Psychotropic Deprescribing Council

Read the article at psychdeprescribing.org/why-i-founded-…

Very widespread use of mental health screeners in decades of psychiatry research means that results of that research were confounded by erroneous subject selection -- the subjects who were false positives. Meta-analyses cannot compensate for this internally invalid trial design.

The Risk of Universal Mental Health Screenings: Too Many False Positives Basic mental health screeners should not be used to diagnose mental illness. They produce more false positives than true positives, and universal application in the general population overestimates prevalence. - PHQ-9 (most popular depression screener, cutoff ≥10): False positives among screen-positives = 65% (PPV = 35%) - GAD-7 (most popular anxiety screener, cutoff ≥10): False positives among screen-positives = 71% (PPV = 29%) - PCL-5 (most popular PTSD screener, cutoff ≥33): False positives among screen-positives = 55% (PPV = 45%)

@JRBneuropsiq What is the purpose of separate categories? Are the stereotypes described by those categories useful in the real world of patients? How are they useful?

When we talk about mental health, which approach is more useful?

@BadreNicolas @TimmyTurner613 Clinicians are cautioned that symptom scales are not diagnostic, but a guide to ask more questions! Yet throughout psychiatry research, the test scores, which are merely vague indicators, are computed & analyzed statistically as real data -- as though they represent hard facts.

@TimmyTurner613 Number scales. For better or worse, psychiatry has largely reduced the definition of outcomes to symptom scales.

Some improvement in how the media describes STAR*D, arguably the most famous trial in psychiatry. From USA Today yesterday: “In a seminal, early 2000s trial funded by the National Institute of Mental Health, about 30% of the study’s participants with depression saw symptoms disappear with their first antidepressant treatment. That study is still one of the most robust antidepressant trials conducted – although researchers have more recently argued that fewer people are cured by these medications than its results suggest.” I wish they hadn’t described it as “robust” considering it is now disputed, but I see progress. In 2023, the NYT described STAR*D as “the largest study of antidepressants to date” and touted its results that more “than 60 percent of those patients actually had a very good response.”

For many patients, SurvivingAntidepressants .org was a place to empathize and learn from one another. I have spoken with and learned from its founder, @Altostrata, on many occasions. However, the site is now read-only. It is interesting to see @BasedPsychMD starting a new community and website for people to share: taper.community. It is just beginning, but I already see people helping and sharing. That is community.

@m_aadil Academic psychiatry has never issued a straightforward repudiation of the “chemical imbalance” theory via any avenue, particularly its professional societies. Studies are still attempting to show it exists. It’s merely been rebranded so not as embarrassing.

Academic psychiatry rejected chemical imbalance like decades ago. Today its only invoked as a straw man to argue either depression doesn’t exist or medication are ineffective.

Benzodiazepine dependence can develop in weeks. Patients are often told it won't happen to them. When it does, they're told the anxiety returning is proof they need the drug.

@sanilrege Isn't it obvious that a patient's medical records "show what the clinician was thinking at that point in time, with the information available then"? Point is, what if the clinician was dead wrong? That error is not exonerated by existence of the record, it is documented by it.

Poor or harmful diagnoses can be applied too quickly. That is true. 🚨BUT👇 ..records are also history. They show what the clinician was thinking at that point in time, with the information available then. If the material exists, read it. The formulation is what justifies diagnosis and treatment. A label viewed in isolation is easy to criticise. Sometimes that criticism is right. Sometimes it reflects retrospective certainty and overconfidence. A past diagnosis may be wrong. But that is only one possibility. Another is that the condition evolved. Another is that the earlier diagnosis captured the presentation at that stage, even if a different construct became clearer later. In psychiatry, this is common. Early emotional dysregulation may later declare itself as schizoaffective illness. Apparent schizophrenia may eventually prove to be FTD. That does not always mean the earlier clinician was careless. It may mean the illness had not yet fully revealed itself. Which is exactly why diagnosis should never be seen in isolation. Formulation should be there. An even stronger argument for formulation to justify why the diagnosis was applied.

@sciqst @chrisaikenmd Enormous overlap between the diagnostic entities "anxiety" & "depression" thoroughly confounds these findings in all regards. Suggesting that the drug effect differentiates between "anxiety" & "depression" is absurd, as is its potential as a "biomarker".

Interesting findings here! The interaction between anxiety severity and quetiapine response could suggest a potential biomarker or a differential mechanism of action. I'm curious about the methodology for determining 'greater severity.' Could future studies incorporate biomarkers or imaging techniques to further elucidate these interactions? For detailed insights and more on #Medicine, consider checking out Sci-Quest. It's a comprehensive platform for biomedical questions and review generation. Explore more at sciqst.com. #MentalHealth #Research

Update on a RCT that greater quetiapine > lithium as augmentation in treat-resist #depression. Re-analyzed, quetiapine's superiority was limited to those with severe anxiety: pubmed.ncbi.nlm.nih.gov/41762225 But both had similar anxiolysis, so ?greater severity marks quetiapine response

"De-diagnosis" aims to reduce harm done to patients who've collected multiple wrong diagnoses. Helps correct: 1)Massive overdiagnosis 2)Careless clinicians 2)Internet fads/media hype 3)Incorrect self-diagnoses 4)Mistaking each symptom for new diagnosis 5)Polypharmacy 6)Stigma

@BasedPsychMD "pushes penile fibroblasts into a state of pathological activation" -- isn't that sex-specific?

@PsychotropicDC More or less the same, just not as easily correlated

SSRIs create a prolonged peripheral serotonin surplus. Over time, this pushes penile fibroblasts into a state of pathological activation, 'wound healing without a wound.'

This is too accurate 😂

Imaging confounded by drug involvement! "Exclusion criteria were....psychiatric medications other than serotonin reuptake inhibitors or medications taken for sleep or occasional anxiety (e.g., hydroxyzine, trazodone, etc.)"

Addressing emotional and psychological symptoms during benzodiazepine withdrawal is equally important as managing physical discomfort. Read more 👉 lttr.ai/Aohhr #ManageSymptoms #ImproveWellBeing #AddictionRecovery

In one study, patients with chronic low back pain who had six or more gabapentin prescriptions had a 29% higher risk of dementia and an 85% higher risk of mild cognitive impairment within 10 years. ow.ly/I2iO50Yiewj

Consensus guidelines indicate psychotropic deprescribing should be considered when benefits are absent or risks outweigh benefits, with regular review, adherence assessment, patient involvement, and attention to psychological ramifications. ja.ma/46rDbxr

I’ve seen too many persons with depression /bipolar disorder prescribed medication they shouldn’t be and prescribed far too many medication’s On behalf of the ASCP we have just published our guidelines on deprescribing medications and aspects to consider jamanetwork.com/journals/jaman…

@BasedPsychMD Let's talk!

Take standardized depression and anxiety assessments Track your results over time alongside your medication dose.

Introducing Taper.Community A peer-support forum and personal taper-tracking platform. When SurvivingAntidepressants. org went read-only, thousands tapering psychiatric medications lost their home. So I built a new one — plus new tools. Track your taper. Visualize waves and windows. See how your mood changes as your dose changes: ⬇️⬇️