Gul123: SSRI damage

[GUL123]

Hi, 

I took an SSRI (ecitalopram 5mg) which I think I did not need as I was all right and a friend of mine (doctor) gave me that nasty med. I remained on it for 3 months and then tapered it off in the coming 3 months. 

For two or 3 months I was ok but after that I developed moderate sexual dysfunction. The doctor gave me levosulphride (antipsychotic) along with some other supplements but there was no improvement so I quit taking those medicines and now for the last 1 and a half month I have developed emotional numbness/apathy. 

It was an intolerable situation for me and I was very much worried bcz of it. I could not stay calm and was on pins and needles. Since quitting that ssri my condition has gradually deteriorated. I started taking bupropion and alprazolam but no effect however I feel calm now and am not very much worried about my condition. I don't know whether this calm is because of anti-anxiety med (alprazolam) or I have just got used to being emotionally numb. 

Now I have a few questions. 

1. I quit SSRI 8 months ago, and developed emotional numbness last month. Could it be because of levodulphride that I took a month ago (for 25 days and went off it cold turkey) or it is because of SSRI that I quit 8 months ago? 

2. Since quitting ssri my condition has gradually deteriotarted. Can it further worsen??? 

3. Should I go off all my meds?(bupropion+alprazolam) as they have not helped except giving me some energy and relieving my tension and worried state of mind. I want to allow my brain to heal itself on its own as i have been told that our brains are neuroplastic.

4. My pssd and apathy are not severe. Can it worsen over time? 

5. Will this emotional numbmess ever go away?? 

Plz comment. 

[ChessieCat]

Hi Gul and welcome to SA,

 

We ask all members to create a drug signature so we can see your history at a glance.  Please use the following format:

 

A request: Would you summarize your history in a signature - ALL drugs, doses, dates, and discontinuations & reinstatements, in the last 12-24 months particularly?

• Please leave out symptoms and diagnoses.
• A list is easier to understand than one or multiple paragraphs. 

• Any drugs prior to 24 months ago can just be listed with start and stop years.
• Please use actual dates or approximate dates (mid-June, Late October) rather than relative time frames (last week, 3 months ago)
• Spell out months, e.g. "October" or "Oct."; 9/1/2016 can be interpreted as Jan. 9, 2016 or Sept. 1, 2016.
• Link to Account Settings – Create or Edit a signature.

 

This is your own Introduction topic where you can ask questions and journal your progress.

[Gridley]

Gul123,

 

Welcome also from me.  To address your questions as best I can:

 

1. When you discontinue or make changes in drugs, it is difficult to say with any accuracy what is causing what.  My own experience with anhedonia/apathy came about after several months of too-fast tapering, so my personal opinion would be it's a delayed WD symptom from the SSRI.  The cause is not so important as how you deal with it.  These links should help:

 

Emotional numbness on and off drugs

Creating a new self after withdrawal

Post by BrassMonkey

 

2.  It might or it might not worsen or it might improve.  We don't know.  The important thing is to deal with it as best you can.  Please read these links:

 

Brain Remodelling

Video:  Healing From Antidepressants - Patterns of Recovery

Non-drug techniques to cope with emotional symptoms

 

3. NO.  Please read the following:

 

"Another frequent question (even if not explicitly put forward every time) is this: isn't it better to just get the toxic drugs out of my system so my nervous system can start healing? (and variations).

 

I know we can all explain this very well in our own words but why wasting time and effort when Rhi wrote it so beautifully in this passage that you probably got tired of me quoting?

 

 A lot of people, including healthcare practitioners; in fact, I guess, most people-- are operating from entirely the wrong paradigm, or way of thinking, about these meds. They're thinking of them like aspirin--as something that has an effect when it's in your system, and then when it gets out of your system the effect goes away.

That's not what happens with medications that alter neurotransmitter function, we are learning.

What happens when you change the chemistry of the brain is, the brain adjusts its chemistry and structure to try to return to homeostasis, or biochemical and functional balance. It tries to restabilize the chemistry. 

For example: SSRI antidepressants work as "serotonin reuptake inhibitors." That is, they cause serotonin to remain in the space between neurons, rather than being taken back up into the cells to be re-used, like it would be in a normal healthy nondrugged brain.

So the brain, which wants to re-establish normal signaling and function, adapts to the higher level of serotonin between neurons (in the "synapse", the space between neurons where signals get passed along). It does this by removing serotonin receptors, so that the signal is reduced and changed to something closer to normal. It also decreases the amount of serotonin it produces overall. 

To do that, genes have to be turned on and off; new proteins have to be made; whole cascades of chemical reactions have to be changed, which means turning on and off OTHER genes; cells are destroyed, new cells are made; in other words, a complex physiologic remodeling takes place. This takes place over time. The brain does not grow and change rapidly. 

This is a vast oversimplification of the amount of adaptation that takes place in the brain when we change its normal chemistry, but that's the principle.

When we stop taking the drug, we have a brain that has designed itself so that it works in the presence of the drug; now it can't work properly without the drug because it's designed itself so that the drug is part of its chemistry and structure. It's like a plant that has grown on a trellis; you can't just yank out the trellis and expect the plant to be okay.

When the drug is removed, the remodeling process has to take place in reverse.

SO--it's not a matter of just getting the drug out of your system and moving on. If it were that simple, none of us would be here. 

It's a matter of, as I describe it, having to grow a new brain. 

I believe this growing-a-new-brain happens throughout the taper process if the taper is slow enough. (If it's too fast, then there's not a lot of time for actually rebalancing things, and basically the brain is just pedaling fast trying to keep us alive.) It also continues to happen, probably for longer than the symptoms actually last, throughout the time of recovery after we are completely off the drug, which is why recovery takes so long. 

With multiple drugs and a history of drug changes and cold turkeys, all of this becomes even more complicated. And if a person is started on these kinds of drugs at an early age before the brain has ever completely established normal mature functioning--well, it can't be good. (All of which is why I recommend an extremely slow taper particularly to anyone with a multiple drug history, a history of many years on meds, a history of past cold turkeys or frequent med changes, and a history of being put on drugs at a young age.)

This isn't intended to scare people, but hopefully to give you some idea of what's happening, and to help you respect and understand the process so you can work with it; ALSO, because you are likely to encounter many, many people who still believe these drugs work kind of like aspirin, or a glass of wine, and all you need to do is stop and get it out of your system. 

Now you can explain to them that no, getting it out of your system is not the issue; the issue is, you need to regrow or at least remodel your brain. This is a long, slow, very poorly understood process, and it needs to be respected."

 

Also:

 

Why taper by 10% of my dosage?

 

 

 

 

 

 

•  

Edited November 27, 2017 by Gridley

[GUL123]

Gridley, Thank you very much. It is so nice of you. 

[Altostrata]

Welcome, Gul.

On 11/24/2017 at 10:18 AM, GUL123 said:

1. I quit SSRI 8 months ago, and developed emotional numbness last month. Could it be because of levodulphride that I took a month ago (for 25 days and went off it cold turkey) or it is because of SSRI that I quit 8 months ago? 

2. Since quitting ssri my condition has gradually deteriotarted. Can it further worsen??? 

3. Should I go off all my meds?(bupropion+alprazolam) as they have not helped except giving me some energy and relieving my tension and worried state of mind. I want to allow my brain to heal itself on its own as i have been told that our brains are neuroplastic.

4. My pssd and apathy are not severe. Can it worsen over time? 

5. Will this emotional numbmess ever go away??

 

1. It sounds like the emotional anesthesia was caused by levodulphride. It's possible your nervous system was vulnerable because of your going off escilatopram. Emotional anesthesia is a very common effect of psychiatric drugs. Please stay as calm as possible about this, it will very gradually fade away over some months.

 

2. How has your condition deteriorated? It sounds like the most distressing symptom, emotional anesthesia, started after levodulphride.

 

3. How much buproprion and alprazolam are you taking, and at what times of day? Emotional anesthesia is a common side effect of alprazolam.

 

4. Generally, even PSSD and apathy go away with time.

 

5. It sounds like you may be making yourself anxious, even panicky, about emotional anesthesia. Please stay as calm as possible about this, it will very gradually fade away over some months.

[GUL123]

Altostrata, I am indebted to you for being that generous and kind.

I have been taking bupropion 150mg morning and 150 mg evrning and alptazolam 0.25mg at nigjt for the last 40 days. And yes I have been very very very much anxious and worried about it, however now things are better.

My anxiety, excessive worry and tension have decreased now for the last few days, i feel better but still a moderate degree of numbness is there. (My PSSD and apathy were not very severe). I don't know whether this relief is because of bupropion and alprazolam. I added ginkgo biloba a few days back and it has helped me somewhat with sexual dysfunction (arousal and errection). 

This is my current condition. 

As far your question as to how my condition deteriorated, I experienced a moderate degree of pssd and now for the last one and a half month i feel apathy. This is how my condition deteriorated gradually. 

I want to taper off meds to let my brain heal itself. Don't know whether it is a sane decision. Thank you very much for your generisity. 

[GUL123]

On 11/27/2017 at 4:59 AM, Gridley said:

Gul123,

 

Welcome also from me.  To address your questions as best I can:

 

1. When you discontinue or make changes in drugs, it is difficult to say with any accuracy what is causing what.  My own experience with anhedonia/apathy came about after several months of too-fast tapering, so my personal opinion would be it's a delayed WD symptom from the SSRI.  The cause is not so important as how you deal with it.  These links should help:

 

Emotional numbness on and off drugs

Creating a new self after withdrawal

Post by BrassMonkey

 

2.  It might or it might not worsen or it might improve.  We don't know.  The important thing is to deal with it as best you can.  Please read these links:

 

Brain Remodelling

Video:  Healing From Antidepressants - Patterns of Recovery

Non-drug techniques to cope with emotional symptoms

 

3. NO.  Please read the following:

 

"Another frequent question (even if not explicitly put forward every time) is this: isn't it better to just get the toxic drugs out of my system so my nervous system can start healing? (and variations).

 

I know we can all explain this very well in our own words but why wasting time and effort when Rhi wrote it so beautifully in this passage that you probably got tired of me quoting?

 

 A lot of people, including healthcare practitioners; in fact, I guess, most people-- are operating from entirely the wrong paradigm, or way of thinking, about these meds. They're thinking of them like aspirin--as something that has an effect when it's in your system, and then when it gets out of your system the effect goes away.

That's not what happens with medications that alter neurotransmitter function, we are learning.

What happens when you change the chemistry of the brain is, the brain adjusts its chemistry and structure to try to return to homeostasis, or biochemical and functional balance. It tries to restabilize the chemistry. 

For example: SSRI antidepressants work as "serotonin reuptake inhibitors." That is, they cause serotonin to remain in the space between neurons, rather than being taken back up into the cells to be re-used, like it would be in a normal healthy nondrugged brain.

So the brain, which wants to re-establish normal signaling and function, adapts to the higher level of serotonin between neurons (in the "synapse", the space between neurons where signals get passed along). It does this by removing serotonin receptors, so that the signal is reduced and changed to something closer to normal. It also decreases the amount of serotonin it produces overall. 

To do that, genes have to be turned on and off; new proteins have to be made; whole cascades of chemical reactions have to be changed, which means turning on and off OTHER genes; cells are destroyed, new cells are made; in other words, a complex physiologic remodeling takes place. This takes place over time. The brain does not grow and change rapidly. 

This is a vast oversimplification of the amount of adaptation that takes place in the brain when we change its normal chemistry, but that's the principle.

When we stop taking the drug, we have a brain that has designed itself so that it works in the presence of the drug; now it can't work properly without the drug because it's designed itself so that the drug is part of its chemistry and structure. It's like a plant that has grown on a trellis; you can't just yank out the trellis and expect the plant to be okay.

When the drug is removed, the remodeling process has to take place in reverse.

SO--it's not a matter of just getting the drug out of your system and moving on. If it were that simple, none of us would be here. 

It's a matter of, as I describe it, having to grow a new brain. 

I believe this growing-a-new-brain happens throughout the taper process if the taper is slow enough. (If it's too fast, then there's not a lot of time for actually rebalancing things, and basically the brain is just pedaling fast trying to keep us alive.) It also continues to happen, probably for longer than the symptoms actually last, throughout the time of recovery after we are completely off the drug, which is why recovery takes so long. 

With multiple drugs and a history of drug changes and cold turkeys, all of this becomes even more complicated. And if a person is started on these kinds of drugs at an early age before the brain has ever completely established normal mature functioning--well, it can't be good. (All of which is why I recommend an extremely slow taper particularly to anyone with a multiple drug history, a history of many years on meds, a history of past cold turkeys or frequent med changes, and a history of being put on drugs at a young age.)

This isn't intended to scare people, but hopefully to give you some idea of what's happening, and to help you respect and understand the process so you can work with it; ALSO, because you are likely to encounter many, many people who still believe these drugs work kind of like aspirin, or a glass of wine, and all you need to do is stop and get it out of your system. 

Now you can explain to them that no, getting it out of your system is not the issue; the issue is, you need to regrow or at least remodel your brain. This is a long, slow, very poorly understood process, and it needs to be respected."

 

Also:

 

Why taper by 10% of my dosage?

 

 

 

 

 

 

•  

Thank you so very much. I found it very informative 

[GUL123]

On 11/27/2017 at 3:08 AM, ChessieCat said:

Hi Gul and welcome to SA,

 

We ask all members to create a drug signature so we can see your history at a glance.  Please use the following format:

 

A request: Would you summarize your history in a signature - ALL drugs, doses, dates, and discontinuations & reinstatements, in the last 12-24 months particularly?

• Please leave out symptoms and diagnoses.
• A list is easier to understand than one or multiple paragraphs. 

• Any drugs prior to 24 months ago can just be listed with start and stop years.
• Please use actual dates or approximate dates (mid-June, Late October) rather than relative time frames (last week, 3 months ago)
• Spell out months, e.g. "October" or "Oct."; 9/1/2016 can be interpreted as Jan. 9, 2016 or Sept. 1, 2016.
• Link to Account Settings – Create or Edit a signature.

 

This is your own Introduction topic where you can ask questions and journal your progress.

Thanks u honorable. 

This is my brief history. 

September 2016 ecitalopram 5mg once daily for 3 months.

December 2016 started tapering.

Fabruary 2017 got off ecitalopram completely. 

June 2017 developed moderate sexual dysfunction.

September 2017. Levosulphride 50mg twice daily. Only for 25 days. Then I quit it.

Mid October 2017. Developed apathy, anxiety (excessive worry) and pessimistic mood.

November 2017 Bupropion and alprazolam 

Sexual dysfunction relieved partially.

But apathy is the same. 

Excessive worry came to an end. 

Currently My symptoms are low sex drive, low mood, pessimism, apathy. 

Have started tapering my meds. Let's see. Thank u.