Collateral Damage: A Mixed Methods Study to Investigate the Use and  Withdrawal of Antidepressants Within a Naturalistic Population

The use of modern antidepressants has flourished over the past few decades with the modern attribution of affective disorders such as depression to biomedical causation. However, recent re-examination of clinical trials has raised questions regarding antidepressant drug efficacy, and issues around side effects and dependency are prevalent. In spite of this, as many as 10% of us may be taking these medications (Szabo, 2009). This study examines responses to an anonymous online survey about antidepressant use and withdrawal. Participants included 176 current users, 181 currently withdrawing, 108 ex-users, and a control group of 44 participants who had never used antidepressants. Participant groups were compared quantitatively regarding attitude towards antidepressants use and perceived value, effect on well-being and mood, symptoms and side effects, and their perceived changes in themselves on and off the drugs. Participants were also given the opportunity to include spontaneous comments at the end of the survey which were analysed thematically. Key findings include: 1) Antidepressant users have a more positive estimation of the value of the drugs than those who have discontinued the drugs or who have never used them; 2) Scores on the WHO-5 well-being survey for all three groups with antidepressant experience (users, those withdrawing, and ex-users) showed poor levels of wellbeing, suggesting that neither antidepressant therapy nor cessation of antidepressant therapy were adequate interventions to create positive well-being; 3) Multivariate analysis of participant responses revealed a significant difference between the four groups on 35 of 37 physical and emotional symptoms associated with antidepressant use or withdrawal, with the never-used group scored the lowest in all cases except one, and the withdrawing group scoring the highest for 27 of the symptoms; 4) Concern over antidepressant dependency and withdrawal was the most prevalent topic reported by all user groups in spontaneous comments; other key themes included frustration with side effects and lack of information and support from the medical profession; 5) study results suggest that antidepressant withdrawal may take longer and be more challenging than the assumed "mild", "self-limiting" and "resolving spontaneously…three weeks after onset" (Haddad & Anderson, 2007); and 6) 30% of ex-users spontaneously reported what they believed were adverse drug reactions, or withdrawal reactions, months or years after antidepressant use had ceased, a long-term iatrogenic disablement that has yet to be addressed in the literature. Overall, the study reveals that antidepressants are not an adequate intervention to create positive well-being in patients and their use comes with a substantial risk of unpleasant side effects, dependency, and the potential for residual post-drug health complications.