A patient stops her SSRI under medical supervision over four weeks. She has never previously experienced panic attacks, insomnia, or akathisia. All three now arrive at once, alongside brain “zaps,” agitation, and suicidality. Emergency services diagnose agitated depression, then revise to a psychotic disorder. She is involuntarily treated with antipsychotics. But a paper published in Psychotherapy and Psychosomatics in early 2025 by the psychiatrist Mark Horowitz and the psychotherapist James Davies documents precisely this pattern and names it for what it is: withdrawal symptoms misdiagnosed as relapse — or worse, as an entirely new illness. The diagnostic instruments used in most discontinuation trials cannot distinguish between the return of a condition and the pharmacological consequences of stopping a medication. The patient is not sick again. She is trapped.

[https://markhorowitz.org/]

That case sits at one end of a system that has, by any quantitative measure, lost all sense of proportion. In England, 92.6 million antidepressant items were dispensed to nearly nine million patients in the year to March 2025, a four per cent rise on the previous twelve months and part of a trajectory that has seen sertraline prescriptions alone climb 685 per cent between 2010 and 2023. In Australia, the proportion of the population filling an antidepressant script rose from twelve per cent to fourteen per cent over the decade to 2024–25 — 3.9 million people, with GPs writing ninety two per cent of the scripts. Iceland leads the OECD table at roughly 165 defined daily doses per thousand inhabitants as of 2023, with Portugal and Canada close behind. The global antidepressant market, already valued at some eighteen billion US dollars, is forecast to breach twenty billion by 2030, with the Middle East now the fastest growing regional segment — a striking detail for a region where, according to recent data, seventy two per cent of anxiety sufferers still rely on family or religious support rather than licensed clinicians. The pills are arriving before the psychiatrists.

None of this would matter if the prescribing........

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