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Stockmann, 2019 What it was like to stop an antidepressant

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bubbles

Poor man, we know how he feels. Mentions us here.

 

Stockmann, T. (2019).

What it was like to stop an antidepressant.

Therapeutic Advances in Psychopharmacology. https://doi.org/10.1177/2045125319884834

 

Full free text at https://journals.sagepub.com/doi/full/10.1177/2045125319884834

 

My attempt to stop a long-term antidepressant began shortly after gaining my membership of the Royal College of Psychiatrists. I quickly discovered that my knowledge about this, although adequate for the written exam and for counselling a mock patient in a clinical exam, left me unprepared for the reality of the difficulties ahead.

 

I had taken 60 mg of the SNRI duloxetine for around a year, prescribed by a psychiatrist for low mood. I received no warning about the potential difficulty of stopping it, nor did I myself anticipate this. I understood a ‘discontinuation syndrome’ was possible, but not withdrawal, and any symptoms would be ‘usually mild and self-limiting over about a week’.1 It was only later that I learned the name and its description both originated from an industry-sponsored conference.2

 

I waited the recommended 6 months post-recovery to stop the drug.1 I was under the care of my GP at the time. We both anticipated a straightforward process over around a month,1 and I was happy to be delegated management of the reduction. My first step was to halve the dose to 30 mg.

 

Within a day, I began to experience several unpleasant symptoms. I was light-headed, dizzy and had strange electric shock-like sensations in my arms, and sometimes, when I looked around, in my head. I felt disoriented, unable to think clearly, indecisive. I became irritable, anxious and at times depersonalized – feeling disconcertingly unreal or detached from myself. One of the worst symptoms was a dysphoria, similar, but distinct from my familiar low mood, in somehow feeling more deep-seated and physical. It was difficult to describe some of my experiences; I was interested to discover later the various descriptions used by people to capture an assortment of unfamiliar sensations.3 Some of these, such as ‘brain fog’, ‘emotional pain’ and ‘inner torment’ particularly resonate with me.

 

I initially attempted to simply push through the dose-halving. I tried to do this several times but could not endure the symptoms. I needed a slower approach. As is typical, my tapering was constrained by the limited range of doses; reducing by 10%, 20% or even 25% was not possible. The onset of symptoms proved too rapid for alternate-day dosing. The drug was composed of capsules encasing hundreds of tiny beads. I couldn’t halve them like a tablet, but I could take one apart and remove beads. I started doing this to reduce the dose, opening the tablets on a bathroom shelf and coaxing out portions of beads.

 

I tried progressively smaller fractions, on a trial-and-error basis. Unbearable withdrawal symptoms continued. It felt absurd. I could not understand why it was proving so difficult, and why I had to improvise capsule disassembly rather than follow some standard procedure.

 

The symptoms got in the way of normal life. My relationships were challenged. I had to work dose-reduction attempts around my job and social commitments because of interference from the withdrawal. I took repeated breaks between reductions, sometimes days, sometimes weeks – waiting for a more convenient time or to feel settled enough to make another reduction.

 

My symptoms were different to my original symptoms and alleviated within the day by returning to my baseline dose. This made it clear to me that it was withdrawal, but for a long time, perhaps due to their severity, or the anxiety and foggy thinking, I couldn’t shake the worry that I was pushing myself into a relapse. On top of this, the quick, effective relief of increasing the dose began to feel like taking a hit of a drug of dependency. I worried I was trapped on the drug.

 

Eventually, I resorted to tapping just one bead out of the capsule each day, to slowly lower the dose. It was frustratingly slow. Impatiently pouring out even a few more proved unwise; occasional impulsive reductions proved increasingly painful as the dose decreased. In the end, it took me almost a year to finally stop. I remember distinctly, walking through woodland shortly afterwards. The birds were louder, the trees and sky more vivid. I felt happy, more alive. I realized my senses and emotions were no longer dulled by the drugs. I had no more withdrawal symptoms, and no depressive symptoms, finally convincing me I had been going through withdrawal, rather than relapse.

 

I was aware this was just one person’s experience. However, I came to realize I was far from the only person who had experienced this problem. At a conference I met others who had gone through similar experiences. There, I heard about the Surviving Antidepressants (SA) website,4 which offers peer support for tapering off psychiatric drugs and managing withdrawal symptoms. Many people report finding such resources necessary in the absence of sufficient understanding and support by mental health services;5 this is borne out by SA’s 12,000 registered users and 300,000 hits per month.4

 

There have also been high-profile and moving accounts of antidepressant withdrawal in the media, which also highlight the crucial issues of a dearth of research and the risk of misdiagnosing withdrawal as relapse.6,7

 

I am pleased to see the recent acknowledgement of the gravity of this issue by the Royal College of Psychiatrists,8 and a planned NICE prescribed drug dependence and withdrawal guide, including antidepressants.9 Together with more research, I hope this leads to patients and doctors having comprehensive and accurate information about withdrawal to draw on when considering starting an antidepressant, and clear, useful guidance and support around reduction for the millions who are prescribed these drugs.

 

This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).

 

Edited by Altostrata
Journals format

My thread here at SA: https://www.survivingantidepressants.org/topic/1775-bubbles/page/14/

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 dropped from 100mg to 75mg, held for six months

2015 tapered to 50mg over several months, held for several months, some more drops

2016 Feb 35mg, 6 Mar 33mg, more drops (note big drop (calc error) & up to 25mg), more drops (about 2mg at a time)

2017 - more small drops, more long holds

2018 March at 11mg;  April 20 9mg; June 11 8.1mg; (July 10 7.7mg / July 18 7.3mg); ( Sept 2 7.2mg, Sept 5 7.1mg, Sept 9 7mg); 30 Sept 6.5mg, ? 6mg, 23 Nov 5.5mg) 19 Dec 5mg

2019 (micro drops over two weeks 24 Mar 4.9mg, 28 Mar 4.8mg, 31 Mar 4.7mg, 4 Apr 4.6mg, 7 Apr 4.5mg / 22 April 4.4mg, 26 April 4.3mg, 2 May 4.2mg, 5 May 4.1mg, 9 May 4mg), 3 Oct 3.9mg, (20 Oct 3.8mg, 27 Oct 3.7mg, 3 Nov 3.6mg), 24 Nov 3.5mg, 8 Dec 3.4mg, 15 Dec 3.3mg, 22 Dec 3.2mg

2020 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

Current Sertraline: July 24: 2 mg / Armour Thyroid / endless allergy meds, erg

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Rhiannon

wow


Started on Prozac and Xanax in 1992 for PTSD after an assault. One drug led to more, the usual story. Got sicker and sicker, but believed I needed the drugs for my "underlying disease". Long story...lost everything. Life savings, home, physical and mental health, relationships, friendships, ability to work, everything. Amitryptiline, Prozac, bupropion, buspirone, flurazepam, diazepam, alprazolam, Paxil, citalopram, lamotrigine, gabapentin...probably more I've forgotten. 

Started multidrug taper in Feb 2010.  Doing a very slow microtaper, down to low doses now and feeling SO much better, getting my old personality and my brain back! Able to work full time, have a full social life, and cope with stress better than ever. Not perfect, but much better. After 23 lost years. Big Pharma has a lot to answer for. And "medicine for profit" is just not a great idea.

 

Feb 15 2010:  300 mg Neurontin  200 Lamictal   10 Celexa      0.65 Xanax   and 5 mg Ambien 

Feb 10 2014:   62 Lamictal    1.1 Celexa         0.135 Xanax    1.8 Valium

Feb 10 2015:   50 Lamictal      0.875 Celexa    0.11 Xanax      1.5 Valium

Feb 15 2016:   47.5 Lamictal   0.75 Celexa      0.0875 Xanax    1.42 Valium    

2/12/20             12                       0.045               0.007                   1 

 

I'm not a doctor. Any advice I give is just my civilian opinion.

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Giulietta
23 hours ago, bubbles said:

this is borne out by SA’s 12,000 registered users and 300,000 hits per month.4

 

Stunning figures.


2014-present  Lamotrigine ER 600 mg (sz)

2000 - present  Clonazepam 1 mg (.25 mg am;.75 mg pm)

2000 - present  Gabapentin 1000 mg (sz)

2014-2019   Lisinopril 2.5 mg

2010-present Lorazepam/Ativan .5 mg prn only  (sz)

 

2005-2018/19   Assorted SSRIs taken intermittently, incl. dulox.

(6/2015-4/2020) Unwitting 20 mg duloxetine CT Dec 2018. Prev. CT from 20 mg  9/2018.

Suplmnts:  omega 3 fatty acid, CoQ10,  Calcium  Citrate with Vit D3/Mages.

I am not a medical professional. My comments are not medical advice.  They  are based on personal experience.

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bubbles

Thanks @Altostrata for shifting and editing my post. My version was essentially a link and two lines. :)

 

He was an author on this paper, listed here at SA 

 

 

 


My thread here at SA: https://www.survivingantidepressants.org/topic/1775-bubbles/page/14/

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 dropped from 100mg to 75mg, held for six months

2015 tapered to 50mg over several months, held for several months, some more drops

2016 Feb 35mg, 6 Mar 33mg, more drops (note big drop (calc error) & up to 25mg), more drops (about 2mg at a time)

2017 - more small drops, more long holds

2018 March at 11mg;  April 20 9mg; June 11 8.1mg; (July 10 7.7mg / July 18 7.3mg); ( Sept 2 7.2mg, Sept 5 7.1mg, Sept 9 7mg); 30 Sept 6.5mg, ? 6mg, 23 Nov 5.5mg) 19 Dec 5mg

2019 (micro drops over two weeks 24 Mar 4.9mg, 28 Mar 4.8mg, 31 Mar 4.7mg, 4 Apr 4.6mg, 7 Apr 4.5mg / 22 April 4.4mg, 26 April 4.3mg, 2 May 4.2mg, 5 May 4.1mg, 9 May 4mg), 3 Oct 3.9mg, (20 Oct 3.8mg, 27 Oct 3.7mg, 3 Nov 3.6mg), 24 Nov 3.5mg, 8 Dec 3.4mg, 15 Dec 3.3mg, 22 Dec 3.2mg

2020 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

Current Sertraline: July 24: 2 mg / Armour Thyroid / endless allergy meds, erg

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Altostrata

And thank you for posting both links, bubbles.


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Valhalla

What a wonderful validation for an awful drug. I took duloxetine/Cymbalta for a little over a decade. Now free from the drug for a bit over a year, I'm still suffering from cortisol spikes beginning at 2:30am, nystagmus (involuntary eye movements) and severe anxiety. I don't know what to do anymore. 


2001–2002 Lexapro
2002-2005 Celexa
2005-2008 Zoloft
2008-2018 duloxetine 50mg
Tapered duloxetine from 50mg down to 40mg over 30 days 
Tapered duloxetine from 40mg down to 20mg over 60 days
Stayed on 20mg duloxetine for 60 days
CT 20mg duloxetine down to zero on 9/19/18

12/2018- 4/2019 0.5mg lorazepam. Began taper middle March 2018. Last dose on 4/27/2019

 

 

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