Christopher James Dubey, Psychiatric Survivor
Voiceover by Sterling at Evernote. For my final essay for General Psychology I at CT State Community College, I reviewed recent research on health professionals’ perspectives about antidepressant discontinuation. The findings echo my decades-long journey through the mental healthcare system, which both ruined my life and radically transformed it. Essay follows. Journal Article Review of: “Discontinuing antidepressant medication: a qualitative evidence synthesis and logic model based on health professionals’ views” Article Summary In their article [https://doi.org/10.1186/s12913-025-13445-7], Christoforou and Sutcliffe (2025) examine health professionals’ (HPs) perspectives about factors acting as barriers to or facilitators of antidepressant medication (ADM) deprescribing and discontinuation, finding that societal norms and pressures and systemic healthcare delivery issues appear to influence whether patients receive adequate support to discontinue antidepressants. Additionally, they identify potential policy interventions to address these barriers. This is important because of public health concerns related to antidepressants (Christoforou & Sutcliffe, Background section, pp. 2-3). Deprescribing, the process of reducing or stopping the prescription of medications that may no longer be helpful, is identified as an important step to address these concerns. Using a form of archival research methodology (Feldman, 2024 [https://www.mheducation.com/highered/product/essentials-of-understanding-psychology-feldman.html], pp. 29-30) called a systematic review, Christoforou and Sutcliffe (2025) synthesized data from 14 qualitative studies capturing the views of over 280 HPs. They analyzed findings using Bronfenbrenner’s Social Ecological Model (SEM), which examines environmental contexts affecting social policy issues, and a logic model to illustrate complex concepts and hypotheses (p. 4). Christoforou and Sutcliffe identify themes in HPs’ viewpoints using the SEM’s societal dimensions, called the microsystem (individual level), mesosystem (interpersonal relationships), exosystem (organizations and institutions,), and macrosystem (cultural or societal customs and patterns). At the microsystem level, they identify themes of HPs’ perceptions of antidepressants and depression, sense of professional duty, and confidence in supporting discontinuation (pp. 6-9). In the mesosystem, HPs’ assessments of patients’ circumstances and characteristics, and assessments of patients’ desires, motivations, and capabilities (pp. 9-10). In the exosystem, systemic healthcare delivery issues (pp. 10-11); in the macrosystem, societal norms and pressures (p. 11). They describe how these themes in HPs’ perspectives support or hinder deprescribing. The four most common themes they identify are HPs’ fears (especially about harming patients, relationships, and professional liability), limited time and space, insufficient knowledge, and needs for support and collaborative decision-making (pp. 11-12). Some potential policy interventions mentioned or alluded to include improved deprescribing guidelines, training, and tools, greater access to alternative treatments such as psychotherapies, medication reviews and alerts, improved collaboration, and seminars and campaigns to improve HP education (pp. 12, 14-15). Connection to Course Concepts Christoforou and Sutcliffe’s review (2025) extends Feldman’s (2024) textbook discussion of major depressive disorder (Ch. 12, Module 38) and drug therapy (Ch. 13, Module 42), by exploring beliefs influencing antidepressant deprescribing. While ADM is widely used to treat depression (Feldman, Module 42), Christoforou and Sutcliffe describe public health concerns about antidepressants, with social justice implications of potential overdiagnosis and overtreatment (pp. 2-3). These concerns are offshoots of foundational issues discussed by Feldman (2024), such as differences in the major perspectives in psychology and the key issue of nature vs. nurture (Ch. 1, Module 2; Ch. 12, Module 37). An underlying question is: Is depression caused more by heredity or the environment? Christoforou and Sutcliffe mention debates about the chemical imbalance hypothesis of depression (p. 2). This hypothesis is based in psychology’s neuroscience and medical perspectives, which view behavior through the lens of biology, while behavioral, humanistic, and sociocultural perspectives focus on environmental or social factors (Feldman, 2024, Ch. 1, Module 2; Ch. 12, Module 37). Uncertainties about the etiology of depression, effectiveness of ADM, and risks of long-term antidepressant use support notions that promoting deprescribing is important. I found it intriguing how the opinions of HPs are directly or indirectly influenced by psychology’s major perspectives, reflecting fundamental disagreements about the causes of mental processes and behaviors. I also gained insights into how the differing perspectives of psychology are influencing conceptions of psychological disorders and how to treat them. How to distinguish normal vs. abnormal behavior, disagreements about psychological diagnosis (Feldman, 2024, Ch. 12, Module 37) and questions about medicalizing reactions to life circumstances and overdiagnosis of depression (Christoforou & Sutcliffe, pp. 2, 11) are not simply abstract debates. Differences in psychological perspectives are having tangible real-world impacts in mental healthcare, like deciding when to use antidepressants and when to discontinue them. Personal Reflection Content note: suicide attempts, medical harm Christoforou and Sutcliffe’s article deeply resonates with my experiences as a mental health patient, as I’ve experienced many of the same beliefs and themes in my treatment. In 2002, I was an 18-year-old college freshman. A psychiatrist diagnosed me with depression, and I took her suggestion to take the antidepressant paroxetine, a decision I regret immensely. This led to a nightmare of successive adverse effects, including unrecognized severe antidepressant withdrawal syndrome and suicide attempts. Christoforou and Sutcliffe (p. 2) and Feldman (2024, Ch. 13, Module 42, p. 518) briefly mention the increased suicide risk of antidepressants, a fact hardly mentioned when I was 18. I’m 42 now. Most of my life has involved managing health issues, medication adverse effects, and traumatic or unpleasant medical treatment while living on disability benefits, Medicare, and Medicaid. I’ve encountered many HPs expressing dogmatic neuroscience or biomedical perspectives of mental health, which have contributed to worsened healthcare. However, in 2015 I started following HPs and researchers with alternative perspectives on social media, gaining many insights. One I follow is British psychiatrist Joanna Moncrieff [https://joannamoncrieff.com/], who recently spoke at an FDA panel [https://www.youtube.com/live/2Nha1Zh63SA] and is lead author of the 2022 umbrella review [https://www.nature.com/articles/s41380-022-01661-0] cited by Christoforou and Sutcliffe (p. 2) concluding that there is no convincing evidence for the serotonin imbalance hypothesis of depression. Moncrieff shared Christoforou and Sutcliffe’s review online—that’s how I found it. I’ve also learned that Study 329, a fraudulent [https://www.justice.gov/archives/opa/pr/glaxosmithkline-plead-guilty-and-pay-3-billion-resolve-fraud-allegations-and-failure-report], ghostwritten 2001 study that declared paroxetine to be safe and effective for adolescent depression, is now targeted by a lawsuit [https://brownstone.org/articles/study-329-the-big-fraud-is-finally-under-review/] to have it retracted. In 2021 I was fortunate to come across a New Yorker [https://www.newyorker.com/magazine/2019/04/08/the-challenge-of-going-off-psychiatric-drugs] article [https://www.newyorker.com/magazine/2019/04/08/the-challenge-of-going-off-psychiatric-drugs] about Laura Delano [https://www.lauradelano.com/], and I pondered if, like her, many of my health issues were actually misinterpreted medication adverse effects and withdrawal effects. I highly recommend her memoir Unshrunk: A Story of Psychiatric Treatment Resistance [https://unshrunkthebook.com/]. I began online support groups with her nonprofit organization Inner Compass Initiative [https://www.theinnercompass.org/] (ICI). With difficulty, I found a prescriber willing to help me gradually taper off my last antidepressant, who didn’t express fear or discomfort. My taper took almost four years. After over twenty years believing I needed them for life, I’ve been free from psychiatric drugs for the past year. On December 3-4, I will attend ICI’s conference in West Hartford [https://www.theinnercompass.org/conference]. Speakers will include Joanna Moncrieff, Javeed Sukhera [https://javeedsukhera.com/], chief psychiatrist at Hartford Hospital, and other influential professionals, researchers, patients, and family members. I wish none of this happened to me and that I didn’t have this life full of illness and pain. It still feels surreal, and I’m figuring out what comes next. But I’m glad for the community I’ve found, and I look forward to going. References Christoforou, L., & Sutcliffe, K. (2025). Discontinuing antidepressant medication: a qualitative evidence synthesis and logic model based on health professionals’ views. BMC Health Services Research, 25(1), 1226. https://doi.org/10.1186/s12913-025-13445-7 [https://doi.org/10.1186/s12913-025-13445-7] Feldman, R. S. (2024). Essentials of Understanding Psychology [https://www.mheducation.com/highered/product/essentials-of-understanding-psychology-feldman.html] (2024 Release, 15th ed). McGraw Hill LLC. e-book. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit chrisjamesdubey.substack.com [https://chrisjamesdubey.substack.com?utm_medium=podcast&utm_campaign=CTA_1]
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