Psychotropic Deprescribing Council

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[Psychotropic Deprescribing Council @PsychotropicDC]

Read the article at https://t.co/R5V3l1GOQV

[Psychotropic Deprescribing Council @PsychotropicDC]

@BadreNicolas @BShapiroMD @DanielCohrsMD I'd also like to point out that while SERT occupancy or extracellular 5-HT level may be approximate markers, the processes that generate withdrawal symptoms may lie elsewhere. SSRIs affect all parts of the body. We should take care not to fall into looking under the streetlight.

[Psychotropic Deprescribing Council @PsychotropicDC]

@RecoveryDoctor @javeedsukhera You may feel it as violence if certain deleterious assumptions were applied to you and you were demeaned or denied access or privilege on that basis.

[Javeed Sukhera MD PhD @javeedsukhera]

I agree that epistemic violence is real, especially when experiences of harm are dismissed or pathologized instead of being taken seriously. However, I think the problem is that the science is often limited and value-laden. There is a gap between certainty and humility where harm tends to happen.

[Allen Frances @AllenFrancesMD]

DSM diagnosis can also be destructive if it:
1)is wrong
2)leads to needless/harmful treatment
3)promotes stigma
4)reduces expectations
5)creates hopelessness
6)has no expiration date
7)is rushed/unempathic

[Psychotropic Deprescribing Council @PsychotropicDC]

@tylerblack32 Nonetheless, despite your hypothetical abstract analysis, if your patient is telling you that their anxiety is unusual, that's a red flag. If their unusual anxiety is accompanied by odd physical symptoms, it is likely withdrawal.

[Psychotropic Deprescribing Council @PsychotropicDC]

@tylerblack32 Definitely a straw man argument: Claiming critical psychiatry says "the relapse-prevention literature is fake."

If drawn from confounded data, then conclusions of a high risk of relapse are very much questionable. Questionable means foundational sand of misclassification. #QED

[Psychotropic Deprescribing Council @PsychotropicDC]

@tylerblack32 Not a steel man. If "Some unknown fraction of the placebo relapses are withdrawal", then the data drawn from the "relapses" is confounded, is it not? Yes, the proportion of withdrawal vs relapse is unknown, but incidence of relapse is also possibly minor.

[Psychotropic Deprescribing Council @PsychotropicDC]

@tylerblack32 What is the source of these graphs? Why do you describe this as a smooth taper?

[Nicolas Badre @BadreNicolas]

@ohmygodgab I have a shocking number of those but many are too easy.

[Psychotropic Deprescribing Council @PsychotropicDC]

Withdrawal-induced brain zaps are a symptom similar to L'hermitte's sign, from induced excitability of neurons instead of deterioration of neurons.

If taken regularly, potential remedies gabapentin, benzos, etc. may also cause withdrawal symptoms.

[Dr Sanil Rege FRANZCP | MRCPsych @sanilrege]

@Mosghos @PsychotropicDC Yes they are liked to the mechanism .
The ‘reversal’ of the excitability of neurons. https://t.co/D438P95kJ5

[Psychotropic Deprescribing Council @PsychotropicDC]

@RecoveryDoctor @Josh__Hardman In this case, the bias indicates how much the market wants psychedelics to be widely available, so no problem.

[Psychotropic Deprescribing Council @PsychotropicDC]

@tylerblack32 You would encourage GPs to do surgery?

[Psychotropic Deprescribing Council @PsychotropicDC]

@awaisaftab In initiating antidepressant treatment, how can a doctor differentiate a milder condition with a less favorable risk-benefit ratio from a more severe condition? Lack of differential diagnosis is where it seems too many people are falling into the drug treatment basket.

[Javeed Sukhera MD PhD @javeedsukhera]

Why do so many people end up on psychiatric medications when they no longer need them? Especially when the evidence says that it is safe to stop them?

Here are some thoughts on the topics of deprescribing, epistemic trust, and the questions we should be asking, but are not actually taking the time to make space for... 🧵

[Psychotropic Deprescribing Council @PsychotropicDC]

@wendyburn @samhall404 @StanfordMed Evidence base, including animal research, is robust for eventual diminished effect of antidepressants. Plus many "augmentation" strategies.

OTOH, the placebo effect is powerful & individuals might not report diminished benefit even if drug effect has been countered by tolerance.

[Psychotropic Deprescribing Council @PsychotropicDC]

@wendyburn @samhall404 @StanfordMed "Diminished response" is the definition. This occurs with antidepressants as well as all other regularly dosed psychotropic drugs.

[Psychotropic Deprescribing Council @PsychotropicDC]

@awaisaftab @RITB_ @DrAnnieHickox About polarization https://t.co/792FNiJGz9

[Psychotropic Deprescribing Council @PsychotropicDC]

@wendyburn @samhall404 @StanfordMed "Tolerance is a person's diminished response to a medication or substance, which occurs when the medication or substance is used repeatedly and the body adapts to the continued presence of the medication or substance. Resistance refers to the ability of microorganisms...."

[Psychotropic Deprescribing Council @PsychotropicDC]

@wendyburn @samhall404 @StanfordMed Merck Manual Tolerance and Resistance to Medications. Also see the UK-specific MSD Manuals website https://t.co/jS8A1Mfi9e