Helping H: SSRI Withdrawal

Print Friendly, PDF & Email
July 13, 2020 | 18 Comments

Comments

  1. Was there any information published regarding the volunteers who developed withdrawal symptoms after two weeks trial? Is there no duty of care which should include investigations of the causes of these effects and to look for treatments for them?. If people pulled out or were taken out of the trial – were was there any longer term follow ups to identify any long lasting effects? or how these may have been different for individuals. Would have been useful surely – or just a waste of money.
    By the way Covid vaccine researchers are advertising for volunteers presently – £20 for vols £50 for referring doctors —would we – should we..older people especially being ‘targeted’ – economically dispensable, expensive to ‘look after’ – as one commentator observed – they will be dead soon anyway. Phsych Pharma companies and their macho allies are just as happy to throw dead bodies into the river whether women or children or men .

    • The healthy volunteer trials and their data remain under wraps entirely – even though by definition there are no issues of clinical confidentiality. These are the trials where pharma learns how to frame their clinical trials so they don’t show the same problem.

      D

  2. Ah, yes, totally understandable…

    ‘I say this as someone who isn’t sure I would be able to deal with significant pain or withdrawal without a stack load of meds.’

    However – if you had previously taken meds for significant pain and this had proven disastrous for you, I think you may have found that the dangling of temptation in this circumstance would totally put you off taking anything at all – even if it was coated with beluga – you would have to bear it – that is when superlative willpower takes over.

    The no-choice but to grin and bear it.
    That is the difference between someone who has been through/going through the pharma, Caravan, and someone who has not.

    And that is surely the prevailing attitude of the doctors..

    They think they are helping out having made obvious mistakes, as the Stephen O’Neill case showed up. And even when they have it explained to them, they still don’t get it. In fact, in some ways it seems to rankle to the point where they dig their heels in even more.

    The doctors duty is to make life easier for the patient.
    A whole toolbox is at their disposal.
    SSRIs must have seemed like Manna from Heaven when they came along.
    Certainly my psychiatrist was overwhelmed with excitement about Seroxat, the wonder drug.
    Even then, when he sent his letter of recommendation to my surgery – I voiced doubts.

    A very heavy-handed bunch of gps put paid to my approach and, as they say, the rest is – H and H – and H……

    All of us with exceptionally bad experiences can see how H has fallen in to the trap, like Stephen O’Neill.

    We have probably all noticed that bursts of publicity in the media have all but ceased – the Katinkas and the Peters –

    The time should be up by now, on impressionable doctors flinging around their drugs with wild abandon, why it isn’t is anyone’s tale…

  3. Re: GSK wins legal case over withdrawal effects of paroxetine after 13 years and £9.33m in costs. (A reminder for prescribers of the severity
    thebmj r.r. 14/7/2020
    The GSK/ Paroxetine case spurred me to highlight an area of prescribing GPs & psychiatrist often seem to neglect – withdrawal effects from antidepressants. A recent study exploring GP and psychiatrist’s knowledge and attitudes towards withdrawal effects found that about three-quarters of respondents claimed they usually or always informed patients of potential withdrawal symptoms when they started a patient on antidepressants, but patient surveys say only 1% are warned.(1) Between 2017 and 2018, I undertook an audit of antidepressant prescribing in a rural GP practice in Ireland. Preceding the first prescription of an antidepressant, I found that 0 of 30 patients audited had a discussion of withdrawal effects documented in their notes. (2) This would be more in keeping with patient survey results.

    Withdrawal effects are easily mistaken for relapse or medically unexplained symptoms and evidence is mounting to show they are much more common and severe than what was initially thought.(3) For a vivid personal account of a psychiatrist with lived experience of withdrawal effects from 6 months of Duloxetine under the care of his GP, see Stockmann (4). With consults limited to 10 to 15 minutes, I rarely if ever prescribe an antidepressant on first meeting. I often direct patients to my own website (4) where I have personalized patient information leaflets on alternatives to antidepressants and withdrawal effects (5) – this is in response to the limited information available on NHS websites. I welcome anyone to contact me at the email below (will do )if they wish to use these leaflets in for their own practice as I believe we have an ethical duty to fully inform patients, in a way that they can understand, regarding the risk and potential severity of withdrawal effects.

    (1) McCabe, J., Wilcock, M., Atkinson, K., Laugharne, R., & Shankar, R. (2020). General practitioners’ and psychiatrists’ attitudes towards antidepressant withdrawal. BJPsych Open, 6(4), E64. doi:10.1192/bjo.2020.48
    (2) Sapouna L, Gijbels H, Sidley G. Inside out, outside in: Transforming mental practices. Chapter Pause before prescribing – rethinking antidepressant use in general practice. 2019 PCCS books
    (3) Davies, J, Read, J. A systematic review into the incidence, severity and duration of antidepressant withdrawal effects: are guidelines evidence-based? Addict Behav 2019; 91: 111–21.
    (4) Stockmann T. What it was like to stop an antidepressant. Ther Adv Psychopharmacol. 2019;9:2045125319884834. Published 2019 Nov 1. doi:10.1177/2045125319884834
    (5) https://bryanmcelroygp.com/index.php/resources/
    Bryan McElroy
    GP, Diploma in Clinical Psychiatry
    None
    Taunton, Somerset

  4. We seem to be struggling for paradigm for which to understand this phenomena (and were running out of mobile molecules to blame it on).

    Let me ramble a bit and use physical pain as a comparator:
    Good management of moderate to server pain is thought to be when the pain is treated early with an opiate and with only enough to make patent comfortable. Then when the nature of the pain starts to change, start reducing the dose according to patient’s description and signs (an experience pain-nurse should spot the signs and explain to the patient what he is experiencing– if your lucky enough to get one on the NHS).
    Benefits:
    (1) By getting the pain under control quickly, less painkiller is required to keep the patient comfortable with less side effects like depression of breathing and constipation.
    (2) Less chance the patient will be left with low grade chronic pain.
    (3) Opiates only seem to create dependency if the patient receives more than that which is required to control the pain and for too long (and often boredom is a factor, as has been found with studies on rats).

    If someone should be suffering moderate to server emotional pain (and perhaps be suffering the terrors of hallucinations), to the degree where they become a danger unto themselves. Then I think it is appropriate (and I’ve spoken to patents who thought is was VERY appropriate) that they can receive something that gives them a respite.
    This is the point where I split from the existing psychiatric/pharmaceutical industrial complex paradigm. The drug dosage should then be reduced according to patient’s description of the current symptoms and signs (an experience psychiatric-nurse should know the signs and explain to the patient what he is experiencing). The lowest therapeutic starting doses always seem to be far too high (from a patient’s subjective perspective which I take to be a symptom of toxidity). This must surly ensure withdrawal symptoms to manifest eventually, just like having had too much morphine. Maybe the ‘therapeutic dose’ is based on drug trials which use a behaviour scale that only looks scientific… etc.
    In a perfect world, treatment should keep in mind the pioneers in mental health treatment like Dr. William Charles Ellis, who kept his patients occupied, which aided the speed of recovery. Psychologist/priest/appropriate other, could then help the patient to make sense of their experience. Exploring how the physical/mental injury came about etc. For we are a social animal and the model of the world we carry around in our minds needs recalibrating and updating constantly with other peoples existential models, so that the collective ‘we’ can make sense of our world(s). The ‘we’ also includes therapists et. al. who have to listen listen to the accounts of sometimes horrific events and can not go home feeling totally unaffected.
    I don’t think I can condense any of the above — as its all relevant to the whole.

    Second part of the ramble (whoops, I mean tangential speech [joke]).
    Through evolution, our nerve cells have come to fire the rate they do. If a nerve cell fires too frequently, ‘for too long’ a feedback system makes a ‘long term’ epigenetic adjustment (to be pedantic for a moment – there is still some debate about the exact details). So even when the (say) physical trauma has healed and those ‘sensor nerve’ return to normal firing rate. The complimentary excitatory/inhibitory neural complex however, doesn’t fully stop the random ‘background noise’ of the ‘sensory nerves’ from reaching the brain and being perceived consciously as ‘pain’.
    So why shouldn’t the same phenomena happen within the motor nervous system in reverse, manifesting as tardive dyskinesia. And time-dependant manifestations in general?
    In this model, an epigenetic change in some of the formally ‘under driven’ (say) motor neurons (due to the due to the action of the drug) will allow this ‘background’ random firing through to some of the nerve branches (possibly within the spinal cord) that control muscles, causing involuntary movements. Any muscle group, or organ or gland which is controlled by the brain could be effected by this mechanism. As an aside: On the ‘under-driven’ aspect. Reminds me that some people said in effect, that when first put on neuroleptics, they had to concentrate hard in order to make the body move and then only slowly at that. Hence their slow shuffling gait. Perhaps the signals from the brain were being inhibited (causing under firing) too much by the drug. Think it was one particular neuroleptic. Maybe this rings a bell with DH.
    Conclusion.
    If this model is right, then looking for a ‘dynamic’ biochemical explanation is leading us up a blind ally. Also, if this model is right, the focus should be on finding ways to de-methylate the gene(s) responsible in those affected cells. Problem: how to take a biopsy from the right place to confirm theory (or at least add weight to it) and identify the affected gene(s), other than on a suitable cadaver and who is going to fund it?

  5. This is where the problem lies in most of the Western Medical Culture:

    In this case, totally normal women, with no hints of nervous problems ever, can end up suicidal, beyond agitated and in complete disbelief – facing doctors who pass their problems off as depression or anxiety and in need of a tweak to the meds.

    Just this statement alone can create more harm than good! The lack of CARE is what makes me sad : ‘(
    Then adding more pills to fix up what the first medicine induced is indeed, very incomprehensible!
    The complacency and nonchalant attitude that many in the caring profession display is what really worries me.
    The ignorance and arrogance some clinicians display when in total disbelief or denial, are other human traits that really make people who are experiencing hell with these SSRI’s, feel so down and alone. The smirk on some of these clinicians faces when something unforeseen happens to ones health because of their ‘lack of duty of care’ is ohhhh so surreal and indifferent.

    With all honesty, these SSRI’s should not be prescribed to any man or creature.
    What were they thinking when they created these inhumane meds & other futile meds?
    I can understand that ‘human nature’ is inclined to get a quick fix from a pill however, when unforeseen health problems start to take over and impact ones mental/physical well-being, is it worth all the risks that some clinicians fail to mention, especially the ones mentioned above in this blog.
    Sadly, once the damage is done, many patients are left in the lurch and are made to feel like their concerns, pain and suffering are insignificant or psychosomatic.
    Those like myself, who have been impacted are very tired of all the lies, lack of support and ‘we don’t care’ attitudes.
    All I understand and appreciate, is that any medicine that is capable of inflicting so much pain and suffering, should not be out there, on the market, in the first place!
    Some clinicians know that when patients are immunosuppressed, they have to be very careful of what they prescribe. They know this but still do it!
    Some clinicians have the patients medical history in front of them and still continue to hand out meds, like smarties! Either they are:
    – Ignorant
    or
    – Don’t care
    Why do so many people have diseases? ~Delve deeper and look at the medication history.

  6. Will Hall, one of the ‘experts’ contacted by Risk has written a free to down load book
    HARM REDUCTION GUIDE TO COMING OFF PSYCHIATRIC DRUGS AND WITHDRAWAL 2nd edition published Icarus Project

    After exposing the fact that the majority of doctors lie about the extent they provide info on prescribing drugs ,a letter in thebmj won’t make any difference, (imagine them smirking Carla)and the coll of psychs won’t be worried about the resources document Bryan M above has produced – they would probably claim it mirrors their own advice. Respect to him for ‘caring’ though (He is more on the whole person approach than many others however much the suggestions can’t be a reality for many experiencing severe problems or have no funds to experimnent with
    , see his Flowing Intelligence.com site. A catch twenty two is There is always the caveat in publications – if any adverse effects go back to ‘your’ doctors/ health workers for help – as if…

    • Thanks for the pertinent and relevant article Carla

      Lies can grow exponentially, more so when confronted and more so when coroners and journalists and ‘et al’ get in on the act.

      It might be fitting to do a replay

      Katinka Blackford Newman talks about her new book

      AN ARTICLE ABOUT HOW I WROTE MY BOOK.

      David Healy kindly hosted an article on his website about how I came to write my book. Here it is: Link 

      May, 23, 2016

      23 Comments

      https://davidhealy.org/the-pill-that-steals-lives/

      STOP, LOOK, and LISTEN…

      – an impossible situation where the patient still may or may not have the problem they came with, are living in an obtunded mental state from all the medications, and have the added prospect of one or more withdrawal syndromes to face. One unholy mess!

      http://1boringoldman.com/index.php/2016/05/24/65837/

      There is no safety-net, nowhere to go, no-one to see – cast adrift – as this excerpt from Carla’s link describes :

      Lies in the doctor-patient relationship can have both immediate and far-reaching consequences. The experience of being deceived is often associated with complex emotions (eg, confusion, rage, betrayal, and despair). The deceived are also narcissistically injured; they may realize that they are not that important to the deceiver or that they were not savvy enough to have recognized the lie. Their trust in others and in themselves is violated. In addition, faith in one’s neighborhood, church, and country can become suspect. People can become negative and cynical or feel so disenfranchised that they become avoidant (so as not to be wounded again).

      The ‘unholy mess’ means the reverberations and the fall-out for the patient can be cataclysmic.

      Or, in a word of one syllable, how ‘small’ do we get …

  7. This wait for suggestions must seem an age for H. So am going to put forward a proposal for a interim life-belt, which I feel sure will at least bring some small relief. I’ll first lay down my reasoning (in simple terms) as to why I have confidence in what I will suggest.

    Would think that hardly a single pharmacologist hasn’t paused to wonder in awe at times, at how amazing the human body and any other plant eating animal are, at coping with many plant toxins. Evolution appears most definitely, to have given these detoxification processes ‘priority’ over the many other metabolic processes the body requires. To wit. If the body needs to detoxify a poison, the body’s available supply of chemical compounds goes to satisfy that need before all others. If the quantities of one component is in short supply, the other less urgent metabolic processes that also require said components slow down or even stop for the duration (the body does have a plan B for some essential functions but lets keep it simple). I’ll come back to this.

    Many of our modern drugs are synthetic analogues of plant toxins.
    Researcher Arthur Haines studied the diet of one African community and they ate over 200 different varieties of wild plants. Aha, some might say, modern vegetables have had their ‘toxins’ bred out of them. Well, any phytologist will tell you otherwise. Example: Back in the early 70’s, women thinking of having a baby were being advised not to eat the humble spud. When a plant comes under attack, it up-regulates the amount of poisons it produces as a defence. The concern focused on and around a potato disease called ‘Late Blight.’ A very strong correlation was found in regions of the UK and Ireland (that ate these poor quality potatoes each time this blight broke out), with a rise in the incidence of children born with a spectrum of related deformities like anencephaly. The UK potato produces where quick to defend their spuds by pointing out that these deformities were almost unheard of, in potatoes eating places like Taiwan. [1]

    This is a bit of a simplified account, but a confounding factor hid the true casualty (apart from what the potato toxins will directly do to one). In Taiwan (for example) people also ate plenty of rice, green vegetables, sea food, etc., that enabled their diets to supply sufficient of a chemical compound that the body needs for both detoxification of the potatoes poisons (which is always present at some level even in modern spuds) and also necessary for the prevention of this deformity. I won’t need to tell you the name of this regionally elusive compound, when I tell you that the most commonly occurring form in this spectrum of deformity is spina bifida. So supplements of this chemical (as it occurs in its natural form) are now recommended to women who are intending to conceive.

    Both the detoxification of natural poisons and synthetic drugs, rob the body of some of the chemical compounds its needs for other precesses and can lead to shortages of enzymes, hormones, proteins, etc. Which in-turn lead to other problems and shortages, For the body normaly and efficiently, recycles and resynthesises, biochemical round and round, time and time again. Sometime the negative feedback systems can get ‘locked up’ or seized so that even when detoxification has finished, a previously staved metabolic process can not resume their normal well regulated cycles. Some might be stuck on Plan B still. This equally applies to man made machinery which has negative feedback regulating systems, they can get so out of tune and what with levers getting bent from too much force, they can only operate in fits and starts.

    So whilst SSRI SNRI have been reported to deplete iodine, selenium, folate (B9) and the hormone melatonin, I don’t think just supplementing with these on their ‘own’ will be sufficient to bring about very much improvement. Other subsystems might (and most probable will be) be stuck and need the opportunity and ‘the means’ to be reset. Every which-way I look at it, further withdrawal becomes a Catch 22 whilst the war over resources due to inefficient recycling, is itself a drain and thus continues the war.

    What I’m proposing is a treatment protocol to bring back into full operation, all those metabolic systems which are not damaged but out of tune and running rough before going any further with withdrawal. That should help to reduce the understandable desperation and a healthier body will then make further reduction in dosage easier.

    In all honesty, if I had to blindly give this protocol a ‘Level of Evidence’ score, it would be only 2 minus. This is using a scale where 2 minus is defined as: “Case control or cohort studies with a high risk of confounding or bias and a significant risk that the relationship is not causal”. Therefore, my judgment is based on the fact that the cohort who self-reported back each month, volunteered to do so and volunteers are known to often want to please the person asking the questions. Therefore, high risk of bias there. Also, by virtue of its design, there was no control over confounding factors, since the volunteers were at home and unsupervised during trial. Yet, based on my personal experience of juggling all sorts supplements including amino acids, I have great faith in this protocol as a first response to severe toxic damage, including pesticides and aluminium adjuvants given in intermuscular injections — with or without an antigen. When supplements work– their efficacious in a way that can’t be matched by other main stream options.

    After eleven weeks over 50% reported that they found themselves much better both mentally and physically (I have found the actual figures). Needleless to say, countless others went on and used it with much positive and joyful feedback. Some reporting that as they no longer felt any need for their proscribed medication, they had come off totally. [2]
    This trail was instigated and the survey followed up by Gwynneth Hemmings, Dr. Angela Gliddon and David Horrobin, the latter being the one who devised it based on his research. Therefore, DH will be able to guess what the protocol consists of. DH may have also met Gwynneth when he launched the David Horrobin Memorial Prize back in June 2004.

    However, for H to undertake this, I’d imagine she’ll need some moral support from others here. For a start, if she’s living on welfare benefits only, the monthly cost may be out of her reach (and I will have to think of an appropriate solution). Second, it might seem daunting (from her perspective) to follow through and take these everyday on top of what she is having to do already. Still, more than 40% of people reported feeling better than they did before in just the first 3 weeks.

    I can only imagine, that as DH is a psychopharmacologist, then like a good shoemaker he has stuck to his last, rather than get sidetracked into investigating these ways to aid recovery. It require quite a shift in mindset, that perhaps (almost certainly) I wouldn’t had undergone, if I hadn’t started to experiment upon myself out of curiosity and try and work out WHY? at each discovery. For by nature, I’m a bit sceptical of everything, until all alternative explanations have been reasonably exhausted — even then, I sometimes wonder if I might have missed something.

    Anyway. I need some feedback now.

    [1] Hudson, James D., “The Great Potato Debate” (1974). Honors Theses. Paper 164. https://scholarworks.wmich.edu/cgi/viewcontent.cgi?article=1164&context=honors_theses
    [2] G. Hemmings (2000); SAGB Newsletter 30, Pg 27. ISBN 1359- 9194. Bangor, Gwynedd, Wales. UK.

  8. Thank you, David, Annie, Suzanne and Pogo for highlighting matters which are of great importance/significance, to anyone who has suffered an unholy mess.
    Trying to assist/support or encourage anyone who has suffered from damages induced by an insurmountable cascade of synthetic medicines that induce harm and irreparable/merciless damages to ones physical/mental well being, is just beyond cruel.
    Those who perform procedures with the intent to harm are no better than the medicines which induce harm.
    Inflicting pain or suffering to any individual is a sick human trait and sadly, sadists exist in any profession.
    Some clinicians fail to explain how many medicines or certain procedures, impact people’s lives.
    I have spoken to a few unfortunate souls who regret having gone through a certain procedure(s) and then being prescribed a cascade of medicines, to keep up with what each medicine/procedure induces.
    It is a diabolical domino effect of continuous assault and attack to the 11 organs of the body:
    integumentary system, skeletal system, muscular system, lymphatic system, respiratory system, digestive system, nervous system, endocrine system, cardiovascular system, urinary system, and reproductive systems. ~Just when you think one system heals another one is attacked by a medicine that is ‘supposedly’ geared to heal!
    This is not called healing.
    It is sickening and only has the poor person locked into a futile ‘gridlock’, one cannot escape.
    It just makes me want to scream at the top of my lungs, so that the entire universe can hear what I am trying to say.
    No one ever hears the screams because some people are not programmed to believe that this continuous destruction to the precious human body can occur.
    It happens and some poor souls can never escape the diabolical mess.
    Sadly, the clinicians involved, never explain or are very ambiguous about the train wreckage of permanent damages it does to one’s physical/mental well-being.
    It is like a bad dream for some because many were never informed about the unforeseen risks they would encounter.

    To many, we are seen as a threat and to others we are seen as educators. If people want to cause harm to their fellow man, it is a stain on their conscience.
    I would all love to leave you with a quote that inspires me especially when I witness people who fail to practice with a pure, sincere and caring heart.

    “Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure. It is our light, not our darkness that most frightens us. We ask ourselves, Who am I to be brilliant, gorgeous, talented, fabulous? Actually, who are you not to be? You are a child of God. Your playing small does not serve the world. There is nothing enlightened about shrinking so that other people won’t feel insecure around you. We are all meant to shine, as children do. We were born to make manifest the glory of God that is within us. It’s not just in some of us; it’s in everyone. And as we let our own light shine, we unconsciously give other people permission to do the same. As we are liberated from our own fear, our presence automatically liberates others.” ~
    ~Nelson Mandela

    Silence, can be so deafening, I sometimes wonder if people who refuse to hear have somehow forgotten that people matter. Carla

  9. https://pssdcanada.squarespace.com/

    Found this webpage today. It is for people suffering from PSSD in Canada. I don’t know how long it has been up, but I think it is quite new.

    The stories on there echo everything I have been suffering for almost 13 years.

    Numb genitals, zero libido, pleasure less orgasms, weak erections or impotence, low seminal volume, numb emotions and unable to feel romantic feelings or enjoy the emotional effects of music, and anhedonia and an inability to enjoy everyday things.

    Disbelieved, ridiculed, (and occasionally humiliated) by Psychiatrists and GP’s, and misunderstood by family and friends, and self harm and suicidal thoughts because of it all. It is the same story I have been hearing from so many others with PSSD for over a decade.

    Oh the joys of PSSD are many, and potentially unending.

    Apparently there is supposed to be a UK Association of PSSD officially starting soon to help UK sufferers of PSSD, so keep your eyes out.

  10. Pogo, very interesting suggestions in your post here. I have always used UltraClear Sustain Gastrointestinal support system (for leaky gut) combining a balance of minerals, vitamins, enzymes and amino acids, made in I think Germany by Metagenics and sold mail order in U.K. by Nutri. It costs about £40 a pot which lasts a month if you just use two scoops in water before breakfast. It was originally prescribed by a doctor at an Environmental Hospital, but I pay for it and order it myself since. I feel it helped my son Olly detox a bit from RoAccutane isotretinoin liver damage and also from the worst side effects of SSRIs, and it was noticeable how his memory and mood improved when he took it before breakfast every day. You need to drink plenty of water during the day if taking it. This is of course anecdotal evidence and the regulator may not consider it appropriate info here, but following on your interesting ideas Pogo I though it was worth risking it. It might be more affordable that the protocol you suggest, might be worth an initial try during lockdown anyway.

  11. I wonder what the ‘Truth’ is behind Jordan Peterson’s highly publicised difficulties with benzos and the unorthodox withdrawal treatment. He claims in a recent podcast that he could get no real help in the US, but found some relief in a clinic in ‘Russia’.
    This withdrawal involved him being put in a kind of coma? Presumably being unconscious for several days helped lessen the torment of the benzos being in his system. JP then talks of further treatment in Belgrade involving working with a anesthetist…….
    JP seems however to favour using anti-depressants.

  12. Here is Dr David Horrobin’s supplement protocol that I posted about earlier. Its a bit of a blunderbuss approach to help get the body working again as best it can. This seems to aid more than half of those that try it. With the body not staved of any of the basic nutrients and at a level to take the strain off over stressed biochemical processes, any withdrawal methods and other adjuncts have more chance of succeeding more quickly whilst taking these. It was found in surveys that full effect took on average about three months, individuals may be able to cut down to normal everyday maintenance doses sooner.

    Some of the supplements are in combos only for the reason that it means less items need to be swallowed.

    Description Strength Daily amount.

    Fish Oil EPA/DHA 1000mg capsule 1 to 3 per day.
    Vitamin B12 1000 µg 1 tablet per day.
    Folic acid 400 µg 1 tablet per day.
    Vitamin B1 (Thiamin) 100 mg 1 tablet per day.
    Vitamin C 1000 mg 1 to 2 tablets per day.
    Vitamin B-100 Complex (strength is ‘B-100,’ 1 tablet per day.
    i.e., B-50 is half)
    Magnesium 150mg 1 to 3 times per day
    Selenium plus vitamins combo (contains: Selenium 200µg, Vitamin A 450µg, Vitamin C 90µg, Vitamin E 30mg). 1 tablet per day.
    Vitamin D3 25 µg (equal to 1000 IU ) 1 tablet per day.

    Any reputable brands will do.

    Fish OilDifferent manufactures have slightly different ratios of EPA/DHA in their fish oil and describe them differently. Sometimes even differentiating and stating the active oil content and total oil content separately. So to bring some clarity:
    The important oil is the EPA. So as long as each capsule has 300 mg or so of active EPA oil they should be fine. Therefore, in IMHO the biggest difference in these three examples below is the look of the container and the price. Start with one capsule in the morning and again in the late afternoon. Then adjust dose up or down by 1 capsule to what suits you best.
    This is an example of some of the brands I’ve tried and any one doesn’t seem to me to be any superior to any of the others.

    Holland & Barrett Omega 3 Fish Oil Concentrate 250 Capsules 1000mg: https://www.hollandandbarrett.com/shop/product/holland-barrett-omega-3-fish-oil-concentrate-capsules-1000mg-60003832?skuid=003835

    Lamberts Pure Fish Oil 1100mg: https://www.lambertshealthcare.co.uk/essential-fatty-acids/fish-oil/pure-fish-oil-1100mg/
    Kirunal Triple Strength:
    https://bodybio.co.uk/products/kirunal-triple-strength-120-softgels-500mg
    Note: This brand has a 3:1 ratio of EPA/DHA so the 500mg capsule (for this purpose) is equivalent to a 1000 mg capsule of the other brands. Therefore, still only need 1 to 3 per day. Hope that makes sense.

    Vitamin C: Some people find that 2000 mg loosens the bowls, especially if take in one dose (although this diminishes as the body gets used to it). Also, some prefer the chewable tablets. I buy ½ kilo tubs of Ascorbic Acid powder and transfer some as necessary to a smaller pot. Means measuring it out each time (with a double ended plastic 2½ ml/ 5ml measuring spoon free from my local hospital pharmacist) but its less expensive.
    Magnesium: The reason for adjusting the dose to suit, is that this mineral is involved in maintaining the body’s fluid balance. So if you start getting diarrhoea, reduce the magnesium. Don’t take at meal times — it neutralises the stomach acid just like magnesium based anti-acid indigestion tablets do.
    B100 complex is just to save having to swallow a lot of individual tablets. Holland & Barrett’s have slightly more of the lesser important ones but exactly the same amounts of the important ones. I don’t see as it makes any difference.
    Folic acid When possible take Folate (L-5-Methyltetrahydrofolate) rather Folic acid as the later is slightly toxic and has to be converted into a bioactive form in the liver by a multi step process which gives the organ more work to do. This is especially so if one has a slight polymorphic enzyme deficiency. Hence, fortifying bread etc,. with folic acid alone, will not prevent all cases of spina bifida. Note: 1 mg of Folate (and depending on exact form) is not equivalent to 1 mg of Folic acid. So sick with these Folic acid doses until you are ready too move on. Folate rich food is always the best source ultimately.
    Vitamin D3From what we know now, it take time for the body to replenish its store of D3 so I think that doubling the dose should be considered, from 25µg to 50 µg (equal to 2000 IU ).
    Iodine: As Reuptake Inhibitors have been reported to deplete iodine, then I think 5mg per day of Lugol’s Iodine wouldn’t go amiss (not to be confused with Iodine Tincture for external use). Initially, it may give an unpleasant sensation of too much energy if one is very low on it.
    Important: Get containers and doses organised in a way that suits you. Nothing’s worse than having to remember each day how many of what to take and this saps the spirit. Also take notes of any observations that come to mind. These can come in handy later and it helps some to avoid mulling (or ruminating) over symptoms all day long. The act of writing things down also engages the “neopsyche” ego and helps one remain more objective and positive.
    B12: Of H’s symptoms including the original ‘mild depression’ as defined on the Hamilton Depression Rating Scale (HAM-D). I suspect that there has developed a deficiency in the metabolic utilisation of B12, even though blood level maybe normal. This was once thought to occur as a inborn genetic mutation only (as still taught in Med School). Yet, it seems that virus infections, pesticides and vaccinations can do damage and down regulate utilization. Injections of B12 gets around this, as the vitamin is given in a more bioactive form of hydroxocobalamin.
    There is and interesting interaction with SSRI/SNRI’s and injected B12 taken with folic acid which may ease withdrawal (guessing here). From a peer reviewed article with no author conflicting interests (which is a good sign) :
    “We have made repeated clinical observations that B12/folic acid may cause paradoxical sedation when combined with SSRI/SNRI drugs; the sedation vanishes when the SSRI/SNRI dosage is reduced or cancelled. This might be in analogy with the old pharmacological observation that demethylation converts potent sedatives into antidepressant agents [17]. Maybe B12/folic acid, by its remethylating potential, reverses the normal demethylation of SSRI/SNRI and thus keeps SSRI/SNRI in its original form, which is much more sedating than its demethylated form?” [emphasis mine] [1]
    This review article gives more good background info on the potential benefits of Methylcobalamin B12. [2] The article also mentions lipoic acid. Again, this acid always seems to help the strained nervous system and I often take it myself for Brain Fog. I also take B12 (cobalamin) in the active form of Methylcobalamin via a mouth spray. [3] It acts very fast and if I haven’t taken it for a while can make me almost dizzy for a minute (maybe a sudden drop in the blood’s potassium level?).
    Due to the over reliance on antidepressants, I would love to see an article in the BMJ suggesting that GP’s keep an oral B12 preparation in their draw at all times, to be administered ‘without comment’ to every ‘depressed’ or sad looking patient that walks in (say during measuring the SpO2 or BP as to attempt to make it single-blind and ovoid a placebo effect). If the patient is deficient, it will only take a 2 – 3 minutes before patients asks or even demands “Hey doc, what WAS that stuff you just gave me?!!” For it can work that fast (and whilst the number of exclamation marks may very between individuals — expect one at least). Of course this would evoke a flurry of Rapid Responses from irate BMJ readers about the absence of obtaining ‘informed consent’ from the patient before hand. Funny, how proper ‘informed’ consent, isn’t thought to be needed nor sought, when proscribing SSRI/SNRI’s for the first time! Regarding the medical ethics question, I would consider such a stunt to be justifiable, as a ‘emergency’ on-the-fly diagnostic procedure, which could prevent a possible suicide. Yet, a licensed practitioner always has to consider how the GMC, through their Pharma coloured spectacles, would view it…
    I’m not providing any of this as medical advice, just passing on what I have come across on my journey and my personal experiences, in the hope that other find it useful too.

    [1] Regland B, Forsmark S, Halaouate L, Matousek M, Peilot B, Zachrisson O, et al. (2015) Response to Vitamin B12 and Folic Acid in Myalgic Encephalomyelitis and Fibromyalgia. PLoS ONE 10(4): e0124648. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0124648
    [2] Gupta JK and Sana QS. Potential Benefits of Methylcobalamin: A Review. Austin J Pharmacol Ther. 2015; 3(3).1076.
    https://www.researchgate.net/profile/Jeetendra_Gupta/publication/339412930_Potential_Benefits_of_Methylcobalamin_A_Review/links/5e4ff1bd458515072dafa8be/Potential-Benefits-of-Methylcobalamin-A-Review.pdf
    [3] The B12 Oral Spray which I use: https://betteryou.com/boost-b12-oral-spray

  13. Wendy E Stephen
    Retired nurse
    Stonehaven, Scotland
    Re: Montgomery and informed consent: where are we now? Wojtek Wojcik, Jane E Norman, et al. 357:doi 10.1136/bmj.j2224
    Dear Editor
    How very sad that on entering the sixth year since the Judgement in Montgomery vs Lanarkshire Health Board was published, reporting on a July 2020 Review chaired by Baroness Julia Cumberlege, “Analysing the Cumberlege Review: who should join the dots for patient safety?” evidences the fact that huge failings are still taking place with patient consent not being properly engaged for many medical interventions, patients not receiving the correct level of information and being excluded from the decision making.(1)
    How can it be, after all this time, we as nation still have not effectively learnt from past failures re informed consent and imposed higher standards and tighter controls since Montgomery? The legal and ethical requirements re the correct standards of pre intervention care, dialogue and discussion to ensure informed consent, are clearly laid out in Montgomery.
    Why are there still an inexcusable number of occasions where informed consent has not been properly obtained, often with disastrous consequences for the patient and huge fines for the health care professionals and their employers for failing to do so? Research undertaken at Queen Mary University of London found that while the rate of increase of other claims has remained steady, cases relating to consent have risen four-fold since March 2015.
    Is it not time for the many bodies who support, insure and regulate health care professionals to take determined action to not only identify the root cause of this persistent failing but to effectively deal with it once and for all so as to protect patients and their rights hereafter?
    How many more years of reports, reviews, findings and recommendations identifying failures associated with informed consent and the remedies required to tackle the problem will it take to bring an effective change in procedures and a resultant downward trend in the statistics?.
    The Cumberlege Review focussed specifically on three interventions all of which have been in the news; hormone pregnancy tests, Sodium Valproate and pelvic mesh implants.
    ith regard to pelvic mesh implants, the authors of the Review stated that that they were “appalled by the numbers of women who have come forward to say they never knew they had had mesh inserted, or where they gave consent for ‘tape’ insertion they did not know they were being implanted with polypropylene mesh”
    Patients who took Sodium Valproate for their epilepsy during pregnancy did so without knowing that they could harm their unborn babies.
    Hormone pregnancy tests, such as Primodos, which were withdrawn from the market in the late 1970s and which are thought to be associated with birth defects and miscarriages were the third intervention considered in the review.
    Reporting on the Review included Baroness Cumberlege’s assessment of the impact on patients
    ……..Perhaps one of the most shocking revelations lies in doctors still failing to respect patient autonomy in excluding them from decision making processes.
    There was evidence of……
    “Patients not being informed of risks involved, with doctors giving “advice based on their own assumptions, without involving patients in the decision-making process”(4)
    Paragraph 87 of the Judgement from Montgomery determined the right of the patient to decide which treatment to undergo with the doctors role confined to ensuring that the patient was made aware of the scope of treatments available and the risks involved.
    “An adult person of sound mind is entitled to decide which, if any, of the available forms of treatment to undergo, and her consent must be obtained before treatment interfering with her bodily integrity is undertaken. The doctor is therefore under a duty to take reasonable care to ensure that the patient is aware of any material risks involved in any recommended treatment, and of any reasonable alternative or variant treatments.”
    The MDDUS following Montgomery advised their membership that……..
    “The judgment also states that it cannot be left to the doctor to determine what is reasonable to disclose; the move is to what a patient would attach importance to”(5)
    The Review, raises further concerns in highlighting the fact that since Montgomery there had been “a significant increase in patient safety leaflets sharing information on risks of specific treatments but that the sheer variety of these and differing consent forms can be “bewildering and a major source of confusion”,…… a practice which definitely incapable of satisfying the legal requirements today.
    … “bombarding” patients with technical information with they cannot be reasonably expected to grasp does not absolve the practitioner of his role in providing patient specific information so tailored so as to be comprehensible to the individual patient.
    …..would be a matter of grave concern, particularly when considered in light of the findings from the Review, if the profession had sought to comply with Montgomery, not by improving personal doctor – patient access, and information sharing etc but by churning out an increased number of patient safety leaflets as a substitute.
    As for the question “who should join the dots for patient safety?” The Cumberlege Review of 2020 clearly provides the answer just as Montgomery did back in 2015………….

    • (Published 06 August 2020)
      Cite this as: BMJ 2020;370:m3099
      Helen Haskell, president
      Consumers Advancing Patient Safety
      Haskell.helen@gmail.com

      On 8 July the Conservative peer Julia Cumberlege published..
      The Cumberlege review —was inspired by longstanding patient campaigns alleging harm ……….. The published report lives up to that promise. …… They documented pervasive shortcomings in the marketing and oversight ………. They considered their findings generalisable across healthcare, as the cover letter states: “We have found that the healthcare system—in which I include the NHS, private providers, the regulators and professional bodies, pharmaceutical and device manufacturers, and policymakers—is disjointed, siloed, unresponsive, and defensive. It does not adequately recognise that patients are its raison d’être.”1

      Hormone pregnancy tests, sodium valproate, and pelvic mesh have been the subject of regulatory action in the UK and elsewhere. The tests were withdrawn in 1979, 11 years after concerns first emerged.
      Sodium valproate, now also used as a psychiatric medication, is the subject of warnings and voluntary restrictions for women of childbearing age, although, as the report documents, it is surprisingly difficult to get this critical information to either patients or doctors.34……..

  14. Think I’ll make this my last post as I only came here to defend Vit C.

    Yet, I’m so shocked to see how Pharma has been able to keep any threat to their business model, out from mainstream medicine, to the extent that they are still pressurizing regulatory agencies to outlaw the sale to the public and prevent use within clinical practices, any of the most effective but non-patented (i.e., not ‘Pharma owned’) supplements. See: Consumers for Health Choice https://consumersforhealthchoice.com/

    The fish oil, vitamin and mineral which I previously posted should be enough to start the ball rolling. I was in two minds whether to go and finish the job off by mentioning amino acids, oligosaccharides and peptides (phytochemicals including adaptogens) because the efficacy depends so much on individual (polymorphic determined) needs. Even identical (monozygotic) twins can differ in which genes have become deregulated. So it is impossible for anyone to offer the same one-size-fits-all treatment plan. Still, knowing what its like to suffer 24/7 month after month after month, I feel compelled to post some links which may hopeful suggest practical adjuncts to tapering.

    It goes without saying, it would be enormously helpful to find a healthcare provider with some experience to guide you. But its only ones own body that will tell one which supplement works.

    As an aside: I googled all the common generic and lesser used names for the above substances and filtered for ‘Serbia’. Only one reference came up and it was for an establishment which fits everything Jordan Peterson describes in the video with his daughter. Said establishment lists all these under the heading ‘Neurometabolic therapy.’ This type of therapy is also good for rapid recovery from Postoperative Delirium and Postoperative Cognitive Dysfunction which of coarse can happen with induced coma detox. The dots line up. How about that!

    Here’s my quick pick of thinks to read, to point those interested to ways of mitigating the damage done, when modern synthetic drugs are inexpertly proscribed and treatment poorly monitored. Also like Jordan Peterson, I do consider modern drugs to still have a place when properly used.

    First. For those that want some in-depth idea as to what the class of plant chemicals called ‘Adaptogens’ are and how they are thought to act:
    * Understanding adaptogenic activity: specificity of the pharmacological action of adaptogens and other phytochemicals. A review article.
    Annals of the New York Academy of Sciences (2017). Issue: Phytochemicals in Medicine and Food. https://nyaspubs.onlinelibrary.wiley.com/doi/epdf/10.1111/nyas.13399

    Some case studies which employed amino acids and phytochemicals (called here botanicals) together with dosages.
    *Tapering Off Psychotropic Drugs: Using Patient Cases to Understand Reasons for Success and Failure. JOM Volume 28, Number 4, 2013 Educational Article
    http://psychrights.org/research/Digest/Wthdrawal/Tapering_Success_and_FailureJProusky2013.pdf
    Because the amino acid L-Theanine (mentioned in this article) when take with magnesium, is ‘claimed’ to be so effective at reducing anxiety, Pharma has already got it banned in some European countries, together with high dose Niacinamide tablets and the anxiolytic Piper methysticum.

    * What You Need to Know About L-Theanine (easy to read article with references)
    https://www.psychologytoday.com/us/blog/sleep-newzzz/201708/what-you-need-know-about-l-theanine

    * Advert for L-Theanine with dosages for difference indications:
    https://www.nootropics.com/l-theanine-dosage/

    * Natural plants effective in treatment of sexual dysfunction: A Review
    https://www.researchgate.net/publication/215483102_Natural_plants_effective_in_treatment_of_sexual_dysfunction_A_Review

    *How To Take Amino Acids While On Antidepressants Although its a advertorial, it explains things simply.
    https://dominatedepression.com/how-to-take-amino-acids-while-on-antidepressants/

    Consider for a moment. It was only some 400 generations ago that our forbears got up in the morning wondering if they would be able to eat something that day, without something eating them first or some plant poisoning them after. Its our machinery designed to detoxify plants which our bodies use to detoxify synthetic drugs. Its seems reasonable, based on all the research, that evolution has ensured we can ramp up detoxification processes quickly during times when only the more toxic plants are available to forage, but to only revert back to normal levels slowly — when the danger has passed. The re-set appears to require the return of plants into our diet, which are rich in adaptogens. This makes mechanistic sense, for the negative feedback system we have, needs ‘feedback’ about its phytochemical environment in order to remain in prime metabolic fitness.

    Finally. I’ll leave you with a video presentation by researcher Arthur Haines who picks holes in Diet Mythology. And in so doing, shows what rich phytochemical environment humankind evolved in. He got me thinking about what ‘food’ is, in a whole new way.
    https://www.youtube.com/watch?v=-9Cz0QTvBjo

Leave a Reply to susanne