Psychiatric Times 'sorts out' the Antidepressant Withdrawal "Controversy"

[Linus]

Psychiatric Times 'sorts out' the Antidepressant Withdrawal "Controversy"

 

http://www.psychiatrictimes.com/couch-crisis/sorting-out-antidepressant-withdrawal-controversy

 

1) "The second scenario is not one we have seen in our practice but is commonly reported among the “layperson withdrawal community.” (talking about a case of a person having difficulties coming of antidepressants)

 

Yes, laypersons should just keep their mouth shut, real doctors know what is going on, discontinuing antidepressants does not really pose any problems, I guess we are all here on this forum because we have nothing better to do.

 

2) "We believe, based on our extensive experience with antidepressants, that serious withdrawal symptoms are extremely rare when tapering periods of 2 to 6 months are used. "

 

Too fast, try again.

 

3) "Such potentially lethal withdrawal reactions appear to be exceedingly rare, or non-existent, when SSRI/SNRI antidepressants prescribed in therapeutic doses are abruptly stopped and are virtually unheard of when these antidepressants are tapered gradually."

 

Hmm.

 

Swedish researchers analyzed data in a timespan in which antidepressant prescriptions rose steadily.  As antidepressant prescriptions increased 270% over 15 years, suicide rates also increased. How many of those who tragically took their on lives, discontinued their medication?

 

4) "In conclusion: when managed appropriately, discontinuation of antidepressants need not pose a significant clinical problem and should not discourage depressed patients from using these beneficial medications"

 

Nothing to worry about folks, move along, keep taking these 'beneficial' medications.

 

I and a significant amount of people tapering their antidepressants beg to differ, but we are just 'laypersons' of course, so what do we know.

[thecowisback]

wow! well that's us told then! we are all obviously making up our withdrawal problems.....thanks for that Linus ☺️

[FarmGirlWorks]

"One website run by a psychiatrist (who will not prescribe antidepressants) declares that these medications “. . . are habit forming, so withdrawal can be excruciating.”

 

Way to go, Dr Kelly Brogan! You are scaring them.

 

"Furthermore, the claim by some “layperson” groups that antidepressants are associated with the development of tolerance¹ requires context and clarification. Unlike with genuine substances of abuse, such as alcohol or barbiturates, true tolerance—ie, the need for higher and higher doses, over time, to produce the same clinical effect—is not commonly observed with antidepressants."

 

Why do  psychodrugs usually need to be increased in dosage or, if the drug quits working or poops out, then another is prescribed? Anecdotally, this layperson has seen people unable to get off these non-addictive substances many many times. And why are laypersons in quotes? To diminish victims? This reads like a high-school term paper.

 

In our view, the vast majority of serious “withdrawal” symptoms following discontinuation of SSRIs/SNRIs occur when the tapering period is less than 1 to 2 months.

 

Again with the quotes... and @Linus, you called it -- not long enough by a long shot. I'm getting too mad to continue reading this drivel. And I want my "brain" to "heal" from this "non-addictive" "withdrawal" by not getting too "upset" by "b*llsh*t" that establishment "psychiatrists" write.

[Linus]

2 hours ago, FarmGirlWorks said:

And I want my "brain" to "heal" from this "non-addictive" "withdrawal" by not getting too "upset" by "b*llsh*t" that establishment "psychiatrists" write.

 

I know, it is "infuriating" 😄 

 

I wish you all the healing you need, you deserve it. Take care !

[bubbles]

‘Why do  psychodrugs usually need to be increased in dosage or, if the drug quits working or poops out, then another is prescribed.’

 

Yes!!! This has been my argument for years. 

[Altostrata]

Dr. Ronald Pies, King of the Straw Man Argument. CCHR is not the "lay media," it's a favorite hobbyhorse of paranoid psychiatrists for its association with a certain organization with church tax status.

 

Jha, 2018, recycles the same old- same old unfounded assumptions about antidepressant withdrawal syndrome from decades of scholarly articles, some written for and by drug companies. Pies interates those assumptions in his article.

 

As ever, Pies is particularly irked by suggestions that antidepressants have a withdrawal syndrome in common with addictive drugs and expends considerable effort to explain that they are not "addictive." Okay, they're not technically addictive -- patients still suffer withdrawal from them. Enough of this tangental semantic argument, Dr. Pies.

 

Here are the key paragraphs that need much more attention by Dr. Pies:
 

Quote

 

....

While we do not deny that severe reactions can and do occur when antidepressants are stopped suddenly (or the dose reduced too rapidly), we also believe that fears of such “excruciating” experiences are greatly overstated, in the context of proper psychiatric care. At the same time, we acknowledge that many “prescribers” of antidepressants—nearly 80% of whom are primary care physicians4—discontinue antidepressants much too rapidly. Moreover, as critics of these drugs rightly point out,1 it is very hard to find detailed, professionally approved guidelines for tapering and discontinuation of antidepressants.

....

In our view, the vast majority of serious “withdrawal” symptoms following discontinuation of SSRIs/SNRIs occur when the tapering period is less than 1 to 2 months. This may be particularly the case when the patient has taken the medication for a year or longer. There has been insufficient systematic study of longer tapering periods, eg, on the order of 2 to 6 months, as one of us [RP] recommended several years ago.20

 

We believe, based on our extensive experience with antidepressants, that serious withdrawal symptoms are extremely rare when tapering periods of 2 to 6 months are used. However, we acknowledge that such long tapering periods are probably uncommon in general medical practice, and even in most psychiatric settings. Indeed, our second vignette, involving a rapid, 3-week taper of high-dose (60 mg/day) paroxetine, is an illustration of poor medical management that may be common in some practice settings.

....

Even more important than a specific timetable for tapering is the need for careful, systematic, individualized assessment of the patient. Similarly, strategies for cross tapering from one antidepressant to another must be individualized, based on the particular switch that is planned.21 While attending carefully to the patient’s reported response to treatment is always important, it is especially critical during the vulnerable period of antidepressant tapering.

 

In conclusion: when managed appropriately, discontinuation of antidepressants need not pose a significant clinical problem and should not discourage depressed patients from using these beneficial medications.20

 

 

I wish Ronald Pies would retire already and spare us the self-serving bloviating.

 

As usual, Dr. Pies employs a great many words in the service of poor logic.

 

Yes, it's true most prescribers of antidepressants are non-psychiatrists who discontinue the drugs too rapidly, putting patients at risk for withdrawal syndrome. This indicates that antidepressant withdrawal syndrome is under-reported.

 

Even with the participation of non-psychiatrists, psychiatry is still responsible for providing guidelines for psychiatric drug treatment. It has avoided addressing withdrawal syndrome for decades.

 

Dr. Pies's assumption that "proper psychiatric care" is significantly better is based on nothing but Dr. Pies's ego-driven identification with his profession. Dr. Pies is not all psychiatrists and all psychiatrists are not Dr. Pies. See below.

 

While, referring to his prolix 2012 paper, Dr. Pies asserts "I told you so" regarding longer tapering periods, he has done nothing through his long career to promulgate this practice.

 

Dr. Pies's braggadocious statement from his 2012 paper -- "In my own practice, I would typically “wean” a patient off a chronically administered antidepressant over a period of 3 to 6 months and sometimes longer. To my knowledge, this period of tapering has rarely, if ever, been used in existing studies of antidepressants or in routine clinical practice." -- tends to confirm that "proper psychiatric care" in terms of lengthy tapering practices is exceedingly rare.

 

Therefore, guidance for tapering "managed appropriately," as stated in Dr. Pies's conclusion to this article, is virtually impossible for patients to find.

 

This article sorts out nothing, except that psychiatry is culpable of vast negligence in formulating practices for safely going off antidepressants. Dr. Pies, however, is off the hook.

 

[Linus]

4 hours ago, Altostrata said:

I wish Ronald Pies would retire already and spare us the self-serving bloviating.

 

I guess you are right, mr. Pies seems to have a history of twisting the facts trying to defend psychiatry.

 

Case in point: the whole "chemical imbalance" theory. Mr. Pies blamed the promotion of the chemical imbalance story on “antipsychiatry” activists and the pharmaceutical industry, psychiatrists (the little angels) did not wrong. Robert Withaker however clearly showed psychiatrists were also to blame, but I guess mr. Pies would describe him as an "antipsychiatry" activist. You could say psychiatrists were frontrunners in peddling "alternative facts".

 

Ronald Pies Doubles Down (And Why We Should Care), Robert Withaker, https://www.madinamerica.com/2015/09/ronald-pies-doubles-down-and-why-we-should-care/

 

I have no doubt some psychiatrist could find a diagnosis for mr. Pies in the long list of mental disorders listed in the DSM 5