Clinicians are more aware than they once were of the potential for problems to occur when someone comes off long-term dependence on common antidepressants, even with an extended taper. Not everyone experiences discomfort, of course. But when it does occur, it can be a real problem for an unlucky patient.

This article vividly describes the writer’s own experience and follows up with a question: why wasn’t I adequately warned about the potential for such problems? Or more accurately: Was the prescribing physician even aware that this could happen? and if so, why not share the info with me?

Good question. After all, taking a prescribed med is different from deciding on your own to light up a Marlboro or have a beer. Those are drugs too, although we often forget that. With prescribed medications, the physician serves as our trusted intermediary — the figure in the white coat in whom we place our faith that the drug we’re about to take is not only necessary but safe.

And most of us do pay attention to the doctor’s advice. It helps us overcome our misgivings about ingesting an unfamiliar substance.

The physician, meanwhile, depends on information provided by medical science, usually in the form of materials available from the Pharma firm that markets the product. We can imagine how easily this  information could be distorted during communication — for instance, by a salesperson with skimpy knowledge of the drug and an aggressive quarterly sales quota to meet.

Sometimes the flaw is in the research itself– perhaps it failed to catch a hidden problem that becomes apparent once the medication is in wide circulation. Perhaps the clinical trial lasted only a few months, yet in practice patients wind up taking the medication for a much longer period, possibly years. Where’s the research on that? There isn’t any.

When patients ask questions that are too difficult, doctors may fall back on conditional responses, such as “I saw no evidence of that in the literature.” It’s very Mueller-like. But as we all know, absence of evidence is not evidence of absence. Could simply be that the data wasn’t in yet, or wasn’t widely publicized.

Don’t forget, once the drug is on the drugstore shelf, the incentive is to keep it there, earning back the company’s financial investment in its development.

I suspect that’s what happened with Prozac and its sisters. There was such widespread popular  enthusiasm about this new generation of antidepressants that concerns about longterm problems were simply pushed aside. The SSRIs were far superior, partly because unlike earlier variants, patients who took them did not gain weight. That’s especially relevant when you remember that at the time, two-thirds of adults in treatment for depression were women.

Even if later on problems did emerge, it would have been tempting to blame them on a recurrence of the primary disorder. In fact, some practitioners, psychiatrists included, increased the dose, thinking the patient needed more. Or perhaps added another medication in the hope that it would correct the problem. And inadvertently complicated the situation.

Unless the patient sought other advice and treatment, s/he may never have realized there were other options.

It’s a bit like being caught in a trap. At some point you begin to wonder: Am I taking this drug because I have an illness that requires it, or simply to satisfy my ever-growing dependence? There’s no easy way to tell.