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Mario's "turtle taper" opinion


Mario

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Dear all, I am happy that this forum tackled a very important topic on which I would like to give my personal opinion:

*** ACCUMULATION TIME OF SSRI ***

SSRI accumulates in the adipose tissue of the brain.  

For simplicity, you can consider the adipose tissue like a lake (it needs time to be filled and to get empty).

How much time ??

It obviously strictly depends on the DOSAGEs !!!  In my experience If you take 20mg of Paxil (and/or Citalopram) it takes more or less 1 month to accumulate to a dosage that is high enough in order to block my crisis.

Differently if I take only 10mg,  it can take 2 or 3 months to accumulate and block my crisis.

The same happens when one reduces the dosage.

If one suddenly stops to take the SSRI, it can be a matter of few weeks to feel the symptoms. Differently, if one reduce only a little bit (e.g. 20%) it can take up to 3 or 4 months to feel the effect.

 

Never forget to perform the reduction VERY SLOW (if you fall into a serotoninergic crisis it is obviously because you were reducing too fast) !

 

What to do in case you have a crisis ?

Well, my opinion is that first you should try to figure out "how strong" are the symptoms. If a symptoms are mild try to support it for a couple of weeks, they may just disappear (but STOP THE REDUCTION !).  Otherwise, if they are strong and/or if you still experience symptoms after a couple of weeks you should act immediately.

There are only two options available:

1) Augment the SSRI (if you decide to do that you have to take the full dosage such that they accumulate as fast as possible. Only when you feel better, you can reduce them quite fast up to your maintenance dosage… because your brain is adapted to that dosage.  It will take 1 month for you to feel better, and you could also feel worst when you augment the dosage because of minor side effects… but you shouldn't give them much importance before 1 month ).  

2) Use a special benzodiazepine called Clonazepam (i.e. try to sedate well the symptoms for a while with the hope that blocking the crisis your brain can adapt to the new SSRI level.  If you decide to do this you should keep the level of the SSRI constant.).  If I will be so unlucky to have a crisis again I will try to adopt this second approach (as suggested by some famous psychiatrists). In my calculation, the use of Clonazepam should save you around 5 or 6 months of time with respect to augmenting the SSRI.

1) Started paroxetine in 1997 at 16 years old of age (maintenance dosage 10 mg)
2) Failed several reduction attempt up to 2007
3) Started a gradual reduction protocol in 2007 at a rate of 0.2 mg per month
4) Strong relapse at 3.6 mg of paroxetine (even trying to resist the symptoms for 3 months didn't work and a reinstatement of a slightly higher SSRI dosage didn't work as well)
5) Shifted to Sertraline, eliminated paroxetine and moved Sertraline dosage up to the correspondent maintenance dosage of 3.6 mg of Paroxeine, in few months and without problems
6) reducing Sertraline very slow (now at 8 mg, that corresponds to 3 mg of Paroxetine/Citalopram).
7) From now on I decided to follow the Turtle protocol: http://ssrigr.altervista.org

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I also take the occasion to add another protocol that I find interesting (I hope can be of help):

http://ssrigr.altervista.org/turtle_protocol.pdf

1) Started paroxetine in 1997 at 16 years old of age (maintenance dosage 10 mg)
2) Failed several reduction attempt up to 2007
3) Started a gradual reduction protocol in 2007 at a rate of 0.2 mg per month
4) Strong relapse at 3.6 mg of paroxetine (even trying to resist the symptoms for 3 months didn't work and a reinstatement of a slightly higher SSRI dosage didn't work as well)
5) Shifted to Sertraline, eliminated paroxetine and moved Sertraline dosage up to the correspondent maintenance dosage of 3.6 mg of Paroxeine, in few months and without problems
6) reducing Sertraline very slow (now at 8 mg, that corresponds to 3 mg of Paroxetine/Citalopram).
7) From now on I decided to follow the Turtle protocol: http://ssrigr.altervista.org

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Mario, thank you for the "turtle taper." It is more in line with what we recommend, although the example for olanzapine seems rather rapid.
 
Did you translate this into Italian?

I moved your post in the reinstating topic here, with my comments. Thank you for the thoughtfulness you brought to this.
 

Dear all, I am happy that this forum tackled a very important topic on which I would like to give my personal opinion:
*** ACCUMULATION TIME OF SSRI ***
SSRI accumulates in the adipose tissue of the brain.
For simplicity, you can consider the adipose tissue like a lake (it needs time to be filled and to get empty).
How much time ??
It obviously strictly depends on the DOSAGEs !!! In my experience If you take 20mg of Paxil (and/or Citalopram) it takes more or less 1 month to accumulate to a dosage that is high enough in order to block my crisis.
Differently if I take only 10mg, it can take 2 or 3 months to accumulate and block my crisis.
The same happens when one reduces the dosage.
If one suddenly stops to take the SSRI, it can be a matter of few weeks to feel the symptoms. Differently, if one reduce only a little bit (e.g. 20%) it can take up to 3 or 4 months to feel the effect.

That is an interesting interpretation. It may be true that various drugs are stored in the fatty tissues. However, what seems more likely is that the nervous system resists the initial effect of antidepressants, which is why it is said it takes some time for them to be effective.

Likewise, withdrawal symptoms may not be immediate because it may take some time for the nervous system to become destabilized by the lack of the drug.

You may wish to read papers by Giovanni Fava, an Italian psychiatric researcher, regarding this.
 

Never forget to perform the reduction VERY SLOW (if you fall into a serotoninergic crisis it is obviously because you were reducing too fast) !

What to do in case you have a crisis ?
Well, my opinion is that first you should try to figure out "how strong" are the symptoms. If a symptoms are mild try to support it for a couple of weeks, they may just disappear (but STOP THE REDUCTION !). Otherwise, if they are strong and/or if you still experience symptoms after a couple of weeks you should act immediately.
There are only two options available:
1) Augment the SSRI (if you decide to do that you have to take the full dosage such that they accumulate as fast as possible. Only when you feel better, you can reduce them quite fast up to your maintenance dosage… because your brain is adapted to that dosage. It will take 1 month for you to feel better, and you could also feel worst when you augment the dosage because of minor side effects… but you shouldn't give them much importance before 1 month ).
2) Use a special benzodiazepine called Clonazepam (i.e. try to sedate well the symptoms for a while with the hope that blocking the crisis your brain can adapt to the new SSRI level. If you decide to do this you should keep the level of the SSRI constant.). If I will be so unlucky to have a crisis again I will try to adopt this second approach (as suggested by some famous psychiatrists). In my calculation, the use of Clonazepam should save you around 5 or 6 months of time with respect to augmenting the SSRI.

I agree with #1 above, but there are problems with using clonazepam (a benzo) to treat withdrawal symptoms -- which many, many people here have experienced:

  • Benzos may have a side effect of depression or anxiety
  • When they wear off, benzos may have a daily rebound effect of worsening symptoms
  • Used over time, a benzo may go paradoxical -- causing worse symptoms than the withdrawal symptoms
  • Used regularly, benzos are physiologically addicting (some people become psychologically addicted to them as well), requiring higher and higher doses for the same effect
  • Used regularly for 2 weeks or more, benzos can be difficult to discontinue, requiring very gradual tapering
  • If the benzo is not tapered slowly enough, benzo withdrawal syndrome can last months or years

While benzos might be effective in relieving some withdrawal symptoms, they need to be used very carefully, at the lowest effective dosage and as infrequently as possible. If you use them every day, you run the risks above. It's not unusual for people who take benzos for only a week or two to find they need to taper extremely gradually to go off them. So with benzos, you run the risk of trading one kind of withdrawal syndrome for another that might be even worse.

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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You are welcome.

I took only olanzapine for few months

(so unfortunately I think I didn't acquire enough experience in order to be able to bet all my money that 1 year of time is slow enough).

Mmmm….. very good point.  I will try to reach who wrote the protocol to ask them to check that part.

Whahooo,  if you are right with that the situation could be very bad for those people who are taking both Olanzapine and SSRI :-(

Olanzapine is unfortunately becoming very popular…. Let's hope it doesn't give so much addiction as the SSRI.

Yes, good idea. I think I can manage to produce a translation into Italian :-)

1) Started paroxetine in 1997 at 16 years old of age (maintenance dosage 10 mg)
2) Failed several reduction attempt up to 2007
3) Started a gradual reduction protocol in 2007 at a rate of 0.2 mg per month
4) Strong relapse at 3.6 mg of paroxetine (even trying to resist the symptoms for 3 months didn't work and a reinstatement of a slightly higher SSRI dosage didn't work as well)
5) Shifted to Sertraline, eliminated paroxetine and moved Sertraline dosage up to the correspondent maintenance dosage of 3.6 mg of Paroxeine, in few months and without problems
6) reducing Sertraline very slow (now at 8 mg, that corresponds to 3 mg of Paroxetine/Citalopram).
7) From now on I decided to follow the Turtle protocol: http://ssrigr.altervista.org

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Hello, I was re-writing while you were posting, please see my comments above.

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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I agree with all your points.

I know Giovanni Fava. I read some of his publications (and I had the occasion to visit him also in person in Padua few weeks ago, where he visits patients ).

He is one of the persons who fully supports the idea that Clonazepam should be used instead of SSRI (like you can see from his publications).  I am happy that you know him :-)

I think you are right of what you say about benzodiazepine in general,  but you have also to consider a very important point:

not all the benzodiazepines are the same.

 

If for example you substitute Clonazepam with Alprazolam in the protocol (… I know because I tried. At first I didn't want to trust the suggestions of Giovanni and I used Alprazolam instead of Clonazepam), you make a VERY BIG mistake (at a certain point I was not able even to sleep anymore !!).

The reason is that only Clonazepam is good to be taken for longer periods of time (mainly because its prolonged half life).

I shouldn't had made such mistake, but I was scared to test a drug that I had never tried before.

1) Started paroxetine in 1997 at 16 years old of age (maintenance dosage 10 mg)
2) Failed several reduction attempt up to 2007
3) Started a gradual reduction protocol in 2007 at a rate of 0.2 mg per month
4) Strong relapse at 3.6 mg of paroxetine (even trying to resist the symptoms for 3 months didn't work and a reinstatement of a slightly higher SSRI dosage didn't work as well)
5) Shifted to Sertraline, eliminated paroxetine and moved Sertraline dosage up to the correspondent maintenance dosage of 3.6 mg of Paroxeine, in few months and without problems
6) reducing Sertraline very slow (now at 8 mg, that corresponds to 3 mg of Paroxetine/Citalopram).
7) From now on I decided to follow the Turtle protocol: http://ssrigr.altervista.org

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Oh, do you mean Dr. Fava recommends using clonazepam in a psychiatric "crisis" instead of an SSRI?

 

Yes, short-term use of clonazepam might suffice in that case.

 

But no one should count on being able to take a benzo to compensate for withdrawal syndrome. The best way to reduce the risk of withdrawal syndrome is to taper.

 

Some people are sensitive to substituting one benzodiazepine for another, but all benzos can incur physical or psychological dependency, or both.

 

Please give my regards to Dr. Fava.

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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Exactly. I confirm.

Prof. Giovanni Fava strongly suggests to tackle serotoninergic crisis that are caused by SSRI reduction with the sporadic use of CLONAZEPAM (if and only if the symptoms are strong and hence don't go away in few days).

 

I guess It would be very useful for the field if people would test more this approach, and eventually further confirm its applicability.  I will bring your regards to him ;-)

 

Obviously I fully agree with you about the tapering (and also prof. Fava has the same opinion).  SSRI should be tapered very gradually.

1) Started paroxetine in 1997 at 16 years old of age (maintenance dosage 10 mg)
2) Failed several reduction attempt up to 2007
3) Started a gradual reduction protocol in 2007 at a rate of 0.2 mg per month
4) Strong relapse at 3.6 mg of paroxetine (even trying to resist the symptoms for 3 months didn't work and a reinstatement of a slightly higher SSRI dosage didn't work as well)
5) Shifted to Sertraline, eliminated paroxetine and moved Sertraline dosage up to the correspondent maintenance dosage of 3.6 mg of Paroxeine, in few months and without problems
6) reducing Sertraline very slow (now at 8 mg, that corresponds to 3 mg of Paroxetine/Citalopram).
7) From now on I decided to follow the Turtle protocol: http://ssrigr.altervista.org

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Many doctors prescribe a benzo to counter withdrawal symptoms. The problem is that people are tempted to take them frequently, and then benzo dependency results. Even with sporadic use, people can get rebound or a paradoxical reaction from a benzo, which worsens withdrawal symptoms considerably.

 

So, unfortunately, benzos are a crutch that's not very reliable.

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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So, it is absolutely true that SSRI have to be reduced extremely slow (i.e. in several years and NOT in few months).  The slow reduction is useful to gradually reduce the maintenance dosage.

A very positive thing, is that in case of crisis it is possible to go back very fast to the maintenance dosage :-) 

This means that even if one is so unlucky to have a crisis, the gains of a slow reduction are NOT LOST !!!

 

Here is the happy math.

Let's suppose that Mr X reduced in 3 years from 10mg of Citalopram to 4mg of Citalopram.

 

Then suddently Mr X has a very strong crisis and after two weeks the symptoms get worst.

 

OPTION 1)

Mr X prefers to cure himself using Citalopram and hence applies the following emergency plan

Citalopram 20 mg (for 45 days)

Citalopram 15 mg (for 30 days)

Citalopram 10 mg (for 30 days)

Citalopram 7.5 mg (for 45 days)

Citalopram 5 mg (stabilize for 120 days)    REACHED MAINTENANCE DOSAGE (i.e. the dose that Mr X was taking 4 months before the crisis)

start from here to reduce VERY SLOW     (after 4 months Mr X is back to 4 mg)

 

OPTION 2)

Mr X wants to try to cure himself using Clonazepam  (and hence he is keeping Citalopram constant at 4mg)

Clonazepam 5 drops every 12 hours (for 5 weeks)

Reduced Clonazepam 1 drop per week up to 4 drops (i.e. 6 weeks in total)

Reduced Clonazepam 1 drop every 10 days up to full clonazepam elimination (i.e. 40 days)

start from here to reduce Citalopram VERY SLOW

 

 

Both the options are quite good :-)

OPTION 1 takes 12 months 

OPTION 2 takes 4 months

 

 

I share the perplexities of Altostrata for OPTION 2 (it is faster, but it could be less safe).

Most psychiatrists would suggest option 1 but few very famous psychiatrists strongly suggest option 2 (e.g. prof. Giovanni Fava in Italy/USA and apparently also prof. Versiani in Rio de Janeiro ).

I would be very curious to hear the experience of people who tried OPTION 2… 

 

 

WARNING:  OPTION 3 (i.e.VERY BAD OPTION !!!  NEVER DO THIS !!!)

Mr X fears to loose the efforts of his 3 years of reduction. That is why he is very scared to augment the SSRIs.  Besides he is also scared about Clonazepam.

Hence he decides to try to resists the symptoms for months.

He is very unlucky and the symptoms get worst and worst (given that he is not curing himself).

At a certain point he obviously looses his job (because he even lost concentration and the tremendous anxiety prevents him to be active at work).

He thinks is a good idea to increase Citalopram to 5mg, but even after several months he still have symptoms (because probably with such a little increase the accumulation is very slow and/or the cure of the crisis require the receptors to get saturated, and 5mg is clearly not enough).

One day he is almost invested by a car because with such a loss of concentration is even difficult to go around in town.

So, he thinks it could be better to increase to 6mg, and then to 7 mg.

After 1.5 years of living like hell, having lost the job and having made a bad figure with at least 10 friends, he starts to feel better (of course he is very lucky to have survived).

Now he is at 7mg and he needs to reduce to 5mg… still several months.

 

OPTION 3 takes 2 years (of which 1.5 years living in hell).

 

 

I write about this because I see all the times people in the forums who describe how they are trying hard to accomplish option 3, and unfortunately there are even other people that encourages them in what they are doing :-(

I was also so stupid to start to try option 3, but at a certain point I thought is better to not suicide myself and pass to option 1.

1) Started paroxetine in 1997 at 16 years old of age (maintenance dosage 10 mg)
2) Failed several reduction attempt up to 2007
3) Started a gradual reduction protocol in 2007 at a rate of 0.2 mg per month
4) Strong relapse at 3.6 mg of paroxetine (even trying to resist the symptoms for 3 months didn't work and a reinstatement of a slightly higher SSRI dosage didn't work as well)
5) Shifted to Sertraline, eliminated paroxetine and moved Sertraline dosage up to the correspondent maintenance dosage of 3.6 mg of Paroxeine, in few months and without problems
6) reducing Sertraline very slow (now at 8 mg, that corresponds to 3 mg of Paroxetine/Citalopram).
7) From now on I decided to follow the Turtle protocol: http://ssrigr.altervista.org

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Mario, I guess you are preparing for a flareup of Major Depressive Disorder once one has reduced dosage of an antidepressant.

 

While this is something psychiatry is constantly warning about, it's not all that likely.

  • Most people who have been prescribed antidepressants have been told they have "depression" but in reality do not have a severe psychiatric disorder. Thus, they're not going to "relapse" to Major Depressive Disorder.
  • The statistics about "depression" as a chronic disease with increasing frequency of episodes are based on research that confounds "relapse" with withdrawal syndrome. When they say "relapse" is frequent, much of that "relapse" is withdrawal, not relapse. We don't know what how often "relapse" actually occurs once people are off psychiatric drugs. If they haven't tapered slowly enough, their state is quite different from "relapse" -- although doctors can't seem to recognize that.
  • When you've been on the drugs for a while, they change your nervous system in ways that might take a very long time to go back to normal -- the state at which you were diagnosed with "depression." Even so, if you never had Major Depressive Disorder in the first place, you're not going to relapse into it.
  • Not even Major Depressive Disorder always requires treatment with drugs.

Furthermore, what we've seen is that once people reduce their dosage, they react differently to the drug if they try it again. For example, if Mr. X is down to 4mg citalopram from 10mg citalopram, should Mr. X hit a bad patch, often 4.5mg or 5mg is enough of an updose.

 

What we see is that when people reduce their psychiatric drug dosage, withdrawal symptoms are far more likely than a psychiatric "crisis." In fact, many people go to the hospital when they have withdrawal symptoms, the hospital thinks it's a psychiatric "crisis," applies large doses of drugs, and makes the condition worse. We have many members here who have gotten caught in a cycle of drugs and adverse reactions in this way.

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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Dear Altostrata, I completely agree with you that if you are able to guess which is the right reduction speed you are never going to get a strong serotoninergic crisis (also known as OCD or MDD), while it could be more likely that you just get what I would call a "weak relapse" or better "premonitory signs" (see below).

That is why is very positive that the messages of the patients in this and other forums provide clear evidence that is smarter to plan the reduction in a time range of years (and NOT of months).

 

I also completely agree with you that "strong relapses" are much less frequent than "weak relapses".

 

Those two cases are very different and in my opinion it is somehow important to be able to differentiate them (like it is clearly explained in the Turtle Protocol).

 

However, I would assume that it could also be difficult to impose a clear "cut" that can distinguish a "not so strong relapse" from a "not so weak relapse".

That is also why the sporadic use of Clonazepam could be an advantage.  Clonazepam is for sure more flexible than SSRI  (given that it requires only 1.5 hour to have effect and not 1 month like SSRI). Hence it could also be used in "border line" cases (just taking it once on the strongest anxiety attacks, instead of instantiating a regular therapy like one should do if he is suffering of a very strong relapse).

I take the occasion again to point out that Clonazepam seems to be the only "high quality" benzodiazepine that should be used in psychiatry  (at least this is the opionion of prof. Fava).

 

 

Let's go back to your example of Mr X.

As you said, when Mr X arrived at a dosage of 4 mg he has an anxiety attack.  Hence he thinks that it is better to increase the dosage to 5 mg and in about 2 days he feels better.

 

This is a clear example of "weak relapse".  Mr X doesn't feel better because he augmented the dosage to 5 mg, but simply because his brain adapted spontaneously to the current dosage of SSRI (i.e. 4 mg).  It is highly probable, that even if Mr X would have left the dosage to 4 mg, he would have got better anyhow.

 

However, the idea of Mr X to SUSPEND the reduction and even AUGMENT a little bit the dosage is absolutely GOOD !!!  This is because the anxiety attack that Mr X had is CLEARLY a sign that his brain is having trouble to adapt to the current dosage of SSRI (and hence the risks for Mr X to have a strong crisis are much higher in this particular moment).  Hence Mr X should be very careful and NOT REDUCE in the following 4 or 5 months.

 

 

During my gradual reduction (from 2008 up to today) I had 3 weak relapses and 1 strong relapse:

(2010)  single episode of clear anxiety, little panick attack, that lasted only few hours

(June 2012)  single episode of a quite strong panick attack that lasted a night and I sedated it using alprazolam

(August 2012) single episode of clear anxiety that lasted only few hours

(15 December 2012) very strong relapse that I have already described in the above messages

 

As you can see from my clinical record,  it would have been for sure SMARTER if I would have suspended the reduction in Summer 2012 !!! 

My brain was clearly showing signs of difficulties in adapting to the dosage. 

1) Started paroxetine in 1997 at 16 years old of age (maintenance dosage 10 mg)
2) Failed several reduction attempt up to 2007
3) Started a gradual reduction protocol in 2007 at a rate of 0.2 mg per month
4) Strong relapse at 3.6 mg of paroxetine (even trying to resist the symptoms for 3 months didn't work and a reinstatement of a slightly higher SSRI dosage didn't work as well)
5) Shifted to Sertraline, eliminated paroxetine and moved Sertraline dosage up to the correspondent maintenance dosage of 3.6 mg of Paroxeine, in few months and without problems
6) reducing Sertraline very slow (now at 8 mg, that corresponds to 3 mg of Paroxetine/Citalopram).
7) From now on I decided to follow the Turtle protocol: http://ssrigr.altervista.org

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Oh, now I understand. You are referring to the crisis of a withdrawal reaction. This can look like MDD or OCD, but it is not.

 

Yes, one can use occasional clonazepam to cope with withdrawal symptoms. But slightly increasing the dose might have less risk. Then, one would hold on any further dosage changes until the nervous system stabilizes. This reserves clonazepam to be used as a last resort.

 

Depending on how sensitive a person is, the increase in dosage to stop withdrawal symptoms might be a fraction of a milligram. In the Introductions forum, you can see many people doing this http://tinyurl.com/3o4k3j5

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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Hi Altostrata,

Thx also for having clearly separated the posts and to administering well the forum :-)

1) Started paroxetine in 1997 at 16 years old of age (maintenance dosage 10 mg)
2) Failed several reduction attempt up to 2007
3) Started a gradual reduction protocol in 2007 at a rate of 0.2 mg per month
4) Strong relapse at 3.6 mg of paroxetine (even trying to resist the symptoms for 3 months didn't work and a reinstatement of a slightly higher SSRI dosage didn't work as well)
5) Shifted to Sertraline, eliminated paroxetine and moved Sertraline dosage up to the correspondent maintenance dosage of 3.6 mg of Paroxeine, in few months and without problems
6) reducing Sertraline very slow (now at 8 mg, that corresponds to 3 mg of Paroxetine/Citalopram).
7) From now on I decided to follow the Turtle protocol: http://ssrigr.altervista.org

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You're welcome, Mario. Having two threads of discussions in one topic was confusing.

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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  • Moderator Emeritus

Clonazepam, just to make it clear to anyone reading this forum, is Klonopin, a benzo, and I hate to tell you all the horror stories I have heard from people who would give ANYthing to have never taken it.  

 

It's no magic bullet. Believe me, if it was, I'd be shouting it from the rooftops. Klonopin, like all benzos, is highly addictive and can lead to all kinds of problems. Any benzos should only be used for short periods or very intermittently and cautiously. I just have seen so much suffering caused by Klonopin and other benzos that I cannot encourage anyone to use them.

Started on Prozac and Xanax in 1992 for PTSD after an assault. One drug led to more, the usual story. Got sicker and sicker, but believed I needed the drugs for my "underlying disease". Long story...lost everything. Life savings, home, physical and mental health, relationships, friendships, ability to work, everything. Amitryptiline, Prozac, bupropion, buspirone, flurazepam, diazepam, alprazolam, Paxil, citalopram, lamotrigine, gabapentin...probably more I've forgotten. 

Started multidrug taper in Feb 2010.  Doing a very slow microtaper, down to low doses now and feeling SO much better, getting my old personality and my brain back! Able to work full time, have a full social life, and cope with stress better than ever. Not perfect, but much better. After 23 lost years. Big Pharma has a lot to answer for. And "medicine for profit" is just not a great idea.

 

Feb 15 2010:  300 mg Neurontin  200 Lamictal   10 Celexa      0.65 Xanax   and 5 mg Ambien 

Feb 10 2014:   62 Lamictal    1.1 Celexa         0.135 Xanax    1.8 Valium

Feb 10 2015:   50 Lamictal      0.875 Celexa    0.11 Xanax      1.5 Valium

Feb 15 2016:   47.5 Lamictal   0.75 Celexa      0.0875 Xanax    1.42 Valium    

2/12/20             12                       0.045               0.007                   1 

 

I'm not a doctor. Any advice I give is just my civilian opinion.

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Oh, now I understand. You are referring to the crisis of a withdrawal reaction. This can look like MDD or OCD, but it is not.

 

Yes, one can use occasional clonazepam to cope with withdrawal symptoms. But slightly increasing the dose might have less risk. Then, one would hold on any further dosage changes until the nervous system stabilizes. This reserves clonazepam to be used as a last resort.

 

Depending on how sensitive a person is, the increase in dosage to stop withdrawal symptoms might be a fraction of a milligram. In the Introductions forum, you can see many people doing this http://tinyurl.com/3o4k3j5

 

Yes. What she said. 

Started on Prozac and Xanax in 1992 for PTSD after an assault. One drug led to more, the usual story. Got sicker and sicker, but believed I needed the drugs for my "underlying disease". Long story...lost everything. Life savings, home, physical and mental health, relationships, friendships, ability to work, everything. Amitryptiline, Prozac, bupropion, buspirone, flurazepam, diazepam, alprazolam, Paxil, citalopram, lamotrigine, gabapentin...probably more I've forgotten. 

Started multidrug taper in Feb 2010.  Doing a very slow microtaper, down to low doses now and feeling SO much better, getting my old personality and my brain back! Able to work full time, have a full social life, and cope with stress better than ever. Not perfect, but much better. After 23 lost years. Big Pharma has a lot to answer for. And "medicine for profit" is just not a great idea.

 

Feb 15 2010:  300 mg Neurontin  200 Lamictal   10 Celexa      0.65 Xanax   and 5 mg Ambien 

Feb 10 2014:   62 Lamictal    1.1 Celexa         0.135 Xanax    1.8 Valium

Feb 10 2015:   50 Lamictal      0.875 Celexa    0.11 Xanax      1.5 Valium

Feb 15 2016:   47.5 Lamictal   0.75 Celexa      0.0875 Xanax    1.42 Valium    

2/12/20             12                       0.045               0.007                   1 

 

I'm not a doctor. Any advice I give is just my civilian opinion.

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Clonazepam, just to make it clear to anyone reading this forum, is Klonopin, a benzo, and I hate to tell you all the horror stories I have heard from people who would give ANYthing to have never taken it.  

 

It's no magic bullet. Believe me, if it was, I'd be shouting it from the rooftops. Klonopin, like all benzos, is highly addictive and can lead to all kinds of problems. Any benzos should only be used for short periods or very intermittently and cautiously. I just have seen so much suffering caused by Klonopin and other benzos that I cannot encourage anyone to use them.

 

Yes. What she said.

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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Hi Mario.. just to add my two cents. I was on 3.5 mgs of Klonopin and it took me 3 years to taper off. Something I most assuredly would rather have avoided. It's a miserable drug, and made me quite ill at the dose cited. I no longer need to genuflect to docs because I need a benzo to get by. Wheeeee I'm FREE!

 

Rhi... my sympathies regarding the script panhandler MO. It's really crummy. (I would rather say it's really !@#$%!)

As always, LISTEN TO YOUR BODY! A proud supporter of the 10% (or slower) rule.

 

Requip - 3/16 ZERO  Total time on 25 years.

 

Lyrica: 8/15 ZERO Total time on 7 or 8 yrs.

BENZO FREE 10/13 (started tapering 7/10)  Total time on 25 years.

 

Read my intro thread here, and check the about me section.  "No matter how cynical you get, it's almost impossible to keep up." Lily Tomlin

 

 

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I NEVER suggested to become addicted to Clonazepam.

Please don't misconceive the precious suggestions that we are generously getting from prof. Fava.

From what is written in the turtle protocol, Clonazepam is suggested ONLY when the reduction has been performed VERY gradually and ONLY when the symptoms are VERY STRONG and do persists for several days.  

Besides in the article there is a very clear limitation on the maximum amount of time that the Clonazepam can be taken (i.e. 5 weeks) and to the appropriate gradual reduction that is required in order to tackle the little dependency that one gets in those 5 weeks.

 

My interpretation is that the use of Clonazepam when the reduction is performed Cold Turkey and/or unreasonably fast is STRONGLY DISCOURAGED !!!!  

(the reason is that 1 month of sedation by Clonazepam in this case are probably not enough for the brain to adapt to the Cold Turkey reduction and hence the emergency plan will obviously fail !!!!  In this case the use of Clonazepam is INAPPROPRIATE !!!.)

 

Under your suggestion, I will contact immediately the authors of the protocol and ask them to put more warnings about the possible dependency that can be generated by Clonazepam (in order to hopefully educate the reader to a very responsible usage  ) !  

 

Thx again for the important suggestions.

1) Started paroxetine in 1997 at 16 years old of age (maintenance dosage 10 mg)
2) Failed several reduction attempt up to 2007
3) Started a gradual reduction protocol in 2007 at a rate of 0.2 mg per month
4) Strong relapse at 3.6 mg of paroxetine (even trying to resist the symptoms for 3 months didn't work and a reinstatement of a slightly higher SSRI dosage didn't work as well)
5) Shifted to Sertraline, eliminated paroxetine and moved Sertraline dosage up to the correspondent maintenance dosage of 3.6 mg of Paroxeine, in few months and without problems
6) reducing Sertraline very slow (now at 8 mg, that corresponds to 3 mg of Paroxetine/Citalopram).
7) From now on I decided to follow the Turtle protocol: http://ssrigr.altervista.org

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If withdrawal symptoms occur during a gradual taper, we recommend stop tapering for a while to allow symptoms to dissipate or updose slightly if they do not, rather than take a benzo.

 

People can get addicted to benzos very quickly. We have people here who have had difficulty going off benzos after only a couple of weeks.

 

Not only that, there is the possibility of paradoxical reactions to the benzo, which can be mistaken for severe withdrawal symptoms or some other kind of "crisis."

 

Please convey this information to Dr. Fava, Mario.

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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Five weeks of Klonopin is more than enough to develop dependency. It's not like we get "lighter" dependency versus "heavier" dependency; there are variations on how hard it is for people to get off and how bad their WD symptoms are, and time on the med is one variable, but it's not that simple or predictable, there's a lot of individual variation and many factors involved.

 

I knew a guy on the benzo boards that took Klonopin for three weeks then stopped, got sick, so he took it again, stopped again, got sick again...He didn't want to taper slowly (can't blame him, he only took it for three weeks and couldn't imagine tapering off it for months after such short use). But because of that he kept going on and off and his ordeal by the time he finally got off was over a year and a half, and he was still sick at the end.

 

And many people who took it for only a couple of months who ended up in addiction and withdrawal trouble that took years to untangle.

 

We often find members here (there's one right now actually) who have used benzos as rescue medicine in withdrawal, not even taking them daily, just a few times a week, who have ended up with aggravated and worsened withdrawal symptoms when they quit the benzos, even if they were supposedly not taking them long or often enough to develop dependence.

 

Our nervous systems are not made of separate compartments. All the neurotransmitters and all of the cells connect and interact with each other, so when you disrupt one thing, you shift something else, which affects another thing, which affects another thing. And all of these things affect other things on the side, in complicated feedback loops. In biochemistry they're called "chemical cascades".

 

I just feel that benzo use to alleviate WD symptoms should be done very carefully, only sporadically (never daily), and only as a last resort. 

Started on Prozac and Xanax in 1992 for PTSD after an assault. One drug led to more, the usual story. Got sicker and sicker, but believed I needed the drugs for my "underlying disease". Long story...lost everything. Life savings, home, physical and mental health, relationships, friendships, ability to work, everything. Amitryptiline, Prozac, bupropion, buspirone, flurazepam, diazepam, alprazolam, Paxil, citalopram, lamotrigine, gabapentin...probably more I've forgotten. 

Started multidrug taper in Feb 2010.  Doing a very slow microtaper, down to low doses now and feeling SO much better, getting my old personality and my brain back! Able to work full time, have a full social life, and cope with stress better than ever. Not perfect, but much better. After 23 lost years. Big Pharma has a lot to answer for. And "medicine for profit" is just not a great idea.

 

Feb 15 2010:  300 mg Neurontin  200 Lamictal   10 Celexa      0.65 Xanax   and 5 mg Ambien 

Feb 10 2014:   62 Lamictal    1.1 Celexa         0.135 Xanax    1.8 Valium

Feb 10 2015:   50 Lamictal      0.875 Celexa    0.11 Xanax      1.5 Valium

Feb 15 2016:   47.5 Lamictal   0.75 Celexa      0.0875 Xanax    1.42 Valium    

2/12/20             12                       0.045               0.007                   1 

 

I'm not a doctor. Any advice I give is just my civilian opinion.

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Our nervous systems are not made of separate compartments.

Never a truer word was spoken

Please note - I am not a medical practitioner and I do not give medical advice. I offer an opinion based on my own experiences, reading and discussion with others.On Effexor for 2 months at the start of 2005. Had extreme insomnia as an adverse reaction. Changed to mirtazapine. Have been trying to get off since mid 2008 with numerous failures including CTs and slow (but not slow enough tapers)Have slow tapered at 10 per cent or less for years. I have liquid mirtazapine made at a compounding chemist.

Was on 1.6 ml as at 19 March 2014.

Dropped to 1.5 ml 7 June 2014. Dropped to 1.4 in about September.

Dropped to 1.3 on 20 December 2014. Dropped to 1.2 in mid Jan 2015.

Dropped to 1 ml in late Feb 2015. I think my old medication had run out of puff so I tried 1ml when I got the new stuff and it seems to be going ok. Sleep has been good over the last week (as of 13/3/15).

Dropped to 1/2 ml 14/11/15 Fatigue still there as are memory and cognition problems. Sleep is patchy but liveable compared to what it has been in the past.

 

DRUG FREE - as at 1st May 2017

 

>My intro post is here - http://survivingantidepressants.org/index.php?/topic/2250-dalsaan

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I would not recommend anyone to take a "Benzodiazepine" for withdrawal symptoms.

Withdrawal symptoms unmanageable, are an indication you are tapering too fast.

Its all about the Brain Chemistry, and all of us are different.

 

Peace

 

Olivia

100mg Zoloft

Tapered 3 mg of Xanax to 2mg @.25mg cuts. 5/12-10/12  Seizure 6/12

1mg X tapered to 0 1/13-11/28/13 .0625mg compound caps

100mg Zoloft to Taper

 

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I did not taper but did cold turkey had a traumatic experience (death of a close friend while in early withdrawal) I took one lorazepam which I had taken before without issue the first worked I think I had been up all night and I did sleep the next night I took another .5mg tab and had a paradoxical reaction meaning it did the opposite of what I expected... I walked the floor with complete and utter agitation till it wore off which I will say was much longer than it would have made me sleep if it did work as expected. 

I was told this was a very odd thing to have happen and that generally children are the only paradoxical reaction to this drug but it can happen because it happened to me. 

My 2 cents. 

WARNING THIS WILL BE LONG
Had a car accident in 85
Codeine was the pain med when I was release from hosp continuous use till 89
Given PROZAC by a specialist to help with nerve pain in my leg 89-90 not sure which year
Was not told a thing about it being a psych med thought it was a pain killer no info about psych side effects I went nuts had hallucinations. As I had a head injury and was diagnosed with a concussion in 85 I was sent to a head injury clinic in 1990 five years after the accident. I don't think they knew I had been on prozac I did not think it a big deal and never did finish the bottle of pills. I had tests of course lots of them. Was put into a pain clinic and given amitriptyline which stopped the withdrawal but had many side effects. But I could sleep something I had not done in a very long time the pain lessened. My mother got cancer in 94 they switched my meds to Zoloft to help deal with this pressure as I was her main care giver she died in 96. I stopped zoloft in 96 had withdrawal was put on paxil went nutty quit it ct put on resperidol quit it ct had withdrawal was put on Effexor... 2years later celexa was added 20mg then increased to 40mg huge personality change went wild. Did too fast taper off Celexa 05 as I felt unwell for a long time prior... quit Effexor 150mg ct 07 found ****** 8 months into withdrawal learned some things was banned from there in 08 have kept learning since. there is really not enough room here to put my history but I have a lot of opinions about a lot of things especially any of the drugs mentioned above.
One thing I would like to add here is this tidbit ALL OPIATES INCREASE SEROTONIN it is not a huge jump to being in chronic pain to being put on an ssri/snri and opiates will affect your antidepressants and your thinking.

As I do not update much I will put my quit date Nov. 17 2007 I quit Effexor cold turkey. 

http://survivingantidepressants.org/index.php?/topic/1096-introducing-myself-btdt/

There is a crack in everything ..That's how the light gets in :)

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Dear Rhi, dalsaan,

 

From my honest opinion, every drug that affects the brain is addictive.

 

However, this doesn't mean that every brain drug is useless. There are pathologies that clearly need to be cured with the use of drugs.

Every drug can be used in a good or bad way. This is valid also for Klonopin (i.e. the drug that is mentioned in the emergency plan of the Turtle Protocol)

 

Your example about your friend's problem with Klonopin, is clearly an example of bad use.

I believe that taking Klonopin few times x week is not a great idea.

I would rather choose one of the following 2 options:

1) take it sporadically (no more than once every 7-10 days). I guess this could be useful in case of a weak relapse

2) take it regularly (i.e. 2 times x day at a well defined dosage). This is what the Turtle protocol suggests in case of a strong relapse.  Obviously, after 5 weeks the protocol prescribes a gradual reduction of Klonopin in the successive 3 months.

 

If instead one assumes Klonopin in a sort of "disordered" way (i.e. few times x week), than I guess that even more dependency would be acquired with respect to assuming it regularly  (because this on and off from Klonopin is for sure not healthy for the brain !).

 

I will convey your observation to the authors of the article… let's see if they will accept to add some additional warnings for potential misusage.

1) Started paroxetine in 1997 at 16 years old of age (maintenance dosage 10 mg)
2) Failed several reduction attempt up to 2007
3) Started a gradual reduction protocol in 2007 at a rate of 0.2 mg per month
4) Strong relapse at 3.6 mg of paroxetine (even trying to resist the symptoms for 3 months didn't work and a reinstatement of a slightly higher SSRI dosage didn't work as well)
5) Shifted to Sertraline, eliminated paroxetine and moved Sertraline dosage up to the correspondent maintenance dosage of 3.6 mg of Paroxeine, in few months and without problems
6) reducing Sertraline very slow (now at 8 mg, that corresponds to 3 mg of Paroxetine/Citalopram).
7) From now on I decided to follow the Turtle protocol: http://ssrigr.altervista.org

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Hi Olivia,

Yes, you are right: withdrawal symptoms are for sure an indication that you are tapering too fast (that is why it is important to slow down the reduction).

However, if the symptoms are so strong to not go away in 2 or 3 weeks, it also means that the "too fast reduction" caused a sort of "psychiatric flu" that needs to be cured in a proper way (e.g. going to a psychiatrist or at least trying to do the right things).

1) Started paroxetine in 1997 at 16 years old of age (maintenance dosage 10 mg)
2) Failed several reduction attempt up to 2007
3) Started a gradual reduction protocol in 2007 at a rate of 0.2 mg per month
4) Strong relapse at 3.6 mg of paroxetine (even trying to resist the symptoms for 3 months didn't work and a reinstatement of a slightly higher SSRI dosage didn't work as well)
5) Shifted to Sertraline, eliminated paroxetine and moved Sertraline dosage up to the correspondent maintenance dosage of 3.6 mg of Paroxeine, in few months and without problems
6) reducing Sertraline very slow (now at 8 mg, that corresponds to 3 mg of Paroxetine/Citalopram).
7) From now on I decided to follow the Turtle protocol: http://ssrigr.altervista.org

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Mario, in Italy it may be different, but in the US we're not finding psychiatrists are very helpful regarding withdrawal symptoms.

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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Dear Altostrata,

From my opinion the situation in Italy is more or less the same (with the exception of prof. Fava).  Most of the psychiatrists continue to deny the strong addiction of the SSRI (probably because of the strong advertisement campaign of the pharmaceutical companies).

I do believe that the main difference from withdrawal symptoms and "fresh" symptoms (i.e. symptoms of a person that had never taken drugs before or kept those at a constant level) are two:

1) their severity (if the reduction has been performed too fast, than withdrawal symptoms can be very bad !)

2) withdrawal symptoms normally lack a very strong psychological interpretation 

 

This is also way it is important to know that one could feel a reduction of the SSRI even 3 or 4 months later (many people don't even realize that the relapse was caused by a reduction because of the late effects…  and they would attribute the fault to very minor psychological issues that every normal person has in life).

1) Started paroxetine in 1997 at 16 years old of age (maintenance dosage 10 mg)
2) Failed several reduction attempt up to 2007
3) Started a gradual reduction protocol in 2007 at a rate of 0.2 mg per month
4) Strong relapse at 3.6 mg of paroxetine (even trying to resist the symptoms for 3 months didn't work and a reinstatement of a slightly higher SSRI dosage didn't work as well)
5) Shifted to Sertraline, eliminated paroxetine and moved Sertraline dosage up to the correspondent maintenance dosage of 3.6 mg of Paroxeine, in few months and without problems
6) reducing Sertraline very slow (now at 8 mg, that corresponds to 3 mg of Paroxetine/Citalopram).
7) From now on I decided to follow the Turtle protocol: http://ssrigr.altervista.org

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Yes, exactly.

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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Dear all,

I have been notified that The Turtle Protcol has been recently updated:

 


 

Several discussion topics that have been raised in this forum are now addressed and explained extensively

1) Started paroxetine in 1997 at 16 years old of age (maintenance dosage 10 mg)
2) Failed several reduction attempt up to 2007
3) Started a gradual reduction protocol in 2007 at a rate of 0.2 mg per month
4) Strong relapse at 3.6 mg of paroxetine (even trying to resist the symptoms for 3 months didn't work and a reinstatement of a slightly higher SSRI dosage didn't work as well)
5) Shifted to Sertraline, eliminated paroxetine and moved Sertraline dosage up to the correspondent maintenance dosage of 3.6 mg of Paroxeine, in few months and without problems
6) reducing Sertraline very slow (now at 8 mg, that corresponds to 3 mg of Paroxetine/Citalopram).
7) From now on I decided to follow the Turtle protocol: http://ssrigr.altervista.org

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Mario, what changes did you make?

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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Dear Altostrata,

A new section on how to guess the right tapering speed has been added.

Besides, the authors tried to better clarify the emergency plan adding an FAQ section.

1) Started paroxetine in 1997 at 16 years old of age (maintenance dosage 10 mg)
2) Failed several reduction attempt up to 2007
3) Started a gradual reduction protocol in 2007 at a rate of 0.2 mg per month
4) Strong relapse at 3.6 mg of paroxetine (even trying to resist the symptoms for 3 months didn't work and a reinstatement of a slightly higher SSRI dosage didn't work as well)
5) Shifted to Sertraline, eliminated paroxetine and moved Sertraline dosage up to the correspondent maintenance dosage of 3.6 mg of Paroxeine, in few months and without problems
6) reducing Sertraline very slow (now at 8 mg, that corresponds to 3 mg of Paroxetine/Citalopram).
7) From now on I decided to follow the Turtle protocol: http://ssrigr.altervista.org

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Mario, thank you for the "turtle taper." It is more in line with what we recommend, although the example for olanzapine seems rather rapid.

 

Did you translate this into Italian?

 

I moved your post in the reinstating topic here, with my comments. Thank you for the thoughtfulness you brought to this.

 

Dear all, I am happy that this forum tackled a very important topic on which I would like to give my personal opinion:

*** ACCUMULATION TIME OF SSRI ***

SSRI accumulates in the adipose tissue of the brain.

For simplicity, you can consider the adipose tissue like a lake (it needs time to be filled and to get empty).

How much time ??

It obviously strictly depends on the DOSAGEs !!! In my experience If you take 20mg of Paxil (and/or Citalopram) it takes more or less 1 month to accumulate to a dosage that is high enough in order to block my crisis.

Differently if I take only 10mg, it can take 2 or 3 months to accumulate and block my crisis.

The same happens when one reduces the dosage.

If one suddenly stops to take the SSRI, it can be a matter of few weeks to feel the symptoms. Differently, if one reduce only a little bit (e.g. 20%) it can take up to 3 or 4 months to feel the effect.

That is an interesting interpretation. It may be true that various drugs are stored in the fatty tissues. However, what seems more likely is that the nervous system resists the initial effect of antidepressants, which is why it is said it takes some time for them to be effective.

 

Likewise, withdrawal symptoms may not be immediate because it may take some time for the nervous system to become destabilized by the lack of the drug.

 

You may wish to read papers by Giovanni Fava, an Italian psychiatric researcher, regarding this.

 

Never forget to perform the reduction VERY SLOW (if you fall into a serotoninergic crisis it is obviously because you were reducing too fast) !

 

What to do in case you have a crisis ?

Well, my opinion is that first you should try to figure out "how strong" are the symptoms. If a symptoms are mild try to support it for a couple of weeks, they may just disappear (but STOP THE REDUCTION !). Otherwise, if they are strong and/or if you still experience symptoms after a couple of weeks you should act immediately.

There are only two options available:

1) Augment the SSRI (if you decide to do that you have to take the full dosage such that they accumulate as fast as possible. Only when you feel better, you can reduce them quite fast up to your maintenance dosage… because your brain is adapted to that dosage. It will take 1 month for you to feel better, and you could also feel worst when you augment the dosage because of minor side effects… but you shouldn't give them much importance before 1 month ).

2) Use a special benzodiazepine called Clonazepam (i.e. try to sedate well the symptoms for a while with the hope that blocking the crisis your brain can adapt to the new SSRI level. If you decide to do this you should keep the level of the SSRI constant.). If I will be so unlucky to have a crisis again I will try to adopt this second approach (as suggested by some famous psychiatrists). In my calculation, the use of Clonazepam should save you around 5 or 6 months of time with respect to augmenting the SSRI.

I agree with #1 above, but there are problems with using clonazepam (a benzo) to treat withdrawal symptoms -- which many, many people here have experienced:

  • Benzos may have a side effect of depression or anxiety
  • When they wear off, benzos may have a daily rebound effect of worsening symptoms
  • Used over time, a benzo may go paradoxical -- causing worse symptoms than the withdrawal symptoms
  • Used regularly, benzos are physiologically addicting (some people become psychologically addicted to them as well), requiring higher and higher doses for the same effect
  • Used regularly for 2 weeks or more, benzos can be difficult to discontinue, requiring very gradual tapering
  • If the benzo is not tapered slowly enough, benzo withdrawal syndrome can last months or years

While benzos might be effective in relieving some withdrawal symptoms, they need to be used very carefully, at the lowest effective dosage and as infrequently as possible. If you use them every day, you run the risks above. It's not unusual for people who take benzos for only a week or two to find they need to taper extremely gradually to go off them. So with benzos, you run the risk of trading one kind of withdrawal syndrome for another that might be even worse.

"SSRI accumulates in the adipose tissue of the brain."

This may be a language issue but to my understanding there is not adipose tissue in the brain. 

 

I did look up the association between the brain and adipose tissue... 

 

Obesity and insulin resistance: A neural hypothesis.

As elaborated earlier in this article, it has become clear that the brain is an insulin-sensitive organ and glucose metabolism in insulin-resistant individuals is disrupted in the brain as in other target organs. What, then, could be the cause of insulin insensitivity of the brain in the state of obesity? First of all, insulin transport may become rate limiting under certain circumstances, as has been outlined above regarding insulin's access to the interstitial space and its action in muscle and fat (1877230). It is notable that the capillary endothelium that comprises the blood-brain barrier is surrounded not only by pericytes but by macrophages, which are stimulated by cytokines and chemokines in inflammatory brain diseases (134) (Fig. 3). It could then be proposed that, in the low-grade inflammatory state found in obesity, these macrophages are also involved in the generalized activation of the NF-κB pathway (31213214). While the insulin receptor-mediated transporter in brain capillary endothelium has not been characterized at the cellular level, it is possible that serine phosphorylation of IRS-1 might adversely affect insulin transport as it does in other insulin-sensitive cells (8). In such a way, the etiology of insulin resistance may be similar in the brain, blood vessels, and, through vasocrine effects, muscle.

Fig. 3.

The Neural Hypothesis. Effects of the brain and central nervous system on glucose metabolism, peripheral insulin action, and adipose tissue mass and metabolism. BBB, blood-brain barrier; Mac, macrophage; Peri, pericyte; As, astrocyte; EGP, endogenous glucose production; VAT, visceral adipose tissue; SAT, subcutaneous adipose tissue.

 

It is likely that the brain's involvement in the regulation of glucose homeostasis serves more as a master regulator rather than as a mere target organ (Fig. 3). Phrased differently, the brain's insensitivity to insulin and/or other nutrients such as glucose or NEFA seems to influence endogenous glucose production, adipose tissue lipolysis, and adipocyte proliferation. In insulin-sensitive subjects, the brain processes information from adiposity signals such as insulin and leptin and integrates this input with nutrient signals such as NEFA and glucose (183229), thereby favoring the return of food intake and glucose production by the liver to their original levels. On the contrary, the brain in insulin-resistant individuals will result in elevated levels of both body fat content and hepatic glucose production due to defects in brain nutrient sensing. Rossetti et al. (185) provided supporting evidence in a study where restoring hypothalamic levels of long-chain fatty acyl-CoAs in overfed rats normalized food intake and glucose homeostasis . This occured in association with markedly improved liver insulin sensitivity and selective activation of brainstem neurons within the nucleus of the solitary tract and the dorsal motor nucleus of the vagus (201). In short, the brain appears to sense nutrient or hormonal signals and subsequently impact hepatic glucose production through the vagus nerve.

 

too special note of the bbb in this article. 

WARNING THIS WILL BE LONG
Had a car accident in 85
Codeine was the pain med when I was release from hosp continuous use till 89
Given PROZAC by a specialist to help with nerve pain in my leg 89-90 not sure which year
Was not told a thing about it being a psych med thought it was a pain killer no info about psych side effects I went nuts had hallucinations. As I had a head injury and was diagnosed with a concussion in 85 I was sent to a head injury clinic in 1990 five years after the accident. I don't think they knew I had been on prozac I did not think it a big deal and never did finish the bottle of pills. I had tests of course lots of them. Was put into a pain clinic and given amitriptyline which stopped the withdrawal but had many side effects. But I could sleep something I had not done in a very long time the pain lessened. My mother got cancer in 94 they switched my meds to Zoloft to help deal with this pressure as I was her main care giver she died in 96. I stopped zoloft in 96 had withdrawal was put on paxil went nutty quit it ct put on resperidol quit it ct had withdrawal was put on Effexor... 2years later celexa was added 20mg then increased to 40mg huge personality change went wild. Did too fast taper off Celexa 05 as I felt unwell for a long time prior... quit Effexor 150mg ct 07 found ****** 8 months into withdrawal learned some things was banned from there in 08 have kept learning since. there is really not enough room here to put my history but I have a lot of opinions about a lot of things especially any of the drugs mentioned above.
One thing I would like to add here is this tidbit ALL OPIATES INCREASE SEROTONIN it is not a huge jump to being in chronic pain to being put on an ssri/snri and opiates will affect your antidepressants and your thinking.

As I do not update much I will put my quit date Nov. 17 2007 I quit Effexor cold turkey. 

http://survivingantidepressants.org/index.php?/topic/1096-introducing-myself-btdt/

There is a crack in everything ..That's how the light gets in :)

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WARNING THIS WILL BE LONG
Had a car accident in 85
Codeine was the pain med when I was release from hosp continuous use till 89
Given PROZAC by a specialist to help with nerve pain in my leg 89-90 not sure which year
Was not told a thing about it being a psych med thought it was a pain killer no info about psych side effects I went nuts had hallucinations. As I had a head injury and was diagnosed with a concussion in 85 I was sent to a head injury clinic in 1990 five years after the accident. I don't think they knew I had been on prozac I did not think it a big deal and never did finish the bottle of pills. I had tests of course lots of them. Was put into a pain clinic and given amitriptyline which stopped the withdrawal but had many side effects. But I could sleep something I had not done in a very long time the pain lessened. My mother got cancer in 94 they switched my meds to Zoloft to help deal with this pressure as I was her main care giver she died in 96. I stopped zoloft in 96 had withdrawal was put on paxil went nutty quit it ct put on resperidol quit it ct had withdrawal was put on Effexor... 2years later celexa was added 20mg then increased to 40mg huge personality change went wild. Did too fast taper off Celexa 05 as I felt unwell for a long time prior... quit Effexor 150mg ct 07 found ****** 8 months into withdrawal learned some things was banned from there in 08 have kept learning since. there is really not enough room here to put my history but I have a lot of opinions about a lot of things especially any of the drugs mentioned above.
One thing I would like to add here is this tidbit ALL OPIATES INCREASE SEROTONIN it is not a huge jump to being in chronic pain to being put on an ssri/snri and opiates will affect your antidepressants and your thinking.

As I do not update much I will put my quit date Nov. 17 2007 I quit Effexor cold turkey. 

http://survivingantidepressants.org/index.php?/topic/1096-introducing-myself-btdt/

There is a crack in everything ..That's how the light gets in :)

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Please let's stop with the references to SSRIs being stored in fat tissue. It's a non-issue.

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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