(thread) An interesting session today on antidepressant withdrawal. Much confusion resolved by looking at how long people are on antidepressants:clear relationship between length of use and risk of withdrawal symptoms. Image
Whether studies are RCTs, observational or survey data all fit along a curve that increases for increasing duration of use. Hugely misleading to patients and doctors to focus on studies for patients only on 12 weeks of antidepressants Image
When half of English population is on antidepressants for more than 2 years. In this group of patients all data points to incidence of withdrawal being 50% +. True for escitalopram, fluoxetine as well Image
Same relationship exists for severity: longer that patients use antidepressants, the more severe withdrawal is reported to be: in patients with over 3 years of use, more than half report moderately severe or severe symptoms. Image

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17 Mar
(Thread) With due respect to others who have contributed to my special edition I consider this one of the most important pieces. bit.ly/2OAa1aH @Altostrata When I was coming off an antidepressant and in dire straits, I could not find any guidance on what was (1/n)
going on or how to navigate out of it from published literature. Without Adele Framer I would not have been able to get off my drugs; indeed I am not sure I would be alive. I have learnt a lot from her and now I am very glad that now other clinicians, patients (2/n)
and researchers will be able to learn from the wisdom she has gained over 15 years and deep study. She tells me she looked and looked for an expert to be able to help her and could not find one. Instead, she was forced to become one herself. (3/n)
Read 6 tweets
4 Mar
If you have been tapered off a psych drug too fast by a doctor, is it possible (after recovering) to go back and try to let them know what happened? Understand there may be a lot of anger. But could help others avoid the same fate. Terrible thing to have ask ppl to do I know
I ask this because in a focus group yesterday some ppl had done this. Know this takes a lot of energy. But ppl need to stop being told 'I have never seen this before', 'I don't know what to do'. At some point I am sure @rcgp will spring into action
It is also a numbers game. There are about 30,000 GPs in England. Based on this paper there are 10,000 English people just on a handful of facebook sites who know how to taper antidepressants. There are more ppl learning all the time bit.ly/3qhgTXb
Read 4 tweets
8 Nov 20
In the same way that benzos can make anxiety worse in the long term, can antidepressants worsen the condition they are designed to treat? Proud to have commissioned this thoughtful analysis: bit.ly/2GDRMgj @TAPsychopharm /1
Current diagnostic systems in psychiatry do not consider the iatrogenic components of psychopathology, and can be applied to only patients who are drug free. They are suited for a patient who no longer exists: most of the cases that are seen in psychiatric clinical practice.../2
"...receive psychotropic drugs and such treatment is likely to affect prognosis and treatment choices."/3
Read 11 tweets
5 Aug 20
How to taper antipsychotic medication to minimise withdrawal problems: more slowly than you think, down to fractions of usually used doses. Might need liquid versions, pill cutters. Thks Robin Murray, David Taylor @sameerjauhar Sridhar Natesan @JAMAPsych bit.ly/2XyvtxM
Summary: Antipsychotics can reduce psychotic symptoms and might reduce relapse rates so can be useful. But lots of side effects: tardive dyskinesia, metabolic problems, subjectively unpleasant, probable brain shrinkage. 1/
Doses should therefore be reduced to minimal effective dose, which for some might be zero. Also evidence that functioning (employment, independent living, relationships) improve for less or no antipsychotic /2
Read 19 tweets
30 May 20
Ketamine, like other anaesthetic agents propofol and nitrous oxide, reduces depression scores in 2 hours. Does that make esketamine a safe and effective antidepressant? No. With @joannamoncrieff in @TheBJPsych bit.ly/3gw4cUC (thread)
We analysed studies submitted by Janssen to FDA to licence esketamine (esk) for treatment-resistant depression (TRD). TRD sounds rare and severe, but Janssen’s defn - people who have ‘failed’ two different ADs - likely to include many current AD users. (1/25)
Esk is one of two mirror image molecules that make up ket. Esk is 2xpotent as ket. 3 trials conducted for 4 weeks to compare esk to placebo. In 2 of these trials there was no sig. difference between esketamine and pbo. (2/25)
Read 27 tweets
6 Mar 19
@Mental_Elf @sameerjauhar @ReadReadj @suzypuss @And_Cipriani @ParianteSPILab @jf_moore @CEP_UK @tony_kendrick @wendyburn 1/We are hoping a more pharmacologically informed approach to tapering will help more patients avoid withdrawal effects. Studies which taper people over months and down to tiny fractions of therapeutic doses have already shown success at avoiding withdrawal symptoms
@Mental_Elf @sameerjauhar @ReadReadj @suzypuss @And_Cipriani @ParianteSPILab @jf_moore @CEP_UK @tony_kendrick @wendyburn 2/This makes a lot of sense because the relationship between dose and serotonin transporter occupancy inhibition is hyperbolic (like it is for most drugs). This means very small doses have very significant effects. Halving the dose does not half the effect at receptor targets.
@Mental_Elf @sameerjauhar @ReadReadj @suzypuss @And_Cipriani @ParianteSPILab @jf_moore @CEP_UK @tony_kendrick @wendyburn 3/Rather surprisingly, even one-eighth of the minimum dose still has about half the effect of a therapeutic dose. We therefore advocate for tapering that follows this relationship. In practice, this will mean halving the medication several times, down to very low levels
Read 6 tweets

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