The Mystery of When to Stop Antidepressants
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Re: The Mystery of When to Stop Antidepressants
#2There's a disconnect between what the meta-analysed randomized clinical trials are saying about antidepressants (that they are at best minimally effective relative to placebo) and what relapse rates suggest (that people relapse when withdrawn from antidepressants because the antidepressant was effectively treating the underlying depression).
This conflict is resolved when antidepressants are acknowledged as addictive. Long-term use of antidepressants creates a biochemical dependency that is only removed with long, slow tapering.
I've experienced this fact personally. When I first attempted to go off antidepressants, I did so at what I thought was a slow pace, but in fact turned out to be far too fast. My life completely fell apart. I was depressed, anxious, obsessive, worse than I had been in many years. I thought this proved that I really "had depression" (as a discrete illness) and needed the drugs, so I increased my dose back up to more or less the original level. Soon after doing this, my depression/anxiety/OCD went away, and I felt normal again.
But a few years later I tried getting off the drugs again, going much more slowly. And now I'm at the same point I was last time when things fell apart, and I'm doing fine. Overall this withdrawal (from 200mg Zoloft) will probably take me 3 or 4 years. (I'm down to 25mg now.)
I'm convinced that I'm succeeding now where I failed before simply because my previous approach was triggering horrible withdrawal effects, whereas my current slower approach does not.
One secret to successful antidepressant withdrawal: the rate of dose reductions needs to decrease as the overall dose decreases. So when I'm at 200mg maybe I decrease by 20mg in a month. But now that I'm at 25mg maybe I decrease by 2.5mg in a month. The rate of decrease should be proportional to the current dose.
Before I was decreasing in constant increments all the way down (200->150->100->50) but then I started going crazy.
Sorry this is so long. It's a favorite subject of mine ;-)
Re: The Mystery of When to Stop Antidepressants
#3There's a disconnect between what the meta-analysed randomized clinical trials are saying about antidepressants (that they are at best minimally effective relative to placebo) and what relapse rates suggest (that people relapse when withdrawn from antidepressants because the antidepressant was effectively treating the underlying depression). This conflict is resolved when antidepressants are acknowledged as addictive…
The annoying thing about (for example) SSRIs is that it's annoying to take accurate doses like that.
My escitalopram comes in 5mg, 10mg and 20mg. If I want to slowly taper down from 20mg a day, I have to start chopping off bits from an already tiny pill every day for months on end. I can't just drop down to 15mg a day, it's too abrupt.
Re: The Mystery of When to Stop Antidepressants
#4There's a disconnect between what the meta-analysed randomized clinical trials are saying about antidepressants (that they are at best minimally effective relative to placebo) and what relapse rates suggest (that people relapse when withdrawn from antidepressants because the antidepressant was effectively treating the underlying depression). This conflict is resolved when antidepressants are acknowledged as addictive…
The annoying thing about (for example) SSRIs is that it's annoying to take accurate doses like that. My escitalopram comes in 5mg, 10mg and 20mg. If I want to slowly taper down from 20mg a day, I have to start chopping off bits from an already tiny pill every day for months on end. I can't just drop down to 15mg a day, it's too abrupt.
Maybe it would be simpler to grind the pills into a more easily-measurable powder and put it into your own empty capsules?
Re: The Mystery of When to Stop Antidepressants
#5There's a disconnect between what the meta-analysed randomized clinical trials are saying about antidepressants (that they are at best minimally effective relative to placebo) and what relapse rates suggest (that people relapse when withdrawn from antidepressants because the antidepressant was effectively treating the underlying depression). This conflict is resolved when antidepressants are acknowledged as addictive…
Can confirm. The part that's really telling IMO is that a lot of the withdrawal symptoms are not at all related to depression: they're dizziness, vertigo, and strange electrical feelings in your head – not symptoms of depression or relapse. Minimally reinforcing in terms of "drug liking" or "wanting to take more" in my experience, but there is definitely profound physical dependence.
Re: The Mystery of When to Stop Antidepressants
#6There's a disconnect between what the meta-analysed randomized clinical trials are saying about antidepressants (that they are at best minimally effective relative to placebo) and what relapse rates suggest (that people relapse when withdrawn from antidepressants because the antidepressant was effectively treating the underlying depression). This conflict is resolved when antidepressants are acknowledged as addictive…
Can confirm. The part that's really telling IMO is that a lot of the withdrawal symptoms are not at all related to depression: they're dizziness, vertigo, and strange electrical feelings in your head – not symptoms of depression or relapse. Minimally reinforcing in terms of "drug liking" or "wanting to take more" in my experience, but there is definitely profound physical dependence.
Probably not a good idea to generalize the withdrawal symptoms. Some people do report severe anxiety and depression from withdrawal in addition to those other symptoms.
Re: The Mystery of When to Stop Antidepressants
#7Lexapro (Escitalopram) saved my life. I don't care what any meta-analysis says: years of diet, exercise, and meditation did 5% of what 1 month of Lexapro did for me. I will take it until I die.
Re: The Mystery of When to Stop Antidepressants
#8There's a disconnect between what the meta-analysed randomized clinical trials are saying about antidepressants (that they are at best minimally effective relative to placebo) and what relapse rates suggest (that people relapse when withdrawn from antidepressants because the antidepressant was effectively treating the underlying depression). This conflict is resolved when antidepressants are acknowledged as addictive…
Interesting customer retention scheme Big Pharma has come up with. Find a pool of folks at risk for suicide, and then get them addicted to expensive chemicals that will exacerbate suicidal ideation if they try to quit.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/
"The FDA requires two adequately conducted clinical trials showing a significant difference between drug and placebo. But there is a loophole: There is no limit to the number of trials that can be conducted in search of these two significant trials."
Re: The Mystery of When to Stop Antidepressants
#9Earlier quoted context omitted.
The annoying thing about (for example) SSRIs is that it's annoying to take accurate doses like that. My escitalopram comes in 5mg, 10mg and 20mg. If I want to slowly taper down from 20mg a day, I have to start chopping off bits from an already tiny pill every day for months on end. I can't just drop down to 15mg a day, it's too abrupt.
Maybe it would be simpler to grind the pills into a more easily-measurable powder and put it into your own empty capsules?
A lot of people take them to a compounding pharmacy and have a solution made out of them, making it easier to measure specific amounts.
Re: The Mystery of When to Stop Antidepressants
#10There's a disconnect between what the meta-analysed randomized clinical trials are saying about antidepressants (that they are at best minimally effective relative to placebo) and what relapse rates suggest (that people relapse when withdrawn from antidepressants because the antidepressant was effectively treating the underlying depression). This conflict is resolved when antidepressants are acknowledged as addictive…
The annoying thing about (for example) SSRIs is that it's annoying to take accurate doses like that. My escitalopram comes in 5mg, 10mg and 20mg. If I want to slowly taper down from 20mg a day, I have to start chopping off bits from an already tiny pill every day for months on end. I can't just drop down to 15mg a day, it's too abrupt.
I'm on 20mg of escitalopram as well. If you don't mind me asking, why are you wanting to taper down? Is this recommended by your doctor?