help4brother: Trying to save my brother...

[help4brother]

Hello everyone,

My brother is in serious need of help. He has always suffered from Social Anxiety Disorder and Depression. He was taking Paxil for a few years until his doctor switched him to Zoloft. He stayed on Zoloft for a few years until about 3 months ago when the dr. switched him to Lexapro and he also took Prozac for one week.

 

He quit "cold turkey" and two weeks later, started to suffer numerous withdraw symptoms. He suffered for a week, and read everything he could on the internet about SSRI Withdraw. This definitely caused him anxiety, since, he believes nothing will ever allieviate his symptoms and he will be like this for life!

 

He threatened suicide so my parents and I got him into a clinic. He's been there for one week now. The doctor "doesn't believe" that he is suffering from withdraw and that his depression has returned. He is now on Zoloft, Abilify and Remeron. His symptoms do seem to be getting better, however, I have a few questions:

 

1) Could he have permanent symptoms? (This is his biggest concern)

 

2) Should he stay on these meds? And if so, for how long until he tapers?

 

3) Should I just pull him out of this clinic and send him to a place where they DO understand SSRI Withdraw?

 

Thank you all, in advance, for any and all advice. I love my brother so much and I just want him to be happy!

[Nadia]

Oh, dear... that sounds like an awful situation. I'm so sorry you are dealing with that. Unfortunately, there is very little "belief" in the medical community about withdrawal. I took antidepressants for YEARS, trying to quit multiple times, because every time the doctor said it was just my original depression that was back, and it was taken as further evidence to be on medication. I believed this for years, until my last two attempts to quit brought on such strange symptoms, and I remembered back to the person I used to be before taking antidepressants, and realized something strange and new was going on, and that it could not possibly be JUST depression.

 

What is awful about this situation is that not only have they put him back on medication, but have given him a 3 drug combination!! The fact that he is better doesn't prove that his problem is not withdrawal, however! (Nor does it mean that, once off drugs, he would not have to find other ways of dealing with the original problem, if it arises again). The issue here is that often these drugs cause more harm than good, especially in the long run.

 

It would be great if you could find a doctor that would be willing to help him taper off these drugs, if that is what he wants (I suppose he stopped taking them for a reason?). I understand how scared he must have been when he read about withdrawal syndrome. It is a really dark night of the soul when you realize what you may be up against. However, there is no reason to believe he cannot get better and overcome it.

 

I'll leave it to other people here to give you more advice regarding your specific questions (unfortunately I quit cold turkey so I'm no expert in the tapering dept.)... in the meantime, check out the scientific literature that's posted in other sections. Also keep in mind that most of the people who post here have EXTENDED withdrawal symptoms, but that this is NOT typical for most people who do long tapering off their medication. So some things might seem dire (which is why your brother freaked out, I'm sure), but they are not necessarily that way.

[alexjuice]

Hello everyone,

My brother is in serious need of help. He has always suffered from Social Anxiety Disorder and Depression. He was taking Paxil for a few years until his doctor switched him to Zoloft. He stayed on Zoloft for a few years until about 3 months ago when the dr. switched him to Lexapro and he also took Prozac for one week.

 

He quit "cold turkey" and two weeks later, started to suffer numerous withdraw symptoms. He suffered for a week, and read everything he could on the internet about SSRI Withdraw. This definitely caused him anxiety, since, he believes nothing will ever allieviate his symptoms and he will be like this for life!

 

He threatened suicide so my parents and I got him into a clinic. He's been there for one week now. The doctor "doesn't believe" that he is suffering from withdraw and that his depression has returned. He is now on Zoloft, Abilify and Remeron.

....

 

Hey help4brother,

 

Others will be along to share their thoughts, but lemme say this in the hopes that you find some comfort.

 

I've had social anxiety for a long while. Social anxiety responds well to specific types of cognitive-behavioral techniques that do not require medication. Zoloft, Remeron & Abilify were not very helpful in the long or short run in treating my social anxiety (or depression) -- I've been on all 3. Psychiatric medications like Zoloft and Paxil can cause or worsen anxiety when they are stopped, especially if they are stopped cold-turkey.

 

It's important to try to learn a bit before making quick decisions such as to abruptly quit meds. It's not for me to give medical advice, I'm not a doctor, but I do have experience with some of the psych problems that affect your brother. I can tell you what happened to me and what I've seen happen to others.

 

It's really scary having to deal with a situation like this. It's scary for your brother and for you and his other family members too. I've been on medications and put in 'clinics' and I've been scared and anxious myself. The important thing to realize is there is no reason to panic. As Nadia said, many people posting on internet forums are 'worst cases' and your brother isn't doomed to suffer because of something that happened to someone else. Many people have been in your brother's shoes and have recovered to live fulfilling lives. Even the worst cases can recover, so there is always cause for hope.

 

I wish you the best through this awful time. It won't last forever -- I promise you that.

 

Alex.i

[help4brother]

Thank you Nadia and Alex! It's comforting to hear that my brother is not alone. It is equally as comforting to hear that there may be hope for him. He is feeling EXTREMELY HOPELESS because he read the symptoms of Protracted Withdrawl and became CONVINCED that he had it, since, he had most of these symptoms! The doctor, my family, his friends and I CAN NOT convince him that these symptoms won't persist and that his horrible nightmare is temporary! This whole experience has deeply affected our family.

 

I understand that many Doctors aren't familiar with SSRI Withdrawl. Is it possible that by staying on these new meds for awhile and tapering off of them SLOWLY will make him feel normal again? And if so, does anyone know how long it will take to taper off of them?

[btdt]

Hello everyone,

My brother is in serious need of help. He has always suffered from Social Anxiety Disorder and Depression. He was taking Paxil for a few years until his doctor switched him to Zoloft. He stayed on Zoloft for a few years until about 3 months ago when the dr. switched him to Lexapro and he also took Prozac for one week.

 

He quit "cold turkey" and two weeks later, started to suffer numerous withdraw symptoms. He suffered for a week, and read everything he could on the internet about SSRI Withdraw. This definitely caused him anxiety, since, he believes nothing will ever allieviate his symptoms and he will be like this for life!

 

He threatened suicide so my parents and I got him into a clinic. He's been there for one week now. The doctor "doesn't believe" that he is suffering from withdraw and that his depression has returned. He is now on Zoloft, Abilify and Remeron. His symptoms do seem to be getting better, however, I have a few questions:

 

1) Could he have permanent symptoms? (This is his biggest concern)

 

2) Should he stay on these meds? And if so, for how long until he tapers?

 

3) Should I just pull him out of this clinic and send him to a place where they DO understand SSRI Withdraw?

 

Thank you all, in advance, for any and all advice. I love my brother so much and I just want him to be happy!

 

"3) Should I just pull him out of this clinic and send him to a place where they DO understand SSRI Withdraw?"

 

Ahhh that would be a dream come true a place where understand withdrawal unfortunately I don't know of any.

As he was in a bad place and the family decided he needed help I am afraid that is what will happen he will stay where he is until he gets said help. Keep this in mind for whenever he decides to taper off the meds if he does...

because

a too fast taper can cause undo stress and wild thoughts ect he needs to have support for sure but he needs to have a very slow and gentle taper when he is ready. He is not ready now he is getting emergency help and once you reach that place all bets are off and they have the power that is the best I know of that situation it has never happened to me. I have never been locked up to scared to go.

So once he is stable a good while maybe a good long while ... when he is ready the taper MUST

be slow and steady to avoid causing him to be unstable again and having to go back into care.

That time is not now it maybe a long time from now. Once he is stable working on issues that cause his anxiety and learning new ways to deal with are are what I suggest he do when he is stable. Also read about withdrawal when he is stable and has some extra help with the anxiety so he can handle the rigors of reading about withdrawal. A therapist may help with this. When he is READY he can do all these things but now I think he has to stay where he is. Again I have no experience with people in hosp I don't know how the system works but I don't think they will let him out if he is a danger to himself think it is a law.

What you can do be supportive let him know you will help him to understand and maybe even research this.

One thing you need to know going in is that protracted withdrawal is more apt to be an issue for people who quit cold turkey so don't let him do that. The best they have found so far is that withdrawal is dose and length of time on dependent which mean the longer he was on the higher his dose the worse the withdrawal will be from ct.

As far as protracted withdrawal goes there is nothing to be afraid of really but fear itself if he can't stand to stay on the drugs and needs to come off there is not choice really stay on come off simple... I understand his fear of withdrawal but there really are two choices and that is it. The point I can make for withdrawal is this eventually it ends... I hope. If the drugs were really working well for him I don't think he would want off them would he? so take good care of yourself and learn all you can. go see him

[Altostrata]

Welcome to our community, help4brother.

 

I agree, if your brother had a supportive doctor or was able to go to a clinic, he would be saved from further overmedication and withdrawal symptoms.

 

We know of very few supportive doctors. I wish I knew of a center for withdrawal. I know of two in the planning stages.

 

Since he was threatening suicide, by this time he may have been mislabeled as psychotic or bipolar or some other grand nonsense.

 

While tragic, that might in fact be an opportunity. If your family has means and has bought into the psychiatric diagnosis, there's the Cooper-Riis center in North Carolina http://www.cooperriis.org/overview/index.html

 

Sending your brother for a stay at CooperRiis might make sense to them.

 

It's an impatient facility, quite expensive: $12,500 a month. It sounds very pleasant. One location is a farm and the other is in Asheville.

 

My guess is your brother might be able to stay for a month or two, get his tapering instructions, and then leave.

 

They say they've seen other people in your brother's situation -- misdiagnosed and overmedicated. Robert Whitaker is one of their allies.

 

Pajaro Valley Sunrise Center http://www.pvsunrise.org/ubercart/board won't open for a couple of years. One of their directors is Janet Foner in New Cumberland, PA, also on the MindFreedom board: http://www.mindfreedom.org/kb/mental-health-alternatives/creative-revolution-janet-foner She may know of a supportive doctor. She may be in the phone book or you might be able to contact her through Pajaro Valley postmaster .at. pvsunrise.org

 

Otherwise, you might start calling the psychiatry faculty of major medical centers, such as University of Pennsylvania http://www.med.upenn.edu/psych/faculty_database.html and ask for referrals to psychiatrists who know about tapering. (No one knows anything about withdrawal syndrome.) Please let us know what you find out.

[Nadia]

I understand that many Doctors aren't familiar with SSRI Withdrawal. Is it possible that by staying on these new meds for awhile and tapering off of them SLOWLY will make him feel normal again? And if so, does anyone know how long it will take to taper off of them?

 

I know several people who have quit SSRIs by tapering and have done just fine. It's hard to say what the outcome will be because everyone is different, but as Alexejice mentioned, there are scientific studies that have found a correlation between the length of tapering and withdrawal symptoms. However... those studies still tapered quite quickly, and like Alto mentions, they don't really distinguish between the types of discontinuation problems you have immediately, and, for a small subset of people, the types of problems that arise over time (which is what I'm dealing with now, for example).

 

If I could do it all over again, I think I would take one or two years to do a taper, to allow my brain to adjust.

 

It would be simpler if he were only going to taper off one medication. I wonder what the reason for adding Abilify and Remeron were, for example. It seems like they didn't even try just the Zoloft and seeing if he would stabilize on that? Usually they recommend going back on whatever was the last med you were on and tapering that (though in this case, he wasn't on Lexapro very long... perhaps Zoloft IS the best one to reinstate--hopefully Alto, the site owner, will be around, she knows a lot more about this)... But there are many hypotheses out there... including one saying it might help to switch to Prozac because it has a longer half life, and tapering off that. What is clear to me is that the more meds you add to the equation, the more complicated the whole thing can get. It's unfortunate they didn't just start him on, say, the Zoloft, without adding the other two. I wonder if there would be a way to start tapering him off of the other two fairly soon (but it might not be a good idea... how long has he been taking them?). What is maddening about all of this is that it's so hard to find a doctor who isn't so drug-prescription-happy. So many of the nightmare stories you find on this site involve doctors just adding medications or switching them like crazy or upping dosages when they don't see the results they want. That can wreak havoc on the brain.

 

Question: why was your brother switched to Zoloft, and then why was he switched to Lexapro? What were the doses? Why did he decide to quit? I suspect it was either because he was having side effects he didn't like, or because the drugs stopped working. In my case, a Zoloft/Wellbutrin combination was what had me doing fine (other drugs didn't help or had side effects), but it invariably stopped working after a couple of years. What they say happens is that your brain makes adjustments in response to the medicine... it down-regulates serotonin receptors, since it detects there is more serotonin around. There are probably other changes... it makes sense that if you quit the drug suddenly, your brain freaks out because it's changed in response to the drugs. You need to give it time to go back to normal.

 

As for what your brother is fearing about never getting better: if you look at my intro topic, or that of a lot of other people on here, you'll see there is a lot of freaking out going on. I am not surprised he had that reaction. You read about people doing awful 6 years later, and you think, there is no way I can live through that. I too had a reaction of deep depression and more anxiety, thinking this was it, this was the end of everything. I felt like I had gotten 16 relatively stable years (though looking back, just how much the drugs helped seems questionable, I think I would have been better off with other types of interventions, like cognitive behavioral therapy, even if they required more effort on my part and if results were more gradual), but had burnt that possibility away, and now not only was I going to have to suffer a protracted withdrawal, a pure nightmare, but there was no hope of going back on ADs to fix it. I had seen the light for a while, had felt like a normal person thanks to drugs, only to be punished later. It made me think of the book Flowers for Algernon. I wanted to die. It has been a whole mourning process to accept what I am going through, and realize that YES, THERE IS A WAY OUT. It has also been a moment of painful awakening, and of realizing that there are other and better ways of dealing with depression and anxiety than drugs. There are tons of studies that show that various forms of therapy help in more profound and lasting ways.

 

Sites like this can be a double-edged sword. You can find answers and comfort here, but also despair. But as someone pointed out in one thread, would you be posting on a site like this if you had overcome your problems? You don't hear so much about the many, many success stories because they don't stick around! I hope you can somehow convince your brother that there is a way out, that there IS hope. And what is good news is that he quit fairly recently, so going back on medication and stabilizing and THEN tapering has a good chance of working.

[Altostrata]

My guess is they slammed his brain with Abilify because they escalated his diagnosis to something more serious than depression.

 

Remeron probably was added for withdrawal insomnia.

 

If he has the latitude, help4brother, I'd encourage him to quickly taper off both of these drugs and stay on Zoloft for a bit until his withdrawal symptoms stabilize.

 

How old is your brother?

[help4brother]

Thanks everyone for the valuable input. I am really freaking out now!! I just went to visit my brother in the clinic and THEY ARE TAKING HIM OFF ZOLOFT!!! Apparently, he is experiencing insomnia. So there goes the SSRI OUT OF HIS SYSTEM and what is left??? Abilify and Remeron, which ARE NOT SSRI's!!! Since he is experiencing SSRI Withdrawl (due to overwhelming symptom evidence), what is going to happen to him and how can I possibly help him now?!?!

 

By the way, a lot of his initial withdrawl symptoms have dissipated or are infrequent now. That is a good sign, however, his depression is worse. And worse yet, he is getting discharged Monday and will be put on an Outpatient Program. My family and I are obviously worried!!

[Altostrata]

I agree, taking him off Zoloft is a bad move.

 

How old is your brother? How is your communication with your family? Can you educate them about withdrawal syndrome?

 

Antidepressant withdrawal syndrome is very well-documented. There really is no doubt it exists. The doctor who said he "didn't believe" in it was shockingly remiss. You might even have a malpractice suit against him.

 

Some papers about withdrawal syndrome are listed here:

 

http://survivingantidepressants.org/index.php?/topic/317-important-topics-in-journals-and-scientific-sources/

 

You might print out some and show your family. I recommend:

 

2011 Antidepressant discontinuation manic states

(assuming your brother was manic or not making sense)

 

Potential adverse effects of discontinuing psychotropic drugs: part 2: antidepressant drugs.

 

2006 Antidepressant discontinuation syndrome

 

2001 Antidepressant discontinuation syndromes: common, under-recognised and not always benign

 

Where available, full text is attached to the topic. You can download it and print it out.

[help4brother]

My brother is 27 years old. I am very close to my parents and brother. I have been doing exhaustive research on my brother's case. I am like in "Operation Save Him" mode!

 

I have found some conflicting research by trusted sources. One of the papers states that using a drug like Remeron and Abilify will help to allieviate withdrawl symptoms (even in the absence of an SSRI!) That is good news, but, I have also found the opposite conclusion with other reports.

 

I honestly do not know what to believe anymore. Thank you for the links that you've provided. I appreciate it and will do my best to help my brother.

[Altostrata]

I would like to see that paper about alleviating withdrawal symptoms with Remeron and Abilify. I have never heard of such a thing.

 

Your brother is an adult, you can help him make decisions about his care. He needs to be more assertive.

[btdt]

Me too.

I am trying to get my head around Remeron as I have not heard a lot about it.

http://en.wikipedia.org/wiki/Remeron

From what I can gather at the above link it is an entire new beast.

 

Does anyone here have any insight into this drug? that would further the understanding.

[Altostrata]

It's mirtazapine, it's been around since 1990. It acts on serotonin and norepinephrine.