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Peter Lehmann / Craig Newnes (Eds.): Withdrawal from Prescribed Psychotropic Drugs

Foreword

Doctors, including psychiatrists, prescribe antidepressants, neuroleptics ("antipsychotics"), mood stabilizers, tranquilizers and psychostimulants all over the world, and, in most cases, without providing information about the risks of taking them and problems when stopping, for example, adverse effects, tolerance formation, bodily and psychological dependence and withdrawal symptoms. Nor they tell people about ways to avoid or minimize the risks.

This volume presents a collaboration of users and survivors of psychiatry (ex-patients), professionals, researchers, lawyers, and academics around the world committed to helping people understand the potential harm (including drug dependence) that prescribed psychotropic drugs can cause and how to safely reduce or stop taking them. The chapters include individual accounts of people who discontinued their prescribed psychotropic drugs, information about withdrawal groups, research data (especially about antidepressants and neuroleptics) and a commitment to safe withdrawal that will offer hope to many people; those who want to help and those who want to withdraw.

David Richman reminds us in the foreword that in 1984 he was the first doctor in the world to critically report on the possibilities of risk-reducing discontinuation of prescribed psychotropic drugs. Almost 40 years later, he reflects on the urgent need for education and the provision of support and specific approaches to discontinuing prescribed psychotropic drugs. Reforms in the psychosocial field around the world continue, but the dominance of biologically oriented psychiatry persists in both the Global North and the Global South. Knowledge about how to reduce and discontinue psychotropic drugs without risk and how to help with the withdrawal process is poorly promoted – as Paulo Amarante from Brazil says in his introductory remarks. In the industrialized north, the situation isn't much different – only rudimentary mention is made by manufacturers and psychiatrists of drug dependence risks and professional help to withdraw is hard to find. Thus, many doctors and psychotropic drug takers discontinue treatment far too quickly, confuse withdrawal symptoms with relapses and prescribe or take psychotropic drugs again instead of using different ways to cope with their problems, as Markus Kaufmann and Peter Lehmann explain. Fernando Freitas and colleagues demonstrate in their chapter that there is a distinct lack of scientific knowledge in mainstream psychiatry about drug dependence, withdrawal symptoms and especially safe and effective withdrawal techniques.

Reasons for reducing and discontinuing prescribed psychotropic drugs, especially antidepressants and neuroleptics, are the topic of the first section. Antidepressants and neuroleptics including the newer antidepressants and the so-called atypical neuroleptics cause major physical and mental problems. Antidepressants and neuroleptics are the focus of this book. The problems of withdrawal symptoms and dependence on prescribed psychotropic drugs have been known for a long time, as Peter Lehmann points out. In its report to the General Assembly of the United Nations, even the Human Rights Council's Working Group on Arbitrary Detention demanded assistance for those withdrawing from prescribed psychotropic drugs. As with benzodiazepine tranquilizers until the 1980s, the withdrawal problems with antidepressants and neuroleptics have been denied, ignored or redefined as patient discontinuation problems by most mainstream psychiatrists. The Mental Health Self-Help Network points out undesired effects of antidepressants and neuroleptics – reasons for their discontinuation – in their information sheets, designed with the more responsible directors of psychiatric clinics. The Network suggests alternatives and, like most of the authors of this book, approaches to reduce withdrawal problems. While antidepressants and neuroleptics are currently offered to patients as the only way to prevent relapse, Robert Whitaker's critical review of the evidence shows that these substances can exacerbate and lengthen conduct described as psychotic in the medium and long term. Their claimed relapse-preventive effects are based on poor science and a remarkable refusal to acknowledge a solid research base that argues for a very different use of these drugs. In his chapter Craig Newnes comes to the same conclusion with antidepressants: these substances have been shown by researchers to increase suicidality, and depression itself is listed as a possible consequence of taking these substances. The chapter also uses depression as an example of the invalidity and unreliability of psychiatric diagnosis.

Section Two is about professional and self-help strategies for discontinuation. Psychiatrists Swapnil Gupta and Naama Hofman report on deprescribing as a structured intervention to reduce prescribed psychotropic drug use and manage withdrawal symptoms. Bryan Shapiro focuses on the hyperbolic tapering of antidepressants; this approach of small, subtherapeutic doses of the antidepressant combined with a flexible attitude, patient education about withdrawal problems, and psychological support, whether through formal counselling or psychotherapy or peer support, should reduce the risk of withdrawal symptoms. The institutional support in crises during withdrawal from prescribed psychotropic drugs in his catchment area, a model region, is presented by the psychiatrist Martin Zinkler. A service philosophy that is positive about discontinuing psychotropic drugs is a basic prerequisite. It ensures that psychotropic drug takers do not become dependent on the goodwill of individual psychiatric practitioners and are protected from unsettling contradictory statements about withdrawal problems. His colleagues Jann Schlimme and Michael Schwartz explain individual prescriptions during individual recovery; these make reduction easier and more successful. Pharmacists' strategies resulting from the special metabolism of psychotropic drugs during discontinuation are presented by molecular genetic researcher Peter Groot and psychiatrist Jim van Os: tapering strips tailored to the individual needs of the psychotropic drug takers. These make hyperbolic discontinuation possible with product units that the pharmaceutical industry does not want to provide. Hilde Schädle-Deininger and Christoph Müller explain the valuable contribution that nursing staff can make to alleviating withdrawal problems when discontinuing prescribed psychotropic drugs.

Because of the small number of effective strategies practised in the psychosocial field, approaches founded by former psychotropic drug takers or non-governmental support-organisations, in which professionals, users and survivors of psychiatry and relatives cooperate, are of particular importance. Anna Emmanouelidou discusses The Observatory for Human Rights in the Field of Mental Health in Greece. The Observatory created a supportive social network to accompany the discontinuation of prescribed psychotropic drugs and the search for a new way of life, thus contributing to a different understanding of emotional distress and well-being. From Canada, Céline Cyr reports how her self-help organisation offers psychotropic drug takers knowledge about the effects of these substances, so that, with the combined knowledge of peers and self-help experiences, they can get closer to what they want in terms of psychotropic drugs and what they want out of life, thus regaining power over their own lives. Since there are only very few self-help organisations that offer structured and competent help to cope with prescribed psychotropic drugs and their discontinuation, reliable and responsible online withdrawal support, as presented by Trudy Slaght and Leela Ehrhart, is of great importance. Here, those who are often isolated and misunderstood by those around them can find others who understand their problems and point the way to existing hidden resources. Exemplary individual strategies for coming off prescribed psychotropic drugs are presented at the end of this section. While Craig Newnes draws a comparison with the withdrawal from street drugs, alcohol and tobacco and reports on a woman dependent on antidepressants and her agreement with the psychologist to reduce and discontinue at her own pace, Susanne Cortez uses the example of the so-called atypical neuroleptic quetiapine to describe how she finally freed herself from this neuroleptic by a well thought-out, small-step procedure despite repeated initial failures at withdrawal.

Three contributions in the second section's last part deal with policy-oriented approaches to discontinuation. Olga Runciman describes the International Institute for Psychotropic Drug Withdrawal, which promotes the dissemination of practical knowledge on risk-reducing discontinuation. She compares mainstream psychiatry to Fort Knox, the heavily secured gold depository in the USA, which needs to be cracked open in order to challenge its monopoly position and force it to recognise and embrace patient-centred knowledge about withdrawal problems and options. Marion Brown and Stevie Lewis approached the Scottish Parliament with a public petition to draw attention to medically unexplained symptoms and functional neurological disorders in antidepressant withdrawal and to express their continuing concern about the lack of recognition and support for people who have problems with discontinuation. That withdrawal of prescribed psychotropic drugs also affects people in countries of the Global South is demonstrated by Tatiana Castillo-Parada and friends from the Mad Pride movement in Chile, which shows that discontinuing prescribed psychotropic drugs is possible and that there are alternatives to regain autonomy, emotional balance and quality of life without being dependent on harmful substances.

The contributions in the third section deal with liability issues arising from inadequate information about drug dependence and withdrawal risks. If the lack of information about these risks leads to a significant health impairment of a patient, this can justify a liability of the pharmaceutical company because of an instructional error, according to the jurists Marina Langfeldt and Jim Gottstein in their two contributions, whereby the latter emphasises the difficulty that currently still exists to enforce such claims in court.

What is to be done? Concrete approaches to action for the individual psychotropic drug takers are the topic of the fourth section. If one decides to discontinue prescribed psychotropic drugs, what has to be considered, regardless of whether one discontinues alone or with medical support? Volkmar Aderhold and co-authors answer these questions in the first article. Next, Peter Breggin makes the case for making withdrawal from prescribed psychotropic drugs as safe as possible and recommends experienced clinical care, especially if someone has been taking combinations of psychotropic drugs for many months. Mary Ellen Copeland then explains how to use her Wellness Recovery Action Plan for prescribed psychotropic drug withdrawal to manage possible withdrawal-related mental and physical health problems reflectively.

The contributions in the fifth section deal with failures that can never be ruled out during discontinuation. First, Peter Lehmann recommends an advance directive tailored to discontinuation. Volkmar Aderhold concludes: if psychotropic drug takers are unable to stop taking prescribed drugs, especially neuroleptics, it is important that they and their doctors are informed about the possibility of minimum dosing and the necessity of monitoring their state of health.

All contributions show it is essential to support psychotropic drug takers if they want to stop taking their drugs or need to stop them for health reasons. Psychotropic drug takers, their relatives, their friends, their therapists and their doctors need information on how to stop these drugs carefully, responsibly and with risk-reducing measures. In addition, fundamental changes are needed in the psychosocial field, starting with a change in the training of medical doctors, in which the risks of dependence on prescribed psychotropic drugs are to be addressed as well as the possibilities of low-risk withdrawal, via the integration of the experiential knowledge of users and survivors of psychiatry, i.e., former patients. The development and provision of low-threshold forms of support during withdrawal, the financial support of independent organisations for psychotropic drug takers that offer help during withdrawal including supportive internet portals, the development of safe reduction techniques or their financing as they already exist, and the development of an industry-independent diagnostic system that includes dependence on prescribed psychotropic drugs are also needed. Finally, improved possibilities of recourse for injured parties as well as possibilities of sanctions for pharmaceutical companies and doctors who misinform about dependence risks need to be expanded. Perhaps it is time to develop a humanistically oriented help system in which the prescription of psychotropic drugs would only be the exception.

Peter Lehmann & Craig Newnes