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No doctors receive any formal education in safe withdrawal from psychiatric drugs


Mark840
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Hello all,

 

Does anyone know supporting references for the statement below from https://withdrawal.theinnercompass.org/page/about-withdrawal-project ?

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Virtually no doctors or psychiatrists receive any formal education or training in safe withdrawal from psychiatric drugs, and there are currently no established clinical protocols for guiding safe withdrawal.

 

September-December 2012; Cymbalta (60mg), Zyprexa (1.25 mg), Lexappo (5 mg), Wellbutrin SR (150mg) 

December 2012-April 2013; Lithium Carbonate Tab (150mg), Wellbutrin SR (150mg), Rivotril (1mg)

May 2013-February 2015; unable to trace record

March 2015-September 2020; Cymbalta (60mg), Seroquel XR (50mg), Rivotril Tab (0.5mg)

September-October 2021; Cymbalta (60mg), Quentiapine (50mg)(IR), Rivotril Tab (0.5mg, when needed)

November 2021-January 2022; Ceased medicine voluntarily beginning of November 2022. All was well until a friend offended me with an insensitive remark that lasted longer than usual and I became sensitive.

End of January 2022; I resumed medicine but with Cymbalta (30mg) on 29 January 2022.

End of February 2022; doctor replaced Cymbalta (30 mg) with Remeron (15 mg), as Cymbalta now caused sleepless nights.

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@Mark840

Uk Nice guidelines are slowly changing for the better. 
 

Some or their withdrawal advice is “safe” but may be very uncomfortable. 
 

OD 

My Intro topic.  Was Dickie in FB gabapentinoids 

2020 January Stopped Quetiapine 150 at night in a fairly chaotic fashion with holds, jumping at 6mg 

2020 June Stopped Pregabalin 150 at night using Ashton Method Some holds. 

2021 December Stopped Mirtazipine 15 using Ashton Method. (Slower at end). 

Nov 21 - Given Quetiapine 12.5 for sleep. Reduced mid March 2022 to 6mg - Off 30/5/22

Feb 2022 Ongoing Diazepam 17.5, Blip at Christmas when took 22.5mg for a few days, now 24 FEB Stable 17.5 as advised. Had long covid. Now going to 16.25 from 8/7/22. 7% drop 

Oxazepam 10mg.STOPPED 10th FEB 2022  “Rescue dose x 2 in 2 months. 

Buccastem 3mg less than 1 a month for nausea. 

Past meds since 1969 -Approx dates only available. Tranxene 15, Clomipramine 150 for about 25 years. 1993 Paroxetine 20 AD change. Diazepam 20mg swap from Tranxene.

Oxazepam 10mg Prn since 1990's  1995 Trial of MAOIS. 2000 Escitaopram 10mg. 2015 trial of Trazadone. 2004 Pregabalin 150 at night.

2015 Started on Quetiapine 150 note, Mirtazipine 15 note. Diazepam increased to 30mg split dosing. 

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@Mark840

 

Maybe one way to think about it is, what information and training do most doctors and medical students receive? (It can be difficult to prove a negative.)

If you look at the inserts in drug packets, for example, doctors have access to that same marketing material concocted by Big Pharma. 

 

Personally I've never had a doctor tell me anything i wasn't able to read myself in the official Pharma-issued write-up. 

I don't know what the psych-drug curriculum is in medical school but would be curious to find out to what extent non-commercially motivated science is presented. 

 

You might also check out Dr. Mark Horowitz' story. From his website:

 

When I tried to come off this antidepressant over 4 months I received a very abrupt education into antidepressant withdrawal symptoms. (....) I had experienced nothing like it before.

 

It was also something that I had not been taught about at medical school or in psychiatry training. I soon learnt by reading the academic literature available that the psychiatrists and academics at the institution I had studied at and others like them around the world had little helpful to say about withdrawal effects from antidepressants – they recommended stopping the drugs over 2 to 4 weeks, and reported that the symptoms were mild and brief. Many prominent academics with close ties to pharmaceutical companies attacked academics and patients who complained of trouble coming off their antidepressants, accusing them of malingering, or seeking legal payments.  

1996-2018 - misc. polypharmacy, incl. SSRIs, SNRIs, neuroleptics, lithium, benzos, stimulants, antihistamines, etc. (approx. 30+ drugs)

2012-2018 - 10mg lexapro/escitalopram (20mg?)    Jan. 2018 - 10mg -> 5mg, then from 5mg -> 2.5mg, then 0mg  -->  July 2018 - 0mg

2017(?)-2020 - vyvanse/lisdexamfetamine 60-70mg    2020-2021 - 70mg down to 0mg  -->  July 2021 - 0mg

March-April 2021 - vortioxetine 5-10mg (approx. 7 weeks total; CT)  -->  April 28th, 2021 - 0mg

supplements: magnesium powder (dissolved in water) as needed throughout the day; 1 tsp fish oil w/ morning meal; 2mg melatonin 9pm 

August 1, 2022 - 1 mg melatonin, approx. 10:30pm

 

Courage is fear that has said its prayers.  - Karle Wilson Baker

love and justice are not two. without inner change, there can be no outer change; without collective change, no change matters.  - Rev. angel Kyodo williams

Holding multiple truths. Knowing that everyone has their own accurate view of the way things are.  - text on homemade banner at Afiya house

 

I am not a medical professional; this is not medical advice. 

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I have recently changed to a low carb/keto lifestyle and have been listening to a lot of videos and podcasts.

 

Doctors receive very little training in nutrition.

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

 

MISSION ACCOMPLISHED:    (6 year taper)      0mg Pristiq      on 13th November 2021

Woohoo!!!  Finally off Pristiq    Post 0 updates start here

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

My full tapering program     My Intro (goes to my tapering graph)    My website

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.  Please DO NOT TAG me - thank you.

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On 6/25/2022 at 8:36 PM, ChessieCat said:

I have recently changed to a low carb/keto lifestyle and have been listening to a lot of videos and podcasts.

 

Doctors receive very little training in nutrition.

This. It wasn't until recently that I realized every time I went to a doctor for broad spectrum issues they never once asked about diet.

 

No energy in the morning? Instead of lowering caffeine intake during the whole day, how about a stimulating AD like wellbutrin.

 

Cholesterol borderline elevated? Instead of cutting back on unhealthy fats and high cholesterol foods, how about a statin?

 

Heartburn from greasy or acidic foods? Instead of asking what the patient eats or if they are willing to change their diet, how about a proton pump inhibitor first?

 

Rampant headaches? Instead of finding out if you are well hydrated, eating well, and practicing good stress management, how about an rx for extra strength ibuprofen?

 

Doctors seem to be generally more geared to treatment of symptoms over treatment of causes. And it isn't entirely their fault. In today's societies people expect instant relief to what ails them without any sacrifice or lifestyle changes on their own part. Many have come to expect every cure to come in pill form.

 

Symptoms should be viewed as the body's check engine light. Most meds prescribed just turn off the check engine light and fail to address the problem that caused it to come on to begin with.

2008: March, Klonopin .5 mg to 1 mg

2009: Dec, CT Klonopin

2010: full year heavy alcohol use

2011: Jan - withdrawals start

2012: Apr- bad wave, start zoloft 50

2014 to 2020: Switch ADs

Sertraline 100mgs >Lexapro 20 mgs>Prozac 20 mgs >Lexapro 20

2021: Sertraline 25 mgs

2022: Mar. Cut dose down to 12.5

End of May, starting to crash physically/mentally.

 

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As to the main issue of this topic. I do believe that Doctors do follow withdrawal guidelines for psych meds. It's just that those guidelines are suggested by the makers of said drugs.

 

Most are familiar with acute withdrawal but don't acknowledge the possibility of post-acute withdrawal showing up months after discontinuation. Not to mention that there are also people who are able to stop psych meds with little trouble. The few that can are held up as the standard and those that suffer tend to be viewed as outliers or diagnosed as relasped.

 

They need to look at the empirical evidence of PAWS that can be found in people who are prescribed drugs for off-label use.

 

If a patient with no history of anxiety or depression is prescribed a benzo or AD for help with sleep, but ends up with anxiety or depression weeks to months after discontinuation of those meds, that should be a red flag that the med withdrawal was the cause of their newfound issues. Instead, people get diagnosed with new anxiety or depression disorders that they never had prior to going on these meds for off-label use. And thus starts the merry-go-round of psych meds.

 

Listen to the interview that Alto did regarding her withdrawal. Doctors were literally saying her brain zaps were from relapse, which makes no sense because she didn't go on Paxil for treatment of brain zaps.

2008: March, Klonopin .5 mg to 1 mg

2009: Dec, CT Klonopin

2010: full year heavy alcohol use

2011: Jan - withdrawals start

2012: Apr- bad wave, start zoloft 50

2014 to 2020: Switch ADs

Sertraline 100mgs >Lexapro 20 mgs>Prozac 20 mgs >Lexapro 20

2021: Sertraline 25 mgs

2022: Mar. Cut dose down to 12.5

End of May, starting to crash physically/mentally.

 

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  • 1 month later...

Thanks @Kaervin. It's been a while but I'd like to ask what PAWS stands for though.

September-December 2012; Cymbalta (60mg), Zyprexa (1.25 mg), Lexappo (5 mg), Wellbutrin SR (150mg) 

December 2012-April 2013; Lithium Carbonate Tab (150mg), Wellbutrin SR (150mg), Rivotril (1mg)

May 2013-February 2015; unable to trace record

March 2015-September 2020; Cymbalta (60mg), Seroquel XR (50mg), Rivotril Tab (0.5mg)

September-October 2021; Cymbalta (60mg), Quentiapine (50mg)(IR), Rivotril Tab (0.5mg, when needed)

November 2021-January 2022; Ceased medicine voluntarily beginning of November 2022. All was well until a friend offended me with an insensitive remark that lasted longer than usual and I became sensitive.

End of January 2022; I resumed medicine but with Cymbalta (30mg) on 29 January 2022.

End of February 2022; doctor replaced Cymbalta (30 mg) with Remeron (15 mg), as Cymbalta now caused sleepless nights.

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@Mark840

 

PAWS = Post-Acute Withdrawal Syndrome

 

See also:

 

1996-2018 - misc. polypharmacy, incl. SSRIs, SNRIs, neuroleptics, lithium, benzos, stimulants, antihistamines, etc. (approx. 30+ drugs)

2012-2018 - 10mg lexapro/escitalopram (20mg?)    Jan. 2018 - 10mg -> 5mg, then from 5mg -> 2.5mg, then 0mg  -->  July 2018 - 0mg

2017(?)-2020 - vyvanse/lisdexamfetamine 60-70mg    2020-2021 - 70mg down to 0mg  -->  July 2021 - 0mg

March-April 2021 - vortioxetine 5-10mg (approx. 7 weeks total; CT)  -->  April 28th, 2021 - 0mg

supplements: magnesium powder (dissolved in water) as needed throughout the day; 1 tsp fish oil w/ morning meal; 2mg melatonin 9pm 

August 1, 2022 - 1 mg melatonin, approx. 10:30pm

 

Courage is fear that has said its prayers.  - Karle Wilson Baker

love and justice are not two. without inner change, there can be no outer change; without collective change, no change matters.  - Rev. angel Kyodo williams

Holding multiple truths. Knowing that everyone has their own accurate view of the way things are.  - text on homemade banner at Afiya house

 

I am not a medical professional; this is not medical advice. 

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On 6/25/2022 at 4:45 PM, Mark840 said:

Virtually no doctors or psychiatrists receive any formal education or training in safe withdrawal from psychiatric drugs, and there are currently no established clinical protocols for guiding safe withdrawal.

 

On 6/25/2022 at 7:54 PM, Ariel said:

I don't know what the psych-drug curriculum is in medical school but would be curious to find out to what extent non-commercially motivated science is presented. 

Hi @Mark840 and @Ariel, I know it is an old post, but I got curious. In Denmark the GP-curriculum relating to psychiatric disorders is 17,5 ECTS (a full academic year is 60 ECTS). Beyond that they get 5 ECTS for general neurobiology, and another 10 points for courses relating to the CNS (mostly the sensory side of things). So all in all: Half a semester relating to psychiatric disorders, and another half a semester relation to CNS and general neurobiology. https://sund.ku.dk/uddannelse/for-studerende/studieordninger/medicin/ (danish). 

What worries as much is that you future doctor only a statistics course amounting to 10 ECTS. You simply can't learn statistics on any meaningful level in 1/3 of a semester. And that means future GPs ability to evaluate quantitive information in scientific papers about diseases and treatments is practically nill. 

 

2004: (apr): Citalopram 20 mg, June 60 mg., dec 20 mg

2004 (dec): Mirtazapine 15 mg.

2014 (Jun): Citalopram stop cold turkey. Began 10 mg Vortioxetine

2017: (dec): Mirtazapine 15 mg ->30 mg (after three day stint on psych ward)

2020: (aug): Vortioxetine 10 mg stopped cold turkey. 

2020 (dec): Mirtazapine 30 mg -> 15 mg (GPs instructions)

2021 (feb): Mirtazapine reinstatement 26,25 mg

2022 (Jan): Mirtazapine (5% taper): 14. Jan 24,9 mg, 6. feb 23,7 mg, 1. marts 22,5 mg, 15. marts 21,3 mg, 2. april 20 mg, 26. april 19. mg, 25. may 18.1 mg, 26 jun 17 mg - HOLD UNTIL I AM IN PHYSICAL SHAPE.

 

Have always taken fish oil capsules. Do not drink alcohol when tapering. 1 multivitamin pill a day. Try to eat healthy, but impossible on mirtazapine.

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