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
Not hearing a lot of successful stories - probably not surprising. Doctors exist within a fairly rigid epistemiological framework (what seniors tell them) - hard to prise out
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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
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 @JAMAPsychbit.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
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 @TheBJPsychbit.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)