SSRIs/SNRIs should never be prescribed without a warning of P.A.N.E.S.

priory. com/psych/panes. htm Which states that PANES is defined as "Persistent Adverse Neurological Effects Following SSRI Discontinuation". The article speaks exclusively on withdrawal symptoms. I respond with more background information for the audience regarding the matter and ask two questions: One of which was never answered in full, and another which was never addressed at all. ROUND TWO: My opponent offers Source 2, a forum of people he alleges are "all suffering from PANES" and "victimized by ignorant physicians" when they discontinue or withdraw from their medication. He then offers Source 3, a study regarding withdrawal and dependence, claiming it shows that doctors misdiagnose PANES upon discontinuation and withdrawal for resurgence of symptoms. I then completely discredit Source 2 as merely a collection of the unsubstantiated worries of laypersons who, upon close examination of the forum, are doing a variety of things wrong, misdiagnosing themselves, and incorrectly taking medical care into their own hands. In addition, I discredit my opponent's assumptions about the Defining Source, pointing out that the author himself is unsure whether PANES (persistent neurological symptoms due to withdrawal) is actually significant, and that PANES is actually just "proposed", not proven. "Further case reports and surveillance data are needed to establish the significance or otherwise of what we propose to be persistent adverse neurological effects of SSRIs (PANES). " I also discredit Source 3, as I have noticed that the article is not dealing with PANES (persistent withdrawal symptoms), but with SSRI withdrawal syndrome, which is the far more common, transient and self-limiting form of PANES. ROUND 3 My opponent does not address the collapse of any of his sources, and merely offers Source 4, which simply defines a list of neurological symptoms after withdrawal that the source itself says could either be temporary, or in some cases, possibly persistent. I respond by indicating that I agree with most of these facts, and that it still doesn't contribute any factual evidence that shows that these medications should *NEVER* be prescribed without a mandated warning. I also raise the following exceptions to the resolution: 1. Since PANES (by definition) only develops during withdrawal, what about doctors who don't intend to discontinue the medication? 2. Should counseling be mandated if a patient is in dire need of medication and in no mental capacity to choose not to take the drug, such as in a psychiatric ward? 3. This list of symptoms being permanent is extremely rare, as evidenced by the lack of studies and sources, and the plethora indicating that its temporary counterpart, SSRI withdrawal syndrome, is far more common. If we mandate counseling for something so rare, wouldn't we be forced to mandate the same for all the other side effects for all other medication? Doctors simply wouldn't have the capacity! **** Now, I will respond to my opponent's latest arguments in Round 4: My opponent submits another source with "anecdotal evidence", however, even in his description he explains why it fails: for the same reason why his initial anecdotal source fails. "The language is vague merely because when describing emotional problems, you can't be certain t you are describing is 100% accurate because emotions are subjective. " All of these symptoms are blurry and subjective, and these sufferers do not demonstrate that they can accurately diagnose themselves with anything BUT those symptoms. They *cannot* diagnose themselves with PANES, because they cannot accurately determine the difference between withdrawal symptoms and recurrence symptoms, and because the forum is providing a place for people to perpetuate and dwell in their own self-diagnoses. As of yet, my opponent has contributed no sources that have withstood even mild scrutiny. Now, I will address his attempts to refute my three points. Audience, please note that my opponent's burden is to ensure that there are no exceptions to his resolution and that my burden is to indicate at least one. If my opponent does not satisfactorily disprove all three of my points, this debate is decided. I wish him the best of luck. FIRST: I have stated that since PANES, as defined, are a collection of withdrawal symptoms that never seem to go away, it makes sense that a doctor who intends for perpetual use should not have to warn about it. My opponent, for the first time in the debate, attempts to change the definition and say that PANES can occur without withdrawal. I will point not to my own sources, but to his, indicating that every single source he has put, deals exclusively with discontinuing or withdrawing from medication, and the effects that can have. Even the name of his defining source indicates the following: "Persistent Adverse Neurological Effects Following SSRI Discontinuation (PANES). " The acronym PANES encompasses "SSRI Discontinuation" in the very title. After all of our discussion on whether proper titration for withdrawal can prevent PANES, and about the difference between transient SSRI withdrawal and PANES, my opponent has made this statement without any legitimate basis. PANES, by definition, is a persistent version of SSRI withdrawal syndrome. I have included this in my own definitions before and my opponent did not seem to have a problem with it until now. I ask that the audience refuse to accept this new definition as it is not only unsubstantiated, but also too far into the debate. The time for rehashing definitions is over. The time for debating is now. In that regard, my opponent *must* address my first point. SECOND: I have noted that there are individuals who do not have the mental capacity or health to make their own medical decisions. Should a doctor need to place this medicine on such a patient, it would not be necessary to warn the patient. My opponent states that this is irrelevant because "it's an argument against any and all warnings under the described circumstances. If the patient has no say in what treatment they get, what good is warning them of side-effects of the treatment? " That is correct, and exactly my point. Something need not be specific to be relevant. If you see the news say "All Americans must serve jury duty", would you assume that you need not go serve because it doesn't mention you by name? This point *is* relevant, audience, and my opponent himself agrees that this is a reason NOT to warn them of the side-effects of treatment. If my opponent concedes this point, then he concedes the debate. An argument against any and all warnings, is still a legitimate argument, because we are dealing with a resolution about a warning. THIRD: I point out that there are more common and more severe side effects for all other medications outside SSRIs that do not require mandatory warnings to prescribe. My opponent believes that since "sometimes, it is resistant to all treatment", it makes his case special. However, audience, let me ask tell you, this does not make his case special. In truth, every side effect is "sometimes" resistant to treatment attempts. **** In conclusion: As it stands in the debate so far, my opponent has offered no credible sources to his point, and has failed to indicate why SSRIs/SNRIs should *never* be prescribed without a mandated warning. Furthermore, my opponent has attempted to redefine the resolution, and has not refuted my three exceptions. For my opponent's sake, I hope he addresses these issues in the final round. Thank you!