Our review of safe withdrawal of depression drugs

Our review of safe withdrawal of depression drugs  shows that length of taper is highly predictive for the chance of success (P = 0.00001). All the randomised studies we reviewed were of poor quality. They confounded withdrawal symptoms with relapse; did not use hyperbolic tapering; withdrew the depression drug too fast; and stopped it entirely when receptor occupancy was still high. We are therefore convinced that the true proportion of patients on depression drugs who can stop safely without severe withdrawal symptoms is considerably higher than the 50% we found.

Our review had a very difficult birth, which I have described on the Mad in America website in the article “Cochrane reviews of psychiatric drugs are untrustworthy,” and our troubles included Cochrane editorial misconduct.

In 2016, I contacted psychiatrist Rachel Churchill, editor of the Cochrane Common Mental Disorders group, who showed great interest in my proposal to do a review on safe withdrawal of depression drugs. But what subsequently happened is a story of how Cochrane protected psychiatry’s guild interests and furthered the interests of the pharmaceutical industry.

Cochrane abused the peer review process. The Cochrane group raised their demands to our review protocol along the way to absurd levels with many irrelevant requirements including that we should add marketing messages in our protocol about the wonders that depression pills can accomplish, according to Cochrane dogma. But out review was aimed at helping patients who wanted to successfully come off the drugs, not about convincing them to stay on the drugs or start taking them!

The Cochrane group rejected our protocol 2.5 years after we first submitted it, while it accepted a similar protocol by other authors and published a very embarrassing Cochrane review, which is full of misleading statements and marketing messages of great value for the drug industry but irrelevant for doctors and patients. This editorial misconduct violated two of the ten Cochrane key principles: Collaboration, which involves open and transparent communication and decision-making, and avoiding duplication of effort, which is about avoiding two reviews cover more or less the same ground.

We first published our review on a preprint server where I described what happened internally, in our author group. We were two authors, in addition to me my PhD student, psychologist Anders Sørensen. We submitted the review to Therapeutic Advances in Psychopharmacology, which was very interested but asked for a revision. Sørensen promised to revise the manuscript but did nothing. And he didn’t respond to my emails, didn’t picked up the phone when he could see the call came from me, and ignored telephone messages.

After a year, I lost my patience and updated the literature search, added a new trial, responded to the peer review comments and sent it all to Sørensen. When he continued to ignore me, I asked the journal for advice. The editor suggested I drop Sørensen and add a new author, as there was a new trial to consider.

I submitted the revision with Maryanne Demasi. Then, the editor succeeded in making contact with Sørensen who suggested his own changes, but sent them directly to the editor, without copying Maryanne or me.

I added Sørensen’s name to the paper again, agreeing to most of his suggestions and resubmitted it to the journal. Then, when Sørensen ignored all further emails from the journal, we were instructed to publish without him.

The editor-in-chief asked me to get Sørensen’s signature confirming he was OK with not being an author, but this was an impossible task, since he did not respond to emails from us or the journal. We sought to ensure that he was in fact well, and we eventually established that he had been active with other projects.

The editor-in-chief got cold feet and asked the journal’s ethical team. After this, we were told they could not publish the paper.

The paper is highly important for psychiatric patients and for those who want to help them come off their drugs, which is part of Sørensen’s clinical practice. It is unacceptable that a researcher is allowed to block publication of important research in the general interest. The main delays were caused by Cochrane and Sørensen. I launched the idea of the review in 2016 and it was published 8 years later. This is the longest gestation period for a scientific paper I have been involved with.