Discover and read the best of Twitter Threads about #antidepressant

Most recents (22)

@kevinpmiller left when Elon took over. That's the kind of man he is. I'm honored to call him my friend. He doesn't toot his own horn. So I try to when I can. Because of his work.

From Kevin
Those of you who have been ardent supporters if this page—and of 'Letters from Generation Rx' - know full well that over the past 11-12 years, I have devoted countless thousands of hours in pursuit of the truth. Many view my work as controversial;
some have said I "had no right" to the story of a family who fought off the ravages of mental health symptoms with vitamins and minerals; others objected to the stories of two parents who killed their children while under the toxic influence of psychiatric drugs;
Read 12 tweets
Does blinding work in #antidepressant #RCT? Recently there were 2 papers on this topic with opposite conclusions. A🧵on #blinding and why #robustness #DataAnalytics may lead to better #science
The two papers are (p1; by @AmeliaJScott, @LSharpeUSYD and @BenColagiuri) and (p2; by @Toshi_FRKW and colleagues).
Their two conclusions:
-p1: "meta-analysis suggested that blinding was unsuccessful among participants and investigators."
-p2: "patients or assessors were unlikely to judge which treatment the patients were on."
Read 16 tweets
@_pem_pem Why this is nonsensical: "Jeffrey Lieberman, a professor of #psychiatry at Columbia University...“The problems that they’ve been criticized for have more to do [with] the way they’re used by doctors & the heterogeneity of the condition that they’re indicated for.” /1
@_pem_pem What Lieberman is saying is that if #antidepressants were prescribed to a population for which they are known to work well, they would have a much better track record. This is true, because it is a tautology. /2
@_pem_pem The reasoning is circular, if #antidepressants were prescribed for those people for whom the drugs worked, they would work. /3
Read 38 tweets
Monoamine hypothesis aka "chemical imbalance" & other synonyms, arose circa 1965, but was known to only #psychiatrists, who were unhappily prescribing TCAs and MAOIs to a niche market. Patients hated the many adverse effects of the drugs. /1
Until mid-1990s, monoamine hypothesis (aka "chemical imbalance", "serotonin deficiency" etc.) was not circulating as a "folk model", not in medicine or in the general public. 1990 is ~center of this chart, when #psychiatrists, many paid by pharma, started churning out papers. /2
As a meme or "folk model", monoamine hypothesis (aka "chemical imbalance", "serotonin deficiency", "neurohormone imbalance", etc.) was diligently planted by dozens of #psychiatrists -- not a few -- many paid by pharma. Not something that arose organically out of nowhere. /3
Read 15 tweets
Lewis, et al. respond to letters to the NEJM editor, demonstrating they do not understand basic concepts of #antidepressant withdrawal @ANTLERtrial

Maintenance or Discontinuation of Antidepressants in Primary Care | NEJM…
@ANTLERtrial Some in non-discontinuation group were taking their drugs inconsistently. Lewis, et al. missed potential withdrawal symptoms in that group: "but participants reported some new & worsening symptoms while continuing to take #antidepressants"
@ANTLERtrial Lewis, et al. claim "an increase in depressive symptoms might lead to an increase in “new & worsening” symptoms that are recorded as withdrawal symptoms" EXCEPT they also recorded physical withdrawal symptoms, failed to identify who had both, & did not exclude them from "relapse"
Read 4 tweets
With all due respect to the fine @awaisaftab, these are the varieties of #antidepressant withdrawal syndrome:

1) WS with only physical, no emotional symptoms
2) WS with both physical & emotional symptoms
3) WS with only emotional symptoms
4) WS manifested as emotional anesthesia
@awaisaftab Of the above, types 1 & 2 are WS, not "relapse", even if "depression" is present. Emotions such as those that compose "depression" do not exist apart from experience. Emotional reaction to feeling neurobiologically out of control should not be diagnosed as "depression".
@awaisaftab Type 3 may include the waves of intense anxiety, fear, & "black holes" characteristic of WS. Characterized by intense sensations with interludes of relative calm. Typically, these very gradually abate over months.
Read 14 tweets
"It is now well-established that most pediatric #antidepressant trials were #industry-sponsored & had serious methodological limitations; many trials remained unpublished due to unfavorable results, "

#Children: the sacrificial lambs of capitalism.…
"& those published were mostly ghost-written, selectively reported efficacy outcomes & misrepresented the true rate of treatment-emergent #suicidal events"

Those that claim to care about your health allow #pharmacological & #psychological experimentation on #children & #youth.
"in most countries #antidepressant use has considerably increased in #children & #adolescent over the last 10–15 years (11–13), despite #suicidality warnings, the serious limitations of the evidence-base, & ongoing controversies surrounding risks [] [and] #placebo response."
Read 7 tweets
@awaisaftab Hello, Awais. I will attempt to answer your excellent questions. @HengartnerMP may wish to add his perspective as well. /1
@awaisaftab @HengartnerMP Re your #2: This was a retrospective study. Duration & symptom criteria from Chouinard & Chouinard, 2015 were used in selecting subject population. Other of C&C's criteria (C) were addressed in analysis & discussion. The paper only weakly corroborates C&C's criteria (C). /2
@awaisaftab @HengartnerMP "Greater severity of illness": We relied upon subjects reporting symptoms were qualitatively different than prior to treatment. It is impossible to quantify "greater severity", the symptoms being so various & most unlike original condition. They certainly were distressing. /3
Read 27 tweets
@DrFulli @lapsyrevoltee I do agree, Dr. Fulli. Response to the drug most certainly is not a diagnosis, & those physicians who conclude an adverse reaction to an #antidepressant is diagnostic of bipolar disorder not only have poor pharmacology knowledge but poor logical skills as well. /1
@DrFulli @lapsyrevoltee Even people with no pre-existing #psychiatric symptoms may have a severe adverse reaction to an #antidepressant or any other psychotropic.

Conversely, any psychotropic might relieve "depression" in someone, eg. amphetamines or opiates. This is another law of psychotropics. /2
@DrFulli @lapsyrevoltee For what it's worth, I have a collection of case studies where people had immediate severe adverse reactions to #antidepressants & even though they quit within a handful of doses, suffered symptoms identical to post-acute withdrawal syndrome #PAWS for months or years. /3
Read 12 tweets
UK woman tapering paroxetine: "After 18 years of stupor—of emotionless head fog, of sleeping 14 hours a day, of apathy—I’m succeeding in getting off the #antidepressant Seroxat." /1…
After reducing to 7mg paroxetine: "I spent the first half of 2019 in continual, breathless, agitated terror.
I couldn’t sit still, and my constant squirming made my partner cry. I suspect I had something I’ve since found out is called #akathisia."…
"Within days of that first panic attack in January [2109], I decided to stop tapering the Seroxat and stay on the same 7mg dose. I got in touch with my GP to tell her what had happened.

I was referred to the local mental health crisis team." /3…
Read 14 tweets
@psychunseen: "...if the goal of anti-psychiatry is to get #psychiatrists to listen...this is better done within a therapeutic relationship, not in a picket line at the American Psychiatric Association annual meeting or on social media" apparently refers to me personally. /1
I thought it stood out as particularly illogical in his most recent screed…

Who pickets the APA other than Scientology?
Then I recalled I had attended an APA meeting where there were pickets. I did not do any picketing myself, but I was invited to speak outside:

Read 16 tweets
I'm in a particularly bad mood about the delusions of #psychiatry having spent the last week analyzing the case histories of 70 people with #antidepressant post-acute withdrawal syndrome #PAWS: duration 5-166 months, median 29.5 months. Lots of #psychiatrists involved. /1
5/70 reported recovered, 2 reported suicides. One suicide, better after 69 months of #PAWS, had an adverse reaction to an antibiotic that threw her back into the depths of withdrawal. The other, a 21-year-old woman, because of 38 months of post-SSRI sexual dysfunction #PSSD. /2
The 63 for whom I do not have reports of recovery from antidepressant post-acute withdrawal syndrome #PAWS or suicide have mostly been lost to follow-up. After years of reporting grueling symptoms, they didn't come back to tell us how they were doing. I hope they did recover.
Read 4 tweets
@dianamswancutt @shayla__love Truly excellent article, Shayla.

I know you couldn't cover everything -- @angpeacock1111 represents the epidemic of misdiagnosis & overprescribing affecting millions of people. Issues around psychosis are fascinating to academics, but there's a larger public health issue..../1
@dianamswancutt @shayla__love @angpeacock1111 Please consider another in-depth article on the patient movement represented in Medicating Normal. It is huge. There is a large peer support underground helping people deprescribe themselves -- they can't find doctors who know how to taper. Millions are looking for this help. /2
@dianamswancutt @shayla__love @angpeacock1111 Millions have been misdiagnosed & overprescribed. GPs mostly do this, but #psychiatry ignores it.

This is a patient movement that is not academic anti- or critical psychiatry, but very angry with #psychiatry for not stepping up for patient safety in #psychiatric treatment. /3
Read 12 tweets
"I sit here now in disbelief that I suffered from increasing anxiety for 9 years on Celexa (& 5 years on Zoloft), & the doctors simply raised the dose, not by a little, but by 50% each time....I developed dystonia in my feet & toes & my chest & neck...."…
10 years of citalopram: "I had no idea what [dystonia] was, & doctors' appointments resulted in no doctor suggesting the [#antidepressant] could be the culprit. I didn't even know the terms dyskinesia or dystonia. No one mentioned them either."…
"In 2011 I gave birth to a girl....the OB...switched me from Celexa 150 mg to Zoloft 10 mg with no cross taper, no advice, & no warning of the Hell I was about to endure. After many nights with no sleep due to this switch I finally started to sleep again."…
Read 3 tweets
@DBDouble @f_hieronymus @awaisaftab @rcpsych I took it as "contend" but @f_hieronymus does not seem to be aware that while #antidepressant withdrawal problems are well-documented, this awareness has not translated to clinical practice for 60 years. What is the nature of the barrier? This is the epistemiological question.
@DBDouble @f_hieronymus @awaisaftab @rcpsych First, late '80s-early '90s, new #antidepressants were held not to have a withdrawal syndrome (despite known pharmacological principles of psychotropics & appearance in clinical trials).

Then, starting with Schatzberg et al., 1997, withdrawal syndrome was held to be trivial /1
@DBDouble @f_hieronymus @awaisaftab @rcpsych Schatzberg et al., 1997 claimed #antidepressants "discontinuation" symptoms were mild, transitory, lasting only a few weeks, barely needing tapering. This held sway to the present day (despite decades of many, many patient complaints of more severe problems). /2
Read 16 tweets
Hyman & Nestler, 1996 Initiation & adaptation: a paradigm for understanding psychotropic drug action

"...describes a conceptualize the drug-induced neural plasticity that underlies the long-term actions of psychotropic drugs in the brain."
Hyman & Nestler, 1996 Initiation & adaptation: a paradigm for understanding psychotropic drug action

"Chronic perturbations can produce different types of adaptations in the brain. Many adaptations can be viewed as compensatory homeostatic responses...."
Hyman & Nestler, 1996 Initiation & adaptation: a paradigm for understanding psychotropic drug action

"Rather than conceptualizing receptor down-regulation as the mechanism of action of #antidepressant drugs, a marker of adaptation."
Read 8 tweets
Why #psychiatry research seems to exist in a parallel universe: "Academic psychiatrists who pursue research careers may not have patients after residency, let alone practice psychotherapy." -- psychologist Jonathan Shedler…
"But aren’t we seeing the same kind of arrogance & reductionism in #psychiatry today?....I cannot tell you how many depressed patients I’ve worked with...successfully....who had been on 1 medication after another for years or decades with little benefit."…
"These patients often go from #antidepressants to mood stabilizers to atypicals....We see polypharmacy nightmares, with patients on 5 or 6 or more #psychiatric medications, and they are just as depressed as when they started."…
Read 7 tweets
"I was eventually convinced by a psychologist (and my wife) to try Zoloft because I was one of those people that was either born with a chemical imbalance or I acquired one due to my childhood traumas. Well...those 3 days were...pure hell on earth."…
After 2 years on #antidepressants: Diagnosed Paroxysmal Supra Ventricular Tachycardia "24 years of my life chasing this, never not once did any medical or other professional suggest I go see a cardiologist but they were all too willing to take my money.."…
"I was very very ill about a week after I started Pristiq & I told my GP numerous times but she just said to "keep going" as it takes about 6-8 weeks to kick in and start was obvious she was in too far over her head..."…
Read 13 tweets
At age 33: "I ran into a situation that required me to confront someone. As that time approached, I became increasingly anxious about my ability to handle the situation....I went to my doctor for help. He immediately threw 20 mg of Prozac at me...."…
"I left my GP & sought out the top Psychiatrist in my city...By this time, I was such a mess due to the effects of the Prozac, I was diagnosed with GAD Generalized Anxiety Disorder....We tried several other types of antidepressants...."…
"we tried several other types of antidepressants over the following months....Each one effecting me the same way....Over the last 20 years I ran into a few occasions that required the medication to be increased....Again, I would lose my mind!"…
Read 15 tweets
1/ Thread: New study forthcoming on whether #gene-testing can help guide #antidepressant selection for #depressed patients who have failed to respond to 1 or (on average) 3-4 trials of medication. I have been skeptical: mostly, scant added value…
2/ & I found the reporting of this study annoying. On the primary endpoint, improvement in average #depression rating scores, the gene-testing failed. Patients whose MDs chose new meds w/o help of gene tests did just as well—& yet news reports suggested that tests can help…
3/ That's because the gene testing led to a choice of new meds that led to significantly more remissions (patient no longer depressed) and responses (halving of symptom burden). In general, in drug trials, response/remission shows antidepressants to better effect…
Read 7 tweets

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