The Mystery of When to Stop Antidepressants • Hacker News Board

Re: The Mystery of When to Stop Antidepressants

#51

Post by johnchristopher » Tue, Mar 08, 2016, 2:20 PM UTC

jobu wrote: post #19

pc2g4d wrote: post #2

There's a disconnect between what the meta-analysed randomized clinical trials are saying about antidepressants (that they are at best minimally effective relative to placebo) and what relapse rates suggest (that people relapse when withdrawn from antidepressants because the antidepressant was effectively treating the underlying depression). This conflict is resolved when antidepressants are acknowledged as addictive…

A close family member was on antidepressants for almost two years after being misdiagnosed with depression (that's a whole different story though). The tapering process was _very_ rough. At first the doctor recommended tapering by 1/4 each week for four weeks, but with the first reduction she had headaches, vertigo and nausea for nearly two days. After that the doctor changed the recommendation to tapering by 1/8 of…

> A close family member was on antidepressants for almost two years after being misdiagnosed with depression (that's a whole different story though).

What was the good diagnostic then ? What were the overlapping symptoms ?

I am personally really interested in learning more about illnesses that look like depression but aren't.

Re: The Mystery of When to Stop Antidepressants

#52

Post by mariodiana » Tue, Mar 08, 2016, 3:00 PM UTC

digi_owl wrote: post #39

arc_of_descent wrote: post #32

Earlier quoted context omitted.

I experienced this in mid 2014. I was feeling great and decided to stop taking anti-depressants. I was on 10 mg of an SSRI. Man, I fell into a well. I was depressed for 3 months. Couldn't get _any_ work done. Had a constant headache. I then checked myself into a hospital after 3 months for a full medical check up. Not surprisingly all the tests were fine. Finally the psychiatrist there put me back on anti-depressants…

Dunno about the sweating, but i think doing something physical allows part of the mind to focus on something rather than fluttering about. It may well be that our stationary modernity and our hindbrain simply don't mix.

I've heard that the human animal evolved to walk/run 12 miles per day, and that some people suspect that our sedentary lives are at the root of all sorts of mental and cognitive issues.

Re: The Mystery of When to Stop Antidepressants

#53

Post by johnchristopher » Tue, Mar 08, 2016, 3:03 PM UTC

gusfoo wrote: post #48

erikw wrote: post #8

Earlier quoted context omitted.

Interesting customer retention scheme Big Pharma has come up with. Find a pool of folks at risk for suicide, and then get them addicted to expensive chemicals that will exacerbate suicidal ideation if they try to quit. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/ "The FDA requires two adequately conducted clinical trials showing a significant difference between drug and placebo. But there is a loophole: There…

> Interesting customer retention scheme Big Pharma has come up with. Yes, keeping the customer alive is indeed good for business.

Just like vendor lock-in is good for business.

Re: The Mystery of When to Stop Antidepressants

#54

Post by thatcat » Tue, Mar 08, 2016, 3:08 PM UTC

ZeroGravitas wrote: post #40

biturd wrote: post #21

Earlier quoted context omitted.

Worse, keep in mind that pill, broke perfect in half, will not have equal amounts of the active or inactive ingredients in each side. Further, if it is a generic, it doesn't even have to have the same mg amount of the active ingredient, only within a margin of something like 90%, which is huge when dealing with these types of meds.

Why does the error margin only apply to generic medicines? Surely all pills have the same manufacturing issues and legal tolerances?

Presumably because patented drugs don't have any bioequivalent drugs to compare to and the margin of error is based off of how different the generic is from the original. Originals do have stricter regulations on the amounts of inactive fillers used though.

> Most regulators worldwide have decided that a 20% variation is generally not clinically significant.

>Two versions of a drug are generally said to be bioequivalent if the 90% confidence intervals for the ratios of the geometric means (brand vs. generic) of the AUC and Cmax fall within 80% and 125%. The tmax (brand vs. generic) must also be comparable — and there should not be any significant differences between different patients.

[1]https://www.sciencebasedmedicine.org/generic-drugs-are-they-...

[2](cmax, auc, graph comparison) http://www.bpac.org.nz/BPJ/2007/March/bioequiv.aspx

Re: The Mystery of When to Stop Antidepressants

#55

Post by xlm1717 » Tue, Mar 08, 2016, 3:42 PM UTC

gusfoo wrote: post #48

erikw wrote: post #8

Earlier quoted context omitted.

Interesting customer retention scheme Big Pharma has come up with. Find a pool of folks at risk for suicide, and then get them addicted to expensive chemicals that will exacerbate suicidal ideation if they try to quit. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/ "The FDA requires two adequately conducted clinical trials showing a significant difference between drug and placebo. But there is a loophole: There…

> Interesting customer retention scheme Big Pharma has come up with. Yes, keeping the customer alive is indeed good for business.

Keeping the customer addicted is good for business.

Re: The Mystery of When to Stop Antidepressants

#56

Post by GFK_of_xmaspast » Tue, Mar 08, 2016, 4:03 PM UTC

erikw wrote: post #8

pc2g4d wrote: post #2

There's a disconnect between what the meta-analysed randomized clinical trials are saying about antidepressants (that they are at best minimally effective relative to placebo) and what relapse rates suggest (that people relapse when withdrawn from antidepressants because the antidepressant was effectively treating the underlying depression). This conflict is resolved when antidepressants are acknowledged as addictive…

Interesting customer retention scheme Big Pharma has come up with. Find a pool of folks at risk for suicide, and then get them addicted to expensive chemicals that will exacerbate suicidal ideation if they try to quit. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/ "The FDA requires two adequately conducted clinical trials showing a significant difference between drug and placebo. But there is a loophole: There…

Lot of SSRIs are generic and cheap these days.

Re: The Mystery of When to Stop Antidepressants

#57

Post by GFK_of_xmaspast » Tue, Mar 08, 2016, 4:05 PM UTC

Tiksi wrote: post #50

DanBC wrote: post #33

Earlier quoted context omitted.

Habit forming - addiction - tends to include tolerance (doesn't exist for anti depressants), pre-occupation (doesn't exist), drug seeking and holding (doesn't exist). There are problems with anti depressants being over prescribed and misprescribed to people who should have had a talking therapy, and they are difficult for some people to stop, but calling them hanit forming is incorrect.

Wouldn't the withdrawls qualify them as habit forming? Calling them extremely addicting would probably be inaccurate, but "There's a good chance you'll feel awful if you stop taking this" seems like it may encourage forming a habit. Apparently there may be tolerance for antidepressants: https://en.wikipedia.org/wiki/Antidepressant_treatment_tachy... > ADT tachyphylaxis incorporates drug sensitivity as a potential cau…

There is a difference between 'addiction' and 'physical dependence'.

See: https://www.drugabuse.gov/publications/teaching-packets/neur...

Re: The Mystery of When to Stop Antidepressants

#58

Post by GFK_of_xmaspast » Tue, Mar 08, 2016, 4:08 PM UTC

biturd wrote: post #22

julie1 wrote: post #12

Earlier quoted context omitted.

Could antidepressant just be a placebo requiring to be addictive then? And could hooking off an addiction be very similar to depression? Would any psychoactive works? If so maybe why not using a less dangerous psychoactive drug if it is a placebo that works good enough to alleviate the pain?

Opiates will cure depression, stop it dead in it's tracks for a large majority of people. Good luck finding a Dr to help you down that road though. There is a reason people have an illicit drug of choice, and that is a good indicator of what anti-d's may work best for you. Opiates, you are screwed, meth, there is Adderal or Ritalin, ( All these probably have had their names changed by now to something else ), if you…

> Anxiety, ideally they lighten up and give you a benzodiazepine,

I was on ativan for anxiety a couple years back, and jesus if you thought ssri withdrawls were tough, don't try getting off benzos.

Re: The Mystery of When to Stop Antidepressants

#59

Post by jobu » Tue, Mar 08, 2016, 4:35 PM UTC

johnchristopher wrote: post #51

jobu wrote: post #19

Earlier quoted context omitted.

A close family member was on antidepressants for almost two years after being misdiagnosed with depression (that's a whole different story though). The tapering process was _very_ rough. At first the doctor recommended tapering by 1/4 each week for four weeks, but with the first reduction she had headaches, vertigo and nausea for nearly two days. After that the doctor changed the recommendation to tapering by 1/8 of…

> A close family member was on antidepressants for almost two years after being misdiagnosed with depression (that's a whole different story though). What was the good diagnostic then ? What were the overlapping symptoms ? I am personally really interested in learning more about illnesses that look like depression but aren't.

It was/is a combination of a couple MTHFR gene mutations and black mold exposure. The mutations make it more difficult for the body to process mycotoxins, and those started messing with her nervous and endocrine systems.

The misdiagnosis happened because there were some similar symptoms to depression. (She was very tired, but could never sleep. Dark moods, but in hindsight that was mostly because she felt crappy.) The doctor had no idea and she was willing to try anything to feel better, but SSRI's never really helped.

Re: The Mystery of When to Stop Antidepressants

#60

Post by joveian » Tue, Mar 08, 2016, 5:55 PM UTC

erikw wrote: post #8

pc2g4d wrote: post #2

There's a disconnect between what the meta-analysed randomized clinical trials are saying about antidepressants (that they are at best minimally effective relative to placebo) and what relapse rates suggest (that people relapse when withdrawn from antidepressants because the antidepressant was effectively treating the underlying depression). This conflict is resolved when antidepressants are acknowledged as addictive…

Interesting customer retention scheme Big Pharma has come up with. Find a pool of folks at risk for suicide, and then get them addicted to expensive chemicals that will exacerbate suicidal ideation if they try to quit. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/ "The FDA requires two adequately conducted clinical trials showing a significant difference between drug and placebo. But there is a loophole: There…

Really interesting article all around, thanks for posting. I didn't realize the FDA's procedures were that bad :(.