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

[Cocopuffz17]

4 hours ago, Rhiannon said:

So my current very rough hypothesis about the 3-6 month thing is that there is an immediate adjustment/adaptation to the sudden release of the serotonin reuptake inhibition, causing increased serotonin to flood into the ends of the neurons (forget what that spot is called) and a big drop in serotonin inhabiting the spaces between neurons (forget what that's called too). That's what happens acutely, and it causes symptoms. Then the body tries to adjust and reestablish homeostasis. I think that process involves turning on and off genes to synthesize various proteins, etc, because that's how bodies work. And I think THAT process is what causes, or leads to, the 3-6 month symptoms.

 

What do y'all think? Am I missing something? Does that make sense? Not that I'll ever get a chance to really test it... But maybe someday someone will.

I like the theory. There is something going on with the neurotransmitters that cause it to be fine for awhile(after the acute phase) and then get hit with PAWS. 

[bubbles]

I couldn't begin to understand the mechanism, hence my sponge analogy, lol.

 

A bit later in the year I will have a bit more time and I'll see if I can do some more investigation. I ran out of time previously.

[Bee5]

On 9/9/2019 at 4:59 PM, Cocopuffz17 said:

I follow The Plant Paradox by Dr.Gundry.  My body has been ravaged by autoimmune diseases while on my AD. Since changing my diet my autoimmune diseases have retreated and my withdrawals are manageable. I tried to taper off paroxetine 4 years ago and it was  an absolute meltdown. The book really challenges everything we know about foods. I’ve been on it for almost 300 days now. 

 

Thanks so much! I will definitely look into this!

[Bee5]

On 9/9/2019 at 9:20 PM, Rhiannon said:

I even had it recently when I quit citalopram at 0.1 mg after a very long, slow taper.  At something like 7-8% receptor occupancy I had zero acute symptoms, nothing at all. But pretty much right at 10 weeks out (which is when it hits for me historically) I started being symptomatic.

 

@Rhiannon did you manage to stay off, or did you have to reinstate when the delayed WD hit?

[persistente]

i just saw this topic. i am an living example of how late onset of depression leads to being misdiagnosed and pushed back to drugs.

 

delayed wd reactions and doctors who do not know about it made me believe i was in relapse. it caused me to go back to the AD twice. first time wd symptoms disappeared from the first pill. second time the hell started from the first pill. 

 

i strongly feel from many cases that i have read about that the main reason why so many people believe that they must go back to AD are delayed wd reactions. another truth that is so well hidden is that many bipolar diagnosis were nothing but cycles of waves and windows. i was lucky and escaped that trap for an inch.

 

 

 

On 5/28/2019 at 10:07 PM, Colonial said:

 

If I had not already been qualified as disabled with nothing else to do all day but lay in bed and be physically ill, I never would have gotten as far as I have in WD..

The physical side effects have been crippling as well as the increased anxiety, and there's no possible way I could have done anything other than be "homebound" for most of the past 4 years.

 

i understand this very well.

[Bee5]

On 9/11/2019 at 7:30 PM, persistente said:

it caused me to go back to the AD twice. first time wd symptoms disappeared from the first pill. second time the hell started from the first pill. 

 

Did you manage to get off the AD eventually? If so, how did you prevent the 'relapse'?

[persistente]

7 hours ago, Bee5 said:

 

Did you manage to get off the AD eventually? If so, how did you prevent the 'relapse'?

i have been off for nearly 2 years. it was hell because i got off 2 drugs without tapering. i did not know any better at the time. i did not prevent the "relapse". once i realized that it is wd and not relapse although my doctors did not agree and that it was wd both times earlier and knowing what happened at the last reinstatement, i had no other choice but to endure.  realizing how my doctors and most of them knew nothing about wd and being as stubborn and persistent as i am, i decided to endure without their "help" . i am still doing it but lately it is not that hellish although i still have bad waves.

 

i managed to stay off but even i wonder how did i do it. at times i could not do anything. my brain was not able to work at all. i could not sleep, i was in constant fear. many days i had no desire to eat at all. i could or did not want to move from my sofa for weeks. then i would be fine for few days and then back to terror of fear, anxiety, adhedonia and depression. if i did not have all the support needed from my parents, i could not do it.

 

but with each day i knew that i was doing something for myself. i was staying off that poison that my doctors prescribed to me without knowing enough about it. i was astonished how the truth about wd is hidden, i was mad and wanted to win this battle. 

[Cocopuffz17]

1 hour ago, persistente said:

but with each day i knew that i was doing something for myself. i was staying off that poison that my doctors prescribed to me without knowing enough about it. i was astonished how the truth about wd is hidden, i was mad and wanted to win this battle. 

 

Great work! CT is really tough. It is mind blowing how much they just downright deny it. I had an appointment with my psychiatrist after my 3 month taper and explained the WD symptoms I was having, he denied it. Then I had a 6 month follow up. There was a student there and she asked me how coming off it was and then he said “ Yes, this can happen sometimes”. Mind blown !!! 

[Bee5]

On 9/18/2019 at 9:20 PM, persistente said:

i have been off for nearly 2 years. it was hell because i got off 2 drugs without tapering. i did not know any better at the time. i did not prevent the "relapse". once i realized that it is wd and not relapse although my doctors did not agree and that it was wd both times earlier and knowing what happened at the last reinstatement, i had no other choice but to endure.  realizing how my doctors and most of them knew nothing about wd and being as stubborn and persistent as i am, i decided to endure without their "help" . i am still doing it but lately it is not that hellish although i still have bad waves.

 

i managed to stay off but even i wonder how did i do it. at times i could not do anything. my brain was not able to work at all. i could not sleep, i was in constant fear. many days i had no desire to eat at all. i could or did not want to move from my sofa for weeks. then i would be fine for few days and then back to terror of fear, anxiety, adhedonia and depression. if i did not have all the support needed from my parents, i could not do it.

 

but with each day i knew that i was doing something for myself. i was staying off that poison that my doctors prescribed to me without knowing enough about it. i was astonished how the truth about wd is hidden, i was mad and wanted to win this battle. 

 

You are a beacon of hope, and you make me feel better about being able to come off someday. You are fortunate to have had the support of your parents. I need to keep working, and being a mom, so for me, it's going to be a multi-year tapering journey to stave off the WD symptoms. Hoping to come off the quetiapine by the end of next year, then two more meds to go. 

[ChessieCat]

I cold turkeyed citalopram and felt great, the best I had in a very long time, for about 2 months after stopping.  Then I was bedridden for 2.5 weeks with symptoms which seemed like the flu but I knew it was not.  I couldn't eat and lost 8kgs in that 2.5 weeks.  My counsellor told me "you will always need an AD like a diabetic needs insulin" so I started on Pristiq.

 

However, after experiencing withdrawal symptoms when reducing my Pristiq and then researching and finding SA, I am certain that what I experienced was delayed withdrawal symptoms. 

[Bee5]

@ChessieCat, out of interest, if someone told you it was delayed withdrawal at the time, what would you have done differently? Would you have reinstated a small dose of the citalopram?

[Hms123]

I also had this - my symptoms started 4-5 months after quitting. Not sure whether this is a good or bad thing when it comes to recovery.

[Escitalopram21]

How are you all doing? I am now 3 months post escitalopram and Quetiapin and a few weeks back i got all kinds of wd symptoms! Worst is probably heart palpations, anxiety and lack of sleep. Going to see my doctor tomorrow, sure he Will want me to reinstate the drugs, dont want to. Hoping that some of these symptoms would go away soon!

[Altostrata]

@bubbles it took a while, but here are some journal articles to answer your original post. I was a co-author of the last one.

 

Belaise, C., Gatti, A., Chouinard, V.-A., & Chouinard, G. (2014). Persistent Postwithdrawal Disorders Induced by Paroxetine, a Selective Serotonin Reuptake Inhibitor, and Treated with Specific Cognitive Behavioral Therapy. Psychotherapy and Psychosomatics, 83(4), 247–248. mac. https://doi.org/10.1159/000362317

 

Chouinard, G., & Chouinard, V.-A. (2015). New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal. Psychotherapy and Psychosomatics, 84(2), 63–71. https://doi.org/10.1159/000371865

 

Fava, G. A., & Cosci, F. (2019). Understanding and Managing Withdrawal Syndromes After Discontinuation of Antidepressant Drugs. The Journal of Clinical Psychiatry, 80(6). https://doi.org/10.4088/JCP.19com12794

 

Cosci, F., & Chouinard, G. (2020). Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications. Psychotherapy and Psychosomatics, 1–24. https://doi.org/10.1159/000506868

 

Hengartner, M. P., Schulthess, L., Sorensen, A., & Framer, A. (2020). Protracted withdrawal syndrome after stopping antidepressants: A descriptive quantitative analysis of consumer narratives from a large internet forum. Therapeutic Advances in Psychopharmacology. https://doi.org/10.1177/2045125320980573

[Marta]

On 7/19/2021 at 4:47 PM, Hms123 said:

I also had this - my symptoms started 4-5 months after quitting. Not sure whether this is a good or bad thing when it comes to recovery.

Mine were bad but still functional immediately after going off, for few months. Then i had like 5 months of well being. Then the real hell at ~1yr off (still completely in). I recognize this as WD from a previous fast taper attempt. It feels the same and it doesn't feel "pre drug" at all.

 

In one article they said protracted wd can start after 6 months, in another (Hengartner if i remember correctly) that 6 months is more an arbitrary time and can be even more.

 

I was also wondering if this worsen the recovery or it's totally random. Would be interesting to look into.

(However there are also so many factors like which ad, for how long,ct or no that probably the statistic will be poor)

 

[Guest]

Are there many reports of people quitting a drug, having a month or two of little to no symptoms, then a delayed onset of protracted symptoms, a gradual recovery, and then a new delayed onset of symptoms months or years after that?

 

What I'm getting at is whether it is even somewhat common for two or more distinct periods of delayed-onset, protracted symptoms to occur with months of feeling good inbetween. I've read a lot about the typical windows and waves pattern of stabilization and recovery on this website and others. That's not what I'm talking about here.