
The Mystery of When to Stop Antidepressants - Jasamba
http://www.wsj.com/articles/the-mystery-of-when-to-stop-antidepressants-1457377316?mod=e2fb
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pc2g4d
There's a disconnect between what the meta-analysed randomized clinical trials
are saying about antidepressants (that they are at best minimally effective
relative to placebo) and what relapse rates suggest (that people relapse when
withdrawn from antidepressants because the antidepressant was effectively
treating the underlying depression).

This conflict is resolved when antidepressants are acknowledged as addictive.
Long-term use of antidepressants creates a biochemical dependency that is only
removed with long, slow tapering.

I've experienced this fact personally. When I first attempted to go off
antidepressants, I did so at what I thought was a slow pace, but in fact
turned out to be far too fast. My life completely fell apart. I was depressed,
anxious, obsessive, worse than I had been in many years. I thought this proved
that I really "had depression" (as a discrete illness) and needed the drugs,
so I increased my dose back up to more or less the original level. Soon after
doing this, my depression/anxiety/OCD went away, and I felt normal again.

But a few years later I tried getting off the drugs again, going much more
slowly. And now I'm at the same point I was last time when things fell apart,
and I'm doing fine. Overall this withdrawal (from 200mg Zoloft) will probably
take me 3 or 4 years. (I'm down to 25mg now.)

I'm convinced that I'm succeeding now where I failed before simply because my
previous approach was triggering horrible withdrawal effects, whereas my
current slower approach does not.

One secret to successful antidepressant withdrawal: the rate of dose
reductions needs to decrease as the overall dose decreases. So when I'm at
200mg maybe I decrease by 20mg in a month. But now that I'm at 25mg maybe I
decrease by 2.5mg in a month. The rate of decrease should be proportional to
the current dose.

Before I was decreasing in constant increments all the way down
(200->150->100->50) but then I started going crazy.

Sorry this is so long. It's a favorite subject of mine ;-)

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erikw
Interesting customer retention scheme Big Pharma has come up with. Find a pool
of folks at risk for suicide, and then get them addicted to expensive
chemicals that will exacerbate suicidal ideation if they try to quit.

[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/)

"The FDA requires two adequately conducted clinical trials showing a
significant difference between drug and placebo. But there is a loophole:
There is no limit to the number of trials that can be conducted in search of
these two significant trials."

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gusfoo
> Interesting customer retention scheme Big Pharma has come up with.

Yes, keeping the customer alive is indeed good for business.

~~~
xlm1717
Keeping the customer addicted is good for business.

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seibelj
Lexapro (Escitalopram) saved my life. I don't care what any meta-analysis
says: years of diet, exercise, and meditation did 5% of what 1 month of
Lexapro did for me. I will take it until I die.

~~~
stevedonovan
Myself likewise. I don't wish to revisit the pit and wallow through the
cognitive fog. An interesting aside: why do users of antidepressants feel the
need to reduce their dose? It's a benign addiction, like moderate caffeine
dependency. One reason is that there _is_ a trade-off; these drugs make us a
little dull and less interesting to ourselves.

~~~
biturd
side effects.

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stevedonovan
Fair enough, I've been lucky. The only side-effect I've noticed over long-term
use is a slight dullness. Some people suffer all kinds of weirdness.

~~~
neverknowsbest
The worst luck is experiencing side effects/personality change from the meds,
but not being able to notice them _because_ of the medication.

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exabrial
While SSRIs and SNRIs have been around for years and have shown questionable
efficacy, opioids have been around for centuries and have shown to provide
instant and effective relief to depression. Unfortunately, opioids have a side
effect called "ruining your life". Based on this though, there's a new
generation of antidepressants that target a completely different part of the
brain. Essentially it's the depression blocking effects of opiods without the
euphoria, so low to no addiction potential. alks-5461 is the one that will hit
the market soon... hoping it's not too expensive.
[http://mentalhealthdaily.com/2014/08/05/new-
antidepressant-a...](http://mentalhealthdaily.com/2014/08/05/new-
antidepressant-alks-5461-trials-2016-expected-availability)

~~~
exabrial
And actually... if you have MDD, you might consider signing up:
[https://clinicaltrials.gov/ct2/show/study/NCT02218008?term=a...](https://clinicaltrials.gov/ct2/show/study/NCT02218008?term=alks-5461)

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skyhatch1
Unfortunately, you cannot cite clinical trials as the sole means to determine
individual patient relapse potential.

Many doctors, especially psychiatrists, use clinically-proven if-then-else
type criteria tools created by professional psychiatrist bodies.

As your therapy progresses, depending on how you score with the criteria, the
doctor will opt to:

\- Taper down and cease medication

\- Reduce medication dose and supplement with behavioral therapy

\- Stay on the current dose

\- Increase dose if your symptoms worsen

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partomniscient
\- That one didn't seem to work (or was intolerable), try this one. (Continue
to repeat cycle until something gives...)

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jackfrodo
Anyone know how to get around the paywall?

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roghummal
Google for "The Mystery of When to Stop Antidepressants" and click through
there. Didn't work for me in 'incognito mode' but it did when running
normally. YMMV.

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biturd
I was totally unable to bypass it as well.

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cat-dev-null
Same here. Tried Chrome and FF in regular mode, all extensions off.

