This year, I celebrated my 2nd anniversary of being Paxil-free. (The “hurray!” I feel compelled to type here is a complete understatement of my joy.) Back in 2004, I started taking the drug under the advice of my primary care physician for panic …
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Great article, Summer. One of the big problems is that no one is informed that they ~should~ prepare themselves for withdrawal from an antidepressant. When I came abruptly off Effexor a decade ago, I was not at all ready for the meltdown that followed. I reinstated, then tapered slowly off of it. An even bigger shock was what happened when I tried to get off the Xanax my doctor had prescribed to deal with some of the side effects of the Effexor he gave me. I went into full Benzodiazepine Withdrawal Syndrome. It took me literally years to get off benzodiazepine, years during which I was disabled in many ways. Now four years off, I’m still not free of the after effects.
What bothers me most about your story and my own is that when being offered these psychiatric medicines by our doctors, the potential risks of developing a chemical dependency is hardly ever mentioned. Doctors are even reluctant to hear that there ~is~ a problem getting off of them later. It took years before the medical community would admit that there is an SSRI Discontinuation Syndrome. They have one model of “addiction”, wherein the addict craves the substance in question and tends to abuse it, and won’t accept the very rational idea that if a patient is unable to discontinue a medication without severely disruptive consequences, that patient is an ~addict~ even though they don’t fit the psychological/behavioral stereotypes. Sadly, it is most often a result of patients sharing information with other patients, such as you have done here with this blog, or I did by writing a book about getting safely off benzos, that people can minimize the damage psychiatric drugs do.
To all those contemplating discontinuing SSRI’s/SNRI’s or benzodiazepines (Xanax, Ativan, Klonopin, Dalmane, etc.) please follow the advice in this article and gather as much information and support as you can, to prepare yourself for what may follow.
–Jack
Jack, thanks for the comment. I agree with you completely about doctors rarely mentioning the possibility of addiction and/or severe side effects. But it’s not necessarily the doctors who are at fault — many of them probably rely on the information provided directly from the pharmaceutical sales reps. And the information coming from the drug companies is bound to be spun into a shiny top hat & bow tie. Truthfully, all doctors who visit with any type of sales representative ought to go through a full course of training on identifying techniques of persuasion.
That being said, it’s not just the drug companies, either. I saved a Patient Prescription Information pamphlet that I received with my Paxil script back in 2006 from CVS. The black box warning isn’t yet on it, and I noticed this blatantly opinion-based comment in the “Side Effects” section:
“Remember that your doctor has prescribed this medication because the benefit to you is greater than the risk of side effects.”
Seriously!? How can they say something like that? To anyone with a current Paxil script from CVS: can you check to see if this line is still printed on there?
It’s too bad that you had not heard of The Road Back, a very workable program that has been used by thousands of people and endorsed by many in the medical field, that helps get people off these types of drugs without side-effects. For others interested, just Google “The Road Back.”
Another reason why people need to start realizing why there is a problem with the statistic that about 70% of antidepressant prescriptions are written by NON psychiatrists. If you go to your PCP/OB/nurse practitioner/internist for psychiatric care, you will get the care that a non specialist can offer. This is not a slight or insult to the above providers, it is just they underestimate the expertise in writing for these meds IF the meds are indicated. And, if you want to help demystify and destigmatize mental illness, you as a patient or invested person to someone with mental health problems should be advocating for psychiatric/mental health services.
If I had a nickel for every person who came to me after seeing a non-psychiatrist for meds first, I would have one helluva dinner in front of me from a first class restaurant!
Road to hell, folks, it is not what any doc should realistically be thinking if the patient in front of them is asking for psychiatric meds.
just my opinion.
therapyfirst, board cert psych MD
Peter, the Road Back doesn’t guarantee no side effects while withdrawing. It just keeps you healthy. It could possibly make things easier, but it’s very expensive in this economy and when it comes to withdrawal from prescription drugs, there are no guarantees. If you could solve brain imbalances so easily, no one would be complaining about withdrawal.
It works for some, but for others it does nothing more than take a bit of the edge off. I would personally neither speak for or against it.
Thanks for this useful post. Were you aware that 1 ml and 0.5 ml graduated oral syringes are available from your pharmacist? Having one of these little puppies to control dosage would have made some of my daughter’s attempts to taper off sertraline, starting at 50 mg/day, a lot easier. Note that at the wikipedia sertraline site I am trying to add information about oral syringes and alternate ways to taper off (“Gradual discontinuation, or tapering, can be accomplished by breaking pills into parts or using a graduated oral syringe with the liquid form. However, in some cases sertraline users develop SSRI discontinuation syndrome even on gradual discontinuation. Transfer to another SSRI, with less SSRI discontinuation syndrome, has sometimes been effective at discontinuation.”), but the site guardians don’t like the information because it is uncited. If you know any relevant citations in the medical or psychiatric literature I would appreciate knowing them. In any event, I think you should feel free to “gently” modify that site.
Hi, A Dad. Yes, I am aware of (and have used) the syringes to take liquid Paxil near the very end of my taper. It took me awhile to get my hands on a bottle of liquid Paxil — it hadn’t yet gone generic yet when I was tapering, so a bottle cost $199 at CVS. (I didn’t have Rx coverage at the time, either. Lucky me.)
Anyway, I checked in the aisles at CVS and the smallest medicine droppers for infants didn’t have small enough measurements for my final few milliliters. So I asked the pharmacist if they had any diabetic syringes, and he happily gave me one (sans needle, of course).
I recommended this method to other people across the US who were also trying to taper down their dosage. Several of them said that their pharmacists would not give them a dropper, so they had to resort to guesstimation with teaspoons and other completely inaccurate measuring devices. It’s a shame that the logistics of withdrawal are nearly as frustrating as the mental and physical effects as well.
Regarding sources for that information, I can’t think of anything off the top of my head. Page through The Antidepressant Solution, though — much of it is available to view on Google Books — and hopefully it will lead you to some useful references!
thanks for the useful info
Great article summer!
To Jack sorry to hear of your struggles.
Do you mind if i ask what your symptoms are at 4 years off? and do they come in waves?
my blog is about my journey of withdrawing from 6 meds including an antidepressant…
the about page offers tons of resources…both on and off my blog…
http://bipolarblast.wordpress.com/about
The Road Back is over priced…you can do all it says for a fraction of the price and pay attention to you individual needs as well…
for dietary guidelines to support yourself I recommend
Joan Larson’s
Depression Free Naturally
Thanks to each of you for your postings. I thought
that I was the only one feeling dizzy when I skip a dosage or try to cut down. My Dr’s who prescribed the Paxil, specialty is internal medicine and I have seen a psychologist who agrees that I needed to be on the medicine. I AM NO SURE IF I WILL EVER GET OFF. But after reading these postings, maybe there is hope.
Dee
I am currently weaning off 225 mg of Effexor – I am down to 75 mg per day (I already weaned off 300 mg of Seroquel with no problems). I was advised to do the 50% reduction every 2 weeks by my psychiatrist and have pretty much stuck to that. The first reduction to 150 was killer – nausea, dizzy, night sweats – for about 2 or 3 days before I started to stabilize. The next reduction I did 75 + 37.5 for 2 days and now I’ve been at 75 for about 5 days. After my first reduction I did a lot of reading on the internet and found great information about the benefits of vitamins and supplements to help not only manage the withdrawl symptoms but also as a replacement for antidepressents. I started taking B Complex and Vitamin C, in addition to the multivitamin I was already taken, plus Ginger Root capsules twice a day for the nausea. Last week I did acupuncture for the first time and I have to say it was the best thing ever! I felt so good and the effects lasted a good 2-3 days.
The thing that frustrates me so much about all of this is the lack of information from the physicians and psychiatrists and drug companies. That and the way “they” hand over pills without fully explaining the long-term risks and side effects. I was put on Effexor 5 years ago after suffering from severe postpartum depression and attempting suicide. Granted, at the time I was in a crisis situation, but my psychiatrists never explained the side effects or even offered weaning as an option later in life. I was led to believe I would need to be on meds for life. But I had good therapy and made positive changes in my life, and am confident that I can live a full and healthy life without the aid of drugs.
Summer, yes, that statement is still printed on the drug inserts.
VERY IMPORTANT:
ALWAYS see your Psychiatrist so he can wean you off the drug.
DON’T attempt to do this yourself!!
Isn’t this website s’pose to condone people from ending their medications without a psychiatrist’s approval?
It’s very easy to end up in the hospital again after trying to wean yourself off anxiety medication or any psychiatric medication for that matter!
My 2 cents: Seek psychiatric help before you let go of a medication. He may just save your life.
Regards, Sara
Karen and Dee, I have slowly tapered from 4 meds down to 1. I expect to be completely off either this year or sometime next year depending on how things go.
And I was essentially told I would need to be on meds for life. Don’t believe that type of lie.
Sara, normally, your advice would be on target but not with psychiatric meds and most psychiatrists. No offense TF but you’re the exception to the the rule regarding psychiatrists who know how to taper people off of these meds.
If I had listened to my psychiatrist’s advice about tapering, it would have been too fast and there is no doubt in my mind that I wouldn’t have succeeded in tapering the way I have. Most people report similar experiences.
Many people come to the Paxil Progress Boards essentially reporting that their psychiatrists tapered them real quickly causing horrific side effects. When they complained, they were falsely told it was a return of their illness.
Anyway, I feel I saved my life by taking the bull horns and telling my psychiatrist I was going to taper and the slow plan (10% of current dose every 3 to 6 weeks) I was going to use to do it.
AA
Hi Sara.
Yes, there is a disclaimer on the website that suggests you review information with a doctor before making any decisions regarding medication, treatment, etc.
That being said, I believe that if someone truly wants to stop taking an antidepressant (particularly in cases like mine where it should have been a last resort & not a front-line treatment), they should certainly bring some research with them to the doctor’s office. SSRI withdrawal isn’t an exact science, unfortunately. So, some doctors will tell you to reduce your dosage in half for a week & then quit. Others might suggest an every-other-day dosing schedule (which worked out horribly for me, BTW, and I would never ever recommend it). Still others will attempt a cross-taper with Prozac. It’s easy to automatically trust a doctor that you’ve built a relationship with, but doing your own research in tandem & becoming a more competent consumer of prescription medication is a wiser choice for both doctor and patient.
On my primary care physician’s advice, I attempted to reduce my Paxil intake. My M.D. recommended tapering from 20 mg. to 10. That was a disaster, emotionally and physically. I had greater success, and dramatically reduced withdrawal symptoms, when tapering by 5 mg. at a time. I’ve let my M.D. know this. While she is a highly-regarded cardio-pulmonary critical care internist and med school teacher, she is NOT a psychiatrist, and her initial recommendation must have been what she herself had been taught — in a book, not by real patients.
I wa on fluoxetine, switched to amyltripaline, which I decided to take myself off of, because the side-effects were horrible. i felt a bit horrible for a few weeks, but it was alright. I am not starting to relapse (2 years on) and I can pretty much guarantee i will be medicated again. at least my new dr is against meds if they are avoidable. My old doc used them as a solution t everything, but my new doc sees them as a way to help you stand on your own two feet.
cant wait to see what they put me on this time.
sorry *not = now. typos
Comment to ‘therapist’ – it is thanks to a variety of PSYCHIATRISTS who have had me on mega doses of a variety of psychiatric medication for years, sometimes a ridiculously high polypharmacy mess, that I have now ended up with a heart condition! I’m not sure where you are from, but I am in Australia and after 27 years of experience with a wide variety of psychiatrists NONE of them paid heed to or were cautious about prescribing taking into account negative side-effects, so don’t tell me it is ONLY people who go to insufficiently qualified professionals that end up in this kind of a mess. PSYCHIATRISTS have a lot to answer for in regard to the physical health and subsequent additional disabilities brought on by injudicious presciption of these drugs.
Summer – I thank you for your wise advice re coming off medication. It is the most balanced view I have come across so far. I have made note of your ideas and am preparing myself for coming off mertazapine which has seen me put on massive amounts of excess weight in just 7 months.
Hi permssion! I’m glad you found it useful. Certainly the weight gain sounds awful, and I just pulled up the Wikipedia article for mertazapine — perhaps you’re also experiencing a great deal of drowsiness too. Both weight gain and excessive sleepiness look common for that drug. Best of luck with the withdrawal & remember to treat your body & mind well!
all this is making me depressed. i was on zoloft for a few years and found myself flat lined so then my psychiatrist wanted me to try cymbalta. that sucked. after working hard over the last few years on my negative thoughts and anxiety i decided to stop all antidepressants. im on day 5 and the withdrawls are drving me crazy. dizziness, cold sweats, light headed, light sensative and nausea have been happening every afternoon at about the same time. i feel crappy and i just want it to stop. readin here that it will take longer than i thought is scary.
Hi Quinbee. I know withdrawal sounds like a lot of work, but the ultimate result is a much smoother transition. I’ve personally attempted to withdraw from Paxil cold turkey and it was an awful decision (and it wasn’t long before I was back on my full dose again). I know you might want to get out of this mess as soon as possible — I’ve been there — but a slower taper seems to lessen those awful symptoms for a lot of people. Paxilprogress.org got me through the worst of my withdrawal — the folks there are very helpful & genuinely concerned about your progress — so if you haven’t been there already, I highly recommend it. You’ll find others who are going through the same thing at this very moment.
Can anybody help me ! I stopped taking celexa cold turkey about 2 weeks ago and started having hot flashes & night sweats. Today I feel weak and foggy. Did anybody elsew have this ? What should I dostart back on and then try to taper off. I wanted to go off because of side effects. I broke three teeth grinding. I think that that was a side effect of the Celexa. I’ve been on this drug for about 4 years.
Anyone in my shoes ????
Hi lw,
The reason you are going through this is because you stopped Celexa on your own!! Typically an individual taking antidepressants or any medication is suppose to tell their doctor and their doctor will slowly lower the dosage of the medication and then completely take you off. The effects encountered after stopping a medication on your own can be so extreme that you can have flu like symptoms.
I can guess some of the reasons why you stopped your medication, but I would strongly encourage you to speak with your doctor before you feel worse.
Best of luck
Yes, I agree. Most doctors want to taper you way too fast – or not at all. When I first started taking Paxil nobody knew about the withdrawal and I was certainly never warned. A doctor I saw recommended Effexor but I really hesitate because it seems to be the worst to withdraw from. Also, my daughter took it and on the third night, she was hearing voices in her head that kept her awake. They say people in the same family can have similar reactions, so I don’t know why anyone would suggest that drug for me.
So, Dr. T , with all due respect, the doctor can be part of the problem.
I will look into Glenmullen’s book. Thanks for the info.
Up until mid-January 2009 I was taking 100mg of Sertraline (Zoloft). I weaned off by by reducing 25mg each week. Even till this day, I still experience flashbacks / ptsd and some depression. I take B-12 16000 mg / day and L-Tryptophan 200mg/day. They work on some days, and on others they seem to have little benefit.
I’m thinking of going back on Sertraline but on the lowest dosage and see of I can slowly wean off slowly this time.
Do you know of anyone who has tried doing this? Was it successful?
Thanks for the insight, I’m relieved to know others are dealing with the same issues.
I am currently taking 50mg of Seratraline and I am very sensitive to the side effects as it is. If I am just one hour late in taking the pill I have nausea, headaches and hot flashes and tremors, and at times I get agitated. I have been wanting to get off the medication for quite some time but the side effects are too much.
I can cut the pill in half, but I can’t really go any smaller than that, seeing that the pill is very small to begin with.
And, even after I lower the dose and I am off the medication, how long will the symptoms last?
Is there anything I can take to rid the nausea and fatigue?
Please help.
Good article, and I especially like the part where you end with: This is not professional advice. Only your doctor knows best how to treat you best!! (yes, that’s the very best part!)
When my son’s psychiatrist told me exactly to stop his Luvox after taking it for five years, I said “NO”, I would not. She told me to give him 50% for three days and then zero.
Not to mention that the Luvox caused my son to become ‘bipolar’, and my whole family lived in fear and agony for years. So then we spent one year trying to find the right medicine…on top of the Luvox…to treat his manic depression, and if it were not for me, and only me, he would long be dead. There were no warnings, nothing, and a year of agony. Then , when there was no mood stabilizer that did not kill him, the psychiatrist wanted him on risperdal.
Anyway, the best thing that ever happened was when my son got into trouble and someone called DHS and sent out a caseworker to my house. The guy was great, (except that he was paranoid and distracted that someone was watching him all the time) but he listened very carefully, then asked for permission to talk to my son’s psychiatrist and the next day I got the order to take my son of the Luvox. That was the very end of bi-polar, and he has not had even one second of a symptom of such in n ow about three years.
(the whole issue was never discussed or mentioned again after that, as if five years of hell never happened.)
Thanks again for writing this,
KATRIN
correction: where you NOT end with!!!
What a fabulous article Summer.
This was informative and offered realistic and safe advice whilst also putting safety precautions in place. I feel very good about my decision to come off my medication (wellbutrin)with my Dr’s permission of course and your article has given me even greater confidence.
Last year I graduated with honours in Music. Although I had spent 4+years with depression ( untreated and undiagnosed) I was still able to be extremely creative and had a very active imagination which in songwriting is key.
After my grad I basically ‘burnt out’ put mildly, and had to come home to live. In the year spent at home, I visited a raft of Drs, counselors, Psychiatrists, psychologists you name it, and in desperation wanted to explore every avenue.
As you said, whilst developing relationships with certain people you do put a lot of trust in them and are often more then willing to give their method of ‘therapy’ a shot. In the space of the year I tried a total of 5 different antidepressants and cross faded (sorry musical term) from one to another.
At one stage when I was on a high dose of Effexor, I went cold turkey and boy did I pay for it.
I did this without telling my parents or my Dr, because I hated the side effects and the fact my mind was numb and I had no ability to create or feel. It basically took my spirit away as music is my soul food. Well….. As hard as I tried to cover up the vomiting, brain shivers, irrational thoughts, from my parents.. playing the ‘Flight to Health’ card, I was a total wreck and learnt a very valuable lesson.
It took a lot of convincing for me to try another antidepressant after several episodes of flat lining and new anxieties developing but I finally, again out of desperation, was willing to give Wellbutrin (burpropion, zyban) a go.
After 3.5 months and no improvement only worsened symptoms, I made the decision that antidepressants were not for me. I was and still am, prepared for talk therapy, I mean whatever works for you folks! but I wanted to have the ‘old colourful me’ back. Right now I am tapering ever so gradually and yes I am experiencing some terrible brain zaps, nausea and some slightly obscure thought processes, but, already I am seeing wonderful improvement and feel like I have a purpose in life again.
As you wrote re: being prepared for side effects, this is definitely crucial, especially if you have built up a dependency on the drug. But knowing that in time, through gradual reduction, this will pass, makes it all worth it. Side effects unfortunately are part and parcel but having support in place, friends/fam/counsellor whatever, can make this easier.
This article had a profound and positive impact on me and I will be sure to send people to this link.
Thank you Summer! You’re a legend.
Colorful,
Thanks for your kind comment!
Like you, I also experienced a complete loss of creative motivation while on antidepressants. It’s even clearer now in retrospect — the 2+ years that I spent taking Paxil are not well-documented because I wasn’t motivated enough to keep writing in a journal (something I’ve done since I was about 8 years old!). I also enjoy creative writing, but during my time on Paxil, I felt no reason to continue on with that, either. Same with music — music is a big part of my life as well, but while on Paxil, I couldn’t be bothered with it. Songs were just a series of notes and chords; no song could rise above and become more meaningful than another.
The good news is this: my very last dose was in January of 2007. Nearly 3 years post-Paxil, I can safely say that ALL of the creativity has returned. Things DO improve!
Here’s my story, I would welcome comments. I have been on antidepressants for 28 yrs. I am not enjoying the simple joys of life. No interest, no sex drive etc. I have been on several different
antidepressants, not happy with any. I have done cognitive therapy, group therapy, and several psychiatrists. they tell me I will be on this stuff the rest of my life. As of now 150mg zoloft and 15 mg at night of Remron. The Remron took care of the daily nausea that I have had forever but I became an eating machine. Plus my daughter n law didn’t want my grandson to sleep with me cause I was knocked out. I cut the remron in half and then two weeks later stopped it all together. All I want to do is sleep, unmotivated and can’t eat. Constant headache. OVer the yrs. I have chased my tail with these drugs, cut back, get worse and go back on thinking I am just a sick person. I’m so glad to read about withdrawal syndrone. I would love to see if I could also live better without the zoloft but am terrified. I read that it is wise to go to a compound pharmacist and have the med. dosed out so I can make 5 percent reductions spread out over two or three weeks. I have moved to another state so now I need to find another psychiatrist. I don’t trust them but feel compelled to go to one.
How do you find a good one!!!! Has anyone gone the naturalpath route?
The article was very helpful, thank you. I just thought I would share my tips as I have been on Lexapro for year now for depression and anxiety. I think the best step is to visit a medical doctor and not necessarily a psychiatrist. The medical doctor asked me simple questions and really wanted to help me get better. I was against medicine from the start, but I knew it was best for me. It has helped tremendously, and I think for me an everybody, you should talk to your doctor 1st before getting off the medicine. As much as I just want to quit taking it, I will wait until I speak to my doctor. Can’t wait for the day to be off of it! P.S. I skipped a dose once and felt really dizzy, maybe that was a side effect…
Ellen –
Your description sounds exactly like emotional blunting from antidepressants. Long-term use can cause it. After a while, your serotonin receptors have downregulated (shut off) to the extent they can’t do their job anymore, no matter how much serotonin is squirted over them.
When this occurs, your drug is truly your problem, as Dr. Peter Breggin’s book says.
And, of course, antidepressants are well-known for eliminating sex drive and sexual response.
These are a couple of those unintended consequences of long-term antidepressant use, typically denied by doctors and the pharmaceutical industry.
See http://tinyurl.com/3dk5vjb for a scientific paper about emotional blunting caused by antidepressants.
Hi, I have been on one or more antidepressants now for seven years. I want so badly to be off of them but my psychologist and psychiatrist tell me I am destined to be on them the rest of my life. I have tried slowly backing off and will do okay for a while but then fall back into depression, often worse than before. As a result of my attempts I am now taking Abilify on top of Effexor and Lexapro. Is there any hope for me to one day be free of my meds?
PJ
Hi Pinyon Jay,
As a person who is approaching the year anniversary of my freedom from psych meds after 15 years, the pessimistic attitude of your psychologist and psychiatrist greatly angers me.
I am also extremely angry that their ignorance in confusing withdrawal symptoms with a relapse has led to you being placed on a drug, Abilify, that has very dangerous side effects. That is the equivalent in my opinion, to putting someone on heroin who suffered withdrawal symptoms from cocaine.
The key to getting off of psych meds is to taper at 10% of current dose every 4 to 6 weeks. In some cases, you may have to even taper more slowly.
The exception is if you haven’t been on a psych med for very long and I hope to god that is the case with the Abilify. By the way, i would taper that drug first and then taper either Lexapro or Effexor at the slow tapering rate that I suggest. Please only taper one drug at a time.
For additional peer run support, google “Surviving Antidepressants” which will result in the Surviving Antidepressants site being listed first in the search results. It is a great place for support in tapering off of psych meds. It totally depends on donations and is not affiliated with any organization.
Hope this helps.
but how do i controll withdrawal problem…and what i will do improve myself…
dizziness,blurred vision and nrevousness…? i quit antidep 1 month ago….i took amytripline 10 mg and revotlri .5 for 6 months…..
Did any of you get irritability or fear of losing control and lashing out while stopping celexa… well not stopping but tapering? I was only on 10mg took it for 8 months at that dose then tapered down to 5mg with help from psychiatrist because I was getting like ocd harm thoughts when NEVER have happend to me before.. very terrifying experience being on the med, the only emotion I could feel was anger and irritability and an increase in panic attacks and anxiety! I wasnt depressed before meds but somehow ended up with bouts of depression… anywho I just tapered down to 1/4 of a pill on the 8th… had 2 days of panic (which I havent had in a couple months due to first taper) and a day in between feeling completely happy and like myself, then today headaches and dizziness… today is day 4 at 1/4 pill (2.5 mg)… this stuff has def been a ride to taper off of my first taper was 10mg down to 5mg that was heck in itself but that was the biggest drop Im having to make. So basically Im just wondering if its normal to feel irritated and have fear of lashing out, not that I would its like agitation anger crap… oh and I can Cry again = ) thats the positive in all this! See therapist and psych tomorrow.. not looking forward to brain zaps.. headaches make me think thier coming soon LOL!
oh and my “things” are GAD and Panic Disorder if that helps someone give me the answer im looking for! Hope everyone else is doing okay and I wish all of you luck with withdrawl!