One in eight people in the world suffers from a mental health problem, according to a report by the World Health Organization (WHO).
In this context, there has also been an increase in the demand for the use of medications to treat them.
But, paradoxically, just as it has become common to use these medications, it is also common for people to stop using them at a moment’s notice, experts told the BBC.
Many patients fall into this trap, often because the drugs are having an effect: because they feel good, they may be under the impression that the problem is solved.
In other cases, it is the adverse effects of treatment that lead some people to stop treatment abruptly.
However, according to psychiatrists, anyone who decides to stop using the drug without consulting a physician may suffer immediate and long-term effects.
The effects of abrupt interruption
Stopping medications such as those used to treat anxiety and depression for even one day can alter chemical signals in the brain and cause symptoms such as nausea, fatigue, dizziness and a “light-headed” feeling.
A recent study indicates that more than half (56%) of people who try to stop taking antidepressants have adverse symptoms, and almost half of them (46%) describe the side effects as severe.
This is the so-called “withdrawal syndrome“, which can be caused by discontinuing the use of not only antidepressants and anxiolytics, but also hypnotics, antipsychotics, mood stabilizers and stimulants (including drugs used in the treatment of attention deficit hyperactivity disorder (ADHD).
Elson Asevedo, a psychiatrist and technical director of the Center for Integrated Mental Health Care at the Federal University of São Paulo, adds another effect he frequently observes in his medical practice.
Patients who initially respond well to a drug may respond more slowly or resist resuming treatment that was abruptly stopped.
Why do they stop ‘from one day to the next’?
The main reason someone stops taking a medication is that the condition being treated seems to stabilize.
“When you notice improvement in depression and anxiety, it’s natural to feel that the medications are no longer necessary, as the symptoms seem to have subsided,” explains Asevedo.
“However, the catch here is that this improvement in symptoms often occurs before the physical improvement in the brain,” he adds.
The physician compares the brain to a computer and the disease to a program installed on that machine.
Treatment eliminates the program, he explains, but in order for the brain to be protected against future relapses, a considerable period of medication use is needed for the brain to create new ways of functioning without the influence of depression.
“It is recommended that antidepressants be used for at least 12 months after medical discharge and can last up to two years or even indefinitely, if the patient has had two or more episodes of depression throughout life,” says Antônio Geraldo, president of the Brazilian Psychiatric Association (BPA).
Vanessa Favaro, director of the Outpatient Service at the Institute of Psychiatry at the University of Sao Paulo, says many patients do not see treatment as part of an ongoing pursuit of mental health.
Another very common reason to stop taking medication is the unwanted effects on the body.
“It’s relatively easy to tolerate the side effects of an antibiotic that we only have to take for seven days,” says Asevedo.
“But when it is a depressive condition that requires continuous treatment for a year, it is much more difficult to treat,” he adds.
Among the most common side effects of psychiatric medications, the doctor cites:
- Decreased libido;
- Drowsiness;
- Weight gain;
- Gastrointestinal effects;
- Dizziness;
- Nausea;
- Tremors.
- In cases like these, it is important that the doctor and patient have enough trust to discuss the possibilities together.
“They can consider alternatives, such as changing the medication even introducing an additional medication to mitigate the side effects,” Asevedo says.
How drugs act on the brain
Drugs used to treat mental disorders alter the electrical signals that are transmitted within the brain through changes in the chemical composition of the organ.
“The brain is a computer that, instead of wires, has neurons. But these neurons are not directly connected. Between them there is a small space, where neurotransmitters are found,” explains Asevedo.
Neurotransmitters are chemical substances that enable electrical transmission from one neuron to another.
Serotonin, noradrenaline and dopamine are some of the neurotransmitters that regulate the passage of electrical signals between neurons.
A mental disorder usually occurs when these chemicals are not regulated.
Depression, for example, is caused by an imbalance of the neuronal transmitters responsible for the sensation of pleasure and well-being, experts point out.
Medications then act by regulating the production of neurotransmitters and increasing the transmission of electrical signals between brain cells.
How to stop taking psychiatric medication correctly
It is common for a person in psychiatric treatment to think that he or she will be doomed to take these medications forever, says Vanessa Favaro.
“Most of the time this is not the case. Treatments usually have a beginning, a development and an end,” says the physician.
The end requires a process that can last months or even years.
“Withdrawal must be gradual to avoid abrupt changes in brain functioning,” Favaro says.
The first step, experts say, is to have the recommendation of the physician accompanying the patient to do so.
“First we need the symptoms to have completely improved and six months to a year of improvement,” Asevedo says.
“Before that, there hasn’t been absolute brain improvement and it’s possible that the symptoms are going to return.”
Some strategies can then be adopted, the psychiatrist explains, such as starting to take the medication every other day or progressively reducing the dose.
“It is important to consult a psychiatrist to assess the most appropriate medication for your type and pathology,” Favaro concludes.