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Belaise, 2012 Patient Online Report of Selective Serotonin Reuptake Inhibitor-Induced Persistent Postwithdrawal Anxiety and Mood Disorders

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A study of prolonged antidepressant withdrawal syndrome, based on online reports, has just been published. Free access and full text at http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowAbstract&ArtikelNr=341178&Ausgabe=257398&ProduktNr=223864

 

Psychother Psychosom. 2012;81(6):386-8. doi: 10.1159/000341178. Epub 2012 Sep 6.

Patient online report of selective serotonin reuptake inhibitor-induced persistent postwithdrawal anxiety and mood disorders.

Belaise C, Gatti A, Chouinard VA, Chouinard G.

 

aDepartment of Psychology, University of Bologna, Bologna, Italy; b Massachusetts General Hospital/McLean Adult Psychiatry Residency, Training Program, Harvard Medical School, Boston, Mass., USA; and cDepartments of Psychiatry and Medicine, McGill University, Montreal, Que., Canada

 

Abstract and full text at http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowAbstract&ArtikelNr=341178&Ausgabe=257398&ProduktNr=223864 and http://www.ncbi.nlm.nih.gov/pubmed/22964821

 

Recently, Schifano et al. [1] analyzed online self-reporting of misuse of pregabalin, and found psychedelic dissociative effects induced by pregabalin in this selected population of drug abusers, information that apparently can only be obtained at least initially through online self-reporting studies [1].

 

In the present study, we analyze online self-reporting from a variety of websites visited by patients who had discontinued selective serotonin reuptake inhibitor (SSRI) antidepressants and were reporting, spontaneously on those internet forums, significant withdrawal symptoms and postwithdrawal psychopathology, that they attributed to discontinuation of their SSRI antidepressants. SSRI withdrawal, like for other classes of CNS depressant type (alcohol, benzodiazepine, barbituric, narcotic, antipsychotic, antidepressant), needs to be divided into two phases: the immediate withdrawal phase consisting of new and rebound symptoms, oc- curring up to 6 weeks after drug withdrawal, depending on the drug elimination half-life [2, 3], and the postwithdrawal phase, consisting of tardive receptor supersensitivity disorders, occur- ring after 6 weeks of drug withdrawal [4].

 

One example of self-reporting new withdrawal symptoms of the CNS depressant type is the publication by Shoenberger [5], which described new withdrawal symptoms (headaches, agitation, irritability, nausea, insomnia) as listed in controlled studies [6, 7]. Shoenberger self-reporting does not mention postwith- drawal disorders following withdrawal of paroxetine (taken for 3 years) [5], but reports disturbing feelings of ‘zaps’, electric zap- ping sensations described as ‘washing over his entire body’ or ‘riding on a rollercoaster’ [5], a withdrawal symptom of the CNS depressant type, which lasted into the fourth week of withdrawal. Zajecka et al. [6] had already listed ‘electric sensations’ as one of new withdrawal symptoms included in four published case reports.

 

In general, most studies have looked only at minor new symptoms of the CNS depressant withdrawal type [6], but there are some exceptions which examined SSRI postwithdrawal emergent persistent disorders [7–9]. In the present study, we looked at both new SSRI withdrawal symptoms [6] and postwithdrawal persistent symptoms.

 

Between February 2010 and September 2010, qualitative Google searches of 8 websites including p******.org, ehealthforum.com, depressionforums.org, about.com, medhelp. org, drugLib.com, topix.com and survigingantidepressant.org were carried out in English, using keywords as ‘SSRIs withdrawal syndrome’, ‘Paxil withdrawal’, ‘SSRIs forums’. Links from the above websites/forums and other related material were also followed.

 

In table 1, we list selected online patient self-reporting of physical and psychiatric withdrawal symptoms for each of the 6 SSRIs: paroxetine (n = 3), sertraline (n = 2), citalopram (n = 2), fluoxetine (n = 1), fluvoxamine (n = 1) and escitalopram (n = 3), which we thought reflected best patient self-reporting of SSRI withdrawal symptoms. From online information available, gender is known for 4 patients (2 men and 2 women), the mean length of SSRI treatment (n = 9) was 5.13 years, range 0.25–15 years, median 4.5, and the mean duration of withdrawal symptoms (n = 7) was 2.5 years, range 0.125–6 years, median 2.1 years.

 

As can be seen in table 1, 58% of patients (7 out of 12) reported persistent postwithdrawal symptoms: 3 of 3 paroxetine patients, 2 of 2 citalopram, 1 of 1 fluvoxamine, 1 of 3 escitalopram and none of both sertraline and fluoxetine patients. We note in table 1, persistent postwithdrawal disorders, which occur after 6 weeks of drug withdrawal, rarely disappear spontaneously, and are sufficiently severe and disabling to have patients returned to previous drug treatment. When their drug treatment is not restarted, post-withdrawal disorders may last several months to years. Significant persistent postwithdrawal emergent symptoms noted consist of anxiety disorders, including generalized anxiety and panic at- tacks, tardive insomnia, and depressive disorders including major depression and bipolar illness. Anxiety, disturbed mood, depres- sion, mood swings, emotional liability, persistent insomnia, irri- tability, poor stress tolerance, impaired concentration and im- paired memory are the more frequent postwithdrawal symptoms reported online. In the Fava et al. [8] gradual SSRI discontinua- tion controlled study on panic disorders, 9 of 20 patients (45%) had new withdrawal symptoms and 3 of the 9 (33%) paroxetine- treated patients had persistent emergent postwithdrawal disorders, consisting of bipolar spectrum disorder (n = 2) and major depressive disorder (n = 1) during a 1-year postwithdrawal follow-up.

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Edited by Altostrata
updated

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

KUDOS, Alto!


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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flower

I need to show this to my Doctor. Copy?


C/T Celexa and Trazadone on Jan.29th 2014
Prescribed 1mg of Klonopin every 6 hours on Jan.29th
Began tapering Klonopin April 18th..stretching time between doses...at first one hour for 2 weeks then a half hour for app.10 days then another half hour 10days later.
Presently at .25 three times a day..6 2 and 10pm. Trying to stabilize.
Also still taking gabapentin 300mgs 2xs a day..

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Altostrata

There's a link above to the free full text.


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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WinningThrough

Apologies if there is already a topic on this but I just found it and thought it might be of interest.

 

http://www.alphagalileo.org/ViewItem.aspx?ItemId=129563&CultureCode=en


The only way out is through.

 

Aug 2013 - Augmentin leading to akathisia

Sept-Nov 2013 - Citalopram 20mg, severe reaction, off at 5mg. Valium 4mg, prn

Oct 2013 - 5 zopiclone tablets, 7.5mg

End Nov 2013-end Feb 2014, Seroquel, top dose 150mg, off at 25mg

End Nov 2013-early march 2014, Zoloft 100mg top dose, off at 25mg

End Dec-2013-early April 2014, lorazepam 1mg prn

April 3rd 2014 zoloft 5mg for a few days. 18/4/14 - zoloft, 1mg. Came off at 0.35 mg,14th June 2014

29 June 2014 - 1mg lorazepam, last ever

29 June 2014 - med free

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Altostrata

Thank you, WT, the journal article is in post 1 of this topic.


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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Wildflower0214

Do the people who wrote this article think WD makes one more likely to develop a mood disorder??? It's WD, not mental illness. Or they just refuse to call it what it is.


2005-Zoloft bad reaction.....2006-Lexepro......2012-Upped Lexepro.......2013-Upped Lexepro......2/2014- Attempted Taper Lexepro...2/2014- Updosed Lexepro.......3/2014-Ativan.....5/2014- CT switch from Lexpro to Effexor.....

5/2014-7/2014-Tapered Ativan from 1mg to .25mg.....6/2014-Bad reaction to Effexor........7/2014- Rapid taper Effexor every other day......7/5/2014- Off Effexor.......7/2014-12/2014 - Ativan .25mg.......12/25/2014 -Taper Ativan by 4% due to paradoxical reaction .24mg...11/18/2015-Taper Ativan 1% CURRENTLY ON: .2376mg Ativan taken in 6 .0396mg doses.

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LexAnger

Another great thread, alto!


Drug free Sep. 23 2017

2009 Mar.: lexapro 10mg for headache for 2 weeks.

2009-2012: on and off 1/4 to 1/3 of 10mg

2012 June--2013 Jan,: 1/4-1/3 of 10mg generic, bad jaw pain

2013 Jan-Mar: 10 mg generic. severe jaw and head pain;

2013 Mar--Aug. started tapering (liquid ever since) from 10 to 5 (one step) then gradually down to 2.25 mg by July. first ever panic attack, severe head/jaw pain

2013 Aug.: back to 2.75 mg; Nov: back to Brand Lex. 2.75mg -- 3mg,

2014 June: stopped PPI, head pressure/numbness. up-dosed 4.5mg, severe reaction mental symptoms added on

2014 Aug--2015 Aug: Micro taper down to 3.2mg, .025mg (<1%) cut holding 2-3 weeks.

2015 Aug 15th, Accidental one dose of 4.2mg. worsening brain non-functional, swollen head, body, coma like, DR

2016 Feb., started dosing 10am through 11 pm everyday 2/13--3.2mg, 3/15-- 2.9mg, 4/19-- 2.6mg, 6/26--2.2mg, 7/22 --1.9mg, 8/16--1.8mg,8/31--1.7m g, 9/13--1.6mg, 9/27--1.5mg, 10/8--1.4mg, 10/14--1.3mg, 11/1--1.2mg, 11/29--1.1mg, 12/12--1mg, 12/22--0.9mg

2017: 1/7--0.8mg, 1/15--0.7mg, 1/17--0.6mg, 1/20--0.52, 1/21--0.4mg, 1/22--0.26, 1/23--0.2, 2/13--0.13mg, 2/20--0.06mg, 3/18--0.13mg, 6/1--0.12mg, 7/6--0.1mg, 7/14--0.08mg, 8/17--0.04mg, 8/20--0.03mg, 8/28--0.02mg, 9/6--0.0205mg, 9/8--0.02mg, 9/17--0.015mg, 9/20--0.01mg, 9/21--0.0048mg, 9/22--0.0001mg,

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