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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

#51

Post by marmarama »

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…

"As effective as placebo" does not mean worthless. As you point out, placebo antidepressants are fairly effective.

It's a terrible bind. Patients want a pill to fix things, but if they know it's just a sugar pill, it doesn't work. It has to have active ingredients that might work. That's why there's little desire to change the status quo on antidepressants much. Anyone who reads the medical literature knows they're statistically underwhelming, but the experienced reality is that they help people a lot.

Talking therapies, CBT, exercise are all good alternatives but they take time and effort that a depressed person might not be able to manage. An antidepressant prescription they can get in 15 minutes.

Re: Doctors are finally learning to manage antidepressant withdrawal

#52

Post by cameronh90 »

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.

Clothes too. If you're cold, why not just move to a tropical country where you can be naked, as nature intended?

Re: Doctors are finally learning to manage antidepressant withdrawal

#54

Post by D-Machine »

marmarama wrote: post #51
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…

"As effective as placebo" does not mean worthless. As you point out, placebo antidepressants are fairly effective. It's a terrible bind. Patients want a pill to fix things, but if they know it's just a sugar pill, it doesn't work. It has to have active ingredients that might work. That's why there's little desire to change the status quo on antidepressants much. Anyone who reads the medical literature knows they're s…

> As you point out, placebo antidepressants are fairly effective.

This is a misunderstanding of concepts like regression to the mean, and also the active placebo elements involved.

> but the experienced reality is that they help people a lot

And the evidence is that the reality people think they are experiencing is wrong, i.e, they are improving and factually experiencing improvement, but misattributing the cause to the drug.

> "As effective as placebo" does not mean worthless

In one sense of worthless, perhaps, but since drugs have larger costs relative to placebo, well, we can argue they are worse than worseless in another.

Better instead to talk about cost-benefit tradeoffs, number-needed-to-treat vs number-needed-to-harm and etc though, and try to get better at prescribing more carefully to those they clearly benefit.

Re: Doctors are finally learning to manage antidepressant withdrawal

#55

Post by aardvark92 »

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…

My anecdotal experience going on and off Paxil is that it does work for me, and no matter how badly I want to live Rx-free, I consistently devolve into a moody mess without them.

Re: Doctors are finally learning to manage antidepressant withdrawal

#56

Post by throwaway250501 »

When I was diagnosed with depression - amongst other things - my doctor prescribed SSRIs with a caveat that they might or might not work.

After a few weeks I was tapered off them.

I felt no different before, during or after them.

What helped was 3 daily walks around the park, around 9km per day after each meal.

Anecdotal but it is what it is. Right now I have bigger problems than just depression.

Re: Doctors are finally learning to manage antidepressant withdrawal

#57

Post by [deleted] »

sandcat_ wrote: post #19
delichon wrote: post #13

Earlier quoted context omitted.

Good news, exposure therapy is quite effective for arachnophobia and is the first-line treatment. SSRIs do not have the same level of supporting evidence, and the effects are not as durable.

Thanks, yeah, but if I’m honest I don’t really care enough to go through with it. I almost did once, years ago, the London Zoo have a programme. I mentioned it though as one of the most stark changes I noticed after getting on an SSRI was pretty much immediately losing my fear of spiders. It was the first sign I had that showed it was doing something . I used to literally, on occasion, launch my phone across the room…

[deleted]

Re: Doctors are finally learning to manage antidepressant withdrawal

#58

Post by odyssey7 »

marmarama wrote: post #51
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…

"As effective as placebo" does not mean worthless. As you point out, placebo antidepressants are fairly effective. It's a terrible bind. Patients want a pill to fix things, but if they know it's just a sugar pill, it doesn't work. It has to have active ingredients that might work. That's why there's little desire to change the status quo on antidepressants much. Anyone who reads the medical literature knows they're s…

It’s unethical to prescribe a patient a placebo in a way that suggests that what they are receiving is scientifically proven.

In a clinical trial setting, you can prescribe a placebo, because the patient is fully aware and clearly consenting to the fact that they may receive a placebo. Lying to a patient, in a clinical setting, from a position of authority, is a completely different matter. The informed consent would be completely absent, the patient’s ability to make informed choices about their own healthcare would be undermined and withheld, and the provider would be deriving financial benefit from the patient and / or through insurance claims for what amounts to a scam.

The patient, who would be seeking a treatment from a trusted expert, would believe that they are receiving proven treatments in exchange for their time, patience, money, reduced quality of life due to side effects, and opportunity costs in terms of not going to a different provider or trying something else, but in reality their provider would be misleading them. Some patients would even die as a result of taking a particular placebo and depending on it—either because of side effects or due to the lack of effectiveness—when they tragically would have been better off trying a different approach or medication. How could a patient possibly give informed consent in such a scenario, for one thing? How could they meaningfully compare treatment options and make their own informed choices when the advice they receive includes lies?

Alas, some providers believe in placebo effects so much more strongly than their patients’ right to autonomy that when faced with complaints of side effects, they will just lie more and more to their patients in hopes that the side effects will go away, but that’s really just more gaslighting to people who are already in difficult situations.

Re: Doctors are finally learning to manage antidepressant withdrawal

#59

Post by D-Machine »

wat10000 wrote: post #50
D-Machine wrote: post #39

Earlier quoted context omitted.

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.

I suppose it can be moralizing, and probably is in the parent comment.

For me I still feel the surprise because I've followed the evidence carefully for well over a decade, and the methodological problems and lack of evidence for meaningful effectiveness have always been clear. I.e. it is clear standardized effect sizes are meaningless, and you need to determine important differences, as this is just basic science, but only a tiny handful of papers ever bothered.

So it feels very much like "how can we have normalized something so incredibly scientifically shaky", i.e. for me the moralizing is not "drugs are bad, how are we normalizing drugs" it is "how can an entire medical field and society so recklessly adopt something so obviously weakly supported". I.e. my dismay is more about the weak epistemic standards of society than it is about drugs.

Re: Doctors are finally learning to manage antidepressant withdrawal

#60

Post by garciasn »

throwaway250501 wrote: post #56

When I was diagnosed with depression - amongst other things - my doctor prescribed SSRIs with a caveat that they might or might not work. After a few weeks I was tapered off them. I felt no different before, during or after them. What helped was 3 daily walks around the park, around 9km per day after each meal. Anecdotal but it is what it is. Right now I have bigger problems than just depression.

Lexapro, noted in the article, was literally life changing for me. I felt better within 3d and I notice severe issues if I miss ~3d of doses in a row, even though the half-life should support ~7d without according to my physician.

That said, yes; walking is the best medicine for me.

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