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Post by Admin on Oct 5, 2020 18:55:49 GMT
Researchers found that taking an SSRI (the most commonly prescribed type of antidepressant) was associated with a 26% increased risk of violent crime conviction. This effect could not be explained by pre-existing risk—the researchers compared the same people in periods on and off the drugs and found that their risk of committing a violent crime was higher when they were on the drug than after they stopped taking it. The study measured only the extremely severe outcome of violent crime convictions, so the risk of increased aggressive behavior, in general, is likely much higher. The published, peer-reviewed version of this study was previously reported on at Mad in America. However, a report on Medscape on September 21 detailed further results presented at the 33rd European College of Neuropsychopharmacology (ECNP) Congress. Researcher Tyra Lagerberg led the study at the Karolinska Institutet, Stockholm, Sweden. Further Results Confirm Antidepressants Increase Risk of Violent Crime By 26% Taking an SSRI antidepressant was associated with a 26% increased risk of violent crime conviction.www.madinamerica.com/2020/10/results-confirm-antidepressants-increase-risk-violent-crime-26/SSRIs Linked to 'Small But Significant' Increase in Violent Crime www.medscape.com/viewarticle/937766
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Post by Admin on Oct 7, 2020 21:11:37 GMT
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Post by Admin on Oct 10, 2020 18:10:16 GMT
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Post by Admin on Oct 10, 2020 18:12:11 GMT
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Post by Admin on Oct 15, 2020 18:10:53 GMT
How Academic Psychiatry Minimized SSRI Withdrawal: Key Evidence Was Ignored and the Condition Itself was Renamed If academic psychiatry is evidence-based, why did it take two decades to recognize SSRI withdrawal as widespread and chronic among patients, despite reports in the 1990s?www.madinamerica.com/2020/10/academic-psychiatry-minimized-ssri-withdrawal/“For more than 25 years,” Michel Lejoyeux and Jean Adès confirmed in their 1997 essay “Antidepressant Discontinuation,” “physicians have known that abrupt or tapered withdrawal from antidepressants can produce discontinuation phenomena consisting of somatic and psychological symptoms. Flu-like symptoms; gastrointestinal distress, including nausea and vomiting; arrhythmias; anxiety; sleep disturbances; movement disorders; mania or hypomania; panic attacks; and delirium have all been reported.” The Paris-based researchers were, however, referring to imipramine and other tricyclic antidepressants from the 1950s, discussed in my previous post, and were keen to cast their second-generation counterparts, selective serotonin reuptake inhibitors (SSRIs), as largely “well-tolerated” and not dependency-inducing. The new class of antidepressants (Prozac, Zoloft, and Paxil, in particular) were at worst said to produce “transient, mild,” and self-resolving symptoms lasting up to 7-14 days after treatment. Lejoyeux and Adès claimed at the time that incidence rates for SSRI withdrawal reactions varied between “0% for fluoxetine [Prozac], 50% for paroxetine [Paxil], and 86% for fluvoxamine [Luvox]”—rates that subsequent systematic reviews determined were set too low. Just as significant, the researchers were instrumental in renaming antidepressant withdrawal as “discontinuation syndrome,” a term the drug companies favored because it implied treatment had ended too soon and needed to be resumed, either at a higher dose or on a different drug. The 7-14 day time-frame for “discontinuation” would be repeated almost unchallenged for more than two decades, including by professional associations such as the UK’s National Institute for Health and Care Excellence (NICE), Royal College of Psychiatrists, and the American Psychiatric Association, which has yet to update its prescribing guidelines. It would also be used (including by those same professional bodies) as a way to minimize or outright deny the existence of longer-term withdrawal, which was subsequently found to last months, often years. These associations might instead have paid closer attention to the concerned letters their professional journals began to receive just months after the drugs’ formal approval—letters largely ignored by the leaders of clinical trials, who until recently tended to dismiss them as anecdotal evidence, mostly valueless in altering the drugs’ treatment profiles.
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Post by Admin on Oct 22, 2020 22:16:43 GMT
Antidepressants: is there a better way to quit them?www.theguardian.com/lifeandstyle/2019/apr/22/antidepressants-is-there-a-better-way-to-quit-themMillions of us take SSRIs, and most can give them up without too much trouble. So why do a minority suffer severe side-effects? Sarah Boseley Sarah Boseley Mon 22 Apr 2019 08.00 BST Antidepressants can save lives. At best, they work. At worst, they are a sticking plaster, hopefully enabling people to hold it all together until they get other help in the form of talking therapies. Either way, they are not supposed to be long-term medication. NICE guidance anticipates people will usually stop taking taking them 6 months after the depression has lifted. Often, however, they are prescribed for long periods of time. [See footnote] Whether depression is now better diagnosed or we live in sad times, more and more people are taking the pills and the weeks extend into months and years. In some cases, the users find they can’t stop. “I am currently trying to wean myself off,” one told researchers, “which honestly is the most awful thing I have ever done. I have horrible dizzy spells and nausea whenever I lower my dose.” “The withdrawal effects if I forget to take my pill,” another reported, “are severe shakes, suicidal thoughts, a feeling of too much caffeine in my brain, electric shocks, hallucinations, insane mood swings … Kinda stuck on them now cos I’m too scared to come off.” “While there is no doubt I am better on this medication,” said a third, “the adverse effects have been devastating when I have tried to withdraw – with ‘head zaps’, agitation, insomnia and mood changes. This means that I do not have the option of managing the depression any other way.” These anonymised accounts come from scientific studies cited in a report last year to the all-party parliamentary group for prescribed drug dependence and published in the journal Addictive Behaviors. They give a flavour of the reality of dependence on modern antidepressants, the SSRIs (selective serotonin reuptake inhibitors). The most famous is Prozac, AKA fluoxetine, once portrayed as a wonder drug that would make the world rosy and shiny again for all of us, without the dangerous dark side of Valium and the rest of the benzodiazepines. Not only was it harder to overdose on SSRIs than on “benzos”, the experts said; it was also easier to come off them. That may have been true for some people, but many users have other tales to tell. Zoe (not her real name) is one of them. She tried coming off her pills by tapering – gradually reducing the dose – and it was so awful that she is back on them. “I’d been on paroxetine for 12 years, with a brief try at citalopram and Prozac during that time,” she says, “and last year I decided I’d had enough of the shit side-effects and I’d try to do without. I tapered off very slowly over about six months, as I knew it’d be tough. I’d tried coming off a few years earlier, too quickly, and wound up a bit hysterical in an emergency room.” The second attempt started well enough, she says, but soon became very difficult. “Brain zaps, dizziness, insomnia, intense rage – I was smashing stuff up! I felt like I was in total chaos. “I was still taking half a tablet of paroxetine every other day. I went to my doctor and she changed me over to Prozac to take the edge off. It helped a little. But I was still getting into these rages and crying a lot. About four months in, I wondered if it was just my depression coming back – rather than symptoms of discontinuation.” After spending “loads” on a psychiatrist and counselling, she is now back on another SSRI – sertraline, this time. “This was after filling the prescription and then just staring at it for two weeks without taking it, trying to decide if I could let go of all that hard work of trying to come off them. I feel really disappointed in myself that I wasn’t able to push through. It’s almost a feeling of grief. I’ve read that it can take people up to a year, or even years, to adjust after having taken SSRIs for a long period, so I do wonder how I would have gone if I waited it out.” Her GP gave very little guidance, she says, other than: “Taper slowly.” “I found myself combing online message boards for help and advice, and Googling things like: ‘how to calm down when extremely distressed.’ It was a bleak time. Anyway, I’ve been on meds for two weeks now, and feel myself starting to feel more stable – except for all the shit side-effects being back.” In their report to the all-party group, Dr James Davies and Prof John Read said that 56% of people who try to come off antidepressants suffer withdrawal effects, and 46% of those having withdrawal effects describe them as severe. And when you think that more than seven million people were prescribed the pills in England alone in 2016-17, that’s quite a problem. Mark Horowitz, a trainee psychiatrist from the Princess of Wales hospital in Sydney, Australia, who is now working at the North East London Foundation Trust, may have come up with an answer. He and David Taylor, a professor of psychopharmacology at King’s College London, have published their proposals as a personal view in the Lancet Psychiatry journal. In their paper, they cite an imaging study of the brain that shows that extremely small doses of SSRIs still have an effect on their target. Very slow reductions in the dose until it is almost nothing allow the brain to get used to doing without.
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Post by Admin on Oct 26, 2020 10:03:45 GMT
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Post by Admin on Oct 28, 2020 17:51:01 GMT
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Post by Admin on Nov 1, 2020 16:07:51 GMT
Adele Framer - Surviving Antidepressantswww.youtube.com/watch?v=evhyaQKMwVcAdele Framer, also known by her online handle Altostrata, is the founder of SurvivingAntidepressants.org, a critical and comprehensive peer-support website that features several thousand case histories of psychiatric drug withdrawal. The site is a hub of information on the topic, highlighting methods of safe drug tapering and recovery and underscoring the humanity of those in the grips of withdrawal. Framer arrived at her expertise through personal experience. In 2004, after three years on 10 mg of paroxetine, she went off under medical supervision and suffered symptoms of withdrawal that her doctor discounted as relapse. She then went on to visit more than 50 psychiatrists, trying and failing to find someone knowledgeable in antidepressant withdrawal. Her own research into the topic, including close readings of journals and FDA recommendations, led her to the creation of SurvivingAntidepressants.org in 2011. Registered members now stand at roughly 14,000, with around 56,000 visitors per month. The site features 6,000 case histories and contains more than 60 topics covering tips on the gradual tapering off of specific drugs. All of the site’s information is pulled from scientific papers, governmental advisories, and package inserts, and much of it has been shared across Facebook and other platforms on the web. The site has received mentions in scientific journals and mainstream outlets such as Psychiatric Times and Psychology Today. Framer, who grew up in New York, has lived in San Francisco for more than 40 years. She’s now retired from a career in software user design.
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Post by Admin on Nov 3, 2020 17:52:11 GMT
Exposure to Antidepressants in the Womb Linked to Autistic Behavior in MiceResearchers experimenting on mice found that exposure to fluoxetine (Prozac) in utero resulted in behaviors considered in animal studies to be analogous to autism in humans. www.madinamerica.com/2019/05/exposure-antidepressants-womb-linked-autistic-behavior-mice/Approximately 10% of pregnant women continue taking antidepressants during pregnancy, which may affect fetal growth in a variety of ways, including brain development. Children exposed to antidepressants in the womb may be more susceptible to behaviors associated with psychiatric disorders and autism. However, it’s challenging to study this effect experimentally in humans, as most types of experiments would be unethical. Now, researchers, led by H. Shawn Je at Duke-National University of Singapore (NUS), used a mouse model to study this effect, concluding that antidepressant exposure causes memory and social learning problems that may mirror autistic behaviors in humans. The research was published in the journal Molecular Brain. Je and the other researchers injected pregnant mice with the selective serotonin reuptake inhibitor (SSRI) fluoxetine (Prozac), then studied how their offspring behaved. There were two main tests: first, the mice were given a Y-maze to explore (this is a maze that has several branches: in this case, three). Typically, mice will explore all branches, as they have a preference for exploring new stimuli. The mice exposed to fluoxetine consistently failed to explore new branches. Second, the mice were exposed to additional mice in a social task. Usually, mice will have a preference for spending time sniffing the new mice, as again they have an inclination to explore new stimuli. However, the mice exposed to fluoxetine spent equal time sniffing new and familiar mice. The researchers describe this as a social-memory failure. The researchers then gave the mice a drug called volinanserin, which also works on the serotonin system, although in a different fashion from fluoxetine. They found that this treatment appeared to reverse the effect, making the mice more likely to engage in stimuli-seeking behaviors. It is, of course, a significant limitation of the study that it was conducted in mice, so it is unclear how well these results will translate to humans. However, in humans, exposure to antidepressants in utero has been associated with a variety of health problems, and congenital disabilities, including brain development problems and an increased risk of psychiatric disorders, including autism, which has been repeatedly documented. Other risks include speech disorders and dyslexia, newborn hypertension, bone problems, heart problems, and even dental problems, as SSRIs may affect craniofacial development. Prenatal exposure to antidepressants is also linked to pre-term births and spontaneous abortions. Neonatal abstinence syndrome (NAS), which is caused by newborns experiencing physical withdrawal from drugs they were exposed to in utero, occurs in about 30% of babies exposed to antidepressants. In the future, the researchers plan to give SSRI drugs to autistic children in the hopes that it might reverse the behaviors that may have been caused by exposure to those drugs in utero. According to the press release, “The team next wants to examine autistic children born to mothers treated with antidepressants using positron emission tomography (PET) scans, an imaging technique used to observe metabolic processes in the body. If they also show enhanced serotonin receptor activity in the same area of the brain, the team plans to test whether FDA-approved serotonin receptor blockers can normalize their behaviors.” Prenatal selective serotonin reuptake inhibitor (SSRI) exposure induces working memory and social recognition deficits by disrupting inhibitory synaptic networks in male miceWeonjin Yu,#1,2 Yi-Chun Yen,#1 Young-Hwan Lee,1 Shawn Tan,1 Yixin Xiao,1,3 Hidayat Lokman,1 Audrey Khoo Tze Ting,1 Hasini Ganegala,1 Taejoon Kwon,4 Won-Kyung Ho,corresponding author2 and H. Shawn Jecorresponding author1,3 www.ncbi.nlm.nih.gov/pmc/articles/PMC6444596/
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Post by Admin on Nov 4, 2020 17:14:29 GMT
Throughout the year, the peer-reviewed journal Frontiers in Psychiatry has published multiple studies on the use of antidepressants for children and adolescents—specifically on whether there is any evidence of benefit despite the well-documented harms. These studies have provided support for the notion that antidepressants are still associated with increased suicides in youth and that there is little, if any, benefit of using the drugs. Now, Michael P. Hengartner, at the Zurich University of Applied Sciences, Switzerland, has written an editorial in Frontiers in Psychiatry which collates the information published on this topic this year. According to Hengartner: “The use of antidepressants in children and adolescents has a troubled history, for almost all principles of good evidence-based medicine were violated or compromised. It is a history characterized by systematically biased research, financial conflicts of interest, and professional recklessness.” Researchers: Antidepressant Use in Children Increases Suicide, No Evidence of BenefitNoted antidepressant researcher, Michael Hengartner, summarizes the latest research on the use of antidepressants in children and adolescents. www.madinamerica.com/2020/11/researchers-antidepressant-use-children-increases-suicide-no-evidence-benefit/Editorial: Antidepressant Prescriptions in Children and AdolescentsMichael P. Hengartner* Department of Applied Psychology, Zurich University of Applied Sciences, Zurich, Switzerland www.frontiersin.org/articles/10.3389/fpsyt.2020.600283/fullEditorial on the Research Topic Antidepressant Prescriptions in Children and Adolescents The use of antidepressants in children and adolescents has a troubled history, for almost all principles of good evidence-based medicine were violated or compromised. It is a history characterized by systematically biased research, financial conflicts of interest, and professional recklessness (1–3). In 2004, the Lancet Editors (4), in an article titled “Depressing research” bluntly stated that “The story of research into selective serotonin reuptake inhibitor (SSRI) use in childhood depression is one of confusion, manipulation, and institutional failure” (p. 1335). It is now well-established that most pediatric antidepressant trials were industry-sponsored and had serious methodological limitations; many trials remained unpublished due to unfavorable results, and those published were mostly ghost-written, selectively reported efficacy outcomes and misrepresented the true rate of treatment-emergent suicidal events (5–9). Drug regulators issued a suicidality warning for pediatric antidepressant use in 2003 (MHRA) and 2004 (FDA) and advised to use fluoxetine only. By consequence, some authors argued that SSRI should be reserved as a second-line option for youth with severe and resistant forms of depression (10). However, in most countries antidepressant use has considerably increased in children and adolescent over the last 10–15 years (11–13), despite suicidality warnings, the serious limitations of the evidence-base (14), and ongoing controversies surrounding risks and benefits (15) as well as the placebo response (16). The aim of this special topic was thus to provide a collection of articles broadly focused on two main issues; first, on the current scientific evidence for the efficacy and safety of antidepressants, with a special emphasis on suicidality and related regulatory warnings, and, second, on recent trends in prescription rates and patterns of utilization, including antidepressant overuse, and the increasingly medicalized approach to mental health. Safer and Zito reviewed the efficacy of new-generation antidepressants for pediatric depression. They found no meaningful benefits in children and only marginal benefits in adolescents based on placebo-controlled short-term trials. Moreover, they considered the evidence for maintenance treatment based on discontinuation (placebo-substitution) trials problematic and inconclusive due to high dropout rates, potential withdrawal syndromes that mimic relapse, and relapse rates not dissimilar from the natural course of the disorder. Boaden et al. conducted a meta-review on the efficacy, tolerability, and suicidality-risk of antidepressants for the treatment of various pediatric disorders. The meta-review found that just a few antidepressants were effective and well-tolerated. For instance, only fluoxetine was more effective than placebo in major depression, and only fluvoxamine and paroxetine were effective in anxiety disorders. Venlafaxine (in major depression) and paroxetine (in anxiety disorders) were associated with significantly increased risk of suicidality. However, of the nine meta-analyses included, only one met criteria of high quality; five were rated moderate quality, one was of low quality and two of critically low quality. The authors further state that the quality of the available evidence is inadequate due to short trial duration, selective reporting and publication bias, and they emphasize the paucity of data on suicidal ideation and behavior in antidepressant trials. The issue of increased risk of suicidality with antidepressants was specifically addressed in two articles. In the first, Spielmans et al. review the scientific evidence and conclude that the FDA black-box suicidality warning was justified and firmly rooted in solid data from placebo-controlled antidepressant trials. They further detail that prominent claims suggesting that the FDA warning has led to decreasing prescription rates and thus increasing suicide rates were based on methodologically weak and potentially misleading ecological studies. In the second, Whitely et al. describe how prominent psychiatrists and influential mental health organizations challenged the black-box suicidality warning for adolescents and young adults. The authors argue that various ecological studies were cited misleadingly as evidence that increased antidepressant use reduces youth suicide risk. Contrary to these claims, they further show that, in Australia, both antidepressant use and suicide rates increased substantially from 2008 to 2018. Another serious safety issue was addressed by Kapra et al.. In their mini review they discuss the evidence for and against a potential effect of antidepressant use during pregnancy on autism spectrum disorders in the offspring. The authors found evidence for an association between prenatal SSRI exposure and an increased risk of autism spectrum disorders based on several observational studies, but caution that causality has not been demonstrated yet due to confounding by indication. The authors conclude that there is a need for more research on this serious safety issue, as accumulating data from animal studies suggest that SSRI exposure may alter normal brain development. Trends of increasing antidepressant use in young people were addressed in two articles. In the first, Zito et al. analyzed administrative claims of Medicaid-insured youth aged <20 years from 1987 to 2014. During this 28-year period, antidepressant use grew 14-fold. They further show that in 2014, antidepressants were prescribed six times more often for youth in foster care than for their income-eligible Medicaid-counterparts. Off-label prescribing was also very common: a quarter of antidepressant-medicated youth were diagnosed with a behavioral disorder. In the second, Cosgrove et al. state that antidepressant use in children and adolescents rose substantially over the last 15 years in part due to commercially driven off-label prescriptions, despite ongoing controversy over their effectiveness and safety. From the perspective of institutional corruption, they discuss two drivers of overuse resulting from an increasingly medicalised approach to mental health. The first is the empirically unsupported demand for depression screenings in youth and the second the emphasis on scaling up diagnosis and treatment of mental disorders as part of a renewed Global Mental Health Movement. Last but not least, Locher et al. make an interesting case for open-label placebos in the treatment of chronic pain conditions in children and adolescents as an alternative to long-term antidepressant use. The authors acknowledge that this approach still lacks empirical evidence, but also stress that open-label placebos constitute a promising avenue for future research as they may help to mitigate the serious adverse effects of antidepressants. In conclusion, the articles in this special topic demonstrate that pediatric antidepressant use is still controversial. Although antidepressant use in children and adolescents has increased substantially over the last 10–15 years, convincing evidence that the benefits outweigh the risks is lacking and treatment-emergent suicidality remains a major concern. Overuse and off-label prescribing are pressing issues, and there certainly is a need for safer and more effective treatments, both pharmacological and psychological (17). It is hoped that this article collection will spur innovative research and critical discussion.
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Post by Admin on Nov 10, 2020 18:01:19 GMT
Differentiation of SSRI and Benzo Dependence/Withdrawal “Not Rational”www.madinamerica.com/2012/05/ssri-and-benzo-dependence-and-withdrawal-are-similar/Researchers from the Cochrane Center and University of Copenhagen in Denmark, publishing in the May issue of Addiction, “explore the rationale for claiming that benzodiazepines cause dependence while selective serotonin re-uptake inhibitors (SSRIs) do not.” They find that the two discontinuation syndromes were “very similar for 37 of 42 identified symptoms described as withdrawal reactions,” and that differentiating them “does not seem rational.” What is the difference between dependence and withdrawal reactions? A comparison of benzodiazepines and selective serotonin re‐uptake inhibitorsMargrethe Nielsen Ebba Holme Hansen Peter C. Gøtzsche First published: 12 October 2011 doi.org/10.1111/j.1360-0443.2011.03686.xCitations: 50 onlinelibrary.wiley.com/doi/abs/10.1111/j.1360-0443.2011.03686.xABSTRACT Aims To explore the rationale for claiming that benzodiazepines cause dependence while selective serotonin re‐uptake inhibitors (SSRIs) do not. Methods We analysed the definitions of dependence and withdrawal reactions as they had appeared over time in the Diagnostic Statistical Manual of Mental Diseases (DSM) and the International Classification of Diseases (ICD). We also compared the discontinuation symptoms described for the two drug groups in a systematic review. Results The definition of substance dependence has changed over time in both the DSM and ICD. In the most recent classifications several criteria, including behavioural, physiological and cognitive manifestations, must be fulfilled. This change was published with the revision of the DSM‐III revision in 1987 (DSM‐IIIR), after the recognition of benzodiazepine dependence and just before the SSRIs were marketed in 1987–88. We found that discontinuation symptoms were described with similar terms for benzodiazepines and SSRIs and were very similar for 37 of 42 identified symptoms described as withdrawal reactions. Conclusions Withdrawal reactions to selective serotonin re‐uptake inhibitors appear to be similar to those for benzodiazepines; referring to these reactions as part of a dependence syndrome in the case of benzodiazepines, but not selective serotonin re‐uptake inhibitors, does not seem rational.
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Post by Admin on Nov 15, 2020 17:54:20 GMT
Review Calls for Critical look at Prescribing Antidepressant Drugswww.madinamerica.com/2016/09/review-calls-for-critical-look-at-prescribing-antidepressant-drugs/The August issue of Psychotherapy and Psychosomatics published a review conducted by André F. Carvalho and colleagues regarding the literature around the long-term use of newer generation antidepressant drugs (ADs) and their side effects. Their investigation, which focused on data obtained from populations diagnosed with Major Depressive Disorder (MDD), found that there were a number of safety issues and potentially serious adverse events, which occurred as a consequence of using ADs. “ADs, particularly following long-term use, may increase the risk of experiencing additional psychopathological (e.g. treatment-emergent affective switches and paradoxical symptoms), or medical (e.g. obesity and bleeding) problems that do not necessarily subside after discontinuation of the drug, and that may modify responsiveness to subsequent treatments,” they write, citing a previous article written by one of the co-authors. MDD is considered a major public health issue and antidepressants have been found to be the most frequently prescribed medications in the U.S. among certain age groups. A projection study conducted by the World Health Organization has predicted that unipolar depressive disorders will be one of the top three leading causes of “burden of disease” by 2030. As newer drugs are developed, these are typically considered “safer” than the tricyclic agents (TCAs) that were first used for the treatment of MDD. “It is a common belief that newer generation antidepressants (and particularly SSRIs) have fewer side effects than TCAs. This assumption only pertains to the safety of ADs in overdose. On the contrary, the long-term use of SSRIs and SNRIs is likely to yield important side effects…” Despite recent research efforts, evidence regarding the safety and efficacy of these newer drugs remains fraught with controversial results. The Safety, Tolerability and Risks Associated with the Use of Newer Generation Antidepressant Drugs: A Critical Review of the LiteratureAndré F Carvalho 1, Manu S Sharma, André R Brunoni, Eduard Vieta, Giovanni A Fava Affiliations expand PMID: 27508501 DOI: 10.1159/000447034 pubmed.ncbi.nlm.nih.gov/27508501/Abstract Newer generation antidepressant drugs (ADs) are widely used as the first line of treatment for major depressive disorders and are considered to be safer than tricyclic agents. In this critical review, we evaluated the literature on adverse events, tolerability and safety of selective serotonin reuptake inhibitors, serotonin noradrenaline reuptake inhibitors, bupropion, mirtazapine, trazodone, agomelatine, vilazodone, levomilnacipran and vortioxetine. Several side effects are transient and may disappear after a few weeks following treatment initiation, but potentially serious adverse events may persist or ensue later. They encompass gastrointestinal symptoms (nausea, diarrhea, gastric bleeding, dyspepsia), hepatotoxicity, weight gain and metabolic abnormalities, cardiovascular disturbances (heart rate, QT interval prolongation, hypertension, orthostatic hypotension), genitourinary symptoms (urinary retention, incontinence), sexual dysfunction, hyponatremia, osteoporosis and risk of fractures, bleeding, central nervous system disturbances (lowering of seizure threshold, extrapyramidal side effects, cognitive disturbances), sweating, sleep disturbances, affective disturbances (apathy, switches, paradoxical effects), ophthalmic manifestations (glaucoma, cataract) and hyperprolactinemia. At times, such adverse events may persist after drug discontinuation, yielding iatrogenic comorbidity. Other areas of concern involve suicidality, safety in overdose, discontinuation syndromes, risks during pregnancy and breast feeding, as well as risk of malignancies. Thus, the rational selection of ADs should consider the potential benefits and risks, likelihood of responsiveness to the treatment option and vulnerability to adverse events. The findings of this review should alert the physician to carefully review the appropriateness of AD prescription on an individual basis and to consider alternative treatments if available.
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Post by Admin on Nov 21, 2020 17:25:55 GMT
Stopping Antidepressants: Exploring the Patient’s Experiencewww.madinamerica.com/2020/11/stopping-antidepressants-exploring-the-patients-experience/From the Royal College of Psychiatrists: “Professor Wendy Burn, old-age psychiatrist and the immediate past President of the Royal College of Psychiatrists (2017-20), discusses the challenges of stopping antidepressants with an expert by experience, James [Moore]. James experienced panic attacks, lethargy and extreme discomfort whilst tapering his doses of antidepressants. They also discuss the College’s new patient information resource on stopping antidepressants and what more is needed to better support patients.”
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Post by Admin on Nov 21, 2020 17:30:22 GMT
Over 1,000 Antidepressant Users Describe how Their Personal Life has Been AffectedSurvey examines adverse personal and interpersonal effects of antidepressants and the impact of polypharmacy www.madinamerica.com/2017/07/1000-antidepressant-users-describe-personal-life-affected/Staggeringly high rates of antidepressant prescriptions continue to climb. In England, prescriptions have doubled since 2005. Similarly, antidepressant use doubled in Australia between 2000 and 2014 becoming the most commonly used medication taken by 1 in 10 Australians each day. By 2005, antidepressants were the most widely prescribed drug in the United States, and by 2012, one in eight adults had incorporated their usage into their daily routine. The efficacy of antidepressants for mild to moderate major depression, when tested in blinded, non-industry studies, are found to be no different from placebo. The authors cite meta-analytic evidence demonstrating that “the overall effect of new-generation antidepressant medications is below recommended criteria for clinical significance.” Researchers contend that the harmful costs of taking antidepressants outweigh any potential benefits, only demonstrated to have potentially greater than placebo effects on individuals exhibiting signs of very severe depression. Negative symptoms that are most commonly reported by antidepressants users include nausea, headaches, dry mouth, insomnia, somnolence, diarrhea, dizziness, and constipation. Other findings from placebo-controlled studies has similarly focused on medically-related symptoms. While acknowledging the significance of these findings, the authors of this study sought to expand upon existing research to examine how antidepressants negatively impact people in terms of their personal and interpersonal lives. Currently, the largest dataset covering antidepressant usage and its negative effects on one’s personal life identified experiences of sexual difficulties, emotional numbness, feeling not like oneself, agitation, reduction in positive feelings, suicidality, and caring less about others. Very few studies have investigated how prescribers go about informing patients of adverse effects, and almost none have examined the effects of combining other psychiatric medications with antidepressants. Read and co-researchers surveyed over 1,000 antidepressant users in the U.K. on their experiences of interpersonal and daily-life related symptoms. To address the gaps in the literature, they additionally questioned to what extent participants were informed of negative effects by prescribers and whether participants were simultaneously taking other psychiatric drugs. The online survey was designed and disseminated by Mind, a mental health charity located in England and Wales. The majority of participants taking only antidepressants (85.9% of 484) reported side effects of antidepressant use. Of those effects reported, adverse symptoms related to sex life (43.7), work or study (27%), physical health (26.8%), and social life (23.5%) were most commonly endorsed, followed by negative effects in their close relationships (20.9%) and independence (10.5%). Additional participant comments about their experiences on antidepressants were included: “I hate it. It makes me emotionally flat – for example, I had to stop taking them after a recent family bereavement to make sure I was able to cry at the funeral.” “The drugs make me totally disconnected from everything and lifeless.” “I think it is causing fatigue, amongst other things so I have had to drop my hours at work from full-time to 3 days a week.” “It affected my sexual relationship with my partner as I had no desire to have sex and we are still feeling the effects of this now as he is nervous to ask after knowing that I wasn’t interested for such a long time.” “It is very hard to separate the effects of the meds and the effects of the illness.” The remaining 524 participants reported taking antidepressants alongside tranquilizers or sleeping pills, antipsychotics, and/or mood stabilizers. This indicates that just over half of the 1,008 survey respondents were taking two or more psychiatric drugs. Furthermore, the more medications being used, the more severe the reported side effects. Polypharmacy, or the simultaneous use of at least 2 psychiatric drugs, more than doubled the rates of experiencing most of the negative symptoms listed and was found to be more common when drugs were prescribed by a psychiatrist rather than a general practitioner (GP). “Despite its rapid increase polypharmacy cannot be described as an evidence-based approach,” note the authors who address that almost no study has examined the impact of polypharmacy, much less found evidence to support it. Approximately 48% of participants taking antidepressants indicated that they had been given enough information about the medication whereas about 40% reported that they had not received enough information. The remaining percentage noted that they were unsure or could not remember. Interestingly, men (53.5%) were significantly more likely to report being given enough information than were women (46.8%). Age was positively related to not being given adequate information such that the older one was, the less informed they felt about adverse symptoms. Additional participant comments regarding informed consent were as follows: “In reality, psychiatrists refuse to answer questions and refuse to accept or discuss side effects.” “The side-effects weren’t explained very well by the prescribing GP. Anorgasmia is a particularly bad side-effect.” “Would of liked to hear more about side effects….. I had to find out lots of information myself when I was in a difficult anxious state.” “I wasn’t told of all the side effects; in fact, when I researched them myself and then told my doctor, she hadn’t got a clue it could affect you in the way it affected me.” Overall, the results of this underscores how extremely common it is to experience negative symptoms when taking antidepressant drugs, particularly those related to personal and interpersonal functioning. “In reducing the depression the drugs may also be reducing all feelings and thereby replacing painful feelings with an empty emotional void, both personally and, as a further consequence, interpersonally.” Interestingly, 85% of participants experienced antidepressant drugs to be at least “fairly effective.” The authors offer the following context for this finding: “Many people do feel less depressed when taking ADs [antidepressants] but it seems this is primarily because of the expectation raised by the processes involved in prescribing and taking the pills rather than by the chemicals therein.” They add that in the largest study conducted on antidepressant-related negative personal symptoms, “one of the strongest predictors of perceived efficacy was the perceived quality of the relationship between the prescriber and the patient.” Finally, the findings underscore the importance of informed consent, exploring symptoms beyond the bio-medical domain, and discouraging the growing rates of polypharmacy found, in this study, to be especially promulgated by psychiatrists. The interpersonal adverse effects reported by 1008 users of antidepressants; and the incremental impact of polypharmacywww.sciencedirect.com/science/article/abs/pii/S0165178117305371?via%3DihubAbstract Antidepressant drugs are being prescribed at ever increasing rates internationally, despite marginal benefit compared to placebo and a range of adverse effects. Most studies of adverse effects focus on biological phenomena. This article presents the results of an online survey of 1008 self-selected anti-depressant users in Britain, which asked about five adverse effects in the interpersonal domain. The most commonly reported among participants who took only antidepressants were: Sex Life – 43.7%, Work or Study – 27.0% and Social Life – 23.5%. These rates of interpersonal adverse effects were even higher for the 52% of participants who were also taking one or more other psychiatric drugs. Only about a half (48%) felt they had been given enough information about side effects by the prescriber. Those initially prescribed medication by a psychiatrist were more likely to be on several types of drugs and reported more adverse effects than those whose prescriber was a General Practitioner (GP). Researchers and prescribers are encouraged to pay greater attention to interpersonal adverse effects.
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