16 ms·

The Challenge of Going Off Psychiatric Drugs

166 points by laurex 8y ago

ctdonath 8y ago
Underdiscussed: the horror of missing a couple doses of antidepressants. Being on such meds may work, keeping the patient stable. Nobody mentions that when a couple doses are missed, the result can be a week of anger & angst as resumed medication balances back out again - living hell not just for the patient, but for those around. Weaning off such meds is difficult, reducing doses by literally counting out & down individual granules of medicine daily. Easy to get on. Nightmare to get off.
- fwip 8y ago
  I agree that it's under-discussed. Part of the reason seems to be that people have such variable reactions. I have friends who literally had to quarter their pills while tapering off of them, and I also have friends who were able to stop taking them cold turkey and felt fine in less than a week.
  - mmjaa 8y ago
    >I agree that it's under-discussed. I think the reason its under-discussed is that there is a collective group-think which functions as overwhelming (to the individual) reinforcement: "there is no other way available to solve this problem than the mass sale and consumption of pharmaceuticals". The moment someone proposes a non-pharmaceutical (read: profitable) solution to many of these ills, they are shut down by the group-think. This is under-discussed, imho, because in the context of social/peer pressure to conform to a very Western normative (consumerism), individual responsibility is shut down. EDIT: and the downvotes demonstrate my point, because "everyone knows pharmaceuticals are the only solution" ...
    - SketchySeaBeast 8y ago
      Therapy is also a long lasting, lucrative approach. I think you're confusing consumerism with the long standing idea that we should be able to solve everything with a pill. It's evident in the older generations insistence that if they could just have that one surgery for their knees, or that round of antibiotics for their cold, their lives would be 100% better.
      - mmjaa 8y ago
        Consumerism: the protection or promotion of the interests of consumers I think there are very definitely market forces at work, keeping people in the mindset that pharmaceuticals are the only 'real' effective solution to their ills - when so, so many other alternatives are available. I don't doubt that chemicals can make peoples lives happier - I see it all the time. What I resist, however, is the notion that individuals should subjugate themselves to collective will just because everyone says pharmaceuticals are the way. Maybe strengthening ones resistance to groupthink and collective-derived thought processes is also an effective way to strengthen ones mental health .. alas, this point of view is too often overwhelmed by the very mob it serves to service, however ...
        SketchySeaBeast 8y ago
        > What I resist, however, is the notion that individuals should subjugate themselves to collective will just because everyone says pharmaceuticals are the way. Maybe strengthening ones resistance to groupthink and collective-derived thought processes is also an effective way to strengthen ones mental health .. alas, this point of view is too often overwhelmed by the very mob it serves to service, however ... What I'm getting from this is you have a specific agenda against "group think and collective-derived thought processes" and are being purposefully vague, as demonstrated with "...". What is your alternative? You seem to have one in mind.
        mmjaa 8y ago
        The alternative: question what you are being told about why you don't feel good, and don't just go along with the pack - its not always headed in the right direction. Case in point: The West's mental health addiction problem. It isn't getting better because of pharmaceutical treatment: its getting worse.
    - DanBC 8y ago
      > to a very Western You meant American, because in the UK the front-line treatment for depression or anxiety is a talking therapy, coupled with social prescribing (which to be fair has variable availability), and then medication if indicated. OP talks about a long term prescription for clonazepam, and current advice is that long term benzo use must be avoided.
      - jdietrich 8y ago
        >You meant American, because in the UK the front-line treatment for depression or anxiety is a talking therapy, coupled with social prescribing (which to be fair has variable availability), and then medication if indicated. It's the front-line treatment for mild depression and mild-to-moderate anxiety, because of the poor evidence for the efficacy of antidepressant medicines for patients with less severe illness. SSRIs and talking therapies are recommended equally for moderate or severe depression and severe anxiety, because the evidence suggests that they are equally effective. NICE guidance states that benzodiazepines should not be prescribed for more than two weeks, because of diminishing efficacy and the risk of dependence. SSRIs are cheaper and more convenient than psychotherapy, which should not be underestimated. The NHS certainly can't afford to offer psychotherapy to everyone who could benefit and many Americans don't have adequate insurance coverage. Getting psychotherapy outside of office hours can often be a significant challenge, which is a total dealbreaker for many people. I would certainly like to see greater use of psychotherapy (particularly for people with chronic and/or severe disorders), but there's nothing innately wrong with the widespread use of a safe and effective class of drugs. There just isn't any evidence to suggest that SSRIs are inferior to psychotherapy, although it may be the case that some patients who do not benefit from SSRIs would benefit from psychotherapy (and vice-versa). https://www.nice.org.uk/guidance/cg90/chapter/1-Guidance#step-3-persistent-subthreshold-depressive-symptoms-or-mild-to-moderate-depression-with-inadequate https://www.nice.org.uk/guidance/cg90/chapter/1-Guidance#ste... https://www.nice.org.uk/guidance/cg113/chapter/1-Guidance#stepped-care-for-people-with-gad https://www.nice.org.uk/guidance/cg113/chapter/1-Guidance#st...
  - LyndsySimon 8y ago
    > Part of the reason seems to be that people have such variable reactions. I was prescribed Lexapro a few months ago, and while I don't have any plans to go off of it in the immediate future, I did have an encounter with unexpectedly discontinuing it a couple of months ago. I was planning on getting my prescription filled on a Friday, but forgot. I realized this at 12:30pm on Saturday, after the pharmacy had closed. I went without Lexapro for three days: Saturday, Sunday, and Monday (it was a holiday). During that time I lost a significant portion of my hearing of all things; things sounded muffled, as if I had pressure built up in my ears and needed to pop them, but I could easily pop them and it didn't improve. I was also very irritable and had "brain fog", but that wasn't unexpected and was manageable. Tuesday my pharmacist said that he'd never heard of anyone complaining about hearing issues discontinuing Lexapro and to let him know if it didn't clear up. About three hours after taking it again, I noticed I was able to hear better, and by the next morning I was back to normal.
  - rincebrain 8y ago
    People don't seem to grasp exactly how variable this can be, or that it's a very inaccurate guessing game to predict a priori how much disruption this can cause. The best sources of data are your historical responses and those of your family members, and even then, it's really unreliable. Historically, I have had extremely few side effects from any medication, cold turkey (unintentionally, except for v. small doses of v. safe meds) or tapered off, and I have unfortunately had occasion to try a large spread of psychopharmacology. Some of those medications either did nothing for me from their primary/intended effect set, while they were extremely effective for family members - not just limited to psychiatric medications, but they do have a great deal of variability in response compared to some. Some medications that work on me but have no obvious secondary effects than sometimes mild sedation (opioids) do nothing for some of my immediate family (positive or negative) or are extremely powerful on others. Some medications that leave me with no positive or negative emotional responses to anything are extremely effective for some immediate family members and even worse for others. Some medications that are strongly sedating for some of my family members (antihistamines) have never done anything useful for me. Some medications (both in the ??RI classes and a couple of atypical ones) that are helpful or neutral for me induce manic or depressive episodes in family members. This is a hard problem, and it's going to take a good amount of work and better data curation (e.g. not asking a patient what they took for how long and how well it worked by word of mouth as a primary source) before we get any better at guessing.
- unquietcode 8y ago
  It is the single strongest reason I continually try to migrate myself away from long-term use of these drugs. While I have basically accepted that I will probably need to be on these or similar medications for the rest of my life, the side effect profiles and withdrawal symptoms of even a single missed dose is a punch to the gut. As soon as you are feeling better and like you want to go and enjoy life, you can't. It is all very frustrating and makes me question whether being alive will for me ever be a truly enjoyable experience. Nausea, tremors, memory loss--these are just the basics. Throw in anhedonia and loss of desire for good measure, and long after you've stopped the medications too. The options as I see them are either: be miserable, and probably just die, or: be not miserable, but sabotaged and unable to actually enjoy your newfound life. This usually just leads to a cycle of starting and stopping medications, desperately trying to have a happy yet functional life that is worth living.
- crazypills 8y ago
  I spent a decade on antidepressants and more times than I care to count I wound up in a foreign country with no meds (lost, forgot, you name it) and had to find a pharmacist willing to help me out. Luckily / thankfully they did. Not a fun conversation to start with a queue of folks behind you at the corner drug store.
- askvictor 8y ago
  Not easy to get on. The first month of antidepressants is hell, since you're compounding depression or anxiety with the nausea of the onset symptoms. Risk of suicide increases considerably in that first month or so. There's some recent research that due to the onset effects, the surveys of the patient's well being at the 8 week and 12 week marks are inaccurate or even useless, since it's really hard to objectively measure your state of mind compared to before you started.
tcj_phx 8y ago
> In the course of a year, her doctors had created what’s known as “a prescription cascade”: the side effects of one medication are diagnosed as symptoms of another condition, leading to a succession of new prescriptions. This term, "prescription cascade", should be lesson #1 at medical school. It's the natural result of an incomplete diagnosis, and is present in every medical field. > At the hospital, where she stayed for two weeks, she was put on a new combination of pills: Lamictal, a mood stabilizer; Lexapro, an antidepressant; and Seroquel, an antipsychotic that she was told to use as a sleep aid. (emphasis added) These descriptions -- mood stabilizer, antidepressant, antipsychotic -- are just marketing terms that don't actually describe the actual function of the drug. These marketing terms are most useful for tricking medical professionals into prescribing these products. 'Antibiotic' is the prototypical name for a class of drug that does what it describes: acts against bacteria. > She saw her drugs as precision instruments that could eliminate her suffering, as soon as she and Dr. Roth found the right combination. “I medicated myself as though I were a finely calibrated machine, the most delicate error potentially throwing me off,” she later wrote. I think this attitude is probably common for all the smart people who find themselves medicated into a downward spiral. > “It is tempting to add a second drug just for the sake of ‘doing something,’ ” a 2004 paper in Current Medicinal Chemistry warns. This is the trap the mental health system has fallen into: the professionals want to help. The drug industry has FDA-approved drugs for the various diagnosises. Joel on Software said a re-write is something that shouldn't be done. But what other choice does the mental health industry have? Their system doesn't work. The modern industry is based on the flawed chemical imbalance theory of mental illness. Little bits of progress have been made, in spite of the inertia to treat misunderstood behavioral problems with patent medicines. I have to conclude this comment before I can finish the article, so I'll link to my recent comment on the submission on the Szasz's book, the myth of mental illness: https://news.ycombinator.com/item?id=19243417 https://news.ycombinator.com/item?id=19243417 edit: shortened my first quote from the linked article
- azernik 8y ago
  "Mood stabilizer" is a quite accurate description of the usual function of the drug - in bipolar patients like me, it reduces the magnitude and stabilizes the period of mood swings. Mood stabilizers also tend to be anti-seizure meds, and have all kinds of off-label uses because of neurological phenomena we don't understand, but the label is a very useful one. Same for antidepressants - often the same drugs (especially SSRIs) are both antidepressants and anxiolytics, but both labels are useful descriptions of the meds' common effects. Antidepressants in particular happen to be fantastically idiosyncratic drugs, but on average they do what they say on the label. Part of the problem is that, due to the ill-understood nature of the brain, good psychiatrists need to know strange drug interactions and ill-studied minority reactions in order to serve the full range of their patients. This edges on art rather than science, which is always a recipe for cognitive biases to gain control.
deleted 8y ago
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transfire 8y ago
Prescription Cascade with psychiatric drugs is out of control. Seen it first hand. Had to step in and put a lot of pressure on doctors (and change doctors) to finally get my finance off the worst of the meds they had her on -- and finally "cure" her -- they just wanted to keep playing new drug musical chairs.
- mrguyorama 8y ago
  My mother spent 8 years trying drug after drug for her serious anxiety and chronic depression. The problem is that nobody has a strong understanding of how the different medications work to help, or even who they can help, so it often is that you have to just try until one works. My mother eventually found one that works and is absolutely necessary for her to live a normal life.
- LyndsySimon 8y ago
  I've had similar experiences with myself. After high school I was prescribed two drugs in combination (Lexapro and Abilify) that helped me deal with and get a handle on my (serious) depression, and that was really easy. When I told them that I hated the way they made me feel and wanted to taper off of them once I was stabilized... that wasn't so easy. At the end of the day I had to issue a sort of ultimatum: I was going to discontinue those drugs with or without their assistance, but recognized the risks of doing so and would prefer to do it with their oversight. I did it "against medical advise, but with medical supervision". Years later I asked for and was once again prescribed Lexapro, but at a lower dosage and for a different issue. Apparently it was either Abilify or the combination of the two that caused my issues before.
  - clydethefrog 8y ago
    The high mention of Abilify in the article and your comment makes me worried. I am currently on Abilify (10mg) for antipsychotic reasons. It seemed to be a "new generation" safer antipsychotic. Reading the Wikipedia article about it makes it sound a lot of research is unclear about the side effects. https://en.wikipedia.org/wiki/Aripiprazole https://en.wikipedia.org/wiki/Aripiprazole
dmortin 8y ago
Does depression go away after a while if taking meds? Or does the person having depression need to take meds for the rest of his/her life to avoid relapsing?
- 0x0000000 8y ago
  This varies from person to person. As it's been explained to me, some people are indeed "lifers", others use it temporarily (years, even, but not necessarily for the rest of his/her life). Meds alone generally don't make the depression "go away".
- empath75 8y ago
  Depends on whether the depression is situational. People don't like to admit that sometimes people are sad because their situation, and not because of something inherent to themselves. Sadness -- even persistent sadness -- can sometimes be a healthy response to an unhealthy environment, that drives you to try and change your situation for the better. The problem is when the sadness becomes the crippling kind that prevents you from acting to change the situation that's making you sad to begin with. It can be helpful, I think, to take anti-depressants long enough for you to be able to enact positive change in your life. My wife was taking anti-depressants as she finished up college, then she went traveling, met me while we were both backpacking, we got married, have two kids. She weaned off the anti-depressants while we were engaged. She gets transitory anxiety attacks every once in a while, but she's told me she's never had a relapse of depression. I think she was just bored and lonely and stressed in college -- a temporary situation. This is all just my personal opinion, i'm not a psychiatrist.
  - mrguyorama 8y ago
    >Sadness -- even persistent sadness -- can sometimes be a healthy response to an unhealthy environment, that drives you to try and change your situation for the better. Depression is sort of different than generic sadness as it DOES NOT drive you to improve your situation, due to the severe hopelessness it causes. It's the massive problem with depression, and why medication can be so helpful. Depression can cause you to stop functioning, even at your situationally reduced level, essentially fucking you over even worse. As you show, it was an external event that kicked your wife out of her rut. Sometimes that required kick is helped by medication
com2kid 8y ago
I generally am supportive of people seeking psychiatric treatment, but wow, this woman's case seems, in retrospect, rather mismanaged. It is like her doctors tried to medicate away an epiphany. Realizing that "the glittering balls and designer clothing has no real underlying substance" and being depressed that one's life is limited to such things, is not a cause for medication. It sounds like she was struggling to be happy in a situation in which she was never going to find happiness. Finding purpose, the thing she said was missing so early on, seems to ultimately be what helped her. Her reason to get up every day is that she can now help others, instead of live just for herself. Some people look inward, they want to be the best dressed at the party, have a good career, and overall be successful in life. If that brings them happiness, then good for them! They have found what makes their life fulfilling. But different people need other forms of fulfillment, be it an artist completing their latest work, or someone who wants to have a daily positive impact on the world around them. Medication cannot make people happy. (Well at least not the legal drugs, and the illegal ones won't work long term!) They can only create the possibility for happiness for those who need some extra help. But, doctors need to do a better job of discovering if that extra help is just needed, or if the road their patient is going down is not going to lead to happiness no matter what is written on the prescription pad.
- nerdponx 8y ago
  Psychiatry should not be front-line treatment for most people. End of story.
  - com2kid 8y ago
    For most people, psychiatry is overkill, sure sure. But heck, look at the diagnostic criteria for Bi-Polar, > The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features. That line about "marked impairment in occupational functioning" is a common theme in the DSM. (Hypomania has a lower threshhold, but still involves risk to self) If someone is able to live their life, hold down a job, isn't a risk to themselves / others, then they should be directed to a psychologist or therapist. Bloody hell, the DSM says this, again and again and again. In the must be met criteria for ADHD: > There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning. Major depressive disorder, again, with this requirement: > Cause significant distress or severely impact social, occupational or other important life areas The diagnostic criteria is pretty on point. But even so, misdiagnosis is possible. If someone comes in and says that they hate their job and their spouse is abusive, the correct solution is a lawyer / career training (probably in that order?), not a pill! If someone comes in and says "my life has no meaning", maybe it isn't anhedonia, maybe the activities in their life legitimately aren't of interest to them! We all feel social pressure to fit in with the culture we grow up with. The great thing about America is, if we don't fit in with that culture, plenty of other culture's abound! But first people have to realize that they can leave the culture they are familiar with if it isn't bringing them happiness. We all know that one engineer who decided to be become a brick layer, and who is now super happy! Heck one of my friends and old co-workers went from being a preacher to coder! We all need to realize that laying bricks is just as fulfilling and meaningful as writing code[1] and not being judgmental about people's choice to leave one career behind and go into another. My masseuse used to be in the corporate world. One of the best Chocolatiers[2] alive used to work at Microsoft. Parents, if you kids aren't happy living the upper class lifestyle that you dreamed of when you were working your way up the ladder, then support them doing something else! Tell them that they don't have to live up to your dreams, or fit into the societal image of perfection created by the culture one is surrounded by. [1] Possibly more so, the bricks are going to outlive 99.9% of code that is ever written, and will likely be appreciated by far more people. [2] I've traveled to quite a few countries and found her equal, but none that surpass. http://bruggechocolates.com/ http://bruggechocolates.com/
GlenTheMachine 8y ago
I am on Klonopin and Remeron. My diagnosis is anxiety, but really it's insomnia. I had a horrible, multiple-year episode of insomnia that started in my early thirties. For about three years I got maybe one night a week of decent sleep. I was mentally and emotionally out of it; I'm kind of surprised I still have a job after that. A few years in, I found a psychiatrist who was willing to experiment and we discovered that the two meds above helped tremendously with the insomnia. I was then getting a solid eight hours most nights. There were side effects but they were much better than suffering with the insomnia was. Now, after a decade, the insomnia seems to be completely gone. Knowing that I have medications available to me that can help me get to sleep is enough that I think I don't actually need the medications any more. So I'm very slowly going off of them. Klonopin first. There are, as far as I know, no guidelines for how to do this. I tried cold turkey, but the side effects from that were fairly severe. So I started tapering. I'm now down to half my original dose. If things go well, within four months I'll be off the Klonopin for good, and then I'll start on the Remeron. These medications are not easy to stop taking.
- mmjaa 8y ago
  >Knowing that I have medications available to me that can help me get to sleep is enough that I think I don't actually need the medications any more. Honest question: Have you ever considered that your insomnia was psychosomatic and, through your doctors involvement in for-profit sales of pharmaceuticals, socially re-inforced?
  - GlenTheMachine 8y ago
    Most chronic insomnia is psychosomatic. The problem with calling it "psychosomatic" is that people who haven't experienced it think that means it isn't real. But it is. You can't just talk yourself out of psychosomatic illnesses. They're as real as any other kind. You need some sort of medical care to manage or overcome them, just as much as if you had a broken leg. In my case, I see my psychiatrist once a quarter for fifteen minutes. Klonopin and Remeron are two of the cheapest drugs there are. My meds cost me less than $40 a year. I don't think anyone is making a lot of money off of me. Cognitive Behavioral Therapy or biofeedback, which are two alternatives that were presented to me, would have been far more expensive.
throwaway55254 8y ago
This terrifies me. I've been trying to get up the nerve to talk to my doctor about my mental health for years now. I've been depressed on and off for a large portion of my life. I've always been really wary of pills though and reading things like this makes me worry even more. I wonder if the efficacy is actually there or if the withdrawal is worth it.
- SolaceQuantum 8y ago
  I've found that if you're firm that you want to explore non-drug solutions first, medical professionals are pretty receptive.
- boomboomsubban 8y ago
  Talk to your doctor and get a recommendation/prescription for therapy, it has a higher efficacy than medication anyway. If medication is advised, set a time line immediately for when you want to be off it. Withdrawal usually isn't bad, though worrying about it makes it worse.
- avgDev 8y ago
  Everyone should be skeptical about medications. I had suffered a reaction to an antibiotic, it is now documented by case studies, FDA, and EMA. I still have some side effects years after last dosage. I have seen maybe 30 docs over the years, ONLY ONE agreed that my symptoms appear to be a direct reaction to that medication. Few refused I even after I showed that information. Said "it doesn't really matter at this point".... Imagine this: You know arrays start at 0 in C#/Java even though you don't program but you saw a meme online. Now, you want to have an application developed. During the first conversation with a dev he says, ah "no problem we can use arrays and those start 1".......This has been my experience, the amount of doctors that just are ignorant, relying on knowledge from 80's when they attended school is saddening. Entering the medical system has been eye opening for me, I feel that developers could do a better job treating people with just google (obviously surgery is different, I am talking mainly about prescriptions)
- gwbas1c 8y ago
  Look up the history of heroin, or methamphetamine. They both were marketed as safe in the early days. Drug companies like to sell drugs like soda companies like to sell soda. The conflict of interest is so awful that sometimes I wonder if we should ban for-profit drug companies.
empath75 8y ago
> Laura had always assumed that depression was caused by a precisely defined chemical imbalance, which her medications were designed to recalibrate. She began reading about the history of psychiatry and realized that this theory, promoted heavily by pharmaceutical companies, is not clearly supported by evidence. This is the most harmful idea in psychiatry and it's pure marketing bullshit -- everyone knows it, but they still sell this to people.
colesdefectum 8y ago
I rarely comment on anything but this hits rather close to home. After a rather severe bout of depression my doctor started feeding me drugs. SSRIs, NDRIs, benzos, and a handful of misc other prescriptions that were the flavor of the week. I felt like every visit was a game of 'lets try this new drug!' which would lead to negative side effects more often than not. Fast forward a couple years and I'm realizing that medications aren't the answer for me. So what do my doctors do? They try to push yet another pill or three down my throat. Finally I'd had enough of it and told them I didn't want to take anything anymore. Their idea of a tapering plan from over 2 years of medications was a week and a half. They were sure to tell me that if I stopped treatment I wouldn't be given any more refills and one doctor condemned me for even showing up to my appointment with the intention of discontinuing medications. He said I was wasting everyones time. Anyway, I figured sure, I got this. I can get myself off these meds. I was very wrong. I made it about two weeks before withdrawals really kicked into overdrive. Dizzy, brain zaps, tinnitus, profuse sweating all hours of the day, insomnia, numbness in my face and arms, racing heart, involuntary muscle spasms... I started stuttering and couldn't force my body to stop twitching and shaking. My mind was completely fogged over and at times I couldn't even articulate words to talk to someone. It was a state of being in a perpetual panic attack multiplied by 100. After I thought I was actually going to die I setup an emergency appointment to try and get a prescription refill and a longer tapering plan only my doctors wouldn't have it. They flat out refused treatment and told me to go to the ER if I thought things were getting that bad. I was floored. Here this doctor got me physically addicted to powerful mind altering medications over the course of a couple years and now that I want out they treated me like a drug addict and dismissed me. In the end I sourced some darknet meds and very slowly tapered myself down. To this day I'm still not even close to being back to normal, whatever that is. I get random panic attacks out of the blue on a daily basis. Sometimes the left side of my body will go numb. Other times I'll just start sweating while my heart beats like I just finished running a marathon. The ringing in my ears is horrible. I'm now extremely sensitive to stimulants of any kind (no more caffeine, meh) so I've had to make some significant changes to my diet. The good news is I've been 100% off any medications for two months now and I'm finally getting to where I can get more than four consecutive hours of sleep several days a week (so much better than zero sleep every day). I feel as though being able to enjoy coffee, sugary drinks, and having the ability to actually sleep an entire night has been permanently removed from my life now. At any rate, if there's anything anyone should get from all this rambling, it's that you should exercise extreme caution with pill pushing doctors. They have the ability to drag you into your worst nightmare of existence and leave you high & dry when you want the ride to stop.
mnm1 8y ago
Tapering off over the course of a few months or longer is especially important for benzodiazepines. Not doing so can lead to seizures or death. Luckily, it'll be pretty obvious to the patient if they are going too quickly and tapering slowly should lead to minimal side effects. Cannabis can also help some here. Unfortunately, most psychiatrists and doctors have no experience with this and will even discourage patients. Often, patients will have to just get a supply and do this on their own. https://www.benzo.org.uk/index.htm https://www.benzo.org.uk/index.htm is a great resource of people who are doing this and probably the most valuable out there. Psychiatrists, in my experience, are not your friend in this process. They're the pill pushers and dope dealers. Of course they don't want their patients to taper off and discover a better life. Where would they get their money from if people stopped buying their bullshit about 'chemical imbalances?' What this industry has perpetrated on millions of people is downright inhumane, all so a few doctors and pharma companies can get rich. It is very possible, however, to taper off this garbage and get back to leading a normal life afterwards. That includes benzos, SSRIs, and other 'anti-depressant' garbage like Welbutrin. I know from experience. If this is something you want to do, don't let these vile doctors keep you addicted to their garbage and their bullshit, away from a real life.
limeblack 8y ago
"Lamictal, a mood stabilizer; Lexapro, an antidepressant; and Seroquel, an antipsychotic that she was told to use as a sleep aid." Lamictal and Seroquel can cause an often permanent condition called tardive dyskinesia[1]. Basically the dopamine receptors tend to permanent up scale leading to sleep disorders. This is fairly unique compared to most Psychiatric drugs out there. [1]: http://www.onlinelawyersource.com/tardive-dyskinesia/seroquel http://www.onlinelawyersource.com/tardive-dyskinesia/seroque...
- rednerrus 8y ago
  I don't see Lamictal on that list: https://medlineplus.gov/ency/article/000685.htm https://medlineplus.gov/ency/article/000685.htm
  - limeblack 8y ago
    I believe the risk is fairly small compared to the drugs on that list which is why its left out. Not that I trust this site more then a government site, but this list has it[1]. [1] https://www.ehealthme.com/ds/lamictal/tardive-dyskinesia/ https://www.ehealthme.com/ds/lamictal/tardive-dyskinesia/
- darpa_escapee 8y ago
  Dopamine blockade isn't significantly induced by doses of Seroquel used for sleep. Although it and its metabolites do have action at certain dopamine receptors, lower doses will first occupy other receptors that they have a higher binding affinity for. Its metabolites are partial agonists at 5HT1A autoreceptors that induce downstream release of dopamine, which theoretically reduces the risk of tardive dyskinesia from direct dopamine blockade. If you're curious about this, Stahl's Essential Psychopharmacology textbook goes into detail about this and is written in a way that some idiot (me) on HN can grok it.
  - limeblack 8y ago
    > Dopamine blockade isn't significantly induced by doses of Seroquel used for sleep. True at typical low dosages. I have been on Seroquel at very high dosages for sleep and the doctor gave me the explanation above. I have after multiple attempts failed to taper off of it. I have even tried liquid. I will definitely check out the book. The key issue being that the receptor up scale permanently.
tamaharbor 8y ago
Supplemental iron and magnesium saved me. No more GAD, panic attacks, night sweats, or insomnia, and no more RX drugs!
- noamelf 8y ago
  Can you elaborate a bit? I'm looking into supplements as well to replace or enhance my meds
- mastox 8y ago
  Just curious, but were you ever tested for an anemia or anything?
  - tamaharbor 8y ago
    Full and frequent blood tests continually measured low ferritin, but since hematocrit and hemoglobin (and all other) levels were within range, three separate primary physicians and my psychiatrist all indicated there was no problem. I took it upon myself (after ‘internet research’) to gradually get off all the meds prescribed over the course of three years (klonopin, alprazolam, gabapentin, mirtazapine, sertraline, and others) and start supplementation with two basic minerals obtained from WalMart. I felt wonderful almost immediately, and ever since.
abstractbarista 8y ago
I found this to be a very intriguing read. Upon finishing it, I am terrified of these drugs, terrified of pharmaceutical companies, and terrified of the cognitive dissonance in the study of mental illness. I would try absolutely anything before these drugs. It's a freaking nightmare, thrust into reality.
- thanatropism 8y ago
  That's a shame. Most of these pieces are hysteria. Journalists and lawyers never go after people who seem to be fine with medication. Here's hoping you don't have serious mental health problems in the future.
  - abstractbarista 8y ago
    I definitely understand where you're coming from. Surely there are a lot of people that this stuff actually helps really well. In the past I did have serious issues, but I was able to bring myself out of it over time, by myself. And now, I have nurtured a far more stable and enduring mindset. :) EDIT: By far the biggest part in me getting better was moving on to a different way of life. Basically, changing the set and setting. Which I think is underrated by the professionals described in this article, hence the problem: Treating the symptoms, not their source.
  - mastox 8y ago
    I think some would argue that you aren't fine if you are on these kind of medications, and "fine" might be an illusion to the patient and their peers.
eecc 8y ago
Well, haven’t read through more than the first intro paragraph and whatever hollowness Miss Delano might have felt can be also attributed to the spleen of a comfortable yet purposeless life, planting daffodils and watching them wither. With this I don’t want to disparage her personal odyssey or that of people suffering from psychiatric difficulties, but the framing of this article is unfortunate. Very much
kmm 8y ago
When I stopped taking Venlafaxine (Effexor), the side-effects were immensely unpleasant. Brain zaps, panic attacks, hypersensitivity to light, barely any cognitive function. My psychiatrist was a sweet lady, but she did not appear to understand how tough it was for me. It boggles my mind she did not get it, she must have had so many patients stop with the medication, did she just not take any of them seriously? In the end, I opened up the plastic casing of the pill, which turned out to contain a few dozen grains. Over the course of 2-3 weeks, I took a few grains less every day, until I was completely done with them. I don't know if you're allowed to do that, maybe there is no guarantee that every grain contains the same amount of medication? I'm not a fan of tampering with medication, but I didn't feel like I had a choice.
- mattyb678 8y ago
  Even if I’m just a few hours late taking my Effexor I start getting brain zaps. They are terrible. I’m not looking forward to ever having to go off it
- adyavanapalli 8y ago
  How the flying heck did your psychiatrist let you stop taking your medication cold turkey? There's usually a weaning off process for any sort of psychiatric drug.
- darpa_escapee 8y ago
  > I don't know if you're allowed to do that, maybe there is no guarantee that every grain contains the same amount of medication? There are entire fields of material science dedicated to this problem. Generally, if a single pill is metered into smaller doses, resources went into ensuring that each dose is metered accurately. The grain form was probably for absorption or time-release.
- tachyonbeam 8y ago
  It may be that most psychiatrist don't follow patients long term, or that when things don't go well for a patient, they stop seeing that psychiatrist, and so they don't hear about bad withdrawals very often. Crazy idea, but maybe psychiatrists should take antidepressants for a short bit as part of their training. It would give them some perspective.
tylerjwilk00 8y ago
I was prescribed a benzo for insomnia and thought nothing of it. I went from enjoying a good night's sleep to completely dependant on it just to function. The only way to describe it was that I became "psychologically fragile" such as if things didn't go exactly according to expectations I would be in a state of panic and fear. It was horrible. I decided then to go cold turkey (no one told me otherwise) and it was hell! I thought I would die or lose my mind. To say nothing of the electric shock sensations that were constant and the feeling that my skin was buzzing. After a couple months I felt like myself again and my mental fortitude had returned. I will never take another. For me the benzo class of meds are way more dangerous than helpful.
- tachyonbeam 8y ago
  It's awful how easily they prescribe addictive medications, and how uninformed doctors are. Benzo withdrawal can cause seizures and even death. There are much less addictive sleep aids such as trazodone, and those should probably be prescribed first.
- bobowzki 8y ago
  I'm curious what type and dosis you were prescribed? (I'm an MD).
  - tylerjwilk00 8y ago
    I believe it was temazepam. I do not remember the dose.
- sjg007 8y ago
  One benzo? What dose?

166 points by laurex 8y ago

Underdiscussed: the horror of missing a couple doses of antidepressants. Being on such meds may work, keeping the patient stable. Nobody mentions that when a couple doses are missed, the result can be a week of anger & angst as resumed medication balances back out again - living hell not just for the patient, but for those around. Weaning off such meds is difficult, reducing doses by literally counting out & down individual granules of medicine daily. Easy to get on. Nightmare to get off.

fwip 8y ago
I agree that it's under-discussed. Part of the reason seems to be that people have such variable reactions. I have friends who literally had to quarter their pills while tapering off of them, and I also have friends who were able to stop taking them cold turkey and felt fine in less than a week.
- mmjaa 8y ago
  >I agree that it's under-discussed. I think the reason its under-discussed is that there is a collective group-think which functions as overwhelming (to the individual) reinforcement: "there is no other way available to solve this problem than the mass sale and consumption of pharmaceuticals". The moment someone proposes a non-pharmaceutical (read: profitable) solution to many of these ills, they are shut down by the group-think. This is under-discussed, imho, because in the context of social/peer pressure to conform to a very Western normative (consumerism), individual responsibility is shut down. EDIT: and the downvotes demonstrate my point, because "everyone knows pharmaceuticals are the only solution" ...
  - SketchySeaBeast 8y ago
    Therapy is also a long lasting, lucrative approach. I think you're confusing consumerism with the long standing idea that we should be able to solve everything with a pill. It's evident in the older generations insistence that if they could just have that one surgery for their knees, or that round of antibiotics for their cold, their lives would be 100% better.
    - mmjaa 8y ago
      Consumerism: the protection or promotion of the interests of consumers I think there are very definitely market forces at work, keeping people in the mindset that pharmaceuticals are the only 'real' effective solution to their ills - when so, so many other alternatives are available. I don't doubt that chemicals can make peoples lives happier - I see it all the time. What I resist, however, is the notion that individuals should subjugate themselves to collective will just because everyone says pharmaceuticals are the way. Maybe strengthening ones resistance to groupthink and collective-derived thought processes is also an effective way to strengthen ones mental health .. alas, this point of view is too often overwhelmed by the very mob it serves to service, however ...
      - SketchySeaBeast 8y ago
        > What I resist, however, is the notion that individuals should subjugate themselves to collective will just because everyone says pharmaceuticals are the way. Maybe strengthening ones resistance to groupthink and collective-derived thought processes is also an effective way to strengthen ones mental health .. alas, this point of view is too often overwhelmed by the very mob it serves to service, however ... What I'm getting from this is you have a specific agenda against "group think and collective-derived thought processes" and are being purposefully vague, as demonstrated with "...". What is your alternative? You seem to have one in mind.
        mmjaa 8y ago
        The alternative: question what you are being told about why you don't feel good, and don't just go along with the pack - its not always headed in the right direction. Case in point: The West's mental health addiction problem. It isn't getting better because of pharmaceutical treatment: its getting worse.
  - DanBC 8y ago
    > to a very Western You meant American, because in the UK the front-line treatment for depression or anxiety is a talking therapy, coupled with social prescribing (which to be fair has variable availability), and then medication if indicated. OP talks about a long term prescription for clonazepam, and current advice is that long term benzo use must be avoided.
    - jdietrich 8y ago
      >You meant American, because in the UK the front-line treatment for depression or anxiety is a talking therapy, coupled with social prescribing (which to be fair has variable availability), and then medication if indicated. It's the front-line treatment for mild depression and mild-to-moderate anxiety, because of the poor evidence for the efficacy of antidepressant medicines for patients with less severe illness. SSRIs and talking therapies are recommended equally for moderate or severe depression and severe anxiety, because the evidence suggests that they are equally effective. NICE guidance states that benzodiazepines should not be prescribed for more than two weeks, because of diminishing efficacy and the risk of dependence. SSRIs are cheaper and more convenient than psychotherapy, which should not be underestimated. The NHS certainly can't afford to offer psychotherapy to everyone who could benefit and many Americans don't have adequate insurance coverage. Getting psychotherapy outside of office hours can often be a significant challenge, which is a total dealbreaker for many people. I would certainly like to see greater use of psychotherapy (particularly for people with chronic and/or severe disorders), but there's nothing innately wrong with the widespread use of a safe and effective class of drugs. There just isn't any evidence to suggest that SSRIs are inferior to psychotherapy, although it may be the case that some patients who do not benefit from SSRIs would benefit from psychotherapy (and vice-versa). https://www.nice.org.uk/guidance/cg90/chapter/1-Guidance#step-3-persistent-subthreshold-depressive-symptoms-or-mild-to-moderate-depression-with-inadequate https://www.nice.org.uk/guidance/cg90/chapter/1-Guidance#ste... https://www.nice.org.uk/guidance/cg113/chapter/1-Guidance#stepped-care-for-people-with-gad https://www.nice.org.uk/guidance/cg113/chapter/1-Guidance#st...
- LyndsySimon 8y ago
  > Part of the reason seems to be that people have such variable reactions. I was prescribed Lexapro a few months ago, and while I don't have any plans to go off of it in the immediate future, I did have an encounter with unexpectedly discontinuing it a couple of months ago. I was planning on getting my prescription filled on a Friday, but forgot. I realized this at 12:30pm on Saturday, after the pharmacy had closed. I went without Lexapro for three days: Saturday, Sunday, and Monday (it was a holiday). During that time I lost a significant portion of my hearing of all things; things sounded muffled, as if I had pressure built up in my ears and needed to pop them, but I could easily pop them and it didn't improve. I was also very irritable and had "brain fog", but that wasn't unexpected and was manageable. Tuesday my pharmacist said that he'd never heard of anyone complaining about hearing issues discontinuing Lexapro and to let him know if it didn't clear up. About three hours after taking it again, I noticed I was able to hear better, and by the next morning I was back to normal.
- rincebrain 8y ago
  People don't seem to grasp exactly how variable this can be, or that it's a very inaccurate guessing game to predict a priori how much disruption this can cause. The best sources of data are your historical responses and those of your family members, and even then, it's really unreliable. Historically, I have had extremely few side effects from any medication, cold turkey (unintentionally, except for v. small doses of v. safe meds) or tapered off, and I have unfortunately had occasion to try a large spread of psychopharmacology. Some of those medications either did nothing for me from their primary/intended effect set, while they were extremely effective for family members - not just limited to psychiatric medications, but they do have a great deal of variability in response compared to some. Some medications that work on me but have no obvious secondary effects than sometimes mild sedation (opioids) do nothing for some of my immediate family (positive or negative) or are extremely powerful on others. Some medications that leave me with no positive or negative emotional responses to anything are extremely effective for some immediate family members and even worse for others. Some medications that are strongly sedating for some of my family members (antihistamines) have never done anything useful for me. Some medications (both in the ??RI classes and a couple of atypical ones) that are helpful or neutral for me induce manic or depressive episodes in family members. This is a hard problem, and it's going to take a good amount of work and better data curation (e.g. not asking a patient what they took for how long and how well it worked by word of mouth as a primary source) before we get any better at guessing.
unquietcode 8y ago
It is the single strongest reason I continually try to migrate myself away from long-term use of these drugs. While I have basically accepted that I will probably need to be on these or similar medications for the rest of my life, the side effect profiles and withdrawal symptoms of even a single missed dose is a punch to the gut. As soon as you are feeling better and like you want to go and enjoy life, you can't. It is all very frustrating and makes me question whether being alive will for me ever be a truly enjoyable experience. Nausea, tremors, memory loss--these are just the basics. Throw in anhedonia and loss of desire for good measure, and long after you've stopped the medications too. The options as I see them are either: be miserable, and probably just die, or: be not miserable, but sabotaged and unable to actually enjoy your newfound life. This usually just leads to a cycle of starting and stopping medications, desperately trying to have a happy yet functional life that is worth living.
crazypills 8y ago
I spent a decade on antidepressants and more times than I care to count I wound up in a foreign country with no meds (lost, forgot, you name it) and had to find a pharmacist willing to help me out. Luckily / thankfully they did. Not a fun conversation to start with a queue of folks behind you at the corner drug store.
askvictor 8y ago
Not easy to get on. The first month of antidepressants is hell, since you're compounding depression or anxiety with the nausea of the onset symptoms. Risk of suicide increases considerably in that first month or so. There's some recent research that due to the onset effects, the surveys of the patient's well being at the 8 week and 12 week marks are inaccurate or even useless, since it's really hard to objectively measure your state of mind compared to before you started.

tcj_phx 8y ago

> In the course of a year, her doctors had created what’s known as “a prescription cascade”: the side effects of one medication are diagnosed as symptoms of another condition, leading to a succession of new prescriptions. This term, "prescription cascade", should be lesson #1 at medical school. It's the natural result of an incomplete diagnosis, and is present in every medical field. > At the hospital, where she stayed for two weeks, she was put on a new combination of pills: Lamictal, a mood stabilizer; Lexapro, an antidepressant; and Seroquel, an antipsychotic that she was told to use as a sleep aid. (emphasis added) These descriptions -- mood stabilizer, antidepressant, antipsychotic -- are just marketing terms that don't actually describe the actual function of the drug. These marketing terms are most useful for tricking medical professionals into prescribing these products. 'Antibiotic' is the prototypical name for a class of drug that does what it describes: acts against bacteria. > She saw her drugs as precision instruments that could eliminate her suffering, as soon as she and Dr. Roth found the right combination. “I medicated myself as though I were a finely calibrated machine, the most delicate error potentially throwing me off,” she later wrote. I think this attitude is probably common for all the smart people who find themselves medicated into a downward spiral. > “It is tempting to add a second drug just for the sake of ‘doing something,’ ” a 2004 paper in Current Medicinal Chemistry warns. This is the trap the mental health system has fallen into: the professionals want to help. The drug industry has FDA-approved drugs for the various diagnosises. Joel on Software said a re-write is something that shouldn't be done. But what other choice does the mental health industry have? Their system doesn't work. The modern industry is based on the flawed chemical imbalance theory of mental illness. Little bits of progress have been made, in spite of the inertia to treat misunderstood behavioral problems with patent medicines. I have to conclude this comment before I can finish the article, so I'll link to my recent comment on the submission on the Szasz's book, the myth of mental illness: https://news.ycombinator.com/item?id=19243417 https://news.ycombinator.com/item?id=19243417 edit: shortened my first quote from the linked article

azernik 8y ago
"Mood stabilizer" is a quite accurate description of the usual function of the drug - in bipolar patients like me, it reduces the magnitude and stabilizes the period of mood swings. Mood stabilizers also tend to be anti-seizure meds, and have all kinds of off-label uses because of neurological phenomena we don't understand, but the label is a very useful one. Same for antidepressants - often the same drugs (especially SSRIs) are both antidepressants and anxiolytics, but both labels are useful descriptions of the meds' common effects. Antidepressants in particular happen to be fantastically idiosyncratic drugs, but on average they do what they say on the label. Part of the problem is that, due to the ill-understood nature of the brain, good psychiatrists need to know strange drug interactions and ill-studied minority reactions in order to serve the full range of their patients. This edges on art rather than science, which is always a recipe for cognitive biases to gain control.

deleted 8y ago

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transfire 8y ago

Prescription Cascade with psychiatric drugs is out of control. Seen it first hand. Had to step in and put a lot of pressure on doctors (and change doctors) to finally get my finance off the worst of the meds they had her on -- and finally "cure" her -- they just wanted to keep playing new drug musical chairs.

mrguyorama 8y ago
My mother spent 8 years trying drug after drug for her serious anxiety and chronic depression. The problem is that nobody has a strong understanding of how the different medications work to help, or even who they can help, so it often is that you have to just try until one works. My mother eventually found one that works and is absolutely necessary for her to live a normal life.
LyndsySimon 8y ago
I've had similar experiences with myself. After high school I was prescribed two drugs in combination (Lexapro and Abilify) that helped me deal with and get a handle on my (serious) depression, and that was really easy. When I told them that I hated the way they made me feel and wanted to taper off of them once I was stabilized... that wasn't so easy. At the end of the day I had to issue a sort of ultimatum: I was going to discontinue those drugs with or without their assistance, but recognized the risks of doing so and would prefer to do it with their oversight. I did it "against medical advise, but with medical supervision". Years later I asked for and was once again prescribed Lexapro, but at a lower dosage and for a different issue. Apparently it was either Abilify or the combination of the two that caused my issues before.
- clydethefrog 8y ago
  The high mention of Abilify in the article and your comment makes me worried. I am currently on Abilify (10mg) for antipsychotic reasons. It seemed to be a "new generation" safer antipsychotic. Reading the Wikipedia article about it makes it sound a lot of research is unclear about the side effects. https://en.wikipedia.org/wiki/Aripiprazole https://en.wikipedia.org/wiki/Aripiprazole

dmortin 8y ago

Does depression go away after a while if taking meds? Or does the person having depression need to take meds for the rest of his/her life to avoid relapsing?

0x0000000 8y ago
This varies from person to person. As it's been explained to me, some people are indeed "lifers", others use it temporarily (years, even, but not necessarily for the rest of his/her life). Meds alone generally don't make the depression "go away".
empath75 8y ago
Depends on whether the depression is situational. People don't like to admit that sometimes people are sad because their situation, and not because of something inherent to themselves. Sadness -- even persistent sadness -- can sometimes be a healthy response to an unhealthy environment, that drives you to try and change your situation for the better. The problem is when the sadness becomes the crippling kind that prevents you from acting to change the situation that's making you sad to begin with. It can be helpful, I think, to take anti-depressants long enough for you to be able to enact positive change in your life. My wife was taking anti-depressants as she finished up college, then she went traveling, met me while we were both backpacking, we got married, have two kids. She weaned off the anti-depressants while we were engaged. She gets transitory anxiety attacks every once in a while, but she's told me she's never had a relapse of depression. I think she was just bored and lonely and stressed in college -- a temporary situation. This is all just my personal opinion, i'm not a psychiatrist.
- mrguyorama 8y ago
  >Sadness -- even persistent sadness -- can sometimes be a healthy response to an unhealthy environment, that drives you to try and change your situation for the better. Depression is sort of different than generic sadness as it DOES NOT drive you to improve your situation, due to the severe hopelessness it causes. It's the massive problem with depression, and why medication can be so helpful. Depression can cause you to stop functioning, even at your situationally reduced level, essentially fucking you over even worse. As you show, it was an external event that kicked your wife out of her rut. Sometimes that required kick is helped by medication

com2kid 8y ago

I generally am supportive of people seeking psychiatric treatment, but wow, this woman's case seems, in retrospect, rather mismanaged. It is like her doctors tried to medicate away an epiphany. Realizing that "the glittering balls and designer clothing has no real underlying substance" and being depressed that one's life is limited to such things, is not a cause for medication. It sounds like she was struggling to be happy in a situation in which she was never going to find happiness. Finding purpose, the thing she said was missing so early on, seems to ultimately be what helped her. Her reason to get up every day is that she can now help others, instead of live just for herself. Some people look inward, they want to be the best dressed at the party, have a good career, and overall be successful in life. If that brings them happiness, then good for them! They have found what makes their life fulfilling. But different people need other forms of fulfillment, be it an artist completing their latest work, or someone who wants to have a daily positive impact on the world around them. Medication cannot make people happy. (Well at least not the legal drugs, and the illegal ones won't work long term!) They can only create the possibility for happiness for those who need some extra help. But, doctors need to do a better job of discovering if that extra help is just needed, or if the road their patient is going down is not going to lead to happiness no matter what is written on the prescription pad.

nerdponx 8y ago
Psychiatry should not be front-line treatment for most people. End of story.
- com2kid 8y ago
  For most people, psychiatry is overkill, sure sure. But heck, look at the diagnostic criteria for Bi-Polar, > The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features. That line about "marked impairment in occupational functioning" is a common theme in the DSM. (Hypomania has a lower threshhold, but still involves risk to self) If someone is able to live their life, hold down a job, isn't a risk to themselves / others, then they should be directed to a psychologist or therapist. Bloody hell, the DSM says this, again and again and again. In the must be met criteria for ADHD: > There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning. Major depressive disorder, again, with this requirement: > Cause significant distress or severely impact social, occupational or other important life areas The diagnostic criteria is pretty on point. But even so, misdiagnosis is possible. If someone comes in and says that they hate their job and their spouse is abusive, the correct solution is a lawyer / career training (probably in that order?), not a pill! If someone comes in and says "my life has no meaning", maybe it isn't anhedonia, maybe the activities in their life legitimately aren't of interest to them! We all feel social pressure to fit in with the culture we grow up with. The great thing about America is, if we don't fit in with that culture, plenty of other culture's abound! But first people have to realize that they can leave the culture they are familiar with if it isn't bringing them happiness. We all know that one engineer who decided to be become a brick layer, and who is now super happy! Heck one of my friends and old co-workers went from being a preacher to coder! We all need to realize that laying bricks is just as fulfilling and meaningful as writing code[1] and not being judgmental about people's choice to leave one career behind and go into another. My masseuse used to be in the corporate world. One of the best Chocolatiers[2] alive used to work at Microsoft. Parents, if you kids aren't happy living the upper class lifestyle that you dreamed of when you were working your way up the ladder, then support them doing something else! Tell them that they don't have to live up to your dreams, or fit into the societal image of perfection created by the culture one is surrounded by. [1] Possibly more so, the bricks are going to outlive 99.9% of code that is ever written, and will likely be appreciated by far more people. [2] I've traveled to quite a few countries and found her equal, but none that surpass. http://bruggechocolates.com/ http://bruggechocolates.com/

GlenTheMachine 8y ago

I am on Klonopin and Remeron. My diagnosis is anxiety, but really it's insomnia. I had a horrible, multiple-year episode of insomnia that started in my early thirties. For about three years I got maybe one night a week of decent sleep. I was mentally and emotionally out of it; I'm kind of surprised I still have a job after that. A few years in, I found a psychiatrist who was willing to experiment and we discovered that the two meds above helped tremendously with the insomnia. I was then getting a solid eight hours most nights. There were side effects but they were much better than suffering with the insomnia was. Now, after a decade, the insomnia seems to be completely gone. Knowing that I have medications available to me that can help me get to sleep is enough that I think I don't actually need the medications any more. So I'm very slowly going off of them. Klonopin first. There are, as far as I know, no guidelines for how to do this. I tried cold turkey, but the side effects from that were fairly severe. So I started tapering. I'm now down to half my original dose. If things go well, within four months I'll be off the Klonopin for good, and then I'll start on the Remeron. These medications are not easy to stop taking.

mmjaa 8y ago
>Knowing that I have medications available to me that can help me get to sleep is enough that I think I don't actually need the medications any more. Honest question: Have you ever considered that your insomnia was psychosomatic and, through your doctors involvement in for-profit sales of pharmaceuticals, socially re-inforced?
- GlenTheMachine 8y ago
  Most chronic insomnia is psychosomatic. The problem with calling it "psychosomatic" is that people who haven't experienced it think that means it isn't real. But it is. You can't just talk yourself out of psychosomatic illnesses. They're as real as any other kind. You need some sort of medical care to manage or overcome them, just as much as if you had a broken leg. In my case, I see my psychiatrist once a quarter for fifteen minutes. Klonopin and Remeron are two of the cheapest drugs there are. My meds cost me less than $40 a year. I don't think anyone is making a lot of money off of me. Cognitive Behavioral Therapy or biofeedback, which are two alternatives that were presented to me, would have been far more expensive.

throwaway55254 8y ago

This terrifies me. I've been trying to get up the nerve to talk to my doctor about my mental health for years now. I've been depressed on and off for a large portion of my life. I've always been really wary of pills though and reading things like this makes me worry even more. I wonder if the efficacy is actually there or if the withdrawal is worth it.

SolaceQuantum 8y ago
I've found that if you're firm that you want to explore non-drug solutions first, medical professionals are pretty receptive.
boomboomsubban 8y ago
Talk to your doctor and get a recommendation/prescription for therapy, it has a higher efficacy than medication anyway. If medication is advised, set a time line immediately for when you want to be off it. Withdrawal usually isn't bad, though worrying about it makes it worse.
avgDev 8y ago
Everyone should be skeptical about medications. I had suffered a reaction to an antibiotic, it is now documented by case studies, FDA, and EMA. I still have some side effects years after last dosage. I have seen maybe 30 docs over the years, ONLY ONE agreed that my symptoms appear to be a direct reaction to that medication. Few refused I even after I showed that information. Said "it doesn't really matter at this point".... Imagine this: You know arrays start at 0 in C#/Java even though you don't program but you saw a meme online. Now, you want to have an application developed. During the first conversation with a dev he says, ah "no problem we can use arrays and those start 1".......This has been my experience, the amount of doctors that just are ignorant, relying on knowledge from 80's when they attended school is saddening. Entering the medical system has been eye opening for me, I feel that developers could do a better job treating people with just google (obviously surgery is different, I am talking mainly about prescriptions)
gwbas1c 8y ago
Look up the history of heroin, or methamphetamine. They both were marketed as safe in the early days. Drug companies like to sell drugs like soda companies like to sell soda. The conflict of interest is so awful that sometimes I wonder if we should ban for-profit drug companies.

empath75 8y ago

> Laura had always assumed that depression was caused by a precisely defined chemical imbalance, which her medications were designed to recalibrate. She began reading about the history of psychiatry and realized that this theory, promoted heavily by pharmaceutical companies, is not clearly supported by evidence. This is the most harmful idea in psychiatry and it's pure marketing bullshit -- everyone knows it, but they still sell this to people.

colesdefectum 8y ago

I rarely comment on anything but this hits rather close to home. After a rather severe bout of depression my doctor started feeding me drugs. SSRIs, NDRIs, benzos, and a handful of misc other prescriptions that were the flavor of the week. I felt like every visit was a game of 'lets try this new drug!' which would lead to negative side effects more often than not. Fast forward a couple years and I'm realizing that medications aren't the answer for me. So what do my doctors do? They try to push yet another pill or three down my throat. Finally I'd had enough of it and told them I didn't want to take anything anymore. Their idea of a tapering plan from over 2 years of medications was a week and a half. They were sure to tell me that if I stopped treatment I wouldn't be given any more refills and one doctor condemned me for even showing up to my appointment with the intention of discontinuing medications. He said I was wasting everyones time. Anyway, I figured sure, I got this. I can get myself off these meds. I was very wrong. I made it about two weeks before withdrawals really kicked into overdrive. Dizzy, brain zaps, tinnitus, profuse sweating all hours of the day, insomnia, numbness in my face and arms, racing heart, involuntary muscle spasms... I started stuttering and couldn't force my body to stop twitching and shaking. My mind was completely fogged over and at times I couldn't even articulate words to talk to someone. It was a state of being in a perpetual panic attack multiplied by 100. After I thought I was actually going to die I setup an emergency appointment to try and get a prescription refill and a longer tapering plan only my doctors wouldn't have it. They flat out refused treatment and told me to go to the ER if I thought things were getting that bad. I was floored. Here this doctor got me physically addicted to powerful mind altering medications over the course of a couple years and now that I want out they treated me like a drug addict and dismissed me. In the end I sourced some darknet meds and very slowly tapered myself down. To this day I'm still not even close to being back to normal, whatever that is. I get random panic attacks out of the blue on a daily basis. Sometimes the left side of my body will go numb. Other times I'll just start sweating while my heart beats like I just finished running a marathon. The ringing in my ears is horrible. I'm now extremely sensitive to stimulants of any kind (no more caffeine, meh) so I've had to make some significant changes to my diet. The good news is I've been 100% off any medications for two months now and I'm finally getting to where I can get more than four consecutive hours of sleep several days a week (so much better than zero sleep every day). I feel as though being able to enjoy coffee, sugary drinks, and having the ability to actually sleep an entire night has been permanently removed from my life now. At any rate, if there's anything anyone should get from all this rambling, it's that you should exercise extreme caution with pill pushing doctors. They have the ability to drag you into your worst nightmare of existence and leave you high & dry when you want the ride to stop.

mnm1 8y ago

Tapering off over the course of a few months or longer is especially important for benzodiazepines. Not doing so can lead to seizures or death. Luckily, it'll be pretty obvious to the patient if they are going too quickly and tapering slowly should lead to minimal side effects. Cannabis can also help some here. Unfortunately, most psychiatrists and doctors have no experience with this and will even discourage patients. Often, patients will have to just get a supply and do this on their own. https://www.benzo.org.uk/index.htm https://www.benzo.org.uk/index.htm is a great resource of people who are doing this and probably the most valuable out there. Psychiatrists, in my experience, are not your friend in this process. They're the pill pushers and dope dealers. Of course they don't want their patients to taper off and discover a better life. Where would they get their money from if people stopped buying their bullshit about 'chemical imbalances?' What this industry has perpetrated on millions of people is downright inhumane, all so a few doctors and pharma companies can get rich. It is very possible, however, to taper off this garbage and get back to leading a normal life afterwards. That includes benzos, SSRIs, and other 'anti-depressant' garbage like Welbutrin. I know from experience. If this is something you want to do, don't let these vile doctors keep you addicted to their garbage and their bullshit, away from a real life.

limeblack 8y ago

"Lamictal, a mood stabilizer; Lexapro, an antidepressant; and Seroquel, an antipsychotic that she was told to use as a sleep aid." Lamictal and Seroquel can cause an often permanent condition called tardive dyskinesia[1]. Basically the dopamine receptors tend to permanent up scale leading to sleep disorders. This is fairly unique compared to most Psychiatric drugs out there. [1]: http://www.onlinelawyersource.com/tardive-dyskinesia/seroquel http://www.onlinelawyersource.com/tardive-dyskinesia/seroque...

rednerrus 8y ago
I don't see Lamictal on that list: https://medlineplus.gov/ency/article/000685.htm https://medlineplus.gov/ency/article/000685.htm
- limeblack 8y ago
  I believe the risk is fairly small compared to the drugs on that list which is why its left out. Not that I trust this site more then a government site, but this list has it[1]. [1] https://www.ehealthme.com/ds/lamictal/tardive-dyskinesia/ https://www.ehealthme.com/ds/lamictal/tardive-dyskinesia/
darpa_escapee 8y ago
Dopamine blockade isn't significantly induced by doses of Seroquel used for sleep. Although it and its metabolites do have action at certain dopamine receptors, lower doses will first occupy other receptors that they have a higher binding affinity for. Its metabolites are partial agonists at 5HT1A autoreceptors that induce downstream release of dopamine, which theoretically reduces the risk of tardive dyskinesia from direct dopamine blockade. If you're curious about this, Stahl's Essential Psychopharmacology textbook goes into detail about this and is written in a way that some idiot (me) on HN can grok it.
- limeblack 8y ago
  > Dopamine blockade isn't significantly induced by doses of Seroquel used for sleep. True at typical low dosages. I have been on Seroquel at very high dosages for sleep and the doctor gave me the explanation above. I have after multiple attempts failed to taper off of it. I have even tried liquid. I will definitely check out the book. The key issue being that the receptor up scale permanently.

tamaharbor 8y ago

Supplemental iron and magnesium saved me. No more GAD, panic attacks, night sweats, or insomnia, and no more RX drugs!

noamelf 8y ago
Can you elaborate a bit? I'm looking into supplements as well to replace or enhance my meds
mastox 8y ago
Just curious, but were you ever tested for an anemia or anything?
- tamaharbor 8y ago
  Full and frequent blood tests continually measured low ferritin, but since hematocrit and hemoglobin (and all other) levels were within range, three separate primary physicians and my psychiatrist all indicated there was no problem. I took it upon myself (after ‘internet research’) to gradually get off all the meds prescribed over the course of three years (klonopin, alprazolam, gabapentin, mirtazapine, sertraline, and others) and start supplementation with two basic minerals obtained from WalMart. I felt wonderful almost immediately, and ever since.

abstractbarista 8y ago

I found this to be a very intriguing read. Upon finishing it, I am terrified of these drugs, terrified of pharmaceutical companies, and terrified of the cognitive dissonance in the study of mental illness. I would try absolutely anything before these drugs. It's a freaking nightmare, thrust into reality.

thanatropism 8y ago
That's a shame. Most of these pieces are hysteria. Journalists and lawyers never go after people who seem to be fine with medication. Here's hoping you don't have serious mental health problems in the future.
- abstractbarista 8y ago
  I definitely understand where you're coming from. Surely there are a lot of people that this stuff actually helps really well. In the past I did have serious issues, but I was able to bring myself out of it over time, by myself. And now, I have nurtured a far more stable and enduring mindset. :) EDIT: By far the biggest part in me getting better was moving on to a different way of life. Basically, changing the set and setting. Which I think is underrated by the professionals described in this article, hence the problem: Treating the symptoms, not their source.
- mastox 8y ago
  I think some would argue that you aren't fine if you are on these kind of medications, and "fine" might be an illusion to the patient and their peers.

eecc 8y ago

Well, haven’t read through more than the first intro paragraph and whatever hollowness Miss Delano might have felt can be also attributed to the spleen of a comfortable yet purposeless life, planting daffodils and watching them wither. With this I don’t want to disparage her personal odyssey or that of people suffering from psychiatric difficulties, but the framing of this article is unfortunate. Very much

kmm 8y ago

When I stopped taking Venlafaxine (Effexor), the side-effects were immensely unpleasant. Brain zaps, panic attacks, hypersensitivity to light, barely any cognitive function. My psychiatrist was a sweet lady, but she did not appear to understand how tough it was for me. It boggles my mind she did not get it, she must have had so many patients stop with the medication, did she just not take any of them seriously? In the end, I opened up the plastic casing of the pill, which turned out to contain a few dozen grains. Over the course of 2-3 weeks, I took a few grains less every day, until I was completely done with them. I don't know if you're allowed to do that, maybe there is no guarantee that every grain contains the same amount of medication? I'm not a fan of tampering with medication, but I didn't feel like I had a choice.

mattyb678 8y ago
Even if I’m just a few hours late taking my Effexor I start getting brain zaps. They are terrible. I’m not looking forward to ever having to go off it
adyavanapalli 8y ago
How the flying heck did your psychiatrist let you stop taking your medication cold turkey? There's usually a weaning off process for any sort of psychiatric drug.
darpa_escapee 8y ago
> I don't know if you're allowed to do that, maybe there is no guarantee that every grain contains the same amount of medication? There are entire fields of material science dedicated to this problem. Generally, if a single pill is metered into smaller doses, resources went into ensuring that each dose is metered accurately. The grain form was probably for absorption or time-release.
tachyonbeam 8y ago
It may be that most psychiatrist don't follow patients long term, or that when things don't go well for a patient, they stop seeing that psychiatrist, and so they don't hear about bad withdrawals very often. Crazy idea, but maybe psychiatrists should take antidepressants for a short bit as part of their training. It would give them some perspective.

tylerjwilk00 8y ago

I was prescribed a benzo for insomnia and thought nothing of it. I went from enjoying a good night's sleep to completely dependant on it just to function. The only way to describe it was that I became "psychologically fragile" such as if things didn't go exactly according to expectations I would be in a state of panic and fear. It was horrible. I decided then to go cold turkey (no one told me otherwise) and it was hell! I thought I would die or lose my mind. To say nothing of the electric shock sensations that were constant and the feeling that my skin was buzzing. After a couple months I felt like myself again and my mental fortitude had returned. I will never take another. For me the benzo class of meds are way more dangerous than helpful.

tachyonbeam 8y ago
It's awful how easily they prescribe addictive medications, and how uninformed doctors are. Benzo withdrawal can cause seizures and even death. There are much less addictive sleep aids such as trazodone, and those should probably be prescribed first.
bobowzki 8y ago
I'm curious what type and dosis you were prescribed? (I'm an MD).
- tylerjwilk00 8y ago
  I believe it was temazepam. I do not remember the dose.
sjg007 8y ago
One benzo? What dose?