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Thread: Coming off antidepressants . . . .

  1. #1

    Coming off antidepressants . . . .

    Posting this from another thread (the "Rolex vs Smiths who was first to the top of Everest" one in Watch Talk)

    My job involves me speaking in public (I'm a vicar) and I'm good with words but there's a chance I'll be on Radio 4 on Wednesday speaking to millions of people (whom I can't see) about a complex and sensitive subject (antidepressants and specifically the difficulty of reducing and coming off them). It's a personally painful topic for me (I think the kids call it "triggering") and so for all those reasons I am, quite frankly, dreading it.

    Any thoughts? Please try and keep any comments positive!

    Thanks

  2. #2
    Grand Master Chris_in_the_UK's Avatar
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    Understand the trepidation.

    From what you have said, you have some experience personally, you clearly know your subject - invited to speak on Radio 4 is evidence of this.

    A bit of 'bum twitch' is healthy in this kind of situation - speak with the experience and passion you have.

    Best of luck!.
    When you look long into an abyss, the abyss looks long into you.........

  3. #3
    Thanks. One of the things I want to suggest is tablets in 10, 5, and above all 1mg with the last one scored (indented) so it can be split. Also more readily available liquid forms of the medications so that doses can be reduced smoothly in very small increments.

  4. #4
    Grand Master
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    Sounds like a thoroughly sensible idea that you have there. Very gradual dosage reduction over a time period, why not.
    Best of luck.

  5. #5
    Master yumma's Avatar
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    Good luck. It hopefully won’t be too hard. I did this last year. I still struggle a bit but the difference to me for being on them or off them is negligible. I’ve thrown myself into all-sorts and it helps. Best of all is that I’m getting two kittens next week and just seeing them has picked me up no end. I wish you all the best.

  6. #6
    Master Iceblue's Avatar
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    Yep if I remeber I went from 20ml to 10ml then half a tablet Dailey then half a table ever other day over a three month period , one hundred percent never just stop taken them , good luck with your talk I will try and listen in

  7. #7
    Stay strong and keep positive.

    My lad is being reduced on his antipsychotic drugs at the moment, tough times.

  8. #8
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    This interview with Johan Hari on the subject of depression and anti-depressants is well worth listening

    Best of luck, and a brilliant thing to do with the broadcast.

    https://m.youtube.com/watch?v=CDpjvFn4wgM

  9. #9
    Master Rocket Man's Avatar
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    I think it's scandalous that so many people are prescribed antidepressants without any proper plans or support available for reducing them. Many people experience terrible problems and GP's often advise just to stay on them.

    I believe that this might be the answer: Tapering strips. Sadly not available on the NHS yet but such a good idea!

    https://www.taperingstrip.org/

  10. #10
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    Good luck, Rev.

  11. #11
    Grand Master TheFlyingBanana's Avatar
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    I’ve been on the Radio many times, and a long time ago even presented shows.

    The old trick, but it really works for nervous guests, is to just focus on having a conversation with the host. They will control the conversation and keep it moving along - they won’t let you falter with an awkward silence.

    And smile before you answer the first question. That helps psychologically too.

    I’d say good luck, but you won’t need it. It will be over so fast you’ll wonder what you were worried about.

  12. #12
    Master Skier's Avatar
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    You're speaking for a reason - you know a great deal about the topic. Don't over analyse the audience and its knowledge, it will almost universally be low. As has been said, have a one-to-one conversation, maintain a positive tone, intonation and a humility and empathy. As a vicar I'm sure the latter two will come naturally.

    I offer the above as a former senior military officer used to speaking to large audiences, briefing ministers, providing evidence/information to government committees etc.

    Good luck.

  13. #13
    my advise would be to make it plain from the start that you have some personal experience regarding the subject , people with depression or anxiety disorders that take this medication get sick of others telling them they 'know how they feel' when its obvious they have never experienced it themselves and dont have a clue.

    gradual reduction (taper) is the usual method , you can withdraw as slowly as you like using a pill cutter from the chemist.

  14. #14
    Quote Originally Posted by pugster View Post
    my advise would be to make it plain from the start that you have some personal experience regarding the subject , people with depression or anxiety disorders that take this medication get sick of others telling them they 'know how they feel' when its obvious they have never experienced it themselves and dont have a clue.

    gradual reduction (taper) is the usual method , you can withdraw as slowly as you like using a pill cutter from the chemist.
    Health professionals should have more than a clue about the topic. With respect to the OP, his experience is as one (I presume) individual whereas professionals will undoubtedly have access to research/studies involving many.

    Doctors (and others) don't need to have experienced conditions they are expected to be an expert on.

  15. #15
    Quote Originally Posted by Kingstepper View Post
    Health professionals should have more than a clue about the topic. With respect to the OP, his experience is as one (I presume) individual whereas professionals will undoubtedly have access to research/studies involving many.

    Doctors (and others) don't need to have experienced conditions they are expected to be an expert on.
    You'd think, right? But the current NICE guidelines are rubbish and GPs (quite rightly) look to them when advising patients

    E.g. here http://www.pulsetoday.co.uk/clinical...037572.article

  16. #16
    Quote Originally Posted by Rev-O View Post
    You'd think, right? But the current NICE guidelines are rubbish and GPs (quite rightly) look to them when advising patients

    E.g. here http://www.pulsetoday.co.uk/clinical...037572.article
    Interesting, why do you think NICE might be so misguided?

  17. #17
    Quote Originally Posted by Kingstepper View Post
    Interesting, why do you think NICE might be so misguided?
    It looks like the evidence they use is both too small and very old.

    Modern meds often have a far shorter half life than, say, Prozac.

  18. #18
    Quote Originally Posted by Rocket Man View Post
    I think it's scandalous that so many people are prescribed antidepressants without any proper plans or support available for reducing them. Many people experience terrible problems and GP's often advise just to stay on them.

    I believe that this might be the answer: Tapering strips. Sadly not available on the NHS yet but such a good idea!

    https://www.taperingstrip.org/
    Thanks, I did not know about that. Looks good.

  19. #19
    Grand Master Chris_in_the_UK's Avatar
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    Quote Originally Posted by Kingstepper View Post
    Health professionals should have more than a clue about the topic. With respect to the OP, his experience is as one (I presume) individual whereas professionals will undoubtedly have access to research/studies involving many.

    Doctors (and others) don't need to have experienced conditions they are expected to be an expert on.
    GP's are not experts.
    When you look long into an abyss, the abyss looks long into you.........

  20. #20
    Quote Originally Posted by Kingstepper View Post
    Health professionals should have more than a clue about the topic. With respect to the OP, his experience is as one (I presume) individual whereas professionals will undoubtedly have access to research/studies involving many.

    Doctors (and others) don't need to have experienced conditions they are expected to be an expert on.
    you would think so but in most cases this is not the case , service users knew about withdrawel symptoms from AD's for many years before professionals even acknowledged they existed , doctors simply follow generic guidleines with a one size fits all approach.
    reading about something and experiencing it directly are two very different things.


    *imo one of the main problems is GP's dishing out Ad's like sweets as a band aid before pychological interventions can be put in place -simply due to long waiting times in this area.

    ** the best thing to do when tapering off AD's is to look at the half life , the shorter the half life the slower the taper needs to be to stop any withdrawel symptoms.
    Last edited by pugster; 17th March 2019 at 22:49.

  21. #21
    Quote Originally Posted by Chris_in_the_UK View Post
    GP's are not experts.
    Indeed, they might not be.

  22. #22
    Quote Originally Posted by Kingstepper View Post
    Indeed, they might not be.
    The clue is in the name: they are General Practitioners -- and a bloody good job job they do most of the time.

    But on this issue I think the empirical patient data is ahead of the accepted academic evidence

  23. #23
    you do get the odd GP that has more of an idea , they have a GPSI in mental health -though they are few and far between .

  24. #24
    Quote Originally Posted by Rev-O View Post
    The clue is in the name: they are General Practitioners -- and a bloody good job job they do most of the time.

    But on this issue I think the empirical patient data is ahead of the accepted academic evidence
    To be fair, I didn't mention General Practitioners.

    Anyway, good luck with your radio slot. With your experience of public speaking plus subject matter knowledge I'm sure you'll be fine!

  25. #25
    Master Wolfie's Avatar
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    You know your onions…. That’s part 1 in the bag…

    I’ve been on the radio 4 or 5 times…. I am the East Midlands expert on anything related to the smart home apparently! I know a reasonable amount on the subject, but, I’m quite happy to ‘busk’ it too!

    My ‘local’ radio audience is way smaller…. I’ve twice been in the studio and then the other times it was on the phone…. Either works…. In the studio you’re having a chat with the person opposite you and on the phone, well, you’re having a chat on the phone…. Keep it at that level and you’ll be fine….

    I don’t know if you have any experience acting? But, it’s always a case of getting your first line out (try and work that out in advance)…. After that you’ll start to relax and enjoy it…. You’ll be great 👍🏼

    Please let me know the show and time of recording as I’d love to have a listen…

    Ben

  26. #26
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    I was on citalipram for a while and found myself dependent on them to get through work, though I didn't enjoy how they made me feel in other ways (I felt like a passenger in my own body).

    I wasn't mentally ready to come off them, then I got a new job and found soon after I felt ready to ween off them.

    Not sure the moral of the story but I think addressing the source of the issue is the hardest thing to do and the key to getting self sufficient again.

  27. #27
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    I have on occasion had to do some radio interview. Once on live TV about 25 years ago. I also sometimes give classes (sermons). (I'm a Hare Krishna priest). Two friends of mine sometimes do Thought for the Day. Public speaking freaks me out, but the best advice I got was to treat it as if you are just having a conversation with one person, and keep it reasonably simple but to the point.

  28. #28
    I did an interview on Radio 4's Front Row with a Government education minister a couple of weeks ago. I went up to Salford to do the interview (said Minister was in London). The host of the show and the producer were absolutely brilliant at putting me at ease and I actually enjoyed the whole experience (despite having some nerves in the run up). I'm sure you will be fine. I always find it useful to over-prepare for these types of things and then resign yourself to the fact that you won't be able to get every point across exactly how you imagined it. Oh, and if the piece isn't going out live be happy with the skills of the producer in getting the final edit together. You won't get a say what is or is not included.

    Here is said interview if you are interested:

    http://www.ucanplay.org.uk/front-row-discussion/

  29. #29
    You'll be fine, I'm sure. It sounds as if what they're looking for is personal testimony, so other than trying to distil your experiences into a few sentences you don't need to do any prep. You're not there to offer journalistic or medical/policy input. So just think of what you'd say to a friend facing these issues about your own experience, and say that.

    One practical tip: when doing two or three-ways I always made a note of the names of the other participants, when first introduced. Nothing worse than saying 'as your other contributor said', so have a notebook and pen to hand - useful for noting down points if folk say especially interesting things.

    However, if you feel that contributing to the discussion would have a seriously negative impact on you then maybe stand down. There's no shame in that, and the world is chock full of people ready to talk...

  30. #30
    Coming off depressants was covered on R2 Jeremy Vine this afternoon, well worth a listen, its on iplayer/catch up

  31. #31
    Thanks everyone.

    Here's my crib sheet for what I hope to be able to say:


    My own story – came off ADs in 2009 etc. Hellish. Went back on them pdq.

    The first thing to say is that these drugs have saved lives and improved the quality of life for countless people. They are, on the whole, cheap, efficacious and relatively safe.

    The NHS in general and GPs in particular are overstretched and underfunded so it’s quick and easy just to write a prescription for these drugs and in many cases leave patients on the same dose of the same medication for years.

    BUT . . . like anything that’s too good to be true these drugs have a dark side. And the biggest problem with them is when people decide to reduce them or try to come off them. This is called “antidepressant discontinuation syndrome” and the withdrawal effects can be horrendous and long-term. Even a slight reduction can cause unpleasant mental and physical symptoms.

    (E.g. Dizziness, insomnia, panic attacks, tinnitus, headaches, muscle cramps, nausea, crying, mood swings, anxiety and irritability.)

    And then when faced with these horrible mental and physical problems caused by the removal or reduction of the medication people understandably believe EITHER that their underlying depression has resurfaced OR that they need to resume the meds at the previous dose and give up any hope of every stopping them.


    Three factors in the severity of discontinuation syndrome: first, the dose (obviously a higher dose is harder and will take longer to reduce) second, the length of time that the drug has been used for (because it seems the brain and nervous system adapt over time to the medication) and third the half-life of the medication (that’s the rate at which the drug is metabolised and how long it stays in your system; the shorter the half-life the harder it is to get a slow, smooth taper.)

    People do need to taper down very slowly and come off the medication over weeks, months or even years.

    But that is hard because antidepressants are one of those things – and life is full of them – that it’s easier to get into than to get out of.


    Doctors and the pharmaceutical companies need to take this seriously. At the very least I would like to see all of these drugs available in much smaller doses so that people can adjust and fine-tune their reduction.

    It would be a start if the drug companies made, say, 1mg tablets that are indented or scored and can easily subdivided.

    It’s worth saying, too, that liquid forms of most of these medications are already available and they are very good because they can accurately measured and even diluted down to give a pretty precise dose. But they are expensive and GP practices have a limited budget so they are understandably reluctant to prescription that form of the drug.

    At the moment people are cutting and chopping up pills and weighing their dose like backstreet drug dealers. Or making their own liquid solutions.

    Neither option – pill splitting or amateur titration – are accurate and both are difficult.

    It’s simply not good enough.


    In the Netherlands there’s a brilliant scheme called Tapering Strips, developed by Dr Groot at the University of Maastricht that pre-packages antidepressant medication with tiny incremental reductions in dose.

    I’d really like to see the Dutch Tapering Strip system widely adopted in this country.

    As I said at the beginning: these drugs have saved lives and improved the quality of life for countless people. They are, on the whole, cheap, efficacious and relatively safe. So they provide quick and easy solution for an overstretched NHS. That much is obvious.

    However patients need support at the other end of the process, too, and coming off these medications is under-resourced and poorly supported.

    My own medication only comes in 20, 10 and 5mg tablets which doesn’t really allow for finely calibrated tapering. It also available in liquid form but I’m told that that is much more expensive and is also absorbed quicker so isn’t quite an exact equivalent.

    What would really help would be smaller doses (tablets down to 1mg or less) and readily available liquid forms as both allow for accurate reduction.

    Also, the Dutch “Tapering Strip” method should be more widely known and used.

    The main thing is to a have very slow and steady withdrawal that is patient-led and carefully monitored. But all of that, of course, takes time and money.

    Finally, I don’t want to scare people who may already be prone to anxiety. Many people have no problems coming off these medications – especially if they are on a relatively low dose of a drug with a long half-life and have been on it for a year or less. My own daughter recently tapered off Prozac very easily as she ticked all three boxes.

  32. #32
    Master
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    Just imagine the audience all naked.... Erm maybe not.

    Think how many people you'll be helping with your words. Get lots of sleep the night before. Pray for spiritual guidance. Your confidence in what you're saying will come from your experience of the subject which sounds strong.

    Sent from my CLT-L09 using Tapatalk

  33. #33
    There was an interesting interview on Jeremy vine Radio2 today regards this

    I didnt catch it all

    I have had a bad time of it if Kate with depression and enxiety and I feel the “system” of support is overrun

    It’s great more people can talk about issues but the nhs cannot cope

    As for coming off the pills, it must be gradual if at all - most people take them for a minimum of two years

    Chemical imbalance in the body can be fast when unsettled

    Good luck with your piece - and we’ll done

  34. #34
    Is there anything this forum doesn't know?

    I'd forgotten how much I love this place.

    Now someone say "Veblen", "Eddie" or "NATO" -- I've got my tz-uk bingo card relatively unfilled on this thread. ("Fanboy" "SC" and "patina / wabi" also appreciated.)

  35. #35
    Master Maysie's Avatar
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    Quote Originally Posted by nick67 View Post
    Coming off depressants was covered on R2 Jeremy Vine this afternoon, well worth a listen, its on iplayer/catch up
    Posted for ease of reference. Skip to 1:09:30

    https://www.bbc.co.uk/sounds/play/m0003d1m

    Rev, you will be absolutely fine. Knowing your subject makes you strong.
    Last edited by Maysie; 18th March 2019 at 18:20.

  36. #36
    Master
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    Good luck
    Having personally had some I definitely undesirable circumstances myself and come off them not too long ago I know how much of a trigger this can be, talked myself into speaking up myself a while ago and it was the most liberating thing to share with others so get stuck in, talking and sharing I found was a great healer, by all means message me if you want to know the gory details but radio 4 is very cool, well done for getting that gig!
    Chin up Rev and give em hell (is that a bad euphemism for a vicar I’m not sure)


    Sent from my iPhone using Tapatalk

  37. #37
    Master Rocket Man's Avatar
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    I really like what you have to say on your 'crib sheet'.

    Some excellent points made and speaking as a mental health professions I agree with all of them.

    Best of luck for tomorrow, although with material like that you won't need it.

  38. #38
    Hi all, I recorded the interview earlier today. Just had a nice email saying, among things “I’m hoping we’ll play the interview on tomorrow’s programme.”

    So listen out for the PM programme between 5-6.

    Thanks!

  39. #39
    Master Kirk280's Avatar
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    Glad it went well for you, and I can understand your nerves. Your views re: decreasing dose medications sound very sensible, but I’m not experienced in these matters.

    At the risk of pushing the ‘no religion’ remit of the G&D, may I ask: given your occupation and (presumable) beliefs, didn’t religion help at all? Both with the need for anti-depressants, and the public speaking nerves?
    Last edited by Kirk280; 20th March 2019 at 22:30.

  40. #40
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    Coming off antidepressants . . . .

    Reducing over time as has been suggested by many is the best way.

    Someone very close to me went cold turkey and although they are off them and “ok” now, they had some very hard withdrawal issues.

    I’m glad it’s better understood these days the implications of taking pills.

    Sent from my iPhone using TZ-UK mobile app
    Last edited by Tahiti; 21st March 2019 at 10:51.

  41. #41
    Grand Master sundial's Avatar
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    I was asked to appear and speak on 'For What It's Worth' years ago and was dreading it … even though was a recorded programme. However, the presenter did the talking / questioning and replying was easy. I'd bought a duff camera lens from a notorious London dealer ... when I knew nothing about lenses. For a 5 minute interview I ended up making a profit on the lens as Canon repaired it FOC via the TV programme and I sold it to another dealer … and FWIW paid me over £100 in expenses including travelling.

    BTW, FWIW were preparing a feature about this notorious dealer and several other disappointed customers were also interviewed … and FWIW had been given the 'heads up ' about the dodgy dealer by the Trading Standards Office … which had a whole shelf of faulty cameras / lenses purchased by disgruntled customers. The dealer is still trading and last I heard had gone bust several times … but bought back the w/o stock and commenced trading again … and again.

    REV-O, don't forget to claim your expenses :)

    dunk
    "I know not how to abstain from reading" … Samuel Pepys

  42. #42
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    Hi Revo, did the piece you contributed on PM air yet? I somehow missed it!

  43. #43
    Quote Originally Posted by size11s View Post
    Hi Revo, did the piece you contributed on PM air yet? I somehow missed it!
    Not ye. So far Brexit has managed to push me off the agenda and the airwaves. (Had a nice email from Evan Davis: "Lovely to talk to you Oliver. Sorry we didn't get to broadcast it as yet. It will get an airing, but I have a horrible feeling it might not be for a few days as we are in the midst of this constitutional crisis right now which is very absorbing. [. . . .] Keep well. Evan”)

    Maybe this evening? Who knows!

    In true political style I did duck the questions about what my condition and medication mean for my faith in God (nothing good, to be honest) and also the one about magic mushrooms (I was offered a place on a trial at Imperial College who are using psilocybin, the psychoactive substance in the fungi, to treat chronic depression. Unfortunately the study required me to come off my antidepressants in fairly short order; I think they wanted a two month taper to be “clean” in readiness for the start of the trial. I think I could manage two years but not two months. Early results are quite promising though, with an apparent ability to “reset” the brain for 6-12 months before another dose is needed and administered by the team. It remains, of course, illegal: a Class A drug under Schedule 1 but the University has a special license or permit or something to use it in controlled studies. I could see the "Tripping Vicar” headlines, though, and was keen to avoid sensationalising an important area of research.)

    I have no control over how they’ve edited it so I’m hoping it comes across OK, if indeed it ever appears!

    We'll see . . . .

  44. #44
    Master petethegeek's Avatar
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    Quote Originally Posted by Rev-O View Post
    Had a nice email from Evan Davis . . .
    Not wanting to take this thread too far off topic, but Evan Davis does appear to have made a good start in taking over a slot which Eddie Mair had pretty well made his own.

  45. #45
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    Ok. I did scan iplayer, there was a piece in PM on anti-depressants on 11th March before you did your bit, which was quite good.

    A scarily large number of folk I know are on Citalopram and I have spent some time on it too. It seems to be the go to drug for the GP for anxiety related issues, which in itself is too much of an umbrella term, it all needs refining. Above all though I feel we need a more developed, integrated and available counselling system to help folk through, or to make sense of difficult times. Church in times past I hear you say, was that ever so? I shall keep my ear open for the PM article if I can bear the endless, spiralling Brexit chatter that makes me anxious.....

    - - - Updated - - -

    Quote Originally Posted by petethegeek View Post
    Not wanting to take this thread too far off topic, but Evan Davis does appear to have made a good start in taking over a slot which Eddie Mair had pretty well made his own.
    All hail Eddie Mair....

  46. #46

    Coming off antidepressants . . . .

    17:25h today

    It was a good conversation.


    Sent from my iPhone using Tapatalk
    Last edited by BillyCasper; 25th March 2019 at 19:14.

  47. #47
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    You came across as thoughtful, calm yet urgent about the issue Revo. Good stuff.

  48. #48
    I heard it, you came over very well.

  49. #49
    Master Wolfie's Avatar
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    Well done Oliver…. You did really well

    These direct personal stories in relation to this issue resonate much more strongly with people who can relate to them…. Some great practical suggestions too…. A good 7-8 minute interview on prime time…

    A TZ star is born!

  50. #50
    Grand Master Mr Curta's Avatar
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    Very interesting and thought provoking, well done. Starts at 25:17

    https://www.bbc.co.uk/sounds/play/m0003jsy

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