Author Topic: Antidepressant Withdrawal  (Read 46901 times)

[Buddie]

Antidepressant Withdrawal
« on: September 21, 2015, 01:13:46 am »
Antidepressant Withdrawal –
How to Prepare and What to Expect


NOTE:  This post is meant for those who are already on an AD and are interested in tapering off safely.    This thread is NOT meant as a discussion for or against AD’s, but rather as a list of “best practices”  I discovered in various psychiatric withdrawal forums as I completed my journey off the last of many drug cocktails taken over a 30 year time frame.


I. How to Set up a Taper Strategy:


1. Check all of your medications to ensure there are no interactions.

Place all of your medications in the below drug interaction checker:

          Drugs.com Interaction Checker

If there is an interaction, please contact your doctor immediately.


2. Decide which medication to taper first.

Because all psychiatric drugs come with a discontinuation syndrome (i.e. withdrawal), it’s best to taper one medication at a time while holding the others steady.

The best article I’ve found on this is from Surviving Antidepressants called Taking multiple psych drugs? Which drug to taper first?


As you can see from this article, the benzo may not always be the medication to taper first.  Many people fail at psychiatric drug withdrawal simply because they can’t sleep.  Please take the time to carefully read over this article. The goal is to taper the most stimulating drug first and the most sedating drug last.  By using these guidelines, you’ll set yourself up for [...] from the very beginning.


3. Set up your AD taper rate.

The Icarus Project and Freedom Center produced a very good booklet called the “Harm Reduction Guide to Coming off Psychiatric Drugs” which advises a taper rate of 10% every 2 - 3 weeks (or longer).  Some AD web forums suggest a month.  You can adjust this as you go along depending on your symptoms.

The complete “Harm Reduction Guide” can be found here.  Note that a detailed description of how to come off psych drugs starts on page 35:

          Harm Reduction Guide to Coming Off Psychiatric Drugs



4. Switching from a short half-life AD to a long half-life AD.

In benzo terminology, this is similar to switching from a short half-life drug like Ativan to the longer half-life drug Valium.

For some people, this may be the only way to get off the short acting AD. For other people, it simply won’t work.  Because this is way beyond the scope of BenzoBuddies, if you’re interested in doing a crossover, please visit Surviving Antidepressants, and they can help you set up a crossover. There is no fee to set up an account or to make use of the site.


If you are on an AD with a short half-life such as Paxil, I would encourage you to research this. Many people report Paxil as being one of the more challenging AD's and the withdrawal can be severe.


5. Switching from a potent SSRI to a less potent (and more sedating) Tricyclic or Tetracyclic AD.

If you were placed on a benzo to control the anxiety and insomnia of your SSRI, then your SSRI is definitely considered "stimulating" and may cause an uptick in insomnia and anxiety. If the withdrawal effects upon coming off the AD are intolerable, you may wish to talk to your doctor about switching to an older AD such as imipramine (or any other tricyclic or tetracyclic AD). Not only are these less potent, for many people, they're also very sedating. This may help with insomnia and anxiety and perhaps improve your odds for a successful taper, especially if you came off your benzo first and no longer have that for sleep.

This is too complex for BenzoBuddies, so please consult Surviving Antidepressants before speaking with your doctor about this type of crossover.


II. How to Monitor Your AD Taper:


1. Start slow and keep track of your symptoms.

The 10% rate is a good rate to start with. However, if you find your symptoms are extreme, consider a slower rate or even a liquid taper.  The website Surviving Antidepressants will be able to guide you through this.

Just like with benzo withdrawal, if you come off your AD too quickly, you may suffer for months or even years with PAWS due to the effect on the CNS. There’s no way to tell ahead of time who is dependent and who isn’t, so please start out slowly. You can always increase the rate and speed as you go along.

Although benzos affect GABA receptors and AD’s affect various transmitters such as serotonin, norephedrine, and dopamine, both benzos and AD's affect the CNS.  If you’re tapering your AD prior to your benzo, you certainly don’t want to compromise your CNS before you taper the benzo (which is a CNS depressant).

And if you’re tapering the AD after the benzo, your CNS may already be compromised. Even more reason to start out slowly.

Many doctors advocate alternating doses; however, this is not recommended by most AD web forums because it may destabilize your CNS. Keeping your dose steady and then gradually decreasing seems to work best.

Keep this in mind as you monitor your symptoms. I would encourage you to keep a Progress Log for your AD taper either online or offline.  I used the number of hours I slept as a gauge. Others use a depression or anxiety scale to rate their symptoms.  Some people see patterns develop over time and use this as a way of predicting when they should decrease their dose. Others see no pattern and simply pick a rate such as 10% and decrease once a month and handle the symptoms as best they can.


2. Notes on updosing:

From my own experience and everything I’ve read on various support forums, updoses and reinstatements are very unpredictable.  Once your CNS becomes used to a lower dose, you may become even more sensitive to certain side effects such as insomnia and anxiety, especially from the more stimulating AD’s.  So any increase in dose may come with an uptick in side effects.

So when considering an updose, increase by only a very small amount of the drug and then wait 3 – 4 days to gauge your symptoms.

3. Notes on reinstating:

While reinstatements are not recommended for benzos after 2 weeks, AD’s have a different pattern and may be reinstated even months after coming off them.  I had successful reinstatements over the years from as far out as 4 months, and that’s the case for others on various forums such as Surviving Antidepressants and The Icarus Project.  HOWEVER, for every successful reinstatement there are reports of this NOT working.

When considering a reinstatement, note that some people are able to reinstate at their jump dose even several months after coming off. 

AD’s may also have a DELAY in withdrawal by several months. This can easily be misdiagnosed by your doctor as a new depression or a re-emergence of the original depression. 

This is a really good article from Surviving Antidepressants and is well worth reading before you attempt a reinstatement: About reinstating and stabilizing to reduce withdrawal symptoms.


III. How to Distinguish AD Withdrawal from a “Real” Depression:


Dr. David Healy researches antidepressant withdrawal and keeps up with the side effects / withdrawal symptoms on his website Rxisk.org. According to Healy, there are ways to distinguish AD withdrawal from a "real" depression:

1. If the problem begins immediately on reducing or halting a dose or begins within hours, days or weeks - then it is more likely to be a withdrawal problem. If the original difficulties have cleared up and you are doing well, on discontinuing treatment no new problems should show up for several months or indeed years.

2. If the nervousness or other odd feelings that appear on reducing or halting the SSRI (sometimes after just missing a single dose) clear up quickly when you are put back on the SSRI or the dose is put back up, then this also points to a withdrawal problem rather  than the original illness. When original illnesses return, they take a long time to respond to treatment. A quick response to the reinstitution of treatment points to a withdrawal problem.

3. While withdrawal may overlap with features of any problem for which you were first treated - both may contain elements of anxiety and of depression. Withdrawal will also often contain new features not in the original state such as pins and needles, tingling sensations, electric shock sensations, pain and a general flu-like feeling.

4. If you are on a treatment and doing well but the treatment then stops working and you need more of the same drug to get the original benefit, you have likely become dependent and are at a greater risk of having withdrawal problems.


This is taken from: Guide to Stopping Antidepressants.

This guide contains a lot of useful information for tapering and for handling AD withdrawal symptoms.



Further Reading


Re-packaged SSRIs:

Over the past twenty years or so, the pharmaceutical companies began re-packaging older antidepressants and marketing them for other maladies.  By re-packaging these older drugs, the pharma companies were able to gain new patents and thus more profits.

Be sure to check any other medications you’re on, as these drugs may complicate your withdrawal.  This has hit women’s healthcare especially hard.

Here are some examples. There may be others, so please check your medications very carefully. This seems to be a growing trend.

Sarafem (for PMS) is repackaged Prozac

Brisdelle (for menopause) is repackaged Paxil

Addyi (also known as “female Viagra”) is a failed antidepressant - (http://www.bmj.com/content/349/bmj.g6246)


The smoking cessation drugs are also potentially dangerous:

Zyban is repackaged Wellbutrin

Chantix is antidepressant-like (affecting dopamine) and it contains a black box warning about suicide and suicidal thoughts


An Update on Dr. Heather Ashton’s View on Antidepressants:

I’m including a section on this because  members frequently refer to the Ashton Manual for information on antidepressants.

The Ashton Manual is reflective of the time it was written – in the 1980’s before the SSRIs first came to market in December 1987. This was before much was known about the “discontinuation syndrome” of the antidepressants.

Since then, she has spoken out not only about the withdrawal problems with these drugs, but also about the aggressive marketing by the pharmaceutical companies, as well as the reckless and callous actions of the American Psychiatric Association.

Both benzos and AD’s have a discontinuation syndrome that is eerily similar. However, benzos were placed on the controlled substance list before the American Psychiatric Association changed the definition of addiction in 1994 to exclude dependence-only addiction.

Dr. Aston spoke about this in her lecture at the Bridge Project: 

After a while it became apparent that SSRIs, like benzodiazepines, produced a similar withdrawal syndrome, when they were stopped.   The doctors were surprised by this discovery and this was another example of their ignorance and lack of thought. It was already known that the older antidepressants produced a withdrawal reaction. Of course, the drug companies did not test SSRIs for withdrawal  reactions.

As I mentioned, the benzodiazepines had been accepted as being addictive on the basis of their withdrawal effects. Now the all‐powerful physicians of the American Psychiatric Association were faced with SSRI withdrawal. So once again they shifted their position. They adroitly changed their definition of drug dependence in the DSM IV. Withdrawal effects were no longer enough to qualify. The criteria for dependence were extended to include tolerance, dosage escalation and other characteristics. And the withdrawal syndrome was replaced by the patronising euphemism “discontinuation reaction”. As if a patient would think there was some subtle distinction between ‘discontinuation’ and ‘withdrawal’.
- Dr. Heather Ashton (author of The Ashton Manual)

Dr. Ashton's complete speech is found here: THE  BRIDGE  PROJECT, BRADFORD Professor C Heather Ashton, DM, FRCP



Lists of Books, Websites, and Videos about Psychiatric Drugs, Withdrawal, & Recovery:

Books:

Robert Whitaker - Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America

Robert Whitaker - Psychiatry Under the Influence: Institutional Corruption, Social Injury, and Prescriptions for Reform

Joseph Glenmullen, MD - The Antidepressant Solution: A Step-by-Step Guide to Safely Overcoming Antidepressant Withdrawal, Dependence, and "Addiction"

Bessel van der Kolk, MD - The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma

David Healy, MD - Pharmageddon

Joanna Moncrieff, MD - The Myth of the Chemical Cure: A Critique of Psychiatric Drug Treatment

Irving Kirsch, MD - The Emperor's New Drugs – Exploding the Antidepressant Myth

Allen Frances, MD - Saving Normal: An Insider's Revolt against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life


Websites:

Surviving Antidepressants


Mad in America


The Icarus Project


Dr. David Healy


Council for Evidence-based Psychiatry


Madness Radio


Videos:


Will Hall (The Icarus Project) -  Coming Off Psychiatric Drugs: A Harm Reduction Approach to Medication Withdrawal | Will Hall - YouTube

Robert Whitaker - Robert Whitaker - Global Psychiatric Epidemic - October 23, 2012 - CPH

Joanna Moncrieff - The Myth of the Chemical Cure: The Politics of Psychiatric Drug Treatment  - YouTube

David Healy - The Antidepressant Era

Peter Gøtzsche  Peter Gøtzsche - Overdiagnosed & Overmedicated
« Last Edit: October 13, 2015, 09:03:44 am by [Buddie] »
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Antidepressant Withdrawal
« Reply #1 on: September 21, 2015, 07:22:53 pm »
Mind, this is incredibly well organized and has an amazing amount of information.  Thank you for doing this for our members! 
[...]  :smitten:
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Antidepressant Withdrawal
« Reply #2 on: September 21, 2015, 07:59:52 pm »
Thank-you for posting this!
I intend to taper off my other meds once I'm more stable, and this is a wonderful resource  :thumbsup:
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Antidepressant Withdrawal
« Reply #3 on: September 23, 2015, 12:14:25 pm »
Thanks, [...] and [...].   :smitten:

I just added a couple of things, including a movie I found - The Antidepressant Era.

I'll add more resources as I find them.

Please feel free to post any books or videos that you find helpful about AD's and withdrawal.   :thumbsup:
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Antidepressant Withdrawal
« Reply #4 on: September 24, 2015, 12:06:01 am »
My gosh, how I wish I'd had all this information all those years ago before embarking on my AD withdrawal from Hell.

Mind, this is an absolutely amazing piece of work!  The sheer amount of time, effort and *passion* you've put into this article is very evident, and I can only imagine the number of people who will be helped by this in the future!  I hope many doctors get to see this too!

Awesome, awesome job, my friend!

 :smitten:

Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Antidepressant Withdrawal
« Reply #5 on: September 24, 2015, 01:06:49 pm »
Mind this is truly an incredible labor of love.  :smitten:

There is a significant need for awareness and resources to share with members searching for information. Previously I'd simply direct members to surviving antidepressants, but not everyone has an interest in joining another forum. Thank you for creating and organizing so much information into one link. Needless to say I wish I'd had even a fraction of this information or awareness. ::)

Simply an amazing job...thank you :smitten:
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Antidepressant Withdrawal
« Reply #6 on: September 24, 2015, 05:02:18 pm »
Yes, we are very fortunate that Mind was willing and able to take the time to formulate such and well written and informative thread. Thank you Mind!  We are so lucky to have you on the team!

[...]  :smitten:
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Antidepressant Withdrawal
« Reply #7 on: September 25, 2015, 10:24:28 am »
Thanks, everyone.   :smitten:

I recently came across Dr. Healy's updated version of the Rxisk.org Guide to Stopping Antidepressants.

The article mentions crossing over from a potent SSRI to imipramine (an older tricylic). I hadn't even thought about that before, but I wish I'd done it when I had to come off my last SSRI due to a severe manic / akthisia reaction.  I might have saved myself a horrible crash. I ended up on a second benzo plus a Z drug because of the insomnia. By switching to an older tricyclic or tetracyclic, I might have been spared the extra drugs and had a much softer landing.

Anyways, I just added a section to this article to include information on this.
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Antidepressant Withdrawal
« Reply #8 on: September 30, 2015, 03:07:08 pm »
wish I had heeded all this before I ignorantly came off Zoloft in 4 weeks time after 15yrs on it..was told to start gabapentin and I would be fine..

read up on gabapentin and made the decision NOT to take anymore drugs that play with my brain chemistry

so here I am 5 months off as of Oct 9th (next week) and I am DIEING!@!!!!!

but for me reinstating seems futile. I also tapered .125mg from my lorazepam last Saturday...so I must just be a martyr or masochist

let me say that coming off the sertraline is as hard as the benzo...I AM WICKED sick
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Antidepressant Withdrawal
« Reply #9 on: October 07, 2015, 08:49:32 am »
I have a question, do you think AD recovery is slower than benzo?
I don't really like survivingantidepressants but it seems to have a lot of +5 years members and that is very scary.
With benzo's we all say: 18 months, how is this for AD? Are these protracted members a minority but vocally active or are there much more protracted members than here  :-[
I'm starting to think benzo's is not my worst problem but probably my 5-HT receptors are, because everything I took has an effect on these receptors
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.