Withdrawal symptoms while discontinuing antipsychotic medications

[Altostrata]

A clinician acknowledges antipsychotic withdrawal syndrome in this undated article from Medscape. However, she understates the potential duration of symptoms and what a "very slow taper" might mean. One of her sources was a patient discussion in an online forum.

http://www.medscape.com/viewarticle/529317
(free registration required)

Question
I have encountered severe withdrawal effects when discontinuing ziprasidone HCI (Geodon), even with a very slow taper of the drug. I'm wondering whether others have seen this in their patients.

Response from Wendy L. Wright, MS, RN, ARNP, FNP, FAANP
Adjunct Faculty, University of Wyoming, Fay W. Whitney School of Nursing, Laramie, Wyoming; Family Nurse Practitioner, Merrimack Village Family Practice, Merrimack, New Hampshire

Titrating and discontinuing antipsychotics and selective serotonin reuptake inhibitors (SSRIs) can pose significant challenges. Patients who abruptly discontinue one of these medications can suffer serious adverse events such as dizziness, lightheadedness, nausea, tremors, insomnia, sedation, electric shock-like pains, and anxiety.^%5B1%5D ....
 
The literature abounds with references to a phenomenon known as "SSRI discontinuation syndrome." Less frequently reported, particularly with newer antipsychotics such as ziprasidone HCI, is a similar effect known as "antipsychotic discontinuation syndrome." While the actual incidence of antipsychotic discontinuation syndrome is unknown, it is a documented phenomenon, even in patients who have been weaned from their medication slowly. As one patient reports, "I have had unbearable physical responses to tapering Geodon -- even very, very slowly."^%5B2%5D
 
Antipsychotics can be associated with untoward effects upon withdrawal; the more abrupt the withdrawal, the more profound the symptoms. Even with slow tapering, patients may experience symptoms such as an anticholinergic withdrawal reaction, which can last for days after discontinuation. In addition, withdrawal dyskinesia may occur for 2-4 weeks and rebound dystonia for several days upon discontinuation of the drug.^%5B3%5D
 
Numerous theories have been proposed to explain these symptoms. Three neurotransmitters might play a role: dopamine, serotonin, and histamine.^%5B4%5D Dopamine, serotonin, and histamine receptors are found in the medulla of the brain, the area that, when stimulated, triggers nausea and vomiting.^%5B4%5D In addition, dopamine and serotonin also affect the autonomic control system within the brainstem.^%5B4%5D When neurotransmitters are withdrawn from these regions, a discontinuation syndrome results in autonomic dysfunction with nausea, vomiting, and a variety of other troubling symptoms.
 
Strategies to prevent antipsychotic discontinuation syndrome include:
 

 

• When planning to introduce a new antipsychotic, try titrating up the new agent while slowly titrating down the older agent, provided that both medications may be safely used together. Unfortunately, very few guidelines exist to aid the clinician with this strategy, particularly with regard to the newer antipsychotics^%5B4%5D;
• If complete discontinuation of an antipsychotic is indicated, taper the medication over 4-8 weeks;
• If symptoms develop, even during a slow taper, temporarily increase the dose slightly temporarily to reduce symptoms. Once the patient is stable and the symptoms have abated, the taper may be resumed; and
• When medication discontinuation is essential and symptoms occur despite a slow taper, prescribe an additional medication in the interim. For instance, anticholinergics, beta-blockers, prochlorperazine (Compazine), or benzodiazepines have all been used for this purpose.^%5B4%5D
• Antipsychotic discontinuation syndrome does occur in patients even with a slow medication taper. Numerous prevention strategies have been proposed; regardless of strategy, the patient needs to be reassured and supported during this very difficult period.^%5B3%5D

Edited April 10, 2014 by Petu
fixed text

[Aria]

"In addition, withdrawal dyskinesia may occur for 2-4 weeks and rebound dystonia for several days upon discontinuation of the drug.^%5B3%5D"

 

My psychiatrist had me to suddenly stop the Seroquel saying I'd have no trouble doing this and when I called his office in withdrawal hell was told to go to the ER. The w/d (dyskensia and akathsia) lasted a long long time so reading a few weeks I beg to differ. It's scarey prescribing doctors don't know how to get a client off atypicals without pain and suffering.

 

Thank you for the article.

[flower]

this was a good read..thank you..an occasional beta blocker has been on my mind.

[Utahgal]

I will keep this in mind as I taper the geodon.

 

I take 20 mgs. I was thinking decreasing by 1 mg at a time.

[aries19835]

I am currently on seroquel 175 mg, is it possible to taper off it? Also which drug atypical and typical antipsychotic is easiest to taper off? Any answer will be appreciated, thank you.

[SquirrellyGirl]

I don't have the answer to the second question as I am not familiar with antipsychotics, but I do know it is possible to taper off of Seroquel and there are people on SA doing so.  What would be best is for you to start an Intro topic for yourself aries19835 since you haven't yet.  You will get more attention drawn to your situation in Intros and can keep track of your journey there.  Please see the stickies at the top of the forum:

 

Introductions and updates

 

Maybe someone will answer your question about which is easier, but if you are thinking of switching to another one because it might be easier, it's not so simple as that.  It is better the he devil you know than the one you don't!

 

SG

[tyson]

Hi, aries, I'm only had few experience with my family member about antipsychotic meds. We have tried seroquel, abilify, zyprexa. What the doc. do is they sometime start small,which means it does block 80% dopmine or seratonine from their regular function. Also, you talking about the old and the new drugs when you say typical and atypical. I would say there is no that much difference except the old ones were blamed for more side effect. which is not true in my opinion. Since the new ones have the same or even worse. In addition, you asked about possibility of tapering. Any one is capable of tapering if you learn and ask in this form and fellow the advice of those people who went through it. I'm following the 10% on each reduction and s.time smaller. you fellow their steps, you will get out of these evil meds. 

good luck. 

[AutumnRose]

It is 100% possible to taper off Seroquel. I did it a couple years ago. My dose was extremely high (1200mg-I'm not kidding). You will experience some withdrawals but remember it's only temporary. It took me a few months to be free of Seroquel but I have fully recovered. 

[Altostrata]

None of them is easiest to taper. All can be tapered.

[vilus]

I'm going through withdrawal too.

[vilus]

You want to increase the dose sometimes right?

[tyson]

My son is taking anti psychotic medication, zyprexa. he is on 0.6 mg. 

does anyone know if it's ok to take antibotic med. while on zyprexa? or should we wait. he is not sick or anything. but he

some times gets stomach flue and we are afraid of the mix. 

Any body have any advice. since the doctors don't have any idea, I trust this group here. 

[mammaP]

Hi Tyson, antibiotics would not be effective against flu because it is generally a viral infection. I would take a good pro biotic to balance the gut's natural bacteria that is essential for gut health.   

 

http://survivingantidepressants.org/index.php?/topic/1229-probiotics-and-gut-health/?view=findpost&p=26917&hl=diet

 

It would be good if you could start an introduction for yourself and your son, so we can get to know you and you can ask questions there. They can be easily missed among the many posts here. 

[AwareButStruggling]

I think that Seroquel would be easier to taper in your situation since the dose you are on isn't huge. Seroquel in lower doses (< 300mg) tends to act more as an antiistamine blocker, and is very sedating. It's really when you get to around 300mg that it becomes and adrenaline blocker, and it's around 500mg that it exhibits the antipsychotic properties. These are rough estimates, though, so it may vary from a person to person. 

 

I don't know anything about Abilify's mechanism of action, but I know that Zyprexa works as an antipsychotic in much smaller doses, and its taper may need to be very slow and gradual. 

 

Technically, I am more concerned about Abilify and Zyprexa in your case, and tapering those succesfully. Atypical antipsychotics like Zyprexa and Abilify, can generally be harder to taper than typical antipsychotics like Seroquel. 

 

Mind you, these are not personal experiences of mine, so please take it with a grain of salt. However, I spent some time looking at the mechanism of action for Seroquel and Zyprexa. Abilify is a bit enigmatic in terms of how it works.

 

If i were you, I'd study up on all three and get very familiar about their mechanism of action. Usually the wikipedia pages are a good start

 

 

So, this is the catch. While you may be able to taper off Seroquel more easily than the other 2, losing the sedating qualities of Seroquel, may make you more agitated and may make it harder to taper off Zyprexa and Abilify. i think the order you do it in may be more important than how easy it would be to taper each of them individually. And honestly, I don't know what that order would be for you......

 

 

*** I am not a doctor, and this is not medical advice ****

[Kelmo137]

On 9/24/2013 at 12:38 PM, Utahgal said:

I will keep this in mind as I taper the geodon.

 

I take 20 mgs. I was thinking decreasing by 1 mg at a time.

how do u plan on tapering 1 mg at a time. my geodon is a capsule and only comes in 20 mg caps

[ChessieCat]

57 minutes ago, Kelmo137 said:

how do u plan on tapering 1 mg at a time. my geodon is a capsule and only comes in 20 mg caps

 

Tapering by reducing 1mg at a time would be okay until you got below 9mg.  After that the reduction would be greater than the recommended 10%.  9mg x 0.9 = 8.1mg

 

Post #1 of this topic explains how to get your dose:  tips-for-tapering-off-ziprasidone-geodon-zeldox