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Shelton, 2006 The nature of the discontinuation syndrome associated with antidepressant drugs

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At the same time this paper was published, Dr. Shelton sent me personal correspondence admitting that "I actually think the discontinuation syndrome is pretty bad in some situations and truly horrible in others....First, let's acknowledge one thing: there is a great deal of variability in response, with a lot of people experiencing bad symptoms and others little at all, but almost all resolve; that is, except for a very small group, where the symptoms become persistent...."

 

However, in this paper Dr. Shelton asserts withdrawal symptoms are mild and last only a couple of weeks -- anything after that is due to "something else."

 

This paper and the supplement to the Journal of Clinical Psychiatry in which it appeared was sponsored by Wyeth, manufacturer of Effexor.

 

J Clin Psychiatry. 2006;67 Suppl 4:3-7.

The nature of the discontinuation syndrome associated with antidepressant drugs.

Shelton RC.

 

Source

 

Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, Tenn. 37212, USA. Richard.Shelton at vanderbilt.edu

 

Abstract at http://www.ncbi.nlm.nih.gov/pubmed/16683856 Full text here.

 

A common phenomenon accompanying treatment with nearly every major class of antidepressant is the emergence of the discontinuation syndrome in some patients. It is seen most frequently after the abrupt cessation of agents with shorter half-lives. The term withdrawal has been used in the past; however, the distinctions between discontinuation symptoms and drug withdrawal are clear. Thus, the use of proper terminology when discussing this phenomenon with patients will help to alleviate concerns and stop the spread of common misperceptions. In addition, awareness of the unique nature of discontinuation effects and a grasp of the typical time frame of their emergence can assist in distinguishing between discontinuation syndrome and relapse. As a result, it is vital that both patients and their relatives, especially caregivers, be provided with adequate education and a realistic and objective appraisal of expected outcomes upon initiation of antidepressant treatment.

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Altostrata

Note: This paper was one in a supplement attached to the Journal of Clinical Psychiatry:

 

On his blog, Dr. David Allen says of journal supplements:

 

Journal Supplements are mini-journals mailed along with more legitimate, peer-reviewed journals (and usually having the same cover design) that consist of multiple articles which claim to review a particular topic in the field. Most doctors are unaware that the articles in a journal supplement are not peer reviewed like the articles in their accompanying primary journal, and that the supplements are usually sponsored by one pharmaceutical company.

The supplement was sponsored by Wyeth, manufacturer of Effexor, one of the worst antidepressants for withdrawal, and did its best to whitewash the problem of withdrawal syndrome. Alan Schatzberg was one of Richard Shelton's co-authors.

 

In the article posted above, Shelton describes categorically withdrawal symptoms as lasting only a couple of weeks, and if they persist after that time, directs the clinician to ascribe them to "something else."

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alexjuice

Very nice... this racket is pretty distasteful even by racket standards.

 

By the way, I know a psychiatric doc named Shelton... no relation.

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compsports

I saw your post on the 1Boring Old Man blog about this.

 

Good work. Dr. Shelton's hypocrisy needs to be exposed big time.

 

CS

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Barbarannamated

I feel so delicate at this point. I'm afraid to go to any docs who will either dismiss, misdiagnose, or, as I get from my MD husband, mock me.

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Altostrata

Bar, do pop in and see Richard Shelton at Vanderbilt, just to say hello. He's known about prolonged withdrawal syndrome for years and years, but has declined to publish about it. He gets a lot of income from pharma.

 

I believe he's a devout Christian and will no doubt put on a good show of concern. He might pat your hand and give you a cup of tea.

 

You might tell him thousands of people are posting on the Web suffering from protracted withdrawal and they're not getting any respect or help anywhere because journal articles say it lasts only a couple of weeks.

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Barbarannamated

I'm in CA right now, but will stop in to see Dr. Shelton when I'm back in Nashville. I'm planning to go to the ISEPP Conference in LA this weekend, so hopefully will have a better grasp of the info and players.

Do you know of anyone else attending the conference?

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Altostrata

Mark Foster is going to be there. How about starting a topic in Taking action about the conference?

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alexjuice

He's known about prolonged withdrawal syndrome for years and years, but has declined to publish about it. He gets a lot of income from pharma.

 

Alto, I read your 06 exchange. Have you had occasion to talk to Dr. Shelton recently? Perhaps he is no longer as enthusiastic about the evidence in support of prolonged w/d? At least publicly, say?

 

Alex

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Barbarannamated

Interesting themes in his research.... socioeconomic status and depression, adiposity as a causal factor of depression, and I think I saw something about religion, too. Can't wait to meet this guy. I'm anti-religion, married to an MD, have bag lady syndrome-- and skinny! Think I'll confuse him?! Fun fun fun!

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Altostrata

He seems like a pharma shill to me. Loves hangin' with the jerks from Harvard. But who knows, maybe he was the one arguing for psychotherapy.

 

http://www.ncbi.nlm.nih.gov/pubmed/21450147

 

J Clin Psychiatry. 2011 Mar;72(3):e11.

Crisis of confidence: antidepressant risk versus benefit.

Nierenberg AA, Leon AC, Price LH, Shelton RC, Trivedi MH.

 

Source

 

Department of Psychiatry, Harvard Medical School and Massachusetts General Hospital, Boston, USA.

 

Abstract

 

Andrew A. Nierenberg, MD, assembled a group of experts to discuss recent research and lay media reports about the safety and efficacy of antidepressants for treating mild-to-moderate depression, including recent controversy surrounding antidepressant-related suicidality. The panel agreed that the data regarding the efficacy of antidepressants are complex, making it easy to misinterpret meta-analysis results. Additionally, the issue of suicidality is quite complicated, but the risk is not great enough to abandon the use of antidepressants, although patients should be monitored carefully. The panel discussed that patients who have mild or moderate depression may benefit from receiving evidence-based psychotherapy first, instead of antidepressants. The panel stressed that additional research and novel treatments are needed to improve outcomes for patients with depression. However, measurement-based pharmacotherapy is an effective tool for helping many patients with depression achieve remission and recovery. Clear communication with the public, the media, and nonpsychiatric clinicians about the safety and efficacy of antidepressants will encourage those who need treatment to seek it.

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btdt

I guess Dr Shelton is a bust as far as help goes unless he has in some other place defined and offered understanding of and treatment for this drug induced  "something else."  very disappointing :(

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