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Shapiro, 2018. Subtherapeutic doses of SSRI antidepressants demonstrate considerable serotonin transporter occupancy: implications for tapering SSRIs

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bubbles

The whole paper isn't available, just the first para or two, so it's hard to see where they go with it but the second para cuts off where they start talking about three different groups of symptoms after discontinuing the med. The author's email address is there, if someone feels inclined to contact him.

 

Psychopharmacology

September 2018, Volume 235, Issue 9, pp 2779–2781 | Cite as

Subtherapeutic doses of SSRI antidepressants demonstrate considerable serotonin transporter occupancy: implications for tapering SSRIs

Shapiro, Bryan

https://link.springer.com/article/10.1007/s00213-018-4995-4

(Pubmed didn't have an abstract for this paper, however, the link above has the first paragraph and a bit. I have not posted as uncertain about the copyright status in this case.)


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

https://www.semanticscholar.org/paper/Subtherapeutic-doses-of-SSRI-antidepressants-for-Shapiro/0afdb525d3a049649c31ad91b02876a86ab51408

 

Subtherapeutic doses of SSRI antidepressants demonstrate considerable serotonin transporter occupancy: implications for tapering SSRIs

Antidepressants are usually tapered to mitigate the risk of antidepressant discontinuation syndrome, a new entity in DSM-5 characterized by nonspecific sensory, somatic and cognitiveemotional symptoms emerging within 2–4 days of the dose reduction or abrupt discontinuation of antidepressants taken continuously for at least 1 month (American Psychiatric Association 2013). Selective serotonin reuptake inhibitors (SSRIs) are commonly implicated, and among these, discontinuation symptom risk is highest with paroxetine and lowest with fluoxetine (Rosenbaum et al. 1998). Three patterns of symptomatology have been observed in patients discontinuing SSRI antidepressants: (1) New symptoms, which consist of Bclassic^ withdrawal symptoms that are not part of the patient’s original psychiatric illness, (2) rebound symptoms, consisting of the patient’s initial psychiatric symptoms necessitating SSRI treatment but of greater intensity; and (3) persistent postwithdrawal disorders, which resemble rebound symptoms but persist at least 6 weeks and may include features of a new psychiatric illness (Chouinard and Chouinard 2015). Because SSRI discontinuation symptoms are broad and nonspecific, patients may undergo unnecessary medical investigation or be misdiagnosed with a new or recurrent psychiatric illness. Intuitively, a gradual taper of an antidepressant would mitigate the risk of these symptoms but studies in this area are few and mixed. To date, there are no consensus guidelines regarding the optimal taper rate of SSRIs or other antidepressants. Over the last two decades, the development of radioligands highly specific for the serotonin transporter (5-HTT) have allowed for positron emission technology (PET) studies that accurately measure the binding characteristics of serotonin reuptake inhibitors in the brain. These studies demonstrate that minimum effective doses of SSRIs for the treatment of major depressive disorder (20 mg of fluoxetine, paroxetine, or citalopram, and 50 mg of sertraline) are associated with approximately 80% 5-HTT occupancy in the striatum and other regions (Meyer et al. 2004; Arakawa et al. 2016). Because percent 5-HTT occupancy with respect to either maintenance daily SSRI dose or plasma SSRI concentration is a logarithmic expression, a yet-to-be-acknowledged point is that subtherapeutic maintenance doses of SSRIs demonstrate considerable occupancy of 5-HTT. Meyer et al., for instance, extrapolated 50% 5-HTT occupancy at maintenance daily doses of only 2.7 mg of fluoxetine, 5.0 mg of paroxetine, 3.4 mg of citalopram and 9.1 mg of sertraline in chronically dosed subjects (Table 1) (Meyer et al. 2004). Of note, healthy subjects receiving subtherapeutic maintenance doses of SSRIs were included in their study to more accurately estimate the doseoccupancy curve at low dosage strengths. Although the mechanisms underlying SSRI discontinuation syndrome are not well-elucidated, these doseoccupancy data may explain counterintuitive findings of minimal-to-no reduction in discontinuation symptoms with the gradual taper of SSRIs as compared to abrupt discontinuation. In one prospective study of outpatients on maintenance SSRI therapy for panic disorder with agoraphobia, subjects were evaluated for discontinuation symptoms after tapering at the Bslowest possible pace^ (Fava et al. 2007). Fluoxetine, paroxetine, or citalopram doses were reduced by 10 mg every 2 weeks prior to discontinuation and sertraline doses were reduced by 50 mg every 2 weeks. Nonetheless, 45% of patients met criteria for antidepressant discontinuation syndrome 15 days after complete discontinuation and three patients reported discontinuation symptoms lasting at least 6 months. Considering that the subjects’ terminal dosage strengths prior to complete discontinuation were 10 mg of fluoxetine, paroxetine, or citalopram and 50 mg of sertraline, the 5-HTT dose-occupancy curves suggest that these patients may have....
 

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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Happy2Heal

wish this info would be more widely available 

 


  • pysch med history: 1974 @ age 18 to Oct 2017 (approx 43 yrs total)
  •  Drug list: stelazine, haldol, elavil, lithium, zoloft, celexa, lexapro(doses as high as 40mgs), klonopin, ambien, seroquel(high doses), depakote, zyprexa, lamictalBrief trials of dozens of other psych meds over the years
  • started lexapro 2002, dose varied from 20mgs to 40mgs. I tried to get off it several times. WD symptoms were mistaken for "relapse". 
  •  2013 tapered down to 5mg but WD forced me back to 20mgs
  •  June of 2105, tapered again, too rapidly to 2.5mgs by Dec 2015. Found SA, held at 2.5 mgs til May 2016 when I foolishly "jumped off". Crashed in Sept, reinstated at 0.3mgs in Oct. 2106
  • Tapered off to zero by  Oct. 2017 Doing very well
  • Nov. 2018 feel 95% healed, current age 63 
  • Jan. 2020 feel 100% healed, peaceful and content 
 

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bubbles
On 7/19/2020 at 5:45 AM, Altostrata said:

lowest with fluoxetine

 

 

Is it really less likely to get WD with fluoxetine, or does it just take longer?


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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Frogie
13 minutes ago, bubbles said:

 

Is it really less likely to get WD with fluoxetine, or does it just take longer?

You will get wd from fluoxetine. It is just much longer lasting that other antidepressants


PREVIOUS medications and discontinuations: Have been on medications since 1996. 

 Valium, Gabapentin, Lamictal and Prilosec from 2000 to 2015 with a fast taper by a psychiatrist.

 Liquid Lexapro Nov, 2016 to 31-March, 2019 Lexapro free!!! (total Lexapro taper was 4 years-started with pill form)

---CURRENT MEDICATIONS:Supplements:Milk Thistle, Metamucil, Magnesium Citrate, Vitamin D3

 Xanax 1mg three times a day June, 2000 to 19-September, 2020 Went from .150 grams (average weight of 1 Xanax) three times a day to .003 grams three times a day.

19-September, 2020 Xanax free!!!

 

 

I am not a medical professional. The suggestions I make are based on personal experience.

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Altostrata

It's possible some people will adapt over the 4-week washout period (amount of time for removal from the body) for fluoxetine. This would reduce the incidence of withdrawal. But others still will get withdrawal from fluoxetine.


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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bubbles

I always wonder. Cheers.


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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Bruci
On 7/18/2020 at 6:41 PM, Happy2Heal said:

wish this info would be more widely available 

 

 

You can obtain free scientific papers at this site: https://sci-hub.tw

NOTE: It is an illegal site based in Russia so use at your own risk. It bypasses copyright restrictions. It you want to stay legit, contact the authors directly. 


1980s: First diagnosed with depression. Treated with a tricyclic. 1988: Switched to Prozac 20 mg after triclyclic stopped working. 1990s to 2010: On and off Prozac. Increased dose led to side effects. 

2010: Work stress led to increased depression/anxiety. Tried several SSRIs but tolerated none of them. Put on Zyprexa. 

2011: Work burnout and breakdown. Hospitalized for suicidal depression. Switched to Seroquel. Prozac increased to 80 mg.

2017: Started psychotherapy. Helped a lot. Switched to Celexa 40 mg and lithium 300 mg. 

2019: Stopped Seroquel. Lost weight.

2020 June: Added Wellbutrin to try and correct sexual dysfunction. Could not tolerate Wellbutrin.

2020 July: Decreased Celexa to 30 mg in attempt to alleviate sexual dysfunction. Worked somewhat.

2020 August: Decreased Celexa to 20 mg. Sexual function improved but w/d effects started. 

2020 September: Maintaining Celexa at 20 mg. Experiencing w/d effects - fatigue, dysphoria, mood instability

2020 September 13: Increased Celexa to 30 mg due to w/d effects. Still on lithium 300 mg/day.

2020 October 3: Reduced Celexa to 27 mg. Started taper. 10% per month as recommended.

 

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