This post follows on from last weeks Potentially Inappropriate Deprescribing and has links to this weeks The Creation Narrative and God Complex.
It brings up a painfully tricky point. Reducing Medication Burdens is perhaps the most important task in medicine today. Many well-meaning folk are aware of and raising the profile of this need and attempting to work out how to go about this dangerous task – which requires a switch from an Evidence Based Medicine to a Relationship Based Medicine to stand any chance of working.
The difficulties forced or systematic deprescribing of benzodiazepines are now causing brings this home. Many people in the benzodiazepine community who have been doing great good in raising awareness of benzodiazepine hazards now find their efforts being turned against them. The same is happening to advocates for the need to help people get off SSRI antidepressants.
Today benzodiazepines are in the firing line. No-one should complacently think it will not happen to us. Tomorrow, it will.
Last week’s post called for quotes from and links to documents that people caught in a firing line can use. There has been some great input. We will make a start here listing some of it and will add more as it comes in.
Resources
One great resource is a European J of Hospital Pharmacy article linked here.
Deprescribing and Legal implications.
“A prescriber must obtain informed consent and advise a patient of potential risks of a medication when prescribing continuing or increasing a medication.
Similarly, potential risks on withdrawal or reduction must be outlined.
As regard consent, legally deprescribing is no different from prescribing: there is a risk associated with both deprescribing and prescribing (ie continuing to prescribe)”.
“It is important that the discussion of risks be tailored to the individual patient — — we must be mindful that what is material to one patient may not be to another”.
“A patient is entitled to full disclosure of all material risks whether it is on starting or stopping the medication”.
“WE suggest that patient centred consultations – – are the key to supporting safe deprescribing practice”.
TAPERx
Dee Mangin, in McMaster’s Department of Family Medicine, has been a leader in terms of reducing medication burdens. Dee created TAPERx. Taper stands for Team Approach to Polypharmacy Evaluation and Reduction.
Unlike the Deprescribing Networks listed below, Taper does not major on Inappropriate Medication lists. It focuses on Evaluation, at the heart of which are conversations, which can lead to possible Pauses with Monitoring rather than a one-way street to getting you off meds – meeting targets that is.
TAPER in this sense has nothing to do with the tapering of antidepressants or benzodiazepine. It highlights the risks of ever starting people on drugs like these that for some can be so difficult to get off when they might need to reduce their number of medicines in order to accommodate a new one that will be life-saving.
Deprescribing Networks
There is a growing number of deprescribing networks. Some of these mention the need for relationships and the need to respect the views of the person on treatment.
Unlike TAPER, though many go over the top in listing drugs like the anticholinergics as inappropriate in a manner that is unlikely to brook any likely correct response from a patient who wants to hang onto their anticholinergic drug and pause something else instead.
- Australian Deprescribing Network (ADeN)
- Canadian Medication Appropriateness and Deprescribing Network (CADeN)
- English Deprescribing Network (EDeN)
- Network of European Researchers in Deprescribing (NERD)
- US Deprescribing Research Network (USDeN)
Almost all of these and other deprescribing groups can be found on twitter and you might find material emerging there hostile to or supportive of what you are reading here that might be worth emailing us about – we are happy to include both hostile and supportive comments here.
Most family doctors pay little heed to novelties like deprescribing networks – not because they are hostile but because they are too busy. Your appeal to them needs to focus on two things. One is the opportunity to exercise their own judgement rather than be steam-rollered. If you are being really mischievous you can mention that this is how they can distinguish themselves from physician associates or nurse consultants – who are cheaper than them and rapidly replacing them. The one thing doctors will listen to even you don’t explicitly mention it is any hints they might go out of business.
The second point is whether things go well or badly, if deprescribers press ahead in accordance with the algorithm, costs are more likely to go up than down. Older cheaper drugs will get replaced with newer more costly and likely less effective ones.
The US Veterans Affairs’ Clinicians Guide on Benzodiazepines
The VA Guide is included primarily for this marvellous photo on its cover. On safe tapering it advises:
- There is no one-size-fits-all approach to tapering benzodiazepines. Each patient may require a different rate of taper.
- A proper benzodiazepine taper can take many months or even years.
- The rate of taper should ultimately be determined by the patient’s symptoms.
- For a “Shorter Taper” gradually reduce dose by 50% over the first 4 weeks (e.g. 10-15% weekly); maintain on that dose (50% original dose) 1- 2 months then; reduce dose by 25% every 2 weeks.
- A “Longer Taper” regimen advises reducing the dose 10-25% every 2-4 weeks.
British National Formulary (BNF)
The BNF is the British equivalent of the US Physicians Desk Reference. It is essentially written by industry. The section on Hypnotics and Anxiolytics. Dependence and Withdrawal says:
- Withdrawal of a benzodiazepine should be gradual because abrupt withdrawal may produce confusion, toxic psychosis, convulsions or a condition resembling delirium tremens.
- The benzodiazepine withdrawal syndrome may develop at any time up to three weeks after stopping a long acting benzodiazepine, but may occur within a day in the case of a short acting one.
- Some symptoms may continue for weeks or months after stopping benzodiazepines.
- Short term users of benzodiazepines (2 -4 weeks only) can usually taper off within two to four weeks. However, long term users should be withdrawn over a much longer period of several months or more.
- For long-term patients, the period needed for complete withdrawal may vary from several months to a year or more. Withdrawal symptoms for long-term users usually resolve within 6-18 months of the last dose.
- Some patients will recover more quickly, others may take longer’.
- The addition of beta-blockers, antidepressants or antipsychotics should be avoided where possible’.
How can an unexpected, digital notice of withdrawal over four weeks, in a decades-long benzodiazepine prescription recipient, (Potentially Inappropriate Deprescribing), be anything other than unsafe ?
FDA
The US Federal Drug Administration (FDA) has commissioned the development of guidelines for safe deprescribing. A draft is scheduled for release for public comment in June. Some on the inside are worried that the new guidelines will no reflect the lived experience of individuals who have enormous difficulty discontinuing benzodiazepines taken as prescribed.
Any drafts anyone gets to see will need review to ensure deprescribing is safe rather than a risky concept semi-mandated into practice.
BRITISH GENERAL MEDICAL COUNCIL (GMC)
Intro: Shared decision making and consent are fundamental to good medical practice.
Consent is a fundamental legal and ethical principle. All patients have the right to be involved in decision about their treatment and care and to make informed decisions if they can.
Serious harm can result if patients are not listened to, or if they are not given the information they need ,and time and support to understand it —
Seven Principles of decision making and consent : –
4/. Doctors must try to find out what matters to patients – –
If you disagree with a patients choice of option.
48. You must respect your patient’s right to decide. If their choice of option (or decision to take no action) seems out of character or inconsistent with their beliefs and values, it may be reasonable to check their understanding of the relevant information (see paragraph 10) and their expectations about the likely outcome of this option and reasonable alternatives. If it’s not clear whether a patient understands the consequences of their decision, you should offer more support to help them understand the relevant information. But you must not assume a patient lacks capacity simply because they make a decision that you consider unwise.*
Comment on GMC:
The GMC can repeat this all they want but in practice many doctors, and most psychiatrists, do not accept the validity of our decisions if they conflict with their assessment. If our condition has any mental health link, they diagnose us as lacking in Insight and as having a functional neurological disorder (FND).
The GMC wording implies the doctor is right and we are wrong. Doctors might be forced to let us be stupid but they should make heroic efforts to avoid this outcome. Whatever you think is in-between the lines, you can use the actual words.
There is an element here of something systems and doctors are good at – sounding morally superior and telling us our life is our responsibility
Structured Medication Reviews
SMRs are creeping in everywhere. Britain is intensely proud of its National Institute of Healthcare and Clinical Excellence (NICE) Guidelines, even though when it comes to medicines these are based on a ghostwritten literature designed to market drugs rather than keep you healthy.
NICE Guidelines on Benzodiazepines state.
A gradual drug withdrawal schedule, Dose Tapering should be negotiated. The person should guide adjustments so that they remain comfortable with the withdrawal..
Dependence may develop and continuing treatment may serve only to prevent withdrawal symptoms..
People who do not wish to stop taking benzodiazepines should be listened to and any concerns about stopping should be addressed. They should not be pressurized.
In practice, however, neither the NICE apparatus nor the National Health Service require any auditing of the consequences of SMRs. As the link above shows, the Guidance for SMRs says ‘First do no Harm’. But no one has any idea what the outcomes are after an SMR that leads to benzodiazepine deprescribing.
- How often are there serious medical events that lead to hospitalization.
- How often are there events like convulsions that might lead to loss of a driving license and loss of a job.
- How often is Quality of Life badly impaired?
Without figures for things like this doctors are pretty free to do whatever they feel in the mood for. This Paul Klee drawing is called Demons at the Entrance.
Shocking Vignettes
In addition to the resources above we mentioned assembling a catalogue of shocking things people have had said to them or ways in which they have been treated like the two men in Potentially Inappropriate Deprescribing, one of whom was accused for doctors shopping when he tried to get hold of a liquid form of the drug he was being forced to Taper and another who was informed by email he was being Tapered.
A Draft Tapering Quotes Document is linked. We will add more quotes and vignettes as you send them in.
annie says
My daughter was eight years old, and I was fifty, when in 2002, a doctor took me off Seroxat.
Suddenly, I was the child, the doctor the parent. An extremely severe, and shockingly bullying parent.
The way I was spoken to, when clamouring for relief from Seroxat cold-turkey was vented with extreme hostility and these four statements thrown at me with abandon, I can still feel to this day.
‘Pull yourself together!’
The doctor was called late in the morning. She came in to my bedroom when I was hyperventilating so badly, I could hardly breathe. I felt like I was suffocating. I could not get enough air in to my lungs.
“You have to be whiter than white”
This almost threat, came at me when she started handing out the Benzodiazepines. Month after month these were changed from Librium to Lorazepam to Diazepam and then finally to Beta-Blockers (Propanalol). It sounded to me as if I had made some big mistakes and that if I made any further mistakes then there might be repercussions.
“Don’t come here looking for sympathy”
I found it increasingly difficult to have any communication with this doctor. My mind and body had almost reached total collapse at this point, and at that point her disregard and rejection of me left me in a most dangerous predicament.
She sent a few highly critical write-ups about me to the psychiatrist.
What she should have done before discontinuing the Seroxat was to refer me back to the psychiatrist who was the initial prescriber. Not to take it upon herself to do this, when he had even written to the surgery at this time with instructions to give me Fluoxetine. This letter was ignored by all and sundry for a year and a half, when all the terrible things had happened. It was after the Paroxetine liquid fiasco, that brought her up short, and then the Fluoxetine arrived – in another moment of acute distress. Needless to say, no more drugs for me.
I will throw this in to the mix, as she had developed an attitude that all my problems came from my little family.
What an horrendous cheek
“No more men”
But you’ve got one, I said.
Oh, but he is just part of the furniture, she said.
This lady doctor took my breath away.
Dangerous doesn’t come even close.
She scared my family witless, my little girl, my partner, my mother, and all for what?
A very bad decision, a very bad prescribing cascade, a very bad lack of attention to detail, and all-in-all the inability to separate the drugs from the personal persecution.
She died in 2012 from lung-cancer, having puffed her way through a barrel of nicotine.
tim says
Thank you for this informative and valuable post which clearly identifies that deprescribing involves safety, scientific, ethical and medico-legal challenges which require relationship-based care and patient-focused consultation.
I am not sure that these issues have been addressed in detail in the primary care literature.
In the current edition of the British Journal of General Practice : – Editor’s Briefing: – Euan Lawson states that the RCGP ‘remains loyal to its Scientia Cum Caritas motto’.
With an FRCGP background, (three years contribution to the Joint Committee on Post Graduate Training for General Practice, and some twenty five years of a VTS* designated, hospital-specialist-post training of very committed future G.P.s) – I would find it very helpful if the content of this outstanding post might appear as an Editorial in BJGP.
Deprescribing and S.M.R.s are the day to day business of Primary Care. Surely it might be appropriate to initiate a discussion of Harm Avoidance, as well as acknowledging the benefits?
(* VTS – 3 Year Vocational Training Scheme (for General Practice). Full time, 6 months, Senior House Officer attachment).
Harriet Vogt says
‘Treating and stopping is not the same as not treating. Attempting to stop can be highly dangerous. The safest course of action is not to prescribe in the first instance.’
This, from last week’s blog, ‘Potentially Inappropriate Deprescribing- PID’ – is surely – THE POINT.
In contrast to, one assumes the politically acceptable and eagerly embraced reversal of dysregulated brain receptors theory, (as if the chemicals we ingest only travel on some express highway to one stop – the brain), there have been some astute responses on X to THE POINT, mostly from patients harmed by ‘deprescribing’, or those who loved them:
‘In withdrawal there’s no change agent as there is when initiating the drug. The presence of the drug forces adaptation – but we can’t rely on the absence of the drug to force re-adaptation. Maybe we can try drugs with the opposite action to SSRIs but right now it’s a lottery’
James Moore @jf_Moore
‘Brain plastic, not elastic, so no reversal, only further changes from withdrawal, + brain dynamic, not static, organic, not mechanic, so opposite agents won’t help if harm is a cascading sequela or due to a “dysfunctional equilibrium” that new homeostasis keeps in place’
@asenicide
‘I question the somewhat authoritarian manner in which we are told to get off antidepressants. Deprescribing is a personal, individual experience and requires a harm reduction approach without goals and prescriptive guidelines.’
Beverley Thomson @Anbtidepressed1
‘Yes & for BZDs, BIND definition includes toxic harm, not only neuroadaptive. For neuroadaptive, I don’t know it’s claimed (by BIC, Maudsley) it’s guaranteed to always or fully reverse after tapering off. I certainly don’t see it claimed that a toxic CNS injury from BZD will heal.’
@JoshuaMIreland, surviving spouse of co-founder Benzodiazepine Information Coalition
I’ve been trying to make sense of Australia – one of the highest ranking global consumers of ADs. These patient comments, (taken from the qualitative phase of research to develop a seemingly quite sensible, personalised online tapering tool WiserAD – ( though how it would cope with akathisia and suicidality is unclear) – sum it up quite well:
‘Next time I saw [the doctor], which, I can’t remember when, fortunately I don’t need to go to the doctor very often, I said “Thank you so much for recommending it.” It’s a great opportunity particularly because I’ve been taking it for 24 years.’
‘No, I hadn’t [thought about coming off]. It was, it sparked the interest that, if [the medication] is doing that to my emotional roller coaster, what else is it doing to various other parts of my life that aren’t really what they were, or what they might be, and I haven’t really noticed all that much. And if I don’t, if I don’t need to be on it, why would I be on it? It was sort of like trying to get to the stage where this would be something I don’t really need to be on, best I get off it if I can’.
And from the background to the study – sounding all too familiar:
‘Deprescribing of antidepressants is not routinely occurring in clinical practice.1 GPs prescribe the majority (86%)1 – of antidepressants… However, ceasing antidepressants is complex and GPs lack guidance to conduct safe tapering and often wait for patients to initiate the deprescribing discussion.15 16 Patients are willing to taper their antidepressants but report that GPs are unable to provide them with education, tailored guidance and withdrawal support leading them to cease antidepressants without clinical support.17 18 complexities of antidepressant cessation suggest that there is a need to determine what approaches are useful for patients and GPs when making the decision to stop.’
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10868251/
Most of us will be encouraged by the overall direction of travel – reducing the autopilot prescribing of psychotropics where, for the majority, harms outweighs benefits. But the volteface to DEPRESCRIBING and clinician insecurity in the face of any individual uncertainty, does feel a bit like that moment when the plane’s engine note changes – and, as an experienced but deeply unenthusiastic flyer , I always anticipate a plummet. Annie’s horrendous experience was far worse than that.
Harriet Vogt says
Coda
In case anyone has missed it, the academic researchers driving the UK’s deprescribing effort – Mark H , Jo Moncrieff and John Read – are doing their damnedest to dodge the PLUMMET.
Striving to develop a belt and braces system – for differentiating between withdrawal and relapse symptomology – the Discriminatory Antidepressant Withdrawal Symptom Scale (DAWSS)
Work to date suggests 15 symptoms are key differentiators; brain zaps, palpitations, dizziness/light-headedness, vomiting, vertigo, nausea, diarrhoea, sensitivity to light/noise, tinnitus, gait/co-ordination problems, muscular problems (cramps etc.), vivid dreams, memory problems, psychotic symptoms.
https://www.sciencedirect.com/science/article/pii/S2666915324000519?via%3Dihub#tbl0004
Let’s hope work like this helps to save patients from the deadly misdiagnosis and inappropriate drugging cascades that have haunted the past. You have to wonder – is the connected humanity of relational medicine still possible in an industrialised system? Gloomy Wednesday.
annie says
Thanks for this, Harriet; and for the touching tribute to Ed White, at the bottom of the Report.
Acknowledgements
We would like to acknowledge the work of Dr Edward White who helped to design the study, write and distribute the survey. Dr White sadly passed away before completion of the study after a long struggle with antidepressant withdrawal, while providing support for countless others in the same situation. We would like to acknowledge Adele Framer for her input into the design of the study. We would also like to acknowledge the assistance provided by moderators of peer-led websites in distributing the survey to their members.
British Journal of Medical Practice
Dr Ed White: Tapering antidepressants
Marion Brown, Psychotherapist & Mediator (retired)
17 October 2021
This is to very sadly record that Dr Ed White, since writing this article for BJGP for the express purpose of communicating with GPs (and who was hoping to write more to further the discussion) ran into further serious difficulties himself.
A tribute to him has been published here: RIP Ed White: Advocate – researcher- supporter http://www.madintheuk.com/2021/10/rip-ed-white-advocate-researcher-and-supporter.
The best tribute of all will be for GPs to really take notice of the antidepressant issues that Ed White has exposed and the actions that Ed asked for.
RIP: Ed White – Advocate, Researcher and Supporter
By James Moore 17/10/2021
https://www.madintheuk.com/2021/10/rip-ed-white-advocate-researcher-and-supporter/
(This tribute contains a video with Ed)
It is with great sadness that we write about the loss of one of our colleagues from the psychiatric drug withdrawal community; Doctor Ed White. Ed was a brave and tireless advocate for the community and spent a great deal of his time advising and supporting others despite his own challenges. Tragically, Ed ended his life on Wednesday, October 13, 2021. He was 57.
I had the pleasure of interviewing Ed for the Mad in America podcast, where we discussed his research work which laid bare the staggering number of people supporting each other in online withdrawal support groups. His paper, authored with John Read and Sherry Julo, was published in Therapeutic Advances in Psychopharmacology and will remain as a lasting and powerful tribute to his work as an advocate and researcher.
Ed White: “I was alarmed when I found tens of thousands of people online seeking help with stopping antidepressants, many of whom are in a perilous state after being tapered too fast by their prescriber.
Online peer support has become such an important avenue of care for people suffering antidepressant withdrawal and needing guidance to safely taper off these medications in the absence of medical backup from Doctors.
The groups included in the research are probably the tip of the iceberg.”
Professor John Read, who co-authored the research said: “In the last months of his life, Ed was working with us on a research paper analysing a collection of several thousand inquest reports of deaths involving antidepressants. It is significant that the person who spent ten years collecting those reports chose Ed, of all the thousands of people in the community, to share their work with.”
Ed spent time as an administrator of a large Effexor withdrawal group where he provided help and support to others despite his personal challenges with the drug.
Gus Hibberd, a colleague and fellow support group member said “Ed helped others in desperate times of need and I hope they are thankful just like I’m thankful for that guy who messaged me from England while I was doing my shopping in Australia. He fought so hard, it wasn’t supposed to be this way, we were meant to meet one day.”
Ed spoke out openly and often of his experiences, always aiming to encourage debate and allow voices to be heard. He was selfless in his dedication to raising awareness and challenging misinformation. In January 2020, he was interviewed by Sky News in the UK and in February 2021 he wrote an important blog for David Healy’s Rxisk.org entitled Antidepressant Withdrawal: Avoid Doctors. With Katinka Newman he was a co-founder of the website Antidepressant Risks, where he and others share their stories.
In an extensive interview in The Telegraph (paywall) Ed said that he was put onto antidepressants in 2009. It was six years later, when starting to withdraw, that he began experiencing unusual symptoms and difficulties that he could not explain. He said “After four months, all hell broke loose, I had mood swings, panic attacks and nausea. Eventually, I was forced to take five months off work. I would drop my kids at school, go back to bed and cry. I was told by a psychiatrist that I had developed an ‘emotional attachment’ to my venlafaxine.”
Psychiatrist Mark Horowitz, who collaborated on research with Ed, said “Ed’s death is a huge loss. In the absence of medical support for people going through withdrawal from psychiatric drugs, members of the community have stepped forward to take their place and offer support and guidance to those going through the most awful times of their lives – Ed was one such person who selflessly shouldered the responsibility to care for others and did so with warmth, wisdom and patience.
He showed himself to be equally dedicated, passionate and diligent in communicating the silent epidemic of drug harm through research and advocacy, even whilst looking after his family, working full time alongside enduring his own personal suffering. It is sorrowful to have lost this good and kind man. And we must continue to work to prevent this preventable tragedy from happening again to others, as Ed had done so, tirelessly.”
Psychiatrist Joanna Moncrieff said “Ed was an intelligent and caring spokesman for people undergoing antidepressant withdrawal. Despite his own suffering, he made huge efforts to help other people going through the same thing, and particularly to ensure that the experience he and others have had of this awful condition could be put to good use!”
We wish to send our deepest condolences to Ed’s wife and two teenage sons. Ed was a scholar, a gentleman and we will so miss him and his crucial participation in many of the online support groups for psychiatric drug withdrawal where he supported and advised so many.
Ed made a significant and important contribution to the scientific evidence that shines a light on the experience of difficult withdrawal. His work had great impact and will continue to do so as we make progress in getting such experiences recognised and responded to.
“This is a frightening place to be. The combination of professional pressure to comply, family belief it is the right way and the symptoms of the withdrawal, combined to make me feel utterly powerless to resist.”
https://rxisk.org/antidepressant-withdrawal-avoid-doctors/
“If my actions save a few from the fate I suffered I will be happy.” – Ed White
Harriet Vogt says
Ed’s words are so poignant, Annie.
I only knew him slightly from shared Twitter convos – mostly both interrogating @altostrata, aka Adele, for drug withdrawal wisdom. And occasionally having a laugh.
It’s still hard to believe he’s not there. He supported so many others, it felt like he had to be a survivor.
His X page remains. This was another poignant moment, where he quotes Rxisk:
‘Some people do have the experience that medication has saved their lives. This most probably stems from their experience when they try stopping the drug, feel absolutely terrible and even suicidal, and feel so much better when they restart. The drug does save their life from the dependence it has caused’.
Stuart Shipko says
The whole issue of discrimination between withdrawal and relapse is a conceptual mistake. It assumes that there is a condition being treated by receptor manipulation that comes back when the drug is taken away.: a restatement of the chemical imbalance hypothesis.
Dr. David Healy says
Stuart
Just to get this straight – you’re saying the only chemical imbalance is caused by treatment. As an extra, you’d maybe extend that to a lot of treatments in medicine other than meds that do correct a defect like an infection and even then short courses of treatment can create imbalances
David
chris says
I’ve just read this it makes my blood boil:
https://www.inquest.org.uk/sophie-alderman-inquest-concludes
chris says
After a nasty fall and broken bone late last year my 90 year old mother couldn’t sleep in hospital. The nurse said they would not be prescribing any Z tablets ok fine I asked if she could have Promethazine the answer was no way.
To read that they are ripping people off sleeping tablets, well my jaw dropped. All I can say is it will make akathisia induced suicide and violence far more ostensible but unless a heck of a lot more people – like the whole of the NHS – realise this it will be seen as relapse mental illness and the cycle of abuse continue.
chris says
‘chemical imbalance hypothesis’
Obviously I can not prove any of this but I think there is a chemical imbalance with regards glutamate and gamma – Aminobutyric Acid being as the literature states one (GABA) is biosynthesis from the other – glutamate.
“Emerging evidence has revealed the presence of the glutamate decarboxylase (GAD)-encoding gene, a key enzyme to produce GABA, in the prominent human intestinal genus Bacteroides.”
https://pubmed.ncbi.nlm.nih.gov/33936013/
I also think both a diet of food high in glutamate/MSG and stress can cause an imbalance as well as alcohol, benzos and like drugs. I’d reference my own experience here.
Dr. David Healy says
Chris
The point is there is no chemical imbalance in the brain that we know of that causes depression or anxiety. The SSRIs wouldn’t work if there were an imbalance
SSRI and related drugs cause an imbalance – that we do not have a treatment for. Its a bit like nicotine or smoke or whatever it is causing lung cancer. We would not expect and anti-nicotinic drug or anti-X smoke factor to cure cancer.
Nicotine is a good treatment for OCD for many people – better than SSRIs – people take the risk in using it but at least they know the risk they are taking and can balance that against the benefit they are actually getting.
With SSRIs they are forced to stay on treatment on medical instructions, often without any benefit and with developing problems that will likely lead to an early death – all of which the system denies could be happening.
Whether MSG etc causes an imbalance in the sense of a cancer is an open question.
D
chris says
“With SSRIs they are forced to stay on treatment on medical instructions, often without any benefit and with developing problems that will likely lead to an early death – all of which the system denies could be happening.”
I totally agree
Dr. David Healy says
Of course there is an extra element to complying with medical instructions in this case – because every time they try to stop they feel so awful there is no incentive to try again.
D