The Truth About SSRIs/SNRIsWhat they don't tell us... on purposeGet the book free ↓
Truth About SSRIs
The Effects of SSRIs
Not the side effects. The effects. There's a difference, and nobody ever told you what it was.
What it does
Remolds your brain around it
What it takes
Your emotional range
What they skipped
Informed consent
What it costs
Getting back off it
What we were toldWhat we weren't
Not disclosed
What you were told
Your serotonin is low Told
The pill puts it back Told
Side effects usually fade Told
You can stop any time Told
What the drug can actually do
Emotional blunting Not told
Sexual dysfunction Not told
Akathisia Not told
Withdrawal that outlasts the drug Not told
Suicidal thinking Boxed warning
1%
recalled being told anything about withdrawal. 1,829 patients.10
<5%
were told about suicidality, numbing, withdrawal or addiction. 1,431 patients.9
01 — Where this comes from
I was on an SSRI for 9 years. Not one doctor ever told me what it was doing to me.
Nobody sat me down and explained what an SSRI actually is, or what its Mechanism of Action does inside a human brain. I got a prescription and I got sent home.
Everything that came after that I had to work out for myself, while I was living inside it.
That is not informed consent. That's a sales transaction with a white coat on. And once you understand what these drugs really do, you'll see why I call that criminal.
Every claim on this page carries a number. The number takes you to the paper it came from. If a claim isn't cited, it isn't here.
02 — The reframe
A side effect is an accident. This is not an accident.
What they told you
Your serotonin is low. The pill puts it back. A few people get some side effects and they usually fade. You can stop taking it any time you want.
What the drug does
The drug blocks the serotonin transporter, and every single thing that happens next runs downstream from that one move.1 Serotonin doesn't just carry your mood. Serotonin neurons also modulate noradrenaline, dopamine and GABA,1 and serotonin receptors live in your gut and your blood vessels too.1 The numbness isn't the drug misfiring. The numbness is the drug working.
One move. Everything downstream of it.
Serotonin neurons modulate noradrenaline, dopamine and GABA, and serotonin receptors sit in the gut and the blood vessels as well as the brain.1This is a map of the pathway, not measured data. It's here so you can see why one blocked transporter turns into effects all over your body.
03 — The drug remolds the brain
The drug doesn't fix your brain. It forces your brain to rebuild around it.
01
The overload
The pill blocks the pump that clears serotonin out of the synaptic cleft, the tiny gap between one nerve cell and the next. That gap is now overwhelmed with concentrated serotonin, and with an SNRI norepinephrine on top of it, held there way longer than your body ever intended.1
02
The pushback
Receptors that get hit by a drug are routinely turned down, or made less sensitive, to hold the system steady. Your brain is actively defending itself against the pill you're taking.15
03
The new normal
Those adaptations harden into a new set point, and it happens more the longer you take it and the higher the dose.15 The drugged brain becomes the only brain you've got.
04
The crash
Pull the drug and that equilibrium breaks. The opposing processes keep running with nothing left to push against, and what you feel is often the exact opposite of what the drug did to you.15 They call it withdrawal. It behaves a lot more like an injury.
What the rebuild looks like
Schematic, not measured data. It draws the mechanism described in the tapering review1 and in the oppositional tolerance model,5 where the adaptations that held you steady on the drug keep running once the drug is gone. Nobody has plotted a real human's signalling like this, and any chart that claims to is selling you something.
04 — What that means
Here's what that actually means when it's your life
You're not on a drug you can simply stop. You're on a drug your brain has already built itself around.
Getting off isn't going back to who you were. It's asking a rebuilt brain to rebuild all over again, and that takes exactly as long as it takes. In one study withdrawal generally ran up to 6 weeks, with a quarter of people still going past 12 weeks. In another, it had lasted at least a year for 58.6% of people, and more than 3 years for 16.2% of them.6
Nobody would sign up for that. Which is exactly why nobody gets told.
How long it actually lasts
25%: a quarter of people were still in withdrawal past 12 weeks.158.6% and 16.2%: of the people who got withdrawal effects, that share still had them at 1 year and past 3 years.6 Two different studies and two different denominators, which is exactly why they are drawn on the same line and not stacked into one bar. Both come out of self-reported samples and both are on the page so you can weigh them yourself.
05 — Emotional blunting
The drug doesn't lift the floor. It lowers the ceiling.
You stop crying at the things that used to break you open. You also stop laughing at the things that used to make you laugh. Music stops hitting. Sex stops hitting. Your kid's face stops hitting. You know you're supposed to feel something and nothing shows up.
The clinical names for it are emotional blunting and apathy syndrome, and it's one of the biggest reasons people walk away from these drugs.13 Researchers are still arguing about why it happens. Nobody serious is arguing about whether it happens.
This isn't rare. This is close to standard.
Clinically significant apathy in SSRI patients, chart review92%
Felt emotionally numbed71%
Felt foggy or detached70%
Did not feel like themselves66%
Emotional blunting, patient-reported survey46%
92%: Padala et al. 125 outpatient charts. 92% of SSRI-treated patients scored clinically significant apathy against 61% of those on a non-SSRI antidepressant. Retrospective, and mostly male veterans.13
71%, 70%, 66%: Read & Williams. 1,431 antidepressant users across 38 countries, self-reported.9
46%: Goodwin et al. 669 patients, and the most conservative number of the set. Funded by Servier, and the authors themselves argue blunting behaves partly like a residual symptom of depression and not purely as a drug effect.8 I'm telling you that so nobody else has to.
Ask a doctor how many of their patients are blunted and they guess around 32%. Ask the patients and it's far higher, with nearly three quarters of them calling it extremely severe.14
06 — The umbrella
40–60% of SSRI and SNRI users will experience emotional blunting.
You have better odds at getting rich playing roulette than having a positive experience on SSRIs and SNRIs.
Between 4 and 6 out of every 10 people who take one of these drugs lose the ability to feel things at full volume.238
That's not a rare reaction buried in the small print of a leaflet. That's close to a coin flip, and it's the most reported experience people have on these drugs.
Here's the part nobody frames properly for you. Emotional blunting isn't one complaint sitting in a list of complaints. It's the thing sitting over the top of the whole list. You block the transporter, your brain adapts around the drug, and your emotional range comes down with it. Everything underneath is what a narrowed range looks like once you have to live inside it.
One cause. Everything underneath it.
Schematic, not measured data. Emotional numbness, feeling foggy or detached, not feeling like yourself and loss of positive feelings were reported by 71%, 70%, 66% and 60% of 1,431 antidepressant users across 38 countries.9 Apathy and loss of motivation come out of the apathy syndrome literature.13 The 40% to 60% figure is the range the reviews land on for people on SSRIs and SNRIs.2314
Read this one twice
This is basic cause and effect. These are not SIDE effects.
A side effect is something a drug does by accident on the way to doing the thing you actually wanted. Blunting isn't the accident. Blunting is the drug doing its job, and the flatness you've been apologising for is the mechanism working exactly the way it was built to work.
No large-scale epidemiological study of blunting has ever been run, which the researchers themselves say out loud.8 Every number in that 40% to 60% band comes out of surveys and cross-sectional samples. That's also why the range is that wide.
07 — The effects
Now here's the disclosure you should have gotten
Your doctor read a warning off a card in about 30 seconds. Doing it properly takes a lot longer than that.
Warning
Akathisia. Sexual dysfunction. Tinnitus. Visual disturbances. Hearing sensitivity. Insomnia. Panic attacks. Anxiety. No drive and no desire. Neuropathy. Suicidal ideation. Nervous system injury.
And the withdrawal syndrome on its own runs to dizziness, vertigo, nausea, vomiting, diarrhoea, shock-like sensations, numbness, pins and needles, visual trails, rushing noises in your head, insomnia, nightmares, confusion, memory loss, tremor, sweating, flu-like aches, irritability, dread and tearfulness.1
That's one syndrome. It isn't the whole list.
What it does to your nervous system
Akathisia
An inner restlessness so violent that people describe needing to crawl out of their own skin. There's a whole section on it below.
Insomnia
Sleep breaks apart on the drug and again coming off it. Insomnia, nightmares and excessive dreaming are all listed withdrawal symptoms.1
Panic and anxiety
Anxiety and agitation are documented withdrawal effects,1 and rebound panic has been reported after paroxetine was stopped.1 Then it gets blamed on you instead of on the drug.
Nervous system injury
Pins and needles, numbness and shock-like sensations sit at the core of the withdrawal syndrome, and case reports describe them running for a year or longer.1
Suicidal ideation
Every antidepressant carries an FDA boxed warning for suicidal thinking in anyone under 25.20 And the 14 days after you stop carry a 60% increase in suicide attempts against previous users, which puts the risk on the withdrawal itself rather than on going untreated.15
What it does to your body
Sexual dysfunction
Reported by 66% of 1,431 antidepressant users.9 Desire disappears, genitals go numb, orgasm gives you nothing back.
No drive, no desire
Apathy syndrome. The wanting goes offline, and patients can tell the difference between this and their depression.13
Visual disturbances
Palinopsia, which means visual trails, is a listed withdrawal symptom.1 Blurred vision, trouble focusing up close and light that suddenly hurts get reported constantly by patients and have barely been studied.
Ears and hearing
Rushing noises in the head sit in the sensory cluster of the withdrawal syndrome.1 Tinnitus and painful sound sensitivity are reported everywhere by patients and have barely been studied.
Gut chaos
Nausea, vomiting, diarrhoea and appetite gone. Serotonin receptors live in your gut, which is exactly why this part hits so hard.1
Neuropathy
Burning, tingling, numbness and electric shocks through your limbs and your head.1
Straight with you, because that's the whole point of this page. The effects above carrying a citation are documented in the peer-reviewed literature. Tinnitus, visual snow and peripheral neuropathy are reported constantly by patients and have barely been studied. That gap is not evidence the harm isn't real. It's evidence nobody funded the study.
08 — Post-SSRI sexual dysfunction
The sexual damage doesn't always stop when the drug does
June 2019
The European Medicines Agency accepted that sexual dysfunction can carry on after these drugs are stopped, and ordered manufacturers to update the labels.19 Health Canada, Australia's TGA and Hong Kong's Drug Office have moved the same way since.19
In the United States, that persistence warning appears only on the fluoxetine label.19 For every other SSRI, an American doctor is required to tell you nothing at all.
What PSSD is
Genital numbness. No libido. Orgasm with no pleasure anywhere in it. Erectile dysfunction. People describe their brain and their body getting disconnected from each other. It often shows up or gets worse after you stop rather than while you're on it, and for some people it has never gone away.19
How often it happens is genuinely unknown. Anybody who hands you a percentage is guessing.
June 2019
European Medicines Agency
Ordered the labels changed. Sexual dysfunction can persist after the drug is stopped.
Since 2019
Health Canada
Moved the same way.
Since 2019
Australia, TGA
Moved the same way.
Since 2019
Hong Kong Drug Office
Moved the same way.
Still
United States
On the fluoxetine label only. For every other SSRI, your doctor is required to tell you nothing.
Every box on this row is sourced to the same reference.19Regulators accepting that the harm persists is not the same as anybody counting how often it happens. Nobody has counted. That is the whole problem.
09 — Why nobody told you
This is what people were actually told before they started
1%
recalled being told anything at all about withdrawal when they were prescribed the drug
You can't consent to a risk that nobody ever named for you.
A third survey, 867 patients across 31 countries, landed on 0.7%.11 These are self-selected online samples and a critic will tell you so within about 4 seconds. Three separate samples across dozens of countries all landed in the same place, and no industry-funded study has ever tried to show otherwise.
10 — The gap
Your doctor thinks they warned you. They didn't.
GPs who say they always warn you about withdrawal77%
Patients who remember being warned1%
Both of them are telling the truth. A warning that gets muttered that fast, and buried that deep, never lands as a warning.
GP figure from a survey of UK general practitioners, where most GPs also said their own knowledge of withdrawal was inadequate.12 Patient figures from the two largest surveys ever run on this.1011 The GP paper put the two side by side itself and called the contrast stark.12
11 — The salesperson
The script your doctor recited came from a salesperson
One free meal
Doctors who received a single industry-sponsored meal promoting a drug prescribed that brand at higher rates than doctors who got none. The median meal was worth under $20. Antidepressants were one of the four drug classes studied.17
More meals, more scripts
And it scaled. More meals, and meals worth more than $20, went with higher prescribing still.17
Take the meals away
When academic medical centres restricted sales visits, the promoted drugs lost market share. 25,000 physicians, 262 drugs, 8 drug classes.18
What one free meal did to the prescription pad
279,669 doctors. 4 drug classes. One sponsored meal, mean value under $20.17 The antidepressant is the biggest jump of the 4, at 2.18 times the odds (95% CI 2.13 to 2.23).17The authors call it an association and not cause and effect, and so do I. The promoted antidepressant was desvenlafaxine, so this measures brand against brand inside the class, not antidepressants against nothing.
Neither study proves a doctor was bought, and I'm not saying one was. Both show that the cheapest gift on earth moves prescribing in a way you can measure, and that taking it away moves it back. The authors of the second called it as close to causal as you can get without a randomised trial.18
This is how your consent gets hollowed out
01
The rep shows up
The pitch is efficacy, tolerability, safety. Withdrawal gets called discontinuation syndrome, a term that was coined specifically to describe what happens when you stop an antidepressant.1
02
Your doctor repeats it
Not out of bad faith. Doctors themselves say there isn't enough guidance on how to get anybody off these drugs,1 and most British GPs surveyed said their own knowledge of withdrawal was inadequate.12
03
You hear nothing
Nothing about blunting. Nothing about your sex life. Nothing about how brutal it is to ever get back off.910
04
The harm arrives and you get blamed for it
Withdrawal gets mistaken for the illness coming back, which leads to prolonged treatment for people who might not need it at all.1 Your chart says your depression got worse. It says nothing about the drug.
A doctor who does their own homework breaks this chain. Almost none of them have the hours.
12 — Nobody helps you get off
The taper they gave you is built on a math error
Guidelines say taper over 2 to 4 weeks, cutting by equal amounts, down to the minimum dose, then stop.1 In randomised studies, tapering over 14 days gave either no reduction or a minimal one in withdrawal severity compared with just stopping cold.1 In one of them a 3-day taper and a 14-day taper produced the identical rate. 46% either way.1
Here's why that happens. Dose and receptor occupancy are not a straight line. They're a curve, and every PET study ever run on it says the same thing.23
An occupancy-linear taper
Citalopram. Straight out of the paper.1 An example, not a protocol.
Dose
Transporters blocked
20 mg
80.5%
9.1 mg
70%
5.4 mg
60%
3.4 mg
50%
2.3 mg
40%
1.5 mg
30%
0.8 mg
20%
0.4 mg
10%
0 mg
0%
Every step there costs your brain the same 10 points. That's the entire idea. The milligrams get tiny because the milligrams were never the thing that mattered.
What each equal 5mg cut actually costs you
20mg down to 15mg3 points
15mg down to 10mg6 points
10mg down to 5mg13 points
5mg down to zero58 points
The same 5mg every single time. A wildly different hit to your brain every single time.1 Even a quarter of the smallest tablet down to nothing takes out 42.9% of occupancy. An eighth of a tablet down to nothing takes out 28%, which is a bigger drop than going from 40mg all the way down to 5mg.1
The number they never show you
2mg of citalopram has about half the effect on your serotonin transporter that 20mg does.
So the last few milligrams aren't the easy part. They're the hardest part of the whole taper, and that is the exact point where your doctor tells you you're finished.
The final step to zero should be no bigger than a step you've already survived. On citalopram that puts your last dose before zero somewhere around 0.4mg.1 No tablet on earth splits that fine. The paper says it outright: liquid formulations may be necessary to reach these doses.1
Horowitz & Taylor.1 Occupancy figures derived from the Michaelis-Menten fit of Meyer et al.'s PET imaging data.2
0.1 at a time isn't fussy. It's the whole difference.
When your nervous system is already injured, the power to move a tenth of a milligram at a time is the difference between a taper you survive and one that puts you straight back on the drug.
A tablet cutter gets you to a half, then a quarter, and then it has finished helping you. Everything below that is where the cliff lives. A liquid, or a compounded capsule, is what lets you take a step small enough that your brain can actually absorb it. The Maudsley deprescribing guidelines walk a citalopram taper all the way down to 0.1mg before stopping.4
And it has to be yours. The people who built this method say so themselves. There are individual differences in how people experience SSRI withdrawal.1 They suggest a trial reduction first, then watching how severe it gets and how long it lasts, then setting your rate from what your own body just told you, with the whole thing titrated to what you can tolerate.1 They also flag, in their own limitations, that the PET studies under this curve had small groups, which limits how well the numbers capture individual variation.1
The shape of the curve holds for everybody. The speed you can walk down it does not. If a step flares you, you hold there. You don't push through it. Holding is not failing.
Read this before you do anything
That table is an example out of a published paper. It is not a protocol and it is not a prescription. It's citalopram, and your drug, your dose, your years on it and your nervous system are not that example.
Go read the paper yourself, it's reference 1 at the bottom and it's worth your afternoon. Then find a prescriber who actually knows this material, and if the first one doesn't, go find another one. Do not change a dose on your own because of a website. Mine or anybody else's.
And then they tell you the withdrawal is mild and brief
56%
of people coming off an antidepressant get withdrawal effects
Know the counter-argument, because a psychiatrist is going to hand it to you. A 2024 meta-analysis of 79 studies put the incidence of any discontinuation symptom at 31%, severe symptoms at 2.8%, and found 17% of people got symptoms coming off a placebo.7 That review leaned on randomised trials where people had often been on the drug for weeks rather than years, and length of use is one of the biggest predictors of withdrawal there is.1 Both numbers are real. They are measuring different people. Say that out loud and nobody can accuse you of hiding anything.
What actually worked in the studies
Slow, and titrated to you
Paroxetine cut by 10mg every 2 weeks dropped withdrawal from 33.8% to 4.6%. Tapered over an average of 38.6 weeks and individualised to the patient, it dropped from 78.2% to 6.1%.1
Tapering strips
895 people, 62% of whom had already failed to withdraw before. 71% of them got off, median 56 days.16
Doses no pill can make
Liquid may be necessary to reach the doses at the bottom of the curve.1 That's the whole ballgame, and it's written in the paper.
The guidelines are catching up
NICE now recommends proportional reductions instead of fixed ones.21 American protocol still hasn't moved.
13 — Accountability
Did your doctor cause brain injury by not knowing how to help you taper off your SSRI/SNRI?
Your doctor handed you a tapering plan built for a drug your brain never had to rebuild itself around.
The guidelines told them to cut by equal amounts over 2 to 4 weeks, drop to the minimum dose, then stop.1 That's the schedule you write for something your nervous system isn't actively bracing against. It's the wrong schedule for these drugs, and the studies said so out loud. Tapering over 14 days gave either no reduction or a minimal one in withdrawal severity compared with quitting cold.1
Here's why that matters more than it sounds. Your brain doesn't sit still while the drug blocks the transporter. It pushes back, it turns its own signalling down to hold the system level, and those adaptations harden in the longer you take it and the higher the dose.15 That pushback isn't a complication that happens to some unlucky people. That pushback is the mechanism in action. Once it's in, coming off stops being a scheduling question and starts being an injury risk.
A doctor who hands you a taper built on the wrong pharmacology owns what happens to you next.
What the taper advice assumes
Pull the drug away in equal steps and the body walks back to where it started. Two to four weeks is plenty. The last few milligrams are the easy part.
What your brain actually did
It rebuilt itself around the drug, and it will not hand that back on a calendar. The last few milligrams are the hardest part of the whole taper, and that is the exact point where you get told you're finished.1
Nobody warned them either. That explains it. It doesn't excuse it, and it doesn't give anybody their life back.
Only 29% of British GPs surveyed felt their knowledge of withdrawal was adequate, and only 17% trusted themselves to tell withdrawal apart from the original problem coming back.12 Doctors themselves say there isn't enough guidance on how to get anybody off these drugs.1 NICE now files antidepressants in the same guideline as opioids, benzodiazepines and Z-drugs, and tells prescribers to reduce proportionally so the steps get smaller as the dose comes down.21 That guideline landed in 2022. Your taper probably didn't.
14 — Akathisia
It isn't anxiety and it isn't agitation
It's a motor running inside your nervous system that will not shut off.
Akathisia
You need to crawl out of your own skin. Sitting still is unbearable so you pace. Your whole body is screaming that you have to escape, and there is nowhere on earth to go, because the thing you're trying to escape is inside you. People who have lived through it call it torture, and they mean it literally.
It hits in the first weeks on the drug, after any dose increase, during a taper, and after your very last pill.
Here's the trap that makes it worse
01
The drug causes it
It starts as an inner restlessness and you can't name it, because nobody ever gave you the word for it.
02
You call it anxiety
It's the only language you've got. And SSRI withdrawal symptoms can genuinely resemble the anxiety or the depression the drug was handed to you for in the first place.1
03
It gets logged as relapse
Withdrawal gets misdiagnosed as the illness coming back, and that leads to long-term treatment for people who might not need it.1 Your chart says nothing about the drug.
04
So they raise your dose
Which is the one thing on earth guaranteed to make akathisia worse. And the trap closes on you.
The 4 windows it comes for you
The boxed warning names the same 2 windows on the drug: early in treatment, and after any dose change.20The 60% is a comparison, not a personal risk. It compares people inside the discontinuation window against people who had used antidepressants before and were outside it, in a nested case-control study of 10,456 suicide attempts.15 That same study found the highest risk of all sat at initiation, then dose changes, then discontinuation.15
The drug creates the harm. The harm gets blamed on you. And the blame is what justifies more of the drug.
On how common akathisia is, I'm not putting a number on this page, because the published estimates are mush and I can't cite one I trust. Milder cases go unreported, and the rest get filed as anxiety or as the illness getting worse. So don't argue the percentage. Argue the undercounting, because the harm and the hiding run on exactly the same machinery.
Boxed warning
This is the one that kills people.
Somebody in akathisia doesn't want to die the way a depressed person wants to die. They want the sensation to stop, and they will do anything at all to make it stop. That's the difference, and it's why akathisia is the effect tied most directly to suicide.
The FDA put a boxed warning on every antidepressant in 2004 and widened it in 2007 to cover everyone up to 24. It warns about suicidal thinking and behaviour, especially early in treatment and after any dose change.20 Those are the exact same two windows where akathisia shows up. And the 14 days after you stop carry a 60% increase in suicide attempts against previous users, which lands the risk on the withdrawal rather than on being untreated.15
The boxed warning covers suicidal thinking and behaviour. It does not say these drugs cause completed suicide, and neither do I. Say it exactly the way it's written and nobody can take it away from you.
15 — The receipts
Nobody warned them either
These comments were left under my videos by people I have never met. I blurred their names and their faces so nobody can go find them. I did not change a single word of what they wrote.
Nobody was paid for these and nobody was asked to write them. Every one of these people sat down under a video about their own medication and typed out what happened to them. Read enough of them and you stop being able to call it rare.
16 — The book
I wrote the book I needed when I started, and I'm giving it away free.
Dead Inside goes deeper into what SSRIs and SNRIs do to your brain, your body and your identity than anything a prescriber ever handed you.
Every mechanism in it is cited. Every number traces back to a study you can go pull yourself.
It used to cost money. Now it costs your name and your email, because more people getting this information matters more than the seventeen dollars did.
That's also WHY I go live on social media (most days). I talk with doctors and users alike, getting different perspectives about what happens when we use these drugs.
FreeInstant PDF download
Your download
Here's the book. It's yours.
Save it somewhere you'll be able to find it again.
The file is called Dead-Inside-Mark-Pescetti.pdf and it reads on any phone, tablet or computer. On a phone it may open in your browser first, and you can save it from there.
⚠ Important
Do NOT ever suddenly stop taking psych meds
That includes SSRIs and SNRIs. Bring this information to your doctor and discuss your next steps, if you have any concerns.
This book is educational information, not medical advice. Always work with your prescriber before making any changes to your medication.
Your email goes to me and nowhere else. I don't sell it, and I don't hand it to anyone. Nobody is paying me to say any of this, and nobody is paying me to stop.
17 — Sources
Every number on this page traces back to one of these
Journal, volume, pages, and a DOI or a PubMed ID wherever one exists. Go check them. That's what they're for.
Horowitz MA, Taylor D. Tapering of SSRI treatment to mitigate withdrawal symptoms. Lancet Psychiatry. 2019;6(6):538–546. doi:10.1016/S2215-0366(19)30032-X
Meyer JH, Wilson AA, Sagrati S, et al. Serotonin transporter occupancy of five selective serotonin reuptake inhibitors at different doses: an [11C]DASB positron emission tomography study. Am J Psychiatry. 2004;161(5):826–835.
Sørensen A, Ruhé HG, Munkholm K. The relationship between dose and serotonin transporter occupancy of antidepressants: a systematic review. Mol Psychiatry. 2022;27(1):192–201. doi:10.1038/s41380-021-01285-w
Horowitz MA, Taylor DM. The Maudsley Deprescribing Guidelines: Antidepressants, Benzodiazepines, Gabapentinoids and Z-drugs. Wiley; 2024.
Fava GA. May antidepressant drugs worsen the conditions they are supposed to treat? The clinical foundations of the oppositional model of tolerance. Ther Adv Psychopharmacol. 2020;10:2045125320970325. doi:10.1177/2045125320970325
Davies J, Read J. A systematic review into the incidence, severity and duration of antidepressant withdrawal effects: are guidelines evidence-based? Addict Behav. 2019;97:111–121. doi:10.1016/j.addbeh.2018.08.027
Henssler J, Schmidt Y, Schmidt U, Schwarzer G, Bschor T, Baethge C. Incidence of antidepressant discontinuation symptoms: a systematic review and meta-analysis. Lancet Psychiatry. 2024;11(7):526–535. doi:10.1016/S2215-0366(24)00133-0
Goodwin GM, Price J, De Bodinat C, Laredo J. Emotional blunting with antidepressant treatments: a survey among depressed patients. J Affect Disord. 2017;221:31–35. doi:10.1016/j.jad.2017.05.048
Read J, Williams J. Adverse effects of antidepressants reported by a large international cohort: emotional blunting, suicidality, and withdrawal effects. Curr Drug Saf. 2018;13(3):176–186.
Read J, Cartwright C, Gibson K. How many of 1829 antidepressant users report withdrawal effects or addiction? Int J Ment Health Nurs. 2018;27(6):1805–1815. doi:10.1111/inm.12488
Read J. How common and severe are six withdrawal effects from, and addiction to, antidepressants? The experiences of a large international sample of patients. Addict Behav. 2020;102:106157.
Read J, Renton J, Harrop C, et al. A survey of UK general practitioners about depression, antidepressants and withdrawal: implementing the 2019 Public Health England report. Ther Adv Psychopharmacol. 2020;10:2045125320950124.
Padala PR, Padala KP, Majagi AS, Garner KK, Dennis RA, Sullivan DH. Selective serotonin reuptake inhibitors-associated apathy syndrome: a cross sectional study. Medicine (Baltimore). 2020;99(33):e21497. doi:10.1097/MD.0000000000021497 · PMID 32871995
Christensen MC, Ren H, Fagiolini A. Emotional blunting in patients with depression. Part IV: differences between patient and physician perceptions. Ann Gen Psychiatry. 2022;21:22. doi:10.1186/s12991-022-00391-5
Valuck RJ, Orton HD, Libby AM. Antidepressant discontinuation and risk of suicide attempt: a retrospective, nested case-control study. J Clin Psychiatry. 2009;70(8):1069–1077.
Groot PC, van Os J. Antidepressant tapering strips to help people come off medication more safely. Psychosis. 2018;10(2):142–145.
DeJong C, Aguilar T, Tseng CW, Lin GA, Boscardin WJ, Dudley RA. Pharmaceutical industry-sponsored meals and physician prescribing patterns for Medicare beneficiaries. JAMA Intern Med. 2016;176(8):1114–1122.
Larkin I, Ang D, Steinhart J, et al. Association between academic medical center pharmaceutical detailing policies and physician prescribing. JAMA. 2017;317(17):1785–1795. doi:10.1001/jama.2017.4039 · PMID 28464141
European Medicines Agency, June 2019. Label update requiring SSRI and SNRI product information to state that sexual dysfunction may persist after discontinuation. Health Canada, Australia's TGA and Hong Kong's Drug Office have issued or begun comparable warnings. In the US the persistence risk appears on the fluoxetine label.
US Food and Drug Administration. Boxed warning on antidepressants for suicidal thinking and behaviour, 2004, extended in 2007 to cover young adults up to age 24.
National Institute for Health and Care Excellence. NG222 (depression in adults) and NG215 (medicines associated with dependence or withdrawal symptoms). Both recommend proportional rather than fixed dose reductions.
Read J, Cartwright C, Gibson K. Adverse emotional and interpersonal effects reported by 1829 New Zealanders while taking antidepressants. Psychiatry Res. 2014;216(1):67–73. doi:10.1016/j.psychres.2014.01.042 · PMID 24534123
Ma H, Cai M, Wang H. Emotional blunting in patients with major depressive disorder: a brief non-systematic review of current research. Front Psychiatry. 2021;12:792960. doi:10.3389/fpsyt.2021.792960
Where a claim is patient-reported rather than clinically measured, this page says so. Where two good studies disagree, this page gives you both of them. If you find an error in here, tell me and I'll fix it, because the entire point of this thing is that it holds up.
