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ris as mental health s greatest success story in 2001 a landmark report on a clinical trial into paroxetine sold as seroxat in north america and paxil in the uk called study 329 concluded that it demonstrated remarkable efficacy and safety study 329 led directly to a massive increase in prescriptions by 2003 worldwide sales of seroxat manufactured by glaxosmithkline were worth 2 7bn but concerns were raised about the study the us food and drug administration fda officer who reviewed the data disagreed with the findings calling it a failed trial and in 2015 the british medical journal published a re evaluation seven authors went through as many of the thousands of individual case reports as they could and found not only that the efficacy of paroxetine was not statistically or clinically different from placebo but that there were clinically significant increases in harms including suicidal ideation and behaviour the original study reported 265 adverse reactions the bmj found 481 the re evaluation also found that psychiatric responses were grouped together with dizziness and headaches rather than given their own category in 2003 the uk banned the use of seroxat by anyone under 18 and in 2004 the fda required a black box warning on all antidepressants its strictest level of patient warning patient safety is our number one priority a glaxosmithkline gsk spokesperson tells me we believe we acted responsibly in researching paroxetine monitoring its safety once it was approved and updating its labelling as new information became available many ssri users report blunted emotions even long after they have ceased taking pills and an impact on sexual function they should be called anti sex drugs rather than antidepressant drugs says jon jureidini a child psychiatrist of 30 years standing a professor of psychiatry and paediatrics at the university of adelaide and co author of the bmj study it s more reliably predictable that they re going to get rid of sexual function than it is that they re going to get rid of depression again some people find this persists long after they cease taking the drug one person i spoke to kevin had taken prozac for six months when he was 18 now 38 he hasn t had an erection since last september healy and colleagues published a further examination of the data gathered for study 329 this data followed the trial participants for six months after they started taking paroxetine the continuation phase and while they were tapered off it gsk which in 2004 published a clinical study report had argued that the long term safety profile of paroxetine in adolescents appears similar to that reported following short term dosing healy and co however concluded that the continuation phase did not offer support for longer term efficacy more alarmingly they found that the taper phase when patients were being taken off the drugs was the riskiest of all showing a higher proportion of severe adverse events per week of exposure this they said opens up the risk of a prescribing cascade whereby drug side effects are thought to be symptoms so are treated with further drugs causing further side effects and further prescriptions thus increasing the risk of long term prescription drug dependency in october the british medical association published its response to a two year fact finding exercise into long term use of psychoactive drugs it noted that while benzodiazepines z drugs opioid and antidepressants are a key therapeutic tool that their use can often lead to a patient becoming dependent or suffering withdrawal symptoms the evidence and insight presented to us by many charity and support groups shows us that the lived experience of patients using these medications is too often associated with devastating health and social harms it was therefore the report concluded a significant public health issue the bma made three key recommendations first and most urgently that the uk government establish a 24 hour helpline for prescribed drug dependence second that it establish well resourced specialist support units and third that there should be clear guidance on prescription tapering and withdrawal management they found the current approach to antidepressants in particular to be inconsistent too many patients were suffering significant harm there are also increasingly urgent calls for studies into long term effects that are not funded by drug companies because moncrieff says we don t have very much data this research is really important but hasn t been done it s a massive blind spot it s extraordinary or maybe given the pressures and interests at work not extraordinary at all that it hasn t been filled in march this year members of the bma along with mps and researchers from roehampton university went to parliament to lobby public health england armed with research estimating that there are 770 000 long term users of antidepressants in england alone at a cost of 44m to the nhs per year a figure that does not account for the cost of gp appointments or the impact of side effects withdrawal effects and disability payments i think you have to adopt a very conservative approach says psychiatrist jon jureidini these are brain altering drugs and our overall experience with brain altering drugs of all kinds is that they tend to have a detrimental effect on some proportion of people who take them long term all we know about the benefits is from short term symptom reduction studies the careful prescriber needs to say well in balancing the likely benefits and harms i need to be very cautious about how much benefit i m expecting and i need to be very generous about the possibility that the harms might be more than they appear to be quite a few long term users such as those i spoke to below and who wished to be anonymous would agree tapering off is the hardest thing i ve ever done sarah 32 has taken seroxat for 14 years i was prescribed seroxat when i was 18 the year i started university i grew up with a disabled sister so things at home were very stressful and i had a history of anxiety and panic attacks i had counselling but the problems persisted so i went back to the gp i don t remember everything that was said but there was no conversation about side effects within the first two weeks of starting seroxat i remember i was sitting in the front room watching tv when out of nowhere i had this intense feeling of heat like an electric shock it started in my hands went all the way up my arms and through to my head the gp said it was probably just my body getting used to the drug and after a few weeks the weird sensations did ease off i had a fabulous time at university i still had panic attacks and there were certain situations i would avoid as i still do so it wasn t a wonder drug but there were no major problems but in 2006 i tried to come off it there were a couple of panorama documentaries about the side effects and i was starting to become concerned the gp said that s fine but do it gradually over three weeks i immediately became incredibly unwell i thought i was losing my mind i was going to work but it was difficult to get through the day my mouth was so dry i was constantly drinking water i had bizarre thoughts not hallucinations that were frightening or distressing i had a strong sense of detachment from reality eventually the doctor said look you coming off is obviously not working we need to get you back to 20mg within a week i was much better a few years later when i realised my mental health was getting worse even though i was on the medication i started to do some research reading case studies about withdrawal i find it so offensive when a gp says this is who you are i didn t have these symptoms 10 years ago i didn t have this sense of detachment i saw various psychiatrists they just kept saying the drug is safe you need to be on it a couple of others told me the reason i was having these problems was because i wasn t taking enough another said if you were diabetic you d take insulin and you wouldn t have an issue why are you so bothered about taking this drug i ve been on it since i was 18 so i don t know who i am without it as an adult who knows i might have all kinds of problems but i need to know i ve tried tapering off is the hardest thing i ve ever done it s taken me three years just to get from 20mg to 5mg i m no longer with my partner we were together for six years i believe seroxat has played a part it affected my moods it made my anxiety worse and by necessity i ve had to be selfish really i don t want to say all my problems are to do with seroxat because they re not but i do believe that it has caused me harm i don t have much of an interest in interacting romantically or physically with the opposite sex jake 24 took ssris for eight years i had been dealing with symptoms of ocd and anxiety for a lot of my childhood it s in my family affecting two siblings and one parent i was prescribed zoloft when i was 12 i took a variety of ssris zoloft to prozac to lexapro and then two others for eight years did they help you know i can t really tell you because i got through school i got high marks i had a lot of friends so in that sense they must have helped that s the thing for people with major depression it s easy to say this has a measurable effect but i kept taking them just because that s what i ve always done i went to university right out of school i did very poorly i had a bit of a breakdown isolating myself not sleeping i was still on medication i came home and enrolled at a community college that was my worst period i was very depressed and i started to think i ve been on these medications a long time i m not doing well why not get off them i don t recommend this at all to anyone but i stopped going to a psychiatrist and took myself off for months i had trouble sleeping i was jittery i had brain zaps my anxiety was pretty ramped up i would feel numbness in my extremities generally my arms my psychiatrist told me these were just normal withdrawal symptoms and they d be gone in four to six weeks anything you feel beyond that is your anxiety and depression returning basically if you still feel anything beyond this window that the medical community has established it s all in your head eventually i went back to school full time and i remember doing ok feeling somewhat better i ve now been drug free for four years what s lasted are the sexual side effects they were definitely worse in withdrawal than they had been on the drug even though i didn t really realise or understand it at the time primarily because i started to take ssris at 12 while my brother took the same medicine over the same period and had a normal sexual life i had a lack of sexual interest i had erections and i have regularly masturbated my entire life but i don t have much of an interest in interacting romantically or physically with the opposite sex i didn t even start thinking about sex until a couple of years ago it s almost like i woke up one day and thought ok i started getting these windows days or weeks when normal sexual feelings would appear but they re new to me and i don t know what to do about them and because i don t know what to do i get anxious and the anxiety kills any feeling and then i m anxious because i ve lost all my feeling online i ve come across a big asexual community some also took antidepressants i think there are a lot of people like me out there i d like to think that if i keep going to counselling and sleeping and eating properly i can rectify these things in the end it s about pros and cons if you re lying in bed and can t get up is it better to function if it was up to me i d say that barring extreme circumstances nobody under 18 should be prescribed these things your brain develops around them drug companies should be thinking of the long term effect on people who can t even consent if i missed a dose i d get shocks down the side of my body chris 43 has been taking seroxat for 26 years i was originally prescribed seroxat for mild anxiety about my gcses it was 1991 about the time glaxosmithkline released seroxat i was one of the first people to be given it i was prescribed 20mg the basic dose to start with it helped me i got through school i went to uni i went to work but i had side effects from the off profuse sweating low libido i m quite a placid person but i became aggressive i never suffered in the beginning with the suicidal thoughts that people talk about now but what i did notice was that if i missed a dose especially after eight years of taking it i d get shocks down the side of my body i d be nauseous my limbs would become weak i d be in a constant state of confusion and was very impatient i couldn t communicate well with people i said this to the doctor and he said we ll up the dose to 40mg that was 1998 the 10 years after that weren t too bad i managed to work as a sales rep for 18 20 years but by 2012 by which time i was up to 60mg i had tried on numerous occasions to withdraw i tried to go back to 20mg but my words became slurry so the doctor put me back up to 60mg by the time i was 38 even that wasn t enough i tried to take my life the doctor wouldn t prescribe a higher dose i couldn t do my job i couldn t concentrate i couldn t drive a psychiatrist once said to me that coming off seroxat is harder than quitting heroin that really hit home i have now been unable to work for four years i m still seeing a psychiatrist i ve also been diagnosed with fibromyalgia constant tiredness aches in the neck and in the lower back and lower limbs i m 43 and still live with my mum and dad i also have no libido since the age of 30 i have had no feelings in that regard whatsoever i have had relationships but they ve all failed i haven t been in a relationship for 10 years which is a long time to go without sex but i just don t get the urge i don t really have emotions to tell you the truth the drug takes your emotions away i m sort of existing not living and when the drugs do work i wanted to be able to feel good when good things were happening bad when bad things were happening by simon hattenstone i suppose i was a depression snob a purist why should i take antidepressants yes there was something rubbish about crying all the time not functioning being unable to answer simple questions because of the fug in my head but hey at least i was true to myself my depression went back to my late teens i didn t like to think of myself as depressive because depressives were losers and i didn t think i fitted the bill i was pretty funny and able and i could get girlfriends i guess most depressives don t think they fit the bill it might have been genetic my dad had paralysing depression and so did his father as a young boy i d spent three years off school with encephalitis an inflammation of the brain that is often fatal survivors are often left with depression i remember as a teenager being on holiday in greece with friends the weather was...