September 18, 2019

David Lazarus, a business columnist for the Los Angeles Times, last week wrote a column detailing his struggles quitting antidepressants, but his article—titled "Hi, I'm David. I'm a drug addict"—received backlash from some critics for conflating addiction and physical dependence.

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Lazarus' column

In his column, Lazarus disclosed that in 2007 he was diagnosed with Type 1 diabetes. Among his symptoms was insomnia that "turned [his] nights into minefields, tossing, turning, lying awake for hours."

He sought help from his endocrinologist, who wrote him a prescription for an antidepressant to address the "systemic imbalance" that was preventing him from sleep.

Lazarus wrote that his sleep and overall mood improved significantly. "I started sleeping better within a few weeks. As an added benefit, my wife said I'd become mellower and more pleasant to be around," he wrote.

Lazarus took the pills regularly for years. But then, in 2018, he came across a New York Times investigation highlighting how some longtime antidepressant users suffered serious symptoms of "discontinuation syndrome" when they stopped taking the drugs.

The article caused Lazarus to take a hard look at his own antidepressant use, which by that point had spanned about a decade. "What if there was an earthquake or some other disaster and I couldn't get my pills? What if the withdrawal symptoms were more than I could handle? How would I cope?" he wrote.

He also began reflecting on the medication's effects on his personality. "Yes, I liked that my wife felt I was more pleasant to be around," he wrote. "But who was I? Was I me or was I the product of chemical enhancement? If I came off the drug, what would happen?"

After consulting his endocrinologist, Lazarus worked out a program to taper himself off of his antidepressants. "At first I felt a bit better," Lazarus wrote. But after a few weeks, "I [felt] worse—sluggish, moody, short-tempered," he wrote. "I've even started thinking about going back on antidepressants."

He wrote that his experience "mirrors the struggle many people face in trying to wean themselves from powerful prescription drugs—drugs that can play a positive role in your life until you realize you're trapped."

Lazarus receives criticism

After Lazarus' column ran, it faced a flood of criticism on Twitter and in the media, with critics arguing that his depiction of antidepressant dependence was inaccurate and stigmatizing.

For instance, Jessica Moreno, a psychiatric clinical pharmacist, argued that Lazarus had painted with too broad a brush in suggesting that anyone who regularly takes a medication is an "addict":

Most of the comments thus far are spot-on, and I'm not sure I have much more to add, but I feel a professional responsibility to add to the ratio.

Others argued that Lazarus' portrayal of his experience contributed to stigma around mental health treatment and addiction:

Lazarus issues response column

In response to the wave of criticism, Lazarus wrote a new column, acknowledging that he had erred in describing his experience as an "addiction."

According to the National Institute on Drug Abuse, addiction "is characterized by an inability to stop using a drug; failure to meet work, social or family obligations; and, sometimes (depending on the drug), tolerance and withdrawal."

Lazarus's own experience did not, he acknowledged, meet these criteria. Rather, he was dealing with physical dependence—a sometimes serious, but distinct, issue.

"There's a difference between being addicted to a prescription drug and being dependent on it," he wrote. He added that the criticism was "a fair point—and an important one to many in the recovery community, as has been made plain to me in recent days."

Lazarus wrote that, "[i]n retrospect, a more nuanced headline would have been better, rather than an eye-catching (albeit imprecise) riff on a line from countless movies."

He clarified that he was not "encouraging other people to stop taking their drugs, and certainly not without consulting a doctor. If a drug therapy works for you, if it's improved your quality of life, by all means stick with it."

Instead, Lazarus wrote, his point was to warn people who want to quit their prescriptions that "[w]ithdrawal is withdrawal. It's not easy."

For anyone considering changing their medication regimen, Lazarus offered some lessons he's learned from his experience.

He wrote that patience is important, and that it's easy to start prescription medications but harder to get off of them. He also emphasized the importance of ensuring "you've got a health care professional at your side."

And he wrote that you should "set reasonable goals" and allow your tapering process to take as long as necessary. And finally, "Stay strong," Lazarus wrote. "And remember you're not alone" (Lazarus, Los Angeles Times, 9/6; Lazarus, Los Angeles Times, 9/10; Hill, KCRW, 9/10).

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