If Lexapro Worked for Me in the Past Will It Work Again
S arah never planned to accept antidepressants for 14 years. Iii years after she began taking them, when she was 21, she went to her GP and asked to stop: 20mg of Seroxat a twenty-four hour period had helped her alive with feet and panic attacks, merely she began to feel uncomfortable about being on medication all the time. Her md advised her to taper down her medication advisedly.
At once, "I was a mess," she says. "I thought I was losing my mind. My appetite completely went. I lost the best part of two stone. I was broken-hearted constantly. My mouth was dry out. It was hard to sit and exist calm." She became withdrawn, refusing to run across friends, and remembers asking her mother to become her a couple of boxes of paracetamol, thinking, "I'grand going to have to take all these tablets, because I can't live like this."
Sarah's medico encouraged her to get back up to 20mg. "Within a calendar week, I was much better. I feel anger when I await back. That wasn't me relapsing, that was withdrawal. Only I was and so unwell, I didn't stop to retrieve, 'I've never had this before.' I truly idea it was me. Now the only reason I am on the drug is because I am dependent upon it. And that is not proficient plenty."
Prescriptions of SSRIs (selective serotonin reuptake inhibitors), the most common type of antidepressant, have doubled in the past decade. There are now more than 70m prescriptions dispensed in the United kingdom in a year, the "greatest ascension" of any drug in the concluding year, according to NHS enquiry. But while the side-furnishings of starting and and then withdrawing from these drugs are reasonably well known (the patient information leaflet accompanying the SSRI Seroxat is half-dozen pages long), there is very petty research into the long-term effects of using antidepressants.
Last year, an all-party parliamentary grouping began hearing evidence as to whether at that place is a link between a measurable ascent in mental health disability claims – 103% between 1995 and 2014 – and that in antidepressant prescriptions. (Claims for other conditions fell by 35% in the same period.) "We demand to have a serious rethink well-nigh current levels of prescribing, because it may well exist that the drugs are in fact contributing to the disability burden," Dr Joanna Moncrieff, a consultant psychiatrist and senior lecturer at University College London, told the committee.
Reports both anecdotal and clinical have included side-effects such as abiding pain, an altered sense of smell, sense of taste or hearing, visual problems, burning hands and feet; food or drug intolerances and akathisia (the medical term for a deep inner restlessness). When a patient begins tapering downwards their dosage, these effects are generally ascribed to the drug leaving their system; if it is long after withdrawal is supposed to be over, still, patients are often disbelieved (according to the drug companies, withdrawal should take but 2 weeks for nearly people, though they admit that for some it can be months).
Professor David Healy, director of the department of psychological medicine at Cardiff Academy and author of 22 books on psychopharmacology, believes that antidepressants are overprescribed. "If you lot go into your boilerplate doctor – if you lot've been off the drug for half a yr or more – and yous complain [of a range of symptoms] and say, 'I call back it'southward caused by this pill I was on', he or she would say, 'It'southward been out of your torso for months. You lot're neurotic, you're depressed. All nosotros need to practice is put you on some other pill.'"
GPs, Healy says, are "relying on your word, and if it'southward a selection between believing what you say and relying on what drug companies say to them, they [tend to] believe the drug companies". Healy, who has been a consultant for, and expert witness confronting, most of the major pharmaceutical companies, has long argued that long-term side-effects are routinely ignored or misunderstood.
Simply many experts believe these drugs do more good than harm. "Most of the people I run into who have moderate to astringent low benefit from them," says Daniel Smith, a professor of psychiatry and researcher into bipolar disorder at the Academy of Glasgow. For some, medication tin can be no less than "transformative. It tin go them through a actually disquisitional menstruation of their life."
However, when it comes to long-term impact, especially later a person stops taking SSRIs, Smith says it can be hard to work out which symptoms chronicle to the drug use and which to the underlying conditions. "There'due south manifestly an issue of cause and outcome. How can nosotros be sure the SSRI caused it? Depression affects libido and sexual interest. How much [of the reported effects] is depression and/or feet symptoms coming dorsum?"
SSRIs accept been around for more than than xl years, only grew in popularity in the late 1980s and 90s after pharmaceutical visitor Eli Lilly launched fluoxetine, otherwise known as Prozac. Time magazine put the drug on its cover twice, asking, "Is Freud finished?" and describing SSRIs every bit "mental health's greatest success story". In 2001, a landmark report on a clinical trial into paroxetine (sold as Paxil in North America and Seroxat in the UK), chosen Study 329, ended that it demonstrated "remarkable efficacy and safety". Written report 329 led directly to a massive increase in prescriptions: past 2003, worldwide sales of Seroxat (manufactured by GlaxoSmithKline) were worth £2.7bn.
Just concerns were raised near the study –the United states of america food and drug administration (FDA) officer who reviewed the data disagreed with the findings, calling it a failed trial – and in 2015 the British Medical Journal published a re-evaluation. Seven authors went through equally many of the thousands of private case reports as they could, and found non only that "the efficacy of paroxetine… was not statistically or clinically dissimilar from placebo", but that "there were clinically significant increases in harms, including suicidal ideation and behaviour". The original written report reported 265 agin reactions; the BMJ constitute 481. The re-evaluation also found that psychiatric responses were grouped together with "dizziness" and "headaches", rather than given their own category. In 2003, the United kingdom banned the use of Seroxat by anyone under 18; and in 2004 the FDA required a "black box alert" on all antidepressants, its strictest level of patient warning.
"Patient safety is our number one priority," a GlaxoSmithKline (GSK) spokesperson tells me. "We believe we acted responsibly in researching paroxetine, monitoring its safety once it was canonical and updating its labelling as new information became available."
Many SSRI users study blunted emotions, even long after they have ceased taking pills, and an bear on on sexual office. "They should be called anti-sexual practice drugs rather than antidepressant drugs," says Jon Jureidini, a child psychiatrist of 30 years' standing, a professor of psychiatry and paediatrics at the University of Adelaide and co-author of the BMJ study, "Information technology's more reliably predictable that they're going to go rid of sexual function than information technology is that they're going to get rid of depression." Again, some people notice this persists long after they terminate taking the drug. 1 person I spoke to, Kevin, had taken Prozac for six months when he was 18; now 38, he hasn't had an erection since.
Last September, Healy and colleagues published a further examination of the data gathered for Study 329. This information followed the trial participants for half dozen months later on they started taking paroxetine (the "continuation phase") and while they were tapered off it. GSK, which in 2004 published a clinical study report, had argued that "the long-term safety profile of paroxetine in adolescents appears similar to that reported post-obit brusk-term dosing". Healy and co, all the same, concluded that the "continuation phase did not offer support for longer-term efficacy". More than alarmingly, they found that the taper stage, when patients were existence taken off the drugs, was the riskiest of all, showing a "college proportion of astringent agin events per calendar week of exposure". This, they said, opens upwardly the risk of a "prescribing cascade", whereby drug side-effects are thought to be symptoms, so are treated with farther drugs, causing further side-furnishings and further prescriptions – thus increasing the risk of long-term prescription drug-dependency.
In October, the British Medical Association published its response to a two-year fact-finding exercise into long-term utilize of psychoactive drugs. It noted that while benzodiazepines, z-drugs, opioid and antidepressants are "a key therapeutic tool", that their use can "oft lead to a patient becoming dependent or suffering withdrawal symptoms... the evidence and insight presented to u.s. past many charity and support groups... shows us that the 'lived experience' of patients using these medications is too often associated with devastating health and social harms"; it was therefore, the report concluded, a "meaning public wellness result".
The BMA made 3 primal recommendations: showtime, and about urgently, that the Britain government establish a 24-hr helpline for prescribed drug dependence; second, that it establish well-resourced specialist support units; and third, that there should be clear guidance on prescription, tapering and withdrawal management (they found the current approach to antidepressants, in particular, to be inconsistent: besides many patients were suffering "significant harm"). At that place are also increasingly urgent calls for studies into long-term effects that are not funded by drug companies, because, Moncrieff says: "Nosotros don't have very much data. This inquiry is really of import, but hasn't been done. Information technology's a massive blind spot. It's extraordinary – or maybe, given the pressures and interests at work, not extraordinary at all – that it hasn't been filled."
In March this twelvemonth, members of the BMA, along with MPs and researchers from Roehampton Academy, went to parliament to lobby Public Wellness England, armed with research estimating that there are 770,000 long-term users of antidepressants in England alone, at a price of £44m to the NHS per twelvemonth (a figure that does non account for the price of GP appointments, or the impact of side-effects, withdrawal effects and inability payments).
"I think you lot have to adopt a very conservative approach," says psychiatrist Jon Jureidini. "These are encephalon-altering drugs, and our overall experience with brain-altering drugs of all kinds is that they tend to take a detrimental effect on some proportion of people who have them long term. All we know virtually the benefits is from short-term symptom-reduction studies. The careful prescriber needs to say, 'Well, in balancing the likely benefits and harms, I demand to exist very cautious about how much benefit I'chiliad expecting, and I need to be very generous about the possibility that the harms might exist more than they appear to be.'"
Quite a few long-term users, such equally those I spoke to below (and who wished to be anonymous), would agree.
'Tapering off is the hardest thing I've ever washed': Sarah, 32; has taken Seroxat for 14 years
I was prescribed Seroxat when I was eighteen, the year I started university. I grew up with a disabled sister, so things at domicile were very stressful, and I had a history of feet and panic attacks. I had counselling, but the problems persisted, then I went back to the GP. I don't think everything that was said, but there was no conversation about side-effects.
Within the first 2 weeks of starting Seroxat, I retrieve I was sitting in the forepart room watching Television when out of nowhere I had this intense feeling of heat, similar an electric stupor. Information technology started in my hands, went all the style upwards my artillery and through to my head.
The GP said it was probably but my trunk getting used to the drug. And after a few weeks the weird sensations did ease off. I had a fabled time at academy. I withal had panic attacks, and there were sure situations I would avoid – as I still practise – so it wasn't a wonder drug, only there were no major issues.
But in 2006 I tried to come off it. In that location were a couple of Panorama documentaries almost the side-effects and I was starting to become concerned. The GP said, "That's fine, but do it gradually, over iii weeks."
I immediately became incredibly unwell. I thought I was losing my heed. I was going to work, merely it was difficult to get through the 24-hour interval. My mouth was so dry out, I was constantly drinking water. I had bizarre thoughts – not hallucinations – that were frightening or distressing. I had a strong sense of detachment from reality.
Eventually, the doc said, "Look, you coming off is obviously not working: nosotros need to get y'all dorsum to 20mg." Within a week I was much meliorate.
A few years later, when I realised my mental health was getting worse, even though I was on the medication, I started to do some research, reading case studies about withdrawal. I notice it then offensive when a GP says, "This is who you lot are." I didn't have these symptoms ten years ago. I didn't have this sense of disengagement. I saw various psychiatrists. They just kept saying, "The drug is safe, you need to be on it." A couple of others told me the reason I was having these problems was considering I wasn't taking enough. Some other said, "If you were diabetic, you'd take insulin and you wouldn't have an upshot. Why are you then bothered about taking this drug?"
I've been on it since I was 18, and then I don't know who I am without it, equally an adult. Who knows? I might have all kinds of problems, merely I need to know I've tried. Tapering off is the hardest thing I've ever washed. It's taken me three years just to become from 20mg to 5mg. I'm no longer with my partner – nosotros were together for six years. I believe Seroxat has played a part: it afflicted my moods, it fabricated my anxiety worse and, by necessity, I've had to be selfish, really. I don't want to say all my problems are to exercise with Seroxat, considering they're not. But I do believe that it has acquired me damage.
'I don't take much of an interest in interacting romantically or physically with the contrary sexual practice': Jake, 24; took SSRIs for eight years
I had been dealing with symptoms of OCD and feet for a lot of my childhood. It'due south in my family, affecting two siblings and i parent. I was prescribed Zoloft when I was 12; I took a variety of SSRIs, Zoloft to Prozac to Lexapro, and then two others, for eight years.
Did they help? Y'all know, I tin can't really tell you, because I got through school. I got high marks, I had a lot of friends. And then, in that sense, they must have helped. That's the thing: for people with major depression, it's like shooting fish in a barrel to say, this has a measurable effect. But I kept taking them just because that's what I've always washed.
I went to university right out of school. I did very poorly. I had a chip of a breakup, isolating myself, not sleeping. I was still on medication. I came dwelling and enrolled at a community college. That was my worst menses – I was very depressed. And I started to recollect, "I've been on these medications a long time. I'one thousand not doing well – why not get off them?" I don't recommend this at all to anyone, merely I stopped going to a psychiatrist and took myself off.
For months I had trouble sleeping. I was jittery. I had brain zaps. My feet was pretty ramped up. I would feel numbness in my extremities – generally my arms. My psychiatrist told me these were merely normal withdrawal symptoms, and they'd be gone in four to 6 weeks: "Anything you experience across that is your feet and depression returning." Basically, if you still feel anything beyond this window that the medical customs has established, information technology's all in your head.
Eventually I went back to school full-time, and I remember doing OK, feeling somewhat amend.
I've now been drug-complimentary for four years. What's lasted are the sexual side-effects. They were definitely worse in withdrawal than they had been on the drug, even though I didn't really realise or empathize it at the fourth dimension, primarily because I started to take SSRIs at 12. While my brother took the same medicine over the same menses and had a normal sexual life, I had a lack of sexual interest. I had erections, and I take regularly masturbated my entire life. Merely I don't have much of an interest in interacting romantically or physically with the reverse sex.
I didn't even outset thinking well-nigh sexual activity until a couple of years agone. It'due south almost like I woke up i day and idea, "OK!" I started getting these windows – days or weeks – when normal sexual feelings would announced. But they're new to me and I don't know what to do near them. And because I don't know what to do, I get anxious, and the anxiety kills any feeling – and then I'm broken-hearted because I've lost all my feeling.
Online, I've come across a big asexual customs. Some also took antidepressants; I call back there are a lot of people like me out there. I'd similar to think that if I keep going to counselling and sleeping and eating properly, I can rectify these things.
In the cease, it'south about pros and cons. If y'all're lying in bed and can't get up, is it better to function? If it was upwards to me, I'd say that, barring extreme circumstances, nobody nether 18 should be prescribed these things. Your encephalon develops effectually them. Drug companies should be thinking of the long-term issue on people who tin can't even consent.
'If I missed a dose, I'd get shocks down the side of my body': Chris, 43; has been taking Seroxat for 26 years
I was originally prescribed Seroxat for mild anxiety almost my GCSEs. Information technology was 1991, about the fourth dimension GlaxoSmithKline released Seroxat. I was 1 of the first people to exist given it.
I was prescribed 20mg, the basic dose, to start with. It helped me: I got through school, I went to uni, I went to work. But I had side-furnishings from the off: profuse sweating, low libido. I'one thousand quite a placid person, just I became aggressive. I never suffered, in the outset, with the suicidal thoughts that people talk virtually at present, but what I did notice was that if I missed a dose – particularly after eight years of taking it – I'd get shocks downwards the side of my body. I'd be nauseous, my limbs would become weak. I'd be in a constant land of confusion and was very impatient. I couldn't communicate well with people. I said this to the dr., and he said, "We'll upwards the dose to 40mg." That was 1998.
The 10 years after that weren't too bad. I managed to work, every bit a sales rep, for 18-xx years. Only by 2012, by which time I was up to 60mg, I had tried on numerous occasions to withdraw. I tried to get back to 20mg, just my words became slurry, and so the doctor put me support to 60mg.
By the time I was 38, even that wasn't enough. I tried to have my life. The doctor wouldn't prescribe a higher dose. I couldn't do my job, I couldn't concentrate, I couldn't drive. A psychiatrist once said to me that coming off Seroxat is harder than quitting heroin. That really hit home.
I accept at present been unable to work for 4 years. I'chiliad still seeing a psychiatrist. I've also been diagnosed with fibromyalgia: constant tiredness, aches in the neck, and in the lower back and lower limbs. I'1000 43 and still live with my mum and dad.
I besides have no libido. Since the age of 30, I take had no feelings in that regard whatsoever. I take had relationships, but they've all failed. I haven't been in a human relationship for 10 years, which is a long fourth dimension to go without sexual activity, but I merely don't get the urge.
I don't really accept emotions, to tell you the truth. The drug takes your emotions abroad. I'thou sort of existing, not living.
And when the drugs exercise work...
'I wanted to exist able to feel proficient when adept things were happening, bad when bad things were happening'
By Simon Hattenstone
I suppose I was a depression snob. A purist. Why should I have antidepressants? Yes, there was something rubbish nearly crying all the time, not functioning, existence unable to answer simple questions because of the fug in my head. But, hey, at least I was true to myself.
My depression went back to my late teens. I didn't like to think of myself as depressive, because depressives were losers. And I didn't recollect I fitted the neb: I was pretty funny and able, and I could get girlfriends. I approximate most depressives don't recollect they fit the bill.
Information technology might have been genetic. My dad had paralysing depression, and so did his father. Every bit a young boy, I'd spent iii years off school with encephalitis – an inflammation of the brain that is often fatal. Survivors are often left with depression.
I remember every bit a teenager being on holiday in Greece with friends. The weather was gorgeous, and I idea, "Why tin't information technology piss down, because then at to the lowest degree I'd take a reason to feel this way?"
That is what I e'er craved – objectivity. To be able to feel good when skillful things were happening, to feel bad when bad things were happening. I hated the fact that my feelings rarely correlated to what was going on in my outer world.
In my 20s, I got by. I held down a expert chore, fell in love, had kids, fabricated friends, had a pretty good life. But things came to a head when my best friend killed herself. I'd find myself weaving in betwixt traffic wondering what the touch on would be like. I took a period off work and gratefully accepted my Prozac prescription.
Things had changed since I starting time rejected them. Prozac looked absurd (lovely green-and-white pills) and stone bands wrote dandy songs about information technology (fifty-fifty if REM'due south Shiny Happy People was supposed to be dystopic). After telling people I was off work with depression, I ended up feeling like a priest at confessional. Information technology turned out that virtually everybody I knew was a depressive and pilling their way out of it; now it was "our secret".
Initially, Prozac made me experience sick. And so magically, afterward a couple of weeks, I felt lighter, every bit if something had been lifted. I could hear questions properly, answer logically, savor a sunny day.
My partner said I was transformed. Occasionally, I would try to come up off the pills and felt rubbish again – not more rubbish than I had before, but the same. So I returned, and later on a while, I thought, "What's the bespeak of even thinking virtually coming off the pills if they make life work for me?"
There are times now when I wonder if I weep and fret and withdraw too much, and whether I'm becoming immune to the Prozac. But on balance I retrieve not, because life is however so much better than information technology was.
If Prozac was no longer working for me, would I stop taking it? Probably. Would I stop taking antidepressants full stop? I dubiety it. I'd merely look for another super pill.
Are you lot a long-term user of antidepressants? Tell us about your experiences
- If you lot are affected by the issues raised in this piece, contact the Samaritans hither.
- This article was amended on 8 May 2017 to clarify that paroxetine is sold every bit Paxil in the United states of america and Seroxat in the UK, non the other style effectually as stated in an earlier version.
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Source: https://www.theguardian.com/society/2017/may/06/dont-know-who-am-antidepressant-long-term-use
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