Jump to content
dignan

dignan: Pre-work for an eventual taper attempt

Recommended Posts

dignan

Hi, 

 

I hope to be a regular contributor. Here is a bit of background: Throughout high school I was mildly depressed and anxious, which turned into a pretty horrible social anxiety and moderate depression in first year of university. Eventually I left school and was pretty depressed for eight months. I started Paxil when I was nearly 20 in 11/06 and immediately my anxiety and depression seemed to vanish. I returned to school and withdrew my Paxil six months later with no noticeable withdrawal. 

 

Two and a half years later when I was 22 I began experiencing some horrible anxiety triggering some gastro issues. I took one dose of Paxil and woke up that night with some sort of terrible panic attack. I ceased taking the Paxil but the panic attacks (flu-like symptoms) continued and lasted hours at a time. I feared that I was dying. Eventually I was hospitalized and put on Cipralex and Olanzapine. My anxiety eventually halted and the Cipralex gave me more energy and motivation than I typically have. Eventually I was labelled bipolar ii because of the initial but short lasting activating effects that some antidepressants have in me.  The Cipralex pooped out in three weeks and I was polydrugged for the next four years, including two more hospitalizations in that first year for depression. Eventually my mood and anxiety stabilized for two years on Cymbalta, lithium, and Alertec; however, the fatigue was unbearable.

 

In 08/13 I came off Cymbalta and my mood started to deteriorate (I probably experienced about a month of withdrawal syndrome including insomnia, irritability, brain zaps, and flu-like symptoms). After more polydrugging, I decided that the drugs may be making things worse. At nearly age 27, I came off of Pristiq and lithium. Pristiq brought on a similar syndrome as Cymbalta. I came off of both antidepressants too quickly, however, usually in a matter of a month. I also came off of lithium way too quickly, in about six weeks. As I was coming off lithium I began to feel normal again for the first time in four and a half years. About three weeks after my last lithium dose (02/14) I woke up vomiting. I then had severe anxiety for a couple of days but it lifted in a week. It was replaced by a mild or moderate depression that was, for the most part, quite manageable. I was actually hopeful, had normal energy for the first time in years, and beginning meditation and psychotherapy and thought I might recover. Unfortunately, some bad life events happened: there was conflict in the house that I live in and I ended up living on my own for a while (not a good thing). Worse, however, is that I injured by back. It remains injured and I am now getting some tests done to try and figure out what is wrong with it. I can't walk more than five minutes without it getting quite achey and knotty. Eventually this bodily stress had me thinking thoughts that I was dying again and that my back will never heal. This lead to me to being in a constant state of panic. I was losing lots of weight and my body had been in panic mode for nearly a week. I was terrified. I went to a community crisis centre who I thought might help me without psych drugs -- but they basically told me to go get drugs. I ended up hospitalized (06/14) and was immediately put on mirtazapine and then Lyrica. A few days later the anxiety left and I entered the most severe depression of my life: it was incredibly painful, I could barely move, my voice had no emotion, and I was asking my parents to kill me. The depression would occasionally lift at nighttime and I would be normal again. The depression lifted one morning and was replaced by a depressive/anxious hellish state that did not lift in the evening. Defeated, uncertain how the pain would go away, and pressured by my nurses and my psychiatrist, I upped everything and began lithium again albeit at a lower dose: mirtazapine 30mg, Lyrica 100mg, lithium 600mg. 

 

I was discharged from the hospital last week. I feel incredibly discouraged. Before I found this site (and the 10% rule) I tapered 25mg off of Lyrica so that now the Lyrica fog is much more bearable during the day. 

 

My biggest questions at this point are: after tapering off of drugs or during the taper for some people, how does one deal with severe panic anxiety or with severe, profoundly painful depression? I am beginning to browse these forums looking for these answers. I fear that there may not be answers and that people just ride through it which takes a lot of courage. I tried to ride out depressions when I was younger but they it went on for over a year and a half before I took Paxil. It is especially challenging as I live in Toronto and I cannot find much support here for tapering off of psych drugs or for dealing with a crisis that comes during or post taper. I am in the process of finding a new psychiatrist, which is quite difficult, as my psychiatrist is as biology-based as possible (he wanted me to have shock therapy in December which is partly why I came off drugs around then as I realized he didn't know what he was doing.) Unfortunately, I still had to see him when I was recently in hospital, which is another trigger. 

 

I just never imagined I would be back on psych drugs. The injury to my back is also depressing me. I've gone from hopeful to hopeless in a matter of months. Right now my anxiety is not too severe and neither is the depression. I've read that Mirt has a habit of pooping out early, which is partly why I think every minute is invaluable in determining tapering and eventual crisis.

 

The crisis pattern for me seems to be severe anxiety followed by depression, then maybe a mixed anxious/depressed state. Anyone with similar experiences, advice, or encouragement? The scariest things for me are how to deal with severe panic anxiety and a physically excruciating depression. 

 

Thanks for reading.

 

Share this post


Link to post
Rhiannon

As you have discovered, many of us found a psych drug to be helpful initially but to lead to serious problems over the longer term, generally leading to the kind of polydrug history that you have and eventual long-term disability and deterioration. (You might find Gianna Kali's story interesting too--she was also started at a young age, as you were). All of this was avoidable, of course.

 

You would probably find the book Anatomy of an Epidemic by Robert Whitaker very informative and helpful.

 

What we recommend here is a slow taper which in the case of multiple drugs and a complex history like yours will be a multi-year process. If the taper is done slowly enough, people usually don't end up experiencing profound depression or panic and anxiety attacks. There are some withdrawal symptoms after the small cuts, but they are less severe and fade relatively quickly. The folks who are struggling with those kinds of intense symptoms are the ones who CT'd their meds or came off them too fast. We don't know of any magic, easy solution in that situation.

 

Since you just came through a bout of nasty withdrawal followed by being put on more meds and were just discharged last week, it's too early to begin to taper yet, although it looks like you're aware of that. 

 

Please put your drug history in your sig line like this:

http://survivingantidepressants.org/index.php?/topic/893-please-put-your-withdrawal-history-in-your-signature/

 

Then read through the "Three KI's" post pinned at the top of this page, and then the topics pinned in the Tapering section and the links in those topics. You'll get a good sense of our tapering methods and philosophy here. You may also find it interesting and helpful to read through some other peoples' topics here as well--you'll see you are certainly not alone.

 

Welcome to the forum. If you take your time, I'm certain we can help you, although your history is complicated by several factors and you'll need to move cautiously.

Share this post


Link to post
dignan

Thanks for responding. 

 

I am aware of Gianna and Beyond Meds. I also read Whittaker's book a few months ago after I came off of everything. The book made me pretty indignant and now that knowledge makes me even more upset since I'm back on psych drugs.

 

After reading through the forums a bit, the 10% reduction makes sense. Is there some literature may indicate how long I should be on drugs before taper? Or is it more a subjective thing? I know for now at least that the drugs are masking some pretty wicked anxiety and depression. My biggest fear at this point is that I'll become more severely depressed again and wind up in front of my psychiatrist. It's obvious what his solution will be. 

 

I am beginning CBT tomorrow. Maybe it will help me deal with all my negative thinking.

Share this post


Link to post
dalsaan

Hi Dignan

 

Welcome to the site. Wish we could meet under better circumstances : )

 

Re how long before you taper, it is a subjective thing. We tend to have a 'listen to your body mantra'. Do you have any symptoms at the moment?

 

If you are concerned, You may find that you want to start with a 5 percent cut and just monitor what happens, if your system copes you can increase the percentage to 10.

 

In the mean time, explore every non drug treatment fir anxiety and depression that you can including therapy, mindfulness, meditation etc.

 

The fact that your are thoughtfully planning your taper us a very positive sign and you have a community here to walk with you

 

Take care

 

Dalsaan

Share this post


Link to post
Altostrata

Welcome, dignan.

 

When I read your first post, I was struck by

I took one dose of Paxil and woke up that night with some sort of terrible panic attack. I ceased taking the Paxil but the panic attacks (flu-like symptoms) continued and lasted hours at a time.

 

 

This sounds to me like a severe adverse reaction to Paxil. My guess is that ever since then, all of your symptoms have been either adverse reactions to drugs or withdrawal syndrome.

 

You're one of many people here who got on a drug merry-go-round and couldn't get off.

 

Is Lyrica causing you to be dopey during the day? How often do you take it, and when? When do you take mirtazapine and lithium?

Share this post


Link to post
dignan

Hi Dalsaan and Althostratha,

 

I am still symptomatic. When I left the hospital five days ago things seemed fairly under control, though I still occasionally felt a bit anxious. Four days ago I cut Lyrica by 25mg (25%) after being on it for about a month. Since then I have experienced some fleeting moments of depression and anxiety. This evening I was anxious for thirty minutes or so and then it subsided. Before that it seemed like the depression was fading and the anxiety was improving. I hope this recent anxious bout is related to the Lyrica drop and not the anxiety and depression just ripping through these sedatives.

 

I am looking into the whole liquid tapering thing now and it seems a bit intimidating but I am willing to learn. Maybe I should reinstate the Lyrica dose. As of now, I take 25mg in the morning (9am) and 50mg in the evening (5pm). I dropped the morning dose by 25mg because the Lyrica makes me extremely dopey during the day, like I am in a fog. Taking only 25mg makes for a significantly more alert day. Maybe it is coming at a cost, however. I also have not been very consistent in taking it at precise times -- sometimes I am an hour late or I spread out the evening dose over two times to maximize alertness and help if I feel some anxiety. I know I need to be more consistent. 

 

I take mirtazapine and lithium at night (9:30pm-10:00pm).

 

I am trying to start meditating again. It is a bit difficult with the fatigue. I will continue to seek support for depression and anxiety. I am not ready to taper much yet (outside of some Lyric for alertness) as I first need more coping skills and, further, I am extremely fearful of the depression and anxiety that the psych drugs are now suppressing. 

Share this post


Link to post
Rhiannon

I agree with Alto that it sounds like most of the depression and anxiety and inner pain that you've struggled with over the years has been due to the drugs, both taking them and withdrawing from them. I definitely can relate to the withdrawal symptoms you describe--been there.

 

I also definitely can relate to and identify with the fear of going back there again. Many people here have expressed that same fear (terror, more like it), and it's no wonder, because it's indescribable hell.

 

I don't think you need to go back there ever again. With a cautious and slow taper, allowing your nervous system lots of time to stabilize and adjust as you go, listening to your body, I think you can bring your drug doses down to where you'll feel better than you can imagine right now, and eventually come off altogether if you want. You can do it slowly enough that although you will have some bad days and even a few bad weeks, they won't be hell, just...not so great. They will be tolerable and they will pass. 

 

And you will be in control. If you taper slowly and take breaks to allow your nervous system to adjust to the small and gradual changes, you'll know how much withdrawal to expect and you'll be able to choose when to make cuts and when to hold and take a break. You won't spiral out of control into that horrible dark place. 

 

I don't really think the drugs are preventing or suppressing a depression/anxiety state that lies beneath the surface somehow and must be prevented from re-emerging. I don't think that's your baseline condition. 

 

You may, as time goes along, want to acquire some tools and perhaps do some healing therapeutic exploring to deal with whatever was at the root of your emotional distress in high school and early college, but really at those ages those are not unusual things to experience as a normal, healthy human being. You needed therapy and support, not pills. 

 

As for your Lyrica, since you only reduced it four days ago, you might consider going back up to 90 mg and holding there, a 10% cut, or even 95 mg. If you didn't have such an extreme history of multiple med changes and polydrugging and severe reactions in the past, I'd say you could risk sticking it out, but I'm concerned you might not want to risk that at this point. And I think there's a chance the fogginess will improve a bit over time, too.

 

If you find after a few weeks at 90 mg that you are having no further withdrawal symptoms, you can try another 5-10% cut.

 

That's what I would suggest given everything you've described to us.

 

I want you to be cautious, because I've worked with lots of folks and people with histories like yours do tend to be very sensitive to any med changes and usually need to make only small changes and take it very slowly. But I also want you to know that I'm optimistic for you. I've seen a lot of people with histories like yours do very well with extremely slow tapers.

Share this post


Link to post
Rhiannon

Oh, and everyone feels a bit intimidated by the whole liquid taper thing at first. It's a lot of information and it sounds more complicated than it is. Just take it one small bite at a time and digest it slowly. You have lots of time to prepare now, while you give your nervous system lots of loving support and time to stabilize.

Share this post


Link to post
dignan

Thank you so much Rhi. 

 

I have reinstated the Lyrica as my anxiety was getting a bit too much and my sleep was less than desirable. Maybe the 25% drop was too much for my system.

 

My anxiety today has been a bit better. The previous two evenings I experienced moderate anxiety in the evening but tonight I've only had brief and mostly mild anxiety. I think in part it may be due to my CBT sessions, which I think may help with my anxiety. I am very nervous about my ailing back and my potentially ramping anxiety and it flipping over into depression. I am looking into ways to heal my back. It's kind of an elusive muscular issue. I've had poor posture for many years yet with no pain; then, for a few weeks I tried to correct my posture manually and upheld myself in an unnatural manner. This has led to at least three months of increasing backache and stiffness. Even my legs are stiff now. And walking makes it worse. I've read here that magnesium may be good for achey muscles and anxiety. I am not sure if this would interact with my lithium, however. I am seeing my GP tomorrow. Maybe I can get my magnesium levels tested. I am paranoid about interactions.

 

I tend to obsess over things and my back and my health are major triggers. In the meantime it seems like one of my main tasks is simply not to worry so much. I am causing myself too much grief. I am hoping to stabilize but I am afraid I will reach an early tolerance on mirtazapine, which I hear is common. 

 

I am finally going to invest in a syringe tomorrow. I think the Lyrica fog may be improving a little bit. That, or I'm just getting used to it. 

Share this post


Link to post
Altostrata

I strongly recommend chiropractic, osteopathic, or physical therapy for pain such as yours.

Share this post


Link to post
dignan

Thanks. I am seeing an osteopath next week and I am doing physical therapy now. The chiropractor I was seeing basically said there was not much he could do considering it was a muscular issue. I have seen many chiropractors in my life and none have been particularly helpful. 

Share this post


Link to post
Altostrata

The quality of practitioners varies quite a bit.

Share this post


Link to post
Rhiannon

My daughters and I all have a congenital spinal defect and we find that the thing that helps most with our backs is keeping our abs strong. Don't know if you're already working on that, you probably are.

 

As far as the rest of it, hang in there, you're doing fine, keep educating yourself, learn to make the liquid solutions, no rush. When you're feeling pretty stable you can start the slow taper journey.

Share this post


Link to post
Altostrata

Me, too -- Pilates for my back.

Share this post


Link to post
dignan

Thank you for the feedback. I am beginning a strengthening program shortly. I saw an osteopath a few days ago and, for now at least, my back discomfort is significantly reduced. I see him again in a few weeks. It seems rather extraordinary how much my back has improved after months of discomfort. I am trying not to get my hopes up too much as it seems almost too good to be true! 

 

Over the past few days I seem to have gotten (for now at least) a better grip on my anxiety. Undoubtably this is associated with the improved back condition and CBT.

 

I found a compound chemist near me who has made me some lower dosages of Lyrica. I began tapering 10% this morning. I just want some bit of relief from this godforsaken Lyrica fog.  

Share this post


Link to post
Rhiannon

Oh good, keep us posted about how the 10% cut goes. Glad you have a pharmacist who can compound the smaller doses for you.

Share this post


Link to post
Altostrata

I've found osteopathic manual therapy to be remarkably effective.

Share this post


Link to post
dignan

My first 10% reduction of Lyrica to 90mg was uneventful. Three weeks later, my second 10% reduction of Lyrica to 81mg was more noticeable. I had some periodic anxiety for four days but it was nothing significant. The last few days the anxiety has settled down.

 

Now, my first two Lyrica cuts have been from my morning dose (31mg), while my evening dose (50mg) has remained untouched. As a result, my clarity during the  daytime has somewhat improved. I am wondering, however, if I my next cut should be from my evening dose and begin to even things up. 

 

Further, I am wondering whether I should taper off Lyrica completely before I begin tapering Remeron. 

 

Thanks.

Share this post


Link to post
dignan

Also, I'm a little confused as well. According to the "Why taper by 10% of my dosage?" post, it says that with the harm reduction approach it is possible to finish a taper in six months. Following the the principles set out in the post, however, it would take me more like a year to come off of Lyrica. After 4.5 months I'd still be at like 38mg and reducing 10% on each subsequent dose... I must be missing something.

Share this post


Link to post
dalsaan

Hi Dignan,

 

I'm not sure about the 6month comment (I don't have time at the moment to read back over the thread) but we usually say tHrow the calendar away and take as long as you need in order to do it well.

 

Re drops, I don't know much about lyrica but I stability is a key in withdrawal so I would try and keep things balanced. On that basis my next cut would be from the night time one, particularly given you have achieved the desired effect of lifting some day time fog

 

Re remeron taper, we do usually recommend that you do one at a time. Does the remeron help you sleep?

 

D

Share this post


Link to post
dignan

Thanks for relying. 

 

When I initially took Remeron it knocked me out cold every night. I've been on it for two months now. In the last little while, however, my body seems to  really be adapting to its antihistamine effect. It now takes me longer to fall asleep but, at this point, I'm still sleeping well. 

 

That said, I am worried. Since beginning Lyrica and Remeron I cannot fall asleep during the day even if I'm extremely tired; I don't know why. For whatever reason my body needs a fresh dose of Remeron to sleep. I have never had sleep issues before... only a few nights here and there, mostly from other antidepressant withdrawals. I'm afraid I will develop such a tolerance to Remeron that my sleep will deteriorate. I have never before been dependent on anything for sleep. It is alarming.

Share this post


Link to post
dalsaan

I do think remeron disturbs your sleep architecture.  It is also important to note that its sleep effects are actually higher at lower doses.  With these two things in mind, you might want to consider tapering the remeron down a bit.  I had very few withdrawals from 30 down to 15 but you need to see what your system says about this.   I would make a small initial cut and see what happens.   dont do this at the same time as the other one or you wont be able to tell what is causing what if you get wd symptoms.

 

Hopefully you will be able to drop a bit, maintain a good sleep pattern (this is important for healing) and be closer to coming off when the time is right.

 

D

Share this post


Link to post
dignan

I am not really having any night time sleep issues now, but you think I may as my body continues to adjust?

 

I am a little hesitant to start cutting Remeron now as I am already taking lithium and Lyrica. If Remeron becomes more of a sedative than an activator, then I'm afraid I will become extremely tired. I'm considering though,

Share this post


Link to post
dalsaan

You may do, many experience insomnia. If your sleep is ok at the moment and you are worried about over sedation leave the remeron where it is. Usually better to do one at a time so you can really read what's happening

Share this post


Link to post
dignan

I made my third cut last Saturday to 72.9mg of Lyrica (from 81mg) I made the cut after two weeks as things felt under control. The day before and the day of the cut, however, I did notice some restlessness and agitation. 

 

The past several days have been challenging but today has been the worst. I have been very anxious this evening with the levels reaching into panic. My stomach has dropped several times and I've have used the washroom several times as a result. Things have settled a little bit now but I still feel panic lurking on the surface. Honestly, this evening's anxiety has been similar to the levels that brought me to hospital in the first place. I am afraid the panic will continue to build, exhaust me, and send me into depression. I am so early in the taper? Was 26mg of Lyrica the difference between me and a meltdown?

 

I know I have tapered too quickly. I guess I thought I could go a bit faster since I've only been on Lyrica a few months.

 

I don't know what to do!

Share this post


Link to post
Petunia
Since you just came through a bout of nasty withdrawal followed by being put on more meds and were just discharged last week, it's too early to begin to taper yet, although it looks like you're aware of that. 

 

 If you take your time, I'm certain we can help you, although your history is complicated by several factors and you'll need to move cautiously.

 

 

I made my third cut last Saturday to 72.9mg of Lyrica (from 81mg) I made the cut after two weeks as things felt under control. The day before and the day of the cut, however, I did notice some restlessness and agitation. 

 

I know I have tapered too quickly. I guess I thought I could go a bit faster since I've only been on Lyrica a few months.

 

I don't know what to do!

 

Hi Dignan,

I'm sorry you are not feeling well.  I think the two quotes above may explain why.  I don't think your nervous system had stabilized enough to start tapering,  you probably needed to wait several months.

 

Earlier this year, you did a 6 week taper off 3 drugs which you had been on for 3 years.  I believe this would have caused significant nervous system destabilization and ongoing sensitivity which is most likely still a factor. Your back injury is adding further stress. I would like to repeat what Rhi wrote about your need for caution

 

I'm reluctant to suggest anything, because any change is going to cause further destabilization, but you probably need to updose back to 81mg.  I just don't know.  Perhaps others will have some ideas.

 

Petu.

Share this post


Link to post
dignan

Thank you for advice. My dose wouldn't change until tomorrow evening. I guess it gives me something to think about. I should have been much more cautious, I agree. 

 

Any other advice is much appreciated. I'm quite frightened. 

Share this post


Link to post
dignan

Do I risk taking 1mg of Ativan for a day in hopes that things settle down? (I haven't had Ativan in a couple of months.)

Share this post


Link to post
dignan

I barely slept last night, which is very unusual for me. I am anxious this morning. I guess that up dosing is what I must do? I can't believe I've gotten myself into this situation again so quickly. I feel at God's mercy right now.

Share this post


Link to post
dignan

Maybe I should also try some magnesium or something? Any other supplement that might help? I know there are threads on this just wondering if anything might be of immediate benefit?

The anxiety is pretty constant and fairly intense. At this rate I anticipate another sleepless night.

I plan to up dose. The thing with up dosing is that it was at 81mg that I began, after two weeks, to feel some agitation and restlessness. Maybe I wasn't even going to thoroughly stabilize at that dose?
 

Sorry for posting so much just in a real state.

Share this post


Link to post
Altostrata

dignan, one might complete a 10% taper in 6 months if decreases are made every 2 weeks.

 

However, that topic clearly explains NOT to accelerate reductions until you are sure of your tapering pattern and you are sure faster reductions will not cause a problem for you after MONTHS of monthly reductions.

 

Clearly, you were pushing your taper too fast. I agree with Petu, your recent going on and off psychiatric drugs has made your system sensitive to dosage changes. You need to think about your propensity to make big changes frequently.

 

Updosing slightly might help. You probably will need to stabilize for at least a month before attempting another reduction. If I were you, I'd be thinking in terms of 5% per MONTH.

 

Taking Ativan with any frequency will compound your withdrawal problems, it will need to be tapered, too.

 

Many people do better with fish oil and magnesium supplements, see
http://survivingantidepressants.org/index.php?/topic/36-king-of-supplements-omega-3-fatty-acids-fish-oil/
http://survivingantidepressants.org/index.php?/topic/1300-magnesium-natures-calcium-channel-blocker/
 

Share this post


Link to post
dignan

Thank you for replying.

 

I know I tapered much too quickly. I got over eager and now it's costing me. Just before I cut to 72.9mg I had some suicidal idealization, which I've never had before in my life. I have occasionally had these same thoughts since then. I have read that this may happen on Lyrica and or during Lyrica withdrawal. 

 

Before I saw your message I up dosed back to 81mg (The last dose I guess I felt stable on for at least three weeks is 90mg). This seemed to help as yesterday evening was much better. This later afternoon and this evening are off to a much rockier start, however. Quite a bit of anxiety. I have not slept much the past two nights. I took a bit of magnesium this morning and will take some later tonight. I also got some melatonin for tonight.

I am just hoping dearly that I can stabilize on 81mg!

Share this post


Link to post
dignan

My anxiety has maybe marginally improved. This will be my third day back on 81mg. I am still having suicidal idealization and other terrible impulses. I have never experienced these things in my life. This did not emerge until my second week from my initial drop to 81mg. I don't know if I should stay put or up dose or what. These impulses are horrible! What the hell is one supposed to do when he is a addicted to the very drug is causing such terrible impulses?

Share this post


Link to post
Rhiannon

I think probably a lot of what you're experiencing now is still due to the original CT and destabilization earlier this year. You only came to us in early July and you've already cut Lyrica three times! You need to understand: Your nervous system has been through major traumatic chaotic hell and you have not yet given it a chance to heal at all. On top of that it's adjusting to a whole new medication regimen and remodeling itself in response to that.

 

There are so many factors involved in your situation that you can't assume that what's happening today is due to what you did yesterday. It may be due to what you did six months ago. 

 

It's not ideal, but it's what you've got: you're on meds now, and it's too soon to taper them after so much injury so recently, so you have to deal with them.  If you do insist on tapering you need to be thinking in terms of 2 to 5% cuts and then holding each cut for four weeks. Personally I think it's a mistake to taper anything right now. I think what your nervous system needs right now is stability and NOT changing things.

 

Have you read this yet?

 

 A lot of people, including healthcare practitioners; in fact, I guess, most people-- are operating from entirely the wrong paradigm, or way of thinking, about these meds. They're thinking of them like aspirin--as something that has an effect when it's in your system, and then when it gets out of your system the effect goes away.

That's not what happens with medications that alter neurotransmitter function, we are learning.

What happens when you change the chemistry of the brain is, the brain adjusts its chemistry and structure to try to return to homeostasis, or biochemical and functional balance. It tries to restabilize the chemistry. 

For example: SSRI antidepressants work as "serotonin reuptake inhibitors." That is, they cause serotonin to remain in the space between neurons, rather than being taken back up into the cells to be re-used, like it would be in a normal healthy nondrugged brain.

So the brain, which wants to re-establish normal signaling and function, adapts to the higher level of serotonin between neurons (in the "synapse", the space between neurons where signals get passed along). It does this by removing serotonin receptors, so that the signal is reduced and changed to something closer to normal. It also decreases the amount of serotonin it produces overall. 

To do that, genes have to be turned on and off; new proteins have to be made; whole cascades of chemical reactions have to be changed, which means turning on and off OTHER genes; cells are destroyed, new cells are made; in other words, a complex physiologic remodeling takes place. This takes place over time. The brain does not grow and change rapidly. 

This is a vast oversimplification of the amount of adaptation that takes place in the brain when we change its normal chemistry, but that's the principle.

When we stop taking the drug, we have a brain that has designed itself so that it works in the presence of the drug; now it can't work properly without the drug because it's designed itself so that the drug is part of its chemistry and structure. It's like a plant that has grown on a trellis; you can't just yank out the trellis and expect the plant to be okay.

When the drug is removed, the remodeling process has to take place in reverse.

SO--it's not a matter of just getting the drug out of your system and moving on. If it were that simple, none of us would be here. 

It's a matter of, as I describe it, having to grow a new brain. 

I believe this growing-a-new-brain happens throughout the taper process if the taper is slow enough. (If it's too fast, then there's not a lot of time for actually rebalancing things, and basically the brain is just pedaling fast trying to keep us alive.) It also continues to happen, probably for longer than the symptoms actually last, throughout the time of recovery after we are completely off the drug, which is why recovery takes so long. 

With multiple drugs and a history of drug changes and cold turkeys, all of this becomes even more complicated. And if a person is started on these kinds of drugs at an early age before the brain has ever completely established normal mature functioning--well, it can't be good. (All of which is why I recommend an extremely slow taper particularly to anyone with a multiple drug history, a history of many years on meds, a history of past cold turkeys or frequent med changes, and a history of being put on drugs at a young age.)

This isn't intended to scare people, but hopefully to give you some idea of what's happening, and to help you respect and understand the process so you can work with it; ALSO, because you are likely to encounter many, many people who still believe these drugs work kind of like aspirin, or a glass of wine, and all you need to do is stop and get it out of your system. 

Now you can explain to them that no, getting it out of your system is not the issue; the issue is, you need to regrow or at least remodel your brain. This is a long, slow, very poorly understood process, and it needs to be respected. 

Share this post


Link to post
dignan

Thank you kindly for the responses. Thank you also for the very helpful article. I need to remind myself of such information when I have the urge to steamroll through these drugs. It hasn't worked for me in the past and it's not working for me now. So I will hold for a month, regroup, see where I am, and eventually make smaller reductions.

 

 Fortunately, the up dose back to 81mg worked -- and the past two days have been "better" with the panic and horrible thoughts having largely abated. It's incredible how, in a few days, I shifted from a such terrible state back into my new normal, that is, a drugged drone.

Share this post


Link to post

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now
×

Important Information

By using this site, you agree to our Terms of Use.