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Post by Admin on Apr 26, 2021 20:05:59 GMT
New Cochrane review explores the latest evidence on approaches to stopping long term antidepressants australia.cochrane.org/news/new-cochrane-review-explores-latest-evidence-approaches-stopping-long-term-antidepressantsThere are many reasons to undertake a Cochrane review. For the author team behind the new review on safe and effective approaches to stopping antidepressants, the motivating factors were both personal and professional, national and international. 'Long-term antidepressant use is on the rise around the world and all of us recognise the urgent need for evidence on safe and effective approaches for people who want to stop taking them,’ says Mieke van Driel, Emeritus Professor of General Practice at the University of Queensland. ‘As a GP myself, I see first-hand the struggles many patients have coming off antidepressants, yet we don’t know enough about how to reduce inappropriate long-term use or what the safest and most effective approaches are to help people do this.' 'Our latest Cochrane Common Mental Disorders review confirms that while much is known about the increasing global uptake of antidepressant medications, there’s little high quality evidence on safe and effective approaches to stopping treatment. For example, there are over 1,000 studies looking at starting antidepressants, yet we found only 33 randomised controlled trials (RCTs) around the world that examined stopping them. It’s clear that this area needs urgent attention.’ Over three million (or 1 in 7) Australian adults take antidepressants for depression and anxiety every day, making Australia the second highest consumer of antidepressants of all OECD countries. In 2019, there were 27 million prescriptions provided for antidepressants across Australia, with around 86% of those written by GPs. The average duration of treatment is four years. Guidelines typically recommend that antidepressants be taken up to 6–12 months after improvement, or for up to 2 years in people at risk of relapse, but many people take antidepressants for much longer. Surveys of antidepressant users suggest that 30–50% of long-term antidepressant prescriptions have no evidence-based or clear medical reason to keep taking them. Long-term use can put people at risk of adverse events such as sleep disturbance, weight gain, sexual dysfunction, low blood sodium and gastrointestinal effects (eg diarrhoea, constipation), as well as feeling emotionally numb and unable to deal with problems in life without medication. Mieke and the international author team looked at the findings from 33 RCTs that included 4,995 participants who were prescribed antidepressants for 24 weeks or longer. In 13 studies, the antidepressant was stopped abruptly; in 18, it was stopped over a few weeks (known as ‘tapering’); in four, psychological therapy support was also offered; and in one study, stopping was prompted by a letter to GPs with guidance on tapering. Most tapering schemes lasted four weeks or less and none of the studies used very slow tapering schemes beyond a few weeks - in contrast to new guidelines from the UK Royal College of Psychiatrists that recommend tapering over months or years to safely stop. ‘For me, this is such a critical issue, from both a personal and a professional perspective,’ says London-based Australian Cochrane author Dr Mark Horowitz. ‘I am one of the hundreds of thousands of people who have experienced long, difficult and harrowing battles coming off long-term antidepressants because of the severity of the withdrawal effects. And rather than being able to find or access any high-quality evidence for guidance in this situation, I instead found that the most useful information was on peer support sites where people who had gone through withdrawal from antidepressants have been forced to try to become lay experts themselves. This lack of evidence in such a critical area is just not good enough, and is one of the main reasons I got involved with this Cochrane review. For me coming off antidepressants, though a difficult process, has been transformative – having improved the tiredness, issues with memory and concentration that I had long thought were due to other conditions. I want other people to have the option to come off antidepressants without the same trouble I have had.’ ‘We compared different approaches and looked at benefits (such as successful stopping rates) and harms (such as return of the depressive or anxiety episodes, side effects and withdrawal symptoms). We outline detailed findings across all these areas, but in a nutshell there was only very low certainty evidence on the pros and cons of each of the different approaches to stopping – making it difficult to reach any firm conclusions at this time. The key issue is that studies do not distinguish between symptoms of a return (or relapse) of depression and symptoms of withdrawal after stopping, and that’s just so problematic.’ ‘The difficulty of distinguishing between withdrawal symptoms and relapse presents a real challenge for patients, doctors and researchers alike - often resulting in inappropriate continuation of antidepressant medication and uncertain evidence on which to base healthcare decisions. For example, in studies where antidepressants are stopped, withdrawal symptoms such as insomnia, low mood, anxiety and changes to appetite register on the questionnaires used to detect a return of the patient’s anxiety or depression. This might make it look like more people are having a return of their anxiety or depression than is really the case.’ ‘To address this critical issue and provide the evidence we need, future studies need to distinguish carefully between withdrawal symptoms and relapse, and try using taper schemes of many weeks or months (or longer for long-term users) down to very low doses before stopping. These kinds of studies would give us a clearer idea if we can safely discontinue antidepressants without triggering a relapse.' ‘Ultimately we really need more studies about discontinuing antidepressants – especially in primary care given that’s where most prescribing takes place – before we can make more definitive conclusions. In the meantime, we hope this review provides a starting point to help GPs openly discuss continuing or stopping antidepressants with their patients. We also want to raise awareness that withdrawal symptoms from antidepressants are common and can be mistaken for relapse of the underlying condition. Experiencing withdrawal symptoms isn’t a sign that the patient has relapsed – it might be that they need to taper more gradually down to much lower doses instead, before eventually stopping.’ ‘Looking ahead, we await the results of current studies underway that are looking at discontinuing antidepressants,’ Mark adds. ‘Studies like the REDUCE trial in the UK, led by our review’s co-author Prof Tony Kendrick, which is testing online and psychologist telephone support for patients withdrawing from long-term antidepressants where this is appropriate, and the WiserAD trial of nurse-led support led by Prof Jane Gunn at the University of Melbourne. We know future studies will be critical in addressing the urgent need for more and better evidence, given the concerning trend of long-term use of antidepressants here in Australia and around the world.’
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Post by Admin on Apr 26, 2021 20:12:20 GMT
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Post by Admin on Apr 26, 2021 22:56:48 GMT
A new Cochrane review examines the current body of research on stopping antidepressant use, finding a major lack in this area. The researchers call for further investigation into safe and effective strategies for stopping antidepressants. “We know the rise in long-term antidepressant use is a major concern around the world,” says lead review author and Belgian-based researcher Ellen Van Leeuwen. “As a GP myself, I see first-hand the struggles many patients have coming off antidepressants. It’s of critical concern that we don’t know enough about how to reduce inappropriate long-term use or what the safest and most effective approaches are to help people do this. For example, there are over 1,000 studies looking at starting antidepressants, yet we found only 33 randomized controlled trials (RCTs) around the world that examined stopping them. It’s clear that this area needs urgent attention.” www.madinamerica.com/2021/04/cochrane-review-calls-research-antidepressant-withdrawal/Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults Ellen Van Leeuwen 1 2, Mieke L van Driel 2 3, Mark A Horowitz 4, Tony Kendrick 5, Maria Donald 3, An Im De Sutter 2, Lindsay Robertson 6 7, Thierry Christiaens 1 Affiliations expand PMID: 33886130 DOI: 10.1002/14651858.CD013495.pub2 pubmed.ncbi.nlm.nih.gov/33886130/
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Post by Admin on Apr 29, 2021 21:50:47 GMT
Suicides Are Increasing – And So Are Antidepressant Prescriptions www.madinamerica.com/2018/08/suicides-are-increasing-and-so-are-antidepressant-prescriptions/Suicide rates decreased steadily from the mid-eighties until the new millennium in the USA and, on average, in Organisation for Economic Cooperation and Development (OECD) countries.1 In Europe, suicide rates decreased until around 2007 in most countries.2 Parallel to this drop of suicides, prescriptions of SSRI’s, the new generations of “antidepressants,” gradually increased. This led to numerous publications arguing that the negative correlations between antidepressant prescription rates and suicide rates was evidence that antidepressants are likely helpful in reducing suicide because they can alleviate symptoms of depression, one of the major risk factor for suicide. Authors of these papers often had financial or other ties to the pharmaceutical industry (e.g., Ulrich Hegerl, Göran Isacsson, John Mann, Zoltan Rihmer). In 2004, a kind of shock wave hit mainstream psychiatry when the FDA released the black box warning about prescribing antidepressants to children and youth. Not long after, Robert Gibbons and others published a now widely cited paper, based on data from 2003 to 2005, reporting that the black-box warning led to a reduction in the prescribing of antidepressants which was associated with an increase of suicides among young people.3 However, although the article was published in the high-ranked, peer-reviewed American Journal of Psychiatry, the statistical analysis and the related conclusions by Gibbons were quickly shown to be in error; there simply was no increase of suicides associated with the decrease of antidepressant prescriptions (see Jureidini, 20074 and Stone, 20145; see also Robert Whitaker’s report). From 2000 onwards, suicide rates in the USA started to rise again (among youth around 2007). In most countries in Europe, suicide rates stopped declining or even increased again starting around 2007. However, antidepressant prescription rates steadily increased from the mid-eighties until today. As a result, the association between increased antidepressant rates and reduced suicide rates has faded with each passing year. Even worse for mainstream psychiatry, if you look at the past 10 years, antidepressant rates are associated with increased suicide rates. Yet, as this has occurred, there has been, in our opinion, a strange silence. There has been a lack of research updates on the trend of increases in suicide rates as prescriptions of antidepressants have risen. And what about research reports on the long-term outcomes of the FDA black box warnings? Two papers pointed out that suicide rates did not increase as a result of the black box warnings in the United States and in Canada (Rhodes, Skinner, McFaull, & Katz, 20136 and Stone, 2014), but these papers were also “silenced” in psychiatry, since they were much less cited (9 and 36 times, respectively) than the Gibbons et al. paper that was cited 569 times (citation-frequency assessed via Google Scholar on August 12, 2018). Other attempts to show that the FDA warnings led to increased suicides (Lu et al., 2014,7 cited 115 times) have also been debunked (see comments to the Lu article and Philip Hickey’s blog “Suicidal Behavior After FDA Warnings” here on MIA). This silence about increasing suicide and antidepressant rates, and the silencing of studies that disproved harmful effects of the FDA warnings, was interrupted by at least two noteworthy incidents that demonstrate some deep-seated form of “evidence-resistance.” First, Robert Gibbons simply kept on claiming that the black box warning led to an increase of suicides (LA Times, Feb. 06/2012). Second, a research group around Zoltan Rihmer published a paper in 2015 about suicide trends and antidepressant prescription rates in Hungary, but only used data up until 2006, excluding the time span afterwards when suicide rates increased again (Otuyelu et al., 20158). This way, they of course could prove that increased antidepressant prescriptions came along with reduced suicide rates. No word about the restricted time frame or the increase of suicides in recent years in the limitation section of the paper. They even claimed that their results were an indirect proof of the harms of the FDA warnings (of course citing the debunked 2007 Gibbons et al. paper). They said that, since there was no related warning in Hungary, antidepressant prescriptions kept on rising in young people whereas suicides kept on falling. Otuyelu also cited another paper that “proved” the harms of the black box warning (Katz et al., 20089), despite opposing evidence available at that time (Rhodes et al., 2013). All of this is the background to our recent research on this topic. Recently, when we became aware of a newly published paper in the Journal of the American Academy of Child & Adolescent Psychiatry that analyzed trends of suicidality and mental health utilization of young people in the US, we wondered why the authors did not also include the results for prescriptions rates, despite that data being available.10 However, since the data was in the public domain, we were able to investigate the association of the suicide attempt rate with drug prescriptions for mood disorders (most likely antidepressants) among adolescents for the years 2004 to 2016. Our analysis was rejected for publication by the Journal of the American Academy of Child & Adolescent Psychiatry and by JAMA Psychiatry. We were finally able to publish the paper in Epidemiology and Psychiatric Sciences (Plöderl & Hengartner, 201811). Unfortunately, variables for years prior to 2004 could not be compared to later years, but with the available data we could still explore changes in the rate of prescriptions and suicide attempt rates following the FDA warning. The data is based on the annual National Survey on Drug Use and Health, a nationally representative survey among the US population. Past year major depression was assessed with a structured interview, and participants were asked if they had taken prescribed medication for their mood problems in the past year. We used this as a proxy for use of antidepressant medication. Prior suicide attempts were also assessed. This suicide attempt variable seemed to be a valid indicator of past year suicide risk, since it correlated high with the yearly suicide rates of the same age group (r = 0.75, p < .05). Our analysis revealed that the rates of prescriptions, suicide attempts, and suicides decreased in the years following the FDA warning in 2004 but started to rise again in recent years. This is also confirmed by large and statistically significant correlation coefficients. Obviously, this contrasts with the assumption that the FDA warning led to an increase of suicidal behavior. On the contrary, it seems that reduced prescriptions lead to a reduction in suicidal behavior. It also indicates that the FDA warning had no enduring effect, since prescriptions to youth are on the rise again. The usual interpretation by mainstream psychiatry is that our findings are an artefact: young people attempting suicide are more likely to receive mental health treatment, and this produces the found association. This explanation, however, does not fit with the fact that our findings apply both to adolescents with and without a major depression diagnosis. Persons without major depression are rarely suicidal; therefore, in these youths, the strong correlation between suicide attempts and antidepressant prescriptions is hardly explained by diagnosis alone. Also, antidepressant prescription rates increased before the suicide attempt rates did, as indicated via a statistical technique called changepoint-analysis.
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Post by Admin on May 11, 2021 0:25:00 GMT
Why Toxic Antidepressants ? toxicantidepressants.fr/index.htmlThe Toxic Antidepressants site was created to inform people who are taking, tapering or are currently off of antidepressants about the dangers of these meds and the possible neurological damage they may cause. We also give advice on how to alleviate the withdrawal symptoms and facilitate the recovery. We also explain the reasons why most doctors deny the existence of a prolonged withdrawal despite numerous testimonies from the patients and hundreds of articles from professionals. This is a site of suggestions, opinions and advices provided by our experience. It should not be considered as professional services, and is no substitute for professional health care. Please consult your own trusted health professional before making any changes to your medication, or making any other health decisions.
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Post by Admin on May 16, 2021 19:05:00 GMT
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Post by Admin on May 19, 2021 21:16:27 GMT
Allen Frances Takes on the Over-Prescription of Antidepressants The prominent psychiatrist explores why antidepressants remain highly overprescribed and offers solutions to the problem. www.madinamerica.com/2021/05/allen-frances-takes-prescription-antidepressants/Why are antidepressants so overprescribed? And what to do about it? www.healthwatch-uk.org/publications/newsletter/newsletter-115/231-115-antidepressants.htmlBy Allen Frances It's so easy to start antidepressants, but so hard to stop them. That's why they are prescribed for about 12% of the population in both the UK and the US. In England the number of antidepressant prescriptions doubled between 2008 and 2018,(1) despite the fact that the pills are now off patent, which means that pressure from manufacturers to prescribe can likely be ruled out as a factor. There is no reason to believe that the incidence of psychiatric disorder has increased over time - so why are these pills so popular with practitioners and their patients? The most important thing to understand is that general practitioners write most of the prescriptions. Often they must do so after rushed visits with patients they don't know very well; who frequently present on one of the worst days of their lives; with nonspecific symptoms of stress, depression, or anxiety. The quickest way to get a worried patient out of the consulting room is to write a prescription. Half the patients who start an antidepressant continue to take the pills for at least two years (2) – sometimes for decades, or even for life. This is often best practice for those with severe and recurring depressions. But it can be worst practice for the majority of patients who began with mild symptoms that likely would have disappeared on their own with time, stress reduction, placebo effect, and regression of symptoms to the mean. Previous research has shown that between one-third and half of patients taking antidepressants long-term have no evidence-based reason to be on them.(3) Patients who don't really need antidepressants nonetheless often stay on them for two reasons: misattribution and withdrawal symptoms. A person who feels better after starting antidepressants understandably assumes it was the pills that caused improvement – not understanding that most mild symptoms are stress related, self-limited, and likely to go away on their own. Stopping pills that never were, or are no longer, necessary is hard to do once the person believes they have worked. Half the patients who start an antidepressant continue to take the pills for at least two years (2) – sometimes for decades, or even for life. Withdrawal symptoms are most likely to occur when medications are stopped abruptly, after prolonged use, and at higher doses. Withdrawal can be very unpleasant and scary, causing lethargy, sadness, anxiety, irritability, trouble concentrating, sleep problems, nightmares, ’flu symptoms, nausea, dizziness, and strange sensations. They can also go on for a long time. Twenty-five per cent of users are still experiencing some symptoms after 3 months, and for some withdrawal can last 6 months.(4) Withdrawal occurs when doctors fail to deprescribe slowly enough or patients stop on their own. Partly because of the widespread misconception that antidepressants don't cause withdrawal, patients and doctors routinely misinterpret the symptoms as relapse – triggering what is often unneeded long term treatment. Antidepressants are also increasingly being used in children and teenagers, in the UK as well as in the US,(5) despite considerable evidence they don't work in young patients and may even increase risk of suicide.(6) I think antidepressants should be used very rarely in kids, and only for very clear indications and when prescribed by a child psychiatrist. Some highly publicized reviews of the depression literature have concluded that antidepressants are no more effective than placebo.(7) I would argue that this is an artefact caused by the fact that so many of the subjects included in these studies had only milder symptoms that are very placebo responsive. Severe depressions do not respond to placebo or psychotherapy and do require medication or even electro-convulsive therapy (ECT).(8) The trick is targeting – reducing medication use in those who don't need it, while identifying and treating those who do. Self-report depression screening scales have become popular, but result in the massive overdiagnosis of clinical depression in the worried well So what are possible solutions to the rampant over-prescription of antidepressants? The single most powerful intervention is giving general practitioners more time to know their patients and to explain why jumping to a prescription is not a good idea. For mild depressions, the best first steps are watchful waiting, normalization, advice, stress reduction, and a repeat visit after several weeks. For moderate or more prolonged depressions, psychotherapy should be tried first. Medication should always be started immediately for severe depressions, but should be only a last resort in those milder ones that persist, are impairing, and haven't responded to time or talk therapy. Self-report depression screening scales have become popular in the offices of general practitioners. Unfortunately, they result in the massive overdiagnosis of clinical depression in the worried well, with resulting overuse of medication. It is important that we train GPs on the difference between severe and milder depressions and give them time to evaluate their patients more thoroughly. Routine screening for depression is best reserved for high risk groups such as mothers in perinatal period, patients with chronic illness, and people with a history of mental illness or suicidal behaviour. Better initial evaluation and more targeted treatment is certainly costly up front but should be weighed against the harms and costs of long term, unneeded medications and the consultations to prescribe them and deal with side effects. Patients who don't need medication are much better off without them. They avoid the side effectsand inconvenience of long term treatment and also gain the sense of mastery and resilience that comes from enduring and prevailing in the face of life's inevitable stresses. Allen Frances Professor and Chair Emeritus, Department of Psychiatry, Duke University, North Carolina, US Chair, DSM-IV Task Force Dr Frances is author of 'Essentials of Psychiatric Diagnosis' (pub. Guilford Press, 2013) and 'Saving Normal: An Insider's Revolt against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life' (pub. William Morrow, 2013) References BBC News. Jump in antidepressant prescriptions in England. 28 Mar 2018. www.bbc.co.uk/news/health-47740396Kendrick A. Long-term antidepressant treatment: time for a review? Prescriber, 5 Oct 2015: wchh.onlinelibrary.wiley.com/doi/epdf/10.1002/psb.1389Cruickshank G et al. Cross-sectional survey of patients in receipt of long-term repeat prescriptions for antidepressant drugs in primary care. Ment Health Fam Med 2008;5:105–9. All-Party Parliamentary Group for Prescribed Drug Dependence. Antidepressant Dependency and Withdrawal. May 2018. prescribeddrug.org/wp-content/uploads/2018/06/APPG-PDD-report-on-antidepressant-dependence-and-withdrawal.pdfBBC News. Antidepressant prescriptions for children on the rise. 24 Jul 2018. www.bbc.co.uk/news/health-44821886Suicidality in Children and Adolescents Being Treated With Antidepressant Medications. 5 Feb 2018. www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/suicidality-children-and-adolescents-being-treated-antidepressant-medications#:~:text=Antidepressants%20increase%20the%20risk%20of,suicidality%20with%20the%20clinical%20need. Munkholm K et al. Considering the methodological limitations in the evidence base of antidepressants for depression: a reanalysis of a network meta-analysis. BMJ Open 2019;9:e024886. doi: 10.1136/bmjopen-2018-024886 National Institute for Health and Care Excellence (NICE). Step 4: Complex and severe depression in adults. pathways.nice.org.uk/pathways/depression#path=view%3A/pathways/depression/step-4-complex-and-severe-depression-in-adults.xml&content=view-node%3Anodes-inpatient-care22 April 2021
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Post by Admin on Jun 19, 2021 18:31:42 GMT
Do antidepressants create more mental illness than they cure? Robert Whitaker discusses the long-term impact of prescription medication. DEREK BERES 15 June, 2020 bigthink.com/mind-brain/antidepressants-dangersMany antidepressants show no better efficacy than placebo or talk therapy in long-term usage. Proselytizing pharmaceutical interventions has been part of a concerted effort since the 1970s. Journalist Robert Whitaker discusses the impact of pathologizing children, moral therapy, and more. Doctors wrote a record number of prescriptions for Zoloft in March, causing the FDA to add this SSRI to its drug shortage list. Zoloft prescriptions then dropped in April—4.5 million, down from 4.9 million—yet these numbers represent a startling upward trend in antidepressant usage. Nearly 13 percent of the US population over age 12 now regularly swallow these pills. Why would a 12-year-old need an antidepressant? Robert Whitaker, author of "Mad in America" and Anatomy of An Epidemic," discusses the pathologizing of children during our recent conversation. Whitaker has won a number of awards for his reporting on the psychiatry industry; he was a Pulitzer finalist for a series on psychiatric research he co-wrote for the Boston Globe. While his investigative reporting covers a range of topics, an important thread weaves together his work: Why do Americans take so many prescription drugs? In"Anatomy of an Epidemic," Whitaker points out that as prescriptions for SSRIs, SNRIs, and antipsychotics rise, so do anxiety and depression diagnoses. If these drugs worked, fewer people should be diagnosed. In a for-profit health care system, however, new customers are always needed. Minor complaints are now pathologized. Creating an illness is the best way to sell a drug. The 20th century represented a remarkable turning point in medicine. It also marked the beginning of a tragic misunderstanding of mental health. After millions of years of successful evolution, humans were suddenly victims to brain chemistry gone awry. We were sold on the idea that chemical imbalances are the cause of anxiety and depression, not a biological effect created by environmental conditions. Antidepressants predominantly treat a symptom, not the cause, of our malaise. As Whitaker mentions, short-term use of antidepressants can be helpful. Even with an increasing number of studies detailing the negative long-term effects of these drugs, we're swallowing more pills than ever. I chatted with Robert about why that is and how we can course correct. Our talk was edited for clarity, but you can watch the full conversation or read the transcript below.
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Post by Admin on Jul 2, 2021 21:46:02 GMT
Antidepressant Use Leads to Worse Long Term Outcomes, Study Finds Results from a 30-year prospective study demonstrated worse outcomes for people who took antidepressants, even after controlling for gender, education level, marriage, baseline severity, other affective disorders, suicidality, and family history of depression. By Peter Simons -April 30, 2018 www.madinamerica.com/2018/04/antidepressant-use-leads-worse-long-term-outcomes-study-finds/A new study by Michael P. Hengartner, Jules Angst, and Wulf Rossler found that those who took antidepressants were more likely to have worse depression symptoms after 30 years. This finding was independent of illness severity as well as a large number of other potential confounding factors. The authors, from Zurich University of Applied Sciences and the University of Zurich, published their findings online this month in the journal Psychotherapy and Psychosomatics. The study followed 591 Swiss adults from the age of 20/21 until they were 49/50 years old. Antidepressant use at some point in the study was associated with worse depression symptoms at the end of the study—even when controlling for initial symptoms and other factors. “These findings are in line with a growing body of evidence from several naturalistic observational studies suggesting that (long-term) antidepressant use may produce a poor long-term outcome in people with depression,” Hengartner writes.
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Post by Admin on Jul 7, 2021 20:59:16 GMT
Four Essential Studies on Antidepressant Withdrawal Every Prescriber Must Read A researcher and service user Stevie Lewis recounts her own experience with antidepressant withdrawal and what she wishes her doctors knew. www.madinamerica.com/2021/07/223158/In a new article published in the British Journal of General Practice, researcher and campaigner Stevie Lewis writes about her experience with antidepressant withdrawal. She points to four significant studies that she wishes her doctors had read before prescribing her antidepressants in 1996. She goes on to summarize the findings of these important studies. Antidepressant withdrawal, which had long been denied and ignored by the psychiatric community, is at the forefront of the conversation now. Numerous official medical bodies and even prominent psychiatrists have pointed to the adverse and long-lasting effects that can occur when discontinuing antidepressants. This has exposed biased methodologies behind much of the extant antidepressant research, with drug companies often actively suppressing placebo response rates. It has also raised serious doubts about the chemical imbalance hypothesis, so much so that many psychiatrists are now beginning to divorce themselves from it. Service user movements and voices are responsible for drawing attention to this issue and demanding changes. This article adds to those concerns by undertaking an academic analysis through a first-person narrative. Lewis writes that while in 1996 there was already some research around withdrawal effects of antidepressants, campaigns such as Defeat Depression had successfully managed to portray it as a chemical imbalance problem. As a result, antidepressants were claimed to be safe, effective, and non-habit-forming. She then notes that today her experience of repeatedly trying to get off antidepressants and being hounded by severe withdrawal symptoms is neither uncommon nor unknown. Moreover, the hypothesis that antidepressants can cause structural and chemical changes in the brain and result in drug dependence is gaining widespread acceptance. For example, The Royal College of Psychiatry recently released a statement about their severe and long-lasting dependence. Lewis provides an overview of four important studies that are essential reading for general practitioners who want to update and inform themselves of recent findings on antidepressant withdrawal. There are many reasons antidepressants are overprescribed: industry corruption, biased methodology, overprescription by general practitioners, etc. Lewis’ suggestions to general practitioners are thus of particular importance here. The first paper is a 2019 systematic literature review by Davis and Read, which identified and analyzed 24 studies. It found that: “More than half (56%) of people who attempt to come off antidepressants experience withdrawal effects, with nearly half (46%) of people experiencing withdrawal effects describing them as severe. For patients, it is not uncommon for the withdrawal effects to last for several weeks or months.” Lewis writes that the NIMH has for decades underplayed how common antidepressant withdrawal is but recently has admitted to its severity and long-lasting nature. The second important piece of literature is a 2020 paper by Guy, Brown, Lewis, and Horowitz that details the first-person service user experience of mistaking psychotropic drug withdrawal for relapse. In other words, what is actually withdrawal from drugs is wrongly assumed to be the patient relapsing into the original underlying condition (such as depression) or the emergence of a new one. The experience of 158 responders was analyzed for themes, which were used for petitions forwarded to the Scottish and Welsh parliaments. The authors found 8 separate points where doctors mistook psychotropic drug withdrawal for something else; they also lacked knowledge on tapering techniques. In addition, patients were often given inadequate information about withdrawal risks. The next paper summarized by Lewis is a 2019 article by Horowitz and Taylor concerning ways to taper off antidepressants. Lewis considers this to be the most important article, given that if her prescribers knew about it, it might have eased her own ordeal. Using PET scans, the authors conclude that tapering should be slow and hyperbolic (smaller and smaller reduction each time) to doses that are vastly smaller than what is considered minimal dosage. This is essential to reducing withdrawal effects. This article helps differentiate between withdrawal (which occurs in days, responds to antidepressants, and can physiologically and psychologically appear different from original symptoms) and relapse. Despite these differences, sometimes the original symptoms and withdrawal can look the same, complicating matters further. Given the dearth of systemic services that help people withdraw from psychotropics or even provide relevant and updated information, the service-user movement has filled in the void. Social media support groups are an integral part of this. Thus, the last paper suggested by Lewis is a 2021 study by Framer on Facebook support groups for antidepressant withdrawal. Framer is a service user and struggled with antidepressant withdrawal; she is also the founder of survivingantidepressants.org. This paper points to how service users have supported each other and helped to taper from antidepressants – especially in the absence of psychiatric help. She writes: “Framer introduces us to PAWS — Post-Acute Withdrawal Syndrome — which describes the various physical and emotional symptoms that develop as the body readjusts following the adaptations it has had to make while taking the drug. She also touches on ‘neuro-emotions’ — emotions generated by the neurological effects of withdrawal.” Her work has brought together numerous concerns around antidepressant withdrawal – how to taper, protracted withdrawal, identifying drug reactions, coping methods, etc. Lewis’ article is another step in making prescribers more aware of the adverse effects of commonly prescribed psychotropics. **** Lewis, S. (2021). The four research papers I wish my doctor had read before prescribing an antidepressant. British Journal of Medical Practice. DOI: doi.org/10.3399/bjgp21X716321 (Link) *** Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.
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Post by Admin on Jul 11, 2021 9:57:56 GMT
Withdrawal symptoms from antidepressants can last over a year, new study finds We must rethink the "chemical imbalance" theory of mental health. DEREK BERES 05 June, 2020 bigthink.com/surprising-science/antidepressants-withdrawalA new review found that withdrawal symptoms from antidepressants and antipsychotics can last for over a year. Side effects from SSRIs, SNRIs, and antipsychotics last longer than benzodiazepines like Valium or Xanax. The global antidepressant market is expected to reach $28.6 billion this year. In her book, "Blue Dreams: The Science and Story of the Drugs That Changed Our Minds," psychotherapist Lauren Slater discusses psilocybin and MDMA as potential treatments for depression. Sadly, she hasn't tried either given her longstanding antidepressant usage. As she told me in 2018, psychedelics are contraindicated to Prozac. Yet she sees hope in this class of drugs for a wide range of mental health treatments. After I described the psychedelic experience, she replied, "I can imagine them very vividly, but it's not the same as actually getting to take them. I think if I could actually get to take a psychedelic, a lot of what I fear would go away. And I think I would be a better person because of it. But I do understand I have a sort of intuitive understanding of what they do." Slater has been taking antidepressants for decades. While aware of the problems with long-term usage, she is unable to withdraw given the crippling side effects. This is a serious problem for millions of antidepressant users, as detailed in a new review published in the journal Psychotherapy and Psychosomatics. Written by University of Florence Associate Professor of Clinical Psychology, Fiammetta Cosci, and Maastricht University's Guy Chouinard, the review points out popular antidepressant and antipsychotic medications, including SSRIs and SNRIs, exhibit more severe withdrawal symptoms than benzodiazepines (such as Valium and Xanax), Z-drugs, and ketamine. Benzodiazepines were first synthesized in 1955. This class of tranquilizers took the place of Meprobamate (Miltown), which is considered one of the world's first blockbuster drugs. As Miltown lost favor due to a growing population of addicts, benzos took its place in psychiatry offices. By the late seventies, benzos were the world's most prescribed medications despite growing evidence of their addictiveness and side effects. By contrast, SSRIs and SNRIs are generally considered less damaging than benzos—an assessment that must now be reconsidered.
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Post by Admin on Jul 14, 2021 17:25:22 GMT
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Post by Admin on Jul 17, 2021 21:40:45 GMT
An evolutionary understanding of depression as an adaptation, called the analytical rumination hypothesis (ARH), posits that depression may have evolved to allow for sustained thinking about complex social problems. This view suggests that clinical treatments that facilitate the functions that depression evolved to facilitate will be more effective than those – such as antidepressant medications – that merely relieve distress. Further, evolutionary theory suggests that antidepressant medications may have an iatrogenic effect that prolongs the duration of the underlying episode. In other words, by masking symptoms, ADMs might actually prolong depressive episodes, leaving them unresolved. To test this theory, Steven Hollon and his colleagues have outlined a simple research study that could test whether antidepressant medications are, in fact, iatrogenic for this reason. Researchers Propose Study to Test Whether Antidepressants Impede RecoveryEvolutionary theorists suggest that antidepressants interfere with the adaptive function of depression and propose a test of this theory. By Jenny Logan -July 17, 2021 www.madinamerica.com/2021/07/researchers-propose-study-test-whether-antidepressants-impede-recovery/Evolutionary theory and the treatment of depression: It is all about the squids and the sea bassAuthor links open overlay panelSteven D.HollonaPaul W.AndrewsbDaisy R.SinglacMarta M.MaslejdBenoit H.Mulsante www.sciencedirect.com/science/article/pii/S0005796721000486
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Post by Admin on Jul 18, 2021 11:54:39 GMT
Proselytizing pharmaceutical interventions has been part of a concerted effort since the seventies. Journalist Robert Whitaker discusses the failures of modern psychiatry. Do antidepressants create more mental illness than they cure? Robert Whitaker discusses the long-term impact of prescription medication. DEREK BERES 15 June, 2020 bigthink.com/mind-brain/antidepressants-dangers
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Post by Admin on Sept 21, 2021 7:51:11 GMT
breggin.com/jury-awards-1-5-million-for-suicide-involving-antidepressants-based-on-dr-breggins-testimony/Jury Awards $1.5 million for suicide involving antidepressants based on Dr. Breggin’s testimony By Dr. Peter Breggin 11/27/2012 A Syracuse, N.Y. jury has awarded a $1.5 million medical malpractice verdict to the family of a man who committed suicide. I was the medical expert for the family. After the verdict, plaintiff’s attorney Ernest DelDuchetto told me, “It was comforting to see a jury agree with our proposition that these drugs (antidepressants) are not panaceas for all sadness,” and that they can have serious harmful effects. Suicide malpractice suits are notoriously difficult to win. Juries, like most people, want to hold individuals responsible for their self-destructive behavior. They are reluctant to blame a suicide on a drug or on a doctor’s negligent behavior. Many years ago, I used to believe that people must be held responsible for their own behavior under all conditions, but my philosophical beliefs were eventually eroded by the mountain of scientific evidence that I developed through my research and clinical experience indicating that psychiatric drugs can indeed drive people to suicide. This scientific reality is now enshrined in black-box warnings in the FDA-approved labels for many drugs, including all antidepressants, all anticonvulsants, and individual medications like the ADHD drug Strattera (atomoxetine) and the smoking aid Chantix (varenicline). Because of difficulties in evaluating and in winning suicide malpractice suits, I looked very carefully at the case of Joseph Mazella when it was sent to me for my expert opinion by attorney DelDuchetto. Mr. Mazella was a 51-year-old revered high school basketball coach, teacher and assistant principal; and his self-inflicted death was unexpected and shocking to those who knew him and to the Syracuse community. In addition to the potential hazards of the antidepressants themselves, including Paxil (paroxetine) and then Effexor (venlafaxine), I found that a glaring negligence had been committed in the case. Family physician William Beals, M.D., who had a reputation for treating psychiatric and addiction patients, had prescribed Paxil for Mr. Mazella for 10 years without seeing him. When Mr. Mazella began to feel anxious and depressed again, on Aug. 9, 2009 he and his wife telephoned the doctor, who was reportedly on vacation on Cape Cod. Despite having no contact with the patient for a decade, by telephone Dr. Beals doubled his Paxil from 20 mg to 40 mg and added the antipsychotic drug, Zyprexa (olanzapine). This began an escalating decline in his mental condition that ended a little more than one month later with his suicide. After reviewing extensive records and interviewing Mr. Mazella’s wife Janice, I concluded that Dr. Beals was negligent in reportedly prescribing Paxil for 10 years without seeing the patient, in failing to warn the patient and his wife about the serious risks associated with Paxil, in his doubling the Paxil dose and adding Zyprexa by telephone, and then in abandoning the patient during his decline. I also concluded that a hospital psychiatrist was negligent in not recognizing that Mr. Mazella was suffering from adverse drug effects and in discharging him without proper followup two weeks before his death. I later learned that I was not the only one critical of Dr. Beals. The NYS Board for Professional Medical Conduct has placed him on probation for prescribing for patients without seeing them, and has also disciplined him for personally abusing alcohol and drugs. In trial I testified for a day and a half concerning how antidepressant drugs including Paxil and Effexor can increase suicide risk in adults, and also my opinion of how the behavior of the two doctors contributed to or caused the tragic outcome. On Nov. 21, 2012 the jury found both doctors negligent, but concluded that only Dr. Beals’ acts had contributed to or caused Mr. Mazella’s suicide. The jury awarded his wife and three children $1.5 million. This courtroom victory is consistent with a change that I have been witnessing in my media and public appearances, and in my communications with professionals and laypersons around the world. People are becoming increasingly aware that psychiatric drugs are capable of doing more harm than good, including potentially increasing the risk of violence and suicide. Unfortunately, the medical profession, and especially psychiatry, has been slow to catch on. Hopefully this malpractice verdict will encourage my colleagues to take a closer look at their too often cavalier attitudes toward prescribing psychiatric drugs. Follow up note: A New York State court recently overturned the verdict on the grounds that references during trial to Dr. Beals being previously censured by the NYS medical license authorities were not admissible. Dr. Breggin will be testifying again in the upcoming retrial. Originally published in The Huffington Post.
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