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- Hacker News
- > Likewise, a 2025 study found that people with dementia who were taking antidepressants experienced more rapid cognitive decline. “Sometimes we think a lot about medications when we start them, but we don’t think enough about stopping them at some point,” says Sara Garcia Ptacek, a neurologist at the Karolinska Institute in Sweden, who worked on the study.
My aunt had Alzheimer's and had to be put on anti-anxiety medication just so that her caretaker could manage her. (This was at the point where she no longer recognized her children, but recognized her siblings.)
Even if it accelerated her eventual end, it certainly improved the situation. She would have been impossible to take care of otherwise.
That being said, before Alzheimer's, she was a very anxious person and often difficult. If she was medicated earlier in life, would it have accelerated the onset of Alzheimer's?
by gwbas1c - I've been on 40mg citalopram for about 20 years now. I've tried a few times to come off either tapering or cold turkey and in all cases it's been horrendous. My biggest worry is that I'll never be able to come off them as I'm on such a high dosage, even if it was tapered off over a very long period of time.by drayfield
- I said it elsewhere, but it took me a month of micro dosing down to get off my 40mg/day citalopram habit, which I had been on for 15 years. And even on my own super slowed down schedule I still experienced massive side effects. Good luck to you if you ever decide to wean yourself off of it & always remember to keep backup citalopram in case you can't get your script refilled right away.by clsec
- Hey, don't lose hope. I got prescribed and took 30 mg of Citalopram for about 10 years to treat general anxiety. At some point, I wanted to stop taking it because of the emotional numbness (and also because of a tendency toward mildly aggressive episodes).
I gradually reduced the dosage from 30 to 20 mg (over the time of 3 to 4 months), then down to 10 mg (for another 2–3 months), and then I finally reduced it to 5 mg (half a 10-mg tablet) over a period of 4–6 weeks. I told my doctor beforehand, they only told me that I should fade it out slowly. But please excuse me for not knowing the exact time frames of the tapering process any more. I took my time at the beginning of the tapering and moved more quickly toward the end.
During and afterwards I didn’t notice any severe side effects, aside from the fact that the recurring emotions really overwhelmed me at times. Not only that, but I would cry at the slightest hint of emotional and romantic scenes in movies and series, which lasted for about three months. Nowadays, I feel quite normal. I miss the slight comfort Citalopram gave me, but I have my feelings back, I feel more myself again. If a bit more anxiety is the price for that, then so be it.
by move68k - Only slightly related, but can anyone ELI5 why Bupropion XL is not the universal first line treatment for depression and is hardly used at all in Europe?
It has fewer side effects vs. SSRIs, can be safely used as a long term medication (which many people do with SSRIs even though it can have negative effects), and doesn't have the same horrible withdrawal symptoms (although you still need to taper).
by elil17 - It has a long and scary list of side effects, good if it works for youby herbst
- Or Auvelity, which is a newer one that mixes Bupropion and DXM.by Trasmatta
- My doctor tried me on Bupropion for ADHD and I think it caused my BorderlinePD to get much worse, so definitely YMMV.by LoganDark
- Doctor gave it to me and I reacted paradoxically to it. Worse depression and even more peculiar I picked up smoking again. I never felt such an urge to smoke in my life. Over the years I've been looking for an explanation for that reaction but wasnt able to find anythingby attemptone
- Anxiety is a common comorbidity in depression patients and buprioprion can dramatically raise anxiety levels
It is a second-line treatment for a reason. Great when it works. Harmful when it does not.
by hapless - SSRI's saved my life with no side effects that I can discern, yet I still have the urge to try and get off of them from time and so do friends and family of mine that also benefit from them. Maybe that urge needs more study because it is not taking us in a good direction. I'm not saying that because of the difficulty of weaning off, but because of the benefits of staying on. For those of us that need them, trying to wean off of them is like trying to wean off of I don't know, vitamin C or something else essential. Don't do it! Be glad you found something that helps! Keep taking it!by krupan
- I've taken antidepressants for years (20 mg prozac) and have sometimes tapered off them, restarting later. I can barely tell that I'm taking them, I feel 100% like myself on--and off of--them. I know they do something because when talking about difficult traumas with my therapist, if I'm not taking flouoxetine I will get choked up to the point I can't speak. That's the only difference I can perceive. My dose is not a "happy pill", it simply smooths out some extreme lows. Tapering off (a few weeks of 50% exponential declines) I've done because it's recommended, but again, I've never noticed any affect on mood before, during, or after.
after a number of years, a small dose of lithium (300mg) was recommended by a psychiatrist who stood apart (at least in that respect), and it was magic at mood stabilization, I never before even realized that I experienced hypomania (and I took it for anxiety), I just thought I was "bold".
(Lithium is not a drug, it's an element, taken as a metallic salt. It occurs naturally in the water in various parts of the world, and those populations have been studied and suffer lower rates of mental illness. My shrink said his recommendation was based in conjunction with the prozac I was taking, i.e. a known correlation. Bipolar II is a different mental condition than bipolar I, and somewhat slippery/loosely defined)
The extreme anecdotal stories people report online as in this forum strike me, an experienced but likewise only an anecdotal user, as more an artifact of underlying emotional distress rather than a result of the drugs.
I just wanted to contribute a different voice to this topic.
I should add, I do have "extra money" and am able to pay extremely qualified and expensive doctors, an option that is not available to everyone, including those with full public health services.
by fsckboy - > bipolar
I think this is more relevant than people give it credit for. While bipolar depression and unipolar (major) depression might generally be functionally indistinguishable from the outside, they seem to have genuinely different origins within the body and brain.
And the drugs seem to be far more powerful for people with bipolar.
That's both good and bad. Good, because between mood stabilizers and very careful use of antidepressants, many people with bipolar can genuinely achieve complete treatment, or close enough to pass as complete. Which is wonderful! Bad because antidepressants and (hypo)mania are a dangerous combination, and the antidepressants can have more kick than one would normally expect. They'll often cause a patient's first manic episode, which can be very bad on its own but might get things on the right treatment course. (Of course, they often still do nothing much at all.
I think the tapering may be related as well. I was eventually diagnosed with bipolar II and I've never really had to taper off anything that didn't have a black-box warning about tapers (either intrinsically or due to blood-pressure effects, which are worth taking seriously). I've stopped some things cold which one really shouldn't stop cold. I didn't really notice much other than the bad side effects causing the stop going away.
> I do have "extra money" and am able to pay extremely qualified and expensive doctors
I don't really have "extra money" but I still do this anyway. My psychiatrist is $500 an hour, out of pocket, no insurance accepted period. He actually listens. It's worth it.
- Going cold turkey is always the worse way to wean off a SSRI, but the half-life of the drug is also a good indicator of the intensity of the withdrawal. Also, some people might eliminate a drug faster than others, so the result is surely harder on some that others.
Doctors that tells you how to reduce the SSRI/SNRI are following what's available on the market, and generally the gap between doses is always huge and gives a big gap and so bigger withdrawal. Once I asked to a pharmacist if he could make smaller doses and he answered me to be like a good junky and open the capsules and cut them myself. I was a bit shocked at the moment, but at least it costs me less that him having to do it a that helped me greatly to reduce a SNRI without feeling too much symptoms.
So a good advice, is look at the half-life of the drug you are taking, and be a good junky and split the capsules or have liquid form to reduce by small amount.
Half-Life of Specific SSRIs
- Fluoxetine (Prozac): 4 to 6 days, with its active metabolite norfluoxetine lasting 7 to 16 days.
- Sertraline (Zoloft): Roughly 22 to 36 hours.
- Citalopram (Celexa): About 36 hours.
- Escitalopram (Lexapro): About 27 to 32 hours.
- Fluvoxamine (Luvox): 17 to 22 hours.
- Paroxetine (Paxil): About 21 to 24 hours.
Half-Lives of Common SNRIs
- Venlafaxine (Effexor): About 5 hours for immediate-release (extended-release has an effective transit/clearance profile, though parent half-life remains short); its active metabolite (desvenlafaxine) has a half-life of about 11 hours.
- Desvenlafaxine (Pristiq): About 11 hours.
- Duloxetine (Cymbalta): About 12 hours (range of 8 to 17 hours).
- Levomilnacipran (Fetzima): About 12 hours.
by dib258 - Though this article concentrates on the SSRIs, other meds like the SNRIs can have a similar or even worse withdrawal effect. We didn't call it "Side Effexor" for nothing.
People legitimately need these drugs, including in the short term. The problem for acute stressors once they resolve is how to get them back off.
- "People legitimately need these drugs"
First. Do no harm.
by ImHereToVote - Not to mention benzodiazepines...by isolli
- For something prescribed to get someone through a temporary crisis, "how and when do we get you back off this safely?" should probably be discussed at the beginning, not years later when the patient decides to stop.by KurSix
- > Though this article concentrates on the SSRIs, other meds like the SNRIs can have a similar or even worse withdrawal effect.
And don't even get me started on tricyclics or MAOIs... no, seriously, don't get me started on them! The current generation of first-line antidepressants (SSRIs/SNRIs) might as well be free compared to the old school crazy pills.
by Paracompact - I’ve been on a SSRI for 5 years and not once have I thought about getting off of it. It literally saved my life.
I remember a while life of depression and constant churn of recursive emotions destroying me.
I’m worried that too many people are downplaying the benefits that this drug for those of us that it has helped immensely. And it’s extra risky to be downplaying it while RFK jr is actively working to remove the drugs from the market.
by chewbacha - You don't always taper out to stop treatment. Changing medicine also needs tapering.by tokai
- > I’ve been on a SSRI for 5 years and not once have I thought about getting off of it.
I had this same outlook too. Was on one for about 6 years and then my first kid was born. I felt nothing emotionally when she came in to the world and I discussed this with my wife. Two years later, my second child was born and it was a radically different experience and I am glad I got off.
My GP warned me, "Don't cold turkey it, taper off, cut the dosage and ween off. Ask your wife to pay attention to your moods, if you go sour and can't recover, you may want to consider going back on."
Over those 6 years on it, I learned a lot about how to deal with the stress. I definitely think that's a missing key in the whole treatment process.
by warmwaffles - I’m happy for your extreme good response to the drug. I’ve witnessed this type of response in my close circle once, and it is life saving medication in these situations.
I think it’s important to highlight that not every person has the same response to these medications. I think it’s absolutely something anyone struggling with depression should try, but there should be expectations about how long to stay on a medication before moving on.
by bitmasher9 - I think the issue is informed consent. If people find benefit in them by all means they should be able to take them. But currently these drugs are being given out for the most mundane issues, many of them temporary, after a 2 minute visit with a Primary Provider/GP, with little to no discussion on potentially permanent and serious effects, whether that be long term withdrawal or the equally life ruining PSSD. Neither of which seem to be particularly rare given the number of prescriptions.by movespebp
- An unfortunate aspect of modern discourse and thinking is how black and white discussions can feel. Several sides of the topic can co-exist together and all be true, so (well, in my experience and reading):
- Some people really benefit from and even need SSRIs or other psychoactive drugs to function well in society.
- Too many people are prescribed them such that there may be more harm than good. They may have side effects or were prescribed them to deal with a situational problem that could have been better managed with therapy.
- Whether justified or no, a prescription is given with no off ramp provided. It's almost as if you're defective and the drug is fixing you, and the solution are pharmaceuticals, which again may be true for some subset of those prescribed. People clearly are trying to taper and are suffering.
More controversially, psychiatry is something of an art (if you're generous) or a racket. Because there's no way the "chemical imbalance in the brain" theory can be validated empirically. In the US you meet with one for 15m, get prescribed a cocktail of drugs, a few months later you report if it worked, and if not they'll up the dose or play around with the cocktail. I don't know how we call that stuff science.
by mancerayder - This is an absolute failure on the part of medical science. SSRIs went mainstream in 1988.
By 1992! We knew about withdrawal issues: https://www.wikidoc.org/index.php/SSRI_discontinuation_syndr...
Let's be generous and give it until the 2000s for the knowledge to spread and science to validate; and we're still left with 26 years of blundering around without IMO sufficient warning to patients about withdrawal risks.
I would wager some of the doctors who prescribe today were well past a glint in their father's eye when we started to know about this.
by florkbork - Seemingly around the world, physicians are often nepo babies.
In the United States, our physicians are paid by taxes for grad school. The physicians decide the supply with an unelected private org ACGMe.
It really shows that despite the corruption, people will go to great lengths for health.
- My physician told me withdrawal was hard, and laid out all the negative side effects. Searching for them online was pretty trivial too. The pharmacist also spoke to me when I picked up the first bottle, and the pamphlet I received with the medicine also had information about it.
At some point, we have to trust that even if one or two of those fail, the information is readily available and issued four times before you start.
by forestrywat - I went cold turkey off of citalopram when I was a teenager and it was a pretty unpleasant two weeks of heart palpitations, but the immediate benefit of no longer experiencing emotional blunting made me avoid taking any more antidepressants for 10 years. I was prescribed it by a GP and never given any real support in my mental health or in coming off of it. It was a real black pill for me on the UK's treatment of mental health issues.
Last year I started taking buproprion (Wellbutrin) after seeing a private psychiatrist in Romania, and I found it beneficial, but ended up losing more than 10kg, and becoming malnourished to the point of my hair falling out. Again I stopped of my own accord, and buproprion has basically no cessation symptoms.
This spring I saw a psychiatrist through Romania's public health service who prescribed me vortioxetine (Brintellix/Trintellix) after I shared my history and it's been a game changer. I experience basically no side effects besides a slight reduction in libido, with no other effects on sexual function. It's really helped me to find my balance again. And I see a psychiatrist once a month paid for by my public health insurance with the medication fully comped. Vortioxetine has a half-life of 66 hours so the one time I did have to skip a day and a half, the withdrawal was not noticeable.
Just sharing this to say that there are good doctors and good meds out there, and that having low tolerance for one medication doesn't mean that you shouldn't talk to a doctor about it and try others.
by jkxyz - I've heard similar stories. Different people react to the same med differentlyby krupan