Secrets of Seroxat - BBC Panorama criticised by Duncan Double

The facts of antidepressant discontinuation reactions

http://www.bmj.com/content/325/7369/910.1.extract/reply#bmj_el_26377


D B Double, Consultant Psychiatrist and Honorary Senior Lecturer

Norfolk Mental Health Care NHS Trust and University of East Anglia

I agree with Phil Cowen about the poor quality of the Panorama programme on the "Secrets of Seroxat".1 It is unfortunate that the issue of antidepressant discontinuation reactions has been monopolised by experts like David Healy, who tend to adopt a maverick position in psychiatry.2 The public is being presented with too many "facts" which may not be true.3




Nonetheless the medical profession was slow to acknowledge the significance of antidepressant discontinuation reactions. It is not so long ago that the Defeat Depression campaign of the Royal Colleges of Psychiatrists and General Practitioners advocated educatingpatients that discontinuing antidepressant treatment will notbe a problem.4 Even when the issue was recognised in an editorial in the BMJ the problems were minimised.5 A few years later the authors of the editorial had to update their views to admit that such reactions are common.6 There is at least ambiguity about the authority of the statement that antidepressants are not addictive.7



Some of the pharmaceutical companies may not have helped scientific debate because of misleading promotion of their products. Placebo responses to antidepressants are common, so withdrawing such medication may be expected to cause discontinuation problems as a nocebo effect. The difficulty is to establish how much neuroadaptation plays a role. The evidence may not be strong for physical dependence, but the importance of psychological dependence on antidepressants and other medication should not be disregarded by doctors. There is concern about this issue as witnessed by public interest in The Antidepressant Discontinuation Reactions website (http://www.uea.ac.uk/~wp276/antidepressant.htm).







1. Cowen PJ. Review of Panorama: "The Secrets of Seroxat".BMJ 2002; 325: 910 ( 19 October ) [Full text]



2. Double DB. Maverick medicine: Book review of The Creation of Psychopharmacology (2002) by David Healy. Health Service Journal 2002; 112 (5809): 42-43



3. Double DB. Book review of The anti-depressant fact book (2001) by PR Breggin. Metapsychology Online Review:8 December 2001 [Full text]



4. Double DB. Prescribing antidepressants in general practice. People may become psychologically dependent on antidepressants. (letter) BMJ 1997; 314: 826. [Full text]



5. Double DB. Antidepressant discontinuation reactions - dependence on antidepressants is significant. bmj.com/cgi/eletters/316/7138/1105#16, 1 May 1998 [Full text]



6. Double DB. Antidepressant discontinuation reactions - Haddad et al have updated their views. bmj.com/cgi/eletters/316/7138/1105#7244, 1 Apr 2000 [Full text]



7. Double DB. What does it mean to say that antidepressants are not addictive? bmj.com/cgi/eletters/318/7192/1188#3012, 30 Apr 1999 [Full text]