Severe antidepressant withdrawal is often hidden in plain sight. Here's why most clinicians don't recognise it – and why I wouldn't have either until it happened to me.
Great article, and a useful framework for talking with colleagues. As a GP/Rural ED person in Australia, who is at the tail end (I hope) of a lengthy SSRI withdrawal, I find my profession’s addiction to very narrow sources of drug information/guidelines a bit cult-like and anything which might help to gently de-programme them is a boon.
Thanks Gavin. I think it is understandable why busy cognitively overloaded GPs/doctors stick to authoritative guidelines. It is exhausting to go through and do independent reading yourself especially when you have to cover every condition. I did not understand how much work 'expert consensus' or short-term studies which do not reflect real life did in these guidelines before I looked at them closely - as an academic type person it is a luxury most don't have. I hope you are able to at least bring a few people's attention to these issues and I hope your tapering goes Ok.
I’m a primary care peds NP who prescribes these meds - more reluctantly and with more informed consent and more discussion from day #1 about not staying on them forever - than in the past. But, still, I prescribe them.
The above - about “than in the past” has admittedly been very much informed by my own experience and what I learned in the process (so much of that from you, so, thank you for your ongoing work in this area!)
I was on Prozac 20mg for a decade. More than one psych NP over those years and never a discussion about tapering off. In fact, the psychiatrist who originally started me on it advised I take it for life “like insulin for a diabetic”. I thought this was his own clever analogy until years later I hear others say they heard the exact same words.
When I asked about tapering off, I was given the standard “drop to 10mg for a week, then stop” advice. I instead decided to taper over 7 weeks and, at the end, it all fell horribly apart. It made no sense to me. I started googling. Exactly what all of us clinicians hate when our patients do. We don’t know what we don’t know. I know now.
I did a hyperbolic taper. 26 months. I finished a few weeks ago. My psych NP believed me… sort of. He said at one point, “I’ve never had a patient struggle to stop Prozac unless they relapsed.” He let me do my thing. Probably partly because he’s a good guy and a reasonable clinician. Probably partly also because I’m also an NP and got a bit more leeway for that.
I gifted him Maudsley about a year in. At the end, I asked him if he’d ever looked at it. He said no. He said “you’ve taught me things also”. Yes, but. Also it was clear he felt my withdrawal had been mild. Um, so not.
I presented at a national peds NP conference in March on deprescribing and will present at a psych NP conference in October. Like you, I’ve sat on both sides of this which I think gives a unique perspective.
Thanks for sharing. I think so much of what we see is influenced by what we've been taught - perhaps something like eskimoes and snow. If we have 40 words for relapse and almost no words for withdrawal then we are going to see relapse. Interesting that your NP characterised your withdrawal as mild when it was anything but. It is this which makes me understand why so many prescribers on social media swear they never see withdrawal.
Thank you for your work and this excellent article.
I’m not a physician. I suffered from delayed discontinuation after what my doctor considered to be a conservative taper off of Effexor. The experience was horrific. I couldn’t work (I was a lawyer in a big firm from which I’ve since retired.) After 3 months of misery I finally went back on a much smaller dose of the drug and finally stabilized.
My doctor had not seen anything like my withdrawal, although it was easy for me to find sites on the Internet replete with stories like mine.
I am still taking the drug almost 15 years later. I would love to discontinue, but my wife and I both are terribly fearful of going through that again.
I’m now in my 70s and as I age I am equally fearful that I will end up having to depend on someone else to manage my drugs at some point. The thought that someone would intentionally or accidentally discontinued the drug is terrifying.
Thank goodness a few doctors are now specializing in de prescribing.
Thanks Jim - I get endless emails from people like yourself who are stuck on an antidepressant because of a failed taper. And what doctors consider to be a conservative taper is often anything but. You might aware of the newer technique of hyperbolic tapering which can make it easier to stop - but many people are too shellshocked by their previous failed attempt to try again. Sorry for your awful experience.
I have recently written a summary of my experience - as both a psychiatrist and a person who has struggled coming off an SSRI antidepressant. I think it may be helpful to share alongside your article 'Why Doctors Don't See Withdrawal'. I will paste it below. I have tried to keep it short but you may quite reasonably think it is too long for tis comment space [please note: I need to amend the time order as my 'unexplained' seizure happened in December 2021].
aye Peter
For twenty-five years, Dr Peter Gordon worked in the National Health Service as a consultant psychiatrist. However, his understanding of his own profession was fundamentally altered by a prescribed medication: the Selective Serotonin Reuptake Inhibitor (SSRI) Seroxat, also known as paroxetine.
Dr Gordon started taking Seroxat in 1997 during a time of personal and professional stress. He was concurrently sitting his membership examination for Psychiatry whilst his sleep was being disturbed by a new baby at home. At this time, the ‘Defeat Depression Campaign’ was underway across the United Kingdom. Sponsored in good part by the pharmaceutical industry and supported by the Royal College of Psychiatrists (RCPsych), one of the campaign's key messages - designed to "educate" doctors and the public alike - was the confident claim that SSRI antidepressants would not cause any difficulties in stopping. Under this prevailing medical reassurance, Dr Gordon began a treatment that would ultimately span decades; he has now been on this SSRI for three decades.
This thirty-year dependency has taken an ongoing toll on his physical health and demonstrates how institutional denial and a systemic lack of informed consent leave patients entirely unprepared for the reality of long-term drug safety. For decades, the dominant medical narrative minimized the persistent, intrusive nature of SSRI side effects. Yet, throughout his time on Seroxat, Dr Gordon battled chronic, deeply distressing physiological impacts that directly challenged this sanitized orthodoxy. The medication caused heavy sweating, sexual dysfunction in the form of delayed orgasm, and chronic urinary problems, including incontinence.
The unpredictable, systemic hazards of this decades-long exposure culminated in a life-threatening medical emergency in 2020. While out in the Scottish mountains, Dr Gordon suffered an unexplained seizure - a critical event that required the deployment of two rescue helicopters. Although an extensive medical investigation found no definitive cause for the episode, SSRIs are clinically recognized for their potential to lower the seizure threshold. The fact that this neurological risk remains largely unacknowledged within everyday clinical practice underscores a wider institutional failure: a refusal to acknowledge that long-term central nervous system prescribing can carry severe, unpredictable bodily costs.
Originally prescribed the medication for generalized anxiety, Dr Gordon eventually decided to discontinue it. Being aware of the potential for discontinuation symptoms, he did not stop abruptly but instead undertook a gradual reduction that lasted for more than a year. What followed was not a return of his underlying anxiety, but a catastrophic psychological collapse that he had never before experienced.
Despite the careful reduction, the withdrawal process triggered a profound, terrifying state of depressed mood, accompanied by severe, unrelenting suicidality. The intensity of this medically induced state was so overwhelming that it resulted in a serious attempt on his own life. He required acute psychiatric hospitalisation and underwent a course of Electroconvulsive Therapy (ECT). This experience was highly distressing for Dr Gordon and his family. It confirmed that SSRI withdrawal was not the ‘mild, transient discontinuation reaction’ described in pharmaceutical literature and official guidelines at the time.
Dr Gordon recognized that his position as both a survivor of severe withdrawal and a consultant psychiatrist gave him a rare, authoritative vantage point. He began speaking out publicly, giving interviews that were featured in prominent national publications, including the Herald and the Daily Mail. He became a vocal critic of the deeply entrenched financial ties between the pharmaceutical industry and leading psychiatric institutions and demanded absolute transparency regarding pharmaceutical influence. He repeatedly returned to the foundational importance of lived experience, arguing that modern psychiatry had drifted dangerously toward reducing complex human suffering into narrow, simplified, diagnostic checkboxes. He insisted that the story of the sufferer must be heard in order that the suffering is understood, and that true healing required balancing scientific biology with attentiveness to meaning, context, and personal history.
The true test of an institution’s ethics is how it responds to internal critique. For Dr Gordon, the transition to public campaigner was met not with open scientific debate but with institutional defensiveness. When he began publicly raising urgent questions about antidepressant withdrawal, lack of informed consent, and conflicts of interest within the medical establishment, the response from parts of his own profession was one of suspicion, professional distancing, and active marginalisation. Instead of engaging with the substance of his arguments, the psychiatric system turned its diagnostic lens upon the whistleblower himself, contacting Dr Gordon’s employing health board directly to raise concerns about his personal mental welfare. Dr Gordon described the terrifying, disorienting experience of being gaslighted by his peers. The profession was utilizing its unique power - the power to diagnose and deem someone mentally unstable - to undermine his credibility as a critic.
To fully understand why the psychiatric establishment reacted with such defensiveness to Dr Gordon, one must examine the wider historical context of SSRI withdrawal denial in the United Kingdom. For decades, leading psychiatrists and the Royal College of Psychiatrists maintained an official stance that minimized the struggles of hundreds of thousands of patients trying to come off these medications. The official position, propagated by leading figures in the field, was that antidepressant withdrawal symptoms were rare, mild, and self-limiting, usually resolving within a week or two. Any patient who reported severe, long-lasting emotional turmoil, physical distress, or suicidality upon stopping an SSRI was routinely told that they were not experiencing withdrawal at all. Instead, leading psychiatrists asserted that the patient was simply experiencing a relapse of their original depressive illness, requiring them to stay on the medication indefinitely. This stance - deeply rooted in the industry-backed messaging of early initiatives like the ‘Defeat Depression Campaign’ - effectively locked patients into long-term dependency while shielding the medications from critical scrutiny.
Today, the wider perspective on SSRIs is finally shifting, forced open by the sheer volume of individuals coming forward to share harmful consequences similar to Dr Gordon's. Yet, this long-overdue cultural shift has revealed a new, equally troubling institutional response. Psychiatry, having fiercely resisted patient testimony for nearly three decades, now appears to be issuing messages that subtly rewrite history. The profession is increasingly positioning itself as though it always understood that antidepressants can be difficult to stop and cause significant harm whilst trying to come off them. For Dr Gordon, this revisionist narrative represents a refusal by the medical establishment to take accountability for the decades of gaslighting, denial, and institutional defensiveness that preceded this shift.
In Scotland today, nearly one in four of the adult population is taking an antidepressant. Recent figures suggest that a significant proportion are taking them beyond a twelve-month period - despite the fact that the vast majority of Evidence-Based Medicine (EBM) studies of these drugs do not extend past a year.
In 2026, Dr Gordon is left with the following questions:
• Is it really plausible that twenty-five percent of our population require long-term antidepressants for "clinical depression"?
• Is it reasonable for psychiatrists and academics to argue that symptoms after stopping antidepressants are more likely explained by a relapse, rather than the consequences of long term exposure to drugs whose full effects on our nervous system remain unknown?
• Given the defensive, dismissive track record of psychiatry as an institution, can we really continue to trust the advice it gives to us, to the wider medical profession, and to our governments?
Thank you for articulating and sharing this. All so horrible. I'm a retired doctor, who had a life threatening withdrawal as well, still dealing with the gaslighting. I so appreciate this line 'The true test of an institution’s ethics is how it responds to internal critique.' For a profession with intelligent people, the openness to learn seems to have got lost in both the stress of the work and the factors around that, but importantly the overall mindset and curious approach to learn and continue to make things better. The culture of medicine has huge room for growth.
Thank you Rose. I am so sorry to hear what you have gone through, just like myself. Mark H is a fabulous doctor and has done so much to bring real-world experience back into psychiatry.
As a medical professional who, like you and the other commenters, am now in Group 2 due to personal experience…is it terribly cynical of me to not have hope that Group 1 will change their views unless/until they, or someone they love, experiences withdrawal themselves?
I’m always fascinated when people who haven’t been personally affected somehow make it into Group 2.
Thank you for taking the time to put your thoughts into words.
Thanks Mairin. I share your fear - I am really afraid that people in Group 1 cannot be convinced unless they themselves go through it or someone close to them does. We cannot wait for that. I am often contacted by doctors or psychiatrists who are going through withdrawal and part of me thinks great! they will tell their colleagues but often they are too sick to continue working...
Thank you so much for this excellent & illuminating article Mark. I'm two years into a difficult taper from 3 psychiatric meds & it's not always easy to refrain from harbouring intense anger towards the professionals who literally forced me onto these drugs 2+ decades ago. Having deeper insight into why prescribers view the issue of drug discontinuation as they do is incredibly helpful, especially as it falls on my shoulders to allay the concerns of my prescriber when I ask for a lower dose of whatever drug I'm tapering. I cannot see the discipline of psychiatry with it's radical dependence on drugs being overhauled in any meaningful way so I believe what you're doing, ie educating both prescribers and patients, is the way to go. Thank you for your excellent work :)
I can understand why patients who have been harmed by psychiatric drugs start to believe that clinicians must be malicious in some way but I do think a lot of it is just the way they have been taught. I think the academic and leader class of these institutions are more aware of the issues and their motivations are more problematic....
This is so incredibly on point, Mark. As an NP who worked in the medical field for 15 years, I can say that clinicians do aim to help their patients and are severely misled. I now think back to all of the patients who were in withdrawal. Especially in the ICU when the intensivist reconciles a long med list while the patient is on a vent and says “cymbalta?! They won’t need this right now!!”. How many patients died of complications I truly believe to be a result of acute illness mixed with acute psych med withdrawal is horrific and why I’ll never go back.
Although I suspected all of this for many years, this truly became very evident after experiencing severe protracted withdrawals myself for the last 3 years. I then realized I’ve been experiencing some level of neurological dysfunction from being remedicated for withdrawal for the past 18 years since adolescence. You have truly hit the nail on the head and I hope this comes to light in our lifetime.
Yes, like you I've had flashbacks to presentations that I realise now in retrospect were almost certainly withdrawal but that I had not idea of back then. I also wonder how many physical health presentations, emergency presentations must be due to withdrawal. It cannot be a trivial number....But I do think the vast majority of clinicians are there to help people and would change their approach if they were educated to. There are blocks to this sort of educational change.
Thank you for this excellent article!! I appreciate how you highlighted how the patient loses their voice and agency in the power dynamic with the psychiatrist. This power dynamic is so real and it kept me from questioning the medications being prescribed to me as anything but relapse.
Well done in describing the bizarre symptoms of withdrawal and how they are so unbelievable. It is hard to imagine unless you have gone through it, let alone having medical professionals both recognize and accept these symptoms as withdrawal.
I remember the hopeless of seeing doctors, but a need for care. In one appointment the gp said “you can come off ad’s, I came off mine. I reduced, skipped a day and …oh yes I developed awful palpitations so had to go back on them”.
When I tried to make a formal complaint to the NHS mental health trust about their unsafe deprescribing it was dismissed because my consequent problems were labelled relapse and the academic research I was quoting was said to be “vanguard” research - and their practice was based on the established research written into guidelines.
Your analysis is very interesting thank you and I look forward to part two…
How do you think the power dynamics preventing safer withdrawal practices being implemented can be best overcome?
This is a very helpful, important article, written with both thoughtfulness and experience. Thank you Mark for writing this and for trying to help us all understand why psychiatry does not "see" withdrawal.
It might be helpful to share [verbatim] quotes from psychiatry/psychiatrists in relation to antidepressant withdrawal [these quotes are all from the public domain and dates and sources can be provided for all]:
COMING OFF ANTIDEPRESSANTS -WHAT THEY SAID:
DEFEAT DEPRESSION CAMPAIGN: "New guidance in recognizing and managing depression"
KEY MESSAGES:
1. ‘Clinical depression’ is significantly under-treated.
2. Prevalence of clinically treatable depression is 1 in 20
3. Patients should be informed clearly when antidepressants are first prescribed that discontinuing treatment in due course will not be a problem"
PROF SIR SIMON WESSLEY: "We know that in the long-term antidepressants help reduce relapse. They are good drugs and that is why they are used widely."
PROF WENDY BURN: "We know that in the vast majority of patients, any unpleasant symptoms experienced on discontinuing antidepressants have resolved within two weeks of stopping treatment."
DR ADRIAN JAMES: "The majority of people will have either mild side effects or they will be self-limiting."
DR LADE SMITH: "Media and public discourse over the last few years... has at times lacked balance [and] risks undermining the important role of antidepressants"
PROF ROB HOWARD: "The experience of many of us who follow our patients after discontinuation – because we have always been worried about relapse – has been that these phenomena are not common and generally resolve quickly"
DR SAMEI HUDA: "Doctors are following the evidence which shows that antidepressants prevent relapse which is common in depression."
PROF ALLAN YOUNG: "So-called withdrawal reactions from antidepressants are usually mild to moderate and respond well to simple management."
PROF SAMEER JAUHAR: "Despite previous concern about stopping antidepressants, our work finds that most people do not experience severe withdrawal"
PROF DAVID BALDWIN: "We know that in the vast majority of patients, any unpleasant symptoms experienced on discontinuing antidepressants have resolved within two weeks of stopping treatment."
PROF DAVID NUTT: "The definitive overview of antidepressant withdrawal just out today ... the hysteria about antidepressant addiction was unwarranted. Whilst withdrawal effects do exist, the available literature suggests modest, albeit heterogeneous, effects of antidepressant drug discontinuation."
PROF DAME CLARE GERADA: "I can count on one hand the number who have gone on to have long term problems withdrawing from antidepressants"
DR GUY GOODWIN: "Patients who wish to discontinue SSRIs can do so without major problems from withdrawal effects."
Dr MARK BOLSTRIDGE: "The vast majority don't experience SSRI withdrawal"
PROF CARMINE PARIANTE: "This meta-analysis finally puts to bed the controversy on antidepressants."
PROF TONY KENDRICK: "It wasn't possible to get everyone off their antidepressants... Half of people relapse on stopping them. Half the people need them to stay well."
DR DAVID FOREMAN: "We should be careful about language. If someone needs an antidepressant to remain symptom free then the dependence relates to the disorder, not the drug"
Michael Ostacher, MD: “Those likely to have the ‘clinician’s illusion’ have practices limited to people with withdrawal. If only they could see that.”
Dr Tyler Black, MD: "It’s a fabricated crisis. SSRI withdrawal is rare."
I appreciate you outlining this issue in such detail. I hope many other prescribers read it, especially those who have not had this experience themselves. As I mentioned in my restack, it’s a real problem that in areas of the psychology/psychiatry field in which the science has not yet caught up, this is too often the case. Only the doctors who have been through something similar are willing to go out on a limb and say, yes, this experience you are telling me about is real and valid. We need to change this.
I have had many experiences of not being able to find doctors who know why I’m experiencing various symptoms. This helps me listen carefully and learn from my patients, and when there’s something they present that doesn’t line up with what I have learned previously, I know it’s time to do more research and digging.
It is a bit awful if you have to find a doctor who suffers from the same condition as you in order to get help. This is a failure of the medical enterprise. There are more and more studies now finding withdrawal effects, etc but there is also a lot of institutional defensiveness to taking up these new ideas. It is a battle where I fear professional reputations are prioritised above patient welfare.
Right, how long does it have to take for doctors to say: “Hmm, that’s not what I was taught, but let me see if I can find out more.” To be fair I work with a few private practice psychiatrists who do think this way. But I’ve only had one hospital doctor I’ve seen listen to my health story and say, “Wow, I’m going to look into that.”
That's true - I think as more and more information about this comes out it is becoming harder for prescribers to be ignorant. But there is a lot of gatekeeping about what goes into prescriber education - and some of the gatekeepers are conflicted, financially and ideologically. Some of them demonstrate this on Twitter and other social media every day...
Thank you for writing this. I will print it and take it to my GP practice, to go alongside the pertinent pages of your deprescribing book that I gave them - three times over - during the severe and life threatening SSRI withdrawal reactions I had. They seen to yet to have really understood the issue - and I am a retired doctor as well.
I'll be interested in your next part...Having experienced this from the patient side, I have fears that the issues with psychiatry go deeper than antidepressants--but perhaps the deeper issues can be addressed, as more professionals begin to speak up. 🤞
I am curious...the chemotherapy analogy grazed an idea that I've been polishing for a while: do you think it has been at all damaging to the science to frame suicide as a health risk, as if it were an involuntary physical reaction? Those are the stakes that people who get heated about reduced access are latching onto, after all--in their minds, people could die. And I don't mean to say that suicide is voluntary--I want to be very clear that I understand it *is* a risk--but should we perhaps discuss that risk in different terms than we do, say, cancer? Is some scientific accuracy lost when we disregard that nuance?
What an interesting thought about the way we categorise suicide risk. I will be turning that one over in my mind for a while. The comments section on Substack always gives me something to think about!
Thank you, Dr. Horowitz. Both the prank analogy and the iceberg graphic were very helpful to me, to reevaluate and more importantly categorize the rage from my lived experience into ‘flows’ that I may be able to take more meaningful action from.
What remains unchanged in the part of me that holds despair still from a decade of life lost to this insidious circular harm, is that there is no balm for the lack of training in the first place, right?
There’s nothing as clear as all that you have made more clear here in this immensely helpful blog—for me at least—that speaks to the ‘How’ is it possible that the overseeing agencies of medical school educations the world-over, would not catch their own grave error in supposing that it was a good idea to instruct medical students how to prescribe these medications, but not how to deprescribe — safely.
The omission of this is too obvious to let go, for me. It doesn’t seem accidental. And so many emotions flow from that realization; some of the more powerful ones being betrayal, disgust and as mentioned earlier, rage.
I can’t think of a single profession that claims and is trusted for expertise in establishing a service for a customer that they would not also be expected to know how to shut off or stop if the customer changed their mind or was unhappy with the work product.
Thank you for all of the work you are doing through awareness hard won through your own lived experience.
Academic arrogance and ignorance whether that’s wilful or not combined with the program everyone who went to school has of obeying authority combined with persuasive marketing driven by profit driven pharmaceutical companies who fund the biased research and teach the biased curriculum run by financially captured universities run by often compromised and corrupted CEOs combined with multi generational childhood trauma on all sides, not just the patient, overseen by corrupted politicians controlled by anti human and anti life entities. All of that combined, mixed with the fear of being seen as “different “ creates an environment of division.
Personally after years of trying to wake people up, I’ve come to the conclusion that those who realise, realise and start to take responsibility for themselves. Those who want to come off will find the practitioners and community who do “get it”.
I believe these discussions and practices around slow tapering are the tin tak on the ocean going liner of the psychiatric industry.
The tin tak has turned.
It’s just going to take a while for the rest to follow and some won’t and that’s ok.
Oh and by the way, chemotherapy and radiation are the why of death by cancer. That’s another multi million dollar industry that profits from maintaining the status quo. But that’s another hill not to die on!
I’m someone who came off Prozac , Effexor, tegretol and lamictal and now work as a psychotherapist trying to set up a taper clinic in Melbourne.
My aim is to get into the GPS and bribe them with sushi and sandwiches and do b a lunch time talk on deprescibing and recognition of withdrawal symptoms.
The clients are finding me.
I’m a nurse (no longer registered) who worked for years in ED then in the AoD space so I understand the pharmacology, what I’m needing is access to people like you mark who I can discuss tapers clinically with so I can then make educated suggestions to the gps who get scared of psychological symptoms.
The system is terrified of the liability of suicide which also creates caution when faced with patients who want to come off their meds.
All I can say is that we keep on keeping on because the Tim tak has turned.
Great article, and a useful framework for talking with colleagues. As a GP/Rural ED person in Australia, who is at the tail end (I hope) of a lengthy SSRI withdrawal, I find my profession’s addiction to very narrow sources of drug information/guidelines a bit cult-like and anything which might help to gently de-programme them is a boon.
Thanks Gavin. I think it is understandable why busy cognitively overloaded GPs/doctors stick to authoritative guidelines. It is exhausting to go through and do independent reading yourself especially when you have to cover every condition. I did not understand how much work 'expert consensus' or short-term studies which do not reflect real life did in these guidelines before I looked at them closely - as an academic type person it is a luxury most don't have. I hope you are able to at least bring a few people's attention to these issues and I hope your tapering goes Ok.
I’m a primary care peds NP who prescribes these meds - more reluctantly and with more informed consent and more discussion from day #1 about not staying on them forever - than in the past. But, still, I prescribe them.
The above - about “than in the past” has admittedly been very much informed by my own experience and what I learned in the process (so much of that from you, so, thank you for your ongoing work in this area!)
I was on Prozac 20mg for a decade. More than one psych NP over those years and never a discussion about tapering off. In fact, the psychiatrist who originally started me on it advised I take it for life “like insulin for a diabetic”. I thought this was his own clever analogy until years later I hear others say they heard the exact same words.
When I asked about tapering off, I was given the standard “drop to 10mg for a week, then stop” advice. I instead decided to taper over 7 weeks and, at the end, it all fell horribly apart. It made no sense to me. I started googling. Exactly what all of us clinicians hate when our patients do. We don’t know what we don’t know. I know now.
I did a hyperbolic taper. 26 months. I finished a few weeks ago. My psych NP believed me… sort of. He said at one point, “I’ve never had a patient struggle to stop Prozac unless they relapsed.” He let me do my thing. Probably partly because he’s a good guy and a reasonable clinician. Probably partly also because I’m also an NP and got a bit more leeway for that.
I gifted him Maudsley about a year in. At the end, I asked him if he’d ever looked at it. He said no. He said “you’ve taught me things also”. Yes, but. Also it was clear he felt my withdrawal had been mild. Um, so not.
I presented at a national peds NP conference in March on deprescribing and will present at a psych NP conference in October. Like you, I’ve sat on both sides of this which I think gives a unique perspective.
Thanks for sharing. I think so much of what we see is influenced by what we've been taught - perhaps something like eskimoes and snow. If we have 40 words for relapse and almost no words for withdrawal then we are going to see relapse. Interesting that your NP characterised your withdrawal as mild when it was anything but. It is this which makes me understand why so many prescribers on social media swear they never see withdrawal.
Thank you for your work and this excellent article.
I’m not a physician. I suffered from delayed discontinuation after what my doctor considered to be a conservative taper off of Effexor. The experience was horrific. I couldn’t work (I was a lawyer in a big firm from which I’ve since retired.) After 3 months of misery I finally went back on a much smaller dose of the drug and finally stabilized.
My doctor had not seen anything like my withdrawal, although it was easy for me to find sites on the Internet replete with stories like mine.
I am still taking the drug almost 15 years later. I would love to discontinue, but my wife and I both are terribly fearful of going through that again.
I’m now in my 70s and as I age I am equally fearful that I will end up having to depend on someone else to manage my drugs at some point. The thought that someone would intentionally or accidentally discontinued the drug is terrifying.
Thank goodness a few doctors are now specializing in de prescribing.
Thanks Jim - I get endless emails from people like yourself who are stuck on an antidepressant because of a failed taper. And what doctors consider to be a conservative taper is often anything but. You might aware of the newer technique of hyperbolic tapering which can make it easier to stop - but many people are too shellshocked by their previous failed attempt to try again. Sorry for your awful experience.
Dear Mark,
I have recently written a summary of my experience - as both a psychiatrist and a person who has struggled coming off an SSRI antidepressant. I think it may be helpful to share alongside your article 'Why Doctors Don't See Withdrawal'. I will paste it below. I have tried to keep it short but you may quite reasonably think it is too long for tis comment space [please note: I need to amend the time order as my 'unexplained' seizure happened in December 2021].
aye Peter
For twenty-five years, Dr Peter Gordon worked in the National Health Service as a consultant psychiatrist. However, his understanding of his own profession was fundamentally altered by a prescribed medication: the Selective Serotonin Reuptake Inhibitor (SSRI) Seroxat, also known as paroxetine.
Dr Gordon started taking Seroxat in 1997 during a time of personal and professional stress. He was concurrently sitting his membership examination for Psychiatry whilst his sleep was being disturbed by a new baby at home. At this time, the ‘Defeat Depression Campaign’ was underway across the United Kingdom. Sponsored in good part by the pharmaceutical industry and supported by the Royal College of Psychiatrists (RCPsych), one of the campaign's key messages - designed to "educate" doctors and the public alike - was the confident claim that SSRI antidepressants would not cause any difficulties in stopping. Under this prevailing medical reassurance, Dr Gordon began a treatment that would ultimately span decades; he has now been on this SSRI for three decades.
This thirty-year dependency has taken an ongoing toll on his physical health and demonstrates how institutional denial and a systemic lack of informed consent leave patients entirely unprepared for the reality of long-term drug safety. For decades, the dominant medical narrative minimized the persistent, intrusive nature of SSRI side effects. Yet, throughout his time on Seroxat, Dr Gordon battled chronic, deeply distressing physiological impacts that directly challenged this sanitized orthodoxy. The medication caused heavy sweating, sexual dysfunction in the form of delayed orgasm, and chronic urinary problems, including incontinence.
The unpredictable, systemic hazards of this decades-long exposure culminated in a life-threatening medical emergency in 2020. While out in the Scottish mountains, Dr Gordon suffered an unexplained seizure - a critical event that required the deployment of two rescue helicopters. Although an extensive medical investigation found no definitive cause for the episode, SSRIs are clinically recognized for their potential to lower the seizure threshold. The fact that this neurological risk remains largely unacknowledged within everyday clinical practice underscores a wider institutional failure: a refusal to acknowledge that long-term central nervous system prescribing can carry severe, unpredictable bodily costs.
Originally prescribed the medication for generalized anxiety, Dr Gordon eventually decided to discontinue it. Being aware of the potential for discontinuation symptoms, he did not stop abruptly but instead undertook a gradual reduction that lasted for more than a year. What followed was not a return of his underlying anxiety, but a catastrophic psychological collapse that he had never before experienced.
Despite the careful reduction, the withdrawal process triggered a profound, terrifying state of depressed mood, accompanied by severe, unrelenting suicidality. The intensity of this medically induced state was so overwhelming that it resulted in a serious attempt on his own life. He required acute psychiatric hospitalisation and underwent a course of Electroconvulsive Therapy (ECT). This experience was highly distressing for Dr Gordon and his family. It confirmed that SSRI withdrawal was not the ‘mild, transient discontinuation reaction’ described in pharmaceutical literature and official guidelines at the time.
Dr Gordon recognized that his position as both a survivor of severe withdrawal and a consultant psychiatrist gave him a rare, authoritative vantage point. He began speaking out publicly, giving interviews that were featured in prominent national publications, including the Herald and the Daily Mail. He became a vocal critic of the deeply entrenched financial ties between the pharmaceutical industry and leading psychiatric institutions and demanded absolute transparency regarding pharmaceutical influence. He repeatedly returned to the foundational importance of lived experience, arguing that modern psychiatry had drifted dangerously toward reducing complex human suffering into narrow, simplified, diagnostic checkboxes. He insisted that the story of the sufferer must be heard in order that the suffering is understood, and that true healing required balancing scientific biology with attentiveness to meaning, context, and personal history.
The true test of an institution’s ethics is how it responds to internal critique. For Dr Gordon, the transition to public campaigner was met not with open scientific debate but with institutional defensiveness. When he began publicly raising urgent questions about antidepressant withdrawal, lack of informed consent, and conflicts of interest within the medical establishment, the response from parts of his own profession was one of suspicion, professional distancing, and active marginalisation. Instead of engaging with the substance of his arguments, the psychiatric system turned its diagnostic lens upon the whistleblower himself, contacting Dr Gordon’s employing health board directly to raise concerns about his personal mental welfare. Dr Gordon described the terrifying, disorienting experience of being gaslighted by his peers. The profession was utilizing its unique power - the power to diagnose and deem someone mentally unstable - to undermine his credibility as a critic.
To fully understand why the psychiatric establishment reacted with such defensiveness to Dr Gordon, one must examine the wider historical context of SSRI withdrawal denial in the United Kingdom. For decades, leading psychiatrists and the Royal College of Psychiatrists maintained an official stance that minimized the struggles of hundreds of thousands of patients trying to come off these medications. The official position, propagated by leading figures in the field, was that antidepressant withdrawal symptoms were rare, mild, and self-limiting, usually resolving within a week or two. Any patient who reported severe, long-lasting emotional turmoil, physical distress, or suicidality upon stopping an SSRI was routinely told that they were not experiencing withdrawal at all. Instead, leading psychiatrists asserted that the patient was simply experiencing a relapse of their original depressive illness, requiring them to stay on the medication indefinitely. This stance - deeply rooted in the industry-backed messaging of early initiatives like the ‘Defeat Depression Campaign’ - effectively locked patients into long-term dependency while shielding the medications from critical scrutiny.
Today, the wider perspective on SSRIs is finally shifting, forced open by the sheer volume of individuals coming forward to share harmful consequences similar to Dr Gordon's. Yet, this long-overdue cultural shift has revealed a new, equally troubling institutional response. Psychiatry, having fiercely resisted patient testimony for nearly three decades, now appears to be issuing messages that subtly rewrite history. The profession is increasingly positioning itself as though it always understood that antidepressants can be difficult to stop and cause significant harm whilst trying to come off them. For Dr Gordon, this revisionist narrative represents a refusal by the medical establishment to take accountability for the decades of gaslighting, denial, and institutional defensiveness that preceded this shift.
In Scotland today, nearly one in four of the adult population is taking an antidepressant. Recent figures suggest that a significant proportion are taking them beyond a twelve-month period - despite the fact that the vast majority of Evidence-Based Medicine (EBM) studies of these drugs do not extend past a year.
In 2026, Dr Gordon is left with the following questions:
• Is it really plausible that twenty-five percent of our population require long-term antidepressants for "clinical depression"?
• Is it reasonable for psychiatrists and academics to argue that symptoms after stopping antidepressants are more likely explained by a relapse, rather than the consequences of long term exposure to drugs whose full effects on our nervous system remain unknown?
• Given the defensive, dismissive track record of psychiatry as an institution, can we really continue to trust the advice it gives to us, to the wider medical profession, and to our governments?
Thank you for articulating and sharing this. All so horrible. I'm a retired doctor, who had a life threatening withdrawal as well, still dealing with the gaslighting. I so appreciate this line 'The true test of an institution’s ethics is how it responds to internal critique.' For a profession with intelligent people, the openness to learn seems to have got lost in both the stress of the work and the factors around that, but importantly the overall mindset and curious approach to learn and continue to make things better. The culture of medicine has huge room for growth.
Thank you Rose. I am so sorry to hear what you have gone through, just like myself. Mark H is a fabulous doctor and has done so much to bring real-world experience back into psychiatry.
aye Peter
Thanks Peter.
As a medical professional who, like you and the other commenters, am now in Group 2 due to personal experience…is it terribly cynical of me to not have hope that Group 1 will change their views unless/until they, or someone they love, experiences withdrawal themselves?
I’m always fascinated when people who haven’t been personally affected somehow make it into Group 2.
Thank you for taking the time to put your thoughts into words.
Thanks Mairin. I share your fear - I am really afraid that people in Group 1 cannot be convinced unless they themselves go through it or someone close to them does. We cannot wait for that. I am often contacted by doctors or psychiatrists who are going through withdrawal and part of me thinks great! they will tell their colleagues but often they are too sick to continue working...
Thank you so much for this excellent & illuminating article Mark. I'm two years into a difficult taper from 3 psychiatric meds & it's not always easy to refrain from harbouring intense anger towards the professionals who literally forced me onto these drugs 2+ decades ago. Having deeper insight into why prescribers view the issue of drug discontinuation as they do is incredibly helpful, especially as it falls on my shoulders to allay the concerns of my prescriber when I ask for a lower dose of whatever drug I'm tapering. I cannot see the discipline of psychiatry with it's radical dependence on drugs being overhauled in any meaningful way so I believe what you're doing, ie educating both prescribers and patients, is the way to go. Thank you for your excellent work :)
I can understand why patients who have been harmed by psychiatric drugs start to believe that clinicians must be malicious in some way but I do think a lot of it is just the way they have been taught. I think the academic and leader class of these institutions are more aware of the issues and their motivations are more problematic....
This is so incredibly on point, Mark. As an NP who worked in the medical field for 15 years, I can say that clinicians do aim to help their patients and are severely misled. I now think back to all of the patients who were in withdrawal. Especially in the ICU when the intensivist reconciles a long med list while the patient is on a vent and says “cymbalta?! They won’t need this right now!!”. How many patients died of complications I truly believe to be a result of acute illness mixed with acute psych med withdrawal is horrific and why I’ll never go back.
Although I suspected all of this for many years, this truly became very evident after experiencing severe protracted withdrawals myself for the last 3 years. I then realized I’ve been experiencing some level of neurological dysfunction from being remedicated for withdrawal for the past 18 years since adolescence. You have truly hit the nail on the head and I hope this comes to light in our lifetime.
Yes, like you I've had flashbacks to presentations that I realise now in retrospect were almost certainly withdrawal but that I had not idea of back then. I also wonder how many physical health presentations, emergency presentations must be due to withdrawal. It cannot be a trivial number....But I do think the vast majority of clinicians are there to help people and would change their approach if they were educated to. There are blocks to this sort of educational change.
Thank you for this excellent article!! I appreciate how you highlighted how the patient loses their voice and agency in the power dynamic with the psychiatrist. This power dynamic is so real and it kept me from questioning the medications being prescribed to me as anything but relapse.
Well done in describing the bizarre symptoms of withdrawal and how they are so unbelievable. It is hard to imagine unless you have gone through it, let alone having medical professionals both recognize and accept these symptoms as withdrawal.
Incredible.
I remember the hopeless of seeing doctors, but a need for care. In one appointment the gp said “you can come off ad’s, I came off mine. I reduced, skipped a day and …oh yes I developed awful palpitations so had to go back on them”.
I have an additional concern https://substack.com/@octopusface/note/p-200163226?r=2qdx3a&utm_medium=ios&utm_source=notes-share-action
When I tried to make a formal complaint to the NHS mental health trust about their unsafe deprescribing it was dismissed because my consequent problems were labelled relapse and the academic research I was quoting was said to be “vanguard” research - and their practice was based on the established research written into guidelines.
Your analysis is very interesting thank you and I look forward to part two…
How do you think the power dynamics preventing safer withdrawal practices being implemented can be best overcome?
This is a very helpful, important article, written with both thoughtfulness and experience. Thank you Mark for writing this and for trying to help us all understand why psychiatry does not "see" withdrawal.
It might be helpful to share [verbatim] quotes from psychiatry/psychiatrists in relation to antidepressant withdrawal [these quotes are all from the public domain and dates and sources can be provided for all]:
COMING OFF ANTIDEPRESSANTS -WHAT THEY SAID:
DEFEAT DEPRESSION CAMPAIGN: "New guidance in recognizing and managing depression"
KEY MESSAGES:
1. ‘Clinical depression’ is significantly under-treated.
2. Prevalence of clinically treatable depression is 1 in 20
3. Patients should be informed clearly when antidepressants are first prescribed that discontinuing treatment in due course will not be a problem"
PROF SIR SIMON WESSLEY: "We know that in the long-term antidepressants help reduce relapse. They are good drugs and that is why they are used widely."
PROF WENDY BURN: "We know that in the vast majority of patients, any unpleasant symptoms experienced on discontinuing antidepressants have resolved within two weeks of stopping treatment."
DR ADRIAN JAMES: "The majority of people will have either mild side effects or they will be self-limiting."
DR LADE SMITH: "Media and public discourse over the last few years... has at times lacked balance [and] risks undermining the important role of antidepressants"
PROF ROB HOWARD: "The experience of many of us who follow our patients after discontinuation – because we have always been worried about relapse – has been that these phenomena are not common and generally resolve quickly"
DR SAMEI HUDA: "Doctors are following the evidence which shows that antidepressants prevent relapse which is common in depression."
PROF ALLAN YOUNG: "So-called withdrawal reactions from antidepressants are usually mild to moderate and respond well to simple management."
PROF SAMEER JAUHAR: "Despite previous concern about stopping antidepressants, our work finds that most people do not experience severe withdrawal"
PROF DAVID BALDWIN: "We know that in the vast majority of patients, any unpleasant symptoms experienced on discontinuing antidepressants have resolved within two weeks of stopping treatment."
PROF DAVID NUTT: "The definitive overview of antidepressant withdrawal just out today ... the hysteria about antidepressant addiction was unwarranted. Whilst withdrawal effects do exist, the available literature suggests modest, albeit heterogeneous, effects of antidepressant drug discontinuation."
PROF DAME CLARE GERADA: "I can count on one hand the number who have gone on to have long term problems withdrawing from antidepressants"
DR GUY GOODWIN: "Patients who wish to discontinue SSRIs can do so without major problems from withdrawal effects."
Dr MARK BOLSTRIDGE: "The vast majority don't experience SSRI withdrawal"
PROF CARMINE PARIANTE: "This meta-analysis finally puts to bed the controversy on antidepressants."
PROF TONY KENDRICK: "It wasn't possible to get everyone off their antidepressants... Half of people relapse on stopping them. Half the people need them to stay well."
DR DAVID FOREMAN: "We should be careful about language. If someone needs an antidepressant to remain symptom free then the dependence relates to the disorder, not the drug"
Michael Ostacher, MD: “Those likely to have the ‘clinician’s illusion’ have practices limited to people with withdrawal. If only they could see that.”
Dr Tyler Black, MD: "It’s a fabricated crisis. SSRI withdrawal is rare."
I appreciate you outlining this issue in such detail. I hope many other prescribers read it, especially those who have not had this experience themselves. As I mentioned in my restack, it’s a real problem that in areas of the psychology/psychiatry field in which the science has not yet caught up, this is too often the case. Only the doctors who have been through something similar are willing to go out on a limb and say, yes, this experience you are telling me about is real and valid. We need to change this.
I have had many experiences of not being able to find doctors who know why I’m experiencing various symptoms. This helps me listen carefully and learn from my patients, and when there’s something they present that doesn’t line up with what I have learned previously, I know it’s time to do more research and digging.
It is a bit awful if you have to find a doctor who suffers from the same condition as you in order to get help. This is a failure of the medical enterprise. There are more and more studies now finding withdrawal effects, etc but there is also a lot of institutional defensiveness to taking up these new ideas. It is a battle where I fear professional reputations are prioritised above patient welfare.
Right, how long does it have to take for doctors to say: “Hmm, that’s not what I was taught, but let me see if I can find out more.” To be fair I work with a few private practice psychiatrists who do think this way. But I’ve only had one hospital doctor I’ve seen listen to my health story and say, “Wow, I’m going to look into that.”
That's true - I think as more and more information about this comes out it is becoming harder for prescribers to be ignorant. But there is a lot of gatekeeping about what goes into prescriber education - and some of the gatekeepers are conflicted, financially and ideologically. Some of them demonstrate this on Twitter and other social media every day...
Thank you for writing this. I will print it and take it to my GP practice, to go alongside the pertinent pages of your deprescribing book that I gave them - three times over - during the severe and life threatening SSRI withdrawal reactions I had. They seen to yet to have really understood the issue - and I am a retired doctor as well.
This was a really illuminating analysis.
I'll be interested in your next part...Having experienced this from the patient side, I have fears that the issues with psychiatry go deeper than antidepressants--but perhaps the deeper issues can be addressed, as more professionals begin to speak up. 🤞
I am curious...the chemotherapy analogy grazed an idea that I've been polishing for a while: do you think it has been at all damaging to the science to frame suicide as a health risk, as if it were an involuntary physical reaction? Those are the stakes that people who get heated about reduced access are latching onto, after all--in their minds, people could die. And I don't mean to say that suicide is voluntary--I want to be very clear that I understand it *is* a risk--but should we perhaps discuss that risk in different terms than we do, say, cancer? Is some scientific accuracy lost when we disregard that nuance?
Thank you.
What an interesting thought about the way we categorise suicide risk. I will be turning that one over in my mind for a while. The comments section on Substack always gives me something to think about!
Thank you, Dr. Horowitz. Both the prank analogy and the iceberg graphic were very helpful to me, to reevaluate and more importantly categorize the rage from my lived experience into ‘flows’ that I may be able to take more meaningful action from.
What remains unchanged in the part of me that holds despair still from a decade of life lost to this insidious circular harm, is that there is no balm for the lack of training in the first place, right?
There’s nothing as clear as all that you have made more clear here in this immensely helpful blog—for me at least—that speaks to the ‘How’ is it possible that the overseeing agencies of medical school educations the world-over, would not catch their own grave error in supposing that it was a good idea to instruct medical students how to prescribe these medications, but not how to deprescribe — safely.
The omission of this is too obvious to let go, for me. It doesn’t seem accidental. And so many emotions flow from that realization; some of the more powerful ones being betrayal, disgust and as mentioned earlier, rage.
I can’t think of a single profession that claims and is trusted for expertise in establishing a service for a customer that they would not also be expected to know how to shut off or stop if the customer changed their mind or was unhappy with the work product.
Thank you for all of the work you are doing through awareness hard won through your own lived experience.
This is how I perceive the main issues:
Academic arrogance and ignorance whether that’s wilful or not combined with the program everyone who went to school has of obeying authority combined with persuasive marketing driven by profit driven pharmaceutical companies who fund the biased research and teach the biased curriculum run by financially captured universities run by often compromised and corrupted CEOs combined with multi generational childhood trauma on all sides, not just the patient, overseen by corrupted politicians controlled by anti human and anti life entities. All of that combined, mixed with the fear of being seen as “different “ creates an environment of division.
Personally after years of trying to wake people up, I’ve come to the conclusion that those who realise, realise and start to take responsibility for themselves. Those who want to come off will find the practitioners and community who do “get it”.
I believe these discussions and practices around slow tapering are the tin tak on the ocean going liner of the psychiatric industry.
The tin tak has turned.
It’s just going to take a while for the rest to follow and some won’t and that’s ok.
Oh and by the way, chemotherapy and radiation are the why of death by cancer. That’s another multi million dollar industry that profits from maintaining the status quo. But that’s another hill not to die on!
I’m someone who came off Prozac , Effexor, tegretol and lamictal and now work as a psychotherapist trying to set up a taper clinic in Melbourne.
My aim is to get into the GPS and bribe them with sushi and sandwiches and do b a lunch time talk on deprescibing and recognition of withdrawal symptoms.
The clients are finding me.
I’m a nurse (no longer registered) who worked for years in ED then in the AoD space so I understand the pharmacology, what I’m needing is access to people like you mark who I can discuss tapers clinically with so I can then make educated suggestions to the gps who get scared of psychological symptoms.
The system is terrified of the liability of suicide which also creates caution when faced with patients who want to come off their meds.
All I can say is that we keep on keeping on because the Tim tak has turned.