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

I would like to dedicate the beginning of this round to a summary and bring the audience's attention back to the issue at hand. My opponent has done a wonderful job illustrating the nature of what he calls "PANES" and demonstrating that there is indeed a link between the abrupt discontinuation of SSRIs and the list of possible side effects he included in his last response. However, it is important for we the debaters, and for the audience, to focus on the issue at hand. The issue being contested is not whether SSRIs can lead to PANES. Through our mutual research, we know that it is generally accepted as fact that SSRIs can lead to *short term symptoms*, and that from that, we can infer that there is the potential for developing persistent symptoms. **The issue is whether or not a doctor has to be mandated by law to discuss the rare possibility of developing PANES before prescribing any SSRI. ** So, I would ask the audience to exercise caution in reading my opponent's responses. My opponent and I have spent the last few rounds framing the audience's understanding of what PANES is, but from this point on, let us focus on the resolution at hand: *MUST* doctors always warn their patients of PANES before they prescribe SSRIs and SNRIs for any reason? ********** In my opponent's latest response, he provides a source that seemingly indicates how often a patient develops persistent symptoms, but as the audience can see upon closer examination, the language is vague. Dr. Healy indicates that the incidence of developing withdrawal symptoms *in general* is "20-50%". He only vaguely indicates that *some* people may develop persistent symptoms. Like I have stated before, my opponent makes a good case on why patients should be warned of *transient* side effects, but not persistent ones. ********* My opponents asks of me several questions, which I shall now answer. SSRIs and SNRIs may cause side effects during use, but the crux of this debate is on what my opponent has defined as "PANES" in accordance with his first source, which is a list of symptoms that are caused by the withdrawal of an SSRI, that happen to persist for a much longer duration of time and may be permanent. Contrary to what my opponent states, "PANES" is not similar to withdrawal. "PANES" is simply persistent withdrawal symptoms, according to the very first source my opponent listed: http://www.priory.com... Which brings me to my first exception. 1. In order to have PANES, one must stop the medication. If a doctor intends to keep his patient on SSRIs indefinitely, why must there be a warning of PANES? In patients with severe depression or psychosis, doctors usually keep the patients medicated indefinitely. While there are side effects associated with that use, these are the situations in which problems like suicidal ideation may represent a greater risk to the patient. Emphasizing the possibility of PANES would simply upset the patient or frighten them away from needed treatment. This brings me to my second point: 2. Patients who have such severe illness that they cannot care for themselves. SSRIs and SNRIs are frequently used in psychiatric hospitals and psychiatric wards where the patients are simply unable to care for themselves. They are frequently made up of homeless individuals who have no family or friends and who have little remaining mental capability. SSRIs and SNRIs help to restore them to some form of functioning. Most of the time, people are warned about rare side effects so they can exercise judgement and not use the drug. However, for people who are incapable of exercising their own judgement, why would they need to be counseled on such a rare occurrence, especially when they are under constant, vigilant care? Finally, my third point: 3. Slippery slope We know that withdrawal symptoms occur with SSRIs, but in none of the sources my opponent and I contributed was there an indication that the persistent withdrawal symptoms were anything but rare anomalies. I asked my opponent for a source showing the incidence of persistent side effects after controlled lowering of the dose, and he has not provided it. All across the board, there are medications with rare side effects that doctors simply don't have time to discuss. The audience must ask themselves this: Are my opponent's arguments good enough such that they can be applied to ALL similar adverse reactions? For any class of medications, be they antibiotics, cholesterol medications, blood pressure medications, antidepressants, hormones, antidiabetics, etc. there are always rare side effects that are more severe and better studied than PANES. Doctors simply don't have time to go through all of them, especially when in most cases, they don't have much chance of occurring. And keep in mind, these are symptoms that occur by being ON the medication. My opponent wants to place this legal mandate for something that may or may not occur only if a patient withdraws from a medication, which is rare in and of itself. To conclude, my opponent makes many good points, but what he has failed to do so far is explain why SSRIs and SNRIS should NEVER, EVER, EVER be prescribed without a warning of PANES.