drb in the mix

[drb]

hello all - this is my first post on survivingantidepressants

 

a short intro to me, drb and some of my thinking and experience in the matter of surviving antidepressants

 

got my md degree 2 decades ago, 5 yrs specialty training in psychiatry after that, specialist license in psychiatry just over a decade ago have never been prescribed psychiatric medications but have prescribed many though fewer and less often as time goes on am appalled at the pernicious dishonesty on the part of a vocal and well-paid element in my profession and the very nearly equally pernicious lack of critical thinking on the part of many of the rest

 

i will plead that successful journeying through medical school, residency and specialty training - a process that takes 13-15 yrs requires a balancing act between critical thinking and rote learning, in a heavily regimented and guarded world that demands unbelievably extensive rote learning - toeing the line, and that overall punishes critical thinking

 

fully reclaiming the reins on one's full critical faculty after such a harrowing ordeal is a process that takes time and tenacity the cards against successfully pulling this off are stacked against the practitioner

 

though they were rare occurrences, in the process i luckily passed through the hands of a small number of unusually honest and critically thinking colleagues who offered much-needed advice, sometimes medical, sometimes not, pearls of wisdom "follow the trail of trauma" "trust your heart" arguably not your ordinary medical-training fare i listened

Edited December 21, 2014 by Altostrata
broke long post into shorter posts

[Altostrata]

[posted for drb]

 

i began to really notice the problem of antidepressant withdrawal 11 or 12 yrs ago

found no easily accessible information on what it was or how big it is

began actively seeking guidance on how to understand the phenomenon and to deal with the problem technically

discovered literally none was available through official channels, and the internet was still young

 

met a number of concerned individuals including david healy about 10 yrs ago

and things changed

 

discovered over the yrs that i have four family members who were prescribed SSRI's

all have experienced scary withdrawal symptoms

all have believed the doctors' story: their disease was returning

not even the words of a sibling and son could compete with official writ

three have not yet penetrated the veil erected to hide the facts in the official versions

 

one is courageously on the 3rd attempt at stopping medications

the earlier 2 attempts were made from within several ill-smelling soups of 3-5 different drugs

including escitalopram, citalopram, paroxetine, venlafaxin/efexor

carbamazepine, lithium, aripiprazole/abilify

prazosine, trazadone, cyproheptadin, hydrazine

temazepam, clonazepam

all in various configurations

several physicians were involved

[Altostrata]

[posted for drb]

 

the first attempt to get off the meds was done auto-didactically but with no information as to how to go about it

it was a catastrophe

this is when i was contacted

the 2nd attempt to get off the meds was planned as a taper but clearly not as well-planned as it might have been

many factors played a role, including - foremost - the drugs themselves

together with a heartfelt desire to sprint straight away from the ill-smelling soup

and the taper fell apart in dramatic and chastening ways

entailing once again extremes of hardship, in-hospital including compulsory care, and a new soup of 4 drugs including escitalopram

luckily the 3 - not including escitalopram - were ignored by the patient

 

the 2nd incompletely successful attempt was - after the dust had cleared we could see this - technically partially successful

since now a few months into a relatively acceptable emotional space all other drugs are gone for several months

and it is "only" escitalopram that is the problem

 

for a couple current details

a taper-step not exactly on-plan (and on the line of a sprint again...)

was made in one go from 20 to 10mg (gasp!) of escitalopram 24 days ago

the patient had a notably bumpy patch lasting a day and a half, 5-6 days ago

and work for the past week and a half is reported to have been feeling more stressful than in a long time

but all systems are still go

we are still ironing out the details of the rest

including important concepts such as not-sprinting no matter what

even at "a low dose" - there probably isn't any such thing really

remaining at the present dose at least a month is a done deal

 

the patient is one of those who have had the experience reported on david's blog

at http://davidhealy.org/out-of-my-mind-driven-to-drink

of never-before-experienced extreme craving for alcohol

immediately upon being prescribed SSRI just over 4 yrs ago

more of this at least 4-yr-long story when it has been successfully concluded will perhaps be shared here

and the patient has provided permission to share this story

Edited April 14, 2012 by Altostrata
correction at poster's request

[Altostrata]

[posted for drb]

 

i have come to believe personally that our efforts at devising safe tapering techniques and schedules with our patients

ultimately come down to the clinical bottom line which from a physician pov is that a user's status is the all

and present status for obvious reasons has priority

 

thus sensible/safe decisions regarding dose-changes and timing even when decided after careful deliberation and planning are in a sense always short-term

this ("short-term") can in itself cause problems

aside from the very real problem of needing to remain in sync with the often-snail's-pace of a long taper

- when all one wants - now that the problem and its solution are identified - is to get off the meds, preferably yesterday

there is a tangible sense of needing to keep a finger on one's own emotional pulse

this can engender a sense of constant emergency - when anything but that is what is needed

 

on the other hand, if the view in the above lines is to be believed

then keeping in mind those various factors and safeguards, and viewing the process (tapering) as relatively orderly, and understandable, even though extensive and frequent tweaking will likely be required

thus a workable process, and ultimately likely successful, may help engender the relatively relaxed atmosphere a successful taper could really use

[Altostrata]

[posted for drb]

 

one technical problem is to do with how physicians ordinarily see their patients, which is: seldom

once monthly is not an unusual frequency

some might make do with monthly telephone calls (!)

being unable to share the changing tides of a taper with your technical expert and the physical source of your medication except once monthly is probably usually insufficient

this would mean that any knowledgeable and sympathetic physician willing to enter into an agreement with a patient to help plan and carry out a successful taper

has to be prepared for more frequent contact than is customary including emergency contact when the journey gets exceptionally perilous

without it needing to require emergency hospital care with the risk this entails of exposing your patient to a less-clued-in practitioner's new ill-smelling soup as a result

 

for completeness: there is something that shouldn't be ignored, but i will not address it very deeply, since i do not understand it

it is the observation on the part of some users and some practitioners, for instance david healy

that there are some that do not appear able to get off of some medication or other, "no matter what" - how this might be explained i am sure many of us could theorize

and certainly some explanations would entail concepts such as "permanent damage" though there is as far as i am aware to date no physiological data that could prove such a thing when it comes to antidepressants

i will leave the subject in a moment, but for me personally, the concept of the problem not being able to be successfully dealt with, somehow, in some way, using methods we perhaps have no idea about today

smacks of asking for a direction in an unknown geographical locality and hearing "you can't get there from here"

still it could turn out to be true, though as far as i can see we are not there yet

and until there is incontrovertible proof ("can't get there from here") it is not proven

no matter how real the suffering of an individual experiencing one unsuccessful taper after another

to wrap: this exact problem is another matter of crucial importance for honest research

[Altostrata]

[posted for drb]

 

to return:

if a user's present status is the all - or at least has highest priority - in moment-to-moment decision-making during a taper

then one factor that can make things unnecessarily complex is if a user has not been able to enlist the help of a knowledgeable and sympathetic prescriber

 

if the tapers were easier to pull off in every respect - dose-wise, time-wise, emotional-cost-wise

if they were able to be safely navigated in a relatively short time with the help of all of those knowledgeable and sympathetic doctors - we would not have the problem

 

thus the need in a taper to have reliable access to the medication preferably in formulations in the strengths and amounts needed, no matter how long, makes things more complex

 

among the resources in this respect i can imagine but have not been able to locate

although perhaps it is a bad idea - since its existence might appear to offer hope/help, but in fact turn out to be a dud, since very few physicians might openly volunteer to take part -

is a geographically-based master directory of knowledgeable and sympathetic prescribers who both legally and logistically can help so that wherever you live, when you learn you have this problem

there is a practitioner to whom you can turn for help

practitioners willing as well to help shoulder the economic burden entailed in returning to health including full control of one's own life and chemistry

a burden generated in one view by any of us who may have caused harm in our prescribing practices in the past regardless of our intent to never harm

[Altostrata]

[posted for drb]

 

having very nearly lost my job a few times due to altercations with other health-care providers regarding this exact problem

i realize the stakes are high for a practitioner

in my country here in europe, many of us, myself included, would be without employment at once if we were to publicly offer our services for this specific need

 

thus the incredible importance of a site like surviving-ad's

important not only for those who need help to get off a medication

but also for us practitioners, who are in need of a place to find - and share - reliable information as to how to do this safely with our patients

perhaps this access can provide the information physicians will require to attend to the problem

in a safe, legal, and discrete fashion - in the course of their ordinary practices - while waiting for that dream directory full of other knowledgeable and sympathetic practitioners

they will of course need to be prepared to dispense with whatever perks they may have been getting from the pharmaceuticals since the pharmaceuticals apparently keep tabs on our prescribing - not surprising

 

the family member mentioned above, the one presently tapering, living in the usa, is in a situation where the taper has to be kept secret from the present prescribing physician

among other reasons in order to safely ensure a sufficient supply of the offending drug so as to be able to follow through on the taper even if it takes a long time

what a ridiculous problem

 

in a fairly designed public health system all the resources needed for this - one could imagine clinics with this brief alone - would be entirely publicly financed

payers for the service - governments, local included - would at least in part be able to finance this exact need using the money - literally billions of dollars now -

that government already has collected from the pharmaceuticals for their transgressions - the ones that have been discovered so far

[Altostrata]

drb, thank you for your contribution.

 

It is heartening to all of us to see doctors who recognize this problem.

 

And thank you also for your appreciation of this site and its purpose.

[Barbarannamated]

drb -

Your contribution brought tears to my eyes - it is incredibly validating to read these words from someone embroiled in the mess from a personal and professional angle -

THANK YOU - I hope that you will continue to share with us -

B

[Nikki]

Hi drb and thank you....just keep spreading your knowledge and experience with other physicians.

 

My mother's Psychiatrist saw his son go thru hell trying to get off Paxil. I was reminded by your family's journey.

[Karma]

DRB,

 

Thanks so much for joining us .

 

I think you are spot on with regard to giving the taper the relaxed environment that it needs. I've been holding a dose of 40.625 mg for now just over 10 weeks while I tend to other things and I've got to say that I feel really well. It is such a stark contrast from the paranoid and fearful state I was in last fall when I realized my first real withdrawal symptoms.

 

I hope you will stay with our community and that we can learn from each other. Also looking forward to a success story on your family member

 

Love and light,

Karma

[Skyler]

Hi Dr. B,

 

one technical problem is to do with how physicians ordinarily see their patients, which is: seldom once monthly is not an unusual frequency some might make do with monthly telephone calls (!)

among the resources in this respect i can imagine but have not been able to locate

although perhaps it is a bad idea - since its existence might appear to offer hope/help, but in fact turn out to be a dud, since very few physicians might openly volunteer to take part -

is a geographically-based master directory of knowledgeable and sympathetic prescribers who both legally and logistically can help so that wherever you live, when you learn you have this problem there is a practitioner to whom you can turn for help.

What a grand vision you have. We are most happy to have you on board, and hope you want to weigh in on some of our conversations. Being in your position must be lonely for sure and this is a place you can safely share.

 

Schuyler

[Romido]

Nice to have you here DrB. Thanks for reaching out to this community. Hopefully at some point the tide will change to expose what a wake of destruction these drugs leave. Thanks for weighing in, that it is real.

 

I am personally curious about whether you have seen withdrawal syndromes in people who took s-adenosyl-methionine, known as Sam-e here in the US. It's over the counter here in the US, but my withdrawal experience (albeit cold turkey) is on par with the controlled substances.

 

Anyway, welcome! So great to see physicians recognizing these problems are REAL!! I hope your family member makes a full recovery.

[drb]

have no experience of that, sorry

[Altostrata]

I believe Romido's difficulty with SAM-e withdrawal is remarkable, illustrating the dangers of manipulating serotonin even with a relatively weak agent.

[Jemima]

[posted for drb]

 

Thus sensible/safe decisions regarding dose-changes and timing even when decided after careful deliberation and planning are in a sense always short-term. This ("short-term") can in itself cause problems aside from the very real problem of needing to remain in sync with the often-snail's-pace of a long taper - when all one wants - now that the problem and its solution are identified - is to get off the meds, preferably yesterday. There is a tangible sense of needing to keep a finger on one's own emotional pulse. This can engender a sense of constant emergency - when anything but that is what is needed.

 

 

I really wanted to emphasise this paragraph in the post. Impatience and frantically trying all sorts of alternative medicine seem to be symptoms of withdrawal. I've gone through it and still do, and I've seen many, many posts here where sufferers grasp at any passing straw. I've spent more money on supplements and herbs than I care to examine.

 

Perhaps the great spiritual lesson in withdrawal is learning to wait quietly. I'm not there yet.

 

Thank you for joining us, drb. It's reassuring to read your words and know that they're coming from a physician who has not personally experienced the problem. I hope you'll be back again, soon.

[Altostrata]

Bumping this topic for newbies!