
Many People Taking Antidepressants Discover They Cannot Quit - molecule
https://www.nytimes.com/2018/04/07/health/antidepressants-withdrawal-prozac-cymbalta.html
======
dbt00
I was up to 10mg/daily of Lexapro for two years. When my doctor and I agreed
it was time to stop taking it, his advice was to go down to 5mg for a week,
then stop.

When I tried stopping after the 5mg dose I had constant vertigo symptoms and
incredible difficulty sleeping.

What I ended up doing was cutting the pills in half for a few weeks, then
quarters, then removing one day a week from the schedule until I was down
2.5mg/wk. Finally I was able to stop, and only was mildly affected for 3 weeks
after that.

That stuff does weird things to your brain. On the flip side, I couldn't have
gotten through some really rough times without it.

~~~
thearn4
I had the same issues coming off of Lexapro. Weird brain shocks. Bupropion
(Wellbutrin) has been better for me all around, but I worry about what it will
be like coming down off of it too. The good news is that I'm overall in a good
place and feel like I probably don't need it anymore.

~~~
Fnoord
Bupropion is marketed as Zyban as a smoking cessation aid meaning that people
are coming down on it when they quit Zyban, after they quit smoking. I've done
this, twice. I've also used Ritalin in the past. It works similar, and from my
memory the coming down is also similar.

~~~
wolco
I tried Zyban years ago. After 7 days I stopped smoking and then had this
weird time slowing down effect. I guess most people don't have that effect but
I wonder how many do.

~~~
honopu
I had the same thing. I was so used to time flying by, it was going slower,
which I consider a great thing :).

------
Karrot_Kream
To offer the converse, I had a very traumatic event in my life and was put on
an SSRI, which helped me function. After almost 2 years of taking it, I didn't
think I needed it anymore and I tapered myself off very slowly but regularly,
keeping logs and setting alarms. While in the beginning I felt some vertigo
and other symptoms, I tapered very gradually, and was completely free at the
end of my taper. My symptoms never come back and the SSRI helped me make very
real progress on my issues. I'm eternally glad for my SSRI use and a medical
system that knows when to prescribe it, as I would have probably not been able
to hold down a (at the time, very stressful) job during the initial phases
after the event without the help of the SSRI, and it probably would have taken
me many years to recover. For those that SSRIs work on, it really works.

~~~
phkahler
>> I'm eternally glad for my SSRI use and a medical system that knows when to
prescribe it...

Your story of recovery is a good one (and not the only good one). The problem
is that a number of people in that same system don't see any need to get
people off these medications. IMHO they are best used short term (whatever
that means) while you work through your issues - like you did.

For those reading, there is no "correct" timeline for working through your
issues. Everyone goes at their own pace. I would just encourage you to try,
and not assume a lifetime of medication is a good solution.

~~~
indecisive_user
>The problem is that a number of people in that same system don't see any need
to get people off these medications

Why is this a problem? If long term studies prove detrimental effects then
sure, it's a problem.

But taking a pill every day isn't inherently bad for you. If you live in a
northern climate you would probably benefit from taking Vitamin D every day
your entire life, so what's the fundamental difference of an SSRI?

~~~
meowface
The issue isn't taking medication daily; it's taking psychotropic, brain- and
personality-altering medication for years, especially when it comes with
potential for bad side effects which may last after cessation (such as with
SSRIs). I take vitamin D daily and I really don't think you can equate it to
SSRIs whatsoever.

Clearly SSRIs help many people in a significant way, but their mechanism of
action is still poorly understood and their effects are powerful enough that
they should be prescribed and taken long-term only with careful advising and
caution. For some people, maybe taking them until the day they die is the best
option, but it probably is also harmful for some people to take them for
several years.

------
superkuh
>Yet withdrawal has never been a focus of drug makers or government
regulators, who felt antidepressants could not be addictive and did far more
good than harm.

They're not addictive. They cause dependence. There is an important
difference. Addictive things increase incentive salience of stimuli associated
with the drug. They increase wanting. And that increased wanting leads to
increased usage.

Dependence on a drug does not have this aspect. It just represents the bodies
physiological adaptation to the new state.

Conflating the two is bad practice for an article ostensibly about medicine.
And it leads people, and that set includes legislators, to think about using
more government violence to enforce regulations of drugs which create
dependence.

~~~
onetwotree
Having been addicted to prescription pills, and currently being prescribed
(and presumably dependent on) antidepressants, I think there are a few points
that make the distinction abundantly clear:

1\. When I consider stopping antidepressants, I'm not filled with anything
like the dread I was when I thought about giving up the addictive pills.

2\. I forget to take my antidepressants sometimes. I forget to refill the
prescription sometimes.

3\. I have never had any desire to take more than the prescribed dose of my
antidepressants.

It's an important distinction, and unfortunately one that folks in the
recovery community sometimes miss. In my experience the above characterization
usually brings it home much better than some heavily medicalized description
of addiction vs dependency.

------
gabept
The "Chemical Imbalence Theory", although heavely popular and promoted, is
largely unfounded on science:

[https://joannamoncrieff.com/2014/05/01/the-chemical-
imbalanc...](https://joannamoncrieff.com/2014/05/01/the-chemical-imbalance-
theory-of-depression-still-promoted-but-still-unfounded/)

~~~
make3
Meta studies still show that antidepressants help more than the placebo
[https://www.bmj.com/content/360/bmj.k847](https://www.bmj.com/content/360/bmj.k847)

~~~
fogzen
And multiple studies show them no more effective than exercise:
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3674785/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3674785/)

The bigger problem is “depression” is not reproducibly measurable, because it
has no falsifiable or biomedical marker.

~~~
phkahler
>> The bigger problem is “depression” is not reproducibly measurable, because
it has no falsifiable or biomedical marker.

That's something I like to point out using SSRIs as an example. The claim is
that they increase levels of serotonin and that the cause of the depression is
reduced serotonin. The thing is, nobody actually checks your serotonin levels
and says "oh that's low take this." Then there's the problem of _why_ ones
serotonin is low when it wasn't always that way. There are probably many
causes of depression and quite possibly some that don't lower serotonin.

~~~
empath75
If mdma makes you friendlier, does that mean that people who are shy are
suffering from friendliness deficit disorder and can I get a prescription for
it.

------
mirimir
That brings back horrible memories. I took an SSRI for several years,
initially prescribed by a GP. But the problem was that I wasn't "depressed". I
am bipolar, and sometimes got stuck in down mode.

The SSRI _did_ make me more functional. But what it mostly did was make me
affectless. That is, I could be sad or happy or angry or whatever, and I felt
pretty much nothing. However, I still did whatever someone who was sad or
happy or angry or whatever would do. You could say that it made me
sociopathic. But fortunately, not homicidal or suicidal. Or at least, not in a
big way. Also, I lost interest in sex, and it took forever to reach orgasm.

And yes, quitting was painful. Mostly I recall restless leg syndrome. I would
kick my partner while asleep. And I got even crazier for a while, as I tapered
off.

So now I'm taking modafinil and lamotrigine. Which works very well for me. I'm
a little manic most of the time, but I like that. And I'm not at all
sociopathic.

~~~
azernik
Interesting - I have bipolar too (that is, bipolar II), also misdiagnosed as
pure depression for a while. However, the SSRI didn't flatten my affect, but
instead amplified my hypomania to where it was severe enough to be diagnosed.
Now I'm on lamotrigine and sertraline, and the two together keep me stable and
up.

~~~
nexus2045
How did you end up getting properly diagnosed for Bipolar disorder? I'm
currently taking antidepressants after battling SOME kind of mental illness
for most of my adult life. I'm really inside my head, and often have very
existential, self-doubting moods, to the point where I have burned a lot of
bridges (jobs, friends, relationships) with antisocial behaviour (that I would
never logically think is the right thing to do), but in the right mood, having
also tried MDMA, I act completely normal, can hold conversations, etc. (but
that's once in a blue moon normally).

~~~
mirimir
I found a psychiatrist who asked me whether amphetamines made me happy or
nervous. I said happy. He said bipolar.

------
friedman23
Anti depressants along with support from my family and therapist saved my
life. Prior to taking anti depressants I would get into moods so depressed
that I would have significant chest pain and headaches. The headaches were so
severe that without any consideration I almost jumped from the roof of one my
school buildings.

Within the first week of taking anti depressants (wellbutrin, I later switched
to prozac) I would at random moments of the day begin to remember funny
memories. I would be walking to my dorm from class and remember a funny gag
from the simpsons and break into a stupid grin.

After two years on anti depressants I was able to stop taking them. I was able
to do this by accepting and understanding that while I may have real reasons
to be sad, the underlying reason that I was dwelling on these negative
thoughts was my brain chemistry. Once I accepted this I was able to justify
cheaper less harmful ways of medicating my depression. Whenever I began to
feel depressed I would simply go to my tv and start watching episodes of `It's
always sunny in philadelphia` or whatever comedy made me happy

I think the worst mistake people with depression make is reinforcing their
sadness by listening to sad music, watching sad movies or reading sad books
when in fact they should be doing the opposite. They also allow their
depression to become part of their identity.

~~~
hfdgiutdryg
_Whenever I began to feel depressed I would simply go to my tv and start
watching episodes of `It 's always sunny in philadelphia` or whatever comedy
made me happy_

This sounds a bit like you discovered Cognitive Behavioral Therapy. That's
actually a very insightful, practical approach you developed.

------
wbkang
Is there a reason why people are trying to stop taking it? If it helps your
life, why not keep using it? For example, I have been taking antihistamine
daily for the last 18 years for skin allergy. My QoL is significantly better
with it, and unless there is some magical cure, I don't see why I should stop
just because it's a "drug", "chemical" or "unnatural".

For example, from the article,

> "A year and a half after stopping, I’m still having problems. I’m not me
> right now; I don’t have the creativity, the energy. She — Robin — is gone"

If that's important to you, why not continue?

~~~
jack_h
Anecdotally I quit because I had just entered a relationship and the anti-
depressants affected my sex life in a pretty big way.

~~~
himom
Neither mirtazapine nor trintellix affected me at all in that dept.

I can’t take paxil, zoloft or valium, so it’s probably different.

I personally wouldn’t stop antidepressants because my physiology goes straight
into depression without exception, and then the relationship would likely
flounder.

------
benevol
I hope that this doesn't come over as sarcastic, but the pharmaceutical
industry is a _business_ , and they will always operate like one:

A business is about making the most money possible: Maximizing revenue is
about minimizing the main costs which are generated by the activities of:

(a) _acquiring_ the customer (through: advertising and marketing) and,

(b) _retaining_ the customer (in this case: through dependency).

There are alternatives to anti-depressants. Some people quit depression for
good with a well researched and planned LSD trip combined with long-term daily
mindful meditation.

No, I'm not saying everybody should take LSD.

~~~
pcwalton
You _are_ suggesting that depressed people may want to take LSD in lieu of
SSRIs, which is horrendous advice that can, for example, trigger panic attacks
in those with comorbid anxiety. Please don't.

~~~
fogzen
What study shows LSD is more dangerous than SSRI’s? Antidepressants can also
cause psychotic episodes, panic attacks, suicide, etc.

Both drugs have mechanisms of action that we don’t fully understand and both
affect the brains homeostasis.

If it’s irresponsible to prescribe LSD for depression it’s irresponsible to
prescribe SSRI’s as well

~~~
Fnoord
> What study shows LSD is more dangerous than SSRI’s?

Except that's not how it works.

How it works is that SSRIs have been tested in trials, and are approved.

LSD isn't. When someone says "try LSD" (or psilocybin which seems the newest
rage these days) it means they'd illegally acquire the drug (who know for sure
_what_ drug they bought? [EDIT: and who knows the dosage/strength of active
substance(s)?]), and administer it recreationally without the aid of a
professional.

SSRIs, in contrast, are clinically tested, legally acquired, and administered
under the guidance of a professional.

> Antidepressants can also cause psychotic episodes, panic attacks, suicide,
> etc.

Yes, but these side effects are widely documented. There are more common side
effects, btw. These are the extreme ones you mentioned, and also the most rare
ones. Many side effects are temporary. And if you are suicidal, it is unlikely
you get SSRIs prescribed. Unless you lie about that, of course, but if you lie
to your MD you're on your own.

My recommendation is simple: seek professional help. If you don't want to take
SSRIs, fair enough; your MD won't force you. Heck, they might even be
reluctant to prescribe them. But professional help is much more than drugs.
Think about CBT, mindfulness, under the guidance of professionals; not self-
medicating new age hippies.

~~~
fogzen
You keep saying "professional" as if that means anything here.

The professionals that without any evidence promoted the low-serotonin theory
of depression. Who, after over a decade of prescribing SSRI's finally admitted
that low serotonin doesn't cause depression. Yeah, those professionals. They
don't know what causes depression yet they're happy to keep prescribing drugs.
But it's the "self-medicating new age hippies" that are irresponsible?

~~~
Fnoord
It means a lot, it means that the person who's responsible for your therapy
(which might involve drugs) has studied for years (it takes a while until
one's a psychiatrist!). It means they understand the fundamentals required for
their title. Such credentials are worth a lot in our societies, hence the high
wage. Perhaps not in the alternative medicine field where you're flocking
around but realise you are the exception here; not the norm.

Also, those professionals aren't necessarily the same people. Do you fault
Linus Torvalds for a bug in the Windows NT kernel because he's a software
developer? Science is constantly in motion and questioning itself. The drug
usage in the past before drugs were illegal (pre-2nd part of 20th century) was
more irresponsible, and its thanks to science and law this has reduced. And
specifically, SSRIs are more safe than antidepressants used before SSRIs such
as TCAs and MAOIs.

~~~
brookside
> Such credentials are worth a lot in our societies, hence the high wage.

Lots of professionals with great titles and affiliations steer people down a
totally incorrect path.

An easy example of this is Harvard study published in the New England Journal
of Medicine promoting dietary fat reduction, shaping what every credentialed
person would advise for diet for the next 50 years:
[https://www.npr.org/sections/thetwo-
way/2016/09/13/493739074...](https://www.npr.org/sections/thetwo-
way/2016/09/13/493739074/50-years-ago-sugar-industry-quietly-paid-scientists-
to-point-blame-at-fat)

Drug companies shoulder the rep of being cold evil capitalists. Psychiatrists
also become extremely wealthy as part of this medical complex, and get to keep
a positive reputation. It reminds me of ticketmaster essentially being paid to
shoulder negative PR for excessive ticket fees which are often largely passed
on to performers.

~~~
Fnoord
> Lots of professionals with great titles and affiliations steer people down a
> totally incorrect path.

Not _knowingly_ , and they're expert on the field. There's a few exceptions,
but those people are not 100% in the head. Diederik Stapel [1] being a recent
example in social psychology.

The chance that you have a sitter without a clue is much higher. Especially
because those are usually "friendz". The chance a professional knows better
than a self-proclaimed expert is simply too high to discount _all_
professionals.

> Drug companies shoulder the rep of being cold evil capitalists.
> Psychiatrists also become extremely wealthy as part of this medical complex,
> and get to keep a positive reputation. It reminds me of ticketmaster
> essentially being paid to shoulder negative PR for excessive ticket fees
> which are often largely passed on to performers.

In The Netherlands, you first try the drugs which are most likely to solve
your problem but also you need to consider what gets reimbursed by insurance.
Insurance also wants you to go for cheapest generic brand if possible (if
patents expired, and the drug is known to work for your ailment). Example:
something like Concerta doesn't get reimbursed because Ritalin exists and is
considered the generic form. Even though the yo-yo effect is more severe with
Ritalin.

Another example, I had the option of going for a SSRI or a SSRI plus
antipsychotics. The former has a good track record for people with autism; the
latter combo better but it _also_ has more impact. Regular blood checks, and
basic insurance doesn't cover the antipsychotics.

As for the positive reputation, when I went for my autism diagnosis I had an
anamnesis from an asshole of a psychiatrist. He was working there temporary
because they _fired_ their regular psychiatrist very recently. I don't know
exactly why, but I do know it was directly related to his functioning as a
psychiatrist.

Ticketmaster problem is different (and offtopic though I don't mind
analogies). It can be solved by putting a cap by law on how much percentage
profit (e.g. 25%) second hand market may earn. That does require political
willpower and enforcement of such regulation.

[1]
[https://en.wikipedia.org/wiki/Diederik_Stapel](https://en.wikipedia.org/wiki/Diederik_Stapel)

------
cassowary37
Ah, another Benedict Carey antidepressant hatchet job. Anecdotes about
withdrawal symptoms + alarmist statistics about number of Americans on
antidepressants + vague questions about lack of data suggesting that we know
little about antidepressant long-term safety.

A few important points:

1\. Antidepressants can truly change people's lives. Not everyone's, and
they're not the only treatment that works. Somehow this reporter tends to
consistently overlook the clear evidence of benefit (I think this recent meta-
analysis was posted on hn:
[https://www.ncbi.nlm.nih.gov/pubmed/29477251](https://www.ncbi.nlm.nih.gov/pubmed/29477251))

2\. Withdrawal symptoms are common if antidepressants are stopped abruptly -
some of the folks who reported these symptoms originally have been favorite
targets of Benedict Carey, ironically
([https://www.ncbi.nlm.nih.gov/pubmed/9396960](https://www.ncbi.nlm.nih.gov/pubmed/9396960)).
That's why docs encourage tapering antidepressants.

3\. The article doesn't distinguish between this sort of short-term withdrawal
(common), and longer-term problems with discontinuation (likely quite rare) -
they're very very different phenomena.

4\. In some cases, difficulty with discontinuing longer-term is a result of
persistent depression and anxiety (or returning depression and anxiety). It's
not polite to point this out.

5\. It's hard to imagine the Times writing an article about the problem with
statins being that, once you stop them, cholesterol increases again.

6\. If there were substantial long-term risks associated with antidepressants,
we would have seen them - and believe me, people have looked and are looking.

7\. BUT - we /do/ need more research to understand long-term effects of
antidepressant treatment; this absence of systematic long-term study is true
for most meds, frankly, but that's no excuse. My question would be: Who pays
for it? There's no shortage of investigators who would be delighted to study
it. But try getting a foundation, or NIH, to support such a study.

/rant

~~~
dimal
> If there were substantial long-term risks associated with antidepressants,
> we would have seen them

Drug makers have no incentive to see them. I can say from experience that I
have seen them. I spent two months out of work when I had to discontinue
Effexor. Other people complained about “brain zaps” and were largely ignored.
My doctor never warned me. The evidence is there but there if you look, but
there is no one with an economic incentive to pay attention. Just because
there are few studies documenting these symptoms doesn’t mean they’re not.
This is a wake up call that more studies need to be done.

~~~
DanBC
Discontinuation effects are listed on the patient information leaflet for
venlafaxine. Patients, at least in the UK, are always given this leaflet with
every packet of medication.

[https://www.medicines.org.uk/emc/product/4487/pil](https://www.medicines.org.uk/emc/product/4487/pil)

> If you stop taking venlafaxine suddenly you may get withdrawal reactions
> (see section 3)

[...]

> Do not stop taking your treatment or reduce the dose without the advice of
> your doctor even if you feel better. If your doctor thinks that you no
> longer need Venlafaxine tablets, he/she may ask you to reduce your dose
> slowly, before stopping treatment altogether. Side effects are known to
> occur when people stop using Venlafaxine tablets, especially when
> Venlafaxine tablets is stopped suddenly or the dose is reduced too quickly.
> Some patients may experience symptoms such as tiredness, dizziness, light-
> headedness, headache, sleeplessness, nightmares, dry mouth, loss of
> appetite, nausea, diarrhoea, nervousness, agitation, confusion, ringing in
> the ears, tingling or rarely, electric shock sensations, weakness, sweating,
> seizures or flu-like symptoms. Your doctor will advise you on how you should
> gradually discontinue Venlafaxine tablets treatment. If you experience any
> of these or other symptoms that are troublesome, ask your doctor for further
> advice.

~~~
dimal
And of course, all patients read the long pamphlets extensively /s. We depend
on our doctors to explain risks like this. And at the time I was discontinuing
(not abruptly) the concept of “brain zaps” was met with great skepticism. I am
fairly certain that some of the side effects you list (electric shock
sensations) were added more recently. It took years of patients being ignored
for the idea to be taken seriously.

~~~
pasabagi
I've also rarely received accurate advice regarding the likely effects and
side-effects of anti-depressants - but I think calling brain zaps a 'risk' is
a bit much. Maybe my zaps were nicer than yours, but I don't remember them
being particularly painful - except one time I fell in the shower.

Anti-depressants, especially something like venlafaxine, are strong meds for a
strong condition. It would be surprising if they had no side effects - and
honestly, if you go to a psychiatrist instead of a normal doctor, you usually
get a dose that's fine-tuned to the extent that you don't get them.

~~~
verylittlemeat
I had brain zaps and they were very distracting.

I took 2 SSRIs for about 3 years and went off them close to cold turkey. When
I would move my eyes it felt like there was a delay between moving and seeing.
This lasted for about a month. In general everything felt very
disconnected/fuzzy/unreal. Sometimes it was close to what I imagine people
describe as an out of body experience.

~~~
pasabagi
I think if you come off any kind of brain med cold turkey, you're gonna have a
very bad time.

I still find articles like the above absolutely horrible, and wish people
would stop writing them. Meds saved my life. They save the life of millions of
people every year - and they make depression hands-down easier to manage and
to live with.

That doctors over-proscribe is another problem. Muck-raking and fear-mongering
about what are already scary drugs to very scared depressed people has real
costs - people probably die because of articles like the above. Many, many
people suffer for years without medication because they're afraid to start
them.

------
Regardsyjc
What's worse is that the longer you take certain psychiatric drugs, the
greater the long-term damage it can possibly cause to almost disability. It's
being between a rock and a hard place.

I've taken Abilify, Wellbutrin, Seroquel, and a number of other drugs. The
biggest problem when you enter the psychiatric system is you go through pill
roulette. You take a drug, try it, see what works, and keep trying till you
find what works. Even worse is that I entered the system in high school which
is a tumultuous developmental period.

One sad personal story is that a psychiatrist started me on a developmental
drug. A drug that was approved for other problems but was "in development" for
other uses. I tried it and it was worse than Seroquel. Seroquel, if I missed a
dose, I couldn't sleep. For this new drug, if I missed a dose, I had a panic
attack and if I took it, I would fall asleep. So if I was out too long, let's
say traveling, I had to choose between a panic attack or falling asleep.

When I confronted my psychiatrist about this problem, instead of taking me off
the drug, he prescribed me medication for panic attacks.

~~~
dbasedweeb
Seroquel is part of a family of drugs (antipsychotics) which have some of the
worst long term adverse effects of all psychiatric drugs. Everything from
tardive dyskenisia to enlargement of the ventricles of the brain are routinely
observed over decades of use, and that’s not even mentioning adverse effects
which appear almost immediately. In general though, these drugs have little or
nothing to do with antidepressants, SSRI’s or anything most poeple will ever
take.

Of course the adverse effects of psyshcosis and untreated psychotic illness
are much worse, including homelessness and death. So while these drugs are
undeniably difficult to live with, people who have been prescribed the family
including Seroquel generally really need them to function. All of which is to
say that the struggles of people on neuroleptic therapy are generally very
different from what’s being discussed in the article here.

~~~
ada1981
An alternate to psychosis as something to interrupt is that it's a biological
process that happens when the default mode network isn't sufficient.

The ideal environment is one in which the psychosis can complete.

It's very similar to a psychedelic journey in that with the right set and
setting it can lead to deeper compassion, clarity and connection.

I've been through a number of such experiences over the years; I used to be
terrified of them and tried to avoid them at all costs.

Now, it's very much an initiation into whatever the next level of my life
demands of me. I've learned to make symptoms bigger vs supressing them and in
doing so, I recover vital parts of myself.

Without this orientation, I would never have survived so called schizophrenia,
bipolar, suicidal depression, psychosis.

~~~
dbasedweeb
I’m not going to be able to debate the validity of your experiences of course,
and I won’t try to. I can say with confidence however that for most people,
psychosis is strongly correlated with poor outcomes including homelessness and
suicide. Early intervention and prevention leads to the best outcomes, and the
more psychotic events in a persons life, the worse the outcomes are on
average.

~~~
ada1981
Oh I don't disagree. I think the entire culture and system isn't set up for
proper integration of psychosis. So given the current landscape, it makes
sense that outcomes are so poor. It takes resources of time and emotional
capacity to make it through.

Dr. Paris Williams has an incredible book called Rethinking Madness that was
instrumental in helping me adopt a framework to complete a psychosis.

------
himom
I was on 60mg/day Remeron (mirtazapine) for 9 years but discontinued due to
decline in its effects. Tried a bunch of the remaining medications, found
trintellix which ups anxiety 5x but addresses depression. Taking hydroxyzine
as needed for anxiety now.

During taper symptoms:

\- nausea

\- general anxiety

After taper symptoms (continue today):

\- general anxiety

\- strong, brief muscle contractions anywhere in my body (myoclonus)

\- weight loss (good)

~~~
rotexo
I am currently on mirtazapine, and this article is prompting me to look into
tapering off the drug. I would much appreciate any advice you would give on
the process, and any other considerations you can think of that I should be
aware of.

------
StanislavPetrov
>The drugs have helped millions of people ease depression and anxiety, and are
widely regarded as milestones in psychiatric treatment.

History is littered with harmful, poorly-thought out "psychiatric treatments"
that were widely regarded as milestones. Even if there are a tiny minority of
people who's mental condition is so bad that scrambling their brain with drugs
will lead to an "improvement", the widespread reliance on these drugs to treat
the every-growing number of depressed and anxious people is not a good thing
for individuals, or for society. This is especially true when it comes to
young children, whose brains are being warped during the critical stages of
development. Over a million children under 5 years old are being dosed with
these mind-altering chemicals based on ridiculous ADHD or "defiance"
disorders. Over ten million children under 17. Its very telling that the
intelligentsia at the apex of society think that the answer to fixing our
broken children is to drug them rather than to fix the broken society that
they perpetuate.

[https://www.cchrint.org/psychiatric-drugs/children-on-
psychi...](https://www.cchrint.org/psychiatric-drugs/children-on-psychiatric-
drugs/)

~~~
jonhendry18
CCHR is Scientology. You sure you want to believe them?

------
leo_mck
I tried exactly 14 different antidepressants, at different dosages in the last
10 years. None of them got any positive effect and I could stop without
feeling anything different too, except, on some cases, very mild "brain zaps".
I do not know why not any of this drugs had any (positive) effect (only some
common collateral effects in some cases) but I wonder if there is a
correlation between the drug doing it's work and being hard to quit...

------
intralizee
I've seen enough people in my life become addicted to antidepressants because
of a traumatizing event in their life for me to have a dark outlook on it.
Instead of therapy or taking real course of action to resolve the trauma/inner
problem, a doctor will just label a person suffering depression. The greatest
use of an umbrella-word "Depression" to get people on prescription medication
and typically the problem never goes away as the problem is now just a word
associated to illness one must have. A pseudo science practice at best and
impossible for a trusting person to escape it. My personal opinion is that
there are few people actually on the drug that are suffering "depression"
without a rational life event cause.

~~~
make3
There is no doubt that antidepressant therapy needs to be combined with
psychotherapy, sports, meditation and just reducing the unhealthy parts of
your life.

The cost of taking antidepressants is really low however. Most of the time,
they have almost no side effects, and are proven to help
[https://www.bmj.com/content/360/bmj.k847](https://www.bmj.com/content/360/bmj.k847)
Where I live, they are pretty cheap.

I find that there is undue bias against antidepressants. If you need them,
take them! They help.

~~~
nugget
I've seen cases where antidepressants saved people's lives. I've also seen
cases where they were pushed on people who needed psychotherapy and not
medication. Access to quality psychotherapy is unfortunately very low.

~~~
aaron_altamura
Venlaflaxine not only saved my life, but gave me a new one. It shouldn't be
looked to as the only solution, however, it's one of the most powerful ones in
the arsenal. This bias against anti-depressants is quite miseducated and
unfortunate.

------
CocaKoala
My heart and sympathy goes out to anybody who's on antidepressants and is
trying to get off. From what I've seen and heard, it is just an incredibly
painful and unpleasant experience, compounded by the fact that you need to be
constantly negotiating with your insurance to cover the changing prescriptions
as your dosage lowers. The withdrawal symptoms can be incredibly oppressive
and disruptive. I wish there was more research into this, because I think it
could help a lot of people.

~~~
rincebrain
It varies wildly by person, even moreso possibly than antidepressant efficacy.

I've been...fortunate, if you can call it that, that while I've taken a great
many antidepressants and other psychiatric medications, the worst side effects
I've ever faced from stopping have been screwed up sleep/wake cycles,
irritability, and a few days of headache.

I've had friends and family members who have had much worse, and I've had to
carefully consider it each and every time, because we lack any kind of
monitoring or ways of informing us how bad it might be.

~~~
Fnoord
> the worst side effects I've ever faced from stopping have been screwed up
> sleep/wake cycles, irritability, and a few days of headache

I wonder if that's worse than a newborn.

~~~
wolco
Much worse, something that can't be compared. Anyone would prefer a newborn
which is an external person that you provide care and watch grow. Sure it will
keep you up but it also provides emotions to help fuel you past those weak
moments. When you are internally off where you can't sleep the affect is
different.

~~~
Fnoord
I had a severe psychosis in my life which took approx 2 months to recover
from. In the beginning, I could not sleep and felt like I was fully awake when
I slept. I couldn't sleep either, though I wanted to so badly, and my emotions
were virtually non-existent (the lack of self-pity was fun though). It
occurred a while after I was off SSRIs (Citalopram) but not right after.

Newborn creates hormones, sure, but needs constant attention and requires high
maintenance. There's no voluntary break. Ours needs to eat every 3 hrs. Can
set my clock to it, and can't sleep right after feeding (she's gotta sleep
first, or go through intestine pain). I know it isn't the end of the world,
and given the psychosis I been through worse, but this is flat out rough [for
me].

I wish I'd get positive emotions during weak moments. I mean, if I'd have
that, they wouldn't be weak moments. After one hour of crying and trying to
solve in every way I can think of I become desperate and feel lost. Its those
moments I need to control myself and realise it isn't about me; its about her,
our newborn. She's the one who's suffering, and doesn't know better. I wonder
if it helps to cry with her.

------
NetOpWibby
Thanks to the comments here, I was able to figure out why my wife had been
experiencing vertigo for the past couple weeks. She ran out of Zoloft and
didn’t bother taking any of her refill (we were busy moving).

Thanks for sharing your experiences everyone!

------
Friedduck
I know someone who took Effexor, who went through one of the most harrowing
experiences of her life trying to quit. Her doctor seemed vested in keeping
her taking the drug (I personally suspect some kind of incentive to sell the
drug but don’t have evidence to back that up.)

I can’t emphasize enough how serious these drugs are, and what a prison they
can become.

~~~
raisedbyninjas
You can see what pharma companies pay to your Dr. at
[https://openpaymentsdata.cms.gov/](https://openpaymentsdata.cms.gov/)

------
ada1981
Keep in mind that SSRIs appear to do little more than active placebo in the
vast majority of cases with the downsides of withdrawals and all the other
symptoms including deceased emotions in general.

There are many alternatives that have been shown to be as or more effective.

Writing and then reading 14 Gratitude Letters to people.

Spending an afternoon a week outside.

Practicing telling the 100% truth in your relationships.

And of course, Psychedelics.

Many of you know my story of coming from schizophrenia, bipolar, anxiety,
suicidal depression, mania, etc. and going on a path of returning to my self
after having a vision that what was needed to was to go into the pain more
fully and then seeking out various modalities to do just that.

It's possible to do, but you'll need to seek out support outside the
mainstream.

~~~
Fnoord
> Writing and then reading 14 Gratitude Letters to people.

> Spending an afternoon a week outside.

> Practicing telling the 100% truth in your relationships.

> And of course, Psychedelics.

Heh, a decent psychologist would suggest #3 during e.g. CBT sessions.
Suggesting #4 is downright dangerous, you don't know who reads your post.

 _Readers, please seek professional help -based on conventional science-
instead._

I tried all kind of self-help BS, including using psychedelics on my own,
because I did not trust conventional science (ie. psychologists,
psychiatrists). None of the pseudoscientific self-help BS helped, of course,
and it gave me a severe lag in my life and professional career.

At the very least people should try out professional help first. But if I went
on with it after the first failure (a diagnosis + meds for GAD which didn't
quite work out) right afterwards, I might have figured out I have autism at my
27th instead of my 34th.

~~~
fogzen
How is suggesting psychedelics more dangerous than suggesting the use of
antidepressants? Data shows both can cause panic attacks and psychotic
episodes...

Both drugs have mechanisms of action we don’t fully yet understand, and both
may cause serious side effects.

~~~
Fnoord
> Both drugs have mechanisms of action we don’t fully yet [sic] understand,
> and both may cause serious side effects.

This is an extremely narrow and arbitrary ruleset you are applying...

If not merely because of the word "fully". That's a given in science.

> How is suggesting psychedelics more dangerous than suggesting the use of
> antidepressants?

Because psychedelics are not approved, you don't know the source/purity, and
there's a lack of professional guidance.

Yes, you can get a panic attack on SSRIs. I _had_ that when I started
Fluoxetine because I almost fainted because my blood pressure was low whilst I
was in a grocery store and had barely eaten. It happened a few times, though
less severe (it is just low blood pressure), and went away after I got used to
the drugs, which took longer than average.

SSRIs are not psychoactive, and better studied.

Finally, SSRIs are used under guidance by a professional. Recreational drugs,
in contrast, are not.

~~~
fogzen
> SSRIs are not psychoactive, and better studied.

The whole point of taking SSRI's is to affect the mind, so they are literally
psychoactive.

They are better studied, but the risks you mentioned are associated with
SSRI's as well as LSD.

Do you have evidence/study that shows LSD is more dangerous than SSRIs? LSD
not being studied as much doesn't mean it's more dangerous...

~~~
Fnoord
> The whole point of taking SSRI's is to affect the mind, so they are
> literally psychoactive.

Yes, they are; I meant psychedelic/hallucinogenic.

> They are better studied, but the risks you mentioned are associated with
> SSRI's as well as LSD.

Yes, but the possible side effects are well documented and users are informed
and screened beforehand and there is professional guidance (by licensed
professionals who studied for it) in contrast to recreational drugs use.

You know better what you dabble into when you follow the regular scientific
path than the alternative path which is full with shenanigans, amateurs,
wannabe experts, hippies, and downright dangerous, sick human beings.

> LSD not being studied as much doesn't mean it's more dangerous than any of
> the SSRIs.

Ultimately, this is irrelevant. You look at the current scientific evidence
when you decide which treatment you want to follow. Recreational usage of LSD
to self-medicate is very low on that list: actually, it shouldn't even be on
that list until its scientifically tested in clinical trials. The lack of that
doesn't mean we should just suggest it to random strangers; we ought not to!

> Do you have evidence/study that shows LSD is more dangerous than SSRIs?

No, stop turning it around. The burden of proof lies at you. You claim LSD is
as useful or more useful than SSRIs.

~~~
fogzen
I'm not turning anything around. The claim I was responding to was that
suggesting the use of LSD was more dangerous or more irresponsible than
suggesting the use of SSRIs.

I'll say it again: There's no evidence the use of LSD is more dangerous than
SSRI's.

------
fredch
"Cannot stop" is kind of strong. More like "have nasty side effects while
tapering off and puss out".

Having been on the Zoloft,I can say is got a black box warning for a reason
and should only be taken if you're seriously in danger of self harm.

Shrinks like it because it keeps people coming back. People like it because
they're not willing to confront their real problems and want something to numb
themselves out.

Just say "No!".

~~~
stordoff
As someone currently on a somewhat high dose of sertraline (100mg b.d.), "numb
themselves out" feels like an odd descriptor to use. That seems more like a
benzodiazapine-class drug, and certainly doesn't match my experiences (it
makes me more prone to insomnia, which I would not associate with a numbing
agent) and wouldn't be otherwise be enjoyable/desirable but for the fact that
it treats real problems (for me, OCD and anxiety disorder).

> Just say "No!"

They are probably over-prescribed, but a blanket "No!" ignores the cases where
they do work, and provide a significant increase in quality of life.

~~~
markroseman
Some people do get what they'd describe as emotional numbing. Think of it as a
decreased range of emotion. Sertraline has a relatively higher incidence of
this than other SxRI's

------
contingencies
It's the other heroin. People can't get off the stuff, and it's everywhere.

In about 2012 I visited Copenhagen, capital of Denmark, which was until
recently allegedly the self-reported "happiest nation on earth". I found it
extremely weird that everyone was perfectly dressed and all the interiors were
spotless, but nobody was smiling. It was like I had walked on to the set of
some kind of dystopian movie. Mentioning this to an American woman who
appeared and who had been resident there for some time, she simply laughed and
leaned closer. "It's because they're all on antidepressants!"

~~~
projektir
I'm not a huge fan of anti-depressants, but this is just silly. Smiling lots
is mostly a cultural difference and Americans seem to be the odd ones out
there, not the other way around.

~~~
contingencies
Well, it's a true story. Silly is assuming I'm American. I'm an
Aussie/Kiwi/German resident in China, and at the time of the story I had just
crossed over from Germany, who aren't exactly known for unbridled displays of
west coast US optimism either.

~~~
projektir
Someone's personal perception of things is not a "true story". Generally, it's
not anyone's place to try to assess how happy a person is from what they look
like on the outside. Suicidal people may look perfectly happy on the outside,
and perfectly happy people can sport very impressive RBFs.

You referenced an American in your story, and they're the only group I've ever
really heard complaining about people in other countries not smiling enough,
so my assumption is hardly silly. I don't know if Australia shares the same
quirk, given that Australia borrows a LOT from the US culturally, are you sure
you didn't pick that stuff up from the US?

And I'm not sure why the Germans didn't bother you but the Danes did, that
doesn't really add up.

------
tempagain567i
The use of these anti-depressants is extremely irresponsible. Most people who
use them dont even have an inherant chemical problem. This will all be looked
back upon as very stupid indeed.

~~~
finaliteration
I take Wellbutrin and Lamictal (a mood stabilizer) every single day for PTSD
and I wouldn’t really be able to function without them. I really wouldn’t call
myself or the psychiatrist who prescribed them irresponsible. I’d say it’s
equally irresponsible to make a blanket statement about something that does
actually help people in certain circumstances.

That being said, there are a number of GPs out there who prescribe things
without fully understanding the consequences. I’ve always had a GP refer me to
a psychiatrist for any mental health issues, however.

~~~
vanderZwan
I think the "irresponsibility" was aimed at the medical field, not at the
patients. At least that was how I decided to read it.

EDIT: Also, I think that even for the patients where the cause of the
depression is not "chemical" in origin, that does not reduce the severity of
the illness in the slightest. It just means that the causes may lie elsewhere
(for example externally). I have been depressed as an indirect result of the
troubles I got myself into due to undiagnosed ADD. In my case, yes, I needed
medication to treat my condition, as well as therapy. But I did not need
antidepressants, I needed medication for ADHD (and I just checked:
lisdexamfetamine is currently not considered an effective anti-depressant[0]).

[0]
[https://en.wikipedia.org/wiki/Lisdexamfetamine#Depression](https://en.wikipedia.org/wiki/Lisdexamfetamine#Depression)

~~~
finaliteration
Ah, that does make sense. I just tend to be a little on the defensive about it
because often the response I get is that I’m taking the “easy” way out through
medication.

~~~
vanderZwan
> _I just tend to be a little on the defensive about it_

Completely understandable! Most people seem to have such a frustrating
inability to understand that other people can have very different experiences
of the world to their own, and that those experiences aren't wrong.

I am lucky enough that most of my friends _do_ understand mental illnesses a
bit better than the average person out there. Some of them who confided their
mental health problems with me about the kind of reaction they tend to get,
and it's just amazing how ignorant the natural state of the human mind is.

> _that I’m taking the “easy” way out through medication._

Call me crazy, but I partially blame the dualist world view of the Western
world for that, even if most people aren't even aware that they have been
raised with a dualist mindset. This whole mind/matter division makes people
think that mental problems have to be solved by thinking.

~~~
imcoconut
> Call me crazy, but I partially blame the dualist world view of the Western
> world for that, even if most people aren't even aware that they have been
> raised with a dualist mindset. This whole mind/matter division makes people
> think that mental problems have to be solved by thinking.

Not crazy at all. I strongly agree with this.

