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Withdrawal symptoms while discontinuing antipsychotic medications


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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
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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 by Petu
fixed 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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"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.

Unable at this time to correspond by private message.

 

Link to my Introduction thread: http://survivingantidepressants.org/index.php?/topic/2477-aria-my-psych-journey/

Reading my psychiatric records: http://survivingantidepressants.org/index.php?/topic/5466-drugged-crazy-reading-my-psychiatric-records/

My Success Story is listed under "Aria's Recovery".

 

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

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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  • 3 weeks later...

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.

I am on 2.0 mg abilify for 2 yrs now.  I tired to taper every month 2.0....1.5....1.0....0.5....off.  I was fine until I jumped off at the end.  I will need to slow the taper down after 0.5.  Maybe try 0.5, 0.4, 0.3, 0.2, 0.1, 0.05, 0.025...off.

 

8/2/17. Abilify  2.0 mg

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  • 2 years later...

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.

abilify 2 years

zyprexa 5mg 3yearsn 10mg 3 years, 15 mg 3 years

seroquel 200mg 3 weeks, 175 mg 6 days, 150mg 5-29-16

125mg 6/10/16 100mg 6/20/16 87.5mg 7/8/16

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  • Moderator Emeritus

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

Started ADs back around 1995 after bad break-up, starting with Prozac.  Switched to Wellbutrin, and then to Effexor in 2002
Effexor XR 2002-2014 up to 225 mg at one point, down to 37.5 mg towards end but back up to 75 mg in 2014; now realize I had W/D as I dropped down, memory very poor about history.  Extreme emotions, poor concentration as I stepped back down, didn't connect the dots!
Summer 2014 reduced to 0 very quickly, was sick of anhedonia/sexual dysfunction due to meds, depression never controlled if not worse. Didn't recognize WD since symptoms built slowly (thought I had ADD! and menopausal on top of it), starting with severe sweats, very bad cog-fog and memory issues, culminating in weight loss, severe anxiety and depression, panic, severe apathy and insomnia by eight months off.  Saw p-doc who put me on Remeron, increased from 7.5 mg/day to 37.5 mg by May 22, 2015; still doing very badly though able to sleep.

June 1. 2015 Reinstated Effexor XR 37.5 mg, Remeron dropped to 30 mg PM. Immediate relief of symptoms, like nothing had ever happened!  Joined SA and began on advice of friend who recognized it was WD all along! Began tapering in July 2015.

Been tapering both meds ever since, focusing on one more than the other or doing no more than 5% of each per month.

12 mg Effexor and 5.8 mg Remeron (mirtazapine SolTabs to make a solution with OraPlus) as of 5/4/2017 

Update 3/14/18: 2.9 mg Remeron and 6 mg Effexor; 6/10/18:  2.6 mg Remeron and 4.9 mg Effexor

 

My intro: http://survivingantidepressants.org/index.php?/topic/9313-squirrellygirl-effexor-withdrawal-etc/page-2#entry196679

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

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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. 

Hi, 

This is Tyson. I'm not sure if I'm doing this in the right place. But I'm doing this cause I thought I don't have a file here. 

I was trying to get some help from members with my son's withdrawal, but it's been lost somewhere. So, I thought maybe I should 

put my intro. and then that might help.

My son started Respiradol 3mg took that for three month and dropped it. Then Abilify 5mg for six month and due to his restlesnes, stopped by his doc. 

then got ordered to take zyprexa 15mg. He took zyprexa for five years but lowering with the help of doc and compounding pharmacy. he is now on 1.25mg. but 

things are getting tough. no nutrition guide or supplements. 

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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. 

2003- Zyprexa, Seroquel (1200mg), Lithium (900mg), Clonazapam (3mg), Respirodal (8mg), Benztropine, Celexa (20mg)

2009- Began tapering medications. Tapered off Lithium

2010-Tapered off Zyprexa

2012- Began taper off Seroquel

2013-Finished tapering off Seroquel and tapered off benztropine

2014- Started taper of Respirodal and Clonazapam. I was put on Valium (30mg) and started using the Ashton Method to taper from Clonazapam

2015- Tapered completely off Clonazapam.

Current- Taking Respirodal (0.5mg) Celexa (20mg) and Valium (5mg) 

Trying to taper completely from Respirodal this month

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  • Administrator

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

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'm going through withdrawal too.

Olanzapine (Tapered 5 times and marathon trained)

Seroquel 3 months

now back on Olanzapine.

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You want to increase the dose sometimes right?

Olanzapine (Tapered 5 times and marathon trained)

Seroquel 3 months

now back on Olanzapine.

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  • 10 months later...

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. 

Hi, 

This is Tyson. I'm not sure if I'm doing this in the right place. But I'm doing this cause I thought I don't have a file here. 

I was trying to get some help from members with my son's withdrawal, but it's been lost somewhere. So, I thought maybe I should 

put my intro. and then that might help.

My son started Respiradol 3mg took that for three month and dropped it. Then Abilify 5mg for six month and due to his restlesnes, stopped by his doc. 

then got ordered to take zyprexa 15mg. He took zyprexa for five years but lowering with the help of doc and compounding pharmacy. he is now on 1.25mg. but 

things are getting tough. no nutrition guide or supplements. 

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  • Moderator Emeritus

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. 

**I am not a medical professional, if in doubt please consult a doctor with withdrawal knowledge.

 

 

Different drugs occasionally (mostly benzos) 1976 - 1981 (no problem)

1993 - 2002 in and out of hospital. every type of drug + ECT. Staring with seroxat

2002  effexor. 

Tapered  March 2012 to March 2013, ending with 5 beads.

Withdrawal April 2013 . Reinstated 5 beads reduced to 4 beads May 2013

Restarted taper  Nov 2013  

OFF EFFEXOR Feb 2015    :D 

Tapered atenolol and omeprazole Dec 2013 - May 2014

 

Tapering tramadol, Feb 2015 100mg , March 2015 50mg  

 July 2017 30mg.  May 15 2018 25mg

Taking fish oil, magnesium, B12, folic acid, bilberry eyebright for eye pressure. 

 

My story http://survivingantidepressants.org/index.php?/topic/4199-hello-mammap-checking-in/page-33

 

Lesson learned, slow down taper at lower doses. Taper no more than 10% of CURRENT dose if possible

 

 

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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 ****

Prozac 1997- 2013, stopped after 1 month short-taper. 

Ativan  0.5mg intermittent use, end of 2010 - end of 2014

Ativan  up to 2-3mg/day Dec 2014/Jan 2015

Partial Valium crossover: down to 0.5mg/day Ativan and 10mg/day Valium (2015-2017)

(2/2018 - 10/2018, tapered down Valium from 10mg to 3.75mg Valium per day) (HOLDING at 3.75mg/day)

(10/2018) - Ativan 0.5mg a day (HOLDING @ 0.5mg since mid 2017)

11/2018 - Cut valium to 2.5mg a day

3/23/2019 - Cut Buspar from 20mg to 15mg/day (intense symptoms)

4/4/2019 - Updosed Buspar from 15mg to 17mg

4/13/2019 - Ativan - 0.48mg/day

4/17/2019 - Buspar down to 16mg/day

4/24/2019 - Buspar down to 15mg/day

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  • Altostrata changed the title to Withdrawal symptoms while discontinuing antipsychotic medications
  • 1 year later...
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

prozac 2008. do not know the dose. after a few weeks i had suicidal idealization and went to the hospital 4 days.

xanax .5 mg only took a few times

geodon started 2008. highest dose 180 mg

celexa 2008 40 mg

i tried so many different meds i cannot rrecall the name or dosage but all of them had severe side effects within a week and all were stopped

2008-present geodon. current dose 80mg

2008-present  celexa. current dose 40 mg

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  • Moderator Emeritus
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

 

Please DO NOT TAG me - thank you

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions. 

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

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

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

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