VincentV Posted December 21, 2019 Share Posted December 21, 2019 An interesting excerpt from an interview with two eminent doctors who are trying to push forward research on the issue, https://www.psychiatryadvisor.com/home/topics/mood-disorders/depressive-disorder/rethinking-antidepressant-withdrawal-expert-qa/2/ : There is a greater awareness in the field about the risk for adverse symptoms on discontinuation of antidepressants, which has been driven in part by media attention to this topic. Our understanding of this issue remains fairly limited: the true prevalence of discontinuation symptoms, and the biological characteristics that predispose certain individuals to these symptoms, remain uncertain. There is no consensus in the field about how to define the presence of discontinuation symptoms: how many, what severity, how functionally impairing, and for how long. What is certainly clear is that a subgroup of patients prescribed these medications may develop discontinuation symptoms that are particularly disabling. Further, we know that certain antidepressants, such as paroxetine, have much higher rates of these symptoms compared with others, such as fluoxetine. Psychiatry Advisor: How should clinicians address this issue in practice? Dr Davies: Owing to the recent revision in our understanding of dependency and withdrawal issue, NICE has commissioned a specific guideline on this question, which will commence development this month. In the meantime, very slow tapering at a pace comfortable for the patient is imperative. This may mean many doctors tapering more slowly than they are used to. It is imperative to listen to the patient and not misinterpret withdrawal as relapse. Whilst its good because it shows that many are waking up to the reality of all this it is also very frustrating. Theyve yet to define the syndrome(s) let alone measure it. Effective and safe evidence based guidlines around withdrawal and withdrawal syndrome are still likely to quite a long way off. The wind is at least blowiny in the right direction. My understanding is that NICE are looking into trying to publish some sort of provisional guidance or clarification regarding tapering. 1 Citalopram. Briefly early twenties, no ill effects seemingly. Don't remember dose. Sertraline on and off for ten years. I was ignorant and started and stopped frequently. Doses of 50, 75 and 100. I can not recall/did not record dates prior to 2018. JANUARY 2018: Last period of use was was 150mg of sertraline on 14/01/18 (which triggered extreme depression and anxiety that never settled, amongst other symptoms). I then tapered to 100mg in March (15/03/18), then down to 75mg in April(01/04/18) , 50mg later (11/04/18) 25mg in May (16/05/18), and was at 0mg in June (02/06/18). Mirtazapine 15mg: 01/08/18- 02/10/18, 15mg (6 weeks at 15mg the two week taper). - caused deeply unpleasant waves of extreme anxiety, depression, zombie state and mania. Still on 40mg of Propranolol twice a day since April 2018. Supplements: Fish oil, Magnesium, Vit B6 Link to comment Share on other sites More sharing options...
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