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Harvey, 2003 Neurobiology of antidepressant withdrawal


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  • Administrator

This paper describes the neurological activity that leads to withdrawal syndrome. The authors conclude:
 

The distress that potentially accompanies antidepressant withdrawal has not always been sufficiently appreciated. As alluded to earlier, missed doses, abrupt dose reduction, or abrupt discontinuation of some antidepressants may be associated with an antidepressant discontinuation syndrome. Although the severity of withdrawal symptoms may vary with the type of antidepressant and between patients, all too often not enough emphasis is placed on the possible neurobiological effects and possible longer-term risks associated with inappropriate withdrawal or discontinuation.

As emphasized here, antidepressant discontinuation may involve a stress response accompanied by a set of specific biochemical responses that cause further neuronal dysfunction and that may compromise long-term outcome. This is not to say that clinicians should continue antidepressants indefinitely; it is, however, to emphasize that the decision to discontinue antidepressants should be made judiciously and on an individualized basis.


Biol Psychiatry. 2003 Nov 15;54(10):1105-17.
Neurobiology of antidepressant withdrawal: implications for the longitudinal outcome of depression.
Harvey BH, McEwen BS, Stein DJ.


Source

Division of Pharmacology, School of Pharmacy, Potchefstroom University for Christian Higher Education, Potchefstroom, South Africa.

Abstract at http://www.ncbi.nlm.nih.gov/pubmed?term=neurobiology%20withdrawal%20harvey Full text here.

Inappropriate discontinuation of drug treatment and noncompliance are a leading cause of long-term morbidity during treatment of depression. Increasing evidence supports an association between depressive illness and disturbances in brain glutamate activity, nitric oxide synthesis, and gamma-amino butyric acid. Animal models also confirm that suppression of glutamate N-methyl-D-aspartate receptor activity or inhibition of the nitric oxide-cyclic guanosine monophosphate pathway, as well as increasing brain levels of gamma-amino butyric acid, may be key elements in antidepressant action. Imaging studies demonstrate, for the most part, decreased hippocampal volume in patients with depression, which may worsen with recurrent depressive episodes. Preclinical models link this potentially neurodegenerative pathology to continued stress-evoked synaptic remodeling, driven primarily by the release of glucocorticoids, glutamate, and nitric oxide. These stress-induced structural changes can be reversed by antidepressant treatment. In patients with depression, antidepressant withdrawal after chronic administration is associated with a stress response as well as functional and neurochemical changes. Preclinical data also show that antidepressant withdrawal evokes a behavioral stress response that is associated with increased hippocampal N-methyl-D-aspartate receptor density, with both responses dependent on N-methyl-D-aspartate receptor activation. Drawing from both clinical and preclinical studies, this article proposes a preliminary molecular perspective and hypothesis on the neuronal implications of adherence to and discontinuation of antidepressant medication.

Edited by Altostrata
Emphasized "inappropriate discontinuation"

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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Well, they all talk about the discontinuation of antidepressants. But what if people had an adverse reaction? There was no way for me to taper or go on. And because ads change neurochemistry over a certain period, what did they do when I only took them for 4 days?

End of 2008: Remeron 15mg for around 2 months. Unorthodox taper, no problems.
End of August 2009: Lexapro 10mg for only 4 days. Panic attack after 3 pills. Severe gastro problems in the morning for 3 days after last pill. 2 weeks later strong w/d symptoms set in.

Acute WD lasted around 3.5 years. I am feeling much better today, 5.5 years out, but still have some symptoms left.

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  • Administrator

Maybe, some people are stuck and have to make awful decisions.

 

As we've discussed before, some people have violent adverse reactions to very little exposure to SSRIs. They have a serotonin sensitivity. There is a genetic basis for this. It's a natural variation. You are apparently one of those people.

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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But what if people had an adverse reaction?

KEY POINT! We must not forget this unfortunate segment of the withdrawal population either! Indeed there are some people who have terrible toxic reactions to SSRIs and other psych meds which are, of course, misdiagnosed as "unmasked disorders" which leads to more meds.

 

I honestly think this is what happened to "Jasmine" in Robert Whitaker's ANATOMY OF AN EPIDEMIC. Hers is an extreme case, of course, but a powerful cautionary tale of just how devastating an adverse reaction can be and how we MUST find ways of screening for this.

Been on SSRIs since 1998:

1998-2005: Paxil in varying doses

2005-present: Lexapro.

2006-early '08: Effexor AND Lexapro! Good thing I got off the Effexor rather quickly (within a year).

 

**PSYCHIATRY: TAKE YOUR CHEMICAL IMBALANCE AND CHOKE ON IT!

APA=FUBAR

FDA=SNAFU

NIMH=LMFAO

 

Currently tapering Lexapro ~10% every month:

 

STARTING: 15 mg

11/7/10: 13.5 mg

12/7/10: 12.2 mg

1/6/11: 10.9 mg

2/3/11: 9.8 mg

3/3/11: 8.8 mg

4/1/11: 7.8 mg

4/29/11: 7 mg

5/27/11: 6.4 mg

6/24/11: 5.7 mg

7/22/11: 5 mg

8/18/11: 4.5 mg

9/14/11: 4 mg

10/13/11: 3.6 mg

11/9/11: 3.2 mg

12/7/11: 2.6 mg

1/3/12: 2.1 mg

2/2/12: 1.8 mg

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But what if people had an adverse reaction?

KEY POINT! We must not forget this unfortunate segment of the withdrawal population either! Indeed there are some people who have terrible toxic reactions to SSRIs and other psych meds which are, of course, misdiagnosed as "unmasked disorders" which leads to more meds.

 

I honestly think this is what happened to "Jasmine" in Robert Whitaker's ANATOMY OF AN EPIDEMIC. Hers is an extreme case, of course, but a powerful cautionary tale of just how devastating an adverse reaction can be and how we MUST find ways of screening for this.

 

Totally agree about not forgetting this population group.

 

While I taking psych meds, I had an averse reaction to 5mg of Celexa which caused severe agiatation. I am totally convinced that if I had heeded my psychiatrist's advice to stay on the med, I would have been in big time trouble.

 

CS

Drug cocktail 1995 - 2010
Started taper of Adderall, Wellbutrin XL, Remeron, and Doxepin in 2006
Finished taper on June 10, 2010

Temazepam on a PRN basis approximately twice a month - 2014 to 2016

Beginning in 2017 - Consumption increased to about two times per week

April 2017 - Increased to taking it full time for insomnia

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I just hope that a nervous system that had an adverse reaction to a medication is still able to heal. What makes me wonder is that many symptoms are the same like in withdrawl. So an adverse reaction might not be that different from "normal" withdrawl.

End of 2008: Remeron 15mg for around 2 months. Unorthodox taper, no problems.
End of August 2009: Lexapro 10mg for only 4 days. Panic attack after 3 pills. Severe gastro problems in the morning for 3 days after last pill. 2 weeks later strong w/d symptoms set in.

Acute WD lasted around 3.5 years. I am feeling much better today, 5.5 years out, but still have some symptoms left.

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  • Administrator

Right, Maybe, you had one of these rare adverse reactions AND you have withdrawal syndrome.

 

I've gotten a report of another case very like yours, but the person has not registered on this site.

 

Clearly, your nervous system can heal, as it's demonstrated already, with better windows.

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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But those who had symptoms for 4 or even 6 years, don't they have waves and windows as well? It somehow seems to me that this pattern is not really a sign of recovery, but maybe a part of a biochemistry cycle?

End of 2008: Remeron 15mg for around 2 months. Unorthodox taper, no problems.
End of August 2009: Lexapro 10mg for only 4 days. Panic attack after 3 pills. Severe gastro problems in the morning for 3 days after last pill. 2 weeks later strong w/d symptoms set in.

Acute WD lasted around 3.5 years. I am feeling much better today, 5.5 years out, but still have some symptoms left.

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  • Administrator

Yes, Maybe, just about everyone has waves or windows. Nobody gets better all at once.

 

What do you mean a biochemistry cycle? Every operation in our bodies is a biochemistry cycle.

 

Please stop looking for the worst. Some day even you will be unable to deny you've improved, that the windows have gotten longer and more frequent.

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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There surely will be this day. I am just afraid that it might take longer than I thought. I hope so much that I will be better at the 2 year mark...

End of 2008: Remeron 15mg for around 2 months. Unorthodox taper, no problems.
End of August 2009: Lexapro 10mg for only 4 days. Panic attack after 3 pills. Severe gastro problems in the morning for 3 days after last pill. 2 weeks later strong w/d symptoms set in.

Acute WD lasted around 3.5 years. I am feeling much better today, 5.5 years out, but still have some symptoms left.

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  • 5 months later...
  • Administrator

Dr. Harvey sent me this in correspondence:

 

I am very glad to see you are recovering from your own nasty experience. I find it especially interesting that you are showing this recovery using lamotrigine, which is a very effective inhibitor of glutamate release. Our studies have strongly implicated altered glutamatergic activity following antidepressant discontinuation/withdrawal, with especially overt activity at NMDA receptors acting to perpetuate the illness via a kindling-like action. One could even consider this to be a useful case report in support of the argument.

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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Are you still taking lamotrigine, Alto?

'94-'08 On/off ADs. Mostly Zoloft & Wellbutrin, but also Prozac, Celexa, Effexor, etc.
6/08 quit Z & W after tapering, awful anxiety 3 mos. later, reinstated.
11/10 CTed. Severe anxiety 3 mos. later & @ 8 mos. much worse (set off by metronidazole). Anxiety, depression, anhedonia, DP, DR, dizziness, severe insomnia, high serum AM cortisol, flu-like feelings, muscle discomfort.
9/11-9/12 Waves and windows of recovery.
10/12 Awful relapse, DP/DR. Hydrocortisone?
11/12 Improved fairly quickly even though relapse was one of worst waves ever.

1/13 Best I've ever felt.

3/13 A bit of a relapse... then faster and shorter waves and windows.

4/14 Have to watch out for triggers, but feel completely normal about 80% of the time.

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  • Administrator

I've come to the point where my system does not need the lamotrogine anymore and I'm tapering off it. I'm down to .42mg today, from 5.4mg for the last 1.5 years.

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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Alto,

 

If you'd care to share, can you talk about how you came to feel comfortable with the decision to taper? That your system no longer needed the Lamictal?

 

Alex

"Well my ship's been split to splinters and it's sinking fast
I'm drowning in the poison, got no future, got no past
But my heart is not weary, it's light and it's free
I've got nothing but affection for all those who sailed with me.

Everybody's moving, if they ain't already there
Everybody's got to move somewhere
Stick with me baby, stick with me anyhow
Things should start to get interesting right about now."

- Zimmerman

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  • Administrator

Sure. I started sleeping better, my autonomic nervous system stabilized -- many pesky symptoms went away, particularly the autonomic dumping and palpitations -- and I got "signals" from the lamotrigine that it was time to decrease.

 

The signals are a tiny headache in the front of my head, long gaps in sleep, or queasiness. I tend to get the headache and sleep gaps.

 

Last night, for example, I woke up about 2:30 a.m. with the tiny headache. I'd been at .45mg for maybe a week, so this morning I went down to .42mg. (I keep the drops at 10% or less in proportion to the current dosage to keep from destabilizing the whole ball o' wax. It usually takes a couple of days for the decrease to take effect. I might have a tiny headache tonight.)

 

Headache and queasiness or nausea are signs lamotrigine dosage is too high.

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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That's interesting. I talked with a new doctor recently and we discussed how best to conduct my benzo taper.

 

It seems right now that I am still too hypersensitive so some other interventions have been recommended. I've specifically been fanatical about avoiding caffeine and walking daily. I'm feeling on the upswing, but I still have gastro issues that affect vocal strength and these make me so leery of reducing the benzos.

 

Some speculate that the benzos could make GI issues worse, while others speculate that the w/d syndrome is responsible and that the benzos tame it...

 

Anyway, these things will work out in time, I believe.

 

Alex

 

ps - What do you mean by autonomic dumping?

"Well my ship's been split to splinters and it's sinking fast
I'm drowning in the poison, got no future, got no past
But my heart is not weary, it's light and it's free
I've got nothing but affection for all those who sailed with me.

Everybody's moving, if they ain't already there
Everybody's got to move somewhere
Stick with me baby, stick with me anyhow
Things should start to get interesting right about now."

- Zimmerman

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  • Administrator

Autonomic dumping is a sudden wave of a bunch of autonomic symptoms all at once. For example, for a long time I had frequent palpitations, feeling hot, dizziness, and belching, all together.

 

The combination of benzo withdrawal syndrome with antidepressant withdrawal syndrome is a more complicated beast than either one by itself, and may not respond to lamotrigine, since lamotrigine has an indirect effect on the benzo system (increases GABA).

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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  • 1 year later...

I'm wondering, given the glutamatergic dysregulation theory of SSRI withdrawal, if anyone thinks that in addition to microdosing of lamotrigine, an NMDA antagonist like Ketamine (or new drugs in development, like GLYX-13, that apparently work on glutamate) could be useful in withdrawal. I realize that taking any such drug would then put one in the position of having to taper something else. (But I knew nothing about tapering when I quit my SSRI cold turkey, and would welcome the opportunity to taper something that put a dent in my withdrawal syndromes.) I, like many who have protracted, severe withdrawal (2 years in my case), am hypersensitive to any psychotropic drugs, so the question may be moot or silly. I'm just curious.

-300 mg Wellbutrin 2002-2005 (withdrew cold turkey with only mild complications)

-150 mg Wellbutrin, 10 mg Celexa 2006-2010

-Discontinued both cold turkey Jan 1 2011

-Unsuccessfully reinstated Celexa March 2011, but stuck with it until Jan 2012.

-Remeron 7.5 since Jan 2013---only thing that puts a dent in perpetual headache and "akathisia"

6.5 mg Lamictal since Dec 2012

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Psychiatry is prone to fads. Ketamine is the fad du jour.

 

Every "promising" molecule is reported in breathless terms. The SSRIs received the same hype.

 

I talked to a doctor who investigated ketamine; he found its effects inconsistent and whatever benefits it had were temporary. Same as it ever was.

 

Whatever medicine knows (or doesn't know) about treating depression in people with stable nervous systems emphatically does not apply to those whose nervous systems have become destabilized by withdrawal syndrome. Withdrawal syndrome is not relapse, it cannot be treated as depression.

 

In general, psychiatric drugs are far too strong for the hypersensitive nervous systems in people who have prolonged withdrawal syndrome. Even lamotrigine has to be carefully titrated so as not to trigger paradoxical reactions.

 

The prevalence of paradoxical reactions to drugs in people sensitized by withdrawal makes treatment of withdrawal syndrome very tricky. Doctors who have tried it have not seen much success because they think in terms of "therapeutic" dosages that tend to make withdrawal syndrome 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

All postings © copyrighted.

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Barbarannamated

Alto wrote: "Withdrawal syndrome is not relapse, it cannot be treated as depression."

 

Withdrawal syndrome, especially protracted w/d as in my case, makes 'depression' look like a walk in the park. I'm in severely rough shape at ~18 months after last dose of Pristiq. I'm open to any suggestions. Hydrocortisone (for autoimmune/adrenals) made the morning dread of life far worse and i tapered off after a few months. My endocrinologist thought Wellbutrin might help but it messed with my sleep, my only escape from this hell.

 

There was a comment in Harvey about glucocorticoids being a possible CAUSE of neurodegenerative process..?

 

"Preclinical models link this potentially neurodegenerative pathology to continued stress-evoked synaptic remodeling, driven primarily by the release of glucocorticoids, glutamate, and nitric oxide."

But SSRIs increase cortisol, correct? Is withdrawal of SSRIs causing a steroid/cortisol-type w/d and rebound also? I'm very fuzzy today so excuse if this is tangential or has been covered.

 

The LOW cortisol symptoms flared badly after several months off of Pristiq. Very low pulse, low blood pressure, low energy, depressed state. During taper and early w/d, i had more typical symptoms of anxiety, hypomania, cortisol dumping in early morning. Adding hydrocortisone (a glucocorticoid) to this while still in dysautonomia seems counterintuitive.

Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc).

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  • Administrator

I believe that refers to the current thinking that stress is neurodegenerative. Kind of saying that life is neurodegenerative.

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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FWIW: I was taking the NMDA antagonist memantine (Namenda) for an unrelated reason prior to and during my initial bungled attempts at withdrawing from psych drugs, including an SSRI. Didn't help a bit.

 

Sparrow

2009-2011: tapered off Trazodone, Namenda, Lamictal, Dextroamphetamine, Zyprexa; cold-turkeyed Pristiq; reduced Lexapro dose 50%.
On clonazepam since 2004, 0.5 - 1.0 mg daily PRN. Three failed (too rapid) partial tapers, 2010 - 2011.
Dec. 2011 - March 2013: Tapered off 0.5 mg clonazepam (Klonopin)

August 2013: Switched to liquid escitalopram (Lexapro) and began tapering from 10 mg.

January 2014: 4.5 mg escitalopram

March 2014: One year off benzos

May 2014: 3.0 mg escitalopram

June 2014: severe depression, updosed to 4.0 mg

Sept 1, 2014: 2.7 mg

Dec 7, 2014: Can't get below 2.5 mg without unbearable symptoms. Doing an extended hold (I hope)

March 2015: TWO YEARS POST-BENZO

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Has anyone else besides Alto been helped by micro dosing lamotrigine?

-300 mg Wellbutrin 2002-2005 (withdrew cold turkey with only mild complications)

-150 mg Wellbutrin, 10 mg Celexa 2006-2010

-Discontinued both cold turkey Jan 1 2011

-Unsuccessfully reinstated Celexa March 2011, but stuck with it until Jan 2012.

-Remeron 7.5 since Jan 2013---only thing that puts a dent in perpetual headache and "akathisia"

6.5 mg Lamictal since Dec 2012

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  • 1 month later...
FeelingAlone

I have been...I'm currently on 5mg of Lamictal. At my docs advice he cold turkeyed me off both Celexa and Lexapro. I was in horrible horrible withdrawal. So after 2 weeks of no medication I tried low dose lamictal at 2.5 mg. The Lamictal has helped me sleep better, tremors almost gone, and cut my anxiety and depression in half. It has also helped me with DP/DR symptoms. All in all, I feel calmer and more sure of recovery. It's given me hope.

Celexa 40mg from 2004-Oct. 2012. Had to stop cold turkey due to Serotonin Syndrome. Tried to reinstate 3 weeks after ct, but had an allergic reaction to it.

 

Amitriptyline 25 mg from 11/07/12-11/30/12. Stopped due to inability to stay awake and made anxiety worse.

 

Lexapro started at 5mg and slowly increased to 15mg Dec. 8 2012-Feb. 15th 2013. Had to stop cold turkey due to Serotonin Toxicity.

 

Lamictal 5mg 3/2/13 to try to stabilize my nerves. Seems to be helping with the brain zaps, emotional rollercoaster, and DP/DR.

 

Find a reason to smile everyday :-)

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  • 3 weeks later...

I just found this paper and to be honest I'm not sure if it makes me feel better or worse. In my case I stopped Prozac abruptly in 2010, got severe withdrawal, and since then have tried several SSRI's and SNRI's (including Prozac again) with no success. This article seems to imply that once the damage is done, things change and it becomes impossible to go back. So the argument is 'don't stop'.

 

But what do people like me do that have stopped, have suffered the effects, and are now looking for some way to fix things? Clearly based on all the info here (and my last three years of trying), I don't think it's recommended to go back on SSRI's. So is the only option to wait it out? The article doesn't seem to imply that people heal naturally, it actually implies the opposite.

 

How do we reconcile this conclusion with the fact that people do seem to get better over time?

Started on Zoloft in 2002
Switched to Lexapro in 2005
Switched to Prozac in 2008
Off Prozac abruptly in 2010 (a mistake) - crashed
Lexapro end of 2010 - didn't work
Effexor until 2012 - roller coaster from hell
Back to Prozac November 2012 - one last rise and fall
Quit Prozac 01/13

Reinstated Prozac 5mg 05/13
Trial of 7.5 Remeron for one month 06/13, then off

Off Lamictal 06/13

Quit benzos 06/13

 

Reduced to 4mg Prozac 8/15/13

 

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  • Administrator

Dr. Harvey actually is very concerned about withdrawal risks. As with most papers on antidepressants, his includes some boilerplate blather about their value, etc.

 

He is describing the process that causes nervous system dysregulation, not the recovery process, which is based on neuroplasticity.

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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  • 4 months later...

Sure. I started sleeping better, my autonomic nervous system stabilized -- many pesky symptoms went away, particularly the autonomic dumping and palpitations -- and I got "signals" from the lamotrigine that it was time to decrease.The signals are a tiny headache in the front of my head, long gaps in sleep, or queasiness. I tend to get the headache and sleep gaps.Last night, for example, I woke up about 2:30 a.m. with the tiny headache. I'd been at .45mg for maybe a week, so this morning I went down to .42mg. (I keep the drops at 10% or less in proportion to the current dosage to keep from destabilizing the whole ball o' wax. It usually takes a couple of days for the decrease to take effect. I might have a tiny headache tonight.)Headache and queasiness or nausea are signs lamotrigine dosage is too high.

Alto,

Is Lamictal used to help withdrawal insomnia?  I'm wondering if this is something I should suggest to my doctor. I've tried Lamictal before but at a much higher dose, and had all sorts of symptoms.  But maybe it's something I should revisit, since it seems that even a small reduction (4.2%) is giving me insomnia.

 

Also, how were you able to measure .45 and .42 mgs? 

2005-2008: Effexor; 1/2008 Tapered 3 months, then quit. 7/2008-2009 Reinstated Effexor (crying spells at start of new job.)
2009-3/2013: Switched to Pristiq 50 mg then 100 mg
3/2013: Switched to Lexapro 10mg. Cut down to 5 mg. CT for 2 weeks then reinstated for 6 weeks
8/2013-8/2014: Tapering Lexapro (Lots of withdrawal symptoms)
11/2014 -8/2015: Developed severe insomnia and uncontrollable daily crying spells
12/2014-6/2015: Tried Ambien, Klonopin,Ativan, Lunesta, Sonata, Trazadone, Seroquel, Rameron, Gabapentin - Developed Anxiety disorder, PTSD, and Psychogenic Myoclonus
7/2015-1/2016: Reinstated Lexapro 2 mg (mild improvement, but crying spells still present)

1/2016-5/2017: Lexapro 5 mg ( helped a lot, but poor stress tolerance & depressive episodes)

5/20/2017 - Raised dose to Lexapro 10 mg due to lingering depression(Total of 2 failed tapers & severe PAWS)

9/11/2018 - Present: Still on 10 mg Lexapro and mostly recovered.(Extremely sensitive to stress which triggers Myoclonus.)

Intro page: http://survivingantidepressants.org/index.php?/topic/4149-lilu-depression-worsened-by-meds/

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Please read this entire thread http://survivingantidepressants.org/index.php?/topic/392-one-theory-of-antidepressant-withdrawal-syndrome/ .

 

I had lamotrigine compounded into a liquid and used a .5mL oral syringe.

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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  • 2 years later...

Dr. Harvey sent me this in correspondence:

 

I am very glad to see you are recovering from your own nasty experience. I find it especially interesting that you are showing this recovery using lamotrigine, which is a very effective inhibitor of glutamate release. Our studies have strongly implicated altered glutamatergic activity following antidepressant discontinuation/withdrawal, with especially overt activity at NMDA receptors acting to perpetuate the illness via a kindling-like action. One could even consider this to be a useful case report in support of the argument.

 

I was looking at causes and treatment for mcs multiple chemical sensitivity which some of us seem to have post AD use. I found an article NO searched here think this applies here

 

 

Martin Pall asserts that MCS is initially triggered by volatile organic solvent exposure, organophosphorus/carbamate pesticide exposure, organochlorine pesticide exposure, and/or pyrethroid pesticide exposure.   These initiating triggers act to increase the levels of nitric oxide (NO) in the body.  Nitric oxide then acts through its oxidant product, peroxynitrite (ONOO-), to maintain a vicious cycle mechanism which is responsible for the resulting chronic illness (MCS).  This cycle is called the NO/ONOO- Cycle (pronounced “no oh no”).  In Summary,

 

· Short term triggers initiate MCS by raising nitric oxide synthesis and consequent levels of nitric oxide and its oxidant product peroxynitrite.

· Initiation is converted into a chronic illness through the action of a vicious cycle mechanism in which chronic elevation of nitric oxide and peroxynitrite and is produced and maintained.

· Symptoms of MCS are generated by elevated levels of nitric oxide and elevated levels of peroxynitrite or inflammatory cytokines, oxidative stress and elevated NMDA and vanilloid receptor activity. This is called “up-regulation”.

· Treatment should focus on down-regulating NO/ONOO- cycle biochemistry. 

 

Pall first developed a nutritional protocol for down-regulating the NO/ONOO– cycle with Dr. Grace Ziem and later developed his own variation.

http://mcs-america.org/index_files/mcsmedicaltreatment.htm

I am not recommending any of the suggested treatments btw. 

I of course had to look up the vanilloid receptor 

 

The vanilloid receptor: a molecular gateway to the pain ...
www.ncbi.nlm.nih.gov/pubmed/11283319
  •  
by MJ Caterina - ‎2001 - ‎Cited by 1346  - ‎Related articles

The vanilloid receptor: a molecular gateway to the pain pathway. Caterina MJ(1), Julius D. Author information: (1)Department of Biological Chemistry, Johns 

 

For me wd was very painful

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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  • 4 months later...
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Altostrata

Going way off-topic. Please don't do this.

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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OK

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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  • 1 month later...

@Alto. I just read Psychology Today's article 7-17-11, referencing your journey. After reading the below, how can we regrow/sprout new neural pathways? Thanks!

 

"Several receptors—including 5-HT1A—aren't especially malleable, moreover, and take longer to sprout anew after drug treatment ends, delaying the patient's return to neuronal health. Indeed, some studies I consulted found that in certain patients those receptors fail to grow back at all, in effect leaving the patients worse off than before. (See for instance "Dissociation of the Plasticity of 5-HT1A Sites and 5-HT Transporter Sites" in Paxil Research Studies 19.3 [1994], 311-15.)"

Effexor XR 300 (brand) mg & various SSRIs 15 yrs (Effexor XR 300 mg past 10 yrs

Clonazepam, 1.0 mg. am, .5 mg pm. - 15 yrs, 7-17-16- Began .5 three times a day

Vyvanse 60 mg, - 2 yrs, Cut to 50 mg for 6 mths, Cut to 30 mg. on 4-1-16. Tapering.

Approx. 4-1-15 began Effexor XR 300 taper, very slowly for a year. Held at 37.5 for about 3 mths. Cut to 18 mg for 2 wks to 0. WD began 2 wks later. Depression, anxiety, paranoia, low appetite, nausea.

7-14-16-Reinstated 5 beads Effx after 4 mths misery.Pooped out 10 days.

9-12-16-to present- Wide eyed terror, bedridden fear, no appetite/feeling of being full.

10-30-16- Began 15% liquid tapering of 30 mg Vyvanse. (25 mg)

11-13-16- Liquid Vyvanse 22 mg,11-27-16- Liquid 15 mg, 12-12-16- Vyvanse 12.5 for 5 days. 12-16 - 12-29, 15 mg.

11-20-16- Switched back to 1.0 clonazepam am & .5 bedtime

12-30-16- Moved to 15 mg COMPOUNDED Vyvanse.Current 4/11-4/25 7.5 mg.(10% ev 2 wks) Off Vyvanse

Current meds:Effexor XR- 3 Beads, Clonazepam-1.0 mg am, .5 mg bedtime,Vyvanse-(tapering) Estradiol- 2

mg,Progesterone 200 mg,Testosterone 30 mg/ml,Nature Throid- 48.75 mg.(12-21-16-65 mg.) (4-18-17-81.25 mg) Current supplements: Fish Oil-1360 mg, Curamin- 2706 mg.

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This is not the last word on 5-HT1A receptors, or any receptors. Much is not known about them.

 

The nervous system has many ways to create alternative routes around any area that's not working right. That's what neuroplasticity is all about.

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 love researching and find Neuroplasicity intriguing. Dr. Carolyn Leaf's work is one of several that I've been following.

I want to thank you for your tireless efforts in helping others. I'm so very grateful.

Effexor XR 300 (brand) mg & various SSRIs 15 yrs (Effexor XR 300 mg past 10 yrs

Clonazepam, 1.0 mg. am, .5 mg pm. - 15 yrs, 7-17-16- Began .5 three times a day

Vyvanse 60 mg, - 2 yrs, Cut to 50 mg for 6 mths, Cut to 30 mg. on 4-1-16. Tapering.

Approx. 4-1-15 began Effexor XR 300 taper, very slowly for a year. Held at 37.5 for about 3 mths. Cut to 18 mg for 2 wks to 0. WD began 2 wks later. Depression, anxiety, paranoia, low appetite, nausea.

7-14-16-Reinstated 5 beads Effx after 4 mths misery.Pooped out 10 days.

9-12-16-to present- Wide eyed terror, bedridden fear, no appetite/feeling of being full.

10-30-16- Began 15% liquid tapering of 30 mg Vyvanse. (25 mg)

11-13-16- Liquid Vyvanse 22 mg,11-27-16- Liquid 15 mg, 12-12-16- Vyvanse 12.5 for 5 days. 12-16 - 12-29, 15 mg.

11-20-16- Switched back to 1.0 clonazepam am & .5 bedtime

12-30-16- Moved to 15 mg COMPOUNDED Vyvanse.Current 4/11-4/25 7.5 mg.(10% ev 2 wks) Off Vyvanse

Current meds:Effexor XR- 3 Beads, Clonazepam-1.0 mg am, .5 mg bedtime,Vyvanse-(tapering) Estradiol- 2

mg,Progesterone 200 mg,Testosterone 30 mg/ml,Nature Throid- 48.75 mg.(12-21-16-65 mg.) (4-18-17-81.25 mg) Current supplements: Fish Oil-1360 mg, Curamin- 2706 mg.

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You're welcome!

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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fema4psychiatrists

drugs are just poisons that create imbalances percieved as theraputic. disrupting natural enzyme activity. mono amine oxidadise INHIBITOR. selective serotonin re-uptake INHIBITOR. no drugs are curing anything. our bodies are fantasticly designed to survive large amounts of malnutritions and multi-generational habits, damage and poisions. 

Cocktail drugged since 9

Genitals went numb

Extreme intestinal gas and pain

Extreme anxiety cant concentrate

All permanent

 

Post-SSRI Sexual Dysfunction (PSSD)

http://pssdblog.blogspot.com

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