Q+A: Antidepressant Side Effects

Dec. 15, 2004 — -- Dr. Joseph Glenmullen, a clinical instructor in psychiatry at Harvard Medical School, appeared on "Primetime Live" to discuss the often-unrecognized side effects of antidepressant drugs. Here is a sampling of his answers to your questions on the subject.

Norma asks: Are there currently any class action lawsuits against the makers of Paxil?

Dr. Glenmullen: There is a large group of lawsuits against GlaxoSmithKline, the maker of Paxil, involving patients who experienced Paxil withdrawal. It's not exactly a "class action" but it's similar and called an MDL for multi district litigation.

Annette in Massachusetts writes: Is there a safe way to stop taking Paxil? Any help would be greatly appreciated.

Dr. Glenmullen: There is a safe way: Tapering carefully off the drug. This is true for all 32 antidepressants currently on the market in the United States. One of the most difficult aspects of tapering antidepressants is how widely patients vary in their susceptibility to withdrawal reactions. While one patient may be able to taper off an antidepressant in two months, the next patient may need to take eight months to taper off the same dose of the same antidepressant. So, an antidepressant tapering program has to provide standard dosage reductions for each antidepressant and at the same instruct doctors and patients on how to customize the dosage reductions when patients have moderate to severe withdrawal reactions that require slowing the taper down to keep patients safe and comfortable. In The Antidepressant Solution I present a 5-Step Antidepressant Tapering Program. The five steps are: 1) evaluating whether your are ready to try tapering off your antidepressant; 2) making the initial dosage reduction based on standard tapering schedules for each of the 32 antidepressant on the market; 3) monitoring withdrawal symptoms after dosage reductions; 4) customizing the size of additional dosage reductions if necessary; and 5) safely completing the taper.

Alex in Minneapolis asks: What are the symptoms of antidepressant withdrawal?

Dr. Glenmullen: The symptoms of antidepressant withdrawal can include suicidality, impulsivity, aggression, anxiety, depression, crying spells, insomnia, dizziness, vertigo, nausea, vomiting, headaches, tremors, and electric "zap" sensations in the brain. When patients stop antidepressants cold turkey the symptoms can be so severe that they are debilitating: the patients cannot get out of bed or work. In fact, there are more than 50 symptoms of antidepressant withdrawal. Be sure to educate yourself about all of them before you make your first dosage reduction. If the dosage reduction is reasonable in size, you may not have any withdrawal symptoms at all. On the other hand, if the dosage reduction is too large, you may have severe, debilitating withdrawal symptoms that require you to go back up on the dose and slow the taper down.

Tominell in Texas asks: What tests should a 15-year-old girl take before she is diagnosed bipolar and depressed, other than a verbal interview?

Dr. Glenmullen: There are no medical tests to diagnose bipolar disorder, depression, or any other psychiatric condition: no blood tests, X-rays, brain scans, or any other objective tests. Medical tests should be used to rule out other conditions that can look like depression such as thyroid conditions. But all psychiatric diagnoses are subjective and based on the patient's personal history rather than on objective medical tests. This is what makes psychiatric diagnoses susceptible to being abused at times. In recent years, many patients who have toxic reactions to antidepressants are misdiagnosed as bipolar and put on powerful anti-manic drugs because the pharmaceutical industry has not adequately educated doctors on how to recognize antidepressant toxicity. For years the pharmaceutical industry denied antidepressant-induced suicidality, saying it was the patients' underlying depression. In effect, this was blaming the victims. Now that the FDA has officially warned that antidepressants may make patients suicidal, the pressure to diagnose patients who do poorly on antidepressants as bipolar is the latest variation on this theme of blaming patients rather than the drugs.

Karen in Tulsa wants to know: If antidepressants can make patients suicidal and cause withdrawal reactions, do you prescribe them at all?

Dr. Glenmullen: Yes. I am a moderate in the debate about antidepressants. I prescribe antidepressants to many patients who report how helpful they are. At the same time, I am a critic of over-prescribing antidepressants to patients with mild, even trivial conditions. I advise patients that if they are depressed enough to need medication, they should use other forms of treatment to address the underlying problem and hopefully ultimately wean off the drug. I also argue that many patients are not adequately warned of the side effects and dangers of antidepressants, especially when treated in managed care settings where doctors barely have enough time to write a prescription let alone do a thorough evaluation and educate patients about side effects. With antidepressant-induced suicidality, the most dangerous scenario is when patients are not warned. Under these circumstances, they mistake the drug side effect for a worsening of their condition and are at serious risk to harm themselves. When patients are warned, no matter how badly they may begin to feel, they can remember "This might be the drug, not me. I need to call the doctor right away." Under these circumstance, patients can almost always be kept safe. When antidepressants make patients suicidal it looks very different in most instances from depression making patients suicidal. But doctors and patients need to be educated about how to recognize the difference and how to treat antidepressant-induced suicidality. With regard to antidepressant withdrawal, so far I have been able to get patients off the drugs with a careful taper. Some patients can be off in two months or less while others may take eight months to get off the same dose of the same antidepressant because they have severe withdrawal reactions.