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Eveleigh, 2017, Too Much or Too Little Antidepressant Medication: Difficult to change. Two rcts


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Mental Health in Family Medicine (2017) 13: 1-9

 

Too Much or Too Little Antidepressant Medication: Difficult to Change. Two Rcts

 

Rhona Eveleigh, Esther Muskens, Peter Lucassen, Peter Verhaak, Jan Spijker, Chris van Weel, Richard Oude Voshaar, Anne Speckens.

 

Full text link - http://www.mhfmjournal.com/open-access/too-much-or-too-little-antidepressant-medication-difficult-to-change-two-rcts.pdf 

 

Abstract

 

Background: Antidepressant use has increased exponentially in the last decades, mostly due to long continuation.

 

Objective: To assess the effectiveness of a tailored recommendation to cease or adjust antidepressant treatment.

 

Methods: Two cluster-randomized controlled trials (PANDAstudy) in primary care. Long-term antidepressant users (> 9 months) were selected from GPs prescription databases. Patients were diagnosed with the Composite International Diagnostic Interview. Long-term users were split up in patients without indication for maintenance treatment (over-treatment trial) and patients undertreated despite maintenance treatment. The intervention consisted of disclosure of the current psychiatric diagnosis combined with a tailored treatment recommendation. We followed patients 12 months. Results: We included 146 participants from 45 family practices in the over-treatment trial. Of the 70 patients in the intervention group, 34 (48%) did not comply with the advice to stop their antidepressant medication. Of the 36 (52%) patients who agreed to try, only 4 (6%) succeeded. These figures were consistent with the control group, where 6 (8%) of the 76 patients discontinued antidepressant use successfully. In terms of relapse rate, patients who were recommended to discontinue their antidepressant medication reported a higher relapse rate than the control group (36% versus 14%, p = 0.015). We included 58 patients in the undertreatment trial, with 29 patients in both the intervention and control group. The proportion of remission was equal in both groups (n = 13, 45%).

 

Conclusion: Changing inappropriate long-term antidepressant use is difficult.

Please note - I am not a medical practitioner and I do not give medical advice. I offer an opinion based on my own experiences, reading and discussion with others.On Effexor for 2 months at the start of 2005. Had extreme insomnia as an adverse reaction. Changed to mirtazapine. Have been trying to get off since mid 2008 with numerous failures including CTs and slow (but not slow enough tapers)Have slow tapered at 10 per cent or less for years. I have liquid mirtazapine made at a compounding chemist.

Was on 1.6 ml as at 19 March 2014.

Dropped to 1.5 ml 7 June 2014. Dropped to 1.4 in about September.

Dropped to 1.3 on 20 December 2014. Dropped to 1.2 in mid Jan 2015.

Dropped to 1 ml in late Feb 2015. I think my old medication had run out of puff so I tried 1ml when I got the new stuff and it seems to be going ok. Sleep has been good over the last week (as of 13/3/15).

Dropped to 1/2 ml 14/11/15 Fatigue still there as are memory and cognition problems. Sleep is patchy but liveable compared to what it has been in the past.

 

DRUG FREE - as at 1st May 2017

 

>My intro post is here - http://survivingantidepressants.org/index.php?/topic/2250-dalsaan

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Thanks for posting Dalsaan.

Gee this is one scary study.

 

They talk about discontinuing patients so i kept wondering how?

The answer was found in 'reference 21' which i searched for and to my surprise found here.

 

Muskens E, Eveleigh R, Lucassen P, van Weel C, Spijker J,
et al. Prescribing ANtiDepressants Appropriately (PANDA):
a cluster randomized controlled trial in primary care. BMC
Fam Pract. 2013; 14: 6.

 

Go down the page to Table1 in this study and we find some very disturbing stuff. So much so that i was horrified and felt sick when i saw it.

 

Table 1

Applied schemes for tapering long-term antidepressant usage in primary care

I dont know how to get the table copied into here but take paroxetine long term user on 40mg appears to be tapered in 4, 2 week steps

being 40, 30, 20, 10.

 

Basically this is a 6 week taper for someone on 40mg of paroxetine.

(BM just took 6 years!! to do this taper)

 

Interesting they define long term user as  equal to or greater than 9 months use.

 

In this group i have no doubt that there are people here with many years exposure. And now they are subjected to the above tapering. Thats criminal! I feel outraged.

No wonder "(48%) did not comply with the advice to stop their antidepressant medication"

 

Yet look at this sentence under the tapering table...the word 'proposals ' i would think are the tapering proposals.

To check the reliability of the proposals by the GP and psychiatrist, we provided another GP (CvW) and psychiatrist (AS) with 10 randomly selected case vignettes from included patients. Comparing these judgments, there was a 100% agreement.

 

At the end of the study they say:

We found a noncompliance with the given recommendation in almost half of the cases.

Does this surprise anyone here. What about the other half what on earth became of them?

 

Due to the pragmatic nature of this study, we did not impose our intervention on the patients and their GPs.

Thank goodness for that. Perhaps better to say due to the dangerous nature of this study...

 

This is also considered conservative, as in contrast to benzodiazepines, psychological dependency does not play a major role in long-term use of antidepressants.

!!!!!

 

The full conclusion from the study 'too much [ado about the obvious] is':

 

This study demonstrates the difficulty of correcting inappropriate long-term antidepressant use (according to the guidelines), fuelled by an apprehension from both patient and GP to change. A recommendation to discontinue in case of over-treatment is not effective, and maybe even counterproductive. It might be useful to forewarn patients about the difficulty to discontinue and to encourage using antidepressants for a limited period. Regular review could possibly prevent both over and under-treatment.

 

Its all about 'the guidelines', cant someone in 2017 with half a brain question the guidelines for goodness sake!!

 

nz11

"5 of every 6 antidepressant users do not benefit "

Thought for the day: Lets stand up, and let’s speak out , together. G Olsen

We have until the 14th. Feb 2018. 

URGENT REQUEST Please consider submitting  for the petition on Prescribed Drug Dependence and Withdrawal currently awaiting its third consideration at the Scottish Parliament. You don't even have to be from Scotland. By clicking on the link below you can read some of the previous submissions but be warned many of them are quite harrowing.

http://www.parliament.scot/GettingInvolved/Petitions/PE01651   

Please tell them about your problems taking and withdrawing from antidepressants and/or benzos.

Send by email to petitions@parliament.scot and quote PE01651 in the subject heading. Keep to a maximum of 3 sides of A4 and you can't name for legal reasons any doctor you have consulted. Tell them if you wish to remain anonymous. We need the numbers to help convince the committee members we are not isolated cases. You have until mid February. Thank you

Recovering paxil addict

None of the published articles shed light on what ssri's ... actually do or what their hazards might be. Healy 2013. 

This is so true, with anything you get on these drugs, dependance, tapering, withdrawal symptoms, side effects, just silent. And if there is something mentioned then their is a serious disconnect between what is said and reality! 

  "Every time I read of a multi-person shooting, I always presume that person had just started a SSRI or had just stopped."  Dr Mosher. Me too! 

Over two decades later, the number of antidepressant prescriptions a year is slightly more than the number of people in the Western world. Most (nine out of 10) prescriptions are for patients who faced difficulties on stopping, equating to about a tenth of the population. These patients are often advised to continue treatment because their difficulties indicate they need ongoing treatment, just as a person with diabetes needs insulin. Healy 2015

I believe the ssri era will soon stand as one of the most shameful in the history of medicine. Healy 2015

Let people help people ... in a natural, kind, non-addictive (and non-big pharma) way. J Broadley 2017

 

 

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From the first paragraph:

 

During the 1990’s, antidepressants were promoted widely and general practitioners (GPs) were criticized for under-diagnosing and under-treating depressive and anxiety disorders.

Efforts were made to increase quality of care and prescription rates for antidepressants increased.

Now, contrary concerns are raised concerning overtreatment with antidepressants . Long-term continuation contributes to the large amount of antidepressant use.

 

Isnt it just so sad the way the medical profession equate 'increased quality of care' to 'increased prescribing of antidepressants.'

Efforts were made by who? who was doing the criticizing?  ...probably pharma.

I wonder if they actually realise the reason for  long term continuation being the difficulty in getting off the drug their taper procedure doesnt reflect this.

Thought for the day: Lets stand up, and let’s speak out , together. G Olsen

We have until the 14th. Feb 2018. 

URGENT REQUEST Please consider submitting  for the petition on Prescribed Drug Dependence and Withdrawal currently awaiting its third consideration at the Scottish Parliament. You don't even have to be from Scotland. By clicking on the link below you can read some of the previous submissions but be warned many of them are quite harrowing.

http://www.parliament.scot/GettingInvolved/Petitions/PE01651   

Please tell them about your problems taking and withdrawing from antidepressants and/or benzos.

Send by email to petitions@parliament.scot and quote PE01651 in the subject heading. Keep to a maximum of 3 sides of A4 and you can't name for legal reasons any doctor you have consulted. Tell them if you wish to remain anonymous. We need the numbers to help convince the committee members we are not isolated cases. You have until mid February. Thank you

Recovering paxil addict

None of the published articles shed light on what ssri's ... actually do or what their hazards might be. Healy 2013. 

This is so true, with anything you get on these drugs, dependance, tapering, withdrawal symptoms, side effects, just silent. And if there is something mentioned then their is a serious disconnect between what is said and reality! 

  "Every time I read of a multi-person shooting, I always presume that person had just started a SSRI or had just stopped."  Dr Mosher. Me too! 

Over two decades later, the number of antidepressant prescriptions a year is slightly more than the number of people in the Western world. Most (nine out of 10) prescriptions are for patients who faced difficulties on stopping, equating to about a tenth of the population. These patients are often advised to continue treatment because their difficulties indicate they need ongoing treatment, just as a person with diabetes needs insulin. Healy 2015

I believe the ssri era will soon stand as one of the most shameful in the history of medicine. Healy 2015

Let people help people ... in a natural, kind, non-addictive (and non-big pharma) way. J Broadley 2017

 

 

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  • Mentor

it's kind of scary how stupid these investigators are, eh?

 

they seem to have no critical thinking skills at all.

 

and the pts who supposedly "relapsed"?? what do you want to bet that was WD mis diagnosed as symptoms of disease

:/

 

 
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