
Withdrawal from Antidepressants - ipunchghosts
https://www.madinamerica.com/2016/12/withdrawal-from-antidepressants/
======
vomitcuddle
As someone who had to abruptly come off venlafaxine due to side effects, I can
tell you that it was complete hell. I experienced vomiting, the weirdest, most
horrible nightmares every night, sleep paralysis with hallucinations and a
recurring feeling of "electic shocks" inside my head. This lasted about a
month. I think it borders on inhumane not to mention possible withdrawal
symptoms before prescribing this awful "anti-"depressant.

My doctor eventually prescribed me trazodone, so I could just sleep the
withdrawals off.

~~~
harshreality
I'm curious... you, and all other commenters who mentioned electric shocks...
which I'd previously heard of as "brain zaps"...

What difference would it make if the doctor had told you of that side effect
before you started the drug? Imagine you have no idea of what brain zaps felt
like. Would you have avoided the drug based on such a vague description?

Can you describe the sensation? It's not painful, right? The sensation of an
electric shock is sensory nerve input driven by external electricity, but
there are no sensory nerves in the brain are there? So it's confusing to me
(never been on psych drugs, so never gone through psych drug withdrawal) what
these brain electric shocks could possibly feel like.

I assume you can't localize the sensations to somewhere that has nerves, like
maybe the eyes, or somewhere—anywhere—else that really does have nerves? So
it's like re-balancing the synapses after quitting these drugs causes a
phenomenon in the somatosensory cortex that simulates non-localized zap
sensations in a place there are no sensory nerves? Is it limited to a
sensation, or are other senses (vision, hearing, smell, taste) ever involved?
Is it perhaps more like a non-physical zap that's more like an interruption or
glitch in consciousness than a ghost physical sensation?

[edit] So one person's experience with one day off meds was a feeling of
floating or vague floating-like feeling of imbalance. That's probably related,
perhaps an earlier stage of the phenomenon, but doesn't sound quite the same
as the electric shocks people mention they get after quitting. Are the
electric shock feelings anything like a rapid (instantaneous?) change in
balance, like a shift to zero-g and back?

~~~
butterfinger
To me, it felt like the moment after some limb went numb and you start to feel
it again, just for the whole body. And I had some visual effects like
everything being brighter for a moment. It's not painful per se but very
disorienting and irritating and it happens several times per hour.

I probably would not have avoided the drugs based on the description, because
it doesn't sound as bad as it feels, but I would never quit a SSRI without
tapering off again.

~~~
jat850
This is probably the best way I can put it too - like a waking limb, but brief
and intense - and it's the brain instead of a limb. It's really difficult to
describe accurately, but this is good.

------
guhcampos
I have experienced discontinuation effects from Paroxetine, Venlafaxine and
Fluxoetine in the past, Paroxetine was by far the worst, but absolutely within
the boundaries of what the doctor and the tab mentioned. With Paroxetine
itself the worst effects would be "blackouts" when I would loose all my senses
for a split second, just short enough that I would not fall if walking, but
long enough that people would notice during a conversation.

During one specific Venlafaxine withdrawal, however, I have experienced severe
depression, and got close to suicide. What saved me, ironically as it sounds,
was a huge dose of Clonazepan I rationally decided to take just so I could
sleep the withdrawal over. I'm still on Venlafaxine for a couple years now, I
take it for Anxiety/Panic and that was the only time I've experienced severe
depression in years.

What I've learned from all that is simple: that stuff is messing directly and
profoundly with your brain, so take it very seriously: anti-depressants are
not your over-the-counter shit. Apart from that, find a doctor you trust and
talk to them,every little detail. Never trust a psychiatrist who does not
suggest some kind of therapy: the meds won't cure you.

Also, I don't know of a single drug that won't give me some kind of
discontinuation syndrome if interrupted after continuous use. From nose sprays
and anti-acids to hypnotics, all have some rebound effects to them. I believe
the bottom line is to be rational about taking any drugs, yet specially the
ones messing with your head.

~~~
cerrelio
I've taken sertraline, venlafaxine, bupropion and fluoxetine.

Fluoxetine is the only SSRI I experienced no withdrawal from. I was on a low
dose (10-20mg) though, and it mostly worked (went from severe depression to
mild/none). I have a standing prescription for this as a fallback, but haven't
taken it in 3 years. I avoid taking it because of the sexual side effects. I
like having orgasms.

Bupropion triggered a seizure after the first dose. Immediately discontinued.

Venlafaxine was mostly effective, but I went from depressed to
robotic/apathetic. When I stopped taking it, I tapered off, but I had brain
zaps and developed acute tinnitus for over a month, alternating in each ear.
To this day, 15 years after treatment, I still experience moderate hearing
loss in my ears several times a month for about 60-90 seconds at a time.

Sertraline was the worst. I got up to 150mg before the problems. It triggered
a hypomanic episode that lasted for about a month. I didn't sleep at all for
the first three days it manifested. The doctor stopped treatment immediately
and put me on risperidone, which is a new level of awfulness. I just quit
taking it after a month, and told my doctor I would never take any
antipsychotic again.

I have a _great_ doctor now. He's not even a psychiatrist, just a generalist,
but he's treated many cases of depression over the past 20 years. He figured I
didn't have unipolar depression, but bipolar, due to the hypomania. SSRIs are
bad, and not recommended, as monotherapy for bipolar. So he put me on
lamotrigine and I haven't had a depressive (or manic) episode for over two
years. I've also experienced no noticeable side effects.

I've found the only thing that matters in the treatment of mental/behavioral
disorders is your doctor's skill and knowledge. Don't be afraid to dump a
mediocre doctor; it's your wellbeing on the line.

~~~
powmonk
>Sertraline was the worst

I had a very similar experience. Tried a couple of SSRIs prior to sertraline
and had a manic episode shortly after starting it. I was up for about 3 days
and drinking furiously. Felt like I was on coke. Immediately stopped once I
realised what was happening but it was so gradual and I was manic so it had to
be pointed out to me that I was flying.

------
KirinDave
I had this terrible experience before I was publicly out about my gender that
sent me into a very suicidal train of thought. I had a moment clarity to get
myself to a doctor (my partner was pregnant at the time, or I probably won't
be here writing this now).

The doctor gave me citalopram (brand name is Celexa, I think?) I had to stop
taking it. I'll list the side effects I had, but not before I point out: _It
saved my life._ Yes, I had bad side effects. But it also helped me overcome
the anxiety and rage I was suffering from and resolve to come out about my
status.

Ultimately I had to taper off of it, which was hard. My doctor advised
reducing my dose by 1/4 the original value every 9 days until I was done. The
end of it was quite rough, I confess.

But while on it, I gained nearly all the weight I lost in a year of physical
training back (just 4 months of treatment), my heart palpitations were
nauseatingly bad, and I suddenly had to sleep a lot longer to get even a
modicum of rest.

When people say, "You should consider medication" it is to help normalize the
idea that in trauma situations medication can help people with some types of
MI. It is not because they're fun, side-effect free, or not a "real" course of
treatment. It's important to remember that when considering these stories and
your own mental health.

~~~
harshreality
I don't think even people like the anti-med Robert Whitaker would be against
using these medications short-term, for major clinical depression or for other
conditions where patients are low- or non-functioning; the primary goal there
is to get people stable so they can participate in productive behavioral
therapy or modification so that they don't need the meds long-term
(particularly since afaik the balance of evidence is that the effectiveness of
these meds declines to the placebo level over the long term). It's the use of
psychiatric medication for relatively minor psychiatric disturbances in high-
functioning individuals, and for long periods of time (years), that draws most
of the criticism.

~~~
KirinDave
I have talked with many people who think meds will ruin their careers, destroy
their cognition, render them feeble, or are a profound mark of shame.

At a personal level, many people refuse chemical intervention for these
issues.

------
jrapdx3
The effects of abruptly stopping SSRI (and later on SNRI) medications have
been well-known since the 1980's. It's considered related to the widespread if
individually variable distribution of serotonin receptors in the body.

Having prescribed a ton of SSRI/SNRI meds since their introduction, and taken
my share as well, it's a phenomenon I'm _very_ familiar with.

Called a "discontinuation syndrome", technically not the same as "withdrawal",
which is associated with _tolerance_ , the need to continually increase dose
to get the same effect. SSRIs can produce a D/C effect at low or high dose if
more likely with greater dose.

Individual response to SSRI D/C varies greatly. I've been very surprised at
times when people tell me they've gone off 200mg of Zoloft and never noticed a
thing. Others report D/C effects for weeks even after tapering down very
gradually.

Most of the time problems with D/C reflect short half-life of compounds.
Effexor is notorious in this regard. OTOH more persistent agents like Prozac
are typically less troublesome. In fact it's a common strategy to use Prozac
as an means to ease D/C when stopping short duration meds.

Going by reports of (probably) a thousand patients, as well as my own
experience of D/C effects, generally they're mild to moderate and dissipate
within a few days. However there are exceptions and I never hesitated to go as
slowly as necessary to minimize excessive discomfort while tapering off the
medication.

As I've commented before on HN, this subject again emphasizes some crucially
important principles. One is that any medication can cause any side effect at
any time. No free lunch, all medicines have numerous effects, some favorable
and some not, so it's important to make sure there's a damn good reason for
using any medication and understand the risks and benefits.

Finally, every individual has a unique condition and responds uniquely to the
treatments we have to offer. It's a partnership between the prescriber and the
patient, communication about what's happening during the course of treatment
is vital. Believe me I know, whether in the role of doctor or patient, it's a
highly evolved art form.

~~~
an_d_rew
That was a carefully worded and thoughtful reply... thank you!

------
thanatropism
Oh boy oh boy oh boy.

The problems pointed out in this article -- which are in some degree real even
if heavily editorialized -- must be understood in light of a wider context
which includes:

0) The very poor standards of validity and replicability in most fields of
experimental psych-whatever. The Popperian method ain't what it used to be.

1) The Viennese Waltz of bad incentives throughout the psychiatry research
pipeline. Most notably, drug companies are incentivized for fraud and deceit
by being rewarded for closely-guarded research, hiding negative studies and
obtaining patent extensions for new applications of existing drugs.

2) Somewhat related to (1): the unfortunate drug safety model prevalent in all
relevant nations in which drugs must be _proven to work_ for some pathology.
Besides incentivizing recklessness in industry-led research, this means viable
off-label usages go "underground" (topiramate for dissociative disorders is a
typical case where FDA-worthy testing might be impossible). It might be better
if the FDA and its counterparts instead regulated for drug _safety_ in humans
and let the academic and clinical communities evolve their professional
consensuses.

3) Much related to (0): the effective failure of "talking cures" in
outcompeting drugs (specially "dirty drugs" like anticonvulsants, neuroleptics
and non-SSRI antidepressants) for "simple" depression, bereavement and related
mental health issues of which one could whip up a "social critique" of drug
use and so forth. "Mad in America" is obviously not willing to make a fuss of
things like bipolar where people will take their lithium for decades and bear
the side-effects because the alternative is to go actually mad-crazy.

Did I miss something?

~~~
tcj_phx
> "Mad in America" is obviously not willing to make a fuss of things like
> bipolar where people will take their lithium for decades and bear the side-
> effects [...]

The creation and promotion of "Bipolar" as a DSM disorder is covered in
_Anatomy of an Epidemic_ , Robert Whitaker's followup to _Mad in America_.

> [...] because the alternative is to go actually mad-crazy.

The whole point of Whitaker's _Mad in America_ foundation is to change the
paradigm of our approach to mental health. nstead of trying to find the right
drug to make a symptom go away, it would be much more effective to figure out
non-psychotropic-drug ways to help people function better.

~~~
thanatropism
Erm, manic depression as distinct from schizophrenia was basically established
by Emil Kraepelin in the 1880s.

Dr. Whitaker _could_ be going full Foucault, but as well established by
Hollywood, you _never go full Foucault_.

~~~
tcj_phx
> Erm, manic depression as distinct from schizophrenia was basically
> established by Emil Kraepelin in the 1880s.

The physiological basis for scihzophrenia wasn't figured out and ignored until
the 1970's.

> Dr. Whitaker could be going full Foucault, but as well established by
> Hollywood, you never go full Foucault.

Robert Whitaker is a journalist, not a doctor. He's sort of like the kid who
points out that the emperor got swindled by his tailors.

I like the reference to the quote from Tropic Thunder, but I'm not up to date
on Foucault's contributions to philosophy.

------
Alex3917
On a related note, there's no good half-life calculator on the web for people
tapering off SSRIs. The issue is that in order to actually have as gentle a
taper as possible, you need to halve your dose only every few weeks because of
how long the half life of these drugs is. So ideally you'd want something
where you would enter your starting dose and how much of the drug you plan on
taking each day, and it would show you your projected concentration of the
drug each day as well as the percent change.

I made this in Excel for someone a few years ago, but it would make a good
weekend project if someone wants to learn react or whatever.

~~~
ipunchghosts
I second this. I was on zoloft for IBS. Getting off of it was terrible. I had
to taper down 25% each step and each step lasted weeks. Overall, it took the
same time to taper off of it as when I needed it.

I quit taking it because my IBS was not really IBS, it was a defective
gallbladder. It was removed and my symptoms went away.

~~~
DenisM
IBS - irritable bowel syndrome?

------
tokenadult
The home page of the site hosting the webpage submitted here, "Mad in America:
Science, Psychiatry, and Social Justice" looks to put a lot more emphasis on
the social justice, as the authors published on the site define that, than on
science in general or psychiatry in particular. This is more a site that
advocates for a particular policy point of view than a site that neutrally
reviews the latest methodologically careful research.

[https://www.madinamerica.com/](https://www.madinamerica.com/)

"

~~~
geofft
But of course _which_ methodologically careful research has been done of late
is extremely agenda-driven and politicized, too!

You can't launder your biases away by putting them behind the abstraction
barrier of what the government or what drug companies are willing to fund.
That's how you end up with _p_ -hacking. Better to acknowledge that the reason
people do science is to _do things with_ science, not because they find sound
research intrinsically fulfilling, and that everyone and every funding agency
brings their biases, their hopes and dreams for society, with them.

~~~
mmjaa
> agenda-driven

More like, profit-driven. If we want to get better, we have to stop allowing a
class of society to profit from the sickness. Pharmaceutical companies exist
not to make anyones lives better - they exist to generate profit.

I'm highly suspicious of the drug-taking culture, as it attempts to justify
the enslavement of the individual by way of supplanting their supposed mental-
health problems with a very profitable subscription to a
proprietary/patented/owned drug formula. I think it is very sad to read this
HN article and listen to all the stories of folks who think they are improving
their lives with this chemical dependency, and it is really tragic that drug-
taking is such a cultural phenomenon that anyone who dares to rise above the
field and say "hey, maybe we don't need to do this - maybe there is another
way" gets cut down to serve as fodder for the rest of the poppies.

Its quite possible that we've all been swindled by our own hubris. Its
happened before. The Romans had their lead pipes, the Victorians their
laudanum, and we - "modern" society - have our Prozac and Zoloft. Dare to
mention alternative means of lifting oneself out of the mire, and you will
incur a great deal of wrath - such is the investment in the propaganda from
the multi-billion-dollar pharmaceutical industry in capturing the subject and
making sure nobody dares think otherwise to their drug-delivery supply
chains...

------
aaron-lebo
Not sure if this supports the article or is just a warning, but going off of
anti-depressants can be fatal. If depression relapses anti-depressants that
once worked can prove ineffective. (edit: wrongly said SSRIs and not anti-
depressants)

David Foster Wallace:

 _Wallace died by suicide on September 12, 2008, at age 46. Wallace 's father
reported in an interview that his son had suffered from depression for more
than 20 years and that antidepressant medication had allowed him to be
productive.[42] When Wallace experienced severe side effects from the
medication, he attempted to wean himself from his primary antidepressant,
phenelzine.[43] On his doctor's advice, Wallace stopped taking the medication
in June 2007,[42] then the depression returned. Wallace received other
treatments, including electroconvulsive therapy. When he returned to
phenelzine, he found that it had lost its effectiveness.[43] His wife kept a
watchful eye on him in the following days, but on September 12, Wallace went
into the garage, wrote a two-page note, and arranged part of the manuscript
for The Pale King before hanging himself from a patio rafter.[49]_

It's something to be very careful about...

~~~
drzaiusapelord
Phenelzine is actually a MAOI, which is a different class of drug. My
understanding is that Wallace had hard to treat depression and was on this
more dangerous class of drug as SSRI's didn't work well on him. He also died
with Clonazepam and Temazepam in his system. Wallace also received electric
shock therapy, which suggests his depression was much more serious than most
cases.

I think his case is very much an edge case here. He had very serious problems
with a hard to treat depression and was on a MAO inhibitor, which is seen as
the last resort for pharmacological treatments of depression because its so
unstable, short-lived, and has nasty side effects and is difficult to ween
off. SSRI's are much more safe.

~~~
nylonstrung
He actually wrote about his experiences with MAOIs in an early short story in
a college journal. This was in the early 80s, well before Prozac and SSRIs
made it to market.

[https://quomodocumque.files.wordpress.com/2008/09/wallace-
am...](https://quomodocumque.files.wordpress.com/2008/09/wallace-
amherst_review-the_planet.pdf)

~~~
outworlder
I just read it and I'm at a loss for words. All I can say is that it's a
incredibly sad tale.

------
throwaway713
I was on Nardil (phenelzine) for about 6 months. That's some weird stuff right
there. I gained a whole bunch of weight, lost the ability to dream while
sleeping, and couldn't eat any foods with tyramine in them (like Iberian ham
or fava beans), but man, chocolate cake never tasted so heavenly as when on
Nardil.

Prior to Nardil, I had been taking Prozac (fluoxetine) but a combination of
sexual side effects, an impatient disposition, and scientific curiosity
prompted me to ask my psychiatrist about Nardil. He said, "Why not?" This
psychiatrist would prescribe just about anything (not that I see anything
wrong with that) so over the course of grad school I tried Prozac, Nardil,
Modafinil, and Adderall. Oddly enough, it turned out that an extremely low
dosage of Adderall fixed most of my issues. My psychiatrist started with me 30
mg twice a day but I found that 10 mg worked better (less euphoria, more
focus), so nowadays I only take 10 mg Adderall about twice a week and don't
seem to have any depression or focus issues anymore.

~~~
chillwaves
What did you think about Modafinil? I went on it for a few months (without
advice of a doctor) and thought it put a great pep in my step. Now that I have
insurance, I will try to get it prescribed but it seemed gentle in a way, like
a different flavor of caffeine but also gave me confidence. Unless I took too
much, then I felt on edge, like I was clenching my jaw (probably was).

I guess I am asking you about Modafinil because somehow I was under the
impression it's a somewhat casual drug and the rest in your list seem like
heavy weights to me. I have never taken any kind of antidepressant but
sometimes think I need to.

~~~
throwaway713
I had no response to Modafinil at all. I started at 100 mg and worked up to
400 mg (under my psychiatrist's supervision), but at 400 mg, both he and I
decided it wasn't doing anything — positive or negative — so I quit taking it.

After researching the subject a bit, my guess as to why Modafinil had no
effect on me is that I probably have the wrong variant of the rs4680 gene.
rs4680 is known as the worrier/warrior gene; those with the AA variant tend to
be neurotic, have high anxiety, and handle stress poorly (my personality in a
nutshell). Studies have shown that people with this variant of rs4680 do not
significantly respond to Modafinil, so I suspect that I am one of them. I plan
on sending a DNA sample to 23andme soon to confirm whether or not my hunch is
correct.

With regard to getting a prescription, I'll note that my psychiatrist couldn't
prescribe Modafinil directly to treat anxiety, so he indirectly prescribed it
to address the "sleep issues" that were caused by my anxiety/depression.

For me, 5 mg of Adderall does what I was _hoping_ Modafinil would do.
Personally speaking, productivity is far more important to me than "feeling
good", which is what I think a lot of people abuse Adderall for (and it
certainly does produce that "feel good" sensation at high enough dosages). But
at 10 mg and less, it's like a much "smoother" version of caffeine. In fact,
lately I've found that I don't really like caffeine anymore because it makes
me crankier, sweatier, and more jittery than Adderall does, and it doesn't
help my ability to focus as well.

------
dbg31415
We think of doctors and medications as being scientific and precise. But it's
more like just throwing some food coloring into a black garbage bag full of
all sorts of stuff and shaking it up in hopes of getting it to get to a
specific color... but not really being able to see the color through the bag.

The drugs all have side-effects, different for each person who takes them. And
often those side-effects are as bad as the original ailment. But you trust
your doctor, and you're in a bad spot... and you figure, "Fuck it, maybe it'll
work and I'm willing to try anything at this point..." And ugh, it just all
sucks.

It's so hard to fix once you start down the medication path. Testing drugs,
trying to find the right dose... deciding if the side-effects are worth the
gains... withdrawal from drugs... drugs to help with the side-effects... drugs
to help with the withdrawal... (often a few loops)... all of this can
fundamentally change your personality and motivations, or have just no impact
on you what-so-ever and leave you beyond frustrated.

If you had cancer, everyone would be there to support you. If you have a
mental illness, there's not much chance of getting support from peers... or
friends -- it's tough, it's not their job to support you -- sure... but a lot
of times mental health issues are exacerbated by feeling of isolation... which
leads to medical treatment because you don't have other options... and the
doctors all seem confident that drugs will help...

Anyway, anything you can do to avoid mental health issues in the first
place... do that. And if you don't have mental health issues, be thankful and
humbly accept you're one concussion, bad breakup, car accident, death in the
family, death of a pet, loss of job, or bad decision away from it if you
aren't careful.

~~~
chris_wot
In Australia (or at least NSW), the health system doesn't know what to do with
you. About 7 months ago I had a mental breakdown and experienced thoughts of
suicide. When the health system found out, I had finished having the thoughts,
and was at home trying to sleep, being supported by my loving family having
been awake at the time for over 14 hours.

I was ripped out of my bed by ambulance officers with police present, despite
my protests and my wife's - eventually agreeing to go voluntarily with them in
their ambulance. Then after I got into the ED itself I discovered I'd been
sectioned and not allowed to leave. After I realised this was what had
happened I got placed in an isolation room, with no explanation as to why, and
there I sat quietly rotting for the next 5.5 hours. In other words, I got no
care, had my rights stripped and was treated like a criminal because after a
sustained period of incredible stress I had a breakdown. I was then sent back
home as they decided I shouldn't have been there in the first place.

I was then sent a bill for $600.

The system sucks.

~~~
jrochkind1
> After I realised this was what had happened I got placed in an isolation
> room, with no explanation as to why, and there I sat quietly rotting for the
> next 5.5 hours. In other words, I got no care, had my rights stripped and
> was treated like a criminal because after a sustained period of incredible
> stress I had a breakdown

That sounds like enough to _cause_ a breakdown!

~~~
chris_wot
I have been living with sustained emotional stress for the last six months.
There are days I go to work and as I'm driving in my car at a certain point I
scream from the trauma. It's the only place I can do it, I don't dare do it
around my family, friends or work colleagues.

And I absolutely cannot talk to anyone involved in medicine, because their
treatment for suicidal ideation from a mental breakdown has the unique side
effect of making me feel like I want to die to escape the disrespect and
indignity of being treated like a criminal who must be locked away.

------
mrbill
Even tapering off Cymbalta and tapering on to a different med at the same
time..

Worst sickness of my life. Felt like death flu. Uncontrollable vomiting,
diarrhea, chills, shivering, fever. I spent 4 days between bed and bathroom.
Then suddenly on day 5 I was fine.

While I was on it, it completely turned off everything below the belt. No
response to stimulation at all. And mentally I was a zombie. Evil stuff.

No such problems on Zoloft, celexa, or Prozac.

~~~
ryan-allen
I've come off Lexapro with some odd 'brain' sensations but nothing super
serious, 2 week taper from 15mg.

I ended up coming back on it though. It helps a lot!

~~~
mrbill
I had occasional brain zaps when first on Lexapro (the first SSRI I ever took)
but it wasn't bad.

------
benevol
If you want to stop being dependent on anti-depressants (and their side-
effects) while stopping depression at the same time, you may try a normal dose
of LSD (after becoming a domain expert and testing the substance you have
acquired). Complement this with daily practice of mindful meditation and you
have a good chance to succeed. Also, you need to make sure to permanently
change whatever lifestyle caused your depression.

~~~
echlebek
Don't combine LSD with prescription medication. Don't take LSD if you are
experiencing depression or mental illness.

------
KermitCole
As an editor on Mad in America, I appreciate the thoughtful and thorough
discussion here. We would welcome any stories or analysis that the commenters
here might venture to contribute to MIA. Thanks, Kermit Cole

~~~
dannylandau
Are there any comprehensive portals that provide information about the
prevalence of each drug's side effect? The only one I know of is HealthBee? -
[https://healthbee.co/](https://healthbee.co/)

~~~
markroseman
I find drugs.com useful, which seems to be derived from product monographs.
Knowing that "very common", "common", "uncommon", "rare" and "very rare" have
specific meanings (e.g. common -> 1%-10%) helps.

------
rudolf0
The article seems sound, but the source does look a bit biased.

~~~
0xcde4c3db
The source isn't just a bit biased, it's hugely biased. Mad in America has an
open editorial viewpoint, which is opposition to "the current drug-based
paradigm of care" in psychiatry [1]. It's headed by Robert Whitaker, probably
best known for his book _Anatomy of an Epidemic_ that questions the routine
use of psychiatric drugs [2].

Of course, that doesn't mean the article is useless or not addressing real
phenomena. Antidepressant withdrawal is real, and IME it's something you're
more likely to hear about as a horror story from a patient (especially if they
tried to stop Effexor cold-turkey) rather than as part of standard
descriptions of depression treatment and its risks/shortcomings.

[1] [https://www.madinamerica.com/about-
us/](https://www.madinamerica.com/about-us/)

[2] [https://www.madinamerica.com/robert-whitaker-
new/](https://www.madinamerica.com/robert-whitaker-new/)

~~~
rudolf0
Oh yeah, I've used SSRIs and suffered the withdrawal. I know they're not
making things up or whatever.

But I also think that taking such a universal anti-psychiatric drug stance is
probably too hardline of a position. I think they are the lesser of two (or
more) evils for a lot of patients.

------
numinary1
It seems to me that many of the drugs in this category are effective sometimes
for some people. People I have known who were suffering acutely often cycled
through several drugs, sometimes in combination, dosages etc. It appears to me
to be mostly trial and error.

But for some people the results are miraculous. They solve real problems with
few if any side effects. For others, they either don't work at all or have
intolerable side effects.

The situation would be a whole lot better if we could predict likely efficacy
and side effects in advance, especially cases where treatment is more likely
to do harm that to help.

Interestingly, I've read a lot (not so much recently) on the subject and taken
several SSRIs myself (with good short term experience, minor sides), but I
learned a lot from the discussion here. So many people take these drugs — the
data necessary to understand and perhaps to predict ... is out there. Not easy
to get at, but really plentiful. Reading this made me think about the
feasibility of mining message boards for first person accounts of SSRI
experience.

~~~
markroseman
While there is some work done on matching people up with specific drugs, this
is still very much in the research phase.

Still, for many people, it's more trial and error than it needs to be. Many
family doctors still don't match up symptoms with neurotransmitters, and then
put people on the wrong class of drugs altogether (e.g. something like
Wellbutrin which works on norepinephrine and dopamine instead of an SSRI for
anxiety which is more associated with serotonin).

Part of the reason is that new drugs keep coming out so it's difficult to keep
up, and eventually they all start to blur together.

The best practical predictor of success on a given medication today is if you
have a close relative who's had success on that medication.

~~~
numinary1
That certainly makes sense since the problem has a higher likelihood of
stemming from the same root cause, but also speaks to how little is known.

So include the social graphs of people who are on antidepressant discussion
boards and pick up on friends, family, socioeconomic features ...

I so want to use ML tools on medical treatment data, but it's so hard to come
by. Have toyed with a couple of startup ideas based on the tendency of people
who share a condition to establish ties. Crohn's disease, cutaneous lymphoma.
But the groups are too small. Mood disorders on the other hand...

------
seibelj
10mg Lexapro every day... it _saved my life_. I am not joking

~~~
ryan-allen
Me too :)

------
naveen99
I think people should see an endocrinologist and cardiologist before seeing a
psychiatrist. A lot of real correctable health issues are hard to
differentiate from depression, burnout, and can cause fatigue, anxiety etc.

------
ffwacom
"the distinctions between discontinuation symptoms and drug withdrawal are
clear"

Are they? Calling it "Discontinuation syndrome" rather than withdrawal seems
like clever marketing.

------
feld
My brother was going through a divorce and committed suicide after his doctor
refused to refill his prescription for antidepressants.

I've always wondered if it was a windrawl side effect

------
bobharris
I started Lexapro 10mg 5 days ago. 5mg taper up week. Reading stuff like this
scares me. However based on my depression scales for months my LCPC and MD
recommended it. Major life upsets back to back to back to back. I have light
momentary nausea starting out. I hope it doesn't get worse. :( I'm only using
it as a footing to work some recovery programs. Then I'm done.

------
aserafini
Biggest effect from reducing my dose of fluoxetine was dreaming again. It's
great.

~~~
krylon
Huh. I've had rather vivid dreams on fluoxetine (although at a very low dose),
but I remember the dreams being very un-spectacular in content. (Trimipramine
on the other hand gives me highly vivid and very strange dreams, which I kind
of like, but they are incredibly hard to remember.)

------
69mlgsniperdad
I have been on paxil(paroxetine) three separate times. Each was between six
months and one year in duration. The first time, I was on a 10mg daily dose. I
had quite a few issues when starting the medication the first time; however
after a few weeks, I felt great. When I initially discontinued, I had the
worst side effects I have ever experienced. Electric shocks in my neck and
back of head, depression, mood swings, and terrible panic attacks lasting
almost two weeks. The doctor told me it wasn't 'addictive' and there is no
issue stopping the medication, afterwards I changed my physician. The new
doctor also insisted there were no known withdrawal symptoms. If you google
the issue there are thousands of reports and dozens of websites about this
exactly. I have no idea why doctors tell people there is nothing to worry
about but there are certainly many negative side effects experienced while
starting and discontinuing SSRI's. For subsequent treatments of paxil and
other SSRI's, I have made sure to slowly titrate my dose when starting and
discontinuing treatment. 1/4 doses for a week, half for a week, 3/4 for a
week, and then full dosage. I have done the same for discontinuing, sometimes
even more gradual then that, and have avoided the terrible experience since.

~~~
rudolf0
Doctors can be notoriously ignorant and contradictory when it comes to mental
illness-treating drugs. There's a lot of literature out there and a lot of
them don't keep up. I don't know why it is.

Not that you shouldn't trust doctors, but I always do some Googling to get a
second opinion about all psychoactive drugs I'm prescribed.

~~~
agumonkey
It's very very uneasy when doctors are too handwavey on your issues. You don't
know if they're skipping beats because they don't want to explain 10 years of
med school so you obey, or if they just don't want to investigate more than
what the usual answer is.

I tried to nitpick on things that mattered for me, but you cannot easily claim
"I'm more up to date than you on <xyz> illness" to a legal doctor without
feeling a little ridiculous.

That's why I root for more non invasive monitoring and intervention. Many
doctors told me the "based on these tests, you have nothing", bailing out when
I asked for more because deeper tests would require potential ICU. So you end
up floating in the unknown hoping for the best.

~~~
phkahler
You may or may not be more up to date on a particular illness, but you are the
best authority on your specific case.

~~~
agumonkey
But you have your own bias. The amount of fuzz from your personal data can be
huge. That's why I wish I could have objective monitors and not rely on sparse
visits to the doctor when symptoms aren't here.

One dared me to reproduce heart failure on the spot because there was some
tension between me and him.

It odd.

~~~
phkahler
Objective measures are always nice, but when there are none it all comes down
to self report. Your own bias will still be present in that, and then you get
to add on the doctors own bias. We hope that their experience can cut through
both sources of distortion, but the less common the problem the harder that
is.

