The withdrawal question

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NICK EICHER, HOST: Coming up next on The World and Everything in It: rethinking antidepressants.

Health Secretary Robert F. Kennedy Jr. says doctors need to do more to warn patients about the risks of stopping certain antidepressants.

The number of Americans using them has increased by the millions since the 1990s.

MYRNA BROWN, HOST: One in six American adults now takes an antidepressant daily, as does roughly one in 10 American children.

And while many in the medical community say the drugs are safe and effective, a growing number of critics are calling attention to the possibility of severe side effects.

EICHER: Now, Kennedy’s HHS is pushing new guidance on how those drugs are prescribed—and how patients come off of them.

WORLD's Josh Schumacher reports from Washington. 

JOSH SCHUMACHER: When Morgan Stewart was 26, a doctor put her on Prozac. It's a drug commonly used to treat depression, obsessive-compulsive disorder, and anxiety. But Stewart says those labels didn’t really fit her situation—she was just going through a hard time.

STEWART: I had a sick family member. It was just kind of like a tough time. And I was given an SSRI for that.

Prozac is an SSRI, or a Selective Serotonin Reuptake Inhibitor. SSRIs elevate mood by increasing the hormone serotonin in the brain and preventing brain tissue from reabsorbing that serotonin.

Stewart was on Prozac for nine years. And in that time, she met her husband and started a family.

STEWART: And so life looked very different. So yeah, I was 35 when when I got off, and it was a wild time.

Stewart says she started experiencing what she called “otherworldly” symptoms.

STEWART: My withdrawal, it kind of started with really bad insomnia. I had fasciculations up and down my body, or twitches.

Then, it got mental.

STEWART: I had violent intrusive thoughts that I had never had before—prior to the medication, on the medication—of harming myself, harming other people. They were very bizarre.

She says she even admitted herself to a psychiatric hospital during that time.

Once she got back on her feet following her withdrawal, Stewart founded an organization that raises awareness about the possible negative effects of SSRIs.

She was at the conference where Secretary Kennedy made his announcement.

KENNEDY: Patients must understand the benefits, the risks, and the consequences of long-term use before they start, while they continue, and when they consider stopping.

Kennedy also said HHS would train doctors on how to taper their patients off antidepressants…and incentivize them to do it.

KENNEDY: The Center for Medicaid and Medicare Services is issuing billing guidance that allows clinicians to get paid for de-prescribing work for the first time. [Applause] They'll be paid for care planning, for monitoring withdrawal, for coordinating treatment, and for tracking outcomes.

Both Kennedy and the APA, the American Psychiatric Association, agree that SSRIs have been important and even lifesaving for many people. But the organization criticized Kennedy’s assessment that there’s an “overmedicalization” or “overprescription” crisis in the mental health industry. They said that was an oversimplification. 

The APA also said that psychiatric medications like antidepressants shouldn’t be stigmatized. The organization says patient-by-patient treatment plans are important. 

And Dr. Shannon Yarosz, a professor of pharmacy practice at Cedarville University, agrees. She says everyone interacts with antidepressants differently.

YAROSZ: Some people have had success using antidepressants and SSRIs, and you know, maybe with very little side effects, and it has worked well for them. And again, there's been other people I've talked to, they haven't worked as well for them, or maybe not to the extent that they were really hoping

Yarosz said she appreciated the way Kennedy’s new posture on SSRIs focuses on informed decisions, rather than a one-size-fits-all approach.

YAROSZ: You know, your healthcare provider, your doctor, knows you personally, and they know what you need and they want to make that shared decision with you, what would be best for you.

Morgan Stewart says the public at large needs to become aware of what they could be getting into by taking antidepressants.

STEWART: I think if they knew how serious withdrawal could be and they could make an accurate informed risk-benefit assessment, I think they would opt out.

This summer, HHS plans to host seminars to train doctors and patients to better understand the possible risks of SSRIs.

Reporting for WORLD, I’m Josh Schumacher in Washington, D.C.

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