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Dr. Stuart Shipko writes e-book on Xanax Withdrawal


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http://xanaxwithdrawalbook.com/ Available in many formats, the e-book costs less than $5 US.

 

I wrote this eBook because so many people coming to see me have read the Ashton Manual and feel that this is the only way to wean from Xanax. The book is mostly about Xanax, which I find easier to stop than either Ativan (especially Ativan) or Klonopin. Patients are unaware that they can taper directly from Xanax without the Ashton switch to Valium.

 

While I applaud Ashton as a pioneer and a sharp clinician, she is still only one doctor who writes that she is aware that she is not the final opinion on the subject. Certainly I am not the final opinion either, but I share my extensive experience on Xanax withdrawal. I disagree with the notion that after a dosage cut that one should never updose. I also disagree with the notion that antidepressants should be prescribed for withdrawal related depression.

 

My outcomes have been good, and I think that Xanax Withdrawal offers a lot of useful information for the clinician and the patient. The book has been really useful in my subspecialty practice regarding panic disorder. Xanax dependency is often a complication of treatment. It is a useful companion to the clinical experience of Xanax withdrawal.

 

From http://xanaxwithdrawalbook.com/

"Jane, a 42-year-old secretary, was driving home from work when, out of the blue, she had a frightening panic attack. She was hyperventilating, felt unable to breathe and it seemed like she was looking out through a long tunnel. Her hands began to clench and she had chest pain. She pulled over to the side of the road and called an ambulance. By the time she got to the hospital, she already felt better. The doctor in the emergency room told her that she had had a panic attack.

 

Prescribed Xanax 0.5 mg twice daily, Jane was advised to follow up with her family physician soon. A few days later Jane met with her family doctor, who advised her to take Xanax three times a day, and prescribed a month's supply with two refills.

 

After three months on Xanax with no further panic attacks, Jane decided not to refill the prescription. That night she was unable to sleep at all, with a severe headache and intense, unfocused worry about everything. Jane called her doctor the next day. The doctor explained to Jane that this happened because Jane had a chemical imbalance and that Jane needed the Xanax to treat the chemical imbalance.

 

Jane took Xanax every day, exactly as prescribed for the next 7 years. One day, on a vacation out of state, her Xanax was stolen from her hotel room, and she was unable to find a local doctor willing to prescribe more for her. Because of the intensity of her physical and emotional withdrawal, she cut her vacation short and came home to get her Xanax refilled. It was at that point that Jane realized the intensity of her addiction to Xanax."

Xanax Withdrawal provides a road map for stopping Xanax. Xanax dependency is a common problem, and there is little practical information available on how to safely and comfortably stop taking it. A patient can unknowingly become dependent on Xanax, with dependency sometimes happening after as little as a week or two of regular use. Dr. Shipko addresses issues related to stopping Xanax; why to stop, when to stop, how to taper the drug and what to expect during withdrawal. A practicing psychiatrist for over 34 years, Dr. Shipko has had considerable experience with Xanax because of his subspecialty interest in panic disorder.

TABLE OF CONTENTS

 

Chapter 1 Introduction

 

Chapter 2 Working With Xanax

 

Chapter 3 Xanax is Replaced by Antidepressants

 

Chapter 4 Reassessment

 

Chapter 5 The Results of Change

 

Chapter 6 The Ashton Manual

 

Chapter 7 Comments on Prolonged Withdrawal Syndromes

 

Chapter 8 Physician Supervision

 

Chapter 9 To Stop or Not to Stop

 

Chapter 10 What is the Best Time to Stop

 

Chapter 11 Withdrawal and Relapse

 

Chapter 13 Groundwork

 

Chapter 14 Xanax Withdrawal Symptoms

 

Chapter 15 General Approach to Tapering

 

Chapter 16 Making the initial Dosage Reductions

 

Chapter 17 Tapering from 1.5 to Zero

 

Chapter 18 Stopping Completely

 

Chapter 19 Post Script

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

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

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Barbarannamated

I have not read this. Im assuming that Chapter 3 is psychopharmacology history he's reviewing.

"Chapter 3 - Xanax is Replaced by Antidepressants"

 

That is my understanding of the advent of SSRIs: to be a safer, non-addictive "anxiolytic/antidepressant". The blurring of "anxiety" and "depression" and treating anxiety and "anxious depression" with SSRIs has led to this disaster we have today. Transition people from prn meds to maintenance.

 

In my opinion, anxiety and depression are opposite ends of a continuum with "anxiety" characterized by TOO MUCH ENERGY/thinking (easily confused with mania) and "depression" as LACK OF ENERGY/movement/thinking. I understand how SSRIs could *potentially* alleviate anxiety due to the dulling of emotions and secondarily relieve DISTRESS.

 

In one whose emotions/senses/energy are already stunted or dulled, SSRIs worsen that while causin agitation and movement disorders (throretically due to disruption of dopamine).

 

Dr. Shipko's approach is interesting. My pdoc thought Xanax had less addiction potential than Klonopin and would be easier to withdraw from due to the short halflife. I took it prn for awhile but never experienced response.

 

Interested to hear other's thoughts on this.

Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc).

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In a word, I think terms like "anxiety" etc. what a person thinks they mean. "Anxiety" especially seems to be a word applied to just about everything under the sun short of being unconscious.

 

As for xanax having less addiction potential for klonopin - that is absurd but a common belief. ALL benzos are addictive. And xanax is much harder to withdraw from than other benzos due to its short-acting nature, and possibly other properties as well.

 

Your pdoc's thinking seems to be like what doctors used to think about paxil - that short-acting is "safer" and easier to get off of.

 

The opposite is true. One's body is thrown in and out of virtual withdrawal (although at different rates depending on many individual factors - but still faster than longer-acting meds in the same family).

 

I was prescribed xanax soon after it was put on the market. I was told it would NOT be addictive (if used as directed - which was a LARGE though not "abuse" dose). The reason the doctor gave was that "it leaves your system before your body can get addicted to it." Yes, he really said that. Total fallacy.

 

Ironically I'd been on a long-acting benzo (tranxene) for many, many years without problem. (As long as I didn't stop taking it, that is!) I was switched to the xanax because it was "safer." After about a couple of months on xanax, I was experiencing severe interdose w/d. Absolutely terrifying. The doctor adjusted the dose very slightly in order to add back a small amount of tranxene "because I'd never had any problem with that." This is scientific thinking????

 

btw, I don't think one can generalize about how a person responds to SSRIs, anymore than with benzos or other meds affecting the nervous system. For me and many others, paxil was extremely sedating. In my case, I went off it because I couldn't stay awake - it was only in withdrawal that I experienced agitation and movement disorders (including akathisia and muscle jerks etc.).

 

Ironically, I was put on the paxil to alleviate six years of protracted benzo withdrawal. (To "balance out my neurotransmitters." I was wary of any new med (wary isn't the word!), but doctor (different one, and one who is very cautious with meds and had been appalled at my benzo experience) said that paxil couldn't possibly be addictive because it worked completely differently.

 

Such is the state of pharmacological "science" in our era. I question everything now.

 

(Re Dr. Shipko's "Chapter 3 - Xanax is Replaced by Antidepressants" - I haven't read his book, but would expect he might be referring to ADs being the current trendy "drug of choice" that doctors are likely to prescribe for whatever ails ya...).

I was "TryingToGetWell" (aka TTGW) on paxilprogress. I also was one of the original members here on Surviving Antidepressants

 

I had horrific and protracted withdrawal from paxil, but now am back to enjoying life with enthusiasm to the max, some residual physical symptoms continued but largely improve. The horror, severe derealization, anhedonia, akathisia, and so much more, are long over.

 

My signature is a temporary scribble from year 2013. I'll rewrite it when I can.

 

If you want to read it, click on http://survivingantidepressants.org/index.php?/topic/209-brandy-anyone/?p=110343

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This is good news. Ashton's monopoly on benzo d/c, with respect to her, isn't ideal for a diverse patient population.

 

doctors sharing their clinical experience with tapering generally is also a plus. The more, the better... Get the word out...

"Well my ship's been split to splinters and it's sinking fast
I'm drowning in the poison, got no future, got no past
But my heart is not weary, it's light and it's free
I've got nothing but affection for all those who sailed with me.

Everybody's moving, if they ain't already there
Everybody's got to move somewhere
Stick with me baby, stick with me anyhow
Things should start to get interesting right about now."

- Zimmerman

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I strongly suggest you read whatever Dr. Shipko put in "Chapter 3 - Xanax is Replaced by Antidepressants" before critiquing it.

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

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

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I strongly suggest you read whatever Dr. Shipko put in "Chapter 3 - Xanax is Replaced by Antidepressants" before critiquing it.

 

Is that what he actually suggests?

 

I realize the chapter title seems to imply AD supplementation but the introduction seemed clear that Shipko opposed antidepressants to treat benzo-w/d-induced depression. Or at least that's how i read it.

"Well my ship's been split to splinters and it's sinking fast
I'm drowning in the poison, got no future, got no past
But my heart is not weary, it's light and it's free
I've got nothing but affection for all those who sailed with me.

Everybody's moving, if they ain't already there
Everybody's got to move somewhere
Stick with me baby, stick with me anyhow
Things should start to get interesting right about now."

- Zimmerman

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I don't know, I just bought it and downloaded it. But I try not to critique something before I've read it.

 

Selections:

 

I am writing about Xanax in particular because I have used it far more than other benzodiazepines in my practice and am most familiar with it. General principles described in Xanax Withdrawal apply to other similar benzodiazepines, such as Ativan and Klonopin, however I have had much more experience working with Xanax. While it is generally thought that that Klonopin and Ativan are less addicting than Xanax, my experience is that Xanax is considerably easier to stop than either Ativan or Klonopin.

Chapter 3 XANAX IS REPLACED BY ANTIDEPRESSANTS

Prescribing Xanax alone, without any other drugs, went out of style in the early 90’s after the serotonin specific (SSRIs and SNRIs – these include Prozac, Paxil, Zoloft, Luvox, Celexa, Lexapro, Effexor and Cymbalta) antidepressants came out. As a strategy to capture the lucrative Xanax market, the pharmaceutical companies vilified Xanax for its addictive properties and convinced most physicians to avoid prescribing Xanax in favor of the new antidepressants. The antidepressants are also addictive, and it turned out that SSRIs, when prescribed alone for panic disorder, often made the problem much worse, so benzodiazepines were generally still prescribed along with the SSRI. The standard of care became that Xanax would be given along with the SSRI, hopefully just for a few weeks or months, until the SSRI “kicks in” at which time there should be little or no problem stopping the Xanax because the SSRI had now “cured” the problem. This was marketing mythology, but became the standard of care. Although Xanax alone was still approved by the FDA to treat panic disorder, clinicians trended away from using Xanax alone, to either a SSRI alone or a SSRI with a benzodiazepine.

 

Because of the pharmaceutical companies’ attack on the Xanax market I was constantly confronted with negative information about Xanax, particularly its addictive properties. Early on I had the good fortune (or misfortune, depending on how you look at it) to recognize the numerous severe side effects of the SSRI antidepressants. In the late 80’s and early 90’s I saw patients on SSRIs who committed senseless crimes, who inexplicably became suicidal, who had sexual dysfunction that persisted long after stopping the drug, and who had massive weight gain. Most of all I found that stopping SSRIs often came with a serious and often lengthy withdrawal syndrome. While the SSRIs can also be very effective in alleviating anxiety, I never jumped on the SSRI bandwagon because the side effects and addictive properties of this class of drugs seemed excessive.

 

Still, I already was having some doubts about continuing to work with Xanax....

He's saying that in pharmaceutical marketing, Xanax was replaced by antidepressants.

 

I've only sampled the book, but so far I think it's quite good.

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

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

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I don't know, I just bought it and downloaded it. But I try not to critique something before I've read it.

 

Yea, you make a good point.

 

I hope he contributes in a positive direction. I'm encouraged that you seem satisfied of what you've thus far read.

"Well my ship's been split to splinters and it's sinking fast
I'm drowning in the poison, got no future, got no past
But my heart is not weary, it's light and it's free
I've got nothing but affection for all those who sailed with me.

Everybody's moving, if they ain't already there
Everybody's got to move somewhere
Stick with me baby, stick with me anyhow
Things should start to get interesting right about now."

- Zimmerman

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Barbarannamated

My apologies for launching into that although I have read similar on his website and (not that it matters) agree completely... pharma had a new game in town.. SSRIs, daily, maintenance med$ and vilified something (benzo) that could be taken prn. I've mentioned this a few times. I think we're seeing the same thing with pain meds - vilifying opiates as "addictive and deadly" because they have immediate onset (lending to abuse potential) and are pushing SSRIs, Cymbalta and "membrane stabilizing agents" for pain. Again, daily, maintenance meds over prn.

Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc).

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Hi

 

For those who are reading the book, since he talks about the way that SSRIs have (sort of) replaced xanax etc, does he talk about any similarities or differences in tapering both of them?

 

B

2005 St John's Wort / 2006-2012 Lexapro 20mg, 2 failed attempts to stop, tapered over 4.5 months in early 2012

January 2013 started Sertraline, over time worked up to 100mg

July 2014 Sertraline dropped from 100mg to 75mg, held for six months, slower tapering until 2019 22 Dec 3.2mg

2020 Sertraline 19 Jan 3.1mg, 26 Jan 3.0mg; 1 Mar 2.9, 7 Mar 2.8, May (some drops here) 24 May 2.5, May 29 2.4, June 21 2.3, June 28 2.2mg,  July 4 2.1mg, July 24 (or maybe a bit before) 2mg, early Nov switched to home made suspension; 29 Nov 1.8mg; approx 25 Dec 1.6mg)

2021 Some time in about Jan/Feb realised my dosing was off and as probably on more like 1.8mg and possible mixing error in making suspension; doses after 10 Feb accurate; 10 Feb 1.6mg; 7 Mar 1.4

 

My thread here at SA: https://www.survivingantidepressants.org/topic/1775-bubbles/page/17/

CurrentSertraline: 7 Mar 1.4mg / Armour Thyroid / endless allergy meds, erg

 

 

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He does NOT say that antidepressants have replaced Xanax for treatment purposes. He says antidepressants replaced benzos in pharmaceutical company marketing plans.

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

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

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From the book -- comparing Xanax and SSRI withdrawal:

 

Chapter 6 THE ASHTON MANUAL

....Ashton notes that the rate of withdrawal, as long as it is slow enough, is not critical. Whether it takes 6 months, 12 months or 18 months is of little significance if you have taken benzodiazepines for a matter of years. Over time that Xanax causes significant adverse effects and indefinite use of Xanax is likely to cause problems. Eventual success in withdrawal is not affected by duration of use, dosage, rate of withdrawal, severity of symptoms, psychiatric diagnosis, or previous attempts at withdrawal. Patients who have been taking Xanax for 10 or 20 years at substantial dosages can still stop it. I cannot say the same for antipsychotic medications or serotonin specific antidepressants, often referred to as SSRIs, (Zoloft, Paxil, Prozac, Celexa, Lexapro, Effexor, Cymbalta, Luvox) in which successful withdrawal becomes increasingly unlikely with increasing dosage and increasing duration of taking the drug. It is important to note that an unsuccessful attempt to stop taking Xanax does not mean that the patient will not be successful on subsequent withdrawal.

 

....

Chapter 7 COMMENTS ON PROTRACTED WITHDRAWAL SYNDROMES

Protracted withdrawal syndromes involve prolonged and often more intense withdrawal symptoms lasting for a year or sometimes several years after stopping the last pill. Some withdrawal symptoms do take longer than others to resolve. For example, withdrawal related neuropathies (numbness or tingling in extremities or skin) typically take months to resolve. Ashton writes about symptoms of neuropathy, muscle pain, cognition and gastrointestinal disturbance sometimes lasting years, and she estimates that this occurs about 10 -15 percent of the time.

 

There is no central databank to report withdrawal symptoms similar to the databanks which collect reports of adverse effects while a person is still taking the drug. Withdrawal that lasts a year or two – or longer after stopping a drug, indicates that the drug has had a toxic effect which is taking a long time to heal. It may be that what is called protracted withdrawal is quite different than what is typically thought of as a withdrawal phenomenon.

 

I have not yet seen a patient in my own practice with a protracted benzodiazepine withdrawal syndrome. On the other hand, protracted SSRI withdrawal syndromes are quite common in my practice. In a personal email communication Breggin he wrote that, in his experience, protracted withdrawal is rare and found in individuals with high dosages of benzodiazepines used over long periods of time. Similarly Ashton notes that many patients with protracted withdrawal have taken benzodiazepines for 20 years or more, and had bad experiences in withdrawal.

 

My assumption is that my patient population was less predisposed to protracted withdrawal. There are several confounding factors relating to my practice which might explain this difference. Perhaps the most important of these factors is that most of the patients I have helped to withdraw from Xanax have only been using the drug regularly for five years or less....

 

....

Often Xanax or other benzodiazepines are prescribed along with a SSRI antidepressant. Almost all of my patients were on a Xanax alone, and were not also taking SSRI antidepressants. Xanax, and other benzodiazepines can be useful in reducing side effects of the SSRI antidepressants such as restlessness and jitteriness (akathisia) as well as SSRI induced anxiety, irritability and tremor. It is common to find Xanax prescribed along with a SSRI. Also, I find that Xanax and the benzodiazepines are the best medications to use to ameliorate symptoms of SSRI withdrawal. Xanax can mask many of the symptoms of SSRI antidepressant related side effects and antidepressant related withdrawal effects. I strongly suspect that, for at least some patients, the difficult and protracted withdrawal relates ultimately to unmasking of antidepressant-induced side effects, withdrawal effects or neurotoxicity, which had been partially ameliorated with the Xanax.

 

Many of the reported difficulties with prolonged Xanax withdrawal are in patients who were already having problems with SSRI type antidepressants prior to stopping Xanax....

 

Ashton writes that a high percentage of her patients who were on benzodiazepines were also prescribed antidepressants. It is unclear whether Ashton’s relatively high rate of observed protracted withdrawal symptoms may have related to use of antidepressants.

 

After reading of such experiences on the Internet patients may have a disproportionate fear of protracted withdrawal but fortunately this is not a common occurrence.

 

Chapter 8 PHYSICIAN SUPERVISION

....

The worst outcomes occur when a doctor rapidly substitutes another class of drug such as buspirone, or an antipsychotic or an antidepressant for Xanax. This occurs when the physician mistakenly believes that the issue in successful Xanax withdrawal is not so much about treating Xanax dependency as it is about treating the “underlying” anxiety with another category of drug. They mistakenly believe that the patient can’t stop the drug because of their illness and not because of addiction to Xanax. What occurs is worse than stopping Xanax cold turkey because, in addition to abrupt Xanax withdrawal, there will also be side effects from the new drug. The constellation of side effects and withdrawal effects are often subsequently misdiagnosed as a bipolar disorder, leading to prescription for mood stabilizers such as lithium and depakote – and often more benzodiazepines as well....

 

....

Chapter 20 POST SCRIPT

“One of the first duties of the physician is to educate the masses not to take medicine.”

William Osler, M.D. (circa 1910)

 

Xanax is just one of a long line of medications sold to the public as a new, safe, miracle drug which in reality is of dubious long term therapeutic value and comes with extraordinary side effects, particularly dependency. I think that it is safe to say that there never has been and never will be a mood/mind altering drug that does not cause dependency.

 

SSRIs, the supposedly nonaddicting alternative to benzodiazepines are now known to cause serious withdrawal syndromes. Right now, the latest, newest category of supposedly nonaddicting psychiatric medication are the antipsychotics, such as Abilify, Zyprexa, Risperdal and Seroquel prescribed casually for depression, anxiety and insomnia. My limited experience with antipsychotic withdrawal has taught me that these drugs have complex and powerful withdrawal reactions of their own which are poorly understood.

 

The issue of prolonged withdrawal deserves more careful attention. Withdrawal is thought of as a series of symptoms that occur for a week or two after stopping a drug while it washes out of a person’s system. If, however, it is a cluster of symptoms persisting for a year or two after stopping a drug, then a more accurate description of the phenomenon would be a neurotoxic effect and not a withdrawal effect. While it is fairly easy to make a report to the FDA about a drug’s side effects, there is no way to report symptoms of a withdrawal reaction and no way to report a prolonged withdrawal reaction. Most medication education has come directly or indirectly from pharmaceutical companies who are unlikely to carefully study the long term adverse reactions of a drug that they promote.

 

It is important for the patient to realize that tolerance, dependency and side effects are most likely going to occur with any psychiatric drug, not just Xanax, and to take this into consideration before committing to a course of treatment with psychiatric medication.

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

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

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Thanks, Alto, just what I was wondering about. Interesting.

2005 St John's Wort / 2006-2012 Lexapro 20mg, 2 failed attempts to stop, tapered over 4.5 months in early 2012

January 2013 started Sertraline, over time worked up to 100mg

July 2014 Sertraline dropped from 100mg to 75mg, held for six months, slower tapering until 2019 22 Dec 3.2mg

2020 Sertraline 19 Jan 3.1mg, 26 Jan 3.0mg; 1 Mar 2.9, 7 Mar 2.8, May (some drops here) 24 May 2.5, May 29 2.4, June 21 2.3, June 28 2.2mg,  July 4 2.1mg, July 24 (or maybe a bit before) 2mg, early Nov switched to home made suspension; 29 Nov 1.8mg; approx 25 Dec 1.6mg)

2021 Some time in about Jan/Feb realised my dosing was off and as probably on more like 1.8mg and possible mixing error in making suspension; doses after 10 Feb accurate; 10 Feb 1.6mg; 7 Mar 1.4

 

My thread here at SA: https://www.survivingantidepressants.org/topic/1775-bubbles/page/17/

CurrentSertraline: 7 Mar 1.4mg / Armour Thyroid / endless allergy meds, erg

 

 

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This is scaring the crap out of me. Maybe I should scrap my long-term plan to withdraw from Lexapro? I've been taking ADs (SSRI or SNRI) almost continuously for 20 years. Oh god how I wish I could go back and start this whole thing over so I could do it right.

 

Sparrow

2009-2011: tapered off Trazodone, Namenda, Lamictal, Dextroamphetamine, Zyprexa; cold-turkeyed Pristiq; reduced Lexapro dose 50%.
On clonazepam since 2004, 0.5 - 1.0 mg daily PRN. Three failed (too rapid) partial tapers, 2010 - 2011.
Dec. 2011 - March 2013: Tapered off 0.5 mg clonazepam (Klonopin)

August 2013: Switched to liquid escitalopram (Lexapro) and began tapering from 10 mg.

January 2014: 4.5 mg escitalopram

March 2014: One year off benzos

May 2014: 3.0 mg escitalopram

June 2014: severe depression, updosed to 4.0 mg

Sept 1, 2014: 2.7 mg

Dec 7, 2014: Can't get below 2.5 mg without unbearable symptoms. Doing an extended hold (I hope)

March 2015: TWO YEARS POST-BENZO

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Barbarannamated

Dr. Shipko is a very wise man. I admire his willingness to state in writing what other physicians are afraid to admit, maybe even to themselves.

Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc).

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Yeah, I knew that part would be scary, Sparrow. But it's actually something that's long been suspected about antidepressants -- the longer you're on them, the harder it is to get off them.

 

What he's saying is the cases of prolonged antidepressant withdrawal syndrome he's seen have been associated with long-term use. He's not saying prolonged withdrawal syndrome is inevitable for people who have been taking antidepressants long-term.

 

We have people here who have successfully gone off long-term antidepressants.

 

(Note that he's caved in and is using the term "prolonged withdrawal syndrome." We've debated for years about that.)

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

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

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For what it's worth, from what I've seen, the people who have prolonged withdrawal syndrome fall in these groups:

  • Had immediate adverse reactions to antidepressants. These are people who are genetically hypersensitive to serotonergics, including LSD and MDMA ("bad trips"). Although they might have been on the medications for only a few days, they suffer prolonged symptoms very similar to withdrawal syndrome for a long time after that.
  • Always had adverse reactions to antidepressants, but stayed on them anyway.
  • People who cold-turkeyed.
  • People who tapered too fast, over weeks rather than months.
  • People who have been on multiple psych drugs for a long time, and tapered off any of them too fast.
I have not see a definite relationship between length of time on the drugs and prolonged withdrawal syndrome. I've seen people who have been on medications since childhood taper off successfully.

 

As Drs. Shipko, David Healy, and Peter Breggin have observed, there are a small number of people who have difficulty tapering at any rate and may never be able to go completely off. I spoke to a knowledgeable doctor recently about this and he was confident that eventually he would be able to find the right "bridge" for these people. (Prozac works as a bridge off antidepressants for most people.)

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

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

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Interesting. Let me know if he says anything radical and new. I don't know if I want to read it--my Xanax withdrawal is going well, as is my whole withdrawal program, and I kind of don't want to mess with that or introduce self-doubt.

 

Personally I'm finding it not really that difficult to taper the Celexa, either, even though I've been on ADs of one kind or another for most of 21 years, and CT'd several of them several times over those years. I mean, I did almost everything wrong at one time or another. That's how I ended up in the hospital.

 

I think it's how slow I'm going. By slow I mean, in two and a half years I'm down from 10 mg to 3.1 mg. Seems to be working fine, no problems that I can detect so far. Should I be worried?

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

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

 

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

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

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

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

2/12/20             12                       0.045               0.007                   1 

 

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

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Nope, that's how it should work, Rhi.

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

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

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For what it's worth, from what I've seen, the people who have prolonged withdrawal syndrome fall in these groups:

  • Had immediate adverse reactions to antidepressants. These are people who are genetically hypersensitive to serotonergics, including LSD and MDMA ("bad trips"). Although they might have been on the medications for only a few days, they suffer prolonged symptoms very similar to withdrawal syndrome for a long time after that.
  • Always had adverse reactions to antidepressants, but stayed on them anyway.
  • People who cold-turkeyed.
  • People who tapered too fast, over weeks rather than months.
  • People who have been on multiple psych drugs for a long time, and tapered off any of them too fast.
I have not see a definite relationship between length of time on the drugs and prolonged withdrawal syndrome. I've seen people who have been on medications since childhood taper off successfully.

 

My 2 cents.

 

I've cold-turkeyed from Prozac back in the days without any problem, but I was relatively "new" to psychotropics at that time.

 

I've cold-turkeyed from Xanax, Zyprexa (but I took it only for a week or so, so maybe it doesn't count) and Wellbutrin without any problem, but I was still on a SSRI at the same time, so maybe it "masked" the withdrawal symptoms.

 

I've cold-turkeyed from Daparox two years ago and I had some bad reactions from it, but not nearly as bad as Cymbalta's ones.

 

So my gut feeling is that time, but also drugs pharmacokinetics/pharmacodynamics do influence the magnitude of the withdrawal syndrome.

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Frank, there's a wide range of experiences with quitting psychiatric medications.

 

Many people find they can quit quickly or even cold-turkey with few or no withdrawal symptoms.

 

However, this catches up with you, as you can see. Even if you've cold-turkeyed before without a problem, you can't predict if you'll be able to cold-turkey again.

 

There is some evidence that going on and off psychiatric medications, even if no withdrawal symptoms are observed, sensitizes the nervous system and makes you more prone to withdrawal syndrome and adverse reactions if you take additional psychiatric drugs.

 

The nervous system is not made of rubber, although the psychiatric drug culture treats it as so. It is not endlessly elastic. Every time you take one of these drugs, it leaves a footprint behind, distorting your natural functioning.

 

When it comes to psychiatric drugs, the less, the better. Eventually this will be understood, but in the meantime millions of people are being medicated unnecessarily and set up for nervous system fragility.

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

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

All postings © copyrighted.

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Interesting. Let me know if he says anything radical and new. I don't know if I want to read it--my Xanax withdrawal is going well, as is my whole withdrawal program, and I kind of don't want to mess with that or introduce self-doubt.

 

Personally I'm finding it not really that difficult to taper the Celexa, either, even though I've been on ADs of one kind or another for most of 21 years, and CT'd several of them several times over those years. I mean, I did almost everything wrong at one time or another. That's how I ended up in the hospital.

 

I think it's how slow I'm going. By slow I mean, in two and a half years I'm down from 10 mg to 3.1 mg. Seems to be working fine, no problems that I can detect so far. Should I be worried?

 

I bought his ebook which I found informative and a welcome addition to the literature. I've said this before, but I've yet to meet a mental health professional familiar with Heather Ashton's name. This subject needs exposure. Hope this book helps.

 

Alto has excerpted several passages of interest.

 

If my taper was working well, I'd continue as is. Dr. Shipko argues that patients need to assume a significant amount of managerial responsibility in a proper taper, as the rate of taper should not exceed the patients ability to accept the reductions. I suppose, a better way to say this is that doctor flexibility in response to patient input is a necessity.

"Well my ship's been split to splinters and it's sinking fast
I'm drowning in the poison, got no future, got no past
But my heart is not weary, it's light and it's free
I've got nothing but affection for all those who sailed with me.

Everybody's moving, if they ain't already there
Everybody's got to move somewhere
Stick with me baby, stick with me anyhow
Things should start to get interesting right about now."

- Zimmerman

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Frank, there's a wide range of experiences with quitting psychiatric medications.

 

Many people find they can quit quickly or even cold-turkey with few or no withdrawal symptoms.

 

However, this catches up with you, as you can see. Even if you've cold-turkeyed before without a problem, you can't predict if you'll be able to cold-turkey again.

 

There is some evidence that going on and off psychiatric medications, even if no withdrawal symptoms are observed, sensitizes the nervous system and makes you more prone to withdrawal syndrome and adverse reactions if you take additional psychiatric drugs.

 

The nervous system is not made of rubber, although the psychiatric drug culture treats it as so. It is not endlessly elastic. Every time you take one of these drugs, it leaves a footprint behind, distorting your natural functioning.

 

When it comes to psychiatric drugs, the less, the better. Eventually this will be understood, but in the meantime millions of people are being medicated unnecessarily and set up for nervous system fragility.

 

Alto,

 

don't get me wrong, I wasn't disagreeing with you:) Quite the contrary.

 

I was just stating that in my humble opinion some drugs are a little bit "easier" (forgive me for this term) to discontinuate than others, due to their intrinsic pharmacokinetics/dinamics. Prozac for example has a longer half-life and acts on only one neurotransmitter, while SNRIs have a shorter half-life and act on two of them, so probably they create even more mess when they are taken off because the internal balance of the nervous system is even more disrupted.

 

With that said, I didn't intend in any shape or form to belittle the harshness of the withdrawal experience of anyone.

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Prozac seems to have a better track record than the others, but still there are people who have difficulty reducing Prozac as well.

 

We really can't take anything for granted about what's known about withdrawal. Much of the literature is contaminated by pharma interests, who made a huge effort to downplay how difficult it might be to go off psychiatric drugs.

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

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

All postings © copyrighted.

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I absolutely, definitely think from my experience that each time you reduce you sensitise your nervous system a bit more... i think it loses it's resilience - not to say that it won't recover over time, but the first few times i got off effexor i didn't have w/d anxiety for 4 months - now i can get it when i am still on - just reducing.

Started in 2000 - On 150mg most of the time, (but up to 225mg at highest dose for 6 months in the beginning)
Reduced off easily first time - but got depressed (not too much anxiety) 6 months later
Back on effexor for another 9 months.
Reduced off again with no immediate w/d - suddenly got depressed and anxious ++ again 3 or 4 months later.
Back on effexor - this time for 3 years
Reduced off over a month - 6 weeks later terrible anxiety - back on.
Rinse and repeat 4 more times - each time the period before the anxiety comes back got shorter and shorter
Jan - July 2012 75mg down to 37.5mg;, 8/3/12 - 35mg. 8/25/12 - 32mg. 9/11- 28mg, 10/2 - 25mg, 10/29 - 22mg, 11/19 - 19.8mg; 12/11 - 17m,
1/1- 15.5mg; 1/22 -14mg, 2/7 14.9mg, 2/18 - 17.8mg - crashed big time: back to 75mg where i sat for 2 years....

4th  March 2015 - 67.5mg;   31st March - 60mg;  24th April - 53mg; 13th May - 48mg; 26th May - 45mg;  9th June - 41mg; 1 July- 37.5mg; 20 July - 34mg; 11 August - 31mg; 1st Sept - 28mg;  1st Dec - 25.8mg;  28th Dec - 23.2mg; 23rd Jan-21.9mg; Feb 7th- 21mg; March 1st - 20.1mg, March 30th - 18mg

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  • 6 months later...

I re-read Shipko's ebook on Xanax tapering the other day. I found his experience with benzo withdrawal helpful and am glad he published his findings.

 

Has anyone else bought it?

 

Alex

"Well my ship's been split to splinters and it's sinking fast
I'm drowning in the poison, got no future, got no past
But my heart is not weary, it's light and it's free
I've got nothing but affection for all those who sailed with me.

Everybody's moving, if they ain't already there
Everybody's got to move somewhere
Stick with me baby, stick with me anyhow
Things should start to get interesting right about now."

- Zimmerman

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  • 8 months later...
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i read it tonight in one go so just very quick reflections.

 

It's remarkable that a doctor would so honetyl and openly admit to his mistakes and being misled by pharma.

 

I found it a very helpful reading altogether. Especialyl combined with the Ashton manual. Where I find it lacking is insisting that the patience he helped withdrew were typically on Xanax around 5 years or less and weren't at the same time taking any other psychiatric medication. Maybe I misread it because he does say that people are soemtime son Xanax for over 20 years and are usually on AD as well, he doesn't seem to address that challenge.

Current: Xanax 0.26 (down from 2 mg in 2013), Lexapro 2.85 mg (down from 5 mg 2013)

Amitriptyline (tricyclic AD) and clonazepam for 3 months to treat headache in 1996 
1999. - present Xanax prn up to 3 mg.
2000-2005 Prozac CT twice, 2005-2010 Zoloft CT 3 times, 2010-2013 Escitalopram 10 mg
went from 2.5 to zero on 7 Aug 2013, bad crash 40 days after
reinstated to 5 mg Escitalopram 4Oct 2013 and holding liquid Xanax every 5 hours
28 Jan 2014 Xanax 1.9, 18 Apr  2015 1 mg,  25 June 2015 Lex 4.8, 6 Aug Lexapro 4.6, 1 Jan 2016 0.64  Xanax     9 month hold

24 Sept 2016 4.5 Lex, 17 Oct 4.4 Lex (Nov 0.63 Xanax, Dec 0.625 Xanax), 1 Jan 2017 4.3 Lex, 24 Jan 4.2, 5 Feb 4.1, 24 Mar 4 mg, 10 Apr 3.9 mg, May 3.85, June 3.8, July 3.75, 22 July 3.7, 15 Aug 3.65, 17 Sept 3.6, 1 Jan 2018 3.55, 19 Jan 3.5, 16 Mar 3.4, 14 Apr 3.3, 23 May 3.2, 16 June 3.15, 15 Jul 3.1, 31 Jul 3, 21 Aug 2.9 26 Sept 2.85, 14 Nov Xan 0.61, 1 Dec 0.59, 19 Dec 0.58, 4 Jan 0.565, 6 Feb 0.55, 20 Feb 0.535, 1 Mar 0.505, 10 Mar 0.475, 14 Mar 0.45, 4 Apr 0.415, 13 Apr 0.37, 21 Apr 0.33, 29 Apr 0.29, 10 May 0.27, 17 May 0.25, 28 May 0.22, 19 June 0.22, 21 Jun updose to 0.24, 24 Jun updose to 0.26

Supplements: Omega 3 + Vit E, Vit C, D, magnesium, Taurine, probiotic 

I'm not a medical professional. Any advice I give is based on my own experience and reading. 

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A couple of things that hit me when I read this a couple of months ago: He said he'd taken about 70 patients off....that seems like a small number...and he's an expert. No wonder the regular pdocs are clueless (and many other reasons). He is not nearly as stringent as we are with ourselves...if you feel lousy, just take a bit more medication. If this isn't working, try again in a year or two. Relapse is very low...the withdrawal process is the ultimate behavioral modification plan.

 

He does say coming off is more difficult if the patient has been exposed to an antidepressant or antipsychotic. His Mad in America article about antidepressant withdrawal was more grim.

1st round Prozac 1989/90, clear depression symptoms. 2nd round Prozac started 1999 when admitted to dr. I was tired. Prozac pooped out, switch to Cymbalta 3/2006. Diagnosed with bipolar disorder due to mania 6/2006--then I was taken abruptly off Cymbalta and didn't know I had SSRI withdrawal. Lots of meds for my intractable "bipolar" symptoms.

Zyprexa started about 9/06, mostly 5mg. Tapered 4/12 through12/29/12

Wellbutrin. XL 300 mg started 1/07, tapered 1/18/13 through 7/8/13

Oxazepam mostly continuously since 6/06, 30mg since 12/12, tapered 1.17.14 through 8.26.15

11/06 Lithium 600mg twice daily, 2.2.14 400mg TID DIY liquid, 2.12.14 1150mg, 3.2.14 1100mg, 3.18.14 1075mg, 4/14 updose to 1100mg, 6.1.14 900 mg capsules 7.8.14 810mg, 8.17.14 725mg, 8.24.24 700mg...10.22.14 487.5mg, 3.9.15 475mg, 4.1.15 462.5mg 4.21.15 450mg 8.11.15 375mg, 11.28.15 362.5mg, back to 375mg four days later, 3.4.16 updose to 475 (too much going on to risk trouble)

9/4/13 Toprol-XL 25mg daily for sudden hypertension, tapered 11.12.13 through 5.3.14, last 10 days or so switched to atenolol

7.4.14 Started Walsh Protocol

56 years old

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