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May 09, 2007

'Discontinuation' or Withdrawal?

An article in last Sunday’s New York Times Magazine, describing the author’s struggle to get off the anti-depressant Effexor (vinlafaxine), caught my attention because I had recently taken histories from two cannabis users who were both frightened and bitter about their own inability to stop, or even significantly reduce, their use of the same drug for reasons that were quite similar to those described by author Bruce Stutz, who also happens to be a a well informed popularizer of science. Effexor is a second generation SSRI, which, it was apparently hoped, would combat depression more effectively than Prozac or Paxil because it increases the ‘reuptake’ of  both norepineophrine and serotonin. Cymbalta is another such agent. Now known as ‘SNRIs, a new class of agents that have also gained recent fame because of their association with a new clinical problem known as the ‘discontinuation’syndrome.

Skeptic that I am, I began to wonder how discontinuation differed from old fashioned withdrawal, so I googled them consecutively. That they are similar is evidenced by finding the same antidepressants on the first few pages of the‘withdrawal’ search. What was different  was the company: alcohol other agents were also listed as associated with withdrawal syndromes. Another study that  caught my attention was one by Dr. Elena Kouri, who had devised a complicated experiment to look for evidence of a marijuana withdrawal syndrome.

Rather than parse her article in detail. I will simply say that, in common with most studies of ‘drugs of abuse,’ it's laden with evidence of unconscious investigator bias, and describes only a mild, transient, and completely reversible increase in aggression  distinguishing chronic users as compared to two groups of controls. As someone not committed to strict observance of federal dogma, i would suggest an alternative: what Dr. Kouri’s chronic users were exhibiting after three weeks of abstinence was an exacerbation of the symptoms they ususally kept under control with pot.

It comes down to what I’ve been maintaining all along: the only ‘success’ our drug war has enjoyed as policy has been its ability to scare parents about ‘drugs of abuse;’ if that requires glossing over real problems with FDA approved agents, what's the harm?

'Discontinuation' indeed.

Doctor Tom

Posted by tjeffo at May 9, 2007 02:54 AM