Peer-Support Groups Were Right, Guidelines Were Wrong: Dr. Mark Horowitz on Tapering Off Antidepressants

In an interview with MIA, Dr. Horowitz discusses his recent article on why tapering off antidepressants can take months or even years.

Peter Simons
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I was fortunate recently to interview Dr. Mark Horowitz. Dr. Horowitz is a training psychiatrist and researcher and recently co-authored, with Dr. David Taylor, a review of antidepressant withdrawal that was published in Lancet Psychiatry, which we’ve written about here at Mad in America (see here). Their article suggests that tapering off antidepressants over months or even years is more successful at preventing withdrawal symptoms than a quick discontinuation of two to four weeks.

Dr. Horowitz is currently completing his psychiatry training in Sydney, Australia, and has completed a PhD in the neurobiology of antidepressants at the Institute of Psychiatry at King’s College, London. He is a clinical research fellow on the RADAR study run by University College, London. His research work focuses on pharmacologically informed ways of tapering patients off of medication. He plans to conduct studies examining the best methods for tapering medications in order to develop evidence based guidelines to assist patients and doctors.

What follows is a transcript of our conversation, edited for clarity.

Peter Simons: Dr. Horowitz, welcome.
Dr. Horowitz: Welcome. Nice to meet you.
Peter Simons: Nice to meet you too. So, to start with, I’m curious about what your background is and how you became interested in this subject.
Dr. Mark Horowitz

Dr. Horowitz: My background is in psychiatry and research. As well as being a psychiatrist I’m also a patient, probably like a few people. I only really became interested in this topic when I experienced it firsthand. So, after many years of being on an antidepressant, I reached the point where I tried to come off. Probably I was on it for about 12 years. I tried coming off, what I thought was relatively slowly, according to the guidelines I was aware of and ran into all sorts of trouble. Which was a great surprise to me.

I’d never heard about withdrawal symptoms from antidepressants, not in medical school, not in my psychiatry training. But when I experienced incredible insomnia, dizziness, trouble concentrating, and a very rapidly beating heart, and anxiety, I was very surprised by it. I wasn’t quite sure what to make of it. And in fact, I came across an article on the Mental Elf websites where they had reviewed the Fava et al. (2015) systematic review about antidepressant withdrawal symptoms. I recognized a lot of what was in that paper in my own experience. And that kind of led me on a bit of a journey.

So the first time I tried to come off, I actually went back on the medication because I just couldn’t handle what was happening. It was probably the most unpleasant experience of my life—it definitely was the most unpleasant experience of my life. And it was actually part of the reason that I ended up moving back from London to Australia. So, I’m kind of a bit of a nerdy guy, and my approach was to try to read everything I could about antidepressant withdrawal symptoms. I scoured the academic literature, clinical guidelines, and found essentially the same message, that coming off over two to four weeks was what was recommended with the idea that it may—for some people it might not, it might need to be longer, but there was no detail at all on what longer meant or what slower meant or how to do it. And so I ended up going on patient websites to try to make more sense of what was going on.

The website that was far and away the most helpful was Surviving Antidepressants, run by Altostrata. It’s a wonderful resource with a quite incredible number of people involved in it. I think there are hundreds of thousands of posts and tens of thousands of people all talking about experiences that were just like mine. And it was the first time that I felt that I had a handle on things when I went on that website. And I soon learned that people came down off their medication much more slowly than guidelines recommended. And I began following their guides, thinking it’s useful that these people were around, but how come I need to go to peer support websites for this, when there are so many doctors and psychiatrists and professors around? Why is this? Why is the best information around on a peer support network?

It was on that site that I came across a graph that seemed to make sense of what was happening to people. And that was the graph that was sort of the centerpiece of my article in Lancet Psychiatry: this kind of hyperbolic relationship between the dose of antidepressant and effect on receptors. Essentially when you increase the dose, the effect is not linear, but it sort of tapers off. And the main relevance of that to tapering off medication is that at very low doses changes happen very quickly at receptors. In fact, when I saw that graph on the website, I basically spat my food out because it matched so closely to what people were experiencing. All these people talking about how they’re having trouble getting off the last bit of their medication, how they had to slow down. And it sort of fit together so nicely for me I thought people should know about this. And that was when I wrote the paper, and I reached out to a professor I’d worked with in the past who was excellent and we wrote the paper together.

Peter Simons: Thank you for sharing your personal experience with that and how that informed your research interests. That’s really amazing. And it’s amazing that it takes someone with that personal experience to be able to say, hey, there’s this big gap in our research literature. Why is that? I’m curious to know if you have thoughts about why is there such a big gap in the research literature around getting off of antidepressants.
Dr. Horowitz: I think there are a few reasons. One, it comes down to the way doctors think. I think, had I not experienced the withdrawal syndrome, I would have been very skeptical. I think if a patient had come to me [before I’d experienced it] and said they had real trouble coming off an antidepressant, I would probably be inclined not to believe them. I guess that’s because my understanding of antidepressants through sort of medical school and training had been that they’re relatively benign substances that are reasonably effective. And I’d always regarded them in that way. So if people had told me, with these benign substances, they had such serious problems, I would have been skeptical. And I think that’s one of the reasons for doctors being skeptical of this.

Two, all the psychiatrists I know are very well-meaning people who want to help their patients. They also want to feel like they’re doing a good job. So I think when there are critiques or anecdotal stories or studies that show that the treatments that are giving have side effects, or aren’t as effective as they would like them to be, I think they find that difficult to hear.

And three, there has simply not been the same attention given to stopping the medication as to starting medication. And that is in part to do with the priorities of the pharmaceutical industry: they run studies in order to get approval for their drugs. So they have a reasonably narrow interest when it comes to medications. And that doesn’t necessarily include all the things that are best for patients. So we have, so we have the circumstance where there are more than 500 studies on starting antidepressants and less than 10 on withdrawal symptoms from stopping them. I think that difference just represents the difference in attention from drug companies and from the academic community. I think some of those elements are why doctors have been so slow to recognize this as an issue, but I have to say I think that is changing. You know, I do think patients and advocacy groups have been reasonably effective making their voices heard and I do think that colleges of psychiatry are now paying more attention to this issue.

Peter Simons: Yeah… So is there yet or do you think there will soon be a chapter on antidepressant withdrawal in a psychiatric textbook or something like that?
Dr. Horowitz: I hope so. I’m aware that in the United Kingdom, which is much more aware of it than America, there are two reviews going on at the moment: the NICE guidelines, which are sort of the national guidelines for depression, are being reviewed and I know as part of that they’re looking at antidepressant tapering and withdrawal; and also another review undertaken by Public Health England, which is another national body.

Again, one part of it is looking at withdrawal symptoms. Whether that will produce better guidelines or greater attention, I’m not sure, but it’s at least a step in the right direction. So I’m a bit uncertain about what the next steps will be. I think there is evidence that the college is paying more attention to the issue. I’m not sure what tangible steps that will lead to.

Peter Simons: What is your hope for how doctors and the medical field might respond? Because, I mean, it sounds like, from your personal experience, it was the internet and peer support that enabled you to get the information that you needed about antidepressant withdrawal. So what is your hope for the future, in terms of the medical field understanding this and interacting with their patients?
Dr. Horowitz: I hope they listen more. I hope they do a few things: I hope they conduct more studies on withdrawal symptoms to try to work out who is getting them exactly, which medications, how long patients were on them, all the kind of details that do need to be worked out and then, of course, next step, on how to avoid them and hopefully our paper will be helpful. I think they need to run studies to work out what proportion of patients need to do a very slow taper. What sort of tapering is most effective? I think when they have those studies that it’ll be able to inform the guidelines and inform the everyday practice of psychiatrists.

I think in the meantime because, obviously, it does take time for those sort of studies to be conducted, I would hope that a little bit more awareness of withdrawal symptoms will mean that psychiatrists discuss issues with their patients in a more understanding way. Because I think I certainly heard stories of people going to see psychiatrists and having their stories dismissed, told that it’s their disease coming back. And, of course, that is a dilemma. There is always the possibility that an underlying disorder comes back when you stop a medication. There are ways of distinguishing withdrawal symptoms from a relapse. Things, funny symptoms like dizziness and electric shocks and how quickly they come back on. So I hope a bit more awareness of that will have an immediate effect on the way that psychiatrists respond to patients when they have trouble coming off medication. And not only assume that it must be a relapse, but rather think about things like tapering slower, which I think is likely to help patients get off without as much trouble as they’ve been having so far.

Peter Simons: Great. Thank you. So your study does talk in great detail about the neurobiological processes that underlie discontinuation. It’s pretty technical. Do you think you could summarize some of that for the layperson?
Dr. Horowitz: Ok, this could be the snooze-section. I think number one, I think it should be said, the neurobiology is not very well understood. You know, I put together the little bits that were available. I think the broad story is, any drug that increases a neurotransmitter in the body will lead to a down-regulation of its receptors. The technical word is homeostasis. When there’s a very loud noise, your eardrum accommodates so that all noises are heard a bit quieter. And the same thing happens in the body when a drug like an antidepressant increases the amount of serotonin in the body, the body’s serotonin receptors probably down-regulate.

Now, we put in a few pieces of evidence in the paper that shows that there is evidence of that, that serotonin levels do down-regulate over time. It’s likely that when you stop the medication, and serotonin levels return to normal, that is seen by the body as a lack of serotonin in the same way as when you walk out of a very loud concert, everything sounds very quiet. So when you go off your antidepressant pretty quickly, you’re used to the high levels of serotonin, suddenly you’re down to what is normal for other people but, but low for you—that is a reasonably simplistic view of what’s going on. But that is the dominant idea in the field of why people might feel what they feel.

In some ways what people feel on withdrawal is similar to when they have their serotonin depleted, which you can do to people by giving them a lack of the precursor in their diet. Some people will develop some low mood. And, I think one interesting aspect that I was surprised to find out, was that serotonin is involved in balance so that when there is low serotonin, people will experience a sea-sickness. So that is kind of known in a small study. So, it’s possible, and this is just a hypothesis, that some of the symptoms people get in withdrawal, things like dizziness or the electric shocks in their head when they move their head, maybe related to sea-sickness, because of the role that serotonin plays in that system.

Now, I would say all those ideas are kind of speculative. There aren’t detailed studies to know what is the exact relationship between those different receptors and symptoms. But that’s the broad outline. And then one other point, which I hadn’t also thought of before, was that there are serotonin receptors outside the brain, there are serotonin receptors in the gut. And, and it’s possible that some of the gastrointestinal upset that some people experience may be related to those serotonin receptors. Yeah, that’s my neuroscience spiel.

Peter Simons: That’s great. A very clear way of explaining the neurobiology of why certain withdrawal symptoms might happen. Thank you for that. And then the other part of your study is sort of an explanation of this nonlinear relationship between, as you taper off of the antidepressant, the dose that you have. And it still has a large effect on the neurobiology even as you’re at very small doses. Can you also maybe explain that a little bit more?
Dr. Horowitz: So I think that’s one of the main messages of the paper. That graph that I mentioned, essentially it’s a brain imaging study that looked at the relationship between doses of antidepressant and their ability to block the serotonin transporter. So the serotonin transporter is something that controls how much serotonin exists in between neurons and the way that the SSRI’s (the selective serotonin reuptake inhibitors, the main class of drugs that are used), the way they work, is by blocking that transporter. And that increases how much serotonin is in between the synapses.

The graph is a hyperbola, which people might remember from high school, sort of like an upside down ‘U’ so that as you increase the dose, it starts rising very quickly and then it kind of tails off. So the punchline is that very tiny doses of antidepressant—and by tiny I mean as little as 1/40th or 1/50th of a normal dose, so for example, 20 milligrams of citalopram is a regular dose. Doses as small as 0.5 milligrams have quite significant effects on that serotonin transporter. So a dose 1/40th the size of a normal dose actually has about a quarter of the effects at the receptor.

So I have heard doctors laugh when they hear about how low patients have gone before they stopped their medication, they’re hearing doses that sound to them trivial. But I think what the brain imaging data shows is that doses that low are not trivial. And so to me it’s about how big the jump is to zero.

So I’ll work through a brief example. If you’re on citalopram for example, and you halve your dose, then you’ve actually only gone down a very small amount in terms of the effect on receptors. But if you then go from that half dose to zero, you’ve gone down a huge amount. So just to give some context, when you go down from say 20 milligrams to 10 milligrams, you go down less than 10% of the effect. And when you go down from 10 milligrams to zero, you’ve gone down more than 70%.

This then gives a guide to what evenly going down means. So I think lots of people think that evenly going down would be like going down 20 milligrams to 15 to 10 to five then to zero, and that’s evenly going down along dose. But what we argue in the paper is that going evenly down means going evenly down in effect at receptors. So in practice, what that means is you go down by increasingly small amounts. So for example, going down from 20 to 10 to five to 2.5 to 1.25, 0.6 to 0.3 before stopping. Apology for all the numbers!

The point is that in order to have evenly spaced out withdrawal symptoms, you probably need to make the jump smaller and smaller. What is so interesting about that is, that is what people online have kind of worked out when they recommend going down by a percentage of a dose every month that achieves a very similar effect to what I’m describing. And still, I guess the punchline for people who don’t want to go through lots of graphs is, go down slowly and go down to a very small amount of medication before you stop, is the punchline.

Peter Simons: That’s a very clear explanation of that. I appreciate it. So I guess, I’m also curious about where we’re going from here. Have you had a good response to this study? How have people responded?
Dr. Horowitz: Right. Well, it’s been interesting. I have received a lot of appreciation from patients who I guess recognize the technique that we describe as being something that they’ve used and I guess seeing what they’ve experienced validated by the science and by a publication. I’ve had several psychiatrists write to me to ask for the paper and the appendices, with a plan to help them take their patients off their antidepressant, which is good. That’s the intention.

The Royal College of psychiatrists, the college in Britain, has put in a couple of comments in a couple of news articles where they’ve, I would say, cautiously welcomed the paper. They’ve Identified that it explains the pharmacology of the medication. It makes it a bit clearer why patients might be experiencing the symptoms they experience on low doses, and they seem to be a calling for more attention to this issue. So in an article in the Daily Mail, the spokesperson for the Royal College said that the College identifies that withdrawal symptoms from antidepressants are a problem. I hope this is a signal that they will give this more attention.

There certainly has been a lot of attention on this issue in the UK. There was a recent program on the BBC, there have been a number of articles published in journals that have got a lot of attention in the British media. So I do think this is something that is in the public’s eye and in the college’s mind. So I would say the responses so far have been positive and that’s both from patients as well as from doctors and the Royal College. So I hope, I think there might be some forward movement in this.

Peter Simons:  And for you personally, I know that you’re involved in the RADAR study, which is a study of discontinuation on antipsychotics. Is that right?

Dr. Horowitz: Exactly. That’s right, yes. So it’s a very interesting study that is trying to replicate an earlier study, a study done in Holland, to see if you lower antipsychotics in patients with a chronic psychotic illness slowly, can you avoid a significant increase in relapse? And in the long term, can you improve their social functioning? And that’s what this previous study has shown, that patients who were withdrawn slowly from their antipsychotics in the long-term had better social outcomes than patients who remained on the medication. So it’s a fantastic study.

Peter Simons: What’s the timeline on that study? Is it a trial that’s ongoing right now?

Dr. Horowitz: Yes, it’s being run by Dr. Joanna Moncrieff, and it will run for another couple of years. So altogether it’s a five-year program, so we’re sort of in the middle now and it should be very interesting.

Peter Simons: And then in your personal work, are you intending to keep working on antidepressant withdrawal or withdrawal symptoms in general?
Dr. Horowitz: We—David Taylor and I—are working on similar papers for a few of the major classes of psychotropic medication. So our next paper will be on a pharmacologically informed way to discontinue antipsychotics. And then the one following that will be on benzodiazepines.

Probably most of my focus will be on antidepressants, but I can see that the graphs and the relationships that we showed for antidepressants are true for other medications. And I certainly think it’s a very under-researched area, the broader idea of how do you stop medication and when do you stop it. So I think there’s a lot of data around about when you might start it, but I think the area on when you stop it, how do you stop it, who should you stop it for, is an area that needs a lot more attention. That’s where I hope to spend my career.

Peter Simons: Great. Thank you. Anything further that you wanted to say about your study or about antidepressant discontinuation in general that we didn’t get to today?

Dr. Horowitz: For me, the next step that I would like to do is to get funding to test the idea in the paper, because we’ve put together essentially a hypothesis that if patients are to reduce the medication as we suggest, slowly, down to a very low level, in a hyperbolic way, that the withdrawal symptoms will likely be reduced. I think there is some evidence that exists for that, that studies that taper patients over longer periods of time do show fewer withdrawal symptoms. Studies that taper patients over very many months, six, nine, 12 months show better results. There are also studies that taper patients down to very low doses as low as the ones that we suggest in the paper also have better results. But I guess to really influence guidelines and to really have the evidence that could be applied to patients, we need to do this study. So we want to have a group of patients and compare what the NICE guidelines suggest to do. So reducing over four weeks, perhaps eight weeks, and compare it to our proposed method over many months, maybe variably, also sort of titrate it to the individual, so to see what people require. I think that that would be the next aim, to do that step.

Peter Simons: That sounds like that would be a huge addition to the research literature around discontinuation. I hope that you do get the funding to be able to carry out that study. Thank you again, Dr. Mark Horowitz, for speaking with me today.
Dr. Horowitz: Thank you, Peter.

 

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Peter Simons
Peter Simons
MIA Research News Team: Peter Simons was a published researcher, on track to becoming a psychologist, when he decided to leave that world behind him due to creative differences. As a science writer for Mad in America, he tries to provide the layperson with a view into the sometimes inscrutable world of psychiatric research. As an editor for blogs and personal stories at Mad in America, he prizes the accounts of those with lived experience of the psychiatric system and hopes to create alternatives to the mainstream assumptions of the biomedical model.

51 COMMENTS

  1. And this was pretty obvious during 15 minutes googling I did a year ago.

    I put it to the psychiatric doctor that a 2 week taper, which would go from 80% occupancy to zero in one fell swoop, was way too fast. I begrudgingly achieved 3 weeks. Why the rush? Well maybe this “we would like to meet the minute you come off because that is when most people realise that they need to go back on antidepressants”.

    Anyway within days they were panicking, doing blood tests, because of unexplained flu symptoms.

    This was in the UK – I can honestly say that everything they did, from providing information, obtaining consent, drug choice, dosage and taper was way outside EXISTING pediatric NICE guidelines which require written information and consent, and, on tapering, say “Where antidepressant medication is to be discontinued, the drug should be phased out over a period of 6 to 12 weeks with the exact dose being titrated against the level of discontinuation/withdrawal symptoms. [2005]”

    Psychiatrists cannot currently be trusted to prescribe or taper antidepressants to minors in accordance with CURRENT guidelines.

  2. I am angered by Dr. Horowitz’disclosure of his ephiphany as it relates to the challenges of withdrawing from psych drugs. He mentions that most of his information on the subject was from medical school training and was not helpful.Are pre med students not taught to think critically? Dont young medical students ever question why their training is not informed by service recipients- especially in the practice of psychiatry? Dont they have any common sense thinking skills that allows them to smell the corruption? Good Lord- what a bunch of zombies med students are becoming! No wonder the doctor suicide rate is exploding: disconnection-putting career and financial security above the interests of their own and their patients spiritual mental physical and emotional health-the lack of moral compass to speak out against the colonization of health care by industrial interests.

    • To answer your question….no, med students are not taught to think critically. We have med students rotating through where I work all the time and they are about the most clueless people I’ve ever met. Many of them are not bad people but they’ve swallowed the bait…..hook, line, and sinker when it comes to psychiatric stuff. They couldn’t sniff their way out of a brown paper bag when it comes to smelling out corruption. Medical schools need a huge overhaul and most of them end up turning out arrogant twits rather than real critical thinking and empathic people.

      I lived in a neighborhood where I was the only non med student resident and I could tell you some stories about how so many of them feel that they’re entitled and special, so special that they can’t even respond back to you when you wish them good morning on the street. I got tired of them very quickly and was very glad that none of them lived in my apartment building.

    • I only had one psychiatrist I could call truly evil. On the other hand–out of more than a dozen–only two or maybe three talked to me like a human being. They will only listen to you (generally speaking) if you say what they want to hear.

      If you say, “Gee doctor you’re so intelligent. These medicines you prescribed make me feel great. This Zoloft is a life saver.” That they will listen to and use as evidence that what they’re doing works.

      If a “consumer” says, “This Haldol is giving me seizures and while I seize I have terrifying hallucinations.” “I haven’t been able to sleep since you put me on Anafranil two weeks ago.” “My depression is worse than ever on Prozac. Can’t quit thinking of suicide.” Well all those patients are clearly delusional and should not be taken seriously. Except you should lock up the third. That will teach him to be treatment resistant! 😀

      • I only had one psychiatrist I could call truly evil. On the other hand–out of more than a dozen–only two or maybe three talked to me like a human being.

        Isn’t this sort of beside the point? Supposed all the shrinks you talked to were very nice and “talked to you like a human being” — if what they’re saying to you is based on fraudulent ideology the effect is the same or worse, so wouldn’t it be less confusing for them to drop the veneer of “politeness”?

      • My experience was similar. I dealt with five psychiatrists while dealing with my issues. Only one was truly a doctor in any sense of the word. He not only listened to me he actually asked me what I wanted and needed and when I told him he did exactly as I stated. He was young and not totally jaded yet. But he was helpful and I don’t really see him as a psychiatrist at all.

        The other four were fools of one sort or another. And as you stated, you can get them to eat out of your hand if you stroke their egos and tell them what they want to hear and are listening for. Two were actually emotionally and psychologically abusive. One of them actually told me that I was stupid for being overwhelmed by the murder of my sister and year to the day of my mother’s burial. I came very close to planting my fist directly between his eyes and I tried to get him fired from the community mental health center where he was employed. They actually did fire him a few months later. The second jerk was screaming at me and shouting so badly that saliva was flying from his mouth. He needed a ten and two and seclusion and restraint!

  3. “… it’s useful that these people were around, but how come I need to go to peer support websites for this, when there are so many doctors and psychiatrists and professors around? Why is this? Why is the best information around on a peer support network?”

    Psychiatrists tend to not listen to, hear, or believe their clients, and I found them to be the most ungodly disrespectful, delusional, and delusions of grandeur filled people I’ve ever personally met. Most normal people are mutually respectful, listen to, believe, and care for other people. That is why the best information around is on peer support networks.

    It is rather a shame the psychiatrists, who claimed way back in 2002, that they “know everything about the meds” are still, in 2019, just starting to learn about the common symptoms of antidepressant discontinuation syndrome. And it’s even more of a shame that they went out mass drugging the population, fraudulently claiming they had knowledge they did not have, and have killed and destroyed the lives of millions.

    https://www.naturalnews.com/049860_psych_drugs_medical_holocaust_Big_Pharma.html

    Just an FYI about the antipsychotics/neuroleptics, they create what appears to the DSM deluded to be the negative symptoms of “schizophrenia,” via neuroleptic induced deficit syndrome. And the antipsychotics also create what appears to the DSM deluded to be the positive symptoms of “schizophrenia,” via antipsychotic induced anticholinergic toxidrome. Both of these medically known psychiatric drug induced syndrome/toxidrome are missing from the DSM.

    https://en.wikipedia.org/wiki/Neuroleptic-induced_deficit_syndrome
    https://en.wikipedia.org/wiki/Toxidrome

    It took this “peer” three years to learn medical lingo, and find the actual medical evidence of how the antipsychotics create psychosis. Why does it take the psychiatric industry so long to garner insight into reality? “It is difficult to get a man to understand something, when his salary depends on his not understanding it.”

  4. Thanks you for your work Dr Horowitz.
    “So if people had told me, with these benign substances, they had such serious problems, I would have been skeptical. And I think that’s one of the reasons for doctors being skeptical of this”
    To me this is the most important thing doctors need to be taught to listen. That people’s experiences are real!!! Psychiatrist’s need to stop thinking they are the expert on someone else’s experiences. If we don’t agree with them we “lack insight”. For years and years we have been trying to tell them about withdrawal symptoms but it takes a psychiatrist to actually experience this to get research like this done.
    I have seen some very horrendous iatrogenic harm done. I work with one lady who’s psychiatrist thought it quite ok to cold turkey her off clozapine, and withdraw her off an antidepressant and clonazepam in a 2 month period (she’s been on all of them for over ten years) and change her diagnosis from schizophrenia to borderline personality disorder and then called all her withdrawal symptoms behavioural. No listening to her, her family or me as an advocate. After all what do we know!!!!!!
    I hope you get every opportunity to keep on with this kind of research cause we need it to make doctors listen.

      • I am new to the truth about psychiarty. And so thankful to all of you on MIA. I am getting familiar w your name Rachel777. I have a Masters Degree in Physical therapy that included many neuroscience courses. However, do you have any idea how medical students psychiatrists and ones that say they are board certified in neurology can miss the 10 th grade High school biology concept of homeostatsis? Or the 10th grade high school biology concept the the human body needs our CNS to run it. So taking anything that is going to depress our CNS is going to impair ones ability to function. With this in mind I wonder if neurobiology is making things way more confusing and complicated than it needs to be??

        • Rachel, I realize my last comment my have been discouraging to take neuro courses. Since I learned the truth about psychiatry (fairly recently) and the amount of unnecessary suffering it has caused me, I have been a bit on the negative side and think everything and everyone is corrupt and evil. I am working on that. So I actually think you could learn alot about the adverse reactions by taking neuro courses. That is how I learned what psychomotor retardation is. And my knowledge from such courses probably has been key to me escaping this hell. I thank you again for getting the truth out.

          • I too have struggled with misanthropy Lcostanzo. Many survivors do–long after withdrawal has ended.

            My solution? Unconditional love. Still a work in progress.

            Realize in rejecting the “mentally ill” the undiagnosed seek justification for their own failings. In rejecting us they are rejecting the dark, ugly sides of themselves they refuse to own. They are not so much EVIL or delighting in cruelty as foolish and careless of others.

            Plus it’s impossible for “outsiders” to fully understand the agony psych drugs cause us. My best friend was shocked when I told her how dead and miserable I felt under the influence. For some reason I seldom complained about THAT, though I whine a lot.

            Probably knew no one would listen; just one of those things I had to put up with. Plus I didn’t want to hurt anyone and feared I would if undrugged.

  6. “For me, the next step that I would like to do is to get funding…”

    That was predictable. I guess we have nothing better to do with our resources, like feed hungry kids who are deprived, etc.

    More money, more money, more money!! And for what, exactly? More research, of course! Researchers have to eat, too, ya know…

    • Sadly researchers do Alex. We all have to eat.

      If my writing never pays–the interesting stuff probably won’t–I will have to find another way to earn a livelihood. Using up time and energy that could be used for writing.

      Don’t you charge something for the services you offer?
      The laborer is worthy of his hire.

      • Rachel, I’m surprised at your response here. I would have thought you were totally aware that millions (billions?) of $$$ are wasted on bogus research, that resources in general are terribly wasted and misused by these research institutions–resources which could (and I think, should) be rerouted to more urgent and practical, humane needs. That’s what I meant, stated with a bit of irony. I’m fine with people making a living and drawing income, everyone that desires this has that right of course, nothing wrong with that. But the ecomonic and class disparity is glaring, and so much of that is created by “research funding.” I don’t have to tell you this, do I?

        As far as my charging for services, sometimes I do, but not always. In fact, the majority of the time I don’t. I made more money acting than I have ever charged for my healing services. And I’ve retired from theater.

        Most of my work in the world–healing, teaching, public service films, musical community service–has been for no remuneration whatsoever. Often I’ve told people that I wouldn’t charge them for something, and next thing I know they are offering a donation. I’ve received unsolicited cash in the mail as well as via PayPal, along with really lovely gifts, when people value the work I do and get a lot of healing out of it. If the work makes no impact, then no payment would be expected, although that’s never happened.

        I’ve experimented a lot with this over the years, it’s a challenge. What I’ve never had is set fees. If I do charge, it’s always a negotiation based on my economic needs and what a client can comfortably pay. This is all so flexible for me, definitely not my motivator. It’s simply an exchange of energy, and that can be in a variety of manifestations. I’ve had my computer fixed in trade for healing work, for example. Whatever is practical and fair at the time, for everyone concerned.

        When one does authentic healing work (what I learned to call “working with the light”), then the universe pays, one way or another. That’s happened to me all throughout the time I’ve been doing healing work, for the past 14 or so years. Kind of a trick of the trade, but it’s based on knowing how giving/receiving energy works. It really simplifies things, and the focus is the healing, period. I’m more interested in a person being present with their healing work, that is way more valuable, satisfying, and fulfilling than money.

        I live very frugally, not on much, month to month, and all my modest needs are met and then some. It’s called “working my abundance.” I don’t need to charge $100s and $1000s of dollars to do good work in the world. Although when people think my work is worth that kind of money, and many have said as much, I certainly don’t scoff at it 🙂

        I always pay it forward. Money is only energy, we give it too much power. And we don’t need nearly as much as we think we do (as per social programming), not if we understand our power of manifesting. That’s the gold!

        Well, not just manifesting, but specifically, manifesting from the heart. That’s an important discernment from manifesting from the ego. Seriously! If we’re manifesting from the ego, money will matter in a way that is quite stressful, and constantly so. If we’re manifesting from the heart, not so much. That’s ease.

        No charge! 🙂

        • 🙂
          Okay. Not attacking you Alex.
          So, you’re not protesting his earning a livelihood so much as overpricing it?

          Btw, I wish someone would do a survey on people diagnosed with Bipolar 2 to find out how many cases were triggered (“unmasked” the mental illness makers call it) through SSRI use for depression or some off label purpose. Do you need to be a professional to conduct one?

          • That would be valid research if it did not start with a presumption that such a “thing” as bipolar exists and there are “cases” of “it.”

            How would you do that kind of research anyway — give it to healthy people and see if it ruins them? (“We have some fresh data here, doctor…”)

          • “Not attacking you Alex.” Yeah, yeah, “friendly” challenge works for me.

            I’m protesting wasted resources, and this is an all-too-typical route for that. Perhaps that would be up for debate in some way and maybe even I am generalizing. Not interested in elaborating further on this, that would be a waste of MY resource.

            Are you asking me or anyone that last question? Seems like either a total non-sequitur or you’re being cryptic. Either way, I’ve no idea what you’re asking or why, sorry.

            Edit: Oh, ok, I posted this and saw that oldhead gets you here. I’ll let you two talk amongst yourselves. G’day!

          • Labels exist Oldhead. Biologically valid or not.
            I want to show the public how even using drugs for “soft diagnoses” like depression/anxiety can ruin your life with a Bipolar 2 label rendering you a degraded non-person in the public’s eye. And a non-citizen with no legal rights at all.

            Knowledge of neurobiology can come in useful in revealing and repairing damage done by psychiatry so don’t poo poo that.

            I would survey those already labeled by psychiatrists as Bipolar 2 to discover how many were fine till a shrink messed with their brains.

          • I was just wondering about your train of thought and looking for something to toss around. I might have been subconsciously triggered by the word neurobiology because it so closely resembles “neuropsychiatry,” which is a very disturbing concept.

            Scientific-wise however there’s the question of not having objective data on people’s physical/brain condition prior to taking drugs; a plausible argument could be made that if they were “fine” prior to being diagnosed and drugged what were they doing in a shrink’s office in the first place, so it’s hard to study this in retrospect

            Conversely, is a shrink going to say “you’re fine, now let’s see what happens when you take this”? So there are some methodological problems here.

          • Rachel 777, I think your survey is worthwhile and you should do it. Collecting stories from people who got a bipolar2 diagnosis after a psych drug reaction (and all that follows) is the first step into deeper research and discussion on a neglected topic, and could potentially be published at MIA, on Medium, or other venues.

            It happened to me about a decade ago. Standard doses of antidepressants of any class amped me up horribly, and pretty soon psychiatrists were tossing around diagnoses like “hypomania” and talking about Zyprexa. Fortunately I didn’t buy it and walked away from this treatment and recovered by other means. But I’ll never forget being told it was me “at fault” when it was so obviously the drug.

          • “I want to show the public how even using drugs for “soft diagnoses” like depression/anxiety can ruin your life with a Bipolar 2 label rendering you a degraded non-person in the public’s eye. And a non-citizen with no legal rights at all.”

            Good grief. Talk about fear-mongering and shaming! Please let’s not. What on earth is this website about, anyway???

          • Rachel, we’ve medically proven that the two most “serious mental illnesses” are iatrogenic, not ‘genetic’, illnesses. The head of NIMH confessed to the “invalidity” of all the DSM disorders six years ago. So it’s a complete waste of money to continue to research for genetic markers for illnesses we’ve already medically proven have iatrogenic, not genetic etiologies. And looking for such was always a waste of money.

            As to “bipolar,” Whitaker did a good job of pointing out the iatrogenic etiology of the “childhood bipolar epidemic” was created with the antidepressants and/or ADHD drugs. And since drugs are not cognitive entities that can determine the age of the person taking them, that’s likely the case for most “bipolar” misdiagnosed, in all age groups.

            Especially since the psychiatric industry is still claiming to be unaware of the common symptoms of antidepressant discontinuation syndrome, and the adverse effects of their drugs in general. And given this claimed ignorance on the part of the psychiatric industry, it’s highly likely most “bipolar” (type I and type II) was likely created with the psych drugs.

            And when even the so called experts on the psych drugs claim ignorance of the adverse effects of the antidepressants, then none of the “mental health” workers, or misinformed mainstream doctors, can abide by this disclaimer in the DSM-IV-TR. And even you mention their systemic, delusional “unmasking bipolar” theology.

            “Note: Manic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder.”

            And when the fact that the antidepressants, and antidepressant withdrawal, can create the “bipolar” symptoms was pointed out by Whitaker worldwide, what happened?

            The psychiatrists took that disclaimer out of the DSM5. Proof of the complete and total lack of ethics of the psychiatric leadership, and all “mental health” workers who are grateful for that change. Which includes the “mental health” workers that work through my childhood church.

            Bye, again, unrepentant child rape covering up Lutherans, and the iatrogenic illness creating “mental health” lunatics who profiteer off of covering up child abuse for that religion, and the wealthy society wide.

            https://www.indybay.org/newsitems/2019/01/23/18820633.php?fbclid=IwAR2-cgZPcEvbz7yFqMuUwneIuaqGleGiOzackY4N2sPeVXolwmEga5iKxdo
            https://www.madinamerica.com/2016/04/heal-for-life/

            The “mental health” workers are nothing but industries who work contrary to the law, to unjustly protect the now globalist “satanic elite,” who now seemingly control all of Western civilization.

          • “So it’s a complete waste of money to continue to research for genetic markers for illnesses we’ve already medically proven have iatrogenic, not genetic etiologies. And looking for such was always a waste of money.”

            Yes, thanks, Someone Else, for bringing it back around. Exactly my initial point–the money wasted on needless research is astronomical and a huge problem of corruption, lack of accountability, and basically a lack of real value. These very sizable funds would better serve people who are IN NEED.

          • Rachel your commentary here is spot on. I want to add another point to rebut both Oldhead and Alex.

            First, there are a great deal of people who are not going to a psychiatrist’s office for help. They go to their physician when they aren’t feeling well. They may be screened for symptoms of depression or asked about their home lives. Without any testing at all, this gives the physician “insight” into whether the patient’s problems are truly physical or somatic. So it’s important to spread the word to people to lie their asses off when they are screened for mental health problems by their physician.

            The way most people now develop a bipolar diagnosis is exactly as Rachel said. They are drugged first with psych drugs by a physician who deems their physical problems to have a somatic nature, this destabilizes them, at which point they may be referred to higher levels of care such as to a psychiatrist. This is how I was made “bipolar” and I’ve heard the story repeated so many times that it’s almost comical that anyone would deny this or call it fear-mongering.

          • This has become our policy ever since our 18-year-old son was “screened” for depression by a doctor, who afterwards went into the usual tirade about how “depression is a disease, just like diabetes” and “it’s now treatable” and so on when he told them he’d been suicidal. The doctor never for ONE MOMENT asked why he had felt that way. It actually pissed him off big time, as he had been struggling with an assault and other issues and so had many good reasons to feel hopeless or discouraged at the time. Now if someone asks, we simply decline to answer those questions, or else say, “I’m just fine!”

          • As Rachel and then kindredspirit pointed out, it’s a common story of the assembly-line conveyor belt that can lead to a “bipolar” dx.

            Reminds me more than a little of reading up on childbirth back in the day when I was having babies. One of the best pieces of advice for avoiding unnecessary surgery (aside from birthing at home, of course) is to refuse the earlier interventions. So when I went into labor with my first child and arrived at the ER and they went to put in an IV, I refused. I did not climb up on their conveyor belt by allowing that very first unnecessary intervention. Women before me sharing their childbirth horror stories is what allowed me to understand the conveyor belt that leads to the scalpel and steer clear.

            Sounds to me like Rachel wants to gather stories that demonstrate the conveyor belt that leads to a “bipolar” dx so people can be aware of it and refuse that very first step onto the conveyor belt. I steer clear of it by never allowing such “screenings,’ and answering questions about my thoughts/feelings with “that’s none of your business,” but a lot of people don’t know any better.

            I don’t see any gaslighting or fear-mongering in any of this. It’s no different than a woman with the belly scar of unneeded surgery wanting to warn other women of childbearing age about the insanely high rate of cesareans and how doctors manipulate women into accepting it for their body, their baby.

          • I’m deeply concerned how many people urge battered wives not “to be afraid to get help from a psychiatrist for the disease of depression.”

            I urged a woman in one forum not to take SSRIs since she needs her wits about her to escape. Plus she may get a harder diagnosis (like bipolar) and wind up unable to work, and losing custody rights to her husband. Plus the court will be biased against her due to her label. Egregious and unjust as that is. 🙁

          • KS still this is would be a subjective test based on people’s personal feelings and descriptions, not one conducted according to strict conditions accounting for variables etc. The conclusions might be accurate nonetheless, as people know their own experience, but it wouldn’t be accepted for publication in a scientific journal; they only allow pro pharma research to evade accepted scientific standards.

          • Well if I conduct it for journalistic purposes OH, I don’t need to follow scientific research guidelines. Polls don’t require doctorates come to think of it. They conduct them on the 6:00 news all the time.

            And it’s not just feelings but the “diagnosis” of a “medical expert.” You need the legally valid psychiatric label of Bipolar 2 to take it. Is it scientifically valid? No. Is it socially valid? Many here say “mental illness” is a social construct. It can really alter your life.

          • Keep in mind that saying something is a “social construct” is a way of acknowledging that it has no material reality, but is a product of subjective values and beliefs. Not sure how you’re interpreting what I’m saying though. All I was saying is that if there is no initial, at least somewhat objective, observation of someone being “fine” then deteriorating following drug use, it’s hard to draw “scientific” conclusions.

            This is not to say you couldn’t compile a collection of people’s experiences and the conclusions they draw from them on their own, which might even have more impact than a “scientific” study, but the latter is what I thought you were referring to when you brought this up.

  7. I’m glad Dr. Horowitz has seen the light.

    But in retrospect, it should have been obvious: They tell us that it takes 4 to 6 weeks for antidepressant levels to build up in our brain so the drug can “work.” Yet somehow the reverse process of tapering off can be accomplished in only 2 weeks?

    • I had a similar response… I am sort of relieved that At Last, a psychiatrist has experienced what so many of us know from the inside, and now understands that his medical training is unnacountable, b*s* (although Dr Horowitz was more diplomatic than that). But I’m feeling pretty tetchy, too.

      It’s well known, by, like, everyone that if you withdraw suddenly from many drugs, you get withdrawal syndromes. Why would it be such a stretch for the 0.5% of the supposedly brightest members of our population to understand that a drug that alters neurochemistry (in unexplained and poorly understood ways) would not have the potential for dramatic withdrawal reactions if suddenly withdrawn? It’s not like the body says, ok, this is a nasty street drug, so we’re up for withdrawal syndrome, but this is a nice pharmaceutical, so we’ll just reset ourselves quietly without a fuss. I mean, that sounds stupid, and yet something like that must be the thinking process…

  10. I would say that the iatrogenic problems caused by psychiatric drugs override any original problem (or that’s my experience of it).

    (To prove the point:- A 2nd generation Afro Caribbean person is (factually) 10 times more likely than a white UK person to receive a diagnosis of Schizophrenia in the UK. So a reasonable percentage of these diagnosis must be False; but this does not present itself in the Recovery figures. Because (in my opinion) any person exposed to the *SMI medical system, is nearly always guaranteed to remain *SMI.
    *Severely Mentally Ill).

    • https://www.mentalhealth.org.uk/a-to-z/b/black-asian-and-minority-ethnic-bame-communities

      “..Chinese people
      There is very little knowledge of the extent of mental health problems in the Chinese community.

      It has been suggested that the close-knit family structure of the Chinese community provides strong support for its members. While this may be beneficial, it may generate feelings of guilt and shame, resulting in people feeling stigmatised and unable to seek help…”

      The Chinese don’t have much contact with the SMI Psychiatric Services and appear to remain WELL.

      (Apologies if I’m wandering off topic here)

    • There might be another reason for that, too, Fiachra. People with different genetic heritage have a different risk of allelic variations, which affect drug metabolism (I am referring to the CYP450 system here). For example, I have no 2d6, so I get paranoid on cannabis, got serotonin syndrome on mdma, and didn’t sleep for days when I used to take street drugs. This is because I wasn’t metabolising the drugs out of my system effectively, and they would build up to toxic levels.

      In psychiatry, this translates to a much higher incidence of adverse drug reactions in people who don’t have a full complement of genes in the CYP system (there could well be other systems involved too, but I don’t know about them) who are prescribed psych drugs. Maybe this leads to a higher rate of diagnosis of ‘mental illness’, which are actually adverse drug reactions, be it to psych or street drugs.

      Unfortunately (and bizarrely, considering how important it is), psychiatrists do not know about pharmacogenetics (the relationship between drugs and genes). However, doctors who aren’t psychiatrists know about it somewhat. For example, that you shouldn’t eat lots of brocolli or grapefuit if you’re taking statins, because the brocolli and grapefruit inhibit the liver enzymes that are responsible for metabolising the statins. It’s the same with psych drugs; giving an ‘antidepressant’ or ‘antipsychotic’ to a poor metaboliser will result in a much higher chance of an ADR. As will giving one of these drugs to an older person, or a very stressed person, or a person on birth control, or on other drugs… some substances inhibit, and some induce…and knowing what substance does what, and what enzymes are available for metabolism is a basic and crucial question to answer if you’re going to force drugs on people (obviously I wish they wouldn’t, but they do)…

      I am still struggling to understand why psychiatrists are so illogical, unscientific, and incurious…

  11. This article is of special importance because it speaks to physicians in a language that they can hear. Providing data that supports slow tapering is scientific and palatable – and it avoids directly criticizing clinical and academic psychiatry. As noted in the posts above, the egos of psychiatrists are so fragile, and they are so easily threatened, that discourse on the lack of effect and the many side effects overwhelms them. The article, published in Lancet, will have an effect on the field.

    Medical students are not in a position to be critical thinkers. The amount of information they are given is overwhelming, and the typical student withholds judgment on many aspects of medical practice (not just psychiatry), assuming that their teachers, with many more years of experience, know best. Of course, by the time a young doctor is in a position to be a critical thinker, they find that expressing their views is likely a jeopardy to their position.

    I agree with Dr. Horowitz that the best available information on withdrawal is in Altostrata’s survivingantidepressants.org She deserves a lifetime achievement award.

  12. I am new to the truth about psychiarty. And so thankful to all of you on MIA. I am getting familiar w your name Rachel777. I have a Masters Degree in Physical therapy that included many neuroscience courses. However, do you have any idea how medical students psychiatrists and ones that say they are board certified in neurology can miss the 10 th grade High school biology concept of homeostatsis? Or the 10th grade high school biology concept the the human body needs our CNS to run it. So taking anything that is going to depress our CNS is going to impair ones ability to function. With this in mind I wonder if neurobiology is making things way more confusing and complicated than it needs to be??

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