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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

#111

Post by nvarsj »

lachlanj wrote: post #84
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…

Is it possible for phobias to be treated with antidepressants or other medications? I need to look into this

I can believe it. They are used for general anxiety disorder which I imagine can be kind of similar - an over-reaction to some stimuli.

Re: Doctors are finally learning to manage antidepressant withdrawal

#112

Post by sixeyes »

lachlanj wrote: post #84
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…

Is it possible for phobias to be treated with antidepressants or other medications? I need to look into this

both my social phobia and my fear of dark almost vanished on venlafaxine. i take walks in the dark these days, what the fuck.

Re: Doctors are finally learning to manage antidepressant withdrawal

#113

Post by exmadscientist »

fsckboy wrote: post #87

I've taken antidepressants for years (20 mg prozac) and have sometimes tapered off them, restarting later. I can barely tell that I'm taking them, I feel 100% like myself on--and off of--them. I know they do something because when talking about difficult traumas with my therapist, if I'm not taking flouoxetine I will get choked up to the point I can't speak. That's the only difference I can perceive. My dose is not a…

> bipolar

I think this is more relevant than people give it credit for. While bipolar depression and unipolar (major) depression might generally be functionally indistinguishable from the outside, they seem to have genuinely different origins within the body and brain.

And the drugs seem to be far more powerful for people with bipolar.

That's both good and bad. Good, because between mood stabilizers and very careful use of antidepressants, many people with bipolar can genuinely achieve complete treatment, or close enough to pass as complete. Which is wonderful! Bad because antidepressants and (hypo)mania are a dangerous combination, and the antidepressants can have more kick than one would normally expect. They'll often cause a patient's first manic episode, which can be very bad on its own but might get things on the right treatment course. (Of course, they often still do nothing much at all.

I think the tapering may be related as well. I was eventually diagnosed with bipolar II and I've never really had to taper off anything that didn't have a black-box warning about tapers (either intrinsically or due to blood-pressure effects, which are worth taking seriously). I've stopped some things cold which one really shouldn't stop cold. I didn't really notice much other than the bad side effects causing the stop going away.

> I do have "extra money" and am able to pay extremely qualified and expensive doctors

I don't really have "extra money" but I still do this anyway. My psychiatrist is $500 an hour, out of pocket, no insurance accepted period. He actually listens. It's worth it.

Re: Doctors are finally learning to manage antidepressant withdrawal

#114

Post by sixeyes »

KurSix wrote: post #91
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.

For something prescribed to get someone through a temporary crisis, "how and when do we get you back off this safely?" should probably be discussed at the beginning, not years later when the patient decides to stop.

for my snri i lessened the dose by 25% and that alone cost me a week of work, i was so fucked over. when i quit this i will for sure do the thing where you open the capsules and remove a little of the contents, gradually removing more each day.

i read online about people doing this and thought they were nutjobs. well, now i know.

Re: Doctors are finally learning to manage antidepressant withdrawal

#115

Post by vermilingua »

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…

I also went cold turkey from escitalopram about a decade ago, and my experience was not as tame as yours; my ideation kicked into 6th gear, with paranoia, nausea, and insanely intense and vivid dreams every night. That was while on a 10mg dose.

I have been on over-max-dose venlafaxine for nearly a year now. I think it has been an enormous improvement in my life on nearly every axis, but if I miss a dose by even a few hours I get zaps, confusion, and dizziness. What happens to me now if I become unable to access my meds for more than a couple of days really keeps me up some nights.

Re: Doctors are finally learning to manage antidepressant withdrawal

#116

Post by Otterly99 »

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…

Thanks for the paper, it is actually quite crazy to think about when SSRI are basically the standard to treat depression.

I recently read a book about "The brain energy theory of mental illnesses"[1] which encapsulates depression and found it pretty compelling.

It seems to be a relatively new and active area of research[2], so there is hope!

[1]: https://books.google.fr/books/about/Brain_Energy.html?id=GIx... [2]: https://pubmed.ncbi.nlm.nih.gov/38183680/

Re: Doctors are finally learning to manage antidepressant withdrawal

#117

Post by pcrh »

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…

Here are a few additional reports:

>1. Selective serotonin reuptake inhibitors versus placebo in patients with major depressive disorder. A systematic review with meta-analysis and Trial Sequential Analysis. Conclusions: SSRIs might have statistically significant effects on depressive symptoms, but *all trials were at high risk of bias and the clinical significance seems questionable*. SSRIs significantly increase the risk of both serious and non-serious adverse events. The potential small beneficial effects seem to be outweighed by harmful effects.

>2. The trouble with antidepressants: why the evidence overplays benefits and underplays risks. Widespread prescribing has not reduced mental disability or suicide, raising questions about the assessment of evidence on effectiveness and safety of antidepressants

>3. In search of a dose–response relationship in SSRIs—a systematic review, meta-analysis, and network meta-analysis. Conclusions: There is no conclusive level I or level II evidence of a clinically meaningful dose–response relationship of SSRIs as a group or of single substances. High SSRI doses are not recommended as routine treatment.

>4 The serotonin theory of depression: a systematic umbrella review of the evidence "We did not identify *any* trials using ‘active placebo’ or ‘no intervention’ as control interventions. "

[1] https://pubmed.ncbi.nlm.nih.gov/28178949/

[2] https://www.bmj.com/content/370/bmj.m3200

[3] https://pubmed.ncbi.nlm.nih.gov/32970827/

[4] https://pubmed.ncbi.nlm.nih.gov/35854107/

Re: Doctors are finally learning to manage antidepressant withdrawal

#118

Post by mrec »

ernsheong wrote: post #110

Lookup "occupancy chart antidepressant", study the chart. There is an exponential drop-off at lower doses. Hence to taper off without feeling it, one needs to cut smaller and smaller doses, (or liquify) which may be impractical.

Interesting; I wasn't aware that 20mg was considered the minimum effective dose for fluoxetine. I tried tapering from 20mg to 15mg (alternating 10/20) after ~4 years and was absolutely fine; I then tried the next step down to 10mg and crashed hard. Probably going to stay on it for life now, which is fine; I never really experienced any negative side effects.

Re: Doctors are finally learning to manage antidepressant withdrawal

#119

Post by attemptone »

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).

Doctor gave it to me and I reacted paradoxically to it. Worse depression and even more peculiar I picked up smoking again. I never felt such an urge to smoke in my life. Over the years I've been looking for an explanation for that reaction but wasnt able to find anything

Re: Doctors are finally learning to manage antidepressant withdrawal

#120

Post by DataDaoDe »

sitharus wrote: post #61
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.

This. If there is one thing I've learned it is certainly not that you can generalize from yourself to others, especially for medication and its side-effects and withdrawal effects. I get so sick from taking novalgin that its a medical emergency (Agranulocytosis). Apparently, this occurs in like 1 case in a million. Conversely, I've heard of horrible side-effects or withdrawals from other medications where I experienced absolutely none of them.
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