My Papers

SUMMARY We now recognise that withdrawal symptoms from antidepressants are common, and can be severe and long-lasting in some people. Many withdrawal symptoms overlap with symptoms of anxiety or depression, making it difficult to distinguish withdrawal from relapse. We describe how their onset soon after dose reduction, the association of psychological with physical symptoms, their prompt response to reinstatement, and their typical ‘wave’ pattern of onset, peak and resolution can...

Abstract Background Depression and anxiety are the most frequent indication for which antidepressants are prescribed. Long‐term antidepressant use is driving much of the internationally observed rise in antidepressant consumption. Surveys of antidepressant users suggest that 30% to 50% of long‐term antidepressant prescriptions had no evidence‐based indication. Unnecessary use of antidepressants puts people at risk of adverse events. However, high‐certainty evidence is lacking regarding the effectiveness and safety of approaches to discontinuing long‐term...

ABSTRACT The UK’s National Institute for Health and Care Excellence (NICE) is in the process of writing guidelines for “Medicines Associated with Dependence or Withdrawal Symptoms: Safe Prescribing and Withdrawal Management for Adults”. NICE has excluded antipsychotics, despite inclusion having been requested by all four groups participating in the guideline scoping workshop, as well as the Royal College of Psychiatrists, the All-Party Parliamentary Group for Prescribed Drug Dependence, the International...

Background: Stopping antidepressants commonly causes withdrawal symptoms, which can be severe and long-lasting. National Institute for Health and Care Excellence (NICE) guidance has been recently updated to reflect this; however, for many years withdrawal (discontinuation) symptoms were characterised as ‘usually mild and self-limiting over a week’. Consequently, withdrawal symptoms might have been misdiagnosed as relapse of an underlying condition, or new onset of another medical illness, but this has never...

We thank Sudhakar Selvaraj and colleagues1 for their interest in our work. They offer several critiques of the relevance of PET occupancy data to withdrawal effects. However, we think their claim that changes in plasma levels of drug would not be associated with withdrawal symptoms has little evidential support. The more abrupt reduction in plasma levels of antidepressants with shorter half-lives is understood to cause their more severe and quick-onset withdrawal...

Antipsychotics are recommended for long-term treatment of schizophrenia because they reduce risk of relapse. However, antipsychotics have many adverse effects, including metabolic complications, tardive dyskinesia, and probable brain volume reduction.1 Patients may ask to reduce or stop their medication or do so abruptly without professional support, sometimes with dire consequences. As there is some evidence that not all patients need lifelong antipsychotic treatment and some may have improved social functioning...

Abstract Most guidelines recommend long-term, indefinite neuroleptic (or antipsychotic) treatment for people with schizophrenia, recurrent psychosis or bipolar disorder, on the basis that these medications reduce the chance of relapse. However, neuroleptics have significant adverse effects, including sexual dysfunction, emotional blunting, metabolic disturbance and brain shrinkage, and patients often request to stop them. Evidence for the benefits of long-term treatment is also not as robust as generally thought. Short-term randomised...

We read with interest the Article by Fredrick Hieronymus and colleagues in The Lancet Psychiatry.1 The authors showed that SSRIs significantly improve scores in a subset of items in the 17-item Hamilton Depression Rating Scale (HDRS-17), over and above placebo, after a treatment period of 6 weeks, irrespective of baseline depression severity. However, we think that some uncertainties exist that should temper the authors’ conclusion that the “claim that antidepressants are useless...

Nobody can fail to be intrigued by, if not sceptical of, studies which appear to show that the prescribing of antipsychotics [which can cause weight gain, metabolic disturbance, QT prolongation, akathisia-linked suicide (Salem, Nagpal, Pigott, & Teixeira, 2017) and dose-related sudden cardiac death (Ray, Chung, Murray, Hall, & Stein, 2009)] results in people living longer than those not prescribed these drugs. The expectation, of course, is that people taking antipsychotics...