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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

#371

Post by ulfw »

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.

A GP nowadays is a triage person and nothing more. Sadly. My old school GP back in the day was a proper doctor. My current one is a really really nice guy who knows less about anything than I do. I literally tell him what to prescribe me and he doesn't know what it is. Whenever I have some issue he never diagnoses it but sends me off to radiology because those doctors will come up with a diagnosis for him. He then might treat if simple or more likely triage me to see a specialist.

I kind of find it cute to be able to be paid for this. I could do it easily and better but I would have to spend years studying medicine, which at 50 is not an option anymore

(this is just to my modern GP's job. I could definitely today NOT do my old proper full-on-doctor GP's job)

Re: Doctors are finally learning to manage antidepressant withdrawal

#372

Post by D-Machine »

Xortl wrote: post #75
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…

What's your opinion of the claim that antidepressants have small impact on people with mild to moderate depression, but significantly more impact on people with severe depression [1]? I ask as a nonexpert because this is a view I've read a few times from people I trust more than most, and I know two people who suffered from severe depression who credited SSRIs for getting them through. [1] https://pubmed.ncbi.nlm.nih…

Wait, I finally found a paper that properly presents the results in a way that lets you decide for yourself! See figure 2 here: https://pmc.ncbi.nlm.nih.gov/articles/PMC9344377/#f2, you want to focus on the second plot with the dotted and dashed lines.

Basically, both placebo and drugs can have huge responses, but basically, for severe depression, yes, it looks like the drug is more likely to have a large positive effect than the placebo is likely to have a large positive effect.

There are still a lot of limitations, main one being that study criteria generating the data for this would exclude most cases of really high severity actually seen in practice. Also "blinding" is mostly BS in these kinds of studies, and antidepressants have massive, noticeable effects, so the proper comparison is really an active placebo, and we really can't be sure the whole apparent antidepressant effect is basically just "woah, I can really feel this doing shit", basically, at some level, and this is still bad because the placebo vs. drug difference is still super tiny and below what we would consider typical minimal clinically important differences.

So still hard to say. But, yeah, there is a good chance the drugs are more effective in severe cases, and, technically, you should definitely treat in a severe case.

Re: Doctors are finally learning to manage antidepressant withdrawal

#373

Post by ButlerianJihad »

https://en.wikipedia.org/wiki/Killing_of_the_Clancy_children...

  While her husband was gone, Lindsay strangled their three children one by one with exercise bands in the basement. She then attempted suicide by cutting her wrists and neck and jumping from a second-story window.[6][27] Lindsay sustained spinal cord injuries from the fall and was hospitalized; she remains paralyzed from the waist down as of 2026.[31][32] A forensic toxicologist later testified that Lindsay's blood showed evidence of Remeron, Lamictal, Trazodone, and Seroquel.[33]

Re: Doctors are finally learning to manage antidepressant withdrawal

#374

Post by tsoukase »

TazeTSchnitzel wrote: post #323
tsoukase wrote: post #177

All cases are possible with S{S|N}RIs (I am a doctor but I know a little regexp). Patients that took them for two months and never needed again and others that cannot stop them after 20y. The start, the stop and every restart of the drug needs an indication so it should be approached with the same care as any medical decision. It's not right to call it withdrawal. These drugs are not addictive like benzos or alcohol…

> It's not right to call it withdrawal. These drugs are not addictive like benzos or alcohol are. What does “not addictive” matter? Clearly, SSRIs are something that induce a dependency, because the withdrawal symptoms are horrific. A drug doesn't need to give you a high to create a dependency problem. > If any symptom reappears it's just that the mental disease most usually changed form after so long time. How do yo…

The guideline "The benefit must outweigh the harm" is more relevant for aD drugs than anything else in medicine. The problem is that it's difficult to estimate the risk for such relatively rare but debilitating side effect. When I prescribe an aD, there is a wide margin of expected benefit taking into consideration a dozen of long term risks, among which, I admit, PSSD is of less worry. Others more important are cardiovascular, metabolic (permanent weight gain), cognitive (dementia), even social (disruption of relationships).

Re: Doctors are finally learning to manage antidepressant withdrawal

#375

Post by hirako2000 »

orangedog wrote: post #277
hirako2000 wrote: post #266

Earlier quoted context omitted.

They don't post on HN but a cousin post references an entire subreddit dedicated to it. They are also anecdotal, hundreds, thousands of people suffering side effects. Given dozen of millions people in the U.S alone are prescribed those things daily, that a drop in the ocean. But not everyone post on Reddit either

Yes but again this is the exact example of anecdotes. Those not suffering aren't going to seek out subreddits to post about their non-problems. You can find a subreddit about everything, whether that's representative of anything or not.

I did mention they were anecdotes.

I never found a sub reddit talking about the side effects of mineral water, how eating apples regularily lowered their libidos, on that sleeping on a mattress made them senile.

At some point common sense primes over what funded science wants people to believe.

The side effects exist since some doctors do warn about them, one may also find them in the counter indications mentioning those things. It isn't unfounded.

What's taboo today is to criticize SSRIs over prescriptions. Odd, given that over 25% of the U.S population are taking them, or some other form of legal psycho active substance, just to be able to "function".

Re: Doctors are finally learning to manage antidepressant withdrawal

#376

Post by _bernd »

in_cahoots wrote: post #302
micromacrofoot wrote: post #300

Earlier quoted context omitted.

chemistry of complex systems you don't experience side-effects now, but you will if you need to stop taking it

Been on hormonal birth control for 20 years. I've stopped twice to get pregnant. No side effects. I don't know why you're so confident here.

It's cool that you have not encountered any issues but especially birth control pills are also no smarties but many use them as they were candy.

In my personal circle I only new of a single woman who had no issues. The majority had all flowers off issues. During and afterwards. No most of the time it got downplayed or simply ignored but doctors and society a like. I'm personally glad that birth control pills are not longer sold as a wonder pill because many woman suffered needlessly and the worst part is that many did not knew that is was the pill in the first place.

Re: Doctors are finally learning to manage antidepressant withdrawal

#377

Post by ernsheong »

mrec wrote: post #173
ernsheong wrote: post #157

Earlier quoted context omitted.

With this chart we now know why stepping down from 15mg to 10mg is a HUGE step.

Could you link to the specific chart you're looking at? I think our searches are finding different things.

https://www.madinamerica.com/2021/09/antidepressant-effects-... and its variants
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