Discover and read the best of Twitter Threads about #antidepressants
Most recents (24)
I have no followers so I'm sure this post will be a waste of #TwitterSpace. I have personally been blessed and cursed by the whole medical system most of my life. To start off, my father shot himself when I was 7 due to mental health issues. Back then depression and bipolar 👇🏼
was treated with drugs like Valium. He had a really low moment and boom. “Tell Roger I’m sorry” is what they told me he said. I was introduced to #oxycontin at the ripe age of 15. My first dose was 40mg and I was sick as a dog for hours. That would trigger a lifelong battle 👇🏼
With addiction to #opiods. After my mom abandoned me when I was 16 and after some time in a homeless shelter
then rehab, I began to get my life together at age 22. 23 im married and doing ok and wreck an #ATV (4-wheeler) off a mountain in #NorthCarolina and become #paralyzed👇🏼
then rehab, I began to get my life together at age 22. 23 im married and doing ok and wreck an #ATV (4-wheeler) off a mountain in #NorthCarolina and become #paralyzed👇🏼
In the @COMPASSPathway trial the 25mg vs 1mg (=placebo) #Psilocybin difference is not only significant statistically, but also clinically. On the MADRS the 'minimal important difference' is ~3-6 points (tinyurl.com/5apzv8h8), the 25mg dose meets this criteria (more context 👇)
The 'minimal important difference' sounds like a low bar to cross, but actually most #antidepressants fail to do so relative to #placebo, tinyurl.com/yut6xyhd - thank you @PloederlM for your work on this, would love to hear your take on this trial!
Lack of blinding remains an issue, but the dose-response relationship should alleviate this concern. As I argued before, #psychedelics macrodose trials most likely will always lack blinding due to obvious drug effects, it is the nature of the intervention.
🧵 Reducing #PrescribingCascades ⬇️
1/ What are #Prescribing Cascades?
1⃣ A drug is prescribed 💊
2⃣ #AdverseEvent occurs but is misinterpreted as a new medical condition ⚠️
3⃣Another drug is prescribed for the drug-induced adverse event 💊💊
ti.ubc.ca/letter138 #MedEd
1/ What are #Prescribing Cascades?
1⃣ A drug is prescribed 💊
2⃣ #AdverseEvent occurs but is misinterpreted as a new medical condition ⚠️
3⃣Another drug is prescribed for the drug-induced adverse event 💊💊
ti.ubc.ca/letter138 #MedEd
2/ Anticholinergics ➡️ cognitive dysfunction ➡️ drugs for #dementia
#Anticholinergic 💊 block acetylcholinergic neurotransmission in the brain, impairing cognition & memory
Can lead to new Rx or ↗️ acetylcholinesterase inhibitor doses
ti.ubc.ca/letter138 #MedEd #FOAMed
#Anticholinergic 💊 block acetylcholinergic neurotransmission in the brain, impairing cognition & memory
Can lead to new Rx or ↗️ acetylcholinesterase inhibitor doses
ti.ubc.ca/letter138 #MedEd #FOAMed
3/ Drugs for #dementia ➡️ incontinence ➡️ anticholinergics
Conversely, AChE-I can cause urinary or fecal incontinence, that may "cascade" to prescription of an #anticholinergic
👉🏽 full Letter here: ti.ubc.ca/letter138
#MedEd #PrescribingCascades #MedTwitter
Conversely, AChE-I can cause urinary or fecal incontinence, that may "cascade" to prescription of an #anticholinergic
👉🏽 full Letter here: ti.ubc.ca/letter138
#MedEd #PrescribingCascades #MedTwitter
Do NOT suddenly drop venlafaxine for 2 days
🧵
#mentalhealth #bipolardisorder #depression #antidepressants
🧵
#mentalhealth #bipolardisorder #depression #antidepressants
I had the wildest night today.
It started with a really bad dream - an absolutely miserable experience. It was a wild mix between reality, warped cotton-like air and an extremely vivid feeling of being a complete failure as a professional and just as a decent human being.
It started with a really bad dream - an absolutely miserable experience. It was a wild mix between reality, warped cotton-like air and an extremely vivid feeling of being a complete failure as a professional and just as a decent human being.
All the wrong things I did were causing overwhelming pain. Sometimes I almost woke up and saw my real room through my closed eyelids.
Does blinding work in #antidepressant #RCT? Recently there were 2 papers on this topic with opposite conclusions. A🧵on #blinding and why #robustness #DataAnalytics may lead to better #science
The two papers are tinyurl.com/2p9atk4t (p1; by @AmeliaJScott, @LSharpeUSYD and @BenColagiuri) and tinyurl.com/mtmtx7m3 (p2; by @Toshi_FRKW and colleagues).
Their two conclusions:
-p1: "meta-analysis suggested that blinding was unsuccessful among participants and investigators."
-p2: "patients or assessors were unlikely to judge which treatment the patients were on."
-p1: "meta-analysis suggested that blinding was unsuccessful among participants and investigators."
-p2: "patients or assessors were unlikely to judge which treatment the patients were on."
Depression is probably not caused by a chemical imbalance in the brain – new study
theconversation.com/depression-is-…
A few have asked me for my thoughts on this, so here's a thread
But basically; I agree. So much so, I've been saying it in most of my writing for 5+ years now
/1
theconversation.com/depression-is-…
A few have asked me for my thoughts on this, so here's a thread
But basically; I agree. So much so, I've been saying it in most of my writing for 5+ years now
/1
You can see where the 'depression is due to a chemical imbalance in the brain' theory came from. Antidepressants were discovered (by accident), and they caused an increase in certain chemicals in the brain, reducing depressive symptoms. Ergo, depression = low chemicals
/2
/2
Except since then, ample evidence has accumulated to show that depression is far more complex a thing than can be explained by 'not enough brain chemicals', and there are a lot more theories and models out there now that try to explain it more thoroughly
/3
/3
@_pem_pem Why this is nonsensical: "Jeffrey Lieberman, a professor of #psychiatry at Columbia University...“The problems that they’ve been criticized for have more to do [with] the way they’re used by doctors & the heterogeneity of the condition that they’re indicated for.” /1
@_pem_pem What Lieberman is saying is that if #antidepressants were prescribed to a population for which they are known to work well, they would have a much better track record. This is true, because it is a tautology. /2
@_pem_pem The reasoning is circular, if #antidepressants were prescribed for those people for whom the drugs worked, they would work. /3
Monoamine hypothesis aka "chemical imbalance" & other synonyms, arose circa 1965, but was known to only #psychiatrists, who were unhappily prescribing TCAs and MAOIs to a niche market. Patients hated the many adverse effects of the drugs. /1
Until mid-1990s, monoamine hypothesis (aka "chemical imbalance", "serotonin deficiency" etc.) was not circulating as a "folk model", not in medicine or in the general public. 1990 is ~center of this chart, when #psychiatrists, many paid by pharma, started churning out papers. /2
As a meme or "folk model", monoamine hypothesis (aka "chemical imbalance", "serotonin deficiency", "neurohormone imbalance", etc.) was diligently planted by dozens of #psychiatrists -- not a few -- many paid by pharma. Not something that arose organically out of nowhere. /3
What’s the deal w/ people in #pain using #opioids? (Read entire thread.) We are not “drug addicts.” We are physically DEPENDENT on our meds, which we need to function w/out pain (i.e, to function). Physical dependence occurs on heart meds & #antidepressants too. #ThisIsUs
And I am not trying to stigmatize #addiction here. But rly, let’s talk; chronic pain patients (#CPPs) have been forced to KILL themselves due to untreated pain, due to bad #policy, due to the #stigma, foolishness & financial incentives of others. This has a name: opiophobia…
If you took me off ALL opioids, I (like most #painpatients) would go through ugly opioid #withdrawals (and make sure to poop/puke on YOU for causing them)! 😂
And even after months of “abstaining,” and withdrawals disappearing, I would be “clean” in the eyes of the world, but…
And even after months of “abstaining,” and withdrawals disappearing, I would be “clean” in the eyes of the world, but…
Lewis, et al. respond to letters to the NEJM editor, demonstrating they do not understand basic concepts of #antidepressant withdrawal @ANTLERtrial
Maintenance or Discontinuation of Antidepressants in Primary Care | NEJM nejm.org/doi/full/10.10…
Maintenance or Discontinuation of Antidepressants in Primary Care | NEJM nejm.org/doi/full/10.10…
@ANTLERtrial Some in non-discontinuation group were taking their drugs inconsistently. Lewis, et al. missed potential withdrawal symptoms in that group: "but participants reported some new & worsening symptoms while continuing to take #antidepressants"
@ANTLERtrial Lewis, et al. claim "an increase in depressive symptoms might lead to an increase in “new & worsening” symptoms that are recorded as withdrawal symptoms" EXCEPT they also recorded physical withdrawal symptoms, failed to identify who had both, & did not exclude them from "relapse"
@sanilrege @markhoro @SenadHasanagic1 Not at all, Sanil. Among my site members, many people come off #antidepressants & other drugs with slight or no withdrawal symptoms except an emotional anesthesia, which they may describe as depression, anhedonia, various kinds of malaise, even "relapse" but.... /1
@sanilrege @markhoro @SenadHasanagic1 ....it's a "relapse" unlike anything they've experienced before. While they may use #psychiatry's vocabulary, because that's all they've got, this emotional anesthesia is actually a result of long-term psychotropic exposure, not "relapse"..../2
@sanilrege @markhoro @SenadHasanagic1 Post-drug emotional anesthesia is well known among those who have gone off psychotropics classified as addictive & considered a feature of those protracted withdrawal syndromes. There is no reason to think chronic #psychiatric psychotropics are exempt..../3
With all due respect to the fine @awaisaftab, these are the varieties of #antidepressant withdrawal syndrome:
1) WS with only physical, no emotional symptoms
2) WS with both physical & emotional symptoms
3) WS with only emotional symptoms
4) WS manifested as emotional anesthesia
1) WS with only physical, no emotional symptoms
2) WS with both physical & emotional symptoms
3) WS with only emotional symptoms
4) WS manifested as emotional anesthesia
@awaisaftab Of the above, types 1 & 2 are WS, not "relapse", even if "depression" is present. Emotions such as those that compose "depression" do not exist apart from experience. Emotional reaction to feeling neurobiologically out of control should not be diagnosed as "depression".
@awaisaftab Type 3 may include the waves of intense anxiety, fear, & "black holes" characteristic of WS. Characterized by intense sensations with interludes of relative calm. Typically, these very gradually abate over months.
An important review which finds that we are overprescribing potentially harmful drugs and that people are far too often left on drugs with no proper review.
theguardian.com/society/2021/s…, via @guardian
theguardian.com/society/2021/s…, via @guardian
If you are called in for a review of your #antidepressants, #antipsychotics, #benzodiazepines or #opioid pain meds, it is very important that your prescriber works with you to reduce slowly and safely. Mishandled withdrawal can have lifelong consequences. @sajidjavid
Don’t assume that standard withdrawal advice is safe, it often isn’t. Learn from others experiences, use liquid forms or tapering strips to allow your body chance to acclimate to the change, especially at low doses. If you feel unwell after reducing, it’s withdrawal not relapse.
REFLECTIONS ON FORGIVENESS // FORGIVENESS OF SELF // NO CONDEMNATION IN CHRIST JESUS // ROMANS 8:1
Happy Saturday, beloved family! I hope your weekend has been off to an excellent start! 🌅☀️❤️
Happy Saturday, beloved family! I hope your weekend has been off to an excellent start! 🌅☀️❤️
Our focus text for today, comes to us from Romans chapter 8, which focuses on life in the Spirit.
In verse 1, we have THE blessed assurance from God, that there is indeed NO CONDEMNATION FOR THOSE WHO ARE IN CHRIST JESUS.
In verse 1, we have THE blessed assurance from God, that there is indeed NO CONDEMNATION FOR THOSE WHO ARE IN CHRIST JESUS.
To be “in Christ Jesus” means that He dwells within us, & us within Him. We are ONE.
So, by sending His own son, Jesus Christ, to die for our sins, God made sure that there is NO CONDEMNATION for us.
So, by sending His own son, Jesus Christ, to die for our sins, God made sure that there is NO CONDEMNATION for us.
REFLECTIONS ON FORGIVENESS // FORGIVENESS OF SELF // GOD IS GREATER THAN OUR HEART // 1 JOHN 3:20
Blessed Friyay morning to you all, beloved children of God! 🌅☀️❤️
Blessed Friyay morning to you all, beloved children of God! 🌅☀️❤️
Our focus today will be within 1st John , chapter 3. This chapter deals EXCLUSIVELY with our identities as children of God. We are encouraged to strive to be a people of ethical integrity & to live a life that is reflective of our spiritual identity.
In verse 20, we are reminded of the truth that God is actually GREATER THAN OUR HEART. People of God, this is a quite profound assertion! 🤯🤯🤯
Welcoming Prof Hamish McAllister-Williams - @HamishMcAW to the virtual stage this morning to talk about: When depression is proving difficult to treat #RCPsychIC #Depression
Standard is 6-week antidepressant, however sometimes 8-week trial before classed as failed. Psychotherapy is often not taken into account
#RCPsychIC #Depression
#RCPsychIC #Depression
More an more patients are being treated for mild/ moderate depression with #antidepressants in general practice, despite there being very poor evidence for efficacy. In my experience, some people experience a transient benefit between 4&12 weeks (likely placebo mediated) &
This transient (non specific) effect of taking antidepressants gradually wears off. Patients present back to their GP with similar symptoms or a variant of the same symptoms & most GPS simply up the dose, meanwhile none or little of the psychosocial distress is being addressed.
Many ppl then become psychologically & physically dependent on higher doses of antidepressants with risk of side effects & withdrawal effects accumulating. Often a significant % of these patients barely meet the criteria for what we call depression & even if they do...
#Antidepressants seem effective in the clinic but not in controlled studies. Why? Let’s consider all possibilities. @PeterDKramer @AllenFrancesMD @DrHowardLiu @DalackMd @blackdoginst @NAMICommunicate @Got_Anxiety @EikoFried @PsychTimes @matthewckeller @RiadhAbed1 @APAPsychiatric
Most of us who have prescribed antidepressants for thousands of patients have heard hundreds of them report transformed lives. “It is as if I walked out of a dark room into sunlight” “All of a sudden I can experience pleasure again”
But perhaps the effectiveness is an illusion. The improvement of patients taking #placebo is barely better than that for those taking antidepressants.
Here are 10 reasons why antidepressants
->Could seem effective when they are not, or
->Could seem ineffective when they are
Here are 10 reasons why antidepressants
->Could seem effective when they are not, or
->Could seem ineffective when they are
@sash_andy @samwoolfe @lisa63artist @jonathanstea @bmj_latest @hrw @C4Dispatches @gmcuk Sam, please note 3 Blind Psychs whining that there are real, serious flaws that need attention in #psychiatry but they are prevented from addressing them because dings from "anti-psychiatry" patients (on Twitter, no less) hurt their feelings. What does this say about the doctors?
@sash_andy @samwoolfe @lisa63artist @jonathanstea @bmj_latest @hrw @C4Dispatches @gmcuk The epithet "anti-psychiatry" directed at patients is nothing but ad hominem from clinicians who have no intention of bringing patients into the discussions of improving clinical care. (This is #psychiatry we're talking about, the science of human emotion.)
@sash_andy @samwoolfe @lisa63artist @jonathanstea @bmj_latest @hrw @C4Dispatches @gmcuk The argument that people are dissuaded from necessary #psychiatric treatment by purported "anti-psychiatry" is intellectually dishonest on so many levels.
1) #Psychiatric prescribers report being swamped by demand for their services; they plead for additional prescribers. /1
1) #Psychiatric prescribers report being swamped by demand for their services; they plead for additional prescribers. /1
@awaisaftab Hello, Awais. I will attempt to answer your excellent questions. @HengartnerMP may wish to add his perspective as well. /1
@awaisaftab @HengartnerMP Re your #2: This was a retrospective study. Duration & symptom criteria from Chouinard & Chouinard, 2015 were used in selecting subject population. Other of C&C's criteria (C) were addressed in analysis & discussion. The paper only weakly corroborates C&C's criteria (C). /2
@awaisaftab @HengartnerMP "Greater severity of illness": We relied upon subjects reporting symptoms were qualitatively different than prior to treatment. It is impossible to quantify "greater severity", the symptoms being so various & most unlike original condition. They certainly were distressing. /3
@DepressionLab @tkaiser_science @Martin_Ploederl @HengartnerMP @CVolkmannMD @f_hieronymus My theory, published nowhere but Twitter, is that #antidepressants are psychotropics, & any psychotropic might be marginally effective for "depression" in some population, at very similar slim rates of efficacy.
Efficacy determined by subjective effect on subjective sensation.
Efficacy determined by subjective effect on subjective sensation.
@DepressionLab @tkaiser_science @Martin_Ploederl @HengartnerMP @CVolkmannMD @f_hieronymus Categorization of a drug as "antidepressant" is, of course, arbitrary. Some say benzodiazepines are antidepressants. Antipsychotics are promoted as antidepressant. Amphetamines & buprenorphine have been floated as antidepressant. Some like marijuana.
Any psychotropic will do.
Any psychotropic will do.
@DepressionLab @tkaiser_science @Martin_Ploederl @HengartnerMP @CVolkmannMD @f_hieronymus So search for the reason "antidepressants" are "antidepressant" is doomed. Ultimately, you'd find any psychotropic causes neurobiological adaptation, that's the definition of a psychotropic, & some humans will subjectively interpret the effect as antidepressant. Others won't.
@benzosarebad @wendyburn @_eleven13_ @BubblesTapering @rcpsych There are a number of studies exploring both physician & patient attitudes towards going off #antidepressants.
Lack of physician confidence in tapering plays a large role. Their patients don't trust their knowledge, either, & rightly so. This is a subject nobody wants to unpack.
Lack of physician confidence in tapering plays a large role. Their patients don't trust their knowledge, either, & rightly so. This is a subject nobody wants to unpack.
@benzosarebad @wendyburn @_eleven13_ @BubblesTapering @rcpsych McCabe, J., Wilcock, M., Atkinson, K., Laugharne, R., & Shankar, R. (2020). General practitioners’ and psychiatrists’ attitudes towards antidepressant withdrawal. BJPsych Open, 6(4). doi.org/10.1192/bjo.20…
@benzosarebad @wendyburn @_eleven13_ @BubblesTapering @rcpsych McCabe, J., Wilcock, M., Atkinson, K., Laugharne, R., & Shankar, R. (2020). General practitioners’ and psychiatrists’ attitudes towards antidepressant withdrawal. BJPsych Open, 6(4). doi.org/10.1192/bjo.20…
@DrFulli @lapsyrevoltee I do agree, Dr. Fulli. Response to the drug most certainly is not a diagnosis, & those physicians who conclude an adverse reaction to an #antidepressant is diagnostic of bipolar disorder not only have poor pharmacology knowledge but poor logical skills as well. /1
@DrFulli @lapsyrevoltee Even people with no pre-existing #psychiatric symptoms may have a severe adverse reaction to an #antidepressant or any other psychotropic.
Conversely, any psychotropic might relieve "depression" in someone, eg. amphetamines or opiates. This is another law of psychotropics. /2
Conversely, any psychotropic might relieve "depression" in someone, eg. amphetamines or opiates. This is another law of psychotropics. /2
@DrFulli @lapsyrevoltee For what it's worth, I have a collection of case studies where people had immediate severe adverse reactions to #antidepressants & even though they quit within a handful of doses, suffered symptoms identical to post-acute withdrawal syndrome #PAWS for months or years. /3
@sandysteingard @awaisaftab Clarifying: Across psychotropics, withdrawal syndrome is not "time-bound" except by arbitrary distinction between acute & post-acute withdrawal syndrome #PAWS, which can last years & is often conflated with "relapse". Lerner & Klein, M. (2019). doi.org/10.1093/brainc…
@sandysteingard @awaisaftab Presentation from a Merck scientist that lays out tolerance, withdrawal, protracted withdrawal #PAWS: Markgraf, C. G. (2012, October). Introduction to Physical Dependence and Withdrawal. 12th Annual Meeting. Safety Pharmacology Society, Phoenix, Arizona. safetypharmacology.org/AM2012/am12pre…
@sandysteingard @awaisaftab Only wishful thinking & fixation on dangers of addiction have given #antidepressants, etc. a free pass from psychotropic adaptation, dependence, tolerance, withdrawal, & #PAWS. With very few exceptions, all regularly taken psychotropics cause withdrawal & #PAWS.
