Morgan Stewart

For the millions of long-term antidepressant users in the US, hyperbolic tapering is currently the best strategy to reduce the risk of severe and protracted withdrawal. Linear tapers can work for short-term users, but many people who’ve been on antidepressants for >12 months find they need progressively smaller dose reductions at lower doses. Why? Antidepressants interact with serotonin transporters in a hyperbolic way, meaning tiny reductions become much more powerful near zero. Featuring ACE founder Morgan Stewart @morgan_stewar, Mark Horowitz @markhoro and Awais Aftab @awaisaftab, read more about hyperbolic tapering from WebMD below.

As a Democrat and someone who is not affiliated with MAHA, I want to continue to reiterate that antidepressant withdrawal is a nonpartisan issue. People are suffering and need our help. It shouldn't matter what side of the fence you are on to come together on this. I posted this video over a year ago but it still seems highly relevant today.

People who have gone through severe antidepressant withdrawal are a community. There are hundreds of thousands of us in Facebook groups, online forums, and posting on social media. This isn't a partisan topic or a political agenda. These are harmed people trying to get help. #ssriwithdrawal #antidepressantwithdrawal #fsc1

I think when doctors say they don’t see withdrawal it goes something like this. - The average GP/PCP has 2000 patients under their care, -200 on antidepressants (10% of pop), -studies show 6% of people stop their AD each year (eveleigh, 2018) in regular practice so 12 people stop -4 will have no major issues, -4 will have moderate issues, -4 severe issues. Of the 8 with problems 6 or 7 will be told or think it is relapse and go back on meds (of course textbooks and training say relapse is very common, withdrawal is a minor concern so it would be a pretty rare physician to see what they haven’t been taught to see). 1 or 2 will say this doesn’t make sense, research it, try to work out what is going on and make a point about it to doctor (30% of people on social media groups for withdrawal have graduate degrees). And so the doctor will say ‘I rarely if ever see this’ because drugs are rarely stopped and the correct diagnosis is rarely made. It takes a motivated, thoughtful patient to push the issue. There are currently about 200,000 such patients, and growing rapidly. Given that most studies of withdrawal from relatively long term treatment show 60%+ of patients experience withdrawal syndromes of at least 4 withdrawal symptoms (Rosenbaum 1998) it is simply not plausible that most people are not having pronounced withdrawal effects. And that's before we even talk about the plausibility of the concept of 'relapse'....

I really enjoyed talking to Angie Peacock about akathisia, withdrawal and life after psychiatric diagnosis. Watch our conversation, and click below for a short article and details of where to find Angie (@angpeacock1111) 👇 youtu.be/XiBd1vaIZGE?si…

This essay is about the most wonderful thing that has ever happened to me. It’s about how I stopped believing that I was ‘mentally ill’. Link below 👇

In this detailed account of navigating the mental health industry, Carrie Clark writes about her journey of being diagnosed with mental illness as a teen, the futility of medication, and ultimately leaving psychiatry and deconstructing the diagnostic paradigm. We highly recommend this captivating Substack. Link in comments!

Always gratifying to see someone who has criticised and dismissed your work then copy it (without attribution).

Psychiatry does not understand human beings because it sees us as nothing more than brains, which is unfortunate because psychiatry also does not understand brains.

Quick reminder from Christina, ACE’s Community Liaison, to check your email today. We’re seeing another wave of people who previously submitted @FDAMedWatch reports receiving follow-up emails from the @US_FDA. This is really encouraging! If you’ve received one, please take the time to respond. These follow-ups matter. They help strengthen our petition and support our requests for updated labeling and evidence-based tapering guidance. If you haven’t submitted a MedWatch report yet, we strongly encourage you to do so and share your experience with antidepressant withdrawal with the FDA. We’ll drop the link in the comments!

I've just replied to the email I received from the FDA after submitting my MedWatch report about withdrawal induced akathisia. Thanks to the NHS deprescribing clinic (cc @markhoro), I was able to include an assessment letter confirming the diagnosis of akathisia. If you supported the @ACE_CoalitionEd campaign, please check your inbox and follow up! Better warnings about akathisia could save lives.

If a drug can induce physical dependence and withdrawal, then a plan for stopping it should be part of the prescription. LINK: blog.maryannedemasi.com/p/akathisia-th… @MaryBowdenMD @ACE_CoalitionEd @angpeacock1111 @atomicaceso @RPurssey

1/ Many of us who participated in our reporting drive and submitted MedWatch reports are now receiving follow-up emails from the FDA. If you’ve received one of these emails, please make sure to respond. These follow-ups matter. If you’ve already submitted a MedWatch report but haven’t seen an email, try searching your inbox for “MedWatch” just in case.

Trauma, loss and hopelessness are not brain diseases. Melancholia is not a brain disease. Stress responses are not brain diseases. And acknowledging that these aren’t brain diseases doesn’t mean we are invalidating one’s suffering or abandoning them. This strawman argument is nonsense.

Dear @DrMcFillin, saying depression is not a real brain illness doesn’t hold up clinically. Life events can break people into trauma, loss & hopelessness. This kind of suffering has always existed; Hippocrates described it as melancholia centuries ago. But for many, it doesn’t stop there. It evolves into something deeper in the form of changes in brain circuits, a dysregulated stress response and biological shifts, we now recognize. In practice, I have seen patients who were profoundly broken, some suicidal, find their way back with the right support i.e. therapy and medication when needed. Without care, many simply don’t recover. Telling someone to “just awaken” risks leaving them alone in that suffering, despite help being available. If a mother walked into your clinic having lost her job, her marriage and now struggling with suicidal thoughts, what would she truly need in that moment?

Big thanks to all the mental health professionals, patients and advocates who made this happen, with a special thanks to @samhall404 AKA Mark Horowitz Thanks @BasedPsychMD for the meme :)

@m_aadil The DESS scale most definitely doesn’t explicitly screen for withdrawal and is a major (methodological) problem in the study. Maybe we should let those who are suffering be the ones to decide what discredits “real suffering”.

It is probably one of the most rigorous studies we have on antidepressant withdrawal. They explicitly screened for it using a DESS scale. I agree that there are certainly limitations, especially blinding and symptom overlap. but it is not the same as saying the findings are meaningless. My main criticism is of the absolutism in this debate. The assumption that every use of antidepressants inevitably leads to withdrawal, or that any demonstrated antidepressant benefit is therefore meaningless, is too far removed from a serious academic reading of the literature. Such overstatement ends up discrediting the real suffering

Antidepressant withdrawal can be and often is worse than heroine withdrawal. Like other specialties, addiction medicine fails to adequately address and differentiate physiological dependence from psychological addiction with psychotropics, in particular, psychiatric drugs. Nearly every class of antidepressants cause physical dependence when taken regularly, resulting in withdrawal. If severe, withdrawal can cause a neurological injury referred to as protracted withdrawal. “Discontinuation syndrome” is a euphemism coined by pharmaceutical companies to dissociate antidepressants with dependence-forming drugs. Using such a euphemism is an indicator of one’s education on the topic.

Dr @DrJosefWD with the utmost respect, I must disagree with the claim that antidepressant withdrawal can be worse than heroin withdrawal, a statement originally echoed by RFK Jr. You mentioned that individuals with brain injuries may experience severe withdrawal from antidepressants, but the same question applies to heroin withdrawal in such vulnerable populations. As a physician who practices both Adult Psychiatry and Addiction Medicine, and someone who manages detox and rehabilitation in addition to psychiatric care, my clinical experience and the existing body of medical evidence do not support that comparison. This is not to dismiss antidepressant discontinuation symptoms. They are real and medications should always be tapered carefully under psychiatric supervision. However, in real world clinical practice and based on current medical science, equating or suggesting they can be worse than heroin withdrawal is not an accurate or evidence based characterization.

After 11 Pills of Zoloft, He Lost the Ability to Feel. Anthony was a healthy husband and father of three. After just 11 Zoloft pills for mild insomnia, he developed emotional numbness, suicidal thoughts, and permanent PSSD. He was a shell of who he once was, and the suffering became so unbearable that he recently took his own life. It’s same familiar pattern of blaming the patient, gaslighting their lived experience, and dismissing any harms caused by pill 💊 … never the treatment. And I’m reminded of the tagline we used while fighting for the black box suicide warnings: “We are not anecdotes. We matter.” Anthony matters. These stories are not isolated. Thank you, @MoralMedicine, for giving these voices a platform and making people feel seen. youtu.be/ywOt23JeuVA?si… via @YouTube

If young people ‘believe passionately’ that chemotherapy is a good treatment for tonsilitis, do we need to run a trial to find out if they’re right? Very sad to see this quote from Dr Cass, who apparently thinks we might: “Given that there are clinicians, children and families who believe passionately in the beneficial effects [of puberty blockers], a trial was the only way forward to make sense of this.” This is medicine as consumerism. Do no harm, clinical judgement, careful assessment of risk…all must give way to patient preference. In this brave new world, the role of the medical professional is simply to give patients what they want. bbc.co.uk/news/articles/…

@woodymatters Happy birthday, Woody!

Happy Heavenly Birthday, Woody. (11.21.65) 🦋😇 #foreveryoung