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stan

Tolerance or "poop-out" or Tachyphylaxis

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stan

2 examples:

  • a person who takes paxil 12 years and weans one year (never in tolerance)
  • my example : 6 years ok + 6 years in "tolerance"

the difference is during my six years tolerance, i feel my body deteriorate, and in fact after my tapering i was and am very deteriorate

i think if i would not be six years in "tolerance", i would be much better

 

12 years without "tolerance" is much more healthier than 12 (6 in "tolerance")

testimonies with years in "tolerance" seem more damaged

Edited by Altostrata
updated title to content

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angie007

Hi Stan,

 

This post really scares me, as i was exactly he same, in tolerance after my 8th year of use,

and never got off until my 14t year.

Basically, because it took me so longto realise that the symptoms were due to he drug,

then the fear set in, about how to taper in the gentlest, easiest way that would minimise

symptoms, after my ct effort in 05 that petrified me.

 

Im now really really scared, just as i know you are too,

but i still think, that the brain has the capacity to heal for us both,

thats wha keeps me going, as some days are just hard, and there seems to be

some new symptom crawling out the woodwork when we least expect it.

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Altostrata

stan and angie -- we don't know if there is a relationship between tolerance, poop-out, and severity of withdrawal syndrome.

 

It seems some people have severe and prolonged withdrawal after taking antidepressants a relatively short amount of time, before poop-out occurs.

 

We need to see a lot more cases to tell.

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Claudius

I never reached poopout, I had some terrible CT attempts but just before my final CT I felt terrific, in fact so terrific that the failed attempts of the 2 previous years were a vague and distant memory.... and that is why I did the same stupid non well-thought thing again.

But as you know, my WD has been atrocious and very long lasting despite never hitting poopout and always using a "low" dose. SO I do not think that there is any relationship between hitting poopout, dose or symptoms during use.

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stan

i am searching explanations...

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Healing

You may be onto something here, Stan.

 

It’s true that tolerance w/d is not a 1:1 predictor of difficulty post-taper. But, intuitively, it does seem that having difficulty with the drug while still on it might be a bad sign.

 

Maybe we are confounding more than one thing under the heading of tolerance w/d.

 

IOW, maybe what *looks* like tolerance w/d is sometimes 1) tolerance w/d, aka poop out, and sometimes 2) a worsening side effect profile.

 

Ironically, #2 could be called “intolerance.”

 

These drugs do cause changes in the body all the way down to gene expression. People who are developing an intolerance to the drug may have a worse time in w/d.

 

On the other hand, at a more simple level, these drugs just exhaust the body. People whose bodies have simply become exhausted and unable to respond to the drug any more might have simple tolerance w/d, and they don’t have a worse time in w/d. In fact, getting off the drug is helpful to them fairly quickly.

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Altostrata

One aspect of "tolerance" or "poop-out" may be emotional blunting: http://survivingantidepressants.org/index.php?/topic/343-about-treatment-resistant-depression-and-poop-out/page__view__findpost__p__3655

It is thought this results from maximal serotonergic downregulation -- your serotonin receptors have shut down as much as possible, to the extent they don't fulfill their intake function anymore.

Increasing dosage makes the problem worse. Unless your serotonin receptors are the kind that bounce back fast, if you've experienced this in poop-out, it's likely to continue into withdrawal syndrome.

Theoretically, I guess, maximal serotonergic downregulation might contribute to other neurochemical systems continuing to be imbalanced and, thus, severe withdrawal syndrome. However, from people's reported experiences, it does not seem to be a predictor of prolonged withdrawal syndrome. Still, wait for more research to come out about "antidepressant tachyphylaxis" -- poop-out -- and "tardive dysphoria" -- prolonged emotional blunting.

 

Papers on poop-out:

 

Fava 2003 Can long-term treatment with antidepressant drugs worsen the course of depression?

 

Amsterdam, 2009 Does tachyphylaxis occur after repeated antidepressant exposure...

 

Fava, 2011 The mechanisms of tolerance in antidepressant action

 

Katz, 2011 Tachyphylaxis/tolerance to antidepressants...

 

El-Mallakh, 2011 Tardive dysphoria: The role of long term antidepressant use...

 

Andrews, 2011 Blue again: Perturbational effects of antidepressants

 

Articles:

 

Now Antidepressant-Induced Chronic Depression Has a Name: Tardive Dysphoria

Edited by Altostrata
updated

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Hopeful

I never thought I was in “tolerance or poop-out”, but looking back I think the last year I was on the drug “something” was happening. I was finding it hard to relax, normal things seemed overwhelming and I was not as motivated. At the time I chalked it up to peri menopause and a move to a new house.

 

When I started to get off the Paxil and got to 10 mgs I felt much better despite some of the w/d symptoms like “swooshing head” and my motivation returned. Unfortunately I continued to taper by 5 mgs. and all h*ll broke loose after getting off completely. I wonder though, if I was in “tolerance or poop-out” why the Lexapro did stop all Paxil w/d symptoms. It took about six weeks and an up dose from 10 mg. to 20 mg. at the four week mark for the Lexapro to kick in, but it did work. Although, motivation dropped again while I was on the Lexapro.

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Altostrata

Interesting, Hopeful. Lexapro is much stronger than Paxil. I guess it got a little more mileage out of your downregulated receptors.

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angie007

Now this has me thinking, whats a possible scenario with me then,

 

2005 symptoms i now know to be wd, then ct off 30mg

2006 after 4.5 months off, reinstate @ 20mg, symptoms ease somewhat.

2007 start slow taper from 20-18mg, brain fog left overnight, seriously!!

 

Anxiety ramps and akathsia sets in

 

2011 May off at a tiny sliver. but severe symptoms of akathesia/anxiety being the worst.

 

Im just hoping now by doing a slow slow taper, i havent prolonged or made my suffering worse, or taken the drug

longer than i needed to do, making damage possibility worse.

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squirrel

Sorry nor following this can someone explain the difference between tolerance & poop out please?

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stan

Sorry nor following this can someone explain the difference between tolerance & poop out please?

 

there is no difference, it is when the med do not more work,be in tolerance is live taken a med who do not work (only his side-effects)

 

and then the doc double dose or switch

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Mixter

We say that tolerance is when drug does not work anymore, causing tolerance. But there are mechanics behind. I think a part of this "syndrome" is when serotonin insuffiency happens during poopout and accounts for symptoms as there is not enough serotonin and neurotransmitters to "cover" receptors.

 

Other theory is the serotonin reuptake pumps get depleted, so even adding more 5-htp to increase serotonin (which is risky)

will not get into the situation because we need more pumps, and probably other factors as well.

 

Just I thought sudden decrease in serotonin pumps scattered over all places could happen after an adverse reaction, as one of the explanations, and receptor site changes, increasing glutamate turnover and too much/too little serotonin in right and wrong places.

 

If the body sense too little serotonin, after a time the body will ramp up serotonin pumps right?

I just dont have an too enough deep knowledge but I hope this could explain a part of it all.

 

As when reducing the drug, the reuptake of serotonin it initially increase serotonin turnover but also increases glutamatergic impact.

Maybe I am on something. There is always a way out, by slowly removing the offending drug and let the CNS heal without "additives".

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stan

hi Mixter,

 

hope you are better,

tolerance for me is a body overhelmed by a poison which the body tried to do homeostasis with, since years often; the body fall in nerves depression;

and there are degree in tolerance: very strong, strong, there exist even mild tolerance often in beginning years(i had this)...

tolerance can be brutal or slow increasing over months or years, but all ends in chaos; a poison is a poison.

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Altostrata

Good topic! I think I might agree with both of you.

 

As I understand it (and I'll find the citation somewhere), tolerance occurs when the serotonergic receptors have reached a maximal point of downregulation.

 

For a while, the body tries to maintain homeostasis in a flood of medication-induced serotonin by reducing intake valves (serotonin receptors). But eventually it has depopulated the receptors as much as physically possible and can no longer maintain homeostasis.

 

This causes reactions in other parts of the nervous system, leading to the symptoms of "poop-out," because the serotonergic feedback loop is no longer participating in a normal way and the brain is at a loss to cope with the excessive amount of serotonin.

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bruno2016

Ok so I have been in pretty bad shape and may need to go back on AD. I am confused about something, though: some people report taking a drug and after a while it stops working and so they need to up their dose. I was experiencing this with celexa. I Was doing great on 20mg for about six months and then began to feel bad so had to go to 30mg. So how does this situation fit into withhdrawal? If someone is unable to stay at a certain dose for long and they need to up the dose every so often, how will they ever be able to taper and get off the drugs? I often wonder if some people will need to be on drugs forever, especially if their symptoms were severe before ever using drugs, you know? And that brings up something else- what are we to do about the original symptoms that got us on the drugs? I know I have tried many things and have had mixed results, but shouldnt that be one of the main things we consider before going off the drugs? There is a doctor name Alice Lee-Bloem who advocates supporting various organs and neurotransmitters and what not before getting off drugs (http://holisticpsychiatrist.com). She says that the drugs are toxic that when we get off them we must repair any damage the drugs have caused. She says, "When withdrawing from a medication, everything that the medication suppresses will become elevated, and everything that it elevates will become suppressed—unless you do something to prevent that condition beforehand." Actually, I cant say for sure, but in my opinion the long term use of the antidepressants has made my condition worse.

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Altostrata

Zepp, you really are confused!

 

You're talking about several different things:

 

1) Yes, the drugs often stop working. Reaching tolerance is a sign that they've worn out their welcome in your nervous system.

 

Antidepressants were never intended for long-term use and were never tested for this.

 

Doctors increase the dosage because...well, they don't know what else to do and usually don't grasp tapering. They'll try drug after drug. This is part of the fallacy of treatment with antidepressants.

 

You're right, in this situation people will never get off the drugs. They're on a merry-go-round of drugs, drug reactions, and withdrawal.

 

Evidence is emerging that once you've experienced tolerance, switching among antidepressants leads to "treatment-resistant depression," a state where your nervous system simply does not respond well to drugs or reacts paradoxically. This is not a good state for your nervous system, with neuronal receptors are maximally downregulated. It needs to rest, not to be exposed to more drugs or, heaven forfend, ECT.

 

2) Even if you reach tolerance, you can get withdrawal symptoms when you taper. Withdrawal symptoms are a sign your nervous system is destabilized, not that a psychiatric disorder is emerging.

 

For some people, slow tapering is needed even if the drugs are not working.

 

3) Even if you have reached tolerance, if you develop withdrawal symptoms, going back on a small dose of the medication may relieve them. It won't make your existence perfect and it won't have a better effect on you than it did initially.

 

4) If you decide you want to live without antidepressants, you will have to learn to manage your initial symptoms (depression, anxiety, etc.) with non-drug methods, such as meditation, psychotherapy, CBT, etc.

 

If drugs have stopped working for you, you are out of choices. You have to do this.

 

5) Dr. Lee-Bloem is correct about some things. She knows that tapering must be done gradually. Personally, I take her recommendations for orthomolecular treatment, NeuroScience supplements, etc. with a grain of salt. If she gets good results getting people off drugs, it could be simply that she's gradually tapering them and the supplements are irrelevant.

 

6) At any rate, you have already developed withdrawal syndrome. The tapering train has left the station. It is too late for you to follow any tapering regimen. Whatever supplements etc. might be helpful during tapering will not be helpful for you now.

 

7) You need to make some decisions for yourself. You're off Celexa. You have withdrawal symptoms. No pill or treatment is going to instantly put you back together better than new. That's the simple sad truth of it.

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bruno2016

yes i am very confused because things have just crashed all around me. My mind is often racing and so worried about things that i panic. I just feel as though I will stay in this condition forever, you know? Like how can I go about life in this state yet at the same time I know if i turn to drugs that i will become a different person and have to go through withdrawal all over again or stay on drugs forever. Ugghh its quite hard these past couple months. I had to drop out of school and some days i can hardly get out of bed. But at least i am eating good (usually), sleeping decent, and my gf is supporting me. I just get so scared that I wont be able to manage my issues without falling back to drugs and so I am constantly stressed out.

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Altostrata

Many of us have had to take on responsibilities we weren't expecting, Zepp -- to take care of ourselves.

 

You've got to consider that medication may not fix you. Your nervous system may not accept it.

 

Good to hear your gf is supporting you. I'm sure you'll get through this fine.

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Rhiannon

"No pill or treatment is going to instantly put you back together better than new. That's the simple sad truth of it. "

 

 

*********

 

This is the hardest thing to have to say to people, here and on the benzo forum that I post on.

 

We are so brainwashed to believe that a pill will fix us. Unfortunately there are no pills to fix withdrawal.

 

And the pills we are withdrawing from didn't fix us, either, they broke us, which is why we are having withdrawal to begin with.

 

Sometimes going back on a smaller dose of the drug we are withdrawing from will ease the withdrawal symptoms and we can taper more slowly. But this doesn't always work. Sometimes a small dose of another similar drug will ease withdrawal symptoms for a while. This doesn't always work either.

 

But there does not seem to be anything that will actually fix the problem. And so many people end up, like me, losing decades of their lives on the drug merry-go-round because of trying to find a drug that will fix them, and taking the drugs their doctors say they need.

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jr1985

I've heard people claim they reached "poop-out", which meant the drug stopped working AND they were having w/d symptoms even while on a full dose.

 

I understand the drug no longer working, but how is it possible to have w/d symptoms while on the full dose? It doesn't make sense to me since your body is still getting the drug.

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Baxter

Another phrase for poop-out is tolerance. Your brain/nervous system is dynamic, and is adjusting to the effects of the ADs all the time, trying to regain balance. As time goes by, the accomodations the brain makes reduces the impact of the drug - then you have withdrawal symptoms.

 

If you search for poop-out on this site you'll find explanations that go into the science behind it.

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Skyler

Another phrase for poop-out is tolerance. Your brain/nervous system is dynamic, and is adjusting to the effects of the ADs all the time, trying to regain balance. As time goes by, the accomodations the brain makes reduces the impact of the drug - then you have withdrawal symptoms.

 

If you search for poop-out on this site you'll find explanations that go into the science behind it.

 

Right Baxter I've been puzzling this too. I thought poop-out was just the point at which ADs are no longer effective. By comparrison, Benzos may cause withdrawal symptoms at the same level, ADs not, or leastwise, not so much. For some folk Benzos cause w/d symptoms while on a full dose, or to put it another way, before the dose is reduced.

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jr1985

I thought the consensus here was tolerance w/d was a myth and a more likely explanation was that w/d symptoms were catching up from previous drops.

 

It doesn't make sense that the brain would alter itself in such a way that w/d symptoms begin, when it has become dependent on the drug.

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Skyler

I thought the consensus here was tolerance w/d was a myth and a more likely explanation was that w/d symptoms were catching up from previous drops.

 

It doesn't make sense that the brain would alter itself in such a way that w/d symptoms begin, when it has become dependent on the drug.

 

You are confusing symptoms resulting from holding too long DURING a taper (the myth of tolerance withdrawal comes into play here, symptoms are the result of lag time catching up and not because of holding too long), and withdrawal symptoms that start BEFORE the taper begins. The latter is a very real problem, no myth this.

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Altostrata

Merged with our existing "poop-out" topic.

 

Yes, one can have withdrawal symptoms (or other symptoms) when an antidepressant or benzo reaches tolerance. This is "tolerance withdrawal."

 

This happened to me with Paxil. I got to tolerance and had weepy spells. Not really withdrawal symptoms, but symptoms the drug was not benefiting me.

 

(We don't believe applying the term "tolerance withdrawal" to withdrawal symptoms that emerge during a taper is correct -- those are withdrawal symptoms.)

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Gladstone

I'm all confused. When I told my psych doc that lexapro made me feel pretty apathetic, he said,"We call that poop-out. We can try lowering your dose." I thought poop-out was what I had on zoloft, which was moods so far reaching they could of been the moods of someone NOT on medication.

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Brandy

I thought the consensus here was tolerance w/d was a myth and a more likely explanation was that w/d symptoms were catching up from previous drops.

 

It doesn't make sense that the brain would alter itself in such a way that w/d symptoms begin, when it has become dependent on the drug.

 

 

I think the post below is probably the reason for the confusion.

 

Things are clearer now in this thread, but I had been disturbed by reading that "we believe that tolerance withdrawal is a myth" and that made me wary about posting some concerns I thought would be shot down.

 

Perhaps that post can still be re-phrased to the effect that you believe that the idea that holding a dose causes tolerance withdrawal, to prevent others from being misled in the future? (If that's not possible, maybe an explanatory post on the other thread would prevent future misunderstandings on the part of those who might not see this thread.)

 

 

HI schuyler,

as you know im new here havet had much people trying to help me yet im on my benzo tapper 5.5 Valium have been on it 12 yrs ve failed twice i wnt to make it this time ,my trouble they put me on mirtazipine to help me get off the benzo and now have found out they both do the same.,i wish there was some one here that could tell me for sure that the benzo should go first,

 

I know for sure one thing and that the AD im on takes at least 12-24 mths to tapper im on 22.5 of mirtz i am on the bb site and most say get rid of benzo first,but now i dont know wt med should go first i suppose after all these yrs on benzo im tolerant wnt off in july last year then doc put me bk on it so i have been tappering this time since march this year doing a tapper of.5 every three-four weeks was put on 10mgs now down to 5.5.

 

I hope some one may be able to say to me for sure yes yr doing theright thing getting rid off benzo as they are bad **** but now i heard the med im on is more toxic than benzo

 

oohh what to do doctors are no help they want me on more drugs and i want to be free if you know of someone that can help that will be good

 

BG

 

Hi Broomegirl, No one can answer for sure, but what makes the most sense is taper the med causing the most symptoms first.

 

The rule of thumb on this forum, and one I agree with, is to taper the AD first as ADs are more activating (common speech.. cause more problems!). I know the benzo forums advise withdrawing the benzo first, I was active on TRAP for 18 mos, and now on BB for some mos. They believe tolerance withdrawal will cause difficulties if you hold. To add to the confusion, BB is like the Wild Wild West these days because there are so many people using the forum (several big benzo forums have closed recently, so BB is overwhelmed), and it's hard to separate those with real knowledge from well meaning folk who have little understanding. We believe tolerance withdrawal is a myth and unfortunately used to get people to continee tapering even when it is best for them to hold. Go here for an in depth discussion of tolerance withdrawal.

 

The side effect profile from ADs is more severe than from benzos, so I think they are wrong.

 

You need to do what is right for you. So I don't need to reread your thread, a few questions? What is the reason you want to come off the benzos first.. in symptoms, not according to feedback from BB. How are they making you feel. For the ADs.. what side effects are you having from them.

 

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Brandy

I'm all confused. When I told my psych doc that lexapro made me feel pretty apathetic, he said,"We call that poop-out. We can try lowering your dose." I thought poop-out was what I had on zoloft, which was moods so far reaching they could of been the moods of someone NOT on medication.

 

Gladstone, I don't know how long you'd been on the lexapro when your doctor said that, but maybe he thought you were getting depression (if that was what the med was prescribed for in your case) and that you had gone into tolerance (aka poop-out), which can occur after a certain period of time, when the drug no longer gives the desired results.

 

I don't know the particulars of your case so forgive me if what I wrote is inapplicable to your situation.

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Skyler

Perhaps that post can still be re-phrased to the effect that you believe that the idea that holding a dose causes tolerance withdrawal, to prevent others from being misled in the future? (If that's not possible, maybe an explanatory post on the other thread would prevent future misunderstandings on the part of those who might not see this thread.)

 

Hi Brandy.. a few months back we had an exhaustive discussion about tolerance withdrawal. Please refer to My link See what you think? I started out agreeing with your position but after an exhaustive discussion have come away with a different point of view. Getting my head around this after being helped by a major benzo forum for 2 years was very difficult for me, but I finally managed to hold my diazepam taper without fear, and benefited as a result.

 

 

Merged with our existing "poop-out" topic.

 

Yes, one can have withdrawal symptoms (or other symptoms) when an antidepressant or benzo reaches tolerance. This is "tolerance withdrawal."

 

This happened to me with Paxil. I got to tolerance and had weepy spells. Not really withdrawal symptoms, but symptoms the drug was not benefiting me.

 

(We don't believe applying the term "tolerance withdrawal" to withdrawal symptoms that emerge during a taper is correct -- those are withdrawal symptoms.)

 

I agree with Alto who is referring to symptoms that occur at the start of a taper. I was told tolerance withdrawal occurs when a person holds for a prolonged time (more than a month.. this referring to benzo use). The problem is that the risks of holding too long are far outweighed by the risks of tapering too quickly when a prolonged hold is needed, when the primary concern should be avoiding further damage done by neurosensitization. Cases wherein symptoms appear during holds are due to lag time catching up, which accumulates when cuts have been to fast further up the taper.

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Skyler

Big sigh.. what the heck is POOP OUT? Is this when an AD 'stops working' (tolerance) and the doc ups the dose to tweak the initial beneficial effect? This is an AD term.. not benzo term.

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peggy

What do people think about the possibility of 'poop out' happening during a slow (several years) taper?

 

I have always had this fear of effexor not working - everytime i came off and then went back on again i would be obsessing over 'will it work this time' This idea came about after spending countless hours on some of the pro med sites - the sites that prescribe to the chemical imbalance theory. So, i have a lot of de-programming to do!

 

Poop out seems to be an accepted phenomenon, correct me if you think it is not.. so, what is the consensus about reaching this in a very slow taper?

 

Thanks

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jr1985

Ive had similar fears, but then I read poop-out happens because all of your serotonin receptors have downregulated in response to the increase in serotonin from the SSRI's. It seems unlikely that it would happen during a slow taper, as you are slowly removing the drug, which causes your brain to unregulate serotonin receptors (i.e. the opposite of what causes poop-out).

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bubbles

Schuyler, I've always understood it to mean that it stopped working.

B

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Altostrata

Gladstone, apathy is not poop-out, it's an adverse effect of antidepressants. Your doctor was right (for once) to lower your Lexapro dosage (a point in his favor!).

 

Poop-out (tachyphylaxis) means the drug has stopped working. Since with antidepressants "working" means a lot of things, this is a little ambiguous.

 

Withdrawal symptoms once one reaches tolerance ("tolerance withdrawal") are possible, particularly with benzos. (Our member Goldy had this, one symptom was epilepsy-like seizures.)

 

I haven't heard of tolerance withdrawal much with antidepressants, although when I experienced Paxil poop-out I had spells of weepiness, which might have been withdrawal symptoms, I guess. Pre-Paxil, I was not weepy.

 

However, while you are tapering off benzos, we think the symptoms sometimes called "tolerance withdrawal" on some benzo support boards are in fact withdrawal symptoms and indicate slower tapering, rather than forcing through the taper faster as those benzo support boards recommend.

 

I tried to clarify this in the "tolerance withdrawal" discussion topic http://survivingantidepressants.org/index.php?/topic/2233-benzo-tolerance-withdrawal-during-tapering-does-it-exist/

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Altostrata

Exactly. I think it's unlikely you would experience poop-out during tapering. Withdrawal symptoms are bad enough.

 

peggy, there is some evidence that going on and off antidepressants results in "treatment-resistant depression," in which no psychiatric drug relieves the symptoms and psychiatrists resort to natural means (supplements, exercise, etc.) to try to help people.

 

However, it's unclear whether those suffering the iatrogenic condition of "treatment-resistant depression" may in fact be suffering prolonged withdrawal syndrome.

 

Either way, it's a good idea not to go on and off and on and off these medications. You also risk sensitizing your nervous system to a lot of things, not only psychiatric medications.

 

Every person's future on psychiatric medications is limited by the tolerance of the nervous system to chemical stress. You cannot keep on bouncing around on these drugs forever.

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