5 ms·

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 c

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.
        SketchySeaBeast 8y ago
        So reject the best known treatments, flawed as they may be, and instead choose internal reflection, when for many conditions being unable to accurately reflect is either a cause or a symptom of the condition?
  - 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.

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.
        SketchySeaBeast 8y ago
        So reject the best known treatments, flawed as they may be, and instead choose internal reflection, when for many conditions being unable to accurately reflect is either a cause or a symptom of the condition?
- 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.