From LSD to Zoloft, drugs can leave lasting damage

SUMMARY: Post-drug disorders are not side effects that linger, but lasting changes that may be severe and irreversible. These disorders are linked to prescribed drugs as well as recreational drugs, and can arise after one dose or chronic abuse. This post covers post-drug disorders linked to use of alcohol, hallucinogens, antidepressants, benzodiazepenes, isotretinoin (also known as Accutane or Roaccutane), finasteride and dutasteride.

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When post-finasteride syndrome landed in the medical literature in the 2010s, skeptics asked how drug side effects could possibly remain long after stopping the drug. The term “persistent side effects” reinforced the conventional view that drug-related concerns can only occur while a patient is taking the drug. Commentators made the obligatory call for large-scale, controlled trials, then recited the conventional view that finasteride is “safe and effective.”

Yet they overlooked a whole class of post-drug disorders, associated with both recreational and prescribed drugs. Some may resolve over time, while others do not. The lasting disorders underscore that post-drug disorders are not phantom “side effects,” but distinct conditions emerging from a prior drug exposure.

Chronic abuse of alcohol can result in neurological injury including Wernicke-Korsakoff syndrome. According to Hammoud & Jimenez-Shahad (2019), “Chronic alcohol use induces silent changes in the structure and function of the central and peripheral nervous systems that eventually result in irreversible, debilitating repercussions.”

HPPD is the recurrence of perceptual disturbances that appeared during previous hallucinogenic ‘trips’…and re-emerged without recent use.

Using hallucinogens such as LSD or MDMA can result in hallucinogen persisting perception disorder (HPPD). Martinotti et al. (2018) describe this as “the total or partial recurrence of perceptual disturbances that appeared during previous hallucinogenic ‘trips’ or intoxications and re-emerged without recent use.”

Post-drug disorders are also linked to prescribed drugs. These disorders have been underrecognized or outright denied by medical authorities, so many support resources have been gathered and published by patient groups. In some cases, medicine has taken notice of their efforts and changed guidelines accordingly.

Withdrawal syndromes are reactions that follow discontinuation of a drug. They may be long-lasting, but tend to resolve over time. A prominent example is antidepressant withdrawal syndrome which, after years of grassroots discussion and advocacy, has gained some recognition. SSRI/SNRI antidepressants may also lead to a long-term condition, post-SSRI sexual dysfunction (PSSD), with symptoms including genital numbness, loss of libido, anhedonia and loss of skin sensitivity among other symptoms.

Turning to another psychiatric drug, there is a benzodiazepene withdrawal syndrome with symptoms including insomnia, anxiety, panic and depersonalization/derealization.

Fluoroquinolones, a powerful class of antibiotics, were first introduced in the 1980s, but serious safety concerns have only come to light in the last 15 years. FDA updated fluoroquinolone warnings as recently as 2018. The current Cipro label states that fluoroquinolones “have been associated with disabling and potentially irreversible serious adverse reactions [including] tendinitis, tendon rupture, arthralgia, myalgia, peripheral neuropathy, and central nervous system effects (hallucinations, anxiety, depression, insomnia, severe headaches, and confusion).”

There has been a longstanding debate over the safety of isotretinoin, better known as Accutane and Roaccutane. Research has focused on depression and suicidality while on the drug, but there have been reports of a post-drug syndrome. The Reddit forum r/AccutaneDamage states in its description: “Harm from this medication can be serious, disabling, and permanent, it can occur with a delayed onset months or years after exposure.” Dermatologists typically say they have not seen a case of post-Accutane syndrome, attributing any post-drug symptoms to other causes such as depression or “Internet illness.”

Concerns about a lasting and severe post-finasteride disorder are documented throughout this website. Sexual and neuropsychiatric dysfunctions are most common, but there may also be cognitive difficulties, insomnia, energy deficits and musculoskeletal dysfunctions.

Prescription drugs can cause lasting, severe disorders, but medicine has largely remained in denial. Medicine has a bias for the benefits of drugs, known as efficacy, while discounting or ignoring risks and harms. This slant permeates clinical practice, research, drug development and regulation, keeping these disorders underground. When patients speak up, they may be called a “vocal minority” or dispatched to a psychiatrist. In the medical literature, it is easy to find studies of the harms of illicit drugs like heroin, but research on harms of prescription drugs is scarce. By stifling dialogue on post-drug syndromes, medicine has largely kept them a non-entity. For affected patients, it is a long, possibly futile slog to get doctors to understand that the problem is not the patient, but the drug itself.

Resources

General

From the depths: why finasteride harms took decades to emerge. Finasteride Info.

Healy D, Bahrick A, Bak M, et al. Diagnostic criteria for enduring sexual dysfunction after treatment with antidepressants, finasteride and isotretinoin. Int J Risk Saf Med. 2021. doi:10.3233/JRS-210023 • PMC full text

NCBI Bookshelf. StatPearls: Withdrawal syndromes

When medical treatment brings on disease: iatrogenic disorders. Finasteride Info.

Antidepressant withdrawal syndrome

Hengartner MP, Davies J, Read J. Antidepressant withdrawal – the tide is finally turning. Epidemiology and Psychiatric Sciences. 2020. doi:10.1017/S2045796019000465 • PMC full text

UK NICE. Announcement of draft quality standard for antidepressant tapering. January 17, 2023.

Isotretinoin (Accutane / Roaccutane)

Finasteride Info. Research on adverse effects of isotretinoin

Reddit community: r/AccutaneDamage

Benzodiazepines

Ashton, CH. Chapter 3: Benzodiazepine Withdrawal Symptoms, Acute & Protracted. The Ashton Manual. 2002.

Benzodiazepine Information Coalition. BenzoInfo.com.

Mind (UK charity). Withdrawal effects of benzodiazepines. Accessed April 21, 2023.

Royal Australian College of General Practitioners. Prescribing drugs of dependence in general practice, Part B – Chapter 5: Discontinuing benzodiazepines. November 6, 2019.

Finasteride, dutasteride & saw palmetto

Firsthand reports. Finasteride Info.

From the depths: why finasteride harms took decades to emerge. Finasteride Info.

Lasting dysfunctions after use of finasteride or dutasteride. Finasteride Info.

Research on lasting dysfunctions after taking finasteride or dutasteride. Finasteride Info.

Fluoroquinolones

Bennett AC, Bennett CL, Witherspoon BJ, Knopf KB. An evaluation of reports of ciprofloxacin, levofloxacin, and moxifloxacin-association neuropsychiatric toxicities, long-term disability, and aortic aneurysms/dissections disseminated by the Food and Drug Administration and the European Medicines Agency. Expert Opin Drug Saf. 2019. doi:10.1080/14740338.2019.1665022 • PMC full text

Carr T. Fluoroquinolones are too risky for common infections. Consumer Reports. May 16, 2016.

Expert Opinion on Drug Safety: An evaluation of reports of ciprofloxacin, levofloxacin, and moxifloxacin-association neuropsychiatric toxicities

FDA updates warnings for fluoroquinolone antibiotics on risks of mental health and low blood sugar adverse reactions. Food and Drug Administration. July 10, 2018.

Post-SSRI sexual dysfunction (PSSD)

PSSD Network (organization). pssdnetwork.org