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Comment by firecall | Hacker News Reader

And what they never tell you, in my experience, is the horrible experience of trying to come off them!

I'm sorry your experience of coming off them was horrible, but that is not "the experience", and many people come off them without issue.

My wife had multiple talks with a psychiatrist about them to threat depression, and the experience of the psychiatrist was that it's the rare few that can stop taking them without issue. Hell, it's the rare few who find the right kind of antidepressant in one go, most of the time you need to try a few different kinds for a few months, with all the side effects that come with it.

Totally, I'm sure many people have no issues :-)

Here's a recent Guardian article:

https://www.theguardian.com/society/2023/apr/17/i-stopped-sl...

From the article:

> Horowitz experienced a prolonged antidepressant withdrawal in 2015 that caused intense panic attacks and, he says, even left him contemplating suicide. This personal experience has led the training psychiatrist to become an advocate for reforming antidepressant deprescribing.

> In June 2022 the UK health regulator, Nice, amended its guidance on how to support people coming off antidepressants, acknowledging the severity and length of withdrawal symptoms can vary. Nice encourages slow, staggered tapering over many months, if needed.

> In Australia, the RANZCP guidelines continue to recommend tapering by halving and quartering the lowest dose over about two to six weeks, and acknowledged that while slower tapering might sometimes be needed, it mostly isn’t possible in Australia “as current preparations of antidepressants do not allow for the dose to be reduced by such small decrements”.

There are well documented side effects of stopping SSRI usage that are not related to the original symptoms that the drug is prescribed to treat.

But yes, we all have different experiences, and there are many types of SSRIs. :-)

Also from your article:

> psychiatrist and former RANZCP president, Prof Malcolm Hopwood, says most people who taper off a standard antidepressant dose will be able to do so without major withdrawal symptoms ... "There’s a _small_ group who really experience significant withdrawal symptoms that they really find very difficult to manage"

Discontinuation symptoms are a real risk, but people who could really benefit from these drugs absolutely shouldn't be put off by a categorization of these symptoms as being typical.

That guy's job is pushing psychiatric medicine and techniques on society though, right?

The phrasing here definitely makes you wonder how big is the group that experiences moderate side effects that are moderately unpleasant and moderately difficult to manage, and what do these qualifying terms actually mean in terms of severity and overall negative impact on a patient?

A small group that has severe side effects and finds them very difficult to manage is kind of a big deal in a class of drugs that actually have small effect size in the medical literature.

Isn’t the difficult if coming off SSRIs well documented, both from a procedural and symptomatic angle?

Lots of contradictory studies, but this write-up[0] suggests 1 in 5 people have them _if_ they suddenly stop them rather than tapering them off.

0: https://www.health.harvard.edu/blog/discontinuation-syndrome...

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