Blog dedicated primarily to randomly selected news items; comments reflecting personal perceptions

Wednesday, April 18, 2018

Give These A Try: You've Nothing To Lose

"Some people are essentially being parked on these drugs for convenience's sake because it's difficult to tackle the issue of taking them off."
"Should we really be putting so many people on antidepressants long-term when we don't know if it's good for them, or whether they'll be able to come off [them]?"
Dr. Anthony Kendrick, professor of primary care, University of Southampton, Britain

"We've come to a place, at least in the West, where it seems every other person is depressed and on medication."
Edward Shorter, historian of psychiatry, University of Toronto

"It took me a year to come completely off [Cymbaita] -- a year."
"I knew some people experienced withdrawal reactions, but I had no idea how hard it would be [for himself]."
Dr. Tom Stockmann, 34, psychiatrist, East London

"Had I been told the risks of trying to come off this drug [Paxil], I never would have started it."
"A year and a half after stopping, I'm still having problems. I'm not me right now; I don't have the creativity, the energy."
"She -- Robin -- is gone."
Robin Hempel, 54, New Hampshire
Color pills and capsules close-up
According to data acquired by the U.S. federal government, 15.5 million Americans have been prescribed antidepressants, and have been using them on average for an uninterrupted period of at least five years. The number of drug-dependent Americans doubles year over year as long-term prescriptions of such antidepressants continue to rise in the developed world. The 35-member Organization for Economic Co-operation and Development reported that consumption of antidepressant drugs doubled in OECD countries between 2000 and 2015, in their 2017 report.

Britain has seen prescription rates double over the past ten years, with health officials in January initiating a nationwide review of dependence and withdrawal of prescribed drugs. A survey of long-term users in New Zealand found that withdrawal difficulties represented the most common complaint among long-term users there. While antidepressant drugs have been useful for millions of people to ease depression and anxiety, viewed as a valuable tool in psychiatric treatment, many people manage to stop medications with no significant problems surfacing as a result.

On the other hand, the rising long-term use of these medications has resulted in a growing problem where many who make the effort to wean themselves away from the medications find they are unable to because withdrawal symptoms they had never been warned of begin to surface and make them utterly miserable. Not that this was an issue that no one ever thought might arise; it did in the informed minds of some scientists in anticipation that some patients could experience disturbing withdrawal symptoms.

Symptoms caused by drug withdrawal
Symptoms caused by relapse
• usually happen very soon after you start to come off. This is related to half-life – in a drug with a long half-life, withdrawal effects will be delayed by as much as two weeks. • are delayed, and are not related to the half-life of the drug
• are often different from anything you have had before • are the same as the symptoms you had before – when you first started the drug
• go as soon as you re-start the drug • get better slowly if you re-start the drug
• will eventually subside without treatment if you don’t re-start the drug • continue indefinitely without other treatment

The serious issue of "discontinuation syndrome" was never addressed by either regulators or drug makers, unable to see beyond the positive effects of the drugs, to the point where they could turn out to be addictive, the end result being more harm than good. The drugs were, in fact, approved originally to be used short-term, following on studies whose duration was no more than two months, the result being that little data on long-term use of the drugs is available simply because it doesn't exist.

Dr. Kendrick of Southampton University in Britain is developing online and telephone support meant to help both practitioners and patients, with operational funding provided by government. Originally meant to be prescribed in aid of patients suffering episodic mood problems -- taken for six to nine months, an estimation thought to be efficacious to get patients beyond a temporary crisis -- their use has extended far beyond that initial estimated period, since later studies intimated that a return of depression in some patients could be prevented with longer-term use of up to two years.

Currently, however, women and Caucasian adults over 45 appear likelier to take antidepressants than younger adults, men and minorities, with usage on a steady increase in older adults. Prescribing physicians are anything but agreed, upon open-ended prescriptions, some believing in the efficacy of a lifetime prescription, others do not. What results from the use of antidepressants is often emotional numbing, sexual problems (lack of desire, erectile dysfunction) and weight gain.

"The likelihood of developing discontinuation syndrome varies by individuals, the treatment and dosage prescribed", stated Thomas Biegi, spokesman for Pfizer, manufacturer of Zoloft and Effexor. Eli Lilly, for its part, issued a statement that the company "remains committed to Prozac and Cymbalta and their safety and benefits." Sound familiar? Several studies suggest it is more difficult to stop using some medications over others, due to drugs' half-life. Effexor and Paxil with a short half-life seem to cause more symptoms more quickly then others that remain in the system longer, like Prozac.

Eli Lilly produced one study where people taking Zoloft, Paxil or Prozac abruptly stop taking the drug for roughly a week, when half of those on Paxil experienced dizziness; 42 percent, confusion; and 39 percent, insomnia. For patients stopping Zoloft, 38 percent experienced severe irritability; 29 percent dizziness; and 23 percent fatigue, the symptoms resolving once the drugs were resumed. As for Cymbalta, a study of people in withdrawal saw two to three symptoms on average the most common of which were dizziness, nausea, headache and paresthesia (electric-shock sensations in the brain); the symptoms lasting over two weeks.

According to many people interviewed, at first the drugs relieved problems with mood but after a year or so, it seemed unclear whether the medication was having any effect. Quitting their use, however, seemed far more difficult and stranger in outcome than anticipated. Robin Hempel began using Paxil 21 years earlier for severe premenstrual syndrome, recommended by her gynecologist. "He said, 'Oh this little pill is going to change your life'. Well, did it ever", she said.

She managed eventually to wean herself away from the antidepressant by tapering its use over a period of months; down to 10 milligrams, then five from the original 20 milligrams, and "finally all the way down to particles of dust", only to be bedridden for three weeks with dizziness, nausea and bouts of weeping. People who have not met with success in quitting by following a doctor's advice resort to microtapering; tiny reductions over nine months, a year, two years, however long it takes for success.

"It has taken a long, long time to get anyone to pay attention to this issue."
"You've got this huge parallel community that's emerged, largely online, in which people are supporting each other through withdrawal and developing best practices largely without the help of doctors."
Luke Montagu, founder, Council for Evidence-Based Psychiatry, London
Man Suffering From Antidepressant WithdrawalThose who have taken antidepressants for over six weeks are more likely to have withdrawal symptoms if they stop taking the drugs   AddictionCenter

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