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

My opponent has offered 3 sources which I will question and discredit in this round. *** To recap for the audience: My opponent has essentially constructed a clear story to the audience: A population of individuals suffering from persistent, unending withdrawal effects of a group of medications, which is allegedly the result of a lack of communication between prescriber and patient. From that elucidation, my opponent seeks to promote the notion that SSRIs and SNRIs should never be prescribed without an adequate warning to the patient of these persistent withdrawal effects, due to the inherent danger present in the use of those medications. The problem is that there are several key issues with the story that change the plot drastically. *** Now, let us examine my opponent's first source: Drugs. com My opponent points to "mountains" of anecdotal evidence on drugs. com, and I approach that source with much hesitancy. Why? Because my opponent is not pointing to the actual documentation on the site, but rather to the information on the forums. My opponent has stated "It consists largely of posts made by people suffering PANES because of ignorant physicians". Realistically speaking, my opponent cannot make that claim. He is only echoing the assumptions of those on the site, a collection of individuals with no medical training, who cannot diagnose themselves, and who are simply feeding off of each other's descriptions of side effects. A closer examination of this site shows that the individuals are doing a wide variety of things that as a professional pharmacist, I know to be against doctor's warnings. On every page, there is one mention of patient self discontinuation or self tapering, patients trying to turn their medication from solid to liquid form, patients confusing side effects with withdrawal symptoms, patients confusing their own recurrent symptoms with withdrawal symptoms, patients misinterpreting "addiction" with "withdrawal", and a general complete lack of coherency. The vast majority of these patients are NOT suffering from PANES, but from drug interactions between different classes of antidepressants, improper medication use, general side effects of the medications themselves, recurrent symptoms from their discontinuation, as well as mild forms of withdrawal symptoms that are transient and not permanent. My heart goes out to the individuals who are suffering, but we must keep our minds clear in this particular matter. The individuals on the drugs. com forum are *not* a credible source for the prevalence of PANES. *** Now, on to my opponent's second source. The acronym "PANES" is only really used by one particular author for one particular paper regarding SSRI withdrawal, and it specifically refers only to PERSISTENT, unending symptoms after withdrawal. "SSRI Withdrawal Syndrome" is the general term, which encompasses the persistent as well as the transient symptoms after SSRI discontinuation. The crux of his argument regarding PANES revolves around this one article that my opponent has provided: . http://www.priory.com... In it, the author produces five cases in which patients have extreme forms of SSRI withdrawal that seem to last for months. I agree, it sounds frightening, but there is something to note: This is not a clinical trial. It is simply a collection of five cases. "PANES" does not actually exist, even the author makes the statement: "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). " The very source my opponent bases his entire argument on, is questioning whether or not PANES actually exists! This article, which is nothing but a collection of five stories written over a DECADE ago, has had no major updates tagged indicating that PANES has truly been discovered. In fact, a google search shows that the only people who talk about PANES, happen to be the same type of people in my opponent's first source: Self-diagnosing forum-dwellers. *** Finally, my opponent's third source: . http://www.socialaudit.org.uk... What my opponent does not seem to notice, is that this article is not dealing with PANES! It is dealing with transient, temporary withdrawal symptoms, not persistent ones! I, and the scientific community, am in agreement with this article, which indicates that withdrawal symptoms exist. However, PANES refers specifically to the persistent ones, making this article irrelevant. *** To conclude, none of my opponent's first three sources are credible and relevant. I must ask my opponent to resubmit his arguments using credible and relevent sources. *** That having been said, I now make my own advance. The very core of my opponent's argument, is that the patient should be warned of PERSISTENT ADVERSE NEUROLOGICAL EFFECTS on discontinuation of the drug. What is the incidence of these persistent adverse effects? My own professional training teaches that this is extremely rare, and it would harm many more patients by frightening them out of taking beneficial medication. However, I know this is likely not enough for my opponent or for you, the audience. This study indicates that the majority of symptoms coming from SSRI withdrawal are "self limiting and reversible". . http://www.ncbi.nlm.nih.gov... This review on several studies of SSTI withdrawal concludes that the effects tend to be "short lived and mild", whie offering many ways to prevent and treat the withdrawal symptoms. . http://psychrights.org... There are many studies and reviews indicating that SSRIs have withdrawal symptoms, but that these can be managed effectively and often do not last. In my research, I have only come across some that even start to mention persistent effects and even then, only in passing and indicating that it is quite rare. My opponent is right in saying that doctors often treat SSRIs as benign because they are considered first line treatment. This is because for the most part, they are. Doctors may not explicitly tell their patients that they can develop persistent withdrawal symptoms, but they often do tell them that they can develop transient ones. Even if they do not, many doctors intend to keep their patients on antidepressents for a significant period of time, in conjunction with therapy and counseling, before they even THINK of taking their patients off the drug. The only danger is when patients decide that they want to stop the medication "cold turkey" against their doctor's advice. As of now, I still cannot see why my opponent feels that prescriptions should *never* be issued unless the doctor warns the patient about an extremely rare condition that can only be brought about by deliberate patient misuse of the drug. Perhaps my opponent can enlighten me, and you, the audience, in his next reply? I thank you.