@markhoro

Associate Professor in Psychiatry (AdelaideU). Maudsley Deprescribing Guidelines: https://nitter.cf/t.co/MdD00qaw2z (US) https://nitter.cf/t.co/9eUVpPjCRX (UK)

London
Joined April 2013
I've written a blog in response to @awaisaftab's misleading blog about Kalfas: "No, the Kalfas Meta-Analysis Doesn’t Prove Antidepressant Withdrawal Is Modest: Nonsense Disguised as Nuance" bit.ly/4ofhd7S
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Mark Horowitz @markhoro.bsky.social retweeted
"'In my clinic, I see people who have felt trapped on antidepressants for years because attempts to stop have caused unbearable withdrawal symptoms,' Horowitz said. 'Clinicians should recognize that withdrawal is probably more likely than relapse while people are reducing antidepressants. 'An increase in symptoms should prompt a slower, more careful hyperbolic taper, such as outlined in the Maudsley Deprescribing Guidelines, rather than be taken as evidence that the medication must be continued long term. 'For patients considering stopping, my message is: Do not stop abruptly. Speak to a knowledgeable clinician about a gradual, supported taper, using a liquid formulation or compounded capsules where necessary to reach the small doses required.'" buff.ly/K2PAH0d
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This is eminently sensible from Professor Frances on the topic of benzodiazepines. One interesting aspect is that these points which are controversial in the US are largely accepted in the UK for benzodiazepines. Which shows how much culture comes to play in how drugs are regarded. Which raises the question of how much prevailing cultural and professional attitudes affect the perception of benefit and harm for other psychiatric drug classes?
Benzos are awful meds: 1)Highly addicting 2)Dangerous side effects 3)Dangerous withdrawal 4)Deprescribing takes many months 5)90% prescribed carelessly by GPs 6)Esp harmful to elderly (yet 8% are on them) 7)Serves no useful purpose 8)Dont start/Stop slow with MD help Great read:
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Mark Horowitz @markhoro.bsky.social retweeted
Prof Moncrieff said the distinction mattered because patients would weigh up treatment differently if told a drug altered normal brain function rather than repaired a proven defect. gbnews.com/health/mental-hea…
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I don't agree with everything RFK Jr says but I think the mainstream media owe him an apology on this account. I have had many patients say that they found coming off antidepressants harder than coming off heroin. And now there is large-scale data to back up those anecdotes. This of course is distinct from addiction. The pre-requisite for withdrawal is physical dependence which is a predictable physiological response that is the consequence of adaptation to a drug. Physical dependence does not involve compulsion, craving, etc. Opioids cause addiction because of their reinforcing euphoria which antidepressants do not do. But they are both cause physical dependence and evidently comparable levels of withdrawal for the higher risk antidepressants.
In an analysis of drug withdrawal to the FDA adverse effects database here were the signals for the 20 drugs with strongest risk of withdrawal. Paroxetine, duloxetine and venlafaxine where in the top 20. Paroxetine was no. 4, above several opioids.
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Mark Horowitz @markhoro.bsky.social retweeted
Andrew Scull is one of the most important historians of psychiatry. A must-listen podcast for those interested in mental health. His book, Desperate Remedies, is essential to understand psychiatry.
Every generation of psychiatry invents a desperate remedy, declares it a breakthrough, and only later notices the wreckage. The hubris is the same: Psychiatry, Insane Asylums, Mental Illness, ECT, Lobotomies, Freud & Jun... youtu.be/s7d2d8FhevU?si=4Luz… via @YouTube
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MSN covering our new paper showing that plunges in mood and increase in anxiety after stopping antidepressants is most likely withdrawal and not relapse. Led by @HengartnerMP Links below
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Mark Horowitz @markhoro.bsky.social retweeted
Yesterday, a young man told me he still has emotional numbness 10 years after stopping an SSRI. He is not alone and it suggests a persistent re-set of neurological pathways. I really hope these do return to baseline, but for some people it is not quick.
“Is it a permanent rewiring? No, because if we stop the medication, you go back to baseline.” Dr. Anthony Rostain, Chair of Psychiatry and Behavioral Health at Cooper Medical School, falsely claims emotional circuits in the brain are only temporarily affected by SSRIs.
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Mark Horowitz @markhoro.bsky.social retweeted
GB News highlights my work on the misrepresentation of depression and antidepressants as described in the updated paperback version of Chemically Imbalanced out earlier this month. @flint_books gbnews.com/health/mental-hea…
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Mark Horowitz @markhoro.bsky.social retweeted
We do not need emotion-numbing drugs like antidepressants to manage the effects of deprivation and inequality as this article suggests. We need social and economic change and to give people constructive support. theguardian.com/commentisfre…
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Very worthwhile survey for people in Canada
CALLING ALL PEOPLE LIVING IN CANADA WHO HAVE BEEN PRESCRIBED AN ANTIDEPRESSANT! Please take part in a survey about what people are being told about the potential effects of antidepressants, when they are prescribed. madincanada.org/2026/05/call…
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We find that stopping antipsychotic depots abruptly in @SchizBulletin Open is likely to produce too rapid a shift in drug levels to avoid withdrawal effects (which might provoke relapse), despite being much slower than stopping oral medication. This is contrary to the general wisdom that depots are 'self-tapering' on stopping. 6-monthly paliperidone might be an exception. Instead it makes more sense to taper depots to lowest dose and then switch to oral medications for a more careful taper. Led by industrious @jamieroneill. Link below.
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Mark Horowitz @markhoro.bsky.social retweeted
All young women who are considering taking an antidepressant should be shown this graph, and informed about the pregnancy complications associated with taking antidepressants.
NEW STUDY: Antidepressant use is associated with lower pregnancy rates & higher miscarriage rates among women receiving fertility care. Serotonin plays a crucial role in fertility & early pregnancy. SSRIs disrupt the serotonin system and, thus, would be expected to have an impact. This is an observational study, not an RCT, and the authors note that confounding by indication (depression) may contribute. But we have randomized animal studies that demonstrate effects on fertility & increased pregnancy loss. I think the entirety of the evidence supports the conclusion that the SSRI chemicals do have a chemical impact on fertility and early pregnancy, and I believe that patients and the public should be properly informed regarding this. sciencedirect.com/science/ar…
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Mark Horowitz @markhoro.bsky.social retweeted
This conversation in the NYT shows that the conversation on SSRI use is moving away from merely smearing critics towards more constructive engagement. Yet it still sidestepped a lot of the substance of critiques. The most shocking part was where Dr Rostain casually admitted that he didn't know whether one of his patients tapering off SSRIs after long term use was suffering from withdrawal or relapsing. How is it acceptable that after 40 years on the market an expert in the field doesn't know how to recognise SSRI withdrawal? Wouldn't it have been a good idea to establish this before 1 in 6 Americans were put on these drugs?
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Mark Horowitz @markhoro.bsky.social retweeted
New prospective cohort study published by my group with @markhoro We show that rapidly increasing depressive and anxiety symptoms during antidepressant tapering likely reflect withdrawal reactions - and not relapsing mental disorders. Open access: karger.com/pps/article/doi/1…
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Mark Horowitz @markhoro.bsky.social retweeted
The paperback of Chemically Imbalanced was released yesterday amid continuing debate about the never-ending rise in antidepressant prescriptions. I argue that medicalising misery is not supported by science and ultimately does more harm than good.
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