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Doctors are finally learning to manage antidepressant withdrawal

newscientist.com

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Re: Doctors are finally learning to manage antidepressant withdrawal

#21

Post by zdragnar »

Rendello wrote: post #15
Paracompact wrote: post #6

Earlier quoted context omitted.

On an academic level, we have reined in much of the excess enthusiasm in antidepressants that was courtesy of 90s-era pharmaceutical reps and ad men, but I don't think this revision ever occurred in the cultural consciousness at large.

See also: The Serotonin Theory of Depression: a Systematic Umbrella Review of the Evidence (2022). It's worth reading the introduction and results in full, but here are two important quotes (footnote markers removed): > Our comprehensive review of the major strands of research on serotonin shows there is no convincing evidence that depression is associated with, or caused by, lower serotonin concentrations or activit…

The conclusions in that were not universally accepted, and some critiques were rather damning:

https://www.kcl.ac.uk/news/a-response-to-the-serotonin-theor...

Personally, I both agree that SSRI antidepressants were likely overprescribed early on, and disagree with the notion that the chemical imbalance theory is unsupported. N = 1, they can absolutely work. It took a few to find one that really did, hence I am certain it is not a placebo effect.

Re: Doctors are finally learning to manage antidepressant withdrawal

#22

Post by D-Machine »

googaar wrote: post #20
D-Machine wrote: post #3

Best way to manage the withdrawal would be to dramatically reduce them being prescribed in the first place. The linked article says they have "small to moderate effectiveness", but this is being far too generous. The correct way to measure drug effectiveness is if the treatment meets the standard of a minimal important difference. I.e. you measure depression on various rating scales, like the 17-point HAM-D, and rese…

I can’t believe we’ve normalized anti depressants as a society. I’m about to get downvoted into oblivion for this take though. I’m not trying to discount mental health, I just think there are better solutions than drugs to fix your state of mind. Also think that some people are dealt a tougher hand than most, and that for a small subset of humans, anti depressants are the most fitting cure.

Agreed. They have to be significantly helping at least some, but we can't say who these people are for certain yet, or how many there really are.

And yes, in some cases, no other options are possible, so even if the evidence is pretty dismal for their effectiveness, they are still broadly safe enough to definitely be worth a try. They probably just shouldn't be the first-line approach.

Re: Doctors are finally learning to manage antidepressant withdrawal

#24

Post by SV_BubbleTime »

Paracompact wrote: post #5
classichasclass wrote: post #2

Though this article concentrates on the SSRIs, other meds like the SNRIs can have a similar or even worse withdrawal effect. We didn't call it "Side Effexor" for nothing. People legitimately need these drugs, including in the short term. The problem for acute stressors once they resolve is how to get them back off.

> Though this article concentrates on the SSRIs, other meds like the SNRIs can have a similar or even worse withdrawal effect. And don't even get me started on tricyclics or MAOIs... no, seriously, don't get me started on them! The current generation of first-line antidepressants (SSRIs/SNRIs) might as well be free compared to the old school crazy pills.

> school crazy

Yep, that’s how I associate SSRIs.

Re: Doctors are finally learning to manage antidepressant withdrawal

#25

Post by SV_BubbleTime »

googaar wrote: post #20
D-Machine wrote: post #3

Best way to manage the withdrawal would be to dramatically reduce them being prescribed in the first place. The linked article says they have "small to moderate effectiveness", but this is being far too generous. The correct way to measure drug effectiveness is if the treatment meets the standard of a minimal important difference. I.e. you measure depression on various rating scales, like the 17-point HAM-D, and rese…

I can’t believe we’ve normalized anti depressants as a society. I’m about to get downvoted into oblivion for this take though. I’m not trying to discount mental health, I just think there are better solutions than drugs to fix your state of mind. Also think that some people are dealt a tougher hand than most, and that for a small subset of humans, anti depressants are the most fitting cure.

[flagged]

Re: Doctors are finally learning to manage antidepressant withdrawal

#26

Post by jakebol »

D-Machine wrote: post #8
Paracompact wrote: post #6

Earlier quoted context omitted.

On an academic level, we have reined in much of the excess enthusiasm in antidepressants that was courtesy of 90s-era pharmaceutical reps and ad men, but I don't think this revision ever occurred in the cultural consciousness at large.

Yup, I would agree. The meta-research / methodological research and awareness here is really quite impressive, even though its conclusions are a bit grim and not well-known.

A good book on this is Mind Fixers: Psychiatry's Troubled Search for the Biology of Mental Illness. Describing the history of how many of these classes of drugs came about is pretty eye opening, I would say the book is pretty nuanced in its conclusions.

https://www.goodreads.com/en/book/show/40180010-mind-fixers

The title is a play on the Pulitzer prize winning article from the 80's.

https://web.archive.org/web/20041125092022/http://www.byline...

Re: Doctors are finally learning to manage antidepressant withdrawal

#27

Post by tredre3 »

burnte wrote: post #11
D-Machine wrote: post #3

Best way to manage the withdrawal would be to dramatically reduce them being prescribed in the first place. The linked article says they have "small to moderate effectiveness", but this is being far too generous. The correct way to measure drug effectiveness is if the treatment meets the standard of a minimal important difference. I.e. you measure depression on various rating scales, like the 17-point HAM-D, and rese…

> Best way to manage the withdrawal would be to dramatically reduce them being prescribed in the first place. No, that will just hurt more people up front for longer. The truth is antidepressants have a larger effect on mental health than actually gets reported because of how improvements are measured. If you look at a patient who doesn't get out of bed, is in trouble at work/school for performance, doesn't spend soc…

> But you pivot to TMS and you see 60-80 percent improvement rates. Esketamine is close too.

I have received both rTMS and esketamine and the providers themselves told me they saw roughly a 30-40% response rate (not remission, that's even lower!). Upon researching the topic myself, I found that the meta analysis usually agreed with this 30% figure, but recent research papers mark eskatamine even lower. Both treatments can be miraculous for a few select people and it makes a good headline, but it's a total failure for the majority of people.

I agree with you that those treatments should be easier to access, though.

> Too many therapists dismiss meds and too many psychiatrists dismiss therapy.

This is the only factually true statement in your entire comment.

Re: Doctors are finally learning to manage antidepressant withdrawal

#28

Post by D-Machine »

zdragnar wrote: post #21
Rendello wrote: post #15

Earlier quoted context omitted.

See also: The Serotonin Theory of Depression: a Systematic Umbrella Review of the Evidence (2022). It's worth reading the introduction and results in full, but here are two important quotes (footnote markers removed): > Our comprehensive review of the major strands of research on serotonin shows there is no convincing evidence that depression is associated with, or caused by, lower serotonin concentrations or activit…

The conclusions in that were not universally accepted, and some critiques were rather damning: https://www.kcl.ac.uk/news/a-response-to-the-serotonin-theor... Personally, I both agree that SSRI antidepressants were likely overprescribed early on, and disagree with the notion that the chemical imbalance theory is unsupported. N = 1, they can absolutely work. It took a few to find one that really did, hence I am certai…

The idea that simple serotonin deficiency is the whole entirety of all depressions is 100% discredited and completely incoherent in the face of current evidence, but yes, for sure it remains clear and plausible that some forms or aspects of depression involve a serotonin deficiency.

However, tianeptine is serotonin reuptake enhancer and also can help with depression, so any simple deficiency hypothesis also doesn't look good either.

Broadly, the "chemical imbalance" theory, left vague and unspecified, is still basically sane (though not specific enough to be super useful).

Re: Doctors are finally learning to manage antidepressant withdrawal

#30

Post by wat10000 »

googaar wrote: post #20
D-Machine wrote: post #3

Best way to manage the withdrawal would be to dramatically reduce them being prescribed in the first place. The linked article says they have "small to moderate effectiveness", but this is being far too generous. The correct way to measure drug effectiveness is if the treatment meets the standard of a minimal important difference. I.e. you measure depression on various rating scales, like the 17-point HAM-D, and rese…

I can’t believe we’ve normalized anti depressants as a society. I’m about to get downvoted into oblivion for this take though. I’m not trying to discount mental health, I just think there are better solutions than drugs to fix your state of mind. Also think that some people are dealt a tougher hand than most, and that for a small subset of humans, anti depressants are the most fitting cure.

I don’t get why people are so negative about drugs. They’re just a medical treatment, with pluses and minuses. If they help and they’re not too costly then what’s the big deal? Half the population is addicted to caffeine and nobody cares. A huge number of people need medical intervention for other things and we don’t get this quasi moralistic opposition to them.
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