An important analysis by the former director of the NIMH and published in the American Journal of Psychiatry shows that antidepressants “create perturbations in neurotransmitter functions,” causing the body to adapt through a series of biological events that occur after “chronic administration,” leading to brains that after a few weeks function in a way that is “qualitatively as well as quantitatively different from the normal state.”58 In other words, the brain’s natural functionality is assaulted by the medication to the point that it can become permanent. That said, everything we will explore in this book speaks to the body’s tremendous and almost unstoppable resilience when properly supported.
Dr. Paul Andrews of the Virginia Institute for Psychiatric and Behavioral Genetics demonstrated through a careful meta-analysis of forty-six studies that a patient’s risk of relapse is directly proportionate to how disruptive the medication is to the brain.59 The more disruptive the medication, the higher the risk of relapse upon discontinuation. He and his colleagues challenge the whole notion of relapse, suggesting that when you feel terrible upon stopping an antidepressant, what you’re experiencing is withdrawal—not a return of your mental illness. And when you choose the medication route, you’re actually extending the duration of your depression. Andrews writes: “. . . unmedicated patients have much shorter episodes, and better long-term prospects, than medicated patients . . . [T]he average duration of an untreated episode of major depression is twelve to thirteen weeks.”60
In a retrospective ten-year study in the Netherlands, 76 percent of those with unmedicated depression recovered without relapse relative to 50 percent of those treated.61 Unlike the mess of contradictory studies around short-term effects, there are no comparable studies that show a better outcome in those prescribed antidepressants long term.
Harvard researchers have also concluded that at least 50 percent of drug-withdrawn patients relapsed within fourteen months.62 In the words of one team of researchers led by Dr. Rif El-Mallakh from the University of Louisville: “[L]ong-term antidepressant use may be depressogenic . . . it is possible that antidepressant agents modify the hardwiring of neuronal synapses [which] not only render antidepressants ineffective but also induce a resident, refractory depressive state.” Dr. El-Mallakh and his colleagues wrote this bold statement in a letter to the editor of the Journal of Clinical Psychiatry in 1999.63 Then, in 2011, they published a new paper including eighty-five citations proving that antidepressants make things worse in the long run.64 (So when your doctor says, “You see, look how sick you are, you shouldn’t have stopped that medication,” you should know that the data suggests that your symptoms are signs of withdrawal, not relapse.)
In Anatomy of an Epidemic, Robert Whitaker summarizes the matter succinctly:
We can now see how the antidepressant story all fits together, and why the widespread use of these drugs would contribute to a rise in the number of disabled mentally ill in the United States. Over the short term, those who take an antidepressant will likely see their symptoms lessen. They will see this as proof that the drugs work, as will their doctors. However, this short-term amelioration of symptoms is not markedly greater than what is seen in patients treated with a placebo, and this initial use also puts them onto a problematic long-term course. If they stop taking the medications, they are at high risk of relapsing. But if they stay on the drugs, they will also likely suffer recurrent episodes of depression, and this chronicity increases the risk that they will become disabled. The SSRIs, to a certain extent, act like a trap in the same way that neuroleptics [tranquilizers] do.65
More than twenty years have passed since clinicians and researchers started collecting evidence against antidepressants. Although these drugs may offer relief in the short term thanks to the placebo effect, they lead to chronic, persistent depression that resists treatment when taken for an extended period of time. In some people, stopping the drug can cause a slow and gradual lightening of the mood, but this doesn’t always occur, and depression can become more or less permanent. Remember the alcohol effect.
Not surprisingly, the powers that be in my field have not looked into this matter or launched a serious investigation. And yet the studies keep emerging. In early 2015, yet another headline hit that Big Pharma turned a blind eye to. It read “Stopping SSRI Antidepressants Can Cause Long, Intense Withdrawal Problems” and referred to the first systematic review of withdrawal problems that patients experience when trying to get off SSRI antidepressant medications.66 A team of American and Italian researchers found that withdrawing from SSRIs was in many ways comparable to trying to quit addictive benzodiazepine sedatives and barbiturates.67 They also discovered that withdrawal symptoms aren’t fleeting; they can last months or even years. Moreover, entirely new, persistent psychiatric disorders can surface from discontinuing SSRIs.
The authors analyzed fifteen randomized controlled studies, four open trials, four retrospective investigations, and thirty-eight case reports of SSRI withdrawal. Paroxetine (Paxil) was found to be the worst, but all the SSRI antidepressants were documented as causing a wide range of withdrawal symptoms from dizziness, electrical shock sensations, and diarrhea to anxiety, panic, agitation, insomnia, and severe depression. They write: “Symptoms typically occur within a few days from drug discontinuation and last a few weeks, also with gradual tapering. However, many variations are possible, including late onset and/or longer persistence of disturbances. Symptoms may be easily misidentified as signs of impending relapse.”
In their conclusions, they state what should be the obvious: “Clinicians need to add SSRIs to the list of drugs potentially inducing withdrawal symptoms upon discontinuation, together with benzodiazepines, barbiturates, and other psychotropic drugs.” An accompanying editorial to their paper notes that “This type of withdrawal consists of: (1) the return of the original illness at a greater intensity and/or with additional features of the illness, and/or (2) symptoms related to emerging new disorders. They persist at least six weeks after drug withdrawal and are sufficiently severe and disabling to have patients return to their previous drug treatment. When the previous drug treatment is not restarted, post-withdrawal disorders may last for several months to years.”
The editorial also states that “With SSRI withdrawal, persistent postwithdrawal disorders may appear as new psychiatric disorders, in particular disorders that can be treated successfully with SSRIs and SNRIs. Significant postwithdrawal illnesses found with SSRI use include anxiety disorders, tardive insomnia, major depression, and bipolar illness.”
This bit of news is extremely unsettling to current practices in psychiatry. According to the current American Psychological Association treatment guidelines for major depressive disorder, “During the maintenance phase, an antidepressant medication that produced symptom remission during the acute phase and maintained remission during the continuation phase should be continued at a full therapeutic dose.” Such a guideline merely promotes more drug sales, and more crippling side effects.
DON’T GO DOWN THE RABBIT HOLE
We need to break out of the spell that the pharmaceutical industry has put us under. Psychiatry’s swan song has been sung; listen for its plaintive wail. We must reject the serotonin meme and start looking at depression (and anxiety, and bipolar disorder, and schizophrenia, and OCD) for what they are: disparate expressions of a body struggling to adapt to a stressor. There are times in our evolution as a cultural species that we need to unlearn what we know and change what we think is true. We have to move out of the comfort of certainty and into the freeing light of uncertainty. It is from this space of acknowledged unknowing that we can truly grow.68
From my vantage point, this growth will encompass a sense of wonder—both a curiosity about what symptoms of mental illness may be telling us about our physiology and spirit and a sense of humbled awe at all that we do not yet have the tools to appreciate. For this reason, honoring our coevolution with the natural world and