I just saw an akathisia-like report of someone on the new COBENFY drug that was claimed to not cause akathisia based on clinical trial data. There’s angry people online discussing being gaslit by healthcare professionals over this. How many have to die before acknowledgment?

The quasi-linear I’ve described is an intersection of two lines that have different slopes. If that’s sufficient, great! No need for all the hyperbolic stuff.

|cw: self-harm| Medical Stand-up: Google Reviews of a Psychiatric Hospital with comedian @doctor_benji in support of @DoctorsDistress

There are hundreds of thousands of members in withdrawal-related support groups and that figure does not include the countless individuals who never formally joined these communities or those who suffered in isolation, never finding them at all. It is a profound failure that drug manufacturers and regulators did not adequately warn patients, people who simply trusted their doctors, about the possibility of severe, life-altering withdrawal and the need for careful, often years-long tapering. For many long-term users, tapering is not a passive process. It requires measuring tiny amounts of medication (crumbs, beads, or drops) with extraordinary precision to avoid debilitating symptoms. In the absence of meaningful medical guidance, patients have become the experts, creating makeshift laboratories in their kitchens and developing tapering methods through necessity and lived experience. Attempts to dismiss these experiences as mere anecdote, or to discredit patients’ accounts of their own bodies and minds because they have a mental health diagnosis, are fundamentally anti-patient.

My Lamictal taper is a clear example of withdrawal—there's nothing to "relapse." I was prescribed it off-label for misophonia, which it never helped with. Yet since stopping, I've had panic, akathisia, and heart palpitations right after a cut—all of which fade with time.

Hyperbolic tapering is increasingly recommended for the gradual reduction of psychiatric drugs to minimise withdrawal symptoms, yet available formulations rarely accommodate the small dose regimens required. cambridge.org/core/journals/…

@sanilrege “incorrect” -> Grok “No” @tylerblack32 “misinterpreted” -> Gemini “No” @vitorborin_ “inaccurate” -> Claude “No” Look, I appreciate those advocates doing their thing, but I am not an advocate. I don’t try to interpret things in a positive light but an accurate one. Psychiatry deals with very fraught issues. We should be honest about our limitations and not spin things positively. I would have been fine with them saying the NNT could be interpreted in other ways, or that placebos don’t exist in the real world, but instead they used precise words which IMO ended up being more inaccurate. I don’t think that 11% helped is that bad; it just is what it is.

Criticizing the pharmaceutical industrial complex WITH evidence is almost impossible. This is a feature, not a bug. There is decades of published research supporting the notion that medication intervention is indicated and optimal. Research in the opposite direction is purposely suppressed.

Posted on Instagram about the pains of tapering off Cymbalta, and THREE friends out of the 200 who viewed it reached out to share that they've been through this with antidepressants too. One had to take off work because it was so brutal. This is happening all around us.

What I think about when I see psychiatrists on social media debating semantics and deftly diverting attention, as someone whose life has been profoundly affected by psychiatric drug harm. 🧵 (1/9)

(1/2) A psychiatric clinic in New Zealand is running an advert in a major NZ media outlet talking about antidepressant withdrawal to draw attention to what it calls "medication optimisation" and its wider services. Makes me wonder if this clinic is reading the room... "Stopping antidepressants too quickly can lead to withdrawal symptoms such as anxiety, insomnia, dizziness, nausea, and mood swings. Clinical guidance recommends a gradual reduction to minimise these issues, mainly because withdrawal can be mistaken for a return of the original condition***. Without proper support, individuals may become stuck: unable to stop, unsure whether they are experiencing withdrawal or relapse, or returning to medication."

I received a number of messages appreciative of me sharing feedback from clinicians on the ground (mostly GPs) who I lecture to about withdrawal and deprescribing (most weeks at least once and sometimes up to three times a week) as an antidote to the general defensiveness, deflection, minimisation and denial that mostly characterises the responses of a small group of very vocal, often quite extreme, ideologically driven clinicians on this platform. So here are some more de-identified comments from 300 GPs that I lectured to in an English ICB as part of their move to reduce inappropriate antidepressant prescribing. “This very insightful webinar should be made mandatory for all clinicians in primary care in our region. Can the moderators raise this with the ICB?” “This was one of the most sensible and interesting webinar I have listened to for a while. Thank you “ “Thanks really clear and useful” “That was so refreshing. Thanks for being so positive. Can you come and speak to our clinical staff?? 23000 patients” “Excellent session and does raise the valid point of reviewing these along with other medicines/doses for older patients due to pharmacokinetic/pharmacodynamic changes. We need to be more proactive in reviewing long term medicines and the original indication as you highlighted for the AD” “If there is a down regulation of serotonin receptors naturally through homeostosis, how is the drug even effective? Wouldn't the extra serotonin be pointless? Is it more of a psychological effect from taking the anti-depressant?” “does this only apply to patients who are on them for their mental health? what about patients who are on them for chronic pain? secondary care are pushing ALOT for SNRI/SSRI for chronic pain - just had a letter from gynae to use it for a lady with endometriosis.....?! “ “this is fascinating and makes perfect sense. I'm very guilty of doing all the wrong things you have mentioned. I do worry that such a slow withdrawal it is not very practical in the real world. It is making me think about the fact that I think we are too happy to start these medications and give little consideration to the risks of stopping. Though I think this reflects the fact that we have few other options given the waiting times for talking therapies. “ “so does this sort of withdrawal effects in terms of the worst happening on the lower doses, same principle for opioids and gabapentinoids?” Of course there are numerous practical barriers to implementation pointed out by the GPs as well as lots of clinical dilemmas: “A bottle of sertraline costs £201.80” “For patients who’ve been on ADs for many years, and reached a roughly steady state, they’re often very reluctant to come off them. Looking at the prevalence and severity of withdrawal in this cohort, I can see their point. How would you advise these patients? Do the risks of ongoing rx outweigh the risks of withdrawal?”

“ Apparently, once a belief becomes part of our identity, our brains stop treating information as information and start treating it as a territorial dispute. At that point, facts are no longer facts, they're invading armies.” Seems germane. Full piece facebook.com/share/1HFAZBnpd…

I am still waiting....