(THEME MUSIC PLAYS)
This pill could solve all of your problems.
CREW: We are recording. Are you good to go?
And it may mean the end of depression as we know it.
REPORTER: They were a new generation of antidepressants
REPORTER: They were a new generation hailed as the latest wonder drugs.
MARK HOROWITZ: I thought...
..you know, heard so much promise about these things,
this might be the thing to fix everything.
this might be the thing I LOVED being on Prozac.
Now 1-in-7 of us is taking an antidepressant.
Wouldn't you be tempted to take it again and again?
But only now, decades after their launch,
But only now, is a different story being told...
I was, you know, baffled by, you know, how could this be?
I was, you know, baffled by, ..how a patient movement
revealed what some drug companies had tried to ignore.
I didn't know about any of this. I hadn't been warned.
We felt patients on the ground had been vindicated.
DAVID TAYLOR: In the mental-health sphere
we're quite good at making the same mistake more than once.
Many say they've been helped by antidepressants,
Many say they've been helped but for those harmed by them
it's been a struggle to be heard.
I've been waiting for you to show up for 15 years.
I've been waiting for you to show up Thank you for coming.
It's amazing.
ARCHIVE PRESENTER: Now, it's 36 minutes past the hour,
and I'm going to show you an incredible drug.
Imagine a drug that could make everything feel better,
that could take away the stress of everyday life
and transform you into somebody completely different.
That drug was Prozac,
one of the first That drug was Prozac,
one of the first in a new class of antidepressants.
Over nine million people take it here
Over nine million people and the number is growing every day.
WENDY BURN: The first person I ever prescribed to,
she had been depressed for years WENDY BURN: The first person I ever prescribed to,
she had been depressed for years
and basically would hardly leave the house.
She phoned up a week later and said,
"I don't need to see you. I'm going on holiday."
And she took her whole family to Disneyland in Paris.
It was just amazing.
So, they really did seem to me like miracle drugs when they came along.
I've been on Prozac now for about six months
and it's changed my way I think.
I've got more confidence. I want to go out more.
You know, it's just changed my life completely.
All of a sudden here comes somebody that says,
"OK, now try these on, try this Prozac on."
And I tried it on, and for the first time in my life I went,
"Whoa. Is this the way reality really is?"
DAVID NUTT: Prozac had some real advantages.
It was the first time we'd actually been able to prescribe DAVID NUTT: Prozac had some real advantages.
It was the first time we'd actually been able to prescribe
a medicine that didn't have side effects,
or at least it didn't have side effects
that patients complained about.
AUDREY BAHRICK: The first thing I remember was a cover story
where Prozac was called the 'miracle drug'.
In the early 1990s
Audrey Bahrick was working as a psychologist
at the University of Iowa.
At the time, I had just taken a leave of absence from my job
to go with a partner to another city, At the time, I had just taken a leave of absence from my job
to go with a partner to another city,
and that adjustment was difficult
and I decided to seek out Prozac
based on what I'd read.
There was no discussion
about what to expect.
Prozac gave Audrey the boost she'd hoped for.
Prozac gave Audrey I did feel confident and energised.
It was very novel.
I was not a person It was very novel.
I was not a person who had a lot of energy before that.
I LOVED being on Prozac.
This is me looking very happy, with a fuller head of hair,
getting the prize for Public Communication
because I did a few public-education events
in which I talked in part about the benefits of antidepressants
for treating depression and other disorders.
for treating depression So, I was given a couple of prizes.
My mum was impressed by it.
I went to an all-boys school
and I was a know-it-all,
I was a smart-arse
and I was the shortest in the class, I was a smart-arse
and I was the shortest in the class,
I was the youngest
and I was bullied.
And I think and I was bullied.
And I think that had a big effect on me.
Mark was diagnosed with depression when he was 21.
He's been taking antidepressants ever since.
My first one, I was super excited.
You know, I almost ran to the pharmacy to fill the script.
I remember ripping open the packet, you know,
seeing these green and white capsules and thinking, you know,
seeing these green and white "This is a very exciting moment."
I was... I couldn't wait to start them.
I thought...you know, heard so much promise about these things.
This might be the thing to fix everything.
I've got a different view of them now.
During the 1990s
these new antidepressants became global blockbusters...
..driving up
antidepressant prescriptions
antidepressant in the UK
by more in the UK
by more than 200%.
The drugs made billions worldwide.
JERRY ROSENBAUM: The marketing was massive.
There was lots of conferences
and presentations
and, you know, lunches and dinners.
These were extraordinarily commercially successful launches.
This new generation of drugs were called SSRIs -
selective serotonin reuptake inhibitors.
They were made by several companies and had an array of brand names.
I'm David Healy.
I'm a medical doctor, professor of psychiatry,
and I've worked on the serotonin system one way or the other
and I've worked on the serotonin for over 40 years.
SSRIs target a chemical called serotonin.
It can affect mood, appetite, sleep and sex drive.
Serotonin is found in the brain and throughout the body.
Everybody thinks, because it's an antidepressant,
that it's doing something to the brain.
But, actual fact, it's much more likely
But, actual fact, to be doing something to our body.
When I was taking Prozac, I was energised, I felt sharp,
When I was taking Prozac, I was in a good mood,
I had felt more confident.
Prozac made Audrey I had felt more confident.
Prozac made Audrey feel better in herself.
Prozac made Audrey But something else was going on too.
I was almost immediately sexually numbed.
I was almost immediately Within a day, my genitals were numb.
I was very surprised.
I looked at the product insert literature
and saw that sexual side effects were very unlikely,
and certainly I'd never heard of numb genitals.
Prozac patient leaflets in the US at the time
warned small numbers of people might experience
reduced libido, sexual dysfunction and infrequent impotence,
but no mention of numb genitals.
And the numbing sensation wasn't just physical.
I think my range of feelings was somewhat blunted.
I think my range of feelings And it's kind of a mixed bag
because if you're deeply depressed
or highly anxious,
if you can take the edge off
those extremes,
that can be helpful.
Unfortunately,
I was left with being able to feel more intensely distressed
than intensely elated.
It's not known how SSRIs cause sexual or emotional numbing,
It's not known how SSRIs but the two may be linked.
All antidepressants to some extent but the two may be linked.
All antidepressants to some extent
of numbing emotions,
seem to have the property of numbing emotions,
and in some cases of numbing emotions,
and in some cases
this effect seems to be associated
with their ability to cause sexual dysfunction.
Despite drug companies
originally saying sexual side effects WEREN'T common,
originally saying sexual side effects studies now suggest
they affect at least a third of studies now suggest
they affect at least a third of patients while they're taking SSRIs.
AUDREY BAHRICK: I felt confident and well and energised
AUDREY BAHRICK: I felt confident and therefore thought
it was an acceptable temporary and therefore thought
it was an acceptable temporary trade-off to be so sexually numbed.
There was a particular person that I was interested in dating.
There was a particular person I went off of the medication
with the expectation I went off of the medication
with the expectation that my sexual interest and feelings
with the expectation would resume as before.
I was very confused when things didn't change.
That was very, very hard on the relationship.
And, you know, I don't blame him for wanting to move on.
And, you know, I don't blame him I get it.
I stayed fairly hopeful.
All that time I thought being healthy, eating well
All that time could help me resolve this.
But nothing...nothing did.
You know, I continued to hope for months
You know, and then years.
It's been...
..27 years.
DAVID HEALY: We don't actually know
why the sexual problems with these drugs
could persist after the drugs were halted.
In terms of what serotonin does to us,
it's extraordinary, we understand so little.
A few times over the years I had come off my medication
thinking maybe I don't need it anymore.
And all those times I'd felt bad afterwards
and concluded that I was better on the medication.
Mark Horowitz had been taking antidepressants for 15 years.
He was training to be a psychiatrist
and studying antidepressants for a PhD
when he tried to stop again.
It led to complete havoc in my life.
So, I had trouble sleeping,
I would wake up in the morning So, I had trouble sleeping,
I would wake up in the morning in full panic,
like I was being chased by an animal,
like I was on the edge of a cliff.
And that panic wouldn't abate for hours until the late evening.
I took up running 10 kilometres a day,
I took up running I ran until my feet bled
because it gave me a slight reprieve from that panic sensation.
Mark knew he wasn't addicted
but felt he was experiencing withdrawal.
So, antidepressants are not addictive.
Addiction is normally thought of as something extra -
Addiction is normally craving, compulsion,
a focus on the drug
and also a euphoric high.
When you stop a drug that you've become adapted to,
your body and brain will miss the drug,
and that's what causes the withdrawal symptoms.
and that's what causes Nothing in his medical training
had prepared him for what was happening.
As someone that was training in psychiatry,
As someone that had taken antidepressants
and had studied antidepressants in my PhD,
and had studied antidepressants I thought that I knew everything
there was to know I thought that I knew everything
there was to know about antidepressants.
And what I quickly worked out is that I knew almost nothing,
and if I had no understanding, then the public surely had even less.
and if I had no understanding, then From the beginning the SSRIs
were marketed with the message
that they were not addictive,
like the benzodiazepines,
and that they were relatively safe.
Professor David Taylor is chief pharmacist
at one of the UK's leading mental-health hospitals -
The Maudsley in South London.
DAVID TAYLOR: When we started with SSRIs
we had an idea that they were effective
and we were aware
that they caused
short-term side effects.
Hello. Medication Helpline.
The Maudsley ran a helpline in the '90s
for people taking psychiatric drugs.
It was striking for people taking psychiatric drugs.
It was striking that we got so many calls
from people who were having quite severe problems
from people who were having stopping antidepressants
and that those problems seem to go on for weeks or months.
I remember we debated whether or not
we thought that it was possible
for those withdrawal effects to last that long
or it was the case that there was some kind of psychosomatic disorder.
Before the drugs were launched
they were tested by manufacturers in clinical trials
they were tested by manufacturers to assess safety and effectiveness.
In early trials, withdrawal symptoms to assess safety and effectiveness.
In early trials, withdrawal symptoms weren't closely studied.
In early trials, withdrawal symptoms To my knowledge,
this wasn't looked at particularly carefully
in the trials that were done.
You only need to do studies for six weeks,
so, we might not have seen withdrawal
so, we might not after that short duration of use.
For many drugs,
the longer you take them
the more likely you are to experience withdrawal when stopping.
the more likely you are to experience Medicines are licensed
before long-term studies Medicines are licensed
before long-term studies have been done.
before long-term studies And, again, this is about balancing
the need to get effective medicines to patients
and the risk of discovering something
after we've licensed those medicines.
There are very few trials that have lasted longer than six months
and almost none that have lasted longer than a year.
So, really, we can say
that everyone who takes these drugs
for more than a few weeks
is taking part in a huge, unregulated experiment
to find out what the long-term consequences of doing this are.
Panorama has discovered, as evidence of withdrawal symptoms grew,
one pharmaceutical company wanted to keep what it knew to itself.
Your take on a few of these documents...
Your take James Davies is a psychologist
and campaigner on psychiatric drug harms.
He's looking at a confidential Pfizer memo from 1996.
In it staff discuss what the company will tell regulators in Norway
In it staff discuss what the company about its drug sertraline.
It says... (READS)
So, some of the withdrawal reactions they are listing here,
we've got sensory disturbances, sweating, nausea, insomnia,
tremors, agitation, anxiety.
It's quite clear from this document
they know that these effects exist,
that they are hugely problematic.
But this isn't translating often into the information
that patients on the ground were getting,
that patients on the ground presumably because it would affect
the economic profile presumably because it would affect
the economic profile of these medications.
Pfizer says it's been "monitoring and reporting all adverse event data"
to the licensing authorities
"in line with its legal and regulatory obligations
"and updated sertraline labelling as required."
The MHRA, the UK's drug regulator, as required."
The MHRA, the UK's drug regulator,
to "conduct retrospective analyses
says in 2003 it asked manufacturers to "conduct retrospective analyses
"of their clinical trial data." to "conduct retrospective analyses
"of their clinical trial data."
It says it "led to more detailed information" on withdrawal
being added to SSRI labelling. information" on withdrawal
being added to SSRI labelling.
(SIREN WAILS)
I'm Jerry Rosenbaum.
I'm a professor of psychiatry at Harvard Medical School.
During the early 1990s
doctors at one of America's most prestigious hospitals
also began noticing withdrawal symptoms.
We had some pretty dramatic cases in our clinic also began noticing withdrawal symptoms.
We had some pretty dramatic cases in our clinic
of people with emergency-room visits.
We saw people have these symptoms. It was pretty clear.
I think at the time we thought it was rare.
One of the professor's team
was working on an industry-funded trial
for a new antidepressant that also targeted serotonin.
He did something, I guess,
the drug company didn't necessarily approve of,
the drug company which is, after the study was over,
he followed the patients as they discontinued
and published a paper
about the symptoms that emerged during that period.
They published data
showing 78% of those who'd taken the drug for eight weeks They published data
showing 78% of those who'd taken the drug for eight weeks
had some withdrawal symptoms within three days of stopping.
Professor Rosenbaum went on to publish a study
of three other antidepressants.
For two of them - sertraline and paroxetine -
more than half of patients who had taken the drugs
for between four months and two years
experienced withdrawal symptoms when they stopped.
experienced withdrawal symptoms The interesting thing is,
like all of psychiatry,
there was tremendous variation.
I mean, there was a small group there was tremendous variation.
I mean, there was a small group of people who had terrible effects
and a larger group of people who didn't notice it.
You know, it's something that doctors needed to be aware of
because some of the cases that we saw
were of people who were told there's no problem stopping these medicines.
Highlighting evidence of withdrawal symptoms
didn't go down well with the wider medical profession.
It wasn't a message that,
despite our, you know, position in this august institution,
despite our, you know, got out very well.
I also personally got some negative feedback from colleagues
I also personally got some about focusing on that issue,
saying that I was an adverse force for the field,
that we worked so hard to get antidepressants,
you know, acceptable.
Pfizer no longer holds the license for sertraline.
GlaxoSmithKline still makes paroxetine.
They both say patients shouldn't stop treatment abruptly.
They both say patients Any decision to stop
should always be taken in close consultation with your doctor.
With limited research available,
doctors were learning about antidepressants through experience.
For The Maudsley's Professor Taylor, it was his own.
He'd been taking antidepressants himself.
I stopped taking antidepressants more than 20 years ago now,
and I had in mind mild, transient and short-lived.
And it was anything but.
It was really quite an unpleasant experience,
and that's probably an understatement.
I was quite shocked by it.
I gained from the experience
and was better able to appreciate what other people were telling me.
In the mental-health sphere
we're quite good at making the same mistake more than once.
And I suspect people felt that we wouldn't let that happen again,
we wouldn't allow an introduction of a group of drugs
we wouldn't allow which seemed to work really well
but then later find that it was difficult for people to stop them.
But that is pretty much what's happened with SSRIs.
Withdrawal symptoms can be similar to those of depression and anxiety.
Withdrawal symptoms can be similar They're sometimes mistaken
for a return of the condition the drugs were prescribed to treat.
Change in mood, change in sleep, anxiety, panic.
Change in mood, change in sleep, Those kinds of symptoms
are quite common.
There are also physical symptoms,
so, dizziness,
changes in digestion,
strange physical symptoms, which people call 'brain zaps'.
strange physical symptoms, Because of this overlap
it's often quite difficult to know
in the early stages of coming off an antidepressant
whether a person is simply getting withdrawal symptoms
whether a person is simply or they're becoming depressed.
WENDY BURN: People are staying or they're becoming depressed.
WENDY BURN: People are staying on antidepressants
WENDY BURN: People are staying for longer and longer.
And we don't really have long-term studies that support that. for longer and longer.
And we don't really have long-term studies that support that.
And, you know, the drugs DO have side effects.
You shouldn't just stay on them
without ever thinking about coming off them.
I would suggest that anyone who's on an antidepressant
should have their treatment reviewed every six months.
And you must never stop an antidepressant
without discussing it with your doctor.
VIDEO PRESENTER: Imagine a world
where every word ever written
could be viewed instantly in your home
via an information superhighway.
By the early 2000s
the Internet began connecting people
who were experiencing problems with their drugs.
ADELE FRAMER: I already knew about using the web.
I was an early adopter of the Internet.
Adele Framer was working as a software consultant
before she says antidepressant withdrawal forced her to quit.
Her doctors thought she was relapsing.
It was clear to me that I was not having a relapse Her doctors thought she was relapsing.
It was clear to me that I was not having a relapse
because I'd never experienced those symptoms before.
because I'd never experienced They were really strange.
Adele set up a support group called Surviving Antidepressants.
Almost everybody who comes to my site
Almost everybody has been told that they've relapsed.
They've been told has been told that they've relapsed.
They've been told that their withdrawal symptoms
are depression or anxiety or whatever.
are depression or anxiety This is a very universal experience.
AUDREY BAHRICK: The Internet changed everything
for people who were experiencing psychiatric drug harms
for people who were experiencing that were undocumented.
We found each other.
All along I believed I couldn't be alone,
but I never had any evidence that I wasn't alone.
It was a very lonely journey
and it became progressively more isolating.
Mostly I wanted to just be believed.
And in one of my routine searches on the Internet,
And in one of my routine searches I found, oh, my gosh,
someone had started a support group
for people who had enduring sexual dysfunction after stopping SSRIs.
Audrey began publishing
some of the first ever Audrey began publishing
some of the first ever academic papers on her condition.
some of the first ever It's become known as PSSD -
post-SSRI sexual dysfunction.
A large part of my motivation
was to put out some papers into the world
that could be downloaded and brought to their physician
that could be downloaded or brought to their prescriber.
I don't want anybody to ever have to or brought to their prescriber.
I don't want anybody to ever have to go through what I've gone through.
So, this is me writing in 2019.
"Hello.
"I feel so depressed and depersonalised
"I feel so depressed "and fatigued at times.
"I'm not sure what to do with myself.
"If it IS withdrawal,
"then I really hope that it can't last too much longer
"because it is sapping my will to keep going."
It just reminds me of how upsetting it was.
I'm a bit.... I'm in a better place than I was then,
I'm a bit.... I'm in a better place but it was a very hard process.
It's a bit upsetting to read it.
At the time
UK guidelines advised
steadily reducing or tapering UK guidelines advised
steadily reducing or tapering an antidepressant dose
steadily reducing or tapering over four weeks.
They said withdrawal would be generally mild and short-lived.
Mark had already tried to stop his antidepressant, but couldn't,
Mark had already tried to stop so, he looked for advice online
and found Adele's site.
Online I was getting advice
from retired engineers and firemen and housewives.
from retired engineers and firemen It was clear who the experts were.
People said it took months to come off.
It took more than a year for some of them
and it took several years for quite a few of them.
I could see that a lot of people were coming down
by very small amounts of their drug as they got down to lower doses,
by smaller and smaller amounts.
And the reason they were doing that
is because they felt
that their withdrawal symptoms
became more pronounced that their withdrawal symptoms
became more pronounced at lower doses,
which was...you might think is a bit surprising,
you might think you're on less of the drug,
you might think it should be easier to come off.
But I heard it again and again,
people saying it's these small doses
that are particularly hard to come off.
Many drugs don't come in such small doses,
so, some people who are struggling found creative solutions.
They were grinding up tablets with nail files
and measuring them with jeweller's scales.
They were making liquids
by crushing them and making liquids
and using syringes to measure them out.
They were opening up capsules to count beads.
As I followed their guidelines and slowly came off,
it was a lot easier than when I came off more quickly.
Tiredness, memory trouble, concentration issues
started to improve,
which was, I should say, you know, a huge gift to me.
Mark then teamed up with The Maudsley's Professor David Taylor.
Together they wrote the first paper on how to ease withdrawal symptoms
by tapering the dose very slowly.
It was published 30 years after the launch of Prozac.
The way I see it is half the field is empty in psychiatry.
All the papers, all the textbooks, all the research
is about how to start the drugs,
and there's almost no research and guidelines
on how to stop the drugs.
To me, it's the same as allowing on how to stop the drugs.
To me, it's the same as allowing cars to be sold without brakes.
We should know how to start the car and how to stop it.
I remember very clearly
when I first went into I remember very clearly
when I first went into severe withdrawal
looking it up on the Internet
looking it up and I was absolutely horrified
because I saw that so many people were suffering the same thing.
And I didn't know about any of this. I hadn't been warned.
Luke Montagu took Prozac for more than a decade.
When I stopped the Prozac and I had these severe withdrawal reactions
I thought that that was evidence that I was really ill
and that I needed the drug in order to survive.
I used to think of myself as being held together
I used to think of myself by pieces of chemical string.
I remember thinking about that by pieces of chemical string.
I remember thinking about that at the time.
And we just didn't know that it was withdrawal.
And, of course, that then led to the misdiagnosis
of more things that were wrong with me for which more drugs were added.
By now he was on another antidepressant.
When Luke tried to stop taking all the drugs a few years later
he says the withdrawal was so bad he couldn't leave home for three years.
I could at least read online and I could go to websites,
and it was really the volume of people online
suffering in the same way, with the same story,
being left on them long-term,
coming off them, suffering horrendous withdrawal,
and then, critically, having that withdrawal denied,
having the harms denied by the doctors.
And that was my story. Exactly that had happened to me.
And that was my story. And that made me think
that, really, there was a profound problem with the system
and that if I was going to recover
I was going to try and do something about that.
Luke contacted the psychologist James Davies.
He and I got together and we thought, "What can we do to help?"
The critical thing was to get to the experts,
because, ultimately, if things were going to change,
we needed to change the opinion of experts.
There was something that always perplexed us, we needed to change the opinion of experts.
There was something that always perplexed us,
There was something and it was this massive disjunct
between what the guidelines were saying,
that antidepressant withdrawal
is usually mild, self-limiting, resolving over a week,
and what we were encountering online.
James and Luke wrote a letter to The Times newspaper
saying antidepressant withdrawal can be disabling for many patients.
saying antidepressant withdrawal It was 2018
and it started a public debate
with the then-president of and it started a public debate
with the then-president of the Royal College of Psychiatrists.
WENDY BURN: I replied
saying that antidepressants DID work
and also talking about withdrawal saying that antidepressants DID work
and also talking about withdrawal
and saying that withdrawal wasn't really a problem.
I didn't really expect anything to come of that.
It was really quite a kind of, you know,
casual send a letter to The Times, which when you're president, you do.
casual send a letter to The Times, You do quite a lot.
But people got really upset and really angry.
I think Wendy found herself in a really difficult position
I think Wendy found herself because, on the one hand,
she had a lot of her members, a lot of psychiatrists,
she had a lot of her members, who had promoted this story
that antidepressant withdrawal who had promoted this story
that antidepressant withdrawal was mild and short-lived,
that antidepressant withdrawal and then, at the same time,
she had all of these patients and campaign groups
coming to her and saying, "This isn't true at all."
I was realising that the college had got it wrong.
So, then we had to work out how to put things right.
She asked two experts who'd both experienced withdrawal themselves
She asked two experts who'd both to help.
We had a lot of input from different people,
We had a lot of input but two of the big influence
were Professor David Taylor but two of the big influence
were Professor David Taylor and Dr Mark Horowitz.
They produced a patient information leaflet on withdrawal
and how to taper the dose.
We thought, if patients are getting withdrawal symptoms,
they can show it to their doctor and say,
"Look, the Royal College of Psychiatrists
"Look, the Royal College "says that withdrawal is a thing
"and this is how "says that withdrawal is a thing
"and this is how you might experience it."
"and this is how For us, it was a significant U-turn.
This was the first time
a major psychiatric organisation
like the Royal College a major psychiatric organisation
like the Royal College of Psychiatrists
like the Royal College had stepped up and acknowledged
a problem that had been there for a long time.
We felt patients on the ground had been vindicated.
I think now people accept that a small minority of people
will have significant difficulty in stopping antidepressants I think now people accept that a small minority of people
will have significant difficulty in stopping antidepressants
will have significant difficulty and they'll get withdrawal symptoms,
which are severe
inasmuch as that they are difficult to tolerate
and they can go on for a very long time.
Professor Burn is no longer president of the Royal College.
She's still a practising psychiatrist
She's still and personally regrets
that severe and long-lasting withdrawal wasn't recognised sooner.
I can't really explain why it took...why it took so long,
perhaps partly because of the overlap
perhaps partly between relapse and withdrawal.
I don't know. I can't really explain it.
Do you feel like there's an apology that should be made?
I guess, yes.
If there's anybody watching who's gone through withdrawal
If there's anybody watching and it wasn't recognised,
then I'm very sorry.
In the US
Audrey had been trying for years
to get recognition for the serious sexual side effects of SSRIs.
I vigorously reached out to dozens of health journalists.
Every major newspaper in a big city I wrote to them.
All those efforts resulted in just a couple nibbles
All those efforts but no follow-through.
It appeared no-one wanted to listen.
You know, you'd think to yourself,
"Sex - the media will be interested You know, you'd think to yourself,
"Sex - the media will be interested in sex."
It was just the opposite. "Sex - the media will be interested in sex."
It was just the opposite.
You know, you mentioned sex,
and the media shut down.
By 2019
there were 93.6 million
prescriptions in the UK
for all types of antidepressants.
The number had almost doubled
The number had in a decade.
Now even rarer SSRI side effects were being more widely discussed.
People suffering with post-SSRI sexual dysfunction
also began to find each other and raise awareness.
The UK's medicines regulator
has been receiving reports
of persistent sexual side effects since 1991.
Two internal reviews later concluded
there was insufficient data to issue any warnings.
We don't know much about the prevalence of PSSD.
There haven't been any systematic surveys.
There haven't been We don't know how common it is.
But what I would say is that, even if it's quite uncommon,
antidepressants are being used so commonly now
that that would still amount to a substantial number of people.
It's absolutely horrendous.
It flipped whatever plans and future It's absolutely horrendous.
It flipped whatever plans and future I had for my life upside down.
Like, I almost laugh at the fact that I used to think I was suffering
until I got this.
I require medical attention, until I got this.
I require medical attention,
but there is no medical assistance I require medical attention,
but there is no medical assistance to be found for this condition
but there is no medical assistance as it is underreported and understudied.
An acknowledgement that sexual side effects can persist
after stopping the drugs
was finally added to SSRI patient leaflets in 2019.
I just feel like I've been completely done over to SSRI patient leaflets in 2019.
I just feel like I've been completely done over
by the medical community.
They've updated their packaging,
but it still doesn't reflect
the fact that you can be permanently chemically castrated.
To this day we've got doctors simply not believing people
when they say that this can happen.
You know, so, that's still the experience of a lot of people.
You know, so, that's still It adds to the awful problem.
This isn't saying that you won't recover.
We need to hang on to the hope of recovery
and the fact that there is more research happening.
So, this hope is hopefully getting stronger.
All I can do is just hope So, this hope is hopefully getting stronger.
All I can do is just hope that my body knows what to do
All I can do is just hope and it can go back
to the way that it used to be before I took this medication.
In 2021
the number of antidepressant prescriptions in the UK
reached 100 million. the number of antidepressant prescriptions in the UK
reached 100 million.
With 1-in-7 of us taking them,
understanding the benefits and the risks is more important than ever.
They've actually saved the lives of many hundreds of thousands of people
and they've allowed people to cope They've actually saved the lives of many hundreds of thousands of people
and they've allowed people to cope
with what is becoming a more and more stressful society.
And it might be a lot worse without them.
While many doctors report
their patients often improve on antidepressants,
their patients over the last 15 years
how well they work has been over the last 15 years
how well they work has been increasingly called into question.
My name is Erick Turner.
I'm a former FDA reviewer
and before that
a research fellow at National Institute of Mental Health.
When Erick Turner joined the US regulator,
When Erick Turner the Food And Drug Administration,
he'd been prescribing antidepressants the Food And Drug Administration,
he'd been prescribing antidepressants as a psychiatrist.
He'd also researched them as an academic.
When I came to the FDA He'd also researched them as an academic.
When I came to the FDA
it was the spring of 1998.
I thought I knew all about how well drugs work.
And once I got there I found out that I didn't.
I didn't know much of anything.
Working at the FDA,
Dr Turner got to see confidential drug-company data
from their clinical trials.
Those trials measured antidepressants effectiveness
by comparing the drug with a dummy pill, or placebo.
Right away I saw a number of negative studies
where the drug didn't beat placebo,
and I was, you know, baffled by, you know, how could this be?
and I was, you know, baffled It was a shock to me
because, looking at journal articles It was a shock to me
because, looking at journal articles and psychiatry journals,
it appeared that the drugs always were superior to placebo,
and I had no reason to think otherwise.
and I had no reason To gain approval from regulators
companies usually need to show To gain approval from regulators
companies usually need to show at least two successful trials
where their drug beat placebo by a significant margin.
where their drug beat placebo What Erick was seeing
was how many attempts companies needed to achieve that.
And then I spoke with my boss about this.
And then I spoke with my boss I said, "What's going on here?
"What's with all these negative studies?"
"What's with And he kind of chuckled,
"Oh, yeah. And he kind of chuckled,
"Oh, yeah. Basically, it happens all the time.
"Yeah, about 40% of the time these studies will fail."
"Yeah, about 40% of the time And...
Yeah, I didn't see the humour in that.
Erick Turner began scrutinising studies
Erick Turner published by the drug companies
and their trial data published by the drug companies
and their trial data only the FDA got to see.
and their trial data If you look at the FDA data
you find out that the fact is
that it's roughly half the trials are negative,
it did not beat placebo,
and only half were positive.
In 2008 he published the first evidence
of how many antidepressant trials were unsuccessful.
He found the effectiveness of a range of antidepressants
He found the effectiveness had been overstated
by between 11% and 69%. had been overstated
by between 11% and 69%.
If you exaggerate the benefits,
make the drug look more effective than it really is
by suppressing negative studies,
then that's going to alter the risk-benefit ratio right there.
then that's going to alter By that time
clinicians have been prescribing Prozac and Zoloft and Paxil
for many years,
and they probably were quite comfortable with them
and felt that they knew what they needed to know about these drugs.
In 2018
a leading academic and his team
published a review that had taken six years to complete.
Their aim - to settle the debate
over the effectiveness of antidepressants.
ANDREA CIPRIANI: Part of the controversy
is the influence of industry
in this area,
because in the past
we know that there was a push
for prescribing drugs
and trying to market these drugs
as a quick fix, an easy solution.
And they are definitely not.
ARCHIVE REPORTER: Scientists think
they have finally answered the question ARCHIVE REPORTER: Scientists think
they have finally answered the question
they have finally answered in a huge study.
They analysed in a huge study.
They analysed more than 500 clinical trials,
including previously unpublished data held by drug companies.
This was the largest studies ever carried out in mental health.
Professor Cipriani's analysis of trials
involving people with depression analysis of trials
involving people with depression
showed, on average, more improved substantially
with an antidepressant than placebo. more improved substantially
with an antidepressant than placebo.
We know that antidepressants are better than placebo,
but the difference is about 15% from placebo.
So, it's not a huge, dramatic difference.
Around 40% of patients
improved on placebo,
around 55% improved on the drug,
giving a 15% difference
between the two.
The difference between placebo
and active treatment
can be the difference and active treatment
can be the difference between life or death
if it happens to be that it gets you above being suicidal.
if it happens to be that it gets you We have to look at the benefit-risk.
The benefit-risk for SSRI is actually...
..you know, really rather remarkable, I think.
ANDREA CIPRIANI: It's an average effect,
but it doesn't reflect what is the reality,
which is some people don't respond at all
and other people respond a lot to the medication.
This is why we need to get rid of the one-size-fits-all approach.
The companies behind the most widely used SSRIs in the UK
say that many clinical trials and studies by independent researchers
say that many clinical trials and show their drugs are effective,
that they've been taken show their drugs are effective,
that they've been taken by millions worldwide
for potentially devastating and sometimes life-threatening conditions
and that they've helped patients globally.
They say, as with all medicines, SSRIs have potential side effects,
which are clearly stated in the prescribing information.
And they say their drugs are considered to be safe
And they say their drugs with a positive benefit-risk ratio
by doctors, patients and regulators around the world.
Mark's now been reducing his dose for five years.
He's hoping to stop completely in the next few months.
MARK HOROWITZ: The history of psychiatry
is of drugs being put onto the market,
is of drugs being told that they're effective,
there's minimal side effects and they're easy to stop,
and, again and again, that it's turned out
that years later that none of those things are true.
DAVID TAYLOR: What matters are the regulatory conditions,
DAVID TAYLOR: What matters and at the moment, to my knowledge,
there isn't a regulatory demand
that new drugs are tested in terms of their long, very long-term use
and the likely long-term effects of withdrawing.
Millions of people around the world
continue to take SSRI antidepressants.
For many, the benefits still outweigh the risks.
I believe very firmly, as does the college,
I believe very firmly, that antidepressants are helpful.
And I've seen throughout my long and extensive career,
I have seen people benefit from antidepressants
and I see lives being saved by them.
So, I think, you know, the SSRIs will be history at some point.
I think they were more helpful than not.
But, you know, not everybody was helped, for sure.
But, you know, Lots of people weren't.
It's more than 30 years
since the wonder drugs of a generation
promised safe, effective treatment for depression.
But the story has turned out to be much more complicated.
And for those who've been harmed by them,
it's been a long, hard fight to be heard.
it's been a long, hard fight OK, good boy. Yeah.
Let's go home, buddy. Let's go home.
So, you've asked what I think Let's go home, buddy. Let's go home.
So, you've asked what I think my life might have been like
So, you've asked what I think if this hadn't happened.
It's a really painful question.
It's really hard to contemplate.
It's left an indelible mark on my life.
It's left an indelible mark It's been huge.
But nobody's life is predictable.
I've retired now and...
..threw out a lot of my files.
I thought I might have been done.
And how does it feel kind of sitting here and talking about it now?
I've been waiting for you to show up for 15 years.
I've been waiting for you to show up Thank you for coming.
It's amazing.
Captions by Red Bee Media
Copyright Australian Broadcasting Corporation