence has ever been reported’ (to their drug-monitoring database). They are fluoxetine (Prozac), paroxetine (Seroxat/Paxil) and sertraline (Zoloft/Lustral). The report found that researchers used differing terminology to avoid associating SSRIs with dependence, such as replacing ‘withdrawal-syndrome’ with ‘discontinuation-syndrome’. Considering SSRIs such as fluoxetine (and sometimes sertraline) are prescribed in children and adolescents, it is crucial that the potential for harm is acknowledged.
Thus, Fava et al suggested that while ‘clinicians are familiar with the withdrawal phenomena that may occur from alcohol, benzodiazepines, barbiturates, opioids, and stimulants, they need to add SSRIs to the list of drugs that potentially induce withdrawal phenomena. The authors concluded that the term ‘discontinuation syndrome’ minimizes the vulnerabilities induced by SSRIs and thus, it should be replaced by ‘withdrawal syndrome’.
Pretty conclusive I’d say.