00:00So, I was on an antidepressant, a common one in Australia, called escitalopram or Lexapro
00:06for about 15 years, and I tried to come off it several years ago.
00:10I came off it much slower than guidelines recommend, over a few months, down to quite
00:14small doses, what I thought at the time, and I got into a lot of trouble.
00:19I started waking up in full-blown terror, like I was being chased by a wild animal.
00:24I'd had hours and hours a day of that, of sort of a long-standing panic attack.
00:29I had trouble sleeping, things around me appeared strange, and I was dizzy.
00:36That went on for week after week after week, and after a couple of months of that, I thought,
00:42I can't continue living like this.
00:44And the issue was, it was nothing like the issues that had put me on the drug in the
00:47first place.
00:48I'd gone on as a miserable 21-year-old with a variety of existential concerns.
00:55When I came off it, this was nothing like that.
00:56It was of an intensity I'd never experienced.
01:00And so what had your doctor advised you about coming off them?
01:03So the guidelines at the time were the same as they are today in Australia.
01:07They recommend coming off by halving your dose for a couple of weeks, halving it again
01:11for a couple of weeks, and then stopping.
01:13So the recommendations at the moment are stop over about four weeks.
01:17But from your experience, that just didn't work.
01:20So when did you decide, I've got to look into this and help other people through this?
01:25So at first I thought, look, I'm a very unlucky bloke.
01:27I've had a very bad time.
01:29But when I looked around, I saw there were hundreds and then eventually thousands and
01:32tens of thousands of people with similar issues online, all with the same story.
01:37The advice given by my doctor led to a lot of side effects, withdrawal effects from coming
01:41off the drugs.
01:43I found better advice on these online forums.
01:46And what I learned from these forums was that coming off over months, and sometimes more
01:50than a year, even years, going down by very small amounts, using a liquid version of the
01:55drug, made it much easier to come off the drug.
01:58And I actually followed the guidelines on these websites and was able to come off my
02:02drug.
02:03And I hope to inform doctors about a safer way of getting patients off their drug in
02:06the same way.
02:07Yeah.
02:08And so after that experience, you've put together, and you can lift it up for the camera, quite
02:13a substantial book there.
02:15There's a lot of guidelines there.
02:17So yeah, you found that the knowledge among doctor GPs of the challenges around this just
02:23wasn't very good.
02:24Yeah.
02:25So unfortunately, the guidelines are very old in Australia, and they're based on short-term
02:30studies.
02:31So people who've been on the drugs for a few weeks don't have major trouble stopping, and
02:35the guidelines are very adequate for them.
02:37But we now know that the average duration of use of antidepressants in Australia, it's
02:41four years.
02:42So a lot of people are on these drugs for years or decades, and the guidance is not
02:46helpful for them.
02:47They need to come off more slowly, and they get into a lot more trouble coming off.
02:51Do you have an opinion whether they're over-prescribed in Australia, or that's a whole nother story?
02:56Look, they are prescribed now to one in six adults, one in seven people in Australia.
03:01They are doubling every 10 years.
03:03I think there's a rise, a few percent every year.
03:07People have trouble stopping them, which means that the average duration of use is going
03:10up and up.
03:11So it's become a little bit of a one-way valve, where people are starting on these drugs quite
03:14easily, but it's quite hard to stop them.
03:17And I think a major issue is that we are medicalising normal distress.
03:21There are all sorts of ups and downs in life.
03:23Being anxious and being down is a very common response to divorce, job loss, and I think
03:28a lot of those things are being classified as medical illnesses, which is leading to
03:31medical treatment, which in many cases is inappropriate, and that's led to the incredibly
03:37high levels of prescribing we have in this country.
03:40I think we're second in the OECD in terms of prescribing in this country.
03:45So it is a growing concern.
03:46Yeah, and getting off these drugs is a really serious issue.
03:51So for people watching now who might be taking antidepressants and who are going through
03:56similar challenges, can you give us in a nutshell, rather than reading out the whole book, what
04:02are your recommendations for people facing those challenges right now?
04:05Right, just to summarise, 600 pages in a couple of seconds.
04:09The main thing is don't stop your drugs abruptly.
04:11Don't just throw them away.
04:12That's the worst way to get into trouble.
04:14If you hear this, if you think about it, go talk to your doctor.
04:16There's a few principles about coming off them.
04:18Come off them slowly.
04:20That means generally months or more than a year for people that are on them long term.
04:24Number two, go at a rate that you can tolerate.
04:26So the right rate is the rate that doesn't cause you major problems.
04:31And the last thing is the last few milligrams are the hardest to come off.
04:33So right at the end, you often need to go down to doses that are smaller than widely
04:38available tablets.
04:39This is a major issue.
04:41The tablets available at pharmacies are often too big to stop easily.
04:45They cause too big an effect on the brain and stopping them is like jumping out the
04:49fifth floor window of a building.
04:50You need to go all the way down to the ground floor and that often involves using things
04:55like liquid versions of the drug, sometimes crushing the drug up to make a suspension
04:59or getting compounded medication to be able to go down to these very small final doses
05:04to make the landing softer to come off these drugs.
05:06And you'd like to see the official recommendations in relation to this change?
05:10Yes.
05:11So what I'd like to see is that the College of General Practice, which has acknowledged
05:14this book as a resource for its members and the Royal College of Psychiatrists, take on
05:20these principles and update their guidance for GPs and psychiatrists and other doctors
05:25so that all doctors know how to stop these drugs safely.
05:27And it's a core part of the curriculum, in my view.
05:30For every lecture on starting a drug, there should be a lecture on stopping a drug.
05:33In the same way that cars have brakes, we should know how to stop these drugs safely
05:37and that needs to be a core part of medical education and continuing education for senior doctors.
Comments