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Eveleigh, 2017, Too Much or Too Little Antidepressant Medication: Difficult to change. Two rcts


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#1 dalsaan

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Posted 19 April 2017 - 08:15 PM

Mental Health in Family Medicine (2017) 13: 1-9

 

Too Much or Too Little Antidepressant Medication: Difficult to Change. Two Rcts

 

Rhona Eveleigh, Esther Muskens, Peter Lucassen, Peter Verhaak, Jan Spijker, Chris van Weel, Richard Oude Voshaar, Anne Speckens.

 

Full text link - http://www.mhfmjourn...e-two-rcts.pdf 

 

Abstract

 

Background: Antidepressant use has increased exponentially in the last decades, mostly due to long continuation.

 

Objective: To assess the effectiveness of a tailored recommendation to cease or adjust antidepressant treatment.

 

Methods: Two cluster-randomized controlled trials (PANDAstudy) in primary care. Long-term antidepressant users (> 9 months) were selected from GPs prescription databases. Patients were diagnosed with the Composite International Diagnostic Interview. Long-term users were split up in patients without indication for maintenance treatment (over-treatment trial) and patients undertreated despite maintenance treatment. The intervention consisted of disclosure of the current psychiatric diagnosis combined with a tailored treatment recommendation. We followed patients 12 months. Results: We included 146 participants from 45 family practices in the over-treatment trial. Of the 70 patients in the intervention group, 34 (48%) did not comply with the advice to stop their antidepressant medication. Of the 36 (52%) patients who agreed to try, only 4 (6%) succeeded. These figures were consistent with the control group, where 6 (8%) of the 76 patients discontinued antidepressant use successfully. In terms of relapse rate, patients who were recommended to discontinue their antidepressant medication reported a higher relapse rate than the control group (36% versus 14%, p = 0.015). We included 58 patients in the undertreatment trial, with 29 patients in both the intervention and control group. The proportion of remission was equal in both groups (n = 13, 45%).

 

Conclusion: Changing inappropriate long-term antidepressant use is difficult.


Please note - I am not a medical practitioner and I do not give medical advice. I offer an opinion based on my own experiences, reading and discussion with others.On Effexor for 2 months at the start of 2005. Had extreme insomnia as an adverse reaction. Changed to mirtazapine. Have been trying to get off since mid 2008 with numerous failures including CTs and slow (but not slow enough tapers)Have slow tapered at 10 per cent or less for years. I have liquid mirtazapine made at a compounding chemist.
Was on 1.6 ml as at 19 March 2014.
Dropped to 1.5 ml 7 June 2014. Dropped to 1.4 in about September.
Dropped to 1.3 on 20 December 2014. Dropped to 1.2 in mid Jan 2015.
Dropped to 1 ml in late Feb 2015. I think my old medication had run out of puff so I tried 1ml when I got the new stuff and it seems to be going ok. Sleep has been good over the last week (as of 13/3/15).
Dropped to 1/2 ml 14/11/15 Fatigue still there as are memory and cognition problems. Sleep is patchy but liveable compared to what it has been in the past.

>My intro post is here - http://survivinganti...ic/2250-dalsaan

#2 nz11

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Posted 21 April 2017 - 05:32 PM

Thanks for posting Dalsaan.

Gee this is one scary study.

 

They talk about discontinuing patients so i kept wondering how?

The answer was found in 'reference 21' which i searched for and to my surprise found here.

 

Muskens E, Eveleigh R, Lucassen P, van Weel C, Spijker J,
et al. Prescribing ANtiDepressants Appropriately (PANDA):
a cluster randomized controlled trial in primary care. BMC
Fam Pract. 2013; 14: 6.

 

Go down the page to Table1 in this study and we find some very disturbing stuff. So much so that i was horrified and felt sick when i saw it.

 

Table 1

Applied schemes for tapering long-term antidepressant usage in primary care

I dont know how to get the table copied into here but take paroxetine long term user on 40mg appears to be tapered in 4, 2 week steps

being 40, 30, 20, 10.

 

Basically this is a 6 week taper for someone on 40mg of paroxetine.

(BM just took 6 years!! to do this taper)

 

Interesting they define long term user as  equal to or greater than 9 months use.

 

In this group i have no doubt that there are people here with many years exposure. And now they are subjected to the above tapering. Thats criminal! I feel outraged.

No wonder "(48%) did not comply with the advice to stop their antidepressant medication"

 

Yet look at this sentence under the tapering table...the word 'proposals ' i would think are the tapering proposals.

To check the reliability of the proposals by the GP and psychiatrist, we provided another GP (CvW) and psychiatrist (AS) with 10 randomly selected case vignettes from included patients. Comparing these judgments, there was a 100% agreement.

 

At the end of the study they say:

We found a noncompliance with the given recommendation in almost half of the cases.

Does this surprise anyone here. What about the other half what on earth became of them?

 

Due to the pragmatic nature of this study, we did not impose our intervention on the patients and their GPs.

Thank goodness for that. Perhaps better to say due to the dangerous nature of this study...

 

This is also considered conservative, as in contrast to benzodiazepines, psychological dependency does not play a major role in long-term use of antidepressants.

!!!!!

 

The full conclusion from the study 'too much [ado about the obvious] is':

 

This study demonstrates the difficulty of correcting inappropriate long-term antidepressant use (according to the guidelines), fuelled by an apprehension from both patient and GP to change. A recommendation to discontinue in case of over-treatment is not effective, and maybe even counterproductive. It might be useful to forewarn patients about the difficulty to discontinue and to encourage using antidepressants for a limited period. Regular review could possibly prevent both over and under-treatment.

 

Its all about 'the guidelines', cant someone in 2017 with half a brain question the guidelines for goodness sake!!

 

nz11

"5 of every 6 antidepressant users do not benefit "


2000 amitryptaline, nortriptaline venlafaxine clonazepam for  arm pain from keyboard use, told I had a chemical imbalance it would fix my arm was just a matter of finding the right med for me not informed of the nature of these drugs assured safe and not addictive, CT off Effexor after being told to double the dose on reporting adverse effects...later ..uncharacteristic psych panic tearful presented to doctor to get answers. Given paroxetine no questions asked 'safe and not addictive' next please.2001-2010 paroxetine (paxil) 2 failed attempts to quit, a learned helplessness set in. Feb 10 - Sept 10,  8 month clueless taper, hell. Doc said I had underlying depression .. I said that's not right' then found online support group and the truth!...overcome with inconceivable humiliation and outrage. 28 Sept 10 drug free ...  daily psych and emotional torture beginning in the waking hours of the morning receding somewhat in the evening only to start up again the next day. 28 Sept 12 (24 months) Stabilizing  (What an indescribable unimaginable non-functional nightmare). sleep issues start up at 3 yrs  waking daily at 2am -4.30am), April 2016 return to sport for the first time since drug free, Sept 16 return to work on casual basis.  28 Sept 16 (6yrs drug free), still cant sleep with any regularity, pssd continues no sign of improvement, still feel Rip van Winkle-ish, brain fog still improving, psoriasis concerns.

 

"It is unsafe for people who suffer from something that could be treated with an ssri to consult a psychiatrist." Gotzshe 2015. [ I think Gotzsche could have easily meant to say 'to consult anyone with prescribing privileges']. "Going to a psychiatrist is one of the most dangerous actions a person can take." Breggin

 

“Paroxetine is not safe, it is not effective and it meets every known definition of addictive.” McLaren, N, (2016) 'Psychiatry as bullsh*t’ p55..."Psychiatry is stuffed full of 'deep nonsense' better known as bullsh*t." McLaren 2016

 

"Within the first week of when you go on an antidepressant you may have a sexual dysfunction, it can go on forever, often only appearing when you go off the drug ...its extraordinarily common" Healy 2015

 

See  my intro post #451 for the xanax back story and for a CV -GSKs.  Come on guys get taperwise see a TaperMe Schedule

 For a staggeringly shocking 'prozac back story' see the truth post #523

 

"If I were an enemy combatant and the NZ army did this to me someone would be dragged to the Hague and jailed!"  nz11


#3 nz11

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Posted 21 April 2017 - 11:11 PM

From the first paragraph:

 

During the 1990’s, antidepressants were promoted widely and general practitioners (GPs) were criticized for under-diagnosing and under-treating depressive and anxiety disorders.

Efforts were made to increase quality of care and prescription rates for antidepressants increased.

Now, contrary concerns are raised concerning overtreatment with antidepressants . Long-term continuation contributes to the large amount of antidepressant use.

 

Isnt it just so sad the way the medical profession equate 'increased quality of care' to 'increased prescribing of antidepressants.'

Efforts were made by who? who was doing the criticizing?  ...probably pharma.

I wonder if they actually realise the reason for  long term continuation being the difficulty in getting off the drug their taper procedure doesnt reflect this.


2000 amitryptaline, nortriptaline venlafaxine clonazepam for  arm pain from keyboard use, told I had a chemical imbalance it would fix my arm was just a matter of finding the right med for me not informed of the nature of these drugs assured safe and not addictive, CT off Effexor after being told to double the dose on reporting adverse effects...later ..uncharacteristic psych panic tearful presented to doctor to get answers. Given paroxetine no questions asked 'safe and not addictive' next please.2001-2010 paroxetine (paxil) 2 failed attempts to quit, a learned helplessness set in. Feb 10 - Sept 10,  8 month clueless taper, hell. Doc said I had underlying depression .. I said that's not right' then found online support group and the truth!...overcome with inconceivable humiliation and outrage. 28 Sept 10 drug free ...  daily psych and emotional torture beginning in the waking hours of the morning receding somewhat in the evening only to start up again the next day. 28 Sept 12 (24 months) Stabilizing  (What an indescribable unimaginable non-functional nightmare). sleep issues start up at 3 yrs  waking daily at 2am -4.30am), April 2016 return to sport for the first time since drug free, Sept 16 return to work on casual basis.  28 Sept 16 (6yrs drug free), still cant sleep with any regularity, pssd continues no sign of improvement, still feel Rip van Winkle-ish, brain fog still improving, psoriasis concerns.

 

"It is unsafe for people who suffer from something that could be treated with an ssri to consult a psychiatrist." Gotzshe 2015. [ I think Gotzsche could have easily meant to say 'to consult anyone with prescribing privileges']. "Going to a psychiatrist is one of the most dangerous actions a person can take." Breggin

 

“Paroxetine is not safe, it is not effective and it meets every known definition of addictive.” McLaren, N, (2016) 'Psychiatry as bullsh*t’ p55..."Psychiatry is stuffed full of 'deep nonsense' better known as bullsh*t." McLaren 2016

 

"Within the first week of when you go on an antidepressant you may have a sexual dysfunction, it can go on forever, often only appearing when you go off the drug ...its extraordinarily common" Healy 2015

 

See  my intro post #451 for the xanax back story and for a CV -GSKs.  Come on guys get taperwise see a TaperMe Schedule

 For a staggeringly shocking 'prozac back story' see the truth post #523

 

"If I were an enemy combatant and the NZ army did this to me someone would be dragged to the Hague and jailed!"  nz11


#4 catnapt

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Posted 23 April 2017 - 03:28 AM

it's kind of scary how stupid these investigators are, eh?

 

they seem to have no critical thinking skills at all.

 

and the pts who supposedly "relapsed"?? what do you want to bet that was WD mis diagnosed as symptoms of disease

:/


1974-2002 many psych meds, all types; longest used drugs include lithium, seroquel, SSRI's zoloft & celexa; many CT's off drugs

2002-2015 on varying doses of lexapro, as  high as 40 mgs, but usually 20mgs

June 2015: tapered too fast to 2.5mgs, then to 2.5mgs every other day Dec 2015:  found SA forum; holding at 2.5mgs 

Early May 2016: jumped off at 2.5mgs, not smart- crashed in late Sept.

Oct 26 2016  reinstated liquid lexapro 0.05ml/day at night, dose +/- til settling on 0.15BID (0.3/day)= windows and waves

Jan 8, 2017 too quick switch to single dose in the morning, 0.3mgs (bad mistake, led to a crash)

Jan 12 added low dose zyprexa for SI, took infrequently as rescue med, last dose Feb.15

Jan 26 lexapro 0.27mg Feb 25 lexapro updose back to 0.3mg due to unrelenting severe insomnia

March 1 insomnia worse, back down to 0.29 for one day, then 0.27, then 0.25- improving!! March 17 0.24  April 7 0.21

March 7 added low dose lamictal, adjusting dose based on response (currently ~18mgs)

Supplements: Magnesium taurate 250mg, chromium, pro-biotic, biotin, glycine 2grams PM, 1 gram AM