beluebee: Intro: 17-year-old daughter taken off 2 SNRIs and 1 antipsychotic in 3 weeks

[beluebee]

Hi everyone,

I'm a mom looking for guidance and hope. My 17-year-old daughter has struggled with depression and anxiety, and after trying four different SSRIs was hospitalized for bipolar disorder in Feb 2020. She was put on an antipsychotic then, and has been on four different antipsychotics since then. Long story short, after about 16 different mood medications since Fall of 2019, it's become clear that any SSRI or SNRI actually cause her mania and give her suicidal ideation; so she was taken off of Strattera (60 mg) and Wellbutrin (75 mg) April 18 of this year. I and her psychiatrist were wondering if she actually has bipolar disorder, since there's no evidence of mania without either of these classes of meds to cause it. Then on May 8 she developed a severe large motor tic disorder or movement disorder, suddenly, and her psychiatrist took her off of the antipsychotic as well, due to its possible involvement in initiating the disorder or perhaps causing tardive dyskenesia. That leaves her only meds as lithium, levothyroxine (hypothyroidism caused by the lithium), and Inderol or Xanax as needed.

 

It's been a rough ride since May 8, to say the least. After getting much worse, the tics have greatly subsided; we also have reduced her stress. She's struggled with anxiety, which seems to be subsiding, and vomiting and lack of appetite. Now, 18 days since her last dose of Saphris (10 mg once/day), the antipsychotic, she's struggling with depression. Needless to say, she's unable to participate in school. The good news is, up until yesterday her mood has been good, her personality has come back, her facial expressions have returned, and a limp she developed has resolved.  I have detailed notes if anyone is interested in the symptoms she showed with her sudden discontinuation.

 

Can anyone share their experience with sudden discontinuation with an antipsychotic? How long before we hit a baseline with her? I've read 6 weeks but understand it could be less or much more. We're giving her supplements of E, manganese, and Mg; any other suggestions? I know she should exercise but right now I can barely get her to do things she actually enjoys, much less hates.

[Shep]

Hi, beluebee. 

 

Welcome to Surviving Antidepressants (SA). I apologize for the length of this post and the numerous links, but I'm only online for a few minutes before work and want to give you some important information to read over. Take your time. 

 

21 hours ago, beluebee said:

I and her psychiatrist were wondering if she actually has bipolar disorder, since there's no evidence of mania without either of these classes of meds to cause it.

 

Yes, you and her psychiatrist are right - many people are skyrocketed into mania with these classes of drugs. It's unlikely your daughter has any "mental illness" and will benefit greatly from tapering off these dangerous drugs. It's great you're being an advocate for her and doing this research.

 

You may want to read this book, which comes highly recommended here:

 

Anatomy of an Epidemic

 

Scroll down and you'll find source documents and videos for you and your daughter to watch pertaining to this book. Chapter 11 in Anatomy of an Epidemic is called "The Epidemic Spreads to Children" and chapter 12 is called "Suffer the Children."  I would encourage you to get a copy of this book and read these chapters, as they will provide you with the research and give you the language to understand what is happening. Your child is 17, so she's old enough to also read and understand this. Robert Whitaker writes very clearly in layperson's terms. 

 

It's much easier helping someone directly taper off these drugs, so you may want to have her start her own account here so she can have a voice in her recovery. We really try to empower people to read, research, and make informed decisions regarding their health and well being. 

 

Another resource for you both is on the Mad in America site (Robert Whitaker's website):

 

MIA Online Parent Support Groups

 

 

21 hours ago, beluebee said:

I know she should exercise but right now I can barely get her to do things she actually enjoys, much less hates.

 

If she's someone who hates exercise, this may explain her previous history with anxiety and depression. We know that a lot of our emotional problems can be linked to a sedentary lifestyle. So this may be something to consider for the future after she's healed from these drugs. Diet and exercise are really key to our well being, along with having a purpose in life. Seventeen is a difficult age for anyone, so being told that her emotional pain is transient may help her immensely. One of the many problems of labeling a young person with a life-long diagnosis of "depression" or "bipolar" is it creates a self-fulfilling prophecy of life-long pain and needing to numb herself with drugs. But the chemical imbalance hypothesis was debunked. 

 

Again, chemical imbalance is a myth. Stop the lies, please.

 

And prior to the use of these drugs, the outcomes of emotional distress was much better. 

 

History We Can’t Overlook Anymore: Details Before the Anti-Depressant Era

 

Here is some general information for you and your daughter to read over and we can provide more targeted advice once we have her complete drug history. 

 

Why taper by 10% of my dosage?

 

Taking multiple psych drugs? Which drug to taper first?

 

The Windows and Waves Pattern of Stabilization

 

 

How psychiatric drugs remodel your brain

 

Healing from antidepressants. Patterns of recovery video (4 minutes)

 

Before continuing, we need to have her drug history. Please add a signature.  Include drugs, doses, dates, and discontinuations & reinstatements in the last 12-24 months. Also include supplements. This will help us give you the most accurate advice we can. 

• Any drugs and supplements 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. 
• Please leave out symptoms and diagnoses. 
• A list is easier to understand than one or multiple paragraphs. 
• This is a direct link to your signature:  Account Settings – Create or Edit a signature.

For more on setting up a signature, please see the first post here - How to List Drug History in Signature

 

Please encourage your daughter to be an active participant in her own recovery. It's much better for the staff to be able to work directly with someone coming off these drugs than to work through a third party, so you may want to have her create her own account here. 

 

Edited May 26, 2021 by Shep
Fixed typo

[Shep]

18 hours ago, beluebee said:

That leaves her only meds as lithium, levothyroxine (hypothyroidism caused by the lithium), and Inderol or Xanax as needed.

 

One other piece of advice - taking "as needed" drugs can be problematic for someone going through withdrawal. This is especially true for the benzodiazepines (benzos), such as Xanax. Interdose withdrawal (going into withdrawal in between doses) can be problematic, as can paradoxical reactions, which are very common with benzos. 

 

As you and she give us more information, we can help your daughter set up a more consistent dosing schedule that will make her more comfortable. 

[beluebee]

Thank you, @Shep, what a wealth of info. I will encourage her to set up her own profile and start digging into this. I put her history in my signature. It's LONG. Easier to read in my profile. 

 

Does anyone out there have an experience with cold turkey withdrawal from Saphris or an antipsychotic? (With no replacement given?) I think her symptoms are more related to that than to coming off the SNRIs. She was only on Wellbutrin 45 days, and while Strattera was 120 days supposedly it can be stopped abruptly and most people don't report a discontinuance syndrome. 

[Altostrata]

Hello, @beluebee Yes, going abruptly off an antipsychotric can withdrawal symptoms as you've described. This could also happen with Wellbutrin and Strattera, but less likely with Strattera.

 

It sounds like in a relatively short amount of time, your daughter developed severe adverse effects from the strange drug cocktail she was on. I presume it was another doctor and not her current psychiatrist who concocted this? I mention this because whoever it was that had your daughter go on and off all those drugs and finally prescribed those 5 drugs does not know what he or she is doing, and I would question whether she has any significant psychiatric disorder as well.

 

It's much more likely that going on and off a bunch of antidepressants caused your daughter's symptoms rather than bipolar disorder. I hope she and you recover from this disastrous encounter with the medical establishment.

[Shep]

@beluebeeIn order to sort out your daughter's drug cocktail and all the changes, I copied your signature and removed the narrative. I also added in Xanax and levothyroxine in what she's currently taking, since you had mentioned those in your earlier post. 

 

Please verify that the below is correct. 

 

Fall 2015 - Spring 2017 (age 12-14) Lexapro 10 mg. 

Summer 2018 - Lexapro 10 mg, stopped fall 2018. 

Aug - Sept 2019 - Went on Citalopram abruptly discontinued due to anaphylaxis. 

Oct 2019 - Prozac. Caused suicidal ideation within 3 weeks. 

Nov 2019 to Jan 2020 - Lexapro 10 mg. 

Jan 2020 - Added Wellbutrin 150 ER to Lexapro 15 mg. 

Jan 2020 - mono-linyah (for PCOS) 

Feb 2020 - Hospitalized for suicidal ideation, all antidepressants stopped. Diagnosed with Bipolar type unspecified in hospital, put on Latuda 20 mg 

late Feb 2020 - increased Latuda to 40 mg 

March 2020 - Remeron added for sleep 

April 2020 - Effexor added for depression 

April 2020 - taper off Latuda and Remeron, added Abilify and Ambien 

May 2020 - add trazadone for sleep, remove Ambien 

May 2020 - start Lamictal 

May 2020 - remove Abilify, add olanzapine 

June 2020 - removed Effexor (suicidal ideation), olanzapine (weight gain) and Remeron (weight gain) 

July 2020 - add Seroquel for mania. EPA 4000 mg added 

Aug 2020 - Lunesta 3 mg added for sleep 

Aug 2020 - Metformin added for weight gain 

Sept 2020 - Hospitalized for suicidal ideation. Removed Seroquel and added Saphris 10 mg SID. Stayed on Lamictal . 

Oct 2020 - added Inderol for anxiety. Kept Lunesta 1.5 - 3 mg for sleep 

Nov 2020 - Strattera added for focus and Trileptal for depression. Lamictal removed.  

Dec 2020 - Pristiq and light therapy added for depression 

Dec 2020 - Chronic urticaria triggered by Trileptal and/ or Pristiq and/or Strattera. All 3 discontinued. Remained on Saphris 

Jan 2021 - Lithium (150, tapered up to 450 ER BID) added for depression.  

Jan 2021 - hospitalized for suicidal ideation. Lithium was brought up to a therapeutic dose. Saphris was kept and Strattera added back in. Also began Zolaire for chronic urticaria 

March 2021 - added Wellbutrin 75 for depression. Increase in Wellbutrin caused anxiety and more depression, suicidal ideation 

April 18 2021 - cut Strattera and Wellbutrin for suicidal ideation and increase in mania 

May 7, 2021 - cut Saphris because of movement disorder or tics.

 

May 25, 2021 - Now just on Lithium, and Xanax PRN and Inderal PRN for anxiety, and Lunesta 3mg, and levothyroxine (hypothyroidism caused by the Lithium)

Edited May 28, 2021 by Shep
added information on current drugs in the last line to include Lunesta

[Shep]

14 hours ago, beluebee said:

Does anyone out there have an experience with cold turkey withdrawal from Saphris or an antipsychotic? (With no replacement given?) I think her symptoms are more related to that than to coming off the SNRIs.

 

Yes, we do have cold turkey stories with antipsychotic withdrawal. I came off a large cocktail of drugs rapid taper and cold turkey (my success story is linked in my signature) and you can find others in the Success Stories section,  I would encourage you and your daughter to check out those stories. It takes time, but healing does happen. 

 

Quote

 

Mother of a minor daughter with depression that evolved into bipolar, which I believe was med-induced. Here's her history. Please don't judge. We were trying our best.

 

 

 

I noticed this in your signature and wanted to address it. Most people don't come to an online forum for medical advice until they've been damaged by these drugs. It's natural for us to seek out the guidance of western medical doctors and trust them. Don't feel guilty about that. That's how most of us ended up here. 

 

Your daughter is young and there's no reason to think she won't fully recover from this. In the long run, she may be better off because women are particularly being targeted by psychiatric drugs (for example, Sarafem is a PMS drug but it's really re-packaged Prozac and Brisdelle is a menopause drug but it's really repackaged Paxil, another SSRI). With your daughter's history of adverse reactions to antidepressants, these are also drugs she'll want to avoid.

 

Once she gets through this, she'll be golden with all of information she'll have.

 

 

On 5/25/2021 at 1:13 PM, beluebee said:

Then on May 8 she developed a severe large motor tic disorder or movement disorder, suddenly, and her psychiatrist took her off of the antipsychotic as well, due to its possible involvement in initiating the disorder or perhaps causing tardive dyskenesia.

 

On 5/25/2021 at 1:13 PM, beluebee said:

It's been a rough ride since May 8, to say the least. After getting much worse, the tics have greatly subsided; we also have reduced her stress. She's struggled with anxiety, which seems to be subsiding, and vomiting and lack of appetite. Now, 18 days since her last dose of Saphris (10 mg once/day), the antipsychotic, she's struggling with depression.

 

You mentioned that the antipsychotics caused more of her symptoms than the antidepressants. It looks like the antidepressants created adverse effects that lead to the antipsychotics, which did indeed cause a lot of problems. However, I would be hesitant to reinstate the antipsychotic for a taper. I wanted to mention that in case it was a concern for you or your daughter. It looks like she's healing. Because tardive dyskenesia can be permanent, the fact that she's recovering from this side effect speaks to recovery. This is very good. 

 

Questions:

• Is she still on Metformin? If not, when did she come of? Did she develop diabetes or pre-diabetes due to these drugs? 
• How is her sleep? How are her cognitive skills?
• What date did she start taking Xanax? Please also list the dose and any changes of dose. 
• Please let us know more about her Lithium-induced thyroid issue. When did that start? (you and she may want to see this thread - Thyroid symptoms: hypothyroid,  Hashimoto's pay extra attention to Karma's posts, as she's done extensive research on this and is a wealth of information)

 

[Shep]

 

In addition to answering the questions in my last post, it will really help us if you could work with your daughter to post a daily drug and symptoms journal. Here is what we need:

 

Post notes about your drug dosages and daily symptom pattern

 

Please include the time of day, the name of each drug or supplement, the dose, and symptoms before and after. Also include the number of hours she sleeps each night. That link contains an example of what we need and the format. 

 

This will help us see her symptoms within the context of when she takes each drug. The first thing we'll likely do is suggest a constant time of day to take her PRN drugs in order for her nervous system to have a steady supply of these drugs. Inconsistent dosing is extremely problematic when setting up a taper. This is because withdrawal already comes in a window and waves pattern, so it's best to be as consistent with dosing as possible to remove any variables. Also, as noted earlier, benzos like Xanax cause interdose withdrawal problems. 

 

Over the coming days, we can go through her drug and symptoms journal together and come up with a game plan for getting her off these drugs and on the road to healing. 

[Shep]

And one more resource for you. This is a drug and interaction checker website. Please bookmark and work with your daughter to learn how to use it. It's important. 

 

Drug Interaction Checker

 

Here is the report when I entered all of your daughter's current drugs:

 

Drug Interaction Checker - Xanax, lithium, Inderal, levothyroxine, Lunesta

 

As you can see, there are two moderate interactions between inderal and lithium and between inderal and xanax, along with two minor interactions. As you and she do a daily drug and symptoms journal, we can work to space out these drugs to decrease the likelihood of these types of interactions. 

Edited May 28, 2021 by Shep
updated with new information provided by beluebee

[beluebee]

@shep, thank you so much. You are clearly a caring person. The drug list above is correct except she is also taking Lunesta 3mg for sleep. Thank you for color coding it, that's so helpful. Are you able to place it in my signature? I couldn't save a signature that was more than 12 lines.

 

To answer your question, we had one psychiatrist from 2015-April 2020, at which time it was pretty clear he had given up on us. Since May 2020, from the start of the Lamictal, we've been seeing another psychiatrist, who is head of the pediatric unit at a local mental health hospital and was the top recommendation of our pediatrician. It's been a crazy cocktail, yes--she's had multiple adverse reactions mixed with suicidal ideation, and I didn't mention but she had mild ADD going into this (not needing treatment) but her focus got worse in September and hence the Strattera.

 

Thanks for your reassurance. It's been so distressing to see our straight-A gifted daughter have to drop school halfway through 10th grade and that need and desire to get back to school has probably fueled the frenzy of drugs as well. But mostly it's been the suicidal ideation. 

 

Another reason we withdrew the Strattera and Wellbutrin was that both came up when I searched Drugs.com as a "major" cross-reaction with Saphris and lithium by lowering the seizure threshold. I brought this up with the psychiatrist who said seizures weren't a concern, but her symptoms were: (besides mild mania and suicidal ideation!) inability to speak for 10-15 seconds, out of body sensations, excess daydreaming, agitation, headaches, weakness, sleepiness, fatigue, confusion, jerking of arm and leg, and odd feelings. So, he discontinued those. 

 

You give me a lot of hope! Still reading and listening to these resources. And wow, thanks for the heads up on the repackaged SSRIs. 

 

As for the symptoms, I'll post those soon. I've told her about this forum so hopefully she will do this herself. I doubt she will be interested in coming off the Inderol until her therapy helps more with anxiety -- she takes one 20 mg twice a week or so, before an event that stresses her out. The Xanax she takes very infrequently and only when anxiety is quite severe. She's taken it twice in the last month and the precipitating stress has been removed. Before that I don't think she had taken it for 6 months. I'm not opposed to taking Inderol consistently if it wouldn't depress her mood and add to her 30+ lb weight gain over the last year. She did take it consistently (3x/day) when she was hospitalized in January and put on weight, but that could have been because of the crap-ton of antihistamines she was on for all of her med reactions--they're known to pack on weight. Would you recommend it 3 times per day? She's on 20 mg, up to 3 times per day or as needed. She doesn't need that much ... could split the dose. 

[Shep]

20 hours ago, beluebee said:

The drug list above is correct except she is also taking Lunesta 3mg for sleep.

 

Thanks, beluebee, I've edited my earlier post to include this information. I've also updated the drug interaction checker report in my post above. This, of course, added more "moderate" drug interactions, so it's important that she space these drugs out to prevent some of these reactions. Some of her symptoms are likely coming from drugs that simply don't play nice together. 

 

20 hours ago, beluebee said:

Are you able to place it in my signature? I couldn't save a signature that was more than 12 lines.

 

Please see your signature - I've updated it and included a link for drugs taken between 2018 and 2020 which goes to that earlier post. Please verify that it's correct. Also, if you can include dosages for her current drugs (just the last line), that will help the staff when we start giving tapering advice. 

 

20 hours ago, beluebee said:

It's been a crazy cocktail, yes--she's had multiple adverse reactions mixed with suicidal ideation, and I didn't mention but she had mild ADD going into this (not needing treatment) but her focus got worse in September and hence the Strattera.

 

Anyone who's really paying attention to the world has "mild ADD." I would encourage you to avoid psychiatric labels. This is important in learning how to do what's called "un-patienting," for both you and your daughter. If she had an actual disease, such as cancer or heart disease, then it's appropriate to name the disease. But "ADD" is simply an excuse to turn a curious and creative child into what used to be called a "mental defective." In fact, earlier labels for these types of attention "disorders" included "minimal brain dysfunction." This was changed to "ADD" and "ADHD" in order to make the label more appealing to parents and doctors to label children. It was more about marketing than medicine. Robert Whitaker has written about this in his books and you can find other accounts as you continue to research this. 

 

Unfortunately, millions of children have been targeted with these labels. Your daughter is very fortunate that you're doing this research and she's going to escape a life-long sentence with these drugs. 

 

 

20 hours ago, beluebee said:

I doubt she will be interested in coming off the Inderol until her therapy helps more with anxiety -- she takes one 20 mg twice a week or so, before an event that stresses her out.

 

Therapy will not help drug-induced anxiety. A lot of us going through withdrawal will frequently refer to this type of anxiety as a "chemical anxiety." If you were to drink 6 cups of coffee and a few cans of Jolt Cola, I don't that any form of therapy would make you feel calm and tranquil. That's what your daughter is dealing with now. You're doing the right thing by reducing her external stress. That may be the best you can do for her right now. 

 

Many people coming off these drugs report problems with therapy. Unless her therapist is aware of her symptoms coming from these drugs and not some "mental illness," that therapist may be harmful to your daughter. He or she may try to convince your daughter that her negative thinking and emotional liability are a chemical imbalance. Also, if your daughter reports suicidal ideation, the therapist may report that to her psychiatrist and she may end up in forced "treatment" with more drugs added on. I would tread cautiously and if this therapist is not aware of psychiatric drug withdrawal and adverse effects, either stop the therapy or find a therapist who's educated in withdrawal. 

 

Will Hall comes highly recommended. He survived coming off antipsychotics himself and he co-authored Harm Reduction Guide to Coming Off Psychiatric Drugs. His contact information is here:

 

Will Hall - counseling

 

More resources:

 

Recommended doctors, therapists, and clinics

 

Mad in America Provider Directory

 

Also, you and your daughter may find this information helpful in guiding conversations with a doctor: 

 

How do you talk to a doctor about tapering and withdrawal?

 

Withdrawal dialogues & encouragement 

 

Please note that your daughter's history of emotional liability is likely Neuro emotions. Knowing this can help you and her navigate the difficult journey off these drugs. There are many ways to get through this. Here are some resources:

 

Non-drug techniques to cope with emotional symptoms

 

If her symptoms are too intense for non-drug coping techniques, she'll need to learn the art of distraction, which can be video games, taking a walk in nature, watching a favorite TV show, listening to music, drawing, etc. Knowing these emotions are coming from the drugs will help her script a narrative that this is temporary and there's no reason to be alarmed, it's just the effect of the drugs and distraction can keep her busy until the bad thoughts pass. 

 

These threads are particularly helpful:

 

"Change the channel" -- dealing with cognitive symptoms

 

Dealing With Emotional Spirals

 

If she can master these types of skills, by the time she recovers from these drugs, she'll be unstoppable in going after what she wants in life. But it does take time and practice. 

 

21 hours ago, beluebee said:

As for the symptoms, I'll post those soon. I've told her about this forum so hopefully she will do this herself. I doubt she will be interested in coming off the Inderol until her therapy helps more with anxiety -- she takes one 20 mg twice a week or so, before an event that stresses her out. The Xanax she takes very infrequently and only when anxiety is quite severe. She's taken it twice in the last month and the precipitating stress has been removed. Before that I don't think she had taken it for 6 months. I'm not opposed to taking Inderol consistently if it wouldn't depress her mood and add to her 30+ lb weight gain over the last year. She did take it consistently (3x/day) when she was hospitalized in January and put on weight, but that could have been because of the crap-ton of antihistamines she was on for all of her med reactions--they're known to pack on weight. Would you recommend it 3 times per day? She's on 20 mg, up to 3 times per day or as needed. She doesn't need that much ... could split the dose. 

 

Please work with your daughter to start a drug and symptoms journal. We can't recommend anything without that information. We like to thoughtfully go through the daily journal and look at how how her symptoms are showing up within the context of when she takes her drugs. Some of her anxiety may be from the drug interactions, so changing the dosing schedule may work better than changing the amount of the drug, but without her journal, we can't say for sure. The first thing she'll want to do is to take her PRN drugs at a set time daily instead of "as needed" dosing. 

 

After that, we can discuss a game plan for doing a safe and careful taper.