@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
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
@DBDouble @f_hieronymus @awaisaftab @rcpsych Coincidentally, the pharmaceutical company Lilly (manufacturer of Prozac) took great interest in Schatzberg et al., 1997, a supplement to JClinPsych, see this letter about letters to the editor. drive.google.com/file/d/1fMqx_I… /3
@DBDouble @f_hieronymus @awaisaftab @rcpsych The weekend symposium of "experts" that produced Schatzberg et al., 1997 was sponsored by Lilly. At that symposium, the use of "discontinuation syndrome" instead of "withdrawal syndrome" was proposed for #antidepressants, because it sounded more benign. /4
@DBDouble @f_hieronymus @awaisaftab @rcpsych Almost 10 years later, Schatzberg reprised another "expert panel" sponsored by Wyeth, manufacturer of Effexor, producing Schatzberg, et al. (2006). #Antidepressant discontinuation syndrome: Consensus panel recommendations.... The Journal of Clinical Psychiatry, 67 Suppl 4. /5
@DBDouble @f_hieronymus @awaisaftab @rcpsych Schatzberg et al., 2006 reminded all of medicine that #antidepressant withdrawal syndrome was inconsequential -- mild & lasted only a few weeks. This has been the assumption until Davies & Read. (2019). doi.org/10.1016/j.addb… /6
@DBDouble @f_hieronymus @awaisaftab @rcpsych Davies & Read. (2019) found assumptions about insignificance of withdrawal syndrome were wrong, it was much more common & severe than had been described, & it was likely widely misdiagnosed because doctors had been assured it was mild & short-lived. /7
@DBDouble @f_hieronymus @awaisaftab @rcpsych This has been accompanied by a burgeoning patient movement decrying the gap in medicine regarding #psychiatric tapering & withdrawal. Taylor, et al. (2019). Public Health England: Dependence & withdrawal associated with some prescribed medicines... assets.publishing.service.gov.uk/government/upl… /8
@DBDouble @f_hieronymus @awaisaftab @rcpsych Even though red flags were up 60 years ago, #psychiatry made no movement towards establishing effective tapering protocols for #antidepressants & other #psychiatric drugs until Horowitz & Taylor, 2019 doi.org/10.1016/S2215-… /9
@DBDouble @f_hieronymus @awaisaftab @rcpsych Horowitz & Taylor, 2019 caused a stir but tapering protocols still haven't seeped into #psychiatric prescribing. @rcpsych can't even get a leaflet out about tapering due to internal resistance.
Even though psychotropic adaptation-dependence-tolerance-withdrawal is the law. /10
Even though psychotropic adaptation-dependence-tolerance-withdrawal is the law. /10
@DBDouble @f_hieronymus @awaisaftab @rcpsych Meanwhile, millions are taking #antidepressants & other #psychiatric drugs. Hundreds of thousands of complaints on the Internet about how hard it is to quit, months of withdrawal symptoms, years of post-acute withdrawal syndrome #PAWS. 6,000 cases here survivingantidepressants.org/forum/3-introd… /11
@DBDouble @f_hieronymus @awaisaftab @rcpsych Universally, patients are not finding doctors who know anything about tapering except crude "half & half again" tapers & extremely dumb advice to skip doses. Withdrawal syndrome very poorly recognized & often misdiagnosed & treated with psychiatric drug cascade. /12
@DBDouble @f_hieronymus @awaisaftab @rcpsych So, #psychiatry both "knows" about #psychiatric drug withdrawal problems & is entirely ignorant of the problems patients report in the clinical setting. Whatever is in the literature has not filtered down to clinical practice for at least 60 years. /13
@DBDouble @f_hieronymus @awaisaftab @rcpsych Why has difficulty of going off #psychiatric psychtropics been excluded from the drug-oriented #psychiatry paradigm for 60 years? Why has #psychiatry ignored importance of tapering? Why do clinicians so frequently misdiagnose withdrawal syndrome? Why no recognition of #PAWS? /14
@DBDouble @f_hieronymus @awaisaftab @rcpsych After Davies & Read, 2019 and Horowitz & Taylor, 2019, & thousands of patient complaints, why is it such a struggle to get #psychiatry to attend to issues of going off #psychiatric drugs? Each person taking a #psychiatric drug is potential dependence --> withdrawal problem. /15
