Calls for urgent discussion on psychiatric drugs – but who is listening?

The global consumption of psychiatric medication is increasing by 4% annually, with the greatest increase observed in antidepressant use. For people who wish to reduce and/or stop taking medication there are many gaps and unanswered questions on how best to do this.

This is according to researchers at the School of Pharmacy & Pharmaceutical Sciences and School of Nursing and Midwifery at Trinity College Dublin, who have put forward ten priorities for future research on reducing and stopping psychiatric medicines. According to the researchers, the findings will help to improve the future health and well-being of people who are prescribed psychiatric medication.

Agnes Higgins, Professor in Mental Health, School of Nursing and Midwifery and co-author of the paper said: “In the mental health space, for a variety of reasons, people with lived experience of mental health problems, are often excluded from the process of deciding research questions. The methodology used in this study helps to amplify their voices on a topic that is very relevant to their lives and an area where a strong evidence base for practice needs to be developed.”

Prof Higgins recently spoke at the annual Critical Voices Network of Ireland conference on this topic, where she called for an “urgent discussion on medication in Ireland.” Because, she said, despite calls from the UN and the WHO to move away from medication as a first line treatment, it very often is the only treatment on offer. Not talking about medication is putting people more at risk, Prof Higgins said.

Prof Higgins also highlighted the challenge of even getting ethical approval for her research looking at the lived experience of people on psychiatric drugs. This is despite the wealth of evidence that the chemical imbalance theory of depression, which is the basis for the idea that people can be treated by drugs (e.g. antidepressants), is not supported by evidence. In fact, research has shown, the apparent benefits of antidepressants in the treatment of depression and anxiety are likely due to the placebo response, and the difference in improvement between drug and placebo is not clinically meaningful. 

There is a substantial cohort of individuals looking to reduce and/or discontinue long-term use of psychiatric medication. Reasons for wanting to discontinue psychiatric medication include adverse effects, lack of perceived benefit, the desire to recapture personal autonomy and to live a life free of medication.

Prof Higgins’ research is highlighted in the slides below, showing people’s experiences of medication (slide 1) and the positive outcomes from stopping ( slide 2).

The lack of balance in media reporting about mental distress and how to treat it, is something that deeply frustrates campaigners. Just recently, Mind Freedom Ireland wrote to RTE’s Brendan O’Connor, after an interview with a psychiatrist that provided no balance.

The letter said:  “There are “people who have taken the drugs and found that they only compounded their emotional distress, especially if they have been prescribed, as is usual, indefinitely. The adverse effects they report, ranging from extreme akathisia or restlessness to tardive dyskinesia or involuntary muscular spasms to sexual dysfunction to excessive weight gain and cognitive impairment, left them all in a zombie-like twilight zone, only living life in a fog.”

That said, stories about the harms of psychiatric drugs do often make headlines around the world. Just this week, it was reported in the UK media that the son-in-law of Prince and Princess Michael of Kent killed himself after suffering adverse side-effects from antidepressants prescribed by a Buckingham Palace doctor, an inquest found. His wife said: “I believe anyone taking pills such as these need to be made more aware of the side-effects to prevent any future deaths.

A report in the Australian mainstream media recently covered research which found that half of patients who have taken antidepressant medication for more than six months experience withdrawal symptoms when stopping that can include “brain zaps”, anger and irritability, dizziness, nightmares, anxiety, panic and agitation. The study was the most comprehensive analysis to date that confirms withdrawal effects from widely used antidepressant medications are common and increase with longer use. 

Currently in New Zealand, the media is covering an inquest into the suicides of six New Zealand teens, all on Prozac. Parents spoke about how their teenagers were prescribed drugs to deal with issues such as anxiety and dealing with difficult life experiences. The coroner overseeing the inquests previously called for better information about antidepressant withdrawal following another inquest in 2022. In Ireland, despite the serious lack of debate about the use of medications in people with mental health difficulties, there was some public discussion last year when stories about over medicating children in CAMHS pierced the public consciousness, primarily due to the advocacy of parents.

The question is – why is there such a lack of debate on this issue in Ireland? Why do even professionals like Prof Agnes Higgins face pushback just for wanting to research the issue? People are being badly let down. Not only must people in mental health services take pills or be seen as ‘non-compliant with treatment’ or in the case of children, be discharged from CAMHS, but if they want to stop drugs, it is almost impossible to find help.  According to the WHO, shared decision-making and informed consent are crucial to the provision of person-centred and recovery-oriented care. Service users have reported challenges in having their autonomy and choice respected and being involved in decisions around their medication.

Although more and more people are speaking out about their lived experience, how they went through the medical model, the damage it did and what’s needed to help fix things. But little changes. As MindFreedom’s letter pointed out, there is “no support for doctors willing to help with tapering, no information on the process and no safe communities to facilitate them.” This is borne out through research – a study published in Psychology and Psychotherapy: Theory, Research and Practice finds that psychiatrists and other doctors are the most unhelpful factor for service users attempting to withdraw from antipsychotics. In the work, authored by John Read of the University of East London, participants cited lack of knowledge around withdrawal, refusal to support withdrawal, and threats/use of coercion as the main reasons they considered psychiatrists and other doctors unhelpful in their attempts to quit using antipsychotics.  Read the full report about the study here.

International expert on de-prescribing, Dr Mark Horowitz also spoke at the recent CVNI conference, where he outlined the serious and sometimes long-lasting side effects of withdrawal from psychiatric drugs. Drugs affect every organ of body, brain, nervous system, hormonal system (see slides from his presentation below).

Horowitz, a clinical research fellow in psychiatry at the National Health Service (NHS) in London and Visiting Lecturer in Psychopharmacology at King’s College London, recently co-authored the recent Royal College of Psychiatry’s guidance on stopping antidepressants, and his work has informed the UK’s NICE guidelines on the safe tapering of psychiatric medications, including antidepressants, benzodiazepines, and z-drugs. 

Mad in Ireland regularly hears from people looking to stop psychiatric drugs and indeed from people who have been harmed by them. People are being badly failed and as this article outlines, much more research, media coverage, information and debate is needed about this topic. As Prof Higgins – an expert in this area, stated: an urgent discussion on medication in Ireland in needed. But is anyone listening?

Find more information about this topic here, here and here.