Health & Society
Users of Antidepressants may suffer due to Doctors not knowing new Research and Guidelines
Research show people using antidepressants have problems withdrawing from the drugs due to doctors not knowing how to do it correctly, and that it can take months and years due to severe withdrawal effects. Adverse withdrawal effects often are not recognized or misdiagnosed as relapse.
Millions affected
When the SSRI antidepressants first appeared on the market they were presented as drugs that could solve life situations and with no problems related to them. In fact, manufacturers distributed numerous papers with description of withdrawal symptoms from the drugs as being “brief and mild”, based on studies conducted by the drug companies themselves which focused on people who had been on the antidepressants for only 8 to 12 weeks. The result has been that over the years both doctors and the general population have come to believe these drugs can not cause severe and long-lasting withdrawal symptoms on stopping them. And further that stopping the use of these drugs following a treatment would not be a problem.
What has not been the focus in research is that the longer people are on these antidepressants, the harder it is to stop and the more severe the withdrawal effects.
Research presented at this year’s European Psychiatric Congress show there are major problems related to this and research indicate that more than half will have problems stopping, amounting to millions in Europe being affected.
Antidepressants cause residual change to cell structure
The use of antidepressants causes changes to the body and its ability to regulate the use of its own neurotransmitters used to control numerous bodily functions. The result of this change of the cell structures is that once a user has stopped the antidepressants this can cause withdrawal effects and these can last months or years after the drug has left the system. The new research explain what many users have said they have felt for years.
Dr Mark Horowitz, an expert and Clinical Research Fellow in Psychiatry at the National Health Service (NHS) in England, presented extensive research findings that put a new light to the problem.
“When you stop the drug, let’s say months or years after the patient had been started on drug treatment following a stressful period in their life, the antidepressant is metabolized by the liver and kidneys in a few days or weeks. But what doesn’t change in a few days or weeks is the residual changes to the post-synaptic serotonin receptors and other systems downstream of this,” Dr. Horowitz told.
In studies on humans, there are changes to the serotonergic system that persists for up to four years after the antidepressants are stopped.
“In other words, you now have a system that is less sensitive to serotonin being exposed to normal levels of serotonin after the drug is removed. And overall, this could be seen as a low serotonin syndrome,” he clarified.
This of course is a very simplified version of what’s going on. There are many other neurotransmitters and downstream effects of these changes that may also persist for long periods after the drug is stopped. All of these changes also are likely to explain the wide-ranging and long-lasting symptoms that occur after stopping antidepressants.
Adaptation to the drug
The underlying problem that has often been neglected is that years of use has caused an adaptation to the antidepressant drug by the body and brain and this condition persists for longer than it takes the drug to be eliminated from the body, and that’s what causes withdrawal effects.
Dr Mark Horowitz explains why withdrawal effects last for more than a few days or weeks after the drug is out of the system, “it’s not the time taken for the drug to leave the system that determines the length of the effect. It’s the time taken for the system to readapt to the drug not being there that explains how long withdrawal symptoms can last for.”
Antidepressant withdrawal syndrome is a set of physiological symptoms that occur on stopping or reducing the dose of an antidepressant. They can manifest in either psychological or physical symptoms because these drugs affect so many bodily systems. They occur because adaptations to the brain caused by the drug take time to resolve.
Dr Mark Horowitz pointed out that it’s important to understand that withdrawal symptoms do not require addiction, all that is required is adaptation to the drug. This is often referred to as physical dependence. Physical dependence in pharmacological terms means the process of adaptation to appear to exposure to a drug that affects the brain, which is true for antidepressants (and, for example, to caffeine, which does not generally cause addiction but can cause physical dependence and therefore withdrawal effects).
As the SSRI antidepressants act on a neurotransmitter mechanism that influence not only mood but many bodily systems withdrawing from the drug after years of adaptation thus can cause strong reactions on many of these functions and their influence on one’s life.
Symptoms of withdrawal
There are dozens and dozens of possible effects that can be caused. Symptoms include dizziness, insomnia, impaired concentration, fatigue, headache, tremor, tachycardia, and nightmares. Withdrawal can even cause affective symptoms such as depressed mood, irritability, anxiety, and panic attacks.
“We know that these are symptoms of withdrawal and not just relapse (a return of someone’s underlying condition), because they have been found in studies of people who stopped antidepressants with no underlying mental health conditions,” Dr Mark Horowitz told. He mentioned examples such as people who are given these drugs for pain, for the menopause, and even in healthy volunteers.
There are other effects including an increase in suicide attempts in the two weeks after stopping antidepressants. It has been attributed to withdrawal effects itself because it’s too quick for relapse to explain this increase in symptoms. Dr Mark Horowitz further noted that they have also found in studies that while 30% of those who responded were suicidal before starting medication, 60% became suicidal after stopping so that this means for 30% of people they will experience being suicidal for the first time in their lives because of withdrawal effects.
The maybe most disturbing symptom from withdrawal of antidepressants, which often has been neglected, is a condition known as akathisia. Akathisia is a movement disorder usually caused by a psychoactive substance in which the individual generally will experience an intense sensation of unease or an inner restlessness that often prompts the patient to pace backwards and forwards and can be an intensely unpleasant experience. Dr Mark Horowitz noted that it is often recognised as a long-term consequence of antipsychotic exposure, but withdrawal from antidepressants and benzodiazepines and a variety of other psychiatric drugs can also cause the condition.
“It is the most horrible presentations that I see. People are pacing, they feel agitated, they feel terror. A lot of them are talking about suicide because it is a state in which you get no rest and no calm, often for weeks and sometimes longer,” Dr Mark Horowitz pointed out.
And it’s important as this condition is often misdiagnosed when people are presented to the emergency department as agitated depression, as mania, because many clinicians and others are unfamiliar with the fact that coming off these drugs can cause akathisia.
Withdrawal effects not recognized or misdiagnosed as relapse
Tens of thousands users of antidepressants from Europe every month are seeking information and advice from American peer support forums on how to come off their medications. Their stories are for many very similar.
The research group of Dr Mark Horowitz surveyed 1,300 of these. Three quarters of them said their doctor’s advice on withdrawing was unhelpful.
The major reasons where that the doctor had recommended a rate of reduction that was much too quick. And that the treating doctors weren’t familiar enough with withdrawal symptoms to have any advice, or they told the user that stopping with antidepressants would not cause withdrawal symptoms.
Dr Mark Horowitz indicated that doctors often still believe that withdrawal effects from antidepressants are “brief and mild”. And they do not know that withdrawal symptoms include anxiety, depressed mood, and insomnia.
“It’s easy to confuse with a relapse of depression or anxiety, especially when it’s in the clinician’s minds that withdrawal effects are brief and mild. Someone turns up with severe symptoms that are long lasting, it’s very hard to put the connection together,” Dr Mark Horowitz added.
Another disturbing fact is that withdrawal effects is not only related to antidepressants. “The same is true for coming off of all psychiatric drugs. Often the changes produced on the brain by psychiatric drugs can persist for months or years after stopping, which is why withdrawal syndromes can last a lot longer if it takes the drug to be eliminated from the body,” Dr Mark Horowitz pointed out.
Health & Society
Female circumcision in Russia – exists and is not punished
Every year, millions of women and girls in the world are subjected to the procedure “female circumcision.” In the process of this dangerous practice, women have part or all of their external genitalia removed. Among the victims are also residents of the North Caucasian republics of Russia, and the Russian authorities do not punish the execution of the violent procedure.
How this violent religious-ritual tradition exists in modern Russia, do the authorities and the clergy try to fight it – reveals the Russian publication of Verstka.
What is “female circumcision”
Female circumcision is a procedure that is accompanied by either trauma or partial or complete amputation of the external genitalia. As a result of the procedure, sensitivity is reduced and the woman may lose the ability to have an orgasm.
Not for medical reasons
The procedure is not performed for medical reasons, but for ritual or religious reasons to suppress female sexuality. That is why in the international medical community this term is not used, but is called “female genital mutilation operations”. International law considers them an attack on the health of women and girls, a form of violence and discrimination.
Victims
Victims of female circumcision are girls up to the age of 15. According to data from the World Health Organization (WHO), in 2024, more than 230 million women in the world suffered from such operations. They are mostly carried out in African, Asian, Latin American and Middle Eastern countries. But there are also victims of female circumcision in Russia among the residents of the North Caucasian republics – Dagestan, Ingushetia and Chechnya.
Injuries
The procedure has serious negative consequences for women’s health – from serious injuries to death due to blood loss. In addition to physical trauma and the shock of pain, female circumcision disrupts the natural functioning of the body. Women and girls may suffer from infections, their genitourinary system may be damaged, they may experience pain during sexual intercourse, menstrual disorders may occur, and the risk of complications during childbirth and death of the mother and the newborn increases by 50%.
Why do they do it?
The “necessity” of such operations is justified by honoring traditions or religious motives. In some cultures, it is part of the rite of female initiation or entry into adult life. Female circumcision is often associated with Islam, including in the Russian Federation.
Prevents lust
In the words of Dagestan journalist Zakir Magomedov, “in the local religious press, which is issued by the official clergy, articles are published in which it is written that female circumcision has a beneficial effect on a woman and protects her from lustful thoughts and desires, and is even beneficial for a woman.”
Female circumcision is performed by people without medical training, and old pocket knives or cattle shears are used as tools.
Control over female sexuality
In almost all cases, the purpose of the procedure is defined as control over female sexuality: “not to be hoika”, “not to freak out”. The official clergy of Dagestan include female circumcision in religious duties, although it is not mentioned in the Koran. Some Muslims, in addition to the Koran, are also guided by the Sunnah – traditions from the life of the Prophet Muhammad and statements of authoritative religious figures. Therefore, in some cases, female circumcision among Muslims can be interpreted as permissible, desirable and even mandatory.
Officially, the Russian authorities are against it
“All women should be circumcised so that there is no debauchery on Earth, to reduce sexuality”, this is how the head of the Coordination Council of Muslims of the North Caucasus, Ismail Berdiev, reacted to the revelations of the “Legal Initiative” organization in 2016, which confirmed the existence of practice. Later, Berdiev clarified that “he did not call for female circumcision”, but only spoke about the “problem of debauchery”, with which “something must be done”.
The Russian Ministry of Health condemns the procedure, and the prosecutor’s office of Dagestan conducts an investigation and finds no confirmation of the facts presented in the report of “Legal Initiative.”
The deputy of the State Duma from “United Russia” Maria Maksakova-Igenbergs proposes to introduce the concept of “women’s discrimination on religious grounds” into the Penal Code, and that the punishment for “female circumcision” be 10 years in prison. The Ministry of Justice of Russia does not support Maksakova’s initiative, clarifying that the procedure falls under the Criminal Code of the Russian Federation, and more precisely under the paragraphs on “deliberately causing severe, medium and light harm to health, as well as causing harm to carelessness.”
North Caucasus
According to the “Legal Initiative” organization, in the middle of the last decade in Dagestan, at least 1,240 girls were subjected to the procedure annually. The majority of the men surveyed were categorically against the ban on female circumcision, explaining their motive not only with Islam, but also with local traditions and the desire to control the morality of women. Part of the respondents expressed an opinion against the procedure, arguing that the lack of sensitivity in women lowers the quality of sex in men as well.
And in Moscow
In 2018 one of the Moscow medical clinics announces the service of “female circumcision” for ritual and religious reasons for girls from 5 to 12 years old. On the clinic’s website, it was noted that “the operation should be performed not at home, but in a medical clinic.” After a wide public response, the clinic removed the information from its website, but an investigation was carried out, which found the existence of the procedure and other violations. A warning has been issued and the clinic is still open!
First conviction without penalty
Despite the fact that in its second report the organization “Legal Initiative” notes the disappearance of the practice in Chechnya and Ingushetia, the inhabitants of these regions remain in danger. In the spring of 2020, the father of a 9-year-old girl invited him to Magas (the capital of Ingushetia) for a visit and took him to a vaccine clinic. There, female circumcision was forcibly performed on the child. The value of the “service” is 2000 rubles. The little girl, in her bloodstained dress, was then put on a bus back to Chechnya, where she was hospitalized for severe blood loss. The father explains his motive as follows: “So that he doesn’t get excited.”
A criminal case has been opened against the gynecologist who performed the circumcision for intentionally causing minor harm to health. The case has been going on for a year and a half. The judge called on the parties to reconcile, adding that “the girl cannot be helped anyway”. In the end, the doctor was found guilty and fined 30,000 rubles, but was released from serving the sentence due to the statute of limitations. No criminal proceedings have been initiated against the clinic.
In the same year, the mufti of Dagestan issued a fatwa and recognized the removal of the external genitalia as forbidden in Islam, but clarified that “female circumcision” meant only hudectomy — the removal of the foreskin of the clitoris. This is also a crippling procedure, human rights defenders insist.
Health & Society
Four executed for producing illegal alcohol in Iran
Iranian authorities have executed end of October four people convicted of selling illegal alcohol, which poisoned and killed 17 people last year. More than 190 people who consumed the dangerous drink were hospitalized.
The death sentence against the accused in the case was carried out in the Karaj Central Jail.
According to human rights organizations including Amnesty International, Iran carries out the highest number of executions per year after China.
After the Islamic Revolution in 1979, Tehran banned the production and consumption of alcoholic beverages. Since then, the sale of illegal alcohol on the black market has flourished, leading to mass poisonings. The latest case, reported by Iranian media, has killed around 40 people in northern Iran in recent months.
Only Iran’s recognized Christian minorities, such as the country’s Armenian community, are allowed to produce and consume alcohol, but discreetly and only at home.
Illustrative Photo by Amanda Brady: https://www.pexels.com/photo/elegant-champagne-coupes-in-sunlit-setting-29157921/
Health & Society
What is food neophobia – the fear of trying new dishes
Everyone has heard of anorexia and bulimia. But these eating disorders are far from the only ones.
There are people around the world who can only eat certain colored foods. Still others are addicted to water. About 5% of women between the ages of 15 and 35 are affected by some type of eating disorder. Among them are those with neophobia – the inability to try a new type of food. This problem sometimes also affects young children. For them, experts advise parents not to force them, but to explain to them the benefits of a given product. It is also an option to put them on the table in the company of other children who will set a good example.
Neophobia usually disappears around the age of 6. For some people, however, it remains a problem for much longer.
A possible explanation for this condition could be something happening in the person’s life – like choking on food, for example. As a result, a person may begin to avoid a certain type of food and thus give his phobia a “field of expression”.
The reasons for neophobia may lie not only in the psyche, but also in physical features. This disorder is genetically transmitted.
Illustrative Photo by Chan Walrus: https://www.pexels.com/photo/white-and-brown-cooked-dish-on-white-ceramic-bowls-958545/
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