Are We There Yet? How Long Is Withdrawal Going To Take?

One of the most frequently asked questions we get here at survivingantidepressants.org is some variation of “How long am I going to feel this way?”. The simple answer is “we don’t know”. I could stick with that and save myself writing the rest of this essay, but I’m not going to. It’s much too important a question to just brush off in that manner. For many, withdrawal from psychiatric drugs can be a process that puts one’s life on hold, causes extreme emotional disruption and intense physical symptoms, and we all want it to stop now.

Before we get too far there are some things I need to say about this essay. Some of you will find it very upsetting, triggering and not what you want to hear. The information presented here is what I have gathered from my experiences and from helping several thousand people with their journeys to remove these drugs from their lives. To date there are no scientific studies dealing with this information, just data collected from forums such as survivingantidepressants.org and paxilprogress.com. I am presenting it because people need to know what they are up against, and as many of us have discovered withdrawal from psychiatric drugs can be the most difficult thing you’ll ever do.

An understanding of the time involved in tapering, withdrawal and recovery from psych drugs is very important to that recovery. The fact of knowing that there is an endpoint in sight makes it a little easier to bear. It also helps in making plans for one’s life and relationships while tracking one’s progress along the way.

There’s one very important point to bear in mind throughout this entire process:

Healing is happening all the time.

Even if you don’t feel it, from the very first dose reduction the body is sorting things out, making adjustments, reconnecting neural pathways. There’s a tremendous amount of work for the body to do so at first it will seem that things are getting worse instead of better. It’s all part of the healing process which is going on every minute of every day.

We often point out that each individual’s withdrawal experience will be unique, and they are. This makes it very hard to predict how long any individual will be experiencing any given set of symptoms, meaning I will have to talk in generalities for this essay. What we do know though is that stabilizing, tapering, and recovery take a frustratingly long time. We all want it to be over and done within a matter of days or a few weeks, but we have seen rather that it is measured in months and sometimes years.

We frequently have people saying “well, I’m a special case, so I can go faster”. From painful experience, I can honestly tell you “you’re wrong”. Disregarding your withdrawal symptoms to rush a taper is likely to make symptoms worse. Your taper will take longer, that longer time will be very uncomfortable, and you may still need to recover from withdrawal after you’re completely off. If you have Cold-Turkeyed or Fast Tapered, it may take a long time to stabilize and then an even longer time to very slowly taper off a reinstatement. The one hopeful note is, in the end, given enough time it does work.

I will be breaking this essay into a number of posts to make it more accessible and less overpowering. Each post will deal with a different aspect of the withdrawal process and its effect on the overall time required. I would also like to thank all the Moderation team for their input, ideas and help.

Edited December 18, 2021 by ChessieCat
Revised release date/CC added index/add immediate adr to link

July 5, 2020

How Long, the Bottom Line

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So how long is it going to take? I’m not going to string you along and will come right to the point. For most people tapering and recovery is going to take a long time. A nice vague statement that will have some people thinking it will all be over within a few months. That is far from the truth. Because of the nature of what psychiatric drugs do to the body they need to be removed slowly and carefully with plenty of time allowed for the body to adjust to each small change. This process is not measured in weeks but in many months and frequently years. It’s a very unfair situation in which we find ourselves, but we have no choice but to deal with it.

Each of the small adjustments involved in a taper, withdrawal and recovery may require many weeks to stabilize. Because of the sheer number of small adjustments, they add up quickly. If the process is not done very slowly the underlying symptoms do not have time to abate. They then add to each other and grow until the body can’t contain them any longer and they may breakout in the form of a crash. These crashes are very destabilizing to the body, require very careful manipulation and even more time to control.

Part of why it takes so long is simple mathematics. An easy way to look at this is that the half-life of our recommended 10% taper done every four weeks will be six (6) months. So, if you start tapering from 40mg in six months, if all goes well, you will be taking 20mg. Another six months, one-year total, and you will be at 10mg. After a year and a half, you’ll be at 5mg and so on. For a Brassmonkey Slide the half-life is nine (9) months. There are some excellent spreadsheets and calculators available on the site to help you determine just how long a simple slow taper will take. Spread sheets and calculators can be found here: https://www.survivingantidepressants.org/topic/9167-how-to-calculate-dosages-and-dilutions-spreadsheets-and-calculators/

During the taper, as the amount of the drug decreases, there should be a corresponding decrease in any side effects and many people experience a decrease in withdrawal symptoms. Tracking these improvements is a good indicator of healing.

If everything is going smoothly a dose change of 10% will take effect and stabilize in a few days. But a dose change is not just changing the amount of drug being taken. It can also be changing manufacturers, changing from brand name to generic, changing from tablet to liquid or liquid to tablet. It can also involve changing the time of day the dose is taken or splitting the dose during the day. Every one of these Dose Change Events requires time to take effect and more time to stabilize.

Edited July 11, 2020 by ChessieCat
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July 5, 2020

Indirect Factors That Influence Withdrawal Difficulties

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There are a number of other factors that are involved with how long withdrawal (WD) is going to take. Tapering off psych drugs is a very involved process where each piece has a direct effect on all the others. Factors like how long a person has been taking the drugs, how many drugs they are taking, maturity level and how many times they have made changes or tried to quit in the past are all a major part of the equation.

There has been a disturbing trend over the past decades of doctors prescribing cocktails of drugs. The idea is to give a main drug to “treat the condition” and then an assortment of several other drugs to make the side effects less severe. This may muddy the waters and makes the patient more miserable. It also increases the withdrawal time by a factor of the number of drugs, because each one must be tapered at the same slow rate and only one drug should be changed at a time. So, going off could have been a two-year taper for one drug, but depending on the number of drugs in the cocktail, is now a project that can last many more years. As mentioned before though, as the number of and amount of each drug are reduced you will be reducing the adverse effects of the drugs as well.

Neuroplasticity, the brain’s ability to rewire around a traumatic injury, is the underlying mechanism by which recovery works. Withdrawal is a bit different from an actual traumatic injury like a railroad spike in the head, but the principle is still the same. Neuroplasticity is active throughout one’s life.

For people who started psychiatric drugs at a very young age neuroplasticity is again at the root of the matter. A person’s brain and nervous system is not considered mature in a physical sense until they are about 25 years old. Up until that time it is a developing organism and in constant flux. Also, during those years, a person is learning the basics of socialization, relationships, sexuality, and building their basic belief system. After the influence of the drugs has been removed, the person may need to catch up with these areas of personal growth.

After going off of psychiatric drugs, for people with more life experience this effect on the psyche may be more a feeling of stagnation and regret over lost years. There is no going back though. Many of them can realize that withdrawal is just another bump in the road and, although it is a long one, just an accident on the path of life.

I mentioned being polydrugged at the beginning of this post. This is a major factor for another reason. The drugs that are often prescribed together frequently do not play well together or one or more of them is not tolerated well by the patient. This leads to switching the drugs to “tune” the cocktail. This switching is often done by just stopping one drug and starting another. This may cause cold-turkey (CT) withdrawal effects from the first and start up symptoms from the second drug. It may also sensitize the nervous system, which has to adjust to each change. The first couple of changes can be pain free, but at some point, it’s all going to add up and the body shouts “no more”. The body is now sensitized to the changes and any alteration of the dose will be met with a fight. The only solution is to take things extremely slow, make miniscule reductions and listen to your body to guide recovery after a dosage reduction, which may mean a long wait between dosage changes.

We are all taught from childhood that we are the “captains of our ship”, “take control of our life” and “it’s all up to you”. Most of us have learned those lessons too well and when we are faced with a loss of control over our lives, we have a very hard time handling the situation. From the very first pill, as long as there is a trace of the drug in our system, the drug is in control.

When people feel withdrawal symptoms, this loss of control can be very upsetting and can cause a great deal of anxiety and fear. Both of which only serve to compound the situation and make things worse. Not only is it self-imposed anxiety and fear, but there is an element of exaggerated negative emotion also present that is directly produced by a nervous system upset by withdrawal, which we call “Neuroemotions”. More information on neuroemotions can be fond here: https://www.survivingantidepressants.org/topic/14397-neuro-emotions/

We have no control left over neuroemotions, but we do have control over our emotional reactions to these out-of-control sensations in the form of acceptance of the situation. Even though it seems like it is taking forever, WD is just a period of our lives and when it is over, we can get back to the things we love. Until then we are where we are and there isn’t much we can do to change it, so we need to accept the situation and enjoy the little things as we can.

Edited July 11, 2020 by ChessieCat
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July 5, 2020

Is It Really Withdrawal?

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We frequently get comments like “I’ve been tapering for six months and I am still having symptoms” or “I tapered off over three months and have been drug free for six, why do I still feel so bad?”. If you are reducing or have reduced your drug and your symptoms started after the reduction, most likely your symptoms are typical of withdrawal.

It is true that withdrawal symptoms are hard to describe, and some resemble the depression and anxiety that psychiatric drugs are supposed to treat. The nervous system throws up every type of distress signal it possibly can. There is a very long list of symptoms for withdrawal that you can check out. Also, we keep finding new symptoms not on that list. But if your new symptom pattern started after you made a reduction in dosage, most likely it is from withdrawal.

Of course, if you believe you have symptoms of a physical malady, you should see a doctor to rule that out. If you are having chest pains for instance, get them checked by a doctor. We don’t want people having heart attacks. But if your test results come back negative and the doctor shrugs, you can blame it on the drugs.

While these drugs are in your system, they will be affecting how you feel. Even at the miniscule doses near the end of a taper the drug is still changing your body chemistry and the physical makeup of your body. There are many threads here recounting how the member feels every drop up to and including the final jump to “0”. So as long as you’re taking any amount of the drug you may be feeling symptoms of the drug. Also, if you are taking multiple drugs, you will be feeling the effects of the ones you’re not tapering even while tapering off of one of them.

The term Half-life gets a lot of use here at SA. It is the length of time it takes for the body to use up one half of the dose of medication that is present. So, your body uses half of the original dose, then half of that half, then half of that half and so on. Each drug is different, and we see half-lives that range from a couple of hours to weeks. How a person’s body reacts to the drug also makes a difference and can extend or shorten that time quite a bit. This means that even after discontinuation, a drug may still be directly affecting you for weeks.

The expectation of a quick recovery is a major cause of frustration. For many people starting to take psych drugs is relatively easy. I’m not talking about those unlucky ones who have an immediate Adverse Reaction, https://www.survivingantidepressants.org/topic/5280-immediate-adverse-reactions-to-ssris-how-long-for-recovery/page/3/ These drugs work by making biochemical changes to every system in the body. Those changes start with the very first dose and continue to be maintained until well after the drug has been removed. Once the drug has been started, in about a month the changes are so extensive any reduction in dose may result in withdrawal symptoms, which will require a gradual taper method to undo safely.

What it boils down to is, drug changes can cause symptoms afterwards. If you’re worried about a physical illness, get it checked out. When the results come back saying that there is nothing wrong, then it’s highly likely it’s “just” withdrawal.

Edited July 11, 2020 by ChessieCat
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July 5, 2020

Stability

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Let’s start with one of the very basic concepts that we talk about a lot. How long does it take to stabilize? Stability is the state where symptoms are relatively the same from day to day without having any major swings for the better or worse. It is an established pattern that has been present for a good length of time. Stability is not the absence of symptoms or feeling good, it's when your symptom pattern is tolerable and predictable.

Achieving stability takes as long as it takes; we recommend allowing at least a month after a Dose Change Event. Stability is required before any further changes can be made in the medication, because those changes will destabilize the system causing an increase in symptoms. If the system is not stable in the first place the new changes compound the original destabilization and makes matters worse. If the system is in a stable condition the body can more easily make the changes needed to accommodate and adjust to a new Dose Change Event.

When there is a Dose Change Event (a change in the amount, type, or timing of the medication) there are several things that must happen. The first is the level of the medication in the bloodstream needs to become steady state. This means that there is a similar amount of the medication in the blood at all times. For most psychiatric drugs, reaching steady state will take about four days to a week at a consistent daily dose. This takes into account metabolic rates, half-lives and a number of other variables. So right off the bat, every time we make a change there is a waiting period of four to seven days to let the change settle.

Once the drug reaches steady state in the bloodstream, after a Dose Change Event, the body's initial reaction is to get confused. It was functioning fine the way things were and now things are all confused. It can take a couple of days after the Dose Change Event for that confusion to manifest itself as symptoms and is a sign that the system needs time to adjust to the change. There may be a period just after a dose change event during which the body either doesn’t notice the change or will feel better because of it. Many people report their symptoms ramping up between two and five days after the change, but it’s not uncommon for it to take several weeks for them to appear. That is why we recommend reductions at intervals of about a month.

For some people who are very sensitive to changes in dosage, it may take two or three months for people to stabilize after such an adjustment. Some people will take even longer. When this occurs, it is best to try a smaller change the next time to lower the amount of destabilization. A smaller change means less confusion to the body and an easier time to sort it all out.

Edited June 7, 2022 by Ariel
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July 5, 2020

But I only took it for a Week

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I think that some of the most unfortunate members we have are the ones who only took the drug for a short time and had a severe Adverse Reaction. Over the years I’ve seen a number of members join who have taken their drugs for one day to a week and then stopped. They suffer acute symptoms that hit immediately and hard. Some people’s chemical makeup just isn’t compatible with psych drugs and their body immediately tries to reject them, but in doing so throws itself into chaos.

The good news is that their body will sort itself out and they will return to normal. While this is recovery from a severe adverse reaction and not withdrawal syndrome, the bad news is the post-discontinuation symptoms are a lot like post- acute withdrawal syndrome (PAWS), and it’s going to take a long time and there is nothing that will speed up the process. There are some coping strategies and tools that will help you endure the experience, but time is the only thing that will cure it, and it will take months rather than weeks.

These people tend to have a more linear recovery than those with true withdrawal syndrome. The first several months may be more intense. Then, like PAWS, things start to improve very slowly. Eventually, normal life resumes and get back on track. All the members I have known with this immediate Adverse Reaction have made full recoveries and gone on to normal lives and careers.

There is a variation to this theme and that is the ones who have taken the drug for a month or two. They didn’t have the immediate Adverse Reaction, but the drug is not treating them well and they decide to stop taking it because of the way it makes them feel. Because they have only been on the drug for a short time and with their doctor’s encouragement, they stop the drug cold turkey. This might throw them into a more typical withdrawal syndrome and a whole carousel of doctor’s visits and new drugs.

For those people who find themselves in this situation, it’s sometimes possible to do a quick taper over a few months. This is an iffy proposition, as their nervous system may have become adapted to the drug during that short period. Sometimes a fast taper works in their situation and sometimes it doesn’t. Unfortunately, if you get withdrawal symptoms, you’ll know it was too fast.

Psych drugs work by making physical changes to the body, affecting every system and every cell. They start to make these changes from the first dose and by the end of the first month they may have been quite successful. Studies show that people on the drug for only a month are at risk of withdrawal symptoms. The upshot being that even after only one or two months a proper, slow 10% taper is required. Yes, that means that you will be tapering the drug for longer than you took them originally. But those changes, that were quick to happen, require a lot of time to sort out and undo without causing undue symptoms.

Steps for Managing Withdrawal (Cold Turkey, Adverse Reaction)

Edited April 14, 2022 by getofflex

July 5, 2020

Tachyphylaxis, Reaching Tolerance

or as It's Lovingly Known "Poop-Out"

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Poop-out or tachyphylaxis is the body tolerating the effects of the drug and trying to work around them. Usually people sense that the drug is no longer working. It all stems from the body being a self-correcting homeostatic organism designed to make adjustments to maintain a specific balance of neurohormones. One school of thought is that tachyphylaxis is caused by the maximum number of receptors being downregulated, which is like drain outlets being closed.

Tolerance from benzodiazepines Is similar to poop-out, but more often is accompanies by withdrawal symptoms and an inclination to take more of the drug.

To counter poop-out or tachyphylaxis from an antidepressant, typically doctors will increase dosage or switch to another drug (but they are becoming more and more reluctant to increase benzo dosing because of the addiction implications). By changing drugs or increasing the dosage it is hoped that a few more receptors can be affected. The results from this are uneven, and it often stops being effective after a while.

Tapering out of Poop-out or tolerance is the second option and it can be a very frustrating process because there may be no visible results for quite a while. There is not a lot of information available on time frames because Poop-out is not a well-documented phenomenon. Once improvements have started to apear they will increase in fits and starts. Progress can be monitored by comparison with the poop-out baseline.

Edited July 11, 2020 by ChessieCat
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July 5, 2020

Cold Turkey and Too-Fast Tapers

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I will be blunt. Unless there is a serious medical reason, Do Not Cold Turkey or Fast Taper. Take your time tapering. The pain and suffering are just not worth rushing it, and over time you will get off the drugs and recover much faster by doing a gradual taper.

For this discussion, a Cold Turkey (CT) is defined as stopping your drugs abruptly from a “normal” dosage. There is very little information about how many people do manage a CT successfully. Doing a CT is a gamble. You won't know if you've lost until it's too late and develop severe withdrawal symptoms.

Don’t be in a rush to go off the drug with a too-fast taper, either. A too-fast taper is one where you have withdrawal symptoms while you are tapering. The 10% taper we recommend is intended to avoid withdrawal symptoms. If you experience many withdrawal symptoms while tapering it means that your body is having a hard time.

However, like cold turkey, a fast taper may be justified by a serious medical reason, something like liver damage, severe allergic reaction, or other life-threatening conditions, but not just ordinary adverse effects. In these situations, the risk of withdrawal symptoms may be equal to the problems being caused by the drug.

Psych drugs work by making physical changes to the body. The body then requires the presence of those drugs to maintain stability and to keep functioning. Remove the drug abruptly and often the body doesn’t know how to work. It then starts to scramble to fix itself. While that is happening the bodies systems cannot function correctly and we get WD symptoms. Because the body is in such chaos after CT, those symptoms can be very acute and unpredictable.

Because the body is in such chaos those symptoms may last for a very long time. In the nervous system alone, there are hundreds of billions of electrical connections that have to be reviewed and repaired. Throw on top of that the endocrine system, hormonal interactions and a lot of other things, the body doesn’t know what hit it. Over many months the body takes inventory and starts making the changes it thinks will correct the situation. Then, it needs to adjust to those changes. This is where the familiar pattern of “Waves and Windows” comes from.

Like everything else WD there are no statistics on how long recovery from CT will take. But we have a lot of case histories that give us some indication. I frequently post about several of my taper buddies that CTed 40mgai of Paxil at the same time I started my taper. Currently it has been six years, I’m off all my meds and living life at about 95% plus of normal. They, on the other hand, are still suffering waves that rival their initial acute period. On the positive side they are also experiencing very nice Windows. But they are still struggling on a daily basis

Many members have indicated that their doctor refuses to renew their prescription as a reason for a CT. There are just too many resources available to get a renewed prescription for this to be a valid reason. Any doctor can prescribe these medications. They can be obtained through Urgent Care, the ER/A&E, online prescription services, to name a few of the sources available. Sometimes they are available directly from the manufacturer. There will be some hunting and footwork involved, but it is best to do what needs to be done to maintain your supply, so you can keep control over your situation. No one is going to do this for you.

So, I will conclude by restating my second sentence. Unless there is a medical reason, Do Not CT. If you cold turkey or taper too fast and you get withdrawal symptoms, if you are at all able to resume taking your meds, please look into our threads on Reinstatement. You can find more information about reinstatement here:

about-reinstating-and-stabilizing-to-reduce-withdrawal-symptoms

Edited July 16, 2020 by ChessieCat
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July 5, 2020

Reinstatement

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Reinstatement can often reduce withdrawal symptoms from a CT or Taper that has gone wrong. It is the only way doctors know to address withdrawal symptoms. Reinstatement is a very useful tool if used correctly, but it is not guaranteed to reverse destabilization. This is best avoided by doing a proper slow taper in the first place. SA has devoted several threads specifically to reinstatement, https://www.survivingantidepressants.org/topic/7562-about-reinstating-and-stabilizing-to-reduce-withdrawal-symptoms/?tab=comments#comment-33809

Re-stabilization from a Reinstatement may not happen overnight. Some people may start to get some relief from their symptoms right away, while for some people it can take several days to weeks to see improvements. Once symptoms have started to improve, some time may be needed before they reach that state of being the same day in and day out. This state is referred to as WDNormal, which we will discuss later.

If there are large fluctuations in symptoms from week to week then stability has not been achieved and more time is required. Reaching stability is very individual and will frequently take three months or more. A lot of this depends on how bad the symptoms were, the amount of time a person had been off the drug at the time of the reinstatement, and their response to the reinstatement.

A related subject is updosing. This is making a slight increase in the dose taken to try and reduce symptoms that are starting to get out of control. It is considered as a Dose Change Event with all the associated timeframes applying. Improvement may be slight until the drug is at steady state in the blood an updose will frequently show improvements within a few days to a couple of weeks. However, two to three months may be needed for full stabilization before any reduction can be considered. All in all, it is best to wait for clear stability after any Dose Change Event before continuing with a taper.

These drugs do not act like OTC pain killers, take one and the pain is gone in half an hour. They work by making changes to the biology of the body and nervous system. People frequently will think of Updosing as a safety net. Comments such as “if this is too fast, then I will just do an updose and be okay” are all too common. Sadly, updosing doesn't always work. Too many dosage changes can sensitize the body and cause an Adverse Reaction. An Adverse Reaction can take many months to stabilize.

Edited July 11, 2020 by ChessieCat
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July 5, 2020

Drug Interactions

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Often psychiatric drugs do not play well with each other or with other drugs and supplements. Used in the wrong combinations they can cause extreme reactions such as Serotonin Toxicity or Serotonin Syndrome. These extreme reactions are quite dangerous.

A big problem is that many doctors disregard the issue and will prescribe dangerous combinations. If a person is taking any combination of drugs, not just psychiatric drugs, it is wise to check all the drugs you’re taking. Your doctor and pharmacist are supposed to do this but often they skip this step. Always check for potential interactions before adding another drug or supplement. There are a number of good sites available online for doing this. This one is quite popular: https://www.drugs.com/drug_interactions.html

Experimentation with supplements is the second main cause of bad interactions. Any supplement that it sold to “improve mental health”, “help you think clearer” or “take the edge off your day” is more than likely to react badly when taken in combination with psychiatric drugs. For people who are taking psychiatric drugs supplements need to be added with caution.

Once the interaction has started, fixing the situation is not as simple as just stopping one or more of the drugs. Each drug must be tapered over time or withdrawal symptoms may occur. If the interactions cause organ damage or are life threatening a rapid taper may be justified, for safety reasons, but potentially causing withdrawal symptoms. Unfortunately, it may take some time to recover from the adverse reaction and stabilize after removing an offending drug.

Edited July 11, 2020 by ChessieCat
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July 5, 2020

WDnormal

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If you are recovering from withdrawal, WDnormal is the place you are when you're not feeling good, but you're not feeling bad, sort of a rolling average of the past couple of months of windows and waves. Watching the level of WDnormal is a good indicator that things are improving. Over time you should be seeing a raising of the standard for WDnormal. Like how you're feeling now is better than say six months ago. It changes very slowly but is a very good indicator.

WDNormal is a type of stability, It is feeling a predictable way day after day with no big swings to the better or worse, and is unique to each individual

If you are managing withdrawal symptoms while you are tapering, paying attention to your WDnormal is very important. It is an aspect of listening to your body. When a person makes a drop in dose, there may be a corresponding increase in the WD symptoms over the next few days. These symptoms should resolve themselves over the following several weeks and return to WDNormal. After a reduction in dose and the symptoms have resolved to WDnormal the person should then wait a couple of more weeks to let things really settle down (there are a lot of little unfelt changes still going on) before considering doing their next drop.

During that waiting time people may think that they're not doing anything and want to get on with it. When in fact doing nothing is very proactive. It's those little unfelt things that need to be finished before the next step can be taken. It's letting the glue harden, the paint dry, the cement cure. The things that need to be complete before the path is safe to walk on again.

As you are learning this is a very slow process and at first changes in WDnormal are very small and slow in coming. Some lucky people see an improvement in WDnormal after just a few weeks. However, it is common for people to realize they have improved only when looking back after 6 months. I was in very rough shape from adverse drug effects when I started to taper, and it took about two and a half years before I saw any notable improvements. As time passes and one’s body heals you will become more aware of improvement. But it can be frustratingly slow.

A more in-depth discussion can be found here: Brassmonkey's Tips and Tricks for Tapering - Tapering - Surviving Antidepressants

Edited July 30, 2022 by brassmonkey
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July 5, 2020

It Doesn’t end at “0”

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The completion of a taper is in some ways just the beginning, now the real healing can start without the interference of the drugs. The last traces of the drug will be cleared from your system in a matter of weeks. This leaves the body in a position that it can make the necessary changes without having to fight against the drugs influence. One of the big disappointments of reaching “0” is finding out you still don’t feel 100%. With a proper taper the symptoms should be at a minimum, but you may experience the wave and window pattern for a while longer.

The good news is, after you go off, there may be a period where you continue to improve. The big question is “how much longer?”. That we can’t tell because as I’ve said before “every person’s experience is different”. It is also hard to know because members of these forums tend to reach “0”, make the jump and disappear. There is little in the way of journal entries to guide us. Post-discontinuation symptoms may follow the typical windows and wave pattern with milder symptoms that gradually disappear.

Some months after going off, some people report a serious wave of bad symptoms. This is about the time that people are feeling very comfortable with their recovery, not realizing their nervous systems are still very sensitive. This can cause them to get careless in their actions. Drinking alcohol is a major factor in excellent recoveries getting derailed. We just had a case of a member who has been drug free for several years with an excellent recovery underway. They had a couple of drinks over the weekend and tripped off their symptoms all over again. Luckily, it cleared in a few days, but that is not always the case. We have also found that doing a course of antibiotics can trigger a wave, as can the addition of non-psychiatric drugs. There is further discussion on this elsewhere in the forum. cipro-levaquin-azithromycin-z-pack-and-other-antibiotics

A late-breaking wave will typically hit very hard and very fast, flaring up unexpectedly overnight. Sometimes it ends over several days but sometimes re-stabilization takes months. It is not uncommon for this late-breaking wave to happen several times during the post “0” recovery period.

If the person avoids overwhelming challenges to a still-vulnerable nervous system, their RecoveryNormal baseline (the post “0” equivalent of WDnormal) will likely continue to improve. Most of the time withdrawal slowly fades into the background and disappears unnoticed. One day you wake up and realize that it’s all behind you.

Edited November 15, 2020 by ChessieCat
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July 5, 2020

Things to do Along the Way

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I have found that Communications, Acceptance, Support System, and Coping Toolkit are four important keys to a successful journey. These can improve the difficult situation of going off drugs and make it less onerous.

Feelings and emotions are hard to talk about at the best of times. When our minds are fogged, and memories are shot it gets really tough. But, talking it through or writing about it in a clear manner is very important. Otherwise no one will know what is going on, on the inside. What we are feeling, what we have been doing, how we feel, the good things that happened today are all important to document and let people know about.

While in the midst of things, it is normal to dwell on thoughts of “how painful it is” and “I can’t go on like this”. By doing so a person gives power to the bad feelings and painful experiences making them even harder to endure. Being overly optimistic however, can lead to disappointment and frustration. Balance in everything is important.

Here is where acceptance comes into play. We have found ourselves forced into a position that no one should have to go through. Yet here we are and there isn’t much we can do about it. That gives us two options, we can fight against it, scream, shout and beat our chests, or we can accept the position we are in and do what we can to make it tolerable while we work our way out of it. In short “making the best of a situation that is not our preference”.

Having the support of a loving family and friends will help ease the load. This is no mean trick because of how long withdrawal takes. Many friends will drop by the wayside because of what they see as a lack of trying and progress. This is where the communications mentioned above comes in, especially with a spouse or loved one. The experience is quite frustrating for them being on the outside. Some reassurance, an “I love you” and “thank you for all the support you’ve shown” goes a long way maintaining their support. We all want to crawl under a rock and stay there until it’s all over but having friends and family around and interacting with them is a good thing.

Withdrawal causes a great deal of stress on the body. Adding mental stress on top of this just feeds the fires and makes things worse. By accepting the situation, talking about it with friends, and doing that we can, to make ourselves comfortable we will be making a long uncomfortable journey a bit more tolerable.

Packing your coping toolkit with self-care techniques may be very helpful. There is a myriad of things that can be done to mentally ease the symptoms, such as meditation, exercise, CBT and mindfulness. They do make a difference and with practice can change the course of recovery for the better as well as provide tools for a lifetime.

Techniques to support a good night’s sleep are essential elements in you coping toolkit. Unfortunately, sleep can be a big problem for many people trying to reduce their drugs. Learning and practicing habits of good sleep hygiene is very important. Sleep is healing and we need to do everything possible to help it achieve this goal.

Not paying attention to our natural sleep patterns can cause major problems. Staying up late using the computer to research WD can undermine sleep. There are several threads on managing sleep, https://www.survivingantidepressants.org/topic/17471-early-morning-waking-managing-the-morning-cortisol-spike/?tab=comments#comment-41. Regular exercise is also something we need to pay attention to. Gentle exercise helps the body to re-establish its regulatory mechanisms. It is important not to overdo it though. Members who love working out may find they cannot continue at their previous level of exertion while in WD. This is their body saying it needs a rest. It has more important things to do and requires all that energy to heal itself.

Limiting one’s exertion level is important for healing and recovery. Physical training places the body under a huge amount of stress both mentally and physically. For the time one will spend on healing and recovery it is best to put the strenuous training aside. Instead of making a flat out run, take a leisurely walk, enjoy the fresh air, smell the roses, do some forest bathing. Instead of pumping iron, do some relaxing stretches, yoga, tai-chi. Making the change from pushing yourself to relaxing is part of Acceptance, and your body will thank you for it.

Edited July 5, 2020 by brassmonkey

July 5, 2020

So, When Will We Get There?

(14)

Like any parent faced with this question I will give the traditional answer. “We will be there when we arrive”. There are just too many factors to give a definite answer. The one thing we can say is that it will take a lot longer than any of us would like.

When we decide to reduce our dependence on psychiatric drugs, we are taking a large frightening step into the unknown. The medical establishment knows very little about how to reduce these drugs and with faulty information due to their lack of knowledge can sometimes force people into very unpleasant situations. As frightening and painful as those situations are, they will eventually correct themselves and our bodies will heal with time. Each step of the journey must be taken carefully because it’s a very slippery path. Everyone is different in how fast they can traverse the path, but everyone must take it very slowly, one step at a time.

The human body is an amazing thing. From the first combining of two single cells it contains all the information necessary to build itself. If it gets broken, it has all the information it needs to fix and adjust itself. It is such a complex mechanism though it takes a lot of time to sort out what is wrong, adjust the problem one cell at a time and test the results.

The latest calculations determined that on average there are 37.2 trillion cells in the human body. About 95% of those cells are replaced each year. That’s a lot of cells and replacement to keep track of. Then throw on top of it trying to sort out the changes made by psych drugs to every part and system of the body, and you have a monumental job ahead of you. There is an old proverb that says, “a journey of a thousand miles starts with but a single step”, we then keep putting one foot in front of the other until, in time, we reach our destination.

August 21, 2020

On 7/5/2020 at 10:45 PM, brassmonkey said:

Too many dosage changes can sensitize the body and cause an Adverse Reaction. An Adverse Reaction can take many months to stabilize.

Even changes like I did in the last 10 days can do an adverse effect? Because in one side they were so tiny (only one bead out of ~240 in my dose) and in other side there are 3-4 days between the changes. They are written down in my signature.

August 22, 2020

The changes you've been making in the past few weeks are such a small percentage of your dose and relatively wide spaced so there should not be a problem with an adverse reaction. It could make things more sensitive, but would probably just cause a spike in symptoms for a few weeks.

August 22, 2020

1 minute ago, brassmonkey said:

The changes you've been making in the past few weeks are such a small percentage of your dose and relatively wide spaced so there should not be a problem with an adverse reaction. It could make things more sensitive, but would probably just cause a spike in symptoms for a few weeks.

👍Thank you

August 27, 2020

What about situation whan I'm 2 years after quitting and dont have waves and windows and my pssd is all the same? with total genital and emotional numbness?

October 13, 2020

On 7/6/2020 at 5:50 AM, brassmonkey said:

This can cause them to get careless in their actions. Drinking alcohol is a major factor in excellent recoveries getting derailed.

Ok wait, so does this mean no alcohol, even one or two drinks a week? What about coffee? Sorry if there are threads with detail but my search hasn't turned up any specific topics with much detail. TIA 🙏

October 13, 2020

hi @Nnaa

1 hour ago, Nnaa said:

Ok wait, so does this mean no alcohol, even one or two drinks a week? What about coffee

Yes it is recommended to eliminate both during withdrawals. I see you are tapering paxil, and from my own experience with tapering that drug, I would highly recommend avoiding both alcohol and coffee.

All the best to you.

October 13, 2020

Hanna's right. It is recommended that you don't drink any alcohol at all during withdrawal and even after reaching "0". We have a number of members who were nicely into recovery/healing who had a few drinks 10 months after reaching "0" and it threw them right back into acute WD. It is also very common, especially around the holidays, for someone who is having a smooth taper to have a celebratory glass of wine and a day later start an extremely bad wave that lasts a very long time. Also for people who have regular drinks during the week who are having problems with their taper, when they stop drinking they stabilize and have a much smoother time of it.

Paxil is particularly bad because it can cause alcohol cravings and lowers ones resistance to those cravings.

Caffeine can present the same sort of problems. It is a very strong stimulant and does not mix well with psych meds. It can be very hard to withdraw from but the forum is full of stories of members having problems cause by it.

November 15, 2020

I've moved James' posts to his Intro so this topic doesn't get cluttered with chatter.

December 24, 2020

Hey @brassmonkey-

I’ve read this thread so many times over the years I could probably recite most of it. I just read it again as I’m back in crisis mode.

As you can see by my history, I’ve been holding a heckuva long time on 4 MG of Lexapro as I resolve some other health issues, namely trigeminal neuralgia. I was out on Oxcarbazepine/Trileptal for all of one day last week and I immediately stopped when I got vertigo, brain fog and other symptoms. It’s been 8 days and while the brain fog is mostly gone, it’s been replaced by pretty serious anxiety, something that I haven’t had in so long.

The doctors are telling me that Trileptal should be long gone from my system and I’m assuming what I’m feeling now is a destabilized nervous system. Does that sound about right? Trying to get lots of rest, hydrate, avoid triggers, etc.

I’ve always appreciated your perspective and thanks in advance for your time. Happy holidays!

December 24, 2020

Hi Ryan-- it sounds like you had an immediate adverse reaction to the medication, which, from what I have read, is very common. It is a good thing that you have only taken one dose, as the side effects from an adverse reaction can be extremely severe. The drug has a very short half life, so the doctor is right on that account, it is no longer in your system. However, it appears to have it's own version of withdrawal syndrome with brain fog, anxiety and dizziness at the top of the list. A long slow taper is usually recommended, except in the case of an adverse reaction. Having only take one dose you should be fine with just stopping. It appears that the WD syndrome can linger for a while, but as you pointed out the brain fog is already improving, so the rest should follow soon. It would probably be a good idea to hold off on any lexapro tapering until you are good and stable from this episode because you may be more sensitive to reductions.

December 24, 2020

Thank you, sir. I agree 100% that it’s just destabilized me a bit. I’m upset with myself for trying it but trigeminal neuralgia is brutal. I should know better though.

Thanks again, @brassmonkey and I really have appreciated all the knowledge and wisdom that you’ve posted over the years. You help more people than you’ll ever know.

Take care and Merry Christmas!

December 25, 2020

@brassmonkey- Merry Christmas!

Have you ever heard of one pill causing SSRI poop out? My biggest fear is this crushing anxiety is here to stay and I’ll have to switch medications to continue my taper.

I had my meds poop out previously but only after being hospitalized and on Dilaudid regularly for 10 days, resulting in serotonin syndrome.

I appreciate you, sir!

December 25, 2020

The body takes a long time to build up to poopout. Taking one pill can give an adverse reaction, but not poopout. An adverse reaction can then take some time to clear itself. Frequently it is just a matter of weeks, but depending on the reaction it can go on quit a bit longer. Bad anxiety is one of the most common symptoms, like the other symptoms it will clear up over time. While it is sorting itself out acceptance and getting on with life are the best things to practice. Even though a person is feeling intense anxiety, it can be relegated to the background and worked around and over. Takes some practice and can be very tiring and stressful, but it can be done. Worrying about the anxiety will only make it worse.

December 28, 2020

Thanks so much, @brassmonkey. Very appreciative of your knowledge and wisdom. Definitely still dealing with the anxiety and the resulting adrenal fatigue but not trying to focus on it.

January 3, 2021

@brassmonkey

Thanks for all you do and your hard earned expertise.

Hello. I’m hoping to get an opinion. I’ve just read thru these links for a second time and have a question.

Section (8) CT and too fast tapers.

I started a rapid taper from lexapro after 11days of use at 10mg. Started on the 27th of last month, just a few days ago. If you read my posts (understand if you don’t have time) you’ll see the issue. Bad reaction to the 10mg possible drug interaction with my trazadone 50mg.

Im concerned about the fast taper but really want off so I don’t have to do a long taper on anything but trazadone which I plan to do later when I stabilize.

I’ve had bad reactions and a long history so there are many variables including immense work stress which I can’t change now.

Do you think my rapid taper as described in my posts and timeline are a good idea? I’m really hoping so as I was only at 10mg for 11 days and after the fast taper my total time on lexapro would be 17 or 18 days.

Thanks and hope to hear from you.

-Humanist

January 3, 2021

I posted an answer on your intro thread so all your information will be in one place.

January 7, 2021

hey @brassmonkey

Wanted to shoot over a message and let you know that the anxiety has lifted and all that remains is overall my head just feels full and dizzy with low energy levels. I've felt this sensation a lot in the past and I'm sure it will start to dissipate.

Just wanted to send you a note of gratitude for your support as this has been my worst wave to-date. Definitely going to kick my taper into high gear when I stabilize and start the Slide.

Appreciate you and all you do, sir.

January 7, 2021

Last question for you, @brassmonkey. I'm three weeks from my reaction to Trileptal and as mentioned above, still in a pretty bad wave. To put my mind at ease, at what point should I consider an updose? Is that crazy? I definitely don't want to do that or to switch to another med but just like others, desperately want to feel good again.

January 7, 2021

On 1/4/2021 at 7:59 AM, brassmonkey said:

I posted an answer on your intro thread so all your information will be in one place.

@ryan1982

Please as questions specifically related to your own situation in your Introduction topic. This way your history is in one place, previous history is easily available. Thank you.

January 7, 2021

Thanks so much, @ChessieCat- my apologies to you and @brassmonkey. Better days ahead.

January 23, 2021

I was on olanzapine 10mg at day time and 10mg at night for a month. I went cold turkey due to side effect on the 12 of January 2021. I have been experiencing several withdrawal symptoms mostly insomnia. I bought cbd oil to ease the symptoms which didn’t work out so well. Right now my pharmacist placed me on omega 3, Epilim 200mg and Aspain to sleep at night. I don’t know if It will get better.. I need help @brassmonkey

January 28, 2021

Hey @brassmonkey, can you please explain this in your signature: When I hit 3mgpw it became hard to split the drop into 4 parts so I switched to dropping 1mgpw (pill weight) every week for 3 weeks and then holding for another 3 weeks. The 3 + 3 schedule turned out to be too harsh so I cut back to dropping 1mgpw every 4 weeks which is working better.

I am good at math i just need a bit of explanation, did you mean when you hit 3 mg of paxil ,you switched to dropping 0.1 mg every 4 weeks ?

Are We There Yet? How Long Is Withdrawal Going To Take?

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