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Opinions of sertraline

4DQSAR said:
For contrast, citralopam did nothing whatsoever if I took it or if I didn't take it. In that case evergreening HAS taken place as, behold, escitalopram.

I have a feeling that the NHS were able to buy citralopram directly from Lundbeck at a very low price because for a few years it became the first-line medication for unipolar depression in the UK. I suspect GPs soon recognized that it wasn't very good - even some of the human studies showed it to be no better than a placebo.

Just to be clear, the placebo effect is real and why some people swear by altentative medicine - if you BELIEVE a treatment will work, it will work (at least sometimes) and for a mental health condition, I suppose it's easier to think yourself better than, say porphyria, cancer or indeed a broken leg.

I still think if a person is not suicial, tricyclics are more effective. When Prozac arrived I looked at the human studies and noted that they had compared the highest prescribable dose of fluoxetine with the lowest dose of amitriptyline indicated for unipolar depression and the conclusion was that the two medicines were of similar utility. While I can see the theoretical lower risk of intentional overdose most SSRIs offer, we live in a world where medicines can be delivered for a nominal price so a cautious clinician could insist on the tricyclic being dispensed on a weekly basis.

With any medicine, there will always be a risk/benefit ratio and I note SSRIs are associated with INCREASED risk of suicide among some demographics. Yes, taking a whole box of your antidepressant won't kill you but we are surrounded by effective ways to throw a seven.

For those concerned about stopping, the BNF at least DOES advise that SSRIs should be tapered rather than abrupty stopped. Given that all SSRIs have long (or very long) half-lives, how the taper is undertaken can include taking a dose every other day. It does seem complicated and the only good thing I have to fay about fluoxetine is that it's half-life is 4-6 DAYS. I suspect discontinuation syndrome took a while to be accepted because when Prozac was almost a national institution, that extreme duration likely meant discontinuation wasn't as problematic.
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I was prescribed Citalopram first. I took ONE pill....never again. My anxiety - already "severe" was so much worse than it was essentially a panic attack that lasted for like 20 hours.
 
ChemicallyEnhanced said:
Can we get an update? I know it's been 7 years...

Hope it worked out for him!
It literally saved my life. Started it around the same age...been on it for 16 years now (which is weird because I'm only 21) and it still helps.

I actually got a bizzarely RAPID improvement from it and absolutely, positively NOT placebo because it was my second SSRI (Citalopram/Celexa) and the first was a horrible experience, so I did NOT expect much from the Sertraline, plus my doctor gave me the "6 weeks to really help" shpeil. But I felt much better after 3 days...in fact, I was basically high? I'd compare it to a moderate dose of amphetamine sulphate or a hypomanic episode. Anyway, I love it.
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You were put on antidepressants at five years old?!
 
LoginNotSecure said:
All, and I do mean all antidepressants, antipsychotics and their ilk have an increased risk of suicide. I wouldn’t recommend them at all if they can be avoided. Cooking your brain isn’t conducive for longevity.
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Yeah apparently the meds can increase energy or motivation for people to take their own lives, during the earlier stages of starting these meds I believe. After that the risk of suicide lessens?

Has there been any studies correlating the use of these sorts of medications with shortened life expectancy do you know?

Surely this would be very difficult to quantify, because people with mental health issues, could, and probably mostly do, have multiple different but highly significant variables, besides their medications, for not living as long.
 
Bleaney said:
Yeah apparently the meds can increase energy or motivation for people to take their own lives, during the earlier stages of starting these meds I believe. After that the risk of suicide lessens?

Has there been any studies correlating the use of these sorts of medications with shortened life expectancy do you know?

Surely this would be very difficult to quantify, because people with mental health issues, could, and probably mostly do, have multiple different but highly significant variables, besides their medications, for not living as long.
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www.cambridge.org

Antidepressant use and risk of adverse outcomes: population-based cohort study | BJPsych Open | Cambridge Core

Antidepressant use and risk of adverse outcomes: population-based cohort study - Volume 8 Issue 5
www.cambridge.org www.cambridge.org

The key difficulty is that depression itself is linked to increased mortality. Separate UK Biobank research found that a history of depression was associated with roughly a 46% higher risk of all-cause mortality, independent of physical activity levels. That mortality could be from drink, drugs, accidents or just the person press Alt +F4 on themselves. But as I said previously, if they work for you and you have minimal side effects, great. But for the most part them cause more damage than help. In my own opinion, of course. Easy for me to say in my ivory tower and all.
 
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Robi said:
Fucking great,I'm weaning off this shit,just never got anxiety and sleep better,but I know in my heart its bad,tried so many and couldn't go through the two weeks.Shit fuck,its going to kill me.
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Hey @Robi , it took me four attempts to get off mirtazapine and stay off it. Always ended up going back on it.

Not this time though. It can get to fuck. It was definitely taking more than it was giving in my case. I'm really glad to be off it.

If I can offer any help or assistance let me know. Even if it's just a friendly ear to moan to in confidence. My inbox is open.

BB
 
Bleaney said:
Yeah apparently the meds can increase energy or motivation for people to take their own lives, during the earlier stages of starting these meds I believe. After that the risk of suicide lessens?
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Indeed. You can look back at the diaries of famous people who took their own lives and it was rarely in the depths of depression but either on the way down or on the way back up. I suppose Sylvia Plath is a good example of someone who gassed herself just after being prescribed an antidepressant. Virginia Woolf someone who felt a second mixed-episode arriving so filled her pocket with stones and walked into a river.

I honestly don't know if teenagers pose a specific risk or if there is already a higher baseline of suicides and SSRIs are blamed more to have something to blame than to accept that with or without medication, a person might have ended it all.

As to mitrazipine, it's been decades since I took a tricyclic (yes, I know it's a tetracyclic but it's action is closer to a tricyclic than anything else), but I alternated between amitriptyline and mitrazipine i.e. 30mg mitrazipine one day, 50mg amitriptyline the next. Seemed to work as when I decided they weren't of value, I just stopped. I'm in no way recommending anyone else do what I did but alternating the two had been studied and the conclusion was that it ameliorated side-effects while still being effective. I suppose no GP would feel comfortable in prescribing two medications to be consumed in such a way.

We know that almost half of all prescribed medications are not used AS prescribed so making it complicated assumes a lot of the patient.

At the end of the day, person-centred councelling is still considered the 'gold standard' in the treatment of almost all mood disorders but since it takes as long as it takes, it's costly. But if someone I knew was depressed, I would suggest they pay for the councelling (by a psychatrist, not a psychologist) if they can afford it. Often this means that the clinician can spot suicidal tendencies before anything bad happens. That why I specified psychartist - just occassionally in-patient treatment IS the right option but a psychologist cannot refer.
 
It's really difficult to get a psychiatric appointment in this country right now. I'm on the serious mental health register, but I had to wait almost twelve months for a follow up appointment.

If it's like that for me, what about the undiagnosed?

I'm sure therapy would produce some wonderful results, but it's not happening unless you're already jumping off a bridge.

The money just isn't there.
 
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BadBoy377 said:
Hey @Robi , it took me four attempts to get off mirtazapine and stay off it. Always ended up going back on it.

Not this time though. It can get to fuck. It was definitely taking more than it was giving in my case. I'm really glad to be off it.

If I can offer any help or assistance let me know. Even if it's just a friendly ear to moan to in confidence. My inbox is open.

BB
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Welp I don't think its going to be too hard,I take the lowest..so kind of you,really means so much
 
Perkins : Reborn said:
It's really difficult to get a psychiatric appointment in this country right now. I'm on the serious mental health register, but I had to wait almost twelve months for a follow up appointment.
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The tepid bath of austerity.

People keep on wondering how on earth people who had been in and out of secure psychatric units multiple times were released and absolutely no support was provided. While a person suffering from schizophrenia is almost always only a danger to themselves (≈1700 suicides per annum) or the victim of crime (≈45% per annum), it's only when they are violent to others that it becomes apparent that mental health services either hadn't been in contact with the person for over 12 months OR had been allowed to manage their own medications. Given how unpleasent the side-effects of antipsychotic medications are, it's not irrational for a person to think they are fine, stop taking the medication and descend into psychosis.

The reason is simple. It costs around £165,000/annum to treat a patient in a secure psychiatric unit, £175,000/annum to treat a patient in an RSU and around £250,000/annum to treat a patient in one of the four high security psychiatric units in the UK.

But it's just another 'there we are then' situation. The Police Service has almost given up responding to individuals suffering a mental-health crisis and it seems a person more of less has to commit a crime so a magistrate or judge can specify a treatment order and even then, people may end up in a unit hundreds of miles from their family and friends which will only make a person suffering a mental illness worse as they end up even more isolated than a prison inmate.

It's worth noting that the 'Hearing Voices Network' estimates that only about ⅓ of people ever seek medical help at least in part because they fear what will happen if they are honest. We seem to forget that although auditory hallucinations are considered a cardinal symptom of schizophrenia, there are other causes so in truth if a person isn't troubled by what they hear, especially when they comprehend that what they hear isn't 'real', it's more akin to synesthesia than schizophrania.
 
4DQSAR said:
At the end of the day, person-centred councelling is still considered the 'gold standard' in the treatment of almost all mood disorders but since it takes as long as it takes, it's costly. But if someone I knew was depressed, I would suggest they pay for the councelling (by a psychatrist, not a psychologist) if they can afford it. Often this means that the clinician can spot suicidal tendencies before anything bad happens. That why I specified psychartist - just occassionally in-patient treatment IS the right option but a psychologist cannot refer.
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Hmm, not sure many psychiatrists are qualified in person centered counselling - in fact I'd estimate less than 5%.

Psychiatry seems to believe that it's some kind of pinnacle, but almost all of them only have drugs to offer. I'd go as far as to say that psychiatry is miles from being person-centered in general - more like "we're the experts, stfu pleb" really
 
ageingpartyfiend said:
Hmm, not sure many psychiatrists are qualified in person centered counselling - in fact I'd estimate less than 5%.
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Well, obviously if they practice forensic psychiatry or psychiatry for those with learning disorders, children, adolescents or the elderly, or teach, they aren't 'on the market' for private adult patients. But the few I know socially tend to describe their methodolgies as 'hybrid' by which they follow the core elements of PCC in their interactions with the patient but see it as one of the tools they have rather than being the only tool.

I suggest the clearest way they demonstrate this is not telling the patient 'X is wrong with you' but allowing the patient to confront their problems with the psychiartist only providing gentle suggestions on what topics to discuss and just being aware that homo sapiens are far less rational than some seem to think.

It could well be true that only 5% of patients are treated by psychatrists who employ PCC just because that psychatrist will by definition have far fewer patients at any one time due to PPC taking as long as it takes.

I think the key word I used was PAY. I've watched the unfolding disaster of CBT.

But I think the biggest advantage is that by definition a psychiatrist is a qualified doctor first so they have the option of prescribing medication(s) when appropriate and at the other end of the scale, can sign a Section 2 order as someone defined in Section 12. So if someone is REALLY ill, they can refer to in-patient treatment. Which once again, is better if the patient can PAY.
 
Must say I’ve had almost universally great interactions with psychiatrists. 2 out of five - one in particular (the inpatient one) - were shockingly dismissive. Other three have been outstanding.

But I do agree they focus almost exclusively on prescriptions. If you ever get a chance to even see one face-to-face :\
 
Shambles said:
Must say I’ve had almost universally great interactions with psychiatrists. 2 out of five - one in particular (the inpatient one) - were shockingly dismissive. Other three have been outstanding.

But I do agree they focus almost exclusively on prescriptions. If you ever get a chance to even see one face-to-face :\
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wouldn't call it almost universally great given that 40% of your shrinks have been shockingly dismissive - close to a 50/50 split

great that you've seen 3 outstanding ones though - lucky too!

I'd love to have a full psychiatric evaluation tbh, just out of curiosity (don't get me started about 'diagnosis')
 
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