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DavidW: psychiatric nurse


DavidW

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Hello,

I have ten years of experience as a nurse in inpatient psychiatric settings.  I was years into my career before learning about the seedy underbelly of psychiatric drug science.  I have found myself needing to "unlearn" much of the foundational beliefs of my nursing practice, which is painful and disconcerting.  Influential writings have included "Anatomy of an Epidemic," "The Emperor's New Drugs," and "Brain Energy."

 

I'm hoping to learn ways to help people minimize their use of psych meds.  I've become specifically interested in the gut-brain connection after hearing keto and carnivore diet advocates mention that their mental health improved (almost as a side effect after they started the diet due to another medical condition).

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  • Administrator

Welcome to S.A. @DavidW

 

2 hours ago, DavidW said:

I have found myself needing to "unlearn" much of the foundational beliefs of my nursing practice, which is painful and disconcerting.

 

It's encouraging to read that you've seen the need to 'unlearn'. You'll find a wealth of information on this site. It's been life-changing for many.

 

2 hours ago, DavidW said:

Influential writings have included "Anatomy of an Epidemic," "The Emperor's New Drugs," and "Brain Energy."

 

I've read the first book you mentioned, but I'll have to have a read of the other two.

 

I can strongly recommend "Prozac Backlash" by Joseph Glenmullen, if you'd like another insightful read.

 

2 hours ago, DavidW said:

I'm hoping to learn ways to help people minimize their use of psych meds. 

 

Sing out with any questions.

 

Emonda

I am not a doctor. My comments are based on my personal experience with ADs and tapering. Consult your doctor about your own medical decisions.

 

2017 – 2022:   Vortioxetine 15mg, Jan ’22, 15mg->5mg over 4 weeks, Feb ‘22 5mg -> 7.5mg due to WD, July ’22 6.75mg (found SA website), Aug 6.07mg, Sep 5.46mg, 11 Oct 5.00mg, 18 Oct 4.88mg, 25 Oct 4.75mg, 1 Nov 4.63mg, 8 Nov 4.5mg, 3 Jan ’23 4.39mg, 10 Jan 4.28mg, 17 Jan 4.06mg, 13 Feb 3.95mg, 20 Mar 3.85mg, 3 Apr 3.75mg, 10 April 3.65mg, 31 May 3.58mg, 8 June 3.50mg, 15 June 3.43mg, 22 June 3.35mg, 12 Jul 3.29mg,  19 Jul 3.22mg, 26 Jul 3.15mg, 3 Aug 3.09mg, 30 Aug 3.02mg, 7 Sep 2.96mg, 14 Sep 2.89mg, 21 Sep 2.82mg, Oct 11 2.75mg, Oct 19 2.70mg, Oct 26 2.64mg, Nov 2 2.59mg, Nov 23 2.53mg, Nov 30 2.48mg, 7 Dec 2.43mg, 17 Dec 2.38mg, 19 Jan 2.33mg, 26 Jan 2.28mg, 2 Feb 2.24mg, 8 Feb 2.19mg,  29 Feb 2.15mg,  

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  • Moderator

Hi @DavidW, welcome to SA. 

You may find these articles useful as well:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/

 

https://markhorowitz.org/academic-papers/

 

OMW

"Nothing so small as a moment is insurmountable, and moments are all that we have. You have survived every trial and tribulation that life has thrown at you up until this very instant. When future troubles come—and they will come—a version of you will be born into that moment that can conquer them, too." - Kevin Koenig 

 

I am not a doctor and this should not be considered medical advice. You can use the information and recommendations provided in whatever way you want and all decisions on your treatment are yours. 

 

In the next few weeks I do not have a lot of capacity to respond to questions. If you need a quick answer pls tag or ask other moderators who may want to be tagged. 

 

Aug  2000 - July 2003 (ct, 4-6 wk wd) , citalopram 20 mg,  xanax prn, wellbutrin for a few months, trazodone prn 

Dec 2004 - July 2018 citalopram 20 mg, xanax prn (rarely used)

Aug 2018 - citalopram 40 mg (self titrated up)

September 2018 - January 2019 tapered citalopram - 40/30/20/10/5 no issues until a week after reaching 0

Feb 2019 0.25 xanax - 0.5/day (3 weeks) over to klonopin 0.25 once a day to manage severe wd

March 6, reinstated citalopram 2.5 mg (liquid), klonopin 0.25 mg for sleep 2-3 times a week

Apr 1st citalopram 2.0 mg (liquid), klonopin 0.25 once a week (off by 4/14/19- no tapering)

citalopram (liquid) 4/14/19 -1.8 mg, 5/8/19 - 1.6 mg,  7/27/19 -1.5 mg,  8/15/19 - 1.35, 2/21/21 - 1.1 (smaller drops in between), 6/20/21 - 1.03 mg, 8/7/21- 1.025, 8/11/21 - 1.02, 8/15/21 - 1.015, 9/3/21 - 0.925 (fingers crossed!), 10/8/21 - 0.9, 10/18/21 - 0.875, 12/31/21 - 0.85, 1/7/22 - 0.825, 1/14/22 - 0.8, 1/22/22 - 0.785, 8/18/22 - 0.59, 12/15/2022 - 0.48, 2/15/22 - 0.43, 25/07/23 - 0.25 (mistake), 6/08/23 - 0.33mg

 

Supplements: magnesium citrate and bi-glycinate

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Welcome David.  I am trying to unlearn several decades of "accepted wisdom", including tapering down my own AD. 

 

The unlearning is remarkably easy once you start spotting the cracks in research and "evidence".   More of our colleagues are increasingly sceptical too...

 

Various ADs from 1991, always for depression with anxiety and agitation... sertraline, paroxetine, citalopram (with 2.5mg olanzapine briefly), coming off each for increasingly shorter times until 2000 when I went on meds full time with Clomipramine 200mg. Then Venlafaxine (XR) since 2008, initially 225mg, then 300mg, plus tried on venlafaxine with mirtazapine (California Rocket) for only a week in 2017(?) as absolutely intolerable. 

July '23 Venlafaxine XL 300 to 275mg.  Aug '23 275 to 250mg. Sept/Oct '23 250 to 230 to 225mg.  Nov '23 205mg. Dec '23 185mg.  28 Dec '23 reinstated 225mg after crashing. 

 

Supplements: Vitamin D and fish oil. 

 

"L'exposition du merde est temporaries".

 

Although I have a background in health, I am here to learn from others, encourage others and share my experiences, not to give professional guidance. 

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  • Moderator Emeritus

Hi DavidW!  It's wonderful to have you on board.  We can always use help, and member to member help is most welcome!  Are you familiar with our tapering protocol and our harm reduction approach?  If not, here are some links to get you started.  

 

Tapering is best done extremely slowly, and we generally taper by 10% of the current dose no more than once every 4 weeks, so that the reduction becomes exponentially smaller.

 

 Why Taper by 10% of my Dosage  

 

These links explain why we need to taper so slowly, and about how when the nervous system is in withdrawal, recovery is nonlinear, and symptoms change and morph.  This often causes a lot of fear and anxiety in people, so it really helps to reassure them that this is typical, and that things will eventually heal.  

 

How Psychiatric Drugs Remodel Your Brain

 

Video on Recovery from Psych Drugs

 

Windows and Waves Pattern of Stabilization

Please do not private message me.  Only tag me for urgent questions about tapering and reinstating - thank you.  

 

***Please note this is not medical advice.  Discuss any decisions about your medical care with a doctor who understands psych meds and how to withdraw from them, if you can find one.

 

Lexapro   Started Apr 15 2010 - 10 mg;  started taper August 2017, recent taper info: Apr 2 '20  0.18 mg; Jul 16  0.17 mg, Aug 23  0.16 mg, Oct 7  0.15 mg, Nov 8 - 0.14, Jan 16 '21 - 0.13, Feb 7 - 0.12, Feb 22 - 0.11, Mar 26 - 0.10, May 21 - 0.09, June 15 - 0.08 Aug 16 - 0.07, Oct 6 - 0.06, Nov 21 0.05, Dec. 17 0.04, Jan 14 '22 0.03, Feb 19 0.02, Apr 18 0.01, May 15 0.005,  Jul 8, 0.00.  Psych Drug Free as of July 8, 2022!!  Woohoo!!!

other meds: Levothyroxine 75 mg

magnesium in small amounts at 4 AM, before bed

suppl AM: fish oil, flax oil, vit C, vit E, multivitamin, zinc

suppl 8 PM: magnesium 350 mg, extended release vitamin C, melatonin 2 mg

 

Paxil 2002 - 2010, switched to Lexapro 2010 

Trazodone 50 mg. 2002 - 2019, fast tapered in 2019 

Xanax 0.5 mg as needed 2002 - 2019, up to 3x weekly 

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  • 2 weeks later...
  • Administrator

Welcome, @DavidW

 

Do you have any experience taking psychiatric drugs yourself? Please put your drug and withdrawal history in your signature You may need to use a computer to do this.

 

What happened that caused you to question the treatments you had implemented for all those years?

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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On 11/19/2023 at 2:18 PM, Altostrata said:

Welcome, @DavidW

 

Do you have any experience taking psychiatric drugs yourself? Please put your drug and withdrawal history in your signature You may need to use a computer to do this.

 

What happened that caused you to question the treatments you had implemented for all those years?

 

Thankfully, I have never taken a psychotropic prescription myself.

 

I worked as a pharmacy tech both prior to and during nursing school.  In the beginning, I thought that people who talked negatively about "big pharma" were a bit conspiratorial; this opinion was built on my ignorance and optimism.  Over the years, I witnessed first-hand a variety of scandals that made me become more aware and cynical (Oxycontin and Vioxx in particular).

 

In nursing school, the mantra was "evidence-based practice," and rightfully so (I still believe the foundations of our healthcare system must be evidence-based practice, informed consent, and individualized care).  We had classes devoted to analyzing and understanding clinical research; however, none of those classes discussed fraud, racketeering, or any of the other problems rampant in modern medical science (not a single lecture over multiple semesters!).

 

After nursing school, I started working in an inpatient psychiatric setting.  We were trained to tell patients that "your mental illness is a chemical imbalance that is fixed by [SSRIs/antipsychotics/mood stabilizers] that you will have to be on for the rest of your life."  That's what my nursing textbooks said, that's what our patient education handouts said, and that's what our psychiatrists said.

 

I first heard of protracted benzo withdrawal from a patient who self-diagnosed from the internet.  Everyone dismissed her, including me; I read a little about it online at the time, but couldn't find anything from the "credible, authoritative sources" I was trained to trust.  Her distress, however, was unmistakable.

 

A few years later, I was going down rabbit holes regarding state of the science around psychotropics.  The Emperor's New Drugs by Kirsch and Anatomy of an Epidemic by Whitaker were disturbing, but resonated with what I was seeing; those writings were the lens that made the things I was seeing with patients make sense.  I had always deferred to authority without ever looking closely at anything myself; after I did look, I would never again be able to see it the same.  I can think back to so many patients that were mislabeled, misdiagnosed, and mistreated by staff because everyone trusted and deferred to authority.  Unfortunately, the "authoritative sources" I was most connected to in my nursing practice were all essentially pharma propagandists.  I dug around in the closet, found my old mental health nursing textbook, and easily linked it to pharma; why weren't we trained how to do that in school?  With just a couple of clicks, I learned that my hospital's patient education materials were written by none other than Merck, a company rightfully vilified for Vioxx and other deadly frauds.

 

I learned about protracted withdrawal, PSSD, and became outspoken to both my coworkers and patients.  It rocked the boat.  Prescribers were worried about compliance; I found this abhorrent.  You do NOT throw away informed consent because it will make your job as a pill dispenser easier.

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  • Moderator

Hi @DavidW

you may find Kuhn's ideas of science interesting 

 

"Kuhn made several claims concerning the progress of scientific knowledge: that scientific fields undergo periodic "paradigm shifts" rather than solely progressing in a linear and continuous way, and that these paradigm shifts open up new approaches to understanding what scientists would never have considered valid before; and that the notion of scientific truth, at any given moment, cannot be established solely by objective criteria but is defined by a consensus of a scientific community. Competing paradigms are frequently incommensurable; that is, they are competing and irreconcilable accounts of reality. Thus, our comprehension of science can never rely wholly upon "objectivity" alone. Science must account for subjective perspectives as well, since all objective conclusions are ultimately founded upon the subjective conditioning/worldview of its researchers and participants."

 

https://en.wikipedia.org/wiki/Thomas_Kuhn#:~:text=In this book%2C heavily influenced,its increase in popularity)%2C in

 

Lots of people blindly trust science but the "science" we see digested to us in textbooks and pamphlets and even scientific articles has serious flaws. Some of these flaws are in the transmission of the knowledge (an article exaggerates something, a textbook chooses a side in a debate that is not yet settled), some of these flaws are contextual (the statistics of this one study were wrong) but some of these flaws are systemic - i.e. the way we do and reward science does not lead us directly to the truth. An example of the latter would be that dissenting interpretations of data could be blocked from publication during the peer review process because the peers reviewing a new controversial theory believe a different interpretation of the data and they are biased and they consider the controversial interpretation wrong. This doesn't even need to be malicious. And of course fraud and profit driven agendas can also be presented to us as science but science that is biased. 

 

Blind belief in science is called "scientism." The best scientists are sceptics - I need a lot of proof to be convinced of things. I often get articles from pubmed thrown at me on reddit/twitter trying to convince me of various things - most recently that ADHD means that we have a dopamine deficiency etc. If you start unpeeling the article, however, its claims are quite tenuous and very specific to one receptor in one group of people given this one medicine, in this part of the brain etc. Then you look at the various choices made in the running of the study (more women recruited, age different) sample and by the end you realize that the study has actually shown something very small that does not support the broad claims being made. Yes, it is statistically significant but this tiny irrelevant thing that is statistically significant and has no clinical value. 

 

Now, science is still our best approximation to the physical truth in this world and we need to be conducting science constantly so that we do chip away at the "Truth" as best as we can.  But science as a process and endeavour is only an approximation to the ideal system of seeking for the rules of nature similar to how democracy is only an approximation to the ideal system of governance - both are bad approximations but the best we have as of now. 

 

Science requires us to be always sceptical and at the same time open minded - two conflicting states of mind. Ideally, we would let the data speak for itself. But the data is always interpreted - through statistical test that the authors ran (these choices can impact the results), through the questions being asked and not asked. For example, you could show that after people stop ADs their anxiety increases. Some will conclude this to be a relapse. But how do we know that the same data doesn't mean that the patient has withdrawal symptoms instead?

 

The best way to be a science consumer is to know statistics inside out. We all know correlation is not causation etc. but we are not very good at understanding how to actually discern true causation (or lack thereof) - the vast majority of observational studies in medical journals have some flaws. Randomized, placebo controlled clinical trials are the gold standard but they can also be manipulated - for example, suicidality was classified as lability in many later psych drug trials after prozac trials showed that suicidality in the drug group was higher than in the placebo group. And this reclassification/relabeling allowed any opponent of drugs to be shut down by "you are endangering people by warning them about side effects of XYZ antidepressant." The best clinical scientists need to be great statisticians - unfortunately, they are not! And we are not even taught good data analysis in high school. There are some students who graduate uni without having taken a statistics or quantitative reasoning class. That is truly a pity. 

 

You need to keep a sceptical mind about the SA protocols as well - we are doing the best we can with the knowledge we have and we are erring on the side of caution. It would be amazing if we could study withdrawal better but unfortunately, we don't have the resources to do that. People like you, from the trenches have a voice and you can push for more studies. Mark Horowitz's  book on deprescribing is coming out - perhaps get a copy around in your ward and recommend it to colleagues?  

 

I am glad that you have kept an open mind and compassion towards your fellow humans in your care. Many in psychiatry see patients as inferior, as garbage where a compassionate approach would be so much more healing. 

 

Stay curious, 

OMW

 

"Nothing so small as a moment is insurmountable, and moments are all that we have. You have survived every trial and tribulation that life has thrown at you up until this very instant. When future troubles come—and they will come—a version of you will be born into that moment that can conquer them, too." - Kevin Koenig 

 

I am not a doctor and this should not be considered medical advice. You can use the information and recommendations provided in whatever way you want and all decisions on your treatment are yours. 

 

In the next few weeks I do not have a lot of capacity to respond to questions. If you need a quick answer pls tag or ask other moderators who may want to be tagged. 

 

Aug  2000 - July 2003 (ct, 4-6 wk wd) , citalopram 20 mg,  xanax prn, wellbutrin for a few months, trazodone prn 

Dec 2004 - July 2018 citalopram 20 mg, xanax prn (rarely used)

Aug 2018 - citalopram 40 mg (self titrated up)

September 2018 - January 2019 tapered citalopram - 40/30/20/10/5 no issues until a week after reaching 0

Feb 2019 0.25 xanax - 0.5/day (3 weeks) over to klonopin 0.25 once a day to manage severe wd

March 6, reinstated citalopram 2.5 mg (liquid), klonopin 0.25 mg for sleep 2-3 times a week

Apr 1st citalopram 2.0 mg (liquid), klonopin 0.25 once a week (off by 4/14/19- no tapering)

citalopram (liquid) 4/14/19 -1.8 mg, 5/8/19 - 1.6 mg,  7/27/19 -1.5 mg,  8/15/19 - 1.35, 2/21/21 - 1.1 (smaller drops in between), 6/20/21 - 1.03 mg, 8/7/21- 1.025, 8/11/21 - 1.02, 8/15/21 - 1.015, 9/3/21 - 0.925 (fingers crossed!), 10/8/21 - 0.9, 10/18/21 - 0.875, 12/31/21 - 0.85, 1/7/22 - 0.825, 1/14/22 - 0.8, 1/22/22 - 0.785, 8/18/22 - 0.59, 12/15/2022 - 0.48, 2/15/22 - 0.43, 25/07/23 - 0.25 (mistake), 6/08/23 - 0.33mg

 

Supplements: magnesium citrate and bi-glycinate

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  • Moderator

Well said @Onmyway 👏

2003-2009 on and off various SSRI's for short periods, Ativan prn

2010-2011 Ativan, up to 1.5mg/day - tapered off without issue

2013-2021 ativan 1-1.5mg 10-12x/month, daily starting Oct 21 to help with buspar WD

2016 - Effexor 75mg, short-term

2021 Mar -Jun Buspar ADR at high dose, tapered 3 months

2021 Aug Wellbutrin 150mg for 5 days (ADR), then MIrtazapine 7.5mg for 7 days (ADR)

Oct 22/21 - Direct switch ativan to clonazepam (don't do this)

Tapered clonaz Oct/21 - Apr/23 0.25mg - 0mg!

 

Supplements: omega-3, mag-glycinate, vitamin D

 

"Believe that your tragedies, your losses, your sorrows, your hurt, happened for you, not to you. And I bless the thing that broke you down and cracked you open, because the world needs you open" - Rebecca Campbell

 

*** Disclaimer: Please note, my suggestions/comments are based on my own personal experiences. Please consult a knowledgeable practitioner to discuss decisions regarding your medical care *** 

 

                                                             *** Please do not send me PM's ***

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20 hours ago, Onmyway said:

Hi @DavidW

 

I am glad that you have kept an open mind and compassion towards your fellow humans in your care. Many in psychiatry see patients as inferior, as garbage where a compassionate approach would be so much more healing. 

 

Stay curious, 

OMW

 

 

Thank you very much for this, OMW.  We share very similar views.  I particularly appreciate how you advise against dogmatic thinking and the need to balance skepticism with open-mindedness.

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