Dr. Joseph Glenmullen's withdrawal symptom checklist

[dalsaan]

ADMIN NOTE www.drglenmullen.com seems to be closed.

 

The checklist is here (PDF will download) glenmullen_symptoms_AS Appendix 1.pdf
 
Our esteemed member ChessieCat has provided these resources:

PDF Monthly List of Dr Glenmullen's Symptoms to Print & PDF Monthly List BLANK to Print
 
Excel Spreadsheet Monthly format of Dr Glenmullen's Symptoms to use on the computer
 
Related topics:

Rate symptoms daily to track patterns and progress

What symptoms should I expect while tapering?

Papers on diagnosis of antidepressant withdrawal syndrome

Guides to tapering off psychiatric medication

---

Hi Glenmullen has provided a checklist of withdrawal symptoms available here [see below] I found this helped me put 2 and 2 together in terms of the diverse range of symptoms I was experiencing (some obvious ones I had identified as withdrawals, others I thought were an unfortunate coincidence : ). The checklist got me on the right page as such. Its also helpful to track changes with dose reductions and to take to Dr's appts. I have printed a heap of them odd and have them in a folder. It can help gps understand and accept what you are saying It may not be perfect but I think it helps to get your head around it and short circuits reading a lot of stuff Don't know if you want to put this with the intro stuff or start a thread for it or ... And I don't know how to make it a link as such Dalsaan

 

 

 

Edited January 18 by ChessieCat
updated

[Altostrata]

Thanks, dalsaan. A valuable addition to our Tapering section.

 

I thought Joseph Glenmullen's book The Antidepressant Solution was excellent. His tapering schedule is moderate, but he specifies over and over that it should be slowed if needed for the individual.

 

It's also a good book to give to your doctor. Joseph Glenmullen is a Harvard psychiatrist. The book has a complete citation section.

[Rhiannon]

Nice! You could totally print out a bunch of those and use them to journal and keep track of your symptoms.

 

I think keeping a journal of symptoms and ranking them on a scale is really useful in withdrawal. Our subjective sense of how well or poorly we're doing is often not so great during withdrawal. I've seen it in myself and I've seen it in other people. The journal helps me see more objectively the patterns of ups and downs and how I respond to cuts and holds.

[strawberry17]

I read the book "Coming off Antidepressants" by Joseph Glenmullen, and I always recommend it to people thinking of tapering, that book was my big lightbulb moment when I suddenly understood what was going on and that I was experiencing withdrawals, it is still available on Amazon and I can really recommend it.

[starlitegirlx]

Thanks, dalsaan. A valuable addition to our Tapering section.

 

I thought Joseph Glenmullen's book The Antidepressant Solution was excellent. His tapering schedule is moderate, but he specifies over and over that it should be slowed if needed for the individual.

 

It's also a good book to give to your doctor. Joseph Glenmullen is a Harvard psychiatrist. The book has a complete citation section.

 

I used his book as the template to doing my withdrawal. However, I should add that he writes in his book that imipramine withdrawal is limited to flu like symptoms for the most part and that the recommended decrease is 50 mg per month or so. That's about as far off from my experience as on gets. I think he's got the SSRIs pretty accurately, but there's not much info on other ADs like imipramine or perhaps taking it for 16 years is the factor. Who knows? But he didn't really acknowledge the severity of withdrawal that imipramine users can face and for the most part the book is about SSRI users, yet I have most of the right hand column from that sheet. Not all, thankfully, but a lot of it. I also had parts of the left hand column but they are mostly diminished. So in a way he's right, just didn't give it much coverage. My main withdrawal symptoms are physical at this point with some random emotional ones mixed in but I think they tend to be just coping with what I've been and am going through (like crying a lot or varied emotions which there's not way an experience like this would not cause a person to have a myriad of emotions to deal with).

[starlitegirlx]

I think you're right he does concentrate on the newer SSRI's, or that's the impression I get, he doesn't seem to address the older style tricyclic antidepressants.

 

No, he doesn't. I was on the older ones - imipramine. I actually think that bodes better for someone who has been on an older one. The SSRIs are where this discontinuation syndrome or whatever more pleasant crock of hooey name they're calling it is where the focus is because it's more severe, sadly. Imipramine got a few pages toward the back and he was pretty far off in my case though he did say flu like symptoms seem to be the main withdrawal for tricyclics and most of mine (barring during worst parts of a withdrawal phase after a reduction) have generally been in the physical domain. I can pretty much go straight down that right hand column a check several of them. They seem to cycle as the diminish. Two good days then a worse day. Sort of like that. So actually, I'm going to take that as a sign of getting past this permanently.

 

Your impression is accurate. I guess it's because the SSRIs, when they came out, was when docs started handing them out like pez candies thinking they were this miracle drug. I was lucky in that they had an immediate horrific effect on me so I never got put on them for more than a few months. Some, just weeks. That was decades ago.

 

So this doctor is good for SSRIs, but that's his area. Much like my doc who knows about the issue with SSRIs, but is stunned at what I've been going through. Cie la vie. I'll get through it. It improves gradually. I had just expected once I was off and not decreasing any longer the withdrawal would go away and I'd have been fine within a month.

[Altostrata]

I wonder if The Antidepressant Solution and Coming off Antidepressants (a much better title) are the same book? It doesn't seem Coming off Antidepressants was published in the US.

 

strawberry, is this table of contents from The Antidepressant Solution the same? http://books.simonandschuster.com/Antidepressant-Solution/Joseph-Glenmullen/9780743288989/excerpt Table of Contents

Contents

Preface 1. Antidepressant Withdrawal and Dependence: Defining the Problem

2. Resolving the Controversy over "Addiction" to Antidepressants: The BBC Exposé

3. The Withdrawal Spectrum: Mild, Moderate, and Severe Withdrawal Reactions

4. How Changing the Dose of Antidepressants Up or Down May Make Patients Suicidal

5. Worst Offenders: The Antidepressants that Cause the Most Frequent Withdrawal Reactions

6. The 5-Step Antidepressant Tapering Program: How to Avoid Uncomfortable or Dangerous Withdrawal Reactions

7. Step 1. Evaluating Whether You Are Ready to Try Tapering Off Your Antidepressant

8. Step 2. Making the Initial Dosage Reduction

9. Step 3. Monitoring Withdrawal Symptoms After a Dosage Reduction

10. Step 4. Making Additional Dosage Reductions

11. Step 5. The End-of-Taper Evaluation 12. Tapering Children Off Antidepressants Afterword Appendix 1: Daily Checklist of Antidepressant Withdrawal Symptoms

Appendix 2: Graph of an Antidepressant Withdrawal Reaction

Appendix 3: Tapering Older Tricyclic and Heterocyclic Antidepressants

Appendix 4: Tapering Monoamine Oxidase Inhibitor Antidepressants

Notes

Acknowledgments

Index

Edited January 16, 2014 by Altostrata
fixed text

[strawberry17]

Hi Alto, just looked in my well thumbed copy and it appears to be identical so obviously mine is a UK/European copy, wonder why they gave them different titles?

[Altostrata]

They probably realized Coming off Antidepressants is a much better title! The Antidepressant Solution gives the exact opposite impression.

 

Dr. Glenmullen should update it and reissue it under Coming off Antidepressants.

 

I like this book the best of all the withdrawal books. It's practical and to-the-point. Dr. Breggin's books are hard to get through.

[starlitegirlx]

They probably realized Coming off Antidepressants is a much better title! The Antidepressant Solution gives the exact opposite impression.

 

Dr. Glenmullen should update it and reissue it under Coming off Antidepressants.

 

I like this book the best of all the withdrawal books. It's practical and to-the-point. Dr. Breggin's books are hard to get through.

 

The Antidepressant Solution should be updated to The Antidepressant Solution Lie. That is all.

[Nikki]

I read Dr. Glenmullen's book and got alot out of it at that time. Somewhere in that book I remember reading that he can be contacted for advise.

 

It was very validating for me at that time.

 

Hugs

[Nikki]

OMG Dalsaan.....

 

I have the left column symptoms.  Moods, anxiety, terrible dreams, crying, etc.  Don't really have physical stuff  ~Except~ I just realized that I get numbness and tingling in my arms, particularly if I sleep for a short period of time with them under my body or bent.

 

I though I was having nerve or circulation problems.  I never made the connection as I sit here and journal and wonder what the heck is wrong with me every day of my life, over and over again with mornings being horrible.

 

Could it be that I don't have physical symptom unless I drop the dose that I don't understand that my emotional stuff is in large part due to WD?

 

But what about the other things going on?

 

Where do we/I draw the line on what's what?

 

Thank you

[Rhiannon]

I am weird, because I basically have only psychiatric symptoms. but those I have big time! from medical symptoms, only maybe some from dizziness category.

 

I remember when I did faster quit, which ended up in total disaster after 4-5 months after that - then I had initially also medical symptoms. but actually, as I think of it, they were also mainly dizziness symptoms, and maybe some sensory abnormalities - I remember I thought I had sharper vision. but that was all even then. 

 

am I some kind of mystery, because my symptoms are all psychiatric? that's why I haven't really understood, why I am so different - for example I have not got any intolerances (like for some foods, coffee, vitamins etc). I guess I'm lucky for that. although my symptoms are really not easier, I'm really tortured by them. 

 

No, it's not that weird, certainly not a mystery or anything. Withdrawal plays out differently for people, that's all.

[Lilu]

What symptoms would you add to this chart?  I noticed that there are a few consistent ones that I get, that are not listed here. Like, brainfog, dizzy, light-sensitive, noise-sensitive, insomnia (at bedtime and/or in early AM).  Please contribute your experience!

 

I am thinking of making a better chart to be used daily.  Maybe even creating a custom journal somehow.  I wish there was a 2014 planner that had all these categories listed, as well as sections on sleep, exercise, weather, etc.  Kind of like: http://www.memoryminder.com/healthminder_detail_view.asp

I also found an online journal that tracks symptoms based on conditions, and is currently free to use: http://www.symptomjournal.com/

 

For your convenience, I am posting them here:

 

PSYCHIATRIC SYMPTOMS

That Mimic Depression

1. Crying spells

2. Worsened mood

3. Low energy (fatigue,lethargy, malaise)

4. Trouble concentrating

5. Insomnia or trouble sleeping

6. Change in appetite

7. Suicidal thoughts

8. Suicide attempts

 

That Mimic Anxiety Disorders

9. Anxious, nervous, tense

10. Panic attacks (racing heart, breathless)

11. Chest  pain

12. Trembling, jittery, or shaking

 

Irritability and Aggression

13. Irritability

14. Agitation (restlessness, hyperactivity)

15. Impulsive

16. Aggressiveness

17. Self-harm

18. Homicidal thoughts or urges

 

Confusion and Memory Problems

19. Confusion or cognitive difficulties

20. Memory problems or forgetfulness

 

Mood Swings

21. Elevated  mood (feeling high)

22. Mood swings

23. Manic-like reactions

 

Hallucinations

24. Auditory hallucinations

25. Visual hallucinations

 

Dissociation

26. Feeling detached or unreal

 

Other

27. Excessive or intense dreaming

28. Nightmares

 

MEDICAL SYMPTOMS

That Mimic the Flu

29. Flu -like aches and pains

30. Fever

31. Sweats

32. Chills

33. Runny nose

34. Sore eyes

 

That Mimic Gastroenteritis

35. Nausea

36. Vomiting

37. Diarrhea

38. Abdominal pain or cramps

39. Stomach bloating

 

Dizziness

40. Disequilibrium

41. Spinning, swaying, lightheaded

42. Hung over or waterlogged feeling

43. Unsteady gait, poor coordination

44. Motion  sickness

 

Headache

45. Headache

 

Tremor

46. Tremor

 

Sensory Abnormalities

47. Numbness, burning,or tingling

48. Electric zap-like sensations in the brain

49. Electric shock-like sensations in the body

50. Abnormal visual sensations

51. Ringing or other  noises in the ears

52. Abnormal smells or tastes

 

Other

53. Drooling or excessive saliva

54. Slurred speech

55. Blurred vision

56. Muscle cramps, stiffness, twitches

57. Feeling of restless legs

58. Uncontrollable twitching of mouth

[Nikki]

I just read this recently and there is a WD checklist a bit more extensive than this on TheRoadBack Site.  Yes, there are other symptoms, but this just about sums it up.....

 

Thank goodness at least one doctor recognizes it:)

[kristinacc]

I agree. I have also thought about making a custom one. I especially like that it includes a section for diet and weather. I think those are two very important factors that are sometimes overlooked.  I just purchased a 2014 Calendar/planner notebook. (for now) I figured I would be more likely to stick with the charting if the paper was already there and bound together rather than needing to print one out for each day, and find a way to keep them together and in order. However there's not much room for me to write.

 

Blurb.com has spiral bound notebooks you can create. Not sure of the price though.  I'm sure you could make a file on your computer and upload it to there. The healthminder journal you posted looks good too though. $13.45 for 95 days doesn't sound too hateful when you consider paper and ink. I might look into that one. 

[Altostrata]

Lilu, is that site specifically capturing withdrawal symptoms?

[Lilu]

Lilu, is that site specifically capturing withdrawal symptoms?

Probably Not...but I haven't signed up and explored it yet.

[Altostrata]

Unless it's specifically capturing withdrawal symptoms, my guess is if you check off symptoms that "mimic" psychiatric symptoms, that site is going to put you in the psychiatric diagnosis basket.

[Lilu]

 

Unless it's specifically capturing withdrawal symptoms, my guess is if you check off symptoms that "mimic" psychiatric symptoms, that site is going to put you in the psychiatric diagnosis basket.

 

I don't think that matters. It would be a private account that would let you track your symptoms daily. As long as the symptoms are listed, you can include them.

 

But I think I found something even better - a downloadable and customizable mental health software!  It is currently free, and can be found on this site:  http://www.findingoptimism.com/

 

I looked at the screen shots of the software, and there is a section where you can add or delete symptoms and categories as you wish.  Looks very promising.  There's a section for goal setting, and it allows one to also track triggers and create charts and reports of your progress.  I also noticed a SYNC button, I wonder if I can sync it with Outlook and create a calendar.

I'll report back after I try it. 

 

I tried the optimism software and found that I can't use it due to the fact that the font is too tiny for me to see and there's no way to change it.  Also there seems to be a bug in the software, as the main window can't be maximized. Also the only place to note the medication dose info is in the notes section.  So I decided to just make due with a good old fashioned daily planner for now.

[Altostrata]

Thanks for reporting back, Lilu.

[Altostrata]

Glad you appreciate it! The bbs structure is good for collecting odd bits of info. The problem is finding them later.

[Addax]

I am wondering about the purely psychological symptoms of withdrawal (as opposed to the physical symptoms). Primarily the ones that have only been experienced AFTER taking and/ or withdrawing. I'm hoping people will add to the list if I've missed some (I'm sure I have).

 

Some of the psychological symptoms I've experienced and read about in other threads are:

 

Intense Anxiety

"Complete" Anhedonia

Ruminating thoughts (negative content)

Extreme guilt/obsessing over things you feel guilty about

Self loathing / extreme self consciousness

Suicidal ideation

[Laura1981]

I had paranoid thoughts and thoughts that I would class psychotic at some stage.

 

I also have crying spells and fits of rage.

[westcoast]

• early-morning awakening with a) dread/terror & regret/hopelessness at the entire experience of the first few hours at least.

• difficulty enjoying face-to-face meet-ups occasions

• long periods of sitting without moving

• sense of having been"left behind age cohort while using

[GardeniaBlossom]

dissociation

[Laura1981]

loss of caring for others, even family

obsessiveness

complete absence of motivation

[Dan998]

• I constantly think about my life before meds.

Grieving for the person that I used to be. 

Difficulty with language and comprehension.

Inability to concentrate.

[DLB]

Wow Dan, I constantly think about me before meds too and I grieve for the person I was too but it is ever so slowly coming back so have hope.....

[Laura1981]

Me too.... I look at old pictures and cry....

[a99]

impaired short term memory

horrible DR/DP

sky high anxiety

ruminating thoughts

[Addax]

Laura, Westcoast, Gardinia, Dan, DLB, and a99, thank you for contributing to this list. Hopefully there will be more contributions and of course if you think of others add them.

 

Feeling as though the pre-medicated person is lost... Grief. That's one I hadn't thought of in terms of grief until now, but it's definitely something I've read about repeatedly in people's threads.

[Addax]

This complete absence of motivation I experienced last fall. For me it wasn't part of depression. It wasn't like, I dont "feel" like doing... Whatever. It was not feeling at all. Numb. Intellectually I knew I should do it, but that was the extent of it. Even eating and showering. It wasn't that I didn't feel like doing them. I just didn't feel anything about them and didnt do them. Does that sound familiar to anyone?

[Prestorb]

Complete lack of motivation and depression much of the time, then something will trigger a switch to the other extreme - emotional overload, crying, etc... I try to see this as progress because I am "feeling", it is just highly unregulated. Maybe the other extreme is my brains way of protecting me from overwhelming emotions all of the time. I can appreciate this, even though both ends of the spectrum are challenging in their own ways.

[westcoast]

I found an interesting diagnosis in ICD-10. I wonder if they made it for post-AD syndrome. I googled but haven't found its origin yet. I hope it isn't a thread hi-jack. It doesn't all ring true, but some of it does.

 

 

Enduring personality change after psychiatric illness

 

Personality change, persisting for at least two years, attributable to the traumatic experience of suffering from a severe psychiatric illness. The change cannot be explained by a previous personality disorder and should be differentiated from residual schizophrenia and other states of incomplete recovery from an antecedent mental disorder.

 

-This disorder is characterized by an excessive dependence on and a demanding attitude towards others;

 

-conviction of being changed or stigmatized by the illness,

 

-leading to an inability to form and maintain close and confiding

 

-personal relationships and to social iso-lation

 

-passivity, reduced interests, and diminished involvement in leisure activities;

 

-persistent complaints of being ill, which may be associated with hypochondriacal claims and illness behaviour;

 

-dysphoric or labile mood, not due to the presence of a current mental disorder or antecedent mental disorder with residual affective symptoms;

 

-and longstanding problems in social and occupational functioning.

[Laura1981]

Arghhhh... misdiagnosis made it into the DSM... that so doesn't surprise me