Psychological factors in antidepressant withdrawal should not be ignored

As a veteran of the antidepressant withdrawal debate (see eg. previous post), my views are often marginalised on Twitter (eg. see recent tweet by Adele Farmer, founder of the Surviving Antidepressants forum). My Antidepressant Discontinuation Reactions webpage still exists. My entry into the field was a 1997 BMJ letter. I elaborated my views in a book chapter. 

A recent special report in Psychiatric News provides information for psychiatrists about antidepressant withdrawal. It emphasises that low doses of Serotonin Specific Reuptake Inhibitor (SSRI) antidepressants still have high levels of Serotonin Transporter (SERT) occupancy, and essentially seems to relate withdrawal symptoms to SERT occupancy, without too much evidence. It also acknowledges the lack of research and knowledge about antidepressant withdrawal in general. 

As I have always said, it’s common sense to believe that discontinuing a drug which is said to treat depression will be difficult. Taking antidepressants affects our experience, so that it can be difficult to know whether what I experience is because of illness, the medication or ‘just me’ (see article by Sanneke de Haan). Making sense of our experience is important but may well not be easy, including when experiencing antidepressant withdrawal.

Throughout this blog I’ve emphasised the fallacy of blaming our brains for our psychological difficulties despite the attractions and temptations (see eg. previous post). Because antidepressants can affect our experience, if only because of the placebo effect (see eg. another previous post), then any apparent stability acquired on antidepressants may be attributed to the medication, even though it may be more to do with factors like the passage of time or change of circumstances. It fact, the social situation which caused the depression in the first place may not have really changed at all, or have been dealt with, leaving us with a sense that we are not really back to our true self (see eg. yet another previous post). It worries me that both mainstream psychiatry and critics that argue for brain effects of antidepressants causing withdrawal do not place enough emphasis on these psychological factors.