FWIW, I haven’t seen protracted withdrawal myself either. Although I have seen some cases of severe acute withdrawal (Venlafaxine, usually), or acute destabilization post-discontinuation, or cases where taper just took a long time.
How many patients have you tapered off of antidepressants who had been on them for years? And how many of your patients were lost to follow up? While there is clearly a tension between the higher rates reported in some of the earlier studies and clinical experience, I also feel like clinicians tend to mentally clump together all patients they’ve seen get off antidepressants, rather than actually segmenting by those who are vs aren’t Long term users.
I think it would be interesting to ask patients who do report protracted withdrawals what their interactions with clinicians were like. Did many of them go through this on their own and their most recent psychiatrist wasn’t even aware? Did their psychiatrist prove unhelpful and the patient then resorted to patient-led resources online? I could see many of them being managed by their PCP at the point the patient felt well enough to try getting off their antidepressant, and maybe the PCP was ill informed about withdrawals? In that case their last psychiatrist may also never know what the patient went through.
You did not mention the most profound limitation of the study, that 12 of the 17 authors of the study had $ ties to Big Pharma. There is a lengthy literature documenting that $ ties to industry strongly distort the conclusions the researchers produce. Do you believe doctors who are paid by Big Tobacco? Or climate scientists paid by oil companies? Neither do we. If you are going to report accurately, report all the facts around this study.
They may as well test the cheese composition of the moon or the life-extending effects of cliff jumping. You don’t need this kind of method to demonstrate something you can observe for yourself ad nauseam. It is neither a marginal nor modest effect size and so failure to detect it is simply a scientific embarrassment, a telescope that can't even locate the sun.
It’s lies, damn lies, and statistics.
And I say that as someone who does think a lot of people exaggerate withdrawals, and that most tapering protocols online are nonsense. I’m also a big fan of drug therapy.
But we’ve turned the observation of drug effects into something obfuscatory and painfully scholastic. If you want to know what they do, "suck it and see." There’s no controversy over the reality of alcohol intoxication or withdrawal, why? Because the effects of alcohol and its accompanying withdrawal syndrome are neither marginal nor modest. Yet somehow, the more “rigorous” we try to be with psychiatric drugs, the less the findings match plain observable reality.
I don't think it’s any coincidence that every day I go to work and see the drug effects early researchers described. People pine over the heyday of biological psychiatry, and they should, like Kraepelin's ideas, you just see it them out over and over. People get well on lithium. People get well on ECT. Antipsychotics are pretty good, but they lack the same je ne sais quoi that lithium has. It’s just a reality that you're constantly confronted by as you go about your day talking to people.
It’s no different with drug withdrawals. Some people bellyache a little too much, but for the most part, withdrawals are clearly quite common and sometimes pretty jolly bad.
I would say a bigger issue is worsening under treatment, that is, people getting worse on a drug and it going unrecognised. This often seems to happen when people or their family push the doctor to give them something to help the immediate complaint, are happy with the result, but the later deterioration goes unrecognised.
I was thinking about all this, how we arrive at truth, a few weeks ago. Then I heard the CIA had decided COVID came from a lab. Why? They phoned their man in China.
I think we should go back to the careful case observations of the heyday of biological psychiatry. To me it’s simply evident that early research was a closer match to reality. I have no interest in arguing about that any more than I do the percentage of cheese in the moon.
Great write-up
200+ different patients a week
Treated over 4 000 different patients
Never seen a "protracted withdrawal" lasting for years
I m not saying it doesnt exist, but I've never seen it
Will keep looking
Some of these reported protracted withdrawal cases may be, I suspect, functional neurological disorder of some sort.
FWIW, I haven’t seen protracted withdrawal myself either. Although I have seen some cases of severe acute withdrawal (Venlafaxine, usually), or acute destabilization post-discontinuation, or cases where taper just took a long time.
How many patients have you tapered off of antidepressants who had been on them for years? And how many of your patients were lost to follow up? While there is clearly a tension between the higher rates reported in some of the earlier studies and clinical experience, I also feel like clinicians tend to mentally clump together all patients they’ve seen get off antidepressants, rather than actually segmenting by those who are vs aren’t Long term users.
I think it would be interesting to ask patients who do report protracted withdrawals what their interactions with clinicians were like. Did many of them go through this on their own and their most recent psychiatrist wasn’t even aware? Did their psychiatrist prove unhelpful and the patient then resorted to patient-led resources online? I could see many of them being managed by their PCP at the point the patient felt well enough to try getting off their antidepressant, and maybe the PCP was ill informed about withdrawals? In that case their last psychiatrist may also never know what the patient went through.
You did not mention the most profound limitation of the study, that 12 of the 17 authors of the study had $ ties to Big Pharma. There is a lengthy literature documenting that $ ties to industry strongly distort the conclusions the researchers produce. Do you believe doctors who are paid by Big Tobacco? Or climate scientists paid by oil companies? Neither do we. If you are going to report accurately, report all the facts around this study.
They may as well test the cheese composition of the moon or the life-extending effects of cliff jumping. You don’t need this kind of method to demonstrate something you can observe for yourself ad nauseam. It is neither a marginal nor modest effect size and so failure to detect it is simply a scientific embarrassment, a telescope that can't even locate the sun.
It’s lies, damn lies, and statistics.
And I say that as someone who does think a lot of people exaggerate withdrawals, and that most tapering protocols online are nonsense. I’m also a big fan of drug therapy.
But we’ve turned the observation of drug effects into something obfuscatory and painfully scholastic. If you want to know what they do, "suck it and see." There’s no controversy over the reality of alcohol intoxication or withdrawal, why? Because the effects of alcohol and its accompanying withdrawal syndrome are neither marginal nor modest. Yet somehow, the more “rigorous” we try to be with psychiatric drugs, the less the findings match plain observable reality.
I don't think it’s any coincidence that every day I go to work and see the drug effects early researchers described. People pine over the heyday of biological psychiatry, and they should, like Kraepelin's ideas, you just see it them out over and over. People get well on lithium. People get well on ECT. Antipsychotics are pretty good, but they lack the same je ne sais quoi that lithium has. It’s just a reality that you're constantly confronted by as you go about your day talking to people.
It’s no different with drug withdrawals. Some people bellyache a little too much, but for the most part, withdrawals are clearly quite common and sometimes pretty jolly bad.
I would say a bigger issue is worsening under treatment, that is, people getting worse on a drug and it going unrecognised. This often seems to happen when people or their family push the doctor to give them something to help the immediate complaint, are happy with the result, but the later deterioration goes unrecognised.
I was thinking about all this, how we arrive at truth, a few weeks ago. Then I heard the CIA had decided COVID came from a lab. Why? They phoned their man in China.
I think we should go back to the careful case observations of the heyday of biological psychiatry. To me it’s simply evident that early research was a closer match to reality. I have no interest in arguing about that any more than I do the percentage of cheese in the moon.