Before You Quit Antidepressants ...

NY Times ^ | January 12, 2010 | RICHARD A. FRIEDMAN, M.D.

[neverdem]

Last week, The Journal of the American Medical Association published a study questioning the effectiveness of antidepressant drugs. The drugs are useful in cases of severe depression, it said. But for most patients, those with mild to moderate cases, the most commonly used antidepressants are generally no better than a placebo.

For the millions of people who take these drugs, and the doctors who prescribe them, this provocative claim had to be confusing, if not alarming. It contradicted literally hundreds of well-designed trials, not to mention considerable clinical experience, showing antidepressants to be effective for a wide array of depressed patients.

But on close inspection, the new study does not stand up to that mountain of earlier evidence. To understand why, it helps to look at the way it was conducted.

The study is a so-called meta-analysis — not a fresh clinical trial, but a combined analysis of previous studies. A common reason for doing this kind of analysis is to discover potential drug effects that might have been missed in smaller studies. By aggregating the data from many studies, researchers gain the statistical power to detect broad patterns that may not have been evident before.

But meta-analyses can be tricky. First, they are only as good as the smaller studies they analyze. And when there are hundreds of studies out there, how to decide which ones to include?

For the recent analysis in the journal, the authors identified 23 studies (out of several hundred clinical trials) that met their criteria for inclusion. Of those 23, they could get access to data on only 6, with a total of 718 subjects. Three trials tested the antidepressant Paxil (a selective serotonin reuptake inhibitor, in the same class as Prozac) and three used an older drug, imipramine, in the class known as...

[goat granny]

You obiviously have never been in that deep black hole called clinical depression...your lucky....

[kmiller1k]

Pristiq is the active metabolite of Effexor XR. EXR had to be metabolized by the liver to be made in to the active ingredient to have any effect on the serotonin and norepinephrine reuptake in the brain. Pristiq has few side effects and a longer half life than EXR—it is a better, easier alternative to EXR. You will do well on this medication.

Also if you are taking any other medications, since Pristiq does not use the CYP 2D6 pathway in the liver for metabolism, so it has a very low chance of causing any interference with the other drugs. Some anti-depressants can cause other drugs to have more or less of the drug in the blood stream.

SNRI’s have a weight neutral profile unlike SSRI’s which can cause the patient to put on the pounds.

[cva66snipe]

You can get serotonin syndrome from SSRIs when starting them or increasing the dose and serotonin withdrawal syndrome when you try to stop them. Anyone tryong to stop them should be switched to Prozac as the dose is reduced. Prozac, aka fluoxetine, has the longest halflife of the SSRIs.

IIRC it takes 30 days for SSRI's to completely leave the bloodstream once therapeutic levels are reached. Serotonin syndrome is nothing to mess around with and can be deadly. It's basically the same result as someone on LSD and this is not an exaggeration as I have seen it for myself.

Anyone taking antidepressants of any type need to understand what Serotonin Syndrome is and as well as the persons family. Do not expect a doctor to know what it is as many don't and mistake it for Acute Psychosis and try for committal and more Serotonin Migration causing drugs.

If a person wants off of them inform your doctor first and taper off gradually but not cold turkey. Serotonin is a digestive promoting chemical with 98% contained in the stomach. When migration occurs it goes to the brain. That triggers Serotonin Syndrome which among other things causes halucinations. Your spouse may think you are the devil for example. It's serious too because the person may respond to that danger the way they ares seeing it in their halucinations.

Among other not so desirable things SSRI's may cause is bladder blockage. If this occurs go to an emergency room immediately if not sooner. This is highly dangerous and will trigger the onset of Dysreflexia which is shock followed likely by a stroke and if not treated death. I am not a doctor but I know this can happen.

Next is this. If you have sensory processing damage such as Inner Ear issues you are likely more prone to Serotonin Syndrome as you will be treating the wrong primary cause of depression or anxiety which is the Vestibular disorder itself. Again many doctors do not recognize this I speak from personal experiences. A damaged sensory processing system such as an Inner Ear disorder does not need to be overtaxed by enhanced sensory impulses. The opposite is true as sensory function needs to be toned down to a level you can function at.

Something as simple as an Inner Ear infection can cause depression, anxiety, and a bad startle reaction/and/or/intolerance's to certain noises.

For mild to moderate depression I would highly recommend a good physical and hopefully the doctor will ask extensive medical history questions such as hey fever, tubes in ears at some point etc. Ruling out physical causes seeking the help of a Therapist is money very well spent. They are a step below psychologist and can help a person work to find the source of depression etc.

[BenKenobi]

Was on Celexa for awhile, but I’m off it now. I found it helpful to wean off in the summer, as again, plenty of light.

Clinical depression is not fun and I was depressed for years until I finally got into treatment.

For the folks saying bad stuff happens, etc, that’s fine, but you’ve not really experienced depression, so you don’t know what it’s like to deal with it. It’s not that bad stuff happens and you feel down for awhile, you feel bad regardless of what happens, good or bad.

[Jeff Chandler]

I know people for whom antidepressants are a god-send.

Me? I don’t get depression. I’m a carrier.

[grame]

that bladder blockage thing is frightening. I only took one pill, and no more.

[cva66snipe]

Don't get me wrong if it works by all means take it. You're right Clinical Depression is no fun and it usually requires medication. What they usually don't tell you is there are other types of meds then AD’s. If someone had problems with antidepressants then Benzopines might possibly work but doctors who write SSRI’s like candy freak at the very mention of these type of medications.

I am 16 year user of Xanax myself. But my doctor knows how to write the script and the right strength and times per day. Many doctors prescribe too much in one dose too few times a day. For example 2Mg twice a day is a disaster in the making as it will not be in your system 24/7. You'll crash. but a half a Mg or .5mg 4 times a day or for some even three times will do wonders. With lower dosages you don't get the complications except dependency. My wife has used it 25 years also. Both of us have neurological conditions that make antidepressant use a danger to take.

With her she went into Serotonin Syndrome twice and the doctors didn't catch it. Thanks to some prayer, some discussions {sometimes heated with other Freepers prior to that LOL} I found the answer as to why she was halucinating and what they called was in a severe acute psychotic state. They should have had a clue when she went about 48 hours without a SSRI and became normal. Going unconscious with pupils unresponsive should have been a second clue to them as mental disorders as a rule do not cause these type of symptoms.

I post this information to educate people to the possible and by no means is it a probable risk. But it can happen and knowing what to day can save a loved ones life or maybe your own. I would never advise anyone to go off these type of meds without consulting their doctor. If I go off mine cold turkey I could go into convulsions. I am dependent on the medication. The alternative would be living in my home and not be able to do even the basic trip to a store for myself.

I have some severe sensory processing problems in what I hear and see and how the brain interpits and responds to it. Much of the damage is Inner Ear related. It produces myoclonic seizures among other things like agiation and depression if I don't keep it in check. All I know about my disorder I hade to learn myself and it came through Vestibular disorder venues. Mental health is still a decade or two behind medical science in catching up on this one and recognizing it.

[cva66snipe]

that bladder blockage thing is frightening. I only took one pill, and no more.

LOL I can't determine your gender but if you are female worry no more. It happens to males. It doesn't suddenly happen or didn't with me. It crept up on me over a day or three. I am trained due to my wifes quadriplegia to recognize Dysreflexia and I darn near missed it in myself. I thought it was part of what was wrong with me and this was very early on when I knew nothing about my disorder.

Any bladder difficulities while taking SSRI's a person should call their doctor ASAP. The treatment is usually wearing a cathater a few days.

[Revelation 911]

http://www.ottlite.com/ - here ya go Randy - many different stores carry them - a little pricey but worth it and well made....Im looking at one right now

[Mr. Blonde]

What did I say, some people genuinely need these prescriptions. That can be true, and they also be over-prescribed to others as well.

[goat granny]

You are right, anything can be abused...most anti-depressants do not do anything for you if you in fact are not depressed..Not all anti depressents work on all people. It is somewhat of an art to find the right medication for the right patient..

[grame]

Yep, I’m female and have metabolism issues. Only took one pill because it made me very jittery and unable to sleep. 36 hours later my bladder refused to work. Slowly resolved itself over 12 hours.

[cva66snipe]

Generally it's men it does that way or so I was told in the Emergency Room. The nurse asked what meds I was on and I said Paxil. He said yep that will do it. The irony of it all was I had several dozen catheters the size he used at home belonging to my wife.

There's likely meds you can take but to be honest in your case I would consult a Neurologist or at least an Internal Medicine Specialist. I sure would not let a shrink dispense it to me. In general I don't trust psychiatrist for treating such disorders as clinical depression or PTSD either. For more severe issues usually they seem to have their act together but on these issues it's here have a pill see ya in three months. They only treat symptoms and in general are apathetic or oblivious as to finding the cause.

I know what you mean by the symptoms though and yes despite what shrinks say one pill can do it. Antidepressants wired me out too. I had to go the tranquilizer route for relief. IMO a much safer way as generally those type of medications are short bloodstream life lasting less than 12 hours usually.

Benzapines class medications such as Atavan, Valium, Xanax, are actually counter agents or the medication protocol used to try and limit or reverse Serotonin Syndrome once it begins.

[cva66snipe]

One more word of caution for anyone on any type antidepressant. Do not for any reason no matter how bad you feel take any unprescribed over the counter cold medications. This mixed with antidepressants is a known common trigger to developing Serotonin Syndrome.