A recent investigation by BBC Panorama has revealed that over a quarter of patients in England who are prescribed antidepressants, totaling approximately two million people, have been taking

the medication for five years or longer. Surprisingly, there is limited evidence supporting the benefits of extended antidepressant use.

A doctor who runs an NHS clinic assisting individuals in discontinuing antidepressant use highlighted the challenges faced by patients due to withdrawal symptoms, making it difficult for them to stop taking the medication. Although withdrawal guidance was updated in 2019, little progress has been made in addressing the issue.

The NHS prescribing figures show that over eight million people in England are currently on antidepressants, indicating an increase of one million individuals compared to five years ago. However, it is important to note that the data provided by the NHS to BBC Panorama reflects the overall picture and does not consider the individual circumstances of patients who may have valid reasons for long-term antidepressant use.

The investigation also uncovered evidence suggesting that a leading pharmaceutical company attempted to conceal potential withdrawal effects associated with one of its antidepressant drugs 27 years ago.

Selective Serotonin Re-Uptake Inhibitors (SSRIs), such as Prozac, emerged in the late 1980s as modern antidepressants and were initially hailed as remarkable drugs compared to their predecessors, which had more severe side effects. These medications were believed to address depression by correcting imbalances of serotonin, a chemical that regulates mood in the brain. However, researchers are now uncertain about their exact mechanism of action, proposing that they may simply alter thoughts and feelings rather than address the underlying problem.

While the NHS recommends antidepressants as a treatment for severe depression, it also advocates for alternatives such as talking therapy, exercise, and lifestyle changes. According to Prof Wendy Burn, former president of the Royal College of Psychiatrists, antidepressants have benefited numerous individuals throughout her extensive career, transforming lives. However, she acknowledged the lack of long-term studies supporting prolonged antidepressant use.

The effectiveness of antidepressants has been a subject of debate, with comprehensive research from the University of Oxford indicating that these medications do provide some short-term benefits to certain individuals. However, the overall benefits are relatively modest, and responses vary, with some individuals showing no response at all.

Moreover, there is evidence suggesting that long-term use of antidepressants may be associated with health risks, including heart problems and diabetes. Additionally, extended use may increase the likelihood of withdrawal symptoms in certain individuals. Withdrawal occurs when a drug that the body has become accustomed to is abruptly discontinued, leading to symptoms such as low mood and anxiety. In some cases, withdrawal symptoms can be mistaken for a relapse of the original condition.

Panorama's investigation revealed that a major pharmaceutical company manufacturing SSRIs was aware of a range of withdrawal symptoms as early as the mid-1990s but chose not to disclose this information to the public and regulatory bodies. A confidential 1996 memo from Pfizer, the company that originally sold sertraline (the UK's most commonly prescribed antidepressant), discussed strategies to avoid describing withdrawal symptoms to regulators in Norway.

The memo referred to withdrawal reactions, including sensory disturbances, sweating, nausea, insomnia, tremors, agitation, and anxiety. Pfizer, which no longer produces sertraline, responded to the findings by stating that it reported all adverse event data to licensing authorities in compliance with legal obligations. The company emphasized that sertraline and other SSRIs are recognized as the preferred treatment for adult depression by public health organizations and professional medical bodies worldwide.

In 2019, the Royal College of Psychiatrists updated its guidance on withdrawal, acknowledging the severity and prolonged duration of withdrawal symptoms experienced by some patients. Photo by Tom Varco, Wikimedia commons.