I was prescribed Lexapro a few months ago, and while I don't have any plans to go off of it in the immediate future, I did have an encounter with unexpectedly discontinuing it a couple of months ago. I was planning on getting my prescription filled on a Friday, but forgot. I realized this at 12:30pm on Saturday, after the pharmacy had closed. I went without Lexapro for three days: Saturday, Sunday, and Monday (it was a holiday). During that time I lost a significant portion of my hearing of all things; things sounded muffled, as if I had pressure built up in my ears and needed to pop them, but I could easily pop them and it didn't improve. I was also very irritable and had "brain fog", but that wasn't unexpected and was manageable.

Tuesday my pharmacist said that he'd never heard of anyone complaining about hearing issues discontinuing Lexapro and to let him know if it didn't clear up. About three hours after taking it again, I noticed I was able to hear better, and by the next morning I was back to normal.

The best sources of data are your historical responses and those of your family members, and even then, it's really unreliable.

Historically, I have had extremely few side effects from any medication, cold turkey (unintentionally, except for v. small doses of v. safe meds) or tapered off, and I have unfortunately had occasion to try a large spread of psychopharmacology.

Some of those medications either did nothing for me from their primary/intended effect set, while they were extremely effective for family members - not just limited to psychiatric medications, but they do have a great deal of variability in response compared to some.

Some medications that work on me but have no obvious secondary effects than sometimes mild sedation (opioids) do nothing for some of my immediate family (positive or negative) or are extremely powerful on others.

Some medications that leave me with no positive or negative emotional responses to anything are extremely effective for some immediate family members and even worse for others.

Some medications that are strongly sedating for some of my family members (antihistamines) have never done anything useful for me.

Some medications (both in the ??RI classes and a couple of atypical ones) that are helpful or neutral for me induce manic or depressive episodes in family members.

This is a hard problem, and it's going to take a good amount of work and better data curation (e.g. not asking a patient what they took for how long and how well it worked by word of mouth as a primary source) before we get any better at guessing.

I think the reason its under-discussed is that there is a collective group-think which functions as overwhelming (to the individual) reinforcement: "there is no other way available to solve this problem than the mass sale and consumption of pharmaceuticals".

The moment someone proposes a non-pharmaceutical (read: profitable) solution to many of these ills, they are shut down by the group-think. This is under-discussed, imho, because in the context of social/peer pressure to conform to a very Western normative (consumerism), individual responsibility is shut down.

EDIT: and the downvotes demonstrate my point, because "everyone knows pharmaceuticals are the only solution" ...

You meant American, because in the UK the front-line treatment for depression or anxiety is a talking therapy, coupled with social prescribing (which to be fair has variable availability), and then medication if indicated.

OP talks about a long term prescription for clonazepam, and current advice is that long term benzo use must be avoided.

It's the front-line treatment for mild depression and mild-to-moderate anxiety, because of the poor evidence for the efficacy of antidepressant medicines for patients with less severe illness. SSRIs and talking therapies are recommended equally for moderate or severe depression and severe anxiety, because the evidence suggests that they are equally effective.

NICE guidance states that benzodiazepines should not be prescribed for more than two weeks, because of diminishing efficacy and the risk of dependence.

SSRIs are cheaper and more convenient than psychotherapy, which should not be underestimated. The NHS certainly can't afford to offer psychotherapy to everyone who could benefit and many Americans don't have adequate insurance coverage. Getting psychotherapy outside of office hours can often be a significant challenge, which is a total dealbreaker for many people. I would certainly like to see greater use of psychotherapy (particularly for people with chronic and/or severe disorders), but there's nothing innately wrong with the widespread use of a safe and effective class of drugs. There just isn't any evidence to suggest that SSRIs are inferior to psychotherapy, although it may be the case that some patients who do not benefit from SSRIs would benefit from psychotherapy (and vice-versa).

https://www.nice.org.uk/guidance/cg90/chapter/1-Guidance#ste...

https://www.nice.org.uk/guidance/cg113/chapter/1-Guidance#st...

I think there are very definitely market forces at work, keeping people in the mindset that pharmaceuticals are the only 'real' effective solution to their ills - when so, so many other alternatives are available. I don't doubt that chemicals can make peoples lives happier - I see it all the time.

What I resist, however, is the notion that individuals should subjugate themselves to collective will just because everyone says pharmaceuticals are the way. Maybe strengthening ones resistance to groupthink and collective-derived thought processes is also an effective way to strengthen ones mental health .. alas, this point of view is too often overwhelmed by the very mob it serves to service, however ...

What I'm getting from this is you have a specific agenda against "group think and collective-derived thought processes" and are being purposefully vague, as demonstrated with "...".

What is your alternative? You seem to have one in mind.

Case in point: The West's mental health addiction problem. It isn't getting better because of pharmaceutical treatment: its getting worse.

Do you mean a over reliance on antidepressants for treatment?

My only point is, don't just blindly accept pharmaceutical dependence without at least considering the alternatives. Pharmaceutical addiction is no benign thing - addiction and dependency is a key factor in the profit motives of the military-industrial-pharmaceutical complex. Before you fall for their traps, be sure you've considered the alternative.

Accepting ones own personal responsibility is a requirement for a healthy mental condition; leaving the responsibility for ones mental health to other agencies and denying ones own agency - well, this is the very definition of mentally un-well.

Educate yourself before you fall into this scenario, is what I'm saying. Sure, if you're so mentally un-well that you can't care for yourself, you're going to need help - but too many times, that help turns to betrayal when one problem (mental illness) gets supplanted with another (pharmaceutical addiction).

There are no silver bullets to mental illness - not even the ones that come in a nicely packaged pill container.

We do not have the handle on mental illness that we think we do.

So no, just assuming "because everyone else is doing it" is not a good enough reason, imho, to put oneself in the position of addiction to pharmaceutical products. Take personal responsibility, and consider the alternatives before one becomes pharmaceutically dependent in order to maintain a 'healthy life'. This is a mine-field, and is by no means a settled issue in our current culture.

Agreed!!

> I just want there to be an awareness that all therapies aren't created equal, and people could be lead some bad places depending on how poorly educated they become. After all, people still use alcohol to cope with mental health. Who knows what ridiculous notions someone could come up with given enough ingenuity and misinformation?

Unfortunately in my experience, the level of education doesn't help. I've known medical doctors that know exactly the risks involved yet still make poor choices because they haven't resolved the underlying issues. Medical doctors can be good at treating other people, but very bad at "treating" themselves and family.

So the best answer I can come up with is, who cares if someone wants to use alcohol (or heroine, etc.) to get relief as long as it's not causing anyone else physical or mental harm, recognition by that individual that its a crutch therefore temporary, and a focus in resolving the real issues.

And that's really why you need a medical doctor taking the edge off your symptoms and therapist who helps you deal with the underlying issues themselves. Medicating and go is a terrible, terrible idea.