Prefaces
Preface
by Judi ChamberlinMuch of the conventional wisdom about
psychiatric drugs is wrong. Psychiatrists and the pharmaceutical industry have
successfully convinced much of the public, through the media, that psychiatric
drugs are "safe" and "effective" in "treating" "mental illnesses." Let us look
at each of these words in turn: Safe generally accepted to
mean that they cause no harm, despite many known negative effects such as movement
disorders, changes in brain activity, weight gain, restlessness, sudden death
from neuroleptic malignant syndrome and many others. Effective generally
accepted to mean that they reverse or cure the symptoms for which they are prescribed,
despite the fact that much research has shown they have a generally sedating effect
that masks not only the targeted behavior, but all activities. Treating generally
accepted to mean that the prescribed agents have specific effects on specific
disease processes. Mental illnesses generally accepted to
mean that there are specific clinical entities known as "schizophrenia," "bi-polar
disorder" etc., despite the fact that there are no known structural or chemical
changes in the body that can distinguish people who have these so-called illnesses
from those who do not. How is it that these myths have been so
successfully accepted as fact? For one thing, those promoting the drugs are authority
figures, doctors and scientists who are generally accepted to be presenting value-free
experimental results. Another factor, perhaps even more significant, is that those
who are given the drugs and who are the ones who have spoken out about their negative
effects, are automatically discredited by having been labelled mentally ill. The
diagnosis of mental illness carries with it a host of associations, particularly
that the person so labelled has impaired judgment and is not a reliable reporter
of his or her own experiences. Nonetheless, it is personal stories
which in fact carry enormous weight in the evaluation of the value of these drugs.
Reading the eloquent personal testimonials of people who have taken and then discontinued
these drugs, some who started with the belief that they were truly lifesaving
agents, should be considered along with the positive accounts of researchers and
prescribers. In psychiatry, it is the experiences, thoughts and feelings of the
patient which are considered to be diseased; therefore, these experiences, thoughts
and feelings in response to treatment must be taken into account. Of course, many
psychiatrists and other believers in the efficacy of psychiatric drugs can dismiss
these accounts by considering them additional "symptoms," but this, of course,
is circular reasoning. The experiences of people who have taken
(or continue to take) psychiatric drugs are enormously varied. Some people find
them helpful in dealing with troublesome symptoms, and these people, of course,
are unlikely to want to discontinue using them. In fact, within this group, many
are willing to tolerate troublesome unwanted effects because they find the benefits
outweigh the negatives. This group of people is not the subject of this book.
Instead, the book focuses on people who, for a wide variety of
reasons, have decided that the drugs are not helpful to them, and who have made
the decision to discontinue their use. Such a decision carries enormous consequences,
as the treating physician almost always wants the patient to continue and the
physician often has enormous powers (such as involuntary commitment) at his or
her disposal in order to "persuade" the patient to continue. Indeed, the lack
of support a person faces upon a decision to discontinue the use of drugs is often
a factor in what is labelled relapse. As an advocate and activist
in the field of mental health and patients' rights (and as a person who discontinued
the use of drugs as part of my own personal process of recovery), one of the most
common questions I am asked is "how can I discontinue the use of psychiatric drugs?"
There is a crying need for information on stopping safely, as well as for supportive
structures (such as short-term residential programs and physicians who are willing
to consider non-drug approaches) that will enable people who wish to withdraw
to do so. The act of choosing to stop taking psychiatric drugs
may be taken for a variety of reasons. Often it is that the negative effects are
more troubling than the original problems, or it may even be that no positive
effects are experienced at all (this was certainly my own experience). Unfortunately,
the media image of a person who has stopped taking psychiatric drugs is the one
that has captured the popular imagination: a person so deluded that he or she
is unable to realize that his or her behavior is abnormal and who then usually
goes on to commit some horrendous violent crime. Reading about real people and
the complex reasons behind their decisions might be a way to counter this negative
and destructive image. It is often said that psychiatric drugs
are given to people labelled mentally ill in order that those around them, such
as medical personnel and family members, can feel better. Certainly, being around
people who are troubled, especially when they are vocal about what is troubling
them, can be wearing and difficult. But simply silencing them is not the answer.
Instead, we need to listen carefully to the real experiences that people have
so that we can learn the true costs of psychiatric drugs on people's lives.
Judi Chamberlin
Co-Chair, World Network of Users and Survivors of
Psychiatry, Director of Education and Training, National
Empowerment Center
Arlington, Massachusetts, October 30, 2002
|
Preface
by Pirkko Lahti
This world wide
first book about the issue "Successfully coming down from psychiatric drugs,"
published in Germany in 1998, primarily addresses individuals who want to withdraw
based on their own decisions. It also addresses their relatives and therapists.
Millions of people are taking psychiatric drugs, for example Haldol (neuroleptic,
active ingredient haloperidol, marketed also as Dozic, Haloperidol, Peridol, Serenace,
P.L.), Prozac (antidepressant, active ingredient fluoxetine, marketed also as
Auscap, Deprax, Eufor, Felicium, Fluohexal, Fluox, Fluoxetine, Lovan, Oxactin,
Psyquial, Sarafem, Veritina, Zactin, P.L.) or Zyprexa (neuroleptic, active ingredient
olanzapine, P.L.). To them, detailed accounts of how others came off these substances
without once again ending up in the doctor's office are of genuine interest. Many
of my colleagues in the mental health field spend much of their time developing
criteria for the application of psychiatric drugs. Diagnoses like compulsive acts,
depression, dermatitis, hyperactivity, hyperemesis gravidarum, insomnia, nocturnal
enuresis, psychosis, stuttering, travel sickness etc. can lead to the application
of neuroleptics, antidepressants, lithium (mood stabilizer, marketed as Camcolit,
Camcolith, Cibalith, Eskalith, Li-Liquid, Liskonum, Lithicarb, Lithium, Lithobid,
Lithonathe, Lithotabs, Priadel, Quilonum, P.L.), tranquilizers and other drugs
with psychic effects. This development of indications is a responsible task, rich
with consequences. Diagnoses and indications often result in a
treatment with psychotropic drugs that can last for a long time. Who can predict
whether the drugs when time arrives can be withdrawn from easily? From
minor tranquilizers, especially the benzodiazepines, we already know the effects
of dependency. Withdrawal without therapeutic help and without knowledge about
the risks can take a dramatic course. What risks arise from the withdrawal of
neuroleptics, antidepressants and lithium. What factors favor
successful withdrawal successful in the sense that patients do not immediately
return to the doctor's exam room, but live free and healthy lives, as all of us
would wish? Have we not heard about pharmacogenic withdrawal-problems, receptor-changes,
supersensitivity-psychoses, withdrawal-psychoses? Who is able to distinguish relapses
from hidden withdrawal problems? Do we not leave our patients
alone with their sorrows and problems, when they for whatever reasons decide
by themselves to come off their psychotropic drugs? Where can they find support,
understanding and good examples, if they turn away from us disappointed (or we
from them)? Peter Lehmann, board-member of the European Network
of (ex-)Users and Survivors of Psychiatry and former board-member of Mental Health
Europe (the European section of the World Federation for Mental Health), has earned
recognition for this difficult task as the first world wide expert to gather experiences
from people themselves and their therapists, who have withdrawn from psychotropic
drugs successfully or who have supported their clients to do so. In this manual
28 people from Australia, Austria, Belgium, Denmark, England, Germany, Hungary,
Japan, the Netherlands, New Zealand, Sweden, Switzerland, the USA and Yugoslavia
write about their experiences with withdrawal. Additionally, eight psychotherapists,
physicians, psychiatrists, social workers, psychologists, natural healers and
other professionals report on how they helped their clients withdraw. Via the
internationality of the authors the book provides a broad picture of different
experiences and knowledge.
The book has a provocative message: life-experiences
sometimes differ from scientific agreements. Based on the
personal experiences of (ex-)users and survivors of psychiatry
and the few professionals who assist people to come off psychiatric
drugs, the book is a good place to open the discussion. The
book should be available in every medical practice, in every
therapeutic ward, in every patients' library.
Pirkko Lahti
Executive Director of the Finnish Association for
Mental Health and President of the World Federation
for Mental Health (2001-2003)
Helsinki, August 19, 2002
|
Preface
by Loren R. Mosher "There is no tyranny so great as that
which is practiced for the benefit of the victim." C.S. Lewis This
volume is devoted to a topic that is the subject of a great deal of misguided
thinking these days. We live in the era of a "pill for every ill" but too little
attention has been devoted to the pills given specifically to affect our psyches.
What does it mean to medicate the soul, the self, and the mind? Webster's dictionary
defines psyche in all three ways. Are not these chemicals ("psychotropic drugs")
interfering with the very essence of humanity? Should not great care and thought
be given to this process? If begun, should it not be continuously monitored? Since
all three soul, self and mind are at the core of each human being should
not he/she determine whether these drugs should be taken based on her/his own
subjective experience of them? The answer is, of course, a resounding yes. Now
let's get real. Since there are few objective indicators of the effects of these
drugs the patients' own reports are critical. Do the psychiatrists and other physicians
prescribing psychotropic drugs listen carefully to each patient's personal experience
with a particular one? The answer to the question varies of course but if you
speak a different language, are a member of a minority, poor, seen as "very ill"
or forcibly incarcerated in a mental hospital the likelihood of being really listened
to falls dramatically although it is not very high for anyone. Hence,
the focus of this book the stories of persons who were not listened to as
they suffered torment of the soul, self and mind from psychotropic drugs often
given against their will, is very important. They are the stories of courageous
decisions made against powerful expert doctors (and sometimes families and friends) and
the torment that sometimes ensued. Stopping medications began to restore their
brains' physiology to their pre-medication states. Most had never been warned
that the drugs would change their brains' physiology (or, worse yet, selectively
damage regions of nerve cells in the brain) such that withdrawal reactions would
almost certainly occur. Nor were they aware that these withdrawal reactions might
be long lasting and might be interpreted as their "getting sick again." They are
horror stories of what might happen (but does not have to happen) when attempting
to return brains to usual functioning after being awash with "therapeutic" chemicals.
Unfortunately, the suffering was usually necessary in order restore soul, self
and mind the essence of humanity. However, because the drugs
were given thoughtlessly, paternalistically and often unnecessarily to fix an
unidentifiable "illness" the book is an indictment of physicians. The Hippocratic
Oath to above all do no harm was regularly disregarded in the rush to
"do something." How is it possible to determine whether soul murder might be occurring
without reports of patients' experiences with drugs that are aimed directly at
the essence of their humanity? Despite their behavior, doctors are only MD's,
not MDeity's. They, unlike gods, have to be held accountable for their actions.
This book is a must read for anyone who might
consider taking or no longer taking these mind altering legal
drugs and perhaps even more so for those able to prescribe
them.
Loren
R. Mosher MD
Director, Soteria Associates
Clinical Professor of Psychiatry, University of California
at San Diego, School of Medicine
August 26, 2002
|
Editor's Preface to the Print Edition
The point of departure for this book is the
moment at which those who are taking psychiatric drugs
the objects of psychiatric treatment have already made
their own decision to quit or to want to quit. This starting
point may be alarming to those readers who look upon the consumers
of these substances not as subjects with a capacity for individual
decision-making but rather as psychologically unsound and,
above all, unable to recognize their own illness (or alternately
as consumers of pharmaceuticals from whom they can profit).
Psychiatric drugs are substances which are given
to influence the psychic condition and the behavior of their
patients. This book refers to the treatment of human beings
only. Mentioned are neuroleptics, antidepressants, lithium,
carbamazepine and tranquilizers. The withdrawal of drugs used
to treat epilepsy in the field of neurology is not a subject
of this book.
-
Neuroleptics (known also as "major tranquilizers")
are so-called antipsychotic drugs, which are administered
when physicians (mostly general practitioners, pediatricians
or psychiatrists) decide to give a diagnoses such as
psychosis, schizophrenia, paranoia, hebephrenia and
hysteria. Other possible symptoms that lead doctors
to prescribe neuroleptics are those sometimes considered
psychosomatic in origin: whooping-cough, asthma, stuttering,
disturbances of sleep and behavior in children, travel
sickness, pruritus (itching) or vegetative dystonia.
In the same way that rebellious or aggressive animals
of all sorts are given drugs to calm stress-related
reactions, so too are elderly disturbed people treated
with neuroleptics.
-
Antidepressants are given after diagnoses such as reactive,
neurotic or brain-organic depression, restlessness,
anxiety disorder or obsessive-compulsive disorder, night-anxiety,
panic attacks, phobia (e.g. school-anxiety in children),
nocturnal enuresis, insomnia and many others. Unhappy
animals might receive antidepressants, too, for instance
sad dogs, if they are locked up in the house all day
while their master is at work.
-
Lithium is administered mostly under diagnoses such
as mania or schizoaffective disorder.
-
The main psychiatric indication for carbamazepine (as
well as the chemically-related valproate [mood stabilizer,
marketed as Convulex, Depacon, Depakene, Depakote, Epilim,
Sodium Valproate, Valpro, Valproic Acid] and oxcarbazepine
[mood stabilizer, marketed as Trileptal]) is the diagnosis
of affective psychosis, especially when the treating
psychiatrist has failed to reach the effect he desires
with his normal psychiatric drugs. Carbamazepine, valproate
and oxcarbazepine which are administered for the treatment
of epilepsy in the field of neurology are not subjects
of this book.
-
Tranquilizers (sometimes called "minor tranquilizers")
are substances which are administered after diagnoses
such as a lack of motor impulse, depressed mood, phobia,
neurosis, panic attack, sleep disorder. Tranquilizers
which are administered for the treatment of epilepsy
in the field of neurology are not a subject of this
book.
"Authors wanted on the subject: 'withdrawing
from psychiatric drugs.'" This was the call for articles
I sent out to relevant groups worldwide in 1995. I wrote:
"'Coming off Psychiatric Drugs. Successful
Withdrawal from Neuroleptics, Antidepressants, Lithium,
Carbamazepine and Tranquilizers.' This is the title of a
book that will be published in German in 1997/98. A publication
in English translation is intended later. We are looking
for people who have been prescribed one or several of the
above-mentioned psychiatric drugs and who have decided to
quit taking them. Of particular interest are positive examples
that show that it is possible to stop taking these substances
without ending up in the treatment-room of a physician or
right back in the madhouse again. For that reason I am looking
for authors willing to report in exchange for royalties
about their own experiences on the route to withdrawal
and who now live free from psychiatric drugs. I am also
looking for reports from people who have successfully helped
others to withdraw from psychiatric drugs in the course
of their professional life (e.g. user-controlled support
centers, natural healers, homeopaths, social workers, psychologists,
pastoral workers, physicians, psychiatrists etc.) or in
their personal life (e.g. supporting friends, relatives,
self-help-groups etc.)."
I received a series of responses from people
who were interested in contributing to this book, including
people who had been taking psychiatric drugs as well as some
professionals whose articles also appear in this book. One
psychiatrist from Berlin withdrew her offer to contribute,
fearing (not without reason) that her practice might be flooded
with people wishing to stop taking psychiatric drugs. Because
I had received no responses from family members of (ex-)users
and survivors of psychiatry, I sent my call for articles to
the German "Association for Family Members of the Mentally
Ill." The reaction was again silence. Is the reason for
this perhaps that those family members who have organized
themselves into support groups have been inundated in the
past years with free lectures and information from the pharmaceutical
industry?
In any case, it would be a mistake to reduce
the problem of the prolonged use of psychoactive drugs and
the possible complications arising from withdrawal to the
fault of disinterested or naïve family members, irresponsible
doctors, and the profit-oriented pharmaceutical industry.
Two authors who had showed initial interest in contributing
their experiences with withdrawal later took back their offer
because they had "relapsed." One of them reported
that she had mistimed her withdrawal to concur with a breakup.
The other informed me that she was in a clinic again because
she had experienced another psychosis. Did she experience
what those in the field call a "withdrawal psychosis,"
or was she just overwhelmed with the sudden return of old
problems that had yet to be worked through?
Throughout my endeavor to address this subject,
I've been cautious enough never to urge others to stop taking
psychiatric drugs. I was careful to only approach those who
had already quit before I sent out my call for articles. Nonetheless,
I wonder if I may have been responsible for leading others
to quit in an unconsidered and potentially dangerous way just
by having published material on the subject.
Ever since the emergence of psychiatric drugs,
many people who have taken prescriptions have made their own
decision to quit. One can only speculate how many people have
attempted to quit after having been exposed to the idea in
an uninformed way only to experience a "relapse"
and eventually another prolonged administration of the drugs.
I think it is safe to say that a great number of attempts
to quit would have been more successful if those wishing to
quit and those around them had been better informed as to
the potential problems that may arise as well as of means
for preventing the often-prophesied relapse. With only a few
exceptions, many professionals have little considered how
they can support their clients who have decided to withdraw.
Responses such as turning their backs on clients and leaving
them alone with their problems indicate that professionals
have little sense of responsibility regarding this subject.
The many different methods of successfully withdrawing
from psychiatric drugs cannot be represented in a single book.
As the editor of this book, it was important to me that "my"
authors, with the exception of the contributing professionals,
openly describe the personal path they took as well as the
wishes and fears that accompanied them. They were told that
there was only one thing they should not do, namely, to tell
others what they should do or to offer surefire prescriptions
for how to withdraw. Every reader must be aware of the potential
problems and the possibilities, of their own personal strengths
and weaknesses, and of their individual limitations and desires
such that they can find their own means and their own way
of reaching their goal. These reports by individuals who have
successfully withdrawn are intended to show that it is possible
to reach this goal and to live free of psychiatric drugs.
My sincere thanks go to the numerous good people,
who have helped with proof-reading and other preparatory tasks,
in particular, to Chie Ishii, Christina White, Craig Newnes,
David Oaks, Jeffrey M. Masson, Joey Depew, Laura Ziegler,
Marc Rufer, Mary Murphy, Mary Nettle, Ronald J. Bartle, Tricia
R. Owsley and Wolfram Pfreundschuh. Without friends and supporters
I would have been lost.
Two authors are no longer living: Ilse Gold,
who died on September 7, 1998 from breast cancer, which developed
after the psychiatric treatment, and Erwin Redig, who quitted
his life on June 14, 1999 after repeated violent psychiatric
treatment. They had deserved a life of a hundred years.
Peter Lehmann
Berlin, April 14, 2004
Editor's Preface to
the E-book Edition
People from all over the world ask me again and again for
names of psychiatrists who can help with withdrawal, but this
question generally cannot be answered. Economic issues may
be involved, because unlike the diagnosis "dependence
on benzodiazepines" there is no diagnosis "dependence
on neuroleptics" or "dependence on antidepressants."
Therefore, physicians can’t easily bill health insurance
for services that help people discontinue these drugs. You
can be angry about this, but what would be the benefit of
putting yourself in the care of an inexperienced and unwilling
physician? Who would take his car to a repair garage from
which no car ever left in a roadworthy state?
Many consumers of psychiatric drugs are convinced they need
their physician’s absolute agreement to withdraw. But people
who stop taking psychiatric drugs against their physician’s
advice are just as likely to succeed as those who come off
with physician agreement. This was the finding of the research
project "Coping with Coming Off," commissioned by
the national organization Mind in England and Wales. Funded
by the British health ministry, a team of users and survivors
of psychiatry carried out 250 interviews to investigate experiences
with coming off psychiatric drugs. The forms of support found
most helpful were: support from a counsellor, a support group
or a complementary therapist; peer support; information from
the internet or from books; and activities such as relaxation,
meditation and exercise. Physicians were found to be the least
helpful group to those who wanted to reduce or come off psychiatric
drugs (Read, 2005; Wallcraft, 2007). Following this study,
Mind changed its standard advice to patients. Historically,
their advice was not to come off psychiatric drugs without
consulting a physician first. People were reminded of the
indoctrination of physicians by Big Pharma (Darton, 2005,
p. 5) and advised to seek information and support from a wide
variety of sources (Read, 2005). The contribution by Susan
Kingsley-Smith will help people to find their own path.
To prevent misunderstandings, I cannot repeat often enough:
In the book, only stories about attempts to withdraw that
end positively were included, as I asked expressly for articles
about successful experiences. Withdrawal can also fail or
may not lead to the desired and sustained drug-free life;
this is commonplace. As successful withdrawal is generally
taboo in the psychiatric literature (literature largely sponsored
by the pharmaceutical industry), it seems justified to give
a forum to a reality which has so far been ignored, as counterweight
to the mass of ideological and one-sided information.
Self-determined withdrawal is not only taboo, it has been
declared a risk factor for psychiatric disorders. This arises,
for example, from the diagnostic primer Diagnostic and
Statistical Manual of Mental Disorder (DSM), distributed
worldwide. Its code number V15.81 (Z91.1) "Noncompliance
with Treatment" which comes out of the section
on "Additional conditions that may be a focus of clinical
attention" can be applied to anyone who wants
to stop taking psychiatric drugs. It should be documented
in the patients’ psychiatric records if they decide to go
ahead and withdraw on their own decision and give their personal
interests and value judgments a higher priority than those
of the prescribing psychiatrists:
"The reasons for noncompliance may include discomfort
resulting from treatment (e.g., medication side effects),
expense of treatment, decisions based on personal value judgments
or religious or cultural beliefs about the advantages and
disadvantages of the proposed treatment, maladaptive personality
traits or coping styles..." (American Psychiatric Association,
2000, p. 739).
Ever since the emergence of psychiatric drugs, many people
who have taken prescriptions have made their own decision
to quit. As a National Institute of Mental Health study in
the USA indicated in 2006, three-quarters of all treated people
in this large-scale study eventually quit taking neuroleptics
of any kind, because they did not make them better or because
of the intolerable, unwanted effects (McEvoy et al., 2006;
Stroup et al., 2006). This practice is consistent with the
theoretical knowledge of doctors who have long recognized
that it was time to withdraw prescribed psychiatric drugs,
but did not and still do not act on that knowledge. In 1978,
as the crème de la crème of mainstream psychiatry
celebrated the 75 th anniversary of the opening
of the University Hospital Psychiatric Clinic in Munich, Fritz
Freyhan from Washington, D.C., admitted:
"In the 1950s, psychiatrists with experience
of psychotropic drugs had to use all their powers to persuade
their colleagues of the benefits of the medicinal treatment.
In recent years we have reached the point where psychiatrists,
experienced in the psychiatric drugs, can drastically alleviate
the sufferings of their patients by withdrawing all anti-therapeutic
drug treatments" (1983, p. 71).
In 2010, the German internist Jutta Witzke-Gross discussed
the cascades of prescribed medicine for physical conditions
as well as psychiatric drugs for elders. Referring to the
various interactions and unwanted effects (for example, circulation
disorders), she concluded:
"Quitting medicine can be the best clinical
decision and result in a significant clinical benefit including
a reduction of the tendency to fall (…). You should also
always remember that one option to coming off drugs is not
to start with the drug at all" (pp. 29/32).
My sincere thanks go to the numerous people who have helped
with proof-reading and with many other preparatory tasks:
Ronald J. Bartle, Joey Depew (†), Chie Ishii, Myra
Manning, Jeffrey M. Masson, Mary Murphy, Mary Nettle, Craig
Newnes, Tricia R. Owsley, Darby Penney, David W. Oaks, Wolfram
Pfreundschuh, Marc Rufer, Bill Spath, Peter Stastny, Christina
White, Reinhard Wojke, and Laura Ziegler.
Peter Lehmann
Berlin, September 27, 2013
Editor's Preface to
the Updated and Expanded E-book Edition from March 2020
Manufacturers of antidepressants and neuroleptics, and those
who administer them, continue to avoid talking about physical
dependency these substances may cause. So far, manufacturers
do this only about the antidepressants tianeptine (marketed
as Stablon) and sertraline (marketed as Depreger, Eleva, Inosert,
Lumaz, Lustral, Seretral, Serimel, Serlan, Serlift, Sertralin,
Sertraline, Setrona, Stimuloton, Tatig, Xydep, Zoloft). Psychiatric
associations refuse to include the diagnosis of "physical
dependence on neuroleptics or antidepressants" in their
diagnostic manuals.
Without such a diagnosis, there is no warning about stopping
too quickly and no information about possible withdrawal symptoms
and how to avoid or alleviate them. The treated persons have
little chance of claiming inpatient support for withdrawal,
compensation, and rehabilitation measures. Without such a
diagnosis, doctors believe that they are not obliged to inform
patients about the risk of physical dependence on neuroleptics
or antidepressants. In addition, they may find it difficult
or impossible to bill health insurance companies for measures
to alleviate and overcome dependency.
However, several manufacturers of neuroleptics are beginning
to protect themselves against recourse claims by warning of
withdrawal syndromes, some of which are life-threatening,
and to pass on the risk of litigation to doctors. The first
instance of a successful claim for damages against a pharmaceutical
company in the USA occurred in 2019 against Johnson &
Johnson in the amount of US-$572 million, because the drug
firm had downplayed the risk of addiction to their painkillers.
This decision could indicate that, in future, courts will
make similar judgments in claims for damages when drug firms
also downplay the risk of physical dependence on antidepressants
and neuroleptics. For example, the Swiss company Lundbeck
AG, the licensee of neuroleptic Clopixol (active ingredient
zuclopenthixol; marketed as Clopixol, Zuclopenthixol), informed
doctors in its 2014 information leaflet that a sudden withdrawal
of this substance could lead to severe withdrawal symptoms;
newborns whose mothers received this substance during pregnancy
should be monitored by intensive care and hospitalised for
a longer time if necessary, in view of the life-threatening
risks associated with withdrawal:
"Abrupt withdrawal from zuclopenthixol can
be connected with withdrawal symptoms. The most frequent symptoms
are: Sickness, nausea, anorexia(lack of appetite),
diarrhea, rhinorrhea (nasal hydrorrhea), sweating,
myalgia (muscular pain), paresthesia (subjective
cutaneous sensations experienced spontaneously in the absence
of stimulation) , sleeplessness, restlessness, fear and
irritability. Patients can have feelings of dizziness, feel
alternating cold and warmth, and tremble. Usually, the symptoms
begin within 1-4 days after withdrawal and fade away after
7-14 days. Abrupt withdrawal of the medication has to be avoided.
(...)
After birth, newborn babies whose mothers took antipsychotics
(including zuclopenthixol) during the third trimester of the
pregnancy have the risk of extrapyramidal-motoric symptoms
(disturbances of the muscle tension and the course of motion)
and/or withdrawal symptoms. These symptoms can include agitation,
unusually increased or decreased muscle tonus, tremor, drowsiness,
breathing difficulties, or feeding problems.
The complications may have different severity. Sometimes
they were self-limiting, in other cases they required neonatal
monitoring in the intensive care unit or a longer hospitalization"
(Lundbeck [Switzerland] AG, 2014).
The results of the above-mentioned British MIND study from
2003-2004 have since been confirmed by a comparable study
in the USA. Here, too, psychiatrists were identified as the
profession that is mostly unhelpful in discontinuing psychotropic
drugs (Ostrow et al., 2017). It is long overdue that psychiatrists
gain skills so they can assist patients in withdrawal. It
should be a matter of course that doctors do not kick their
patients out when they want to stop taking psychiatric drugs
and ask for help. However, experience shows that this is exactly
what often occurs. The psychiatrist Asmus Finzen, former medical
director of the psychiatric clinics in Wunstorf, Northern
Germany (1975-1987), and Basel, Switzerland (until 2003),
stated:
"Many threaten to abandon their patients
and some do so. But this is not compatible with the principles
and ethics of their profession. It may even be malpractice:
If a patient wants to withdraw or reduce medication that he
has been taking for a long time, the doctor in charge has
to help him even if he disagrees" (Finzen, 2015,
p. 16).
As shown by the specialist information provided to doctors
by manufacturers, there are many psychopharmacology-related
occasions which require immediate reduction or complete discontinuation.
These include depression or suicidal tendencies (if new);
signs of liver dysfunction or tardive dyskinesia (muscle disorders
that become chronic over time); increased intraocular pressure;
cardiac arrhythmia; and many more (Lehmann, 2017, pp. 29-85).
At the same time, manufacturers often irresponsibly prescribe
extremely short withdrawal periods (Langfeldt, 2018), so that
massive withdrawal problems and the re-prescription and up-dosage
of psychiatric drugs are programmed.
In response to the lack of help and knowledge about withdrawal,
representatives of the Dutch associations of pharmacists,
family doctors, and psychiatrists, and a mixed association
of psychiatric patients and relatives, set up the Discontinuation
of Antidepressants Taskforce. They document ways of reducing
in small steps, especially at the end of the withdrawal process,
as well as withdrawal problems and ways to alleviate them.
They also identify the signs of successful discontinuation
(KNMP et al., 2018; Ruhe et al., 2019). In the United Kingdom,
the Council for Evidence-based Psychiatry (CEP) is a leader
in the field. This group of psychiatrists, researchers, and
other interested parties works with public institutions and
organisations for support in withdrawal. Among other suggestions,
they recommend that Parliament initiate the development of
nationwide services that must provide support with withdrawal
to those who have been deprived of their health (CEP, 2019).
In the meantime, the first psychiatrists oriented towards
conventional medicine have taken the initiative in Germany.
Even before patients decide to take an antidepressant, they
should be informed about the risk of dependency and rebound
effects that may occur after discontinuation, says Tom Bschor
(2018, pp. 121-122), medical director of the psychiatric department
of the Schlosspark-Klinik in Berlin-Charlottenburg. Psychiatrists
from some clinics in Rhineland-Palatinate warn clearly in
informational brochures about the risk of physical dependence
on antidepressants (NetzG-RLP, 2018, p. 12). Since 2018, some
wards of psychiatric clinics in Germany are offering inpatient
admission for patients for the controlled withdrawal of neuroleptics
(see www.antipsychiatrieverlag.de/info/absetzinfos/websites.htm#kl.
Meanwhile, for many people with bad experiences of withdrawal
and their supporters, it has become clear that competent help
is lacking for those who want to stop psychiatric drugs and
need prescriptions for tapering strips, prescriptions for
preparing individually tailored dosages, instructions for
the withdrawal of combinations, or who generally feel overwhelmed.
Nevertheless, the opinion leaders in mainstream psychiatry
are busy working to perfect their systems for controlling
the consumption of psychiatric drugs and developing logarithms
in withdrawal studies to predict an "evidence-base"
determining who should take psychiatric drugs in the long
term. However, the participants in such studies are not informed
about withdrawal problems and measures to minimize them, so
that the results ("You have to take them permanently!")
are pre-determined (Lehmann, 2016).
In the new edition, I added one article. Susanne Cortez describes
the possibility and the necessity of small step tapering at
the end of the withdrawal process after a long period of taking
psychiatric drugs, with the example of the neuroleptic quetiapine
(marketed as Atrolak, Biquelle, Brancico, Geroquel, Mintreleq,
Noletil, Notiabolfen, Quesery, Quetapel, Quetex, Quetiapin,
Quetiapina, Quetiapine, Quentiax, Seropia, Seroquel, Setinin,
Sondate, Syquet, Tevaquel, Zaluron), in her article "And
finally atypically careful." And I included the latest
information on tapering strips, prescriptions for preparing
individually tailored dosages and further possibilities for
small-step reduction, as well as suggestions for discontinuing
combinations in my closing words "And now, how to proceed?
A resume."
It cannot be pointed out often enough that the withdrawal
attempts in this book were all positive. As a counterbalance
to the mass of one-sided information from the pharmaceutical
industry and mainstream psychiatry, I explicitly asked for
successful experiences. It should be common knowledge that
withdrawal can also fail or may not lead to a life permanently
free of psychiatric drugs as desired. Some people have the
experience that for whatever reason they cannot
cope with their living conditions without psychiatric drugs,
regardless of the risks associated with long-term administration.
They and their doctors are advised to read the article "Minimaldosierung
und Monitoring bei Neuroleptika" ("Minimal dosage
and monitoring in neuroleptics") by the German psychiatrist
Volkmar Aderhold (2017), and the information provided by the
Discontinuation of Antidepressants Taskforce on the minimal
dosage of new antidepressants (KNMP et al., 2018, p. 2).
My sincere thanks go to Darby Penney who has helped with
proof-reading and to Peter Stastny who has advised in translating
special psychiatric terms.
Peter Lehmann
Berlin, March 8, 2020
Editor's Preface to
the Expanded E-book Edition from May 2020
Beyond Northwest Europe and North America, pharmaceutical
firms sell psychiatric drugs in an unbridled manner, including
masses of combination drugs, and including mixtures such as
a neuroleptic, a benzodiazepine-tranquilizer, an antidepressant,
and an anti-Parkinson drug in one pill. These firms still
offer psychiatric drugs withdrawn from the Western market
decades ago on suspicion of cancer-causing effects. Sometimes
they sell active ingredients under hundreds of different trade
names. Often, they sell neuroleptics as tranquilizers.
To enable patients, relatives, and supporting people from
those "third world" countries to identify the active
ingredients of psychiatric drugs which are the same
as in Western countries the new edition integrates
all commercially distributed psychiatric drugs, including
their trade names in English-speaking countries, as well as
in countries with English as one official language: Australia,
the Bahamas, Barbados, Bermuda, Cameroon, Canada, Ethiopia,
Fiji, Ghana, Great Britain, Guyana, India, Ireland, Jamaica,
Kenya, Kiribati, Malaysia, Malta, New Zealand, Nigeria, Pakistan,
Papua New Guinea, the Philippines, Rwanda, Singapore, Solomon
Islands, South Africa, Sri Lanka, Sudan, Tonga, Trinidad &
Tobago, the USA, Vanuatu, and Zimbabwe. (No information is
available from Botswana, Micronesia, Samoa, and South Sudan.)
My sincere thanks go again to Darby Penney who has helped
with proof-reading.
Peter Lehmann
Berlin, May 10, 2020
Peter
Lehmann
D. Phil. h.c., certified pedagogue and independent publisher
in Berlin, Germany. Until 2010, a longstanding board member
of the European Network of (ex-) Users and Survivors of
Psychiatry.
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