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Post by Admin on Jun 17, 2020 16:28:43 GMT
Study Finds SSRIs Associated with Increased Risk for Violent Crime Study finds an apparent connection between SSRIs, the most commonly prescribed type of antidepressant, and increased risk of violent crime. A new study, published in the journal European Neuropsychopharmacology, found associations between selective serotonin reuptake inhibitors (SSRIs), the most commonly prescribed type of antidepressant, and violent crime. The authors urge further investigation into SSRI and risk-taking behaviors and for increased clinical awareness of the potential risks associated with SSRI use. They point out that in the context of the widespread use of SSRIs, particularly in Western nations, which have seen a dramatic increase in antidepressant use, these results should be taken seriously and should lead to further research. The researchers, led by Tyra Lagerberg of the Karolinska Institutet in Sweden, add that “in the US, the population prevalence of antidepressant use increased from 6.5% in 1999-2000 to 10.4% in 2009-2010, with almost two-thirds of those prescribed antidepressants being treated with SSRIs in 1999-2010.” www.madinamerica.com/2020/06/study-finds-ssris-associated-increased-risk-violent-crime/
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Post by Admin on Jun 22, 2020 13:20:03 GMT
BBC Radio 4 All in the Mind – Antidepressant Withdrawal By MITUK admin -28/11/2018 www.madintheuk.com/2018/11/bbc-radio-4-all-in-the-mind-antidepressant-withdrawal/Antidepressant Withdrawal: a Survey of Patients’ Experience by the All-Party Parliamentary Group for Prescribed Drug Dependence prescribeddrug.org/wp-content/uploads/2018/10/APPG-PDD-Survey-of-antidepressant-withdrawal-experiences.pdfAntidepressants are a helpful treatment for many, but some people do have problems when they stop taking them. A recent review of the evidence about antidepressant withdrawal symptoms found more people may experience them for longer than previously thought, and many people describe these symptoms as severe. But the study has come in for some criticism over data analysed and the fact that withdrawal symptoms also may vary by antidepressant type. So what does this mean in practice? Claudia Hammond is joined by the survey’s author John Read, Professor of Clinical Psychology at the University of East London, and by Dr Sameer Jauhar, Senior Research Fellow, King’s College London. MITUK admin www.madintheuk.comMITUK’s mission is to serve as a catalyst for fundamentally re-thinking theory and practice in the field of mental health in the UK, and promoting positive change. We believe that the current diagnostically-based paradigm of care has comprehensively failed, and that the future lies in non-medical alternatives which explicitly acknowledge the causal role of social and relational conflicts, abuses, adversities and injustices.
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Post by Admin on Jun 26, 2020 13:00:31 GMT
Youth Antidepressant Use Associated With Increased Suicide and Self-HarmNational data on rates of youth antidepressant prescription, suicide, and self-harm in Australia sparks public health debate about drug safety. www.madinamerica.com/2020/06/youth-antidepressant-use-associated-increased-suicide-self-harm/A new study, published in Frontiers in Psychiatry, discusses an ongoing controversy in Australia following an FDA black box warning cautioning that the use of antidepressants may cause an increase in suicidal thoughts and behaviors in persons under 18 years with a diagnosis of depression or other disorders. The study authors also review data on antidepressant prescription and suicide and self-harm trends to assess whether different perspectives on the safety of these drugs are supported by real-world evidence. The article suggests that prominent researchers and psychiatrists have systematically put forth a narrative that antidepressants are safe and reduce the risk of suicide in youth with no supporting evidence to back these claims while neglecting compelling evidence that the opposite may be true. The researchers, led by Martin Whitely, a mental health patient’s rights advocate and researcher at Curtin University in Australia, explain that major psychiatric institutions have mostly declined to acknowledge this issue: “Several prominent Australian mental health advocacy organizations and influential Australian psychiatrists disputed the antidepressant-youth suicidality nexus, and claimed that the use of antidepressants, on balance, reduced the risk of youth suicide.” REVIEW ARTICLE Front. Psychiatry, 05 June 2020 | doi.org/10.3389/fpsyt.2020.00478Antidepressant Prescribing and Suicide/Self-Harm by Young Australians: Regulatory Warnings, Contradictory Advice, and Long-Term Trends www.frontiersin.org/articles/10.3389/fpsyt.2020.00478/full"In 2004, the US Food and Drug Administration (FDA) controversially issued a black box warning that antidepressants were associated with an increased risk of suicidal thoughts and behaviours in people aged under 18 years. In 2007, the warning was expanded to include young adults aged under 25 years. In 2005, the Australian Therapeutic Goods Administration responded to the FDA warning by requiring Product and Consumer Information leaflets to be updated to reflect the risk. However, there was considerable debate, and at times emotive backlash, in academic journals and the international media. Prominent US and Australian mental health organisations and psychiatrists challenged the FDA warning. They argued that, on balance, antidepressant use was likely to reduce the risk of suicide. Several ecological studies were cited misleadingly as evidence that decreasing antidepressant use increases suicide risk. From 2008 to 2018, Australian per-capita child, adolescent and young adult antidepressant dispensing (0–27 years of age) and suicide (0–24 years) rates have increased approximately 66% and 49%, respectively. In addition, there was a 98% increase in intentional poisonings among 5 to 19 year-olds in New South Wales and Victoria between 2006 and 2016, with substantial overlap between the most commonly dispensed psychotropics and the drugs most commonly used in self-poisoning. These results do not support claims that increased antidepressant use reduces youth suicide risk. They are more consistent with the FDA warning and the hypothesis that antidepressant use increases the risk of suicide and self-harm by young people. Causal relationships cannot be established with certainty until there is a vast improvement in post-marketing surveillance. However, there is clear evidence that more young Australians are taking antidepressants, and more young Australians are killing themselves and self-harming, often by intentionally overdosing on the very substances that are supposed to help them." Ana Florence, PhD www.madinamerica.com/author/aflorence/MIA Research News Team: Ana is a Postdoctoral Associate at the Yale Program for Recovery and Community Health. She is a clinical psychologist with experience in deinstitutionalization and the implementation of community-based mental health services in Brazil. Her research interests include the medicalization of poverty, social determinants of mental health and the Open Dialogue approach.
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Post by Admin on Jul 10, 2020 13:46:33 GMT
A new article published in Ethical Human Psychology and Psychiatry argues that there are two primary false beliefs held by academic psychiatry related to the efficacy of antidepressants. The article was written by researchers with expertise on antidepressants and suicide risk, Michael Hengartner of Zurich University in Switzerland and Martin Plöderl of Paracelsus Medical University in Salzburg, Austria. First, they explain that physicians often attribute antidepressant effects to pharmacological action rather than placebo effects. Second, academic psychiatry maintains that physical dependence on antidepressant drugs does not exist, and therefore any withdrawal or discontinuation symptoms are benign and affect only a small minority of users. These two remain pervasive within the field of psychiatry, despite a wealth of evidence suggesting that they are untrue. Hengartner and Plöderl point to the undue influence of the pharmaceutical industry as one of the forces maintaining the popularity of these misleading beliefs about antidepressants. “The problem is presumably less with erroneous views expressed by patients and researchers critical of psychopharmacological drugs, but rather with false beliefs held by academic psychiatry and promoted by the pharmaceutical industry,” the authors write. Misleading Beliefs about Antidepressants Prevalent in Psychiatry Researchers argue that academic psychiatry maintains at least two false beliefs about antidepressants that have far-reaching implications for the treatment of depression. www.madinamerica.com/2020/07/misleading-beliefs-antidepressants-prevalent-psychiatry/False Beliefs in Academic Psychiatry: The Case of Antidepressant Drugs www.researchgate.net/publication/327610246_False_Beliefs_in_Academic_Psychiatry_The_Case_of_Antidepressant_DrugsAbstract Antidepressant drugs are the mainstay of depression treatment in both primary and specialized mental health care. However, academic psychiatry holds false beliefs about antidepressants and we expose two of them in this essay. First, recent attitude surveys conducted among psychiatrists and general practitioners have revealed that physicians attribute antidepressants’ effects mostly to the drugs’ pharmacologic action and less so to placebo effects. Second, academic psychiatry maintains that physical dependence to antidepressant drugs does not exist and that “discontinuation symptoms” upon stopping maintenance pharmacotherapy are benign and affect only a small minority of antidepressant users. As we review in this essay, these beliefs are at odds with the scientific literature. The largest and most comprehensive meta-analysis of antidepressant trials conducted to date indicates that 88% of the drugs’ treatment outcome is accounted for by placebo effect. Furthermore, physical dependence appears to be a serious issue, as severe and persistent withdrawal reactions affect up to 50% of antidepressant users according to several studies. Correcting false beliefs prevailing in academic psychiatry is needed and has important implications for psychiatric training, continuing medical education, and practice. Madison Natarajan, MS Madison Natarajan is a master’s level psychotherapist and current doctoral student at the University of Massachusetts Boston. As a researcher, her focus is on the impact of religious trauma on female sexual development, specifically assessing the subculture of the evangelical purity movement. Madison has a family history that has been intertwined with psychiatric care, ranging from family members who were institutionalized to those practicing psychiatry, both in the US and India. Madison seeks to challenge the current structure of psychiatric care in the West and disseminate honest and empowering information to the community at large.
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Post by Deleted on Jul 10, 2020 20:49:51 GMT
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Post by Admin on Jul 30, 2020 16:40:31 GMT
Strategies for Tapering and Discontinuing Antidepressants A new review of strategies to support both patients and practitioners through the process of discontinuing antidepressants. www.madinamerica.com/2020/07/strategies-tapering-discontinuing-antidepressants/A new review, published in the British Journal of Clinical Pharmacology, identifies several strategies that prescribers can use to assist patients with coming off of antidepressants, and explores the barriers preventing individuals from doing so. The review highlights the need for further exploration of withdrawal symptoms associated with discontinuing antidepressants as well as to test whether the available tapering strategies work. The author, Tony Kendrick, a professor of medicine at the University of Southampton, writes: “Surveys of antidepressant users suggest 30-50% have no evidence-based indication to continue, but coming off antidepressants is often difficult due to fears of relapse, withdrawal symptoms, and a lack of psychological treatments to replace maintenance treatment and prevent relapse.” Strategies to reduce use of antidepressants Tony Kendrick First published: 12 July 2020 doi.org/10.1111/bcp.14475bpspubs.onlinelibrary.wiley.com/doi/10.1111/bcp.14475Abstract Antidepressant prescribing has increased year on year since the introduction of the selective serotonin reuptake inhibitors (SSRIs) in the 1980s. More than 10% of adults in England are now taking antidepressants for depression/anxiety, with a median length of treatment of more than 2 years, but antidepressants can cause side effects and withdrawal symptoms which increase with longer use. Surveys of antidepressant users suggest 30–50% have no evidence‐based indication to continue, but coming off antidepressants is often difficult due to fears of relapse, withdrawal symptoms and a lack of psychological treatments to replace maintenance treatment and prevent relapse. GPs should not prescribe antidepressants routinely for mild depressive/anxiety symptoms. Patients starting antidepressants should be advised that they are to be taken for a limited period only, and that there is a risk of withdrawal problems on stopping them. Prescribers should actively review long‐term antidepressant use and suggest coming off them slowly to patients who are well. The relationship between SSRI dose and serotonin transporter receptor occupancy suggests that hyperbolic tapering regimes may be helpful for patients with troubling withdrawal symptoms who cannot stop treatment within 4–8 weeks, and tapering strips can allow carefully titrated slower dose reduction over some months. Internet and telephone support to patients wanting to reduce their antidepressants is being trialled in the REDUCE programme. More research is needed to establish the incidence of withdrawal symptoms in representative samples of patients coming off antidepressants, and large randomised controlled trials are needed to test different tapering strategies.
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Post by Admin on Aug 24, 2020 10:06:29 GMT
SSRI Withdrawal’s Elephant in the Room: Tardive Akathisia www.madinamerica.com/2020/08/ssri-withdrawal-elephant/It has been 8 years since I wrote my first blog for MIA, called “Playing the Odds.” I wrote then that if I thought that I could successfully take people off of SSRI antidepressants, that I would have capitalized on it and opened a string of withdrawal clinics. My seeming pessimism was commented upon by MIA readers, and I took the criticism to heart, and renewed my efforts. People who are on medications often need to change psychiatrists because of change of insurance, relocation, or provider loss. Each time I saw a new person who was asymptomatic on a maintenance dose of a SSRI or SNRI I offered them the option of stopping their medication. Almost everyone who felt well wanted to stop their antidepressant. I found that people who had a difficult time tapering early on were unlikely to be able to eventually completely stop. If an initial 5% dosage cut results in a lot of withdrawal symptoms, then it wasn’t worth it to struggle because, more often than not, withdrawal would become intolerably uncomfortable before stopping completely. In these people it is best to settle for harm reduction by just lowering the dose within a range of what is comfortable. When considering how to cut the dose down and various tapering strategies, there is no one right way. The best SSRI tapering information is found on the Surviving Antidepressants web site. This has been a reference source for me. There is a lot that is unexplained about the tapering experience. It isn’t consistent. One person who had been on a SSRI for three years failed a slow tapering due to intolerable withdrawal symptoms. An actor, a year later he went into production where he was busy 17 hours a day. He had forgotten to take his medication with him and didn’t realize he had done so until two weeks later! He was completely asymptomatic, and still asymptomatic six months later. I have also found that people who are unable to stop with a tapering protocol the first time were sometimes able to stop at a later date using the same protocol. It is hard to reconcile this with theoretical, receptor-based explanations of withdrawal. The speed of tapering does not seem to be related to long term outcome. Slower tapering is generally more comfortable on the way down than faster tapering and facilitates stopping completely with a minimum of discomfort. However, success or failure after stopping completely mostly relates to whether tardive akathisia occurs. Around three to six months after the last dose of antidepressant, akathisia emerges suddenly, often as an overreaction to something seemingly minor. It is an intensely anxious, agitated, and gloomy state, so uncomfortable that it is often disabling. People take comfort in considering the possibility of suicide if they don’t get better. Because of this possibility, tapering should not be undertaken lightly. The duration of total use of all current and past SSRIs is related to long term outcome. In my clinical practice tardive akathisia seems to be fairly common in people who taper to cessation after 10 years or more of cumulative use. Once tardive akathisia develops, there are basically three options: wait it out, reinstate the antidepressant, or use benzodiazepines for symptom reduction. Although reinstatement sometimes makes withdrawal akathisia worse, this is very infrequent. With reinstatement most people return to their baseline. I always reinstate the same drug that was withdrawn. Sometimes reinstatement results in rapid return to baseline and sometimes the return to baseline can take several months. On more than one occasion reinstatement required a higher dose than the person was taking before. Waiting out severe symptoms is inadvisable as it can take months or years to get back to baseline, and the discomfort can be extreme. Benzodiazepines can give a high level of symptomatic relief and can be used intermittently to avoid dependency, or, in more serious situations, they can be taken regularly. People generally find that symptoms are also helped by regular exercise, good diet, and some sort of spiritual belief system. Recovery is not linear, and while the trend may be towards improvement, setbacks are expected. During a setback people often worry that they have lost all of their gains and will never get better. This is not the case. It is particularly troubling that antidepressant withdrawal related tardive akathisia is still not recognized by medicine. People know that the tardive akathisia experience is not relapse, and is not like anything they have ever experienced. Most psychiatrists end up labeling the tardive akathisia as a form of bipolar disorder or agitated depression and want to throw a bunch of new meds at it. However, I have also found that there are thoughtful providers who welcome additional information on this subject and will work with an informed person’s information. Not only do people suffer from the akathisia, but they also suffer because they are misunderstood by the medical profession. After the doctor diagnoses a new disorder and prescribes medications, the family will see reluctance to take any new medications as sabotaging treatment and will strongly encourage more medications. This puts the person at odds with their family as well. The experience, in addition to being intensely uncomfortable, can also end up being one of marked emotional isolation. Even if a physician is unable to help a problem medically, kindness and understanding and having someone to act as an educated guide through tardive akathisia is important. There is no way to predict who is going to develop tardive akathisia. It does not result, as most people think, from tapering too fast. It happens even with very slow tapering. I do not think that anyone who has not already experienced akathisia can realistically be prepared for this possibility through informed consent; it is simply too uncomfortable to be fully imagined in advance. In a conversation with a surgeon, we discussed that if there was an operation, performed on asymptomatic people, that would be health promoting but resulted in severe and possibly long-lasting discomfort in an unknown percentage of patients, it would not be ethical to perform such a procedure. There is an analogy here to medical supervision of SSRI tapering. The most common question I am asked by people with tardive akathisia is whether they are going to get better. In my personal experience, everyone has gotten better over time. The duration is unpredictable, and it can take weeks, months, or even years to recover without reinstatement. It is gratifying to see that the issue of stopping psychiatric medications has been given increasing attention in professional circles. To date, I have not seen studies on withdrawal look at the person’s condition over the year after stopping antidepressants. Moving forward, studies on how to best taper and stop antidepressants need to also follow up on patients for at least a year after the last dosage to get a full picture. So, still no string of lucrative SSRI withdrawal clinics for me. I no longer think that the barrier to this is my pessimism so much as the reality that the long-term consequences of SSRI tapering are unpredictable and can be severe. While tapering can be uneventful, no doctor can guarantee a safe and successful withdrawal at this time.
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Post by Admin on Sept 2, 2020 21:27:55 GMT
Side effects from SSRIs, SNRIs, and antipsychotics last longer than benzodiazepines like Valium or Prozac. 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 Prozac. 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. With the global antidepressant market expected to reach $28.6 billion this year, pharmaceutical companies go to great lengths to downplay the long-term effects of these drugs. Slater writes that lithium showed clinical efficacy in treating depression but has never been approved by the FDA (except for manic-depressive disorder). The real issue: you can't patent an element. In the review, Cosci and Chouinard categorize withdrawal symptoms into three groups. University of West Georgia instructor of psychology, Ayurdhi Dhar, breaks them down: "New withdrawal symptoms and rebounds are short-lived, temporary, and reversible. However, new withdrawal symptoms are new for the patient (nausea, headaches etc), while rebound symptoms refer to the sudden return of primary symptoms that are often more severe than pre-treatment. Persistent post-withdrawal disorder refers to 'a set of long-lasting, severe, potentially irreversible symptoms which entitle rebound primary symptoms or primary disorder at a greater intensity and/or new withdrawal symptoms and/or new symptoms or disorders that were not present before treatment.'" Each class of drugs cited in the review produce some withdrawal symptoms. Benzos and Z-drugs can cause confusion, sweating, rebound anxiety, and psychosis, generally lasting between two to four weeks (though in some cases, impaired cognition can last longer). Ketamine, the first psychedelic approved for clinical use in America, can produce rage, tremors, palpitations, and hallucinations, though the effects are short-lived: three days to two weeks. The authors find that SSRIs, SNRIs, and antipsychotics have the worst record for withdrawal symptoms. Antidepressants can produce pain, numbness, depressions, stroke-like symptoms, and much more. With SSRIs, impaired memory, sexual dysfunctions, panic attacks, and pathological gambling can continue for a year after discontinuation even if the patient tapers off slowly. In 2014, Professor Peter C. Gøtzsche of The Nordic Cochrane Centre in Copenhagen published an article highlighting the dangers of antidepressants (featured in Robert Whitaker's "Anatomy of an Epidemic"). Gøtzsche calls for psychiatrists to abandon the longstanding myth of the chemical imbalance theory of the brain. He believes popular pharmacological interventions are the true source of imbalances. "We have no idea about which interplay of psychosocial conditions, biochemical processes, receptors and neural pathways that lead to mental disorders, and the theories that patients with depression lack serotonin and that patients with schizophrenia have too much dopamine have long been refuted. It is very bad to give patients this message because the truth is just the opposite. There is no chemical imbalance to begin with, but when treating mental illness with drugs, we create a chemical imbalance, an artificial condition that the brain tries to counteract." As the #BLM protests are exposing more than ever, systemic issues around inequality and racism create the environmental conditions for mental health problems to manifest. Chemical imbalances are a symptom; writing a script does not treat the cause of depression or anxiety. While a certain percentage of depressed and anxious patients will benefit from short-term usage of prescription medication, mounting evidence against their long-term use, as detailed in this new review, must force the medical establishment to rethink its approach. The for-profit health care system has failed us too long. We can no longer afford to pay its toll.
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Post by Admin on Sept 3, 2020 14:28:44 GMT
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Post by Admin on Sept 7, 2020 14:05:17 GMT
Tapering Strips Help People Stop Using Antidepressants, Study Finds www.madinamerica.com/2020/09/tapering-strips-help-people-stop-using-antidepressants-study-finds/A new study by Peter Groot and Jim van Os investigated whether tapering strips can help people stop using antidepressants. They interviewed 408 people who had used tapering strips within the last five years. The found that tapering strips had aided 66% of the participants to successfully stop using antidepressants. “The evidence-based approach of personal tapering to counter withdrawal […] may represent a simple solution for an important antidepressant-related public health problem, without extra costs,” they write. www.madinamerica.com/2020/09/tapering-strips-help-people-stop-using-antidepressants-study-finds/Outcome of antidepressant drug discontinuation with taperingstrips after 1–5 years journals.sagepub.com/doi/full/10.1177/2045125320954609Abstract Background: Stopping antidepressants is often difficult due to withdrawal. Taperingstrips were developed to facilitate antidepressant discontinuation according to the recently described Horowitz-Taylor method, allowing for personalised titration of discontinuation to the intensity of withdrawal. A taperingstrip consists of antidepressant or other medication, packaged in a 28-day roll of small daily pouches, each with the same or slightly lower dose than the one before it. We previously reported that the short-term success rate of antidepressant taperingstrips was 71%. Here, we examine longer-term outcome after 1–5 years. Methods: Patients whose doctor had ordered taperingstrips between January 2015 and December 2019 were sent a questionnaire for participation in anonymised research in January 2020. Of 1012, 483 participated, of whom 408 (85%) had attempted antidepressant tapering. Results: Of the 408 patients included, 192 (47%) had used strips for tapering venlafaxine, 142 (35%) for paroxetine and 74 (18%) for other antidepressants. Median length of antidepressant use was 4 years, and most (61%) had tried to come off without taperingstrips at least once. After 1–5 years, 270 patients (66%) remained off antidepressants after tapering their antidepressant, 6 (2%) had successfully reduced their medication, 87 (21%) had restarted due to (self-reported) relapse, 35 had restarted for another indication (9%), and 10 (3%) reported another outcome. People with more severe experience of withdrawal prior to tapering, and people who had been on antidepressants for a shorter period of time, were more likely to remain off medication after 1–5 years. Conclusion: The previously reported 71% short-term success rate of taperingstrips in the most severely affected group, was matched by a 68% rate after 1–5 years. The evidence-based approach of personal tapering to counter withdrawal, as used for drugs causing withdrawal, for example, benzodiazepines, may represent a simple solution for an important antidepressant-related public health problem, without extra costs.
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Post by Admin on Sept 12, 2020 14:49:14 GMT
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Post by Admin on Sept 18, 2020 8:20:40 GMT
Is Your Antidepressant Effective and Safe? Is the wave of antidepressant prescribing justified by research evidence? Posted Sep 17, 2020 www.psychologytoday.com/nz/blog/psychiatry-through-the-looking-glass/202009/is-your-antidepressant-effective-and-safeAntidepressant drugs are by no means our first attempt to lift our mood biologically. Prior to the first antidepressants reaching the market, in the 1950s, biological approaches to treating depression, or ‘melancholia’, had included, to name but a few: poppy extract combined with donkey’s milk, bloodletting, starvation, purgatives, enemas, surprise baths, rotating chairs, standing people next to cannon fire, lobotomies and, still in use today, causing grand mal seizures with electric shocks to our brains (the topic of my previous two posts). Last year a report by Public Health England1 found that annual antidepressant prescribing had doubled in ten years. In 2018, 7.3 million adults (17% of the adult population) received at least one prescription. That is one in six of us. Although very recent figures for the USA are hard to find, it has, like the UK, experienced consistent annual increases for two decades, and had already passed 37 million (13% of adults) by 2014. Similarly high rates exist in Australia, Canada, Portugal, Sweden and Iceland. Rapid increases in recent years have been documented in all 20 OECD countries with available data, which, on average, doubled their prescriptions in just five years.2 The global antidepressants market is expected to grow from $14.3 billion in 2019 to about $28.6 billion in 20203 largely because of the effects of the COVID-19 pandemic. Public Health England was not the first to report that certain groups are more likely to be prescribed these drugs, including women, older people and people living in deprived neighbourhood. So about one in every three women over 70 years old in my own London neighbourhood is likely to be on antidepressants. Such findings are the first clue that the causes of the problems for which these drugs are so readily dispensed may be more social than biological. Certainly, the old claim that depression is caused by some kind of chemical imbalance that is somehow corrected by the drugs has now been abandoned by most psychiatrists. Although national guidelines tend to recommend antidepressants primarily for moderate to severe depression, research tells us that millions of people with mild depression, or understandable grief following losses, are being prescribed these drugs. The international increases in prescribing continue to occur despite significant, longstanding concerns about efficacy and safety. For example, in 2008 Professor Irving Kirsch (Harvard Medical School) and colleagues obtained data on all clinical trials submitted to the Food and Drug Administration for the most widely prescribed antidepressants. They found that ‘the overall effect of new-generation antidepressant medications is below recommended criteria for clinical significance’ with benefit compared to placebo only for a tiny minority of recipients (less than 5%) ‘at the upper end of the very severely depressed category’.3 A more recent meta-analysis,4 of 131 placebo-controlled trials, also concluded that the overall effect size does not reach ‘clinical significance’ and argued that ‘The harmful effects of SSRIs versus placebo for major depressive disorder seem to outweigh any potential small beneficial effects’. Before discussing those ‘harmful effects’, a word about placebo effects. There is nothing wrong with creating hope and expectations that things will get better. For years I have taught my clinical psychology trainees that they should actively do so, especially in a first session. Placebo is Latin for ‘I shall please’. The fact that a capsule containing no active ingredient is, for 95% of people, just as effective as one containing an antidepressant speaks volumes about the importance of having someone, especially an expert, listen to one’s problem—even if it’s only for the few brief minutes that typically precede an antidepressant prescription. It also highlights the value of deciding to do something, anything, to address one’s problems, and, even better, actually doing it. All these ‘non-specific effects’ can be overlooked when psychiatrists and GPs exaggerate the effects of their chemicals and when we clinical psychologists inflate the importance of our cognitive therapy techniques or whatever our preferred psychotherapeutic approach is. If these drugs came with no harmful consequences then it would not matter, at least not to me, that positive outcomes are usually due to placebo effects rather than a biochemical process (or perhaps to a bit of both). But the downsides of these drugs come in many shapes and sizes. Firstly, they can be a missed opportunity to wait and see, and perhaps to learn that most low mood, sadness, feeling depressed—call it what you will—passes with time, and is a natural part of life. As the old saying goes, time can, indeed, sometimes be ‘a great healer’. Imagine a world when nobody feels sad when sad things happen. Another potential problem is that the act of reaching for the prescription pad can sometimes inadvertently locate the problem entirely or primarily within the individual rather than in their life history or current social circumstances. It implies there is something wrong with our biochemistry or our genes rather than helping us identify something depressing going on in our lives and make some changes. On a more societal level this can mask the real causes of depression, such as loss, loneliness, poverty, violence, child abuse, and so on, so that fewer resources are put into primary prevention programmes to address those causes. Then there are the’ side effects’. I prefer the term ‘adverse effects’, to put them on the same footing as the positive effects rather than imply, albeit unintentionally, that they are somehow less important. High rates of a broad range of adverse effects have been identified, originally in the biological domain, including nausea, insomnia, diarrhea, dry mouth, dyspepsia, weight gain and sweating, but more recently also in the personal and interpersonal domains. For example, the largest ‘direct-to-consumer’ survey,5 of 1,431 antidepressant users from 38 countries, found 61% of the respondents reported at least ten adverse effects, most commonly: ‘Feeling emotionally numb’ (reported by 71%), ‘Feeling foggy or detached’ (70%); ‘Feeling not like myself’ (66%), ‘Sexual difficulties’ (66%), ‘Drowsiness’ (63%), and ‘Reduction in positive feelings’ (60%). ‘Suicidality’ attributed to the drugs was reported by 50%. Unsurprisingly, the longer people had been on the drugs, the higher the rates of adverse effects. More surprisingly, a third did not recall being told anything about any side effects by the prescriber; and less than 5% were told about suicidality or emotional numbing. Nevertheless, I must strongly caution anyone against coming off, or reducing, their medication on the basis of one blog post. We are only just beginning to understand how many people experience withdrawal effects when coming off antidepressants. Our survey, above, found that 59% reported withdrawal effects. We are still discovering how hard it can be to come off these drugs and how slowly that usually needs to be done. That will be the subject of my next post. In the meantime, there are, in the absence of professionally provided withdrawal services, numerous online resources run by ‘experts-by-experience’, including www.letstalkwithdrawal (UK) and withdrawal.theinnercompass.org (USA). References 1. Taylor, S. et al. (2019). Dependence and withdrawal associated with some prescribed medicines: An evidence review. London: Public Health England. 2. OECD (2017). Antidepressant drugs consumption, 2000 and 2015 (or nearest year). www.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-2017/antidepressant-drugs-consumption-2000-and-2015-or-nearest-year_health_glance-2017-graph181-en3. Kirsch, I. et al. (2008). Initial severity and antidepressant benefits: A meta-analysis of data submitted to the Food and Drug Administration. PLoS Medicine, 5, 260-268. 4. Jakobsen, J. et al. (2017). Selective serotonin reuptake inhibitors versus placebo in patients with major depressive disorder: A systematic review with meta-analysis and trial sequential analysis. BMC Psychiatry; 17: 58 5. Read J, Williams J. (2018). Adverse effects of antidepressants reported by a large international cohort: Emotional blunting, suicidality, and withdrawal effects. Current Drug Safety; 13: 1763-186
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Post by Admin on Sept 29, 2020 18:54:03 GMT
Studies that compare the effectiveness of different antidepressants are unreliable, according to new research in BMC Psychiatry. Unblinding effects—when the researchers and participants can tell who is taking the active drug rather than the placebo—can bias the results. The obvious immediate side effects of the older antidepressant drugs (e.g., amitriptyline and trazodone), such as drowsiness, dizziness, and dry mouth, made it obvious which participants in a drug trial were taking the drug, and which were taking the inert placebo. Because “depression” is a subjective phenomenological experience, it is very susceptible to bias. Clinicians who know that the patient is taking the placebo may interpret ambiguous statements as indicating a lack of improvement. According to the researchers, this explains why the older antidepressants initially appeared highly effective in clinical trials. “It is thus plausible that TCAs appeared highly effective because outcome-raters were able to break blind and hence to correctly guess who was on active treatment and who on inert placebo.” Essentially, when the blind for a study is broken, the placebo appears much less effective. Unblinding in Antidepressant Trials Biases Results Studies that compare the effectiveness of different antidepressant drugs are unreliable, according to new research in BMC Psychiatry. www.madinamerica.com/2020/09/unblinding-antidepressant-trials-biases-results/Comparative efficacy of placebos in short-term antidepressant trials for major depression: a secondary meta-analysis of placebo-controlled trials Lisa Holper & Michael P. Hengartner bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-020-02839-y
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Post by Admin on Sept 30, 2020 13:38:03 GMT
Antidepressants Linked to DementiaA study published in this month’s issue of the Journal of Clinical Psychiatry found that the use of antidepressant drugs was associated with an increased risk for the development of dementia. The researchers used the Taiwan National Health Research Database to perform a retrospective analysis of patients who were diagnosed with major depression and later developed dementia. “Treatment with tricyclic antidepressants was associated with a reduced risk of dementia, whereas treatment with SSRIs, MAOIs, heterocyclic antidepressants, and other antidepressants was associated with an increased risk of dementia,” they concluded. Antidepressant Treatment and Risk of Dementia: A Population-Based, Retrospective Case-Control StudyCynthia Wei-Sheng Lee, PhD; Cheng-Li Lin, MSc; Fung-Chang Sung, PhD; Ji-An Liang, MD; and Chia-Hung Kao, MD www.psychiatrist.com/JCP/article/Pages/antidepressants-and-dementia-risk.aspx
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Post by Admin on Oct 5, 2020 17:07:12 GMT
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