Talk:Antidepressant

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Suicidal ideation[edit]

The summary in this article includes some cherry-picking and leads to a conclusion not found in RS or in the main article. For this reason, I have removed those references and added from the summary of the "Antidepressants and suicide" article in this edit. Although it's been changed quite a bit, I'll add this template to be safe: Template:Copied petrarchan47tc 22:43, 8 June 2014 (UTC)

I disagree with your edit, your edit summary states:

'Rmvd cherry-picking, summarized from main article (where there is no mention that only in the beginning of treatment is the risk greater, as was previously stated here)'

But the main article states 'Fourteen years later, warning labels were put on antidepressants suggesting particular difficulties during the early phase of treatment' So there is reference to problems at the beginning of treatment which is synonymous to early phase.

You've removed an FDA reference, that's a strong reference. You've also removed a meta-analysis (Risk of suicidality in clinical trials of antidepressants in adults: analysis of proprietary data submitted to US Food and Drug) which is a high level of evidence. The meta-analysis agrees with the main article that the increased risk for suicide from antidepressant use is age dependent and decreases with increasing age. There is also a Cochrane Review reference that's been removed.

I don't think you should assume the main article is superior. I think the meta-analysis study should be in the main article. I don't see any evidence of cherry picking. Woodywoodpeckerthe3rd (talk) 23:09, 8 June 2014 (UTC)

I've reverted it. The older version was better referenced, more detailed, and more precise. Petrarchan47, why would you remove a meta-analysis supported statement that the risk of suicide is lowered by anti-depressants in those over 25 unless you have better references saying that this is incorrect? I did not see any mention of such references. Formerly 98 (talk) 23:24, 8 June 2014 (UTC)

Please don't undo this work, it contains much more information. There was a cherry-picked mention from one review stating that only in the beginning of treatment is suicidal ideation increased. First you wrote that in the first few weeks this is the case - which is not found in the source. Then it was changed to "at the beginning of treatment". I would rather see more references stating this relationship, as I can't find support for it. I will revert but leave the reference in place (sans claim that effect is only found in early days of usage). I did not mean to remove any claim that risk is lowered once over 25. I thought my version was pretty clear that this is a risk for younger people. petrarchan47tc 23:30, 8 June 2014 (UTC)
You removed it because it was less detailed, but added an unsupported detail about "in the early stages". You removed:
It remains controversial whether increased risk of suicide is due to the medication (a paradoxical effect) or part of the depression itself. The antidepressant may enable those who are severely depressed, and who ordinarily would be paralyzed by their depression, to become more alert and act out suicidal urges before fully recovered from their depressive episode.[1][2] The increased risk for suicidality and suicidal behaviour among young adults approaches that seen in children and adolescents.[3]
References
  1. ^ Cite error: The named reference Levine-Antonuccio-Healy was invoked but never defined (see the help page).
  2. ^ "SSRI Antidepressants". Patient.co.uk. 2010-10-27. Retrieved 2012-11-30. 
  3. ^ Stone, M.; Laughren, T.; Jones, M L.; Levenson, M.; Holland, P C.; Hughes, A.; Hammad, T. A; Temple, R.; Rochester, G. (2009). "Risk of suicidality in clinical trials of antidepressants in adults: Analysis of proprietary data submitted to US Food and Drug Administration". BMJ 339: b2880. doi:10.1136/bmj.b2880. PMC 2725270. PMID 19671933. 
It makes no sense to argue that you want more detail while removing an entire paragraph. I don't want to edit war, but this makes no sense. petrarchan47tc 23:34, 8 June 2014 (UTC)

Hey Petrarchan47,

Let me look and find some more references. This seems to be "common knowledge" among the psychiatrists I know, but the source is not a great one I acknowledge. Formerly 98 (talk) 23:35, 8 June 2014 (UTC)

Here is what the UK National Institute for Clinical and Health Excellence says:

"A person with depression started on antidepressants who is considered to present an increased suicide risk or is younger than 30 years (because of the potential increased prevalence of suicidal thoughts in the early stages of antidepressant treatment for this group) should normally be seen after 1 week and frequently thereafter as appropriate until the risk is no longer considered clinically important."

is that good enough? Formerly 98 (talk) 23:39, 8 June 2014 (UTC)

It's good enough to maybe add if given attribution, ie, "According to...". However in my knowledge this is WP:FRINGE, and that is evidenced by the fact that you could find only one reference to it. So the previous two versions of this had undue weight. I don't think the statement warrants inclusion with only one reference. This is a claim I have never heard (and I have a good number of Psychiatrists in my family, fwiw). petrarchan47tc 23:53, 8 June 2014 (UTC)
On further consideration, no, this one reference is not good enough. It's 5 years old. A recent MEDRS or two would be great. petrarchan47tc 23:59, 8 June 2014 (UTC)

Ive heard a lot of arguments on Wikipedia before, but this is the first time I've heard NICE called fringe. Do you know who NICE is???? Formerly 98 (talk) 03:59, 9 June 2014 (UTC)

sexual side effects[edit]

just gathering most recent reviews here for use in the future

  • Schweitzer I, Maguire K, Ng C. Sexual side-effects of contemporary antidepressants: review. Aust N Z J Psychiatry. 2009 Sep;43(9):795-808. PMID 19670052
  • Serretti A1, Chiesa A. Treatment-emergent sexual dysfunction related to antidepressants: a meta-analysis. J Clin Psychopharmacol. 2009 Jun;29(3):259-66. PMID 19440080 (already cited)
  • Kennedy SH, Rizvi S. Sexual dysfunction, depression, and the impact of antidepressants. J Clin Psychopharmacol. 2009 Apr;29(2):157-64. PMID 19512977
  • Gartlehner G et al. Comparative benefits and harms of second-generation antidepressants: background paper for the American College of Physicians. Ann Intern Med. 2008 Nov 18;149(10):734-50. PMID 19017592

still hunting. Jytdog (talk) 12:02, 5 August 2014 (UTC)

problem with an extract[edit]

  • hello,

i decided to write on the "talk" of this article because i have a problem with an extract of this article. the extract: "In the late 1990s, some investigators thought that the fact that symptoms emerged when antidepressants were discontinued might mean that antidepressants were causing addiction, and some used the term "withdrawal syndrome" to describe the symptoms. Addictive substances cause physiological dependence, so that drug withdrawal causes suffering. These theories were abandoned, since addiction leads to drug-seeking behavior, and people taking antidepressants do not exhibit drug-seeking behavior. The term "withdrawal syndrome" is no longer used with respect to antidepressants, to avoid confusion with problems that arise from addiction.[1]"

the history of the problem: i wanted to traduct this extract for the french version. i have see your source, this: http://www.ncbi.nlm.nih.gov/pubmed/16913164 and i would like to read the complete article so i search the complete article and i find it here: http://www.aafp.org/afp/2006/0801/p449.html

and i decided to read the article to understand the argument to says that symptoms of discontinuation antidepressant are not caused by dependency or addiction or that the term "withdrawal syndrome" is no longer use. and after reading this article, there are no mention of that anywhere. the source don't justify this extract. and the extract need to be reformulated or deleted.

i think the debate "dependency or not and "syndrome or not" is not close; and putting this extract without justification close the debat.

for exemple in french wiki you read this: here http://fr.wikipedia.org/wiki/Antid%C3%A9presseur in this section: "Syndrome de sevrage et dépendance" : "Les antidépresseurs IRS peuvent entraîner à l'arrêt un syndrome de sevrage. Une méta-analyse danoise a conclu qu'il s'agit de dépendance32. Comme l'akathisie, le syndrome de sevrage peut entraîner des pulsions meurtrières et des suicides33, les suicides étant cette fois entraînés. Le nombre de personnes sujettes a un syndrome de sevrage varie selon les molécules de 50 % à 78 % environ. Certains laboratoires ont été condamnés pour avoir caché cette possibilité (Deroxat / Seroxat / Paxil par exemple)[réf. souhaitée]. Le syndrome prolongé de sevrage aux antidépresseurs (pouvant durer des mois ou des années) n'est pas reconnu en France. Plusieurs forums Internet sont consacrés à ces problématiques.

La revue Prescrire a en 2008 rouvert le débat sur la dépendance en publiant un extrait du livre Medicines out of Control? Antidepressants and the Conspiracy of Goodwill de Charles Medawar et Anita Hardon. L'extrait choisi évoque la dépendance aux antidépresseurs et l'absence de reconnaissance de cette dépendance par le milieu médical. Ce livre a également reçu un des prix Prescrire34."


i hope you will understund what is written in this extract of french wiki.

thanks for reading

(consider that i am not often on the english wiki and perhaps i will not read your response. but you can contact me in the french wiki, the adresse of the account is in my user's page) Vatadoshu (talk) 11:42, 29 January 2015 (UTC)

  • yes, the french wikipedia has different standards than English WP. The controversy over addiction is old and ended about 10 years ago in the scientific community. I rechecked pubmed and found a recent review on this, and have added content to the article based on it. It notes that some drugs sold only in France are more prone to abuse (but even that abuse is rare and mostly limited to people who already had substance abuse issues). Jytdog (talk) 12:11, 29 January 2015 (UTC)
  • perhaps the controversy is ended about 10 years" but it is staying that the "reference" n°112 has no link with the sentence, you may delete the reference.
i didn't talk about substance abuse or misuse, you seem to have no look at the french extract i posted.
i talked about this study http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2011.03686.x/abstract;jsessionid=B0150DB6760E20579DCD1939A7F804B6.f04t01 dated of 2012 so recent. that conclude: "Withdrawal reactions to selective serotonin re-uptake inhibitors appear to be similar to those for benzodiazepines; referring to these reactions as part of a dependence syndrome in the case of benzodiazepines, but not selective serotonin re-uptake inhibitors, does not seem rational". but do what you want. Vatadoshu (talk) 12:55, 29 January 2015 (UTC)
hi - thanks for pointing out again PMID 21992148. I added content based on that, as well as the 2 responses, which re-iterated the scientific consensus. The section of the French article you pointed me to has unsourced content in it and a dead link. Seems written by someone with an ax to grind. Thanks again for raising these issues. The article has been improved with more sources now! Jytdog (talk) 13:14, 29 January 2015 (UTC)


  • ok @Jytdog:
  • there is nothing to read in your links of reference, you post with the sentences added to the article:[121][122]. the links work but on the web site, there is no information, only the title.
you could insert the link of the complete article? why don't you? readers of wikipedia could read the complete article instead of "a title".
(perhaps you do this, in order to have, a link modèle like pubmed or ncbi?)
i post the links of the complete article, corresponding of the "ncbi link" with no information.
121 : http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2012.03862.x/full
122 : http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2011.03736.x/full
  • How did you manage to find studies, that follow (in pages) the article, I gived to you? (i have seen ,concerning the studies you posted, that the study you posted , where on the next page of the same book)

  • you could add (carry on) on this sentence of the article:
"Responses to that review noted that there is no evidence that people who stop taking SSRIs exhibit drug-seeking behavior while people who stop taking benzodiazepines do, and that the drug classes should be considered differently..."

->keeping the same references:

"... (ref121-122), even if ,Symptoms that appear on the cessation of treatment, are similar for ssri and benzodiazepines." (perhaps reformulating in a better english)

  • because the two studies say that:
the first study:
"The fact that these symptoms are similar to those that occur with abrupt discontinuation of the use of benzodiazepines is also true" in this:
http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2012.03862.x/full
the second study:
" Thus, BZD and SSRI withdrawal reactions are very similar in their clinical impact despite the differences in the underlying pharmacology, but there is one major difference...drug seeking"
http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2011.03736.x/full
  • One of the two studies (you posted the link) speaks of "withdrawal reactions." as that term seems to be ok even if there is no dependency.
  • the dead link is normal i have juste copy and paste the text without the code.
i tried to modify but even with copy paste the code it does not work. the second reference of the french wiki is in french here: http://www.prescrire.org/docus/po2008_lpvantidepresseurs.pdf
  • in studies they say that symptomes ar the same as dependency wherehas what is different is only drug-seeking. it is just that the name of that don't exist. dependency is a term too rigid that seem to ban the possibility of a form of isrs dependency. just nobody knows how to name that.
  • Doors should not be closed, whether it is named : dependency or "not dependency" or "another thing".
Vatadoshu (talk) 19:05, 29 January 2015 (UTC)
I don't understand most of what you write above. Thanks again for posting! Jytdog (talk) 19:19, 29 January 2015 (UTC)

@Jytdog: yes i try but it is complicated. please could you read the last post another time.
if you see the term "dependance " it mean dependency, it is an error of traduction. Vatadoshu (talk) 19:55, 29 January 2015 (UTC)

  • What you are trying to say about content in this article... maybe I do not understand. I understood your first post, to say that you think the English Wikipedia are should use the language of "addiction" and "withdrawal" and "dependence" and not "discontinuation syndrome." I responded, saying that the English-language medical literature does not use the language of "addiction" and "withdrawal" and "dependence" - those terms are used for addiction - things like heroin and alcohol. In English, SSRIs do not cause addiction/dependence/withdrawal. If you were making some other point, I am sorry that I do not understand. Jytdog (talk) 19:57, 29 January 2015 (UTC)

@Jytdog:here I use google translation. I am not saying that we should talk about addiction, withdrawal or withdrawal syndrome. i dunno. I'm just saying that we should not close the doors. and if the term addiction is too rigid and does not stick, because of drug-seeking behavior that is not present in the ssri. Perhaps there will one day be a specific name for the ssri or may be it is a form of addiction. so you better understand this message, maybe translate my previous message.Vatadoshu (talk) 20:08, 29 January 2015 (UTC)

Thank you, I understand you! Jytdog (talk) 20:35, 29 January 2015 (UTC)

with the help of google[edit]

@Jytdog:ok i understand English, but I can not write in English it's frustrating.
the previous message:

  • There is nothing to read in the links of your references (references 121 and 122 that you posted with your sentence). The links work, but on the website, there is no information. On the website "ncbi" only the title appears: you can insert a link to the full article?

why do not? readers of "wikipedia" might be interested to read the article complet.
Is it because of the link model: "PMID" you do not want to put the full articles?
(same for the link 120 you did not put the full article as I gave you the link to full article)
links to full items corresponding to the links you put those there are:
http://www.ncbi.nlm.nih.gov/pubmed/22471576?dopt=Abstract
http://www.ncbi.nlm.nih.gov/pubmed/22471575?dopt=Abstract

  • My curiosity: How did you manage to find these items? Knowing that I have noticed that they are on the next page of the same book (with the reference 120 you put in the article and that I have communicated) .
  • You have added this sentence to article:"Responses to that review noted that there is no evidence that people who stop taking SSRIs exhibit drug-seeking behavior while people who stop taking benzodiazepines do, and that the drug classes should be considered differently..."

You could continue your sentence -in keeping the same references- and say,
"... even if the symptoms that appear to discontinuation were similar for ssri and benzodiazepines." (reformulated in a better English)
I propose to continue this way your sentence because the 2 studies (121 and 122) say this:
The first study:
The fact that these symptoms are similar to those that occur with abrupt discontinuation of the use of benzodiazepines is also true" in this:http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2012.03862.x/full
The second study
"Thus, BZD and SSRI withdrawal reactions are very similar in their clinical impact despite the differences in the underlying pharmacology, but there is one major difference...drug seeking"
http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2011.03736.x/full

  • One of the two studies :

http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2012.03862.x/full
refers "withdrawal reactions." This term seems to be ok to name.
" there is a good rationale to support the use of the term ‘Withdrawal Reaction’ in discussions about the discontinuation syndrome associated with cessation of SSRI use."

  • les dead links I posted in the article french are normal, I did not copy and paste tags références. I'tried to copy the text with tags but the links still worked not.The second link is present in the french excerpt I've put this one was:

http://www.prescrire.org/docus/po2008_lpvantidepresseurs.pdf
La "revue prescrire" is a known and respected magazine in France. she revealed in France related problems "mediator".
https://fr.wikipedia.org/wiki/La_revue_Prescrire

  • In studies (ref 121 and 122), the 2 studies say that the symptoms are the same for ssri and benzodiazepines but what is different is only the drug-seeking behavior that leads to an increase doses.It is maybe just the name for the SSRI withdrawal phenomenon is not.The term is too rigid "dependency" and appears to prohibit the possibility of another form of addiction. it's just that nobody knows how the call. it's a battle of words.

the debate should not be closed, it states that it is of dependance/addiction, or that this is not dependance/addiction, or is something else.

  • thank our patience both if you can understand me. google translation too .

(note: I had made a mistake in the previous posts, I thought the term was "dependance" , then "dependency" , while "dependence")
I know that the terms "addiction" and "dependence" are different.
Google seems to substitute one for the other.

  • curiously on the next page

https://en.wikipedia.org/wiki/Physical_dependence
If you do a search on the page with ssri in several places it is written that ssri cause physical dependence.Article on physical dependence contradicts the sentence
" Addictive substances cause physiological dependence, so that drug withdrawal causes suffering. These theories were abandoned, since addiction leads to drug-seeking behavior, and people taking antidepressants do not exhibit drug-seeking behavior. "
of this article on antidepressants.

  • the fact remains that the reference:

"Warner CH, Bobo W, Warner C, Reid S, Rachal J (August 2006). Antidepressant discontinuation syndrome. Am Fam Physician 74 (3): 449–56. PMID 16913164.".
Which is supposed to justify this sentence: " The term withdrawal syndrome is no longer used with respect to antidepressants, to avoid confusion with problems that arise from addiction.".
The full article here: http://www.aafp.org/afp/2006/0801/p449.html.
it is nowhere stated that sort of thing. it is written in this article:
the phrase:
"in early reports it was referred to as a “withdrawal reaction.”
and the phrase:
"Early reports of antidepressant discontinuation syndrome made heavy use of the term “withdrawal” to describe discontinuation symptoms; however, antidepressant medications are not believed to be habit forming and are not associated with drug-seeking behavior."
The phrase "wikipedia":
"The term "withdrawal syndrome" is no longer used with respect to antidepressants, to avoid confusion with problems that arise from addiction";
the term, " is no longer used, is an interpretation of originales.
Moreover again you should put the full article link; and not the link you put that overlooks a summary
http://www.ncbi.nlm.nih.gov/pubmed/16913164.
Vatadoshu (talk) 09:07, 30 January 2015 (UTC)

I've added an additional source that is explicit about abandoning "withdrawal" due to its association with addiction, which is the incorrect paradigm. With regard to citations, the citation identifies the source; pubmed generally provides a link in the upper right corner to the article and if there is a free version on pubmed central, it provides a link to that version. Jytdog (talk) 11:39, 30 January 2015 (UTC)


@Jytdog: Hi,

  • I came to ""pubmed generally provides a link in the upper right corner to the article", I did not know it existed. thank you.
  • I read your new source for the phrase that was a problem, that's ok.
  • I saw that you added this phrase.

"Responses to that review noted that there is no evidence that people who stop taking SSRIs exhibit drug-seeking behavior while people who stop taking benzodiazepines do, and that the drug classes should be considered differently"

  • in fact: one of the two said this review:

"SSRI users rarely escalate their doses, nor do they seek illicit supplies. Similarly, the bulk of BZD users are maintained on therapeutic doses by their prescribers. However, some do escalate their doses, becoming high-dose users with severe dependence" http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2011.03736.x/full#b10

  • not this, "Responses to that review noted that there is no evidence that people who stop taking SSRIs exhibit drug-seeking behavior while people who stop taking benzodiazepines do"
  • but I agree with the end of the sentence, " and that the drug classes should be considered differently."
  • This n 'not black or white. It would be easier, but it is not so.


The other study says this:
"The most appropriate term is a matter of context, not of the characteristics or severity of symptoms." If discontinuation symptoms occur in the context of a behavioral syndrome in which the procurement and use of a drug dominate an individual's motivation ......, this is DSM Dependence" ;and "if an individual takes benzodiazepines as prescribed by a physician for a long period of time and experiences physical and cognitive symptoms following abrupt continuation, this would most appropriately be called a withdrawal reaction" http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2012.03862.x/full

  • but another study says that:

"Withdrawal reactions, ....., are common in a proportion of both BZD and SSRI users, despite their being maintained on normal therapeutic dosages" http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2011.03736.x/full#b10

  • Thank you for the changes you have made.Vatadoshu (talk) 18:52, 30 January 2015 (UTC)
There appears to be some issue that is personally very important to you, but you are getting into nuances of language that google translate cannot support. I believe the current content is well supported. If you want to propose replacing some content and sourcing with some other content and sourcing I might be able to understand what you want. (i did some googling myself, and "having an axe to grind" in English is supposed to be close to "agir dans un but intéressé" in French) Jytdog (talk) 19:06, 30 January 2015 (UTC)

@Jytdog: :) "An ax to grind"~ may be for you. I just mean that studies contradict even if all agree to use another term to avoid confusion. but the new term implies that the symptoms are the same, it is the context and behavior that determines the term.
I would change anything, it is difficult to make myself understood here.Vatadoshu (talk) 19:25, 30 January 2015 (UTC)

@Jytdog: ok the term "antidepressant Discontinuation syndrome" is in the DSM-5. page 412 you can add this too. https://books.google.fr/books?id=lKeTAwAAQBAJ&pg=PA531&lpg=PA531&dq=Antidepressant+discontinuation+syndrome+dsm+5&source=bl&ots=t-XND9gA8G&sig=Lr2V1hpmhbk9LVYMC96rKtXnqdU&hl=fr&sa=X&ei=RufLVJnOG8vmavqPgpAC&ved=0CDMQ6AEwAg#v=onepage&q=Antidepressant%20discontinuation%20syndrome%20dsm%205&f=false Vatadoshu (talk) 20:26, 30 January 2015 (UTC)

I'm having a little trouble following this conversation, but think it is important to communicate that 1) some people experience unpleasant symptoms when they stop an antidepressant, but 2) it is very different from drugs like alcohol, opiates, nicotine and benzodiazpines that induce psychological dependence and drug seeking behavior. For this reason I like "discontinuation syndrome" better than "withdrawal", which carries strong implications of psychological dependence. I'm aware that many in the literature have used these terms interchangably, even though the syndromes are widely agreed to have very different characteristics. I would very strongly urge that we not do so. Formerly 98 (talk) 21:05, 30 January 2015 (UTC)
@Jytdog: ok.

I say, I discovered that the term "antidepressant Discontinuation syndrome" is registered in the DSM-5.
and you can add a sentence that says that the term included in the DSM-5.
I've put the book link in the previous message, the term appears on page 142.
if you do not know what the DSM-5, look here: https://en.wikipedia.org/wiki/DSM-5 Vatadoshu (talk) 22:52, 30 January 2015 (UTC)

My 2¢.[1] Seeing as how this is referring to benzo (GABA) antagonists, I suspect this is indicating physical dependence, since dependence from benzos (and probably GABA antagonists) is primarily physical. In any event, there are many terms for various types of withdrawal-related syndromes that do not constitute true dependence; e.g., rebound effect describes an effect where a user experiences symptoms similar but not identical to a withdrawal syndrome. A meth abuser that uses the drug to stay awake continuously for 100 hours, for example, will experience progressively more physical strain from doing this and will have a massive crash (a rebound effect) upon cessation of methamphetamine use; however, this isn't physical dependence because it typically doesn't involve negative reinforcement (i.e., staving off the ensuing crash isn't the reason for continued meth use: the rewarding effect of the high is). Meth actually doesn't produce physical dependence. In light of this, it's probably best not talk talk about SSRI dependence and withdrawal if most sources use the term "discontinuation syndrome" instead.
Also, dependence is a completely distinct phenomenon from addiction. Addiction involves only positive reinforcement, whereas dependence arises through negative reinforcement; in light of that, it's not surprising that the mechanisms in the brain associated with addiction and dependence are distinct. In any event, there is literally no way a generic SSRI can induce an addictive state unless it also has strong DAergic effects (I don't know of any that fit this description). Blocking the serotonin transporter throughout the brain will have only a trivial effect on signaling in the nucleus accumbens (and therefore have no effect on nucleus accumbens ΔFosB). Seppi333 (Insert  | Maintained) 03:45, 31 January 2015 (UTC)
References
  1. ^ Malenka RC, Nestler EJ, Hyman SE (2009). "Chapter 14: Mood and Emotion". In Sydor A, Brown RY. Molecular Neuropharmacology: A Foundation for Clinical Neuroscience (2nd ed.). New York: McGraw-Hill Medical. p. 355. ISBN 9780071481274. Although the remainder of this section is devoted to a discussion of antidepressant-induced neuroadaptations, a series of clinical studies conducted during the past 10 years, which supports a role for serotonergic and noradrenergic systems in antidepressant action, deserves comment. According to these studies, patients with depression who respond to treatment with an SSRI exhibit a brief relapse when their body stores of tryptophan, the precursor of serotonin, are depleted (Chapter 6). In contrast, such tryptophan depletion does not cause relapse in patients treated with NRIs. Moreover, patients treated with NRIs experience relapse in response to inhibition of catecholamine synthesis with α-methylparatyrosine (AMPT), an inhibitor of tyrosine hydroxylase (Chapter 6), whereas patients treated with SSRIs do not. Overall, these findings indicate that monoamine systems are important substrates for the clinical efficacy of antidepressants. In addition, the brief relapses described here may represent withdrawal phenomena akin to those associated with benzodiazepine antagonists. However, the studies that produced these findings do not reveal the specific changes in the brain that mediate such clinical responses and do not offer information about the pathophysiology of depression. 

Seppi333 (Insert  | Maintained) 03:50, 31 January 2015 (UTC)

Exercise[edit]

Just dropping these refs here for now since I don't have time to add them here for another article for which I was doing this lit. search.

Will probably add something on its efficacy as a sole/adjunct treatment for depression under "Systematic reviews" using these 4 papers sometime tomorrow. Seppi333 (Insert  | Maintained) 04:53, 5 February 2015 (UTC)

Antidepressant[edit]

hi jeatdog (sorry for my english) yes my "source" was french.

http://apps.who.int/medicinedocs/fr/d/Js4896e/9.html "To avoid the association with dependence, an increasing number of researchers have used a different term, discontinuation syndrome, instead of withdrawal syndrome. The number of hits for discontinuation syndrome in searches of the international medical literature began to increase, relative to the occurrence of withdrawal syndrome, in 1997 after a symposium on antidepressant discontinuation syndrome held in 1996."

  • ok it is not written elli lily or pfizer. because it was a sentence i found in this version.

https://en.wikipedia.org/w/index.php?title=Physical_dependence&oldid=647840566 "SSRI drugs, which have an important use as antidepressants, are considered to cause physical dependence, although it is considered mild compared to drugs like opioids and GABA modulators, but they engender a discontinuation syndrome, which was originally called "SSRI withdrawal" until a 1997 symposium sponsored by Pfizer and Eli Lilly (the producers of several anti-depressants including Prozac and Effexor) was held, with the drug representative attendees concluding that "discontinuation syndrome" sounded less threatening than "withdrawal"

and steppi333 had revert this because no source. (and perhaps because the end of the sentence:"with the drug representative attendees concluding that "discontinuation syndrome" sounded less threatening than "withdrawal". i have a source, and i have revert the problematic end of the sentence. what the problem? Vatadoshu (talk) 20:41, 26 February 2015 (UTC)

Thanks for talking! sounds like you understand what was wrong with your initial edit - it was not true, was based on a french source, and bizarrely cited a diff of unsourced being removed from another article. Based on the WHO document it seems that you could write new and accurate content. please go ahead. Jytdog (talk) 21:34, 26 February 2015 (UTC)
@Jytdog: it is not my language. i can't reformulate, i will do spelling mistakes. please do it for me. it is not in my competence to write from zero just with a document. that's why i keep the english sentence.(i cited the diff unsourced because it correspond). (french source can be true). i don't know how to do a correct link. the wikicode is not the same than french wiki. i tried here and it is bad, really. perhaps you have bot that traduct the french wikicode link?. (this document is interesting, there are 31 pages,-the table of content is at the top of the document)Vatadoshu (talk) 09:52, 27 February 2015 (UTC)
I added the source as a reference. Jytdog (talk) 12:18, 27 February 2015 (UTC)
@Jytdog:
yep it's ok.
(i find the original source, it was that http://www.cochrane.dk/research/theses/Nielsen%20PhD.pdf that say"1996Authorities describe SSRI withdrawal reactions as rare and relatively mild.Closed symposium on “Antidepressant discontinuation events” sponsored by Eli Lilly.UK authorities published a review of SSRI withdrawal reactions with the conclusion that there was no evidence of a physical dependence problem with the SSRIs and that withdrawal reactions were rare and “relatively mild”A supplement to the Journal of Clinical Psychiatry was published with several proceedings from the symposium in 1996. The supplement was sponsored by Eli Lilly.1998At a meeting in the Committee on Safety of Medicines (UK) an Eli Lilly representative expressed concern of the use of the term “withdrawal reaction” when referring to the symptoms occurring on withdrawing treatment due to the fact that the term “withdrawal”has a specific meaning and implies that the drug is addictive. Lilly suggested the term “discontinuation reactions”."
->yep neither pfizer, neither "sounded less threatening than" , but the remaining was correct. just needed to be reformulate.).
the modification you made is ok for me.Vatadoshu (talk) 18:03, 27 February 2015 (UTC)