mollie adler

And, many patients just stop going to their psychiatrists when they don’t get the help they need (and often find this help in patient communities), or they just stop going because they’re miserable without clear knowledge of why, so there is a selection bias: the patients that psychiatrists have generally seen are the ones who haven’t reached this point. Again, the point of this isn’t that providers are negligent, uncaring, or incompetent. I think most are well-meaning, doing their best, and *want* to attend adequately to their patients needs. But it can be very difficult for *anyone* to fully appreciate how much hidden assumptions affect what they see—and, more importantly, what they don’t see!

The takeaway is that it’s very difficult to see something you’re not looking for, and which you literally don’t think exists! Most psychiatrists accept that Paxil and benzos can lead to severe withdrawals, but most also don’t really think *protracted* withdrawals, or even irreversible harm, are a thing. And, the standard teaching with drugs like fluoxetine is that it self tapers, and that there are no withdrawals. So, as a clinician, or as a patient, will you be likely to connect the dots when symptoms appear 6-8 weeks after discontinuation? Will a patient even report such symptoms when the possibility of the connection has never been made?