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bubbles

Delayed withdrawal symptoms & "late onset" depression as a WD effect -- looking for journal articles

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bubbles

Hi everyone

 

I'm trying to gather some resources - primarily journal articles or perhaps official guidelines. I am specifically after resources on two topics, but I'll make separate threads for them.

 

I have observed that many people seem to be okay for a bit after dropping meds - a bit being 2-3 months - and then there is a crash. This was my experience with my too rapid taper off Lexapro. (This isn't about me, so I'm not putting it into my personal thread. I was unable to get anyone to see it my way though. :) Absolutely no providers were prepared to entertain the possibility of a delayed withdrawal reaction. Still, it has come up so often that I feel it must exist.

 

I have been looking through the journal articles and trying to find some on my own too. So far I have found nothing that specifically documents this phenomenon. Is anyone aware of anything that I might have missed?

Cheers everyone,
Bubbles

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bubbles

I should say that that crash is probably after a too-fast taper.

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Altostrata

bubbles, this is a great question. In fact, I've tried to pursue it lately.

 

The assumption that withdrawal symptoms start immediately upon cessation appears in Schatzberg, 1997

 

You need to look at the citations for this assertion and trace it back through the years. Schatzberg, 1997 got its information from an earlier paper. Where did that paper get its information? And so forth.

 

By picking apart the trail of evidence, we might be able to show that the assumption in Schatzberg, 1997 is groundless and open up the question to new study.

 

This would be very valuable to a research project I'm working on right now (with CEPUK, Luke Montagu and Dr. James Davies), to be presented to a UK parliamentary committee.

 

If anyone wants to get involved in this, please let me know.

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bubbles

Thanks Alto. That's a great starting point. If I find anything useful for you I'll pass it on.

Cheers!

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InvisibleUnless
On 5/3/2018 at 9:19 AM, Altostrata said:

The assumption that withdrawal symptoms start immediately upon cessation appears in Schatzberg, 1997

 

You need to look at the citations for this assertion and trace it back through the years. Schatzberg, 1997 got its information from an earlier paper. Where did that paper get its information? And so forth.

 

i would be entirely unsurprised if you trace this back to someone importing it from the descriptions of other psychotropic withdrawal syndromes without doing any sort of representative trials to vet its application to antidepressant withdrawal symptomology.

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bubbles
5 hours ago, InvisibleUnless said:

i would be entirely unsurprised if you trace this back to someone importing it from the descriptions of other psychotropic withdrawal syndromes without doing any sort of representative trials to vet its application to antidepressant withdrawal symptomology.

 

That's a really good angle to take in my searching - thank you!

 

 

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Altostrata

bubbles, if you find anything about the origin of the immediate-onset theory, please let me know.

 

The citation in Schatzberg, 1997 appears to be incorrect. It is a report from the Australian government about withdrawal reactions and does not mention onset.

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bubbles

Thanks Alto. I'll keep looking. It's a slow process because I'm fitting it in among other things and this is a busy time. I'll let you know if I find anything.

 

That 1997 article - says there is "free full text" but I can't get it. :( I don't think I have enough information to find that Australian report, which might be useful, because it is clearly 20 years old.

 

 

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InvisibleUnless

the "psychiatrist.com" free full text links are to a page which requires you to enter in some personal information and credentials--you can only access the full article if you sign in.  i gather they use this information for data commercialization.  i feel like this was not always the case, but my memory may just be foggy on the notion.

 

libraries (especially school libraries or inter-library loan programs), asking your healthcare provider to snag you a copy, or writing to one or more of the authors can be tenable ways of accessing full texts.  databases like deepdyve can also provide free access to some articles in a roundabout way.

 

there are also manners in which you can allegedly infringe upon 'intellectual copyrights' in order to secure a pdf, but if you want to keep things squeaky clean then i would avoid those methods even though nobody is getting hurt and it is sometimes a legal grey area (only sometimes!).

 

i think you will probably have to end up writing to someone anyhow--someone involved with the government report, or who can at least tell you more about it.  such reports, at least in the versions offered online to the public, rarely reveal the sources of facts like the ones being incorporated in the Schatzberg article.

 

and even if you bedrock at 'expert opinion', that doesnt really tell us how that opinion came about.  prescribing experiences?  unpublished trials?  talking with other doctors?  it is a rabbithole, for sure.  if youd like to delegate anything to me, i can put some of my time into digging around, just let me know what would be most helpful.  i cannot guarantee enduring contributions, but i would like to help in what ways i can.

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bubbles

Thanks InvisibleUnless

 

I've come up to a busy time at work and school, so I've had to park this bit of research, but I still want to follow it up. I didn't know about deepdyve, so I'll follow that up.


I will get back to it, but I have to prioritize some other stuff first.

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Barbarannamated

This is what happened to me in a sloppy taper of Pristiq in 2010-11 (if I recall correctly).  I was waiting for brain zaps like I had when I was late with a dose of Effexor, but they never happened, so I marched on.  I recall that I actually felt energized and, judging by the screen name and crazy heading I came up with, perhaps a bit hypomanic..?  In retrospect, I was very disconnected, dissociated...weird. There was also someone i know stalking me online, which was 100% factual, but added to the weirdness. 

 

I don't know when I crashed, but I think it was roughly 3 months out and I've never fully recovered.  There are several drugs involved, but this was specifically after Pristiq *taper*.  I even ended up hospitalized for bradycardia. 

 

If I can help in any way, I certainly will.  I have far too much free time and have to be careful about what I focus on.  Social media (Facebook) is not my friend. 

 

I was mildly fatigued and a bit "blah" (not depressed) when I was given Zoloft samples by an MD friend long ago.  I have no basis of comparison for this withdrawal state.  

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bubbles

@Barbarannamated I often wonder whimsy made me choose Bubbles as my name here. I am not the Bubbles type! Bubbles seem optimistic so that's probably it.

 

Unfortunately, I think it is going to be a long project, trawling through papers and following citations back to their papers and so on. It may also be that I have to accept papers calling it relapse without explanation. Perhaps comparing relapse rates for unmedicated people, people with wd and people staying on. I think Robert Whitaker has looked at that. 

 

Stuart Shipko mentions it, but I think he is talking observationally about his clients, not research. Still, perhaps it is worth contacting him to ask.

 

Also, Robert Whitaker talks about worsening chronicity with them, which might have to do with WD but I don't think that's considered - I think he's looking more at population level data about being on disability etc. I don't have his book, I should see if I can get it through my library.

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Henosis

I’ve also been baffled by this and always searching for new information. Some of the newer Fava papers mention “late onset” or “delayed onset”, but I’ve never seen anything concrete.

 

Shipko and others think it’s a tardive reaction, but I have always been skeptical after experiencing it. When I stopped Paxil, the months leading up to full-blown withdrawal were uneventful and I didn’t experience any change in anxiety or OCD symptoms. I would have assumed I would have at least returned to a baseline, pre-SSRI state during this period. It seemed like the drug was still active in my brain during this time.

I did find an interesting paper examining Celexa washout. They only had six people, but it showed an approx. 3x longer half-life in the brain than blood plasma. Obviously that doesn’t explain a multi-month delay, but perhaps with some people with genetic variations / long duration of use, this actually gets extended to weeks or months.  Food for thought anyways, I am not a neurobiologist.

 

 

 

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bubbles

It is an interesting thought.

 

A related idea is the thought that the drug might be stored in our fat for a while. I have read something by Healy, I think, suggesting this, and that it might soften the withdrawal for a bit. If that is the case, I imagine it could have the effect of a delayed withdrawal. That is - it might give you effectively an extra long "half life" so you did discontinue it in March, but you've still got a bit in your system until June or July and then it's all gone.  However, I think Healy's just hypothesizing, not that he has anything concrete. Or, frankly, how you even measure that! Or the mechanism by which it might come out of our fat etc.

 

I think it is only a hypothesis, but I wonder if it might have some merit. I have a vague idea I've seen an issue somewhere that babies might still have somewhat increased risks if mom discontinued the drug even some time before the pregnancy. I'm not sure where I saw this, or how the timing worked out - ie, if it was up to a year, or if the taper was rapid etc etc. Still, it stuck in my mind and when I recently read Healy's thoughts it made me think. Worth following that up, come to think of it.


I might get in contact with Healy and ask if he has anything more on the topic.

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