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Fava, 2020. May antidepressant drugs worsen the conditions they are supposed to treat? The clinical foundations of the oppositional model of tolerance


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https://journals.sagepub.com/doi/full/10.1177/2045125320970325

 

This paper is available free online at the above URL.

It contacts some very useful information, especially for long term users of antiepressants. Fava is well published in this area and a very outspoken researcher in the area of harm caused by these maedications.

 

Giovanni A Fava

First Published November 2, 2020 Review Article 

Abstract

In recent years there has been a considerable debate on antidepressant drugs. Continued drug treatment with antidepressant medications may stimulate processes that run counter to the initial acute effects of a drug. The oppositional model of tolerance may explain loss of treatment efficacy during maintenance treatment and the fact that some side effects tend to occur only after a certain time. These processes may also direct the illness into a treatment-unresponsive course, including manifestations of bipolar disorder or paradoxical reactions. When drug treatment ends, oppositional processes no longer encounter resistance, resulting in potential onset of new withdrawal symptoms, persistent post-withdrawal disorders, hypomania, and resistance to treatment if it is reinstituted. In all these cases, antidepressant medications may constitute a form of iatrogenic comorbidity, which increases chronicity and vulnerability to depressive episodes. Antidepressant medications are essential drugs for the treatment of major depressive episodes. They are less likely, however, to provide protection for relapse prevention. Current prescription practices need to be reformulated in light of consideration of vulnerabilities and adverse effects of treatment. The oppositional model of tolerance provides a conceptual framework for weighing all these elements in the individual case. The model does not appear to apply to all patients who undergo treatment with AD, but only to a part of them. Studying the variables that are associated with such occurrence in certain patients and not in others would be one of the most important tasks of current therapeutic research. Current diagnostic systems in psychiatry do not consider the iatrogenic components of psychopathology, and can be applied to only patients who are drug free. They are suited for a patient who no longer exists: most of the cases that are seen in psychiatric clinical practice receive psychotropic drugs and such treatment is likely to affect prognosis and treatment choices.

2011 - started Venlafaxine (again) at 75mg Raised to 150 mg at some point - unsure of dates. Reduced back down to 75 mg. Doctor advised this would be a lifetime, maintenance dose

2017 - Side effects now intolerable. Started taper from June 15th - 5% dose reduction steps (two 12 hourly doses).

2017 - October 20th - took last dose of Venlafaxine - 4 mg. Debilitating symptoms followed.

2017/18 - diazepam - 8mg/day for 1 month - 7 week taper Feb 2018

2017/18 - duloxetine - max 90mg - now stopped

2018 - Feb 25mg quetiapine, increased to 50mg.

2018 - March/April - increased venlafaxine slowly (10mg steps) to 75 mg/day. Recovery from withdrawal followed.

2018 - July 13 - stopped quetiapine after 2 month taper. Late July - had to reinstate quetiapine due to intolerable withdrawal. Now tapering from 25mg

2019 - June - stopped quetiapine after 10 month taper. Mild insomnia only symptom.

2021 - June - venlafaxine approx 6.0 mg see Taper history details

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  • 2 months later...
persistente

I remember this author's name from the time when I started to question myself about the mainstream approach to deppression. At that time I was a desperate patient who needed help (later I learned I was dealing with adverse reaction to late reinstatement) but even in that state, it looked to me that doctors did not know what they were doing. That was more than 3 years ago. His second word in this new article says it all.

 

"In 1994, I raised the question as to whether antidepressant drugs (AD) might increase chronicity in mood and anxiety disorders..."

 

26 years later and doctors still do not know what are they doing. At least in my country.

3/2012 - sertralin 50 mg, no major side effects

1/2014 - ct sertralin 50 mg (tappered 3 weeks as doctor ordered)

7/2014 - back to sertalin 50 mg, no issues

4/2016 - ct sertralin 50 mg (tappered 3 weeks, my decision)

12/2016 - back to sertalin, major side effects from the first pill and the begginning of hell

2/2017 - mirtazepine 15 mg added for insomnia

6/2017 - stopped sertralin (2 months tapper)

9/2017 - stopped mirtazepine (3 weeks taper)

waves and windows

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