Tag Archives: depression

Early Weight Gain on Antidepressants Predicts Later Weight Gain

People taking antidepressants who gain weight a month after starting treatment are more likely to put on even more extra pounds as they continue to take the medication.

Weight gain is a common side effect with many antidepressants, especially SSRIs (selective serotonin reuptake inhibitors), one of the most popular antidepressant classes prescribed. It also leads many people to stop taking an antidepressant.

Researchers looked at 260 people who were not overweight and were diagnosed with major depressive disorder. At the start of the trial, they began taking an antidepressant. They were examined again for weight gain after 1, 3 and 6 months.

Results, published in the Journal of Affective Disorders, found that after 3 months, 12.4% of participants became overweight. After 6 months, 21.1% were. Patients that had a weight gain of at least 3% after 1 month were much more likely to have a weight gain of at least 15% after 3 months compared to those who didn’t have the early weight gain.

Researchers noted that weight gain of at least 3% after the first month of antidepressant treatment was the best predictor of more significant weight gain after 3 months and 6 months of treatment.

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Quick Hits: Troubled Birth Control Device, Antidepressants and Blood Clots & More

Bayer will stop selling its troubled permanent birth control device Essure by the end of the year. As of 2015, there were more than 17,000 adverse event reports worldwide associated with Essure, which looks like a tiny coil and is made of nickel. Bayer says it will no longer sell Essure because of financial reasons. The FDA responded to Bayer’s announcement noting that their own review of adverse event reports found there are certain risks associated with Essure. The risks include persistent pain, perforation of the uterus or fallopian tubes from device migration, abnormal bleeding and allergy or hypersensitivity reactions. In 2016, the FDA required a “boxed warning” be placed on Essure to alert women to these risks. Posted July 20, 2018. Via FDA.

Taking antidepressants along with having depression itself may be associated with a higher risk of potentially life threatening blood clots. Venous thromboembolism is a blood clot that develops in the leg, groin, arm, or heart. Researchers conducted a meta-analysis that included 8 observational studies involving VTE. An analysis of 3 studies that compared people with depression to those without it found those in the former group had a higher risk of developing VTE. And among antidepressants, those taking SSRIs (selective serotonin reuptake inhibitors) had the highest VTE risk among antidepressant classes. The researchers cautioned that the findings do not prove cause and effect and further studies are needed to demonstrate if the associations are causal and whether it is depression or antidepressant use or both which is responsible for an increase in VTE risk. Posted July 24, 2018. Via University of Bristol.

Adhering to a Mediterranean diet — one that is rich in fish, olive oil, nuts and vegetables — may help to lessen the severity of psoriasis. Researchers examined 3,557 people who’d reported that they had the inflammatory skin condition. Participants were asked about their diet and were given a score based on their adherence to a Mediterranean diet. A MEDI-LITE score of 0 meant no adherence to the diet, while a score of 18 meant full adherence. Patients with the most severe psoriasis had the lowest MEDI-LITE scores, the researchers reported. The diet may work to inhibit psoriasis because of the anti-inflammatory properties of foods in the diet. They are rich in dietary fiber, antioxidants and polyphenols — the latter two especially act to protect cells. Posted July 25, 2018. Via JAMA Dermatology.

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What’s the Best Medicine for Brain Health?

By Marc Manseau
JustCareUSA.org

To support brain health, we know many things that people should not do, such as smoke, drink alcohol heavily, use most recreational drugs, and engage in activities associated with frequent head trauma. But other than getting adequate sleep, there isn’t much that we know people should do to promote brain health, sharp cognition, and good mental health. Of course, we recommend eating a healthy, well-balanced diet, but very few individual foods or nutritional supplements have been proven to be good for the brain. The same goes for “brain teaser” activities and “cognitive skills training” programs. Contrary to logic, they haven’t been shown to produce sustained benefits.

However, time and again, one activity has been connected to robust improvements in brain health and prevention of brain diseases and mental health problems: exercise. And the encouraging results keep rolling in.

Regular aerobic exercise has been linked to reduced risk of developing dementia, such as Alzheimer’s disease. This type of exercise has also been repeatedly shown to prevent depression, and has even been proven to be an effective treatment for depressive and anxiety disorders, with effect sizes roughly equivalent to medications. These benefits have been consistently demonstrated in both human studies and in studies examining animal models of mental illness. More recently, non-aerobic weight training has also been definitively associated with positive effects on brain and mental health outcomes.

The ‘dose ‘ of exercise you need is not as high as you think — walking 20-30 minutes a day may be enough.

As if this news wasn’t good enough, the amount or “dose” of exercise that people need to promote brain health is not as high as you may think. Minimal amounts of exercise such as 20-30 minutes of walking or gardening a day – not even enough to lose weight – may be enough to boost cognitive functioning and lower the risk of mental health problems. So, it should be possible to fit into all but the very busiest schedules.

Exactly how exercise helps the brain is unclear, and there are many theories, multiple of which may be simultaneously true. Exercise may increase blood flow and oxygen supply to the brain. It may also increase the production and activity of “neurotrophic” (literally “brain feeding”) factors, such as brain-derived neurotrophic factor (BDNF). BDNF in critical brain areas such as a memory center called the hippocampus promotes brain health and mental resilience through stimulating the growth of new neurons and connections between them.

Exercise causes chemicals to be released from muscles and bones that may be essential to sustaining proper brain functioning. In addition, physical activity causes the release of several “feel good” substances, such as endorphins and endocannabinoids, which have been implicated in the feeling of general well-being and relaxation after a workout often referred to as a “runner’s high.”

Finally, exercise may benefit your brain for the same reasons that it is good for the rest of your body – it lowers blood pressure and inflammation levels and enhances proper blood flow and heart functioning.

Regardless of the exact reasons why it’s so healthy, we know that exercise is a relatively easy-to-do, inexpensive, and fun way to improve brain health and reduce the risk of mental illness and cognitive decline. So, do your brain a favor and grab those running shoes or that bicycle and head outside!

This article was first published by JustCareUSA.org. Reprinted by permission.

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Antidepressants May Boost Risk of Death in COPD Patients

Older patients with COPD (chronic obstructive pulmonary disease) should take precautions when using certain antidepressants because they may increase the risk of death.

Researchers analyzed 28,360 new users of serotonergic antidepressants – such as SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin norepinephrine reuptake inhibitors) – that had COPD and were aged 66 and older, then matched them to 28,360 non-users. SSRIs and SNRIs are among the most commonly prescribed antidepressants.

The results, published in the European Respiratory Journal, indicated that new users of these antidepressants have a 20% increased risk of death related to respiratory issues, as well as death overall compared to non-users of the medication.

Also, antidepressant use among those with COPD – a progressive lung disease characterized by breathlessness – was associated with a 15% increased risk of hospitalization and emergency room visits due to related symptoms. The results demonstrate a strong association, but not a definite cause and effect, the researchers caution.

According to lead author Nicholas Vozoris, MD, a respirologist at St. Michael’s Hospital in Toronto, the findings were not surprising because “there are biological reasons why antidepressants could lead to respiratory issues.

“These drugs can cause sleepiness, vomiting and can negatively impact immune system cells. This increases the likelihood of infections, breathing issues, and other respiratory adverse events, especially in patients with COPD.”

Researchers noted that the findings shouldn’t alarm COPD patients who are currently using antidepressants, but rather increase awareness among users and prescribers.

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Quick Hits: Many Antibiotic Prescriptions Unnecessary, Prostate Cancer Treatment and Distress & More

A new study suggests that 41% of antibiotic prescriptions written for patients with respiratory infections, such as the flu, were unnecessary. Researchers used data collected by the US Influenza Vaccine Effectiveness Network during the 2013-2014 and 2014-2015 flu seasons. The study involved almost 15,000 patients with respiratory infections. Fifty-six percent of the prescriptions were for broad-spectrum antibiotics, with Zithromax (azithromycin) accounting for 37% of all prescriptions. Of the 6,136 patients who were prescribed the drugs, 41% (2,522) had diagnoses that didn’t require antibiotic treatment. Out of this group, 84% were diagnosed as having a viral upper respiratory tract infection or bronchitis. Posted June 2018. Via JAMA Network Open.

Patients receiving prostate cancer treatment may have a heightened risk of experiencing emotional distress, a new study suggests. The treatment is associated with various side effects, including urinary, sexual and bowel dysfunction. Researchers wanted to evaluate whether these dysfunctions contribute to emotional distress during the first 2 years following prostate cancer treatment and whether this distress may result in decreased function. The study included 1,148 men with clinically localized disease who were treated with either surgery (63%) or radiotherapy (37%). Results indicated that men with more severe urinary, bowel and sexual dysfunction reported more emotional distress than others at subsequent time points. Posted June 2018. Via The Journal of Urology.

Psychedelic drugs are being eyed as potential treatments for anxiety and depression. A new study looked at various psychedelic drugs – such as LSD – and evaluated whether they had a statistically significant effect on the brains of flies and rats. Results indicated that the substances boosted brain connections and improved neuroplasticity – the brain’s ability to adapt — in the test animals. Researchers think psychedelic induced-plasticity could rewire the brain to counter the symptoms of depression, anxiety and other related conditions. Researchers also compared the effects of the substances to ketamine, an anesthetic used in animals, that has been found to alleviate the symptoms of depression. Posted June 12, 2018. Via Cell Reports.

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Concerns About Using Your Antidepressant Long-Term? Talk to Your Doctor

By Marc Manseau
JustCareUSA.org

On April 8, 2018, The New York Times published a front-page article titled “The Murky Perils of Quitting Antidepressants After Years of Use.” The day before, the online version, “Many People Taking Antidepressants Discover They Cannot Quit,” was the most-shared article on its website.

In this analysis, Benedict Carey and Robert Gebeloff described a growing trend over the past few decades in which millions of people have been taking prescription antidepressant medications long-term. For instance, they cite data showing that over 15 million Americans have taken antidepressants for 5 years or more.

They go on to attribute this phenomenon mostly to antidepressants causing “dependence and withdrawal,” rather than people needing long-term antidepressants to manage psychiatric illness or choosing to remain on them because of their benefits.

While Carey and Gebeloff do cite a few studies looking at rates of withdrawal after stopping long-term antidepressant use, they only mention one survey from New Zealand that shows that withdrawal is even a common complaint among individuals taking antidepressants. Most of their argument is based on individual stories (i.e., anecdotal evidence) combined with critiques of how antidepressants have been studied.

While the individual stories are compelling and the critiques of research may be valid, this approach makes their case linking long-term antidepressant use to supposed widespread withdrawal circumstantial at best.

Fortunately, several psychiatric care providers and even patients quickly responded to counter this somewhat misleading article. To be fair, the authors do point out that antidepressants have greatly helped millions of people, and they quote psychiatrists who are expert in treating depression, such as Dr. Peter Kramer.

However, overall, the piece uses logically and scientifically shaky arguments to trigger suspicion and fear of antidepressants among the general public and mental health patients alike. Given that depression and other mental illnesses that antidepressants treat (e.g., anxiety disorders) are very common, highly impairing, sometimes dangerous, and exceedingly undertreated, this type of journalism is risky.

The fact is, antidepressant medications are effective, especially for moderate to severe depression, and while all medications have side effects, newer antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are far more tolerable than older versions. In addition, the past few decades have seen a growing consensus that depression (and many other mental illnesses) is a chronic condition requiring long-term treatment, like diabetes and hypertension. (No one would say that millions of people are on long-term blood pressure medications for hypertension because of fear of withdrawal.)

Therefore, many psychiatrists recommend (and many patients readily choose) long-term antidepressant treatment to avoid relapse once a person has had more than one depressive episode. “Withdrawal” from antidepressants — actually called discontinuation syndrome — is in fact a well-known and not-rare phenomenon. However, it is usually very mild and can be managed with a slow taper in the medication’s dose.

For the relatively rare, more severe cases, a good psychiatrist can almost always reduce or eliminate it with various interventions such as adding low-dose Prozac (fluoxetine) for a while (due to its long half-life) and/or using other prescription drugs in a time-limited manner to treat discontinuation symptoms.

Just like in any medical specialty, not all psychiatric care providers are attentive, responsive or skilled enough to avoid or successfully manage discontinuation syndrome, but that’s a different problem that can’t be solved by avoiding antidepressant treatment to begin with. So, rather than an inability to stop meds due to “withdrawal,” doesn’t it seem much more likely that growing numbers of people are on antidepressant treatment long-term either because they need the medication to prevent symptoms from returning and/or choose to remain on the medication because of low side effect burden and protection against relapse?

The article does make some valid and important points. The research on antidepressants mostly involves relatively short-term studies, so there is a great need to examine the longer-term efficacy and adverse effects of these prescription drugs. And the discontinuation syndrome has received far too little research attention.

These deficits in the science are indeed likely due to pharmaceutical companies having little incentive to investigate prescription drugs that have gone generic or to emphasize problems with the products they produce and market. However, it is unfortunate that these valid critiques were packaged into a misleading and highly public message that has the potential to discourage people from seeking treatment for mental illness and encourage patients to stop their medications.

Here’s some advice from this psychiatrist: Discuss your goals for treatment and any problems with medications with your healthcare provider before changing or stopping them on your own. No one – not even your doctor – can force you to stay on a medication that you no longer want to take, but only an experienced professional can help you to change medications in a safe and healthy way.

This article was first published by JustCareUSA.com. Reprinted by permission.

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Suicide and Mental Illness: The Forgotten Health Crises in America

Last week, mental health was front and center in the news for several reasons. First, the suicides of two high-profile individuals, fashion designer Kate Spade and celebrity chef Anthony Bourdain, captured headlines.

But you may have missed a CDC (Centers for Disease Control and Prevention) report that came out last Thursday that found suicide rates have skyrocketed in the US between 1999 and 2016. Twenty-five states saw suicide rates increase by at least 30%. Montana had the highest rate. Suicide rates rose in every state except 1: Nevada.

Just how serious a problem is suicide? According to the CDC, in 2016, about 45,000 Americans 10 years old and older died by suicide. Taking one’s life is the 10th leading cause of death and is 1 of only 3 leading causes that are on the rise, the CDC says.

These figures are a major wake-up call that we need a multi-faceted approach to not only stem – and hopefully reduce – the rising rates of suicide. It is also an indication that the way mental illness is considered, approached, treated and funded in this country is not right.

Why Now?

The drastic rise in suicide rates is all the more shocking considering that since the early 1990s, access to mental health care has – on the surface — actually increased. The Mental Health Parity and Addiction Equity Act (MHPA), signed into law in September 1996, requires that annual or lifetime dollar limits or benefits on an individual’s health insurance not be lower than limits for medical care.

And in 2014, the major provisions of the Patient Protection and Affordable Care Act (PPACA), also known as Obamacare, that went into effect included mental health care as an essential health benefit that all insurance plans on health insurance exchanges must cover.

Despite MHPA and PPACA, we have a mental health crisis in our midst. Why? It’s hard to say, and it is likely a combination of many things.

Can Antidepressants Make the Problem Worse?

One thing is for sure: An increasing number of Americans are depressed – or at least unhappy. Many of them are turning to their doctors and they are receiving prescriptions for antidepressants. And those drugs could actually be doing more harm than good.

A CDC report that came out in August of last year found that between 1999 and 2014, the number of Americans that had taken an antidepressant rose by 65%. That’s not a typo. In 2014, about 1 in 8 Americans over the age of 12 said that they had recently used an antidepressant.

Why is the relatively high use of antidepressants a concern? While antidepressants may well help a lot of people, there’s a mountain of evidence indicating they are no better than a placebo. They also come with a “black box” warning – the most serious the FDA can require for a drug – stating that they may increase suicidal thoughts or actions.

Another study, published in 2016, found that when given an antidepressant, people with no prior history of mental illness were twice as likely to become suicidal and violent.

Other drugs are also known to have suicidal thoughts as a potential side effect. Bourdain, for example, was said to be taking the smoking cessation drug Chantix (varenicline), according to news reports. The prescribing information for Chantix notes that “serious neuropsychiatric adverse events” have been reported in people taking the drug, including suicidality. Chantix used to have a “black box” warning regarding suicidality, but following an intense lobbying campaign from the med’s manufacturer, Pfizer, the FDA agreed to drop that boxed warning from Chantix’s labeling in December 2016.

We don’t know exactly how much impact antidepressant use has had on the increase in suicide rates (If any mental health researchers are reading this, it would be a good idea to investigate this, if you aren’t doing so already), but the evidence seems to point it could have a significant effect.

We also don’t know exactly what drives people to suicide. It’s likely a combination of factors. But there are roles both governments and society can play in helping to turn the tide of rising suicides.

Federal and State Government Funding Failures

Our federal government — as well as state ones — have a role to play by adequately funding mental health programs, especially for the poor and elderly. Yet, they have largely failed. Under the Trump administration, the situation is getting even more grim. Trump’s proposed fiscal 2019 budget calls for massive cuts to Medicaid and Medicare. It also reduces funding for the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Mental Health and Substance Abuse Treatment Programs of Regional and National Significance by about $600 million, according to the non-profit group Mental Health America.

Inadequate investing of mental health can have severe consequences. “Failure to invest in mental health as a matter of urgency will have health, social and economic costs on a scale that we have rarely seen before,” a World Health Organization (WHO) report on mental health released this year stated.

The WHO report also found that spending on mental health makes economic sense. The organization projects that every $1 invested in mental health treatment leads to a return of $4 in improved health and the ability to work.

Society’s Role in Making Change Happen

Having a mental illness carries a lot of stigma in our society. Many people that could be helped with mental health treatment often don’t get it because they think it will reflect badly on them by their friends, family or co-workers.

This mentality held by far too many among us needs to end and we can help doing so by treating mental illness exactly the same as someone who has a medical condition, such as diabetes or cancer. There is absolutely no shame in having a mental illness.

We need to talk openly about mental illness much more than we do now. We also need to raise awareness that if someone is depressed, is suffering from bipolar disorder, schizophrenia or any other mental illness, there is help available and they shouldn’t feel afraid to seek it.

Together, we can help stop the rise in suicides. Speak up and advocate for greater mental health awareness and funding. It may just save someone’s life.

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No One Is Immune… Woody’s Story Could Be Yours

By Kim Witczak
My life used to look very different back in 2003 than it does today. I was married to my best friend, had a successful career in advertising and was planning to have a family. However, all that changed with one phone call. On August 6, 2003, I became a widow. Woody, my husband of almost 10 years, was found hanging from the rafters of our garage. He was dead at age 37.

Woody wasn’t depressed, nor did he have a history of depression or any other mental illness.

Woody was outgoing, gregarious, smart and had a huge personality. He had just started his dream job as vice president of sales at a start-up company 2 months prior and started having trouble sleeping, which is not uncommon for entrepreneurs. So Woody went to see his family doctor, whom he trusted implicitly, and was given samples of the antidepressant Zoloft for insomnia. His doctor said Zoloft (sertraline) would take the edge off and help Woody sleep. Five weeks later, he was dead.

The 3-week Pfizer-supplied sample pack that Woody came home with doubled the dose from 25 to 50 mg after week 1. No cautionary warning was given to him or me about the need to be closely monitored when first going on the drug or dosage changes. In fact, I was out of the country on business for the first 3 weeks he was on the drug.

Shortly before he died, I found Woody curled up in the fetal position on the kitchen floor

Within days, Woody experienced many side effects, like profuse night sweats, diarrhea and worsened insomnia. He also experienced others, like akathisia (restlessness and an inability to stand still) that were known to Pfizer but not to Woody, his doctor or his family. Shortly before he died, I found Woody curled up in the fetal position on the kitchen floor, holding his head like a vice, crying, “Help me, help me. I don’t know what is happening to me. I am losing my mind. It’s like my head is outside my body looking in.”

We calmed him down and he called his doctor, who said you need to give it 4 to 6 weeks for the drug to kick in. Woody lasted another week.

From the beginning, Woody’s death made no sense to anyone who knew him. Everywhere I turned, all the so-called experts and suicide support groups were telling me Woody must have been depressed. But in the deepest part of me, I knew something didn’t add up.

Why would a guy who loved life take his own life? Woody went from not being able to sleep to experiencing head outside of body, horrific nightmares and extreme crying fits. So we started digging into the only thing that made Woody change during this extremely short period of time. Zoloft.

We Never Questioned the Drug

Woody and I never once questioned the drug. Why would we? Zoloft is FDA approved, samples were given by his doctor, and was advertised and sold as safe and effective. Ironically, the day Woody was found our local newspaper ran a front-page story about a study in the UK finding a link between antidepressants and suicide in teens.

The coroner asked if he was taking any prescription drugs – the only drug he was on was Zoloft. She said she needed to take the bottle with her, that it might have something to do with his death.

My journey for the truth has taken me to the FDA, Congress, the courts and the media. Unfortunately, I quickly learned that Woody was not an isolated case or “anecdotal.” Most people have no idea that the FDA held hearings on Prozac and its link to suicide and violence in 1991 – 13 years before the FDA eventually put “black box” warnings on the drugs for children in 2004 and young adults in 2006. It’s unthinkable how many deaths could have been prevented had warnings been put on antidepressants in 1991.

In the legal battle for Woody, we were able to get confidential internal Pfizer and other drug company and FDA documents made public that showed they knew about the risk of suicide, violence and decided NOT to speak of questionable efficacy. But they failed to tell all this to the public. I hand-delivered these documents to the FDA, members of Congress and the media.

It’s hard not to do something when you have seen these documents in black and white with your own eyes AND you have the experience that I have had. These documents speak for themselves. Lives were being destroyed. It was too late for our family. But, if just one family was informed, then Woody’s life and death made a difference.

I can’t believe that, almost 15 years after Woody’s death, we are still having this debate about antidepressants. In some ways, I think the situation has gotten worse. There are a lot of powerful, commercial self-interests to protect in the current mental health model. All of this is going on behind the scenes while the average, everyday person like Woody goes to their doctor and trusts that they are being given a drug that is “safe and effective.”

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The Right Way to Get Off Antidepressants

Crissi Estep had been on Cymbalta (duloxetine) a few years when the medication seemed to stop working. At first, it effectively controlled both her fibromyalgia-related nerve pain and her depression, but “any successes I had had with it earlier were gone,” Estep says.

“I was very depressed, even agitated, and felt like I had plateaued,” she added. When Estep shared her concerns with her physician, he added Abilify (aripripazole) to her medication regimen.

Estep soon developed intolerable side effects. Frustrated, she decided to quit taking her antidepressants.

Because she’s a registered nurse, Estep knew that antidepressant medications are usually tapered before they’re discontinued. So, she developed her own tapering schedule: 1 day between doses, then 2, until the medicine was gone.

Severe withdrawal symptoms hit about five days after the medication cleared her system. “I genuinely thought I was having a heart attack,” Estep says. “I had chest pains and was shaky and nauseous. When I turned my head, it would swish, like water in a bowl.”

The South Carolina resident was in Maine at the time, camping with her family, “literally googling ERs,” she says, when her husband wondered aloud if her symptoms might be related to the cessation of her medication. Together, they looked up withdrawal symptoms for her antidepressants. Estep was experiencing almost all of them.

Between 2011 and 2014, approximately 1 in 9 Americans reported taking at least one antidepressant medication in the past month. Sixty-eight percent of those people had been on their antidepressant for two years or longer; 25% had been taking anti-depressant medication for 10 years or more. At some point — typically, when they’re feeling better, but sometimes when they are frustrated by side effects — nearly every person who uses an antidepressant considers stopping the medication. But, as Estep learned, stopping antidepressant treatment without medical guidance is risky and can cause uncomfortable side effects, as well as a relapse of depression.

You should also know that the more depressive episodes you have had, the more time you should take to come off of the medication. Harvard Women’s Health Watch says that for those who have had 3 or more such episodes should wait for at least 2 years once symptoms ease to considering weaning off an antidepressant.

Regarding weaning off, it’s important not to taper off to quickly. Time is your friend and you should take things slowly. Coming off too quickly can increase the risk of nasty withdrawal symptoms, and increase the risk of a relapse. It’s not uncommon for some long-time antidepressant users to need a year or more to come off of medication.

The good news is there’s a right way to get off antidepressants.

Set Yourself Up for Success

The best time to go off an antidepressant is when your depression is in remission and life is stable. “Big life transitions, such as a job change, graduating from college, getting married or having a baby, are not a good time,” says Carl Olden, MD, a family physician in Yakima, WA, and a member of the board of directors of the American Academy of Family Physicians.

It’s also a good idea to bolster your support system and boost self-care strategies. “You’ll have the best chances of success if you have a team around you,” says Jane Payne, MD, a psychiatrist in private practice in Portland, OR. Ideally, your team will include the medical professional who prescribes your medication and at least one or two close friends or family members who know about your history of depression.

“Be as forthright as you can with them about what depression was like for you, about how your behavior changed, and let them know you’re going off your medication, so they can be on the lookout for red flags,” Dr. Payne says. Also share with them some successful coping strategies you’ve used in the past (such as journaling, exercise or time in nature), and ask them to encourage and support your self-care efforts as you transition off medication.

With your health care provider, develop a plan. Your provider will want to know how you fare on days or weekends when you forget to take your antidepressant. That information will help your provider plan an appropriate quitting schedule. And if your antidepressant serves multiple purposes – say, managing nerve pain and depression – your provider may need to prescribe another medication to keep your health under control.

Don’t let your antidepressant prescription lapse. Make sure you have some left, “in case you need to start back up,” Dr. Olden says.

Go Slow

“Any medication that you’ve been on for more than a couple of weeks that works on the central nervous system has initiated changes within the brain to adapt to the presence of that medication,” Dr. Payne says. “If you suddenly take the medication away, the changes are still present without anything to balance them.”

Gradually tapering – decreasing the dose – of the medication over a period of time allows your body to readjust. That’s why clinicians recommend weaning antidepressant medication over a period of weeks — and often for far longer than that.

The length of the weaning period will vary depending on the antidepressant, dosage, duration of treatment and individual response. It may take as little as 5 days, or a month or more to wean completely off an antidepressant.

Follow the weaning schedule recommended by your healthcare provider, and don’t hesitate to report adverse effects.

“If you’re having withdrawal symptoms, find yourself unable to sleep or your mood is really up and down, it might be that you’re coming off too fast,” Dr. Payne says. A more gradual approach could eliminate your symptoms.

Know What to Expect

Some people experience a transient increase in depression-related symptoms, such as difficulty sleeping, anxiety and agitation, while coming off their medication. Other adverse symptoms may include constipation, diarrhea, dizziness and nausea.

In most cases, these symptoms will subside within a few weeks. “This is why it really helps to be in contact with a doctor who has a sense of your baseline, who can tell the difference between a rough patch and things going south,” Dr. Payne says. When in doubt, call your physician, who can help you determine if you need medical treatment.

If your depressive symptoms re-emerge after you’ve stopped the antidepressant, you may need to restart the medication – and that’s OK. “There are some folks who are better served by staying on antidepressants,” Dr. Olden says.

Estep restarted her antidepressant while still on vacation. After she returned home, she spoke to her doctor and “did a very slow wean” that was “pretty uneventful,” she says. One month later, she was off her antidepressant.

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The FDA Has It Wrong on Kratom: How the Herb is Helping People Like Me


By Andrew Turner
Some may ask who are the consumers of kratom, an herb used to treat pain, depression and anxiety that has been the subject of controversy lately in the news. It’s complicated.

We can be anyone. We are your neighbor, the veteran in the supermarket, your college professor and even your best friend. There’s a lot of misconceptions about kratom, how it’s used to treat certain ailments and its potential for addiction.

Some incorrectly assume that anyone taking kratom must have been a drug addict before. The reality is most people are taking kratom to supplement their health.

For me, this path to kratom came after trying a number of conventional health options. For many years, I was prescribed a multitude of medications to address all sorts of service-related injuries and illnesses. When my doctors diagnosed me with a rare movement disorder called Meige Syndrome and tried to treat it with limited options, I lost several years of my life due to disability.

For many like me, trapped in a no-win situation with a severe physical or mental disability, you accept that conventional science has not funded research on many rare diseases and you seek other solutions. The path that I was on was not sustainable and too often has led many veterans like myself to take their own lives. I was fortunate that, again, I found an educated doctor, someone who had seen the signs before. My doctor realized that the medications that I was on at the time were doing very little for me — they were not providing me a good quality of life and may have actually been causing more harm than good.

My doctor took me off the medications that weren’t helping and suggested that I “just look into some natural options that will provide you some quality of life. That may be all we can do in your situation.”


Watch Andrew Turner on CBS This Morning, 4/3/2018

Strangely, in my search some 3 years ago, I kept reading people talking about kratom, a plant with medicinal benefits, including relief from pain, depression and anxiety.

I spent many nights reading about this and every time I would read more the only thing I could think was this must be snake oil. I couldn’t imagine some simple plant I’ve never heard of from Southeast Asia could help me in such a phenomenal way. But then I read studies that support the medical use of this incredible herb. (Here’s a review that came out in December that looked at 57 studies of kratom).

The first time I took kratom I can’t say I experienced anything — its effect is subtle. So I was initially still convinced it was nothing but snake oil and I had been duped. But because I had so few options and conventional medication did not help, I stuck with it.

It was a few weeks after I had tried several types of kratom (both in a tincture form and in a ground raw leaf form) when I started to notice something was different. It had an incredibly calming effect, I was sleeping better and my overall well being had changed dramatically. Now 3 years later, I start my day with a cup of kratom tea. I prefer it cold with plenty of lemon or lime juice and just a bit of raw honey.

Now this is not a treatment nor a cure for my physical and mental disabilities. To be able to claim that, substantial sums of money would have to be invested by the pharmaceutical industry so that kratom could undergo clinical trials. I understand my experience may have caused interesting changes to my health, but it may not work for someone else.

FDA Commissioner Scott Gottlieb has said publicly that what I’ve experienced is impossible. I’ve learned that I’ll just accept what he has to say and at the same time I will enjoy my kratom tea. My life has changed so much that I’ve even been able to dedicate myself to almost full-time advocacy work on behalf of kratom.

Now you may ask, “What happens if you stop taking kratom?” and for me, over time I would lose a lot of the ground that I have gained. On a daily basis I have to then fight for my right to have some quality in my life. The one question I have for anyone who supports a ban of plants like kratom or marijuana or dandelions is: Do you feel people deserve to have quality of life or not?

Everyone deserves the right to make decisions about their quality of life. Sometimes to achieve that means allowing things that others are uncomfortable with. Maybe someday folks like Gottlieb will sit down with a kratom consumer like me and say, “You don’t deserve to enjoy the same quality of life I do” and at that point better understand that what is OK for me but not be for thee.

For now I will continue to wake up each day and start with my kratom tea and fight to #KeepKratomLegal for as many days as I have left on this planet. Kratom isn’t perfect. I know that, but it’s perfectly good for what I need. For several years now, I and others have had to fight almost daily to protect our quality of life. That’s a fight worth being in and one that I always say isn’t over no matter what the FDA says.

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Is Kratom Really As Dangerous As the FDA Makes It Out to Be?

America is in the midst of one of the worst epidemics in its history over opioids, which may be one of the reasons the FDA recently issued a warning that kratom, a plant-based supplement often used for pain, is potentially addictive since it has opioid-like qualities.

Kratom has also been used by some people to treat withdrawal from opioids. However, the agency stated that there is “no reliable evidence” to support this and “significant safety issues exist.” The FDA also said it has received reports of 44 deaths related to kratom use. However, as a recent Reason.com blog pointed out, in many of these cases, other substances were found along with kratom in the systems of the deceased, making it difficult to prove kratom was the cause of death.

In one of those deaths, a 22-year-old man had a cocktail of drugs in his system that included the antidepressant Prozac (fluoxetine), antipsychotics Seroquel (quetiapine) and Zyprexa (olanzapine), Lyrica (pregabalin), which is used for nerve pain, and several benzodiazepines (tranquilizers) – in addition to kratom. Also, as Jacob Sullum argued in another Reason.com blog, more people have died from prescription and over-the-counter pain relievers than kratom.

So is kratom really as dangerous as the FDA makes it out to be?

It’s hard to say. But it may be harder to get your hands on kratom. The FDA has already blocked importation of the substance. And in 2016, the Drug Enforcement Agency (DEA) ruled to classify kratom as a Schedule 1 drug, putting it in the same class as marijuana, LSD and heroin as substances with no currently accepted medical use and a high potential for abuse. The DEA backpedaled a bit later in the year following outcry from the public. However, the FDA’s warning could make it more likely for kratom’s Schedule 1 designation to go through.

To me, it seems the FDA is making a bit of a rash decision. Although the FDA says it conducted its own medical analysis of kratom, there is a lot of existing research supporting kratom as effective for conditions such as PTSD and depression. Did they consider this before issuing a warning?

Much like the FDA’s and DEA’s position on marijuana, it seems that decisions are being made based on incomplete examinations of the positives and negatives of herbal substances. The FDA and DEA owe it to patients who use kratom and find benefit from it to conduct a more thorough investigation before deeming it unsafe for public consumption.

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Quick Hits: Antidepressants and Ovarian Cancer, Limiting Opioid Scripts & More

Antidepressants are not linked to ovarian cancer, according to a new study. Although there have been a few studies over the years showing a link between certain classes of antidepressants and the development of tumors, researchers from Shengjing Hospital of China Medical University are suggesting otherwise. The research team thoroughly analyzed data from observational studies that examined the connection between antidepressant use and cancer from 1984 to 2017. The results from this large-scale review indicated that there is not a significant association between antidepressant use and the risk of ovarian cancer, which is contrary to initial findings. Posted February 5, 2018. Via British Journal of Clinical Pharmacology.

Opioid prescriptions for Medicare enrollees would be limited to 7 days under a request from the Centers for Medicare & Medicaid Services. The agency has also proposed that patients who are considered “potentiators” of opioid misuse and opioid-related adverse events be closely monitored, especially those who take Neurontin (gabapentin) and Lyrica (pregabalin). According to the agency, there has been a significant increase in gabapentin use to treat pain. Via CMS. Posted February 2, 2018.

Senate Democrats want the FDA to reject a new alternative cigarette that will be marketed as less risky. Ten Democrats sent a signed letter requesting that the FDA to reject Philip Morris’ risk application for its new iQOS smoking device. The letter was sent after most of the FDA’s scientific advisory panel reported mixed findings on the new product. According to the advisory panel, the tobacco company did not prove whether its new “heat not burn” cigarette reduced harm compared to tobacco cigarettes. However, the advisory panel concluded that iQOS exposes users to lower levels of harmful chemicals. The senators also referenced the Family Smoking Prevention and Tobacco Control Act, noting that modified risk tobacco products must significantly reduce harm and benefit the health of the population. Posted February 7, 2018. Via The Hill.

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