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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

#41

Post by snailmailman »

I forget exactly which antidepressant I was on, but when i finally stopped taking it, i was instructed to reduce dosage by half a pill every two weeks.

Anecdotally, that was not anywhere close to slow enough. I had panic attacks almost every day while I was reducing the dosage. Those weeks were hell. I couldn’t think straight. I honestly don’t remember much of what occurred during that time, because the withdrawal took over my life. The pills were too tiny to split into fourths easily, but I wish I had done something to reduce dosage in smaller increments or over a longer time period.

It makes me strongly reconsider ever taking any antidepressants ever again. They didn’t tell me when I started taking them that the withdrawal would be so terrible. Those months were easily some the worst of my life.

Re: Doctors are finally learning to manage antidepressant withdrawal

#42

Post by sheepscreek »

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.

Much of medicine (especially mental health related) is rather primitive. We are literally reverse engineering discoveries that seem to work on some other animals, and then figuring out how (to the best of our limited ability).

I liken SSRIs to carpet bombing - also their mechanism to increase seratonin in the brain is by making something else not use it (reuptake inhibition). We’re guessing that other thing isn’t a big deal. But who knows. Serotonin is produced in the gut and it controls melatonin, which controls our sleep. It’s all connected in a bizarre way.

Re: Doctors are finally learning to manage antidepressant withdrawal

#43

Post by nabukodonozor »

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…

Well I think that we do not know enough about genesis of depression and other mental issues. So this is just symptomatic therapy. And as such it should be prescribed only for very short terms. Analogy: how would you perceive someone who prescribed his febrile patient paracetamol for 10 years just because it works? And in his defense he/she claims that febrile condition has well known metabolic chain and that paracetamol lowers fever mainly by interrupting the COX → PGE₂ part of the fever pathway in the brain.

Re: Doctors are finally learning to manage antidepressant withdrawal

#44

Post by BeetleB »

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’m not trying to discount mental health, I just think there are better solutions than drugs to fix your state of mind.

Find one that's as effective on the general population.

I mean, sure, perhaps lifestyle changes are better. Can you get a higher percentage to change them and improve people's lives than we currently can with drugs?

As a top performer in school, I definitely think (and still point out), that you can get fantastically high results in SAT/GRE without paying any test prep service. I and many of my peers did it. There are better solutions than paying those services. But how many who don't pay do as well as those who do? I can tell them how to study as much as I can, but the reality is that statistically, people who attend will do better than if they don't.

From a medical standpoint, telling people to change how they live and think has a fairly low success rate. The best options usually don't work on the masses.

Re: Doctors are finally learning to manage antidepressant withdrawal

#45

Post by litigator »

laughing_man wrote: post #37

SSRIs and SNRIs just didn't work very well for me. If they had an positive effect at all, it wasn't enough to rise above the proverbial noise. Coming off of them wasn't too bad though. I got the brain zaps, but those were easy to cope with. More than anything the whole experience was a waste of money, and what finally fixed my problems was retirement and a greater attention to my health.

Have you looked into mirtazapine (tetra cyclic), vortioxetine (serotonin modulator) or atomoxetine (SNDRI). Atomoxetine has been a god send for me.

Re: Doctors are finally learning to manage antidepressant withdrawal

#47

Post by cameronh90 »

SV_BubbleTime wrote: post #23

[flagged]

What if the drugs just make us... better? As in happier, less stressed, and more suited to what modern life requires from us.

Happiness isn't necessary to pass on your genes. Most animals, especially prey animals, spend much of their lives scared, because death is inevitable otherwise. We've now created a safe and pleasant environment our ancestors could only dream of, yet many of us are still unhappy. There's no real evidence we were broadly happier in the distant past either, we're just a different kind of unhappy now.

Seems to me we've developed a tool that makes people feel better and function better, perhaps by blunting some of the vestigial leftover emotions we needed when every tree might have had a sabre-tooth tiger hiding behind it.

Re: Doctors are finally learning to manage antidepressant withdrawal

#48

Post by api »

laughing_man wrote: post #37

SSRIs and SNRIs just didn't work very well for me. If they had an positive effect at all, it wasn't enough to rise above the proverbial noise. Coming off of them wasn't too bad though. I got the brain zaps, but those were easy to cope with. More than anything the whole experience was a waste of money, and what finally fixed my problems was retirement and a greater attention to my health.

They work so well for some they are miracle drugs, and for others they do nothing or have negative effects. This is typical. We still don’t fully understand why or even why they work at all.

Re: Doctors are finally learning to manage antidepressant withdrawal

#49

Post by martinald »

jakebol wrote: post #36
justonceokay wrote: post #10

Earlier quoted context omitted.

So did you take them and have a bad time? Because they definitely work for me and I doubt a placebo could have such a large effect on the 48 hour stomach pains I used to get alongside my frequent panic attacks. I find it funny that people complain about emotional blunting when that is the entire purpose of the drug. I would prefer not to live on the razors edge ever again. I’ve had chronic anxiety and depression ever…

SSRIs have much more clinical evidence of efficacy for addressing anxiety disorders vs a placebo than depression. The effect size is ~0.7 vs 0.2 in meta studies.

Totally agree, they really shouldn't be called antidepressants at all. Important to add tho that for many with depression they have comorbid anxiety and often the anxiety is harder to tolerate than depression, so removal of anxiety symptoms can be hugely beneficial.

Also, IME they are dosed completely wrong. So many people seem to be on very low doses, which has no improvement on placebo in the studies I've read.

Whereas, higher doses are _hugely_ better than placebo, especially for anxiety.

What's worse is a lot/most studies on SSRIs in general often don't adjust for dose. Which seems like an enormous oversight to me.

Re: Doctors are finally learning to manage antidepressant withdrawal

#50

Post by wat10000 »

D-Machine wrote: post #39
wat10000 wrote: post #30

Earlier quoted context omitted.

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.

Agreed. The problem is largely that the pluses of antidepressants have been quite significantly overstated, and the minuses have been understated, meaning the cost-benefit equation is unfortunately quite different than what the general public assumes. We don't want to get rid of them, we just need to recalibrate prescribing, and also to properly assess cessation at intervals more frequently than we have been.

Yeah, I’m open to the idea that their effectiveness may have been overestimated and they’re overprescribed as a result. But this “I can’t believe we’ve normalized antidepressants” “there are better solutions than drugs” stuff is just moralizing.
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