Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Doctors are finally learning to manage antidepressant withdrawal

newscientist.com

Post reply on HN
Print view View original

101–110 of 379 posts

Re: Doctors are finally learning to manage antidepressant withdrawal

#101

Post by simiones »

zzzeek wrote: post #65
bsuvc wrote: post #16

Earlier quoted context omitted.

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.

You are assuming a lot about the competency of some specific doctor who knows where in the world...

Re: Doctors are finally learning to manage antidepressant withdrawal

#102

Post by hapless »

elil17 wrote: post #95

Only slightly related, but can anyone ELI5 why Bupropion XL is not the universal first line treatment for depression and is hardly used at all in Europe? It has fewer side effects vs. SSRIs, can be safely used as a long term medication (which many people do with SSRIs even though it can have negative effects), and doesn't have the same horrible withdrawal symptoms (although you still need to taper).

Anxiety is a common comorbidity in depression patients and buprioprion can dramatically raise anxiety levels

It is a second-line treatment for a reason. Great when it works. Harmful when it does not.

Re: Doctors are finally learning to manage antidepressant withdrawal

#103

Post by simiones »

delichon wrote: post #13
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…

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.

> SSRIs do not have the same level of supporting evidence, and the effects are not as durable.

To the extent that we can measure depression, SSRIs have been widely proven in gold standard phase III clinical trials to help with the treatment of major depression. What exactly is supposed to be lacking in the supported evidence?

Re: Doctors are finally learning to manage antidepressant withdrawal

#104

Post by herbst »

elil17 wrote: post #95

Only slightly related, but can anyone ELI5 why Bupropion XL is not the universal first line treatment for depression and is hardly used at all in Europe? It has fewer side effects vs. SSRIs, can be safely used as a long term medication (which many people do with SSRIs even though it can have negative effects), and doesn't have the same horrible withdrawal symptoms (although you still need to taper).

It has a long and scary list of side effects, good if it works for you

Re: Doctors are finally learning to manage antidepressant withdrawal

#105

Post by D-Machine »

Aurornis wrote: post #73
jaggederest wrote: post #68

Earlier quoted context omitted.

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 medicat…

> 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, These numbers are really misunderstood when taken out of context. SSRIs have an NNT around 7, depending on the study you look at (random Google result https://pubmed.ncbi.nlm.nih.gov/19588448/ as an example ) Which sounds terrible if you know nothing about NNT.…

> SSRIs have an NNT around 7, depending on the study you look at [...] Which sounds terrible if you know nothing about NNT. But when you learn that Tylenol has an NNT of almost 5 and even a powerful drug like Xanax has an NNT of 4, you realize that NNT is a difficult measure of drug efficacy

This kind of comparison is utterly meaningless (like saying a Cohen's d of 0.3 is large for phenomena X, so if we see 0.4 in phenomena Y, it is large in Y), and is just one part of why NNT as usually reported is basically deceptive for antidepressants.

What qualifies as an effective "treatment" has to be anchored to a minimal important difference, and this is what antidepressants really don't clearly have, on average. I.e. saying the NNT of SSRIs is around 7 is not really practically interpretable, because they tend not to base NNTs here on the amount of patients that actually experienced a clinically meaningful change, they just count the number that exceed some arbitrary (usually purely statistical) threshold.

If you reformulate NNT competently to count number of people needed to be treated to ensure one has (on expectation) a minimally important difference in the depression scales, then the NNT gets even larger than is typically reported.

Re: Doctors are finally learning to manage antidepressant withdrawal

#106

Post by esperent »

herbst wrote: post #104
elil17 wrote: post #95

Only slightly related, but can anyone ELI5 why Bupropion XL is not the universal first line treatment for depression and is hardly used at all in Europe? It has fewer side effects vs. SSRIs, can be safely used as a long term medication (which many people do with SSRIs even though it can have negative effects), and doesn't have the same horrible withdrawal symptoms (although you still need to taper).

It has a long and scary list of side effects, good if it works for you

They all do and my reading has always been that bupronion has less scary side effects than e.g. escalitopram.

Re: Doctors are finally learning to manage antidepressant withdrawal

#107

Post by petesergeant »

hapless wrote: post #102
elil17 wrote: post #95

Only slightly related, but can anyone ELI5 why Bupropion XL is not the universal first line treatment for depression and is hardly used at all in Europe? It has fewer side effects vs. SSRIs, can be safely used as a long term medication (which many people do with SSRIs even though it can have negative effects), and doesn't have the same horrible withdrawal symptoms (although you still need to taper).

Anxiety is a common comorbidity in depression patients and buprioprion can dramatically raise anxiety levels It is a second-line treatment for a reason. Great when it works. Harmful when it does not.

Just want to underscore that this is the right answer.

Re: Doctors are finally learning to manage antidepressant withdrawal

#108

Post by petesergeant »

shoopadoop wrote: post #81
almost_usual wrote: post #46

SSRIs not Benzodiazepines. Withdrawals from the later can be life-threatening if you abruptly stop after prolonged use.

"Prolonged" is not a long time either. You can be ensnared after just a couple weeks. And even a safe taper is still pretty hellish. I had to wean off Klonopin, prescribed for a bout of COVID induced insomnia. Only on it for a month and it took a microgram taper and nine months to get off of completely. Had to go slow because the original recommended rate was wayyyyy too spicy for my central nervous system. Even at t…

I don’t think “most doctors” is accurate any more, but a doctor prescribing a month of klonopin for insomnia needs some urgent continuing professional development.

Re: Doctors are finally learning to manage antidepressant withdrawal

#109

Post by simiones »

Rendello wrote: post #78
sneezychl wrote: post #40

Earlier quoted context omitted.

The "chemical imbalance" theory is objectively wrong, but still useful in that it conveys the fact that mental disorders have physical causes. It's a purposeful simplification.

Many people take SSRIs and other medications because they believe the serotonin imbalance theory to be the modern scientific consensus. A doctor would be fired and ostracized for using the four humours , but can prescribe life-altering medication after five minutes to correct chemical imbalance , a theory which has never had much support within the scientific community. Indeed, a rebuttal [1] to that paper starts wit…

Note that it's not uncommon for even more widely prescribed medication to have no firmly established mechanism of action. Acetaminophen/paracetamol is probably the best example.

Ultimately medication is prescribed based on evidence from clinical trials, whether or not the mechanism of action is fully understood. SSRIs work to help with depression in clinical trials when compared to placebo, so they get prescribed.

Post reply on HN