Discover and read the best of Twitter Threads about #antidepressants

Most recents (24)

@_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
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#Medium #Mediumship, was reading an old #Tufts@TuftsDaily⁩ article from 2008 interviewing ⁦@jessicaalba⁩ about her film #TheEye, watched the trailer:
you do see how see people died, though, if contacted by the deceased, they share their personality, images of what is relevant, what they think is, which can be difficult; I take #antidepressants, and, am #healing myself from illness, some #trauma, too, and, was seeing more,
earlier in my healing, and believe it is crucial to have a filter/level of #health with, a pretty well-known #medium told me he also got very sick with #pnemonia, I had #mycoplasmapnemonae, in #MeCFS #CFS, had #Lyme #LymeDisease, too, and, the information is for #healing,
Read 39 tweets
What’s the deal w/ people in #pain using #opioids? (Read entire thread.) We are not “drug addicts.” We are physically DEPENDENT on our meds, which we need to function w/out pain (i.e, to function). Physical dependence occurs on heart meds & #antidepressants too. #ThisIsUs
And I am not trying to stigmatize #addiction here. But rly, let’s talk; chronic pain patients (#CPPs) have been forced to KILL themselves due to untreated pain, due to bad #policy, due to the #stigma, foolishness & financial incentives of others. This has a name: opiophobia…
If you took me off ALL opioids, I (like most #painpatients) would go through ugly opioid #withdrawals (and make sure to poop/puke on YOU for causing them)! 😂

And even after months of “abstaining,” and withdrawals disappearing, I would be “clean” in the eyes of the world, but…
Read 10 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 nejm.org/doi/full/10.10…
@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"
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@sanilrege @markhoro @SenadHasanagic1 Not at all, Sanil. Among my site members, many people come off #antidepressants & other drugs with slight or no withdrawal symptoms except an emotional anesthesia, which they may describe as depression, anhedonia, various kinds of malaise, even "relapse" but.... /1
@sanilrege @markhoro @SenadHasanagic1 ....it's a "relapse" unlike anything they've experienced before. While they may use #psychiatry's vocabulary, because that's all they've got, this emotional anesthesia is actually a result of long-term psychotropic exposure, not "relapse"..../2
@sanilrege @markhoro @SenadHasanagic1 Post-drug emotional anesthesia is well known among those who have gone off psychotropics classified as addictive & considered a feature of those protracted withdrawal syndromes. There is no reason to think chronic #psychiatric psychotropics are exempt..../3
Read 10 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
An important review which finds that we are overprescribing potentially harmful drugs and that people are far too often left on drugs with no proper review.
theguardian.com/society/2021/s…, via @guardian
If you are called in for a review of your #antidepressants, #antipsychotics, #benzodiazepines or #opioid pain meds, it is very important that your prescriber works with you to reduce slowly and safely. Mishandled withdrawal can have lifelong consequences. @sajidjavid
Don’t assume that standard withdrawal advice is safe, it often isn’t. Learn from others experiences, use liquid forms or tapering strips to allow your body chance to acclimate to the change, especially at low doses. If you feel unwell after reducing, it’s withdrawal not relapse.
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REFLECTIONS ON FORGIVENESS // FORGIVENESS OF SELF // NO CONDEMNATION IN CHRIST JESUS // ROMANS 8:1

Happy Saturday, beloved family! I hope your weekend has been off to an excellent start! 🌅☀️❤️
Our focus text for today, comes to us from Romans chapter 8, which focuses on life in the Spirit.

In verse 1, we have THE blessed assurance from God, that there is indeed NO CONDEMNATION FOR THOSE WHO ARE IN CHRIST JESUS.
To be “in Christ Jesus” means that He dwells within us, & us within Him. We are ONE.
So, by sending His own son, Jesus Christ, to die for our sins, God made sure that there is NO CONDEMNATION for us.
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REFLECTIONS ON FORGIVENESS // FORGIVENESS OF SELF // GOD IS GREATER THAN OUR HEART // 1 JOHN 3:20

Blessed Friyay morning to you all, beloved children of God! 🌅☀️❤️
Our focus today will be within 1st John , chapter 3. This chapter deals EXCLUSIVELY with our identities as children of God. We are encouraged to strive to be a people of ethical integrity & to live a life that is reflective of our spiritual identity.
In verse 20, we are reminded of the truth that God is actually GREATER THAN OUR HEART. People of God, this is a quite profound assertion! 🤯🤯🤯
Read 18 tweets
I SO respect & appreciate @ZJAyres sharing this today. There is ABSOLUTELY POSITIVELY nothing wrong with taking medication to improve your #mentalhealth . I used to be vehemently opposed to taking psychotropic medication…
because of stigma & my Christian upbringing. NOW, based on my own lived experiences & through seeking out EXTENSIVE knowledge in the #mentalhealth space, I have a VERY different view of #mentalhealth & medications than most followers of Christ do.
Here’s the thing. Often times, people NEED medication to bring back the levels of their brain chemicals to where it needs to be. And that’s totally OK. Everyone’s condition is a little bit different.
Read 9 tweets
Welcoming Prof Hamish McAllister-Williams - @HamishMcAW to the virtual stage this morning to talk about: When depression is proving difficult to treat #RCPsychIC #Depression Image
Is there a need to define treatment-resistant depression? #RCPsychIC #Depression Image
Standard is 6-week antidepressant, however sometimes 8-week trial before classed as failed. Psychotherapy is often not taken into account

#RCPsychIC #Depression Image
Read 21 tweets
More an more patients are being treated for mild/ moderate depression with #antidepressants in general practice, despite there being very poor evidence for efficacy. In my experience, some people experience a transient benefit between 4&12 weeks (likely placebo mediated) &
This transient (non specific) effect of taking antidepressants gradually wears off. Patients present back to their GP with similar symptoms or a variant of the same symptoms & most GPS simply up the dose, meanwhile none or little of the psychosocial distress is being addressed.
Many ppl then become psychologically & physically dependent on higher doses of antidepressants with risk of side effects & withdrawal effects accumulating. Often a significant % of these patients barely meet the criteria for what we call depression & even if they do...
Read 8 tweets
#Antidepressants seem effective in the clinic but not in controlled studies. Why? Let’s consider all possibilities. @PeterDKramer @AllenFrancesMD @DrHowardLiu @DalackMd @blackdoginst @NAMICommunicate @Got_Anxiety @EikoFried @PsychTimes @matthewckeller @RiadhAbed1 @APAPsychiatric
Most of us who have prescribed antidepressants for thousands of patients have heard hundreds of them report transformed lives. “It is as if I walked out of a dark room into sunlight” “All of a sudden I can experience pleasure again”
But perhaps the effectiveness is an illusion. The improvement of patients taking #placebo is barely better than that for those taking antidepressants.
Here are 10 reasons why antidepressants
->Could seem effective when they are not, or
->Could seem ineffective when they are
Read 18 tweets
@sash_andy @samwoolfe @lisa63artist @jonathanstea @bmj_latest @hrw @C4Dispatches @gmcuk Sam, please note 3 Blind Psychs whining that there are real, serious flaws that need attention in #psychiatry but they are prevented from addressing them because dings from "anti-psychiatry" patients (on Twitter, no less) hurt their feelings. What does this say about the doctors?
@sash_andy @samwoolfe @lisa63artist @jonathanstea @bmj_latest @hrw @C4Dispatches @gmcuk The epithet "anti-psychiatry" directed at patients is nothing but ad hominem from clinicians who have no intention of bringing patients into the discussions of improving clinical care. (This is #psychiatry we're talking about, the science of human emotion.)
@sash_andy @samwoolfe @lisa63artist @jonathanstea @bmj_latest @hrw @C4Dispatches @gmcuk The argument that people are dissuaded from necessary #psychiatric treatment by purported "anti-psychiatry" is intellectually dishonest on so many levels.

1) #Psychiatric prescribers report being swamped by demand for their services; they plead for additional prescribers. /1
Read 18 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
@DepressionLab @tkaiser_science @Martin_Ploederl @HengartnerMP @CVolkmannMD @f_hieronymus My theory, published nowhere but Twitter, is that #antidepressants are psychotropics, & any psychotropic might be marginally effective for "depression" in some population, at very similar slim rates of efficacy.

Efficacy determined by subjective effect on subjective sensation.
@DepressionLab @tkaiser_science @Martin_Ploederl @HengartnerMP @CVolkmannMD @f_hieronymus Categorization of a drug as "antidepressant" is, of course, arbitrary. Some say benzodiazepines are antidepressants. Antipsychotics are promoted as antidepressant. Amphetamines & buprenorphine have been floated as antidepressant. Some like marijuana.

Any psychotropic will do.
@DepressionLab @tkaiser_science @Martin_Ploederl @HengartnerMP @CVolkmannMD @f_hieronymus So search for the reason "antidepressants" are "antidepressant" is doomed. Ultimately, you'd find any psychotropic causes neurobiological adaptation, that's the definition of a psychotropic, & some humans will subjectively interpret the effect as antidepressant. Others won't.
Read 6 tweets
@benzosarebad @wendyburn @_eleven13_ @BubblesTapering @rcpsych There are a number of studies exploring both physician & patient attitudes towards going off #antidepressants.

Lack of physician confidence in tapering plays a large role. Their patients don't trust their knowledge, either, & rightly so. This is a subject nobody wants to unpack.
@benzosarebad @wendyburn @_eleven13_ @BubblesTapering @rcpsych McCabe, J., Wilcock, M., Atkinson, K., Laugharne, R., & Shankar, R. (2020). General practitioners’ and psychiatrists’ attitudes towards antidepressant withdrawal. BJPsych Open, 6(4). doi.org/10.1192/bjo.20…
@benzosarebad @wendyburn @_eleven13_ @BubblesTapering @rcpsych McCabe, J., Wilcock, M., Atkinson, K., Laugharne, R., & Shankar, R. (2020). General practitioners’ and psychiatrists’ attitudes towards antidepressant withdrawal. BJPsych Open, 6(4). doi.org/10.1192/bjo.20…
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@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
@sandysteingard @awaisaftab Clarifying: Across psychotropics, withdrawal syndrome is not "time-bound" except by arbitrary distinction between acute & post-acute withdrawal syndrome #PAWS, which can last years & is often conflated with "relapse". Lerner & Klein, M. (2019). doi.org/10.1093/brainc…
@sandysteingard @awaisaftab Presentation from a Merck scientist that lays out tolerance, withdrawal, protracted withdrawal #PAWS: Markgraf, C. G. (2012, October). Introduction to Physical Dependence and Withdrawal. 12th Annual Meeting. Safety Pharmacology Society, Phoenix, Arizona. safetypharmacology.org/AM2012/am12pre…
@sandysteingard @awaisaftab Only wishful thinking & fixation on dangers of addiction have given #antidepressants, etc. a free pass from psychotropic adaptation, dependence, tolerance, withdrawal, & #PAWS. With very few exceptions, all regularly taken psychotropics cause withdrawal & #PAWS.
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@DrFulli @AllenFrancesMD Yes, we know. I've got 6,000 naturalistic case histories of adverse effects of psychotropics right here. I know more about adverse effects of psychotropics than I ever cared to. Being prescribed isn't a shield for a drug. survivingantidepressants.org/forum/3-introd…
@DrFulli @AllenFrancesMD Not joining handwaving over esketamine because it's so dangerous, though I abhor the dishonesty & hype. I counsel people with akathisia, movement disorders, suicidality induced by prescribed #psychiatric drugs every damn day. A psychotropic is a psychotropic. They all ruin lives.
@DrFulli @AllenFrancesMD I just had to review and document the suicides of 2 of my site members who could not stand their post-acute withdrawal syndrome #PAWS from #antidepressants any more. One was a woman with PSSD sexual dysfunction for 38 months. She was 21. Started sertraline at age 17. /1
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@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
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@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
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"Approximately 10 million U.S. adults are prescribed long-term opioid therapy (LTOT)...."

(vs ~30 million prescribed #antidepressants)

Frank, 2017 Patient Outcomes in Dose Reduction or Discontinuation of Long-Term Opioid Therapy... acpjournals.org/doi/full/10.73…
acpjournals.org/doi/full/10.73…

"Opioid tapering can be challenging for both patients & clinicians. In routine practice, discontinuation of LTOT is uncommon...from 8% to 35%....nearly half reported wanting to cut down or stop, yet 80% were receiving high-dose opioids 1 year later."
acpjournals.org/doi/full/10.73…

"There is little evidence to guide clinicians in the process of opioid tapering, especially in primary care settings, where most opioid therapy is prescribed....little is known about the risks and benefits of opioid tapering."
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