I think there is an odd misconception that hyperbolic tapering means 'everyone needs to spend 3 years tapering off their drugs.' Not true - this is a strawman argument.
Of course some people can taper off with no problem in a few weeks.
Hyperbolic tapering is drawing attention to the shape of the pharmacological road - it is hyperbolic. You can do a hyperbolic taper in 4 weeks (or in 6 months or in 3 years).
A sensible application of the principle is to do a small test dose reduction to see how someone responds. If that is tolerable you could always speed up. If 10% is fine, try 15%, etc.
What is baffling is people who are so virulently against this approach are therefore against the precautionary principle. Who says let's get everyone to jump off buildings and only if they get into trouble will we bother building stairs?
Psychopharmacology boosters on this platform love to paint me as a fiery radical (always amusing to my friends who know what a risk-averse, nervous, four-eyes little geek that I am) : seems somewhat odd when I am advocating for a method of tapering that is slower and more cautious to avoid harm.
It's a bit like driving: if you go too slowly you can always speed up. But if you go too fast and crash (see protracted withdrawal ) it can often be too late to hit the brakes (not always).
So advocating a cautious hyperbolic tapering approach as default is not condemning everybody to years- long tapering, it means taking a cautious approach that can be adapted. Most doctors would do the same for their families (and many have contacted me to get advice to do so).
The risk of a too slow taper (unnecessary exposure to low dose medication) is generally outweighed by the risk of a too quick taper (the possibility of severe and prolonged withdrawal effects which can sometimes be debilitating).
@atomicaceso I was in the die hard “I can’t live without these” crowd for decades. To go from that to absolutely disabled by them was a turnaround that was very hard for me to accept. But it became impossible to deny over time.
What a dangerous and outrageous statement! Just because your personal experience and 100,000s of others aligns with basic pharmacology and increasing numbers of cohort studies we should not act on that! We need to do what we've always done because to do otherwise would be to admit we have been doing things wrongly for decades. And saving face is more important than helping people avoid harm. Shame on you for suggesting otherwise!
@markhoro@cheesyredrocket It turned out what worked best for me aligns with your later work on receptor occupancy. It’s almost as if this is worth looking into more.
Yes 'science'. Unless there are randomised controlled trials we just need to sit around and do whatever we've done, no matter how many people get hurt. That's how science works. There is no hierarchy of evidence to examine. We should not examine cohort studies that compared different tapering techniques, studies which examine rate of tapering and relapse, and we should ignore fundamental principles of pharmacology, and common sense. I love learning about science!
In my career as a psychologist I am unable to recall any one person whose quality of life improved from prescription psychiatric medications. Yet I am haunted by the consistent stream of clients entering my center whose quality of life & health has been negatively impacted.
Women are prescribed antidepressants at about twice the rate as men. This has been pretty consistent for decades.
However the rate in both groups has multiplied almost x8 since the early nineties.
@KennethMPeters1@CorewellHealth@BeaumontUrology As a psych nurse, I proposed an update to our patient education materials to include a warning about PSSD. The medical director's response? "No, that will create hesitancy"
“Illness narrative” psychiatry can be so gross sometimes … maybe they don’t move forward because they feel like shit Hannah and the only treatment they get is being told to think their way out of it
"Suicidal thoughts:
Placebo: 2 (1.5%)
Lexapro: 13 (9.5%)
If this had been efficacy data, AbbVie would have been ecstatic - that difference is dramatic. Unfortunately for the kids, it’s in the direction of killing yourself."
In fact if psych professionals do the essential work to improve it's outcomes and reduce it's harms, the establishment psychiatrists and psychologists will block their careers, hound them on Twitter and manufacture complaints to the GMC.
@Polyphloisbic@samhall404@sash_andy The Evgeny attack bothers me. He was vindicated in the end, but omg did they waste that man’s time without consequence.
Allan Young has 20 unique pharmaceutical/biotechnology companies listed in the “personal fees from” section of this omitted disclosures publication.
In the grants section, Janssen appears again.