@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.
@sandysteingard @awaisaftab Blindness is especially puzzling given it's well known that #antidepressants, etc. incur typical psychotropic adaptation, tolerance, & withdrawal.

Drug tolerance in particular is of great concern to #psychiatry. How could it miss rest of the common psychotropic pharmacology?

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More from @Altostrata

16 Oct
@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
10 Oct
@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…
Read 40 tweets
8 Oct
@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
6 Oct
"Professionalism in any field requires keeping pace with change, & nowhere is it more true than medicine....valid knowledge may come from the patient as well as from clinician resources: a sociological change driven by technological change." #psychiatry /1 journals.sagepub.com/doi/10.1177/00…
"Case after case is presented showing that patients today have generated undeniable value, violating the expectations and assumed best practices of the old model." doi.org/10.1177/009121… /2
"standards of professionalism & appropriate care must be updated, lest we fail to achieve best possible care....new standard must be to teach clinicians to recognize, welcome, & work with empowered #epatients in the new model of participatory medicine." doi.org/10.1177/009121…
Read 4 tweets
6 Oct
"As the meaning of the term has expanded, some #ePatients have developed a high level of expertise & in turn have taken a leadership role within the ePatient movement. @StanfordMedX has coined the term ePatient scholar to describe these leaders...." /1

Nelson, R., (September 13, 2016) "Informatics: Empowering ePatients to Drive Health Care Reform - Part I" OJIN: The Online Journal of Issues in Nursing Vol. 21, No. 3.

ojin.nursingworld.org/mainmenucatego… /2
"The leaders introduced below demonstrate what equipped, enabled, empowered, & engaged patients can and will do to gain a proactive role in managing their healthcare. They demand ‘Give me my own damn data’ & even point out that the data are often dirty." /3
Read 5 tweets
3 Oct
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." linkedin.com/pulse/learning…
"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 linkedin.com/pulse/learning…
Read 14 tweets

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