Many People Taking Antidepressants Discover They Cannot Quit
nytimes.com
nytimes.com
When I tried stopping after the 5mg dose I had constant vertigo symptoms and incredible difficulty sleeping.
What I ended up doing was cutting the pills in half for a few weeks, then quarters, then removing one day a week from the schedule until I was down 2.5mg/wk. Finally I was able to stop, and only was mildly affected for 3 weeks after that.
That stuff does weird things to your brain. On the flip side, I couldn't have gotten through some really rough times without it.
I wonder if there is a form of research that could done by following patients who are receiving this treatment, and track how they wean themselves off of it.
When asked to describe it, I tell people the zapping feels like my mind is lost for a fraction of a second. For that tiny moment I really think I'm completely non-functional, and the thought of this condition lasting for a non-trivial amount of time is frightening, although I've never heard of that happening.
Zoloft was beneficial for me, but not enough to outweigh the discomfort of the brain zapping.
Your story of recovery is a good one (and not the only good one). The problem is that a number of people in that same system don't see any need to get people off these medications. IMHO they are best used short term (whatever that means) while you work through your issues - like you did.
For those reading, there is no "correct" timeline for working through your issues. Everyone goes at their own pace. I would just encourage you to try, and not assume a lifetime of medication is a good solution.
Why is this a problem? If long term studies prove detrimental effects then sure, it's a problem.
But taking a pill every day isn't inherently bad for you. If you live in a northern climate you would probably benefit from taking Vitamin D every day your entire life, so what's the fundamental difference of an SSRI?
Clearly SSRIs help many people in a significant way, but their mechanism of action is still poorly understood and their effects are powerful enough that they should be prescribed and taken long-term only with careful advising and caution. For some people, maybe taking them until the day they die is the best option, but it probably is also harmful for some people to take them for several years.
They're not addictive. They cause dependence. There is an important difference. Addictive things increase incentive salience of stimuli associated with the drug. They increase wanting. And that increased wanting leads to increased usage.
Dependence on a drug does not have this aspect. It just represents the bodies physiological adaptation to the new state.
Conflating the two is bad practice for an article ostensibly about medicine. And it leads people, and that set includes legislators, to think about using more government violence to enforce regulations of drugs which create dependence.
Further, it should be obvious that dependency is a problem. If the medical profession thinks it's solved that problem by redefining words, I'd say state regulation is pretty appropriate step.
1. When I consider stopping antidepressants, I'm not filled with anything like the dread I was when I thought about giving up the addictive pills.
2. I forget to take my antidepressants sometimes. I forget to refill the prescription sometimes.
3. I have never had any desire to take more than the prescribed dose of my antidepressants.
It's an important distinction, and unfortunately one that folks in the recovery community sometimes miss. In my experience the above characterization usually brings it home much better than some heavily medicalized description of addiction vs dependency.
https://joannamoncrieff.com/2014/05/01/the-chemical-imbalanc...
Here's one:
https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12...
"SSRIs might have statistically significant effects on depressive symptoms, but all trials were at high risk of bias and the clinical significance seems questionable. SSRIs significantly increase the risk of both serious and non-serious adverse events. The potential small beneficial effects seem to be outweighed by harmful effects."
"Number needed to treat" is a useful epidemiological concept in this case. A perfect drug that cures every single patient has an NNT of one - for each patient you treat, one patient is successfully treated. When you translate the results of SSRI meta-analyses, you get an NNT of about seven - for every seven patients who take SSRIs, one more patient will recover than if those patients were given a placebo.
It's hard to know what to do with that information. Is it worth prescribing antidepressants to 1,000,000 people to treat 142,000 of them? On a pure cost-benefit analysis, the answer is a resounding yes. Antidepressants are relatively cheap and safe. Are you willing to take a pill every day to get a one-in-seven chance of an effective treatment? Maybe. If you're in the throes of a deep depression, you might be willing to give anything a try. If you're just feeling a bit blue, maybe not. By the same token, if you're taking antidepressants and you don't think that they're helping, you're probably right.
Yes. Reviews suggest that statins have an NNT of between 50 and 200 depending on the patient's underlying risk for cardiovascular disease. Coronary stents are probably useless. Reviews of antibiotics, antivirals and corticosteroids show a wide range of NNTs and often show no positive effect.
The drug approval system has a relatively high bar for safety, but a relatively low bar for efficacy. A drug manufacturer only has to prove that their drug is effective for one particular cohort of patients with a particular disease, but doctors are then free to prescribe the drug to any patient with any disease. Many surgical interventions are never subject to a randomised controlled trial.
The bigger problem is “depression” is not reproducibly measurable, because it has no falsifiable or biomedical marker.
That's something I like to point out using SSRIs as an example. The claim is that they increase levels of serotonin and that the cause of the depression is reduced serotonin. The thing is, nobody actually checks your serotonin levels and says "oh that's low take this." Then there's the problem of why ones serotonin is low when it wasn't always that way. There are probably many causes of depression and quite possibly some that don't lower serotonin.
You say this as if it were a bad thing but if SSRIs are as effective as exercise wouldn't that mean that they are very effective?
If you were to tell me a fat burning pill were no more effective than exercise I would start taking it.
Wait what? Which part? My first sentence? There are a few opinions in what I wrote. What specifically might inspire guilt? Honest question, I try to be sensitive to such things.
But there are many more possible causes of depression than stress - one could compare it to a fever: a high fever kills, but there are many possible illnesses leading to a fever. Expecting that exercise helps with depression every time is like assuming every fever is caused by the same illness. Not to mention the fact that while having more red muscle may help with coping with chronic stress, it does not actually fix the cause of chronic stress in and of itself (although it can of course help with providing someone with the mental fortitude needed to take on that particular problem).
There are all kinds of reasons to do more exercise, but touting them as a catch-all fix for depression is dangerous and ignorant.
[0] https://ki.se/en/news/how-physical-exercise-protects-the-bra...
http://slatestarcodex.com/2014/07/07/ssris-much-more-than-yo...
The SSRI did make me more functional. But what it mostly did was make me affectless. That is, I could be sad or happy or angry or whatever, and I felt pretty much nothing. However, I still did whatever someone who was sad or happy or angry or whatever would do. You could say that it made me sociopathic. But fortunately, not homicidal or suicidal. Or at least, not in a big way. Also, I lost interest in sex, and it took forever to reach orgasm.
And yes, quitting was painful. Mostly I recall restless leg syndrome. I would kick my partner while asleep. And I got even crazier for a while, as I tapered off.
So now I'm taking modafinil and lamotrigine. Which works very well for me. I'm a little manic most of the time, but I like that. And I'm not at all sociopathic.
This is a common side effect of SSRIs. I have the same, but I very much enjoy that side effect. Saves time, and already got a child anyway. I still love pleasuring my significant other just as much as before, btw.
People who have bi-polar usually get mood stabilisers such as lithium prescribed. Perhaps anti-psychotics? SSRIs are known to be problematic for bi-polar personality disorder.
Modafinil (antinarcoleptic, originally) plus lamotrigine (anticonvulsant, originally) works well for me. It's easy to tweak the ratio as circumstances warrant.
Edit: About sex. My wife at the time did like that I took longer to reach orgasm. However, after we separated, I discovered that wearing a condom made orgasm unreachable. And that did become a problem. Albeit an amusing one, in retrospect.
But why do you say "better"?
OK, for example, I would be driving, in a hurry. And without much emotion or warning, I'd find myself running red lights and whatever. Laughing. I remember an accident, where the other driver said something like "Where the hell did you come from?" And I almost said something like "God sent me to kill you!" But I didn't, fortunately.
That SSRI truly made me a danger to society and myself.
I like to say a little on the manic side. I feel more alive. But not too much, because it's bad for me. Now I can just be happy and energetic.
Within the first week of taking anti depressants (wellbutrin, I later switched to prozac) I would at random moments of the day begin to remember funny memories. I would be walking to my dorm from class and remember a funny gag from the simpsons and break into a stupid grin.
After two years on anti depressants I was able to stop taking them. I was able to do this by accepting and understanding that while I may have real reasons to be sad, the underlying reason that I was dwelling on these negative thoughts was my brain chemistry. Once I accepted this I was able to justify cheaper less harmful ways of medicating my depression. Whenever I began to feel depressed I would simply go to my tv and start watching episodes of `It's always sunny in philadelphia` or whatever comedy made me happy
I think the worst mistake people with depression make is reinforcing their sadness by listening to sad music, watching sad movies or reading sad books when in fact they should be doing the opposite. They also allow their depression to become part of their identity.
This sounds a bit like you discovered Cognitive Behavioral Therapy. That's actually a very insightful, practical approach you developed.
For example, from the article,
> "A year and a half after stopping, I’m still having problems. I’m not me right now; I don’t have the creativity, the energy. She — Robin — is gone"
If that's important to you, why not continue?
So basically, it was side effects. Friends worried about me.
I can’t take paxil, zoloft or valium, so it’s probably different.
I personally wouldn’t stop antidepressants because my physiology goes straight into depression without exception, and then the relationship would likely flounder.
Because SSRIs have side effects, and you tolerate those if it's preventing depression, but you might not tolerate them if you're now taking a medication for life.
Except it's not for large groups of people. And for anyone with a history of multiple episodes, the long ramp up time needed for antidepressants is extremely risky to try an "as needed" approach.
Says who? The DSM-5 specifically lists Persistent Depressive Disorder, formerly known as dysthymia, which is defined by chronic depressive symptoms for a period of two years or more. Many people suffer from frequent episodes of major depression; there's fairly good evidence that antidepressants can reduce the risk and severity of relapses.
Patients shouldn't be taking antidepressants in the long term by default, but it's a very good option for a lot of people. If you've had two or three previous episodes of major depression that have been successfully treated by antidepressants and you find the side-effects tolerable, taking them indefinitely might be a perfectly sensible decision.
But that's not most people. Most people with depression have a mild to moderate form that responds well to medication for two years and a talking therapy. These people don't need ot be on meds for life.
On top of that, some people aren't comfortable needing to take a daily dose of medication where the withdrawal symptoms are so disruptive. What happens if you forget to take your meds one morning? What if you lose your insurance coverage and can no longer afford the pills? What happens if you're traveling abroad and the bad with your medications gets stolen?
I also took antihistamines for a long period of time (15ish years) and eventually I got to the point where I got multiple nosebleeds every day I took one. Nobody told me that could happen when I started taking them. I went off for a year (thankfully I discovered nose strips to get me through the night) and now I can take the occasional antihistamine again without my nose bleeding all over. As a result I'm a bit more conscientious of what long term effects I need to be looking out for in any other meds I take regularly. Living without is just unfortunately necessary in some cases.
After I changed jobs, and therefore healthcare providers because yay America, I didn't bother getting a new prescription. It was a rough ride coming off the stuff. I remember distinctly crying, like really intense honest crying with sobbing and tears and everything, over some plot point in a stupid TV show I was watching and, honestly, it was delicious. I was so grateful to be able to experience again, instead of just passively existing.
After several more years, none of them involving doctors, I finally found my way to more-or-less normality. For me, and I suspect many depressed people, it was philosophical. I had this idea of how the world should work, how I felt it should work, and I knew the world didn't work that way, and the dissonance of that manifested as depression. I think this is probably the normal reaction of the mind to this state, and under normal circumstances it is supposed to serve to motivate us to reconcile our model of reality with our observations of it, but for various reasons I once elaborated on in a different post, I think our current cultural mind-set is not only ill-suited to helping us with this, but actively making it worse.
I don't think going off them had to do with worries over "unnatural" , rather it was just human curiosity to understand my own brain. I've tried other illegal drugs for similar cognitive insights. It just so happens that SSRIs are legal and have some degree of clinical efficacy.
As a side note I think therapy did more for me than SSRIs and I'm still in therapy but ymmv. Finding a good therapist is way harder than finding an anti-depressant prescription.
A business is about making the most money possible: Maximizing revenue is about minimizing the main costs which are generated by the activities of:
(a) acquiring the customer (through: advertising and marketing) and,
(b) retaining the customer (in this case: through dependency).
There are alternatives to anti-depressants. Some people quit depression for good with a well researched and planned LSD trip combined with long-term daily mindful meditation.
No, I'm not saying everybody should take LSD.
Both drugs have mechanisms of action that we don’t fully understand and both affect the brains homeostasis.
If it’s irresponsible to prescribe LSD for depression it’s irresponsible to prescribe SSRI’s as well
Except that's not how it works.
How it works is that SSRIs have been tested in trials, and are approved.
LSD isn't. When someone says "try LSD" (or psilocybin which seems the newest rage these days) it means they'd illegally acquire the drug (who know for sure what drug they bought? [EDIT: and who knows the dosage/strength of active substance(s)?]), and administer it recreationally without the aid of a professional.
SSRIs, in contrast, are clinically tested, legally acquired, and administered under the guidance of a professional.
> Antidepressants can also cause psychotic episodes, panic attacks, suicide, etc.
Yes, but these side effects are widely documented. There are more common side effects, btw. These are the extreme ones you mentioned, and also the most rare ones. Many side effects are temporary. And if you are suicidal, it is unlikely you get SSRIs prescribed. Unless you lie about that, of course, but if you lie to your MD you're on your own.
My recommendation is simple: seek professional help. If you don't want to take SSRIs, fair enough; your MD won't force you. Heck, they might even be reluctant to prescribe them. But professional help is much more than drugs. Think about CBT, mindfulness, under the guidance of professionals; not self-medicating new age hippies.
The professionals that without any evidence promoted the low-serotonin theory of depression. Who, after over a decade of prescribing SSRI's finally admitted that low serotonin doesn't cause depression. Yeah, those professionals. They don't know what causes depression yet they're happy to keep prescribing drugs. But it's the "self-medicating new age hippies" that are irresponsible?
Also, those professionals aren't necessarily the same people. Do you fault Linus Torvalds for a bug in the Windows NT kernel because he's a software developer? Science is constantly in motion and questioning itself. The drug usage in the past before drugs were illegal (pre-2nd part of 20th century) was more irresponsible, and its thanks to science and law this has reduced. And specifically, SSRIs are more safe than antidepressants used before SSRIs such as TCAs and MAOIs.
Lots of professionals with great titles and affiliations steer people down a totally incorrect path.
An easy example of this is Harvard study published in the New England Journal of Medicine promoting dietary fat reduction, shaping what every credentialed person would advise for diet for the next 50 years: https://www.npr.org/sections/thetwo-way/2016/09/13/493739074...
Drug companies shoulder the rep of being cold evil capitalists. Psychiatrists also become extremely wealthy as part of this medical complex, and get to keep a positive reputation. It reminds me of ticketmaster essentially being paid to shoulder negative PR for excessive ticket fees which are often largely passed on to performers.
Not knowingly, and they're expert on the field. There's a few exceptions, but those people are not 100% in the head. Diederik Stapel [1] being a recent example in social psychology.
The chance that you have a sitter without a clue is much higher. Especially because those are usually "friendz". The chance a professional knows better than a self-proclaimed expert is simply too high to discount all professionals.
> Drug companies shoulder the rep of being cold evil capitalists. Psychiatrists also become extremely wealthy as part of this medical complex, and get to keep a positive reputation. It reminds me of ticketmaster essentially being paid to shoulder negative PR for excessive ticket fees which are often largely passed on to performers.
In The Netherlands, you first try the drugs which are most likely to solve your problem but also you need to consider what gets reimbursed by insurance. Insurance also wants you to go for cheapest generic brand if possible (if patents expired, and the drug is known to work for your ailment). Example: something like Concerta doesn't get reimbursed because Ritalin exists and is considered the generic form. Even though the yo-yo effect is more severe with Ritalin.
Another example, I had the option of going for a SSRI or a SSRI plus antipsychotics. The former has a good track record for people with autism; the latter combo better but it also has more impact. Regular blood checks, and basic insurance doesn't cover the antipsychotics.
As for the positive reputation, when I went for my autism diagnosis I had an anamnesis from an asshole of a psychiatrist. He was working there temporary because they fired their regular psychiatrist very recently. I don't know exactly why, but I do know it was directly related to his functioning as a psychiatrist.
Ticketmaster problem is different (and offtopic though I don't mind analogies). It can be solved by putting a cap by law on how much percentage profit (e.g. 25%) second hand market may earn. That does require political willpower and enforcement of such regulation.
Western medicine is famously puritanical toward hallucinogenic drugs. Human social history is long and hallucinogenics being illegal is comparatively recent. It's an insult to the study of science that such an interesting and powerful drug is taboo to even study. Thankfully this seems to be reversing in my lifetime.
That's not the case (currently) for LSD, which will be of unknown quantity and unknown purity. It might not even be LSD.
LSD may be great, but telling people with a potentially fatal illness to just go try it is fantastically irresponsible.
But I would agree that the field of psychiatry (not psychology which doesn't require a medical license) has it in their interest to say that antidepressants aren't _narcotics_. And they aren't. But the cruel thing is that the difference between a narcotic and a dependency-causing-drug is blurred.
For example, Wellbutrin is a norepinephrine aka noradrenaline agonist and reuptake inhibitor. It's a stimulant - to call it an antidepressant is a bit of an ongoing joke. If someone has no energy and lacks willpower, any stimulant will get them to do things they might not otherwise have done.
The reason Wellbutrin isn't considered a narcotic is mainly because being full of adrenaline is often a shitty experience - whereas being full of a 10%/90% adrenaline/dopamine mix is quite pleasurable (ADHD stimulants - amphetamines/phenidates.) But it's entirely unscientific to say that an antidepressant cannot be addictive to a person that likes the effects more than the average neurotypical person. Just google Wellbutin abuse and you'll find a ton of personal stories.
And then lets talk about dependency. Dependency is just a rebound effect by the body to adjust its endogenous feedback in order to find homeostasis again. It's why most drugs that have large immediate "gratifying" or noticable psychological effects, also come with a downregulation in the same areas by the brain and body. So when you stop taking the drug, your body is actually BELOW baseline and it will take quite a bit of time before you are back to baseline. In some cases of extreme use, the brain can be structurally changed and permanent damage can result. See "parkinsons from stimulant abuse" for a typical example.
Dependency and addiction only have a difference in a psychological way. The physical withdrawal and rebound effects are mutual. Don't be fooled when you are told that an antidepressant drug is not a "narcotic" and isn't habit forming. It is a lie.
The only psychological drugs that are truly therapeautic are upregulators like Cordyalis, known as Yan Hu Suo in Chinese medicine. It causes neurogenesis and upregulates dopamine. It is quite a beneficial drug to consume when withdrawing from any type of stimulant or dopamine agonist.
Psychedelics used in the right setting are actually proving to be wildly successful in treating depression, PTSD and others.
Maps.org has MDMA in phase 3 clinical trials.
A few important points:
1. Antidepressants can truly change people's lives. Not everyone's, and they're not the only treatment that works. Somehow this reporter tends to consistently overlook the clear evidence of benefit (I think this recent meta-analysis was posted on hn: https://www.ncbi.nlm.nih.gov/pubmed/29477251)
2. Withdrawal symptoms are common if antidepressants are stopped abruptly - some of the folks who reported these symptoms originally have been favorite targets of Benedict Carey, ironically (https://www.ncbi.nlm.nih.gov/pubmed/9396960). That's why docs encourage tapering antidepressants.
3. The article doesn't distinguish between this sort of short-term withdrawal (common), and longer-term problems with discontinuation (likely quite rare) - they're very very different phenomena.
4. In some cases, difficulty with discontinuing longer-term is a result of persistent depression and anxiety (or returning depression and anxiety). It's not polite to point this out.
5. It's hard to imagine the Times writing an article about the problem with statins being that, once you stop them, cholesterol increases again.
6. If there were substantial long-term risks associated with antidepressants, we would have seen them - and believe me, people have looked and are looking.
7. BUT - we /do/ need more research to understand long-term effects of antidepressant treatment; this absence of systematic long-term study is true for most meds, frankly, but that's no excuse. My question would be: Who pays for it? There's no shortage of investigators who would be delighted to study it. But try getting a foundation, or NIH, to support such a study.
/rant
Drug makers have no incentive to see them. I can say from experience that I have seen them. I spent two months out of work when I had to discontinue Effexor. Other people complained about “brain zaps” and were largely ignored. My doctor never warned me. The evidence is there but there if you look, but there is no one with an economic incentive to pay attention. Just because there are few studies documenting these symptoms doesn’t mean they’re not. This is a wake up call that more studies need to be done.
https://www.medicines.org.uk/emc/product/4487/pil
> If you stop taking venlafaxine suddenly you may get withdrawal reactions (see section 3)
[...]
> Do not stop taking your treatment or reduce the dose without the advice of your doctor even if you feel better. If your doctor thinks that you no longer need Venlafaxine tablets, he/she may ask you to reduce your dose slowly, before stopping treatment altogether. Side effects are known to occur when people stop using Venlafaxine tablets, especially when Venlafaxine tablets is stopped suddenly or the dose is reduced too quickly. Some patients may experience symptoms such as tiredness, dizziness, light-headedness, headache, sleeplessness, nightmares, dry mouth, loss of appetite, nausea, diarrhoea, nervousness, agitation, confusion, ringing in the ears, tingling or rarely, electric shock sensations, weakness, sweating, seizures or flu-like symptoms. Your doctor will advise you on how you should gradually discontinue Venlafaxine tablets treatment. If you experience any of these or other symptoms that are troublesome, ask your doctor for further advice.
Anti-depressants, especially something like venlafaxine, are strong meds for a strong condition. It would be surprising if they had no side effects - and honestly, if you go to a psychiatrist instead of a normal doctor, you usually get a dose that's fine-tuned to the extent that you don't get them.
I took 2 SSRIs for about 3 years and went off them close to cold turkey. When I would move my eyes it felt like there was a delay between moving and seeing. This lasted for about a month. In general everything felt very disconnected/fuzzy/unreal. Sometimes it was close to what I imagine people describe as an out of body experience.
I still find articles like the above absolutely horrible, and wish people would stop writing them. Meds saved my life. They save the life of millions of people every year - and they make depression hands-down easier to manage and to live with.
That doctors over-proscribe is another problem. Muck-raking and fear-mongering about what are already scary drugs to very scared depressed people has real costs - people probably die because of articles like the above. Many, many people suffer for years without medication because they're afraid to start them.
Drug makers aren't the people looking, the regulators are.
Here in the UK, the medicines regulator operates an open reporting system for adverse drug effects. Any patient or healthcare professional can make a report of an adverse drug event, no matter how minor. The collected data is publicly available in anonymised summary form. 110 countries share detailed reports of adverse drug events through the WHO VigiBase, which is monitored for risk signals by a dedicated team at the Uppsala Monitoring Centre. Potential safety problems are then fed back to national regulators.
All of this reporting apparatus was put in place after the thalidomide disaster. It's designed as an extremely sensitive early-warning system to detect subtle or rare adverse events. For the most part, it works. I'd suggest taking a look at the WHO Pharmaceuticals Newsletter, which shows how this information sharing works in practice.
https://yellowcard.mhra.gov.uk/ https://www.who-umc.org/vigibase/vigibase/ http://www.who.int/medicines/publications/WHO-Pharmaceutical...
2) They're common while tapering too.
3) Agreed
4) Possibly true. What's unpolite about mentioning this?
5) Wrong analogy; depression only increases would be analogous to increased cholesterol. What are statin drug side effects when quitting, from the drug.
6) The mechanism of action isn't even fully understand. You're absolutely wrong to claim "we would have seen them (long-term side effects)". Isn't there an article on ceiliac disease and how long it took to pin down on HN's front page now?
7) You mentioned in #6 we should already know.
If I had a rant, about overly-confident individuals posting on forums. While I've no reason to believe you were intentionally dishonest, the over confident, "factual" sounding, behavior has the same basis as disinformation activists.
Experience? Was on antidepressants. Had a horrible side effects unrelated to depression coming off them. Safe my ass.
1. Read the reference before responding; the study looked (in part) at antidepressant-placebo differences. Also - I can't prescribe placebo.
2. Got anything to back that up?
3. OK
4. Because it implies that some of the 'withdrawal' symptoms are actually recurrent depressive/anxious symptoms (which can include somatic symptoms). Which is different than arguing that all of these symptoms are a consequence of relapse/recurrence.
5. Well, one of the critiques of antidepressants is that, after someone is on them for years, depression can recur... but fair point, not a perfect analogy.
6. Fully understood? It's not even a little understood. What does that have to do with detecting long-term consequences? We have 25 year follow-up data with antidepressants now. Despite lots of effort to find otherwise, show me some solid literature supporting risk.
7. Yup. We should. And we should keep looking.
We also agree that there's substantial harm associated with people confidently posting misinformation - so while I mostly lurk here on HN, I feel that 20+ years of treating mood disorders and 20+ years of pharmacovigilance research gives me the right to push back. Lived experience is critically important, but it does not trump data.
I would argue that for an individual, lived experience trumps all data - for them. Data is an aggregate of individual experiences. A single persons experience is a data point, not an anecdote.
I've taken Abilify, Wellbutrin, Seroquel, and a number of other drugs. The biggest problem when you enter the psychiatric system is you go through pill roulette. You take a drug, try it, see what works, and keep trying till you find what works. Even worse is that I entered the system in high school which is a tumultuous developmental period.
One sad personal story is that a psychiatrist started me on a developmental drug. A drug that was approved for other problems but was "in development" for other uses. I tried it and it was worse than Seroquel. Seroquel, if I missed a dose, I couldn't sleep. For this new drug, if I missed a dose, I had a panic attack and if I took it, I would fall asleep. So if I was out too long, let's say traveling, I had to choose between a panic attack or falling asleep.
When I confronted my psychiatrist about this problem, instead of taking me off the drug, he prescribed me medication for panic attacks.
Of course the adverse effects of psyshcosis and untreated psychotic illness are much worse, including homelessness and death. So while these drugs are undeniably difficult to live with, people who have been prescribed the family including Seroquel generally really need them to function. All of which is to say that the struggles of people on neuroleptic therapy are generally very different from what’s being discussed in the article here.
The ideal environment is one in which the psychosis can complete.
It's very similar to a psychedelic journey in that with the right set and setting it can lead to deeper compassion, clarity and connection.
I've been through a number of such experiences over the years; I used to be terrified of them and tried to avoid them at all costs.
Now, it's very much an initiation into whatever the next level of my life demands of me. I've learned to make symptoms bigger vs supressing them and in doing so, I recover vital parts of myself.
Without this orientation, I would never have survived so called schizophrenia, bipolar, suicidal depression, psychosis.
Dr. Paris Williams has an incredible book called Rethinking Madness that was instrumental in helping me adopt a framework to complete a psychosis.
https://www.cbsnews.com/news/how-seroquel-a-risky-antipsycho...
During taper symptoms:
- nausea
- general anxiety
After taper symptoms (continue today):
- general anxiety
- strong, brief muscle contractions anywhere in my body (myoclonus)
- weight loss (good)
History is littered with harmful, poorly-thought out "psychiatric treatments" that were widely regarded as milestones. Even if there are a tiny minority of people who's mental condition is so bad that scrambling their brain with drugs will lead to an "improvement", the widespread reliance on these drugs to treat the every-growing number of depressed and anxious people is not a good thing for individuals, or for society. This is especially true when it comes to young children, whose brains are being warped during the critical stages of development. Over a million children under 5 years old are being dosed with these mind-altering chemicals based on ridiculous ADHD or "defiance" disorders. Over ten million children under 17. Its very telling that the intelligentsia at the apex of society think that the answer to fixing our broken children is to drug them rather than to fix the broken society that they perpetuate.
https://www.cchrint.org/psychiatric-drugs/children-on-psychi...
These substances are yet another instance in the history of psychopharmacology where the touted benefits have been exaggerated and the harmful side effects denied. They have their place, but in the bodies of a sizable fraction of the current patients is not it.
The cost of taking antidepressants is really low however. Most of the time, they have almost no side effects, and are proven to help https://www.bmj.com/content/360/bmj.k847 Where I live, they are pretty cheap.
I find that there is undue bias against antidepressants. If you need them, take them! They help.
The study you linked doesn't scientifically prove antidepressants help.
Exactly, what undue bias against antidepressants have you found?
I've been...fortunate, if you can call it that, that while I've taken a great many antidepressants and other psychiatric medications, the worst side effects I've ever faced from stopping have been screwed up sleep/wake cycles, irritability, and a few days of headache.
I've had friends and family members who have had much worse, and I've had to carefully consider it each and every time, because we lack any kind of monitoring or ways of informing us how bad it might be.
I wonder if that's worse than a newborn.
Newborn creates hormones, sure, but needs constant attention and requires high maintenance. There's no voluntary break. Ours needs to eat every 3 hrs. Can set my clock to it, and can't sleep right after feeding (she's gotta sleep first, or go through intestine pain). I know it isn't the end of the world, and given the psychosis I been through worse, but this is flat out rough [for me].
I wish I'd get positive emotions during weak moments. I mean, if I'd have that, they wouldn't be weak moments. After one hour of crying and trying to solve in every way I can think of I become desperate and feel lost. Its those moments I need to control myself and realise it isn't about me; its about her, our newborn. She's the one who's suffering, and doesn't know better. I wonder if it helps to cry with her.
Thanks for sharing your experiences everyone!
I can’t emphasize enough how serious these drugs are, and what a prison they can become.
There are many alternatives that have been shown to be as or more effective.
Writing and then reading 14 Gratitude Letters to people.
Spending an afternoon a week outside.
Practicing telling the 100% truth in your relationships.
And of course, Psychedelics.
Many of you know my story of coming from schizophrenia, bipolar, anxiety, suicidal depression, mania, etc. and going on a path of returning to my self after having a vision that what was needed to was to go into the pain more fully and then seeking out various modalities to do just that.
It's possible to do, but you'll need to seek out support outside the mainstream.
> Spending an afternoon a week outside.
> Practicing telling the 100% truth in your relationships.
> And of course, Psychedelics.
Heh, a decent psychologist would suggest #3 during e.g. CBT sessions. Suggesting #4 is downright dangerous, you don't know who reads your post.
Readers, please seek professional help -based on conventional science- instead.
I tried all kind of self-help BS, including using psychedelics on my own, because I did not trust conventional science (ie. psychologists, psychiatrists). None of the pseudoscientific self-help BS helped, of course, and it gave me a severe lag in my life and professional career.
At the very least people should try out professional help first. But if I went on with it after the first failure (a diagnosis + meds for GAD which didn't quite work out) right afterwards, I might have figured out I have autism at my 27th instead of my 34th.
Both drugs have mechanisms of action we don’t fully yet understand, and both may cause serious side effects.
This is an extremely narrow and arbitrary ruleset you are applying...
If not merely because of the word "fully". That's a given in science.
> How is suggesting psychedelics more dangerous than suggesting the use of antidepressants?
Because psychedelics are not approved, you don't know the source/purity, and there's a lack of professional guidance.
Yes, you can get a panic attack on SSRIs. I had that when I started Fluoxetine because I almost fainted because my blood pressure was low whilst I was in a grocery store and had barely eaten. It happened a few times, though less severe (it is just low blood pressure), and went away after I got used to the drugs, which took longer than average.
SSRIs are not psychoactive, and better studied.
Finally, SSRIs are used under guidance by a professional. Recreational drugs, in contrast, are not.
The whole point of taking SSRI's is to affect the mind, so they are literally psychoactive.
They are better studied, but the risks you mentioned are associated with SSRI's as well as LSD.
Do you have evidence/study that shows LSD is more dangerous than SSRIs? LSD not being studied as much doesn't mean it's more dangerous...
Yes, they are; I meant psychedelic/hallucinogenic.
> They are better studied, but the risks you mentioned are associated with SSRI's as well as LSD.
Yes, but the possible side effects are well documented and users are informed and screened beforehand and there is professional guidance (by licensed professionals who studied for it) in contrast to recreational drugs use.
You know better what you dabble into when you follow the regular scientific path than the alternative path which is full with shenanigans, amateurs, wannabe experts, hippies, and downright dangerous, sick human beings.
> LSD not being studied as much doesn't mean it's more dangerous than any of the SSRIs.
Ultimately, this is irrelevant. You look at the current scientific evidence when you decide which treatment you want to follow. Recreational usage of LSD to self-medicate is very low on that list: actually, it shouldn't even be on that list until its scientifically tested in clinical trials. The lack of that doesn't mean we should just suggest it to random strangers; we ought not to!
> Do you have evidence/study that shows LSD is more dangerous than SSRIs?
No, stop turning it around. The burden of proof lies at you. You claim LSD is as useful or more useful than SSRIs.
I'll say it again: There's no evidence the use of LSD is more dangerous than SSRI's.
Mushrooms appear to be one of the safest mind altering substances known to man, and if used responsibly, can be healing.
Of course, they do show you what's inside, and for many people, they is going to terrify them. That is sort of the point though, to stare down the parts you've long ignored.
Wow, that's the most obvious argumentum ad antiquitatem I read this year.
"For thousands of years Christians have believed in Jesus Christ. Christianity must be true, to have persisted so long even in the face of persecution."
Sounds familiar? Straight out of the book. [1]
What's more, just because its natural or plants doesn't mean it is safe. Example: botulinum toxin the most toxic toxin known to mankind which you might know better under the name botox, entirely natural produced by bacteria.
What matters is that it is standardised, of known origin (traceable/provable), well studied in clinical trials, and the mechanisms well understood.
SSRIs fit all those characteristics, only the latter one not.
We certainly did not have thousands of years of standardised, safe human use. Heck, we didn't even have thousands of years of safe human use to begin with.
We didn't have known origin (a good movie about this is Into The Wild [2], btw). Especially not with amateurs. Doctors were more proficient, but not for thousands of years with every substance.
And studies, back then not. You had doctors and witches.
We've come a very long way.
> Mushrooms appear to be one of the safest mind altering substances known to man, and if used responsibly, can be healing.
> Of course, they do show you what's inside, and for many people, they is going to terrify them. That is sort of the point though, to stare down the parts you've long ignored.
I have used psilocybin, A. muscaria, Ayahuasca, MDMA (or God knows WTF it was) among a myriad of other drugs (the first 3 bought online when it was legal in my country). Terrifying it was -for the most part- not. I had fun and insightful experiences, but now that I am older I realise I was reckless [because I am sensitive to drugs and have autism]. I know you too will, at some point in your life realise how reckless you were when you used recreational drugs. And then you will perhaps realise how reckless it was to recommend that to random strangers. And perhaps you will feel utter regret. Au revoir, all the best to you.
[1] https://infidels.org/library/modern/mathew/logic.html#antiqu...
I used psychedelics irresponsibly in my youth, for recreational purposes -- much like it sounds you did. I'd never take MDMA without a proper spectral analysis (which you can obtain for $100 from ecstasydata.org) and with a sitter.
Then I took a decade off until I was facing recurring suicidal depression and was not interested in deadening my emotional experience via western psychiatry.
I was fortunate enough to be given a chance to do MDMA in a therapeutic setting as well as some healing experiences with mushrooms.
No question these compounds helped me release whatever was beneath the depression and other mental issues.
“Magic mushrooms are one of the safest drugs in the world,” said Adam Winstock, a consultant addiction psychiatrist and founder of the Global Drug Survey, pointing out that the bigger risk was people picking and eating the wrong mushrooms.
https://www.theguardian.com/society/2017/may/23/study-halluc...
Also, I never said they were safe because they were natural -- that is silly. There are plenty of things in nature that will kill you. We haven't had thousands of years of people using botulinum medicinally or ceremoniously.
As to your claim that "What matters is that it is standardised[sic], of known origin (traceable/provable), well studied in clinical trials, and the mechanisms well understood." We have had a draconian prohibition on psychedelics in general for several decades and the promising research was cut off.
So, if one is actually interested in healing, what matters is in finding what works -- and sometimes that means finding ways outside sanctioned medicine. But of course, we do have data on psychedelics and their safety and efficacy for healing -- and the results seem to be much more promising than the current approaches.
[1] https://en.wikipedia.org/wiki/The_Sacred_Mushroom_and_the_Cr...
Gratitude practices have been tested and shown to be significant in reducing depression, many studies on this.
https://pdfs.semanticscholar.org/a7bb/972b39435b0c5481aef88b...
Time in nature is also shown to fight depression, as found by some Stanford Researchers:
https://www.theatlantic.com/health/archive/2015/06/how-walki...
I wouldn't recommend trying psychedelics on your own, rather used in a specific therapeutic setting with a trained sitter / guide.
There are all sorts of studies on the effectiveness of psychedleic mushrooms on depression or MDMA for PTSD, etc.
Maps.org has ample info.
For me, I'm lucky that I didn't trust the mainstream Doctors who wanted to put me on antipsychotics or whatever else.
And I was blessed to find my way through medical research to find a path that worked. In no small part due to helping Peter Theil launch a startup in the private medical research space -- that experience showed my how very inefficient our medical system is at getting up to date information and practices to folks.
This isn't true. We know that antidepressants are significantly more effective than placaebo for most people. https://www.ncbi.nlm.nih.gov/pubmed/29477251
We are now gathering evidence about which antidepressants are most effective and least likely to cause people to stop using them: https://discover.dc.nihr.ac.uk/content/signal-00580/the-most...
Here is a recent meta analysis suggesting not much more than placebo.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592645/
I'm the study you referenced, did you notice if they compared it to active placebo or just placebo? It seemed they did an 8 week eval which is still within the 3 month window in which active placebo seems to be at work.
Also, why would we want people to be less likely to stop using antidepressants (if I read your comment correctly).
Having been on the Zoloft,I can say is got a black box warning for a reason and should only be taken if you're seriously in danger of self harm.
Shrinks like it because it keeps people coming back. People like it because they're not willing to confront their real problems and want something to numb themselves out.
Just say "No!".
sure, but you can make the same point about any drugs that people develop physical dependencies on. aside from alcohol and benzodiazepines, you will survive. antidepressant withdrawal varies a lot from person to person though. the brain zaps can definitely be severe enough that it becomes unsafe to drive a car, for instance.
> Just say "No!".
this I can certainly agree with, for all but the most severe cases. it's almost never worth the common side effects, let alone the rare ones.
> Just say "No!"
They are probably over-prescribed, but a blanket "No!" ignores the cases where they do work, and provide a significant increase in quality of life.
In about 2012 I visited Copenhagen, capital of Denmark, which was until recently allegedly the self-reported "happiest nation on earth". I found it extremely weird that everyone was perfectly dressed and all the interiors were spotless, but nobody was smiling. It was like I had walked on to the set of some kind of dystopian movie. Mentioning this to an American woman who appeared and who had been resident there for some time, she simply laughed and leaned closer. "It's because they're all on antidepressants!"
Well, in the same period I have lived next to Copenhagen for three years (in Malmö) and this does not match my experience of the city nor the country in general in the slightest.
Perhaps you visited near the end of winter, or when spring just started and the sun hadn't fully returned? The long winters can suck out the energy of anyone near the end of them, but during every other part of the year the Danes I know are a very cheerful bunch.
More likely though, I think it's a different attitude towards smiling itself. In the US it seems like much more of a social thing: aside from spontaneous, genuine smiles, there is also smiling as part of how you present yourselves to others, almost like a form of politeness. That doesn't apply to European cultures.
You referenced an American in your story, and they're the only group I've ever really heard complaining about people in other countries not smiling enough, so my assumption is hardly silly. I don't know if Australia shares the same quirk, given that Australia borrows a LOT from the US culturally, are you sure you didn't pick that stuff up from the US?
And I'm not sure why the Germans didn't bother you but the Danes did, that doesn't really add up.
Which leads to another issue that worries me: this kind of thing will end up with a backlash that likely screws over those who really do need the medication.
That being said, there are a number of GPs out there who prescribe things without fully understanding the consequences. I’ve always had a GP refer me to a psychiatrist for any mental health issues, however.
EDIT: Also, I think that even for the patients where the cause of the depression is not "chemical" in origin, that does not reduce the severity of the illness in the slightest. It just means that the causes may lie elsewhere (for example externally). I have been depressed as an indirect result of the troubles I got myself into due to undiagnosed ADD. In my case, yes, I needed medication to treat my condition, as well as therapy. But I did not need antidepressants, I needed medication for ADHD (and I just checked: lisdexamfetamine is currently not considered an effective anti-depressant[0]).
[0] https://en.wikipedia.org/wiki/Lisdexamfetamine#Depression
Completely understandable! Most people seem to have such a frustrating inability to understand that other people can have very different experiences of the world to their own, and that those experiences aren't wrong.
I am lucky enough that most of my friends do understand mental illnesses a bit better than the average person out there. Some of them who confided their mental health problems with me about the kind of reaction they tend to get, and it's just amazing how ignorant the natural state of the human mind is.
> that I’m taking the “easy” way out through medication.
Call me crazy, but I partially blame the dualist world view of the Western world for that, even if most people aren't even aware that they have been raised with a dualist mindset. This whole mind/matter division makes people think that mental problems have to be solved by thinking.
Not crazy at all. I strongly agree with this.
No-one credible talks about a chemical imbalance anymore.
Its anecdotal but I know that in my specific case it helps.. a lot! I can focus better, I am less anxious, I'm happier (though that is not my main complaint at all), and most of all I get less agitated. That doesn't just help me; it helps my significant other, our newborn, my co-employees, and my family in general (don't have friends).
Hey, you can work on that! Especially now that you have medication that seems to catch on.
First and foremost I have one very good friend (my partner!), and a rather good relation with my mother (my father passed away, alas). I consider my mother like a friend, who given her age needs me more and more and this will increase. Same with my mother-in-law. That's both OK, but also a burden of stress.
It appears difficult to become friends as you grow older compared to being young. I burned ships with my old friends because the relations were no longer mutual; no longer developmental ("stuck" or "grown different paths") or downright parasitic. Ironically, my last major friendship was my best friend wanting to use mushrooms with me at my place while I was no longer interested in recreational drugs. I was an avid gamer, but no longer have time to play games so all friends who I had who were into gaming I no longer have that in common with. That's a big blow in my social network and friendship list.
The gist is, I find individuals inherently boring and basically I don't want [new] friends; they're a hassle and nuisance. Friends are a distraction, just like this very forum. At best, they're interesting, like this forum. At worst, its annoying to waste a Sunday on a birthday (with mindless chit-chat, annoying opinionated people, eating crap I could better buy/cook myself, and travel time/cost), just like you can waste an Sunday on this forum. Heck, like Facebook, rather. OTOH, you reap what you sow. I still got like 100 movies to watch if not more, 20 books to read, etc.
My family and partner's friends and our newborn is more than enough. I need to focus on improving those connections first and foremost since my autism does put those relations under pressure both generally as well as incidentally more so. That plus integrating my autism diagnosis with my career which isn't easy in mid 30s. You could argue I'm not ready for it yet but I didn't start taking SSRIs to become more social. I do want to meet more people with autism, but that's out of self-interest, and a long-term project since right now I still feel overburdened due to the above (mostly our newborn).
I am actually going through something that is in some aspects the same, yet as a whole kind of the opposite. I have close friends, but they no longer live in the same city as I do. I emigrated for work two years ago. I didn't really like the city much, and at the time I also felt kind of heartbroken to say goodbye to my friends.
As a result I too did not feel like making new friends, but for opposite reasons: I did not want to root down in this new city, and then break my heart all over again when work finished (I knew it was a temporary thing). So in the last couple of years I have spent most of my time on work, and only "mildly" socialised. Slowly and almost unnoticeably, the relative social isolation has worn me down.
Last year while travelling I met the woman that I want to share my life with. As she lives in another country, we have been in a long-distance relationship (despite both of us having bad experiences with that before and swearing we'd never repeat that). In some sense this made the social isolation worse: we spent so much time on Skyping every day that we forget to meet our friends.
My contract is nearly ending, and our plan was that I would move in with her soon. I am really looking forward to this, and to end this period of solitude. However, she has lived in her city for nearly a decade, is "settled in" and has a network of friends. By comparison, I'm moving to for her - while the city she lives in is nice, I would not have thought of moving there if not for her. I will also have to build up yet another network of friends (like you, I am in my thirties, and I too notice how this is getting harder).
This created an unbalance in our relationship: I "need" her much more than she "needs" me, as I would have noone else in that city when I arrive. This asymmetrical dependency resulted in a a strange kind of tension, making me hyper-oriented towards her to the point where it resulted in me becoming unstable.
So now we changed the plan: I'm looking for a temporary place to live, in some kind of shared appartment arrangement with (ideally) lots of roommates to socialize with and explore the city with. That way I can find my own ground in the new city and discover on my own terms whether I'd like to live there, and what I like about it. We will still see each other most of the time, and after a few months still intend to move in together. But this new plan will take the pressure off the relationship.
I am all with you that friends are often a bit of a distraction, but to me the good friends are an enhancement: they support and enable more than that they distract. I hope that some day you will find a few of those kind of supportive friends, and that they will ease your burdens. Until then I am glad to read that you have a supportive partner and family! And I wish you good luck with parenting.
(aside: after posting my message I was actually a bit worried that I would come across as one of those people who insists on constantly trying to cheer up their depressed friend, but actually only puts more pressure on them that way (I have experienced that). I'm glad it didn't come across that way - well, either that, or you're too polite to mention it)
We would not have a healthy, happy, functional family without these types of interventions available.
I found (I suspect like you) that having an psychiatrist - an MD, who can provide both cognitive/behavioral and pharmacological interventions - is the key.
You might want to consider maintenance therapy. The actual evidence for severe discontinuation effects is quite limited, but we have fairly strong evidence that maintenance therapy significantly reduces the rate of relapse. It's natural to want to avoid taking drugs indefinitely, but it's often a better option than a long-term cycle of depression, treatment, discontinuation and relapse.
I suspect that a substantial proportion of people mistakenly believe that they're "addicted" to anti-depressants, when really they're just receiving an effective treatment for a chronic condition. They feel worse when they stop taking the pills, because the pills are doing what they're supposed to do.
I'd really hate to play Scrabble against you.