Comment by DanBC | Hacker News Reader

Comment by DanBC | Hacker News Reader

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I strongly agree with everything you say, but...

> but I've always been slightly sceptical of claims about withdrawal effects of antidepressants.

Even the manufacturers warn against discontinuation effects. See the "If you stop taking venlafaxine" paragraph here: https://www.medicines.org.uk/emc/product/764/pil#gref

The UK NICE has advice about stopping antidepressant meds: https://www.nice.org.uk/guidance/ng215 and the UK BNF will mention withdrawal for some meds: https://bnf.nice.org.uk/drugs/venlafaxine/#treatment-cessati...

The Royal College of Psychiatrists has advice about stopping anti-depressants: https://www.rcpsych.ac.uk/mental-health/treatments-and-wellb...

Clearly, it's not a problem that affects everybody, and it's more common with some meds than others, but that doesn't mean these effects are not real.

Sorry, in hindsight my comment was unreasonably broad and unclear.

I think it's obviously true that someone might feel anywhere from "a bit weird" to "really quite unwell" for a couple of weeks after discontinuing an antidepressant. I don't know how effective GPs are in communicating that, but you're right that it's there in the patient information leaflet.

What I don't see as particularly plausible are the extremely long withdrawal syndromes reportedly lasting many months or years, or the extremely prolonged tapering regimes that involve tiny fractional doses. I cannot conceive of any plausible biological mechanism for these symptoms, or a plausible mechanism by which a tiny fraction of a clinically relevant dose might alleviate them. Prolonged post-withdrawal effects are reasonably common with GABAergic drugs, but the mechanism and mode of action of these drugs is radically different.

If someone has been taking 20mg of escitalopram, it's perfectly sensible to step down to 10mg and perhaps 5mg over a few weeks to allow their serotonin system to upregulate without too much drama. If they're a year down the line, they're taking 0.2mg and they feel suicidal if they miss a dose, I don't think there's a biochemical explanation for their symptoms.

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