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Communications with Dr. Stuart Shipko

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squirrel

The problems unleashed when slowly tapering drugs can be severe and difficult or impossible to reverse. Even if patients get past the withdrawal symptoms, within the year these 'withdrawal' symptoms may recur - or worse.

 

 

Says It all really !!!!

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Altostrata

I believe Dr. Shipko's perspective is rather dire. I've joined that site so I can ask some questions.

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squirrel

Dear Dr Shipko

Live in the Uk . I took Paxil fro 8 years for panic attacks. I stopped them

in 2005 ( cold turkey) as my doc advised.I have been to hell and back with

horrible withdrawl symptoms. I am still here ! But I am suffering every day

feeling spaced out, kinda drunk, I have balance problems and get rushes of

anxiety for no reason. no one here is willing to help me.Can yo offer any

suggestions please.

 

 

I can't offer you specific suggestions, but I can share some general

educational information. You are writing that you are having persisting

withdrawal symptoms now since 2005 - ? six years. In my practice I have

seen persistent symptoms associated with withdrawal lasting for six or

seven years and then improving for no apparent reason. It is, of course,

important to make sure that the symptoms are not due to some other drug or

medical condition. Regarding the supplement based cures offered over the

Internet, I don't know of any that have offered meaningful benefit. Some

people feel that acupuncture helps these sorts of symptoms. In some

people, for whom the persistent withdrawal symptoms are too uncomfortable,

restarting the drug has sometimes offered the better quality of life. I

good resource for information on this can be found at ******

 

Good luck to you.

Dr.S.

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Altostrata

Interesting. I've also been thinking recovery may take 5-7 years.

 

Coincidentally, I just wrote Dr. Shipko and among other things, told him ****** is no longer a good source for such information.

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cinephile

I believe Dr. Shipko's perspective is rather dire

I agree. He is a tad fatalistic, isn't he? I think he's still in the dark about how if there is truly a will to get off this crap, there is a way. That is to say, even if it takes YEARS. I doubt he's treated patients directly who take many years to slowly get off meds and then succeed.

 

But at least he's admitting how brutal withdrawal can be. And I do also wonder if some of the lingering, persistent symptomology of withdrawal is similar to TD. These drugs could very well cause changes in genetic expression if taken long-term that could be very hard to reverse. Genetic changes due to iatrogenic damage is such an explosive field that I hope takes off in the coming decades because as I've said on another post, if we continue on this medical paradigm of "care" (that is, medicate first, ask questions later), we could very well find that diseases and disorders stemming from the meds themselves outnumber the diseases and disorders arising naturally! Wow, what a mess we've created for ourselves, huh?

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compsports

I believe Dr. Shipko's perspective is rather dire. I've joined that site so I can ask some questions.

 

Great minds think alike.

 

I joined it too to ask another poster some questions.

 

CS

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Altostrata

Dr. Shipko's post referenced in #1 seems to be incongruent with his note to squirrel in #4. We definitely need clarification.

 

In his note to squirrel, he implies he has followed patients for 7 years.

 

Also, squirrel, I wonder at his suggestion after all this time you go back on the antidepressant. Dr. Healy says this doesn't work, a doctor I know says it doesn't work, anecdotal reports say it doesn't work. I wonder if he's tried it or if he's just throwing it out there?

 

(For those new to Dr. Stuart Shipko: He's a Los Angeles psychiatrist who recognizes and diagnoses withdrawal syndrome, but does not seem to know how to treat it. He is an antidepressant skeptic.)

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Maybe

After having read about Dr.Shipko I wrote him as well last year. He said that wd after a small dosis is not that common, but still "normal" (do not remember his exact words). One of his patients had 10 pills and had symptoms for 2 years. So I hope I will be on the way in two more months.Didn't Charles G. of antidepressantsfacts also take 7 years to recover? As far as I can remember he was one of the worst cases.

Edited by Altostrata
name changed by request

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Altostrata

According to Google cache, a 09-03-2009 post on ****** reported that Charly G. wrote:"I consider myself to have been recovered after 6 to 7 years. However, the emotional recovery takes almost twice as long. It's only now that I feel I am becoming whole again and that's more than I could ever asked for."If someone wants to fool around with the Wayback Machine, you might be able to find Charly's original post sometime prior to 2009. Otherwise, it has been thoroughly deleted from the Web.It may have been thread p=548724

Edited by Altostrata
name changed by request

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Sunny1008

Hello all,

 

OK, I just tried to post this, and my computer lost its connection at the last minute, so let me try this again...

 

I spoke to Dr. Stuart Shipko today. For those who don't know who he is, he is a psychiatrist in Los Angeles who recognizes AD withdrawal syndrome and is critical of the use of antidepressants. I told him about my symptoms and how I have been suffering with them now for a year, and his explanation was that when symptoms persist after one year of being off the drug, the symptoms are now considered neurological damage, and not withdrawal syndrome. How long it takes to recover from the neurological damage is different for everyone, but his estimation was FIVE years. UGHHH!!!

 

Just wanted to pass this along to all of you. Sorry if it's old news. When will these drugs be banned, and when will the truth come out???

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Altostrata

Yes, we know Dr. Shipko. He's a good guy, and one of the few doctors who will give you a diagnosis of antidepressant withdrawal syndrome.

 

He is correct, antidepressant withdrawal syndrome is neurological damage. That's a general description. I would say it's more helpful to call it the more specific antidepressant withdrawal syndrome, so as not to let antidepressants off the hook.

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cinephile

How long it takes to recover from the neurological damage is different for everyone, but his estimation was FIVE years.

I guess that's the only thing I object to with Shipko -- where exactly did he get that estimate of five years? He's acting as if there's some large body of clinical research about withdrawal syndrome that he can draw on -- there isn't. Even if he's just giving his clinical experience with his patients, that's still a comparatively small sample of patients when compared to studies of withdrawal syndrome that could have 1,000 patients or more.

 

I've been reading stories of people with withdrawal syndrome for many years and the recovery rate is all over the place (and it doesn't even seem to matter how long people were on the meds). I've seen people on the meds for only 18 months take 3 years to see substantial improvement. I've seen others on for over a decade who do a slow taper and suffer almost no withdrawal. And I've seen people recover from withdrawal in 2 years. And some who have taken longer than 5 years.

 

I don't think we can really estimate how long a protracted withdrawal will take to heal at this point, and to even estimate doesn't make a lot of sense.

 

There's nothing to say you won't "turn the corner" in another year or even another month, Sunny. I would take his estimation of "five years" with a grain of salt. Remember to "unpatient yourself" and realize that the societal veneration of doctors that makes us trust in their knowledge doesn't really apply to psychiatry, since so much of their "research" has been tainted by corruption and pharmaceutical bias, and there have been zero studies on the pathophysiology of antidepressant withdrawal syndrome. But you can bet we're trying to change that here at SA! In fact, check this out:

Researchers seek prolonged antidepressant withdrawal cases

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Claudius

Hello all,

 

OK, I just tried to post this, and my computer lost its connection at the last minute, so let me try this again...

 

I spoke to Dr. Stuart Shipko today. For those who don't know who he is, he is a psychiatrist in Los Angeles who recognizes AD withdrawal syndrome and is critical of the use of antidepressants. I told him about my symptoms and how I have been suffering with them now for a year, and his explanation was that when symptoms persist after one year of being off the drug, the symptoms are now considered neurological damage, and not withdrawal syndrome. How long it takes to recover from the neurological damage is different for everyone, but his estimation was FIVE years. UGHHH!!!

 

Just wanted to pass this along to all of you. Sorry if it's old news. When will these drugs be banned, and when will the truth come out???

 

I am afraid that he is completely right in this, in fact I hope he is because that would mean good news for me. I am now off for 3.75 years, and though healing takes place, I am still far from recovered. Five years would mean another year and a few months for me, and I would be glad it I am healed at that time...

I wonder whhat he thinks of the following: what exactle causes the damage? Is it the use of the drug (and the drug in fact masques its own damage) or is it the act of getting off too fast that causes the damage? I am not sure about this.

I went off c/t several times and felt awfully sick. But reinstating within a few weeks completely lifted the symptoms. Si this does not stroke with ther idea that the hammer-hit of CT causes the damage.

Another theory is that getting off throws the brain in a psychosis-like state which acctually does the damage. I got psychotic after 4-5 months off.

My guess would be that getting off, especially too fast, ignites a sequence of biological processes which destabiliza the whole body, cns and hormone system further and further and damage the nervous system...

I pray for being healed at the 5 years mark... :wacko:

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Maybe

This whole topic is so complex, there surely zounds of factors involved. I read the experiences of people whose adverse reaction was much more severe than mine, but they healed between 6 and 12 months, whereas I still have symptoms 23 months out.

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Claudius

I send him a mail a few days ago, not expecting the silver bullet but just to hear what he had to say.

He answered me one day later in a very kind way and what he says is in line with what we already know. He compares our problems to the tardive dyskinesia syndrome and admits that there is no cure, only time and hope. But in the end he sounds pretty optimistic about a happy end.

 

 

From: xxxxxx

To: xxxxxxx

Subject: The question that you asked on 7/15/11 on power-surge.com has been answered!

Date: 15 Jul 2011 15:09:15 -0000 (07/15/2011 05:09:15 PM)

 

 

Question asked on 7/15/11:

 

Dr. Mr. Shipko,

I read about you on the survivingantidepressants.org forum. I am a former user or Paroxetine (Paxil) and quit for the final time September 2007, after several failed attempts to quit due to horrific symptoms which I know now are AD withdrawal.

I am now at about 45 months! And still having nasty neurological symptoms though I overall feel lot better. The horrific diarrhea and intestinal cramps were, after 20 months, the first symptom to vanish!

I read in one of your publications that symptoms after 1 year off are technically not withdrawal but neurological damage. And that recovery can take up to 5 years. And this is in line whth the 4 years dr. David Healy states in his article.

Have you any advice or are you available for (online) consulting? My GP is clueless.

TIA, XXXXXXX

 

Answer:

 

I have always thought of withdrawal as something that happens shortly after stopping an addicting drug, which goes away in days or wee ks. This is the way it works with alcohol and narcotics. What we are looking at, when a person remains symptomatic after 45 months, is a persistent adverse drug effect. Mislabeling it as a form of withdrawal suggests that the patient is a little crazy, because the definition of withdrawal is that of a short lived phenomenon.

 

Because patients will sometimes complain of the so called withdrawal symptoms while they are still on a stable dosage, I liken the phenomenon to tardive dyskinesia, in which the problem is both apparent while taking the drug and further unmasked by stopping the drug.

 

As with tardive dyskinesia, sometimes it goes away shortly after stopping the drug, and sometimes it is much more long lasting. The time course for long term improvement seems to parallel what I have observed in patients with serious industrial solvent toxicity, in that improvement is slow and continues for 5 to 10 years.

 

These are my opinions based on my observations. I have only followed a handful of patients over a long period of time with these problems, although your web site is full of people with similar problems. Still, there is not a meaningful study of this phenomenon.

 

I don't have any great advice. Supplements, tryptophan, glutathione... no real luck. It is tough to find therapy, since most therapists are not familiar with this. Mild exercise, proper diet, whatever you can do to promote healthy lifestyle is beneficial. Patients have told me that acupuncture brings symptomatic relief.

 

I think what I have to offer you is hope. It may take a few more months or years for you, but most likely you will get over this.

 

 

 

Stuart Shipko, MD (Psychiatrist/Neurologist)

Founder and Medical Director of PDI

The Panic Disorders Institute

Author of Surviving Panic Disorder: What You Need To Know Information provided by Dr. Shipko is general in nature and should not be construed as a substitute for a visit to and examination by your own personal physician.

Please read our disclaimer.

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Punarbhava

How long it takes to recover from the neurological damage is different for everyone, but his estimation was FIVE years.

I guess that's the only thing I object to with Shipko -- where exactly did he get that estimate of five years? He's acting as if there's some large body of clinical research about withdrawal syndrome that he can draw on -- there isn't. Even if he's just giving his clinical experience with his patients, that's still a comparatively small sample of patients when compared to studies of withdrawal syndrome that could have 1,000 patients or more.

 

I've been reading stories of people with withdrawal syndrome for many years and the recovery rate is all over the place (and it doesn't even seem to matter how long people were on the meds). I've seen people on the meds for only 18 months take 3 years to see substantial improvement. I've seen others on for over a decade who do a slow taper and suffer almost no withdrawal. And I've seen people recover from withdrawal in 2 years. And some who have taken longer than 5 years.

 

I don't think we can really estimate how long a protracted withdrawal will take to heal at this point, and to even estimate doesn't make a lot of sense.

 

There's nothing to say you won't "turn the corner" in another year or even another month, Sunny. I would take his estimation of "five years" with a grain of salt. Remember to "unpatient yourself" and realize that the societal veneration of doctors that makes us trust in their knowledge doesn't really apply to psychiatry, since so much of their "research" has been tainted by corruption and pharmaceutical bias, and there have been zero studies on the pathophysiology of antidepressant withdrawal syndrome. But you can bet we're trying to change that here at SA! In fact, check this out:

Researchers seek prolonged antidepressant withdrawal cases

 

Cine........

 

I very much agree with EVERY POINT you have made.

 

I'd like to add one point: There are many complicating variables that exist during psyche drug WD that may not be taken into consideration when these 4, 5 and even 10 year time recovery time frames are given.

 

For example, IF I were to take psychoactive herbs, off and on and throw some benzos into the mix as well as periodically ingest antihistamines, and/or drinking alcohol, while trying to recover from AD WD, my reovery time line is surely going to take longer than if I remained "drug-free".

 

So, my question is: are these doctors taking these variables into consideration AND equally important, are patients accurately reporting what they have ingested throughout their WD journey.

 

 

Thirdly, even if patient reporting is accurate, most doctors are just as ignorant regarding the consequences of ALL medications (not just psychotropics), herbs etc. not realizing how these pharmacologocial interventions compromised the integrity of the healing process from psyche drug WD.

 

For example, my doctor prescribed antihistamines to assist me during WD however, the very thing that he is prescribing is the very thing that will target my receptors sites and thus, will complicate my recovery by not allowing my receptors to be free from similar chemical assaults.

 

Hence, my recovery will certainly be compromised.

 

 

Doctors are prescribing drugs that are cross-tolerant. Eg. prescribing phenobarbital for benzo WD. The pheno does not prevent benzo WD. In fact, it's dousing the receptors with a similar substance. It's trading one drug for another and does nothing to heal the receptors.

 

Thus, a patient cannot make a claim that they re benzo-free on Jan 01 (for example) IF they have taken pheno to detox and remained on pheno for 3 weeks, a month or longer etc. Their actual drug-free date needs to be calculated on the day the stopped the Pheno not when they stopped the benzo. See what I'm saying?

 

 

Anyway, I've mentioned this in a couple of other threads but I feel this is very relevant and needs to be highlighted.

 

 

There is a Canadian addiction specialist (Dr. Steven Melemis) who deals with benzo addiction and other drug addictions ........he follows the Ashton Manual. He states that it takes TWO years to recover. He specifically mentions that the one year mark is only the half-way point. Again, he's speaking in general terms based on the patient base he is serving.

 

AD WD follows the same pattern as benzo recovery. In fact, all psyche drugs follow relatively the same course.

 

But as you have mentioned, there is no predicting. I've witnessed all that you have articulated, on various forums for close to 10 years now. All that you have stated is completely valid.

 

I hope I'm relaying my thoughts in a clear enough fashion. I have a headache and thus, struggling to present my points but I would love to discuss these points with these doctors.

 

Claudius just posted the letter from Dr.Shipko and it appears that he is drawing his conclusions from a handful of anecdotal reports. It stands to reason that Shipko, Melemis and other such doctors are drawing their conclusions based on what they see in their practice and as I mentioned, they must rely on the information that patients provide to them.

 

How do these doctors who IF their patients are drinking alcohol on the side, or taking psycoactive herbs etc. Patients do not fully disclose to their doctors for a variety of reasons. In fact, it's common for patients to withhold information.

 

 

As you mentioned, there are no long term studies on protracted WD. Any long term studies should include all the factors that I have mentioned but that's providing patients are willing to be transparent.

 

I will agree with Shipko re: there is definitely neurological damage done by these drugs to some people. Those who recover quickly, have not sustained any serious damage.

 

 

 

Punar

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Altostrata

To draw a further parallel to addictive drug withdrawal, the initial phase of symptoms is called acute withdrawal and, if prolonged, the condition is called post-acute withdrawal. As with antidepressant post-acute withdrawal, sometimes people take years to recover from post-acute withdrawal from addictive drugs.

 

With all due respect to Dr. Shipko, he has coined his own terms and descriptions, as none really exist in medicine.

 

Some doctors, seeing antidepressant post-acute withdrawal and finding patients react poorly to additional medications, may call it "treatment-resistant depression," others "tardive dysphoria," without reference to the cause -- antidepressant use and withdrawal. Andrews et al 2011 attributes it to an "overshooting" correction due to "perturbational" effects of the medications.

 

No matter what you call it, it takes place in the nervous system, so it is a neurological condition. Dr. Shipko is also correct in calling it an adverse effect. You certainly could not call it a beneficial effect or a good outcome of drug treatment.

 

I prefer to call it prolonged withdrawal syndrome, as most people experience a fairly continuous timeline, with repeated symptom themes, from acute withdrawal syndrome through a prolonged condition. Rather than making the patient seem "crazy," this honors the patient's experience and points back to the cause (the etiology). It is not a free-standing neurological condition, it is an iatrogenic neurological condition.

 

Pun, you are absolutely right, people do prolong recovery by trying other interventions that cause further "perturbation" of the nervous system.

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Punarbhava

To draw a further parallel to addictive drug withdrawal, the initial phase of symptoms is called acute withdrawal and, if prolonged, the condition is called post-acute withdrawal. As with antidepressant post-acute withdrawal, sometimes people take years to recover from post-acute withdrawal from addictive drugs.

 

With all due respect to Dr. Shipko, he has coined his own terms and descriptions, as none really exist in medicine.

 

Some doctors, seeing antidepressant post-acute withdrawal and finding patients react poorly to additional medications, may call it "treatment-resistant depression," others "tardive dysphoria," without reference to the cause -- antidepressant use and withdrawal. Andrews et al 2011 attributes it to an "overshooting" correction due to "perturbational" effects of the medications.

 

 

Excellent points and this is exactly what happened to me, repeatedly. I was even yelled at by a shrink......"YOU HAVE TREATMENT RESISTANT DEPRESSION". However, it was their drugs and the cold switches from one drug to another that created my violent and unrelenting sickness.[/

 

No matter what you call it, it takes place in the nervous system, so it is a neurological condition. Dr. Shipko is also correct in calling it an adverse effect. You certainly could not call it a beneficial effect or a good outcome of drug treatment.

 

I prefer to call it prolonged withdrawal syndrome, as most people experience a fairly continuous timeline, with repeated symptom themes, from acute withdrawal syndrome through a prolonged condition. Rather than making the patient seem "crazy," this honors the patient's experience and points back to the cause (the etiology). It is not a free-standing neurological condition, it is an iatrogenic neurological condition.

 

 

Very true and thank you for bringing forward the section in bold print. This is a very important point IMHO.

 

I also like what you mentioned re: honor the patient's experience rather than labeling the patient as crazy. So many of us have had to experience such emotional, psychological and spiritual abuse due to medical ignorance and arrogance. It is the most frightening experience ever when one KNOWS they aren't crazy but being labeled as such anyway.

 

Once you're labelled you no longer have the right to your own voice in the presence of the so-called mental health professionals since, one is written off as mentally incompetent to judge one's OWN state of health and the causes of one's deterioration, even when one can present bioligical facts in a SANE, educated and logical fashion.

 

BTW, many of my acute symptoms remain to this day (although at a lower intensity). So, it supports what you have mentioned.

 

 

Pun

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squirrel

The time course for long term improvement seems to parallel what I have observed in patients with serious industrial solvent toxicity, in that improvement is slow and continues for 5 to 10 years.

I find this statement very worrying.

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Maybe

What I would like to know is, if recovery is occuring gradual from a certain point on, symptoms slowly getting better and better or if it even can happen suddenly...that symptoms vanish over the course of a short time frame?

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Altostrata

Those are excellent questions, maybe. Perhaps we'll find out from the information people share on this site.

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Barbarannamated

Alto,

I'm glad to hear that Dr. Shipko will diagnose AWS, but curious as to how the diagnosis is being used.

Barb

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Altostrata

For disability insurance and lawsuits.

 

Dr. Shipko calls it tardive neurotoxic syndrome. He thinks doctors find that more convincing than prolonged withdrawal syndrome.

 

I've been corresponding with him about this. He says when patients say they have prolonged withdrawal, doctors see them as silly, or hypochondriacal or crazy, and they've gotten the name from the Internet.

 

This is what Dr. Shipko says: "The issue is that physicians will not ever listen to a patient who comes in to the office with a complaint of 'prolonged withdrawal.' It simply doesn't exist. It would be so much better if patients simply complained of symptoms that started when they tried to stop the drug. If they need to call it something that doctors understand, then they need to call it neurotoxicity. The nomenclature of 'prolonged withdrawal' is a self-diagnosis that guarantees that the physician will discount the patient."

 

What do y'all think?

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Phil

I don't think doctors will believe either one, to be honest.

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compsports

I don't think doctors will believe either one, to be honest.

 

Phil,

 

I agree.

 

Also, if the patients complain about symptoms when they try to stop the drug, the physician will say that is proof you need it.

 

CS

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Hopeful

 

 

According to Google cache, a 09-03-2009 post on ****** reported that Charly G. wrote:"I consider myself to have been recovered after 6 to 7 years. However, the emotional recovery takes almost twice as long. It's only now that I feel I am becoming whole again and that's more than I could ever asked for."If someone wants to fool around with the Wayback Machine, you might be able to find Charly's original post sometime prior to 2009. Otherwise, it has been thoroughly deleted from the Web.It may have been thread p=548724
I think I downloaded it way back when..I'm on my way out, but will look for it tomorrow...Alto, is there any kind of copyright issues with posting the entire post??? Edited by Altostrata
name changed by request

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Altostrata

I'll leave Charley a note about it on Facebook and let you know.

 

Good to see you, Hopeful! Hope you're doing okay.

 

What do you think of Dr. Shipko's suggestion?

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Hopeful

I'll leave Charley a note about it on Facebook and let you know.

 

Good to see you, Hopeful! Hope you're doing okay.

 

What do you think of Dr. Shipko's suggestion?

 

 

My fears about restarting the drug would be that it wouldn't work and that w/d symptoms would get worse, and, if it did work how long would it work aren't some people getting off because it stopped working? How much milage would you get out of it? I do agree with the 6-7 year timeline for some people.

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Barbarannamated

A few quick thoughts : emphasize the physical/measurable symptoms first (early AM, insomnia, food and drug intolerances that didn't exist pre-AD). Always differentiate initial depressive symptoms from w/d symptoms (I did not have anxiety, for example) to prevent the 'return of illness' dx.

The DP/DR is so important, but potential for new dx extreme, IMHO.

Why is it accepted that marijuana, benzos, opiates, APs, etc. cause long term changes/damage, but seems implausible w SS/NRIs w MDs? Can we look at those drugs and draw any loose correlations? EX: amotivational syndrome is known w MJ.

Also, is the mechanism of 'unmasking bpolar' early in treatment known? (Silly question) Many w/d sx seem similar for me (emotional outbursts, etc).

Downregulation of 5HT well documented. Is DA suppression by 5HT and potential delayed rebound playing in? I know we don't want to circle the chem imbalance story. Just thinking ...

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Barbarannamated

I agree w his point. Why would docs have any reason to believe a patient w documented craziness? Oh, this is all so infuriating!

I do appreciate Dr. Shipko doing all he is. Emphasis on symptoms w/o self diagnosing is definitely important.

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compsports

I agree w his point. Why would docs have any reason to believe a patient w documented craziness? Oh, this is all so infuriating!

I do appreciate Dr. Shipko doing all he is. Emphasis on symptoms w/o self diagnosing is definitely important.

 

What infuriates me even more is folks like us get accused of being antipsychiatry and stigmatizing people with mental illness if we post any comments on psychiatry blogs that are deemed as critical of psychiatry. But yet psychiatrists are contributing to this big time by refusing to take anything that someone with an MI label says seriously. They are hypocrites of the worst kind.

 

But I do appreciate Dr. Shipko's advice as he is only trying to help.

 

CS

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Altostrata

A few quick thoughts : emphasize the physical/measurable symptoms first (early AM, insomnia, food and drug intolerances that didn't exist pre-AD). Always differentiate initial depressive symptoms from w/d symptoms (I did not have anxiety, for example) to prevent the 'return of illness' dx.

The DP/DR is so important, but potential for new dx extreme, IMHO.

Why is it accepted that marijuana, benzos, opiates, APs, etc. cause long term changes/damage, but seems implausible w SS/NRIs w MDs? Can we look at those drugs and draw any loose correlations? EX: amotivational syndrome is known w MJ.

Also, is the mechanism of 'unmasking bpolar' early in treatment known? (Silly question) Many w/d sx seem similar for me (emotional outbursts, etc).

Downregulation of 5HT well documented. Is DA suppression by 5HT and potential delayed rebound playing in? I know we don't want to circle the chem imbalance story. Just thinking ...

 

Here's the problem: I would say it's very few patients who have surfed around and found any kind of label for it. Most who go to doctors complaining of withdrawal symptoms get misdiagnosed as relapse.

 

And of those doctors who know about withdrawal, most would just reinstate and not tell the patient about more gradual tapering -- because THEY DON'T KNOW ABOUT MORE GRADUAL TAPERING.

 

My opinion is it doesn't matter what patients call it, they're going to get misdiagnosed and mistreated anyway.

 

The "unmasking of bipolar" mechanism in withdrawal is the glutamatergic hyper-reactivity, symptoms of sleeplessness, nervousness, anxiety, sometimes hypomania or mania. In early treatment, it is an adverse reaction, possibly too much serotonin, causing sleeplessness, talkativeness, restlessness, akathisia, sometimes hypomania or mania.

 

Downregulation of serotonin receptors is responsible for etiology, dysregulation of autonomic system is sequelae causing symptoms.

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Barbarannamated

Does Giovanna Fava (mistakenly called him Maurizio earlier--SORRY!) have any different dx? Dr. Breggin?

I'm back in SoCal for few weeks. Hope to see Dr.Shipko. Has anyone here been evaluated or treated by him in person? This DP/DR/isolation is making me crazy.

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