Before Covid, it was estimated that one in 10 people in Ireland experienced depression. Since the pandemic began, in study after study – including a 2022 ESRI report – the number of people who experience depression and anxiety has increased. And so have the prescription of antidepressants.
Often, alarmist headlines announce these numbers, as if antidepressants are inherently a bad thing. However, the rise in prescriptions over the past decade can tell another story – that of increased awareness around mental health, a reduce in stigma around seeking help, and an increase in GPs helping patients address their mental health issues.
However, although the use of antidepressants has risen across Irish society, many people who use selective serotonin reuptake inhibitor (SSRI) antidepressants, such as Prozac, often find themselves lacking basic information about the drugs and without a GP-supported plan to safely come off antidepressants when they are no longer necessary. Some users of antidepressants can decide, for many reasons, that they would like to stop using them, but they may try to stop cold turkey, or wean themselves off their medications without GP supervision, unaware of the potential physical side effects of SSRI withdrawal.
The physical side effects of withdrawal are well documented and can include dizziness, fatigue, flu-like symptoms, digestive issues, balance issues, restlessness, sweating, and “brain zaps”, which feel like electric shock sensations in the head.
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New research from the universities of Bath and Bristol has shown that antidepressant withdrawal can also cause other side effects that can affect people’s emotional, cognitive and social functioning. These side effects can be particularly pronounced when people don’t slowly taper their medication and, instead, stop taking it suddenly. The lack of awareness around these side effects can cause patients emotional distress and can sometimes prevent them from coming off antidepressants at all.
In their study, researchers from Bath and Bristol investigated the lived experience of antidepressant withdrawal, focusing on the impact of people’s emotional, social and cognitive functioning.
Dr Graeme Fairchild is a professor and reader at the University of Bath and outlines some of the ways that SSRI withdrawal affected people’s emotional and social wellbeing, noting that these effects have not been studied in depth before. “The social element, I think that definitely is something that hasn’t been studied as much before. People were very focused on physical withdrawal, so difficulty sleeping, sweating a lot, feeling anxious, fatigue, brain zaps, all these things. But almost everybody that we interviewed spoke about the social impacts,” says Dr Fairchild.
“They said they didn’t really want to be sociable, they didn’t want to go to social events and they didn’t find them rewarding if they went to them. One of the participants spoke about being a celebrant at weddings, so what would normally be a very exciting and happy time, and they just felt like they were going through the motions. They just didn’t want to be there.”
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The study, which has been published in the journal Health Expectations, lists participants as feeling overwhelmed by their emotions, not enjoying social situations, feeling irritable and detached, and even feeling less empathy towards other people. These symptoms had negative ripple effects on not only their social lives but their close relationships.
“Nearly all of the participants said this, at least in a temporary way, affected their relationships, maybe particularly close relationships,” says Dr Fairchild. “They were harder to be around, they were more grumpy, more irritable, more easy to feel upset or get angry.”
In some cases, people’s mood and behaviour were so impacted by coming off medication that friends and family encouraged them to go back on it. To the researchers, this highlights the vital issue – the lack of awareness around the side effects of SSRI withdrawal may cause people to stay on it for longer than necessary.
“The general public are quite aware when you might give up smoking, you might be a bit of a nightmare to be around,” Dr Fairchild observes. “And it seems like that may be a little bit the case for antidepressants that people are at least temporarily a little bit harder to be around. If people are aware of that, and they can say to their loved ones or their family, ‘I’m coming off my antidepressants, I might get a bit more irritable, I might be a bit harder to live with, just so you know – but this should be better within a few weeks’.”
For people who use SSRIs, sometimes the withdrawal symptoms can make both them and their loved ones fear that their depression is returning and that their feelings of irritability or detachment are the start of a mental health spiral. In reality, most of the emotional, social and cognitive side effects cleared up within weeks.
Participants in the UK-based study expressed a desire for GPs to provide more support and information about these emotional side effects, and expressed frustration with how difficult it could be to get a GP appointment at all, let alone to find a GP who was knowledgeable enough about SSRIs to provide comprehensive information and a personalised plan for withdrawal.
“Certainly quite a few of the participants mentioned having to do it all on their own or having support and also not being able to find support, even online, even through the NHS website or other official legitimate resources out there. I think there are some moves to improve this,” says Dr Fairchild. “But I think there’s also perhaps a need for GPs being informed about antidepressant withdrawal, saying that people shouldn’t give up immediately, should try to do it in a slow way of tapering where they reduce the dose gradually over the course of several weeks, if not months.
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“And also that the GPs also understand what could be the side effects or the symptoms, not only the physical stuff, but the emotional and mental, the social things so that they can say, ‘okay, well you’re ready to give up. But actually, maybe if you’re having a very stressful time in your job at the moment, maybe you want to come back in three months’ time and see if that’s a better time for you’.”
Participants in the study stated that had they known about the social and emotional side effects, they would have planned their withdrawal accordingly, avoiding big stressful events of important social occasions such as weddings or holidays so that they could enjoy big events and not have too much social pressure on them as they withdrew from the medication.
Dr Fairchild stresses that although withdrawing from SSRI medications can have physical, emotional and cognitive side effects that can last for weeks to months, people should not be discouraged from coming off the medications. He notes that, for many people, antidepressants are helpful for a certain period of time, but many people feel positively about coming off them when they do so slowly and carefully under GP supervision. He also notes that the side effects of SSRIs, which can include emotional blunting, difficulties maintaining an erection or having orgasms, and difficulties regulating appetite and gaining weight, can all lead people to want to cease medication use. The important thing is to do so slowly under GP supervision and to be aware of potential side effects so that people can receive support where necessary and know it’s temporary.
“Even if they find the early bits quite challenging, maybe pushing through it. Obviously, if they start having anything like major mood changes or thoughts of self-harm and things like that, then it’s definitely a time to go back and see their GP again. But it’s just to think that this can be a good thing. It might be that you don’t have to live with the side effects. We think about half of people who were on SSRIs can withdraw without getting depressed again.”
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