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ADDICTED TO ANTIDEPRESSANTS? | Psychiatry Doctor Tells You The Truth About Antidepressant Withdrawal

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As a psychiatry doctor, I prescribed antidepressants frequently, particularly the SSRIs like fluoxetine/prozac or sertraline/zoloft. Lots of people worry that they’re addictive. They’re not. BUT they can cause withdrawal symptoms. Weird that I say they can cause withdrawals but not addictive, right? On this video, I tell you about how long you should take these drugs, what the withdrawal symptoms are, and how they can be prevented and managed.

As a doctor who specializes in psychiatry antidepressants are a really important tool in my arsenal of trying to treat mental illness it’s not the only tool but they’re important in the uk over seven million people are prescribed an antidepressant particularly the class called the ssris the selective serotonin reuptake inhibitors now what i’m about to say might

Sound a bit contradictory but bear with me antidepressants can cause dependency and withdrawal symptoms but that does not make them addictive on this video i wanted to go through a few different things one what are antidepressants and what do we tend to use them for two how long should you actually be taking them and three what happens if you choose that you want

To stop them what withdrawal symptoms do some people experience which drugs are their biggest culprits and what can be done to try and prevent them but before we start hello if you’re new to the channel hi my name is elliot i’m a junior doctor in the uk that’s specializing in psychiatry on my channel i do lots of educational videos about mental health everything

From some really serious stuff which is kind of what this video is to lots of lighter stuff we watch like tv shows and explain mental illness concepts that come up if you like that sort of stuff do check out the other videos and do consider subscribing so antidepressant withdrawal is a bit of a hot topic particularly in the last year or two it’s really come to

Light how many more people are experiencing these that perhaps psychiatrists haven’t been very good at recognizing and that’s been reflected in a document that’s been published by the royal college of psychiatrists that has discussed this in a more formal way including giving guidance to try and manage it so antidepressants come in many different forms but the

Most common type are the ssris the selective serotonin reuptake inhibitors fluoxetine sertraline citalopram these are all prime examples now they work by trying to boost the concentration of a neurotransmitter in the brain called serotonin serotonin does lots of different things it helps regulate our mood our appetite our temperature and deficits in serotonin

Transmission in the brain has been repeatedly associated with depression if we boost the concentration of the serotonin it can then bind to various different receptors on various different networks in various different parts of the brain and then somehow someway over the course of days or weeks later that has pretty good evidence are trying to boost your mood

They’re not perfect but despite you know some sort of anti-psychiatry stuff and whatever you might see on here they do work not only do people take them for depression but they can also be very helpful for anxiety disorders as well now antidepressants kind of have two main purposes one to induce remission in an acute episode and in english what that means is if

You’re feeling absolutely awful with depression or anxiety it’s designed to try and make that better as quickly as possible but two is designed as a maintenance therapy to try and prevent relapse so ideally once you’ve got somebody well they should try and stay on that medicine for a decent period of time afterwards to try and prevent a relapse because we know

That both mood disorders and anxiety disorders can relapse and remit we have some evidence about the minimum time you should continue to take these antidepressants after you recover but we don’t really have any evidence about the maximum time that somebody should take them so we know if somebody has a one-off episode of relatively mild or moderate depression

Taking them for at least six months after you get well is probably the minimum you need to stay on them to try and reduce your risk of a relapse if you have severe or recurrent episodes of depression you ought to stay on them longer for at least two years these are the times when the risk of relapse without the age of these medicines is highest and that’s what

We’re trying to prevent anxiety disorders can vary but usually it’s around about a year that you should stay on them now after that period of time some people might go you know what actually i’m tolerating these well i really don’t want to take a risk of relapse and i’m just going to keep taking them that’s fine some people might go you know what i really want

To try without that’s a really valid decision as well one that you should make with your doctor like any medicine there might also be times that you accidentally run out and you forget to get a refill of your prescription from your gp in time so there are a couple of different scenarios where you may go from taking them regularly to not taking them regularly if

You stop these medicines suddenly they do cause withdrawal symptoms probably to do with the way that the serotonin receptors have adjusted in your brain after taking these drugs for a decent period of time and then going from we’re used to having this around all the time and then suddenly we don’t some of these withdrawal symptoms are mild some of them are quite

Severe some of them last for a matter of like hours or a day or two some of them last for a lot longer it’s really difficult to predict who will develop withdrawal symptoms and in what form and what severity people can get some slightly more physical symptoms like dizziness and nausea flu-like symptoms as well and then some people can get more psychiatric and

Psychological and cognitive symptoms difficulty concentrating and focusing big old mood swings you can feel quite irritable have difficulty sleeping can get this internal sense of restlessness and fidgetiness the fancy term for that is called akathesia and in some medications you can get these really distinct horrible and quite frightening electric shock sensations

That can go from your neck all the way down your arms they can even get worse when you start moving your head around now that list isn’t exhaustive but that’s kind of the main types of symptoms that somebody might experience these are not life-threatening but they feel awful and if you don’t know what they are they’re really frightening they tend to happen more

One if you stop these medicines suddenly particularly if you’re on a high dose but we do know that some agents are more likely to do it than others particularly the ones with a short half-life what tends to happen is the concentration in the blood goes up quite quick and then it comes down quite quick and that’s what can lead to the withdrawal symptoms one ssri

Called peroxide is a particular get for that and is much more likely to do it than one with a long half-life that stays in your system for quite a while after taking it an example of that would be fluoxetine or prozac the other group that are more likely to do it are ones that don’t just boost serotonin but also boost another neurotransmitter in the brain called

Nor adrenaline and we have one class called the serotonin and noradrenaline reuptake inhibitors or snris venlafaxine is a good example of that but also some older antidepressants that are very effective but have a lot more side effects the tricyclic antidepressants being an example of that amitriptyline chlamypramine immicramine i’ll go back to that thing that i

Said at the start where you can get withdrawal symptoms but they’re not addictive and that seems like a contradiction in terms right because we usually associate withdrawal and addiction but withdrawal symptoms are actually quite common with a lot of different prescribed medicines and i’m not just talking about psychiatric medications if you take a beta blocker

For an abnormal heart rhythm for a long period of time and then suddenly stop them you can develop really bad palpitations for a while as these receptor levels try and adjust it’s called receptor supersensitivity where these receptors are so used to having a beta blocker around that the moment there’s no blocker and they’re exposed to all this adrenaline again they

Get super sensitive to it and your heart rate speeds up that’s very normal that’s well established and that’s why if you’re going to stop a beta blocker again it’s weaned off gradually and slowly with ssris it’s absolutely no different so to develop what we call a pharmacological dependency where your body has gotten used to it after a certain period of time

And then if you don’t have it you get withdrawal that’s quite normal for a lot of different prescribed medicines and it’s not a reason to worry about them and not a reason to think you can never ever stop them addiction is a wider concept it not only comes with dependency where your body can get you used to it and can get withdrawal symptoms if you don’t have

It but also tends to come with elements of craving where if you don’t have it your body absolutely craves it and you can’t really think and focus on anything else and having access to this drug becomes one of the biggest priorities that you have in your life it’s a much broader concept we don’t see that element of craving and change in what your priorities are

In life with an ssri that we might see with things like alcohol dependency or opioid dependency so finally i suppose we’ve talked about this problem we need to talk about how to try and fix it and how to try and manage it right there’s no foolproof way that’s 100 sure to try and prevent these things from happening however the best things though that you can do

Are one don’t stop them suddenly and don’t do it on your own please do it in conjunction with your doctor whether that’s your gp or your psychiatrist actually most of us are quite happy to support you on that decision and are not going to try and coerce you and force you into staying on these things it’s your body it’s your medicine it’s your choice we’ll have a

Frank discussion about the risks and the benefits but ultimately if you choose that this is what you want to go ahead with we’re going to try and support you on it good doctors will anyway and two plan to come off very slowly and very gradually the advice really is to do that over at least a month if not longer it kind of depends on the drug and the half-life of

The drug because that dictates how quickly it gets out of your system that dictates how quickly we do a dose change but we would say not to do it in any shorter amount of time than one month when you go down slowly if you start to get withdrawal symptoms again talk to your doctor because it’s probably going to be a case that you need to go back up a little bit

More and then plan the next reduction even more slowly and probably in an even smaller increment of dose so please don’t worry that starting an antidepressant means that you’re going to get withdrawal symptoms and that you can never come off it’s just not the case i hope that clarifies things i hope you learned something from that as well as always leave any

Comments below remember i cannot give and will not give any medical advice but i’m happy to try and clarify any concepts that people are finding still a little bit confusing otherwise like subscribe the usual bits of bobs and i will see you for another video very soon thanks very much bye

Transcribed from video
ADDICTED TO ANTIDEPRESSANTS? | Psychiatry Doctor Tells You The Truth About Antidepressant Withdrawal By Dr Elliott Carthy