alt Hacker NewsDoctors are finally learning to manage antidepressant withdrawal
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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).
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.
Well this would be an improvement over my former NHS GP practice deciding the best way for me to come off antidepressants was immediately stopping them without renewing the prescription or even discussing it with me! I think they just forgot to renew the prescription.
My parents tried seeking out help for me when I was about 10 years old, but they got cold feet, and I believe that they were unwilling to accept any responsibility or blame for what was going on at home. So when I reached the age of majority, they fully funded therapist and psychiatrist sessions for me, and they foisted Prozac upon me, starting around 1991.
I began taking Prozac and suddenly exhibited a remarkable improvement in my mood and affect. These improvements were largely because I was getting attention, I was getting "weekly pep talks" from a professional, and at long last, there were names I could affix to those extremely troublesome spirits that tormented me night and day.
But the doctors, having a practice in the Children's Hospital, didn't see fit to warn me not to drink alcohol, especially not to excess, and I was simply reaching that age where this was happening frequently. So, the mixture of SSRI plus ethanol was really disastrous for me and my loved ones.
I cycled through all kinds of meds, and clinicians tried finding some other stuff to medicate, like maybe hypothyroidism, and I really hated the medication, and I got hospitalized and discharged with a cocktail of at least 5 prescriptions all at once. I suffered really awful adverse side effects. But it wasn't realistic to stop. I kept cycling through new and different drugs. Every time it was new and different, and I had more complaints, and I stopped again and again. I had all the "brain zaps" especially Zappy Zoloft, and more hospitals and more upheavals in life.
I've finally reached a point where I can steadfastly refuse any medication, up to the point where inpatient treatment is done. I am 100% off drugs, and I feel great about that. I tend to inform my providers that I have "a Lithium deficiency" because bipolar isn't real: it's merely a cluster of highly-subjective "symptoms" and behaviors, under an ever-widening umbrella, and the bottom line is that they just want to put Lithium Carbonate on the checklist of "subject is treating this thing" and then once I'm taking enough of it, they can heap on more and more drugs on top. And Lithium is one of those where they grab you for a monthly blood test, to "trust, but verify" as the Soviets would say.
So I am pleased that SSRIs and their ilk are far, far behind me. I inwardly chuckle or sigh wistfully when I hear another patient extolling the virtues of ECT or Ketamine or something. How wonderful for you to be dependent on quacks and pseudoscience. Read any Wikipedia page for these drugs.
They are fairy tales.
I am a practicing Roman Catholic: I don't need to believe in fairy tales from foreigners and infidels who distribute condoms and wear white coats.
Thank you for your attention to this matter!
Thank you for coming to my TED Talk.
SSRIs not Benzodiazepines. Withdrawals from the later can be life-threatening if you abruptly stop after prolonged use.
I forget exactly which antidepressant I was on, but when i finally stopped taking it, i was instructed to reduce dosage by half a pill every two weeks.
Anecdotally, that was not anywhere close to slow enough. I had panic attacks almost every day while I was reducing the dosage. Those weeks were hell. I couldn’t think straight. I honestly don’t remember much of what occurred during that time, because the withdrawal took over my life. The pills were too tiny to split into fourths easily, but I wish I had done something to reduce dosage in smaller increments or over a longer time period.
It makes me strongly reconsider ever taking any antidepressants ever again. They didn’t tell me when I started taking them that the withdrawal would be so terrible. Those months were easily some the worst of my life.
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.
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 "happy pill", it simply smooths out some extreme lows. Tapering off (a few weeks of 50% exponential declines) I've done because it's recommended, but again, I've never noticed any affect on mood before, during, or after.
after a number of years, a small dose of lithium (300mg) was recommended by a psychiatrist who stood apart (at least in that respect), and it was magic at mood stabilization, I never before even realized that I experienced hypomania (and I took it for anxiety), I just thought I was "bold".
(Lithium is not a drug, it's an element, taken as a metallic salt. It occurs naturally in the water in various parts of the world, and those populations have been studied and suffer lower rates of mental illness. My shrink said his recommendation was based in conjunction with the prozac I was taking, i.e. a known correlation. Bipolar II is a different mental condition than bipolar I, and somewhat slippery/loosely defined)
The extreme anecdotal stories people report online as in this forum strike me, an experienced but likewise only an anecdotal user, as more an artifact of underlying emotional distress rather than a result of the drugs.
I just wanted to contribute a different voice to this topic.
I should add, I do have "extra money" and am able to pay extremely qualified and expensive doctors, an option that is not available to everyone, including those with full public health services.
SSRIs and SNRIs just didn't work very well for me. If they had an positive effect at all, it wasn't enough to rise above the proverbial noise.
Coming off of them wasn't too bad though. I got the brain zaps, but those were easy to cope with.
More than anything the whole experience was a waste of money, and what finally fixed my problems was retirement and a greater attention to my health.
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.
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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 research suggests a minimal important difference (i.e. one patients and clinicians can actually notice) needs to be about 3-5 points. But the average effects of almost all antidepressants do not meet these thresholds, i.e. the effect actually appears practically invisible. [1]
Then you'll get waffling like "oh, but it really has a big effect for some people", but, well, no, we've looked at that too, and the placebo groups get just as miraculous "big effects", i.e. evidence supporting the idea "they really help some people" is also largely lacking [2-3]. All the other attempted saves ("oh, but eventually you find one that works for you") are also not really well supported either [4].
Like, maybe they really help some people, but it is far, far less clear than most assume, and should be balanced with concerns like withdrawal and serious side effects like emotional blunting and sexual dysfunction.
EDIT: And just to be clear to anyone doing a drive-by downvote thinking this is about recent asinine US politics, it emphatically isn't. There are serious methodological concerns here that desperately need to be communicated to the public.
[1] https://pubmed.ncbi.nlm.nih.gov/33593736/
[2] https://pmc.ncbi.nlm.nih.gov/articles/PMC7451660/
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 patch, and seems (in combination with therapy, and some life changes) to have rewired me a little. Symptoms I had for a decade prior have not returned. And I’m not sure I could have made those life changes without it.
Sadly my arachnophobia came back though. Oh well.