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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

#61

Post by sitharus »

sandcat_ wrote: post #7

To provide one additional anecdote: I came off escitalopram with no taper after taking it for about five years (10mg). I got brain zaps for a while, got very irritated at times, but largely was fine after a few weeks. Not downplaying the withdrawal effects for some people, but they’re not as catastrophic as this article suggests for many (perhaps most). And overall I’m very glad I took it! It got me through a rough p…

Withdrawal effects, like the beneficial effects, are highly individual. I had no withdrawal effects from escitalopram after being on it for a couple of years but I know people who’ve had the issues described in the article.

This isn’t a one size fits all area of medicine.

Re: Doctors are finally learning to manage antidepressant withdrawal

#62

Post by 121789 »

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.

I think exercise, sunlight, good sleep and diet, and good social relationships are all more effective than SSRIs. But anyone who's had bad depression knows how hard those things are to maintain if you're depressed. SSRIs make some portion of people functional enough where they can at least build a healthy life. But definitely not everyone, and they are definitely not "the cure"

Re: Doctors are finally learning to manage antidepressant withdrawal

#63

Post by matheusmoreira »

TLDR: Rate is individualized and determined by the patient's tolerance. If symptoms appear, maintain or increase dose to stabilize, then try reducing again later. Use liquid medication for more granular dosing.

Doctors aren't "finally learning" how to manage withdrawals. This is essentially the common sense algorithm, and I'm pretty annoyed that they wrote this whole ass article just for that.

Re: Doctors are finally learning to manage antidepressant withdrawal

#64

Post by [deleted] »

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.

[deleted]

Re: Doctors are finally learning to manage antidepressant withdrawal

#65

Post by zzzeek »

bsuvc wrote: post #16
sandcat_ wrote: post #7

To provide one additional anecdote: I came off escitalopram with no taper after taking it for about five years (10mg). I got brain zaps for a while, got very irritated at times, but largely was fine after a few weeks. Not downplaying the withdrawal effects for some people, but they’re not as catastrophic as this article suggests for many (perhaps most). And overall I’m very glad I took it! It got me through a rough p…

It's been years since, but I too had brain zaps coming off of it. It took a few months for those to go away. I tried to describe it to my doctor and he seemed like he never heard of it before and sort of look at me like I was crazy, or at least that is what I sensed. But I ended up researching online and found it was a thing that happens.

Interesting is your doctor a general practitioner or a psychiatrist? A psychiatrist definitely knows about this stuff. GPs in my experience know almost nothing about anything beyond what seems like a script they operate from.

Re: Doctors are finally learning to manage antidepressant withdrawal

#66

Post by Aurornis »

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.

> After a few weeks I was tapered off them.

> I felt no different before, during or after them.

SSRI onset is slow, which is one of the common problems with treatment.

In studies where they survey both the patient and their family members, the family members actually start noticing improvements before the patient. Onset is slow and it takes a long time for patients to realize the positive effects.

Ideally they’re prescribed along with other lifestyle changes like your walks. It doesn’t have to be an either-or. A lot of patients get offended when doctors suggest things like walking because they think it indicates the doctor is telling them to “just walk it off” which doesn’t go well.

It’s not surprising you didn’t feel anything noticeable after a few weeks. It’s also unfortunate, but not too surprising, that your doctor wasn’t informed enough to communicate these things. Some doctors are great about setting expectations and following up. Others write a prescription and send patients off to fill it without the necessary context.

Re: Doctors are finally learning to manage antidepressant withdrawal

#67

Post by matheusmoreira »

sheepscreek wrote: post #42
Paracompact wrote: post #5

Earlier quoted context omitted.

> 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 b…

> I liken SSRIs to carpet bombing

It's like inserting objects into the body's event loop and hoping it produces the desired effects as it circulates, only to find that everything reacts to the event, not just the parts we want.

https://news.ycombinator.com/item?id=37029912

Re: Doctors are finally learning to manage antidepressant withdrawal

#68

Post by jaggederest »

Aurornis wrote: post #66
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.

> After a few weeks I was tapered off them. > I felt no different before, during or after them. SSRI onset is slow, which is one of the common problems with treatment. In studies where they survey both the patient and their family members, the family members actually start noticing improvements before the patient. Onset is slow and it takes a long time for patients to realize the positive effects. Ideally they’re pre…

The other problem with SSRI treatment is that individually they are only barely better than placebo. They're among the worst classes of drugs as far as NNT, effect size or remission rate (individually! STAR-D treatment algorithm works for the vast majority of people)

Especially in acute cases, I think they should be replaced or augmented by something stylistically in the direction of esketamine. 6-8 weeks per medication trial is an absolute eternity, especially since some minority of major depressive episodes resolve spontaneously after a few months to a year.

Re: Doctors are finally learning to manage antidepressant withdrawal

#69

Post by zdragnar »

garciasn wrote: post #60
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.

I start getting effects the same day if I miss my morning dose, but like you, it was life changing (in a good way) for me.

I've got two friends who didn't benefit from it, so it isn't a miracle cure for everyone, sadly.

Re: Doctors are finally learning to manage antidepressant withdrawal

#70

Post by jaggederest »

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…

The problem with the entire argument that you're making is that the natural rate of remission in uncomplicated major depressive episodes is very close to the rate that SSRIs create, individually, and very close in terms of timing. If you do something more like STAR-D you see higher rates, but that also takes so long that many people naturally remit.
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