Experts call for reversal of overprescription ‘epidemic’
An Australian doctor has published a landmark step by step guide on how to get off antidepressants safely. It followed his own experience of using the medication for 15 years ending in severe withdrawal symptoms when he came off it.
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00:00So, I was on an antidepressant, a common one in Australia, called escitalopram or Lexapro
00:06for about 15 years, and I tried to come off it several years ago.
00:10I came off it much slower than guidelines recommend, over a few months, down to quite
00:14small doses, what I thought at the time, and I got into a lot of trouble.
00:19I started waking up in full-blown terror, like I was being chased by a wild animal.
00:24I'd had hours and hours a day of that, of sort of a long-standing panic attack.
00:29I had trouble sleeping, things around me appeared strange, and I was dizzy.
00:36That went on for week after week after week, and after a couple of months of that, I thought,
00:42I can't continue living like this.
00:44And the issue was, it was nothing like the issues that had put me on the drug in the
00:47first place.
00:48I'd gone on as a miserable 21-year-old with a variety of existential concerns.
00:55When I came off it, this was nothing like that.
00:56It was of an intensity I'd never experienced.
01:00And so what had your doctor advised you about coming off them?
01:03So the guidelines at the time were the same as they are today in Australia.
01:07They recommend coming off by halving your dose for a couple of weeks, halving it again
01:11for a couple of weeks, and then stopping.
01:13So the recommendations at the moment are stop over about four weeks.
01:17But from your experience, that just didn't work.
01:20So when did you decide, I've got to look into this and help other people through this?
01:25So at first I thought, look, I'm a very unlucky bloke.
01:27I've had a very bad time.
01:29But when I looked around, I saw there were hundreds and then eventually thousands and
01:32tens of thousands of people with similar issues online, all with the same story.
01:37The advice given by my doctor led to a lot of side effects, withdrawal effects from coming
01:41off the drugs.
01:43I found better advice on these online forums.
01:46And what I learned from these forums was that coming off over months, and sometimes more
01:50than a year, even years, going down by very small amounts, using a liquid version of the
01:55drug, made it much easier to come off the drug.
01:58And I actually followed the guidelines on these websites and was able to come off my
02:02drug.
02:03And I hope to inform doctors about a safer way of getting patients off their drug in
02:06the same way.
02:07Yeah.
02:08And so after that experience, you've put together, and you can lift it up for the camera, quite
02:13a substantial book there.
02:15There's a lot of guidelines there.
02:17So yeah, you found that the knowledge among doctor GPs of the challenges around this just
02:23wasn't very good.
02:24Yeah.
02:25So unfortunately, the guidelines are very old in Australia, and they're based on short-term
02:30studies.
02:31So people who've been on the drugs for a few weeks don't have major trouble stopping, and
02:35the guidelines are very adequate for them.
02:37But we now know that the average duration of use of antidepressants in Australia, it's
02:41four years.
02:42So a lot of people are on these drugs for years or decades, and the guidance is not
02:46helpful for them.
02:47They need to come off more slowly, and they get into a lot more trouble coming off.
02:51Do you have an opinion whether they're over-prescribed in Australia, or that's a whole nother story?
02:56Look, they are prescribed now to one in six adults, one in seven people in Australia.
03:01They are doubling every 10 years.
03:03I think there's a rise, a few percent every year.
03:07People have trouble stopping them, which means that the average duration of use is going
03:10up and up.
03:11So it's become a little bit of a one-way valve, where people are starting on these drugs quite
03:14easily, but it's quite hard to stop them.
03:17And I think a major issue is that we are medicalising normal distress.
03:21There are all sorts of ups and downs in life.
03:23Being anxious and being down is a very common response to divorce, job loss, and I think
03:28a lot of those things are being classified as medical illnesses, which is leading to
03:31medical treatment, which in many cases is inappropriate, and that's led to the incredibly
03:37high levels of prescribing we have in this country.
03:40I think we're second in the OECD in terms of prescribing in this country.
03:45So it is a growing concern.
03:46Yeah, and getting off these drugs is a really serious issue.
03:51So for people watching now who might be taking antidepressants and who are going through
03:56similar challenges, can you give us in a nutshell, rather than reading out the whole book, what
04:02are your recommendations for people facing those challenges right now?
04:05Right, just to summarise, 600 pages in a couple of seconds.
04:09The main thing is don't stop your drugs abruptly.
04:11Don't just throw them away.
04:12That's the worst way to get into trouble.
04:14If you hear this, if you think about it, go talk to your doctor.
04:16There's a few principles about coming off them.
04:18Come off them slowly.
04:20That means generally months or more than a year for people that are on them long term.
04:24Number two, go at a rate that you can tolerate.
04:26So the right rate is the rate that doesn't cause you major problems.
04:31And the last thing is the last few milligrams are the hardest to come off.
04:33So right at the end, you often need to go down to doses that are smaller than widely
04:38available tablets.
04:39This is a major issue.
04:41The tablets available at pharmacies are often too big to stop easily.
04:45They cause too big an effect on the brain and stopping them is like jumping out the
04:49fifth floor window of a building.
04:50You need to go all the way down to the ground floor and that often involves using things
04:55like liquid versions of the drug, sometimes crushing the drug up to make a suspension
04:59or getting compounded medication to be able to go down to these very small final doses
05:04to make the landing softer to come off these drugs.
05:06And you'd like to see the official recommendations in relation to this change?
05:10Yes.
05:11So what I'd like to see is that the College of General Practice, which has acknowledged
05:14this book as a resource for its members and the Royal College of Psychiatrists, take on
05:20these principles and update their guidance for GPs and psychiatrists and other doctors
05:25so that all doctors know how to stop these drugs safely.
05:27And it's a core part of the curriculum, in my view.
05:30For every lecture on starting a drug, there should be a lecture on stopping a drug.
05:33In the same way that cars have brakes, we should know how to stop these drugs safely
05:37and that needs to be a core part of medical education and continuing education for senior doctors.