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Nº 58 – Addictive Behaviour

Saturday the 24th of October 2020

If you take a closer look at the latest OECD statistics about the consumption of antidepressants  and compare these with figures from the other 26 EU member states, you will find that Portugal is the country with the highest number of users of this kind of prescription drug. Germany, France and Italy consume only about half that amount. And even Denmark with 77 and Spain with 75 daily doses per 1000 inhabitants remain far behind the European champion Portugal with 103.6 units. On the one hand, we find these figures quite astounding, but yet, on the other hand, they do explain our daily life in this country. Psychological and material problems are not tackled by communication strategies, but instead through the medium of appeasement and repression. To put it bluntly, 103.6 daily doses per 1000 inhabitants means that nearly nine million packets of antidepressants are being sold across the counters of chemist’s shops every year.

So far, so bad. Antidepressants are prescribed for anxiety and suicidal thoughts. However, even those seeking medical help for heavy and persistent headaches will usually be sent on their way with a prescription for this type of drug. Doctors are clearly taking the easier and cheaper option: prescribing pills instead of recommending more expensive treatment in the form of psychological counselling and therapy. Doctors should be able to distinguish between depression, burn-out syndrome and migraines, while also looking for the underlying reasons, particularly in these times of the Covid-19 pandemic. If you are experiencing sleepless nights or suffering from anxiety in the summer months, such as, for example, in the periods before or after forest fires, then under no circumstances should you start taking pills without seeking a second medical opinion. For mainly two reasons: firstly, antidepressants do not really solve such problems, they sedate rather than heal you; secondly, due to their high addiction potential, it is very difficult to wean yourself off them.

In an article published in ScienceDirect magazine in October 2019, academics James Davis and John Read write that over half (56%) of those trying to come off antidepressants experience withdrawal symptoms. And nearly half (46%) of those experiencing withdrawal difficulties describe such symptoms as being severe. It is not unusual for these withdrawal symptoms to last for several weeks, or even months. Current medical guidelines underestimate the severity of the process of weaning yourself off antidepressants, as well as the length of time that this can take and the considerable clinical consequences it may have.

“In principle, the strategy of small slow steps follows the correct logic,” the scientists explain. Weaning yourself off antidepressants results in a reduction in certain neurotransmitters, such as serotonin, in the central nervous system – a condition that the body needs time to adapt to. The researchers looked at the reasons why even a slow tapering off medication may trigger other health problems. To date, the dose has usually been lowered steadily, in slow and regular steps, for example by five milligrams at a time. The researchers did, however, find that antidepressants were more effective the lower the level of the respective neurotransmitter. “This is why a reduction of five down to zero milligrams has a much more drastic effect than a reduction from 20 down to 15 milligrams,” they explain.

In the end, the doctor and patient have to judge carefully, on a case-by-case basis, how much the dosage may be reduced by, in order to make the weaning off process more bearable. According to the article, this depends on a range of different factors – for example, how long the patient has been taking the medication and how quickly this is metabolised in the body – but also on the patient’s genetic predisposition and its influence on their metabolism. Bearing this in mind, the study recommends reducing the initial dosage by just small amounts and checking whether symptoms appear, noting how severe and lasting they are, and then deciding how to proceed from there.

Uwe Heitkamp (60)

trained TV journalist, book author and hobby botanist, father of two grown-up children, knows Portugal for 30 years, founder of ECO123.
Translations : Dina Adão, John Elliot, Kathleen Becker


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