For ADHD, the trials literally last a month. But kids are on them for over a decade! And just this year researchers were forced to admit that, yeah, looks like long term uses increased cardiovascular morbidity… oops.
Issues with over-diagnosis or medicating people too young aside, at least stimulants obviously work. Someone of an appropriate age, at least, can experience the effect, weigh their options, consider risks and unknowns, and make a decision. What's so odd about "antidepressants" is that people take them for so long without even being sure that they help. I swear, every time I ask someone on an SSRI about it,, they prevaricate, and end up somewhere along the lines of "I think so, maybe, in some ways." And they keep taking it, incurring whatever known and unknown risks all the while, because they're told that it's supposed to help, and they trust the medical establishment.
Because the marketing tells everyone how dangerous it is to stop taking them. They tried to put my elderly mother on them, it turned her into a zombie, we stopped it, she recovered, a cookie with some weed it it was all she needed, very content and still functional.
The problem is the doctors, they're the ones who keep prescribing junky medicine. Until the blame is placed on the doctors, with consequences for their deceit, nothing will change.
I started taking Effexor in 2000 then later venlafexine when generic became available. I tried to wean myself off in June of 2024. My doctor apparently knew nothing of the problems stopping....a week into this, my husband died unexpectedly. The side effects I was experiencing were terrible. THe burning mouth was beyond bearable!!! Since I'll be 81 in a few days, I've decided it isn't worth the effort. I'll just take until I die.
After taking effexor for almost 10 years, I had to stop because of the sleepiness it caused -- I couldn't drive 5 miles without falling asleep. I was only on 75mg per day. The next smaller pill was 37.5 mg. I was told to switch to the smaller pill for a few days, and then go off completely. This was IMPOSSIBLE. The withdrawal was so bad, I couldn't even form a thought in my head. I couldn't find two neurons to rub together. I became so desperate, I went to my computer and googled "How the F do you get off effexor?" I actually found a good answer. Someone said you could open the capsules and remove one bead at a time. So I did that. The first day I removed one bead, closed the capsule back up, and swallowed it. The next day, I took another capsule, removed two beads, etc, until I was only taking one single bead per day (It's important not to swallow the beads naked-- they need to be put back inside the capsule.) This way I could taper the dose very slowly. Maybe that could work for you? I wish you good luck. The drug companies don't want us talking about this.
I find it absolutely criminal that these drugs are prescribed without education on on the difficulties or even impossibilities of coming off of them. And even more criminal that they don’t even make smaller doses for you to wean off without debilitating side effects. I, too, have been on Effexor for 10ish years, and only taken 37.5 mg almost that entire time. I finally found a provider experienced in tapering this medication after years of trying off and on to do it myself. How pathetic is it that the same people so willing to hand out these prescriptions don’t know how to help people come off them?! I have no big issue with staying on it if I knew it was really helping. But being stuck on (essentially addicted to) a pharmaceutical purely because it’s too difficult to taper or you can’t find help, is infuriating, and something I wish I was told at 21 when I was prescribed. Anyway, just here to commiserate.
I like that idea. I took a holiday from it for about 2 years and felt like I was slogging thru mud. Since being on it again I’m ok. I will try this wean (I had the same thought!) with my PCP’s blessing.
At last I agree 100% Vinay. The drug use leads to increased serotonin so the pt feels better but then when they stop the serotonin level drops through long term drug induced suppression and they feel suicidal. So they never stop. Sleeping pills the same. They work for a few days but then slowly the sleep pattern returns to where it was before starting but stopping causes even worse insomnia. It's a rort and continued government support should demand a properly run withdrawal trail over a long time period.
Guard against therapeutic nihilism in the difficult realm of the human psyche which often defies efforts to quantify and categorize . Having said that my first effort has always been to help patients find balance in work , diet , sleep and exercise . Every mind is different and the predispositions ,genetic and epigenetic are real .
I don't know if these sorts of trials are even the correct tool for this job. We're not talking about reducing blood pressure or cholesterol by a few points. We're deciding how to handle a debilitating psychiatric illness.
With respect to the trials, there are serious validity issues with the rating scales, the generalizability of the sample population, the trustworthiness of the drug companies running the studies, and the heterogeneity of the condition. Now if all of that was true but the effect was obvious and dramatic, it wouldn't be so concerning. But even after all the finagling it's just so marginal, that I'm not sure what the point is. I don't see why anyone should accept a treatment so flimsy that the patient and clinician are not 100% certain that it is actually working, and working well, *in the individual case*.
It's not so much to ask, honestly: whatever their faults, this is true of antipsychotics for delusional conditions, and of stimulants for ADHD. Many people would argue that this is true of the old MAOI drugs used for depression or severe anxiety (I'm told that they tend to either work dramatically or not at all, but usually dramatically) and I've seen that borne out in a few cases.
I'm assembling a case series on lamotrigine withdrawal. What started as a focus on withdrawal has quickly expanded into a broader examination of adverse reactions. One of the most intriguing patterns emerging from the cases is the delayed onset of problems—sometimes occurring nearly a decade after starting the medication. Even more unusual is that long-term users seem to experience a withdrawal process that mirrors the immune response seen during titration, with reports of a lupus-like syndrome. It’s highly bizarre, and I would love to have more solid data on the long-term effects.
On antidepressants—both my wife and my mother have serious psychiatric conditions, so I've witnessed nearly every kind of psychiatric emergency. Akathisia, in particular, can be breathtakingly severe and absolutely deadly. The suicidal and homicidal urges it induces are nothing like the melancholic "ideation" or contemplation. I can see why it is compared to agitated depression/ melancholia agitata to some degree but really its quite different. It begins with an unbearable need to tear their own flesh off and escalates into an overwhelming urge to tear mine off. I'm talking hospital level emergencies, not a bit of the old neurasthenia.
It all sounds a bit nuts, and certainly, there are plenty of nervous types in these withdrawal groups. But I'm starting to wonder if these nervous people are really the canaries in the coal mine, because once you start really talking to them, they have a lot of receipts for pretty strange things. I feel like a UFOlogist, and I would give anything for these issues to be brought in from the cold and subjected to proper scientific inquiry.
Why the SSRIs were never thoroughly tested against active comparators at adequate doses is a mystery to me. I will simply never understand the lack of scientific curiosity.
Then there is the heterogeneity of the groups they're tested on. There is such a stark contrast between old and new research. The old research is full of bespoke nosology—sometimes dubious—but damn it all, at least they had a point of view. At least the groups of people selected were chosen on the basis of some bold hypothesis and meticulous, if at times idiosyncratic, psychopathology. Give me that any day over a study where I'm in tears just wanting to know, "Do these people even have the same basic set of problems?" I'm reminded of Bernard Carroll's words:
"If we do not differentiate among types of depression, then whatever we can say about psychopathology or genetics or biological mechanisms sounds as though it applies to all of them. Once that attitude gets abroad, the stage is set for chaos in therapeutics and clinical pharmacology."
I’ve been taking 100-150mg of sertraline per day since 2007; I had anorexia and my doctor (or rather a nurse practitioner) threatened to hospitalize me if I didn’t take the meds.
I’m now struggling to taper off. I’ve been taking 75mg/day since September, and I’m really feeling the effects of reducing my dosage; obsessive thoughts, anxiety, insomnia. This article makes me think I’m beholden to meds for the entirety of my life if I ever want to live a life with a “normal” left of anxiety.
Humans have used substances for a variety of purposes for thousands of years without randomized trials .Sometimes only an individual can measure the subtle effects that cause them to prefer a particular one like my dark roast . Having used and prescribed fluoxetine , there are salutary effects in many but not all patients that I think would be difficult to quantify in a trial.
That's right. Humans also have no trouble describing the effects of alcohol, marijuana etc, but ask a doctor what an SSRI does in plain language and see what response you get. At this point so many people are taking them, denying the side effects is as absurd as denying that alcohol makes people tipsy. If doctors have become so bad at basic empirical observation that the general public is more aware of the dangers than maybe the job should be taken off their hands.
For ADHD, the trials literally last a month. But kids are on them for over a decade! And just this year researchers were forced to admit that, yeah, looks like long term uses increased cardiovascular morbidity… oops.
https://thefederalist.com/2025/02/21/dear-secretary-kennedy-please-stop-schools-from-needlessly-drugging-kids/
Like I like to joke, I can give you a three week trial that shows smoking is great for your health - with no pesky side effects!
Issues with over-diagnosis or medicating people too young aside, at least stimulants obviously work. Someone of an appropriate age, at least, can experience the effect, weigh their options, consider risks and unknowns, and make a decision. What's so odd about "antidepressants" is that people take them for so long without even being sure that they help. I swear, every time I ask someone on an SSRI about it,, they prevaricate, and end up somewhere along the lines of "I think so, maybe, in some ways." And they keep taking it, incurring whatever known and unknown risks all the while, because they're told that it's supposed to help, and they trust the medical establishment.
Because the marketing tells everyone how dangerous it is to stop taking them. They tried to put my elderly mother on them, it turned her into a zombie, we stopped it, she recovered, a cookie with some weed it it was all she needed, very content and still functional.
The problem is the doctors, they're the ones who keep prescribing junky medicine. Until the blame is placed on the doctors, with consequences for their deceit, nothing will change.
That’s how it finally changed with opioids. Put a few docs in prison and that shook em.
This was a good and important post Vinay.
I started taking Effexor in 2000 then later venlafexine when generic became available. I tried to wean myself off in June of 2024. My doctor apparently knew nothing of the problems stopping....a week into this, my husband died unexpectedly. The side effects I was experiencing were terrible. THe burning mouth was beyond bearable!!! Since I'll be 81 in a few days, I've decided it isn't worth the effort. I'll just take until I die.
After taking effexor for almost 10 years, I had to stop because of the sleepiness it caused -- I couldn't drive 5 miles without falling asleep. I was only on 75mg per day. The next smaller pill was 37.5 mg. I was told to switch to the smaller pill for a few days, and then go off completely. This was IMPOSSIBLE. The withdrawal was so bad, I couldn't even form a thought in my head. I couldn't find two neurons to rub together. I became so desperate, I went to my computer and googled "How the F do you get off effexor?" I actually found a good answer. Someone said you could open the capsules and remove one bead at a time. So I did that. The first day I removed one bead, closed the capsule back up, and swallowed it. The next day, I took another capsule, removed two beads, etc, until I was only taking one single bead per day (It's important not to swallow the beads naked-- they need to be put back inside the capsule.) This way I could taper the dose very slowly. Maybe that could work for you? I wish you good luck. The drug companies don't want us talking about this.
I find it absolutely criminal that these drugs are prescribed without education on on the difficulties or even impossibilities of coming off of them. And even more criminal that they don’t even make smaller doses for you to wean off without debilitating side effects. I, too, have been on Effexor for 10ish years, and only taken 37.5 mg almost that entire time. I finally found a provider experienced in tapering this medication after years of trying off and on to do it myself. How pathetic is it that the same people so willing to hand out these prescriptions don’t know how to help people come off them?! I have no big issue with staying on it if I knew it was really helping. But being stuck on (essentially addicted to) a pharmaceutical purely because it’s too difficult to taper or you can’t find help, is infuriating, and something I wish I was told at 21 when I was prescribed. Anyway, just here to commiserate.
Amen!!!
I like that idea. I took a holiday from it for about 2 years and felt like I was slogging thru mud. Since being on it again I’m ok. I will try this wean (I had the same thought!) with my PCP’s blessing.
Another thing that works for some people is switching over to Prozac and then weaning off that. It’s a bit less severe.
Try cannabis, it worked wonders for my mom, she made it to 88.
SSRIs apparently take weeks to work according to the literature, so this 8 week period is even more disturbing.
Good point!
At last I agree 100% Vinay. The drug use leads to increased serotonin so the pt feels better but then when they stop the serotonin level drops through long term drug induced suppression and they feel suicidal. So they never stop. Sleeping pills the same. They work for a few days but then slowly the sleep pattern returns to where it was before starting but stopping causes even worse insomnia. It's a rort and continued government support should demand a properly run withdrawal trail over a long time period.
Guard against therapeutic nihilism in the difficult realm of the human psyche which often defies efforts to quantify and categorize . Having said that my first effort has always been to help patients find balance in work , diet , sleep and exercise . Every mind is different and the predispositions ,genetic and epigenetic are real .
Are any of these antidepressants approved to treat depression associated with switching to Epic EHR? Asking for a friend…
bahahaha
I don't know if these sorts of trials are even the correct tool for this job. We're not talking about reducing blood pressure or cholesterol by a few points. We're deciding how to handle a debilitating psychiatric illness.
With respect to the trials, there are serious validity issues with the rating scales, the generalizability of the sample population, the trustworthiness of the drug companies running the studies, and the heterogeneity of the condition. Now if all of that was true but the effect was obvious and dramatic, it wouldn't be so concerning. But even after all the finagling it's just so marginal, that I'm not sure what the point is. I don't see why anyone should accept a treatment so flimsy that the patient and clinician are not 100% certain that it is actually working, and working well, *in the individual case*.
It's not so much to ask, honestly: whatever their faults, this is true of antipsychotics for delusional conditions, and of stimulants for ADHD. Many people would argue that this is true of the old MAOI drugs used for depression or severe anxiety (I'm told that they tend to either work dramatically or not at all, but usually dramatically) and I've seen that borne out in a few cases.
I'm assembling a case series on lamotrigine withdrawal. What started as a focus on withdrawal has quickly expanded into a broader examination of adverse reactions. One of the most intriguing patterns emerging from the cases is the delayed onset of problems—sometimes occurring nearly a decade after starting the medication. Even more unusual is that long-term users seem to experience a withdrawal process that mirrors the immune response seen during titration, with reports of a lupus-like syndrome. It’s highly bizarre, and I would love to have more solid data on the long-term effects.
On antidepressants—both my wife and my mother have serious psychiatric conditions, so I've witnessed nearly every kind of psychiatric emergency. Akathisia, in particular, can be breathtakingly severe and absolutely deadly. The suicidal and homicidal urges it induces are nothing like the melancholic "ideation" or contemplation. I can see why it is compared to agitated depression/ melancholia agitata to some degree but really its quite different. It begins with an unbearable need to tear their own flesh off and escalates into an overwhelming urge to tear mine off. I'm talking hospital level emergencies, not a bit of the old neurasthenia.
It all sounds a bit nuts, and certainly, there are plenty of nervous types in these withdrawal groups. But I'm starting to wonder if these nervous people are really the canaries in the coal mine, because once you start really talking to them, they have a lot of receipts for pretty strange things. I feel like a UFOlogist, and I would give anything for these issues to be brought in from the cold and subjected to proper scientific inquiry.
Why the SSRIs were never thoroughly tested against active comparators at adequate doses is a mystery to me. I will simply never understand the lack of scientific curiosity.
Then there is the heterogeneity of the groups they're tested on. There is such a stark contrast between old and new research. The old research is full of bespoke nosology—sometimes dubious—but damn it all, at least they had a point of view. At least the groups of people selected were chosen on the basis of some bold hypothesis and meticulous, if at times idiosyncratic, psychopathology. Give me that any day over a study where I'm in tears just wanting to know, "Do these people even have the same basic set of problems?" I'm reminded of Bernard Carroll's words:
"If we do not differentiate among types of depression, then whatever we can say about psychopathology or genetics or biological mechanisms sounds as though it applies to all of them. Once that attitude gets abroad, the stage is set for chaos in therapeutics and clinical pharmacology."
— Bernard Carroll, 1981
I’ve been taking 100-150mg of sertraline per day since 2007; I had anorexia and my doctor (or rather a nurse practitioner) threatened to hospitalize me if I didn’t take the meds.
I’m now struggling to taper off. I’ve been taking 75mg/day since September, and I’m really feeling the effects of reducing my dosage; obsessive thoughts, anxiety, insomnia. This article makes me think I’m beholden to meds for the entirety of my life if I ever want to live a life with a “normal” left of anxiety.
Try Taper Clinic. You can do this!
https://taperclinic.com/dr-josef-witt-doerring/
My first job I worked for a generic mfg, one of our projects was paroxetine.
Everyone who worked on it lost their mind.
Seriously.... strange behavior, blowouts with the boss etc.
https://pmc.ncbi.nlm.nih.gov/articles/PMC7882499/ Diet should also be considered.
Humans have used substances for a variety of purposes for thousands of years without randomized trials .Sometimes only an individual can measure the subtle effects that cause them to prefer a particular one like my dark roast . Having used and prescribed fluoxetine , there are salutary effects in many but not all patients that I think would be difficult to quantify in a trial.
That's right. Humans also have no trouble describing the effects of alcohol, marijuana etc, but ask a doctor what an SSRI does in plain language and see what response you get. At this point so many people are taking them, denying the side effects is as absurd as denying that alcohol makes people tipsy. If doctors have become so bad at basic empirical observation that the general public is more aware of the dangers than maybe the job should be taken off their hands.