Mark Horowitz @markhoro Twitter profile

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Mark Horowitz

3 months

The Maudsley Deprescribing Guidelines is available in the UK , US , Australia Canada elsewhere around the world (also at other booksellers).

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Mark Horowitz

@markhoro

2 years

🧵Is depression caused by a chemical imbalance/low serotonin? We conducted a review of all the major areas of research on this topic (free open acccess) @HengartnerMP @joannamoncrieff @tomstockmann 1/n

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Mark Horowitz

@markhoro

10 months

I received 300 emails asking for help coming off antidepressants since the BBC documentary, most have had withdrawal symptoms mis-diagnosed as relapse by their doctors. The most interesting were a handful of psychiatrists who wanted help to come off their own drug.

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Mark Horowitz

@markhoro

2 years

Over the last few weeks I have been contacted by several doctors - physicians, surgeons, GPs and, yes, psychiatrists - for advice on stopping their psychiatric medications.

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Mark Horowitz

@markhoro

6 months

After 3 years of work with @DavidTa23968240 and many other psychiatrists, pharmacists and patient experts I am happy to see The Maudsley Deprescribing Guidelines get a publication date (UK) (US)

The Maudsley Deprescribing Guidelines: Antidepressants, Benzodiazepines, Gabapentinoids and Z-drugs...

The Maudsley Deprescribing Guidelines: Antidepressants, Benzodiazepines, Gabapentinoids and Z-drugs (The Maudsley Prescribing Guidelines Series)

www.amazon.co.uk

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Mark Horowitz

@markhoro

2 years

The main criticism of our paper has been that the ‘serotonin hypothesis’ (or chemical imbalance) is a straw man argument. But for the public this explanation has been no straw man but something that has guided the direction of their choices, health and lives.

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Mark Horowitz

@markhoro

2 years

It is good to see our article on the Conversation generating interest with 140,000 reads today and heading towards being the most read article:

Depression is probably not caused by a chemical imbalance in the brain – new study

A new shows there’s no clear evidence that depression is caused by abnormally low levels of serotonin in the brain.

theconversation.com

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Mark Horowitz

@markhoro

11 months

Looking forward to this documentary on @BBCPanorama at 8pm on the 19th of June about antidepressant withdrawal and how its effects have been minimised by the companies that manufacture them and their academic spokespeople:

BBC One - Panorama, The Antidepressant Story

The companies trying to conceal concerns about their antidepressants.

www.bbc.co.uk

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Mark Horowitz

@markhoro

2 years

Has anyone been told by their doctor that their depression was caused by a chemical imbalance and that an antidepressant would fix it? Please like and retweet if so. If you put what country you are in and the year you were told that would be a bonus.

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Mark Horowitz

@markhoro

7 months

Here is what the data shows (Kendler, 2004) for ‘major depression’ (not bipolar, post-partum). An incredible correlation between number of stressful life events and risk of depression (modulated by personality which of course has some genetic component to it). 1/n

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Mark Horowitz

@markhoro

4 years

How to taper antipsychotic medication to minimise withdrawal problems: more slowly than you think, down to fractions of usually used doses. Might need liquid versions, pill cutters. Thks Robin Murray, David Taylor @sameerjauhar Sridhar Natesan @JAMAPsych

Tapering Antipsychotic Treatment

This Viewpoint discusses principles for tapering antipsychotic treatment when deprescribing them.

jamanetwork.com

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Mark Horowitz

@markhoro

3 years

I wrote a letter to the Guardian: Antidepressant withdrawal symptoms shouldn’t be mistaken for return of illness

Antidepressant withdrawal symptoms shouldn’t be mistaken for return of illness | Letter

Letter: Such symptoms occur in half of patients, and the correct response is to taper off their medication more slowly, says Dr Mark Horowitz

www.theguardian.com

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Mark Horowitz

@markhoro

2 years

NICE has given its opinion for the 3rd time that esketamine (Spravato) should not be used in the NHS for depression for any group of patients . Some of its reasons are worth outlining because they relate to many psych drugs 1/n

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Mark Horowitz

@markhoro

2 years

In future, we should be suspicious of any theory which purports to find that complex emotional problems are caused by a single chemical or vague brain-based process like ‘abnormal neural network’ which is vague enough to be true, but practically meaningless. 31/31.

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Mark Horowitz

@markhoro

2 years

Talked to a person today who stopped their long-term venlafaxine. They experienced brain zaps, akathisia, suicidality (never had previously). Saw a prominent academic psychiatrist who told them it was definitely relapse (they asked if it could be withdrawal - no).

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Mark Horowitz

@markhoro

1 year

Small victory: a patient who contacted me because their GP told them that they would not prescribe liquid to come off their antidepressant because they could just stop, changed their mind when shown the new NICE guidance. Happy patient. Result.

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Mark Horowitz

@markhoro

5 months

Great piece in Economist (paywall) How to stop over-medicalising mental health: "For all their good intentions, campaigns intended to raise awareness are leading some people to conflate normal responses to life’s difficulties with mental-health disorders."

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Mark Horowitz

@markhoro

2 years

We were asked to write about balance of harms and benefits of antidepressants based on current knowledge for @DTB_BMJ , a BMJ journal that is famously independent and does not take pharma sponsorship/advertising 1/n

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Mark Horowitz

@markhoro

2 years

Although it is apparently not news to most academics/psychiatrists it is news to the public because our paper is now the top trending story on many newspapers. Perhaps someone forgot to inform the public? @HengartnerMP @joannamoncrieff

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Mark Horowitz

@markhoro

2 years

Poverty, insecure work, sexism, racism, interpersonal conflict, etc all clearly associate with depression. The vast sums of money spent on looking for the chemical equation of low mood might be missing the forest for the trees 28/n

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Mark Horowitz

@markhoro

5 months

Brave to hear how one professor of psychiatry’s experience of being treated for psychotic symptoms in a biomedical versus humanistic way herself has led to her re-evaluating her treatment of patients.

Prof. Helene Speyer, University of Copenhagen, Denmark

How my lived experience changed my epistemic perspective

www.youtube.com

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Mark Horowitz

@markhoro

3 months

Glad to see a book that we came up with 4 years ago actually hitting people's letterboxes. Makes all those weekends and evenings tied to the computer (almost) worthwhile. Hopefully it will help a lot of people be able to come off their medications more safely.

Dimple Khatiri (Oza)🩷🧡💛💚

@DimpleKhatiri

3 months

It's here!!!! @markhoro cannot wait to get stuck into this! Much awaited! #deprescribing #mentalhealth

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Mark Horowitz

@markhoro

2 years

In short (detail below) we found that looking at all relevant studies that there is no evidence that serotonin is reduced/lower serotonin activity in depression versus healthy controls so no evidence for the serotonin hypothesis of depression in decades of research 4/n

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Mark Horowitz

@markhoro

4 years

Very proud to have co-authored this new guide from @RCPsych on how to stop antidepressants with @wendyburn @georgeroycroft David Taylor. I hope it will help inform doctors and patients. Next step is having services implement these principles

Stopping antidepressants | Royal College of Psychiatrists

Information for anyone who wants to know more about stopping antidepressants.

www.rcpsych.ac.uk

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Mark Horowitz

@markhoro

2 years

The strongest finding that came out of the review was how strongly stressful life events were associated with depression. The UN has suggested that rather than focus on chemical imbalances we should focus on power imbalances. 27/n

UN rights expert urges shift away from drugs in addressing depression

World Health Day – Friday 7 April　 GENEVA (5 April 2017) – Treatment for people suffering from depression must shift from heavy reliance on drugs and medicalised interventions to addressing power...

www.ohchr.org

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Mark Horowitz

@markhoro

7 months

Exactly this - never have I seen the famous textbook 'uncaused depression' in which the person with all their emotional needs met for as yet unfathomed presumed biological reasons is depressed

Jan Resnick

@janresnick

7 months

@wdpsychiatry In over 47 years of psychotherapy practice, I have never once seen a depressed patient who wasn't depressed for a reason. Despite my aversion to generalizing, most often there is unprocessed loss in the past, present, or imagined future.

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Mark Horowitz

@markhoro

11 months

Quite stunning that after widespread damage caused by these drugs has been brought to light by critical/whatevers, the response is not to reflect on how this has come about and what else is being missed but to attack and try to discredit.

Prof Joseph F Hayes

@J_F_Hayes

11 months

Critical/anti/whatever-psychiatry exists in a post-truth world enabled by popularists. There is considerable overlap with anti-vax, anti-science thinking. Science rarely deals with certainties this should be a 🚩 re: antidepressants

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Mark Horowitz

@markhoro

2 years

What is the name for the situation where you are criticising the data produced by drug companies to minimise the negative aspects of their products but the reviewers of your paper are the very Key Opinion Leaders who were paid by the companies to publish that data originally?

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Mark Horowitz

@markhoro

11 months

It was confusing replying to critics of our paper because some argued the serotonin hypothesis of depression was long ago discarded, some argued it was still supported - and some argued both. @joannamoncrieff @HengartnerMP @PloederlM

The serotonin hypothesis of depression: both long discarded and still supported?

Molecular Psychiatry - The serotonin hypothesis of depression: both long discarded and still supported?

www.nature.com

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Mark Horowitz

@markhoro

3 years

(Thread) Today we have published a paper on a way to reduce antipsychotics to minimise withdrawal effects and possibly relapse in @SchizBulletin . with thanks to co-authors Robin Murray, David Taylor, @sameerjauhar and Sridhar Natesan. (1/n)

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Mark Horowitz

@markhoro

3 years

The new edition of the Maudsley Prescribing Guidelines has 102 extra pages of which 25 are about how to deprescribe antidepressants, z-drugs, benzodiazepines, gabapentinoids, antipsychotics and mood stabilisers. Only brief on each - more to come next year

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Mark Horowitz

@markhoro

2 years

Our article on how to distinguish antidepressant withdrawal symptoms from relapse of an underlying condition is now free to access here: in @TheBJPsych Advances With @DavidTa23968240 BJPsych Podcast here: (1/n)

Distinguishing relapse from antidepressant withdrawal: clinical practice and antidepressant...

Distinguishing relapse from antidepressant withdrawal: clinical practice and antidepressant discontinuation studies - Volume 28 Issue 5

www.cambridge.org

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Mark Horowitz

@markhoro

2 years

Gave a tutorial on deprescribing to an entire MH team in London today who are planning increased deprescribing as part of their practice and thinking of setting up a dedicated service. Brilliant, thoughtful group - one of many services I've talked to focusing on this issue now.

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Mark Horowitz

@markhoro

7 months

With 70% of people meeting criteria for a depressive or anxious disorder by the age of 45 it seems hard to believe that 70% of people could have something wrong with their brain. Much more likely to be a response of a normal brain to adversity/stress 4/n

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Mark Horowitz

@markhoro

3 months

For those who claim we are stigmatising them by saying that people with depression have broken brains – we are ofc saying the exact opposite that it does not take an abnormal brain to be depressed – you can do it just fine with a normal one!(1/6)

Difficult lives explain depression better than broken brains

Molecular Psychiatry - Difficult lives explain depression better than broken brains

www.nature.com

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Mark Horowitz

@markhoro

2 years

This is a brilliantly thoughtful article about the serotonin paper, pointing out why both what the drugs do and how they do it are important

Why Has the Misleading “Chemical Imbalance” Theory of Mental Illness Persisted for So Long?

A new study has revived a vicious debate about antidepressants and how we think about depression.

slate.com

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Mark Horowitz

@markhoro

7 months

The WHO/UN in a new position paper on mental health and human rights have called for higher standards on informed consent regarding psychotropic drugs, including their right to discontinue treatment and support to do so

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Mark Horowitz

@markhoro

2 years

Why did we do this? 90% of the public believes that depression is caused by a chemical imbalance (amongst other reasons). Doctors routinely tell patients that their depression is due a chemical problem in their brain, particularly low serotonin. 2/n

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Mark Horowitz

@markhoro

2 years

Saying ‘there is biology in depression’ is not the same as justifying a specific biological treatment.If serotonin is not reduced in depression then what is the consequence of giving drugs that abnormally raise the levels of serotonin in the brain for months, years or longer? 6/n

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Mark Horowitz

@markhoro

3 years

We have a new paper giving an overview of stopping all psychiatric drugs with David Taylor. Principles of stopping slowly in hyperbolic manner apply to all. Outlined well for antidepressants here . Same applies for all psych drugs

Stopping antidepressants | Royal College of Psychiatrists

Information for anyone who wants to know more about stopping antidepressants.

www.rcpsych.ac.uk

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Mark Horowitz

@markhoro

11 months

"People are staying on antidepressants longer, and we don't really have long-term studies that support that." This is certainly a concern - when we know withdrawal effects are worse for longer term users.

Antidepressants: Two million taking them for five years or more

The scale of long-term use - and concerns about withdrawal symptoms - are revealed by BBC Panorama.

www.bbc.co.uk

Anne Guy 💙

@dranneguy

11 months

@markhoro on the Today programme now talking about this Antidepressants: Two million taking them for five years or more

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Mark Horowitz

@markhoro

7 months

SNOMED has today added code 1285639002 'Protracted antidepressant withdrawal syndrome (disorder)' to its system. GP practices I believe need to activate this code locally to use it. It also means that precisely 0 cases of protracted withdrawal have so far been recorded by NHS.

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Mark Horowitz

@markhoro

4 years

Just got an email from a senior scientific director of a major pharma co asking for guidance on how a loved one of his could get off an AD they have been unable to stop. I have now received 100s of such emails since last year. Possibly this is not an anti-psychiatry conspiracy?

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Mark Horowitz

@markhoro

11 months

Written a piece for the @ConversationUK to answer questions people might have after the @BBCPanorama documentary on antidepressant withrawal

Antidepressants can cause withdrawal symptoms – here’s what you need to know

The longer you taken an antidepressant, the more likely you are to experience withdrawal effects.

theconversation.com

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Mark Horowitz

@markhoro

2 years

Indeed, it has been shown that belief in a chemical imbalance as an explanation for depression leads to pessimism, and lower recovery rates. Patient should not be told that antidepressants for depression are like insulin for diabetes. This is not supported by evidence 24/n

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Mark Horowitz

@markhoro

2 months

It's very hard to see what you don't believe exists. There are now specialist neuro-urology clinics in the NHS in London that specialise in PSSD.

Robert Howard

@ProfRobHoward

2 months

Never seen PSSD in any of my patients. Colleagues I ask say the same. If it occurs it is v rare. Different from the recognised problems during treatment. Part of the poorly evidenced, ongoing monstering of antidepressants. Draw your own conclusions from responses to this tweet.

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Mark Horowitz

@markhoro

2 years

Evidence based medicine has been corrupted by corporate interests, failed regulation, and commercialisation of academia, argue these authors in the @bmj_latest

The illusion of evidence based medicine

Evidence based medicine has been corrupted by corporate interests, failed regulation, and commercialisation of academia, argue these authors The advent of evidence based medicine was a paradigm shift...

www.bmj.com

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Mark Horowitz

@markhoro

2 years

If the health system does not make useful formulations of drugs (e.g. liquids, tapering strips) available to patients to enable slow tapers then no amount of guidance matters and patients are stuck in the position of becoming Walter Whites in their kitchens. Words not enough.

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Mark Horowitz

@markhoro

8 months

Patient in England tapered by GP rapidly-> terrible withdrawal. Went back after help from online forums to draw GP practice attention to RCPsych guidance. Now practice has said they will circulate to Drs. pathetic that pts having to educate drs about drugs prescribed to 1 in 6.

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Mark Horowitz

@markhoro

2 months

A repeating story. A drug (in this case pregabalin) produces short term euphoria, hailed as an effective treatment for anxiety, except ofc in the longer term it leads to tolerance, dependence and withdrawal. NIHR continues to fund short-term studies

The Times & The Sunday Times

News and opinion from The Times & The Sunday Times

www.thetimes.co.uk

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Mark Horowitz

@markhoro

2 years

Another fallacy: People say that of course depression is caused by low serotonin because antidepressants increase serotonin and they improve depression. But this is faulty backwards reasoning (fancy Latin term: ex juvantibus). 9/n

Serotonin and Depression: A Disconnect between the Advertisements and the Scientific Literature

Many ads for SSRI antidepressants claim that the drugs boost brain serotonin levels. Lacasse and Leo argue there is little scientific evidence to support this claim.

journals.plos.org

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Mark Horowitz

@markhoro

5 months

We have responded to the argument put forward by Jauhar et al who support the current scale of antidepressant prescribing, including for mild conditions, and for those provoked by social and economic conditions:

No good argument for treating mild depression with antidepressants

www.bmj.com

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Mark Horowitz

@markhoro

2 years

Akin to concluding that headaches are caused by an aspirin deficiency or social anxiety by alcohol deficiency. That’s before we get into the discussion about whether the tiny effects of antidepressant are genuine/artefact and important/irrelevant 10/n

Newer generation antidepressants and withdrawal effects: reconsidering the role of antidepressants...

In England, the prescribing of antidepressants, primarily the newer generation antidepressant classes, has steadily increased over recent years. There is ongoing debate about how the efficacy of...

dtb.bmj.com

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Mark Horowitz

@markhoro

2 months

Good to see the issue of the difficulty stopping antidepressants being covered in France by @Le_Figaro

«Le syndrome d’arrêt des antidépresseurs touche de nombreux patients»

ENTRETIEN - Les travaux du neurobiologiste Mark Horowitz ont abouti à la mise au point d’un protocole de sevrage des médicaments psychotropes au Royaume-Uni. Il explique l’importance d’une démarche...

sante.lefigaro.fr

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Mark Horowitz

@markhoro

10 months

Another pitiful decision by the FDA based on a pitiful study. Escitalopram is more likely to make a children suicidal than to produce remission from anxiety in the pivotal trial but it has been approved from 7 to 11 years for this indication. Explained brilliantly by @PloederlM

Martin Plöderl

@PloederlM

10 months

1/ Escitalopram now approved for generalized anxiety disorders for children & adolescents. FDA considers it as safe and effective for this new indication, based on a recent RCT. Let's have a look at this trial ->

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Mark Horowitz

@markhoro

3 years

Interesting that our talk on deprescribing at the @rcpsych IC was one of the two most attended sessions of the week - suspect that this reflects psychiatrists recognising that this has been a neglected area of practice and research, so interest in upskilling - hopeful @wendyburn

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Mark Horowitz

@markhoro

2 years

I am also glad to get increasing messages from people to let me know that they have been going in to ask their GP for liquid versions to help taper off antidepressants and been able to advocate for this with RCPsych guidelines

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Mark Horowitz

@markhoro

10 months

Addiction and physical dependence are not the same thing. @thelancetpsych with @DavidTa23968240 Long term use of psychotropics leads to adaptation that predicts withdrawal when drug stopped = physical dependence. 1/n

Addiction and physical dependence are not the same thing

In March, 2023, NHS England released a commissioning framework to action the recommendations of the Public Health England report on prescribed drug dependence. A misunderstanding of the word depend...

www.thelancet.com

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Mark Horowitz

@markhoro

10 months

A representative email about the @BBCPanorama doc. A GP who has realised that his own attempts to stop antidepressants were probably withdrawal not relapse...

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Mark Horowitz

@markhoro

2 years

So, patients should not be told that they have a serotonin deficiency/chemical imbalance as there is no evidence for this statement. Suggesting that this is a ‘useful metaphor’ neglects the values of honesty and transparency in communication with patients 23/n

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Mark Horowitz

@markhoro

3 months

We reply to further letters about our serotonin umbrella review "Difficult lives explain depression better than broken brains" @joannamoncrieff @HengartnerMP

Difficult lives explain depression better than broken brains

Molecular Psychiatry - Difficult lives explain depression better than broken brains

www.nature.com

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Mark Horowitz

@markhoro

2 years

Can I ask, doctors, patients, all: Do people think: a)Depression is caused by low serotonin; b)Serotonin is involved in a complex way with depression that we don’t quite yet understand; c)Serotonin has no more to do with depression than any other single neurotransmitter?

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Mark Horowitz

@markhoro

6 months

In 2000s Prof Nutt sent letters to GPs telling them antidepressants worked by rectifying low serotonin. Apparently now that the circus has moved on they blunt emotions, which if I recall correctly, is an outrageous anti-psychiatry position to take. Curiouser and curiouser

Wendy Burn CBE (She/her)

@wendyburn

6 months

Psilocybin and ecitalopram appear to have fundamentally different mechanisms says @ProfDavidNutt . SSRIs damp down emotional responses but psilocybin does not. #FEDRCPsych23

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Mark Horowitz

@markhoro

2 years

The serotonin hypothesis was used to sell drugs by providing a plausible rationale for taking them. It is still promoted and there are similar versions for glutamate and opioids being put about with similar scant evidence. In @bmj_latest .

Why it is important to discuss what antidepressants do

Kendrick and Collinson suggest that we overstepped the data in discussion of the relevance of our serotonin paper to antidepressant use.12 The serotonin hypothesis was propagated by drug companies...

www.bmj.com

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Mark Horowitz

@markhoro

2 years

NICE's analysis of treatments for more severe depression- check out the SMD's on some of those bad boys! Bold means stat sig. Mindfulness, group problem solving, peer support - big effects, bigger than AD+CBT.

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Mark Horowitz

@markhoro

3 months

You can see 2nd sentence says I am a trainee as of course I said. I don't write the headlines. I think you are being devious to suggest I am mis-representing myself. And I think you are doing it to try to discredit my message with an ad hominem attack.

Dr Sanil Rege FRANZCP | MRCPsych

@sanilrege

3 months

@markhoro You need to be transparent with the media that you are NOT a consultant psychiatrist. I've read a few reports, and it keeps happening. Intentional, or do you let it slip? It's misleading - You can still get your message across, but it's important to be clear about…

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Mark Horowitz

@markhoro

2 years

The serotonin hypothesis suited the drug companies’ marketing. It worked like misinformation from Purdue that oxycontin was not addictive in the context of pain. A mistruth that encouraged doctors to prescribe. 29/n

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Mark Horowitz

@markhoro

2 years

Delighted to be involved in a large scale RCT on hyperbolic tapering of antidepressants by GPs compared to usual care, funded by the Australian Department of Health @healthgovau , led by indomitable @WallisKatharine , with @joannamoncrieff .

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Mark Horowitz

@markhoro

3 months

Oh dear, this has become rather silly. Sanil is now re-posting people who say I am not a medical doctor. I feel that rather than this being about a yearning for accuracy, this is about shooting the messenger. In any case I have emailed the journalist to clarify. Good day fellows!

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Mark Horowitz

@markhoro

2 years

If we can see that we are creating a chemical abnormality by elevating levels of serotonin with antidepressants rather than fixing an existing abnormality we can be more clear-eyed about the effects 7/n

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Mark Horowitz

@markhoro

4 months

Largest systematic review and meta-analysis finds there is no long term data on the effectiveness of tricyclic antidepressants, small short term benefits, increase in serious adverse effects, not enough info on whether they affect suicidality

Beneficial and harmful effects of tricyclic antidepressants for adults with major depressive...

Question Tricyclic antidepressants are used to treat depression worldwide, but the adverse effects have not been systematically assessed. Our objective was to assess the beneficial and harmful...

mentalhealth.bmj.com

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Mark Horowitz

@markhoro

4 years

Pleased to see our paper on tapering antipsychotics being one of the most viewed on JAMA psychiatry, but even more to receive so many messages from psychiatrists saying they will use when tapering

Tapering Antipsychotic Treatment

This Viewpoint discusses principles for tapering antipsychotic treatment when deprescribing them.

jamanetwork.com

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Mark Horowitz

@markhoro

1 year

We made a video addressing some of the myths about antidepressants and depression with the brilliant animation by @AfterSkool If you share the link please use this link (and not the errant draft version about):

The Myth of Low-Serotonin & Antidepressants - Dr. Mark Horowitz

Dr. Mark Horowitz, MBBS PhD is a training psychiatrist and Clinical Research Fellow in Psychiatry North East London NHS Foundation Trust (NELFT) and an Honor...

www.youtube.com

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Mark Horowitz

@markhoro

2 years

Some people say well ‘low serotonin’ is a simplification, serotonin is involved in some complex way. But ‘involved in some complex way’ is probably true for a large number of brain chemicals (as they are involved in every emotion). 5/n

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Mark Horowitz

@markhoro

6 months

Apologies, yesterday I mixed up the links for the Maudsley Deprescribing Guidelines. US: UK: It will be published in 2 volumes: the second volume on mood stabilisers, stimulants, antipsychotics and opioids in 2025.

The Maudsley Deprescribing Guidelines: Antidepressants, Benzodiazepines, Gabapentinoids and Z-drugs...

The Maudsley Deprescribing Guidelines: Antidepressants, Benzodiazepines, Gabapentinoids and Z-drugs (The Maudsley Prescribing Guidelines Series)

www.amazon.co.uk

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Mark Horowitz

@markhoro

3 years

People are putting in incredible effort in order to come off psychiatric drugs safely.

KEVIN

@OreElect

3 years

@markhoro

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Mark Horowitz

@markhoro

2 months

There are two clinics that see people with PSSD in London (that I am aware of): one a neuro-urology clinic at Queen's Square and a sexual medicine clinic at St Mary's Hospital. I suspect that is more helpful than the schoolboy sniggering of some of esteemed colleagues.

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Mark Horowitz

@markhoro

10 months

When Janssen tried to push through esketamine, the clinical expert for NICE, as well as the member of RCPsych that put forward a challenge to the NICE rejection were paid by the company. When the latter was asked about this he said 'Oh I'm very conflicted'

Revealed: drug firms funding UK patient groups that lobby for NHS approval of medicines

Observer investigation shows that majority of Nice drug appraisals involve groups financially linked to maker of pharmaceuticals

www.theguardian.com

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Mark Horowitz

@markhoro

2 years

They are told that antidepressants can fix this problem. It is probably no coincidence that alongside this narrative that antidepressants have soared from being rarely prescribed to being prescribed to 1 in 6 of the western world. 3/n

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Mark Horowitz

@markhoro

5 years

(thread) An interesting session today on antidepressant withdrawal. Much confusion resolved by looking at how long people are on antidepressants:clear relationship between length of use and risk of withdrawal symptoms.

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Mark Horowitz

@markhoro

2 years

In the same way as understanding changes in chemistry during depression (which might be epiphenomenal or caused by emotions) might be less useful than understanding the circumstances and stressors that lead to depression 14/n

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Mark Horowitz

@markhoro

2 years

But drug companies did not act in a vacuum – their line was pushed out by academics into medical education and public messaging. And while some have now dropped it others continue to push it 30/n

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Mark Horowitz

@markhoro

2 years

Brilliant paper by @VPrasadMDMPH and John I. on 'obsessive criticism': A good outline of the line of attack on our recent paper and the gutter journalism that has gone for ad hominem attacks on authors

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Mark Horowitz

@markhoro

2 years

BJPsych Adv paper on how to distinguish antidepressant withdrawal from relapse for clinicians as well as the trouble this causes in antidepressant discontinuation trials aimed to show relapse prevention properties (paywall, sorry) with @DavidTa23968240

Distinguishing relapse from antidepressant withdrawal: clinical practice and antidepressant...

Distinguishing relapse from antidepressant withdrawal: clinical practice and antidepressant discontinuation studies - Volume 28 Issue 5

www.cambridge.org

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Mark Horowitz

@markhoro

2 years

Gave a tutorial to 34 undergrad students at Westminster uni today. 2 people in audience trying to come off antidepressants with difficulty (6% of audience). Questions just became about how to get off them. 10% of people 18-24 on ADs.

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Mark Horowitz

@markhoro

5 months

This is very common. In fact, as there has been no diagnostic category for protracted withdrawal or other iatrogenic effects of ADs until recently, it is likely that all such conditions were registered as MH problems, ironically justifying more budget for AD treatment.

Lauren Siân Taylor

@Riggwelter_PSSD

5 months

As an NHS employee and iatrogenically harmed person, I'm very upset that my 8.5 months sick leave was put down as "depression". It was the "treatment" that made me bedbound and unable to function as a human. Still can't function almost a year off the medication. Scandalous.

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Mark Horowitz

@markhoro

1 year

Was great to day to talk to the chief pharmacists in England about the update to NICE guidance on stopping antidepressants and hyperbolic/proportional tapering. Lots of good ideas about ways to take it forward clinically.

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Mark Horowitz

@markhoro

3 months

Looking forward to presenting at the Royal College of Psychiatrists international conference in June on the Maudsley Deprescribing Guidelines approach to safe deprescribing with Prof Taylor and Prof Murray

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Mark Horowitz

@markhoro

2 years

A similar idea is that depression is a heterogenous condition made up of lots of different causes and contributed to by many chemicals. OK, if so, then we might reserve drugs that increase serotonin for those people with a demonstrated serotonin deficiency 8/n

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Mark Horowitz

@markhoro

2 years

But if you were keen to learn Japanese better studying what those chemical and electrical changes were would probably be a less good use of your time than reading Japanese or attending classes. 13/n

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Mark Horowitz

@markhoro

3 years

It's quite extraordinary the dedication required to get off long-term psychiatric drugs. I think most people do not understand the exquisite pain of doing so. I have a similar spreadsheet to this (altho mine is way less neat!)

Morgan

@agirlwakingup

3 years

@KellyMartin02 @dub_mh @JDaviesPhD @BenzoBrains I shook the jars, no need for a blender. I started with 300ml of water and removed 1ml every day. The pace of the taper changes according to how you feel. 7ml removed the first week. Then 14ml the second week. On and on until all 300ml are removed.

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Mark Horowitz

@markhoro

3 years

"Prescribers should warn patients about dependence before starting them on high-risk drugs, says NICE" Prof Taylor:"[guidelines which] for perhaps the first time, formally recognise the dependence potential of antidepressants, Z-drugs and gabapentinoids”.

Prescribers should warn patients about dependence before starting them on high-risk drugs, says NICE

Before starting treatment with antidepressants, opioids, benzodiazepines or other drugs associated with dependence, patients should be warned about how hard it may be to stop taking them, recommends...

pharmaceutical-journal.com

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Mark Horowitz

@markhoro

10 months

It does seem slightly odd to have someone else articulate your arguments and then dispute them without you in the room.

Dr Joanna Moncrieff

@joannamoncrieff

10 months

Royal College of Psychiatrists discusses the 'antidepressant wars' with only one side in the room (again). What's wrong with letting psychiatrists hear the other side and make up their own minds?

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Mark Horowitz

@markhoro

2 months

Good that more attention is given to the long term risks of medications so that people can make informed choices. Would be good to update patient leaflets to reflect the risk and have more research so we can be clearer on how big the risk is.

PSSD Network | Post-SSRI Sexual Dysfunction

@PSSDNetwork

2 months

The @guardian published a great article today on Post-SSRI Sexual Dysfunction ( #PSSD ). We would like to thank the journalist @DrDavidACox , sufferer @ROSIE_PSSD , as well as the scientists ( @DrDavidHealy , @abcsoka and @RMelcangi ) quoted in the article.

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Mark Horowitz

@markhoro

9 months

Quite extraordinary from Prof Peter Kramer who says antidepressant withdrawal effects do not exist. Brave stuff to over-rule the APA, the manufacturers, etc. Clearly a lot of recurrence in his office.

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Mark Horowitz

@markhoro

1 month

Useful that @NatGeo have highlighted how commonly withdrawal effects from antidepressants are mistaken for a relapse, concealing the scale of the problem from the system (paywall)

What’s the right way to wean off antidepressants?

Stopping an antidepressant can trigger debilitating physical and psychological ailments as the brain goes through withdrawal. “The emphasis has been on prescribe, prescribe, prescribe and less on the...

www.nationalgeographic.com

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Mark Horowitz

@markhoro

2 years

Rang up my GP to get a liquid version of an antidepressant.Told it was unnecessary and that halving twice is enough to come off.And liquids not on formulary. Talked to the GP pharmacist and they will ask medicine management to look at including on formulary based on NICE guidance

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Mark Horowitz

@markhoro

3 years

60,000 people turn to facebook groups for help coming off antidepressants because their doctors don't know how to help them. Proud to edit this important paper @TAPsychopharm : authors: @ReadReadj @Reduxreloaded We need dedicated NHS services for this/1

The role of Facebook groups in the management and raising of awareness of antidepressant withdraw...

Background: Antidepressant withdrawal is experienced by about half of people who try to reduce or come off their medication. It can be a debilitating, long last...

journals.sagepub.com

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Mark Horowitz

@markhoro

3 months

Classic description of SSRI withdrawal, often mistaken for relapse by the ill-informed. Perfect explanation of the hyperbolic pattern of effect so that the final 25mg (some drs say 'homeopathic') actually has 75% of the effect of 200mg (see Maudsley Deprescribing Guidelines)

Hegel Borg™️

@xxclusionary

3 months

Why the hell are 12 y/os going on SSRIs?

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Mark Horowitz

@markhoro

3 years

Outline of the Cochrane study a bit for those scared of its length. Metro article: Lead author: the dauntless Ellen van Leuween. Co-author @tony_kendrick While there are hundreds of studies looking at starting antidepressants(1/n)

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