Depression Medications - someone please talk me through this withdrawal ...

Author

someone please talk me through this withdrawal ...

post_restante

2005-01-27, 8:18 am

I was on Lexapro for about 15 months, then it seemed like it wasn't
working that well for me anymore. I was instructed to start to taper
off of it, and gradually introduced to Wellbutrin. When I hit the
300mg/day mark, the Wellbutrin started eating me alive. It made me
incredibly agitated, nervous, and jittery. It was just like Paxil had
done me years ago. I immediately started tapering off after only a
couple of days at 300mg. After a couple of weeks of only 10mg/day
Lexapro, I took my last one last Saturday.

I spoke to my doc, and offered the suggestion that since the med level
in my system was the lowest it had been for over a year, that maybe it
was a good time to try to do without meds and see how I do.

But it's definitely taking it's toll. I've been feeling very mixed up
inside, part nervous, part hopeless, part worried. I'm having this
internal conflict over what's happening. Am I just off kilter because
of the unsettling effects of withdrawal, or am I really this quickly
going back to depressive ways of thinking? Or am I just nervous and
scared? Things that never bothered me before are starting to worry me,
and things that never made me angry before are making me angry.

I am having a hard time knowing if this is just short term or long
term, or what. I wish I wasn't thinking so strongly about taking a
lexapro when I get home. I really wish I was free of the meds, as I can
barely afford them.

Would someone who's been through this give me some feedback? A kind
word telling me this will pass in time would really give me some peace
of mind.

Or am I just making a big mistake trying to be free of the meds?

Provigilance@yahoo.com

2005-01-27, 8:18 am

I hate to tell people what to do with their psychiatric drugs, but if I
were you, I'd resume Lexapro immediately -- no matter what your doctor
says. Whether or not your current symptoms are due to Lexapro
withdrawal or worsening depression, or even Wellbutrin discontinuation,
or all of these things, the smart thing to do is to go back on Lexapro
for now. It's not as though you *have* to discontinue it now. The
level of anxiety that comes across in your post is not a good thing for
someone prone to depression. Once anxiety spirals out of control,
anything goes. It makes sense to want to be off psychiatric drugs, but
now isn't the time, and it's not worth the risk. Possibly, you could
increase the Lexapro dose from what it was prior to starting
Wellbutrin, or add something like Remeron or lithium to Lexapro. You
might want to add a benzodiazepine, short-term, to take the edge off
your anxiety, too.

Consider this passage from "The Peace of Mind Prescription":

"Many people don't relish the idea of taking a medication for the rest
of their lives. Although understandable, we believe this view reflects
a misperception of the nature of mood disorders and a lack of
appreciation for the value of long-term maintenance drug therapy.
Simply put, antidepressants do not cure depression any more than
insulin cures diabetes. True, with the help of an antidepressant some
people make important changes in their lives that reduce their risk of
depression and increase their resilience. In such cases -- usually
involving mild to moderate depression -- slowly tapering off an
antidepressant under the direction of a clinician may be possible. ~!~
But not always. ~!~

The general rule of thumb is to maintain treatment for nine months to a
year following a first depressive episode (Eric, this stuff belongs in
your FAQs), then taper off the dose to see if the medication remains
necessary. If a second episode occurs, the medication should be
continued for two years before another trial of tapering off is
undertaken. If a third episode occurs, the medication should be
continued indefinitely.

Even when depression is precipitated by a specific event, such as loss
of a loved one, the unleashed biochemical chain of events can lead to
longlasting changes in the brain. These changes can leave a person
vulnerable to depression long after the precipitating event has been
successfully dealt with or overcome. More fundamentally, depression
almost always has a preexisting genetic component, which, even if
relatively minor, will not go away.

Studies show that half of those experiencing an episode of depression
will eventually have a recurrence. In addition, numerous studies
demonstrate that continuing medication treatment greatly reduces the
chance of relapse -- from a rate of four of every five people among
those who stopped medication to only one of five people who continued
their medication, according to one large, three-year study. We urge
you to view depression as a chronic condition, analogous to diabetes or
familial high cholesterol, which often requires relatively long periods
of pharmacological treatment as well as attention to lifestyle issues
to build resilience and decrease vulnerability."

So, just go back on Lexapro for now, get something quick-acting for the
anxiety and try not to worry or wonder. Notice how other people don't
share your concern. It's because they're able to realize what you're
experiencing is *temporary*. I've been in this kind of state
(resulting from drug discontinuation) several times, and it will
definitely go away.

post_restante wrote:
> I was on Lexapro for about 15 months, then it seemed like it wasn't
> working that well for me anymore. I was instructed to start to taper
> off of it, and gradually introduced to Wellbutrin. When I hit the
> 300mg/day mark, the Wellbutrin started eating me alive. It made me
> incredibly agitated, nervous, and jittery. It was just like Paxil had
> done me years ago. I immediately started tapering off after only a
> couple of days at 300mg. After a couple of weeks of only 10mg/day
> Lexapro, I took my last one last Saturday.
>
> I spoke to my doc, and offered the suggestion that since the med
level
> in my system was the lowest it had been for over a year, that maybe
it
> was a good time to try to do without meds and see how I do.
>
> But it's definitely taking it's toll. I've been feeling very mixed up
> inside, part nervous, part hopeless, part worried. I'm having this
> internal conflict over what's happening. Am I just off kilter because
> of the unsettling effects of withdrawal, or am I really this quickly
> going back to depressive ways of thinking? Or am I just nervous and
> scared? Things that never bothered me before are starting to worry
me,
> and things that never made me angry before are making me angry.
>
> I am having a hard time knowing if this is just short term or long
> term, or what. I wish I wasn't thinking so strongly about taking a
> lexapro when I get home. I really wish I was free of the meds, as I
can
> barely afford them.
>
> Would someone who's been through this give me some feedback? A kind
> word telling me this will pass in time would really give me some
peace
> of mind.
>
> Or am I just making a big mistake trying to be free of the meds?

Lucida

2005-01-27, 8:19 am

Have to agree here. If coming off makes you feel like this, now is not
the time. Maybe later, maybe not, but definitely not now. Don't make
things harder on you than you have to.

Lucida

Linda

2005-01-27, 8:19 am

post_restante wrote:
>
> Would someone who's been through this give me some feedback? A kind
> word telling me this will pass in time would really give me some
peace
> of mind.

A rebound depression can follow on the heels of the withdrawal
symptoms upon stopping SSRI's.

If you can make it through both the withdrawal symptoms and any rebound
depression ---you home free.

Here is a link to published reports of withdrawal symptoms from SSRI's.

http://www.socialaudit.org.uk/425ssritable.htm

> Or am I just making a big mistake trying to be free of the meds?

welshboy

2005-01-27, 8:19 am

Hey Provigilance. What a fantastic post. I could not have put it any
better myself.

Peter V'ylliki

2005-01-27, 8:19 am

"Linda" <adinllinda@aol.com> wrote in news:1106328348.205756.89650
@z14g2000cwz.googlegroups.com:

>
> post_restante wrote:
> peace
>
>
> A rebound depression can follow on the heels of the withdrawal
> symptoms upon stopping SSRI's.

Or a more obvious cause; the original reason- depression- for taking the
medication returns.

Provigilance@yahoo.com

2005-01-27, 8:19 am

Thanks, man. Are you from Wales?

Clinton Gandy

2005-01-27, 8:19 am

Not to discount the medical/withdrawl aspect of your problem, you are
thinking yourself to death. You are HYPER=aware of everything at the
moment and that is a miserable place to be. I think it takes a couple
weeks for clinical depression to start cycling again. Not a doc though.

You must find something or someway to calm yourself down. Then you can
get proper perspective.

Good luck.

jake

2005-01-27, 8:19 am

"Linda" <adinllinda@aol.com> wrote in message
news:1106328348.205756.89650@z14g2000cwz.googlegroups.com...
>
> post_restante wrote:
> peace
>
>
> A rebound depression can follow on the heels of the withdrawal
> symptoms upon stopping SSRI's.
>
> If you can make it through both the withdrawal symptoms and any rebound
> depression ---you home free.
>
> Here is a link to published reports of withdrawal symptoms from SSRI's.
>
> http://www.socialaudit.org.uk/425ssritable.htm
>
>

Quitting psychiatric drugs
Introduction

A woman may have a variety of reasons for wanting to stop taking
psychiatric medication. She may want to be free of the dulling effect that
most psychiatric drugs cause, or of more serious side effects that she may
be suffering. She may be worried about the long-term effects of the drugs,
including tardive dyskinesia. Or she may be wanting to make a major change
in her life by freeing herself from a dependence on powerful medication.

But whatever her motivation, she has a right to free herself from
using medication. There may well be situations in which you don't agree with
a woman who wants to stop taking psychiatric medication, or you may be
scared that doing so will do her serious harm. But it is her right, and she
probably has sound reasons for wanting to stop using the drugs. After all,
she is the one who has to live with the effects of the medication, and she
is the only one who knows how the medication really affects her.

You can support her by helping her make informed choices about her
options. You can give her information about her medication and its effects.
You can also give her information about getting off the drugs, and you can
support her in carrying out her choice in a safe way.

That safety may be the most important support that you can provide.
Remember, you have little influence over what she does after she leaves the
transition house. She may stop her medication cold, without information or
support, and put herself in serious danger. The symptoms of too-rapid
withdrawal from psychiatric drugs include extreme nausea, anxiety, insomnia,
restlessness, muscular reactions, and strange behaviour. In the case of
minor tranquilizers and sedatives, the reactions to sudden withdrawal can be
life-threatening.

You can support her in struggling with these issues and making an
informed choice. But remember that you are dealing with something that is
her right. If you pass judgement on her wishes, you won't be helping her
find out what is really best for her. And she may simply stop her medication
anyway, without the information and support she needs.

Finally, a woman who wants to stop taking psychiatric medication
should have the support of a sympathetic doctor. By sympathetic we mean a
doctor who is willing to accept a woman's right to choose her own path and
work with her in getting off the medication. This is the best way, to have
the active involvement of a doctor who can help plan and monitor a woman's
withdrawal from psychiatric medication.

Note that many detox centres and drug abuse programs help people to
stop taking minor tranquilizers and sedatives, but not neuroleptics and
antidepressants.

What follows is an overview of the basics. It will help you and women
you work with understand what's involved in the process, and how one goes
about it.

The basic principles

There are some basic principles that a woman has to follow to stop
taking psychiatric drugs safely. Familiarize yourself with them, and make
sure that any woman you work with who wants to stop her medication is
familiar with them, too.

a.. don't try to stop taking psychiatric drugs without support

b.. if at all possible, find a supportive doctor to supervise the
process

c.. never stop taking psychiatric drugs abruptly -- going "cold
turkey" can lead to serious withdrawal symptoms and can be life-threatening

d.. the best way to stop is to reduce the dosage gradually; by
withdrawing gradually and carefully it may be possible to minimize
withdrawal symptoms

e.. withdrawal from sedatives and minor tranquilizers can be
extremely dangerous

f.. withdrawal symptoms don't necessarily start immediately; they
may begin anywhere from 8 hours to several days after quitting

g.. the time it takes for withdrawal symptoms to set in and their
severity varies from person to person, and depends on how long you have been
taking the drugs, your dosage, your overall health, your body weight, and so
on.

Steps to follow

a.. Find a supportive doctor who will work out a withdrawal schedule
with you and monitor your progress. Other psychiatric survivors or a
survivors' group might be able to suggest a doctor.

b.. Have a living situation that is as stable as possible.

c.. Organize support from friends, family, survivor groups, the
local women's centre, and/or counsellors.

d.. Withdraw from the drugs as gradually as you can.

e.. Find out as much as you can about the process so that you will
be prepared for the withdrawal symptoms.

f.. Don't expect to feel much difference in the first few days.

g.. Realize that your body and mind are going through a difficult
experience.

h.. Make sure you get enough sleep. Difficulty in sleeping is a
common problem; it's important that you get at least 6 hours of sleep a
night. Use herbal remedies for sleep, and try yoga, meditation, massage,
etc. But if nothing else helps, it's worth taking sleeping pills just for
this short period.

i.. Stop using stimulants like coffee, sugar, chocolate, alcohol, or
street drugs.

j.. Eat the healthiest diet you can to help your body purify itself.
Vegetables, fruit, nuts, and grains are important; eat as little red meat as
you can, and avoid junk food.

k.. You will have more physical energy as your body gets away from
the drugs. Physical exercise will help you stay calm, and will be very
helpful if your energy seems to be getting out of control. Try to start
exercising, swimming, hiking, or bicycling. But start gradually.

Setting a schedule
Remember, psychiatric drugs should never be stopped abruptly! The more
slowly you can withdraw, the less bad effects you will suffer. The best plan
is to work out a schedule with your doctor that best suits your situation.

Standard practice is to reduce your dosage by 10 percent per week,
monitoring your progress at every step. The first week, you would reduce
your dosage by ten percent. Try that for the first week, and then see how
you are doing. If you feel OK, reduce the dosage by another 10 percent. Try
that for a week, and see if you feel OK.

If you reach a point where you don't feel OK, don't reduce your dosage
by another 10 percent. Stay at the same reduced level for another week, or
until you do feel fine. Then reduce by another 10 percent and continue with
the process. Some steps might be more difficult than others; take your time.

For example, if you are taking 200mg of Chlorpromazine a day, reduce
by 10 percent -- 20mg -- to 180mg per day. Try that level for a week. The
next reduction would be to 160mg a day for a week (or longer), then 140mg a
day, and so on.

If you are taking more than one medication at a time, it's best to
stop them one by one. If you are taking a neuroleptic (major tranquilizer)
and an anticonvulsive drug (anti-Parkinsonian) at the same time, which is
common, withdraw from the neuroleptic first. However, if you are taking more
than one medication, this is a situation where it is definitely best to have
a doctor working with you.

Withdrawal effects by drug class

If you are working with a woman who wants to stop taking psychiatric
drugs, it's important to be familiar with the typical reactions or symptoms
of withdrawal. These vary, depending on the person, how long she's been
taking the drug, her dosage, and the type of drug.

Different classes of drugs bring on different withdrawal reactions.
Some of these reactions may be disturbing and hard to witness but not really
dangerous. Others may be life-threatening.

A familiarity with drug withdrawal reactions will help you in working
with any woman who is taking psychiatric medication. Many patients don't
take their medications as prescribed; they will alter their dosage,
increasing or decreasing the amount they take. Or they will miss a day's
medication, and then catch up by taking twice as much the next day. By
mistakenly taking too little medication, they may bring on the early stages
of withdrawal. Mysterious physical and emotional complaints may actually be
signs that they are not taking their medication as prescribed.

Even when a woman is taking her medication as prescribed, she may
experience the beginnings of a withdrawal reaction as a dose begins to wear
off. For example, a woman who is taking a minor tranquilizer may find
herself feeling agitated and restless before she is to take her next
prescribed dose.

In both cases, these signs are the results of the early stages of
withdrawal. It may seem like the agitation, anxiety, or physical discomfort
are signs of a woman's "mental illness" or a sign that she really does need
the medication she's taking. However, her complaints may actually be due to
the physical effects of the beginning stages of drug withdrawal.

Listed below are the main classes of psychiatric medication, along
with the withdrawal reactions that are most common with each of them.

Antidepressants and neuroleptics

a.. flu-like syndrome with headache, muscle aches, chills, nausea,
vomiting, diarrhea, and loss of appetite

b.. muscular reactions such as uncontrollable rhythmic movements and
tremors (these are more severe with neuroleptics)

c.. insomnia, emotional distress, feeling like one is "going crazy"

Lithium

a.. less side effects generally than other classes

b.. insomnia, anxiety, irritability

Minor tranquilizers, sedatives

a.. sudden withdrawal can result in life-threatening seizures;
withdrawal must be very gradual

b.. seizures common in early stages of withdrawal

c.. other reactions can include flu-like syndrome (see above),
muscle tics, restlessness, and anxiety

d.. withdrawal symptoms usually take a few days to develop, but can
occur immediately and get worse during the first week

What you can do to support a woman withdrawing from medication

a.. Respect the woman's right to make her own choices.

b.. Be informed about the process of withdrawing from psychiatric
drugs.

c.. Be familiar with the withdrawal symptoms so that you can stay
clearheaded and not panic.

d.. Help keep people who disapprove of what the woman is doing from
interfering in the process.

e.. Remind the woman to get enough sleep.

f.. Make sure she gets enough to eat. Help her prepare food, as she
may be too nervous to cook on her own.

g.. Help her get in touch with other people who will support her.

h.. Don't be misled by the withdrawal symptoms, thinking that they
are signs of her "illness." Be patient; it takes time to withdraw from the
drugs and adjust to life without them.

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