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Communications with Dr. Stuart Shipko

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Altostrata

They all call it withdrawal or discontinuation syndrome, example 2001 Antidepressant discontinuation syndromes: common, under-recognised and not always benign and Papers about prolonged antidepressant withdrawal syndrome

 

In Shelton's 2006 e-mail:

I actually think the discontinuation syndrome is pretty bad in some situations and truly horrible in others. Hence, why participated in a scientific focus group that wrote a series of papers teaching docs about the problem (appeared in the Journal of Clinical Psychiatry).

 

First, let's acknowledge one thing: there is a great deal of variability in response, with a lot of people experiencing bad symptoms and others little at all, but almost all resolve; that is, except for a very small group, where the symptoms become persistent.

Bhanji 2006 calls it "persistent tardive rebound panic disorder" -- which, frankly, doesn't sound accurate to me.

 

etc etc etc

 

Back to reality -- Does it matter what patients call it when they see their doctors?

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Barbarannamated

I think what matters is how patients present and describe symptoms to docs. If the doc knows naught about the issue, I doubt it matters.

I'm probably not in a good frame of mind to answer this question after reading Shelton's correspondence.

I do think Dr. Shipko is trying to steer the interaction toward allowing the docs to think it was their idea (in that rare case that they actually consider wd).

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Hopeful

Alto, I agree with Phil and CompSports...but, here are my comments:

 

It's been my experience that most doctors that prescribe the crap think it is wonderful and refuse any suggestion that people have problems coming off of it. I had one “shrink” tell me when I was in w/d that it wasn’t from the drug, but that I had developed an anxiety disorder.

 

Recently, a friend's husband had major surgery...she noticed that "something" was wrong with her husband and mentioned to the nurse that he looked like he was "detoxing". He was also having hallucinations that they caulked up to the pain medication. Five days into this they realized that he wasn't getting his Paxil. Two days after starting the Paxil he was fine...I absolutely can’t believe that a hospital wasn’t aware that you can’t just not take the crap. This friend knew I had trouble getting off of it, but I could tell she was was skeptical. After this experience with her husband she had a different perspective. We were also talking about this with a pediatrician we both know and his comment was oh they never give Paxil to kids because it’s so terrible. He was implying that other ssris weren’t as bad and you could tell he didn’t want to have the conversation.

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annej

My Intro[url="http://survivingantidepressants.org/index.php?/topic/1542-annej-off-long-term-snris-since-july-2011/"]

 

My thoughts on Dr. Stuart Shipko after spending 1.5 hours in consultation with him this year. . .

 

My impression is that Dr. Shipko is highly frustrated by the numbers of people finding out that they experience great distress and discomfort in trying to get off of psychotropics. He was unable or unwilling to offer me any help in getting off of the 5 or 6 medications that I was on at the time I saw him.

 

I don't blame him for not wanting to take on this immense undertaking, but my family and I left his office feeling hopeless after my consultation. He said, and I quote:

 

"The SSRI (SNRI) and the benzo are the very least of your problems". I completely disagree with this statement although I respect his right to think this.

 

 

"You are screwed." Yes, he actually told this to me in front of my family. I sure felt screwed, especially after hearing this.

 

He then went on to say:

 

"I will not be responsible for getting you off medication because I never put you on them in the first place". I respect his personal decision not to get involved with trying to help people get off psychotropics because I am sure that it is very difficult to support someone through their agony, but don't physicians care for people when they are ill and need help?

 

I got the distinct impression that Dr. Shipko does not think it within the best interests of those who might struggle with withdrawal symptoms to take the risk of tapering off of these drugs. His essay which has been posted on this forum, but I will post it again is actually very good and I think it does offer a valid perspective. It is difficult getting off of these drugs and it can be dangerous, but I think he is to quote another poster,a "tad bit fatalistic". I think the scariest possibility that he raises is if the patient goes off medications, finds out that they cannot tolerate the withdrawal symptom, reinstates the drug only to find out that it does not work. I have not run across anyone in my travels that this has happened to, but I don't doubt that this situation exists in the rare minority of patients. [url="http://empathic.ning.com/forum/topics/some-thoughts-on-stopping?xg_source=activity"url]

 

These are just my personal interpretations of my consultation with Dr. Shipko. Other than that, my family and I are very pleased that I decided to get off meds and I hold a lot of hope for the future.

 

I will say one last thing and that is that the quality of my life, even though I am going through benzo withdrawal, is so much better off the multiple drugs than it ever was on them. I'll take my chances and learn how to live drug free.

 

:) Hugs, annej

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Altostrata

Thanks, annej. Yes, Dr. Shipko may be frustrated.

 

He has seen people tapered off very, very gradually and still having to cope with withdrawal syndrome.

 

We have people here who have experienced this. Their situation is real but they are a minority of a minority of a minority (people who taper --> people who have difficulty tapering and have to slow down --> people who get withdrawal syndrome despite very slow tapering).

 

Yet, they also gradually improve over time. Perhaps it has been too painful for Dr. Shipko to keep treating patients knowing the recovery process can be very long.

 

All in all, for people with nervous systems sensitive to reductions in medication, tapering can be a grueling process with no absolute guarantee of success -- but it's the best way we know to reduce the risk of the most severe withdrawal symptoms.

 

It's unfortunate that he's let this discourage him so thoroughly.

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Phil

 

"You are screwed." Yes, he actually told this to me in front of my family. I sure felt screwed, especially after hearing this.

 

 

I can't believe he said this! This is not the sort of thing to say to someone in withdrawal.

 

Alto - thankyou for being the voice of reason on this.

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annej

 

 

"You are screwed." Yes, he actually told this to me in front of my family. I sure felt screwed, especially after hearing this.

 

 

I can't believe he said this! This is not the sort of thing to say to someone in withdrawal.

 

 

Hi Phil,

 

My assumption is that Dr. Shipko would like to see people like myself avoid being placed on these drugs in the first place.

 

I am assuming he is simply frustrated at having to clean up other doctor's messes. If this is the case, I don't blame him one bit. I think I would be very, very upset to see people suffering needlessly.

 

:) annej

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Altostrata

I agree, my intuition is he doesn't want to be the clean-up guy for a patient and bear the responsibility for a long trail of errors by his colleagues.

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compsports

So, if he won't help people get off drugs, what the heck does he do? I had the sense in listening to his interview with Breggin that he doesn't prescribe drugs.

 

I don't know, it seems hypocritical to essentially call yourself a reformer but yet refuse to help patients in dire need.

 

Annej, thanks for sharing your experiences even though I am sure that was very painful. As one who slowly tapered off of 4 meds, I refuse to believe I am screwed for life even though it feels that way constantly due to my insomnia issues that may or may not be related to withdrawal. I have wondered about sleep apnea or upper airway resistance syndrome issues and plan to consult a doctor next week about that.

 

But when I had that great sleep last month. I felt like a new person and definitely not one who was screwed in spite of being on meds for so many years.

 

CS

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Guest damnnardil

Ok folks. Should I be putting this topic on here or on rant and rave? I believe it needs to go here. First of all, thank you so much Tricia for your brilliant, astute comments and the way in which you view this situation. I had the opportunity to see Dr. Shipko a little over a month

 

ago. Before I went to his office he had already commented that he did not agree. with everything Breggin states in his books and I am talking about crucial situations and decisions. Do I have to elaborate? Ironically he was recommended to me from Dr. Breggin. Sorry folks, I agree with everything Dr. Breggin says , especially the points that DR. Shipko does not agree with. Unfortunately Dr shipko oes not want to abide by total truth because he would obviously lose money if he did. Telling me anything in regard or making an excuse for having to take psychotropic medicine for any so called mental illness is complete BS. Dr.Shipko must stay in the prescribing of

 

psychotropic trash...oh excuse me, I meant to say medicine, in order to make a living at the level that an MD is "supposed" to make for the long years of schooling he attended. He like most of the idiots on this earth decided that the money was more important then to stay on line with the absolute truth. He explained to me that the problem is not the psychotropic drugs, it is the fact that the doctors do not

 

warn their patients of potential side effects and how difficult it is to get off the medicine. Oh really? Like that would make a difference. What it would do is maybe make allot more people be allot more careful about making the decision to fry their brain. If Dr. Shipko were to follow the guidelines that a much more brilliant, truthful, empathetic doctor like Dr Breggin does, Dr Shipko would eventually lose his business

 

because the truth is that their is not enough people on psychotropics that have even a slight clue that their problem is the drug and they need to start looking for a doctor that specializes in weaning people off psychiatric medicine. Dr Shipko was very rude to me in my opinion and he told me that he would gladly answer any questions I had after I left andI would be able to get those answered through his email. After answering my first question with about 20 words, he ignored any further questions I have and justifiably so. I'm not a regular patient and he is not writing a regular prescription for me which would require at least semi regular visits so since their was no money involved. Dr. Shipko flipped me the bird. Business is business, right? Regardless of the 17 hells I've been through and that is putting it lightly, If I

 

would have addressed and property worked on my core trauma that happened to me when I was around 15 years old. You would never know who I was because I would have taken the road that is much more proper and that is the road of psychotherapy, meditation, hypnosis, exercise etc.etc. which I am doing now and it is the best thing that happened to me and I cannot say it has been easy but I know in my heart of hearts that any drugs used

 

for the purpose of curing emotional problems of about 98% of all cases is complete utter hogwash and this is the biggest scam that was helped put into motion and made possible by the big filthy rich families, specifically The Rockefellers. Western medical allopathic medicine, biomedicine, conventional medicine, mainstream medicine,and orthodox medicine is practically worthless and senseless and it is all about chasing symptoms of a bigger problem and this is so these people can line their pockets and help you take a few steps further than you normally would, with out the drugs before you collapse. John :angry:

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Barbarannamated

*big sigh*

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annej

So, if he won't help people get off drugs, what the heck does he do? I had the sense in listening to his interview with Breggin that he doesn't prescribe drugs.

 

I don't know, it seems hypocritical to essentially call yourself a reformer but yet refuse to help patients in dire need.

 

Annej, thanks for sharing your experiences even though I am sure that was very painful. As one who slowly tapered off of 4 meds, I refuse to believe I am screwed for life even though it feels that way constantly due to my insomnia issues that may or may not be related to withdrawal. I have wondered about sleep apnea or upper airway resistance syndrome issues and plan to consult a doctor next week about that.

 

But when I had that great sleep last month. I felt like a new person and definitely not one who was screwed in spite of being on meds for so many years.

 

CS

 

Dear compsports,

 

I believe that Dr. Shipko would like to see reform within the psychiatric community, but is experiencing the very real economic constraints in doing so. In other words, how can be possibly make a living by stepping outside of mainstream psychiatry?

 

I like the fact that he is questioning mainstream psychiatry, but it seems that he is currently straddling two sides of a fence.

 

It must be very difficult to try and live with the growing awareness that one's lifelong profession is seriously flawed and has caused so much pain and suffering.

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annej

Ok folks. Should I be putting this topic on here or on rant and rave? I believe it needs to go here. First of all, thank you so much Tricia for your brilliant, astute comments and the way in which you view this situation. I had the opportunity to see Dr. Shipko a little over a month ago.

 

He explained to me that the problem is not the psychotropic drugs, it is the fact that the doctors do not warn their patients of potential side effects and how difficult it is to get off the medicine. Oh really? Like that would make a difference. What it would do is maybe make allot more people be allot more careful about making the decision to fry their brain. If Dr. Shipko were to follow the guidelines that a much more brilliant, truthful, empathetic doctor like Dr Breggin does, Dr Shipko would eventually lose his business because the truth is that their is not enough people on psychotropics that have even a slight clue that their problem is the drug and they need to start looking for a doctor that specializes in weaning people off psychiatric medicine.

 

Dr Shipko was very rude to me in my opinion and he told me that he would gladly answer any questions I had after I left andI would be able to get those answered through his email. After answering my first question with about 20 words, he ignored any further questions I have and justifiably so. I'm not a regular patient and he is not writing a regular prescription for me which would require at least semi regular visits so since their was no money involved. Dr. Shipko flipped me the bird. Business is business, right?

 

Regardless of the 17 hells I've been through and that is putting it lightly, If I would have addressed and property worked on my core trauma that happened to me when I was around 15 years old. You would never know who I was because I would have taken the road that is much more proper and that is the road of psychotherapy, meditation, hypnosis, exercise etc.etc. which I am doing now and it is the best thing that happened to me and I cannot say it has been easy but I know in my heart of hearts that any drugs used for the purpose of curing emotional problems of about 98% of all cases is complete utter hogwash and this is the biggest scam that was helped put into motion and made possible by the big filthy rich families, specifically The Rockefellers. Western medical allopathic medicine, biomedicine, conventional medicine, mainstream medicine,and orthodox medicine is practically worthless and senseless and it is all about chasing symptoms of a bigger problem and this is so these people can line their pockets and help you take a few steps further than you normally would, with out the drugs before you collapse. John :angry:

 

(((((John))))),

 

I can relate to the pain of going down this path. You make perfect sense. I get it.

 

At first I was really angry with Dr. Shipko because I went to see him when I was in extreme agony caused by side effects of my medications. The feeling that my family and I got after consulting with Dr. Shipko was that he was a very angry man who really likes to make a buck. I personally have no problems with paying cash for services, but I do feel that he does not "talk the talk or walk the walk" per Dr. Breggin. He expressed anger towards my pdoc, he expressed disdain for the fact that I was on several meds. I honestly could not figure out if he was more angry with me, the patient, for having taken these meds in the first place, or angry at my doctor for putting me on these meds. The pervasive feeling that my family and I got was that Dr. Shipko was really very unhappy at many, many things and very quick to put several hundreds of dollars in cash in his pocket. I did see a little happiness on his face at that point.

 

The truth as I see it is that there are several prominent psychiatrists, psychologists who make a big hooplah over the so-called "truth" about psychotropics, but where is the actual help? I also called Breggin's office, but there was no "real" help. Even the Icarus Project with the 40 or more page brochure on "harm reduction" and reducing medication is vague.

 

Here is the truth as I see it: There is NO one who is willing to take on the responsibility or liability of helping people to get off of meds. It is seen as being too risky. The information I hear over and over again is, "Do not stop taking your medication without discussing this with your doctor". All I can find on the Internet is a warning and an anecdotal warning to taper one medication at a time and to not exceed 10% every 7 to 10 days. I can NOT hold Dr. Shipko solely accountable for the lack of reliable information and/or support. He is but one small fish in a very large ocean and he is swimming against the tide.

 

I ask where are the Breggins in all of this? Why is everything about selling books or memberships to "Empathic Therapy"? We don't need any more Breggins. We need actual research on how to safely and effectively get people off of medication they no longer want to be on. We need a mental health system instead of a system of mental death. We need to get the homeless people homes and we need to put an end to childhood trauma. The social implications are huge. We need to take back our responsibility for working on our own core issues. We need to stop going to the doctor for a pill. We need to continue to do research and work on providing suspport for people with mental distress instead of the current mode of warehousing people for 72 hours to a week. The FDA needs to get out of bed with PHARMA. We need answers to problems that are difficult, complex, and take up huge amounts of resources we don't have. We need to find ways to prevent suffering in the first place. I could go on and on, but I think I am making my point. The social problems that drive public health/mental health are immense and it did not start with you or I and it certainly won't end with you or I.

 

I have no great ideas on how to end poverty, suffering, pain. I don't know how to stop doctor's from prescribing medications, how to stop pharmaceutical companies from direct to consumer advertising, and I certainly don't know how to stop the average person with horrendous pain to stop reaching for a pill. What I do know is that my experience will not be wasted on blaming one individual because this is not where the solution lies.

 

I hear great strength and resolve in your words. Use this energy to make the transition from wounded to victorious. You have much to offer others. :) Hugs, annej

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Guest damnnardil

Hi Annej. I hear everything you say loud and clear. It is what it is. Good writing. John :)

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Altostrata

For what it's worth, I begged Dr. Breggin's organization (ICSPP or some dang acronym way back then) years ago to start a roster of doctors who would aid people in tapering. His books advise people to go to doctors for help.

 

ICSPP didn't do it then and its successor organizations, both the new one headed by Dr. Breggin and ISEPP, haven't done it yet. I consider this a failure of vision. I hear rumors that Dr. Breggin will soon take action on this, and I have been corresponding with ISEPP, which now at least is aware of the issue and may be more helpful in the future.

 

Why has no one addressed the practical issue of providing services to taper patients off psych drugs? It's not a money issue. The doctors can still charge for office visits.

 

Still, there are doctors out there who are doing this and I intend to find them.

 

Dr. Shipko can focus his practice on whatever he wishes. He does provide documentation of disability from withdrawal syndrome for insurance purposes and I believe he provides expert testimony in court cases. You may note he is not on our list of doctors who assist tapering. There are about 45,600 other US psychiatrists who are also not on the list.

 

Very sorry to hear that people have had such bad experiences with him lately.

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Nadia

For disability insurance and lawsuits.

 

He 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?

 

A little late in on the conversation, but I do think that "withdrawal" has it's drawbacks as a term. Even "prolonged withdrawal"... just because of the way it is used in the medical and scientific literature normally, from what I can tell. On one hand, I don't care what we call it, but on the other, it would be great to come up with a medically-sound term. Not like "discontinuation syndrome" or anything that would try to belittle the problem, but something that really captured the fact that we are suffering from a set of symptoms that are the result of an organic change due to having taken medication. It's more like a long-term side effect (not that it always need be the result of long-term use, of course)... like how aspirin can cause ulcers or corticosteroids can cause cataracts and osteoporosis. The difficult and interesting variation is that in many cases, continuing meds helps mask some of the problems that have developed.

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Barbarannamated

I agree 100% Nadia

You hit all of the points and the difficulty finding a term that encompasses the complexity

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Altostrata

For what it's worth, David Healy uses the term "prolonged withdrawal syndrome." It's not totally unknown.

 

I have a problem with the "neurotoxicity" terminology because I believe it needs to be linked to withdrawal, the process of withdrawal, and the fact that most people are tapered too fast, if they're directed in any kind of taper at all.

 

On the other hand, I believe it's possible antidepressants can be neurotoxic independent of acute withdrawal issues, and a lot of people who believe they had symptom-free withdrawals develop something later that resembles withdrawal syndrome and is misdiagnosed as a psychiatric disorder. (Giovanni Fava has been theorizing that antidepressant use predisposes to relapse -- the "oppositional tolerance" theory.)

 

My personal theory is that initially they overlook mild withdrawal symptoms, which escalate or accumulate into what we would recognize as prolonged withdrawal syndrome.

 

At any rate, whether you call it prolonged withdrawal syndrome or neurotoxicity, doctors don't have a clue what to do about it except to call it relapse and remedicate with the usual trial-and-error.

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Nadia

For what it's worth, David Healy uses the term "prolonged withdrawal syndrome." It's not totally unknown.

 

I have a problem with the "neurotoxicity" terminology because I believe it needs to be linked to withdrawal, the process of withdrawal, and the fact that most people are tapered too fast, if they're directed in any kind of taper at all.

 

On the other hand, I believe it's possible antidepressants can be neurotoxic independent of acute withdrawal issues, and a lot of people who believe they had symptom-free withdrawals develop something later that resembles withdrawal syndrome and is misdiagnosed as a psychiatric disorder. (Giovanni Fava has been theorizing that antidepressant use predisposes to relapse -- the "oppositional tolerance" theory.)

 

My personal theory is that initially they overlook mild withdrawal symptoms, which escalate or accumulate into what we would recognize as prolonged withdrawal syndrome.

 

At any rate, whether you call it prolonged withdrawal syndrome or neurotoxicity, doctors don't have a clue what to do about it except to call it relapse and remedicate with the usual trial-and-error.

 

 

Yeah, "neurotoxicity" doesn't seem like the right option either. The idea of tapering medication is important not only for ADs... for example, corticosteroids need to be tapered. I wonder, for other diseases and treatments, what they call what happens when you withdraw a medication too quickly.

 

At the same time, you can have these kinds of problems after long term use of an AD EVEN IF you taper appropriately... so that is indication that there is something else going on as well. I bet we are actually looking at a variety of effects dependent on a whole lot of factors.

 

In my case, I didn't have too bad a time with the acute withdrawal phase... but it's true I didn't even pay much attention. I had never heard of brain zaps, for example, and only remembered after the fact that I'd felt something like that, and only a handful of times and it resolved quickly. But what is not clear to me is the relationship between that acute withdrawal and prolonged withdrawal. From reading stuff on here, it seems some people have really bad acute withdrawal and then are OK, while others like me do relatively well at first, but then have other stuff go haywire (like high cortisol, dizziness, anxiety). There's a long road ahead in terms of understanding all this...

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Barbarannamated

I had the same thing …no zaps or flu-like symptoms acutely but bad cortisol panics /anxiety /DP/DR • if I had the acute stuff I think it may have clued me in that I wasn't gliding thru unscathed

I recall one day last spring that the sky seemed so bizarre ~an eerie greenish gloom that freaked me out • it reminded me of tornado weather back in the midwest • I am very sensitive to colors as well as light • I can easily tell the warmth factor (lux maybe) of the different fluorescent bulbs in Home Depot

My talents are strange ;)

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alexjuice

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.

 

Yes. Angering.

 

I just went through an ordeal where I was jailed for 13 hrs for driving with an invalid license.

 

I wanted to get access tomy benzos... That didn't happen. Treated like crazy. Terrible to have this problem....

 

I didn't know my license was invalid and it should not be. Red tape mistake.

 

Alex

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Altostrata

My theory is that for some people, the nervous system wobbles a bit after withdrawal (acute withdrawal symptoms) but rights itself. For others, it's more of a slow falling of dominoes, which accumulates or culminates in severe long-term symptoms.

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Barbarannamated

For what it's worth, I begged Dr. Breggin's organization (ICSPP or some dang acronym way back then) years ago to start a roster of doctors who would aid people in tapering. His books advise people to go to doctors for help.

 

ICSPP didn't do it then and its successor organizations, both the new one headed by Dr. Breggin and ISEPP, haven't done it yet. I consider this a failure of vision. I hear rumors that Dr. Breggin will soon take action on this, and I have been corresponding with ISEPP, which now at least is aware of the issue and may be more helpful in the future.

 

Why has no one addressed the practical issue of providing services to taper patients off psych drugs? It's not a money issue. The doctors can still charge for office visits.

 

Still, there are doctors out there who are doing this and I intend to find them.

 

Dr. Shipko can focus his practice on whatever he wishes. He does provide documentation of disability from withdrawal syndrome for insurance purposes and I believe he provides expert testimony in court cases. You may note he is not on our list of doctors who assist tapering. There are about 45,600 other US psychiatrists who are also not on the list.

 

Very sorry to hear that people have had such bad experiences with him lately.

 

I vacillate between 1) anger at docs who 'know' the truth and dangers but don't help and 2) compassion for the difficult position they are in •

Many may be taking the meds themselves or have encouraged loved ones to take ADs • I doubt that any psychiatrists have never prescribed them even though they now realize the dangers •

This is a highly charged emotional issue for us ~most of us have expressed some version of 'how was I so stupid/trusting/giving away my power' etc•

I'm not defending the docs who willing perpetuated the myth „but am realizing the majority believed they were doing the right thing and must now be faced with a multitude of emotions--guilt~helplessness~anger~fear~self loathing at being so gullible and not questioning the data •

In the words of one physician "It's too overwhelming to think about yet"

 

It's impossible to comprehend what emotions and obstacles they are facing as they realize the damage done by decades of education and practice and know of no way to correct it ~

an existential crisis of magnitude proportions •

 

Not an excuse but something to be aware of

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Altostrata

In the words of one physician "It's too overwhelming to think about yet"

Meaning he or she will think about it after retirement?

 

And they accuse patients of not facing reality.

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Barbarannamated

When the doctor himself is the patient the denial may go on forever ~

I suspect there are a fair number of MDs who took "the safe little pills" when feeling fatigued and stressed by eeking out a living in the Managed Care System emerging at about the same time SSRIs were introduced

Free samples…long work hours

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Shipko

This thread is wrong in assuming that I do not "treat" antidepressant withdrawal. I am skilled at it and to this day I still help patients who want to stop taking antidepressants as long as they understand the potential risks and benefits of stopping.

 

Whoever wrote that I don't know how to "treat" misunderstands my opinions. It seems that a doctor has to be either for willy nilly prescribing the drugs or adamant about the importance of stopping the drugs. Once a psychiatrist criticizes the drugs, it is generally the end of a lucrative and successful private practice. The natural next step is to take the position that everyone should be off the drugs and try to make a living off of that position. It is not so simple as an either or situation. Do you really think that Glenmullen and Breggin find universal success when tapering and stopping drugs? Do you think that their patients don't crave the drugs and restart even after an uncomfortable withdrawal? I don't know, but I suspect that my observations are probably universal. The only truth is that people should avoid starting the drugs if at all possible. Once on the drugs, advising everyone to stop is not clinically sound. Just as patients need to be fully informed of the risks and benefits of taking a drug, they need to know the risks and benefits of stopping the drug, which include serious and disabling symptoms which may not remit when restarting the drugs and which may last for years.

 

I want to tell you all, that if I thought that getting people off of SSRIs was universally beneficial, then I would have already opened my SSRI withdrawal clinic and would have a national franchise on withdrawal clinics. I only hope that this board can understand that I report accurately what my clinical experience has been for the benefit of all. I choose not to be another ball and chain on the ankle of people taking the antidepressants promoting a simplistic agenda; stopping SSRIs is not so simple.

 

For the record, I still take patients off of antidepressants, and work with some very difficult cases. However, I give them informed consent about the observations I have made concerning withdrawal, including the fact that a lot of patients go back on the drugs (drug craving is a problem), that sometimes cutting the dosage results in serious and disabling symptoms that do not improve with restarting the prior dosage (Breggin writes about this but has never had this happen in his practice - I have and it is a disaster), and some of the drawn out very uncomfortable and disabling symptoms lasting years - particularly akathisia, which at best resolves slowly over time.

 

There are no meaningful studies on the subject, so all I can offer you is my observations. My observations might reflect a particularly difficult patient population or other confounding variables, but I am honest in my reporting. It irks me that I read comments from people who have come to see me or have contacted me who are very mentally ill and take information in the visit out of context or written completely wrong information. I would love to write back here about those people and the actual interactions, but I am prohibited by confidentiality laws.

 

I am not frustrated or burnt out, and offer my findings to you to take for what they are worth. From my standpoint it is important to consider the disability, the suffering, the craving, the recidivism and the protracted neurotoxic effects that occur sometimes when embarking on a withdrawal strategy.

 

Different clinicians will have different experiences; this is exactly why detailed scientific studies on the subject are needed. Until such studies are obtained, all anyone has is the clinical observations of the practitioners who have worked in the field. I offer my opinions freely and do an enormous amount of pro bono work. Please do not criticize me because I do not take the knee jerk response that everyone taking SSRIs is going to do well with tapering and stopping the drugs.

 

Absent real science on the subject, my opinion is only one opinion, and feel free to disagree with me, but I would hope that it is understood that I accurately report my findings with a purpose to help people the best I can.

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alexjuice

My sole experience comes from the other side of the couch, still I agree with you that studies are needed and absent data all I have to go on is that that I've learned either personally or from others in a boat like mine on websites like this. Obviously, it's an imperfect system.

 

The only truth is that people should avoid starting the drugs if at all possible. Once on the drugs, advising everyone to stop is not clinically sound. Just as patients need to be fully informed of the risks and benefits of taking a drug, they need to know the risks and benefits of stopping the drug, which include serious and disabling symptoms which may not remit when restarting the drugs and which may last for years.

 

I'm happy to endorse this truth, at least its first bit. The tragedy, one not specific to psychiatric medication, is that it is vastly more lucrative to introduce a person to a drug he may never be able or willing to stop yet must visit a licensed professional to obtain than...any other manner of treatment that I can think up. So a system does endure.

 

Absent real science on the subject, my opinion is only one opinion, and feel free to disagree with me, but I would hope that it is understood that I accurately report my findings with a purpose to help people the best I can.

 

Well speaking for myself, I say thanks for clarifying your position and welcome to the forum, doc.

 

Alex

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compsports

Dr. Shipko,

 

I also wanted to welcome you.

 

I will never forget how honest you were with me when I emailed you about the possibility of consulting with you regarding my tapering off of Doxepin when I was on it. You said you had nothing to offer me besides what I was already doing.

 

By the way, a friend recently asked me for advice regarding tapering his meds. I said if he chose to go that route, even tapering slowly was going to result in some ups and downs that he had to be prepared to deal with.

 

I explained that I didn't want to be an alarmist but he had to be prepared that it could be a rough ride.

 

Thank you for being out there.

 

Comp Sports

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Barbarannamated

Dr. Shipko,

THANK YOU for coming online and clarifying your position. I greatly respect the Catch-22 you are in. My husband does Work Comp UR and is asked to authorize continued use of SS/NRIs. He can give no treatment advice or warnings, only a yes or no. Very difficult.

 

Thank you again.

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Altostrata

Thank you for that information, Dr. Shipko.

 

It was I who wrote you do not treat withdrawal syndrome. What I meant was post-acute withdrawal syndrome -- prolonged symptoms. Perhaps I've misunderstood, do you treat this?

 

I do not believe we disagree about the generally unrecognized risks of withdrawal. Those who have difficulty with it can have great difficulty, and recovery can take a very long time.

 

There is a middle ground, however, of people who taper slowly and successfully.

 

How can you determine who will have this extreme difficulty until they have at least started to taper? Under what circumstances would you recommend patients not attempt to go off the medication, if their psychiatric condition does not warrant it?

 

If you can predict who will suffer severely, I beg you to publish your opinions, at the very least on a blog.

 

What about the many people who have been ill-advised by their doctors and find themselves with iatrogenic damage after being overmedicated and tapering too quickly? Or those who suffer adverse reactions and severe withdrawal? Our Introductions forum is full of these cases -- which are probably all too familiar to you.

 

It's too late to tell those people they should never have gone off the drug.

 

From what I've seen, here in San Francisco, it is entirely possible to have a thriving private psychiatric practice minimizing the prescription of medication and assisting people who have suffered iatrogenic damage. Dr. Shipko, if this is of any interest to you, I beg you to consider it.

 

PS This site does not advocate that everyone withdraw from all psychiatric medications. We offer support to people who have already made the decision for themselves. If patients could find knowledgeable doctors to consult, I would be happy to close this site up and leave support to the professionals.

Edited by Altostrata
added postscript

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Jemima

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?

 

Not we---THEM.

 

I agree with you wholeheartedly. My depressive crash was caused by too-low cholesterol induced by Lipitor, which, if you believed my doctor, is God's very own gift to humankind. There was no such thing as a cholesterol number that was too low, in her estimation. One of my favorite authors and bloggers is now making public the suffering that Lipitor has caused him: http://www.kunstler.com/index.php. Lipitor has only been proven effective for men over 35 who have had a heart attack, yet doctors sprinkle it around like they're feeding bread crumbs to the birds. Women, in particular, are likely to suffer numerous side effects, as I have. Aside from depression, I've experienced muscular atrophy and I don't know if I will ever regain normal use of my arms. My doctor gave me a script for physical therapy, which is going to cost me around $200 a month, and that's just the co-pay. Due to withdrawal, I haven't tried it yet.

 

There is nothing I would like better than to see all of this careless prescribing come to light and many drug companies sued right out of business. It would help if state medical boards would refuse to grant CME credit (Continuing Medical Education, required to maintain a medical license) to anything offered by a drug company. Doctors go for the freebies, and this is where a lot of misinformation is disseminated. I'm a CPA, and courses like this would never pass muster with the State Board of Accountancy. Can you imagine CPA's being trained by MF Global instuctors??? I think not.

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Jemima

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?

 

 

I think he has an excellent point. It is hard enough to get a doctor to actually listen to a patient's viewpoint, and calling the problem neurotoxicity at least gives the impression that one is well-read on the subject. An intelligent and well-read patient at least commands some respect if not outright fear from the medical profession.

 

I think Dr. Shipko is a brave and gracious man for joining this site and discussing our problems with us. It's a lot more than most doctors, and especially psychiatrists, are willing to do.

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annej

This thread is wrong in assuming that I do not "treat" antidepressant withdrawal. I am skilled at it and to this day I still help patients who want to stop taking antidepressants as long as they understand the potential risks and benefits of stopping.

 

Whoever wrote that I don't know how to "treat" misunderstands my opinions. It seems that a doctor has to be either for willy nilly prescribing the drugs or adamant about the importance of stopping the drugs. Once a psychiatrist criticizes the drugs, it is generally the end of a lucrative and successful private practice. The natural next step is to take the position that everyone should be off the drugs and try to make a living off of that position. It is not so simple as an either or situation. Do you really think that Glenmullen and Breggin find universal success when tapering and stopping drugs? Do you think that their patients don't crave the drugs and restart even after an uncomfortable withdrawal? I don't know, but I suspect that my observations are probably universal. The only truth is that people should avoid starting the drugs if at all possible. Once on the drugs, advising everyone to stop is not clinically sound. Just as patients need to be fully informed of the risks and benefits of taking a drug, they need to know the risks and benefits of stopping the drug, which include serious and disabling symptoms which may not remit when restarting the drugs and which may last for years.

 

I want to tell you all, that if I thought that getting people off of SSRIs was universally beneficial, then I would have already opened my SSRI withdrawal clinic and would have a national franchise on withdrawal clinics. I only hope that this board can understand that I report accurately what my clinical experience has been for the benefit of all. I choose not to be another ball and chain on the ankle of people taking the antidepressants promoting a simplistic agenda; stopping SSRIs is not so simple.

 

For the record, I still take patients off of antidepressants, and work with some very difficult cases. However, I give them informed consent about the observations I have made concerning withdrawal, including the fact that a lot of patients go back on the drugs (drug craving is a problem), that sometimes cutting the dosage results in serious and disabling symptoms that do not improve with restarting the prior dosage (Breggin writes about this but has never had this happen in his practice - I have and it is a disaster), and some of the drawn out very uncomfortable and disabling symptoms lasting years - particularly akathisia, which at best resolves slowly over time.

 

There are no meaningful studies on the subject, so all I can offer you is my observations. My observations might reflect a particularly difficult patient population or other confounding variables, but I am honest in my reporting. It irks me that I read comments from people who have come to see me or have contacted me who are very mentally ill and take information in the visit out of context or written completely wrong information. I would love to write back here about those people and the actual interactions, but I am prohibited by confidentiality laws.

 

I am not frustrated or burnt out, and offer my findings to you to take for what they are worth. From my standpoint it is important to consider the disability, the suffering, the craving, the recidivism and the protracted neurotoxic effects that occur sometimes when embarking on a withdrawal strategy.

 

Different clinicians will have different experiences; this is exactly why detailed scientific studies on the subject are needed. Until such studies are obtained, all anyone has is the clinical observations of the practitioners who have worked in the field. I offer my opinions freely and do an enormous amount of pro bono work. Please do not criticize me because I do not take the knee jerk response that everyone taking SSRIs is going to do well with tapering and stopping the drugs.

 

Absent real science on the subject, my opinion is only one opinion, and feel free to disagree with me, but I would hope that it is understood that I accurately report my findings with a purpose to help people the best I can.

 

~~~~~~~~~~~~~~~

I had the opportunity of consulting with Dr. Shipko back in 2011 and I believe he did his very best in warning not only myself, but my family about the inherent risks in discontinuing psychotropics. I was hellbent on getting off of medications that I felt had caused me (and my family) great harm, but not until I experienced the subjective horrors of severe Tardive akathisia and Tardive Dyskinesia 4 to 6 weeks after getting off of Klonopin (which undoubtedly "masked" the TA/TD) do I fully appreciate and agree with what Dr. Shipko was intending to convey - getting off of psychotropics has RISKS. My recent update about what happened to me is under "Introductions and Updates" "Tardive Akathisia/Tardive Dyskinesia". I am unable to properly command my brain to properly link back to my update. But it is there for the reading, if anyone is interested in reading what happened to me - the exact same thing as Dr. Shipko's advises in his post that is quoted above.

 

In all honesty, Dr. Shipko was spot on when he told me "you are screwed". Perhaps this was not the most eloquent way of communicating his experience of seeing some patients suffer long term complications of getting off of meds and at the time it made me feel hopeless. However, my recent experiences of the horrors of the complications of psychotropic medication withdrawal, specifically tardive akathisia/TD give me a profound respect for Dr. Shipko's experience and understanding of the withdrawal phenomenon. He is the only pdoc I have seen who acknowledges this phenomenon.

 

For anyone who is contemplating coming off of any psychotropic drug, please, please find out as much as you can as to the possible life long consequences of doing so. Getting off of psychotropics can have devastating consequences that may not be reversed by going back on. At this time, Klonopin is the only thing holding the TA/TD at bay and I can only live one day at a time and hope that in many months or many years that this movement disorder resolves.

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Altostrata

I've corresponded with Dr. Shipko about warning people about withdrawal. Here is my summary of our conversation:

 

Yes, withdrawal can be very difficult. Dr. Shipko and Dr. Healy have both found there is a small minority of people who cannot go off the drug no matter how slowly they taper. There is that risk, but most people can successfully taper at a pace individualized to their own tolerance.

 

I asked Dr. Shipko how he distinguishes people who can go off medication from people who cannot. He can't tell in advance. He said he tries tapering them and if they have problems, he stops.

 

I've clarified that while he is knowledgeable about tapering, Dr. Shipko does NOT treat withdrawal syndrome after a person has quit. This is possible but he doesn't know how to do it (I wish he would learn, because it might brighten his outlook).

 

So, yes, going off psychiatric medications has risks but NO ONE KNOWS who will suffer the worst case scenario. The risk is small, but not non-existent. Most people can successfully taper off if they listen to their bodies and go as slowly as they need to.

 

It is entirely your choice to go off psychiatric medications. This site does not advocate that decision, it only gives you information to discuss with your doctor if you wish to.

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RebelMaven

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.

 

Could someone please elaborate on this theory and provide resources such as links to substantiate it?

 

This may be the missing piece of the puzzle I've been looking for all this time.

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