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Articles reporting negatively on antidepressants should come with a huge disclaimer to those taking them that they should continue to do so unless their doctor

by jmhain 11y ago

Articles reporting negatively on antidepressants should come with a huge disclaimer to those taking them that they should continue to do so unless their doctor / psychiatrist recommends otherwise. It seems obvious, but after being mostly depression / anxiety free for four years and reading an influx of articles claiming that they do nothing or very little based on new research, I decided to quit. Huge mistake that very nearly ruined my life. It turned out that despite all the lifestyle changes I made as well as therapy I received to mitigate depression and anxiety, the pills were almost solely responsible for my recovery. Restarting the SSRI of course did the trick, but they don't work fast and I lost nearly a year of my life. I currently regard this as the worst decision I have ever made.

kafkaesq 11y ago
I look at it the other way: companies "pushing"[1] antidepressants not just on pregnant women, but on all of us, for years on end, should be putting out a very clear message that you should not take these medicines unless absolutely recommended by your doctor, and other, generally more efficacious methods -- such as talk therapy and lifestyle changes -- have been at least explored, and found to be ineffective (or depending on the severity of your case, not immediately effective). Unfortunately, this is not what these companies are doing, as a rule. And given what we've found out SSRIs -- and the behavior of some of the major players in this industry, in recent years -- no one should be terribly surprised at the findings in the JAMA study (assuming they hold up to scrutiny). Also: Restarting the SSRI of course did the trick, but they don't work fast and I lost nearly a year of my life. I currently regard this as the worst decision I have ever made. With all due respect to your situation -- and not intended in the least to belittle either your suffering, or the thought you put into the decisions you made -- perhaps the bigger mistake was not going off SSRIs (at which point the die may have been more or less cast for you, in the short- to medium-term) -- but agreeing to go on them in the first place. [1] Yes, this is a loaded term. But I use it quite intentionally. Having not only studied the tradeoffs associated with one major class of antidepressants, but also having worked for one of the market's leading distributors -- and having made a careful study of their marketing materials -- I'd say "pushing" is not a bad description for the aggressive marketing tactics these companies have used over the years.
- ryan-allen 11y ago
  It's different in different countries. I'm in Australia and we have laws that limit the influence drug companies have over our doctors here, and we don't have pharma ads on television. SSRIs were recommended to me by a proper doctor and it was a good decision to start them. I was fortunate that the first type I took worked well and I didn't have to change types. > perhaps the bigger mistake was not going off SSRIs but agreeing to go on them in the first place. This kind of 'common sense' stigma is what kept me away from professional help for years. It's not helpful, it's FUD.
  - ars 11y ago
    > It's different in different countries. I'm in Australia and we have laws that limit the influence drug companies have over our doctors here, and we don't have pharma ads on television. Is there a difference in prescription rates between Australia and countries with less strict rules? i.e. does it actually change anything?
    - sjy 11y ago
      According to this article, the only countries to allow direct marketing to consumers are New Zealand and the United States, and doctors in NZ noticed a dramatic change when direct marketing became prevalent from 2002. Toop L and Mangin D. The impact of advertising prescription medicines directly to consumers in New Zealand: lessons for Australia (2006) http://www.australianprescriber.com/magazine/29/2/article/787.pdf http://www.australianprescriber.com/magazine/29/2/article/78...
  - kafkaesq 11y ago
    SSRIs were recommended to me by a proper doctor and it was a good decision to start them. I was fortunate that the first type I took worked well and I didn't have to change types. That's great and I'm glad your decision worked out well for you. This kind of 'common sense' stigma is what kept me away from professional help for years. It's not helpful, it's FUD. Funny thing is, there's about an equal amount of FUD floating around as to the potential benefits of talk therapy. Which is what kept me off it for decades and decades. Anyway, what I'm saying about SSRIs isn't FUD. There's a near-consensus view out there that though they may sometimes help, their technical workings are still poorly understood[1]; that they have complex side effects; are hard to get off of, for many people; have been over-proscribed for certain vey broad classes of folks (such as adolescents and children); and have often been disingenuously promoted by their makers -- in at least one very famous case, criminally so. I'm not giving citations for these points. There's plenty of stuff out there to read about these topics -- most of it not only non-sensationalistic, but quite well-reasoned (to the point of sounding dry and impassioned), and really now, pretty easy to find. [1] Not in "serotonin re-uptake inhibition" part; but in the, you know, "how do these drugs actually treat chemical depression?" part. (Assuming your depression actually is chemical, which is also quite debatable).
scott_karana 11y ago
> Articles reporting negatively on antidepressants should come with a huge disclaimer to those taking them that they should continue to do so unless their doctor / psychiatrist recommends otherwise. Shouldn't choosing "my wellbeing over that of my child" be a personal choice, not a healthcare provider choice?...
- someear 11y ago
  You may or may not have had experience with anti depressants. But in the cases referenced in the article (mild to moderate depression), especially during pregnancy, the choice is always with the patient (at least with any good physician). I believe the point being made here is consult with a doctor, since she may have some insight to your specific situation that will help you make an informed decision. If a physician is forcing or heavily influencing your decision, then its likely that the depression is severe, that you don't have the best physician, or some other unusual circumstance.
- ksenzee 11y ago
  You make it sound pretty simple. It's not simple at all. Having untreated depression or anxiety during pregnancy also has bad effects on the child. This is not a decision you make based on one study you read on the internet. You make it based on lots of research, preferably with the help of a perinatal psychiatrist.
- serge2k 11y ago
  It's the choice between telling your doctor you are concerned and would like help to stop the meds vs just flushing them.
  - Abraln 11y ago
    As an aside, NEVER flush medicine. Only dispose of them through proper channels which vary depending on where you live.
- aaronem 11y ago
  Of course, but making an informed choice means discussing it with your doctor, and balancing a very small (yes it is, read the abstract) additional chance of ASD against a practical guarantee of biochemical upheaval, for mother and baby both, which will result from discontinuing an SSRI.
mwfunk 11y ago
I had similar experiences. Going off the antidepressants didn't have an effect initially, if anything I felt more alert and energetic for the first few weeks. After about 6 months I felt like my terrible old self and had to start taking them again. I've been through this 3 times over the past 20 years. Some people will no doubt chime in that they are sure that my brain developed a dependency on the drugs and the return of my symptoms was simply that dependency asserting itself. Maybe, but probably not? That's the most anyone can really say about situations like this one, based on how well these things are currently understood. All I know is that antidepressants saved my freaking life when I first started taking them 20 years ago.
- striking 11y ago
  Antidepressants take a while to take effect and take a while to go away. The people talking about dependencies are almost certainly horribly wrong. That being said, if you feel that decreasing your dose makes you more alert and energetic, take it up with your psychiatrist. You may end up being advised to try a lower dose. (IANA psychiatrist, etc. etc.)
  - ajarmst 11y ago
    Withdrawal symptoms with SSRIs/SNRIs (often called a "Discontinuation Syndrome" to avoid a semantic argument about what "withdrawal" means) are quite well documented. The symptoms are exacerbated by long term use and especially by sudden discontinuation. Medical professionals will invariably recommend a slow tapering of dosage before attempting to discontinue treatment.
- pc2g4d 11y ago
  I went through this, too---I felt there were good reasons to get off my antidepressants, so I began tapering off of them at what I thought was a reasonable rate, something like 10% of the original dose per month (I was at 250mg so that was 25mg per month). Things proceeded smoothly for a long time---getting down to 100mg I felt great. But the closer I got to zero the more sensitive I was to the dose changes, and things started to fall apart for me emotionally. I had terrible withdrawal effects, becoming severely depressed and even developing OCD-like symptoms that I had never experienced before. My anxiety was also through the roof. And so I concluded that I did, indeed, need the antidepressants, and I went back on them at nearly my original doses, and things seemed to go back to normal. (Which wasn't great, but at least wasn't hell either.) But after learning more about other people's successful attempts at antidepressant withdrawal I decided a few years later to try it again. I'm currently in the midst of that tapering process, taking things much more slowly. The important thing seems to be that as you approach a dose of zero your rate of tapering should also diminish. So going from 200mg down to 100mg I did it in 25mg/month increments. From 100mg to 50mg I did it in 10mg/month increments. And now going from 50mg to 25mg I'm doing it in 5mg/month increments. I'm right at the point where things fell apart last time, but so far things are going great. The dose->blood serum concentration response curves for this medication are non-linear, suggesting that something other than constant incremental tapering is needed in order to keep the rate of change to brain chemistry constant. The rate of taper must be decreased as the dose comes down. Of course, in theory you'd have to live infinitely long in order for such an approach to get you to zero. So at some low dose like 12.5mg or 6.25mg I'll just have to cold-turkey it and drop down to zero. I think people underestimate the degree to which their brain chemistry has adapted to the presence of the drugs. When they fail to do well emotionally when off the drugs, they blame it on their native brain chemistry being broken---it's seen as proof that the original "illness" was real and the drugs were needed. But my belief now is that this is an artifact of the brain being given insufficient time to adapt to the absence of the drugs. Slow, slow tapering is the way to go. Regarding antidepressants saving lives, I also believed that mine saved mine in my darkest hours. And perhaps they did, but I now consider that to be only due to the placebo effect. The physical symptoms such as dry mouth made it feel like the drugs were really doing something. But ultimately I think their power was only that which I gave them by believing they were a miracle cure.
hannob 11y ago
It makes me a bit sad reading comments like this. I don't doubt that this is what you experienced, but it's pretty much basic science 101 that personal anecdotes aren't evidence. You experienced that you got worse when you stopped taking SSRIs and you got better when you took them again. There are many explanations for this. That SSRIs were the reason is only one of them. Maybe it was a placebo effect, maybe there were other circumstances that made you feel better, maybe it was pure chance. The only way to find out whether a drug works are properly designed trials. Unfortunately the situation with trials regarding antidepressants is rather murky, with trials results being hidden in the past etc., and from the best I can tell there is no consensus on how well SSRIs work among experts. But the solution to that is not to refer to anecdotes, it is better science.
- jmhain 11y ago
  I made absolutely no claim that my experience provided any sort of scientific evidence for the efficacy of antidepressants. I merely stated that if you're on antidepressants, and are in remission, you probably shouldn't quit because of some FUD you read on the internet as I, quite stupidly, did.
- enraged_camel 11y ago
  >>from the best I can tell there is no consensus on how well SSRIs work among experts. No, this is totally wrong. http://slatestarcodex.com/2014/07/07/ssris-much-more-than-you-wanted-to-know/ http://slatestarcodex.com/2014/07/07/ssris-much-more-than-yo... tl;dr: SSRIs have a substantial and clinically significant positive effect on patients with severe depression. The positive effect only decreases in patients with moderate depression, and becomes indistinguishable in patients with mild depression.
jobu 11y ago
It's also incredibly hard to stop taking antidepressants. A family member was on SSRIs for less than a year, and decided they weren't helping. In the process of trying to wean herself off them she went through long bouts of nausea and vomiting. She said it was like being seasick for 3 months. Antidepressants can be a lifesaver, but they can also have some terrible side-effects. They should only be used as a last resort.
- TeMPOraL 11y ago
  It depends on the person and I guess on the particular SSRI as well. In my case, I could (and did) go from normal dose to zero immediately, and I wouldn't notice any difference until few weeks later when my average mood and productivity started to visibly deteriorate. Anyway, SSRIs are relatively safe - that's why they're deployed as entry-level antidepressants. There are many "heavier" options available. Getting on an SSRI is far from last resort.
  - stordoff 11y ago
    Withdrawal and dependence varies massively from person to person as you say. I had been taking Tramadol (an opioid) at the maximum allowable daily dose for close to a year, and was told to stop by a new consultant. He told me it will be "hellish" and "worse than quitting heroin"; I stopped taking it immediately (without tapering), and the only effect was the return of the original pain.
Igglyboo 11y ago
Also something to note that SSRI withdrawals are on par with heroin or benzo withdrawals, if you decide to quit you need to tell your doctor and have a tapering plan. If you've been taking SSRIs long term and try to quit cold turkey your life will be a living hell.
didgeoridoo 11y ago
> Restarting the SSRI of course did the trick No, not "of course". It is very possible that stopping and restarting drug treatment will put you in a different place entirely, and you may find that things that worked for years just don't anymore. You say it above, but it really cannot be overstated: if you are on a psychotropic medication regimen that is working, for the love of god don't fuck with it except under the supervision of a trained psychiatrist.
aburan28 11y ago
This.
odonnellryan 11y ago
Hey! Mind reaching out to me off line? odonnellryanc@gmail.com

by jmhain 11y ago

kafkaesq 11y ago

I look at it the other way: companies "pushing"[1] antidepressants not just on pregnant women, but on all of us, for years on end, should be putting out a very clear message that you should not take these medicines unless absolutely recommended by your doctor, and other, generally more efficacious methods -- such as talk therapy and lifestyle changes -- have been at least explored, and found to be ineffective (or depending on the severity of your case, not immediately effective). Unfortunately, this is not what these companies are doing, as a rule. And given what we've found out SSRIs -- and the behavior of some of the major players in this industry, in recent years -- no one should be terribly surprised at the findings in the JAMA study (assuming they hold up to scrutiny). Also: Restarting the SSRI of course did the trick, but they don't work fast and I lost nearly a year of my life. I currently regard this as the worst decision I have ever made. With all due respect to your situation -- and not intended in the least to belittle either your suffering, or the thought you put into the decisions you made -- perhaps the bigger mistake was not going off SSRIs (at which point the die may have been more or less cast for you, in the short- to medium-term) -- but agreeing to go on them in the first place. [1] Yes, this is a loaded term. But I use it quite intentionally. Having not only studied the tradeoffs associated with one major class of antidepressants, but also having worked for one of the market's leading distributors -- and having made a careful study of their marketing materials -- I'd say "pushing" is not a bad description for the aggressive marketing tactics these companies have used over the years.

ryan-allen 11y ago
It's different in different countries. I'm in Australia and we have laws that limit the influence drug companies have over our doctors here, and we don't have pharma ads on television. SSRIs were recommended to me by a proper doctor and it was a good decision to start them. I was fortunate that the first type I took worked well and I didn't have to change types. > perhaps the bigger mistake was not going off SSRIs but agreeing to go on them in the first place. This kind of 'common sense' stigma is what kept me away from professional help for years. It's not helpful, it's FUD.
- ars 11y ago
  > It's different in different countries. I'm in Australia and we have laws that limit the influence drug companies have over our doctors here, and we don't have pharma ads on television. Is there a difference in prescription rates between Australia and countries with less strict rules? i.e. does it actually change anything?
  - sjy 11y ago
    According to this article, the only countries to allow direct marketing to consumers are New Zealand and the United States, and doctors in NZ noticed a dramatic change when direct marketing became prevalent from 2002. Toop L and Mangin D. The impact of advertising prescription medicines directly to consumers in New Zealand: lessons for Australia (2006) http://www.australianprescriber.com/magazine/29/2/article/787.pdf http://www.australianprescriber.com/magazine/29/2/article/78...
- kafkaesq 11y ago
  SSRIs were recommended to me by a proper doctor and it was a good decision to start them. I was fortunate that the first type I took worked well and I didn't have to change types. That's great and I'm glad your decision worked out well for you. This kind of 'common sense' stigma is what kept me away from professional help for years. It's not helpful, it's FUD. Funny thing is, there's about an equal amount of FUD floating around as to the potential benefits of talk therapy. Which is what kept me off it for decades and decades. Anyway, what I'm saying about SSRIs isn't FUD. There's a near-consensus view out there that though they may sometimes help, their technical workings are still poorly understood[1]; that they have complex side effects; are hard to get off of, for many people; have been over-proscribed for certain vey broad classes of folks (such as adolescents and children); and have often been disingenuously promoted by their makers -- in at least one very famous case, criminally so. I'm not giving citations for these points. There's plenty of stuff out there to read about these topics -- most of it not only non-sensationalistic, but quite well-reasoned (to the point of sounding dry and impassioned), and really now, pretty easy to find. [1] Not in "serotonin re-uptake inhibition" part; but in the, you know, "how do these drugs actually treat chemical depression?" part. (Assuming your depression actually is chemical, which is also quite debatable).

scott_karana 11y ago

> Articles reporting negatively on antidepressants should come with a huge disclaimer to those taking them that they should continue to do so unless their doctor / psychiatrist recommends otherwise. Shouldn't choosing "my wellbeing over that of my child" be a personal choice, not a healthcare provider choice?...

someear 11y ago
You may or may not have had experience with anti depressants. But in the cases referenced in the article (mild to moderate depression), especially during pregnancy, the choice is always with the patient (at least with any good physician). I believe the point being made here is consult with a doctor, since she may have some insight to your specific situation that will help you make an informed decision. If a physician is forcing or heavily influencing your decision, then its likely that the depression is severe, that you don't have the best physician, or some other unusual circumstance.
ksenzee 11y ago
You make it sound pretty simple. It's not simple at all. Having untreated depression or anxiety during pregnancy also has bad effects on the child. This is not a decision you make based on one study you read on the internet. You make it based on lots of research, preferably with the help of a perinatal psychiatrist.
serge2k 11y ago
It's the choice between telling your doctor you are concerned and would like help to stop the meds vs just flushing them.
- Abraln 11y ago
  As an aside, NEVER flush medicine. Only dispose of them through proper channels which vary depending on where you live.
aaronem 11y ago
Of course, but making an informed choice means discussing it with your doctor, and balancing a very small (yes it is, read the abstract) additional chance of ASD against a practical guarantee of biochemical upheaval, for mother and baby both, which will result from discontinuing an SSRI.

mwfunk 11y ago

I had similar experiences. Going off the antidepressants didn't have an effect initially, if anything I felt more alert and energetic for the first few weeks. After about 6 months I felt like my terrible old self and had to start taking them again. I've been through this 3 times over the past 20 years. Some people will no doubt chime in that they are sure that my brain developed a dependency on the drugs and the return of my symptoms was simply that dependency asserting itself. Maybe, but probably not? That's the most anyone can really say about situations like this one, based on how well these things are currently understood. All I know is that antidepressants saved my freaking life when I first started taking them 20 years ago.

striking 11y ago
Antidepressants take a while to take effect and take a while to go away. The people talking about dependencies are almost certainly horribly wrong. That being said, if you feel that decreasing your dose makes you more alert and energetic, take it up with your psychiatrist. You may end up being advised to try a lower dose. (IANA psychiatrist, etc. etc.)
- ajarmst 11y ago
  Withdrawal symptoms with SSRIs/SNRIs (often called a "Discontinuation Syndrome" to avoid a semantic argument about what "withdrawal" means) are quite well documented. The symptoms are exacerbated by long term use and especially by sudden discontinuation. Medical professionals will invariably recommend a slow tapering of dosage before attempting to discontinue treatment.
pc2g4d 11y ago
I went through this, too---I felt there were good reasons to get off my antidepressants, so I began tapering off of them at what I thought was a reasonable rate, something like 10% of the original dose per month (I was at 250mg so that was 25mg per month). Things proceeded smoothly for a long time---getting down to 100mg I felt great. But the closer I got to zero the more sensitive I was to the dose changes, and things started to fall apart for me emotionally. I had terrible withdrawal effects, becoming severely depressed and even developing OCD-like symptoms that I had never experienced before. My anxiety was also through the roof. And so I concluded that I did, indeed, need the antidepressants, and I went back on them at nearly my original doses, and things seemed to go back to normal. (Which wasn't great, but at least wasn't hell either.) But after learning more about other people's successful attempts at antidepressant withdrawal I decided a few years later to try it again. I'm currently in the midst of that tapering process, taking things much more slowly. The important thing seems to be that as you approach a dose of zero your rate of tapering should also diminish. So going from 200mg down to 100mg I did it in 25mg/month increments. From 100mg to 50mg I did it in 10mg/month increments. And now going from 50mg to 25mg I'm doing it in 5mg/month increments. I'm right at the point where things fell apart last time, but so far things are going great. The dose->blood serum concentration response curves for this medication are non-linear, suggesting that something other than constant incremental tapering is needed in order to keep the rate of change to brain chemistry constant. The rate of taper must be decreased as the dose comes down. Of course, in theory you'd have to live infinitely long in order for such an approach to get you to zero. So at some low dose like 12.5mg or 6.25mg I'll just have to cold-turkey it and drop down to zero. I think people underestimate the degree to which their brain chemistry has adapted to the presence of the drugs. When they fail to do well emotionally when off the drugs, they blame it on their native brain chemistry being broken---it's seen as proof that the original "illness" was real and the drugs were needed. But my belief now is that this is an artifact of the brain being given insufficient time to adapt to the absence of the drugs. Slow, slow tapering is the way to go. Regarding antidepressants saving lives, I also believed that mine saved mine in my darkest hours. And perhaps they did, but I now consider that to be only due to the placebo effect. The physical symptoms such as dry mouth made it feel like the drugs were really doing something. But ultimately I think their power was only that which I gave them by believing they were a miracle cure.

hannob 11y ago

It makes me a bit sad reading comments like this. I don't doubt that this is what you experienced, but it's pretty much basic science 101 that personal anecdotes aren't evidence. You experienced that you got worse when you stopped taking SSRIs and you got better when you took them again. There are many explanations for this. That SSRIs were the reason is only one of them. Maybe it was a placebo effect, maybe there were other circumstances that made you feel better, maybe it was pure chance. The only way to find out whether a drug works are properly designed trials. Unfortunately the situation with trials regarding antidepressants is rather murky, with trials results being hidden in the past etc., and from the best I can tell there is no consensus on how well SSRIs work among experts. But the solution to that is not to refer to anecdotes, it is better science.

jmhain 11y ago
I made absolutely no claim that my experience provided any sort of scientific evidence for the efficacy of antidepressants. I merely stated that if you're on antidepressants, and are in remission, you probably shouldn't quit because of some FUD you read on the internet as I, quite stupidly, did.
enraged_camel 11y ago
>>from the best I can tell there is no consensus on how well SSRIs work among experts. No, this is totally wrong. http://slatestarcodex.com/2014/07/07/ssris-much-more-than-you-wanted-to-know/ http://slatestarcodex.com/2014/07/07/ssris-much-more-than-yo... tl;dr: SSRIs have a substantial and clinically significant positive effect on patients with severe depression. The positive effect only decreases in patients with moderate depression, and becomes indistinguishable in patients with mild depression.

jobu 11y ago

It's also incredibly hard to stop taking antidepressants. A family member was on SSRIs for less than a year, and decided they weren't helping. In the process of trying to wean herself off them she went through long bouts of nausea and vomiting. She said it was like being seasick for 3 months. Antidepressants can be a lifesaver, but they can also have some terrible side-effects. They should only be used as a last resort.

TeMPOraL 11y ago
It depends on the person and I guess on the particular SSRI as well. In my case, I could (and did) go from normal dose to zero immediately, and I wouldn't notice any difference until few weeks later when my average mood and productivity started to visibly deteriorate. Anyway, SSRIs are relatively safe - that's why they're deployed as entry-level antidepressants. There are many "heavier" options available. Getting on an SSRI is far from last resort.
- stordoff 11y ago
  Withdrawal and dependence varies massively from person to person as you say. I had been taking Tramadol (an opioid) at the maximum allowable daily dose for close to a year, and was told to stop by a new consultant. He told me it will be "hellish" and "worse than quitting heroin"; I stopped taking it immediately (without tapering), and the only effect was the return of the original pain.

Igglyboo 11y ago

Also something to note that SSRI withdrawals are on par with heroin or benzo withdrawals, if you decide to quit you need to tell your doctor and have a tapering plan. If you've been taking SSRIs long term and try to quit cold turkey your life will be a living hell.

didgeoridoo 11y ago

> Restarting the SSRI of course did the trick No, not "of course". It is very possible that stopping and restarting drug treatment will put you in a different place entirely, and you may find that things that worked for years just don't anymore. You say it above, but it really cannot be overstated: if you are on a psychotropic medication regimen that is working, for the love of god don't fuck with it except under the supervision of a trained psychiatrist.

aburan28 11y ago

This.

odonnellryan 11y ago

Hey! Mind reaching out to me off line? odonnellryanc@gmail.com