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NICE antidepressant discontinuation guidelines for UK doctors

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Altostrata

Withdrawal symptoms are always mild and only last a couple of weeks? Not according to the applicable NICE guidelines.

 

The National Institute for Health and Clinical Excellence (NICE) publishes practice guidelines for NHS doctors in the UK.

 

The following is from the NICE CG90 guidelines for

 

CG90 Depression in adults: full guidance 28 October 2009

 

11.8 ANTIDEPRESSANT DISCONTINUATION SYMPTOMS

 

The following sections on antidepressant discontinuation symptoms marked by asterisks (**_**) are from the previous guideline and have not been updated except for style and minor clarification.

 

11.8.1 Introduction

There can be confusion over the use of the terms ‘addiction’, ‘psychological depend- ence’ and ‘physical dependence’ when referring to drugs. This has been associated with concern in the mind of the public about whether antidepressants (and indeed other psychotropic drugs) may be addictive. The DSM–IV (APA, 1994) definition of ‘substance dependence’ consists of a combination of psychological, physiological and behavioural effects that together comprise what is commonly called addiction. The diagnosis of substance dependence/addiction requires at least three of the following:

(1) tolerance (marked increase in amount; marked decrease in effect)

(2) characteristic ‘withdrawal’ symptoms or substance taken to relieve withdrawal (3) substance taken in larger amount and for longer period than intended

(4) persistent desire or repeated unsuccessful attempt to quit

(5) much time/activity taken to obtain, use and recover from the substance

(6) important social, occupational, or recreational activities given up or reduced (7) use continues despite knowledge of adverse consequences (for example, failure

to fulfill role obligation, using when physically hazardous).

 

Physical dependence refers to the first two features (tolerance to the effect and ‘withdrawal’ symptoms) and substance dependence/addiction can be with or with- out physical dependence. There is no evidence that antidepressants cause psycho- logical dependence or adverse behavioural and functional effects in the sense defined by criteria 3 to 7 above, and therefore antidepressants are not ‘addictive’ in the accepted sense of the word used to describe dependence on drugs like alco- hol or opioids. There is also no good evidence to support tolerance to the therapeu- tic effect of antidepressants (Zimmerman & Thongy, 2007) and therefore the debate about whether or not antidepressants cause physical dependence centres on the symptoms some people experience when stopping antidepressants. It is impor- tant to understand the nature of the phenomenon and its implications for people with depression who have antidepressant treatment. In this guideline these are described as ‘discontinuation symptoms’, which is a term that makes no assumption about their status.

 

Discontinuation symptoms can be broadly divided into six groups; affective (for

example, irritability), gastrointestinal (for example, nausea), neuromotor (for exam- ple, ataxia), vasomotor (for example, sweating), neurosensory (for example, paraes- thesia), and other neurological (for example, dreaming; Delgrado, 2006). They may be new or hard to distinguish from some of the original symptoms of the underlying illness. By definition they must not be attributable to other causes. They are experi- enced by at least a third of patients (Lejoyeux et al., 1996; MHRA, 2004) and are seen to some extent with all antidepressants (Taylor et al., 2006). Of the commonly used antidepressants, the risk of discontinuation symptoms seems to be greatest with paroxetine, venlafaxine and amitriptyline (Taylor et al., 2006). There have been prospective studies, including some RCTs and quasi-randomised trials, which have examined the effect of discontinuation in people taking paroxetine and other anti- depressants. These studies suggest an increase in discontinuation symptoms in those taking paroxetine compared with escitalopram (Baldwin et al., 2006), fluoxetine (Rosenbaum et al., 1998; Bogetto et al., 2002; Hindmarch et al., 2000; Judge et al., 2002; Michelson et al., 2000), sertraline (Hindmarch et al., 2000; Michelson et al., 2000), and citalopram (Hindmarch et al., 2000). In addition two RCTs measuring discontinuation symptoms when stopping antidepressants after 8 weeks of treatment found that these were more common with venlafaxine than escitalopram (Montgomery et al., 2004) and moderate and severe symptoms were more common with venlafaxine compared with sertraline (Sir et al., 2005).

 

The onset is usually within 5 days of stopping treatment, or occasionally during taper or after missed doses (Rosenbaum et al., 1998; Michelson et al., 2000). This is influenced by a number of factors, which may include a drug’s half-life. Symptoms can vary in form and intensity and occur in any combination. They are usually mild and self-limiting, but can be severe and prolonged, particularly if withdrawal is abrupt. Some symptoms are more likely with individual drugs, for example dizziness and electric shock-like sensations with SSRIs, and sweating and headache with TCAs (Lejoyeux et al., 1996; Haddad, 2001).

 

11.8.2 Factors affecting the development of discontinuation symptoms

**Although anyone can experience discontinuation symptoms, the risk is increased in those prescribed short half-life drugs (Rosenbaum et al., 1998), such as paroxetine and venlafaxine (Fava et al., 1997; Hindmarch et al., 2000; MHRA, 2004). They can also occur in patients who do not take their medication regularly. Two-thirds of patients prescribed antidepressants skip a few doses from time to time (Meijer et al., 2001). The risk is also increased in those who have been taking antidepressants for 8 weeks or longer (Haddad, 2001); those who developed anxi- ety symptoms at the start of antidepressant treatment (particularly with SSRIs); those receiving other centrally acting medications (for example, antihypertensives, antihistamines, antipsychotics); children and adolescents; and those who have experienced discontinuation symptoms before (Lejoyeux & Ades, 1997; Haddad, 2001).

 

Discontinuation symptoms may also be more common in those who relapse on stopping antidepressants (Zajecka et al., 1998; Markowitz et al., 2000).

 

11.8.3 Clinical relevance

The symptoms of a discontinuation reaction may be mistaken for a relapse of illness or the emergence of a new physical illness (Haddad, 2001) leading to unnecessary investigations or reintroduction of the antidepressant. Symptoms may be severe enough to interfere with daily functioning. Another point of clinical relevance is that patients who experience discontinuation symptoms may assume that this means that antidepressants are addictive and not wish to accept further treatment. It is very important to counsel patients before, during and after antidepressant treatment about the nature of this syndrome.**

 

11.8.4 How to avoid discontinuation symptoms

Although it is generally advised that antidepressants (except fluoxetine) should be discontinued over a period of at least 4 weeks, preliminary data suggest that it may be the half-life of the antidepressant rather than the rate of taper that ultimately influences the risk of discontinuation symptoms (Tint et al., 2008).

 

When switching from one antidepressant to another with a similar pharmacological profile, the risk of discontinuation symptoms may be reduced by completing the switch as quickly as possible (a few days at most). A different approach may be required at the end of treatment where a slower taper is likely to be beneficial.

 

**The half-life of the drug should be taken into account. The end of the taper may need to be slower as symptoms may not appear until the reduction in the total daily dosage of the antidepressant is substantial. Patients receiving MAOIs may need dosage to be tapered over a longer period. Tranylcypromine may be particularly diffi- cult to stop. It is not clear if the need for slow discontinuation of MAOIs, and partic- ularly tranylcypromine, is due to the discontinuation syndrome or the loss of other neurochemical effects of these drugs. Since it is not possible to disentangle these phenomena, the clinical advice is that patients on MAOIs and those at-risk patients need a slower taper (Haddad, 2001).**

Many patients experience discontinuation symptoms despite a slow taper. For these patients, the option of abrupt withdrawal should be discussed. Some may prefer a short period of intense symptoms over a prolonged period of milder symptoms.

 

11.8.5 How to treat

**There are no systematic randomised studies in this area. Treatment is pragmatic. If symptoms are mild, reassure the patient that these symptoms are not uncommon after discontinuing an antidepressant and that they will pass in a few days. If symptoms are severe, reintroduce the original antidepressant (or another with a longer half-life from the same class) and taper gradually while monitoring for symptoms (Haddad, 2001; Lejoyeux & Ades, 1997).**

 

11.8.6 From evidence to recommendations

Since the previous guideline, the evidence base for discontinuation symptoms with antidepressants is largely unchanged. Practitioners should ensure that they discuss the issue fully with all patients, and consider prescribing antidepressants that are associ- ated with fewer discontinuation symptoms (for example, fluoxetine), particularly for patients who have had previous experience of these. The previous recommendations are therefore retained, but rewritten to fit the updated NICE style.

 

11.8.7 Clinical practice recommendations

11.8.7.1 When prescribing antidepressants, explore any concerns the person with depression has about taking medication, explain fully the reasons for prescrib- ing, and provide information about taking antidepressants, including:

  • the gradual development of the full antidepressant effect
  • the importance of taking medication as prescribed and the need to
  • continue treatment after remission
  • potential side effects
  • the potential for interactions with other medications
  • the risk and nature of discontinuation symptoms with all antidepressants, particularly with drugs with a shorter half-life (such as paroxetine and venlafaxine), and how these symptoms can be minimised
  • the fact that addiction does not occur with antidepressants. Offer written information appropriate to the person’s needs.
11.8.7.2 Advise people with depression who are taking antidepressants that discon- tinuation symptoms179 may occur on stopping, missing doses or, occasion- ally, on reducing the dose of the drug. Explain that symptoms are usually mild and self-limiting over about 1 week, but can be severe, particularly if the drug is stopped abruptly.

 

179 Discontinuation symptoms include increased mood change, restlessness, difficulty sleeping, unsteadi- ness, sweating, abdominal symptoms and altered sensations.

 

11.8.7.3 When stopping an antidepressant, gradually reduce the dose, normally over a 4-week period, although some people may require longer periods, partic- ularly with drugs with a shorter half-life (such as paroxetine and venlafax- ine). This is not required with fluoxetine because of its long half-life:

 

11.8.7.4 Inform the person that they should seek advice from their practitioner if they experience significant discontinuation symptoms. If discontinuation symptoms occur:

  • monitor symptoms and reassure the person if symptoms are mild
  • consider reintroducing the original antidepressant at the dose that was effective (or another antidepressant with a longer half-life from the same class) if symptoms are severe, and reduce the dose gradually while monitoring symptoms.
Edited by Altostrata
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Altostrata

I believe Dr. Peter Haddad is a main source for the information in these guidelines; he has published extensively on antidepressant withdrawal syndrome and is one of the world's experts in the subject.

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nz11

Sorry but if Dr P Haddad put this stuff together and this is his best shot then quite frankly he has revealed an ignorance to wdl that is disturbng to say the least....what hope is there for people . The NICE guideline says this :

..................................................................

1.9.2 Stopping or reducing antidepressants

1.9.2.1 Advise people with depression who are taking antidepressants that discontinuation symptoms may occur on stopping, missing doses or, occasionally, on reducing the dose of the drug. Explain that symptoms are usually mild and self-limiting over about 1 week, but can be severe, particularly if the drug is stopped abruptly.

1.9.2.2 When stopping an antidepressant, gradually reduce the dose, normally over a 4-week period, although some people may require longer periods, particularly with drugs with a shorter half-life (such as paroxetine and venlafaxine). This is not required with fluoxetine because of its long half-life.

1.9.2.3 Inform the person that they should seek advice from their practitioner if they experience significant discontinuation symptoms. If discontinuation symptoms occur:

  • monitor symptoms and reassure the person if symptoms are mild

  • consider reintroducing the original antidepressant at the dose that was effective (or another antidepressant with a longer half-life from the same class) if symptoms are severe, and reduce the dose gradually while monitoring symptoms.

.........................

i wonder what he means by longer periods ......6 weeks??

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Altostrata

At least he recommends a 4-week taper. The lack of detail about longer tapering is a serious deficiency -- it's why this site exists.

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Tilly

UK GP's in my experience do not follow these guidelines. Especially the part of this guidance (can't locate it here) that stipulates reductions should be made at a speed dictated by what the patient is comfortable with. I made this point along with many others when I complained to my GP. My GP has failed to follow NICE guidelines in many aspects of my 'care'. They didn't even bother to respond to these points when raised.

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Altostrata

No surprise from me.

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Tilly

No surprise from me.

Me either. F%$£*(s!

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Altostrata
Posted (edited)

These guidelines were updated April 2018.

 

https://www.nice.org.uk/guidance/CG90

 

Here is the updated ONLINE section on withdrawal:

1.9.2 Stopping or reducing antidepressants

1.9.2.1 Advise people with depression who are taking antidepressants that discontinuation symptoms[16] may occur on stopping, missing doses or, occasionally, on reducing the dose of the drug. Explain that symptoms are usually mild and self-limiting over about 1 week, but can be severe, particularly if the drug is stopped abruptly.

1.9.2.2 When stopping an antidepressant, gradually reduce the dose, normally over a 4-week period, although some people may require longer periods, particularly with drugs with a shorter half-life (such as paroxetine and venlafaxine). This is not required with fluoxetine because of its long half-life.

1.9.2.3 Inform the person that they should seek advice from their practitioner if they experience significant discontinuation symptoms. If discontinuation symptoms occur:

  • monitor symptoms and reassure the person if symptoms are mild

  • consider reintroducing the original antidepressant at the dose that was effective (or another antidepressant with a longer half-life from the same class) if symptoms are severe, and reduce the dose gradually while monitoring symptoms.

 

From the full National Clinical Practice Guideline 90 for CG90 (707-page pdf file available at the bottom of this page https://www.nice.org.uk/guidance/cg90/evidence  )

 

11.8 ANTIDEPRESSANT DISCONTINUATION SYMPTOMS

The following sections on antidepressant discontinuation symptoms marked by asterisks (**_**) are from the previous guideline and have not been updated except for style and minor clarification.

 

11.8.1 Introduction

There can be confusion over the use of the terms ‘addiction’, ‘psychological depend- ence’ and ‘physical dependence’ when referring to drugs. This has been associated with concern in the mind of the public about whether antidepressants (and indeed other psychotropic drugs) may be addictive. The DSM–IV (APA, 1994) definition of ‘substance dependence’ consists of a combination of psychological, physiological and behavioural effects that together comprise what is commonly called addiction. The diagnosis of substance dependence/addiction requires at least three of the following:

 

(1)  tolerance (marked increase in amount; marked decrease in effect)

(2)  characteristic ‘withdrawal’ symptoms or substance taken to relieve withdrawal

(3)  substance taken in larger amount and for longer period than intended

(4)  persistent desire or repeated unsuccessful attempt to quit

(5)  much time/activity taken to obtain, use and recover from the substance

(6)  important social, occupational, or recreational activities given up or reduced

(7)  use continues despite knowledge of adverse consequences (for example, failure to fulfill role obligation, using when physically hazardous).


Physical dependence refers to the first two features (tolerance to the effect and ‘withdrawal’ symptoms) and substance dependence/addiction can be with or with- out physical dependence. There is no evidence that antidepressants cause psycho- logical dependence or adverse behavioural and functional effects in the sense defined by criteria 3 to 7 above, and therefore antidepressants are not ‘addictive’ in the accepted sense of the word used to describe dependence on drugs like alco- hol or opioids. There is also no good evidence to support tolerance to the therapeu- tic effect of antidepressants (Zimmerman & Thongy, 2007) and therefore the debate about whether or not antidepressants cause physical dependence centres on the symptoms some people experience when stopping antidepressants. It is impor- tant to understand the nature of the phenomenon and its implications for people with depression who have antidepressant treatment. In this guideline these are described as ‘discontinuation symptoms’, which is a term that makes no assumption about their status.


Discontinuation symptoms can be broadly divided into six groups; affective (for example, irritability), gastrointestinal (for example, nausea), neuromotor (for exam- ple, ataxia), vasomotor (for example, sweating), neurosensory (for example, paraes- thesia), and other neurological (for example, dreaming; Delgrado, 2006). They may be new or hard to distinguish from some of the original symptoms of the underlying illness. By definition they must not be attributable to other causes. They are experi- enced by at least a third of patients (Lejoyeux et al., 1996; MHRA, 2004) and are seen to some extent with all antidepressants (Taylor et al., 2006). Of the commonly used antidepressants, the risk of discontinuation symptoms seems to be greatest with paroxetine, venlafaxine and amitriptyline (Taylor et al., 2006). There have been prospective studies, including some RCTs and quasi-randomised trials, which have examined the effect of discontinuation in people taking paroxetine and other anti- depressants. These studies suggest an increase in discontinuation symptoms in those taking paroxetine compared with escitalopram (Baldwin et al., 2006), fluoxetine (Rosenbaum et al., 1998; Bogetto et al., 2002; Hindmarch et al., 2000; Judge et al., 2002; Michelson et al., 2000), sertraline (Hindmarch et al., 2000; Michelson et al., 2000), and citalopram (Hindmarch et al., 2000). In addition two RCTs measuring discontinuation symptoms when stopping antidepressants after 8 weeks of treatment found that these were more common with venlafaxine than escitalopram (Montgomery et al., 2004) and moderate and severe symptoms were more common with venlafaxine compared with sertraline (Sir et al., 2005).

 

The onset is usually within 5 days of stopping treatment, or occasionally during taper or after missed doses (Rosenbaum et al., 1998; Michelson et al., 2000). This is influenced by a number of factors, which may include a drug’s half-life. Symptoms can vary in form and intensity and occur in any combination. They are usually mild and self-limiting, but can be severe and prolonged, particularly if withdrawal is abrupt. Some symptoms are more likely with individual drugs, for example dizziness and electric shock-like sensations with SSRIs, and sweating and headache with TCAs (Lejoyeux et al., 1996; Haddad, 2001).

 

11.8.2 Factors affecting the development of discontinuation symptoms

**Although anyone can experience discontinuation symptoms, the risk is increased in those prescribed short half-life drugs (Rosenbaum et al., 1998), such as paroxetine and venlafaxine (Fava et al., 1997; Hindmarch et al., 2000; MHRA, 2004). They can also occur in patients who do not take their medication regularly. Two-thirds of patients prescribed antidepressants skip a few doses from time to time (Meijer et al., 2001). The risk is also increased in those who have been taking antidepressants for 8 weeks or longer (Haddad, 2001); those who developed anxi- ety symptoms at the start of antidepressant treatment (particularly with SSRIs); those receiving other centrally acting medications (for example, antihypertensives, antihistamines, antipsychotics); children and adolescents; and those who have experienced discontinuation symptoms before (Lejoyeux & Ades, 1997; Haddad, 2001).

Discontinuation symptoms may also be more common in those who relapse on stopping antidepressants (Zajecka et al., 1998; Markowitz et al., 2000).

 

11.8.3 Clinical relevance

The symptoms of a discontinuation reaction may be mistaken for a relapse of illness or the emergence of a new physical illness (Haddad, 2001) leading to unnecessary investigations or reintroduction of the antidepressant. Symptoms may be severe enough to interfere with daily functioning. Another point of clinical relevance is that patients who experience discontinuation symptoms may assume that this means that antidepressants are addictive and not wish to accept further treatment. It is very

important to counsel patients before, during and after antidepressant treatment about the nature of this syndrome.**

 

11.8.4 How to avoid discontinuation symptoms

Although it is generally advised that antidepressants (except fluoxetine) should be discontinued over a period of at least 4 weeks, preliminary data suggest that it may be the half-life of the antidepressant rather than the rate of taper that ultimately influences the risk of discontinuation symptoms (Tint et al., 2008).

 

When switching from one antidepressant to another with a similar pharmacolog- ical profile, the risk of discontinuation symptoms may be reduced by completing the switch as quickly as possible (a few days at most). A different approach may be required at the end of treatment where a slower taper is likely to be beneficial.

 

**The half-life of the drug should be taken into account. The end of the taper may need to be slower as symptoms may not appear until the reduction in the total daily dosage of the antidepressant is substantial. Patients receiving MAOIs may need dosage to be tapered over a longer period. Tranylcypromine may be particularly diffi- cult to stop. It is not clear if the need for slow discontinuation of MAOIs, and partic- ularly tranylcypromine, is due to the discontinuation syndrome or the loss of other neurochemical effects of these drugs. Since it is not possible to disentangle these phenomena, the clinical advice is that patients on MAOIs and those at-risk patients need a slower taper (Haddad, 2001).**

 

Many patients experience discontinuation symptoms despite a slow taper. For these patients, the option of abrupt withdrawal should be discussed. Some may prefer a short period of intense symptoms over a prolonged period of milder symptoms. [NO CITATION]

 

11.8.5 How to treat

**There are no systematic randomised studies in this area. Treatment is pragmatic. If symptoms are mild, reassure the patient that these symptoms are not uncommon after discontinuing an antidepressant and that they will pass in a few days. If symptoms are severe, reintroduce the original antidepressant (or another with a longer half-life from the same class) and taper gradually while monitoring for symptoms (Haddad, 2001; Lejoyeux & Ades, 1997).**

 

11.8.6 From evidence to recommendations

Since the previous guideline, the evidence base for discontinuation symptoms with antidepressants is largely unchanged. Practitioners should ensure that they discuss the issue fully with all patients, and consider prescribing antidepressants that are associ- ated with fewer discontinuation symptoms (for example, fluoxetine), particularly for patients who have had previous experience of these. The previous recommendations are therefore retained, but rewritten to fit the updated NICE style.

 

11.8.7 Clinical practice recommendations

 

11.8.7.1 When prescribing antidepressants, explore any concerns the person with depression has about taking medication, explain fully the reasons for prescrib- ing, and provide information about taking antidepressants, including:

●  the gradual development of the full antidepressant effect

●  the importance of taking medication as prescribed and the need to

continue treatment after remission

●  potential side effects

●  the potential for interactions with other medications

●  the risk and nature of discontinuation symptoms with all antidepres-sants, particularly with drugs with a shorter half-life (such as paroxe-tine and venlafaxine), and how these symptoms can be minimised

●  the fact that addiction does not occur with antidepressants. Offer written information appropriate to the person’s needs.

Advise people with depression who are taking antidepressants that discon- tinuation symptoms179 may occur on stopping, missing doses or, occasion- ally, on reducing the dose of the drug. Explain that symptoms are usually mild and self-limiting over about 1 week, but can be severe, particularly if the drug is stopped abruptly.

 

When stopping an antidepressant, gradually reduce the dose, normally over a 4-week period, although some people may require longer periods, partic- ularly with drugs with a shorter half-life (such as paroxetine and venlafax- ine). This is not required with fluoxetine because of its long half-life: Inform the person that they should seek advice from their practitioner if they experience significant discontinuation symptoms. If discontinuation symptoms occur:

●  monitor symptoms and reassure the person if symptoms are mild

●  consider reintroducing the original antidepressant at the dose that was effective (or another antidepressant with a longer half-life from the same class) if symptoms are severe, and reduce the dose gradually while monitoring symptoms.

 

Edited by Altostrata
updated

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Kittygiggles

Edit: Sorry, I responded before your edit, which reveals more detail and comprehension of SSRI withdrawal, which is a good thing. However, they seem to downplay SSRI withdrawal syndrome likelihood and severity (especially with regards to fluoxetine) with their tone but I am impressed that they at least now take it seriously.

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Colonial
On 6/15/2012 at 4:41 PM, Altostrata said:

1.8.4 How to avoid discontinuation symptoms

Although it is generally advised that antidepressants (except fluoxetine) should be discontinued over a period of at least 4 weeks, preliminary data suggest that it may be the half-life of the antidepressant rather than the rate of taper that ultimately influences the risk of discontinuation symptoms (Tint et al., 2008).

 

This is so misleading. because if Your symptoms don't appear until MONTHS after the change in dose, neither Your not Your doctor are going to make the connection.

I had numerous E Coli bladder infections over 2 months after substantial Wellbutrin drops.

Because it was nothing I had ever had in over 45 years I studied further and found it was a known Wellbutrin issue.

Also,  the cutting of the Wellbutrin in half from 300 to 150 messed My Menstrual cycle up but not right away, again there was a few months delay...

So if You report that, Your doctor is just going to think: "Well your mid 40's go to the gynecologist".

I suspect the longer half life drugs are just as problematic, I think it just takes longer for the problems to occur and thus the connection isn't made.

 

 

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Kittygiggles
On 5/28/2019 at 8:54 PM, Colonial said:

I suspect the longer half life drugs are just as problematic, I think it just takes longer for the problems to occur and thus the connection isn't made.

 

Yes, I think so too and I gather from my limited perception that that's the consensus here: serotonin transporter occupancy is the same with all drugs and withdrawing them changes that at different rates, so the effects are pretty much universal across all drugs but as you said, for those with a longer half-life, "it just takes longer for the problems to occur". 

 

I know some people do Prozac bridging, which sounds like a bad idea to me but I understand why people find it helps. If I do truly have a delayed withdrawal syndrome response to fluoxetine during my taper, due to its longer half-life, I'd consider that a curse, not a blessing. Having to wait longer to find out if a dose change will affect me adversely is frustrating and has made me lose months of tapering time due to excessive adjustments. 

 

Anyway, sorry for rambling; to iterate, I agree with you and it is odd to me that the guidelines didn't draw the same conclusion as you: a longer half-life can delay symptom appearance but not prevent them in any way or to any degree. 

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Colonial
Posted (edited)
On 7/3/2019 at 1:45 PM, Kittygiggles said:

 

Yes, I think so too and I gather from my limited perception that that's the consensus here: serotonin transporter occupancy is the same with all drugs and withdrawing them changes that at different rates, so the effects are pretty much universal across all drugs but as you said, for those with a longer half-life, "it just takes longer for the problems to occur". 

 

I know some people do Prozac bridging, which sounds like a bad idea to me but I understand why people find it helps. If I do truly have a delayed withdrawal syndrome response to fluoxetine during my taper, due to its longer half-life, I'd consider that a curse, not a blessing. Having to wait longer to find out if a dose change will affect me adversely is frustrating and has made me lose months of tapering time due to excessive adjustments. 

 

Anyway, sorry for rambling; to iterate, I agree with you and it is odd to me that the guidelines didn't draw the same conclusion as you: a longer half-life can delay symptom appearance but not prevent them in any way or to any degree. 

 

 

Exactly!  I had a crash 10-11 weeks after a drop of Wellbutrin.  I was going to drop it again after 2 full months (9 weeks), but something told me, "Well, let's just give it one more month to be sure".  Good thing I did.  If I had made the new drop, I would have mis diagnosed why the crash happened. I find with these meds, there's a percentage your body can tolerate per drop, another tolerance level your body can tolerate in any 3 months, 6 months and 1 year period.  Eventually, you just have to slow down and not make any drops for a rest period.  I do it in the Autumn since its the time of year You brain is compromised to begin with.  I make no med changes for 3 months, and that allows everything to settle and keeps my over all numbers, percentage wise, lower towards my yearly total.  I find I make better "progress", in the sense of less symptoms, from March to August of the years.

 

Edited by ChessieCat
extracted response from quote

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