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Post by Admin on Oct 11, 2021 10:29:05 GMT
Tackling the Problem of Antidepressant Withdrawal Support for people struggling to get off antidepressants is long overdue. Posted October 10, 2021 | Reviewed by Devon Frye www.psychologytoday.com/gb/blog/psychiatry-through-the-looking-glass/202110/tackling-the-problem-antidepressant-withdrawalKEY POINTS Millions of people struggle with severe withdrawal effects when stopping or reducing antidepressants. Antidepressants are prescribed disproportionately to poorer people, women, and older people. Health services around the world have failed to recognise the need for dedicated psychiatric drug withdrawal support services.
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Post by Admin on Oct 26, 2021 11:11:11 GMT
Withdrawal symptoms from antidepressants can last over a year, new study finds We must rethink the "chemical imbalance" theory of mental health. bigthink.com/health/antidepressants-withdrawal/#Echobox=1635176357A 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 Nov 2, 2021 10:41:19 GMT
SSRIS Is Your Antidepressant Effective and Safe? Is the wave of antidepressant prescribing justified by research evidence? Posted September 17, 2020 | Reviewed by Kaja Perina www.psychologytoday.com/gb/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 in other countries, including Australia, Canada, Portugal, Sweden, Belgium 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 neighbourhoods. 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. Rest in Link.
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Post by Admin on Nov 5, 2021 20:52:32 GMT
SSRIS Online Antidepressant Withdrawal Support Groups Are Facebook psychiatric drug withdrawal groups filling a void left by doctors? Posted January 28, 2021 www.psychologytoday.com/gb/blog/psychiatry-through-the-looking-glass/202101/online-antidepressant-withdrawal-support-groupsI stress, first, that it is unwise to make decisions about coming off, reducing, or staying on medication on the basis of one blog post, and that withdrawing from antidepressants typically requires tapering very gradually, especially towards the end of the process. Preliminary data in the U.K. suggest that antidepressant prescribing may be increasing even faster during the pandemic than the usual annual rate of increase. This raises the question of whether our COVID-related losses and fears are best understood as mental health problems located in individuals and requiring chemical solutions, or as a shared set of natural reactions requiring, primarily, human care and financial support. My previous posts have summarised the limited efficacy, considerable risks, and overprescribing of antidepressants, and documented the research showing that over half of people who try to come off antidepressants experience withdrawal effects of varying severity. Currently, the NHS in England provides no support services for people trying to come off drugs like antidepressants, benzodiazepines, and antipsychotics. There are just a handful of small local charities in England, and one NHS unit in Wales, providing such a service. This is primarily because the medical professions, and our national guidelines have, until very recently, swallowed the drug company line that withdrawal from antidepressants, for example, is rare, mild, and short-lived. As a result, people describing their withdrawal symptoms to their doctor have often been told that what they are experiencing is not withdrawal but their original disorder returning, with drugs being reinstated as a consequence. Additionally, both our New Zealand1 and international2 surveys of hundreds of antidepressant users found that only 1 percent had been told about withdrawal effects when first prescribed the drugs. So, in the absence of medical knowledge or expertise, how have the millions of people trying to come off psychiatric drugs around the world been coping? Presumably some have suffered in silence and isolation. Others have had the support of relatives or friends. A few will have been lucky enough to find a doctor who has read the research. Many, however, have turned to online support groups. I have just co-authored, with Ed White and Sherry Julo, a research paper reporting on 16 Facebook support groups. The paper, "The role of Facebook Groups in the management, and raising of awareness of, antidepressant withdrawal: Is social media filling the void left by health services?" was published in Therapeutic Advances in Psychopharmacology.3 The 16 groups had over 67,000 members. Membership was found to be growing at about 28% annually. One of the larger groups, which we examined more closely, was more than 80% female. Membership was international, but dominated by the U.S. (51%), followed by the U.K. (17%). The most common reason for seeking out the group was failed clinician-led tapers. Lead author Dr. White has himself suffered frighteningly severe withdrawal symptoms. In the media release about our article, he commented: I was alarmed when I found tens of thousands of people online seeking help with stopping antidepressants, many of whom are in a perilous state after being tapered too fast by their prescriber. Online peer support has become such an important avenue of care for people suffering antidepressant withdrawal and needing guidance to safely taper off these medications in the absence of medical backup from Doctors. The groups included in the research are probably the tip of the iceberg. The lay people who run these groups deserve a great deal of credit. They give support to patients who want to taper off medications which they may otherwise continue to take for an unnecessarily extended period, suffering side effects, having dosages increased, or worse still have other drugs added to treat their withdrawal symptoms. Although there will always be an important role for peer support, these people are currently undertaking a complex, stressful, unpaid, undervalued role that should be provided by the original prescribers. We were pleased that the paper has received significant media coverage in our national newspapers and on national television. We are encouraged that a recent survey of UK GPs4 reported that although there was "a marked lack of consistency in GPs’ knowledge about the incidence and duration of withdrawal effects," two-thirds said they would welcome more training on these matters. In 2019, a comprehensive review5 of dependence on prescribed drugs by Public Health England led to some vitally important recommendations, including: "Improving the support available from the healthcare system for patients experiencing dependence on, or withdrawal from, prescribed medicines, including a 24-hour national helpline and face-to-face withdrawal support." It is impressive that despite all the pressures of the pandemic, NHS planners have recently commenced the consultation process on how to implement this recommendation. It is particularly promising that they have chosen, for their advisory group, many people who have been committed for years to the NHS providing withdrawal support services, including Luke Montagu, Dr. Anne Guy, and myself. Luke co-founded the Council for Evidence Based Psychiatry (CEP) after being misprescribed antidepressants and withdrawn much too rapidly. CEP serves as the secretariat for the All Party Parliamentary Group for Prescribed Drug Dependence. Anne, also a CEP member, is the lead editor of the invaluable 2019 "Guidance for psychological therapists: Enabling conversations with clients taking or withdrawing from prescribed psychiatric drugs."6 I am chair of the International Institute for Psychiatric Drug Withdrawal. Millions of people around the world have been crying out for help getting off psychiatric drugs for decades, while supporting one another to come off the drugs very gradually. Tapering strips have been found helpful by many. Ideally, people should be seeing their GPs as well as Facebook groups, but, sadly, people in these groups are saying that people on Facebook who are withdrawing are more knowledgeable and helpful than their doctors. I stress, first, that it is unwise to make decisions about coming off, reducing, or staying on medication on the basis of one blog post, and that withdrawing from antidepressants typically requires tapering very gradually, especially towards the end of the process. Preliminary data in the U.K. suggest that antidepressant prescribing may be increasing even faster during the pandemic than the usual annual rate of increase. This raises the question of whether our COVID-related losses and fears are best understood as mental health problems located in individuals and requiring chemical solutions, or as a shared set of natural reactions requiring, primarily, human care and financial support. My previous posts have summarised the limited efficacy, considerable risks, and overprescribing of antidepressants, and documented the research showing that over half of people who try to come off antidepressants experience withdrawal effects of varying severity. Currently, the NHS in England provides no support services for people trying to come off drugs like antidepressants, benzodiazepines, and antipsychotics. There are just a handful of small local charities in England, and one NHS unit in Wales, providing such a service. This is primarily because the medical professions, and our national guidelines have, until very recently, swallowed the drug company line that withdrawal from antidepressants, for example, is rare, mild, and short-lived. As a result, people describing their withdrawal symptoms to their doctor have often been told that what they are experiencing is not withdrawal but their original disorder returning, with drugs being reinstated as a consequence. Additionally, both our New Zealand1 and international2 surveys of hundreds of antidepressant users found that only 1 percent had been told about withdrawal effects when first prescribed the drugs. So, in the absence of medical knowledge or expertise, how have the millions of people trying to come off psychiatric drugs around the world been coping? Presumably some have suffered in silence and isolation. Others have had the support of relatives or friends. A few will have been lucky enough to find a doctor who has read the research. Many, however, have turned to online support groups. I have just co-authored, with Ed White and Sherry Julo, a research paper reporting on 16 Facebook support groups. The paper, "The role of Facebook Groups in the management, and raising of awareness of, antidepressant withdrawal: Is social media filling the void left by health services?" was published in Therapeutic Advances in Psychopharmacology.3 The 16 groups had over 67,000 members. Membership was found to be growing at about 28% annually. One of the larger groups, which we examined more closely, was more than 80% female. Membership was international, but dominated by the U.S. (51%), followed by the U.K. (17%). The most common reason for seeking out the group was failed clinician-led tapers. Lead author Dr. White has himself suffered frighteningly severe withdrawal symptoms. In the media release about our article, he commented: I was alarmed when I found tens of thousands of people online seeking help with stopping antidepressants, many of whom are in a perilous state after being tapered too fast by their prescriber. Online peer support has become such an important avenue of care for people suffering antidepressant withdrawal and needing guidance to safely taper off these medications in the absence of medical backup from Doctors. The groups included in the research are probably the tip of the iceberg. Our paper concludes: The lay people who run these groups deserve a great deal of credit. They give support to patients who want to taper off medications which they may otherwise continue to take for an unnecessarily extended period, suffering side effects, having dosages increased, or worse still have other drugs added to treat their withdrawal symptoms. Although there will always be an important role for peer support, these people are currently undertaking a complex, stressful, unpaid, undervalued role that should be provided by the original prescribers. We were pleased that the paper has received significant media coverage in our national newspapers and on national television. We are encouraged that a recent survey of UK GPs4 reported that although there was "a marked lack of consistency in GPs’ knowledge about the incidence and duration of withdrawal effects," two-thirds said they would welcome more training on these matters. In 2019, a comprehensive review5 of dependence on prescribed drugs by Public Health England led to some vitally important recommendations, including: "Improving the support available from the healthcare system for patients experiencing dependence on, or withdrawal from, prescribed medicines, including a 24-hour national helpline and face-to-face withdrawal support." It is impressive that despite all the pressures of the pandemic, NHS planners have recently commenced the consultation process on how to implement this recommendation. It is particularly promising that they have chosen, for their advisory group, many people who have been committed for years to the NHS providing withdrawal support services, including Luke Montagu, Dr. Anne Guy, and myself. Luke co-founded the Council for Evidence Based Psychiatry (CEP) after being misprescribed antidepressants and withdrawn much too rapidly. CEP serves as the secretariat for the All Party Parliamentary Group for Prescribed Drug Dependence. Anne, also a CEP member, is the lead editor of the invaluable 2019 "Guidance for psychological therapists: Enabling conversations with clients taking or withdrawing from prescribed psychiatric drugs."6 I am chair of the International Institute for Psychiatric Drug Withdrawal. Millions of people around the world have been crying out for help getting off psychiatric drugs for decades, while supporting one another to come off the drugs very gradually. Tapering strips have been found helpful by many. Ideally, people should be seeing their GPs as well as Facebook groups, but, sadly, people in these groups are saying that people on Facebook who are withdrawing are more knowledgeable and helpful than their doctors. article continues after advertisement It is really exciting that the NHS is now planning to provide long-overdue support for people struggling to withdraw from antidepressants, benzodiazepines, and other prescribed medicines. We hope the rest of the world will watch and learn. Examples of online support groups: www.survivingantidepressants.orgwww.theinnercompass.orgwww.letstalkwithdrawal.combenzobuddies.orgReferences 1. READ, J., CARTWRIGHT, C., GIBSON, K. (2018). How many of 1,829 antidepressant users report withdrawal symptoms or addiction? International Journal of Mental Health Nursing, 27, 1805-1815. 2. READ, J. (2020). How common and severe are six withdrawal effects from, and addiction to, antidepressants? The experiences of a large international sample of patients. Addictive Behaviors, 102, 106157. 3. WHITE, E., READ, J., JULO, S. (2021). The role of Facebook Groups in the management, and raising of awareness, of antidepressant withdrawal: Is social media filling the void left by health services? Therapeutic Advances in Psychopharmacology. doi: 10.1177/2045125320981174
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Post by Admin on Mar 11, 2022 19:00:06 GMT
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Post by Admin on Mar 26, 2022 20:27:07 GMT
Breaking Off My Chemical Romance www.madinamerica.com/2022/03/breaking-off-my-chemical-romance/From The Nation: “[Training psychiatrist and researcher Dr. Mark] Horowitz’s experience sounded remarkably like that of others I talked to who’d been on antidepressants—and remarkably like my own. He went from being a true believer in the drugs to seeing the antidepressant industry as similar to Big Tobacco in its funding of research and academics who favor its profit margins . . . It’s impossible to say how many people like Horowitz exist—people who once believed in SSRIs, or their close cousins the SNRIs, as near-miracle-treatments for depression and have now changed their minds. But if you go by the hundreds of Facebook pages, Web forums, and subreddits dedicated to negative experiences with antidepressants, it becomes obvious that at least tens of thousands of people feel their lives have been negatively affected, or in some cases ruined, by the drugs. And those are just the ones who feel strongly enough to post about their experiences. The field of psychiatry itself may be going through a similar reckoning. A wave of research suggests that the drugs are less effective and more dangerous than many previously believed. And some medical professionals are concluding what until recently felt too heretical to say out loud: Antidepressants may often cause more harm than good. . . . we don’t know much about how they work, or even if they work for many of the people who take them. The theory that antidepressants correct a chemical imbalance of neurotransmitters like serotonin and norepinephrine is not a proven fact. Their basic functioning has not been definitively established. The story we all know is more marketing than science. And the incentive to find out whether they are indeed the best way to treat depression does not exist. In a world where so much scientific research is conducted by pharmaceutical companies and the entities they back, if drugs are making a profit, there’s little reason to question them. . . . Even psychiatrists who believe in the efficacy of SSRIs and SNRIs know that the idea that they correct a chemical imbalance is, at best, an oversimplification. ‘It’s mostly a discredited theory,’ Michael Thase, a psychiatry professor at the University of Pennsylvania, told me. ‘There’s not any good evidence that depression in and of itself is caused by deficiencies or deficits’ of serotonin or other neurotransmitters. The true believers in chemical imbalance, it turns out, aren’t scientists, but an American public that has mostly gotten its information from advertisements . . . The main argument between pro-SSRI and anti-SSRI researchers is the cutoff for what is considered effective. Do a few points more on a scale that measures patients’ quality of life matter clinically? If so, what is the precise cutoff for ‘effective’ versus ‘ineffective’? Researchers largely agree that antidepressants give a small bump on the standard Hamilton Depression Rating Scale, but the unanswered question is whether that bump means antidepressants are worth it given their possible side effects. ‘My guess is that, 20 years from now, people will look back at prescribing antidepressants the way we now look at things like bloodletting,’ [said Dr. Irving Kirsch, associate director of the Program in Placebo Studies at Harvard]. ‘If they are to be used at all, it should be as a last resort when nothing else is working.’ . . . this calls for changing the mainstream narrative that ‘antidepressants work’ to something more scientifically accurate: Antidepressants may work better than a placebo, especially in the most severely depressed patients, though we don’t know exactly how, and the data is conflicting—and even when the research is promising, it’s tainted by the fact that much of it is funded by drug companies. . . . ‘I think what I experienced during withdrawal is outside the scope of what a human is capable of feeling without chemical manipulation,’ [said Jessica Gonzales, a 36-year-old Californian who started taking antidepressants in college]. ‘Our language doesn’t have the words to describe it.’ Gonzales choked up as we talked. She said she used to feel angry—angry that no one was there to address the underlying reasons for her sadness when she was put on antidepressants . . . And she was angry because she believes that the drugs she thought were helping her had incapacitated her for many years instead. ‘It’s like you’re in a car, and you have this “check engine” light, because your car is about to fall apart,’ she said. ‘And someone comes up and is like, “I have this great solution.” And they just turn off the light. And meanwhile your car is smoking and on fire.'” Breaking Off My Chemical Romance We deserve a fuller picture of both the benefits and dangers of antidepressants. By P.E. MoskowitzMARCH 23, 2022 www.thenation.com/article/society/ssri-antidepressant-side-effects/
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Post by Admin on Mar 27, 2022 17:44:31 GMT
WEDNESDAY / BY VICTOR TANGERMANN SOME EXPERTS ARE STARTING TO SUSPECT THAT ANTIDEPRESSANTS CAN BE QUITE DANGEROUS THEY MIGHT BE DOING MORE HARM THAN GOOD IN SOME CASES. futurism.com/neoscope/experts-suspect-antidepressants-dangerousA contingent of researchers are starting to question the effectiveness of antidepressants, The Nation reports, arguing that in some cases they could be doing more harm than good. Many antidepressants attempt to alleviate what their makers characterize as an imbalance of chemicals in the brain by blocking the reuptake of serotonin, a complex molecule that has been linked to biological functions including mood, cognition, and learning, as well as norepinephrine, a stress hormone. But there’s one problem: according to The Nation‘s reporting, there’s little consensus among scientists that the medications effectively treat the root causes of depression, despite research showing they are effective at alleviating symptoms. For years, a small group of scientists have started calling the widespread use of the drugs into question. One of them, Irving Kirsch, then a psychology professor at the University of Connecticut, found in a 2014 meta analysis of 19 studies that 75 percent of the effect of antidepressants could be attributed to the placebo effect. “My guess is that, 20 years from now, people will look back at prescribing antidepressants the way we now look at things like bloodletting,” Kirsch told The Nation. “If they are to be used at all, it should be as a last resort when nothing else is working.” Patients have also reported a myriad of debilitating withdrawal symptoms, making it near impossible to quit taking the drugs. “I’d get a couple of hours of very broken sleep,” one former patient told the magazine, “and I would absolutely dread waking up, because I knew when I woke up, I would wake up to surging panic. I felt like I was on the edge of a cliff being chased by an animal.” In spite of those concerns, the use of antidepressants in the US is steadily rising, with the pharmaceutical industry heavily marketing the drugs as a way to treat depression on social media and TV. According to the Centers for Disease Control and Prevention, 18 percent of all adult women in the United States used antidepressant medication between 2015 and 2018. Messing with the neurotransmitters in the brain can also have other negative consequences. Side effects of SSRIs often include sexual dysfunction or a blunting of emotions. “Most people think that medications that are FDA-approved [are] free from life-altering adverse reactions,” Josef Witt-Doerring, a Utah-based psychiatrist who worked for the FDA as a medical officer, told The Nation. “Serious problems can be missed for years, especially if they’re subtle or could conceivably be attributed to the condition the drug treats.” “So many of the patients I’d see would be on four or five psychiatric medications,” he added. “Once you start being prepared to say, ‘Maybe one of these drugs is actually making people worse,’ you start asking a lot of questions… and then you begin to notice patterns.” After all, prescribing a pill is convenient, especially considering the influence of the pharmaceutical companies that are directly profiting off each additional prescription. It’s a highly complex topic, interwoven with hidden agendas and conflicting interpretations of existing studies. And many people experiencing depression have unquestionably benefited from taking antidepressants, while others have found it extremely difficult to wean themselves off. But the overall point of the piece — that taking more time to understand the needs of patients, and maybe holding off on serious prescriptions until other options are exhausted — seems fair.
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Post by Admin on Apr 24, 2022 17:14:00 GMT
Antidepressants may not boost quality of life in the long term www.medicalnewstoday.com/articles/antidepressants-may-not-boost-quality-of-life-in-the-long-termOne of the most widely used treatments for depression is antidepressant medications. They are often intended for short-term use. Although antidepressants have some benefits for certain individuals, their impact on the overall quality of life in the long term is not fully understood. A new study suggests that using antidepressants might not improve the overall quality of life for people with depression. Depression is a mood disorder that impacts both how people feel and function. Antidepressants are medications doctors often prescribe to treat depression and improve symptoms. However, researchers are still learning about their effectiveness in the long term. A recent study published in the journal PLOS One found that people with depression who used antidepressants for long periods of time did not have higher improvements in their quality of life compared to people with depression who did not use antidepressants. The study’s results raise questions about how to use medications combined with other methods of care. Depression and antidepressant medications The National Institute of Mental HealthTrusted Source notes that depression is a severe mood disorder that can impact people’s thoughts, feelings, and actions. It can interfere with people’s everyday lives and make it difficult for them to do the activities they want to do. A doctor can diagnose people with depression if they have had specific symptoms for longer than two weeks. Some common symptoms of depression include the following: Feelings of helplessness, guilt, hopelessness, pessimism, or worthlessness Lack of energy or increased fatigue Suicidal thoughts or attempted suicide Changes in appetite or weight Losing interest or lack of pleasure in activities or hobbies Problems with concentrating or making decisions Treatment for depression involves many components, but one major part is medication. AntidepressantsTrusted Source are a group of medications, and they work in different ways. For example, selective serotonin reuptake inhibitors (SSRIs) help increase serotonin and epinephrine levels in the brain. People with depression should take antidepressants under appropriate supervision from their doctors. In general, antidepressants can be an effective treatment for people with depression. However, researchers are still discovering the full effectiveness of antidepressants and their impact on overall well-being and quality of life.
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Post by Admin on May 19, 2022 16:33:38 GMT
Antidepressant use during pregnancy and risk of adverse neonatal outcomes: A comprehensive investigation of previously identified associations Anna-Sophie Rommel,Natalie C. Momen,Nina Maren Molenaar,Esben Agerbo,Veerle Bergink,Trine Munk-Olsen,Xiaoqin Liu First published: 12 February 2022 doi.org/10.1111/acps.13409Citations: 1 Funding information: This study is supported by the National Institute of Mental Health (NIMH) (R01MH122869). Dr Liu is also supported by the European Union's Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grant agreement No 891079. Dr Munk-Olsen is also supported by iPSYCH, the Lundbeck Foundation Initiative for Integrative Psychiatric Research (R155-2014-1724), the Lundbeck Foundation (R313-2019-569), AUFF NOVA (AUFF-E 2016-9-25), and Fabrikant Vilhelm Pedersen og Hustrus Legat. The funders of the study had no role in study design, data analysis, data interpretation, writing, or submission for publication. [Correction added on 18 March 2022, after first online publication: The first sentence of Methods in the abstract and Table 2 has been corrected.] Read the full text PDFPDF onlinelibrary.wiley.com/doi/10.1111/acps.13409?af=R
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Post by Admin on Sept 19, 2022 21:14:04 GMT
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Post by Admin on Nov 2, 2022 18:13:35 GMT
PHILOSOPHY, SCIENCE The Antidepressant Wars A fierce debate that ignores patients. Sandra J. Tanenbaum Global, Health, Mind and Psychology www.bostonreview.net/articles/sandra-tanenbaum-the-antidepressant-wars/Ibegan to think of suicide at sixteen. An anxious and driven child, I entered in my mid-teens a clinical depression that would last for 40 years. I participated in psychotropic drug therapy for almost 30 of those, and now, owing in part, but only in part, to the drug Cymbalta, I have respite from the grievous suffering that is mental illness. As a health policy scholar, I understand the machinations of the pharmaceutical industry. My students learn about “me-too” drugs, which barely improve on existing medications, and about “pay-for-delay,” whereby pharmaceutical companies cut deals with manufacturers of generic drugs to keep less expensive products off the market. I study policymakers’ widespread use of effectiveness research and their belief that effectiveness will contain costs while improving quality. I appreciate that randomized controlled trials are the gold standard for determining what works. Specifically, I know that antidepressant medication is vigorously promoted, that the diagnostic criteria for depression are muddled and limited, and that recent research attributes medicated patients’ positive outcomes to the placebo effect. In my own research and advocacy work, I take a political, rather than a medical, approach to recovery from mental illness. Cymbalta in particular epitomizes pharmaceutical imperialism. Approved by the FDA in August 2004 for the treatment of major depressive disorder, it has since gotten the go-ahead for treating generalized anxiety disorder, fibromyalgia, and chronic musculoskeletal pain, including osteoarthritis and lower back pain. It remains under patent to Eli Lilly. I would not have been surprised if Cymbalta had not worked for me or had not bested the myriad drugs and drug combinations that came before. My path through clinical depression is strewn with discarded remedies. “Who are these people?” I wondered about patients who were said to achieve happiness with the first pill and therefore to violate societal notions of identity and independence. I was just trying to get out of bed, and although my first antidepressant, at age 26, had a strong positive result, it also had incommodious side effects, and relief was tentative and partial. Decades of new and evolving treatment regimens followed. I have been treated with every class of antidepressant medication, often in combination with other psychotropic drugs. Some drugs worked better than others, some did not work at all, and some had unendurable side effects. But Cymbalta did not disappoint, and now I have become a teller of two tales, one about health policy, the other about health. Like many depressed people, I resisted the idea of psychotropic medication. I was deeply hurt when my psychotherapist suggested I see a psychiatrist about antidepressant drugs. How could she think I was that crazy or that weak? But she said she was concerned for my survival, and I eventually did as she asked. I became an outpatient at a venerable psychiatric hospital, where I found a kind stranger who knew my deepest secrets and wanted to end my suffering. He wrote a prescription, and thus began my 30-year trek. Depression is sometimes confused with sadness. Many depressed people are very sad, as I was, but the essence of my depression was feeling dead among the living. Everything was just so hard. William Styron describes depression as “a storm of murk.” Andrew Solomon’s atlas of depression is titled Noonday Demon. I too found depression to be fierce, wrapping me in a heavy woolen blanket and mocking my attempts to cast it off. The self-loathing was palpable; it felt like I was chewing glass. I sensed that other people were seeing things I did not, and apparently they were, because when I began my first course of antidepressants, it was as if someone had turned on the lights. It did not make me happy or even content. The world simply looked different—brighter, deeper—and I was a part of it. I saw something other than the impassable flatness and enervating dullness, and I was amazed. My progress came at a cost. In the late 1970s, before Prozac, antidepressant medication was seldom spoken of. The people I told about my treatment echoed my first reaction and sang throaty choruses of why-don’t-you-just-cheer-up and won’t-this-make-you-a-drug-addict. I was also drowsy after I ate, my mouth was always dry, and when a second medication was added, I began to lose control of my limbs and fall down. I insisted to my psychiatrist that it was the second drug that was causing me to fall. A champion of that one, he instructed me to discontinue the first. I responded in the way only privileged patients can: I went around him, using personal connections to wrest an informal second opinion from a resident in the lab run by my psychiatrist’s mentor. My doctor was convinced, and a little embarrassed, and we both learned something about therapeutic alliances. In another city, another psychiatrist took up my case. We tweaked antidepressants and mood stabilizers, reintroducing the drug that had made me fall, this time in tiny doses. I fell less often, but ultimately gave it up, and when I left this psychiatrist to move again, we acknowledged that I was, in the words of mental health expert Gerald Klerman, better but not well. My depression felt like chewing glass. Then, more than a year after I had seen him for the last time, this psychiatrist phoned to say that there was a new drug I ought to try. It was called Prozac, and it worked differently from, and better than, the other drugs I had been prescribed. An exuberant man, he was especially excited about this addition to his therapeutic arsenal, and my new psychiatrist made the switch. Prozac actually was more effective than the other drugs I had tried, and my dry mouth was gone. When more drugs like Prozac were introduced, I was switched to each of them in turn, still in pursuit of more thoroughgoing relief. This was the ethos of my treatment with every psychiatrist I visited: I could feel better, the drugs were getting better, and we would just keep trying. In the years that followed, we just kept trying. I would remain on a regimen until my psychiatrist proposed another, and, looking back, I was remarkably game. I was treated with monoamine oxidase inhibitors, which can be fatal in combination with some foods, and a famous psychiatrist in Manhattan prescribed a drug sold only in Canada. When a medication produced double vision, my psychiatrist suggested I drive with one eye closed. Drug cocktails deteriorated into over-medication. I tried to enroll in a clinical trial that would implant electrodes in my brain, but it was already full. There was only one remedy I rejected outright: electroconvulsive therapy. I was told by other patients about their memory loss, and I needed a good memory to do my job. I was doing relatively well on one antidepressant when I saw a television advertisement for Cymbalta. A sophisticated viewer, I knew not to be taken in, but the ad spoke of depression’s physical pain—something I had long experienced and to which my psychiatrists paid little attention. I was a rheumatology patient at the time; I was almost always achy, and it worsened when my depression did. My psychiatrist maintained that we had tried everything worth trying, but I was intrigued by the Cymbalta ad: these people knew something about me. Fully aware of my complicity with big pharma, I pressed my psychiatrist to prescribe the drug, and he agreed unenthusiastically to do so. Once I started on Cymbalta, I never needed to visit him or my rheumatologist again. The effects of this drug were different in degree and in kind, and I finally felt well, both physically and mentally. For the past four years, Cymbalta has worked for me, though I recognize that the improvement might be temporary. Intertwined with this pharmaceutical saga are other, related biographical threads. Perhaps most importantly, I have been a psychotherapy patient off and on since age sixteen, and for the past fifteen years, I have participated in psychoanalytic psychotherapy to repair the effects of childhood trauma. This therapy has changed me profoundly, but Cymbalta changed me in a different way, and my psychotherapist agrees. The relative merits of medication, psychotherapy, and their combination are debated in the literature, but in my case, there was plenty of work to go around. There were also leaves of absence, hospitalizations, support groups of various stripes, and board membership in a mental health consumer group that refused, on principle, badly needed funding from the pharmaceutical industry. What difference has Cymbalta made? There is, I think, no way to convey the anguish of mental illness to someone who has not experienced it. In the poem “Having It Out with Melancholy,” Jane Kenyon writes, “A piece of burned meat / wears my clothes, speaks / in my voice, dispatches obligations / haltingly, or not at all. / Is tired of trying.” Solomon’s father had to cut his lamb chops for him. In You Are Not a Stranger Here, Adam Haslett’s fictional character Paul tries to find meaning in his depression because “the opposite has always seemed more frightening to him, lonelier—the idea that so much of him was a pure and blinded waste.” The suffering of depressed people does not justify the misdeeds of the pharmaceutical industry, nor does it minimize the drugs’ deleterious effects on some patients. However, discussion of antidepressants’ value should not forget this suffering or imagine that it is insignificant or suspect. In my experience, antidepressants are neither happy pills nor placebos; they are the difference between life and living death. Evidence for the uselessness of antidepressants has figured prominently in recent health discourse. In the New York Review of Books, Marcia Angell, former editor of the New England Journal of Medicine, favorably reviewed works that challenge the findings of industry-funded FDA trials for several antidepressants. The books reviewed have titles such as The Emperor’s New Drugs: Exploding the Antidepressant Myth and Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America. Psychiatrist Peter Kramer responded in the New York Times “in defense of antidepressants,” noting, among other things, possible problems with the critics’ own research. The day after Kramer’s article appeared, I was contacted by a national mental health consumer group and asked to petition the Times to print a rebuttal to Kramer by Robert Whitaker, author of Anatomy of an Epidemic. Whitaker wrote that Kramer’s misrepresentations of his findings “took my breath away.” At the heart of this fevered back-and-forth is the re-analysis of existing efficacy data, including those provided by drug companies to the FDA. Simply put, efficacy—and broader effectiveness—research relies on statistical analysis of clinical trial data to determine if differences in outcomes between treated and untreated groups occur at a rate better than chance. These are differences, however, between the average outcome of patients in each group, and they tell us nothing about whether some kinds of patients do better or worse, much less about the responses of individual patients. A 2009 review of the randomized controlled trials literature found that only 29 percent of trials tracked whether different kinds of study subjects had different outcomes. Cymbalta epitomizes pharmaceutical imperialism—but it works for me. Antidepressant trials sometimes do group subjects according to the severity of their symptoms, but severity levels are assigned using a brief and inadequate questionnaire. I have been scored this way many times, but I never felt the score sheet’s priorities—it asks yes-or-no questions about sleeplessness and suicidal thoughts, among other symptoms—were my own. Psychiatric patients across diagnoses report dissatisfaction with the researcher-friendly but existentially insignificant measures on which effectiveness findings are often based. Furthermore, the diagnosis of depression itself is based entirely on symptoms, so depressed trial subjects are considered comparable despite genetic and etiological differences that might bear on the effectiveness of a given treatment. These limitations of clinical research may be unavoidable in some circumstances, but they should be admitted to at the very least. They might also engender among all antidepressant warriors an intellectual humility and attentiveness to patients that is currently rare. The intensity of the current debate unsettles me. I understand—and have been directly affected by—the greed of the pharmaceutical industry, the indeterminacy of clinical studies, and the substitution of chemotherapeutics for psychotherapeutics in psychiatry and health insurance policies. I lament, with my colleagues, the cost of unnecessary care and denounce, with my comrades, the toll of unnecessary drugging. I remember an earlier, mirror-image discussion of Prozac, and it was just as heated. In the 1990s, this drug (one of those debunked in The Emperor’s New Drugs) was believed to be so effective, even in people without depression, that it might constitute unjust and unaffordable enhancement rather than legitimate treatment. I once, in a spirited exchange, told a bioethicist colleague that if my antidepressant made me inauthentic so his eyeglasses made him. Medications that affect the mind seem to discomfit us deeply, culturally, viscerally. And so do the people who need them: psychiatric patients have gone, in this discourse, from covetous of an unfair advantage to oblivious to a colossal con. I am not sure which characterization I prefer, but I know my heart will break when a friend in the grip of depression forgoes medication—not because it is not right for her, but because it is only for cheaters or fools. Most parties to the debate agree that antidepressants can be effective for severely depressed patients such as me, but selfishly I fear the rhetoric of antidepressant uselessness will influence the pharmacy policies of my health plan. At present I am charged an inflated copayment for Cymbalta because my health plan claims it is no more effective than generic antidepressants. I am not privy to the basis for this determination; I do not know if it is based on average treatment effects, the preferences of plan professionals, or an overriding concern for cost. I do know that it does not include my experience, and when I queried the plan about an appeal, I was told I could appeal but should not bother: there are no successful appeals. The plan representative was unmoved by my savings on psychiatry, rheumatology, and hospitalization. She intimated that it is just too hard to satisfy individuals and that the plan has enough to do managing costs. The antidepressant wars will continue. The ineffectiveness theory is already popular with the press, pharmaceutical industry critics, and elements of the mental health consumer movement. I imagine it appeals to health care payers, who generally escape notice in the antidepressant discourse. For payers, who live by the profit motive or under public-budget constraints, findings of ineffectiveness can justify restricting or denying access to antidepressants, even by patients who benefit, and thereby generate substantial savings. Some doubt is, of course, reasonable. Our knowledge of the many maladies we call depression is rudimentary, and our technologies of knowing are imperfect. I expect, with Thorstein Veblen, that every research answer will yield two questions, and I look forward to more and better answers. I hope the debate will create healthy skepticism among patients and practitioners. I worry it will call into question the already discounted experiences of mentally ill people. My case is individual, but it is not unique. I have known many depression patients, and their stories also tell of long, hard slogs through antidepressants that do not always work. They are not the lazy, over-consuming, morally hazardous patients of some health policy literatures, but many are afraid to speak publicly about their medications for fear of disclosing their diagnoses and of damaging relationships and careers. I am sure there are people taking antidepressants for the wrong reasons, and perhaps the antidepressant wars will encourage them to re-evaluate. The debate must make room for the rest of us, though—the ones for whom effectiveness and ineffectiveness have been the research questions of our lives.
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Post by Admin on Jan 12, 2023 18:41:08 GMT
Seriously Misleading Network Meta-analysis in Lancet of Acceptability of Depression Pills By Peter C. Gøtzsche, MD -January 5, 20235 1740 In 2018, Andrea Cipriani et al. published a network meta-analysis of trials of depression pills in The Lancet. The authors included both head-to-head comparisons of drugs and comparisons of drugs with placebo. They ranked the drugs according to their effect and acceptability. The acceptability was measured as drop-out for any reason. This is a highly relevant outcome measure in placebo-controlled trials of depression pills. When the patients decide whether it is worthwhile to continue in the trial, they make a judgement about if the benefits they perceive exceed the harms. www.madinamerica.com/2023/01/misleading-lancet-depression-pills/
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Post by Admin on Apr 21, 2023 20:04:14 GMT
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Post by Admin on May 15, 2023 20:54:53 GMT
What I Learned as a Moderator for an Antidepressant Taper Support Group www.madinamerica.com/2023/05/antidepressant-taper-support-group/Iwas a Licensed Clinical Social Worker (LCSW) for 28 years. For 18 of those years, I was an LCSW in a psychiatric hospital that had both inpatient and outpatient units. All patients were on psychiatric medications, and most were on multiple drugs, i.e., antidepressants, benzodiazepines, and/or antipsychotic meds. I never heard about withdrawal syndromes or the need to taper off the medications. Side effects were treated not by taking a person off the drug, but by prescribing more medications to treat the side effects. My education about psychiatric medications and withdrawal began when I tried to go off the antidepressant Cymbalta. I had developed chronic fatigue syndrome (CFS) while working in the psychiatric hospital, and a psychiatrist I worked with said Cymbalta was a good drug for CFS. I did not have pain or depression, but I started taking Cymbalta based on his recommendation. I had taken antidepressants in the past but had not been on an antidepressant for a few years when I began to take Cymbalta.
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Post by Admin on Jun 2, 2023 12:52:31 GMT
Brett Deacon: Antidepressants Aren’t the Answer, the Truth About the DSM, and the Power of Exposure Therapy www.madinamerica.com/2023/06/brett-deacon-antidepressants-arent-the-answer-the-truth-about-the-dsm-and-the-power-of-exposure-therapy/From Psychlings Podcast: “Brett Deacon is a clinical psychologist and distinguished academic who has been at the forefront of academia for over 15 years in the U.S. and Australia. He has published over 100 articles and book chapters on topics ranging from critiques of the biomedical model to co-authoring the book Exposure Therapy for Anxiety: Principles and Practice . . . Please enjoy the knowledge, insight, and strong opinions from Brett covering: –Why psychiatric medication isn’t the solution to mental health challenges –The background to the DSM’s evolution –Why more psychologists should use exposure therapy.”
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