What can we learn from the anti-depressant harm reduction movement?
In many ways, the psychedelic industry is following the same hype cycle as the anti-depressant industry. So what can we learn from the decades-old movement to warn about the risks of SSRIs?
In many ways, the psychedelic industry is following the same hype cycle as the anti-depressant industry - older readers will remember how Prozac was launched in the late 1980s as a total wonder drug, much like psilocybin is being hailed today. So what can our organisation - which works to research and reduce the risks and adverse events from psychedelics - learn from the decades-old movement to warn about the risks of SSRIs?
We interviewed Luke Montagu, who founded of the Council for Evidence-Based Psychiatry, together with Dr James Davies (author of Cracked, and Sedated, two blisteringly good critiques of our over-medicated society). The CEP website says:
CEP exists to communicate evidence of the potentially harmful effects of psychiatric drugs to the people and institutions in the UK that can make a difference. The scientific record clearly shows that psychiatric medications, portrayed as safe and effective by areas of the medical profession, often lead to worse outcomes for many patients, particularly when taken long term.
It's successfully campaigned to get the NHS and NICE (the National Institute for Clinical Excellence) to admit that anti-depressants can cause long-term dependence and withdrawal, as well as other side-effects. Luke himself was severely impacted by SSRI dependency and adverse experiences, as he told us:
1) Why did you start the CEP?
I was wrongly prescribed sleeping pills and antidepressants for decades and found it almost impossible to come off. When I did, I went into severe withdrawal and was unable to function for almost four years. The suffering was indescribable and I still have nerve pain and tinnitus over ten years later. I discovered that very few doctors knew anything about prescribed drug withdrawal, and yet there was a massive online community supporting each other without any recognition or NHS help. I decided to make contact with people and organisations and they began to take notice, starting with the British Medical Association who wrote a report in 2013 highlighting the issue and recommending services.
2) How did Big Pharma react to reports of side effects of anti depressants?
The pharmaceutical industry has a long history of downplaying withdrawal effects from antidepressants. Firstly, they promoted the use of the term ‘discontinuation syndrome’ instead of withdrawal - doesn’t sound so bad does it? And yet withdrawal from antidepressants can be worse than withdrawal from heroin for many people. Secondly, many of their antidepressant trials are flawed because they do not distinguish between withdrawal and the return of an underlying issue. Withdrawal symptoms include high levels of anxiety and depression, and during withdrawal these can be overwhelming. But drug trials often involve stopping one drug quickly and starting another, without realising that the new drug is ‘working’ because it is simply counteracting the withdrawal symptoms. Plus the relapse studies - which consider whether relapse is likely following the stopping of a antidepressant - also fail to acknowledge that the relapse is in fact caused by withdrawal. Of course what often happens is that patients end up on multiple drugs, with each drug combatting the side effects of another. And yet very few of these combinations - known as polypharmacy - have been studied.
3) What has CEP achieved and what do you still want to achieve?
I think CEP has achieved a couple of important things. Firstly we have a website cepuk.org which has helped thousands of people around the world with videos and research summaries that explain the possible harms of prescribed drug dependence and withdrawal. People taking these brain-changing drugs need to be informed, and I think we have helped to achieve that. Secondly, we’ve completed research that shows just how debilitating antidepressant side effects and withdrawal can be for some people. This includes a survey which highlighted that 64% of those surveyed had not been warned about side effects, and 40% had been told they had a chemical imbalance (a widely discredited theory). Thirdly our work has generated lots of coverage in the mainstream media, including major campaigns by The Daily Mail and The Times, which has helped raise awareness and apply policy pressure.
We have also been partially successful in our lobbying of government and the UK health service. Our work led directly to an important report by Public Health England called the 2019 Prescribed Medicines Review. This made several key recommendations, including the need for new guidelines on safe prescribing and withdrawal. I was pleased to be on the NICE committee for this new guideline which covers many important changes, including the requirement for a written management plan when these drugs are first prescribed. The guideline also provides details on safe tapering using a hyperbolic method, where each reduction is smaller than the one before.
But there are two key recommendations which have yet to be implemented: the provision of local withdrawal services and the creation of a national 24 hour prescribed drug helpline. We have these for illicit drugs, and it is shameful that there are no services to help people who are suffering because of drugs taken as prescribed.
4) What do you think of the 'psychedelic renaissance'?
I am very wary, as history keeps repeating itself with drugs that are pronounced safe and effective only for serious harms to be recognised years later, and with many lives destroyed in between. We have seen this with benzodiazepines, with antidepressants and with gabapentinoids. All were released to great fanfare and yet all have proved to be disastrous for some people. We also need to appreciate that the science is unproven - we still don’t understand the biochemistry of depression, or anxiety, or schizophrenia or indeed mental illness. In fact we don’t know that they are illnesses at all! Without understanding the pathology it is reckless to dose the brain repeatedly with drugs that cause biochemical changes. That said, at least psychedelic treatments are less frequent, so perhaps there will be less harm. Though of course a bad psychedelic experience can leave a devastating imprint which is why your work is so important.
5) What advice do you have for our project?
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