Common Misconceptions Around Antidepression

Misinformation regarding antidepressants abounds, which is likely fueling their popularity. Among the most common of these misconceptions are:

Antidepressant withdrawal symptoms are minor and last about two to three weeks, with any severe symptoms interpreted as a depressive recurrence.

Because antidepressants are not addictive, they cannot be that difficult to discontinue. If you're having trouble getting off your antidepressant, it means you need it and in a month or two, you should be able to discontinue your antidepressants.

Antidepressants Function by Stimulating the Growth of New Brain Cells

It is now known that antidepressants cause withdrawal symptoms that might continue for weeks, months, or even years.

Statements that these symptoms only last two to three weeks stem from drug company trials in which participants had only been taking antidepressants for a few months. According to a recent large study, people who had been taking antidepressants for years experienced withdrawal symptoms that lasted an average of nine months.

Over half of the people who discontinue antidepressants report withdrawal symptoms. According to polls, 50% of those who stop using these medicines experience significant withdrawal symptoms.

Withdrawal symptoms can be debilitating and long-lasting for some people. Symptoms include dizziness, headache, memory and concentration issues, emotional instability, and neurological symptoms such as sensitivity to noise and light, muscular spasms, and sexual dysfunction, which can last for years after the drug is stopped.

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The longer the drugs are used, the more intense (and likely longer-lasting) the withdrawal symptoms become.

Antidepressants produce withdrawal symptoms because the brain adapts to their presence. This is commonly referred to as physical dependence. Even while antidepressants do not create highs or cravings and compulsions, which is the precise definition of ‘addiction,’ dependence exists.

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There has also been an evolution in our understanding of how these medications work. Several experts now think that antidepressants do not operate by resolving a chemical imbalance. Some argue that antidepressants function by stimulating the growth of new brain cells; however, this has never been demonstrated in humans.

There is also no convincing evidence that new brain cell development is desirable. Yes, it could have a negative impact because brain injury causes the creation of new neurons (just as damage to the skin leads to the growth of new skin cells).

Evidence-based Hypotheses for how Antidepressants Exert their Effects

Antidepressants have a subtle effect on normal mental states, causing emotional numbing among other things. This has been seen in healthy individuals, indicating that the medication causes emotional numbing in addition to depression.

This action, together with other mental alterations, may account for the antidepressant's effect of decreasing the intensity of unpleasant feelings. These sensations may also alert people to the fact that they are taking medicine, which might intensify the placebo effect.

Finally, regulations are catching up.

The National Institute for Health and Care Excellence (NICE) and the Royal College of Psychiatrists' advice on how to safely discontinue antidepressants has recently changed dramatically. Antidepressants should be tapered down in stages (tapering) over months and perhaps years following long-term use, according to new guidelines.

Because these quantities are substantially less than those that can be made using commonly available tablets, the guidelines recommend using liquid forms of medications (especially made-up smaller dose tablets are another option).

These new guidelines advocate ‘hyperbolic tapering’ as a method of tapering. It is based on the fact that antidepressants have extremely substantial impacts on the brain in very small dosages. This is why the last few milligrams of medicine are sometimes the most difficult to get off.

To account for the bigger effects on the brain at lower medication doses, dose reductions must be conducted in smaller and smaller increments as you get down to lower levels, such that people reduce by as little as 10% or 25% of their most recent dose. According to studies, this procedure can assist people who were previously unable to safely discontinue their medicine using traditional methods.

Researchers are currently testing this approach (hyperbolic tapering) in a large trial in Australia. Sadly, several nations, notably Australia and the United States, have not changed their guidelines and continue to advocate abruptly discontinuing antidepressants. As a result, people may experience severe withdrawal symptoms and incorrectly conclude that they are unable to discontinue their drug.

The difficulties many people have in discontinuing antidepressants underline the need for far more caution in administering these medications. According to the NICE recommendations, antidepressants should not be used as the first-line treatment for mild depression. Even in the case of severe depression, the guidelines now propose eight non-drug alternatives, such as problem-solving therapy, exercise, and several other therapies.

This strategy was recently supported by NHS England, which announced an endeavor to move away from the ‘pill for every sickness’ approach, fund non-pharmaceutical solutions for mental health disorders, and give long-awaited services to assist individuals in discontinuing antidepressants.



Source-Medindia