antidepressants – Freud & Fashion

Antidepressant Awareness

I have a love/hate relationship with antidepressants, specifically selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs). Basically, I love them when they actually help my patients, but hate the intolerable withdrawal that may occur when taking patients off of them. If you’ve ever contemplated abrupt discontinuation of an antidepressant, consult your doctor before stopping them altogether, particularly if you’ve taken them for at least six weeks.

In my practice, I never hesitate to prescribe antidepressants when indicated, however, I always warn my patients of potential withdrawal effects that may occur if the medication was to be discontinued in the future. Informed consent and patient education should be given before a physician prescribes any new medication. Over the course of my training and practice in psychiatry, my observations of the negative impact of weaning off antidepressants shocked me, mostly because I never learned about the phenomena in textbooks the way that I learned about other withdrawal syndromes (such as alcohol, opioid, methamphetamine, etc). From flu-like symptoms to acute somatic pain symptoms — I witnessed a full range of issues (see below for a more extensive list). The unfortunate thing is that patients often internalize the symptoms and believe there’s something wrong with them, though typically the only factor that changed since the last visit was lowering the antidepressant dose.

A telling statement was hearing a patient say that getting off an antidepressant was worse than getting off heroin. Antidepressant discontinuation is no joke. And the unfortunate thing is that many people aren’t aware of the negative withdrawal effects that may occur from lowering the dose or discontinuing the antidepressant. I was fortunate to have an amazing mentor during residency training, who taught me that “slower is better” when it came to lowering the dose of antidepressants. A literature search for any research articles regarding weaning off antidepressants yields little results, therefore, guidance on how to take patients off of them is minimal.

I am NOT writing this post to bash antidepressants especially since they have improved the quality of life of many. However, I AM writing this post to raise awareness because I see this issue OFTEN. And if this information encourages one person to advocate for him/herself and the symptoms they experience, then mission accomplished!

Possible Antidepressant Withdrawal Symptoms:

insomnia
agitation
worsened anxiety
resumption of depressive symptoms
headache, “brain zaps”
stomach upset
flu-like symptoms
increased pain
tiredness
nightmares
dizziness
suicidal thoughts

March 20, 2015 21 comments

Psychiatry

Pill Pusher

written by freudandfashion

I have a simple theory that I like to follow when it comes to psychotropic meds: “Simple is Better.” Pretty straight-forward.

When I inherit a new patient with a list of meds the length of the Declaration of Independence AND they’re still depressed despite all the designer brand name drugs at their disposal, I don’t think it takes a medical degree to figure out that something’s not right.

Question 1: Question the diagnosis. Question 2: They’re still depressed—what the heck am I supposed to do about it?

Whereas most might seek comfort in adding yet another miracle drug to the list, I was inspired by one of my Attendings and made a goal to venture in the opposite direction of the less anxiety-provoking intervention and instead take a medication out (slowly, of course, before withdrawal throws them into a far worse state) and maximize the therapeutic benefit of a truly helpful medication at the same time.

And, the outcome? Well, it’s worked out in many of my patients thus far. Maybe my warmth and reassurance helps as well. Only thing I need now is the research to show it (my next residency venture).

Image via ramoscentral jpg

October 23, 2010 3 comments