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Ah, another Benedict Carey antidepressant hatchet job. Anecdotes about withdrawal symptoms + alarmist statistics about number of Americans on antidepressants +

Ah, another Benedict Carey antidepressant hatchet job. Anecdotes about withdrawal symptoms + alarmist statistics about number of Americans on antidepressants + vague questions about lack of data suggesting that we know little about antidepressant long-term safety. A few important points: 1. Antidepressants can truly change people's lives. Not everyone's, and they're not the only treatment that works. Somehow this reporter tends to consistently overlook the clear evidence of benefit (I think this recent meta-analysis was posted on hn: https://www.ncbi.nlm.nih.gov/pubmed/29477251 https://www.ncbi.nlm.nih.gov/pubmed/29477251) 2. Withdrawal symptoms are common if antidepressants are stopped abruptly - some of the folks who reported these symptoms originally have been favorite targets of Benedict Carey, ironically (https://www.ncbi.nlm.nih.gov/pubmed/9396960 https://www.ncbi.nlm.nih.gov/pubmed/9396960). That's why docs encourage tapering antidepressants. 3. The article doesn't distinguish between this sort of short-term withdrawal (common), and longer-term problems with discontinuation (likely quite rare) - they're very very different phenomena. 4. In some cases, difficulty with discontinuing longer-term is a result of persistent depression and anxiety (or returning depression and anxiety). It's not polite to point this out. 5. It's hard to imagine the Times writing an article about the problem with statins being that, once you stop them, cholesterol increases again. 6. If there were substantial long-term risks associated with antidepressants, we would have seen them - and believe me, people have looked and are looking. 7. BUT - we /do/ need more research to understand long-term effects of antidepressant treatment; this absence of systematic long-term study is true for most meds, frankly, but that's no excuse. My question would be: Who pays for it? There's no shortage of investigators who would be delighted to study it. But try getting a foundation, or NIH, to support such a study. /rant

dimal 9y ago
> If there were substantial long-term risks associated with antidepressants, we would have seen them Drug makers have no incentive to see them. I can say from experience that I have seen them. I spent two months out of work when I had to discontinue Effexor. Other people complained about “brain zaps” and were largely ignored. My doctor never warned me. The evidence is there but there if you look, but there is no one with an economic incentive to pay attention. Just because there are few studies documenting these symptoms doesn’t mean they’re not. This is a wake up call that more studies need to be done.
- DanBC 9y ago
  Discontinuation effects are listed on the patient information leaflet for venlafaxine. Patients, at least in the UK, are always given this leaflet with every packet of medication. https://www.medicines.org.uk/emc/product/4487/pil https://www.medicines.org.uk/emc/product/4487/pil > If you stop taking venlafaxine suddenly you may get withdrawal reactions (see section 3) [...] > Do not stop taking your treatment or reduce the dose without the advice of your doctor even if you feel better. If your doctor thinks that you no longer need Venlafaxine tablets, he/she may ask you to reduce your dose slowly, before stopping treatment altogether. Side effects are known to occur when people stop using Venlafaxine tablets, especially when Venlafaxine tablets is stopped suddenly or the dose is reduced too quickly. Some patients may experience symptoms such as tiredness, dizziness, light-headedness, headache, sleeplessness, nightmares, dry mouth, loss of appetite, nausea, diarrhoea, nervousness, agitation, confusion, ringing in the ears, tingling or rarely, electric shock sensations, weakness, sweating, seizures or flu-like symptoms. Your doctor will advise you on how you should gradually discontinue Venlafaxine tablets treatment. If you experience any of these or other symptoms that are troublesome, ask your doctor for further advice.
  - dimal 9y ago
    And of course, all patients read the long pamphlets extensively /s. We depend on our doctors to explain risks like this. And at the time I was discontinuing (not abruptly) the concept of “brain zaps” was met with great skepticism. I am fairly certain that some of the side effects you list (electric shock sensations) were added more recently. It took years of patients being ignored for the idea to be taken seriously.
    - pasabagi 9y ago
      I've also rarely received accurate advice regarding the likely effects and side-effects of anti-depressants - but I think calling brain zaps a 'risk' is a bit much. Maybe my zaps were nicer than yours, but I don't remember them being particularly painful - except one time I fell in the shower. Anti-depressants, especially something like venlafaxine, are strong meds for a strong condition. It would be surprising if they had no side effects - and honestly, if you go to a psychiatrist instead of a normal doctor, you usually get a dose that's fine-tuned to the extent that you don't get them.
electricEmu 9y ago
1) So do placibos 2) They're common while tapering too. 3) Agreed 4) Possibly true. What's unpolite about mentioning this? 5) Wrong analogy; depression only increases would be analogous to increased cholesterol. What are statin drug side effects when quitting, from the drug. 6) The mechanism of action isn't even fully understand. You're absolutely wrong to claim "we would have seen them (long-term side effects)". Isn't there an article on ceiliac disease and how long it took to pin down on HN's front page now? 7) You mentioned in #6 we should already know. If I had a rant, about overly-confident individuals posting on forums. While I've no reason to believe you were intentionally dishonest, the over confident, "factual" sounding, behavior has the same basis as disinformation activists. Experience? Was on antidepressants. Had a horrible side effects unrelated to depression coming off them. Safe my ass.
- cassowary37 9y ago
  well said... in order, then... 1. Read the reference before responding; the study looked (in part) at antidepressant-placebo differences. Also - I can't prescribe placebo. 2. Got anything to back that up? 3. OK 4. Because it implies that some of the 'withdrawal' symptoms are actually recurrent depressive/anxious symptoms (which can include somatic symptoms). Which is different than arguing that all of these symptoms are a consequence of relapse/recurrence. 5. Well, one of the critiques of antidepressants is that, after someone is on them for years, depression can recur... but fair point, not a perfect analogy. 6. Fully understood? It's not even a little understood. What does that have to do with detecting long-term consequences? We have 25 year follow-up data with antidepressants now. Despite lots of effort to find otherwise, show me some solid literature supporting risk. 7. Yup. We should. And we should keep looking. We also agree that there's substantial harm associated with people confidently posting misinformation - so while I mostly lurk here on HN, I feel that 20+ years of treating mood disorders and 20+ years of pharmacovigilance research gives me the right to push back. Lived experience is critically important, but it does not trump data.
  - phkahler 9y ago
    >> Lived experience is critically important, but it does not trump data. I would argue that for an individual, lived experience trumps all data - for them. Data is an aggregate of individual experiences. A single persons experience is a data point, not an anecdote.
jotm 9y ago
I used to get imipramine, which was replaced with venlafaxine. The latter was shit, but of course no one could prescribe imipramine just because I wanted it (also probably because it went generic and it was too cheap to prescribe). Fuck them all, bunch of crooks.

dimal 9y ago

> If there were substantial long-term risks associated with antidepressants, we would have seen them Drug makers have no incentive to see them. I can say from experience that I have seen them. I spent two months out of work when I had to discontinue Effexor. Other people complained about “brain zaps” and were largely ignored. My doctor never warned me. The evidence is there but there if you look, but there is no one with an economic incentive to pay attention. Just because there are few studies documenting these symptoms doesn’t mean they’re not. This is a wake up call that more studies need to be done.

DanBC 9y ago
Discontinuation effects are listed on the patient information leaflet for venlafaxine. Patients, at least in the UK, are always given this leaflet with every packet of medication. https://www.medicines.org.uk/emc/product/4487/pil https://www.medicines.org.uk/emc/product/4487/pil > If you stop taking venlafaxine suddenly you may get withdrawal reactions (see section 3) [...] > Do not stop taking your treatment or reduce the dose without the advice of your doctor even if you feel better. If your doctor thinks that you no longer need Venlafaxine tablets, he/she may ask you to reduce your dose slowly, before stopping treatment altogether. Side effects are known to occur when people stop using Venlafaxine tablets, especially when Venlafaxine tablets is stopped suddenly or the dose is reduced too quickly. Some patients may experience symptoms such as tiredness, dizziness, light-headedness, headache, sleeplessness, nightmares, dry mouth, loss of appetite, nausea, diarrhoea, nervousness, agitation, confusion, ringing in the ears, tingling or rarely, electric shock sensations, weakness, sweating, seizures or flu-like symptoms. Your doctor will advise you on how you should gradually discontinue Venlafaxine tablets treatment. If you experience any of these or other symptoms that are troublesome, ask your doctor for further advice.
- dimal 9y ago
  And of course, all patients read the long pamphlets extensively /s. We depend on our doctors to explain risks like this. And at the time I was discontinuing (not abruptly) the concept of “brain zaps” was met with great skepticism. I am fairly certain that some of the side effects you list (electric shock sensations) were added more recently. It took years of patients being ignored for the idea to be taken seriously.
  - pasabagi 9y ago
    I've also rarely received accurate advice regarding the likely effects and side-effects of anti-depressants - but I think calling brain zaps a 'risk' is a bit much. Maybe my zaps were nicer than yours, but I don't remember them being particularly painful - except one time I fell in the shower. Anti-depressants, especially something like venlafaxine, are strong meds for a strong condition. It would be surprising if they had no side effects - and honestly, if you go to a psychiatrist instead of a normal doctor, you usually get a dose that's fine-tuned to the extent that you don't get them.

electricEmu 9y ago

1) So do placibos 2) They're common while tapering too. 3) Agreed 4) Possibly true. What's unpolite about mentioning this? 5) Wrong analogy; depression only increases would be analogous to increased cholesterol. What are statin drug side effects when quitting, from the drug. 6) The mechanism of action isn't even fully understand. You're absolutely wrong to claim "we would have seen them (long-term side effects)". Isn't there an article on ceiliac disease and how long it took to pin down on HN's front page now? 7) You mentioned in #6 we should already know. If I had a rant, about overly-confident individuals posting on forums. While I've no reason to believe you were intentionally dishonest, the over confident, "factual" sounding, behavior has the same basis as disinformation activists. Experience? Was on antidepressants. Had a horrible side effects unrelated to depression coming off them. Safe my ass.

cassowary37 9y ago
well said... in order, then... 1. Read the reference before responding; the study looked (in part) at antidepressant-placebo differences. Also - I can't prescribe placebo. 2. Got anything to back that up? 3. OK 4. Because it implies that some of the 'withdrawal' symptoms are actually recurrent depressive/anxious symptoms (which can include somatic symptoms). Which is different than arguing that all of these symptoms are a consequence of relapse/recurrence. 5. Well, one of the critiques of antidepressants is that, after someone is on them for years, depression can recur... but fair point, not a perfect analogy. 6. Fully understood? It's not even a little understood. What does that have to do with detecting long-term consequences? We have 25 year follow-up data with antidepressants now. Despite lots of effort to find otherwise, show me some solid literature supporting risk. 7. Yup. We should. And we should keep looking. We also agree that there's substantial harm associated with people confidently posting misinformation - so while I mostly lurk here on HN, I feel that 20+ years of treating mood disorders and 20+ years of pharmacovigilance research gives me the right to push back. Lived experience is critically important, but it does not trump data.
- phkahler 9y ago
  >> Lived experience is critically important, but it does not trump data. I would argue that for an individual, lived experience trumps all data - for them. Data is an aggregate of individual experiences. A single persons experience is a data point, not an anecdote.

jotm 9y ago

I used to get imipramine, which was replaced with venlafaxine. The latter was shit, but of course no one could prescribe imipramine just because I wanted it (also probably because it went generic and it was too cheap to prescribe). Fuck them all, bunch of crooks.