Editor’s note – apologies from MITUK team for delaying publication of this blog, which also appeared on Mad in America on November 18th 2024
Following my recent experience of antidepressant withdrawal and having worked in psychiatry for nearly 20 years as a registered mental health nurse, I now have a very critical view on what good mental health treatment and recovery should look like. I believe we need a big reform in offering more access to psychological therapies as well as compassionate and recovery focused interventions. I believe we need to move away from the dominant biological model of psychiatric treatment.
I can think of many examples throughout my early career where I saw many people admitted to psychiatric wards having suffered an adverse life event, recent or past trauma, only to leave with prescriptions for multiple drugs to treat their new presumed diagnoses. They also seemed to leave with an increasing sense of hopelessness and possible additional trauma from their inpatient stay. The person is told they have a broken brain which would result in most people feeling very hopeless.
It was common practice for a patient to be prescribed benzodiazepines, which we now know are highly addictive, only to be later discharged after several weeks (sometimes months) of use without a longer-term prescription. It was not surprising to see such a patient re-admitted not long after, probably because they were in desperate need of the drug they had become dependent on to relieve their suffering. It’s tragic that these people may then be wrongly labelled as personality disordered, bipolar, or psychotic.
A person may come into hospital on no drugs at all, only to leave with several psychiatric drugs, often causing adverse side effects which leads to more prescriptions to counteract the side effects. I am not anti-medication by any means, and I will not be put in the conspiracy theory box. It’s very easy to brand someone a conspiracy theorist or anti-psychiatry or an outlier when traditional practice is challenged. I have seen this happen when others question the status quo or the science, but to me having a critical perspective is what good medicine and science should be about. How else can we progress, develop, or advance for the good of the people we are meant to be helping?
In a lot of cases a person suffering from life stress may benefit from a psychological model of ‘treatment’, with compassion, understanding and simple validation that what they are feeling is indeed normal. Instead, we see people with a normal emotional response, being put onto ‘antidepressants’ and other psychotropic drugs which I believe are hugely overprescribed. Some people experience severe adverse reactions to ‘antidepressants’, including a manic presentation; this in turn leads to the prescription of a ‘mood stabiliser’ and the polypharmacy begins. Another person prescribed ‘antidepressants’ may suffer from suicidal thoughts and akathisia and if this is not correctly recognised by the treating clinician, it can result in the dose of the offending drug being increased and in the most extreme cases it can result in suicide.
I do think there is a role for ‘antidepressants’ because I am pro good mental health care, but we need to talk about the risks versus the benefits of these drugs. Parents needs to be told when their children are prescribed psychiatric drugs, so they know what to look out for and when to get help. Prescribers need to have open conversations about possible risks and adverse reactions. I want to make it clear that I do not doubt or wish to take away the reality of people’s suffering. I have seen how debilitating this can be, and this is where I think there is perhaps a role for short-term prescriptions of drugs to relieve intense suffering.
Should we still be calling it emotionally unstable personality disorder?
Over time I have also become more critical in my thinking around the diagnosis of ‘emotionally unstable personality disorder’ (‘borderline personality disorder’) and realise just how unhelpful this is. It often comes with a certain amount of stigma, barriers to accessing other services and potential negative attitudes from healthcare professionals. I believe we need to re-think this label and recognise that many individuals have experienced complex trauma during their lives, potentially further worsened by becoming embroiled in the psychiatric system.
Another pattern I have noticed is a person may be admitted with low mood following a stressful life event. This emotional response may seem to me to be very normal and I question whether we should really be ‘treating’ it with drugs. We risk increasing this person’s depressed mood which in some cases can result in the person self-harming and then the EUPD diagnosis follows shortly after. I have seen this merry-go-round all too often. I don’t claim to have the answers, and I am mindful I am just a small drop in the ocean, when it comes to the voices now speaking out about withdrawal and risks of ‘antidepressants’. I do however believe that every voice helps toward the reform of what good mental health ‘treatment’ should look like.
I certainly think we need a shift in our attitudes, one which encompasses compassion and validation of normal human emotion which is often medicalised at the hands of psychiatry. I don’t believe we should be telling people they have a damaged or broken brain, or that they are missing certain chemicals in their brain. The evidence that mental illness arises from distinct pathology is severely lacking. I know from my own experience when I went on my ‘antidepressant’ for mild work-related stress, I should have changed jobs. Instead, I have become physically dependent on this drug and now have depressive symptoms anytime I miss a couple of doses or try to come off it. However, with the work and resources we now have by researchers such as Mark Horowitz and peer support and patient advocates, I am more confident that I will be able to safely wean off the antidepressant.
We still have a long way to go but I am hopeful that many healthcare professionals are now recognising antidepressant withdrawal and how severe and debilitating this can be. People should not be abruptly taken off their psychotropic medication, or be swapped to a different drug, often too quickly without planning, later to be diagnosed with EUPD when they suffer from suicidal thoughts, akathisia, or self-harm because of extreme drug-induced discomfort.
Thoughts on the care of young and older adults
I am especially concerned for children and young people, often without a voice or whose parents have not been fully informed of the potential risks and side effects of the drugs they have been prescribed. Its sad to see the young person get swallowed up by the system, something I have witnessed all too frequently over the years. I have also become increasingly aware that some of our older-generation people who are admitted to hospital, perhaps with an infection, are abruptly taken off their ‘antidepressant’ or the sleeping tablet which they have taken for years and now come to rely on. I believe in these cases it would be kinder and less harmful to leave the person’s drugs alone unless it is medically essential to change them. It is better to let them enjoy their last years, rather than risk withdrawal which often looks like an agitated depression or psychosis, and may result in admission to a care home where they spend the rest of their days, rather than a discharge back to their own home.
Final thoughts
I am not sure what the future holds for mental healthcare, or what the answers are. What I do know is that it seems to be getting worse while more and more people are struggling to get the support they need. I believe one of the biggest problems and wrongs is the medicalisation of normal human emotion. I also believe that we are now living in an increasingly sick society, one in which we were not evolved to live and cope in. We used to be part of big communities and children would spend their days outdoors. Instead, most find themselves inside, glued to a device or social media account, waiting for the next dopamine hit. I do strongly believe though that the more critical voices speak out, the closer we move towards a change for the good and for that I remain hopeful.
The importance of positivity within the withdrawal community
One thing I have learnt from my own withdrawal experience is the importance of spreading hope and positivity to anyone going through a taper or a protracted withdrawal. I believe the brain is highly adaptable and I am a strong believer in neuroplasticity and therefore believe in the brain’s innate ability to adapt to its previous state over time. I am not underestimating or undermining anyone’s experience with withdrawal as I know first hand how hard this can be. But I refuse to believe in anything other than healing and our body’s natural ability to navigate itself back to its original baseline. In the meantime, I am a big believer on the mind-body relationship to healing, surrounding one-self with positivity and stories of hope and healing and avoiding any naysayers or doom.
There is no doubt that some people may find online forums helpful, but to me it must be centred around a positive, respectful and individual led approach. We are already dealing with many people who are suffering and the primary job of a withdrawal coach, taper service should be one of hope. I don’t believe there is room for anything less in this community. As in medicine we must ‘first do no harm’.
****
Mad in the UK hosts blogs by a diverse group of writers. The opinions expressed are the writers’ own.