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Ostrow, 2017 Discontinuing psychiatric medications: a survey of long-term users


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Psychiatr Serv. 2017 Dec 1;68(12):1232-1238. doi: 10.1176/appi.ps.201700070. Epub 2017 Jul 17.

Discontinuing Psychiatric Medications: A Survey of Long-Term Users.

Abstract

OBJECTIVE:

Individuals undergoing long-term psychiatric treatment frequently choose to stop taking psychiatric medications. To enhance service user choice and prevent undesirable outcomes, this first U.S. survey of a large sample of longer-term users sought to increase knowledge about users' experience of medication discontinuation.

METHODS:

A sample of 250 U.S. adults with a diagnosis of serious mental illness and a recent goal to stop up to two prescribed psychiatric medications, which they had taken for at least nine months, completed a web-based survey about experiences, strategies, and supports during discontinuation.

RESULTS:

About half (54%) met their goal of completely discontinuing one or more medications; 46% reported another outcome (use was reduced, use increased, or use stayed the same). Concerns about medications' effects (for example, long-term effects and side effects) prompted the decision to discontinue for 74% of respondents. They used various strategies to cope with withdrawal symptoms, which 54% rated as severe. Self-education and contact with friends and with others who had discontinued or reduced medications were most frequently cited as helpful. Although more than half rated the initial medication decision with prescribers as largely collaborative, only 45% rated prescribers as helpful during discontinuation. Of respondents who completely discontinued, 82% were satisfied with their decision.

CONCLUSIONS:

Discontinuing psychiatric medication appears to be a complicated and difficult process, although most respondents reported satisfaction with their decision. Future research should guide health care systems and providers to better support patient choice and self-determination regarding the use and discontinuation of psychiatric medication.

2005 St John's Wort / 2006-2012 Lexapro 20mg, 2 failed attempts to stop, tapered over 4.5 months in early 2012

January 2013 started Sertraline, over time worked up to 100mg

July 2014 Sertraline dropped from 100mg to 75mg, held for six months, slower tapering until 2019 22 Dec 3.2mg

2020 Sertraline 19 Jan 3.1mg, 26 Jan 3.0mg; 1 Mar 2.9, 7 Mar 2.8, May (some drops here) 24 May 2.5, May 29 2.4, June 21 2.3, June 28 2.2mg,  July 4 2.1mg, July 24 (or maybe a bit before) 2mg, early Nov switched to home made suspension; 29 Nov 1.8mg; approx 25 Dec 1.6mg)

2021 Some time in about Jan/Feb realised probably on more like 1.8mg and poss mixing error in making suspension; doses after 10 Feb accurate; 10 Feb 1.6mg; 7 Mar 1.4, continued monthly

10% drops until 1mg, then dropped 0.1mg monthly.

May 2022,0.1mg, now dropping 0.01mg per week

My thread here at SA: https://www.survivingantidepressants.org/topic/1775-bubbles/page/18/

CurrentSertraline: 0.08mg / Armour Thyroid

 

 

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  • 4 weeks later...

I like the information that "82% were satisfied with their decision" to try and reduce or stop their psychiatric drug.

My psychiatrist says that 80% of people who have been on psychiatric drugs for three separate episodes fail to get off the drug.  Assuming this is true, I still believe that I'm in the 20% who will succeed.

See LarryS Health History, Introduction's page 6, 4th post from top.

Aug 2014 start Venlafaxine 225 mg.

Other Pharmaceuticals per day:  Amlodipine Besylate 5 mg, As need Melatonin 5 mg

Vitamins per day:  C 2,000 mg; D3 1.25 mg; Probiotic 218 mg; Fish Oil 1,600 mg; Magnesium Glycinate 240 mg; CoQ10 100 mg; Saw Palmetto 320 mg.

Start Taper: 225 mg to 55 mg; June 5, 2018, to June 15, 2019

49 mg July 16, 2019; 44 mg August  13, 2019; 49 mg (up 11%) Aug. 26, 2019: 44 mg Sept. 10, 2019; 40 mg Oct. 8, 2019;  37.5 mg (6%) Nov. 6, 2019; 49.5 mg (up 32%) Nov 18, 2019; 44.5 mg Dec. 30, 2019; 40 mg Jan. 27, 2020; 36 mg Feb. 24, 2020; 32.5 mg March 23, 2020; 29.2 mg April 20, 2020; 26.3 mg May 18, 2020; 23.7 mg June 15, 2020; 21.3 mg July 6, 2020; 19.2 mg Aug. 4, 2020; 17.3 mg Sept. 1, 2020; 15.5 mg Sept. 29, 2020; 14.0 mg Oct. 27, 2020; 12.6 mg Nov. 24, 2020; 11.3 mg Dec. 15, 2020; 10.2 mg Jan. 5, 2021; 9.2 mg Feb. 2, 2021; 8.3 mg March 9, 2021; 7.4 mg April 6, 2021; 6.7 mg 5/4/2021; 6.0 mg 6/01/2021; 5.4 mg 7/13/2021; 4.9 mg 8/10/2021; 4.4 mg 9/9/2021; 4.0 mg 10/14/2021; 3.5 mg 11/11/2021; 7.5 mg (up 200%) 12/6/2021; 6.75 mg 1/17/2022; 6.00 mg 2/21/2022; 5.62 mg 3/21/2022; 4.87 mg 4/25/2022; 4.50 mg 5/30/2022; 4.13 mg 7/5/2022; 3.75 mg 8/1/2022; 

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2005 St John's Wort / 2006-2012 Lexapro 20mg, 2 failed attempts to stop, tapered over 4.5 months in early 2012

January 2013 started Sertraline, over time worked up to 100mg

July 2014 Sertraline dropped from 100mg to 75mg, held for six months, slower tapering until 2019 22 Dec 3.2mg

2020 Sertraline 19 Jan 3.1mg, 26 Jan 3.0mg; 1 Mar 2.9, 7 Mar 2.8, May (some drops here) 24 May 2.5, May 29 2.4, June 21 2.3, June 28 2.2mg,  July 4 2.1mg, July 24 (or maybe a bit before) 2mg, early Nov switched to home made suspension; 29 Nov 1.8mg; approx 25 Dec 1.6mg)

2021 Some time in about Jan/Feb realised probably on more like 1.8mg and poss mixing error in making suspension; doses after 10 Feb accurate; 10 Feb 1.6mg; 7 Mar 1.4, continued monthly

10% drops until 1mg, then dropped 0.1mg monthly.

May 2022,0.1mg, now dropping 0.01mg per week

My thread here at SA: https://www.survivingantidepressants.org/topic/1775-bubbles/page/18/

CurrentSertraline: 0.08mg / Armour Thyroid

 

 

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2005 St John's Wort / 2006-2012 Lexapro 20mg, 2 failed attempts to stop, tapered over 4.5 months in early 2012

January 2013 started Sertraline, over time worked up to 100mg

July 2014 Sertraline dropped from 100mg to 75mg, held for six months, slower tapering until 2019 22 Dec 3.2mg

2020 Sertraline 19 Jan 3.1mg, 26 Jan 3.0mg; 1 Mar 2.9, 7 Mar 2.8, May (some drops here) 24 May 2.5, May 29 2.4, June 21 2.3, June 28 2.2mg,  July 4 2.1mg, July 24 (or maybe a bit before) 2mg, early Nov switched to home made suspension; 29 Nov 1.8mg; approx 25 Dec 1.6mg)

2021 Some time in about Jan/Feb realised probably on more like 1.8mg and poss mixing error in making suspension; doses after 10 Feb accurate; 10 Feb 1.6mg; 7 Mar 1.4, continued monthly

10% drops until 1mg, then dropped 0.1mg monthly.

May 2022,0.1mg, now dropping 0.01mg per week

My thread here at SA: https://www.survivingantidepressants.org/topic/1775-bubbles/page/18/

CurrentSertraline: 0.08mg / Armour Thyroid

 

 

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16 hours ago, LarryS said:

I like the information that "82% were satisfied with their decision" to try and reduce or stop their psychiatric drug.

My psychiatrist says that 80% of people who have been on psychiatric drugs for three separate episodes fail to get off the drug.  Assuming this is true, I still believe that I'm in the 20% who will succeed.

He may be correct.

I have hit a brick wall of low mood (depression) and anxiety the last couple of days after tapering, mostly without serious setback, from 225mg to 62.5mg in 2 years.

Born 1945. 

1999 - First Effexor/Venlafaxine

2016 Withdrawal research. Effexor.  13Jul - 212.5mg;  6Aug - 200.0mg;  24Aug - 187.5mg;  13Sep - 175.0mg;  3Oct - 162.5mg;  26Oct - 150mg 

2017  9Jan - 150.00mg;  23Mar - 137.50mg;  24Apr - 125.00mg;  31May - 112.50mg holding;  3Sep - 100.00mg;  20Sep - 93.75mg;  20Oct - 87.5mg;  12Nov - 81.25mg;  13 Dec - 75.00mg

2018  18Jan - 69.1mg; 16Feb - 62.5mg; 16March - 57.5mg (-8%); 22Apr - 56.3mg(-2%); CRASHED - Updose 29May - 62.5mg; Updose - 1Jul - 75.0mg. Updose - 2Aug - 87.5mg. Updose - 27Aug - 100.0mg. Updose - 11Oct 112.5mg. Updose - 6Nov 125.00mg

2019 Updoses 19 Jan - 150.0mg. 1April - 162.5mg. 24 April - Feeling better - doing tasks, getting outside.  7 May - usual depression questionnaire gives "probably no depression" result.

Supps/Vits  Omega 3;  Chelated Magnesium;  Prebiotics/Probiotics, Vit D3. 

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Peng, I'm so sorry that you're feeling unwell. I've posted on your thread.

2005 St John's Wort / 2006-2012 Lexapro 20mg, 2 failed attempts to stop, tapered over 4.5 months in early 2012

January 2013 started Sertraline, over time worked up to 100mg

July 2014 Sertraline dropped from 100mg to 75mg, held for six months, slower tapering until 2019 22 Dec 3.2mg

2020 Sertraline 19 Jan 3.1mg, 26 Jan 3.0mg; 1 Mar 2.9, 7 Mar 2.8, May (some drops here) 24 May 2.5, May 29 2.4, June 21 2.3, June 28 2.2mg,  July 4 2.1mg, July 24 (or maybe a bit before) 2mg, early Nov switched to home made suspension; 29 Nov 1.8mg; approx 25 Dec 1.6mg)

2021 Some time in about Jan/Feb realised probably on more like 1.8mg and poss mixing error in making suspension; doses after 10 Feb accurate; 10 Feb 1.6mg; 7 Mar 1.4, continued monthly

10% drops until 1mg, then dropped 0.1mg monthly.

May 2022,0.1mg, now dropping 0.01mg per week

My thread here at SA: https://www.survivingantidepressants.org/topic/1775-bubbles/page/18/

CurrentSertraline: 0.08mg / Armour Thyroid

 

 

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  • 3 months later...

My psychiatrist said 90%. I try not to think about that. One day at a time. One small drop at a time.

 

 

Early 1980s 2 mg. vallium prn; Mid-1990s Paxil and 2mg. vallium prn; Somewhere in there Buspar

Early 2000s Sertaline 50 mg. and .25mg Xanax prn 

2008 Sertaline 50 mg but Xanax was increased to .5mg 6 times a day 

2015 Sertaline increased to 100mg. 2 mg. vallium prn and Wellburtrin (only on a few days)

April 2016 Venlafaxine XR 225mg with 50 mg. Zolft  and 10 mg. Vallium 3 times a day as needed

Fall 2017 Venlafaxine upped to 300 mg - 5 mg. Vallium 3 times a day prn; Jan. 2018 Venlafaxine 225mg w/Vallium

April 2018 weaned  to 187.50mg, 150mg, 112.5 mg at 4 to 5 week intervals vallium 3 times a day prn

July 2018 112.5 mg ; July 2018 started SA's 10% guideline w/ 2.5 vallium prn; lost notes  dropped to 89 mg by 10/22; 89 mg 10/29; 10/6 86 mg, 10/13 83 mg; 10/20 - 11/2 updosed to 89mg; 11/3 86 mg; 11/17 80 mg. 11/24 77mg - 12/20 80mg 1/ 20 77 mg venlafaxine; 2/19 75 mg Ven  still taking vallium 2.5 mg morning, after and evening

Simvastatin 40mg. daily with supplements: Magnesium, Omega Fatty Oils, Vitamin D3, Turmeric, Magnesium, 25 mg. to 50 mg. diphendramine for sleep

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WantoffVen, what did your psychiatrist say about 90%? 90% will find it difficult?

2005 St John's Wort / 2006-2012 Lexapro 20mg, 2 failed attempts to stop, tapered over 4.5 months in early 2012

January 2013 started Sertraline, over time worked up to 100mg

July 2014 Sertraline dropped from 100mg to 75mg, held for six months, slower tapering until 2019 22 Dec 3.2mg

2020 Sertraline 19 Jan 3.1mg, 26 Jan 3.0mg; 1 Mar 2.9, 7 Mar 2.8, May (some drops here) 24 May 2.5, May 29 2.4, June 21 2.3, June 28 2.2mg,  July 4 2.1mg, July 24 (or maybe a bit before) 2mg, early Nov switched to home made suspension; 29 Nov 1.8mg; approx 25 Dec 1.6mg)

2021 Some time in about Jan/Feb realised probably on more like 1.8mg and poss mixing error in making suspension; doses after 10 Feb accurate; 10 Feb 1.6mg; 7 Mar 1.4, continued monthly

10% drops until 1mg, then dropped 0.1mg monthly.

May 2022,0.1mg, now dropping 0.01mg per week

My thread here at SA: https://www.survivingantidepressants.org/topic/1775-bubbles/page/18/

CurrentSertraline: 0.08mg / Armour Thyroid

 

 

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Yes 90% cannot be without antidepressants. I read that somewhere so no doubt he's just part of the pack.

Early 1980s 2 mg. vallium prn; Mid-1990s Paxil and 2mg. vallium prn; Somewhere in there Buspar

Early 2000s Sertaline 50 mg. and .25mg Xanax prn 

2008 Sertaline 50 mg but Xanax was increased to .5mg 6 times a day 

2015 Sertaline increased to 100mg. 2 mg. vallium prn and Wellburtrin (only on a few days)

April 2016 Venlafaxine XR 225mg with 50 mg. Zolft  and 10 mg. Vallium 3 times a day as needed

Fall 2017 Venlafaxine upped to 300 mg - 5 mg. Vallium 3 times a day prn; Jan. 2018 Venlafaxine 225mg w/Vallium

April 2018 weaned  to 187.50mg, 150mg, 112.5 mg at 4 to 5 week intervals vallium 3 times a day prn

July 2018 112.5 mg ; July 2018 started SA's 10% guideline w/ 2.5 vallium prn; lost notes  dropped to 89 mg by 10/22; 89 mg 10/29; 10/6 86 mg, 10/13 83 mg; 10/20 - 11/2 updosed to 89mg; 11/3 86 mg; 11/17 80 mg. 11/24 77mg - 12/20 80mg 1/ 20 77 mg venlafaxine; 2/19 75 mg Ven  still taking vallium 2.5 mg morning, after and evening

Simvastatin 40mg. daily with supplements: Magnesium, Omega Fatty Oils, Vitamin D3, Turmeric, Magnesium, 25 mg. to 50 mg. diphendramine for sleep

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He's probably right that 90% of people will suffer if they try to stop antidepressants in the way that doctors tell us to stop. Or if they get "off", they crash and burn soon after (which is the same thing, really).

 

I don't think that it relates to those of us who are really tapering slowly. We are a tiny number of people doing it so doctors don't generally see it, and there has been absolutely zero research about slow tapers. (When they talk about "slow tapers" the times are always absurdly rapid, from our point of view here at SA.)

2005 St John's Wort / 2006-2012 Lexapro 20mg, 2 failed attempts to stop, tapered over 4.5 months in early 2012

January 2013 started Sertraline, over time worked up to 100mg

July 2014 Sertraline dropped from 100mg to 75mg, held for six months, slower tapering until 2019 22 Dec 3.2mg

2020 Sertraline 19 Jan 3.1mg, 26 Jan 3.0mg; 1 Mar 2.9, 7 Mar 2.8, May (some drops here) 24 May 2.5, May 29 2.4, June 21 2.3, June 28 2.2mg,  July 4 2.1mg, July 24 (or maybe a bit before) 2mg, early Nov switched to home made suspension; 29 Nov 1.8mg; approx 25 Dec 1.6mg)

2021 Some time in about Jan/Feb realised probably on more like 1.8mg and poss mixing error in making suspension; doses after 10 Feb accurate; 10 Feb 1.6mg; 7 Mar 1.4, continued monthly

10% drops until 1mg, then dropped 0.1mg monthly.

May 2022,0.1mg, now dropping 0.01mg per week

My thread here at SA: https://www.survivingantidepressants.org/topic/1775-bubbles/page/18/

CurrentSertraline: 0.08mg / Armour Thyroid

 

 

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