12 ms·

Withdrawal from Antidepressants

126 points by ipunchghosts 10y ago

Alex3917 10y ago
On a related note, there's no good half-life calculator on the web for people tapering off SSRIs. The issue is that in order to actually have as gentle a taper as possible, you need to halve your dose only every few weeks because of how long the half life of these drugs is. So ideally you'd want something where you would enter your starting dose and how much of the drug you plan on taking each day, and it would show you your projected concentration of the drug each day as well as the percent change. I made this in Excel for someone a few years ago, but it would make a good weekend project if someone wants to learn react or whatever.
- ipunchghosts 10y ago
  I second this. I was on zoloft for IBS. Getting off of it was terrible. I had to taper down 25% each step and each step lasted weeks. Overall, it took the same time to taper off of it as when I needed it. I quit taking it because my IBS was not really IBS, it was a defective gallbladder. It was removed and my symptoms went away.
  - DenisM 10y ago
    IBS - irritable bowel syndrome?
- DanBC 10y ago
  > The issue is that in order to actually have as gentle a taper as possible, you need to halve your dose only every few weeks because of how long the half life of these drugs is. The meds with worst discontinuation effects are those with short half life. Those with longer half life tend to have gentler discontinuation effects. EG https://www.ncbi.nlm.nih.gov/pubmed/10855379/ https://www.ncbi.nlm.nih.gov/pubmed/10855379/ > Serotonin re-uptake inhibitor withdrawal syndrome generally begins within 24 to 48 hours after discontinuing the drug. Signs reach their maximum on day 5 and usually resolve within 2 to 3 weeks. Withdrawal syndrome is more common with short half-life drugs (paroxetine, fluvoxamine). The intensity of the clinical signs depends on the daily dose and how long the drug has been given.
dbg31415 10y ago
We think of doctors and medications as being scientific and precise. But it's more like just throwing some food coloring into a black garbage bag full of all sorts of stuff and shaking it up in hopes of getting it to get to a specific color... but not really being able to see the color through the bag. The drugs all have side-effects, different for each person who takes them. And often those side-effects are as bad as the original ailment. But you trust your doctor, and you're in a bad spot... and you figure, "Fuck it, maybe it'll work and I'm willing to try anything at this point..." And ugh, it just all sucks. It's so hard to fix once you start down the medication path. Testing drugs, trying to find the right dose... deciding if the side-effects are worth the gains... withdrawal from drugs... drugs to help with the side-effects... drugs to help with the withdrawal... (often a few loops)... all of this can fundamentally change your personality and motivations, or have just no impact on you what-so-ever and leave you beyond frustrated. If you had cancer, everyone would be there to support you. If you have a mental illness, there's not much chance of getting support from peers... or friends -- it's tough, it's not their job to support you -- sure... but a lot of times mental health issues are exacerbated by feeling of isolation... which leads to medical treatment because you don't have other options... and the doctors all seem confident that drugs will help... Anyway, anything you can do to avoid mental health issues in the first place... do that. And if you don't have mental health issues, be thankful and humbly accept you're one concussion, bad breakup, car accident, death in the family, death of a pet, loss of job, or bad decision away from it if you aren't careful.
- chris_wot 10y ago
  In Australia (or at least NSW), the health system doesn't know what to do with you. About 7 months ago I had a mental breakdown and experienced thoughts of suicide. When the health system found out, I had finished having the thoughts, and was at home trying to sleep, being supported by my loving family having been awake at the time for over 14 hours. I was ripped out of my bed by ambulance officers with police present, despite my protests and my wife's - eventually agreeing to go voluntarily with them in their ambulance. Then after I got into the ED itself I discovered I'd been sectioned and not allowed to leave. After I realised this was what had happened I got placed in an isolation room, with no explanation as to why, and there I sat quietly rotting for the next 5.5 hours. In other words, I got no care, had my rights stripped and was treated like a criminal because after a sustained period of incredible stress I had a breakdown. I was then sent back home as they decided I shouldn't have been there in the first place. I was then sent a bill for $600. The system sucks.
rudolf0 10y ago
The article seems sound, but the source does look a bit biased.
- 0xcde4c3db 10y ago
  The source isn't just a bit biased, it's hugely biased. Mad in America has an open editorial viewpoint, which is opposition to "the current drug-based paradigm of care" in psychiatry [1]. It's headed by Robert Whitaker, probably best known for his book Anatomy of an Epidemic that questions the routine use of psychiatric drugs [2]. Of course, that doesn't mean the article is useless or not addressing real phenomena. Antidepressant withdrawal is real, and IME it's something you're more likely to hear about as a horror story from a patient (especially if they tried to stop Effexor cold-turkey) rather than as part of standard descriptions of depression treatment and its risks/shortcomings. [1] https://www.madinamerica.com/about-us/ https://www.madinamerica.com/about-us/ [2] https://www.madinamerica.com/robert-whitaker-new/ https://www.madinamerica.com/robert-whitaker-new/
  - rudolf0 10y ago
    Oh yeah, I've used SSRIs and suffered the withdrawal. I know they're not making things up or whatever. But I also think that taking such a universal anti-psychiatric drug stance is probably too hardline of a position. I think they are the lesser of two (or more) evils for a lot of patients.
aaron-lebo 10y ago
Not sure if this supports the article or is just a warning, but going off of anti-depressants can be fatal. If depression relapses anti-depressants that once worked can prove ineffective. (edit: wrongly said SSRIs and not anti-depressants) David Foster Wallace: Wallace died by suicide on September 12, 2008, at age 46. Wallace's father reported in an interview that his son had suffered from depression for more than 20 years and that antidepressant medication had allowed him to be productive.[42] When Wallace experienced severe side effects from the medication, he attempted to wean himself from his primary antidepressant, phenelzine.[43] On his doctor's advice, Wallace stopped taking the medication in June 2007,[42] then the depression returned. Wallace received other treatments, including electroconvulsive therapy. When he returned to phenelzine, he found that it had lost its effectiveness.[43] His wife kept a watchful eye on him in the following days, but on September 12, Wallace went into the garage, wrote a two-page note, and arranged part of the manuscript for The Pale King before hanging himself from a patio rafter.[49] It's something to be very careful about...
- robertcorey 10y ago
  phenelzine is an MAOI
- drzaiusapelord 10y ago
  Phenelzine is actually a MAOI, which is a different class of drug. My understanding is that Wallace had hard to treat depression and was on this more dangerous class of drug as SSRI's didn't work well on him. He also died with Clonazepam and Temazepam in his system. Wallace also received electric shock therapy, which suggests his depression was much more serious than most cases. I think his case is very much an edge case here. He had very serious problems with a hard to treat depression and was on a MAO inhibitor, which is seen as the last resort for pharmacological treatments of depression because its so unstable, short-lived, and has nasty side effects and is difficult to ween off. SSRI's are much more safe.
  - nylonstrung 10y ago
    He actually wrote about his experiences with MAOIs in an early short story in a college journal. This was in the early 80s, well before Prozac and SSRIs made it to market. https://quomodocumque.files.wordpress.com/2008/09/wallace-amherst_review-the_planet.pdf https://quomodocumque.files.wordpress.com/2008/09/wallace-am...
tokenadult 10y ago
The home page of the site hosting the webpage submitted here, "Mad in America: Science, Psychiatry, and Social Justice" looks to put a lot more emphasis on the social justice, as the authors published on the site define that, than on science in general or psychiatry in particular. This is more a site that advocates for a particular policy point of view than a site that neutrally reviews the latest methodologically careful research. https://www.madinamerica.com/ https://www.madinamerica.com/ "
- tcj_phx 10y ago
  > This is more a site that advocates for a particular policy point of view than a site that neutrally reviews the latest methodologically careful research. Mad in America was the title of investigative journalist Robert Whitaker's first book. Whitaker's second book, Anatomy of an Epidemic, proposes that there is not and has never been any evidence that commonly used psychiatric prescriptions actually work over the long-term. This HN submission was from 2 days ago: Psychiatrists Must Face Possibility That Medications Hurt More Than They Help (scientificamerican.com) - https://news.ycombinator.com/item?id=13186201 https://news.ycombinator.com/item?id=13186201 The Scientific American article says, essentially, that "Maybe Robert Whitaker is right..." I am not anti-psychiatry, I am opposed to treating symptoms instead of causes. My friend would be doing much better if her psychiatrists would prescribe useful drugs (naltrexone, thyroid, B-vitamins, etc), instead of harmful ones.
- geofft 10y ago
  But of course which methodologically careful research has been done of late is extremely agenda-driven and politicized, too! You can't launder your biases away by putting them behind the abstraction barrier of what the government or what drug companies are willing to fund. That's how you end up with p-hacking. Better to acknowledge that the reason people do science is to do things with science, not because they find sound research intrinsically fulfilling, and that everyone and every funding agency brings their biases, their hopes and dreams for society, with them.
  - mmjaa 10y ago
    > agenda-driven More like, profit-driven. If we want to get better, we have to stop allowing a class of society to profit from the sickness. Pharmaceutical companies exist not to make anyones lives better - they exist to generate profit. I'm highly suspicious of the drug-taking culture, as it attempts to justify the enslavement of the individual by way of supplanting their supposed mental-health problems with a very profitable subscription to a proprietary/patented/owned drug formula. I think it is very sad to read this HN article and listen to all the stories of folks who think they are improving their lives with this chemical dependency, and it is really tragic that drug-taking is such a cultural phenomenon that anyone who dares to rise above the field and say "hey, maybe we don't need to do this - maybe there is another way" gets cut down to serve as fodder for the rest of the poppies. Its quite possible that we've all been swindled by our own hubris. Its happened before. The Romans had their lead pipes, the Victorians their laudanum, and we - "modern" society - have our Prozac and Zoloft. Dare to mention alternative means of lifting oneself out of the mire, and you will incur a great deal of wrath - such is the investment in the propaganda from the multi-billion-dollar pharmaceutical industry in capturing the subject and making sure nobody dares think otherwise to their drug-delivery supply chains...
vomitcuddle 10y ago
As someone who had to abruptly come off venlafaxine due to side effects, I can tell you that it was complete hell. I experienced vomiting, the weirdest, most horrible nightmares every night, sleep paralysis with hallucinations and a recurring feeling of "electic shocks" inside my head. This lasted about a month. I think it borders on inhumane not to mention possible withdrawal symptoms before prescribing this awful "anti-"depressant. My doctor eventually prescribed me trazodone, so I could just sleep the withdrawals off.
- mcjiggerlog 10y ago
  I went through a similar experience (although not as extreme) when coming off of citalopram, even with a doctor's guidance. Lots of nausea and disorientation, but worst of all were the "electric shocks" which really were very disturbing. Not a single mention of these when having the medicine prescribed!
  - nspriego 10y ago
    If I miss taking citalopram 2 days in a row I start getting these "electric shocks" and dizzyness. Glad to know I'm not the only one.
- ds18 10y ago
  Do you mind me asking what your dosage was and if you went cold turkey or tapered off at all?
  - DanBC 10y ago
    I'm not the person you replied to, but I was on 350 mg (which is a reasonably high dose). I was on venlafaxine regular release, not the extended release. If I missed a dose I got full on discontinuation effects. When I tapered off it wasn't great, but it wasn't awful. Some people do report problems even with a very gentle long taper down.
    - radd9er 10y ago
thanatropism 10y ago
Oh boy oh boy oh boy. The problems pointed out in this article -- which are in some degree real even if heavily editorialized -- must be understood in light of a wider context which includes: 0) The very poor standards of validity and replicability in most fields of experimental psych-whatever. The Popperian method ain't what it used to be. 1) The Viennese Waltz of bad incentives throughout the psychiatry research pipeline. Most notably, drug companies are incentivized for fraud and deceit by being rewarded for closely-guarded research, hiding negative studies and obtaining patent extensions for new applications of existing drugs. 2) Somewhat related to (1): the unfortunate drug safety model prevalent in all relevant nations in which drugs must be proven to work for some pathology. Besides incentivizing recklessness in industry-led research, this means viable off-label usages go "underground" (topiramate for dissociative disorders is a typical case where FDA-worthy testing might be impossible). It might be better if the FDA and its counterparts instead regulated for drug _safety_ in humans and let the academic and clinical communities evolve their professional consensuses. 3) Much related to (0): the effective failure of "talking cures" in outcompeting drugs (specially "dirty drugs" like anticonvulsants, neuroleptics and non-SSRI antidepressants) for "simple" depression, bereavement and related mental health issues of which one could whip up a "social critique" of drug use and so forth. "Mad in America" is obviously not willing to make a fuss of things like bipolar where people will take their lithium for decades and bear the side-effects because the alternative is to go actually mad-crazy. Did I miss something?
- Lxr 10y ago
  > It might be better if the FDA and its counterparts instead regulated for drug _safety_ in humans and let the academic and clinical communities evolve their professional consensuses. The problem is that safety is not binary - it's a question of severity and probability of adverse effects vs the benefit of the drug (the risk of adverse side effects is more acceptable for a cancer treatment than a cough medicine for instance). The purported purpose of regulation is to balance risk vs benefit. Therefore the regulator needs to incorporate the indication into their decision, and so they must evaluate if it actually works.
- tcj_phx 10y ago
  > "Mad in America" is obviously not willing to make a fuss of things like bipolar where people will take their lithium for decades and bear the side-effects [...] The creation and promotion of "Bipolar" as a DSM disorder is covered in Anatomy of an Epidemic, Robert Whitaker's followup to Mad in America. > [...] because the alternative is to go actually mad-crazy. The whole point of Whitaker's Mad in America foundation is to change the paradigm of our approach to mental health. nstead of trying to find the right drug to make a symptom go away, it would be much more effective to figure out non-psychotropic-drug ways to help people function better.
69mlgsniperdad 10y ago
I have been on paxil(paroxetine) three separate times. Each was between six months and one year in duration. The first time, I was on a 10mg daily dose. I had quite a few issues when starting the medication the first time; however after a few weeks, I felt great. When I initially discontinued, I had the worst side effects I have ever experienced. Electric shocks in my neck and back of head, depression, mood swings, and terrible panic attacks lasting almost two weeks. The doctor told me it wasn't 'addictive' and there is no issue stopping the medication, afterwards I changed my physician. The new doctor also insisted there were no known withdrawal symptoms. If you google the issue there are thousands of reports and dozens of websites about this exactly. I have no idea why doctors tell people there is nothing to worry about but there are certainly many negative side effects experienced while starting and discontinuing SSRI's. For subsequent treatments of paxil and other SSRI's, I have made sure to slowly titrate my dose when starting and discontinuing treatment. 1/4 doses for a week, half for a week, 3/4 for a week, and then full dosage. I have done the same for discontinuing, sometimes even more gradual then that, and have avoided the terrible experience since.
- rudolf0 10y ago
  Doctors can be notoriously ignorant and contradictory when it comes to mental illness-treating drugs. There's a lot of literature out there and a lot of them don't keep up. I don't know why it is. Not that you shouldn't trust doctors, but I always do some Googling to get a second opinion about all psychoactive drugs I'm prescribed.
  - ekianjo 10y ago
    You should always seek a second opinion from different specialists. If all of them tell you the very same thing it is probably safe to assume what they recommended is well established. But its far from being always the case. Doctors are not machines and influenced by a number of factors so none of them should be considered infaillible.
  - agumonkey 10y ago
    It's very very uneasy when doctors are too handwavey on your issues. You don't know if they're skipping beats because they don't want to explain 10 years of med school so you obey, or if they just don't want to investigate more than what the usual answer is. I tried to nitpick on things that mattered for me, but you cannot easily claim "I'm more up to date than you on <xyz> illness" to a legal doctor without feeling a little ridiculous. That's why I root for more non invasive monitoring and intervention. Many doctors told me the "based on these tests, you have nothing", bailing out when I asked for more because deeper tests would require potential ICU. So you end up floating in the unknown hoping for the best.
KirinDave 10y ago
I had this terrible experience before I was publicly out about my gender that sent me into a very suicidal train of thought. I had a moment clarity to get myself to a doctor (my partner was pregnant at the time, or I probably won't be here writing this now). The doctor gave me citalopram (brand name is Celexa, I think?) I had to stop taking it. I'll list the side effects I had, but not before I point out: It saved my life. Yes, I had bad side effects. But it also helped me overcome the anxiety and rage I was suffering from and resolve to come out about my status. Ultimately I had to taper off of it, which was hard. My doctor advised reducing my dose by 1/4 the original value every 9 days until I was done. The end of it was quite rough, I confess. But while on it, I gained nearly all the weight I lost in a year of physical training back (just 4 months of treatment), my heart palpitations were nauseatingly bad, and I suddenly had to sleep a lot longer to get even a modicum of rest. When people say, "You should consider medication" it is to help normalize the idea that in trauma situations medication can help people with some types of MI. It is not because they're fun, side-effect free, or not a "real" course of treatment. It's important to remember that when considering these stories and your own mental health.
- dannylandau 10y ago
  Did the side effects from Celexa correspond to those found on this health search engine Healthbee
  - KirinDave 10y ago
    I listed them and my doctor said they were actually in the most common side effects. I have not pursued information beyond that.
- harshreality 10y ago
  I don't think even people like the anti-med Robert Whitaker would be against using these medications short-term, for major clinical depression or for other conditions where patients are low- or non-functioning; the primary goal there is to get people stable so they can participate in productive behavioral therapy or modification so that they don't need the meds long-term (particularly since afaik the balance of evidence is that the effectiveness of these meds declines to the placebo level over the long term). It's the use of psychiatric medication for relatively minor psychiatric disturbances in high-functioning individuals, and for long periods of time (years), that draws most of the criticism.
KermitCole 10y ago
As an editor on Mad in America, I appreciate the thoughtful and thorough discussion here. We would welcome any stories or analysis that the commenters here might venture to contribute to MIA. Thanks, Kermit Cole
- dannylandau 10y ago
  Are there any comprehensive portals that provide information about the prevalence of each drug's side effect? The only one I know of is HealthBee? - https://healthbee.co/ https://healthbee.co/
  - faitswulff 10y ago
    I was curious how good HealthBee was, so I asked a pharmacist friend of mine. Her response: "Bad LOL. It could not find the first drug I want to look at- apixaban or Eliquis. Generic name and brand name, respectively" Apixaban is apparently a common drug. That said, even she was interested in such a portal as well, saying that it just needs more data.
  - markroseman 10y ago
    I find drugs.com useful, which seems to be derived from product monographs. Knowing that "very common", "common", "uncommon", "rare" and "very rare" have specific meanings (e.g. common -> 1%-10%) helps.
numinary1 10y ago
It seems to me that many of the drugs in this category are effective sometimes for some people. People I have known who were suffering acutely often cycled through several drugs, sometimes in combination, dosages etc. It appears to me to be mostly trial and error. But for some people the results are miraculous. They solve real problems with few if any side effects. For others, they either don't work at all or have intolerable side effects. The situation would be a whole lot better if we could predict likely efficacy and side effects in advance, especially cases where treatment is more likely to do harm that to help. Interestingly, I've read a lot (not so much recently) on the subject and taken several SSRIs myself (with good short term experience, minor sides), but I learned a lot from the discussion here. So many people take these drugs — the data necessary to understand and perhaps to predict ... is out there. Not easy to get at, but really plentiful. Reading this made me think about the feasibility of mining message boards for first person accounts of SSRI experience.
- markroseman 10y ago
  While there is some work done on matching people up with specific drugs, this is still very much in the research phase. Still, for many people, it's more trial and error than it needs to be. Many family doctors still don't match up symptoms with neurotransmitters, and then put people on the wrong class of drugs altogether (e.g. something like Wellbutrin which works on norepinephrine and dopamine instead of an SSRI for anxiety which is more associated with serotonin). Part of the reason is that new drugs keep coming out so it's difficult to keep up, and eventually they all start to blur together. The best practical predictor of success on a given medication today is if you have a close relative who's had success on that medication.
  - numinary1 10y ago
    That certainly makes sense since the problem has a higher likelihood of stemming from the same root cause, but also speaks to how little is known. So include the social graphs of people who are on antidepressant discussion boards and pick up on friends, family, socioeconomic features ... I so want to use ML tools on medical treatment data, but it's so hard to come by. Have toyed with a couple of startup ideas based on the tendency of people who share a condition to establish ties. Crohn's disease, cutaneous lymphoma. But the groups are too small. Mood disorders on the other hand...
jrapdx3 10y ago
The effects of abruptly stopping SSRI (and later on SNRI) medications have been well-known since the 1980's. It's considered related to the widespread if individually variable distribution of serotonin receptors in the body. Having prescribed a ton of SSRI/SNRI meds since their introduction, and taken my share as well, it's a phenomenon I'm very familiar with. Called a "discontinuation syndrome", technically not the same as "withdrawal", which is associated with tolerance, the need to continually increase dose to get the same effect. SSRIs can produce a D/C effect at low or high dose if more likely with greater dose. Individual response to SSRI D/C varies greatly. I've been very surprised at times when people tell me they've gone off 200mg of Zoloft and never noticed a thing. Others report D/C effects for weeks even after tapering down very gradually. Most of the time problems with D/C reflect short half-life of compounds. Effexor is notorious in this regard. OTOH more persistent agents like Prozac are typically less troublesome. In fact it's a common strategy to use Prozac as an means to ease D/C when stopping short duration meds. Going by reports of (probably) a thousand patients, as well as my own experience of D/C effects, generally they're mild to moderate and dissipate within a few days. However there are exceptions and I never hesitated to go as slowly as necessary to minimize excessive discomfort while tapering off the medication. As I've commented before on HN, this subject again emphasizes some crucially important principles. One is that any medication can cause any side effect at any time. No free lunch, all medicines have numerous effects, some favorable and some not, so it's important to make sure there's a damn good reason for using any medication and understand the risks and benefits. Finally, every individual has a unique condition and responds uniquely to the treatments we have to offer. It's a partnership between the prescriber and the patient, communication about what's happening during the course of treatment is vital. Believe me I know, whether in the role of doctor or patient, it's a highly evolved art form.
- an_d_rew 10y ago
  That was a carefully worded and thoughtful reply... thank you!
throwaway713 10y ago
I was on Nardil (phenelzine) for about 6 months. That's some weird stuff right there. I gained a whole bunch of weight, lost the ability to dream while sleeping, and couldn't eat any foods with tyramine in them (like Iberian ham or fava beans), but man, chocolate cake never tasted so heavenly as when on Nardil. Prior to Nardil, I had been taking Prozac (fluoxetine) but a combination of sexual side effects, an impatient disposition, and scientific curiosity prompted me to ask my psychiatrist about Nardil. He said, "Why not?" This psychiatrist would prescribe just about anything (not that I see anything wrong with that) so over the course of grad school I tried Prozac, Nardil, Modafinil, and Adderall. Oddly enough, it turned out that an extremely low dosage of Adderall fixed most of my issues. My psychiatrist started with me 30 mg twice a day but I found that 10 mg worked better (less euphoria, more focus), so nowadays I only take 10 mg Adderall about twice a week and don't seem to have any depression or focus issues anymore.
- chillwaves 10y ago
  What did you think about Modafinil? I went on it for a few months (without advice of a doctor) and thought it put a great pep in my step. Now that I have insurance, I will try to get it prescribed but it seemed gentle in a way, like a different flavor of caffeine but also gave me confidence. Unless I took too much, then I felt on edge, like I was clenching my jaw (probably was). I guess I am asking you about Modafinil because somehow I was under the impression it's a somewhat casual drug and the rest in your list seem like heavy weights to me. I have never taken any kind of antidepressant but sometimes think I need to.
  - throwaway713 10y ago
    I had no response to Modafinil at all. I started at 100 mg and worked up to 400 mg (under my psychiatrist's supervision), but at 400 mg, both he and I decided it wasn't doing anything — positive or negative — so I quit taking it. After researching the subject a bit, my guess as to why Modafinil had no effect on me is that I probably have the wrong variant of the rs4680 gene. rs4680 is known as the worrier/warrior gene; those with the AA variant tend to be neurotic, have high anxiety, and handle stress poorly (my personality in a nutshell). Studies have shown that people with this variant of rs4680 do not significantly respond to Modafinil, so I suspect that I am one of them. I plan on sending a DNA sample to 23andme soon to confirm whether or not my hunch is correct. With regard to getting a prescription, I'll note that my psychiatrist couldn't prescribe Modafinil directly to treat anxiety, so he indirectly prescribed it to address the "sleep issues" that were caused by my anxiety/depression. For me, 5 mg of Adderall does what I was hoping Modafinil would do. Personally speaking, productivity is far more important to me than "feeling good", which is what I think a lot of people abuse Adderall for (and it certainly does produce that "feel good" sensation at high enough dosages). But at 10 mg and less, it's like a much "smoother" version of caffeine. In fact, lately I've found that I don't really like caffeine anymore because it makes me crankier, sweatier, and more jittery than Adderall does, and it doesn't help my ability to focus as well.
guhcampos 10y ago
I have experienced discontinuation effects from Paroxetine, Venlafaxine and Fluxoetine in the past, Paroxetine was by far the worst, but absolutely within the boundaries of what the doctor and the tab mentioned. With Paroxetine itself the worst effects would be "blackouts" when I would loose all my senses for a split second, just short enough that I would not fall if walking, but long enough that people would notice during a conversation. During one specific Venlafaxine withdrawal, however, I have experienced severe depression, and got close to suicide. What saved me, ironically as it sounds, was a huge dose of Clonazepan I rationally decided to take just so I could sleep the withdrawal over. I'm still on Venlafaxine for a couple years now, I take it for Anxiety/Panic and that was the only time I've experienced severe depression in years. What I've learned from all that is simple: that stuff is messing directly and profoundly with your brain, so take it very seriously: anti-depressants are not your over-the-counter shit. Apart from that, find a doctor you trust and talk to them,every little detail. Never trust a psychiatrist who does not suggest some kind of therapy: the meds won't cure you. Also, I don't know of a single drug that won't give me some kind of discontinuation syndrome if interrupted after continuous use. From nose sprays and anti-acids to hypnotics, all have some rebound effects to them. I believe the bottom line is to be rational about taking any drugs, yet specially the ones messing with your head.
- cerrelio 10y ago
  I've taken sertraline, venlafaxine, bupropion and fluoxetine. Fluoxetine is the only SSRI I experienced no withdrawal from. I was on a low dose (10-20mg) though, and it mostly worked (went from severe depression to mild/none). I have a standing prescription for this as a fallback, but haven't taken it in 3 years. I avoid taking it because of the sexual side effects. I like having orgasms. Bupropion triggered a seizure after the first dose. Immediately discontinued. Venlafaxine was mostly effective, but I went from depressed to robotic/apathetic. When I stopped taking it, I tapered off, but I had brain zaps and developed acute tinnitus for over a month, alternating in each ear. To this day, 15 years after treatment, I still experience moderate hearing loss in my ears several times a month for about 60-90 seconds at a time. Sertraline was the worst. I got up to 150mg before the problems. It triggered a hypomanic episode that lasted for about a month. I didn't sleep at all for the first three days it manifested. The doctor stopped treatment immediately and put me on risperidone, which is a new level of awfulness. I just quit taking it after a month, and told my doctor I would never take any antipsychotic again. I have a great doctor now. He's not even a psychiatrist, just a generalist, but he's treated many cases of depression over the past 20 years. He figured I didn't have unipolar depression, but bipolar, due to the hypomania. SSRIs are bad, and not recommended, as monotherapy for bipolar. So he put me on lamotrigine and I haven't had a depressive (or manic) episode for over two years. I've also experienced no noticeable side effects. I've found the only thing that matters in the treatment of mental/behavioral disorders is your doctor's skill and knowledge. Don't be afraid to dump a mediocre doctor; it's your wellbeing on the line.
feld 10y ago
My brother was going through a divorce and committed suicide after his doctor refused to refill his prescription for antidepressants. I've always wondered if it was a windrawl side effect
aserafini 10y ago
Biggest effect from reducing my dose of fluoxetine was dreaming again. It's great.
- krylon 10y ago
  Huh. I've had rather vivid dreams on fluoxetine (although at a very low dose), but I remember the dreams being very un-spectacular in content. (Trimipramine on the other hand gives me highly vivid and very strange dreams, which I kind of like, but they are incredibly hard to remember.)
ffwacom 10y ago
"the distinctions between discontinuation symptoms and drug withdrawal are clear" Are they? Calling it "Discontinuation syndrome" rather than withdrawal seems like clever marketing.
seibelj 10y ago
10mg Lexapro every day... it saved my life. I am not joking
- ryan-allen 10y ago
  Me too :)
mrbill 10y ago
Even tapering off Cymbalta and tapering on to a different med at the same time.. Worst sickness of my life. Felt like death flu. Uncontrollable vomiting, diarrhea, chills, shivering, fever. I spent 4 days between bed and bathroom. Then suddenly on day 5 I was fine. While I was on it, it completely turned off everything below the belt. No response to stimulation at all. And mentally I was a zombie. Evil stuff. No such problems on Zoloft, celexa, or Prozac.
- ryan-allen 10y ago
  I've come off Lexapro with some odd 'brain' sensations but nothing super serious, 2 week taper from 15mg. I ended up coming back on it though. It helps a lot!
  - mrbill 10y ago
    I had occasional brain zaps when first on Lexapro (the first SSRI I ever took) but it wasn't bad.
bobharris 10y ago
I started Lexapro 10mg 5 days ago. 5mg taper up week. Reading stuff like this scares me. However based on my depression scales for months my LCPC and MD recommended it. Major life upsets back to back to back to back. I have light momentary nausea starting out. I hope it doesn't get worse. :( I'm only using it as a footing to work some recovery programs. Then I'm done.
benevol 10y ago
If you want to stop being dependent on anti-depressants (and their side-effects) while stopping depression at the same time, you may try a normal dose of LSD (after becoming a domain expert and testing the substance you have acquired). Complement this with daily practice of mindful meditation and you have a good chance to succeed. Also, you need to make sure to permanently change whatever lifestyle caused your depression.
- echlebek 10y ago
  Don't combine LSD with prescription medication. Don't take LSD if you are experiencing depression or mental illness.
naveen99 10y ago
I think people should see an endocrinologist and cardiologist before seeing a psychiatrist. A lot of real correctable health issues are hard to differentiate from depression, burnout, and can cause fatigue, anxiety etc.
- deleted 10y ago
  [deleted]

126 points by ipunchghosts 10y ago

On a related note, there's no good half-life calculator on the web for people tapering off SSRIs. The issue is that in order to actually have as gentle a taper as possible, you need to halve your dose only every few weeks because of how long the half life of these drugs is. So ideally you'd want something where you would enter your starting dose and how much of the drug you plan on taking each day, and it would show you your projected concentration of the drug each day as well as the percent change. I made this in Excel for someone a few years ago, but it would make a good weekend project if someone wants to learn react or whatever.

ipunchghosts 10y ago
I second this. I was on zoloft for IBS. Getting off of it was terrible. I had to taper down 25% each step and each step lasted weeks. Overall, it took the same time to taper off of it as when I needed it. I quit taking it because my IBS was not really IBS, it was a defective gallbladder. It was removed and my symptoms went away.
- DenisM 10y ago
  IBS - irritable bowel syndrome?
DanBC 10y ago
> The issue is that in order to actually have as gentle a taper as possible, you need to halve your dose only every few weeks because of how long the half life of these drugs is. The meds with worst discontinuation effects are those with short half life. Those with longer half life tend to have gentler discontinuation effects. EG https://www.ncbi.nlm.nih.gov/pubmed/10855379/ https://www.ncbi.nlm.nih.gov/pubmed/10855379/ > Serotonin re-uptake inhibitor withdrawal syndrome generally begins within 24 to 48 hours after discontinuing the drug. Signs reach their maximum on day 5 and usually resolve within 2 to 3 weeks. Withdrawal syndrome is more common with short half-life drugs (paroxetine, fluvoxamine). The intensity of the clinical signs depends on the daily dose and how long the drug has been given.

dbg31415 10y ago

We think of doctors and medications as being scientific and precise. But it's more like just throwing some food coloring into a black garbage bag full of all sorts of stuff and shaking it up in hopes of getting it to get to a specific color... but not really being able to see the color through the bag. The drugs all have side-effects, different for each person who takes them. And often those side-effects are as bad as the original ailment. But you trust your doctor, and you're in a bad spot... and you figure, "Fuck it, maybe it'll work and I'm willing to try anything at this point..." And ugh, it just all sucks. It's so hard to fix once you start down the medication path. Testing drugs, trying to find the right dose... deciding if the side-effects are worth the gains... withdrawal from drugs... drugs to help with the side-effects... drugs to help with the withdrawal... (often a few loops)... all of this can fundamentally change your personality and motivations, or have just no impact on you what-so-ever and leave you beyond frustrated. If you had cancer, everyone would be there to support you. If you have a mental illness, there's not much chance of getting support from peers... or friends -- it's tough, it's not their job to support you -- sure... but a lot of times mental health issues are exacerbated by feeling of isolation... which leads to medical treatment because you don't have other options... and the doctors all seem confident that drugs will help... Anyway, anything you can do to avoid mental health issues in the first place... do that. And if you don't have mental health issues, be thankful and humbly accept you're one concussion, bad breakup, car accident, death in the family, death of a pet, loss of job, or bad decision away from it if you aren't careful.

chris_wot 10y ago
In Australia (or at least NSW), the health system doesn't know what to do with you. About 7 months ago I had a mental breakdown and experienced thoughts of suicide. When the health system found out, I had finished having the thoughts, and was at home trying to sleep, being supported by my loving family having been awake at the time for over 14 hours. I was ripped out of my bed by ambulance officers with police present, despite my protests and my wife's - eventually agreeing to go voluntarily with them in their ambulance. Then after I got into the ED itself I discovered I'd been sectioned and not allowed to leave. After I realised this was what had happened I got placed in an isolation room, with no explanation as to why, and there I sat quietly rotting for the next 5.5 hours. In other words, I got no care, had my rights stripped and was treated like a criminal because after a sustained period of incredible stress I had a breakdown. I was then sent back home as they decided I shouldn't have been there in the first place. I was then sent a bill for $600. The system sucks.

rudolf0 10y ago

The article seems sound, but the source does look a bit biased.

0xcde4c3db 10y ago
The source isn't just a bit biased, it's hugely biased. Mad in America has an open editorial viewpoint, which is opposition to "the current drug-based paradigm of care" in psychiatry [1]. It's headed by Robert Whitaker, probably best known for his book Anatomy of an Epidemic that questions the routine use of psychiatric drugs [2]. Of course, that doesn't mean the article is useless or not addressing real phenomena. Antidepressant withdrawal is real, and IME it's something you're more likely to hear about as a horror story from a patient (especially if they tried to stop Effexor cold-turkey) rather than as part of standard descriptions of depression treatment and its risks/shortcomings. [1] https://www.madinamerica.com/about-us/ https://www.madinamerica.com/about-us/ [2] https://www.madinamerica.com/robert-whitaker-new/ https://www.madinamerica.com/robert-whitaker-new/
- rudolf0 10y ago
  Oh yeah, I've used SSRIs and suffered the withdrawal. I know they're not making things up or whatever. But I also think that taking such a universal anti-psychiatric drug stance is probably too hardline of a position. I think they are the lesser of two (or more) evils for a lot of patients.

aaron-lebo 10y ago

Not sure if this supports the article or is just a warning, but going off of anti-depressants can be fatal. If depression relapses anti-depressants that once worked can prove ineffective. (edit: wrongly said SSRIs and not anti-depressants) David Foster Wallace: Wallace died by suicide on September 12, 2008, at age 46. Wallace's father reported in an interview that his son had suffered from depression for more than 20 years and that antidepressant medication had allowed him to be productive.[42] When Wallace experienced severe side effects from the medication, he attempted to wean himself from his primary antidepressant, phenelzine.[43] On his doctor's advice, Wallace stopped taking the medication in June 2007,[42] then the depression returned. Wallace received other treatments, including electroconvulsive therapy. When he returned to phenelzine, he found that it had lost its effectiveness.[43] His wife kept a watchful eye on him in the following days, but on September 12, Wallace went into the garage, wrote a two-page note, and arranged part of the manuscript for The Pale King before hanging himself from a patio rafter.[49] It's something to be very careful about...

robertcorey 10y ago
phenelzine is an MAOI
drzaiusapelord 10y ago
Phenelzine is actually a MAOI, which is a different class of drug. My understanding is that Wallace had hard to treat depression and was on this more dangerous class of drug as SSRI's didn't work well on him. He also died with Clonazepam and Temazepam in his system. Wallace also received electric shock therapy, which suggests his depression was much more serious than most cases. I think his case is very much an edge case here. He had very serious problems with a hard to treat depression and was on a MAO inhibitor, which is seen as the last resort for pharmacological treatments of depression because its so unstable, short-lived, and has nasty side effects and is difficult to ween off. SSRI's are much more safe.
- nylonstrung 10y ago
  He actually wrote about his experiences with MAOIs in an early short story in a college journal. This was in the early 80s, well before Prozac and SSRIs made it to market. https://quomodocumque.files.wordpress.com/2008/09/wallace-amherst_review-the_planet.pdf https://quomodocumque.files.wordpress.com/2008/09/wallace-am...

tokenadult 10y ago

The home page of the site hosting the webpage submitted here, "Mad in America: Science, Psychiatry, and Social Justice" looks to put a lot more emphasis on the social justice, as the authors published on the site define that, than on science in general or psychiatry in particular. This is more a site that advocates for a particular policy point of view than a site that neutrally reviews the latest methodologically careful research. https://www.madinamerica.com/ https://www.madinamerica.com/ "

tcj_phx 10y ago
> This is more a site that advocates for a particular policy point of view than a site that neutrally reviews the latest methodologically careful research. Mad in America was the title of investigative journalist Robert Whitaker's first book. Whitaker's second book, Anatomy of an Epidemic, proposes that there is not and has never been any evidence that commonly used psychiatric prescriptions actually work over the long-term. This HN submission was from 2 days ago: Psychiatrists Must Face Possibility That Medications Hurt More Than They Help (scientificamerican.com) - https://news.ycombinator.com/item?id=13186201 https://news.ycombinator.com/item?id=13186201 The Scientific American article says, essentially, that "Maybe Robert Whitaker is right..." I am not anti-psychiatry, I am opposed to treating symptoms instead of causes. My friend would be doing much better if her psychiatrists would prescribe useful drugs (naltrexone, thyroid, B-vitamins, etc), instead of harmful ones.
geofft 10y ago
But of course which methodologically careful research has been done of late is extremely agenda-driven and politicized, too! You can't launder your biases away by putting them behind the abstraction barrier of what the government or what drug companies are willing to fund. That's how you end up with p-hacking. Better to acknowledge that the reason people do science is to do things with science, not because they find sound research intrinsically fulfilling, and that everyone and every funding agency brings their biases, their hopes and dreams for society, with them.
- mmjaa 10y ago
  > agenda-driven More like, profit-driven. If we want to get better, we have to stop allowing a class of society to profit from the sickness. Pharmaceutical companies exist not to make anyones lives better - they exist to generate profit. I'm highly suspicious of the drug-taking culture, as it attempts to justify the enslavement of the individual by way of supplanting their supposed mental-health problems with a very profitable subscription to a proprietary/patented/owned drug formula. I think it is very sad to read this HN article and listen to all the stories of folks who think they are improving their lives with this chemical dependency, and it is really tragic that drug-taking is such a cultural phenomenon that anyone who dares to rise above the field and say "hey, maybe we don't need to do this - maybe there is another way" gets cut down to serve as fodder for the rest of the poppies. Its quite possible that we've all been swindled by our own hubris. Its happened before. The Romans had their lead pipes, the Victorians their laudanum, and we - "modern" society - have our Prozac and Zoloft. Dare to mention alternative means of lifting oneself out of the mire, and you will incur a great deal of wrath - such is the investment in the propaganda from the multi-billion-dollar pharmaceutical industry in capturing the subject and making sure nobody dares think otherwise to their drug-delivery supply chains...

vomitcuddle 10y ago

As someone who had to abruptly come off venlafaxine due to side effects, I can tell you that it was complete hell. I experienced vomiting, the weirdest, most horrible nightmares every night, sleep paralysis with hallucinations and a recurring feeling of "electic shocks" inside my head. This lasted about a month. I think it borders on inhumane not to mention possible withdrawal symptoms before prescribing this awful "anti-"depressant. My doctor eventually prescribed me trazodone, so I could just sleep the withdrawals off.

mcjiggerlog 10y ago
I went through a similar experience (although not as extreme) when coming off of citalopram, even with a doctor's guidance. Lots of nausea and disorientation, but worst of all were the "electric shocks" which really were very disturbing. Not a single mention of these when having the medicine prescribed!
- nspriego 10y ago
  If I miss taking citalopram 2 days in a row I start getting these "electric shocks" and dizzyness. Glad to know I'm not the only one.
ds18 10y ago
Do you mind me asking what your dosage was and if you went cold turkey or tapered off at all?
- DanBC 10y ago
  I'm not the person you replied to, but I was on 350 mg (which is a reasonably high dose). I was on venlafaxine regular release, not the extended release. If I missed a dose I got full on discontinuation effects. When I tapered off it wasn't great, but it wasn't awful. Some people do report problems even with a very gentle long taper down.
  - radd9er 10y ago

thanatropism 10y ago

Oh boy oh boy oh boy. The problems pointed out in this article -- which are in some degree real even if heavily editorialized -- must be understood in light of a wider context which includes: 0) The very poor standards of validity and replicability in most fields of experimental psych-whatever. The Popperian method ain't what it used to be. 1) The Viennese Waltz of bad incentives throughout the psychiatry research pipeline. Most notably, drug companies are incentivized for fraud and deceit by being rewarded for closely-guarded research, hiding negative studies and obtaining patent extensions for new applications of existing drugs. 2) Somewhat related to (1): the unfortunate drug safety model prevalent in all relevant nations in which drugs must be proven to work for some pathology. Besides incentivizing recklessness in industry-led research, this means viable off-label usages go "underground" (topiramate for dissociative disorders is a typical case where FDA-worthy testing might be impossible). It might be better if the FDA and its counterparts instead regulated for drug _safety_ in humans and let the academic and clinical communities evolve their professional consensuses. 3) Much related to (0): the effective failure of "talking cures" in outcompeting drugs (specially "dirty drugs" like anticonvulsants, neuroleptics and non-SSRI antidepressants) for "simple" depression, bereavement and related mental health issues of which one could whip up a "social critique" of drug use and so forth. "Mad in America" is obviously not willing to make a fuss of things like bipolar where people will take their lithium for decades and bear the side-effects because the alternative is to go actually mad-crazy. Did I miss something?

Lxr 10y ago
> It might be better if the FDA and its counterparts instead regulated for drug _safety_ in humans and let the academic and clinical communities evolve their professional consensuses. The problem is that safety is not binary - it's a question of severity and probability of adverse effects vs the benefit of the drug (the risk of adverse side effects is more acceptable for a cancer treatment than a cough medicine for instance). The purported purpose of regulation is to balance risk vs benefit. Therefore the regulator needs to incorporate the indication into their decision, and so they must evaluate if it actually works.
tcj_phx 10y ago
> "Mad in America" is obviously not willing to make a fuss of things like bipolar where people will take their lithium for decades and bear the side-effects [...] The creation and promotion of "Bipolar" as a DSM disorder is covered in Anatomy of an Epidemic, Robert Whitaker's followup to Mad in America. > [...] because the alternative is to go actually mad-crazy. The whole point of Whitaker's Mad in America foundation is to change the paradigm of our approach to mental health. nstead of trying to find the right drug to make a symptom go away, it would be much more effective to figure out non-psychotropic-drug ways to help people function better.

69mlgsniperdad 10y ago

I have been on paxil(paroxetine) three separate times. Each was between six months and one year in duration. The first time, I was on a 10mg daily dose. I had quite a few issues when starting the medication the first time; however after a few weeks, I felt great. When I initially discontinued, I had the worst side effects I have ever experienced. Electric shocks in my neck and back of head, depression, mood swings, and terrible panic attacks lasting almost two weeks. The doctor told me it wasn't 'addictive' and there is no issue stopping the medication, afterwards I changed my physician. The new doctor also insisted there were no known withdrawal symptoms. If you google the issue there are thousands of reports and dozens of websites about this exactly. I have no idea why doctors tell people there is nothing to worry about but there are certainly many negative side effects experienced while starting and discontinuing SSRI's. For subsequent treatments of paxil and other SSRI's, I have made sure to slowly titrate my dose when starting and discontinuing treatment. 1/4 doses for a week, half for a week, 3/4 for a week, and then full dosage. I have done the same for discontinuing, sometimes even more gradual then that, and have avoided the terrible experience since.

rudolf0 10y ago
Doctors can be notoriously ignorant and contradictory when it comes to mental illness-treating drugs. There's a lot of literature out there and a lot of them don't keep up. I don't know why it is. Not that you shouldn't trust doctors, but I always do some Googling to get a second opinion about all psychoactive drugs I'm prescribed.
- ekianjo 10y ago
  You should always seek a second opinion from different specialists. If all of them tell you the very same thing it is probably safe to assume what they recommended is well established. But its far from being always the case. Doctors are not machines and influenced by a number of factors so none of them should be considered infaillible.
- agumonkey 10y ago
  It's very very uneasy when doctors are too handwavey on your issues. You don't know if they're skipping beats because they don't want to explain 10 years of med school so you obey, or if they just don't want to investigate more than what the usual answer is. I tried to nitpick on things that mattered for me, but you cannot easily claim "I'm more up to date than you on <xyz> illness" to a legal doctor without feeling a little ridiculous. That's why I root for more non invasive monitoring and intervention. Many doctors told me the "based on these tests, you have nothing", bailing out when I asked for more because deeper tests would require potential ICU. So you end up floating in the unknown hoping for the best.

KirinDave 10y ago

I had this terrible experience before I was publicly out about my gender that sent me into a very suicidal train of thought. I had a moment clarity to get myself to a doctor (my partner was pregnant at the time, or I probably won't be here writing this now). The doctor gave me citalopram (brand name is Celexa, I think?) I had to stop taking it. I'll list the side effects I had, but not before I point out: It saved my life. Yes, I had bad side effects. But it also helped me overcome the anxiety and rage I was suffering from and resolve to come out about my status. Ultimately I had to taper off of it, which was hard. My doctor advised reducing my dose by 1/4 the original value every 9 days until I was done. The end of it was quite rough, I confess. But while on it, I gained nearly all the weight I lost in a year of physical training back (just 4 months of treatment), my heart palpitations were nauseatingly bad, and I suddenly had to sleep a lot longer to get even a modicum of rest. When people say, "You should consider medication" it is to help normalize the idea that in trauma situations medication can help people with some types of MI. It is not because they're fun, side-effect free, or not a "real" course of treatment. It's important to remember that when considering these stories and your own mental health.

dannylandau 10y ago
Did the side effects from Celexa correspond to those found on this health search engine Healthbee
- KirinDave 10y ago
  I listed them and my doctor said they were actually in the most common side effects. I have not pursued information beyond that.
harshreality 10y ago
I don't think even people like the anti-med Robert Whitaker would be against using these medications short-term, for major clinical depression or for other conditions where patients are low- or non-functioning; the primary goal there is to get people stable so they can participate in productive behavioral therapy or modification so that they don't need the meds long-term (particularly since afaik the balance of evidence is that the effectiveness of these meds declines to the placebo level over the long term). It's the use of psychiatric medication for relatively minor psychiatric disturbances in high-functioning individuals, and for long periods of time (years), that draws most of the criticism.

KermitCole 10y ago

As an editor on Mad in America, I appreciate the thoughtful and thorough discussion here. We would welcome any stories or analysis that the commenters here might venture to contribute to MIA. Thanks, Kermit Cole

dannylandau 10y ago
Are there any comprehensive portals that provide information about the prevalence of each drug's side effect? The only one I know of is HealthBee? - https://healthbee.co/ https://healthbee.co/
- faitswulff 10y ago
  I was curious how good HealthBee was, so I asked a pharmacist friend of mine. Her response: "Bad LOL. It could not find the first drug I want to look at- apixaban or Eliquis. Generic name and brand name, respectively" Apixaban is apparently a common drug. That said, even she was interested in such a portal as well, saying that it just needs more data.
- markroseman 10y ago
  I find drugs.com useful, which seems to be derived from product monographs. Knowing that "very common", "common", "uncommon", "rare" and "very rare" have specific meanings (e.g. common -> 1%-10%) helps.

numinary1 10y ago

It seems to me that many of the drugs in this category are effective sometimes for some people. People I have known who were suffering acutely often cycled through several drugs, sometimes in combination, dosages etc. It appears to me to be mostly trial and error. But for some people the results are miraculous. They solve real problems with few if any side effects. For others, they either don't work at all or have intolerable side effects. The situation would be a whole lot better if we could predict likely efficacy and side effects in advance, especially cases where treatment is more likely to do harm that to help. Interestingly, I've read a lot (not so much recently) on the subject and taken several SSRIs myself (with good short term experience, minor sides), but I learned a lot from the discussion here. So many people take these drugs — the data necessary to understand and perhaps to predict ... is out there. Not easy to get at, but really plentiful. Reading this made me think about the feasibility of mining message boards for first person accounts of SSRI experience.

markroseman 10y ago
While there is some work done on matching people up with specific drugs, this is still very much in the research phase. Still, for many people, it's more trial and error than it needs to be. Many family doctors still don't match up symptoms with neurotransmitters, and then put people on the wrong class of drugs altogether (e.g. something like Wellbutrin which works on norepinephrine and dopamine instead of an SSRI for anxiety which is more associated with serotonin). Part of the reason is that new drugs keep coming out so it's difficult to keep up, and eventually they all start to blur together. The best practical predictor of success on a given medication today is if you have a close relative who's had success on that medication.
- numinary1 10y ago
  That certainly makes sense since the problem has a higher likelihood of stemming from the same root cause, but also speaks to how little is known. So include the social graphs of people who are on antidepressant discussion boards and pick up on friends, family, socioeconomic features ... I so want to use ML tools on medical treatment data, but it's so hard to come by. Have toyed with a couple of startup ideas based on the tendency of people who share a condition to establish ties. Crohn's disease, cutaneous lymphoma. But the groups are too small. Mood disorders on the other hand...

jrapdx3 10y ago

The effects of abruptly stopping SSRI (and later on SNRI) medications have been well-known since the 1980's. It's considered related to the widespread if individually variable distribution of serotonin receptors in the body. Having prescribed a ton of SSRI/SNRI meds since their introduction, and taken my share as well, it's a phenomenon I'm very familiar with. Called a "discontinuation syndrome", technically not the same as "withdrawal", which is associated with tolerance, the need to continually increase dose to get the same effect. SSRIs can produce a D/C effect at low or high dose if more likely with greater dose. Individual response to SSRI D/C varies greatly. I've been very surprised at times when people tell me they've gone off 200mg of Zoloft and never noticed a thing. Others report D/C effects for weeks even after tapering down very gradually. Most of the time problems with D/C reflect short half-life of compounds. Effexor is notorious in this regard. OTOH more persistent agents like Prozac are typically less troublesome. In fact it's a common strategy to use Prozac as an means to ease D/C when stopping short duration meds. Going by reports of (probably) a thousand patients, as well as my own experience of D/C effects, generally they're mild to moderate and dissipate within a few days. However there are exceptions and I never hesitated to go as slowly as necessary to minimize excessive discomfort while tapering off the medication. As I've commented before on HN, this subject again emphasizes some crucially important principles. One is that any medication can cause any side effect at any time. No free lunch, all medicines have numerous effects, some favorable and some not, so it's important to make sure there's a damn good reason for using any medication and understand the risks and benefits. Finally, every individual has a unique condition and responds uniquely to the treatments we have to offer. It's a partnership between the prescriber and the patient, communication about what's happening during the course of treatment is vital. Believe me I know, whether in the role of doctor or patient, it's a highly evolved art form.

an_d_rew 10y ago
That was a carefully worded and thoughtful reply... thank you!

throwaway713 10y ago

I was on Nardil (phenelzine) for about 6 months. That's some weird stuff right there. I gained a whole bunch of weight, lost the ability to dream while sleeping, and couldn't eat any foods with tyramine in them (like Iberian ham or fava beans), but man, chocolate cake never tasted so heavenly as when on Nardil. Prior to Nardil, I had been taking Prozac (fluoxetine) but a combination of sexual side effects, an impatient disposition, and scientific curiosity prompted me to ask my psychiatrist about Nardil. He said, "Why not?" This psychiatrist would prescribe just about anything (not that I see anything wrong with that) so over the course of grad school I tried Prozac, Nardil, Modafinil, and Adderall. Oddly enough, it turned out that an extremely low dosage of Adderall fixed most of my issues. My psychiatrist started with me 30 mg twice a day but I found that 10 mg worked better (less euphoria, more focus), so nowadays I only take 10 mg Adderall about twice a week and don't seem to have any depression or focus issues anymore.

chillwaves 10y ago
What did you think about Modafinil? I went on it for a few months (without advice of a doctor) and thought it put a great pep in my step. Now that I have insurance, I will try to get it prescribed but it seemed gentle in a way, like a different flavor of caffeine but also gave me confidence. Unless I took too much, then I felt on edge, like I was clenching my jaw (probably was). I guess I am asking you about Modafinil because somehow I was under the impression it's a somewhat casual drug and the rest in your list seem like heavy weights to me. I have never taken any kind of antidepressant but sometimes think I need to.
- throwaway713 10y ago
  I had no response to Modafinil at all. I started at 100 mg and worked up to 400 mg (under my psychiatrist's supervision), but at 400 mg, both he and I decided it wasn't doing anything — positive or negative — so I quit taking it. After researching the subject a bit, my guess as to why Modafinil had no effect on me is that I probably have the wrong variant of the rs4680 gene. rs4680 is known as the worrier/warrior gene; those with the AA variant tend to be neurotic, have high anxiety, and handle stress poorly (my personality in a nutshell). Studies have shown that people with this variant of rs4680 do not significantly respond to Modafinil, so I suspect that I am one of them. I plan on sending a DNA sample to 23andme soon to confirm whether or not my hunch is correct. With regard to getting a prescription, I'll note that my psychiatrist couldn't prescribe Modafinil directly to treat anxiety, so he indirectly prescribed it to address the "sleep issues" that were caused by my anxiety/depression. For me, 5 mg of Adderall does what I was hoping Modafinil would do. Personally speaking, productivity is far more important to me than "feeling good", which is what I think a lot of people abuse Adderall for (and it certainly does produce that "feel good" sensation at high enough dosages). But at 10 mg and less, it's like a much "smoother" version of caffeine. In fact, lately I've found that I don't really like caffeine anymore because it makes me crankier, sweatier, and more jittery than Adderall does, and it doesn't help my ability to focus as well.

guhcampos 10y ago

I have experienced discontinuation effects from Paroxetine, Venlafaxine and Fluxoetine in the past, Paroxetine was by far the worst, but absolutely within the boundaries of what the doctor and the tab mentioned. With Paroxetine itself the worst effects would be "blackouts" when I would loose all my senses for a split second, just short enough that I would not fall if walking, but long enough that people would notice during a conversation. During one specific Venlafaxine withdrawal, however, I have experienced severe depression, and got close to suicide. What saved me, ironically as it sounds, was a huge dose of Clonazepan I rationally decided to take just so I could sleep the withdrawal over. I'm still on Venlafaxine for a couple years now, I take it for Anxiety/Panic and that was the only time I've experienced severe depression in years. What I've learned from all that is simple: that stuff is messing directly and profoundly with your brain, so take it very seriously: anti-depressants are not your over-the-counter shit. Apart from that, find a doctor you trust and talk to them,every little detail. Never trust a psychiatrist who does not suggest some kind of therapy: the meds won't cure you. Also, I don't know of a single drug that won't give me some kind of discontinuation syndrome if interrupted after continuous use. From nose sprays and anti-acids to hypnotics, all have some rebound effects to them. I believe the bottom line is to be rational about taking any drugs, yet specially the ones messing with your head.

cerrelio 10y ago
I've taken sertraline, venlafaxine, bupropion and fluoxetine. Fluoxetine is the only SSRI I experienced no withdrawal from. I was on a low dose (10-20mg) though, and it mostly worked (went from severe depression to mild/none). I have a standing prescription for this as a fallback, but haven't taken it in 3 years. I avoid taking it because of the sexual side effects. I like having orgasms. Bupropion triggered a seizure after the first dose. Immediately discontinued. Venlafaxine was mostly effective, but I went from depressed to robotic/apathetic. When I stopped taking it, I tapered off, but I had brain zaps and developed acute tinnitus for over a month, alternating in each ear. To this day, 15 years after treatment, I still experience moderate hearing loss in my ears several times a month for about 60-90 seconds at a time. Sertraline was the worst. I got up to 150mg before the problems. It triggered a hypomanic episode that lasted for about a month. I didn't sleep at all for the first three days it manifested. The doctor stopped treatment immediately and put me on risperidone, which is a new level of awfulness. I just quit taking it after a month, and told my doctor I would never take any antipsychotic again. I have a great doctor now. He's not even a psychiatrist, just a generalist, but he's treated many cases of depression over the past 20 years. He figured I didn't have unipolar depression, but bipolar, due to the hypomania. SSRIs are bad, and not recommended, as monotherapy for bipolar. So he put me on lamotrigine and I haven't had a depressive (or manic) episode for over two years. I've also experienced no noticeable side effects. I've found the only thing that matters in the treatment of mental/behavioral disorders is your doctor's skill and knowledge. Don't be afraid to dump a mediocre doctor; it's your wellbeing on the line.

feld 10y ago

My brother was going through a divorce and committed suicide after his doctor refused to refill his prescription for antidepressants. I've always wondered if it was a windrawl side effect

aserafini 10y ago

Biggest effect from reducing my dose of fluoxetine was dreaming again. It's great.

krylon 10y ago
Huh. I've had rather vivid dreams on fluoxetine (although at a very low dose), but I remember the dreams being very un-spectacular in content. (Trimipramine on the other hand gives me highly vivid and very strange dreams, which I kind of like, but they are incredibly hard to remember.)

ffwacom 10y ago

"the distinctions between discontinuation symptoms and drug withdrawal are clear" Are they? Calling it "Discontinuation syndrome" rather than withdrawal seems like clever marketing.

seibelj 10y ago

10mg Lexapro every day... it saved my life. I am not joking

ryan-allen 10y ago
Me too :)

mrbill 10y ago

Even tapering off Cymbalta and tapering on to a different med at the same time.. Worst sickness of my life. Felt like death flu. Uncontrollable vomiting, diarrhea, chills, shivering, fever. I spent 4 days between bed and bathroom. Then suddenly on day 5 I was fine. While I was on it, it completely turned off everything below the belt. No response to stimulation at all. And mentally I was a zombie. Evil stuff. No such problems on Zoloft, celexa, or Prozac.

ryan-allen 10y ago
I've come off Lexapro with some odd 'brain' sensations but nothing super serious, 2 week taper from 15mg. I ended up coming back on it though. It helps a lot!
- mrbill 10y ago
  I had occasional brain zaps when first on Lexapro (the first SSRI I ever took) but it wasn't bad.

bobharris 10y ago

I started Lexapro 10mg 5 days ago. 5mg taper up week. Reading stuff like this scares me. However based on my depression scales for months my LCPC and MD recommended it. Major life upsets back to back to back to back. I have light momentary nausea starting out. I hope it doesn't get worse. :( I'm only using it as a footing to work some recovery programs. Then I'm done.

benevol 10y ago

If you want to stop being dependent on anti-depressants (and their side-effects) while stopping depression at the same time, you may try a normal dose of LSD (after becoming a domain expert and testing the substance you have acquired). Complement this with daily practice of mindful meditation and you have a good chance to succeed. Also, you need to make sure to permanently change whatever lifestyle caused your depression.

echlebek 10y ago
Don't combine LSD with prescription medication. Don't take LSD if you are experiencing depression or mental illness.

naveen99 10y ago

I think people should see an endocrinologist and cardiologist before seeing a psychiatrist. A lot of real correctable health issues are hard to differentiate from depression, burnout, and can cause fatigue, anxiety etc.

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