Friday, December 28, 2018

More research required on withdrawal from antidepressants

Fava & Balaise (2018) in a Psychotherapy and Psychosomatics editorial comment on a failed trial (see letter) of CBT to prevent relapse after withdrawal of antidepressants in remitted anxiety disorder. Despite guidance, only 36% of patients succeeded in discontinuing antidepressants over 16 months and only 28% did not have a recurrence and there were no differences between the CBT group and controls.

As Fava & Balaise say, the trial wasn't futile as it has confirmed that:-
Withdrawal symptoms and syndromes may occur during and despite slow tapering, do not magically vanish after a couple of weeks from discontinuation and may persist for a long time, leading to postwithdrawal syndromes.
As they also say:-
.. discontinuation that is performed without medical consultation and adequate psychotherapeutic support entails substantial risks for the patient and is often bound to fail

Fava and Balaise tend to emphasise their model of oppositional tolerance, which I have said before does not convince me (see previous post). Personally I have tended to argue for the importance of psychological dependence (eg. see previous post). This does get me into trouble with the 'prescribed harm' patient community, but despite what they may think, I am not minimising their problems, which mainstream psychiatry does (eg. see previous post). As Fava & Balaise conclude:-
The time has come to initiate research on withdrawal phenomena related to AD [antidepressants], and to redefine the use and indications of these medications

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