Posted by SLS on March 29, 2009, at 10:34:27
In reply to Re: Stopping w. AD or not? I am feeling better? » SLS, posted by 49er on March 28, 2009, at 17:23:42
> <<I believe that to allow someone to relapse unnecessarily by discontinuing an antidepressant prematurely, the risk of severe depression and suicide is too high to justify.>>
> I think that assumption is based on the fact that meds are tapered way too quickly. I would love to see if that would hold up if people were tapered slowly at the rate I suggest. But psychiatrists will never do that.Well, depending on the length of time it takes to taper, you are still exposing someone to the drug for an extended period of time.
> <<There are many studies demonstrating the need for 6-9 months of treatment after remission is achieved to prevent relapse. This is for someone's first depressive episode only. For the second and third episodes, 18 months is favored. For chronic of recurrent depressions, treatment may need to be indefinite.>>
> Again, that is based on the fact that withdrawal symptoms are confused as a return if the illness.
This does happen. However, I don't believe that the majority of people whom develop depression and anxiety when discontinuing an antidepressant are suffering from a withdrawal syndrome. Unfortunately, I doubt we could find a scientific investigation of this issue. If in doubt, and with the patient's consent, I guess one can opt to persist through a discontinuation protocol despite the emergence of these symptoms.
How do you propose to tell the difference between depressive withdrawal symptoms and true relapse? The fact is, many people have discontinued antidepressants rapidly and remained in remission for a few months before encountering a relapse. The time in between is not one of depression or anxiety. No withdrawal symptoms persisted.
> That isn't just 49er's opinion as Joseph Glenmullen, suggests that.
Unfortunately, what he cannot do is quantify the percentage of people who discontinue antidepressants whom develop depression as a symptom of withdrawal. It is obvious that not everyone does.
> <<I hope that you continue to feel better with your discontinuation of antidepressants. If I am not mistaken, though, you have been on antidepressants for longer than 9 months? I don't see that you can yet use yourself as an example of your contention.>>
> And you can't validly assume you are right either as I feel those studies are based on false premises. And I am not the only one who is succeeding after being on meds for a long time which is 10 plus years.You are not an example of someone who has been on an antidepressant for a limited number of weeks or months to be able to deduce the rate of relapse after such a short course of treatment.
> <<Most relapses occur during the first 4 months after discontinuation, This often is an indication that longer periods of treatment are necessary. In other words, it might be premature to pass judgment on one's need for continued treatment based on how one feels immediately after discontinuation, especially since some people experience a rebound improvement just for lowering the dosage of the drug they are tapering or discontinuing.>>> Again, your premise is based on tapering schedules that are way too fast. Let me give you an example Scott.
And you are basing and comparing the success of the tapering schedules you suggest base upon what exactly?
> Laurie Yorke, is an RN who runs the Paxil Progress Boards. Her son, Ryan, became psychotic due to a way too fast tapering schedule on Paxil.What was he being treated for?
> You would have assumed he needed to be on meds for life.
I don't know what I would have done. It would depend on the length time and patterns spent in a state of illness previous to treatment. Treatment failures must also be taken into consideration. How long had he been taking Paxil before discontinuing it? Either way, it is guesswork at best based upon clinical experience and the studies revealing time until relapse for the several scenarios tested. What was the motivation for discontinuing Paxil in this case?
> Well, 5 years post being off Paxil, he is doing great. Has no signs of mental illness whatsoever. There are plenty of Ryans but unfortunately, they don't have advocates like an RN.For each Ryan out there, there might be many more whose treatments were indeed optimal and have also led lives free of mental illness after discontinuation. Although trite, I believe that it is true that the great majority of people going out of their way to write on the Internet regarding the treatment of mental illness do so as the result of an adverse experience rather than a pleasant one.
- Scott
poster:SLS
thread:887227
URL: http://www.dr-bob.org/babble/20090322/msgs/887577.html