When Medications Hurt Instead of Help: Understanding Iatrogenic Injury and Psychiatric Medication Withdrawal

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Written by Cecily Longo, LMFT

A Note Before We Begin

I am not a doctor, physician, or prescriber.

This article covers a topic that is deeply important to me—both professionally and personally.

As a therapist, I have witnessed many clients benefit greatly from psychiatric medications. I have also seen many individuals harmed by them.

Here, I focus on how therapists, within their scope of practice, can support clients who are experiencing a difficult tapering process with antidepressants or benzodiazepines—when those medications have been taken exactly as prescribed.

I have researched this topic extensively and have included credible sources for the facts presented, along with resources for those who wish to explore further—whether for professional or personal reasons.

This post is not anti-medication. It’s not here to tell anyone what to take, stop, or question. That’s a deeply personal decision, best made in collaboration with a trusted, knowledgeable medical provider.

It’s not about being “for” or “against” psychiatric medication—it’s about understanding the full picture: the research, the risks, the realities, and the stories that too often go unheard, particularly for the 30%+ of people who experience significant challenges both short- and long-term.

My goal is simple: to offer what many never received—true informed consent.

If these medications have helped you? That’s valid. That’s real.
If they’ve harmed you? That’s valid, too.

Both truths can coexist—and this article holds space for both.

Before We Explore Iatrogenic Harm

Here’s a quick, research-based checklist of what some commonly prescribed psychiatric medications do well.

This list is not exhaustive and does not cover every psychiatric medication, but it highlights key, evidence-supported benefits for antidepressants and benzodiazepines when used appropriately and under medical supervision.

What Antidepressants Do Well: Fast Facts

  • 2 out of 3 people respond positively to antidepressants, compared to 1 in 3 on placebo (Cipriani et al., 2018, The Lancet).

  • 67% response rate in adult depression trials with many SSRIs/SNRIs (PMC article).

  • Some of the most effective & well-tolerated meds include escitalopram, sertraline, vortioxetine, and desvenlafaxine (Nature Reviews).

  • For dysthymia (chronic low-grade depression), SSRIs are 55% effective vs. 31% for placebo.

  • With structured support, 42–68% of people successfully discontinue antidepressants without relapse over 1–5 years (Horowitz et al., 2021; The Times UK).

  • Withdrawal symptoms are common but often temporary: about 15–30% report them; with slow tapering, rates may drop to under 5%.

  • Many people stay on these medications safely and without complication—especially when paired with therapy, lifestyle change, and medical monitoring.

What Benzodiazepines Do Well: Fast Facts

  • Rapid anxiety relief – Onset within minutes to hours, making them effective for acute panic attacks, severe anxiety spikes, and crisis stabilization (Lader, 2011).

  • Short-term insomnia treatment – Can help initiate and maintain sleep for short periods (generally ≤ 2–4 weeks) when other strategies have failed.

  • Procedural and medical sedation – Used in dentistry, surgery, and diagnostic procedures to reduce anxiety and induce calm.

  • Muscle relaxation – Helpful in acute muscle spasms, neurological disorders (e.g., multiple sclerosis), and post-injury recovery.

  • Seizure control – Fast-acting rescue medication for status epilepticus and acute seizure clusters.

  • Adjunct in trauma care – Short-term use to manage acute distress after traumatic events while other treatments are initiated.

  • Bridge therapy – Can temporarily stabilize symptoms during the initial weeks of starting an antidepressant, before the antidepressant takes full effect.

Who May Benefit From This Article

This article is intended for clinicians seeking to better understand and support clients experiencing troubling symptoms related to the prolonged use—and tapering—of psychiatric medications, as well as for individuals navigating this complex path themselves.

If you or someone you work with has experienced destabilizing, unexplained, or distressing symptoms after long-term use of a psychiatric medication—or during the process of reducing or stopping one—or if a medication that once seemed helpful now appears to be making things worse, this may speak directly to your experience.

What Is Iatrogenic Injury?

Iatrogenic injury refers to harm caused by medical treatment itself.

In the context of psychiatric medication, it means the symptoms or complications that can arise from the very medications intended to help—especially during or after a taper.

This can include physical, cognitive, and emotional symptoms that are often misunderstood or misdiagnosed.

As a trauma-informed therapist, I’ve worked with many clients who were prescribed psychiatric medications long-term—sometimes for decades—without fully understanding the potential for tolerance, neuroadaptation, or withdrawal.

When these medications are reduced or stopped, some people experience destabilizing symptoms that are frequently mischaracterized as relapse or a new mental illness.

Again—this article is not anti-medication. Many people benefit from psychiatric medications, and for some, they are lifesaving.

The goal here is to increase awareness of the need for improved informed consent, clinician awareness, and trauma-informed support for those who are harmed—especially when they took their medication exactly as prescribed.

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Why This Happens: Tolerance, Tachyphylaxis, and Nervous System Disruption

Tolerance: The nervous system adapts to the presence of a drug, requiring more of it to achieve the same effect. Tolerance can develop even at low doses and with compliant use—especially with benzodiazepines and antidepressants. This process occurs due to receptor downregulation, meaning the brain reduces the number or sensitivity of receptors the substance interacts with, diminishing the drug’s effectiveness over time.

Tachyphylaxis (a.k.a. Prozac poop-out): A sudden or gradual loss of medication effectiveness despite continued use.

Withdrawal: A set of symptoms that can arise when a medication is reduced or discontinued. These symptoms may range from mild to debilitating—and can persist for months or even years in some cases after the medication is discontinued or tapered.

Kindling: A phenomenon where each successive withdrawal becomes more severe, reflecting heightened nervous system sensitization over time.

Tolerance Withdrawal: Another poorly understood but important phenomenon—when withdrawal-like symptoms emerge even while still taking the medication at a stable dose.

This is well-documented with benzodiazepines, where the brain adapts to the drug’s effects over time, and the existing dose no longer adequately regulates GABA (gamma-aminobutyric acid).

The result is a paradoxical worsening of symptoms—like anxiety, panic, cognitive fog, insomnia, and nervous system hypersensitivity—despite medication compliance. This is due to the downregulation of the receptors that bind to the drug.

With antidepressants, a related concept called tachyphylaxis involves a gradual or sudden loss of efficacy. While not always labeled as tolerance withdrawal, it similarly reflects neuroadaptive changes and may cause emotional or physiological destabilization even before tapering begins.

Commonly Prescribed Medications

Many clients are prescribed psychiatric medications for a range of symptoms and diagnoses—including Major Depressive Disorder (MDD), Generalized Anxiety Disorder (GAD), panic disorder, Post-Traumatic Stress Disorder (PTSD), insomnia (though not technically a stand-alone diagnosis), and a wide variety of other mental health concerns.

These medications may be prescribed for months, years, or even decades—sometimes without reevaluation or full awareness of the risks involved in long-term use.

Benzodiazepines

Often prescribed for anxiety, panic attacks, acute stress, insomnia, muscle spasms, and sometimes off-label for PTSD or as adjuncts in depression or pain management.

Common benzodiazepines include:

  • Alprazolam (Xanax)

  • Clonazepam (Klonopin)

  • Lorazepam (Ativan)

  • Diazepam (Valium)

  • Temazepam (Restoril)

Though originally approved for short-term use (typically 2–4 weeks), many clients remain on these medications far longer, increasing the risk of tolerance, dependence, and serious—even life-threatening—withdrawal complications.

Antidepressants

Primarily prescribed for major depressive disorder, generalized anxiety, panic disorder, social anxiety, PTSD, obsessive-compulsive disorder (OCD), PMDD, and chronic pain syndromes.

Some are also used off-label for insomnia, eating disorders, and hot flashes.

Selective Serotonin Reuptake Inhibitors (SSRIs):

  • Fluoxetine (Prozac)

  • Sertraline (Zoloft)

  • Escitalopram (Lexapro)

  • Paroxetine (Paxil)

  • Citalopram (Celexa)

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs):

  • Venlafaxine (Effexor XR)

  • Duloxetine (Cymbalta)

  • Desvenlafaxine (Pristiq)

Although these medications can be lifesaving for some, others experience tolerance, emotional blunting, or withdrawal symptoms that may mimic or exceed the severity of their original condition—especially after long-term use or abrupt changes in dosing.

The Neurotransmitters Involved: GABA, Glutamate, and Serotonin

Benzodiazepines directly affect the brain’s GABA-A receptors—which regulate calming, sleep, and anxiety. Long-term use can lead to downregulation of these receptors and upregulation of glutamate, the brain’s primary excitatory chemical.

During withdrawal, this imbalance can result in severe overactivation of the nervous system—manifesting as anxiety, akathisia, tremors, cognitive impairment, and even seizures (Ashton Manual).

SSRIs and SNRIs affect serotonin reuptake and receptor sensitivity. After months or years of use, the brain may adapt by reducing natural serotonin signaling or altering receptor density.

When these medications are reduced too quickly, withdrawal symptoms can include mood swings, dizziness, electric shock sensations ("brain zaps"), and emotional numbness (Davies & Read, 2019).

These are neurophysiological processes—not character flaws, emotional weakness, or simply a “return” of the original condition.

Unfortunately, many clients are told that their symptoms during withdrawal or tapering are proof their underlying illness is returning, when in fact, these symptoms may be the result of nervous system adaptations caused by the medication itself.

How Common Is Iatrogenic Injury?

Long-term use of psychiatric medication is increasingly common. Yet long-term studies are lacking.

  • Most antidepressant trials are conducted over 6–12 weeks, while many people remain on them for years or decades (Hengartner, 2020).

  • Withdrawal symptoms are common: 56% of patients experience withdrawal after stopping antidepressants, and 46% report them as severe (Davies & Read, 2019).

  • Benzodiazepine withdrawal is well-documented, with some symptoms emerging even after short-term use.

  • Despite being labeled as addictive, fewer than 2% of patients prescribed benzodiazepines misuse them (Jones & McAninch, 2015). Most take them exactly as prescribed—yet still develop physiological dependence.

Dependence vs. Addiction vs. Tolerance vs. Misuse vs. Abuse

Language matters. Many people harmed by psychiatric medications are mislabeled as “addicted” when their experience is iatrogenic dependence, not substance use disorder.

  • Dependence: The body adapts to a medication, and withdrawal occurs if it’s stopped or reduced. This can happen with appropriate, as-prescribed use.

  • Addiction: Involves compulsive use, craving, and loss of control. Most long-term psychiatric medication users do not meet this criteria. This is more behavioral and often accompanies abuse of a substance.

  • Tolerance: A neuroadaptive process where increasing doses are needed to achieve the same effect.

  • Misuse: Taking medication outside the prescribed parameters. This differs from substance abuse and addiction.

Definitions from DSM-5-TR, NIDA, and WHO

Substance Abuse (older term; now folded into Substance Use Disorder):
Refers to a pattern of harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs. In earlier diagnostic models (DSM-IV), it was considered less severe than dependence.

Addiction (clinical shorthand; not a standalone DSM diagnosis):
A chronic, relapsing brain disease characterized by:

  • Compulsive substance use

  • Loss of control over intake

  • Continued use despite negative consequences

  • Often involves craving, tolerance, and withdrawal

Key differences in addiction vs. dependence:

  • Addiction involves behavioral dysregulation and compulsion.

  • Dependence is physical adaptation to a substance (can occur without addiction).

  • You can have dependence without addiction (e.g., many patients on antidepressants or benzodiazepines).

  • You can have addiction without physical dependence (e.g., behavioral addictions or early-stage SUD).

Why Antidepressants Aren’t Considered Addictive—But Benzodiazepines Are

Many people ask:
"If antidepressants cause withdrawal symptoms, doesn’t that mean they’re addictive?"

The answer lies in how we define addiction versus dependence.

  • Antidepressants (like SSRIs and SNRIs) can lead to physical dependence, but they don’t typically cause craving, compulsive use, or a “high.”

  • Benzodiazepines affect the brain’s GABA system, producing calming or euphoric effects for some users, making them more reinforcing.

In short:

  • Antidepressants = dependence possible, addiction unlikely.

  • Benzodiazepines = dependence and addiction both possible, especially with long-term or unsupervised use.

What Therapy Can—and Can’t—Do

I am not a prescriber. I do not offer medical tapering plans. But therapy can be a powerful part of healing.

Therapy can support:

  • Nervous system regulation (grounding, breathwork, EFT Tapping)

  • Emotional processing, grief, and identity shifts

  • Somatic and parts work (e.g., Internal Family Systems)

  • Making meaning of medical trauma and rebuilding self-trust

  • Validation of experiences often dismissed or misdiagnosed

Therapy may not be helpful when:

  • It pathologizes withdrawal as relapse

  • It relies solely on cognitive models (like traditional CBT) that bypass emotional and physiological regulation

  • It focuses on symptom “fixing” rather than nervous system support

What I Offer

I provide trauma-informed, emotionally attuned therapy for clients navigating psychiatric medication withdrawal and healing from iatrogenic injury.

This includes safe, non-pathologizing support for clients who are tapering, holding, or recovering from medications—especially benzodiazepines and antidepressants.

This work isn’t for everyone. But for those going through it, you know how real it is—and you don’t have to go through it alone.

Important Disclaimer

I am not a prescriber, de-prescriber, or tapering advisor. I do not provide medical guidance or make recommendations about whether you should taper.

If you have concerns about your current medication, its risks, or whether tapering is appropriate for you, please consult a licensed medical provider trained in safe deprescribing protocols.

Tapering psychiatric medications carries significant clinical risks and should always be done under medical supervision.

The most up-to-date recommendations reflect hyperbolic tapering, as outlined in the Maudsley Deprescribing Guidelines by Dr. Mark Horowitz. These guidelines emphasize gradual, individualized reductions based on scientific research and the patient’s unique symptom response—rather than rigid dose intervals or timelines.

If you choose to taper, finding a prescriber familiar with these methods can make a critical difference.

References & Resources

Key Clinical Manuals and Guidelines

Research on Antidepressants

  • Cipriani et al., 2018 (The Lancet) – Network meta-analysis: all 21 antidepressants more effective than placebo in acute MDD; comparative efficacy/acceptability.
    The Lancet – PubMed

  • Davies & Read, 2019 (Addictive Behaviors) – Systematic review: withdrawal incidence ~56%; ~46% severe among those with symptoms; duration can be months+ for some.
    PubMed Link

  • Horowitz & Taylor, 2019 (Lancet Psychiatry) – Hyperbolic tapering rationale for SSRIs to mitigate withdrawal; taper much slower to very low doses.
    The Lancet Psychiatry

  • Hengartner, 2020 (Ther Adv Psychopharmacol) – Critical review of relapse-prevention trials and withdrawal confounding in long-term antidepressant evidence.
    PMC Link

Research on Benzodiazepines

  • Ashton Manual – Classic clinical manual on benzodiazepine withdrawal, including tolerance withdrawal and protracted symptoms.
    Benzodiazepine Information Coalition

  • Lader, 2011/2014 (Addiction; Br J Gen Pract) – Reviews of benzodiazepine adverse effects, dependence/abuse potential, and long-term risks.
    PubMed – Addiction

  • Blanco et al., 2018 (J Clin Psychiatry/PMC) – US epidemiology: among benzo users, ~17% report misuse at least once; ~1.5% meet use-disorder criteria (supports the “misuse/addiction ≠ everyone on benzos” point).
    PMC Link

Core Guidance & Definitions

  • NICE (UK) – Quality statement on stopping antidepressants (taper in stages to reduce withdrawal).
    NICE Guidance

  • Royal College of Psychiatrists (RCPsych) – Position statement PS04/19: Antidepressants and depression (acknowledges severe/prolonged withdrawal for some; recommends gradual reduction & support).
    RCPsych Position Statement

  • FDA (US) – 2020 class-wide Boxed Warning update for benzodiazepines (abuse, misuse, addiction, physical dependence, withdrawal).
    FDA Drug Safety Communication

  • National Institute on Drug Abuse (NIDA) – Official definition of addiction (compulsive use despite harm; chronic/relapsing).
    NIDA Definition

Mechanisms & Clinical Differentiation

Patient-Facing & Clinician Resources

Disclaimer

While I am not a medical doctor or prescriber, this article reflects my professional experience as a therapist and my own extensive research on this topic. It is not intended to serve as medical advice. Always consult with a qualified prescriber when making changes to any psychiatric medication.