Thread by @garwboy

A miffed bank holiday thread about this @Guardian article, "Antidepressants: is there a better way to quit them?"

theguardian.com/lifeandstyle/2…

While some important points are raised, it strikes me as pill shaming (again), but delivered more thoughtfully, which is arguably worse
/1

Essentially, I'd argue the whole piece is based on a flawed premise, namely the line in the first paragraph stating categorically that antidepressants are "not supposed to be a long term medication"

Since when? In all my years in the field, I've never come across this claim
/2

The whole article basically rests on the point that, at some point, you are *supposed* to stop taking antidepressants. And some struggle with this, which is true.

But it's still WRONG. You don't *need* to stop taking antidepressants, and arguing otherwise can be v harmful
/3

The most generous interpretation I can think of to support that claim that antidepressants (ADs) aren't *supposed* to be long term is because NO medications are. The end goal is curing the patient, so the medication is no longer needed, which has a certain logic

/4

...BUT, this idea of 'cure' as the end-goal is largely based on the medical model of mental health (i.e. treating mental disorders as the same as physiological ones), and is seldom valid in mental health scenarios, where management and adaptation are often the key to treatment
/5

Point is, there are many good reasons for stopping medications
They no longer work
They're no longer needed
They start causing more issues than the problem they're treating

But "You're not supposed to take them for long" is bollocks, and you can quote me on that
/6

This is especially true for antidepressants and related drugs. People experience enough shame & stigma for needing them in the first place. Lofty-sounding articles that breezily conclude that using them long-term is a sign of failure or weakness just rub salt in those wounds
/7

"But what if you don't NEED antidepressants, because your depression goes away?"

Great if that happens, and obviously psychoactive drugs should be reduced/stopped with expert guidance (and not the ideological scaremongering of certain dubious journos)
theguardian.com/science/brain-…
/8

BUT, just because a depressive EPISODE ends, it doesn't mean the underlying causes have gone away. In fact, psychologists and neurobods describe the 'kindling' effect, i.e. the fact that initial bouts of depression can make subsequent ones MORE LIKELY
ncbi.nlm.nih.gov/pubmed/15783292
/9

Theories differ, but one explanation is down to the brain's adaptability. The stress caused by the initial depression trigger causes key brain mechanisms to become more 'sensitive' to stress, meaning it takes less in future to kick everything off again
/10

Certain neurological systems, like those governing mood, may be suppressed, 'shut down', by the chemical stress response, leading to further episodes of depression in response to relatively minor 'triggers'. Meaning more depression, more often
/11

What can be done about this?

Well, sometimes keeping the the baseline level of activity of key neurons, that shut down during depression, artificially raised, essentially kicks them up the arse (metaphorically) to keep them working and stave off depression
/12

Basically, a baseline level of antidepressant in the system can PREVENT depression. Ergo, taking them indefinitely can be a vital approach for allowing someone to function normally in day to day life

Except, taking pills long-term is bad. So this is wrong. Apparently

/13

Aside: A lot of this is covered in far more extensive detail in my 4th book, which I'm in the middle of writing, which is scheduled for release in October, if you're interested.

Hence this tedious article irked me so much, I'm focusing on this extensively right now

/14

Before I bore everyone senseless, to summarise

Nobody *needs* to stop taking their meds if they're still helping. There's no rule, and it can even be v helpful without signs of depression.

Reasonable-seeming articles which insist (sans evidence) that you do, are dangerous
/15

Just insisting that antidepressants *shouldn't* be used long-term and backing it up with choice quotes from people who struggled to come off them (which is proving a *different* point, i.e. that giving them up is difficult for some) is seriously irresponsible journalism IMHO
/16

As a general rule of thumb, if you see any article that insists you should't take antidepressants long-term and want to know how credible it is, pretend you're diabetic and swap 'antidepressants' for 'insulin', see if it still seems sensible

I'll wager it won't. At all

/end

PS

Another new high-profile article, and a textbook example of the pill-shaming genre

https://twitter.com/NewYorker/status/1120332264074874886

These 2 sentences are UNRELATED! They *seem* linked, but putting them together strongly implies that people not stopping their meds is a problem that needs addressing

Obviously, this would have been the sort of thing a relevantly-qualified *someone* on the Guardian Science Blog network would have torn apart as soon as it was posted, if they hadn't shut it down

Que sera, eh?

https://twitter.com/garwboy/status/1120326078705352704

Irked thread from yesterday on the dangers of ingrained pill shaming, and why antidepressants don't have an automatic time limit despite what many assume

https://twitter.com/garwboy/status/1120326078705352704

This thread now a full article, with links, examples, and generally a higher number of useful details
cosmicshambles.com/words/blogs/de…

https://twitter.com/garwboy/status/1120326078705352704