psychiatric drugs Archives - Amazing Health Advances

How Hard Is It to Stop Antidepressants?

AHA Publisher — Fri, 02 Dec 2022 08:00:18 +0000

Dr. Caroline Leaf – In this podcast (episode #435) and blog, I talk to clinical researcher and fellow at University College London Dr. Mark Horowitz on his own experience on psychiatric medication, the many myths surrounding antidepressants, safely withdrawing from psychiatric drugs, and so much more! Mark works in London as a Clinical Research Fellow in the NHS and an Honorary Clinical Research Fellow at UCL while training as a psychiatry. As well as his work in this field, he has also completed a PhD in the neurobiology of depression and the pharmacology of antidepressants at the Institute of Psychiatry, Psychology and Neuroscience at King’s College London. But Mark does more than study psychiatric medications. As he notes, “At the same time as researching the way in which antidepressants worked I have also been taking this medication since I was a medical student. It was not until 15 years later that I tried to come off this medication as I wondered whether it was responsible for the fatigue which had led to me being diagnosed with the sleep disorder, narcolepsy. When I tried to come off this antidepressant over 4 months I received a very abrupt education into antidepressant withdrawal symptoms. I experienced insomnia, panic attacks, dizziness, anxiety and low mood. This was nothing like the Woody Allen-level neurosis that had led me to start them in the first place – and I had experienced nothing like it before. It was also something that I had not been taught about at medical school or in psychiatry training. I soon learnt by reading the academic literature available that the psychiatrists and academics at the institution I had studied at and others like them around the world had little helpful to say about withdrawal effects from antidepressants – they recommended stopping the drugs over 2 to 4 weeks, and reported that the symptoms were mild and brief. Many prominent academics with close ties to pharmaceutical companies attacked academics and patients who complained of trouble coming off their antidepressants, accusing them of malingering, or seeking legal payments. Instead, the place where I found the most useful advice was online peer-support websites (especially Surviving Antidepressants) filled with people trying to come off their antidepressants. There I found people describing the exact same symptoms I had experienced: like me, their symptoms were neither mild, nor brief. And this was not a handful of people – instead I found tens of thousands of people with near identical complaints. None seemed to be malingerers, in it for a buck or ignorant – they all had been told by doctors that there would be no major issue in coming off their medication and all had been given unhelpful advice by their doctors to come off in just a few weeks. Even more helpfully for me, these online groups described a better way to come off antidepressants: going down by small amounts, that become smaller and smaller as the total dose got lower, and going down to very tiny amounts before completely stopping. I am using this method to come off the antidepressant I have been on for so many years, as well as the other psychiatric drugs I ended up being prescribed, in what I now see as a prescribing cascade, where adverse effects led to more medications. Reducing my medication has greatly improved the tiredness, problems with memory and concentration that have plagued me for years (and for which I was given psychiatric and neurological explanations).” Indeed, based on his research and experience, Mark has written an excellent paper about how to come off antidepressants that was published in The Lancet Psychiatry and widely reported. He also works with other doctors and the public how to teach people how to safely taper off antidepressants and other psychiatric medications based on his own personal and professional experiences, and the realization that he has been “misled on how difficult it is to stop psychiatric medications”. Mark has dedicated his career to “re-evaluating the other information he has taken for granted about psychiatric medications, how they work, what they are treating and what their long-term effects might be” and helping people who are suffering find ways to heal and be at peace within their own minds. Mark is also one of the authors of the groundbreaking study on the serotonin depression myth that recently made headlines around the world. As mentioned in my interview with journalist and mental health advocate Robert Whitakerand my interview with psychiatrist, researcher and professor Dr. Joanna Moncrieff, the chemical imbalance theory has been around for a long time. From the 1970s, drug companies and many mental health professionals have largely marketed psychiatric drugs as anti-psychotic, anti-depressive, or anxiolytic (anti-anxiety)—cures combating a particular disease, notwithstanding the lack of evidence for chemical imbalances or other pathologies related to mental illness. This was recently highlighted in the groundbreaking systematic review study led by Dr. Mike Horowitz, Dr. Joanna Moncrieff and their team. As they note in their study on the serotonin theory of depression (alongside many other mental health professionals and advocates), the chemical imbalance approach is shaped by the assumption that symptoms of depression and other mental health issues are caused by a brain chemical abnormality, and that psychotropics like anti-depressants help rectify this abnormality and improve mental health. Even though this hypothesis dominates the way we think about mental health, we have no evidence that it is the best way to understand mental issues, as Mark and his team point out. First, there is no strong evidence that mental struggles like depression, for example, is associated with any particular biochemical abnormality. Moreover, we do not know if the drugs we use work in this way, i.e. correcting biochemical imbalances. This is due to the fact that the mental health drugs we use are psychoactive. They cross the blood-brain barrier and change the normal state of the brain, which means they can change our feelings, thoughts, perceptions and even behaviors, just in the same way a substance like alcohol can (as Dr. Moncrieff discussed in our interview). As Mark, Joanna and the other authors of the study note in their article in the journal Molecular Psychiatry, “the main areas of serotonin research provide no consistent evidence of there being an association between serotonin and depression, and no support for the hypothesis that depression is caused by lowered serotonin activity or concentrations”. If we do not have good evidence that psychiatric medications like antidepressants do not work by correcting or reversing a chemical imbalance in the brain that causes depression, it is important that we review the way we use their drugs, many of which may even cause chemical imbalances in the brain, and can have many negative side effects (like the ones Mark himself experienced) that, unfortunately, are often just assumed to be the result of the mental condition returning. This is why he is passionate about helping people safely withdraw from these medications. As Mark notes, there is actually very little official guidance on how to stop psychiatric medication safely. There has been very little research on this subject, although, thankfully, this is changing, not least through the work done by Mark and other professionals like him. The key thing to understand about withdrawal is that“no one should stop their antidepressant medication abruptly—this can be dangerous and is known to cause withdrawal effects, which can be severe and long-lasting in some people, especially those using the medications long-term. If anyone is considering this choice…discuss it with your doctor and, if you go ahead, to undertake a gradual and supported reduction as advised by recent Royal College of Psychiatry guidance.” There are ways to withdraw from psychiatric drugs safely, which Mark has written extensively about including in a recent paper about how to come off antidepressants, although this should always be done under the guidance of an appropriate medical professional. When withdrawing, there are several key points to consider: Come off psychiatric medication SLOWLY. Go down in SMALL AMOUNTS. It is very important to understand that very small amounts of any kind of psychiatric medication can have large effects on the brain. It is important to note that with psychiatric drugs you can reduce higher doses a lot quicker than lower doses. For lower levels, people often use tapering strips or liquids to reduce the drug by very small amounts over time. This is why it is important to make smaller and smaller reductions over time as you get down to lower doses (by proportion), based on the effect these doses have on the brain. It is necessary to take a flexible approach as everyone’s situation and past history is different, and avoid switching between certain drugs as much as possible. There are different ways to decrease doses, which should be done under the guidance of a medical professional. These include dividing tablets, using a liquid version of the drug and a syringe, and using compounding pharmacies to order smaller doses or tapering strips. There are also great sources of information like Mad in America, Rxisk, ISEPP and other patient-run websites (like the kind Mark mentions) that seek to provide people with helpful information and address all parts of the human experience, not just our biology. To read the original article click here.

The post How Hard Is It to Stop Antidepressants? appeared first on Amazing Health Advances.

Debunking the Serotonin-Depression Theory (with Psychiatrist & Professor Dr. Joanna Moncrieff)

AHA Publisher — Fri, 16 Sep 2022 07:00:38 +0000

Dr. Caroline Leaf – In this podcast (episode #415) and blog, I talk to psychiatrist, researcher, professor and best-selling author Dr. Joanna Moncrieff about her new study on the chemical imbalance myth, antidepressants as placebo, the causes of depression, how to withdraw from psychiatric drugs, and so much more. As mentioned in my interview with journalist and mental health advocate Robert Whitaker and my previous interview with Dr. Joanna Moncrieff, the chemical imbalance theory has been around for a long time. From the 1970s, drug companies and many mental health professionals have largely marketed psychiatric drugs as anti-psychotic, anti-depressive, or anxiolytic (anti-anxiety)—cures combating a particular disease, notwithstanding the lack of evidence for chemical imbalances or other pathologies related to mental illness. This was recently highlighted in the groundbreaking systematic review study led by the psychiatrist and researcher Joanna Moncrieff, Mike Horowitz and their team. As Moncrieff and Whitaker point out (alongside many other mental health professionals and advocates), the chemical imbalance approach is shaped by the assumption that symptoms of depression and other mental health issues are caused by a brain chemical abnormality, and that psychotropics like anti-depressants help rectify this abnormality and improve mental health. Even though this hypothesis currently dominates the way we think about mental health, we have no evidence that it is the best way to understand mental issues, as Moncrieff points out in her study on the serotonin theory of depression. First, there is no strong evidence that depression, for example, is associated with any particular biochemical abnormality. Moreover, we do not know if the drugs we use work in this way, i.e. correcting biochemical imbalances. This is due to the fact that the mental health drugs we use are psychoactive. They cross the blood-brain barrier and change the normal state of the brain, which means they can change our feelings, thoughts, perceptions and even behaviors, just in the same way a substance like alcohol can. For instance, alcohol may decrease someone’s social anxiety, but this does not mean it is a “cure” for social anxiety. Many psychotropics work the same way, including antidepressants—we have been lied to for decades. As Moncrieff and the other authors of the study note in their article in Molecular Psychiatry, “the main areas of serotonin research provide no consistent evidence of there being an association between serotonin and depression, and no support for the hypothesis that depression is caused by lowered serotonin activity or concentrations.” If we do not have good evidence that psychiatric medications like antidepressants do not work by correcting or reversing a chemical imbalance in the brain that causes depression, it is important that we review the way we use their drugs, many of which may even cause chemical imbalances in the brain. Joanna takes a different approach—what she calls the “drug-centered” model. This centers around understanding what prescribed psychiatric medication is doing in the brain and body, and how it is changing the state of the brain like a substance such as alcohol does. We need to understand the kind of alterations these drugs make and factor them out of the equation—we cannot simply say that they are targeting and “correcting” a hypothetical biochemical imbalance. For example, benzodiazepines are currently used to treat anxiety. These drugs, when given to someone in a high state of arousal, can help calm down the brain and body. Yet they also do the same for someone who is not anxious—they alter the brain by reducing brain activity. There is no strong evidence that these psychoactive drugs are “curing” anxiety. To understand psychoactive drugs and their use in mental healthcare, we first need to understand their general effects in people, including individuals who do not have depression or symptoms of another mental issue. Yes, some people may see these mind-altering effects as an improvement, but not everyone. This may account for the very, very small difference we see between drugs like antidepressants and placebo in randomized control trials (the gold standard of evidence-based medicine). Yet it is also important to consider the negative outcomes that often occur when a person comes off these drugs—withdrawal symptoms can be incredibly traumatic mentally and physically, and last for a long period of time. The chemical imbalance theory about depression is about more than just someone’s brain chemistry. It impacts their sense of self; how they see themselves. It tells someone that the problem mainly resides in their brain, and that there is something intrinsically wrong with their biology, which is a great burden to put on someone who is suffering, especially since there is no scientific evidence to support this hypothesis. This kind of mindset is also less likely to make someone think that their own efforts or anything besides medication can affect their recovery, which can impact their healing in the short and long-term. Depression is not as simple as a “brain disease”. Human brains and bodies are way more complicated than that. Of course, things are going on in the brain when people are feeling depressed. Everything we do is mediated by our brains, whether we are walking, working, feeling, eating, exercising and so on. This does not mean that we can fully understand depression at the level of the brain. Depression is an emotional reaction that is affected by our history, personal inclinations, and so on. It is, at its heart, a reaction to life circumstances mediated by our uniqueness. This means that, to understand depression, we need to understand both the circumstances it is a reaction to and the individual’s personality, history and development (everything that has happened to them). One of the most important things we can do to help people who are depressed is to find ways to help them address their unique life circumstances, not just give them a drug and send them on their way. That is not to say that there is no such thing as severe depression or that people with depression do not suffer greatly, or even that psychiatric drugs do not work for some people over a set period of time. But, unfortunately, we do not have any good evidence that even severe depression responds well to psychiatric drugs or other interventions just at the level of the brain. It is so important that we understand the nature of the psychiatric drugs we are using. They are not harmless, as Moncrieff talks about in detail her book A Straight Talking Introduction to Psychiatric Drugs: The truth about how they work and how to come off them. Drugs like antidepressants have a blunting effect that may help some people for a certain period of time, as mentioned above, but other people may find this effect incredibly unhelpful, especially if they are experiencing many unwanted side effects. Additionally, although blunting someone emotions may be helpful in the short term, it is not a long term solution that will help someone find true and lasting healing. Moreover, the longer someone is on these drugs, the greater chance that their withdrawal effects will be more significant and last longer. In Joanna’s blogs, she points out that this is why it is so important to understand how these drugs affect the mind and brain, so that you are more empowered to know what choice will be best for you and your unique circumstances. Some people may find these drugs very beneficial in the short term; however, it is important to understand how these drugs can be dependence-forming in the long term. This is why you cannot just stop using these medications overnight. It is important to remember that withdrawal should always be done under the supervision of a qualified professional. Take your time, process the information in this podcast and blog, speak to those you trust and the appropriate medical professional. These drugs can alter brain chemistry, and withdrawal can be an incredibly difficult process. The brain adapts to the presence of these drugs. Even if you do not feel a “high” from a drug, this does not mean you cannot become dependent on it. People usually don’t take these psychoactive drugs for a few days or weeks. They generally take them for months or years, often based on research done on the long-term effects of psychiatric drugs like anti-depressants, called “relapse prevention trials”. These trials look as if they are examining the benefits of long-term treatment, but what they are actually doing is enrolling people that have already been using these drugs for years, then randomizing them to either continue the treatment or be weaned off (usually very quickly) onto the placebo. The latter group often experience intense withdrawal effects, since these drugs alter brain function and chemistry. However, in the trials, these withdrawal effects are often assumed to be because of the “brain disease”. This can make someone feel terrible or believe that there is something intrinsically wrong with them, even though what these research studies are actually studying is not the benefit of long term treatment but the adverse effects of withdrawing from these psychoactive medications quickly. Very few studies try to wean people off these drugs gradually, and even these still have a risk of significant withdrawal effects that bias the clinical data. If you do decide you want to go off these drugs, it is important to take a flexible approach, and avoid switching between certain drugs, especially anti-depressants, as much as possible (anti-depressants are often quite different from each other). It is important to note that it is easier to reduce higher doses than lower doses; for lower levels, people often use tapering strips or liquids with the help of a professional to reduce the drug by very small amounts over a specific period of time. Moncrieff uses these methods in her London clinic, which she is hoping to expand into other areas of the UK and perhaps the world. Moncrieff and her team also want to try to set up a peer-support group to help other people trying to withdraw and find hope. Thankfully, there are also great sites like Mad in America, Rxisk, ISEPP and other patient-run websites that seek to provide people with helpful information and address all parts of the human experience, not just our biology. To read the original article click here.

The post Debunking the Serotonin-Depression Theory (with Psychiatrist & Professor Dr. Joanna Moncrieff) appeared first on Amazing Health Advances.

Debunking the Myth of the Chemical Imbalance with Dr. Joanna Moncrieff

AHA Publisher — Wed, 15 Jun 2022 08:01:21 +0000

Dr. Caroline Leaf – In this podcast (episode #383) and blog, I talk to psychiatrist, researcher, professor and best-selling author Dr. Joanna Moncrieff about critical psychiatry, the difference between a drug-centered and disease-centered approach in the field of mental health, the history of psychiatry, withdrawal from psychotropic drugs, the dangers of medicalizing misery, the myth of chemical imbalance, the potential downsides of using psychedelics to treat mental health, and so much more! Joanna calls herself a critical psychiatrist. This means that she doesn’t sign on to the mainstream view of psychiatry, which claims that all mental disorders are the same as brain diseases that need to be treated with drugs, ECT and other interventions that focus on physiological or biochemical symptoms. Human beings come in all shapes and sizes—we are all different. This means we have a huge range of assets, but also a huge range of problems and difficulties. It is not helpful to just call these issues a disease or think of them in solely medical terms, unless we are convinced, by a good body of evidence, that there are specific abnormal brain issues present. Everything we do is reflected in our brains. We need to distinguish brain activity that goes along with everything we do from a neurological disease like a brain tumor. But we are also more than just our biology; everyone’s mental health issue is unique to them on a social, spiritual, biological, psychological and spiritual level. We are also more than just our biology Of course, saying a mental health issue is not a neurological disease doesn’t mean that there is nothing happening in the brain. It also doesn’t mean that we do not influence what happens in the brain by both what we do and how we live and, sometimes, by taking certain drugs. Joanna discusses this difference in depth in her book The Myth of the Chemical Cure: A Critique of Psychiatric Drug Treatment. As Joanna points out, the current disease-centered approach claims that symptoms of depression are caused by a brain chemical abnormality, and psychotropics like anti-depressants help rectify this abnormality and improve mental health symptoms. This hypothesis currently dominates the field of mental health, yet we have no evidence that it is the best way to understand mental issues. First, there is no strong evidence that depression, for example, is associated with any particular biochemical abnormality. Moreover, we do not know if the drugs we use work in this way, i.e. correcting biochemical imbalances. This is due to the fact that the mental health drugs we use are psychoactive. They cross the blood-brain barrier and change the normal state of the brain, which means they can change our feelings, thoughts, perceptions and even behaviors, just in the same way a substance like alcohol can. Joanna takes a different approach—what she calls the “drug-centered” model. This centers around understanding what prescribed psychiatric medication is doing in the brain and body, and how it is changing the state of the brain like a substance such as alcohol does. We need to understand the kind of alterations these drugs make and factor them out of the equation—we cannot simply say that they are targeting and “correcting” a hypothetical biochemical imbalance. For example, benzodiazepines are currently used to treat anxiety. These drugs, when given to someone in a high state of arousal, can help calm down the brain and body. Yet they also do the same for someone who is not anxious—they alter the brain by reducing brain activity. There is no strong evidence that these psychoactive drugs are “curing” anxiety. To understand psychoactive drugs and their use in mental healthcare, we first need to understand their general effects in people, including individuals who do not have anxiety or symptoms of another mental issue. Yes, some people may see these mind-altering effects as an improvement, but not everyone. It is also important to consider the negative outcomes that often occur when a person comes off these drugs—withdrawal symptoms can be incredibly traumatic and last for a long period of time. Unfortunately, even though there is very little specific biological evidence that distinguishes the brains of people diagnosed with mental disorders and people that are not; much of current mental healthcare research and treatments are biased in the direction of the disease-centered approach. For instance, research done on brain abnormalities in people diagnosed with schizophrenia has often been used to “prove” that schizophrenia “shrinks” people’s brains. Yet it has been shown that the antipsychotic drugs individuals diagnosed with schizophrenia take to treat also affect brain volume and function. Based on this new research, we now think that this reduction in brain volume is significantly (if not wholly) due to the effects these drugs have as they cross the blood-brain barrier, not just the fact that these individuals have been diagnosed with schizophrenia. Additionally, it is important to point out that the trials that supposedly establish the “fact” that psychiatric drugs are effective acute treatments are placebo-controlled trials. This means that psychoactive drugs are compared to an inert placebo tablet that doesn’t have any noticeable mind or brain effects. Researchers are not distinguishing whether the drug hypothetically “cures” the purported underlying basis of the disorder or is having specific mind-altering and brain-altering effects (the drug-centered model mentioned above). These trials show the psychoactive drug does something different to the placebo, a feeling which can be enhanced when people in the trials realize they are taking a psychoactive drug. People’s expectations of what treatment they get can have a powerful effect on their outcomes, which is something we do not often consider when it comes to psychiatric medications. These placebo trials are not properly double-blinded, and as such we should not be placing so much trust in the interpretations of the results and any healthcare treatments based on these interpretations. In fact, even when these trials show a positive effect when the drug is taken, this is not significant in the long term. In a large 2018 meta analysis, for example, the difference between taking an anti-depressant and placebo was incredibly small, and of doubtful clinical value. There are also many issues surrounding the research on psychiatric drug withdrawal, as Joanna discusses in detail in her book A Straight Talking Introduction to Psychiatric Drugs: The truth about how they work and how to come off them. People usually don’t take these psychoactive drugs for a few days or weeks. They generally take them for months or years, often based on research done on the long-term effects of psychiatric drugs like anti-depressants, called “relapse prevention trials”. These trials look as if they are examining the benefits of long-term treatment, but what they are actually doing is enrolling people that have already been using these drugs for years, then randomizing them to either continue the treatment or be weaned off (usually very quickly) onto the placebo. The latter group often experience intense withdrawal effects, since these drugs alter brain function and chemistry. However, in the trials, these withdrawal effects are often assumed to be because of the “brain disease”. This can make someone feel terrible or believe that there is something intrinsically wrong with them, even though what these research studies are actually studying is not the benefit of long-term treatment but the adverse effects of withdrawing from these psychoactive medications quickly. Very few studies try to wean people off these drugs gradually, and even these still have a risk of significant withdrawal effects that bias the clinical data. The longer someone is on these drugs, the greater chance that their withdrawal effects will be more significant and last longer. In Joanna’s blogs, she points out that this is why it is so important to understand how these drugs affect the mind and brain, so that you are more empowered to know what choice will be best for you and your unique circumstances. Some people may find these drugs very beneficial in the short term; however, it is important to understand how these drugs can be dependence-forming in the long term. There are ways to withdraw from psychiatric drugs, although this is best done under the guidance of an appropriate medical professional. You can reduce higher doses a lot quicker than lower doses; for lower levels, people often use tapering strips or liquids to reduce the drug by very small amounts over time. It is important to take a flexible approach, and avoid switching between certain drugs, especially anti-depressants, as much as possible. (Anti-depressants are often quite different from each other.) Joanna uses these methods in her London clinic, which she is hoping to expand into other areas of the UK and perhaps the world. Joanna and her team also want to try to set up a peer-support group to help other people trying to withdraw and find hope. Thankfully, there are also great sites like Mad in America, Rxisk, ISEPP and other patient-run websites that seek to provide people with helpful information and address all parts of the human experience, not just our biology. To read the original article click here.

The post Debunking the Myth of the Chemical Imbalance with Dr. Joanna Moncrieff appeared first on Amazing Health Advances.