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Coming off antipsychotics is a breeze


compsports

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"There is no such documented “withdrawal” syndrome associated with discontinuation of antipsychotic medications—even sudden discontinuation--except for generally mild and transient cholinergic rebound symptoms, such as hypersalivation, cramps, or diarrhea. These are usually seen within a few days of stopping the AP; are usually mild and self-limited; and rarely need clinical intervention (In rare instances, they are easily managed with anticholinergic medication)."

 

To read the rest, go to http://www.psychiatrictimes.com/blogs/quality-life-and-case-antipsychoticsand look for the comment titled " Some Methodological Issues: A Supplementary Statement from Drs. Pierre and Pies".  It was posted in response to this blog entry by Robert Whitaker, http://www.madinamerica.com/2016/09/confessions-of-a-trespasser/

 

Needless to say, I can't repeat what my thoughts are about this BS.  I do find it ironic though that alternative medicine folks are accused of quackery but yet advocating a CT of antipsychotics seems to be big time quackery.   But what do I know?

 

 

Drug cocktail 1995 - 2010
Started taper of Adderall, Wellbutrin XL, Remeron, and Doxepin in 2006
Finished taper on June 10, 2010

Temazepam on a PRN basis approximately twice a month - 2014 to 2016

Beginning in 2017 - Consumption increased to about two times per week

April 2017 - Increased to taking it full time for insomnia

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Ronald Pies, as ever, a pompous *ss.

 

My response:

 

If clinicians believe that post-antipsychotic withdrawal syndrome does not exist because there is no "documentation" of such, and consequently diagnose all symptoms after cessation of an antipsychotic as relapse or emergence of a new psychiatric disorder, why would they report such cases as withdrawal syndrome?

 

Antipsychotics are very frequently prescribed for all kinds of conditions short of schizophrenia. There are thousands of anecdotes all over the Web from patients reporting antipsychotic withdrawal symptoms lasting many months. (This is also true of benzodiazepines, antidepressants, and other psychiatric drugs.)

 

It is unfortunate that post-marketing data gathering for psychiatric drug adverse reactions is almost nonexistent. Our scientific literature is inappropriately dependent on studies conducted by pharmaceutical companies or their hired consultants for the purpose of drug approval or sales, which understate adverse reactions of any kind and do not address long-term consequences of psychiatric drug ingestion at all.

 

It begs credulity that, unlike all other drugs that modify the nervous system and cause physiological dependency (at least), psychiatric drugs, particularly antipsychotics, do not incur a withdrawal syndrome.

 

(By the way, de novo ermergence of psychoses-like symptoms has been documented in antidepressant withdrawal syndrome. Is it beyond possibility that the disruption of antipsychotic withdrawal might cause the same?)

 

Good clinicians learn by listening to their patients. Ignoring copious anecdotal evidence of long-term withdrawal syndrome after discontinuation of psychiatric drugs, including antipsychotics, because your colleagues have ignored it is a recipe for psychiatry being stalled in the pharma marketing era.

 

Alto @ Wed, 2016-09-14 15:04

 

 

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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Great response Alto.  I am sure it will be ignored by Pies but hopefully, enough people will read it to make them think.   One can hope, right?

Drug cocktail 1995 - 2010
Started taper of Adderall, Wellbutrin XL, Remeron, and Doxepin in 2006
Finished taper on June 10, 2010

Temazepam on a PRN basis approximately twice a month - 2014 to 2016

Beginning in 2017 - Consumption increased to about two times per week

April 2017 - Increased to taking it full time for insomnia

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Well, I was wrong as here is what Pies wrote in response:

 

""A note to readers: this forum is intended for use by mental health care and other health care professionals, who are expected to sign their comments with their full name. Also, per my standing policy for internet postings, I reply only to fully signed comments.

That said: the note above raises good questions, and either I or Dr. Pierre will try to address the issue of "withdrawal" in a separate posted comment. By the way, listening carefully and respectfully to one's own patients is of course the foundation of good medical care. That is not the same as accepting uncritically anecdotal reports from unknown persons as scientific proof of a "withdrawal syndrome" related to antipsychotic discontinuation.""

My comments - Hmm, anecdotal reports of a positive experience with psych med are accepted uncritically.  

Drug cocktail 1995 - 2010
Started taper of Adderall, Wellbutrin XL, Remeron, and Doxepin in 2006
Finished taper on June 10, 2010

Temazepam on a PRN basis approximately twice a month - 2014 to 2016

Beginning in 2017 - Consumption increased to about two times per week

April 2017 - Increased to taking it full time for insomnia

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compsports: "Hmm, anecdotal reports of a positive experience with psych med are accepted uncritically."

 

me: rotflmao :D

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.
1997-1999 Effexor; 2002-2005 Effexor XR 37.5 mg linear taper, dropping same #beads/week with bad results

Cymbalta 60 mg 2012 - 2015; 2016: 20 mg to 7 mg exact doses and dates in this post; 2017: 6.3 mg to  0.0 mg  Aug. 12; details here


scallywag's Introduction
Online spreadsheet for dose taper calculations and nz11's THE WORKS spreadsheet

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Reading down the postings i came across this one from Dr Pies...

 

Thanks, Dr. Pistone, for your valuable observation. It is regrettable that some "journalist" critics see fit to counsel against the use of antipsychotic medication without having spent a single hour with a grieving or distraught family member, who has seen a loved one decompensate into a life-threatening psychotic relapse, after stopping medication. Yet you and I (and most psychiatrists who treat schizophrenia) have seen dozens of such cases. I am tempted to say that if there were such a thing as "journalistic malpractice", these critics would be up before the Journalism Board for reprimand!

That said--and here, some critics have a point--we must also use these medications judiciously, conservatively, and at the lowest effective dose, while carefully monitoring the patient for side effects, and always in the context of a careful informed consent process. And, to repeat: there may be carefully selected patients with psychotic disorders who warrant a slow taper (over several months) and discontinuation of the antipsychotic, followed by intensive and frequent monitoring.

Finally, patients suffering with schizophrenia deserve more than just medication--they need personal support, vocational assistance, family education, and, of course, our compassion.

Best regards,
Ron
Ronald Pies MD

 

Here we see Pies has put his ignorant cards on the table in that he thinks a slow taper is a couple of months ...probably two or three. (He even used the term tapering medication 'stopping medication'...inferring a CT...!?!)

 

As victims and survivors we all know how misinformed this so called 'slow taper' is....and the 'life threatening' pain and suffering it will trigger. (i have no doubt that these people would have required years of tapering to get off the drug).

....'a carefully informed consent process'....what a joke!! Its outrageous to talk about such a thing when it doesnt even exist.

This has been my experience in that when these clowns like Pies keep opening their mouths they eventually reveal how stupid they actually are.

 

And goodness me did you read that first post by some woman talking about her son.

And then Pies praise soaked reply ....i feel sick.

 

nz11

 

Later...thought i would add the post that Pies was replying to:

 

This comment makes the most important point to respond to critics (who do so without any knowledge/scientific basis); I have seen way too many patients with schizophrenia whose families do whatever they can to ensure the relative with schizophrenia be back on the medication because they can see the difference on the medication and when the patient decides to stop medication; I am sure they have good reasons for that.

Daniel N Pistone, MD, Psychiatrist

 

Revealing isnt it!!!

Like i said QED.

Thought for the day: Lets stand up, and let’s speak out , together. G Olsen

We have until the 14th. Feb 2018. 

URGENT REQUEST Please consider submitting  for the petition on Prescribed Drug Dependence and Withdrawal currently awaiting its third consideration at the Scottish Parliament. You don't even have to be from Scotland. By clicking on the link below you can read some of the previous submissions but be warned many of them are quite harrowing.

http://www.parliament.scot/GettingInvolved/Petitions/PE01651   

Please tell them about your problems taking and withdrawing from antidepressants and/or benzos.

Send by email to petitions@parliament.scot and quote PE01651 in the subject heading. Keep to a maximum of 3 sides of A4 and you can't name for legal reasons any doctor you have consulted. Tell them if you wish to remain anonymous. We need the numbers to help convince the committee members we are not isolated cases. You have until mid February. Thank you

Recovering paxil addict

None of the published articles shed light on what ssri's ... actually do or what their hazards might be. Healy 2013. 

This is so true, with anything you get on these drugs, dependance, tapering, withdrawal symptoms, side effects, just silent. And if there is something mentioned then their is a serious disconnect between what is said and reality! 

  "Every time I read of a multi-person shooting, I always presume that person had just started a SSRI or had just stopped."  Dr Mosher. Me too! 

Over two decades later, the number of antidepressant prescriptions a year is slightly more than the number of people in the Western world. Most (nine out of 10) prescriptions are for patients who faced difficulties on stopping, equating to about a tenth of the population. These patients are often advised to continue treatment because their difficulties indicate they need ongoing treatment, just as a person with diabetes needs insulin. Healy 2015

I believe the ssri era will soon stand as one of the most shameful in the history of medicine. Healy 2015

Let people help people ... in a natural, kind, non-addictive (and non-big pharma) way. J Broadley 2017

 

 

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When I first clicked on the Psychiatric Times link, I was caught off guard by the advertisements.  Psychiatric Times has pharmaceutical ads, making the entire website an extension of the pharmaceutical industry.

 

By advocating for the drugs, Pies is also advocating for the chemical imbalance theory. But in this PT article back in 2011, he said:

 

In truth, the “chemical imbalance” notion was always a kind of urban legend - never a theory seriously propounded by well-informed psychiatrists.

 

Psychiatry’s New Brain-Mind and the Legend of the “Chemical Imbalance”

 

So either Pies is not a "well-informed psychiatrist" or he's a doctor of spin, not medicine. If he doesn't subscribe to the chemical imbalance theory, why would he subject people to all sorts of disabling side effects, including tardive dyskenesia and akathisia? 

 

The quality of life trials that Pies refers to were funded by Eli Lilly and Janssen. So not only are they unethical in the way the research subjects were pulled off their medications and sent into the hell of withdrawal, it was biased before the study was even started. 

 

So lets connect the bolded statements to read:

 

Ronald Pies is a spokesman for the pharmaceutical industry, and he advocates the chemical imbalance theory that he also doesn't advocate (unless he's being paid to). 

 

All he's proven is that money talks louder than patients. 

 

Pies is a petulant child who only wants to talk to other people who are already inside his own pharma-funded echo chamber. It's hard to take him seriously. Of course, the harm being done is deadly serious. 

 

 

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Wow, that quote from Pierre and Pies is really discouraging to read. So I guess what I am suffering right now just trying to get off of low-dose Seroquel is not real because it's not "documented." Well nobody asked me or I would happily document it for them. Pages and pages if they want! Kind of thinking they don't really want it, though. :P

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Shep, great post.

 

MNgal, I feel that even if one gave Pies and his cronies 100,000 pages of documentation, it wouldn't matter.   It is beyond disgusting.

 

CS

Drug cocktail 1995 - 2010
Started taper of Adderall, Wellbutrin XL, Remeron, and Doxepin in 2006
Finished taper on June 10, 2010

Temazepam on a PRN basis approximately twice a month - 2014 to 2016

Beginning in 2017 - Consumption increased to about two times per week

April 2017 - Increased to taking it full time for insomnia

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Well said Shep.

Yes that past quote from Pies immediately came to mind for me me too . This guy, as you say clearly has a foot in both camps.

 

Ronald Pies is a spokesman for the pharmaceutical industry, and he advocates the chemical imbalance theory that he also doesn't advocate (unless he's being paid to).

Brilliant !

 

He says he will address withdrawal in a separate article...i wonder what he will have to say  when or if he posts it.

Thought for the day: Lets stand up, and let’s speak out , together. G Olsen

We have until the 14th. Feb 2018. 

URGENT REQUEST Please consider submitting  for the petition on Prescribed Drug Dependence and Withdrawal currently awaiting its third consideration at the Scottish Parliament. You don't even have to be from Scotland. By clicking on the link below you can read some of the previous submissions but be warned many of them are quite harrowing.

http://www.parliament.scot/GettingInvolved/Petitions/PE01651   

Please tell them about your problems taking and withdrawing from antidepressants and/or benzos.

Send by email to petitions@parliament.scot and quote PE01651 in the subject heading. Keep to a maximum of 3 sides of A4 and you can't name for legal reasons any doctor you have consulted. Tell them if you wish to remain anonymous. We need the numbers to help convince the committee members we are not isolated cases. You have until mid February. Thank you

Recovering paxil addict

None of the published articles shed light on what ssri's ... actually do or what their hazards might be. Healy 2013. 

This is so true, with anything you get on these drugs, dependance, tapering, withdrawal symptoms, side effects, just silent. And if there is something mentioned then their is a serious disconnect between what is said and reality! 

  "Every time I read of a multi-person shooting, I always presume that person had just started a SSRI or had just stopped."  Dr Mosher. Me too! 

Over two decades later, the number of antidepressant prescriptions a year is slightly more than the number of people in the Western world. Most (nine out of 10) prescriptions are for patients who faced difficulties on stopping, equating to about a tenth of the population. These patients are often advised to continue treatment because their difficulties indicate they need ongoing treatment, just as a person with diabetes needs insulin. Healy 2015

I believe the ssri era will soon stand as one of the most shameful in the history of medicine. Healy 2015

Let people help people ... in a natural, kind, non-addictive (and non-big pharma) way. J Broadley 2017

 

 

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Thanks, compsports and NZ.  Yes, it does boggle the mind that a doctor trained in science can be both for the chemical imbalance theory AND against it. And then not understand why there's a psychiatric survivor's group questioning his judgment! 

 

Comsports, I hope you don't mind me adding some more links to your thread on "Coming off antipsychotics is a breeze" because this does seem to tie into what's being discussed.  The whole concept of the validity of antipsychotic research comes into play here, and there's this bioethics researcher I came across recently. Since big pharma is now no longer being regulated, they are getting homeless people who have been labeled with schizophrenia and using them in research. It's really one of the cruelest things I've heard of, especially when you know the unethical nature of pulling someone rapidly off an antipsychotic to study them. 

 

According to bioethics researcher, Dr. Carl Elliott: 

 

Elliott pointed out that because these trials are not regulated, trial subjects receive almost none of the protections of the ordinary worker. There are no regular safety inspections, and if they are injured in the trial, subjects almost always have to pay for their own medical care. Essentially, as the clinical trials have moved into the private sector, the regulatory framework has yet to keep pace. As a result, an already vulnerable population--the homeless--are being exploited. This is particularly apparent in psychiatric trials, which have difficulty recruiting healthy volunteers. In these trials, many of the participants are homeless, and actively recruited by the drug companies.

 

Several seminar participants pointed out that in addition to exploiting the homeless, such trials are unlikely to be of any scientific value because they test on subjects who are often already suffering from mental illness, as well as other possible physical ailments. 

 

Carl Elliott - Exploiting Homeless Schizophrenic Subjects in Clinical Trials

 

So not only is it cruel, the research is pointless and not of any scientific value. And this is NOT coming from Robert Whitaker - that article is from Harvard's Center for Ethics. 

 

Another article worth a read is:  The Best-Selling, Billion-Dollar Pills Tested on Homeless People

 

Just as climate justice researchers remind us of the sacrifice zones caused by climate change, people are becoming sacrifice zones for the pharmaceutical industry. 

 

I agree with Whitaker that psychiatry is not going to police itself. In my own small, brain damaged opinion, once psychiatry loses credibility, it will fall. Wallstreet bankers used to be credible, but now they are seen as crooks that no one should trust. Eventually, that's how psychiatry will be seen. 

 

 

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Shep, I don't mind one bit you adding links as the truth has to be exposed.    Thank you for doing this.

 

CS

Drug cocktail 1995 - 2010
Started taper of Adderall, Wellbutrin XL, Remeron, and Doxepin in 2006
Finished taper on June 10, 2010

Temazepam on a PRN basis approximately twice a month - 2014 to 2016

Beginning in 2017 - Consumption increased to about two times per week

April 2017 - Increased to taking it full time for insomnia

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Thanks, CS.

 

If you're interesting in reading more, Dr. Carl Elliot has a blog:

 

Fear and Loathing in Bioethics

 

Over on the right of the blog, you can see a list of other blogs, and he's linked up with Mad in America, and other like-minded truth tellers. And there are some great links under the "Investigative Bioethics Resources" section. 

 

I do believe the truth will be told, but like with climate change, I wish there wasn't so much damage happening, so much destruction in the wake. Sanity should not be on the endangered species list. 

 

 

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Thanks Shep, great site.

 

I don't know, I am not as optimistic as you about the truth being told.   Even if doctors want to, they pay a price big time career wise if they do.

 

By the way, not to minimize your issues but even if you feel you have brain damage, you do a great job of expressing yourself.

 

CS

Drug cocktail 1995 - 2010
Started taper of Adderall, Wellbutrin XL, Remeron, and Doxepin in 2006
Finished taper on June 10, 2010

Temazepam on a PRN basis approximately twice a month - 2014 to 2016

Beginning in 2017 - Consumption increased to about two times per week

April 2017 - Increased to taking it full time for insomnia

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Ah, but doctors aren't going to be the ones to solve this problem, CS. The people will.

 

From all I've experienced and read, there's no way psychiatry is going to reform itself. The drugs didn't clear out the mental hospitals - they filled up the prisons, at least that's how it is in the US. So psychiatry has not made any progress. Simply put, it's not designed to. It makes money, and it does this very well. 

 

Eventually, we are going to have to face climate change, the pharmaceutical industry, Wall Street, mass incarceration by for-profit prisons, and all of the corporations that have formed what the economic and political philosopher Dr. Sheldon Wolin calls an Inverted Totalitarianism.  This is what happens when corporations take over political power, turning us all into commodities to be used for profit without any ramifications for the elites that own the corporations. 

 

As it is, there are only six corporations who own 90% of the media, so this is why it's so hard to get the truth out. People have retreated into blogs and extreme forms of politics. The printing press has all but disappeared, as most people are getting their news from the internet. However, the web is not a source of news, it's a source of opinion, preying upon other sources of information. 

 

So we know less and less. We spend less and less time in deep reading and more time with what journalist Chris Hedges calls "electronic hallucinations," getting our news from image-based sources, which is very dangerous, as it's much easier to apply techniques of propaganda to images than to methods of communication that encourage critical thought. 

 

The research of Noam Chomsky and his work, Manufacturing Consent, which explores the Propaganda Model, discusses this in detail. In fact, if you read the thread on SA about Dr. Fava's research - Papers by Dr. GA Fava, long-time critic of antidepressants - you can see that Fava cites Chomsky. 

 

The pharmaceutical industries are the master of manufacturing consent and they have mastered the propaganda model. Just look at Direct to Consumer Advertising, as this is used to educate the masses so that doctors can medicate the masses.

 

I think we need to rethink how we're going to go about stopping this epidemic and find out who our true allies are. 

 

It's just my opinion, but I think one reason the truth isn't getting out there is because we're hoping the very people who drugged us are going to stop this epidemic. But they have no intention of doing so. 

 

I think there's a ton of hope for this epidemic to be stopped, but it's going to take a mass movement outside of psychiatry.  Whitaker had the right idea by setting up an independent news site, adding to it with the Mad in America Continuing Education site, which offers classes for free for anyone, with no advertising on either of his sites. 

 

Don't give up hope. This is an outside movement that's just getting started. Nothing like this existed when I was first drugged 30 years ago, so I have a lot of reason to hope. 

 

 

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That is very interesting about "electronic hallucinations."

 

Yes, we must not give up hope, but it is hard when in heavy w/d. :unsure:

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No documented cases? Can I send him
My medical records from last year? Never psychotic in my life til I tried to taper the antipsychotic (strictly under pdoc care - hospital).

Currently on 50mg Fluvoxamine. Reading more before the next attempt at tapering.

 

Started Lexapro 04, have been mostly on med combinations since for 12 years.

May 2015 - zeldox 80 - 100mg, fluvoxamine 200mg, dexamphetamine 10mg

Lorazepam and clonazepam on and off for over a decade. Heavily sedated with antipsychotics - mostly Zyprexa and seroquel. Many hospitalisations. Many types of therapy, last being 7 years of psychodynamic that only figured out my pain was real.

Pain meds - Lyrica 150mg palexia 100mg - discontinued eary 2016

Done ok so far but cant drop the last antidepressant without physical illness.

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One again, great post Shep.

 

Buffy, my guess is that Dr. Pies could receive a million documented cases like yours and he would find a way to blame everything on mental illness.   Sorry for being so cynical.

 

So sorry about what sounds like a horrible experience.

Drug cocktail 1995 - 2010
Started taper of Adderall, Wellbutrin XL, Remeron, and Doxepin in 2006
Finished taper on June 10, 2010

Temazepam on a PRN basis approximately twice a month - 2014 to 2016

Beginning in 2017 - Consumption increased to about two times per week

April 2017 - Increased to taking it full time for insomnia

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Pies wrote an additional comment on withdrawal titled, "Some comments on “withdrawal” and antipsychotic medication"

 

Unfortunately, my summarizing skills aren't working well today but he seems to be talking out of both sides of his mouth.  See what you think:

http://www.psychiatrictimes.com/blogs/quality-life-and-case-antipsychotics

Drug cocktail 1995 - 2010
Started taper of Adderall, Wellbutrin XL, Remeron, and Doxepin in 2006
Finished taper on June 10, 2010

Temazepam on a PRN basis approximately twice a month - 2014 to 2016

Beginning in 2017 - Consumption increased to about two times per week

April 2017 - Increased to taking it full time for insomnia

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compsports i might be missing something but where is that piece i cant see it.

 

Just read Whitakers piece for the first time ...just so excellent.

 

This design lies at the heart of psychiatry’s self-deception, and the gaping hole in its evidence base. Pies and Pierre write in their paper of focusing on “placebo-controlled studies,” as such studies are seen as the gold standard in clinical research. But psychiatry has very few true “placebo-controlled” studies in its research literature. What it has is an abundance of studies where patients abruptly withdrawn from their medications are dubbed a placebo group, which means they masquerade as a placebo group. This is psychiatry’s dirty little secret, and like all dirty little secrets, it is conveniently kept hidden from the public, and as this hiding goes on and on, psychiatry convinces itself it really has “placebo-controlled studies” that it can cite.

Thought for the day: Lets stand up, and let’s speak out , together. G Olsen

We have until the 14th. Feb 2018. 

URGENT REQUEST Please consider submitting  for the petition on Prescribed Drug Dependence and Withdrawal currently awaiting its third consideration at the Scottish Parliament. You don't even have to be from Scotland. By clicking on the link below you can read some of the previous submissions but be warned many of them are quite harrowing.

http://www.parliament.scot/GettingInvolved/Petitions/PE01651   

Please tell them about your problems taking and withdrawing from antidepressants and/or benzos.

Send by email to petitions@parliament.scot and quote PE01651 in the subject heading. Keep to a maximum of 3 sides of A4 and you can't name for legal reasons any doctor you have consulted. Tell them if you wish to remain anonymous. We need the numbers to help convince the committee members we are not isolated cases. You have until mid February. Thank you

Recovering paxil addict

None of the published articles shed light on what ssri's ... actually do or what their hazards might be. Healy 2013. 

This is so true, with anything you get on these drugs, dependance, tapering, withdrawal symptoms, side effects, just silent. And if there is something mentioned then their is a serious disconnect between what is said and reality! 

  "Every time I read of a multi-person shooting, I always presume that person had just started a SSRI or had just stopped."  Dr Mosher. Me too! 

Over two decades later, the number of antidepressant prescriptions a year is slightly more than the number of people in the Western world. Most (nine out of 10) prescriptions are for patients who faced difficulties on stopping, equating to about a tenth of the population. These patients are often advised to continue treatment because their difficulties indicate they need ongoing treatment, just as a person with diabetes needs insulin. Healy 2015

I believe the ssri era will soon stand as one of the most shameful in the history of medicine. Healy 2015

Let people help people ... in a natural, kind, non-addictive (and non-big pharma) way. J Broadley 2017

 

 

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Hi nz11,

 

Go to the link and put in the search term, "Some comments on “withdrawal” and antipsychotic medication".   That should take you right to the comment.

 

Yeah, Whitaker is great.

Drug cocktail 1995 - 2010
Started taper of Adderall, Wellbutrin XL, Remeron, and Doxepin in 2006
Finished taper on June 10, 2010

Temazepam on a PRN basis approximately twice a month - 2014 to 2016

Beginning in 2017 - Consumption increased to about two times per week

April 2017 - Increased to taking it full time for insomnia

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Pies wrote an additional comment on withdrawal titled, "Some comments on “withdrawal” and antipsychotic medication"

 

Unfortunately, my summarizing skills aren't working well today but he seems to be talking out of both sides of his mouth.  See what you think:

http://www.psychiatrictimes.com/blogs/quality-life-and-case-antipsychotics

 

 

Psychiatrists themselves recognized over 30 years ago that sudden discontinuation of antipsychotics can provoke a variety of withdrawal symptoms--but not a specific syndrome. Symptoms may include, for example, nausea, diarrhea, runny nose, sweating, muscle aches, restlessness, and insomnia. [Dilsaver SC, Alessi NE. Antipsychotic withdrawal symptoms: phenomenology and pathophysiology. Acta Psychiatr. Scand. 1988; 77: 241-246]. The specific symptoms probably depend on the particular drug, with more anticholinergic agents (like the older phenothiazines) causing the most problems. However, in general, these symptoms are mild and transient—usually “peaking” within the first 2-3 days, and greatly abating within 5-7 days [Azermai et al, Aging Ment Health. 2013;17(1):125-32]

 

 

Pies is really taking semantics to the extreme when he's discussing the term "syndrome" versus "symptoms". His lack of insight is mind boggling. But I'll see if I can stoop down to his level of nonsense. In the above paragraph, I highlighted the studies he cited, which you can see here: 

 

1.  http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0447.1988.tb05116.x/epdf?r3_referer=wol&tracking_action=preview_click&show_checkout=1&purchase_referrer=www.ncbi.nlm.nih.gov&purchase_site_license=LICENSE_DENIED_NO_CUSTOMER

 

In this preview of the study, it says that the study focuses "on articles describing the development of symptoms within 7 days of the last dose of a neuroleptic". As we all know, many of us suffer from a delayed onset of withdrawal. 

 

 

2.  http://www.ncbi.nlm.nih.gov/pubmed/22928861

 

In this study, 40 participants with a mean age of 84 who had dementia were taken off their antipsychotics. Very minor symptoms are described that were ascribed to the drug withdrawal. HOWEVER, how could the researchers differentiate the cognitive impairment from withdrawal from the cognitive impairment of the existing dementia? Odds are, they couldn't, not to mention the fact that usually elderly people are only placed on low doses of antipsychotics. Using a dementia study for a schizophrenia issue is telling. It's a reach. 

 

 

 

The below comment by Pies is the one I find most troubling:

 

With respect to our article on quality of life, we do not believe that the advantages found with AP treatment are attributable to an untreated “withdrawal syndrome” in the placebo groups. At best, that is pure speculation, absent a case-by-case, clinical evaluation of the individual subjects in the placebo group. It’s possible, of course, that some patients in the placebo group experienced some withdrawal symptoms—but this does not disqualify the entire placebo group or the overall findings of the studies we reviewed. Moreover, there are numerous open and naturalistic studies (not using placebo) that point to improved quality of life (QOL) with antipsychotic use in schizophrenia, as reviewed by Bobes et al. [Dialogues Clin Neurosci. 2007;9(2):215-26

 

 

The study, which I bolded in the above paragraph, can be read here: 

 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181847/

 

Here are the troubling aspects:

 

1.  This is a "switch study" - for many of the examples cited, people moved from one antipsychotic to another. What does that prove, that one drug makes you slightly less miserable than the next one? 

 

2.  A quote from the study:  "There are still doubts as to whether patients with schizophrenia are capable of self-assessment of their quality of life, because of their cognitive deficits and lack of insight into their illness".

 

So what they are saying is simple - if someone who is mentally ill isn't happy with their treatment, it's not that the treatment isn't working, it's that they have no insight into any of it. This isn't science, it's absurdity. 

 

3. I don't see anything in the Conclusions of this study that says that the quality of life is good. It says that it's important to study the quality of life because it's important to the patient and the family. It says that extrapyramidal symptoms (i.e. TD) has an "unclear impact". For that comment, the researchers have to be complete morons. And it says "weight gain and sexual dysfunction have been shown to be negatively associated with quality of life".  My only comment to that is - you really needed a study to find that out?!

 

One final thought - Pies is "targeting" Whitaker, which comes across as more of a PR (public relations) maneuver than anything scientific. For one thing, Whitaker is a journalist who is simply passing on information. This is much easier than going after the scientists who could easily call him out on this. Also, Pies likes to link Whitaker to us, the anti-psychiatry people (whether we call ourselves that or not), and in doing so, he can discredit Whitaker. 

 

As that last study stated, "There are still doubts as to whether patients with schizophrenia are capable of self-assessment of their quality of life because of their cognitive deficits and lack of insight into their illness". 

 
Never mind that the cognitive deficits are caused by the treatment, that still pretty much sums up how Pies feels about the people he's supposed to heal.

 

 

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Thanks again Shep for a wonderful analysis of what Pies has written.   The only point you made that I disagree with is he lacks insight.   I think he knows darn right well what the deal is with these meds but engages in deliberate doublespeak.  

 

And actually, they don't think anyone with a "mental illness" is capable of judging the quality of their lives.   So I had to laugh when a social worker in facebook group I belong to said in her 37 years of experience, she has seen meds greatly benefit patients.   Interestingly, she avoided answering my question when I asked her what she would do if a patient felt the medication was not beneficial and didn't want to try anything else.    She was definitely invested in the psychiatric cool aide BS.

Drug cocktail 1995 - 2010
Started taper of Adderall, Wellbutrin XL, Remeron, and Doxepin in 2006
Finished taper on June 10, 2010

Temazepam on a PRN basis approximately twice a month - 2014 to 2016

Beginning in 2017 - Consumption increased to about two times per week

April 2017 - Increased to taking it full time for insomnia

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  • 4 weeks later...

not only is there no evidence of a lack of a potentially serious antipsychotic withdrawal syndrome, the actual literature reviews tend to be unanimous in pointing out the risk of rebound and withdrawal syndromes.  definitions can be variable, and some researchers focus more on one aspect than the other (even to complete exclusivity), but the quote kicking off this discussion thread has no founding in science.  the difference between "there isnt..." and "i havent read..." (or "i refuse to admit to...") is a world full of peer-reviewed medical journal articles penned on this very topic.

 

below are three examples of journal articles covering information about switching as well as cessations.  even the most evidence-rejecting psychiatrists would have a hard time defending against specific details like withdrawal-emergent movement disorders, though there are indeed still psychiatrists and other doctors out there who deny extrapyramidal symptoms exist, or say they are only a problem for "first generation" antipsychotics.  fancy dancing like separating all the individual symptoms out and calling them unconnected despite all being precipitated by the same event and furthermore having extreme commonality with other psychotropic withdrawal syndromes does not defend against their incidence, and saves face about as well as some john wayne gacy clown makeup.

 

(these are not all free, i think, but you can google around for a copy of ones that might be, or use less governmentally advocated methods of peeking at ones that ought to be free.)

 

https://www.ncbi.nlm.nih.gov/pubmed/23821039

https://www.ncbi.nlm.nih.gov/pubmed/20669865

https://www.ncbi.nlm.nih.gov/pubmed/18230939

 

additionally, i have petitioned janssen for all information they have on antipsychotic withdrawal syndrome per their risperdal studies or any other sources of data.  i do not anticipate receiving anything substantial, and they have already thrown up roadblocks, but it is nevertheless an interesting exercise and one that i will learn from regardless of the outcome.

 

as a final anecdote, i recently encountered an 'expert researcher' type individual who was entrenched in the study and treatment of 'schizophrenia' who expressed literally zero familiarity with the phenomenon of antipsychotic withdrawal syndrome.  after three decades of working with patients using antipsychotics, this person was telling me such a thing does not even exist.  i am still baffled at exactly what can account for these monumental lapses in basic knowledge about commonly prescribed psychotropics--especially when veteran professionals with highly limited fields of study and expertise (comparatively speaking) voice a complete lack of observation.

from 2005-2012, i spent 7 years taking 17 different psychotropic medications covering several classes.  i would be taking 3-7 medications at a time, and 6 out of the 17 medications listed below were maxed or overmaxed in clinical dosage before i moved on to trying the next unhelpful cocktail.
 
antidepressants (SSRIs, SNRIs, NDRIs, tetracyclics): zoloft, wellbutrin, effexor, lexapro, prozac, cymbalta, remeron
antipsychotics (atypical): abilify, zyprexa, risperdal, geodon
sleep aids (benzos, off-label antidepressants & antipsychotics, hypnotics): seroquel, temazepam, trazodone, ambien
anxiolytics: buspar
anticonvulsants: topamax
 
i tapered off all psychotropics from late 2011 through early 2013, one by one.  since quitting, ive been cycling through severe, disabling withdrawal symptoms spanning the gamut of the serious, less serious, and rather worrisome side effects of these assorted medications.  previous cross-tapering and medication or dosage changes had also caused undiagnosed withdrawal symptoms.
 
brainpan addlepation

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I haven't read the full thread but, how can they ignore tardive dyskinesia and tardive akathisia? I realize they likely don't see at least the former as a withdrawal issue but you can't act like the drugs don't do anything serious to people on stopping them when..well when you can get either of those.

 

Any psychiatrist who claims not to know about TD is a liar, it's been documented for sixty years, and they get taught about it in schools.

 

Also I don't know a lot about this but dopamine supersensitivity psychosis.  Is that thought to occur on drug or as you come off ?  I just looked it up and it seems they think it's the the former, but if so, is there not the possibility it could actually be some kind of interdose withdrawal going on...particularly in that I read guess what it has a high association to dyskinesias and if true that's at least indicating that, guess what, the drug is the likely cause of that psychosis...

 

And I was actually diagnosed as having AP withdrawal, after being given them off label for "agitation" due to an AD reaction.  There was utterly no way they could have put me down as suffering some kind of psych condition that explained it all as I was shivering so badly coming off the drugs that I had to lie under three wool blankets just to keep warm and this was on a hot day in summer.  I also developed SEVERE akathisia as the drugs gradually left my system...

 

Actually it was so bad that in emerge I told the doctor I saw I did NOT want any more drugs and he actually said "I don't blame you". 

 

I am not a medical professional and nothing I say is a medical opinion or meant to be medical advice, please seek a competent and trusted medical professional to consult for all medical decisions.

 

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Oh and for anyone suffering antipsychotic withdrawal I believe Dr. Breggin writes a little about it.  But if you are not familiar with his work be forewarned it's extremely frightening and you can get the wrong idea about some problems--like years back I read bits and pieces of it and he seemed to be trying to say that akathisia off antidepressants was permanent. 

 

Mine has been gone for years...So some of his work contains some problems.

I am not a medical professional and nothing I say is a medical opinion or meant to be medical advice, please seek a competent and trusted medical professional to consult for all medical decisions.

 

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[1] how can they ignore tardive dyskinesia and tardive akathisia?

 

[2] Also I don't know a lot about this but dopamine supersensitivity psychosis.  Is that thought to occur on drug or as you come off ?  I just looked it up and it seems they think it's the the former, but if so, is there not the possibility it could actually be some kind of interdose withdrawal going on...particularly in that I read guess what it has a high association to dyskinesias and if true that's at least indicating that, guess what, the drug is the likely cause of that psychosis...

 

[3] And I was actually diagnosed as having AP withdrawal, after being given them off label for "agitation" due to an AD reaction.  There was utterly no way they could have put me down as suffering some kind of psych condition that explained it all as I was shivering so badly coming off the drugs that I had to lie under three wool blankets just to keep warm and this was on a hot day in summer.  I also developed SEVERE akathisia as the drugs gradually left my system...

 

Actually it was so bad that in emerge I told the doctor I saw I did NOT want any more drugs and he actually said "I don't blame you". 

[1] i would draw a distinction between "withdrawal-emergent" EPS and the more general "tardive" EPS.  there may or may not be a shared etiology, or aspects of one, as these sorts of issues seem to have several factors involved in some cases.  but, my main point is that psychiatrists can cede to "tardive" drug effects without calling them a withdrawal state.  it is especially easy to obscure the issue because they often call it "tardive" whether someone is on the drug, just quitting the drug, or having been off it a for a while.  the literature does note EPS specifically resulting from withdrawal syndromes of antipsychotics as well as other drugs...but psychiatrists are not keen on giving credence to case studies and lit reviews.

 

i even encounter the phenomenon, rather often, of pharmacists and other individuals saying we should trust premarketing clinical trials for their claims about efficacy but NOT their claims about side effects.  (and i dont mean they are saying clinical trials understate the harms, as corroborating studies have demonstrated quite robustly.)

 

[2] supersensitivity reactions, insofar as i understand, are primarily about "rebound" phenomena.  some people seem to group rebound with withdrawal syndrome, but others piece it out as rebound (supersensitivity, etc), withdrawal (homeostatic disruption, etc), and stress syndromes (susceptibility, etc), like over at RxISK, i believe.  all these issues, however we choose to label them, can interact, so a clean distinction in particular cases may be impossible.  i thought the conventional idea of supersensitivity symptoms is that use of a drug creates an internal environment in which particular experiences are more likely--largely through the physical dependence we all know about, in its various forms of modification.

 

however, many persons and studies imply that "supersensitivity" pertains specifically to individuals already experiencing the symptoms then said to be worsened or episodically triggered by the circumstances of drug use or drug withdrawal.  so, they are saying "its the patients fault, but the drug mightve tripped things up a bit".  there are many psychiatrists and other doctors still insisting antipsychotics cannot cause rebound issues like psychosis or withdrawal syndromes in people without schizophrenia-spectrum diagnoses.  we all know, of course, that is utter bullsh*t, and the more off-label and non-psychotic prescribing that goes on, the more we are seeing these reactions.

 

BUT, this often leads to the same dodge that we see with antidepressants and mania--expanded diagnoses and entirely new diagnoses are issued to cover over the fact that it is exclusively a drug effect.  antidepressants are more often used for non-psychiatric diagnoses than antipsychotics, so doctors have a tad more cushioning to nurse their ignorance and denial with at the moment.

 

anyway, i was mostly wanting to say: yes, it can be an interdose reaction as well.  antipsychotics, just like antidepressants, cannot be cold-swapped without consequences in many patients.  their binding profiles are not anywhere near close enough to be considered somehow magically tantamount, and supersensitivity reactions can result from dose reductions, cross-tapers, and drug switches.  receptor occupancy, functionality, and all that jazz.  how many of these problems are both caught and attributed to the feeble drug management on part of doctors is...probably not encouraging.  the chouinard article on the topic covers a lot of ground, and i havent had a chance to read it straight through recently.

 

[3] i really wish that was true--that doctors cannot just explain away serious and obviously physical symptoms with psych diagnoses.  ive had psychiatrists call everything from passing out to kidney stones to parkinsonian tremor to electric shocks to akathisia to hemorrhoids purely psychological in nature.  what is impressive is how they manage to get words out at all with their heads so far up their...  plus, when has psychiatry ever been about explaining things?  to paraphrase dr house, psychiatry: idiopathy for idiops.

from 2005-2012, i spent 7 years taking 17 different psychotropic medications covering several classes.  i would be taking 3-7 medications at a time, and 6 out of the 17 medications listed below were maxed or overmaxed in clinical dosage before i moved on to trying the next unhelpful cocktail.
 
antidepressants (SSRIs, SNRIs, NDRIs, tetracyclics): zoloft, wellbutrin, effexor, lexapro, prozac, cymbalta, remeron
antipsychotics (atypical): abilify, zyprexa, risperdal, geodon
sleep aids (benzos, off-label antidepressants & antipsychotics, hypnotics): seroquel, temazepam, trazodone, ambien
anxiolytics: buspar
anticonvulsants: topamax
 
i tapered off all psychotropics from late 2011 through early 2013, one by one.  since quitting, ive been cycling through severe, disabling withdrawal symptoms spanning the gamut of the serious, less serious, and rather worrisome side effects of these assorted medications.  previous cross-tapering and medication or dosage changes had also caused undiagnosed withdrawal symptoms.
 
brainpan addlepation

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