Antidepressed: A Breakthrough Examination of Epidemic Antidepressant Harm and Dependence

PREFACE

Dear Dr. Gordon,

I have been suffering from extremely severe withdrawal symptoms from the antidepressant drug paroxetine for over six months now. These symptoms include but are not limited to: body and head jerking, severe agitation, hyperventilation to the point of passing out, and waves of toxic depression.

I admitted myself to hospital after a failed attempt to take my own life. They discharged me after 10 days as there was nothing they could do for/with me and I was becoming a burden on the nurses and the other patients.

Every second of my waking existence is horrific. I have repeatedly expressed my wish to die with dignity as I am now unable to maintain even the most basic standards of personal hygiene. I have socially isolated to the extreme as my condition makes associating with people impossible.

In my desperate state I have contacted the group My Death My Decision as well as the group Exit international so they will have a record of my experience even though there is nothing they can do to help me.

You have my permission to share my correspondence with anyone you deem to be appropriate.

Yours sincerely,

Antony Schofield

THIS BOOK COMES too late for Antony Schofield. He ended his life aged 52. Being prescribed antidepressants was the start of a ruined and wasted life. I talk with his mother often; at 81, she was left with only memories of a wonderful, intelligent and adventurous son. Antony’s mum is now aware of and understands the effects these drugs, taken as prescribed, had on her son’s life. It was Antony’s wish, and is now his mother’s, that people should learn about the harm these medications have the potential to cause. Towards the end of his suffering, he asked his mother to tell the world about antidepressants. This book is the voice of Antony and his mum Bridget.

INTRODUCTION

Our Wicked Problem with Antidepressants

Wicked’ refers to a problem that cannot be fixed, where there is no single solution to the problem. Wicked denotes resistance to resolution, rather than evil. Another definition is a problem whose social complexity means that it has no determinable stopping point and because of complex interdependencies, the effort to solve one aspect of a wicked problem may reveal or create other problems.¹

NOWADAYS, WE TALK about the urgent need for a paradigm shift in how we think about mental health and for transformation in the way we collectively understand and intervene on mental health issues. ² The reality is we need a revolution. In 2020, the United Nations published a report ³ by Special Rapporteur Dainius Pūras calling for little short of a revolution in mental health care. ⁴

It is important to remember, whatever we need to do to make change and however loud we shout about emerging new ways of thinking, antidepressant prescribing is continuing to soar around the world. The medicalized way we look at mental health has become a dominant and powerful one and millions of us have chosen to take antidepressants knowing very little about them. Whilst the medical profession has a responsibility to first do no harm, we, as patients also have a responsibility to learn about this medication we take, often with very little thought. It is hoped that this book will enable us to become savvy about antidepressants, make informed choices and contribute to changing how we think about, talk about, and cope with life’s up and downs.

Mental illnesses are amongst the most common health conditions in the United States.

More than 50% will be diagnosed with a mental illness or disorder at some point in their lifetime.

1 in 5 Americans will experience a mental illness in a given year.

1 in 5 children, either currently or at some point during their life, have had a seriously debilitating mental illness.

1 in 25 Americans lives with a serious mental illness, such as schizophrenia, bipolar disorder, or major depression.⁵

The US has declared itself to be in the grips of a mental health epidemic. According to Centers for Disease Control and Prevention (CDC) data, one in seven—or 13.2 percent—of adults aged 18 and over took antidepressants between 2015 and 2018; more than 43 million adults. Use was higher amongst women, 17.7 percent, than men, 8.4 percent. This increased with age, rising to 24.3 percent of all women aged 60 and above. Teenagers, aged 13-19, experienced the greatest increase in antidepressant use from 2015 to 2019, up a significant 38.3 percent, from 5.7 percent to 7.9 percent.⁶,⁷ This significant rise in use amongst young people is alarming. One study reports the number of young people with major depression jumped 52 percent between 2005 and 2017. In addition, 1 in 8 young Americans now suffers from anxiety.⁸

This is written at the time of COVID-19 and already in the US there have been significant increases in the prescribing of drugs used to treat mental health conditions. Statistics for 2020 show 45 million Americans were taking antidepressants and this included 2.1 million young people aged 0-17. By March 2020, it was reported prescriptions for antidepressants had risen by 19%, anti-anxiety medication by 34 percent and anti-insomnia drugs by 15 percent. Reports tell of 40 million Americans suffering from anxiety and over 17 million being diagnosed with Major Depressive Disorder.⁹

The American Psychiatric Association (APA) Practice Guideline for the Treatment of Patients with Major Depressive Disorder recommends antidepressants or psychotherapy as the initial treatment for patients with mild-to-moderate depression.¹⁰ Yet financial costs prevent many Americans accessing medication or therapy. It is also reported there is a severe lack of mental health professionals available with a shortage of counsellors, social workers, psychiatrists and psychologists. Only one-third of those diagnosed receive treatment because of the cost of care, according to the Anxiety and Depression Association of America.¹¹ The U.S. Department of Health and Human Services says approximately 111 million Americans live in areas with a shortage of mental health professionals.¹²

Despite prescription statistics, there has never been any sound evidence for the epidemic of depression talked about. We do, however, have a mental health pseudo epidemic in the western world and the case of an epidemic of antidepressant prescribing is a reality. The surge in antidepressant prescribing has always been a growing cultural trend as well as a medical one. It reflects the rise of the medicalization of everyday life and is one which comes at a cost to individuals and society. Unfortunately, the promotion of mental health as medical conditions has led, primarily, to the increase in the prescribing of antidepressants and it is now becoming widely recognized that antidepressants can put us at risk of dangerous adverse effects; most notably they can cause dependence and raise the risk of suicide. It is also ironic that as antidepressant prescribing continues to soar, so does mental health disability.¹³

Dependence on antidepressants is an issue lacking much needed recognition; a worldwide elephant in the room, and for many it can be personally, socially, or politically uncomfortable to deal with. It can be embarrassing, controversial, inflammatory, and downright dangerous. The pharmaceutical industry, psychiatry and doctors are supported by governments and mental health organizations and charities in propagating the unsubstantiated basis on which mental health has grown to be a huge industry. They have made antidepressants the medication so many of us have come to depend on. Many of us claim antidepressants have saved our lives, but many are unaware of the harm antidepressants have caused or of our dependence on the medication we take as prescribed.

Just as happened with the campaigns in the 1990s, the drug companies will no doubt seize the potential COVID-19 presents as an opportunity to capture new customers, expand existing mental health markets, and introduce their medical model of treatment to new ones. In the 1990s, Eli Lilly and the field of psychiatry created an incredibly successful epidemic of pseudo-depression. By 2000, Prozac had 40 million users and accounted for a quarter of Eli Lilly’s $10.8 billion sales and more than a third of its $3 billion profit. Before Prozac arrived, the general public were against antidepressants and believed them addictive.

Media language during COVID-19 is serving to assist the pharmaceutical industry to further boost its profits during and in the aftermath of the crisis. This is a time when language matters and we must be aware of similar campaigns to Defeat Depression and Depression Hurts; crusades which in the 1990s led to the unsubstantiated medicating of our mental health and to millions today being dependent on and harmed by antidepressants.¹⁴ It is important we are not duped into falling for a well-orchestrated Defeat COVID-19 Mental Illness Campaign or COVID-19 PTSD Campaign, which are probably already in the planning stage. The future mental health of a generation now depends on the powerful language used to help us cope with our lives during this time.

Overtreatment with antidepressants and underestimation of risks have left millions around the world with problems to which there are no obvious solutions. Current levels of antidepressant prescribing are unsustainable for many reasons. It is a human time-bomb, sometimes fueled by the willful blindness of both patients and medical professionals. Failure to acknowledge the issues is leading to harm and death and when the issue of dependence is raised, other problems present themselves due to the lack of research, knowledge, and existing support for those who choose to withdraw from antidepressants.

Vulnerability is hardly ever spoken about in relation to antidepressants and yet, it is the one adverse effect we will most probably be prescribed with our medication. We can be vulnerable to physical and psychological adverse effects and vulnerable when dependence causes changes to our health, sometimes leading to many aspects of our life spiraling out of control.

This book acknowledges a problem too complex to solve but offers an opportunity to learn, open minds and explore options to avoid and reduce harm and dependence. People, right now, need help and there is little available. In an ideal world we talk about withdrawal from antidepressants but for many, managing their antidepressants has become a process of damage limitation. Mental illness is not a disease but is described as an epidemic and unless we challenge the current mental health narrative—unless we educate ourselves and learn about the powerful drugs we take, we will see more suffering, illness and death.¹⁵

Taking an antidepressant is an individual’s choice. I hope this book is one people will refer to when making the choice to start taking antidepressants and whilst taking them or considering reducing or managing their medication. It is honest and straight forward about the realities of the effects of Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin Norepinephrine Reuptake Inhibitors (SNRIs).

Taking an antidepressant should be our informed choice based on the benefits and risks. There are things it is important we know about SSRI/SNRI antidepressants and things we need to look at differently. The reality is there are many things we still don’t know about these drugs. What we are told about an antidepressant will initially depend on our prescriber, but only some will be knowledgeable and honest; that it seems impossible to predict how our mind and body will react to the medication.

There is now so much information available in books and online resources about the benefits and adverse effects of antidepressants. Some information is reliable and easily accessible but for many it can appear complex and daunting. I explain the realities of the wicked issue of antidepressants by presenting evidence-based facts and real-life experiences. I have known too many people who wish they had been fully aware, before they swallowed their first pill, of the realities of a life Antidepressed.

This book does not contain medical advice! It encourages and helps us learn about SSRI/SNRI antidepressants and guides us to appropriate resources enabling us to make more informed choices. The resource section of this book includes valuable sources of information including websites, books, articles, and research.

WARNING: There are many reasons why it is important that we never stop taking or start withdrawing antidepressants or any psychotropic medication without the support of a knowledgeable medical professional or support service. Antidepressant treatment should be supported by frequent reviews. We need to be aware, from the very first pill we take, of any physical or psychological changes we experience and report them immediately to our prescriber. Evidence suggests the risk of suicide, self-harm or other severe adverse events is significantly higher when commencing, stopping or changing doses or switching drugs including generics.

This book includes petition extracts from people around the world. The petition called for the Scottish Parliament to urge the Scottish Government to take action to appropriately recognise and effectively support individuals affected and harmed by prescribed drug dependence and withdrawal.¹

In this book, antidepressants refers to SSRI/SNRI antidepressants unless otherwise stated.

PART 1

The Medicalization of

Our Mental Health and

Antidepressant Prescribing

1

HOW OUR MENTAL HEALTH

BECAME MEDICAL

Why do so many of us believe we might be mentally ill and need medication? Why have we been made to believe mental health is a medical issue?

We are told our mental health deserves parity with our physical health. Campaigns by often self-serving organizations have encouraged the developed world to see mental health as being part of our medical system. Reality is, physical health treatment is targeted at the biological cause of an illness, but mental health treatment should be primarily about helping us cope with the many personal and societal factors negatively affecting our ability to cope with our lives. Nowadays, however, it seems to suit both doctors and patients to readily accept medication as the answer rather than address the issues causing our stress, anxiety or sadness.

Something is probably wrong, difficult, uncomfortable, or downright hard in our life but millions of us are not actually mentally ill. Psychiatry and the pharmaceutical industry have created a system of mental health to attempt to reflect diagnostic models used in other areas of medicine. This is to justify psychiatry’s status as a medical profession and the prescribing of antidepressants and other psychiatric medications.

Most of us have never heard of the Diagnostic and Statistical Manual of Mental Disorders or the DSM as it is known. The 5th edition of this manual, (DSM-5), was published in 2013 following work groups creating hundreds of papers and articles to provide the world with a summary of the state of the supposed science relating to psychiatric diagnoses. This current edition of psychiatry’s bible lists over 300 disorders or illnesses for which we are likely to be prescribed antidepressants or other psychotropic medication. It is perhaps the most powerful and influential book we have probably never heard of.¹⁶,¹⁷,¹⁸

Using this manual as their justification, our doctors are taught to categorize our emotional feelings and subjectively and often inaccurately diagnose us as suffering from disorders and conditions. These are not biological diseases and there are no proven biological causes, but it has led to a cultural perception that depression, grief, sadness, anxiety and other normal human feelings and behaviors should be classified as mental illness. Psychiatry’s classifications have become part of our culture and encouraged us to accept our suffering and inability to cope as mental health issues needing medical treatment .

The DSM categories are labels and patients are matched to them using the opinion of the doctor listening to the patient’s own feelings about themselves when asked certain questions. This is not a scientific process and has many flaws; are we always being honest with the doctor and is the doctor always asking the right questions and listening correctly? Do we feel exactly the same from one day to the next? Are there reasons we think a diagnosis will make life easier? A doctor’s often subconscious reference to conditions created for this guidebook is for many of us the start of our feelings and emotions being defined as mental illness, antidepressants or other drugs being prescribed, and the real-life issues we need to address being ignored.

Without us even recognizing it, psychiatry’s DSM has become a dominant part of how we deal with everyday life. Whether we have heard of the DSM of not, its conditions have become part of our everyday language. A doctor will probably not even refer to it, but we have allowed it to mislabel normal emotions and feelings and encourage both overdiagnosis and inappropriate use of medication. There now seems to be a pill for every emotional situation we might find ourselves in and a label for every inconvenient or uncomfortable feeling. The covert DSM has been cleverly and unceremoniously drilled into our psyche and until very recently we have generally accepted it without question.

Ultimately, unless we are informed and question their opinion, whether or not we end up on medication is often decided by little more than a doctor’s subjective diagnosis. Many of us who could quickly improve with time, the support of friends and family or therapy, might not be given the right sort of help we need. A doctor’s appointment is often the start of a lifelong journey as a psychiatric patient resulting in a stigmatizing lifelong condition and dependence on psychiatric medication.

Is there any wonder we have come to believe a pill can make life easier? Why do so many of us turn to antidepressants to help us cope with life’s difficulties?

Prozac (and the language that came with it) changed everything.

Defeat Depression and Depression Hurts campaigns became some of the most influential and successful marketing campaigns of our era. We suddenly had mental health and mental illness and the simple solution was to be found in a psychotropic drug branded Prozac.²⁷

Prozac, the first SSRI antidepressant was introduced in 1988. Eli Lilly marketed it as happiness in a blister pack. Prozac, generic/medical name fluoxetine, was quickly given to Interbrand, the world’s leading branding company and it was given its identity. Over the following years, national campaigns informed doctors and the public of the dangers of depression.²⁸

Prozac was pushed as a wonder drug, entirely safe, an easy answer to the blues. It fixed our faulty brains. On launch day patients were already asking for it by name. And with powerful marketing we were brainwashed into believing depression was a biological disease, chemical imbalances needed balancing and everything could easily be cured by a drug. A new kind of depressed patient was created and they had mild depression needing medical treatment. They were the ordinary people with ordinary life struggles and were sold the idea that a drug could make their life better.

Campaigns assessed public attitudes towards depression to discover which of them needed to be changed. Eli Lilly then began changing the public’s opinion about antidepressants. Conclusions were made Doctors have an important role in educating the public about depression and the rationale for antidepressant treatment. In 1997, Eli Lilly ran a new marketing campaign for Prozac with direct-to-consumer advertising. Advertisements appeared in over 20 general-interest magazines and targeted both adults who suffered from depression and their family and friends. Their target market was the new, first-time depressed patient and their messages were Depression Hurts and Prozac can Help.

Initially, The American Medical Association (AMA) were not overly enthusiastic about Eli Lilly’s strategy, Of course, doctors can—and should—say no to anyone who doesn’t need a particular medication. But let’s not fool ourselves: If doctors are under pressure from their patients to prescribe a particular medication, they must become strong gatekeepers to prevent misuse.²⁹ At this time there was no internet and we relied on doctors and the pharmaceutical company’s Patient Information Leaflet for information and advice. There were no social media groups for support if we needed it. We became guinea pigs in the new medicalized way of dealing with life. It was nothing short of the start of a worldwide unauthorized human experiment which continues today, unabated.

In the TIME Magazine 2003 article If everyone was on Prozac... , Dr. Sanjay Gupta asked, [T]hat raises an intriguing question about the future of mood-altering pharmaceuticals: If Prozac can make you feel better even if you are not depressed, why shouldn’t we all be taking it? Is that the direction we’re going, as the drugs become more socially acceptable and heavily marketed? (More than 11 million Americans already take some form of antidepressant.) It’s a question that arises only because SSRIs are relatively mild and subtle medications. There are plenty of drugs that can make you feel better, at least temporarily—alcohol and heroin come immediately to mind—but they tend to be addictive or toxic or both. Prozac is neither.³⁰

We now know antidepressants can be highly toxic and probably cause dependence for the majority of those who take them. The pharmaceutical industry and psychiatry are supported by governments, the medical profession, the media and mental health organizations and charities to continue to promote the unsubstantiated basis on which mental health has grown to be a huge industry and these drugs are sold to us. The clever marketing of Prozac assisted the birth of the medical model of mental health and we adopted it, until recently, without question.

2

THE MYTH OF THE

CHEMICAL IMBALANCE

We are told it’s our chemical imbalance, but where’s the proof? Why don’t we have tests or scans to confirm this imbalance?

There are no biological tests such as blood tests or brain scans which can be used to provide independent objective data to support our mental health diagnosis. We have all probably heard of and believed in the chemical imbalance theory or that we might have it because we are predisposed genetically; my mother suffered from it or it runs in the family.

Despite everything we might have been told about chemical imbalances, there are no known biological causes for any of the psychiatric and mental health disorders or illnesses apart from dementia and some rare chromosomal disorders.³¹ We are being medically treated for conditions which are most probably not biological.

By means of the carefully scripted pharmaceutical marketing campaigns of the 1990s and pushed by psychiatry, our doctors quickly learned to attribute mental illness to faulty brain biochemistry, defects of dopamine, or a shortage of serotonin. They bought into it, we bought into it and most of us still believe it now. For over 30 years we have all been conditioned to believe what is now starting to be regarded as very questionable science. Research has mostly shown evidence that the brain, which has around 100 billion neurons and is one of the most complex objects in the universe is in fact an elusive target for drugs. It is just way too complicated for it to be as simple as we are led to believe.

From an early age we are taught doctor knows best. Most of us trust, without question, that our doctors adhere to their principle of first do no harm. We have accepted without question their story that our brain chemistry is at fault and these false perceptions of how our brains work have made it easy for us to accept that we might be mentally ill, and antidepressants are the answer. The fact is there are no associations with any biological pathology in relation to the majority of psychiatric diagnoses. Conditions which have become part of our everyday language such as bipolar disorder, depressive disorders, anxiety disorders, personality disorders, obsessive compulsive disorders or post-traumatic stress disorders have no associations with any biological