Millions of people in the UK are physically dependent on antidepressants, with experts saying many are being failed by a medical system that underestimates how difficult it is to stop taking them.

“People lose their jobs, they’re bed-bound, relationships break up because of the problems associated with coming off these drugs,” says Dr Mark Horowitz, a clinician and researcher at North East London NHS Foundation Trust. 

“As the withdrawal symptoms can often be mistaken for a return of an underlying condition like anxiety and depression, when people encounter serious withdrawal symptoms they are often encouraged to keep taking their medication. It’s a bit like saying if people stop smoking, they get anxious and irritable, so they should keep smoking to prevent anxiety, irritability.

“It sounds laughable, but that’s what the national guidelines at the moment say for antidepressants and depression.”

Dr Horowitz, an expert in brain biology who has just co-authored a new medical textbook on the issue, has first-hand experience of these medicines. He was prescribed antidepressants while studying medicine at the University of New South Wales, in Sydney, when he was 21. 

Everyone’s experience of mental ill health and medication is different, but Dr Horowitz says: “If you’ve ever seen a Woody Allen film, I was that kind of neurotic Jewish kid. I came from a medical family, but I was unsure about medical school. I was pessimistic, I was miserable.

“But what I had before I went on the drug was three out of 10, what I had when I came off the drug was 10 out of 10,” he says.

“It was the worst experience of my life. I started waking up in the morning in full-blown panic, like I was being chased by a wild animal, and I would be in a state of terror for 10, 11 or 12 hours a day.”

He went back on the medication, “not because it was helpful to me, but because I was trapped on it. I couldn’t tolerate coming off it”.

Dr Horowitz found online support and advice from patients who had weaned themselves off antidepressants. “I realised there was a huge problem in the education of doctors and what was going on with these drugs,” he says.

“I had done a PhD in the biology of antidepressants at the Institute of Psychiatry at King’s College, London. I studied the work of people from Harvard and Oxford and Cambridge and Stanford, and I thought: ‘How come I am learning how to come off an antidepressant  from a retired software engineer on an online group?’”

It took Dr Horowitz five years to come off antidepressants, taking his last dose a month before his 42nd birthday earlier this year – 20 years after they were first prescribed.

That’s why he has worked with Professor David Taylor, professor of psychopharmacology at King’s College, London, to produce The Maudsley Deprescribing Guidelines: Antidepressants, Benzodiazepines, Gabapentinoids and Z-drugs. The new textbook guides doctors through the process of withdrawal from all types of antidepressants and the problems patients are likely to encounter.

That’s not to say antidepressants aren’t helpful. Professor Wendy Burn, former president of the Royal College of Psychiatrists, says: “I see them working in my clinical practice, I see lives being changed by them.” But she warns: “People are staying on antidepressants longer, and we don’t really have long-term studies that support that.”

On average, people take them for two years and the number of prescriptions is rising. In 2023 almost 8.6million patients in England alone were taking antidepressants, almost twice the number a decade ago.

In a letter to the British Medical Journal, the Beyond Pills All-Party Parliamentary Group said: “Rising antidepressant prescribing is not associated with an improvement in mental health outcomes at the population level, which, according to some measures, have worsened as antidepressant prescribing has risen.”

Until recently, the advice for patients coming off these medicines has been to reduce the dose over the course of a few weeks, or possibly months.

But Dr Horowitz says many patients need to taper off far more gradually, reducing the dose by 10 percent each time – a process that can take years. Rushing withdrawal can result in panic attacks, anxiety and other problems.

“The difficulty of distinguishing between withdrawal symptoms and relapse presents a real challenge for patients, doctors and researchers alike. It’s very easy to start these drugs, but it can take years to come off them and most GPs don’t know how to advise patients, so people end up stuck on them.”

So what’s the alternative? Dr Horowitz believes: “There has been a huge over-medicalisation of normal emotions. We all go through periods of low mood and anxiety, it’s as common, or more common, than a common cold. In 85 percent of cases, untreated depression goes away in 12 months, even in severe cases. There are also all sorts of other ways of approaching depression.

“Exercise and diet can be useful. I learned to meditate along the way. I got therapy. Probably all those things helped.”

The National Institute for Clinical Excellence advises against prescribing antidepressants as a first-line treatment for mild depression. It suggests non-drug approaches including online or group sessions of cognitive behaviour therapy, group exercise, mindfulness and meditation.

The Maudsley Deprescribing Guidelines: Benzodiazepines, Gabapentinoids and Z-drugs is out now (£49.99; Wiley Blackwell).

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