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How to talk to a doctor about tapering and withdrawal? What to expect?

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grandmaD

I noticed that I was “running out of scripts” quickly which was very odd as I don’t get them filled every month any more.  The chemist keeps them and said that the 12months were up, and that was why.  That means either a visit to the Dr. just to get a script (more money and time) or ring up (and they still charge a fee for it).  So I got annoyed about that!  But then my script “ran out” again and the 12 months was definitely not up!  When I checked it, I saw that the Dr. had only given me 1 repeat instead of the usual 5.  This means having to go back more often more scripts, so I’m not impressed.  I already resent paying for the rotten drug that has been killing me and now extra drs visits!  In all fairness to the Dr it could be because I am only taking ¼ of a tablet now, and don't need so many scripts, but I began to wonder if it was a way of making me go back for more visits!

 

He has had me go back recently more often for a visit, just to get results from tests which I also find annoying.  Then when I told him about doing the hold, he wanted me back in a month.  This is quite absurd because for 6 years now I don’t go to him about withdrawal, only for regular tests or check-ups (which is not very often at all) if something is wrong.  Also, it would have made more sense to have regular check-ups during tapering, not during holding.  However, I thought perhaps he cared about my progress, but no, after today's visit I think he still does not get it.

 

Back from my Drs. visit today and feeling quite annoyed again because I took my comparison chart from previous taper showing what had improved and what had worsened and he wasn’t very interested!  I thought he might keep it and put it with my file, but no.  I thought he wasn’t even listening, but he was because he suggested I “take some Endep to help with the head issues.”  That sounded to me like: “this is a special med/painkiller that helps with head issues.”  No mention of it being another a/d.

 

I realise now more than ever what I have been reading all along – that is that Drs. are there to sell you drugs, just like the butcher wants to sell you meat and the baker wants to sell you bread! Perhaps that is why he is so nonchalant, because he sees it as his job to give me drugs.  He wanted me to switch to Prozac last year which I declined because when I researched this site, I couldn’t find sufficient evidence that it was successful.  He says it is successful because of its longer half-life.  However, that is only half the story, as we know here so I asked about the guarantee that withdrawal symptoms wouldn’t worsen by going right off the Paxil!   I now realise now he has to make money somehow – and that’s to keep you coming back to him.

 

Now if I was tapering I would be even more tempted by the Endep but at this point, where I am holding and hoping to see some improvement, I don’t think it is a good idea, but if others think it wouldn’t do any harm, let me know!  My rationale is that my brain is now trying to adjust to a hold after getting worse and worse from previous couple of tapers (and the first 4 weeks hold have been worse than the previous drop for many symptoms) and to add more serotonin would only confuse the issue I suspect.

 

It does make sense to take something to help and the desire to feel “normal” and the temptation to take something artificial to alleviate my suffering is definitely a strong pull.  I can see now that his job is to help alleviate pain and he does that with drugs – that’s his line of business.  He earns a living selling drugs.  I think this is just one of the issues I (and all of us) have to come to terms with!  So at last I get it!

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compsports

GrandmaD,

 

I definitely hear your frustration.

 

In my opinion, even if doctors aren't profiting by prescribing meds, they do it because it is the only language they know.   And in my cases , it is sadly the standard of care.   So if something happens to you, as long at they followed the procedures, they can't get sued.

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JanCarol

I have a friend who got put on Paxil, generic. (face palm - I thought this drug was off the favored list)

 

It was claimed that the reason it was paroxetine, was that the other drugs interfered with her Voltaren (diclofenac) for pain (????)

 

Anyhow, the doctor (Australian) is conscientious enough that she will start tapering after 6 months of use.

 

I wanted to give my friend (and her doctors) the very basics of information in a form that she can use - and that will not take up too much of the doc's time.  So I made up a single page as to "why we taper 10%"  (with the exception that the first cut, under a doctor's care, can be 25%, like Dr. Brogan does)

 

It's probably the most concise thing I've ever written!

 

* * *

Tapering Primer.

Low doses of drugs affect a higher percentage of receptors than high doses of drugs.

In a curve, like this:

Plasma%20Concentration%20Fluoxetine_zpsj

 

https://ils.unc.edu/bmh/neoref/this.dir.unneeded/schizophrenia/review/tmp/352.pdf

 

This drug is similar in strength to your drug.  (Yours, paroxetine, is slightly stronger)

 

So you see, you get a lot of change from 0-10 mg of the drug.  (That goes for going on, and more importantly, coming off)

 

If you were start at 60 mg, the first 40 mg will taper easily.  Then, when you hit around 20 mg, there’s an “Ut-oh” point where the Concentration of the drug on the Receptors drops off rapidly.

 

So sometimes it’s okay (under doctors’ care) to cut 25% the first cut for the first month.  We wait a month for symptoms to settle down before deciding how to continue the taper.

 

But after the first big cut, it is important to slow down, if you wish to minimize symptoms.  Harm reduction (fewest symptoms) practice recommends a 10% of previous dose taper per month, to match these curves.  And we hold, or stop tapering, any time the symptoms flare up.  The goal is a symptom free taper.

 

From information at:  http://www.survivingantidepressants.org

 

Please feel free to show this to your doctor.

Edited by JanCarol
Edited to add Surviving Antidepressants link for doctors

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nz11

David Healy had a delightful blog post this week,

I really like number 4.

 

 

Surrendered doctor

  1. Accept that when it comes to the side effects of treatment the patient (or the in-laws) are likely to know best.
  2. Accept that my job would be more interesting if I learned to co-ordinate the research efforts of my patients rather than continued to dictate to them.
  3. Accept that patients continue to come to me not because I am good at my job but because society has made it impossible to get medicines except through people like me.
  4. Accept that my actions are dictated by ghostwritten articles and inaccessible data mediated through guidelines that I haven’t the guts to stand up to.
  5. Recognize that far from being founts of wisdom and compassion my colleagues and I can get incredibly nasty if questioned. I am an obstacle to work around more often than a source of support.
  6. Medically Unexplained Symptoms point to limitations in current medical knowledge or perhaps my medical knowledge. The term is not a euphemism for hysteria.

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Mort81

This is correct just had an another awful experience at the ER . I've had trouble breathing for almost 3 weeks. I suspect it's from body producing extra acid inflaming my esophagus from my last wave which lasted 3-4 months. After being in the ER for the second time in a week. The person that took me to hospital thought it was a good idea to say that I've been under extra stress from side effects of antidepressants. She later felt very bad about doing this as my care completely changed. I was pushed back for hours as I struggled to breathe and had my throat CT scan which was clear but nobody checked my esophagus. Than I was told the usual this is anxiety and he needs a physchiatris and more meds. . Eventhough I've still not been checked in my esophagus yet. You absolutely cannot mention anything about WD in an emergency room. This is very important. U can say u had a bad reaction to drugs years ago, but probably don't even say a brain med. The standard of care is very reckless. I now have to wait another week to be scoped and I haven't been able to eat properly or breathe properly for 3 weeks.

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AliG

Unfolding Sky . You're kidding - right ?  :)

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ChessieCat

Unfolding Sky . You're kidding - right ?  :)

 

And they will be telling us to Chewbaccy too! ;)

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JanCarol

First feedback on my little "info sheet" (now I wish I had put the survivingantidepressants.org link on it!):

 

Daughter of the woman I wrote it for took it to her doctor, who was impressed.  Daughter is pregnant, on lexapro.  

 

Doctor said - this is good - where did you get this?  (hence I wish I'd put our link on it)

 

So - feel free to use what I wrote if you need to teach a doctor how to taper, and why.  It is just short enough, and just scientific enough that a doctor can "get it."

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ChessieCat

Hi Jan,

 

Can I suggest that you add in the website for SA with no hyperlink so that it is written out in full instead of truncated?  That way it will print out.

 

Maybe also take out the line with reference to Paxil.  You could possibly draw attention instead to the graph being for fluoxetine but that other drugs are similar.

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Lilu

On talking to your doctor about protracted withdrawal from Dr. Shipko.  

 

Ugh. The last time I mentioned "protracted withdrawal" to a doctor, he said, "I never heard of that."  He asked me to describe my symptoms. I did. He said, well, that just sounds like depression." I got angry and emotional. Bad. I said, "Yeah, but it was 10 times worse than my original illness/symptoms!"  Discussion over.

 

https://www.madinamerica.com/2015/09/shooting-the-odds-part-iii/

 

Protracted withdrawal needs a better name.  The term “protracted withdrawal” does describe the time sequence  of symptoms after stopping serotonin based antidepressants, but is a poor choice of language when discussing this with your doctor.  Medicine does not recognize such a thing as protracted withdrawal.  Withdrawal is considered something that goes away within days or weeks of stopping a drug.  If you are going to talk to your doctor about these sorts of problems, then it is best to describe the problem as symptoms that happened after stopping the drugs.  I realize that many physicians will declare these new symptoms the start of a new mental illness – usually bipolar – but calling it protracted withdrawal just confuses the doctor.  Although I refer to protracted withdrawal as drug neurotoxicity, it is still a bad idea to give the doctor a diagnosis rather than to present symptoms.  It’s just the way that doctors work.  They want to make the diagnosis and often feel put off by patients who present with a complaint and a diagnosis.

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Lilu

Doctors recognize the existence of PAWS when it comes to alcohol and drug addiction. I remember seeing flyers in a psychiatric facility. It seems that PAWS - post-acute withdrawal syndrome is almost the same as protracted withdrawal. Everything except drug cravings. Maybe when it comes to talking to doctors, we should start with what is already known. Especially since now, at least in this article, opioids, benzos, and antidepressants are part of the list.

 

http://drugabuse.com/library/post-acute-withdrawal-syndrome/

 

Symptoms of PAWS

 

There are a myriad of symptoms associated with PAWS. Though each of these is fairly common among people withdrawing from drugs and alcohol, the exact number, combination, and timing of specific symptoms is different for each person. Physical differences between people, as well as differences in the types of drugs used and the amount and frequency of use all affect each individual’s experience of PAWS.

 

Mood swings: The brain of a chronic drug user, including patients taking medications under their doctor’s supervision, has become adapted to a constant supply of a mood-altering substance. When that substance is removed, periods of mania or depression can occur for no apparent reason while the brain rebalances itself.

 

AnhedoniaAlthough they work in different ways, virtually all addictive drugs, and many medications like antidepressants, have the end result—in the short term, at least—of boosting neurotransmitters and neural pathways that make the user feel good. Otherwise, why would people take them? Once these drugs and medications are stopped, however, it can take some time for the brain to produce normal levels of these feel-good chemicals on its own again. Until it does, an individual may find that nothing seems fun or interesting anymore – even activities they used to enjoy.

 

AnxietyFor addicts and patients alike, cessation of a drug or medication is a major life change. Therefore, it is understandable that there can be a great deal of anxiety, and even panic attacks, that accompany this shift. Additionally, drugs such as alcohol and BZDs that chronically inhibit brain activity result in a hyperexcitable, anxiety-prone state when they are stopped.

 

InsomniaMany psychoactive drugs and medications affect sleep patterns, and the brain adapts to long-term use. Once these drugs are stopped, it can take time to re-establish healthy sleep patterns.

 

Sleep disturbancesSubconscious desires to take alcohol or drugs, or to resume some aspect of the drug-using lifestyle, can manifest themselves in vivid, realistic dreams. Though such dreams may be very disturbing to a person in recovery, they are not a warning of impending relapse, but simply a reflection of how deeply the drug-taking compulsion can be ingrained in the mind.

 

Cognitive impairmentLike mood changes, this is another symptom of neurotransmitter imbalance. It is important to remember that difficulties in thinking clearly and maintaining concentration are usually temporary and not a sign of permanent brain damage.

 

Depression and fatigue: Many people who stop chronic drug habits or long-term medications experience such intense feelings of depression and fatigue that they fit the criteria for Major Depressive Disorder or Chronic Fatigue Syndrome. Unlike these conditions, however, these symptoms are a phase of readjustment in the brain and generally diminish without treatment over time.

 

Drug cravings: People with PAWS often have intermittent cravings for the drug or medication that they took before. Because the most intense physical withdrawal symptoms have subsided, the individual may feel physically healthy but continue experiencing negative psychological symptoms which make the return to drug use seem appealing.

 

Sensitivity to stress: Many people dealing with the effects of PAWS find that their threshold for daily stress is very low. Trivial irritations or setbacks can feel like the end of the world. Considering that these individuals have given up what has been, for months or years, their primary tool for coping with life’s stresses, this difficulty is easy to understand. New life skills must be learned, and even dealing with normal emotions brought on by stress can take time.

These are some of the most common manifestations of PAWS but not an exhaustive list. One unifying theme among these symptoms is that they all impair various facets of an individual’s emotional state, or their “affect." Another common aspect of these symptoms is that they are intermittent and may come and go over days and weeks, and they generally do not impact a person to the same extent over the entire course of their withdrawal.

 

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shinrinyoku

Hi.

 

So thanks to cysteine I was able to reduce Abilify for depression and anxiety from 20mg to 7.5mg as I have written previously. However, my pdoc still thinks I am on 15mg. Because I have side effects equivalent to dose of 15mg again, I quite need to consult with them, even if it is not urgent. So my question is, how mad do you think they will be with me for not informing them? Has anyone been in my shoes? What should I do?

 

Thanks in advance for hearing me out.

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shinrinyoku

And I have forgotten the most pressing question: Should I even tell them?

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Petunia

shinrinyoku

If you are going to taper off your medication, you need to learn how to do it properly and be willing to take responsibility for everything that entails, including managing any withdrawal symptoms you might experience, and being prepared to slow your taper or updose if withdrawal symptoms become unmanageable. What you are experiencing now may be withdrawal from dropping your dose too fast.

 

Whether you tell your doctor or not is your decision. If you think they will be be cooperative and supportive, then its probably a good idea to work with your doctor and let them know your plans.

 

Unfortunately, very few doctors understand withdrawal and if you seek help for increased symptoms, most doctors will put your dose back up, possibly even higher than before or even try and start you on a new drug.

 

I'm not on any medication now, but if I was and wanting to taper off. With everything I have learned, I would consider it best to taper myself off safely and would only need my doctor to cooperate with writing prescriptions so that I could taper properly.

 

If you write about your symptoms and other details of your situation on your introduction thread, we may be able to make some suggestions for you there.

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JanCarol

Hi Jan,

 

Can I suggest that you add in the website for SA with no hyperlink so that it is written out in full instead of truncated?  That way it will print out.

 

Maybe also take out the line with reference to Paxil.  You could possibly draw attention instead to the graph being for fluoxetine but that other drugs are similar.

 

Hey Chessie, thanks.  I don't know how to not get SA to truncate what it thinks is a web link....

 

I am working on a more formal letter which is not specific, but includes the information in this one.  I'll be ready to post it soon.

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scallywag

Jan & Chessie, the link to SA will be written fully when Jan prints the info sheet from a word processing application (Word, Wordpad, etc.).

 

Jan, to clean up your post for future users who may copy this information, it's easy to fix:

delete the link you've posted and copy and paste this: SurvivingAntidepressants.org.

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ChessieCat

Yes, that's what I was meaning.  Thanks Scally.

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Quest
On 2015-08-22 at 8:05 AM, JanCarol said:

So - I was reading this book on Narcissitic Personality Disorder (NPD) of which I have been a victim of, and still struggle with the trauma to my self esteem, belief system, etc.  The clever book is by Eleanor Payson, "The Wizard Of Oz and Other Narcissists: Coping with the One-Way Relationship,"  uses the tales of the Wizard of Oz, and Dorothy's desire to please the "Great and Powerful" (and special) "Oz" until she finds the little man behind the curtain, as metaphors for dealing with narcissists.  CLEVER book.

 

Anyhow, I'm reading along about the "covert narcissist," and she uses this example:

 

OMG  anyone else know this guy/woman?  I think we've all seen this doctor at one time or another.

 

And I've read Mad In America, and Anatomy of an Epidemic - I know how psychiatry evolved from its treatments.  But this goes deeper - this is in the whole MD profession - the One-Way Relationship - of "I know what is best for you, better than you do."  How did that evolve?

 

I remember as a young girl, hearing the adults talk, "Oh, the doctors think they are Gods, they have the power of life and death in their hands."  This statement filled me with great awe.  As if every time you went to a Doctor, he could save you or kill you right then and there.  But here's the catch:  he's more likely to kill you than save you - and THINK that he's saving you.  

This has been every dr. I have ever been to?  I keep thinking that the next one will be different~

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Sunnyday

Hi!

 

In my country we have a kind of economical support you can get if you can't work. Not really sick-listed, but similar I suppose. 

Now I'm at the point where I've finally met a good psychiatric doctor who is very respectful and actually listens to me. But she did find it weird that I still feel unwell after being off the meds for so many months. Making them believe me, mainly the psychologist I'm about to meet in the near future, will determine if they will give me economical support or not I believe. Because I suspect they might give me a permanent Bipolar disorder instead (because of the manic-depressive symptoms) when they don't understand the situation.

 

Right now I live with my parents, and to not be able to provide for myself adds a lot of worry and feelings of guilt, even if my parents are very supporting. It just doesn't feel right to me. Do any of you have experiences of how to deal with people from psychiatric hospitals who don't seem to understand this ad withdrawal stuff? Because I don't want to seem like a know-it-all and give them a bunch of papers and links. I mostly want to present it in a way that makes me not seem crazy first of all :P. I lost my train of thought now - as usual, but you get the idea. How would I go about approaching the issue in the best way possible without seeming condescending/know-all/crazy?

 

Thank you

 

Edited by ChessieCat
moved from another topic

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MaryDavid

Anyone been to a doctor during withdrawal and how did it go?

 

I have an appointment next Thursday as I cannot get rid of heightened anxiety. I'm 2.6yrs off citalopram and whilst I thought I was improving I don't know anymore.

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powerback

Hi MD ,I have and its mostly a waste of time.about 15  months  ago I went to him in a serious distressed state and all he had for me was a note for a psychiatric hospital and a prescription for Zyprexa .looking back now I think this is an abhorrent reaction to my state that day ,it is infuriating me now just writing this [I'm ok lol].I cant wait to write him a letter when I get better .I simply never needed Zyprexa .I personally will never go near the medical model of todays capitalistic model ever again .I went back to him after suffering months of him saying it is ok to half a 75mg dose ,it took months for me to snap and have a breakdown .

I feel confident to write this because ive lived and practiced the opposite from what he wanted that day .

Be very careful what you tell him you could come out having to come off stronger drugs further down the line .

 

I hope a mod can give you advice because I think you should take this visit very serious .

Of course I cant tell you not to go to the DR and its totally your choice ,I haven't been near one In 10 months now I think it is and I'm simply empowered by this . 

Our quest to be well and feel ok will bring us to DRs but they  simply kick the can down the road in my opinion .

Read and learn and empower yourself is the best way out of this .DRs have 15mins to evaluate us ,you have all day and all year so you keep the power in lap.

Exhaust all non drug  help for anxiety ,there's loads on YouTube  .if your determined to be drug free.

I totally empathise with you about the anxiety .  

Bit of a rant but I love it :).

Take care .

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LilyBlueRose


Most doctors will have absolutely no idea how to help. I went to so many, including naturopathic, regular MDS, specialists, etc and spent SO MUCH MONEY. The only thing that really helped was time! I can truly say time has helped heal a lot!

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MaryDavid

Hi power back, I hear exactly what you are saying. It really sucks.

Thank you for the empowerment! Made me smile :-).

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MaryDavid
Just now, Kalinia said:


Most doctors will have absolutely no idea how to help. I went to so many, including naturopathic, regular MDS, specialists, etc and spent SO MUCH MONEY. The only thing that really helped was time! I can truly say time has helped heal a lot!

Hi Kalina, so sorry you spent so much money. I'm yet to meet anyone who has had a positive experience in this particular area with medical professionals. Thank you :-)

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powerback
Just now, MaryDavid said:

Hi power back, I hear exactly what you are saying. It really sucks.

Thank you for the empowerment! Made me smile :-).

Your welcome MD ,sometimes all we need is a big hug and be told we will be ok ,that's what we are striving for . but watch your behaviour carefully and don't let a MD tell you you have a treatable illness ,when it is really a side affect of meds .

 

I will say again that its your choice if you want to go DRs and don't let anyone put pressure on you either way , but I wanted to tell you my DR  story .

I was as bad as it gets that day and a couple more times since  but I learned to tough it out , it was dam hard but I could well up with emotion with how proud I am of myself .I started to learn and empower myself not long before that visit to the DR, then a few weeks later I joined SA .

Informed consent is the future ,learn= empowerment .hence my screen name :).

Take care MD 

 

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LilyBlueRose

Definitely  do what feels right and best for you! Maybe you'll find a great doctor. Never lose hope because things WILL get better. 

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MaryDavid
1 hour ago, powerback said:

Your welcome MD ,sometimes all we need is a big hug and be told we will be ok ,that's what we are striving for . but watch your behaviour carefully and don't let a MD tell you you have a treatable illness ,when it is really a side affect of meds .

 

I will say again that its your choice if you want to go DRs and don't let anyone put pressure on you either way , but I wanted to tell you my DR  story .

I was as bad as it gets that day and a couple more times since  but I learned to tough it out , it was dam hard but I could well up with emotion with how proud I am of myself .I started to learn and empower myself not long before that visit to the DR, then a few weeks later I joined SA .

Informed consent is the future ,learn= empowerment .hence my screen name :).

Take care MD 

 

 

:-) I'm curious to hear what they will say when I tell them about my noise and light sensitivity since the medication, and how it was hell coming off them. They sent me to counselling 1 year ago but it didn't really help me. I'm going to ask for psychotherapy and tempted to ask for a brain scan. Will come back and update.

Thanks again power back

 

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MaryDavid
2 minutes ago, Kalinia said:

Definitely  do what feels right and best for you! Maybe you'll find a great doctor. Never lose hope because things WILL get better. 

Thanks Kalinia, I'm 2.6yrs off but some symptoms are still persisting. I'm going to resist any medication and see if I can get psychotherapy and tempted to ask for a brain scan. Will come back with an update

 

Thanks again Kalina

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Gridley

MaryDavid,

 

The vast majority of doctors, including psychiatrists, don't believe in extended withdrawal and haven't even heard of it.  They believe what the drug reps tell them.  Be prepared for your doctor to say it is the return of the underlying condition and to suggest you go back on the old drug or a different one.

 

The information and suggestions in these links should be helpful.

 

How do you talk to a doctor about tapering and withdrawal?
 
What should I expect from my doctor about withdrawal symptoms?

 

Best,

Gridley

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MaryDavid
54 minutes ago, Gridley said:

MaryDavid,

 

The vast majority of doctors, including psychiatrists, don't believe in extended withdrawal and haven't even heard of it.  They believe what the drug reps tell them.  Be prepared for your doctor to say it is the return of the underlying condition and to suggest you go back on the old drug or a different one.

 

The information and suggestions in these links should be helpful.

 

How do you talk to a doctor about tapering and withdrawal?
 
What should I expect from my doctor about withdrawal symptoms?

 

Best,

Gridley

Hey Gridley, thanks for that!

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lavendertealatte

I've finally finished Lexapro and I'm very upset with the doctors.  And also upset with people who seem to just want to tell you to speak to them.  Well... I knew what he was going to say.  But I did anyway.  I told my doctor I am still having dizziness and he said discontinuation symptoms should stop after a couple days.  That's it.  This is simply not my experience.  Why don't they look into this more?    I don't understand.

 

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Altostrata

Please read post #1 in this topic for pointers to highlights.

 

Like other people, some doctors, are resistant to learning new things. If your doctor or psychiatrist absolutely refuses to assist you in tapering, and you cannot get prescriptions from anyone else but this doctor, you might stop talking about tapering during your visits and report you're doing fine on the dose you're taking. See Important topics in the Tapering forum and FAQ for information about how to taper specific drugs.

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Altostrata

It's very likely your doctor will not know anything about tapering a psychiatric drug. If you find that a doctor is not cooperating with your tapering plan, you might show him or her the package insert for your drug. The insert for almost all psychiatric drugs except the oldest contain a warning about withdrawal syndrome and advise tapering.

 

For example, here is the section about tapering from the package insert in Prozac capsules, in small type on page 10

 

Quote

 

5.12 Long Elimination Half-Life

Because of the long elimination half-lives of the parent drug and its major active metabolite, changes in dose will not be fully reflected in plasma for several weeks, affecting both strategies for titration to final dose and withdrawal from treatment. This is of potential consequence when drug discontinuation is required or when drugs are prescribed that might interact with fluoxetine and norfluoxetine following the discontinuation of fluoxetine [see Clinical Pharmacology (12.3)].

5.13 Discontinuation of Treatment

During marketing of PROZAC, SNRIs, and SSRIs, there have been spontaneous reports of adverse reactions occurring upon discontinuation of these drugs, particularly when abrupt, including the following: dysphoric mood, irritability, agitation, dizziness, sensory disturbances (e.g., paresthesias such as electric shock sensations), anxiety, confusion, headache, lethargy, emotional lability, insomnia, and hypomania. While these reactions are generally self-limiting, there have been reports of serious discontinuation symptoms. Patients should be monitored for these symptoms when discontinuing treatment with PROZAC. A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Subsequently, the physician may continue decreasing the dose but at a more gradual rate. Plasma fluoxetine and norfluoxetine concentration decrease gradually at the conclusion of therapy which may minimize the risk of discontinuation symptoms with this drug.

 

 

To find the package insert for your drug, do one of these:

 

1. Save the package insert from your prescription.

 

2. If your package does not contain an insert, or if you have thrown yours away, request one from the pharmacist.

 

If you get a package insert in your drug packet or from the pharmacist, it will be in tiny type on thin paper.

 

3. Use search on the Web to find your drug insert -- in Google, put "[name of your drug] package insert". You will see the package insert offered by various sources.

 

To find the official version, choose a link from the site from the manufacturer of the drug, the FDA (US government Federal Drug Administration), drugs.com, or your country's government agency.

 

Most likely, the insert will download as a very long pdf. Print out the page containing the section about discontinuation of treatment.

 

 

Whether you have the original package insert or print out from the Web, look carefully for the section about discontinuation of treatment. It probably will be somewhere after adverse effects. Circle the section -- example from Prozac shown above -- and take this to your doctor. Request that it be included in your medical records.

 

Point out, calmly and firmly, that official instructions recommend gradual tapering, which you would like to accomplish over a long period of time to avoid withdrawal symptoms.

 

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getofflex

Yes, I have experienced just this.  When I tried to get off trazodone and Lexapro in the past, my psychiatrist just kept putting me right back on them.  He saw it as evidence that my original issues were resurfacing. It's amazing to me that these docs can prescribe these terrible drugs, and not know the implications and far reaching consequences in their patients' lives.  

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BfromNJ

Long story short - visit with my GP regarding taper did not go well.  at first he wanted nothing to do with it, since he was not original doctor to prescribe (not happy with my psych nurse and didn't want to go back to him).   He also told me he has never heard of compounding and would not listen any further (this I find hard to believe?).  

 

After he calmed down a bit, he did say he would help me , but gave me HIS taper schedule, which is:

 

25 mg current of luvox is what I am tapering. 

 

he says:

 

for a week do 25 on day , then 12.5 next day, alternating these strengths. 

 

next week, do 12.5 for a whole week

 

next week, 12.5, then 6.25, alternating these strengths.

 

next week 6.25 for a week. 

 

next week 6.25, then 0, alternating these

 

then off. 

 

off course he said I could go slower and do longer than a week. 

 

 

This method seems odd to me.  He says "this is what I do with all my patients". 

 

I have no idea what I am going to do now.  :( 

 

 

 

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BfromNJ

So I went to the Psych nurse yesterday.   that went even worse.  once again another medical professional telling me they have never heard of compounding.  I cant believe that.  Its a long story, but he was condecesing and made me feel like anything I said wasn't valid.  I don't even feel like he was listening half the time as he typed stuff about me in his computer.   Even at one point told me why don't we up the Luvox (the one I want off of!) and lower the others because I am not on the "therapeutic dose".  why does one have to be on the "therapeutic dose just because that is what they determine it to be?  It was once again oh your symptoms are just your anxiety, etc.  not the meds.  "come back in a month".  no I don't think so.   

 

I am so discouraged at this point.   And I am nervous about crushing and weighing myself. I feel like I will mess it up.  :( 

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