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Doctor's Comments on Antidepressant Withdrawal

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Interesting article written by Deborah Orr on her first introduction to Citalopram. She appears to have a possible adverse reaction to her initial dose of Citalopram. Refuted by many in the comments box who have had positive experiences with ssri's and who have really bought into the pervasive pharma position .

 

Of interest, is the ensuing dialogue it  prompts,  in a discussion in the comments, by a poster claiming to be a doctor, calling himself "scubadoc'. Scubadoc is interesting, he seems to oscillate his position. I got as far as his comments in relation to 'SubjectiveSubject's experience of withdrawal, in which he appears discounts and questions the validity of the poster's experience based on his mental health. This appears at the end of some of the comments I've cut and pasted. These are edited from the comment boards, so reading them gives you more context. Still, I find it fascinating to observe the way it plays out as a sort of mirroring of what many experience playing out in their own visits to GPs and psychiatrists.

ARTICLE

https://www.theguardian.com/commentisfree/2017/jul/08/antidepressant-effects-psychotherapy-mental-health-crisis-nhs

 

COMMENTS FROM THE ARTICLE

  • 8081

    It's all a bit strange: I, for instance, prescribe some antidepressants as pain-killers and actually talk to my patients about them. We have written a leaflet that adds to the package insert.

    We see quote a lot of PTSD, and anxiety is a common feature. Dissociation is a feature of the illness, rather than of the medication, but one well-known feature of treatment is a temporary increase in some features of the illness. There is the risk of suicide, particularly in young people, for instance.

    It's important and it's brave to discuss mental health, but it's also important to get the medicine right, or it risks degenerating into simple scare-mongering...

     

     

    89

    Listen to this Deborah Orr :

    https://www.youtube.com/watch?v=NrMPr78UpQI

    Then study prolonged QT interval re Citalopram, you will notice it's dose dependent, well there is no such thing as dose dependent in the context that we all have different Cytochrome P450 liver enzyme systems. You will only ascertain what the phenotype of your liver enzyme system is if you have a pharmacogenetics tes,t good luck with finding one in the UK. Also if you happen to consume one of the common food stuffs/herbs/spices that block/inhibit CYP450, you can expect to go into Akathisia, trust me, you WILL know the meaning of hell if that happens to you.

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    1213

    I had a cardiac reaction (short pauses, bradycardia) when I stopped taking Escitalopram (same drug essentially). I was withdrawn far too quickly (over 2 weeks after 4 yrs use). The withdrawal upset my autonomic nervous system which controls heartbeat. I ended up with a pacemaker as my ANS/ pulse would not settle back into a normal rhythm. Since then it's been determined that my sinus node doesn't work properly any more. Was this long term use of the drug at a dose of 10mg or a withdrawal reaction which was treated with a pacemaker and misunderstood? More research is needed into the cardiac effects of these drugs.

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    01

    Did you make a serious compliant or sue ?

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    1819

    Listen to this, streetphotobeing: a little knowledge is a dangerous thing, particularly if you don't understand it. Yes, cytochrome expression is polymorphic. Yes, drug metabolism is affected by the cytochromes that you happen to have. Yes, a small number of people are more sensitive to adverse effects. The answer? Stop the pill that's the problem! Simples...

    ... yes, I do warn my patients about problems and, yes, I do start medicines at low doses.

     

     

     

    3536

    I think there will be many many comments here with similar poor experiences. I am British but live in Austria. The reality is that most countries' mental health systems are in the same poor shape. After suffering from a few years of crippling depression that had become dangerously total I just walked in, totally broken, to the first point of help, a GP. Five minutes later I had walked out with a prescription. The sertraline gave me panic attacks and mania, feelings I had never experienced. The trazadone gave me crippling anxiety and left me with permanent cognitive loss that I'm still dealing with two years later.

    These drugs are so hit and miss, so random, yet are handed out without any thoughts, warnings, considerations. For some they may save lives, for for others they wreck them, or finish off an already destroyed one. That the first line of defence is not psychotherapy but medication speaks volumes of a part of the health service that needs massive funding increases to move forwards, to re-assess completely how things are done and abandon this insane model we have, and that no politician or the electorate has really cared about mental health provision, ever. Although, maybe, slowly that is changing now. Too slowly.

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    3839

    If you have severe depression, biological treatment works faster than talking therapies. A proper health service would offer both...

    ... but we don't treat mental health like a "real" illness

    45

    Awful drugs till your system accepts them , get off them isn't pleasant either .

    And as for Tramodol , that drug is highly addictive and prescribed like they are handing out sweets .

    Lot more could be done with some of these prescribed drugs , awful side affects .

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    1617

    Tramadol is moderately addictive, often unpleasant, and over-prescribed. It is also, sometimes, the difference between despairing disability and a normal life. Medicine is like that: tricky...

     

    3536

    Another misinformed post. 
    Leave it out if you know bugger all.

    You may as well be saying peanuts are harmless.

    I'm not saying people are allergic to SSRIs but messing with Serotonin has profound effects on some people or we wouldn't be reading this article.

    Have some common sense. If you take a pill that alters your SSRI balance, it begins straight away however small.

    If someone is at a tipping point it doesn't take much to have a dramatic effect on your state of mind.

    I know from experience, so don't spread false information.

     

     

    I know from experience, so don't spread false information.

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    1920

    I also know from experience of being on it for 2 years so don't spout rubbish.

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    3233

    Ok. But that doesn't mean everyone reacts the same.

    You find it works and I'm glad. 
    Don't say it can't do things in this article. 

     

     

    You may well not have the effects described by the author, or by other posters, but everyone is different. Don't discount other peoples' experiences just because they don't reflect your own.

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    1011

    Another misinformed post...

    ... ad nauseam.

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    1112

    mediaboy implies the drugs are bad. It's not true: the drugs are bad for some people. That's a very different thing...

    ... as reflected in the comments.

     

     

     

    12

    One mistake you're making is assuming a GP will even know, in any useful way, about the effects a drug will have (have they taken it themselves? of course not, so how could they really know). Another mistake is thinking the GP thinks you are worth consulting about any of this. They often simply play God with our lives.
    (disclaimer; some GPs are obviously brilliant yada yada, still doesn't mean they aren't affected by the zeitgeist, or even the latest salesman, when prescribing).
    Different drugs do different things to different people but I've heard many a nightmare from Citalopram. And if you think that's bad wait until your GP decides they'll try you on Mirtazapine. And by the time you're some way down the line you'll think that popping pills is a hell of a lot of it, as opposed to there being "very, very much more to it" as your addiction replaces your mental health as your major nightmare.
    SSRIs? Just say no. Or even just say know. Don't get me started on Seroxat. Don't get yourself started on any of them.

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    • 1314

      nnn
      Silly, ignorant comment on many levels.
      1. So, don't take any medication that your GP hasn't tried first?

      2. GPs often spend as much time as they can on a consultation, but they are limited by the NHS appointment system, plus they are general practioners, not specialists.

      3. Many GPS resist the "incentives" to prescribe certain meds (many do not) and genuinely try to give the patient what they think will actually help the patient.

      4. "Just say no". Who tf are you to assume you know about others' mental issues and whether mediction would be of benefit? One thing you are obviously not is a doctor!

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    • 1213

      Doctors are especially trained never to read anything, never to think and never to talk to patients about their experiences. We don't study pharmacology and physiology and we have never, ever discovered that drugs have side effects. We do not understand, and this we appear to have in common with our patients, that all treatment is a balance between good and bad...

      ... I never, ever warn my patients. I never, ever start at a low dose. I never, ever, give advice about when to give up on a drug, and how to stop it.

      Perhaps it is because I'm not a GP? Or I'm a sarcastic SOB?

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    • 1011

      I'm feeling excruciatingly irritated by some of the comments here and I'm just a person on SSRIs. I can't imagine how much worse it must be for you!!!!!

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    56

    This drug produces feelings of intensified worry/anxiety when it is first taken. I found that on a 10mg dose - the starting dose - I felt much worse initially. Those feelings of numbness and being unable to access your feelings will eventually return because that is what the drug does - it numbs you. It won't help you heal, and all of those feelings you couldn't access in therapy will likely come back when you eventually come off it. Problem is, unless you receive helpful tapering advice - which isn't currently available via the NHS - you will struggle with even stronger emotions when you come off which mimic your original symptoms but which are actually your mind reacting to the withdrawal of the drug. For many people this looks like their original symptoms have worsened and they get put back on the drug again. It is this cycle of what is essentially chemical dependency which keeps people in services and which persuades them that they are either more "mentally ill" than before or destined to suffer long term. The issue of chemical dependency and repeat prescribing needs to be addressed !

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    KEY COMMENTS:

     

     

    45

    I have to disagree strongly with this and other statements that one or two tablets of an SSRI can't have that effect. My life was almost completely destroyed by two doses of citalopram 9 years ago. The first dose left me, within hours with intense akasthesia that didn't go away for about two years. The GP said 'side effects were normal' in the early weeks and urged me to continue, so I took another. I then spent the entire night awake in hell begging my husband to never let me take another no matter what. I never took another one, but it took me years to recover. I couldn't sit down to eat or watch TV for a very long time as I was so agitated. It was like prolonged torture and the worst years of my life. It sparked off years of severe anxiety and agoraphobia. The irony was that I wasn't even depressed. I felt really ill with some minor psychiatric manifestations alongside many physical symptoms. Rather than investigate what was actually wrong with me the GP saw late 30,s housewife and thought I needed antidepressants, despite me saying I was not the least bit depressed. The years after the citalopram where the darkest of my life, and o am still now only getting to the bottom of my health issues and understanding what went wrong. It turns out I had Lyme disease with co infections, and we now know I also have a rare disorder- mast cell activation disease- which may have caused the severe reaction. The internet is full of support groups for people who had severe adverse life changing events from this and other antidepressants.

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    78

    The internet is also full of people who think that Donald Trump is the Hand of God...

    ... it doesn't make it true.

    Antidepressants are both life-saving and horrible. Depression comes in many shapes and sizes: there is evidently a fear of admitting to depression. There is also a real confusion, related to the way in which some symptoms of depression are initially exaggerated by treatment with antidepressants, between the illness and the medication No-one should be afraid of reporting depression; no-one should be afraid if it's diagnosed. Drugs should be respected, but not feared: other treatments should be much more widely a available. Depression without drugs is the horror of Bedlam that we do not want back...

     

     

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    1112

    I too have been diagnosed with PTSD which in the past has led to periods of prolonged anxiety symptoms (to the point I couldn't even open the curtains in my home for fear of something intangible awful thing befalling me) which in turn caused severe depression. 
    Twice I have been give SSRI's to 'help' by my doctor. Citalopram the first time, Sertaline the second time. All I would say to anyone who is taking these drugs is to be very very careful!
    I have never normally been suicidal, even at my most ill (just doesn't seem to be in my nature) but two of my paternal uncles and my Father all killed themselves before the age of 40. I was asked about this by both the GP's who prescribed me drugs and they still went ahead with the prescription.
    By the end of a four week course on Citalopram, I couldn't even get out of bed, which frankly even when I was at my most ill was not like me. So I stopped and recovered and was fine for around 7 years. Then I had a severe relapse and got to the doctor (new GP as old one had left the surgery) again and explained the problems I had had with Citalopram and so was given Sertaline instead. Well by the end of a four week course of that I was suicidal, for the first time in my life. In the end the police turned up as I had been reported as a missing person by my employer and I was very close to being carted off and sectioned. So again I stopped taking the medication. Within days I was no longer wanting to die and had begun to recover just the tiniest part of myself.
    When I finally got dragged to my GP (by my boss no less as she was so concerned about the state of me) I explained what had happened and also what happened previously with Citalopram and got the response "It can't of been the medication, it must have been a decline in your mental health that would have happened anyway, the SSRI probably stopped it from being worse" which is exactly what every mental health paitent wants to hear 'it's all in your head'.
    Hasten to say I swapped GP's at the same surgery, when I explained my family history to the new GP she recoiled in horror at what the previous GP's had put me on. She explained that for anywhere between 1-10 and 1-100 patients (apparently research is still undecided as to exactly what the number is) SSRI have almost a polar opposite effect to the one they are designed to have, leading to increased symptoms of anxiousness, depression and suicidal thought. One of the warning signs is a strong family history of suicide.
    I've learnt over the years how to manage my condition. Talking therapy, a good well rounded diet and exercise, meditation and being as open and honest with the people I trust about what is really going on inside my head. They've learnt the warning signs and so have I and it means now if I start to fall off a cliff, I or someone else can grab my hand and intervene to save me. 
    I'm not saying medication doesn't work, it does, some people find it helps them in no end of ways to get that boost to overcome the obstacles that mental illness lay in their path. But I would recommend have a proper in-depth discussion with your GP before taking them (some GP's seem very quick to go 'let me write you a prescription' the moment you explain your symptoms). Also make sure someone you trust and who knows you well is aware of what you are taking and checks on you regularly (daily at least I would say) to make sure they don't see you declining. Often a friend, family member or colleague can pick up something isn't working before you can.

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    • 78

      I'm sorry but it can't have been the medication. Citalopram is not known anywhere to create issues like you had.

      I suggest other things were at play

       

       

      Thanks - take good care of old sport - a fellow traveller!!?

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      56

      Citalopram actually now carries warning labels about its possible risk of increasing suicide rates (as do other SSRI's) and having now volunteered for several mental health charities over the years I have found my experience is far from a one off. As I said it does help plenty of others though. However I notice you seem very defensive about SSRI use (particularly citalopram) not a drugs rep by any chance?

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      23

      Paracetamol carries a label now.

      No not a drugs rep and hate the stronger anti depressants, they are soul sucking.

      There are many people who are a bit more up and down than others, more and more as the years go on. There is a valid place for this mild mood stabiliser.

      I'm defensive on something I've taken for 20 years and the over reaction and exaggeration contained within

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      12

      Very sensible advice.

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      45

      Thanks doctor, for your utter cluelessness.

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      23

      We are trained in cluelessness...

      ... although if Brace is a doctor, I'm Charley's Aunt...

       

       

      12

      After Grenfell, I had the symptoms of PTSD. The correct treatment for this is psychology and drug-free cognitive behavioral therapy but, psychiatrists will deceive people and give them addictive and dangerous drugs. Never trust a psychiatrist, unless they tell the truth about medications.

    56

    OK: but it is likely true that PTSD can be triggered by a perceived threat as well as by a real one, so objectively minor trauma can actually generate the syndrome.

    placebo effect.

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    23

    Dear lovely Deborah. If you're not already working with a sensorimotor therapist and doing some EMDR work it really really helps. Not a quick fix but the safest thing you'll find. Take care, be well.

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    • 45

      Good grief! That took a long time to appear, despite being one of the major therapies: there seems to have been little mention of the importance of combining drugs with other treatments. My practice includes a lot of reactive depression and we rarely use antidepressants for it: GPs seem to use them a lot.

       

       

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      12

      Akathisia from poisoning and/or withdrawal is horrible and dangerous and often causes suicidal ideation and high risk of suicide. The fact is many people do not have the chemistry to handle these toxic drugs and here in the UK, they bypass the testing to see whether it is safe to give patients medications.

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      • 45

        I don"t mean to be nasty, but I'm worried about you: you seem agitated and unwell. I know that you are worried about medication, but could you contact local help, like Healthy Minds or the equivalent, of you can"t face your GP? If you were involved in Grenfell, then there has been more than enough stress to go around. You can refuse drugs, it's your body and your mind, but things sound very difficult for you. A discussion about the comtroversial subject of drugs in mental health isn"t a good place to get advice, as you are getting extremes of opinion and garbled evidence, even "fake news".

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      • 12

        My experience of Grenfell is being treated by professional therapy that has worked. My experience of medication goes back years when I was coerced and poisoned, suffering near-fatal side-effects. This is how I know the industry is a scam. Please don't patronise.

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1999:  Paroxetine (20mg). Age 16. 2007-2008: Fluoxetine (Prozac) for 1.5 years (age 25) Citalopram 20mg 2002-2005, 2009: Escitalopram (20mg), 2 weeks, (age 26) (adverse  reaction)/*Valium 5mg/Temazepam 10mg 2010: Mirtazipine (Remeron)( do not remember dosage) 2010, 5 months.                     2010-2017: Citalopram (20mg) (age 27 to 34) 2016: i.1st Sept- 31st Oct Citalopram 10mg , ii.1st November 2017-30th November 2017, Citalopram 5mg iii.1st December 2017- 4th February 2018, Citalopram 0mg, iv.5th February 2018- March 2018 Citalopram 5mg (10mg every other day) 28th February- tried titration of 5mg ( some adverse effects)

2018: 1st March 2018- 1st June Citalopram 10 mg (tablet form) /started titration 8mg , then 7 mg.2018: June 15th- 10th July Citalopram 10 mg pill every other day 2018: 10th July - 13th Sept Citalopram- 0mg  (CBD oil first month of 0mg, passiflora on and off) 2018 13th Sept Citalopram  2mg ,  approx 16th Sept 4mg , approx 25th Sept 6mg held.  2019: 11 Feb 19: 7mg (instant bad rxn) 12 Feb 19 6mg held 1 May 19 5.4mg held 5 Oct 19 5.36mg 22 Oct 19 5.29mg 30 Oct 19 5.23mg 4/NOV/19 5.18mg 12 Nov 19 5.08mg 20 Nov 19 4.77mg 7 May 22 2.31mg 17/09/2023 0.8mg

(Herbal/Supplements since 1st September: Omega Fish Oil 1200mg, 663mg of EPA- 2 tablets a day, magnesium and magnesium bath salts)

I did not die, and yet I lost life’s breath
- Dante
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