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Marion Brown: Challenging the Misdiagnosis of Antidepressant Withdrawal as FND

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Marion Brown is a retired Scottish psychotherapist, researcher, campaigner, and co-founder of the patient support group Recovery and Renewal. She is also a valued friend of this website. For years, Brown has challenged the medical profession's failure to recognise the consequences of prescribed psychiatric medication, particularly antidepressant dependence, adverse reactions, and withdrawal. Her work raises an uncomfortable question: how many patients have been given diagnoses such as Functional Neurological Disorder (FND) or Medically Unexplained Symptoms (MUS) when the effects of prescribed medication were never adequately investigated?

Brown's involvement began long before antidepressant withdrawal received the attention it does today. Through her work with patients and her involvement in Scottish parliamentary petition PE01651, launched in 2017, she documented concerns about prescribed drug dependence and the lack of appropriate recognition and support. Alongside Welsh campaigner Stevie Lewis, who brought similar concerns before the Welsh Parliament, Brown helped bring patients' experiences into public and professional discussions that had too often excluded them.

Their central concern was straightforward. Patients were reporting serious neurological, physical, and psychological symptoms during or after changes to prescribed medication. Rather than recognising the possibility of withdrawal or adverse drug reactions, some clinicians attributed these symptoms to psychiatric relapse, medically unexplained conditions, or functional disorders. Once such a diagnosis entered the medical record, the original medication history could receive even less attention.


When withdrawal becomes another diagnosis

In 2020, Brown co-authored a peer-reviewed study with Anne Guy, Stevie Lewis, and Mark Horowitz, published in Therapeutic Advances in Psychopharmacology. The researchers analysed accounts from 158 people who responded to an invitation to describe their experiences of withdrawal from prescribed psychotropic medication. The findings exposed serious gaps between what patients were experiencing and how healthcare professionals responded.

  • 47% reported that their treating doctors did not recognise their symptoms as related to medication withdrawal.
  • 25% reported receiving a diagnosis of a new medical condition, including medically unexplained symptoms.
  • 47% reported losing employment as a consequence of their withdrawal experiences.
  • 82% reported a loss of health and wellbeing.

These figures describe a self-selected group of people reporting difficult withdrawal experiences, not the general population of antidepressant users. Nevertheless, the accounts identify an important clinical problem: patients reporting symptoms following medication changes were not always receiving an adequate assessment of withdrawal as a possible cause.

One participant described developing severe involuntary movements after taking and stopping venlafaxine, an SNRI antidepressant. According to the account, neurologists diagnosed a functional movement disorder, migraines, and chronic fatigue syndrome, despite the patient reporting that these problems had not existed before the medication exposure and withdrawal. The published account does not independently establish the cause of every symptom, but it documents precisely the diagnostic concern Brown and her collaborators were investigating.

The implications extend beyond antidepressants. Changes in prescribed psychotropic medication can produce symptoms that overlap with neurological and psychiatric conditions. A medication history should therefore be part of the diagnostic investigation, not an afterthought. Labelling symptoms functional without adequately considering adverse reactions, dose reductions, missed doses, or withdrawal risks overlooking a potentially relevant explanation.


Taking the argument directly to FND

In December 2020, Brown and Lewis published The Patient Voice: Antidepressant Withdrawal, MUS and FND in BJGP Life. They expanded on these concerns in their article of the same name in the Journal of Critical Psychology, Counselling and Psychotherapy, published in its 2020 volume and made available in 2021. Their argument was that antidepressant withdrawal was being overlooked when patients presented with symptoms subsequently classified as medically unexplained or functional.

This was not simply a disagreement over terminology. Brown and Lewis were challenging the diagnostic process itself. If symptoms emerge during medication withdrawal, the timing matters. If a patient reports a clear relationship between changes in medication and the development of new neurological symptoms, that history deserves investigation. Describing the presentation as functional does not establish that medication effects have been excluded.

The distinction matters because FND is commonly presented as a diagnosis based on positive clinical signs rather than a diagnosis of exclusion. Yet positive signs do not automatically identify the underlying cause of every symptom, and they do not establish that a medication-related contribution is absent. Brown's work challenges clinicians to examine what may have been overlooked before treating the functional diagnosis as a complete explanation.

Her criticism also extends to how patients are heard. When someone reports that their health deteriorated after starting, changing, or stopping medication, that account is clinically relevant information. Dismissing it because symptoms appear unusual, fluctuate, or do not fit an immediately recognised disease pattern risks replacing investigation with assumption.


Parliamentary advocacy and informed consent

Brown's contribution has not been limited to academic publications. Her Scottish parliamentary petition, alongside Lewis's Welsh petition, sought recognition of prescribed drug dependence and withdrawal, better professional education, and appropriate support services. Their advocacy helped document the experiences of people who felt abandoned by the healthcare systems responsible for prescribing their medication.

In a 2021 letter published in the British Journal of General Practice, Brown argued that clinicians had been reluctant to engage with patients describing serious problems associated with antidepressants. She called attention to the need to reconsider initial prescribing decisions as well as the difficulties faced by people who had developed longer-term dependence.

In another letter, published in 2022, she questioned how antidepressants were explained to patients, particularly the certainty with which their mechanisms of action were sometimes presented. Her broader concern was informed consent: patients should understand that these medications can have adverse effects and that withdrawal may be difficult, prolonged, or disabling for some individuals.

Recognising these risks does not mean that everyone taking antidepressants will experience severe withdrawal or that patients should abruptly discontinue treatment. It means that withdrawal and adverse effects must be taken seriously, with appropriate medical support and individualised tapering where necessary. Abrupt discontinuation can itself create substantial risks.


Why her work matters

Brown's research and advocacy expose a problem that extends beyond any single diagnosis. When clinicians fail to recognise an established biological possibility, such as medication withdrawal, patients may be left with explanations that do not adequately account for their medical history. A diagnostic label can then become an obstacle to further investigation rather than a useful description of the patient's condition.

Her published work does not establish how frequently FND is incorrectly diagnosed because of antidepressant withdrawal. The available patient accounts cannot provide that population-wide estimate. What they do establish is that patients have reported receiving functional and medically unexplained diagnoses in circumstances where they believed medication withdrawal had been overlooked. That is a legitimate patient-safety concern and a reason for more systematic investigation.

For patients, the consequences can be devastating. Some lose employment, relationships, financial security, and confidence in medical professionals. Others spend years trying to establish whether their symptoms are connected to medications they were originally assured were safe to take or straightforward to discontinue.

Marion Brown has spent years insisting that these experiences deserve attention, documentation, and proper scientific scrutiny. Her work, alongside that of Anne Guy, Stevie Lewis, Mark Horowitz, and other researchers and campaigners, has helped bring prescribed drug withdrawal into discussions about diagnostic error and patient safety.

The question her work leaves clinicians with is difficult to dismiss: before diagnosing unexplained neurological symptoms as functional, have you properly investigated whether the treatment you prescribed could be contributing to them?


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