Antidepressant Withdrawal (NYT Article)

[SixStringPsych]

Many People Taking Antidepressants Discover They Cannot Quit

Any opinions on this article? Is there any research studying discontinuation syndrome and the durations at which it is more likely to occur that this article might have missed?

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[whopper]

I read it. Thought it was a load of misleading facts, and some downright horse$hit.

First off several can't quit their antidepressants cause it's a treatment not a cure. So if they stop their depression comes back. The article makes it out as if this is something horrific and dark. Hey you stupid, we never claimed it was a cure just like there's usually no cure for diabetes when someone's on insulin, but the bottom line is the majority are way better off being on a med that gets them better as a treatment cause there is no cure.

(So you bought a car. Now you have to use it go get to work. Now you have to keep on using it and refilling it with gas. Many find they can't quit using their car to get to work......Play the evil music now).

Second, there's only 2 meds where I see patients getting discontinuation syndrome if they follow the directions, and that's Venlafaxine and Paroxetine. All the rest...no. And this is after literally treating tens of thousands of patients. When I get patients on those 2 I warn them this could happen. I've literally seen maybe less than 10 patients to memory that got discontinuation syndrome so long as they followed the directions except those two meds.

So are these meds terrible if you get problems cause you don't take them as prescribed? Again cue in the evil music. Hey I put a match to the gas tank of my car and it blew up. Their fault!, NOT MINE!

They bring up the case of Ms. Toline who took 9 months to get off Sertraline. Wow, 9 months, but they present nothing else about her case. Did she take an amount over the FDA recommended dosage? Are they sure it was Sertraline and nothing else going on? I can't tell cause all I got is the statement of a laymen who isn't giving much data.

Maybe it took her 9 months cause she didn't follow up with her doctor or her doctor unethically dragged out the wean-off time so he could crank her out for more visits.

It says that "withdrawal was never the focus of drug makers or government regulators." Again this is misleading Withdrawal is written into the FDA package inserts. It's taught in medical school. If a doctor doesn't tell their patient about it their doctor isn't doing their job but this applies to ALL MEDS OUT THERE. It also uses the word "addictive" in description of antidepressants because they require directions to wean off but they are not addictive and the use of the term here is unethically misleading. They do cause DEPENDENCE. That's different than ADDICTION. Dependence meaning that if you stop them suddenly and without parsing it out with your doctor's help you could get withdrawal. Addiction is usually understood to mean that for an extended period, possibly the rest of your life you'll have obsessional thoughts to keep this substance going on in a pathological manner.

Then it goes on to say the medical profession has "No good answer" to help people stop these meds. Not true at all. Hey you wean off of them like you get on them. Slowly up and slowly down under the direction of your doctor. This statement from the NYT is utter BS.

If the doctor doesn't know what they're doing with the meds they're incompetent. It's not the meds fault your doctor sucks. Now that's something going on that I don't see the article addressing.

 

[Attending1985]

I don’t see disabling discontinuation very often but it does occur and I’m sure is awful. Cymbalta seems to be the worst and I never start it but everyone is already on it for chronic pain. I do discuss discontinuation syndrome as a part of informed consent with antidepressants.

 

[randomdoc1]

So alarmist and horse shat. I've had two patients come in this week saying they read the article and urgently want to be discontinued. After a thorough discussion, they opted to stay on their medication. One has very severe PTSD. I hope the NY Times gets an earful about this.

 

[WingedOx]

The big issue is the writer did a sh-tty job of differentiating between withdrawal, recurrence of sxs, and discontinuation syndrome. It's a nontrivial distinction that I have to go over with patients when I discuss stopping meds with them.

 

[Attending1985]

The big issue is the writer did a sh-tty job of differentiating between withdrawal, recurrence of sxs, and discontinuation syndrome. It's a nontrivial distinction that I have to go over with patients when I discuss stopping meds with them.

How do you differentiate between discontinuation syndrome and recurrence of symptoms?

 

[splik]

The big issue is the writer did a sh-tty job of differentiating between withdrawal, recurrence of sxs, and discontinuation syndrome. It's a nontrivial distinction that I have to go over with patients when I discuss stopping meds with them.

There is no such thing as discontinuation Syndrome. It is nothing more than a euphemism for withdrawal.

 

[WingedOx]

bad language, but differentiating between that at as in benzo/etoh or even opiates. (there's no craving for the substance itself in the SSRI sx). Either way I have to come up with a way to explain it within the bounds of the level of education/cognition for the patient.

 

[chocomorsel]

I had the brain zaps. From Prozac withdrawal. Like a lightening bolt going off in your brain. Imagine experiencing that while in a deep sleep and springing up in bed thinking you are dying by a shot to the head. I have anxiety and that’s why I have taken the meds. Worked wonderfully though except for the crazy dreams and sexual side effects.

The last time I got back on them I lowered my dose to the 10mg daily dose and did not experience the brain zaps. Even drugs with a long half life like Prozac can cause this.

 

[Shikima]

I had the brain zaps. From Prozac withdrawal. Like a lightening bolt going off in your brain. Imagine experiencing that while in a deep sleep and springing up in bed thinking you are dying by a shot to the head. I have anxiety and that’s why I have taken the meds. Worked wonderfully though except for the crazy dreams and sexual side effects.

The last time I got back on them I lowered my dose to the 10mg daily dose and did not experience the brain zaps. Even drugs with a long half life like Prozac can cause this.

Of course, anything is possible with any medication. And no one can say what will happen with a person when they start/stop medication that affects the brain for emotional distress.

 

[whopper]

I wrote a reply to the NYT. I doubt it'll do any good but hey I tried.

Dear Editor,

Please be informed the article, "Many People who take Antidepressants Discover They Cannot Quit," published April 7, 2018 is loaded with misleading information.

First it uses the word "addiction" to describe antidepressants. They're not addictive. They can, however, cause dependence which is a different phenomenon. Addiction meaning that one could develop an pathological obsessional desire to continue a substance where as dependence means that getting off of it too quickly could cause withdrawal. The use of the word addiction is wholesale misleading.

The "medical profession" you state has "no answer" to this phenomenon. Not true at all and misleading to the degree that you owe the public and the profession an apology. The profession is well aware that getting off of these medications too quickly could cause withdrawal symptoms. That's why we have it identified as "discontinuation syndrome," and we have guidelines in preventing and dealing with it that's taught in medical school and residency. Package inserts on these medications clearly give warning to this phenomenon and there's clear dosing guidelines on each of these medications.

The article then brings up how withdrawal was never the "focus" of drug makers and legislators. Again not true at all. The FDA (part of the government last I heard) has clear guidelines on this medication. Manufacturers put the FDA guidelines in the package inserts. Where have your reporters used as their source of information for this bogus information?

I expected far better reporting from the source of news "fit to print."

Have people gotten discontinuation syndrome? Of course, but none of this is some type of new area. This has been known for decades. If your newspaper wanted to enlighten the pubic to this phenomenon then good, but it's clear the intent was to scare people concerning medications that could provide benefits to many with a level of risk that for most is relatively small so long as it's taken as prescribed, and to curtail those risks they are available through prescription with a licensed-professional.

Sincerely,

James Cho, M.D.
Diplomate of the American Board of Psychiatry and Neurology in General and Forensic Psychiatry
Fellow of the American Board of Disability Analysts

 

[whopper]

Question from above: how to distinguish Discontinuation Syndrome from benefits from an antidepressant?
Not an exact method cause many of the symptoms happen in both phenomenon.
In general if you follow the guidelines of getting off an antidepressant (same rate as you would increase it. E.g. Sertraline you increase 50 mg/day/week, 50 mg daily x 7 days, 100 mg daily x 7 days, 150 mg daily x 7 days, same thing but in reverse order) you shouldn't get it but biology is never 100%. Some people, however few, could still get it so if you want to be extra cautious do it half-speed.

Also some sx are very specific to Discontinuation Syndrome such as "brain zaps." Now this is something not taught in medical school that I see regularly in patients who get this (and they don't get it cause of me. They had some idiot other doctor who never helped them to get off of it right in the first place).

Also if the sx are within the first 72 hrs of lowering the medication I'd tip that more to Discontinuation Syndrome cause the benefits of antidepressants aren't lost quickly just as they aren't gained quickly either.

 

[SeniorWrangler]

What I tell people about discontinuation syndrome is that it is a reaction to a rapid taper, and that if they are noticing a lot of symptoms, they should go back up to the last stage of the taper and wait a little longer. 90% of the time this fixes the problem.

Of course, much of the time I hear about this from patients who went cold turkey from their meds after not picking up a refill and it's all in the rear view mirror by the time I see them. People do this with all kinds of medications, including meds like benzos and opioids where everybody should already know that they have strong and unpleasant withdrawal syndromes.

 

[whopper]

Of course, much of the time I hear about this from patients who went cold turkey from their meds after not picking up a refill and it's all in the rear view mirror by the time I see them.

Exactly why I wrote that if a patient doesn't take it as prescribed it's on them inviting completely avoidable risk.

I've said this dozens of times in this forum. I've seen several horrendous doctors in practice, and these idiots are the cause of lots of patients getting mistreated and in some cases developing discontinuation syndrome, but the problem here is then the quality of care of doctors. Antidepressants in general (minus MAOIs and TCAs) are relatively safe and much more so vs many other medications.

If a doctor raises someone to a high dosage of an antidepressant and doesn't warn patients of discontinuation syndrome that's a statement on the poor practice of doctors that I completely and freely state and endorse needs improvement, not the medication.

The NYT article makes it out as if this is a new phenomenon that the government and doctors aren't checking upon. Totally off. The FDA fully warns about this and they are part of the government last time I checked.

If anything I blame that doctors can do very poor practice and still get away with it, the shortage of psychiatrists creating a vacuum non-specialists are trying to fill, the shortage is also creating a situation where hospitals know they have a bad psychiatrist but won't replace them cause they can't find another, and that managed care has created a new treatment model where doctors don't explain things to patients. They just throw a med at them, but again this is a problem more systemic and bigger than just blaming antidepressants.

 

[PistolPete]

There is no such thing as discontinuation Syndrome. It is nothing more than a euphemism for withdrawal.

Totally agree. I hate the term "discontinuation" syndrome. Just call it what it is: withdrawal.

 

[Nasrudin]

Jesus. The distraught woman in a sitting fetal position, looking out the window at the world, with her cat.... saying she had to drop out of school. For F's sake. You LIVED to tell about it. And what did you learn from it? My doctor got me hooked on these evil meds. And didn't care about me enough. Wrong. Start the game over, when you came in describing the woes of the world and you being flattened by them, and then not being interested in therapy, not wanting to exercise, or put in the work to reorganize your life, and wanting the symptom to be an affirmation of your crippled state instead of a message for you to get your **** together, and then we reviewed all the possible treatment options and you opted for an SSRI and we said together, ok, let's see how it goes, you agreed to report back faithfully for us to reevaluate based on your reports, we talked about the potential for benefit vs the risks of AE's, and off you went.

And then you wanted an excuse to drop out of school. Because you're a victim. And the new york times wanted to pity you. And make you a glorified victim. Even better.

Yay. You learned nothing, you remained a vapid and shallow person, with no orientation towards meaning, and you will remain a cripple looking for a caretaker. And they'll never be the mommy you want. They'll never come close to the warm, comfy, womb you left so unwillingly. Enjoy the role you're playing. ****. Somebody has to. I'd rather play Dr. Evil, The SSRI slinger, than your character. anyday. At least I've got some cool lines: Laughing grimly, taking the cash stuffed envelope, and saying with a wink, "****'em, I can triple the number of sappy sloths taking this bull****. You just keep these envelopes coming, my man."

 

[WingedOx]

I'd rather play Dr. Evil, The SSRI slinger, than your character. anyday. At least I've got some cool lines: Laughing grimly, taking the cash stuffed envelope, and saying with a wink, "****'em, I can triple the number of sappy sloths taking this bull****. You just keep these envelopes coming, my man."

Picture of me as I receive my pharma kickbacks for my prescriptions of...uhh... $4 a month generic zoloft.

 

[whopper]

Patient: I need some Prozac.
Doctor: It'll cost $4 a month.
Patient: I can't pay that. Please I'll do anything, anything!
Doctor: heheh, you know I can get it for you, but it'll cost you. It'll cost you severely.
Patient: Please anything!

 

[siliso]

I got zaps even with a taper off lexapro and they lasted a good month. However, they are just weird and not in any way disabling. I would love to know what the mechanism is.

Anyway, the profound disabling nonspecific symptoms I would bet are more characteristic of the underlying mood or personality disorder than the drug withdrawal. The study they describe where pts and providers were blinded to whether they were really tapering or not will be v interesting - and seems premature to report the article without the findings.

Addiction/substance use disorder is obviously a different entity. People can have measurable physiologic withdrawal effects from blood pressure meds even - but do they have craving, seeking, life disrupting, escalating behavior and life problems, no. Are they destroying their careers and relationships in order to enjoy another metoprolol bender, no. Withdrawal does not equal SUD.

 

[Nasrudin]

Patient: I need some Prozac.
Doctor: It'll cost $4 a month.
Patient: I can't pay that. Please I'll do anything, anything!
Doctor: heheh, you know I can get it for you, but it'll cost you. It'll cost you severely.
Patient: Please anything!

Hahaha. That was weird. But. Appropriate.

 

[Sardonix]

A classmate posted this article this week and something really felt weird about it.

The reactions in this thread are the perfect combination of righteous indignity, productive response, and hilarious absurdity I was looking for.