Electronic letters to:

Research:
Dorian Deshauer, MD MSc, David Moher, PhD, Dean Fergusson, PhD, Ester Moher, BA, Margaret Sampson, MLIS, and Jeremy Grimshaw, MD PhD
Selective serotonin reuptake inhibitors for unipolar depression: a systematic review of classic long-term randomized controlled trials
CMAJ 2008; 178: 1293-1301 [Abstract] [Full text] [PDF]
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[Read eLetter] Antidepressant withdrawal syndrome contaminates studies of efficacy
Adele L. Framer   (5 August 2008)

Antidepressant withdrawal syndrome contaminates studies of efficacy 5 August 2008
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Adele L. Framer
Patient advocate

Send letter to journal:
Re: Antidepressant withdrawal syndrome contaminates studies of efficacy

a_framer{at}yahoo.com Adele L. Framer

As a patient advocate, I read with interest the recent paper Selective serotonin reuptake inhibitors for unipolar depression: a systematic review of classic long-term randomized controlled trials, Deshauer et al, CMAJ. 2008 May 6;178(10):1293-301.

I highly commend Deshauer et al for making the point that withdrawal symptoms contaminate many studies of antidepressant effectiveness. Indeed, clinicians and patients often take these symptoms to indicate the emergence of serious psychiatric disorder, confirming the necessity of continuing the same or even more strenuous medication. Misdiagnosis and mistreatment of antidepressant withdrawal syndrome can cause further harm to the patient's destabilized nervous system.

The faulty studies showing antidepressant effectiveness tend to further reinforce the almost total clinical misdiagnosis of withdrawal syndrome as they emphasize rate of relapse without mentioning withdrawal syndrome. It is highly likely that some number of patients identified as "relapsed" after discontinuation of medication were in fact suffering from antidepressant withdrawal reactions.

This flaw also contaminates those classic randomized controlled trials that look at rate of relapse or "recurrent depression" after discontinuation. One also wonders about the unreported frequency of adverse effects -- surely a reflection of a lack of efficacy -- among the very large number of dropouts in these trials and whether they suffered withdrawal symptoms.

Indeed, any study that discusses a rate of relapse or "recurrence of depression" but does not provide statistics for antidepressant withdrawal reactions is suspect as withdrawal reactions probably were counted as relapse, "recurrence of depression," or even emergence of a new mood disorder.

Still, the short duration of almost all antidepressant efficacy studies probably would continue to vastly underestimate the prevalence of antidepressant withdrawal syndrome in actual practice, as doctors are encouraged to persuade patients to take antidepressants for much longer periods of time than any studied, likely enhancing the frequency and severity of withdrawal syndrome. (You may read many real-world patient reports of withdrawal syndrome on the Web site paxilprogress.org.)

That psychiatric research continues to misinform doctors about antidepressant withdrawal syndrome damages the medical profession as well as patients.

Thank you for making this paper widely available to the public.

Conflict of Interest:

None declared