A new resource: ‘Understanding Antidepressants’

[Wallace]

Did you see that yesterday the electronic version of the New York Times had a front page article on the difficulties of antidepressants withdrawal?  I thought it might mention a new resource, my book ‘Understanding Antidepressants’.  I’ve presented the science behind how antidepressants work, their possible benefits, drawbacks (notably withdrawal), and alternatives.  It’s available on Amazon.  My hope is that is will be a good source of information.  Would appreciate your feedback and suggestions for future editions.  Link is: https://www.amazon.com/Understanding-Antidepressants-Wallace-B-Mendelson-ebook/dp/B07B4GWKSN/ref=sr_1_1?s=digital-text&ie=UTF8&qid=1520279221&sr=1-1&keywords=Understanding+antidepressants&dpID=51CRhuvoM8L&preST=_SY445_QL70_&dpSrc=srchl      I’d also like to learn from you, am looking forward to reading about your experiences.

[Altostrata]

Welcome, Wallace.

 

Thank you for your interest in patient experiences with going off antidepressants and other psychiatric drugs. You might read a few of the topics in our Introductions forum, they are patient-reported case histories.

 

Can you please explain more about how your book covers the risk of withdrawal symptoms and how to go off to avoid them? (It might be helpful to make that chapter of the book available to members of this forum.)

 

For your information, here are the rationale and tapering methods we recommend. 

 

Members, please be polite and considerate in your responses to this topic. Wallace is a psychiatrist who wants to learn from patients. While you might be frustrated with psychiatry, please be kind to Wallace. Any doctor who would take the time to register, post, and read here is one of the good ones.

[Rosetta]

Dear Wallace, Thank you for your efforts.  Yours, Rosetta

[bhasski]

@Wallace

Nice to see that s1 in that world acknowledging withdrawal.

 

Since you are a doctor and know the effects and possibly treatments for bad one.. can you go through my thread .. i am off 2+ years and still suffering the effects that were not prior to medications.

 

I was polydrugged here in India in a span of 2.5 yrs... . also taken into trust that all the side effects are temporary and for a short while and a trade off that is worth considerable... 

 

I had to leave a starting good job of a software engineer .. lost coginitive abilities.. no memory or recall of past behaviors.. pssd. I am 28 now.

 

Pls look into my thread.. 

 

survivingantidepressants.org/topic/13850-bhasski-damaged-all-over-physically-mentally-and-spiritually/

 

[bhasski]

One more thing .. 

 

I wrote nice as a start... these are the words that I know..

While I rarely feel nice... Just to let you know how pathetic I am. 

 

I can write .. but dont feel , so cant talk same face to face.

[Wallace]

Thank you for pointing me to the introductions forum and the rationale and tapering methods. My book was designed to give folks more information about antidepressants, both benefits and drawbacks, so that it’s possible to weigh them as completely as possible when making choices. It also talks about alternatives that are available.

      Mostly I’m here to learn. What kinds of schedules seemed to work best? Are some antidepressants harder to come off of than others?  Do people who later have withdrawal symptoms have anything in common, which can be predicted in advance? Why do some people get a particular withdrawal symptom, while other people develop another? These are the sorts of things that I would like to learn.

[Altostrata]

All good questions! Here are my observations after counseling thousands of people in tapering:

 

- We advocate 10% reduction per month. While this seems agonizingly slow (it is), the patient consensus is that 25% reductions result too often in severe withdrawal symptoms. The rationale and methodology is here Why taper by 10% of my dosage?

 

- In the literature on withdrawal syndrome, paroxetine and venlafaxine have been repeatedly mentioned as having the highest incidence of withdrawal symptoms. The research drops off in the mid-2000s. Anecdotally, we have also seen a lot of difficulty here with Cymbalta and Pristiq (neither of which are available in graduated dosages). However, we have reports of severe and prolonged withdrawal syndrome from all psychiatric drugs, including fluoxetine, bupropion, lamotrigine, trazodone, and even SAM-e.

 

Our most popular topic is Tips for Tapering Off Wellbutrin (bupropion), with nearly a half-million views, followed by Tips for Tapering off Lexapro (escilatopram), with more than 300,000 views, and Tips for Tapering Off Pristiq (desvenlafaxine), 264,000 views. This probably is related to the frequency of prescription of the drugs rather than severity of tapering difficulty. However, it does indicate that many people have probably tried to go off bupropion, etc., gotten withdrawal symptoms, and resorted to the Web to find an exit path.

 

As they say in the literature, there is a lot of individual variability.

 

- A history of going on and off psychiatric drugs, cold switches, cold turkeys, or prior adverse reactions or withdrawal syndrome seems to predispose people to withdrawal difficulties. (We're also seeing antibiotics precipitating or exacerbating withdrawal syndrome.) Since most people probably have gotten adverse reactions or tried to go off their drug or accidentally skipped a dose and gotten withdrawal symptoms, this aspect of risk is very, very common. The nervous system is not made of rubber.

 

(Wallace, one thing you can do for us is to tell your colleagues never, ever recommend skipping doses to taper. This brings on a humongous withdrawal syndrome. We all know these drugs need to be taken consistently. If you observe your patients getting withdrawal symptoms when they accidentally forget a pill, what would you expect to happen if they skip doses to taper?)

 

Physicians are very blase about switching people from psychiatric drug to psychiatric drug, and they should not be. Every drug switch has its cost.

 

People who have been taking a drug for years are definitely at risk for withdrawal syndrome, the dosage level doesn't seem to matter. (Doctors erroneously often tell patients they're taking a "low dosage" when they're taking the usual dosage. 20mg Prozac is not a low dosage.) However, we see people having difficulty coming off when they've taking the drug for only a few months. The literature says anyone who has taken the drug for more than a month is at risk for withdrawal syndrome; this probably was observed at clinical trials, which are usually less than 2 months.

 

We also see people who have immediate severe adverse reactions, but whose physicians persuade them to continue taking the drug, often with the addition of a benzo (which also incurs physiological dependency). These are people who should never take the drug in the first place. Even if exposure was only a few tablets, they often have symptoms that are identical to severe withdrawal symptoms for years, i.e. neurological dysregulation. Their recovery pattern is the same as that of severe withdrawal syndrome: Very gradual, slow, frustrating, with a lot of setbacks.

 

- Why do people develop particular withdrawal symptoms? First off, sleep disruption is so common as to be almost universal. These drugs affect the sleep cycle.

 

Otherwise, much of withdrawal syndrome is neurological dysregulation, which tends to attack whatever physiological stress point one might have. Generally, the nervous system becomes hypersensitive to all kinds of stimuli; it has this in common with fibromyalgia (a common misdiagnosis, also chronic fatigue syndrome). Hyper-reactivity may be expressed in brain zaps (see Lhermitte's sign) or other paresthesia, pain, or waves of unpleasant stimulation often described as "anxiety" or "panic."

 

It may also be felt as unprecedented dark thoughts, low mood, or horror. Downregulation has sidelined a regulating neurotransmitter from the neurological symphony and it's out of tune.

 

The hypersensitivity extends to all psychiatric drugs, drugs such as antibiotics, and sometimes even supplements and foods. The person may become extraordinarily light-sensitive, for example. For that, we recommend reducing light stimulation by darkening rooms and wearing dark glasses. This reduces the cycle of hyper-reactivity in the eyes and it eventually fades away.

 

To me, it's very important to see withdrawal syndrome as a global neurological dysregulation. That is why symptoms come and go and mutate, the nervous system is struggling to patch itself up, with varying success, despite the handicap of downregulation. Recovery is a slow, progressive, iterative process. As drug hypersensitivity is built in, attempting to repair this drug damage with other drugs often makes it worse. Fortunately, neuroplasticity is also built in, and if the nervous system can adapt to the drugs, it can adapt to their absence -- as long as we don't interfere with it.

[RealMe]

38 minutes ago, Altostrata said:

The hypersensitivity extends to all psychiatric drugs, drugs such as antibiotics,

 

I just had a tooth extraction and implant on Friday and have been taking Amoxicillin, which is making me very nervous about side effects.  The surgeon recommended starting the antibiotic before the surgery, and I told him I would rather not because I am very sensitive to medications.  However, he said they were required after the implant because of the foreign body.  How long should I take them?  Can I cut the regimen short of what he prescribed without danger of infection?  I know you cannot give medical advice, but can you give me anecdotal ideas?  Thank you in advance.

RM

[RealMe]

6 hours ago, Wallace said:

Did you see that yesterday the electronic version of the New York Times had a front page article on the difficulties of antidepressants withdrawal?

Yes, I read it with great interest.  I was also interested in the overwhelming responses of people defending the continuation of SSRIs due to the "return of clinical effects of depression."  Some people abjectly refuse to acknowledge that withdrawal syndrome is not the same as the symptoms of depressing.  https://www.nytimes.com/2018/04/07/health/antidepressants-withdrawal-prozac-cymbalta.html?nl=top-stories&register=google

[Altostrata]

I don't know, RealMe. You don't want to get an infection. You'll have to ask your doctor.

 

1 minute ago, RealMe said:

I was also interested in the overwhelming responses of people defending the continuation of SSRIs due to the "return of clinical effects of depression."

 

I agree, patients as well as doctors make this mistake.

[ChessieCat]

Hi Wallace and welcome to SA,

 

There is currently a petition before the Scottish Parliament:  PE01651: Prescribed drug dependence and withdrawal

 

They are accepting submissions from anywhere in the world, not just Scotland or the UK.

 

The submissions are people's experiences in a nutshell, ie concise.  They are well worth reading if you wish to gain an insight into how psychiatric drugs (being on, trying to get off and bad reactions) have affected people's lives.  I have read about 1/3 of them.

 

This is the link to the submissions which are available to the public:  http://www.parliament.scot/GettingInvolved/Petitions/PE01651  

[Wallace]

2 hours ago, Altostrata said:

All good questions! Here are my observations after counseling thousands of people in tapering:

 

- We advocate 10% reduction per month. While this seems agonizingly slow (it is), the patient consensus is that 25% reductions result too often in severe withdrawal symptoms. The rationale and methodology is here Why taper by 10% of my dosage?

 

- In the literature on withdrawal syndrome, paroxetine and venlafaxine have been repeatedly mentioned as having the highest incidence of withdrawal symptoms. The research drops off in the mid-2000s. Anecdotally, we have also seen a lot of difficulty here with Cymbalta and Pristiq (neither of which are available in graduated dosages). However, we have reports of severe and prolonged withdrawal syndrome from all psychiatric drugs, including fluoxetine, bupropion, lamotrigine, trazodone, and even SAM-e.

 

Our most popular topic is Tips for Tapering Off Wellbutrin (bupropion), with nearly a half-million views, followed by Tips for Tapering off Lexapro (escilatopram), with more than 300,000 views, and Tips for Tapering Off Pristiq (desvenlafaxine), 264,000 views. This probably is related to the frequency of prescription of the drugs rather than severity of tapering difficulty. However, it does indicate that many people have probably tried to go off bupropion, etc., gotten withdrawal symptoms, and resorted to the Web to find an exit path.

 

As they say in the literature, there is a lot of individual variability.

 

- A history of going on and off psychiatric drugs, cold switches, cold turkeys, or prior adverse reactions or withdrawal syndrome seems to predispose people to withdrawal difficulties. (We're also seeing antibiotics precipitating or exacerbating withdrawal syndrome.) Since most people probably have gotten adverse reactions or tried to go off their drug or accidentally skipped a dose and gotten withdrawal symptoms, this aspect of risk is very, very common. The nervous system is not made of rubber.

 

(Wallace, one thing you can do for us is to tell your colleagues never, ever recommend skipping doses to taper. This brings on a humongous withdrawal syndrome. We all know these drugs need to be taken consistently. If you observe your patients getting withdrawal symptoms when they accidentally forget a pill, what would you expect to happen if they skip doses to taper?)

 

Physicians are very blase about switching people from psychiatric drug to psychiatric drug, and they should not be. Every drug switch has its cost.

 

People who have been taking a drug for years are definitely at risk for withdrawal syndrome, the dosage level doesn't seem to matter. (Doctors erroneously often tell patients they're taking a "low dosage" when they're taking the usual dosage. 20mg Prozac is not a low dosage.) However, we see people having difficulty coming off when they've taking the drug for only a few months. The literature says anyone who has taken the drug for more than a month is at risk for withdrawal syndrome; this probably was observed at clinical trials, which are usually less than 2 months.

 

We also see people who have immediate severe adverse reactions, but whose physicians persuade them to continue taking the drug, often with the addition of a benzo (which also incurs physiological dependency). These are people who should never take the drug in the first place. Even if exposure was only a few tablets, they often have symptoms that are identical to severe withdrawal symptoms for years, i.e. neurological dysregulation. Their recovery pattern is the same as that of severe withdrawal syndrome: Very gradual, slow, frustrating, with a lot of setbacks.

 

- Why do people develop particular withdrawal symptoms? First off, sleep disruption is so common as to be almost universal. These drugs affect the sleep cycle.

 

Otherwise, much of withdrawal syndrome is neurological dysregulation, which tends to attack whatever physiological stress point one might have. Generally, the nervous system becomes hypersensitive to all kinds of stimuli; it has this in common with fibromyalgia (a common misdiagnosis, also chronic fatigue syndrome). Hyper-reactivity may be expressed in brain zaps (see Lhermitte's sign) or other paresthesia, pain, or waves of unpleasant stimulation often described as "anxiety" or "panic."

 

It may also be felt as unprecedented dark thoughts, low mood, or horror. Downregulation has sidelined a regulating neurotransmitter from the neurological symphony and it's out of tune.

 

The hypersensitivity extends to all psychiatric drugs, drugs such as antibiotics, and sometimes even supplements and foods. The person may become extraordinarily light-sensitive, for example. For that, we recommend reducing light stimulation by darkening rooms and wearing dark glasses. This reduces the cycle of hyper-reactivity in the eyes and it eventually fades away.

 

To me, it's very important to see withdrawal syndrome as a global neurological dysregulation. That is why symptoms come and go and mutate, the nervous system is struggling to patch itself up, with varying success, despite the handicap of downregulation. Recovery is a slow, progressive, iterative process. As drug hypersensitivity is built in, attempting to repair this drug damage with other drugs often makes it worse. Fortunately, neuroplasticity is also built in, and if the nervous system can adapt to the drugs, it can adapt to their absence -- as long as we don't interfere with it.

Thanks so much for your thoughtful comments.  You’ve given me a lot to think about, and I appreciate it!

[Wallace]

Thanks so much for your thoughtful comments, particularly about skipping doses.  You’ve give me a lot to think about, and I appreciate it.!

[Wallace]

1 hour ago, ChessieCat said:

Hi Wallace and welcome to SA,

 

There is currently a petition before the Scottish Parliament:  PE01651: Prescribed drug dependence and withdrawal

 

They are accepting submissions from anywhere in the world, not just Scotland or the UK.

 

The submissions are people's experiences in a nutshell, ie concise.  They are well worth reading if you wish to gain an insight into how psychiatric drugs (being on, trying to get off and bad reactions) have affected people's lives.  I have read about 1/3 of them.

 

This is the link to the submissions which are available to the public:  http://www.parliament.scot/GettingInvolved/Petitions/PE01651  

 

[Wallace]

Thank you so much, I’m not familiar with this site, and will definitely check it out!

[Dan998]

Thanks Wallace for taking the time to find out the truth about the harm that occurs when trying to withdraw from these horrible drugs. We many heartbreaking personal testimonies from thousands of members.

 

These drugs really do ruin lives. Everyone here would probably agree that the brutal withdrawal symptoms are many times worse than the original condition that caused them to go on the drugs in the first place.

 

If you head over to the success stories section you will find that it is possible to recover from withdrawal, but it can take many, many years of suffering before returning to an acceptable quality of life.

 

 

[Wallace]

Dan, thanks for sharing with me.  Wallace

[Altostrata]

And, may I add, the recovery pattern, which is fairly consistent from person to person (very slow, gradual, waves and windows, frustrating, can take years) demonstrates these people are not suffering from a "relapse" of any sort of psychiatric condition, unless you include iatrogenic neurological dysregulation among psychiatric conditions.

 

(NB: The DSM committee has repeatedly refused to include a diagnosis code for antidepressant withdrawal syndrome.)

[ChessieCat]

We have many members here wondering about the knowledge, or rather lack of knowledge, that medical professionals have regarding psychiatric drug use and withdrawal.  The medical profession gets their information from the pharmaceutical companies.  Gwen Olsen was a pharmaceutical representative for 15 years:

 

We are trained to misinform (6 minutes)

 

Manipulating Doctors (10 minutes)

 

Interview:  Confessions of an Rx Drug Pusher (51 minutes Gwen Olsen - ex pharmaceutical representative)

[Wallace]

Many thanks, I will definitely take a look at it.

[Wallace]

1 hour ago, Altostrata said:

And, may I add, the recovery pattern, which is fairly consistent from person to person (very slow, gradual, waves and windows, frustrating, can take years) demonstrates these people are not suffering from a "relapse" of any sort of psychiatric condition, unless you include iatrogenic neurological dysregulation among psychiatric conditions.

 

(NB: The DSM committee has repeatedly refused to include a diagnosis code for antidepressant withdrawal syndrome.)

 

Thanks for pointing this out, I appreciate it.

 

Edited April 10, 2018 by ChessieCat
added response from following post

[Altostrata]

Thanks for reading, Wallace. From your responses, I don't quite feel we have a dialog going.

 

Could you expand on your understanding of withdrawal syndrome and how our comments might have changed it?

 

(Members and mods, please refrain from any comments that might imply these medical errors are deliberate by the doctors or that, individually, they have anything but good intentions.)

[Wallace]

Dear Altostrata, I just wanted to say that I appreciate all that you’ve shared with me. I realize I’ve only written brief answers, and apologize that they are not more elaborate.  The reason is that I’m really here to learn,, and I do that mostly by listening.  I’ve had the sense that although I’ve been aware of withdrawal issues, and indeed written about them, but have been wondering if I really appreciated their magnitude.  I was finding things to read about it and came across your website.  There’s a famous medical saying: ‘When you’re not sure, try listening to the patient.’, and I’m a great believer in it.  So I joined your group, with interest to hear people’s experiences, and am coming to realize that there’s a large body of people who have had a very difficult time with withdrawal, more than I had realized. That’s the main thing, in response to your question, that your comments may have changed in my understanding. So I’m afraid that I don’t have much to contribute, but am learning a lot and have appreciated your sharing with me.  I hope I’m not being disappointing in not having more of a dialog, but I’m a firm believer that the best way to learn is to listen. 

[Wallace]

1 hour ago, Altostrata said:

Thanks for reading, Wallace. From your responses, I don't quite feel we have a dialog going.

 

Could you expand on your understanding of withdrawal syndrome and how our comments might have changed it?

 

(Members and mods, please refrain from any comments that might imply these medical errors are deliberate by the doctors or that, individually, they have anything but good intentions.)

 

[Wallace]

PS: You might wish to note the public posting I made yesterday on Facebook about The NY Times article, and suggested that there be more attention paid to to, and research in, antidepressant withdrawal.

[bheb]

Thank you Wallace -- you're doing important work. 

[wantrelief]

Thank you from me as well.  I really appreciate your coming here to learn more about our struggles with psychiatric medications.  Hopefully you've had a chance to read through some of the posts on the Introductions page to get a sense of how much pain many of us are in and how withdrawal for some of us has impacted almost all aspects of our lives.

[Shep]

6 hours ago, Wallace said:

PS: You might wish to note the public posting I made yesterday on Facebook about The NY Times article, and suggested that there be more attention paid to to, and research in, antidepressant withdrawal.

 

Hi, Wallace.

 

Thank you for coming to SA with an open mind and an interest in hearing from patients. 

 

Do you have a link to your Facebook post? 

 

You may be interested in a course that's being offered on the Mad in America Continuing Education site on psychiatric drug withdrawal from the vantage point of psychiatrists: 

 

Psychiatric Drug Withdrawal II - The Psychiatrist’s Perspective on Challenges, Opportunities, and Shared Decision Making

 

As you can see, you are not alone as a psychiatrist in your quest to learn more about how to help those of us experiencing difficulties coming off these drugs. These webinars have a chat room so you can ask questions and make contacts with the presenters. It might be worth exploring. 

 

The Mad in America website is a goldmine of information from both experts in psychiatry, as well as those with lived experiences, and I would highly recommend that site as another source of valuable information:

 

Mad in America

 

Again, thank you for listening to us and learning from our experiences. 

[Wallace]

Hi Shep, thanks for writing.  My posting about the New York Times article on antidepressant withdrawal can be found by going to Facebook and doing a search on ‘Understanding Antidepressants’.  

 

Thanks for the link to Psychiatric Drug Withdrawal II; I’ve really appreciated you and other members pointing me to resources such as this!

[Altostrata]

16 hours ago, Wallace said:

Dear Altostrata, I just wanted to say that I appreciate all that you’ve shared with me. I realize I’ve only written brief answers, and apologize that they are not more elaborate.  The reason is that I’m really here to learn,, and I do that mostly by listening.  I’ve had the sense that although I’ve been aware of withdrawal issues, and indeed written about them, but have been wondering if I really appreciated their magnitude.  I was finding things to read about it and came across your website.  There’s a famous medical saying: ‘When you’re not sure, try listening to the patient.’, and I’m a great believer in it.  So I joined your group, with interest to hear people’s experiences, and am coming to realize that there’s a large body of people who have had a very difficult time with withdrawal, more than I had realized. That’s the main thing, in response to your question, that your comments may have changed in my understanding. So I’m afraid that I don’t have much to contribute, but am learning a lot and have appreciated your sharing with me.  I hope I’m not being disappointing in not having more of a dialog, but I’m a firm believer that the best way to learn is to listen. 

 

Thanks, Wallace. You are certainly welcome to learn here! That is one of the reasons I started this Web site -- to inform the medical profession. I would happily close up tomorrow if patients could get tapering guidance and proper treatment for withdrawal symptoms from their physicians.

[Altostrata]

We seem to have a surge of new members, probably related to the NY Times article, which was syndicated in newspapers all over the world.

[Wallace]

Yes, it seems to have had a big impact, I’ve heard a lot of people talking about it.

[Altostrata]

What are your psychiatrist colleagues saying, Wallace?

[Wallace]

Haven’t heard anything.  There are a series of letters to the editor in The NY Times that are worth looking at.

[Shep]

On 4/11/2018 at 11:23 AM, Wallace said:

Haven’t heard anything.  There are a series of letters to the editor in The NY Times that are worth looking at.

 

You may be hearing more from your colleagues soon - Psychiatric Times just ran an article on the withdrawal forums that is really good. Scroll down a bit on the first page to view the article. 

 

Psychiatric Times - Online Communities for Drug Withdrawal: What Can We Learn?

 

Edited April 13, 2018 by Shep

[Wallace]

Thanks for pointing it out.