NEVER SKIP DOSES TO TAPER

[Altostrata]

Many people come here with severe withdrawal symptoms after following their prescribers' or their own misguided plan to skip doses in order to taper.

 

You may hear of people who got away with skipping doses to taper. That is possible, some people cold turkey without a problem. However, after cold turkey, skipping is perhaps the most risky way to come off psychiatric drugs. Both can result in terrible, severe withdrawal symptoms that might not fully be reversed by reinstatement of the drug.

 

Skipping doses causes the level of the drug in your bloodstream to go up and down, even with long-acting drugs such as fluoxetine. This puts stress on your nervous system, potentially causing withdrawal symptoms. It's like playing ping-pong with your brain.

 

NEVER SKIP DOSES TO TAPER.

 

If after seeing this, you decide to skip doses to taper and get withdrawal symptoms, do not come back here asking for help.

 

It is unaccountable why some doctors recommend skipping doses to taper. There is quite a large body of research showing that when people skip doses, they get withdrawal symptoms.

 

Baldwin, D. S., Cooper, J. A., Huusom, A. K. T., & Hindmarch, I. (2006). A double-blind, randomized, parallel-group, flexible-dose study to evaluate the tolerability, efficacy and effects of treatment discontinuation with escitalopram and paroxetine in patients with major depressive disorder. International Clinical Psychopharmacology, 21(3), 159–169. https://doi.org/10.1097/01.yic.0000194377.88330.1d

Bauer, R., Glenn, T., Alda, M., Sagduyu, K., Marsh, W., Grof, P., Munoz, R., Murray, G., Ritter, P., Lewitzka, U., Severus, E., Whybrow, P. C., & Bauer, M. (2013). Antidepressant dosage taken by patients with bipolar disorder: Factors associated with irregularity. International Journal of Bipolar Disorders, 1. https://doi.org/10.1186/2194-7511-1-26

Bulloch, A. G. M., & Patten, S. B. (2010). Non-adherence with psychotropic medications in the general population. Social Psychiatry and Psychiatric Epidemiology, 45(1), 47–56. https://doi.org/10.1007/s00127-009-0041-5

Dilsaver, S. C., & Greden, J. F. (1984). Antidepressant withdrawal phenomena. Biological Psychiatry, 19(2), 237–256.

Drug Ther Perspect. (2001). Antidepressant discontinuation syndromes: Common, under-recognised and not always benign. Drugs & Therapy Perspectives, 17(20), 12–15. https://doi.org/10.2165/00042310-200117200-00004

Gallagher, J. C., Strzinek, R. A., Cheng, R. J., Ausmanas, M. K., Astl, D., & Seljan, P. (2012). The effect of dose titration and dose tapering on the tolerability of desvenlafaxine in women with vasomotor symptoms associated with menopause. Journal of Women’s Health (2002), 21(2), 188–198. https://doi.org/10.1089/jwh.2011.2764

Greden, J. F. (1993). Antidepressant maintenance medications: When to discontinue and how to stop. The Journal of Clinical Psychiatry, 54 Suppl, 39–45; discussion 46-47.

Haddad, P. M. (2001). Antidepressant Discontinuation Syndromes. Drug Safety, 24(3), 183–197.

Henry, M. E., Moore, C. M., Kaufman, M. J., Michelson, D., Schmidt, M. E., Stoddard, E., Vuckevic, A. J., Berreira, P. J., Cohen, B. M., & Renshaw, P. F. (2000). Brain kinetics of paroxetine and fluoxetine on the third day of placebo substitution: A fluorine MRS study. The American Journal of Psychiatry, 157(9), 1506–1508. https://doi.org/10.1176/appi.ajp.157.9.1506

Kaplan, E. M. (1997). Antidepressant noncompliance as a factor in the discontinuation syndrome. The Journal of Clinical Psychiatry, 58 Suppl 7, 31–35; discussion 36.

Meijer, W. E. E., Bouvy, M. L., Heerdink, E. R., Urquhart, J., & Leufkens, H. G. M. (2001). Spontaneous lapses in dosing during chronic treatment with selective serotonin reuptake inhibitors. British Journal of Psychiatry, 179(6), 519–522. https://doi.org/10.1192/bjp.179.6.519

Michelson, D., Fava, M., Amsterdam, J., Apter, J., Londborg, P., Tamura, R., & Tepner, R. G. (2000). Interruption of selective serotonin reuptake inhibitor treatment. Double-blind, placebo-controlled trial. The British Journal of Psychiatry: The Journal of Mental Science, 176, 363–368. https://doi.org/10.1192/bjp.176.4.363

Osterberg, L. G., Urquhart, J., & Blaschke, T. F. (2010). Understanding Forgiveness: Minding and Mining the Gaps Between Pharmacokinetics and Therapeutics. Clinical Pharmacology & Therapeutics, 88(4), 457–459. https://doi.org/10.1038/clpt.2010.171

Rosenbaum, J. F., Fava, M., Hoog, S. L., Ascroft, R. C., & Krebs, W. B. (1998). Selective serotonin reuptake inhibitor discontinuation syndrome: A randomized clinical trial. Biological Psychiatry, 44(2), 77–87. https://doi.org/10.1016/s0006-3223(98)00126-7

Edited June 21, 2021 by Altostrata
updated

[zma1]

Before I knew how to taper properly I was lowering my sertraline by skipping doses. I started a running program and I read that exercise is as good as SSRIs, so I thought on the days I would run, I could skip my drug because the run would be my anti-anxiety med. 😬

 

so my husband and I went on a run one summer morning, came back home and my husband looked at me and said my lips were blue. So i walked over to the bathroom and they looked dark purple/blue! I felt fine, breathing fine, and almost as soon as i got to the mirror they turned back to normal pinkish color. I asked my doctor about it and he seemed unimpressed and said it’s probably Raynaud’s. I don’t have Raynaud’s. I looked online ( which is problematic because I have health anxiety) and some runners get this after a long run, it’s called shunting. Where your body pulls blood from extremities to larger muscles temporarily. But the run we did was a beginning walk/run of just about a half hour.

After that I got obsessed and hyper vigilant and watched my lips all the time for changes—every once in a while my lips would turn this purplish blue for a second or two and then turn back to normal. This was just at rest doing stuff around the house, not after strenuous exercise— I got too scared to run again. I’d check my oxygen levels with a home oximeter and it was always 98-99 oxygen. I haven’t noticed this lip color change in about a year now. I’m going to chalk it up to one of those weird symptoms of messing with my dose.

 

It had me terrified and in circles for a long time, because I couldn’t find anyone else with this particular withdrawal symptom and doctors (more than one) didn’t seem to consider it a symptom that needed further exploration. I think when they see “anxiety” on my chart and no other red flags with blood work and vitals, they put it in the anxiety column. I think this is actually correct, except I really do believe it is connected to an erratic reduction schedule of skipping days.

 

I wanted to share just in case someone else was spinning out with a weird symptom that seems like it’s only happening to them.