Helping you understand adverse reactions, nervous-system effects and withdrawal associated with antidepressants, benzodiazepines, gabapentinoids and Z-drugs — with resources for patients, families and professionals across Ireland.
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Drawing on Irish research and patient experiences, Dr Cathal Cadogan, Associate Professor of Pharmacy at Trinity College Dublin, and Professor Agnes Higgins, former Professor of Mental Health at Trinity College Dublin, examine psychiatric medication tapering and withdrawal through an Irish Lens, and the important role healthcare professionals can play in safer deprescribing.
Akathisia is a severe neurological disorder causing intense inner restlessness, an uncontrollable urge to move, and profound terror, with a severe risk of suicide, most often triggered by adverse reactions or withdrawal from medications like antipsychotics and antidepressants.
What is worse, is that many mental health professionals, both in Ireland and abroad, are not trained to recognise akathisia and often misdiagnose the condition as anxiety, panic disorder, psychotic agitation, or restless legs syndrome.² This then poses a risk of the patient being harmed further, as they may be advised to change medication dosage or switch to a different psychotropic medication.³ In an already sensitised nervous system, this misdiagnosis and treatment can result in a catastrophic reaction in the patient.
This brief observation period completely fails to reflect real-world usage, where patients take medications for months, years, or decades, and it completely misses the reality of protracted withdrawal.
Protracted withdrawal syndrome (PWS), also referred to in literature as Post-Acute Withdrawal Syndrome (PAWS), refers to a group of symptoms than can linger for weeks, months, or even years after reduction or cessation of a psychotropic medication. PWS symptoms do not always show up immediately: in some cases, symptoms have been reported weeks to months post-cessation.⁵
The Royal College of Psychiatrists has explicitly called for training for doctors on best practice in prescribing and managing antidepressants and for adequate support services for people experiencing more severe and prolonged withdrawal.⁶
Sadly, there are still healthcare providers in Ireland who may be unaware of, or underestimate, the severity and potential duration of psychiatric drug withdrawal and medication-induced adverse effects. This can leave patients vulnerable to having genuine withdrawal symptoms dismissed or misattributed to their underlying psychiatric condition. In some cases, patients may even be led to believe that symptoms occurring after discontinuation are simply psychosomatic.
NICE now explicitly instructs clinicians to recognise that withdrawal can last weeks or months, that symptoms can be severe, and that withdrawal needs to be distinguished from recurrence of depression. NICE also recommends ongoing monitoring patients during dose reduction. ⁷
Irish patients deserve the same level of recognition, information and clinical care. Ireland should ensure that its own prescribing and withdrawal guidance keeps pace with the evidence and reflects the reality that psychiatric medication withdrawal can be prolonged, severe and clinically distinguishable from relapse.
Here are just some of the symptoms reported by patients suffering from psychiatric drug injury and withdrawal*:
Akathisia
Anxiety
Panic attacks
Agoraphobia
Irritability
Rage
Agitation/restlessness
Impulsivity
Moodswings
Emotional hypersensitivity
Depression
Dysphoria
Anhedonia (loss of pleasure/feeling emotionally numb)
Apathy
Guilt/shame
Repetitive thoughts
Intrusive thoughts
Paranoia
Impending Doom
Monophobia (fear of being alone)
Inability to maintain relationships
Brain zaps
Delirium
Non-restorative sleep
Nightmares
Exercise intolerance
Malaise
Palpitations/tachycardia
Blood pressure spikes
Delayed gastric emptying / gastroparesis
Acid reflux
Chemical, food and oder sensitivities (MCAS type reactions)
Severe anaphylactic reactions
Reduced / low libido
Erectile dysfunction
Menstrual cycle changes
Thyroid issues
Hematologic abnormalities (anemia, leukopenia, thrombocytopenia, agranulocytosis, pancytopenia)
Facial numbness/tingling
Paresthesia ("pins and needles")
Altered smell and taste
Itching
PSTD-like flashbacks
Heightened startle response
Hyperacusis (sound sensitivity)
Depersonalisation
Derealisation
Mania
Bipolar like mood swings
Psychosis
Suicidal thoughts
Homicidal thoughts
Disinhibition
Transient amnesia/blackouts
Headaches
Brain fog
Pseudo dementia
Aphasia
Ataxia
Vertigo
Seizures
Neuropathy
Hypnic jerks at sleep onset
Jelly legs
Speech difficulties
Shortness of breath / air hunger
Adrenaline surges
Fainting
Difficulty swallowing
TMJ
Elevated cholesterol
Elavated liver enzymes / hepatotoxicity / hepatomegaly
Pre-diabetic / blood sugar dysregulation
Burning skin
Nerve pain
Incontinence
Enuresis (bed wetting)
Fever / lymphadenopathy (systemic inflammatory / hypersensitivity signs).
Dry eyes
Burning mouth
Pharmharmed.ie was born out of one Irish woman's experience being harmed by psychiatric medications. Prescribed mirtazapine for difficulty sleeping, and later wishing to come off, she was given successive stopping and starting advice by her GP which resulted in a catastrophic reaction. Experiencing the horrors of akathisia after multiple failed withdrawals, this was misdiagnosed as an anxiety relapse, and she was therefore instructed to restart the drug again and increase her dosage on a weekly basis. Given her condition, this was dangerous advice. Fortunately, she found an online support group just in time, which supported the gold-standard Horowitz & Taylor Maudsley Deprescribing Guidelines on reinstatement and hyperbolic tapering. She is still stabilising, 2 years on.
No patient should have to rely on an online support group to discover information that could fundamentally change how their medication withdrawal is understood and managed.
No patient experiencing severe withdrawal or akathisia should be left wondering whether what they are experiencing is real.
We believe patients deserve better information, better-informed prescribing and deprescribing, and compassionate clinical care that takes severe medication reactions seriously.
"If I had not found an online support community in time, there is no doubt in my mind that I would have taken my life. It was unbearable. I was waking up every morning vomiting, my entire body internally buzzing, being unable to stop moving and constanly pacing around my garden with an unrelenting feeling of inner terror. Each night as I tried to sleep, my body would be dramatically jolted awake. I was sobbing uncontrollably and couldn't be alone. Thanks to an online support community, I learned what had happened to me: that I was experiencing akathisia as a result of withdrawal induced kindling, as well as a paradoxical reaction to a brand change. I would never have known the terminology, what was happening or what to do if I hadn't stumbled across others who had been through the same thing. I was also incredibly lucky to be able to have a consultation with Dr. Mark Horowitz himself, but for many this is not financially viable, and it shouldn't take having to consult with a psychiatrist outside of my own country to understand what to do. As patients, we deserve to have access to the right knowledge to be able to effectively advocate for ourselves amidst a culture of medical misinformation."
- Emma Henderson (creator of Pharmharmed.ie)
Pharmharmed.ie is an independent, faith-led advocacy and informational resource project designed to equip Irish patients, families, care providers and first responders seeking to better understand medication-related adverse effects, dependence, withdrawal and other potential medication harms. The site brings together plain-English educational information, clinical literature, self-advocacy resources and links to established organisations and professional resources. Our resources cover medication-related difficulties associated with:
Antidepressants and Antipsychotics (SSRIs, SNRIs, benzodiazepines, tricyclics, tetracyclics etc)
Sleeping Pills & Z drugs (Zolpidem, Zopiclone, Zaleplon)
Gabapentinoids (gabapentin, pregablin)
Antiemetics (metoclopramide, prochlorperazine, and promethazine)
Antibiotics (fluoroquinolines, metronidazole)
Pharmharmed.ie does not diagnose, prescribe or provide individual medical treatment. Its purpose is to help people access information, understand the terminology surrounding medication-related problems, and have better informed conversations with their healthcare providers.
Find out more about our mission here
Central Statistics Office. (2025). Analysis of prescriptions dispensed under the General Medical Services Scheme (GMS), 2018–2023. https://www.cso.ie/en/releasesandpublications/fp/fp-apgms/analysisofprescriptionsdispensedunderthegeneralmedicalservicesschemegms2018-2023/
Pringsheim, T., Gardner, D., Addington, D., Martino, D., Morgante, F., Ricciardi, L., Poole, N., Remington, G., Edwards, M., Carson, A., & Barnes, T. R. E. (2018). The assessment and treatment of antipsychotic-induced akathisia. The Canadian Journal of Psychiatry, 63(11), 719–729. https://doi.org/10.1177/0706743718760288
Salem, H., Nagpal, C., Pigott, T., & Teixeira, A. L. (2017). Revisiting antipsychotic-induced akathisia: Current issues and prospective challenges. Current Neuropharmacology, 15(5), 789–798. https://doi.org/10.2174/1570159X14666161208153644
Ward, W., Haslam, A., & Prasad, V. (2025). Antidepressant trial duration versus duration of real-world use: A systematic analysis. The American Journal of Medicine, 138(10), 1400–1407.e10. https://doi.org/10.1016/j.amjmed.2025.05.016
Stockmann T, Odegbaro D, Timimi S and Moncrieff J (2018) SSRI and SNRI withdrawal symptoms reported on an internet forum. International Journal of Risk and Safety in Medicine 29, 3–4, 175–180. doi: 10.3233/JRS-180018
Royal College of Psychiatrists. (2019, May 29). RCPsych calls on NICE to update its antidepressant withdrawal advice. https://www.rcpsych.ac.uk/news-and-features/latest-news/detail/2019/05/29/rcpsych-calls-on-nice-to-update-its-antidepressant-withdrawal-advice
National Institute for Health and Care Excellence. (2022). Depression in adults: Treatment and management (NICE guideline NG222). https://www.nice.org.uk/guidance/ng222
*Withdrawal symptoms can vary greatly from person to person. Factors such as the medication involved, length of treatment, dose, rate of tapering, previous withdrawal experiences, and individual sensitivity may all influence the type, severity and duration of symptoms.
