Dear Sir

I am writing in response to the Guardian article by Mark Rice-Oxley entitled “Drugs alone won't cure the epidemic of depression. We need strategy.” Published at 1000am BST on Monday 3 July.
I also write as someone who is dependant on a prescription drug, specifically an antidepressant. In his article, Mark confidently states:

First, the good bit. Contrary to what detractors may say, antidepressants are not addictive and there is no tolerance effect. They are not like benzodiazapines or opioids – you don’t need more and more of them to obtain the same level of relief. Theoretically, you can sit quite comfortably on the same dose for ever, though it should also be noted that there is little research into long-term usage of these medicines. And while it’s true that science still doesn’t quite know how they work, it is clear that they have helped a great number of people, and certainly saved lives.

I would be interested in the evidence to support this statement. It is my contention that antidepressants can and do create dependence and have profound withdrawal effects in as many as 50% of those who take them. Firstly, it is important to note that addiction and dependance are related but different issues. Use of the term addiction implies pleasure seeking behaviour and I can assure your readers that there is no pleasure whatsoever in finding that if you try to reduce or stop your antidepressant, you suffer a wide range of physical and emotional disturbances, that for some people can be life limiting and, tragically, even life ending.

You may ask for the evidence to support my statement.

In 2014, a
study of New Zealand adults taking antidepressants reported that 55% suffered withdrawal effects. The Royal College of Psychiatrists in their own survey found that 63% reported withdrawal effects (with some antidepressants as high as 82%).

The British Medical Association has recently highlighted the issue of
prescribed drug dependance. In May 2017, they wrote:
Prescribing of psychoactive drugs is a major clinical activity and a key therapeutic tool for influencing the health of patients. But often their use can lead to a patient becoming dependent or suffering withdrawal symptoms.

In the absence of robust data, we do not know the true scale and extent of the problem across the UK. However the evidence and insight presented to us by many charity and support groups shows that it is substantial. It shows us that the 'lived experience' of patients using these medications is too often associated with devastating health and social harms.

This represents a significant public health issue, one that is central to doctors' clinical role, and one that the medical profession has a clear responsibility to help address.

That is why we have undertaken a project working collaboratively with key stakeholders to start to identify what positive action can be taken for the future benefit of patients. This has had a particular focus on the prescribed use of benzodiazepines, z-drugs, opioids and antidepressants.

One of the only UK helplines, the Bristol and District Tranquilliser project, who offer guidance to those in antidepressant withdrawal are also overrun with people needing support and advice.

I have personally conducted over thirty
interviews with both those with lived experience of antidepressant withdrawal and with recognised experts. These interviews leave me in no doubt that antidepressant withdrawal effects are far more common than is reported and cause a great deal of both short term and longer term disability and ill health.

I myself have recently commenced a gradual tapering of my antidepressant, fortunately, with the full knowledge and support of my GP, many are not so fortunate. I can confidently state that withdrawal effects are extremely challenging and quite often, I am unable to leave my house and am occasionally bed ridden. This is after 5 years use of an antidepressant at a low dose and I expect my withdrawal to take more than a year.

I believe that it is irresponsible of Mark to suggest that people can easily remain on these drugs for long periods. In the UK in 2016 we prescribed 64.7 million antidepressants, with many taking multiple drugs. If even 10% of those people struggle when they come to stop, that is millions in need of support and a huge public health challenge, well recognised by the British Medical Association. Doctors and Psychiatrists will struggle to find adequate guidelines to help a patient who wants to stop an antidepressant after many years use. This lack of official guidelines leaves patients at risk of harm through inadequate help and support when they do wish to withdraw.

I am very pleased that Mark seems to have been able to stop and start his particular medication relatively easily, but it is misguided to assume that the same is true of all those who are prescribed psychotropic medications.

Yours faithfully

James Moore