Antidepressant use and its discontinuation: Why & How
by Kelly Brogan, MD
The author acknowledges, with great compassion, that this is a challenging topic for the many individuals who make the difficult decision to begin treatment with psychiatric medication.
All patients must be given the most complete and accurate information about these medications, including side effects (risk for dependence, violence, impulsivity, etc), the importance of properly tapering off medication, the institutional incentives for medical doctors, educators, and others to advocate for their use, and the availability of effective non-pharmaceutical avenues of treatment that can address root causes of mental illness and behavioural problems.
What follows herein is a discussion of steps that the author believes should be taken in anticipation of any medication taper, and the subsequent taper should be handled by an experienced professional. Despite these considerations, some patients may be unable to taper which, in the author’s opinion, speaks to the important of true informed consent prior to medication initiation. This blog is not medical advice and does not replace consultation with a qualified medical professional of your choosing.
There is not a single human study that supports the “monoamine hypothesis” of depression, which is the idea that depression is caused by a certain kind of chemical imbalance in the brain, such as under-activity of serotonin. The only studies in which tryptophan (an amino acid precursor to serotonin) depletion resulted in depression were in patients who had previously taken antidepressants.
Imaging studies, post-mortem suicide assessments, and animal models have never yielded consistent patterns of neurotransmitter levels, metabolites, or receptor profiles.
Compelling discussions by Moncrieff and Cohen suggest that antidepressants actually create abnormal states rather than repair them. They use the analogy of alcohol’s disinhibiting effects: just because booze can ease one’s social phobia, does not imply that alcohol is an appropriate treatment nor a correcting agent.
With this brief synopsis,i would suggest further reading in the following link by those who are interested on the topic.