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Happiness Is A Skill was created as an outlet for me to reach the kind of people who email me every day. Ever since my Washington Post Article, “I spent half my life on antidepressants. Today, I’m off the medication and feel all right” became the #1 read piece on WaPo National the day it was published, my inbox likes to fill up with people who are struggling to get off their antidepressants or benzodiazepines. I respond to every person who contacts me, and often that correspondence leads to a longer conversation.

About 12 weeks ago, after one of these conversations melted two hours away from my day, it occurred to me that I was spending a lot of time saying similar things to lots of different people. Why not take all that information and distill it down into a digest that could reach lots of people at once? And so Happiness Is A Skill was born. There are two overarching themes of these emails. First, people are desperate to find relief from the pain of withdrawal, all while trying to process the anger they have for prescribed drugs and doctors that were supposed to help them. Second, they are looking for someone, anyone, who understands. Psychiatric drug withdrawal is an excruciatingly long and lonely process that you simply cannot relate to unless you have experienced it. It’s rare to encounter another person going through withdrawal in the wild because people in severe withdrawal probably aren’t leaving their house. (And those who are experiencing mild or moderate withdrawal are likely so irritable that they aren’t exactly projecting warm fuzzies.)

Until recently, antidepressant withdrawal was swept under the rug by psychiatrists and doctors, largely due to a lack of substantial research surrounding long-term use and tapering. (Antidepressants and benzos are designed, studied, and tested for short term use, i.e., weeks. There is not a single study on the effects of long-term antidepressant use, and yet 1 in 4 people on antidepressants have been taking them for more than 10 years.)

But in 2019, a group of American and British psychiatrists came together and urged national withdrawal guidelines to be updated after they “discovered” what many patients already knew: it is a hell of a lot easier to start taking antidepressants than it is to get off of them. In a systematic review of existing research, the authors determined that “nearly half of those experiencing withdrawal (46%) report it as severe, and that reports of symptoms lasting several months are common in many recent studies.”

The authors go on to say that their evidence directly contradicts the position of the UK’s National Institute for Health and Care Excellence (NICE) guidelines, which state that “[withdrawal] symptoms are usually mild and self-limiting over about 1 week.” In short, this research shows that half of all antidepressant users will likely experience withdrawal of a substantially longer duration and severity than current guidelines recognize. Shockingly (to this American, anyway), the NICE guidelines were updated to reflect these findings, giving suffering withdrawal patients a smidgeon of validation. All this to say that the tides are changing. My article and others like it are finding space in mainstream media and a new cohort of psychiatrists and researchers are starting to take our claims seriously. But arguably the biggest contribution to bringing this issue to light is the new documentary, Medicating Normal. I had the pleasure of watching a screening a few days ago, and it both broke my heart and fed the fire within me.

A synopsis:

“Combining cinema verité and investigative journalism, Medicating Normal follows the journeys of a newly married couple, a female combat veteran, a waitress and a teenager whose doctors prescribed psychiatric drugs for stress, mild depression, sleeplessness, focus and trauma. Our subjects struggle with serious physical and mental side effects as well as neurological damage which resulted from taking the drugs as prescribed and also from attempting to withdraw. Says one psychiatrist, ’There’s not a chemical on the planet, to my knowledge, that can require years to tapernot Oxycontin, not crack cocaine, not heroin, and not alcohol. But psychiatric medications, any tapered patient will tell you, can take sometimes years if possible, at all.’ … [Medicating Normal] is the untold story of what happens when profit-driven medicine intersects with human beings in distress.”

Statistically, a good chunk of Happiness Is A Skill readers are taking some form of antidepressant or anti-anxiety/benzodiazepines like Xanex or Ativan. For those people, none of this is meant to scare you or bully you into getting off the drugs. You do you. However, if you ever do want to get off these drugs, I implore you to do your research and work with your doctor to create a slow, deliberate tapering plan. Doctors are not required to give patients informed consent when it comes to psychiatric drugs, nor are they well versed in safe withdrawal. It’s not their fault. The medical system simply doesn’t teach them how to take people off these medications. It is possible to wean off psychiatric drugs safely and with few side effects, but the techniques for doing so are being developed at a grassroots level by people who have experienced it, like me. For more information on safe withdrawal, check out SurvivingAntidepressants.orgMad In America, and the Inner Compass Initiative. You can also email me directly. Lastly, Medicating Normal is being screened virtually at several film festivals and hosted events. I would recommend it to anyone who is taking antidepressants or benzos, but I believe it should be required watching for all practicing psychiatrists and doctors. You can find tickets and upcoming screenings here.

Coming September 6, 2022

May Cause Side Effects

Brooke’s memoir is now available for preorder wherever books are sold.

This is a heart-rending and tender memoir that will start conversations we urgently need to have. It’s moving and important.

Johann Hari, author of New York Times bestseller Chasing the Scream and international bestseller 
Lost Connections: Uncovering the Real Causes of Depression—and the Unexpected Solutions

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“Iatrogenic comorbidity” is one of those jargon phrases that makes me want to run far far away from research.  To me, it’s code for this is an article for those who have letters after their name and if you don’t you’re too plebian to understand. For regular folk, it’s a term that’s difficult to remember, impossible to pronounce, and seems to have something to do with death.

It has nothing to do with death. In layman’s terms, iatrogenic comorbidity is illness or disease caused by medical treatment which results in two or more simultaneous conditions in a patient. It is also one of the most important (and overlooked) aspects of treating depression and prescribing antidepressants. If more patients understood what it meant, perhaps more doctors would be forced to take it into consideration.

Let’s break that down even further.

Iatrogenic is an adjective that means, “relating to illness caused by medical treatment or examination.” For example, if a woman has heart surgery and the stitches get infected, the infection is an iatrogenic effect. If the stitches never existed, she wouldn’t have an infection.

Comorbidity means the “simultaneous presence of two or more chronic diseases or conditions in a patient.” For example, an elderly person could have osteoporosis (brittle, porous bones) and dementia at the same time.

Putting the two words together, iatrogenic comorbidity is what happens when medical treatment or examination causes two or more chronic diseases or conditions. In the case of our heart patient, let’s say that she was given antibiotics to fight against the iatrogenic effects of the infected stitches, but that she didn’t know she was allergic to the particular antibiotics. When she takes the drugs, she goes into anaphylaxis. Now, the heart issue, the infection, and the anaphylaxis are all comorbid conditions. A good physician needs to carefully understand what caused what issue in order to properly treat it, otherwise, he might misdiagnose and mistreat.

I am not a doctor, but I imagine it’s generally easier to trace iatrogenic comorbidity in physical illnesses. The heart surgery results in infected stitches which results in anaphylaxis. It’s an unpleasant outcome, but the progression is clear. Mental health, on the other hand, is inherently fuzzier. It is not uncommon for patients to present with comorbid conditions, like depression and anxiety. When medication is administered and more conditions show up, like suicidality, there’s no real way to know what caused what. Did the medication cause the patient to want to kill himself? Or would the urge have developed had the medication not been given? Was it the chicken? Or the egg?

A fancy term for a common problem.

There is a growing faction of psychiatrists and researchers who are calling for a drastic overhaul of the way we prescribe antidepressant and antianxiety drugs because of the risks of iatrogenic comorbidity. General practitioners, in particular, are being called out for defaulting to prescription antidepressants rather than recommending therapy. The argument, essentially, is that general practitioners are well…generalists. They are the traffic control of healthcare, designed to guide people down the appropriate specialist highway so oncologists don’t get bogged up with common colds. In theory, this means that GPs should refer someone suffering from depression to a psychologist for further evaluation. In practice, what often happens is that GPs prescribe an antidepressant (or multiple antidepressants) and send the patient on their way.

To put this practice in perspective, I lived in New York City for eight years and never once saw a psychiatrist for my Effexor XR and Wellbutrin XL. Furthermore, my GP only required that I see him once every 12 – 18 months, for a five-minute appointment. So over the course of nearly a decade, I got about thirty minutes of face time with the man who prescribed me daily psychiatric drugs. That’s fucking absurd.

So why is this happening? A general practitioner would never give a patient a script for chemotherapy, so why is it a widely accepted practice when it comes to depression and anxiety?

I would argue that a major factor is the fact that the iatrogenic comorbidity of chemotherapy is much more obvious and well-studied than it is with antidepressants. We know that chemo is a hell of a drug because it quickly makes most people vomit, turn grey, and lose all their hair. The iatrogenic effects of antidepressants though, do not develop in a common, linear way—if they develop at all. The same drug presented to four people with similar symptoms, background, and genetic makeup can produce four very different effects. One person may gain weight and develop insomnia. The second might sleep well but experience PSSD (post-SSRI-sexual-dysfunction.) The third may lose weight and have suicidal tendencies. The fourth may flourish for a few months, but show symptoms of bipolar disorder years later.

In all of these cases, when the patient goes back to their general practitioner because they’re not sleeping well or their weight has changed or they’re suddenly manic, what’s likely to happen? They get a sleeping pill or they’re put on a diet or they add a Lexapro back to their Celexa. Now they’ve got additional medication in the mix, which creates the potential for even more iatrogenic effects. And so on and so forth, until the patient is drugged up to their eyeballs and their system has gone haywire.

Does this happen every time? No. But it happens enough, and it’s avoidable if protocols are put in place to make it more difficult to prescribe antidepressants. I’m baffled by the fact that a course of some sort therapy is not considered a pre-requisite to prescribing antidepressants, especially given that research indicates that over the long term, therapy is just as, if not more, effective than antidepressants. Additionally, the positive effects are more likely to endure and there is little risk of iatrogenic comorbidity.

More articles from the blog

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September 23, 2022

The Flowering of Human Consciousness

read the article

September 16, 2022

Three Weeks

read the article

September 9, 2022

Wanting

read the article

September 2, 2022

The Ashton Manual: A guideline for withdrawing from psychiatric drugs

read the article