Post-withdrawal nervous system hypersensitivity, hyper-reactivity and kindling

[Altostrata]

Correct, but you need to take care of yourself and not push your nervous system too much. Protect it as much as possible. Wear those dark glasses.

[peggy]

Forgive me for starting yet another topic....

 

But - i was thinking about kindling post alcohol/benzo withdrawal. It is a well established phenomenon that occurs after several difficult withdrawals - people can suddenly find themselves back in withdrawal if triggered by something - even when they haven't had a drink or benzo for years. And i wondered if this is the same thing that happens in antidepressant withdrawal. It is well accepted that alcohol withdrawal should be done slowly with diazepam to avoid excessive withdrawal symptoms, as this seems to reduce the chance of kindling later on.

 

I am not suggesting we should be taking diazepam, the reason it is used in alcohol w/d is that it is believed that it has actions on similar places in the brain - i guess it is harder to ask the person detoxing from alcohol to have a little less each day...

 

But, is this perhaps the same thing that happens in antidepressant withdrawal when people say they suddenly experience withdrawals 4 or 5 months out?

 

I have quite a logical brain and i find that if i can make sense of the process it is better for me

[Altostrata]

Kindling is another name for hypersensitive reactions to neurologically active substances.

 

Yes, people who have withdrawn from antidepressants experience this. We have many, many discussions about post-withdrawal hyper-reactivity.

 

This is another reason to care for the nervous system with a slow taper.

 

(You can start any topic you wish. Use Search first to avoid duplicating topics, please.)

[UnfoldingSky]

I had a kindling reaction to Celexa, after having quit it once (cold turkey) without any problems. I restarted it a year later. It's not something I would willingly do over again; I was perfectly healthy before I restarted, I wasn't even depressed as I had been treating depression effectively with acupuncture. Now my life is a very complicated, very painful mess; I'm actually lucky to be alive after everything I experienced as a result of the restart. While researching what happened to me I found Dr. Joseph Glenmullen, whom briefly mentions something about antidepressant kindling in one of his books. That really helped me, though never was accepted by doctors as the cause of my ongoing issues (however they did diagnose, and then for liability reasons later basically denied, an adverse reaction.)

 

Since we are on the topic, does anyone know if kindling is widely discussed elsewhere? I'd love a reference or two beyond Glenmullen to throw at doctors. No one I have ever seen will take the time to read him.

[Altostrata]

http://www.psycheducation.org/bipolar/controversy.htm#kindling

Dr. Rif El-Mallakh, head of the Mood Disorders Clinic at the University of Louisville, Kentucky, published concern about "loss of response" (sometimes called "Prozac poop-out", or more Greek: antidepressant tachyphylaxis) to antidepressants several years ago: "Can long-term antidepressant use be depressogenic?"El-Mallakh Another of his papers on antidepressant-associated worseningEl-Mallakh,b includes an excellent literature review on this entire subject. However, even Dr. El-Mallakh seems to stop short of saying that antidepressants might permanently worsen a person's mood disorder. One of the only published descriptions of this concern I've found, though I've heard it voiced many times (generally by psychiatrists with a lot of clinical experience and willingness to speak out against prevailing beliefs), states directly my concern: namely that antidepressants could make people "treatment-resistant", even when they started out with a good response, and even when they started out looking "unipolar", not bipolar.Sharma 2006

 

I think I've seen at least one such case in my practice, which was so striking I published the woman's experience as a case report.Phelps This 60-year old woman had done very well on sertaline (Zoloft) for 7 years, for a recurrence of depression she'd had numerous times before. She then developed severe agitation and insomnia in the absence of any factor we could find to account for this change, and these symptoms only stopped after the sertraline was tapered off. But a year later her old depression was back again, so on her own she tried a quarter-dose of the sertraline, and improved dramatically that same day; so she repeated that dose the next day and called me to say how well she was doing. I said that this was nice to hear but would she please come see me tomorrow, by which time, after one more 25 mg dose, she had the same severe agitation for which she had been referred a year earlier, including suicidal thinking. Of course we stopped the sertaline, but it took a month for the agitation to again taper off. We added a very low dose of lithium to the Seroquel she had improved on earlier, and her depression lifted. She ultimately added tap dancing to the activities her excellent therapist had encouraged her to pursue. She remains well, nearly symptom-free, 3 years later (5/2006).

http://www.psychiatrictimes.com/bipolar-disorder/content/article/10168/46826

Of even greater concern, at least theoretically, is the potential for the antidepressants to worsen an underlying BD—a process generally referred to as “kindling.” Readers are likely well aware that this is a model, a framework for thought, not a research-tested concept. Nonetheless, it is an important concept to consider. Yet kindling concern is rarely raised when discussing the use of antidepressants for BD, perhaps because the data by which to evaluate this risk are almost nonexistent.

 

For example, Grunze27 criticized the American reticence to use antidepressants in BD, but his review does not mention kindling as a potential risk. By comparison, El-Mallakh and Karippot28 concluded a review on antidepressant use in BD: “Long-term use may destabilize the illness, leading to an increase in the number of both manic and depressed episodes; induce rapid cycling (at least 4 episodes a year); and increase the likelihood of a mixed state.”

 

A case report of an apparent antidepressant- induced mood instability in a patient with unipolar disorder following 7 years of euthymic response to an antidepressant raises broader concerns,29 akin to the “acid syndrome” (antidepressant-associated chronic irritable dysphoria.)30 Using nationwide register studies, Kessing and Andersen31 have demonstrated that the average risk of recurrence increases with the number of episodes in depressive and bipolar affective disorders.

 

But can precipitating mania or hypomania with an antidepressant kindle an underlying bipolarity so as to make the patient’s long-term course worse than it otherwise would have been? We must ask ourselves this question, even though at present we have no systematic studies of such long-term effects, and such research would be tremendously difficult to conduct. For now and likely for the foreseeable future (perhaps until we have a biomarker to follow over time), this leaves us reliant on case reports and clinical suspicions—a very weak basis for complex treatment decisions.

http://www.bipolarworld.net/Phelps/ph_2007/ph1601.htm

 

 

(Dr. Phelps is well aware that I believe antidepressants trigger adverse reactions destabilizing the autonomic nervous system, not bipolar II.)

 

http://www.ncbi.nlm.nih.gov/pubmed/16725121

Brain Res. 2006 Jun 22;1096(1):97-103. Epub 2006 May 24.

Down-regulation of norepinephrine transporter function induced by chronic administration of desipramine linking to the alteration of sensitivity of local-anesthetics-induced convulsions and the counteraction by co-administration with local anesthetics.

Kitayama T, Song L, Morita K, Morioka N, Dohi T.

See other Pubmed references http://www.ncbi.nlm.nih.gov/pubmed?term=antidepressant%20kindling

[Shanti]

Interesting that it has a name and is seen in other things like Alcohol withdrawal. The last week I've been having some mild w/d symptoms such as crashing in my head, but only when I take a nap in the daytime. I can't figure out if this is because it's been 7 months now off of Paxil, or if it's from the Neurontin taper I did a couple weeks ago. I feel that learning as much as we can about this issue does help psychologically. For some reason, just knowing is empowering in a way.

[peggy]

i am particularly referring to the idea that the neurological instability in withdrawal (if this is what the withdrawal symptoms actually are) somehow sets up fragility in the system so with little stimulus (so little in fact that one doesn't realise there was a stimulus) invokes a return to the withdrawal state.

 

I am thinking about this because i am trying to make sense of my history.

 

I had 3 unmedicated episodes of depression - each lasting a little longer than the previous, from 3 months to 6 months in duration. Each was of the same intensity- i would classify them as moderate, touching on severe at times. They were around 4 -5 years apart. I was very reluctant to take medication.

 

Then i had a severe episode that was severe enough that i couldn't continue without relief - more anxiety than depression, but was unable to work. that was when i went on effexor. I came off the first time and stayed off for 6 months before depression and anxiety again. Then again a few years later when it happened 4 months after coming off. Was this likely withdrawal or relapse?

 

I realise no one can answer these questions.. but if antidepressants have kindled my depressive episodes, how do i stock my toolbox to manage this in the future?

[Altostrata]

Giovanni Fava, a researcher, believes exactly that, Nikki, that antidepressants set up the nervous system for relapse, they make the nervous system less resilient to stress.

 

Stress management would be a good element in your toolbox.

[peggy]

Alto, do you think this 'set up' can be reversed? Time maybe?

 

AND, do you know if there are any thoughts about the nature of the subsequent depressions - that is are they likely to be more severe- that is are they kindled to the severity of the withdrawal depression/anxiety?

 

This kind of research is undoubtedly hard to find as it would be hard to find the population of people that would fit the criteria.

 

I am trying to be somewhat realistic in looking toward my future once i get off drugs. I think it is important to look beyond withdrawal, but i know nobody has a crystal Given my history there is a reasonable chance that i will experience another episode once off and whenever i have thought about this before i have just thought - that's OK, I will just go back on effexor. But now that i have learned what i have about these drugs, I don't want that.

[Altostrata]

I don't believe Drs. Fava and El-Mallakh have adequately taken prolonged withdrawal syndrome into account, or observed the progress of individuals over time.

 

With self-care, I believe the "set up" can be remediated, but it may take lifestyle changes emphasizing good relationships, healthy habits, etc. rather than taking on stressful responsibilities.

[alexjuice]

Is there a paper on post Ssri hypersensitivity? I need something tangible o show a physician and I didn't see anything specific to this via search.

[Altostrata]

It seems that Peter Breggin has an inkling http://survivingantidepressants.org/index.php?/topic/2795-breggin-2011-psychiatric-drug-induced-chronic-brain-impairment-cbi-implications-for-long-term-treatment-with-psychiatric-medication/

 

Also see "kindling," as in

Harvey 2003 Neurobiology of antidepressant withdrawal

 

Shelton 2006 Correspondence from Dr. Richard Shelton about prolonged withdrawal syndrome

 

As far as I know, withdrawal hypersensitivity is unknown to medicine, but known very well to those suffering from it and a few interested doctors. Post-withdrawal adverse reactions to psychiatric medications are often called "treatment-resistant depression" or thrown into the "bipolar II" wastebasket.

[Brandy]

Is there a paper on post Ssri hypersensitivity? I need something tangible o show a physician and I didn't see anything specific to this via search.

 

Does anyone know if there's a medical journal or similar paper documenting the phenomenon of hyperreactivity to medications post-withdrawal, when one is past the acute stage of withdrawal with which doctors are familiar with?

 

My regular doctor takes my med hyperreactivity seriously, but I'm seeing new specialists and he advised me they probably won't take me seriously about severe or protracted w/d so he felt best I not even mention it. But it will come up when they prescribe lab tests or meds that might be necessary (unfortunately).

 

I do have a diagnosis now of MCS (multiple chemical sensitivity) since my sensitivities post-paxil go beyond my long-term allergies and bad reactions to some meds.

 

But anything scientifically documenting hyperreactivity to meds might be useful, if anyone's aware of any.

[alexjuice]

Thanks, Alto. I'll follow those leads. I've been talking to a chiropractor, a Chris Kresser type though without the facebook page, and he's been pretty helpful so far. Sadly, while he understands that psychiatric drugs are bad news he DOES NOT understand why his supplement or remedy presents a risk to me in my current state.

 

So far seems like he's saying. "I think this will work for your problem." To which I say, "It probably would have but after medications it very well may cause a terrible reaction for me. Let's look at 1/10th dose..." And he responds, "I've treated 100 people with your problem, this is an effective, safe dosage."

 

If I could point him to a paper explaining how post-Drug CNS alterations can affect responses to active subatnces, that'd be helpful in expediting the process. Some documentation would aide us. Once we're speaking the same tongue, I hope he can help me, especially with digestive stuff

[Altostrata]

My guess is your chiropractor thinks "your problem" is depression, and he's going the usual naturopathic approach blah blah blah.

[Nadia]

Hmmm... the sources Alto quotes describe kindling in a different way than what I had conceived... an AD kindling an underlying disorder, if I understood correctly.

 

I had thought of it more as what they call "flares" in auto-immune diseases like Lupus, Ulcerative Colitis, etc.

 

For withdrawal, I thought it referred to how, after coming off antidepressants, your nervous system can be left in a fragile state, and problems such as dizziness, anxiety, insomnia, pain, etc. can be "kindled" by emotional, mental or environmental stressors. And that this would explain why we can have "windows" of being OK, when the nervous system calms down to normal or pseudo-normal functioning, and then something can trigger or "kindle" a "wave" of symptoms again.

[Altostrata]

Correct, Nadia, kindling also means a small stimulus setting off a big reaction in a hypersensitive nervous system.

[Nadia]

Ah, OK, thanks for clearing that up!

 

Then I can definitely say that kindling is not my friend lately. =)

[Annie3]

Just wondering what happens to others when they feel they have become hypersensitive to meds and supplements. What are your symptoms? I feel like I get head pressure or a funny head feeling.

[Altostrata]

Hi, annie, I moved your question here. You might read the other posts in this topic for the answer, too.

[Iggy131313]

This is one thing that time does not seem to heal...many people who have been recovered for many years have been left with this hypersensitity to ANY medication and a few have taken meds and been thrown back into withdrawal even years after recovery.

 

I have messaged Charly G about this to see if at 16 years off he has seen any improvements with this but have as yet not heard back from him, hes the only person far out enough to perhaps have an answer to if this resloves or improves.

 

This is something that scraes me alot as it obviously means that I will be unable to have any kind of treatment in the future (if I indeed recover) as it would bring back this condition, one person I speak to took high amounts of iron after her recovery to treat aneimia and has been back in w/d for 3 years with no recovery as yet.

?

Does everyone get this hypersensitivity and does anyone have any ideas what could be the root cause?

 

Its very concerning as I would be terrified to try any medication, Id rather let something kill me than bring this back.

[GiaK]

I know lots of people for whom the sensitivity has diminished over time and some folks have none at all anymore...that seems to be the norm actually...I've been communicating with old-timers for many years now.

 

Some people remain sensitive but the acute nature seems to diminish for most people. I don't really know any old timers who remain acutely sensitive.

 

I certainly hope mine does pass...I agree, it's a nightmare.

[Iggy131313]

Really Gia? thats great news, Gia do you know many people who have recovered then? Its very hard to speak to people who have made it to the other side and thats part of why I find it so hard to keep up the hope that I can heal.

 

I know of someone who had a baby at 4 years post meds, she had a terrible time after the baby was born due to hormonal fluctuations, and was thrown back into w/d for at least a year....she had another child at 7 years post meds and although she again had some negative issues it was like night and day from the first time....I feel this is similar to the meds sensitivities, so it shows that more time does help.

 

Thanks for that message of hope. It means so much to me.

[Iggy131313]

Gia, I see you are now nearly 3 years off meds, how are you?

 

What symptoms do you still have and what improvements have you seen?

 

Thanks

[GiaK]

I know lots of old-timers who have completely recovered, yes.

 

I'm still very sick, but I'm not exactly representative. My history is far more complicated than most people's and I am getting better all the time...just slowly...I'm much much better than I was 2 years ago...but when you go from being totally bedridden and you get better at a glacial pace, it takes some time to be anywhere close to WELL.

[alexjuice]

Looking back I see it appears that my drug and supplement hypersensitivity started to improve the most after I moved out of my mother's house which was heavily infested with toxic mold. My sensitivities are much better today compared to the worse point, despite a host of other problems.

 

I am not ready to say definitely that the move is was the primary cause for the alleviation but I can theorize an explanation for how it could be since the inflammatory and destructive poor air quality is such an obvious burden on the body's detoxification system.

 

Has anyone else noticed that a change of physical environment has had an effect on hypersensitivity. I think that the change of surroundings would not be at all ovious and a cchange in symptoms would likely be miseappropriated to another cause or a general worsening but in any case, does anyone have experience where symptoms changed during a lengthy trip away from home or simply that things got better or worse after a move or temporary relocation to a distinct physical environment?

 

Thanks

[Altostrata]

I wish someone would come and thoroughly clean my apartment. Maybe my allergies would be less.

[GiaK]

YES!

I stayed in a mountain retreat for 2 weeks lately and got SUPER SICK...there were several things about the place that made it toxic...including UBER HIGH EMFs...I got a meter to measure that...

 

anyway...I was supposed to stay there for 2 months. I made it 2 weeks, ended up suicidal (that is NOT a common place for me) and returned home where I felt much better...

 

the house I was staying at in the mountains *looked* idyllic...boy did it teach me a thing or two about environment! I've made my home a very safe place.

[NoMeaning25]

Well this is interesting... My parents home has mold too (I stay there... obviously) and i had a period where i felt much better on my sisters wedding (Far away from my home at a nature reserve) for a couple of days and as soon as i returned home i felt bad again.

 

We are looking into a new home soon. Hopefully mold free... Mold is such a nasty thing

[Barbarannamated]

I feel much worse at home. The air quality is terrible -- all dirt, no grass, horses right up to the house. We also live very close to the San Andreas fault...not sure how that might play in. I attribute most of my worsen symptoms at home to psychosocial factors -- isolated and see husband only, trapped financially. We occasionally visit my sister in law about an hour away and I feel much better in their home. Again, could be lack of isolation or better air quality.

[alexjuice]

I have to say that the hypersensitivity is where I notice this the most. When I first moved into my current living environment, I could not walk through the cleaning supply aisle at the market without getting nauseaus. Today I walk on occasion in the SuperWalMart to push my cart for exercise. I couldn't have breathed in the superwalmart a year ago -- I know because I went there to buy the cot that I had to sleep on when I was made ill by every indoor environment that I slept outside for a while.

 

I also finished my clonopin taper, that's the other major thing for hypersensitivity so it's not for sure the environment but it matches it pretty well because I have lived in my mom's place here and Maine and also in two different aparmtnets so I think the physical environment has played a big part, in the hypersensiviity anyway.

 

I also did an ERMI vacuum test to measure the contaminants and mycotoxins in my mom's old house and then in one of the aparments. An ERMI is about $150 and can be ordered online. If anyone does one to measure thei home air moldiness, please post the results.

[traumatized80]

I was wondering if anyone else here has had a serious adverse reactions to an ssri or snri after being able to take them prior. If so could you tell me about your symptoms and how long it lasted. I am living in hell. I was not aware that I had a adverse reaction and was told it was simply my anxiety getting worse. After several drug trails I nearly ended my life and ended up in a psych ward several times. I had no history of this in my past. My family was nearly destroyed. I still hurting do bad mentally and physically and the only explanation I have gotten is I may be bipolar. . Wth! Looking yo talk to others. I am 7.5 months pregnant now and scared to death.

[lexhex]

You are most likely not bipolar. Once you have been off an AD for any length of time and try to reinstate, extreme mania and paradoxical effects often occur. Even when you stop taking the drug, the hyper manic symptoms can last a year or more. It's not a return of your anxiety. For me, just letting time pass has been the best solution. Things get incrementally better with time but you may never be able to reinstate. Your body may just not allow it. Check out my post on Taurine. You may find this will help you.

[NoMeaning25]

I had an extremely severe adverse reaction to an snri. PM me if you like to talk.

[Meimeiquest]

I developed mania on Cymbalta after switching to it from Prozac. The mania stopped a couple of days before the drug was stopped (dose was halved two weeks prior). I had akathisia/anxiety problems, she threw medicine at it, lithium finally controlled everything but depression. Tolerated Wellbutrin under the cover of Zyprexa...I was actually quite stable and pretty functional. But the Wellbutrin did the same thing as the Cymbalta once I tapered off the Zyprexa, and I had to come off of it faster than I would have liked. My pdoc of course thought it was bipolar, but it has been a year since that all happened, and I am fine...just still symptomatic with other issues as I am tapering and tapering and tapering.

 

That is so not a plan I would recommend, I am just saying the reaction can really, really look like bipolar, and I have mental illness in my family, but that doesn't mean it is bipolar. Some people think the mushrooming of the bipolar diagnosis is from antidepressant use.

[Altostrata]

See above.

 

There were a bunch of scientific papers a while back suggesting an adverse reaction to an antidepressant meant someone was bipolar. Ever since then, there's been a tendency for doctors to misdiagnose adverse reactions to antidepressants as bipolar disorder.

 

An adverse reaction to an antidepressant is NOT bipolar disorder. It is an iatrogenic condition.