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Comment by AdamSteel | Hacker News Reader

I'm consistently amazed at how doctors aren't required - at least in Australia - to talk about side effects or withdrawal symptoms when prescribing medication. I'm capable of googling things, but it shocks me how none of this has ever been discussed with me when getting medication. Pharmacists will ask you questions to determine any contraindications, but I've never been spoken to about withdrawal or side effects. Half the time people find out about them by experiencing them.

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This isn't amazing. It is just a matter of priorities. There are many other things that need to be addressed first to ensure the patient gets onto the therapy they need. In my experience counselling people about interventions far more complex and risky than starting an anti-depressant, it is clear that 99% of people don't want a branching tree exploration of every eventuality. They get information fatigue very quickly. Ultimately, there needs to be some trust between doctor and patient for things to function in any real sense. This is why I personally loathe the word 'client' in lieu of patient - it recasts the relationship in harmful terms in my opinion, splitting the therapeutic alliance that should exist into some slightly adversarial union of compliance on the provider's part and due diligence on the client's part.

Well, information overload has never been an issue with my doctors - quite the opposite.

My doctor has no idea how the meds he prescribes me actually work. You talk of information overload, but my doctor provided no information about the meds, their effects, side effects or withdrawals. For one of the tricyclics he said "these will kill you if you take too many", but that has literally been the total information conveyed.

Regardless of information overload, doctors should at least understand the basic mechanics of how the drugs they prescribe actually work, and understand the body's mechanics of tolerance and withdrawal - and be capable of having a brief conversation about them with patients.

Yep, same in the UK - I've spoken with several GPs and consultants across specialisms about dozens of medications I've tried, and not one has ever even mentioned withdrawal symptoms.

When I spoke to my GP after this episode was finally all over, he clearly didn't even understand the mechanisms behind receptor tolerance withdrawals. I know GPs are by "definition jack of all trades", but I was still somewhat shocked.

He also seemed to think I was over-reacting when I told him I wasn't going to try any more NRI-type medications, which suggests he also doesn't even understand how severe withdrawal symptoms can be.

I realize I got lucky with my GP here in the States, but he did talk about things with me when I went on phentermine to help with weight loss. All the withdrawal symptoms, why I must stop taking it every three months, etc. He even went over every result in my blood work and thoroughly explained each. I think I was in that appointment for two hours, and it was amazing. I wish more physicians were like him, though I also realize they're pressed for time a lot of times and such, which doesn't help.

Hope you find a more competent doctor.

Potential downside - the more aware you are of side-effects, the more likely you are to experience them:

> It has been shown that, due to the nocebo effect, warning patients about side effects of drugs can contribute to the causation of such effects, whether the drug is real or not. This effect has been observed in clinical trials: according to a 2013 review, the dropout rate among placebo-treated patients in a meta-analysis of 41 clinical trials of Parkinson's disease treatments was 8.8%.

https://en.wikipedia.org/wiki/Nocebo

I started an SSRI a couple of months ago to help treat major depression and anxiety. My GP went over all of the side effects and potential health risks, timelines, as well as its severe withdrawal symptoms and that if I wanted to stop I should slowly wean off it by lowering the dosage (cutting the pills in half for a while, then quarters, etc). This was in Sydney, so some at least do it :-)

If you can find access to a psychedelic like LSD/mushrooms, it is more likely a far more effective treatment for anxiety & depression than any SSRI's available.

Microdoses can be very effective and a regimen only needs to last a handful of doses and stopping would have very little side effects. As long as authenticity of the substance can be proven, generally psychedelics are very safe, especially at microdose levels.

A little googling for psychedelic + depression will provide data. A couple of research/articles below.

https://journals.sagepub.com/doi/pdf/10.1177/026988111667551...

http://www.biblioteca.cij.gob.mx/Archivos/Materiales_de_cons...

https://www.google.com/amp/s/amp.businessinsider.com/psyched...

"If you can find access to a psychedelic like LSD/mushrooms, it is more likely a far more effective treatment for anxiety & depression than any SSRI's available."

That's a horribly irresponsible thing to say.

Even though psychedelics look like a promising therapeutic regimen to some people, they should be administered in a therapeutic setting with the supervision of a psychiatrist or therapist, in the least.

Given depression patients have limited energy to do anything, the energy reserves would be far better spent in finding a good therapist rather than sourcing illegal substances.

"As long as authenticity of the substance can be proven, generally psychedelics are very safe, especially at microdose levels."

Please stop.

The most important thing a depressed person needs to do, is to find the professionals with whom they can begin the healing process. Finding a good psychiatrist and a cognitive behaviorial psychotherapist would be my first prirorities.

I'm not denying your claims. But most western societies have primary care pathways to deal with depression in a competent and effective way.

This is not a 100% guarantee, like you could give in a trivial medical matter. Mental illnesses can be really difficult - hence you will always find individuals from whom nothing works. But lot of people get help through the "official" methods - hence that should the first strategy for anyone suffering from depression.

Please don’t pretend to be an expert in something like this. These things can be life threatening and you are suggesting using speculative treatments that may or may not work.

> These things can be life threatening

Hallucinogens aren't 'life threatening'

Suicide is, and untreated depression can lead to death by suicide.

I started taking Lexapro a few days ago. My psychiatrist and pharmacist went over all the side effects in great detail, but never once mentioned the possible withdrawal problems. I already knew something of them through a friend who's been through that with Lexapro and other similar drugs, but still—not one word from the "professionals".

(This was in the US)

Another anecdata point (also in the US): My Doctor DID go over the withdrawals with me when prescribing me Lexapro.

Pro-tip: Don't miss a day. :)

Lexapro doesn't have as severe side effects, its one of the new ones that shouldn't kick you round as much. It is still best for them to taper off the end of usage.

In the UK all medication must come with a patient information leaflet, and they usually talk about the side effects that they picked up during testing or (I think) from the Yellow Card scheme.

It's really important that people fill out yellow cards when they experience side effects. I don't know if anything similar exists outside UK: https://yellowcard.mhra.gov.uk/

Thanks for pointing this out, I had no idea about this - I've got a lot of reports to submit!

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