Tag Archives: antidepressants

Avoiding Withdrawal Syndrome for SSRIs Requires Months, Not Weeks, and a More Gradual Curve, Paper Concludes

New research questions conventional practices regarding rapid withdrawal from selective serotonin reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors, which are sometimes prescribed for migraine, peripheral neuropathy, and other neurologic disorders. Neurologists who prescribe these drugs said the study recommendations fit with their own clinical experience.

Tapering patients off selective serotonin reuptake inhibitors (SSRIs) should be done much more slowly and gradually than currently recommended, over a period of months rather than weeks, in order to avoid withdrawal syndrome, a team of researchers suggested in a paper published online March 5 in Lancet Psychiatry.

Although serotonin and norepinephrine reuptake inhibitors (SNRIs) were not the subject of the paper, studies show they show the same hyperbolic dose-response pattern, said the paper’s first author, Mark Abie Horowitz, PhD, a neurobiologist who is currently a clinical research fellow at University College London and a psychiatry trainee at Prince of Wales Hospital in Sydney, Australia.

“The clinical data also show that withdrawal symptoms from SNRIs last much longer than the one to two weeks ascribed to them by standard texts, much more in the region of months,” Dr. Horowitz told Neurology Today. “Tapering protocols suggested for SSRIs in the paper also apply to SNRIs; they should occur over at least months, down to doses close to one-fortieth of therapeutic doses and titrated to individual tolerability.”

The study authors proposed what they call a “pharmacologically informed method for tapering SSRI treatment.”

For instance, reducing doses of citalopram in steady 5 mg decrements resulted in serotonin transporter inhibition hyperbolically rising from 3 percent when the dose was cut from 20 mg to 15 mg, to 6 percent when the dose was cut from 15 mg to 10 mg, to 13 percent when the dose was cut to 5 mg, and to 58 percent when cut to zero.

“These large reductions in inhibition could account for the paucity of success of previous tapering regimens, and particularly for the difficulties with withdrawal symptoms that patients have towards the end of their taper, at low doses,” the study authors concluded.

Rather than taper by fixed amounts, the study authors recommended that clinicians taper the dose by following a hyperbolic slope. In the case of citalopram, for instance, the dose would be dropped from 20 mg, to 9.1 mg, to 5.4 mg, 3.4 mg, 2.3 mg, 1.5 mg, and then to 0.8 mg, 0.4 mg, and finally to zero.

Neurologists who treat migraine, diabetic neuropathy, and other disorders for which SSRIs and SNRIs are sometimes prescribed said the recommendations fit with their own clinical experience.

“I have seen the withdrawal effect; it can go on for months,” said Richard B. Lipton, MD, FAAN, the Edwin S. Lowe Professor and vice chair of neurology at Albert Einstein College of Medicine, where he is also director of the Montefiore Headache Center. “I definitely agree with the authors of this paper on the need for more gradual tapering in some patients. I’ve certainly had certain patients buy pill cutters to cut an already low dose of an SSRI into quarters and take them daily, then take them every other day, to try to make the taper more comfortable.”

Dr. Lipton said he also agreed with the authors of the paper that current guidelines on tapering SSRIs should be reconsidered, and that randomized, controlled trials would be useful to more rigorously test the effects of a slower, more gradual tapering protocol.

Full article –

https://journals.lww.com/neurotodayonline/pages/articleviewer.aspx?year=2019&issue=04180&article=00004&type=Fulltext

The Top 20 Medications That Cause Memory Loss

Here is a list of medications known to have memory loss as a side effect:

  • for Parkinson’s — scopolamine, atropine, glycopyrrolate
  • for epilepsy — phenytoin or Dilantin
  • painkillers — heroin, morphine, codeine
  • sleeping pills — Ambien, Lunesta, Sonata
  • benzodiazepines — Valium, Xanax, Ativan, Dalmane
  • quinidine
  • naproxen
  • steroids
  • antibiotics (quinolones)
  • antihistamines
  • interferons
  • high blood pressure drugs
  • insulin
  • beta blockers (especially those used for glaucoma)
  • methyldopa
  • antipsychotics — Haldol, Mellaril
  • tricyclic antidepressants
  • lithium
  • barbiturates — Amytal, Nembutal, Seconal, phenobarbital
  • chemotherapy drugs

This list was assembled by Richard C. Mohs, Ph.D., former vice chairman of the Department of Psychiatry at the Mount Sinai School of Medicine.

The Top 3 Types of Drugs That Cause Memory Loss

If you are taking any prescription medication, the odds are that it falls into one of these three categories of drugs known to cause memory loss and other cognitive problems:

The “Anti” Drugs

If you take a drug that starts with “anti,” such as antihistamines, antidepressants, antipsychotics, antibiotics, antispasmodics, or antihypertensives, it’s likely that it will affect your acetylcholine levels.

Acetylcholine is the primary neurotransmitter involved with memory and learning. Low acetycholine can lead to symptoms that resemble dementia including mental confusion, delirium, blurred vision, memory loss, and hallucinations.

Sleeping Pills

Prescription sleeping pills are notorious for causing memory loss.

The popular drug Ambien has been coined by some as “the amnesia drug.” Some users experience night terrors, sleep walking, sleep driving, and hallucinations.

Prescription sleeping pills have been found to put you in a state similar to being passed out drunk or in a coma while bypassing the restorative sleep your brain needs. There are much better ways to get to sleep!

https://realfarmacy.com/beware-20-medications-cause-memory-loss/

Many doctors may be failing to warn patients about the risks of antidepressants, new research suggests

These reports indicate that many doctors are unaware of the potential harms of antidepressants- Oliver Letwin MP

ALL PARTY PARLIAMENTARY GROUP FOR PRESCRIBED DRUG DEPENDENCE

PRESS RELEASE

8 October 2018

For immediate release

Many doctors may be failing to warn patients about the risks of antidepressants, new research suggests

The All Party Parliamentary Group for Prescribed Drug Dependence today publishes two new pieces of research which indicate that many doctors and psychiatrists may be failing to warn patients about the potential risks of antidepressants, and subsequently fail to recognise withdrawal symptoms. Furthermore, sources of NHS support for patients, such as NHS 111, were found to be unhelpful.

The first report, ‘Antidepressant Withdrawal: A Survey of Patients’ Experience’, was authored by researchers at the University of Roehampton on behalf of the APPG, and is based on the results of a survey of 319 UK patients affected by antidepressant withdrawal.

64% of patients surveyed claim not to have received any information from their doctors on the risks or side effects of antidepressants, while only 2.5% of patients found NHS 111 to be a helpful source of support during withdrawal. In addition, responses to the survey make clear that the impact of antidepressant withdrawal can be devastating for some individuals with severe withdrawal reactions, with 30% of respondents reporting being off work indefinitely due to the severity of their symptoms.

The second report, ‘Voice of the Patient: Petition Analysis Report’, identifies failure points in the health care system based on the testimony of 158 individuals impacted by prescribed drug withdrawal who responded to two petitions lodged with parliamentary Petitions Committees in Scotland (1) and Wales (2) in 2017. The report concludes that the failures encountered by the respondents will require systemic change. Both reports will be submitted to Public Health England as part of its review into prescribed drug dependency and withdrawal, due for publication in spring 2019.

Dr James Davies, of the University of Roehampton, commented: “The majority of the people we surveyed and who responded to the petitions indicated that they were never properly informed about the risks associated with antidepressants, including withdrawal. This undermines the principle of informed consent, which is essential if patients are to make a proper assessment of the harms and benefits. This is very concerning, particularly as the survey shows that severe antidepressant withdrawal can have a devastating effect on patients’ lives, including long-term disability. Furthermore, the research suggests that patients who suffer from withdrawal mostly find existing sources of NHS support, such as 111, unhelpful.’

Sir Oliver Letwin MP, chair of the APPG, said: ‘These reports indicate that many doctors are unaware of the potential harms of antidepressants, and fail to communicate the risks to their patients. This highlights the need for additional guidance and training in this area, and we hope that Public Health England will consider this as part of their current review into prescribed drug dependence. Furthermore, it suggests that existing NHS sources of support are inadequate, and new dedicated services, including a 24 hour national prescribed drug withdrawal helpline, are therefore urgently needed.’

NOTES TO EDITORS

The report ‘Antidepressant Withdrawal: A Survey of Patients’ Experience’ can be found at this link: http://prescribeddrug.org/wp-content/uploads/2018/10/APPG-PDD-Survey-of-antidepressant-withdrawal-experiences.pdf

The report ‘Voice of the Patient: Petition Analysis Report’ can be found at this link: http://prescribeddrug.org/wp-content/uploads/2018/10/Voice-of-the-Patient-Petition-Analysis-Report.pdf

For further information please contact Luke Montagu at lukemontagu@me.com.

More information on the All-Party Parliamentary Group for Prescribed Drug Dependence can be found at prescribeddrug.org

prescribeddrug.org

“worse than Hitler” “pharma-whore”

A government adviser on the use of antidepressants has resigned after being called “worse than Hitler” and a “pharma-whore” in a campaign of harassment that he has accused colleagues of fomenting.

David Baldwin claimed that a fellow adviser helped to fan the flames of online abuse in a row over the effects of the drugs. The controversy began when he wrote to The Times in February to downplay the side-effects of coming off the drugs, saying: “In the vast majority of patients, any unpleasant symptoms experienced on discontinuing antidepressants have resolved within two weeks of stopping treatment.”

https://www.thetimes.co.uk/edition/news/drugs-adviser-david-baldwin-quits-after-being-branded-worse-than-hitler-in-online-abuse-row-srtqltmfs

Anti-depressants doubles a child’s risk of suicidal behaviour.

Suicidal thoughts, attempts and self-harm increase in young people prescribed antidepressants, concludes study

Anti-depressants should be a doctor’s last resort when trying to treat children and adolescents with depression, according to the results of a new two year-long study.

The meta-analysis involved researchers conducting a systematic review of all available and relevant test data. Researchers examined 70 trials comparing antidepressants with placebos in order to find out how the use of antidepressants related to increases in suicide, suicidal behaviour and aggressive behaviour in young people.

In 11 of those trials, researchers found out that antidepressants doubled the risk of aggressive behaviour and suicidal behaviour in young people. Suicidal behaviour includes suicide thoughts and attempts, actual suicides and self-harming behaviour such as deliberately cutting oneself.

“There are still psychiatrists who deny that antidepressants can cause suicide in children, which is absolutely incredible,” Peter Gøtszche, the head of the Nordic Cochrane Centre at Rigshospitalet who is the co-author of the new study, told Videnskab.

“I think it is irresponsible to use antidepressants in treating children and adolescents.”

Results no surprise
Anne Katrine Pagsberg – a clinical associate professor, senior researcher and medicine chief physician at the Child and Adolescent Centre, Capital Region Psychiatry at the University of Copenhagen Hospital – was not surprised by the results.

“We are very aware of this risk,” she said. “Especially for children and young people there has long been an awareness that there may be an increase in suicidal behaviour. All our patients are closely monitored and their families informed about the risks.”

Pagsberg said that the national guidelines for the treatment of children and adolescents suffering from depression recommend that antidepressants should never be ‘front-line therapy’ and should never be used as a stand-alone treatment.

“They must always be coupled with psychosocial interventions, and patients should always be closely monitored for side-effects.”

Self-harm may not equate to suicide
Pagsberg said that self destructive behaviour may not always be a sign of suicidal intent.

“Self-harm is a serious symptom, but a young person who cuts their arm is not necessarily suicidal,” she said.

No children or young people in the 70 trials actually committed suicide, but 3 percent of the children and young people taking anti-depressants exhibited suicidal behaviour, compared to 1 percent in the placebo group.

“The front-line treatment for children and adolescents with depression will always be psychotherapy,” said Pagsberg. “In cases of severe depression, we may need to try treatments using anti-depressants, but even then the psychotropics should never stand alone.”

http://cphpost.dk/news/anti-depressants-doubles-a-childs-risk-of-suicidal-behaviour-say-danish-researchers.html

Suicide- 87% on antidepressants

The stats also reveal that more than 87% of people were taking antidepressants at the time of death, while 44.6% were on drugs used in psychoses and related disorders.

New figures have revealed that almost three quarters of all suicides in Dundee were among men.

The latest statistics released by the NHS show that there were a total of 147 suicides in Dundee between 2009 and 2015, of which 109 were men.

The figures also show that the majority of men who committed suicide in the city were employed in senior positions, such as managers, while 43% of men who committed suicide were unemployed, disabled or living off their own means.

One Dundee dad who knows only too well the devastation and heartbreak caused by suicide is Phil Welsh.

Lee Welsh, 27, of the city’s West End, took his own life in August, leaving his friends and family devastated. Phil called for a crisis centre — similar to one in Edinburgh, which is open 24/7 and provides community based, emotional and practical support at times of crisis — to be set up in Dundee.

Phil told the Evening Telegraph: “Not until Lee died did I appreciate just how many men took their own lives.

“Lee’s death left our family heartbroken and we’re doing everything we can to stop this happening to other families.

“We would like to see a crisis centre set up in Dundee similar to the one in Edinburgh where people who feel suicidal can turn.”

The Tele previously told that Lee had battled mental health issues for almost a decade prior to his death.

Lee’s suicide prompted his parents to campaign for more action to help people with similar issues and following his death, the website Not in Vain for Lee was established.

He said: “If through this focus we can prevent one family from enduring the heartache we as a family are currently suffering, then Lee’s death will not have been in vain.”

Rob Burns, development manager of Dundee’s mental health service the Hearing Voices Network, said that the figures relating to men did not surprise him.

Mr Burns said men who have taken their own lives may not have spoken to anyone about the issues they are experiencing.

He added: “It is really quite frightening the number of people who take their own lives.

“We are very aware that up until now men have not been as willing to come forward to talk about their mental issues or other things that are concerning them as women have been.”

“I would think the men in Dundee who have taken their own lives have not previously spoken to anyone about their concerns.

“We are currently doing a lot of work to get men to open up, including taking on more male volunteer supporters.”

The majority of men — 64% — who took their own lives were also single, compared to just over 18% who were married or in a civil relationship.

The figures also revealed that 36 suicides took place within five years of discharge from a mental health service.

More on this story

https://www.eveningtelegraph.co.uk/fp/call-new-crisis-centre-dundee-help-folk-thinking-suicide/amp/?__twitter_impression=true

Heath Ledger – awareness

Overdose awareness Day!

Heath Ledger, Prescription drugs and overdose.

‘It was [10] years ago … but to me it’s like it was yesterday.’

These are the words of Kim Ledger as he recalled the loss of his son Heath to an opioid overdose in January 2008.

The 28-year-old actor had been caught up in a punishing production schedule, flying between three different countries and filming scenes at night in the bitter cold. He contracted a chest infection that developed into pneumonia, and experienced insomnia.

Heath visited a variety of doctors on his travels to help deal with these problems, collecting a veritable cornucopia of prescription medications, including opioids and sleeping pills.

In combination, the opioids, sleeping pills and the chest infection itself had a depressing effect on Heath’s respiratory system, causing it to shut down. This made him a high-profile casualty of what was emerging as a prescription opioid epidemic, which includes the use of legal drugs such as codeine, fentanyl and oxycodone.

This phenomenon has claimed thousands of lives in Australia and around the world.

While Heath’s death was the result of a medication mix he didn’t realise would exact such a heavy toll, other opioid users have a more long-term relationship with these types of drugs, often becoming unexpectedly addicted after using them as a treatment for chronic non-malignant pain.

‘The accidental addict. In a very short space of time, people can become addicted to oxycodone and products like that,’ Kim said.

Such was the case of 30-year-old nurse and mother of two, Katie Howman, found dead following a fentanyl overdose in her Toowoomba home just before Christmas in 2013. Investigations revealed she had visited 20 different doctors and 15 different pharmacies over the previous 13 months in her search for opioids.

Opioids – a category that includes pharmaceuticals such as oxycodone and fentanyl, as well as illicit versions such as heroin – remain the main cause of accidental overdose death in Australia. Opioid-related deaths hovered at around 450 per year at the turn of the century, but these numbers have risen sharply since 2006 to hit over 1100 per year since 2014.

What has led us to this epidemic, and what can GPs do to help curb it?

Too good to be true
In the late 1990s, prescription opioids seemed like an ideal answer to the often-difficult problem of chronic, non-malignant pain.

‘There was an increased demand to treat chronic pain. There were very few options and very little research that had been done on this problem,’ Dr Evan Ackermann, a GP with a special interest in opioids, told the RACGP.

‘This was mixed with a situation of some fairly aggressive drug company marketing of opioids and a change of clinical attitude towards pain. Normally, pain would be part of the healing process, but people started to say we should be looking at pain as the “fifth sign” and treating it aggressively.

‘It was a cultural shift across the healthcare sector, across the board, from pharmacy right through to general practice, specialists and hospitals.’…………….
‘There is a sense out there sometimes that it’s just people choosing to do this, that there’s a dichotomy between the genuine-pain patient and the bad drug user,’ she said. ‘My experience is that they’re the same group of people.

‘Opioids interact with us as a species in a particular way; all of us are at risk of side-effects and one of those major side-effects is dependency and addiction.’

………….

full story

Exerpt from:https://www.racgp.org.au/newsGP/Clinical/Agony-and-ecstasy-Prescription-drugs-and-overdose

Two types of drugs you may want to avoid for the sake of your brain – Harvard Health

If you’re worried about developing dementia, you’ve probably memorized the list of things you should do to minimize your risk—eating a healthy diet, exercising regularly, getting adequate sleep, and keeping your mind and soul engaged. In addition, some of the drugs you may be taking to help you accomplish those things could increase your risk of dementia. In two separate large population studies, both benzodiazepines (a category that includes medications for anxiety and sleeping pills) and anticholinergics (a group that encompasses medications for allergies and colds, depression, high blood pressure, and incontinence) were associated with an increased risk of dementia in people who used them for longer than a few months. In both cases, the effect increased with the dose of the drug and the duration of use.

These findings didn’t come entirely as a surprise to doctors who treat older people. “The Beer’s List published by the American Geriatrics Society has long recognized benzodiazepines, antihistamines, and tricyclic antidepressants as potentially inappropriate for older adults, given their side effects,” says Dr. Lauren J. Gleason, a physician in the Division of Aging at Harvard-affiliated Brigham and Women’s Hospital. Such drugs are on the list because they share troubling side effects—confusion, clouded thinking, and memory lapses—that can lead to falls, fractures, and auto accidents.

Full article:

https://www.health.harvard.edu/mind-and-mood/two-types-of-drugs-you-may-want-to-avoid-for-the-sake-of-your-brain

Withdrawal – What we Know and Don’t Know

Antidepressant Withdrawal – What we Know and Don’t Know

My Doctor/Psychiatrist told me that I have to take an antidepressant to correct a
chemical imbalance in my brain, is this true?

No, it is a myth, we cannot test or measure the state of neurotransmitters in your brain, the
American Psychiatric Association disavowed this myth in 2011(1). It is a pharmaceutical
company invention (2).

How many people experience withdrawal effects?

It varies according to which drug is used, at what dosage, and for how long. Recent
studies (3) are showing the number affected to be greater than 50% of those taking the
drugs. The UK Royal College of Psychiatrists did their own survey (4) (now removed) which
showed that 63% reported withdrawal effects.

Why does my doctor/psychiatrist keep saying ‘discontinuation syndrome’ when I
mention withdrawal?

Discontinuation syndrome is an invented term (5) which minimises the role of the drug in the
harm caused and steers users away from addiction terminology. While dependence and
withdrawal have some features in common with addiction, they are not accurately
described using just this approach. What you are experiencing is an effect of withdrawing
from a drug, not of discontinuing treatment.

Why does my doctor insist that ‘once the drug is out of my system’ I will be fine?

Because not all doctors understand the effects of antidepressant drugs on the brain (6). A
heavy drinker or smoker may suddenly stop drinking/smoking, but the effects on their brain
and nervous system continue to be felt long after they have quit. Antidepressant drugs
change the brain in ways we don’t currently understand. These adaptations (7) to the drug
are responsible for withdrawal effects.

What does withdrawal feel like?

It’s a highly variable experience ranging from mild symptoms which pass quickly, to
profound symptoms that sometimes persist for many years. In a 2017 survey (8), 46% of
those reporting withdrawal symptoms described them as ‘severe’. Most common reported
symptoms (9) are insomnia, dizziness, fatigue, digestive problems, anxiety, panic,
depression, agitation. Withdrawal symptoms can sometimes mimic depressive or anxious states but should not be confused with relapse (10).

I am worried about dependence, what should I do?

The most important thing is never stop your drugs suddenly, this can be dangerous. Talk to
your doctor but be prepared as many doctors do not have the information to be able to
help. Withdrawal is a unique experience, with no fixed rules.

There are some excellent and
reliable online sources for help including:
• theinnercompass.org
• madinamerica.com/drug-withdrawal-resources
• survivingantidepressants.org
www.jfmoore.co.uk August, 2018
Antidepressant Withdrawal – What we Know and Don’t Know

References (to read these online visit www.jfmoore.co.uk/ltw.html)
1. http://www.psychiatrictimes.com/blogs/couch-crisis/psychiatry-new-brain-mind-andlegend-chemical-imbalance
2. https://www.scientificamerican.com/article/is-depression-just-bad-chemistry/
3. http://roar.uel.ac.uk/7402/
4. RCPsych survey (now deleted)
5. https://www.psychologytoday.com/gb/blog/side-effects/201107/antidepressantwithdrawal-syndrome
6. http://time.com/3399344/antidepressant-changes-the-brain-study-finds/
7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4118946/
8. http://roar.uel.ac.uk/7402/
9. https://www.karger.com/Article/FullText/370338
10.http://www.stacommunications.com/journals/diagnosis/2006/Diagnosis_sep_06/DS.pdf
www.jfmoore.co.uk August, 2018

What we know about antidepressant withdrawal V1

James Moore

BBC File on Four program on Antidepressants in Children

A recent BBC File on Four program on Antidepressants in Children, presented by Paul Connolly, has drawn disparaging comments on posts here. Here is some background detail. I was interviewed for the program. My messages were as follows:

  1. That the trials of Prozac in children were identical to the trials of other SSRIs and other antidepressant drugs in this age group – negative. There are more negative Prozac trials for depression in this age group than for any other antidepressant.
  2. Part of our problem s that MHRA and NICE don’t want to be seen to go back on judgements they made 14 years ago when they licensed Prozac. Better children die than regulators lose face.
  3. That all of the literature in this area is ghost or company written.
  4. That there is no access to data from clinical trials – MHRA don’t have access, NICE don’t have access – no-one does.

It was clear to me that Paul Connolly, although expressing shock just like Chris van Tulleken some months before at what I laid out, was not going to include this material. Chris was somewhat the braver of the two. He rather subtly skewered NICE – but probably too subtle for most people. A week before the programme ran, there was an email from File on Four saying that owing to space constraints I was one of several people being omitted.

What File on Four ended up was a combination of the irritatingly anodyne and bizarre. What is the definitive answer about whether antidepressants work, Paul Connolly asked – no one knows he said. There are definitive answers the public deserve to be told about but FoF bottled it. Doctors are all at the mercy of clinical trials, he said, before turning to Ian Goodyer, someone who has pushed antidepressants for children for years who said on the basis of the biggest trials with 475 children he could tell us that fluoxetine (Prozac) worked in 67% of cases rising to 80+ %. I’d fail a medical student who offered me this answer if presented with the results of the TADS trial – the one Goodyer was talking about. There is no good evidence fluoxetine worked in this trial. Goodyer omitted to tell us that there were 34 suicidal events on fluoxetine compared to 3 on placebo. Goodyer made something of the fact this was the biggest trial of Prozac which sounds good but isn’t the biggest – not by a longshot. Even if it were the biggest, Goodyer fails to appreciate that the bigger the trial the greater the chance you can show snake oil works. If drugs are worth it, small trials are all that is needed. Prozac, fluoxetine, is in fact the drug with more negative trials than any other. These points are irritating. The bizarre one was that FoF made Andrea Cipriani out to be the radical outlying voice. AC’s work is totally controlled by industry – he knows he has no access to the data and his work is based on ghostwritten or company written reports . He’s a very nice man but the idea that he is a voice for caution as regards the use of antidepressants is bizarre.

Read the full article