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Chouinard, 2015 New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal


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Psychother Psychosom 2015;84:63-71

(DOI:10.1159/000371865)

New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal

Chouinard G.a, b · Chouinard V.-A.c

 

Abstract at http://www.karger.com/Article/FullText/371865 Fulltext PDF (117 Kb)

 

Selective serotonin reuptake inhibitors (SSRIs) are widely used in clinical practice, and have advanced the treatment of depression and other mental disorders. However, more studies are needed on the effects of decreasing and discontinuing these medications after their long-term use [1]. Withdrawal symptoms may occur with all SSRIs and serotonin-noradrenaline reuptake inhibitors (SNRIs) [1], similarly to other CNS drugs, including benzodiazepines [2,3,4] and antipsychotics [5,6]. Withdrawal from SSRIs and other CNS drugs produces psychiatric symptoms that can be confounded with true relapse or recurrence of the original illness [1,2,7]. When discontinuing or decreasing SSRIs, withdrawal symptoms must be identified to avoid prolonging treatment or giving unnecessarily high doses [6,8].

 

Different types of syndromes have been described with the withdrawal from SSRIs and other CNS drug classes, including benzodiazepines, antipsychotics, antidepressants, opiates, barbiturates, and alcohol: (1) new withdrawal symptoms (classic withdrawal symptoms from CNS drugs) [1,4,5,6,9,10,11,12], (2) rebound [2,6,9,13,14,15,16], and (3) persistent postwithdrawal disorders [7,17,18] (table 1). These types of withdrawal need to be differentiated from relapse and recurrence of the original illness.....

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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I'm glad to see this.

2009: Cancer hospital said I had adjustment disorder because I thought they were doing it wrong. Their headshrinker prescribed Effexor, and my life set on a new course. I didn't know what was ahead, like a passenger on Disneyland's Matterhorn, smiling and waving as it climbs...clink, clink, clink.

2010: Post surgical accidental Effexor discontinuation by nurses, masked by intravenous Dilaudid. (The car is balanced at the top of the track.) I get home, pop a Vicodin, and ...

Whooosh...down, down, down, down, down...goes the trajectory of my life, up goes my mood and tendency to think everything is a good idea.
2012: After the bipolar jig was up, now a walking bag of unrelated symptoms, I went crazy on Daytrana (the Ritalin skin patch by Noven), because ADHD was a perfect fit for a bag of unrelated symptoms. I was prescribed Effexor for the nervousness of it, and things got neurological. An EEG showed enough activity to warrant an epilepsy diagnosis rather than non-epileptic ("psychogenic") seizures.

:o 2013-2014: Quit everything and got worse. I probably went through DAWS: dopamine agonist withdrawal syndrome. I drank to not feel, but I felt a lot: dread, fear, regret, grief: an utter sense of total loss of everything worth breathing about, for almost two years.

I was not suicidal but I wanted to be dead, at least dead to the experience of my own brain and body.

2015: I  began to recover after adding virgin coconut oil and organic grass-fed fed butter to a cup of instant coffee in the morning.

I did it hoping for mental acuity and better memory. After ten days of that, I was much better, mood-wise. Approximately neutral.

And, I experienced drowsiness. I could sleep. Not exactly happy, I did 30 days on Wellbutrin, because it had done me no harm in the past. 

I don't have the DAWS mood or state of mind. It never feel like doing anything if it means standing up.

In fact, I don't especially like moving. I'm a brain with a beanbag body.   :unsure:

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Chouinard has a long-time interest in withdrawal syndrome.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Yep, I am glad to see this too. Sure hope a few people read it.

Started on Prozac and Xanax in 1992 for PTSD after an assault. One drug led to more, the usual story. Got sicker and sicker, but believed I needed the drugs for my "underlying disease". Long story...lost everything. Life savings, home, physical and mental health, relationships, friendships, ability to work, everything. Amitryptiline, Prozac, bupropion, buspirone, flurazepam, diazepam, alprazolam, Paxil, citalopram, lamotrigine, gabapentin...probably more I've forgotten. 

Started multidrug taper in Feb 2010.  Doing a very slow microtaper, down to low doses now and feeling SO much better, getting my old personality and my brain back! Able to work full time, have a full social life, and cope with stress better than ever. Not perfect, but much better. After 23 lost years. Big Pharma has a lot to answer for. And "medicine for profit" is just not a great idea.

 

Feb 15 2010:  300 mg Neurontin  200 Lamictal   10 Celexa      0.65 Xanax   and 5 mg Ambien 

Feb 10 2014:   62 Lamictal    1.1 Celexa         0.135 Xanax    1.8 Valium

Feb 10 2015:   50 Lamictal      0.875 Celexa    0.11 Xanax      1.5 Valium

Feb 15 2016:   47.5 Lamictal   0.75 Celexa      0.0875 Xanax    1.42 Valium    

2/12/20             12                       0.045               0.007                   1 

May 2021            7                       0.01                  0.0037                   1

 

I'm not a doctor. Any advice I give is just my civilian opinion.

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It gives us some ammo against psychiatrists who don't believe in withdrawal syndromes. Probably should keep a laminated copy in my purse!

2009: Cancer hospital said I had adjustment disorder because I thought they were doing it wrong. Their headshrinker prescribed Effexor, and my life set on a new course. I didn't know what was ahead, like a passenger on Disneyland's Matterhorn, smiling and waving as it climbs...clink, clink, clink.

2010: Post surgical accidental Effexor discontinuation by nurses, masked by intravenous Dilaudid. (The car is balanced at the top of the track.) I get home, pop a Vicodin, and ...

Whooosh...down, down, down, down, down...goes the trajectory of my life, up goes my mood and tendency to think everything is a good idea.
2012: After the bipolar jig was up, now a walking bag of unrelated symptoms, I went crazy on Daytrana (the Ritalin skin patch by Noven), because ADHD was a perfect fit for a bag of unrelated symptoms. I was prescribed Effexor for the nervousness of it, and things got neurological. An EEG showed enough activity to warrant an epilepsy diagnosis rather than non-epileptic ("psychogenic") seizures.

:o 2013-2014: Quit everything and got worse. I probably went through DAWS: dopamine agonist withdrawal syndrome. I drank to not feel, but I felt a lot: dread, fear, regret, grief: an utter sense of total loss of everything worth breathing about, for almost two years.

I was not suicidal but I wanted to be dead, at least dead to the experience of my own brain and body.

2015: I  began to recover after adding virgin coconut oil and organic grass-fed fed butter to a cup of instant coffee in the morning.

I did it hoping for mental acuity and better memory. After ten days of that, I was much better, mood-wise. Approximately neutral.

And, I experienced drowsiness. I could sleep. Not exactly happy, I did 30 days on Wellbutrin, because it had done me no harm in the past. 

I don't have the DAWS mood or state of mind. It never feel like doing anything if it means standing up.

In fact, I don't especially like moving. I'm a brain with a beanbag body.   :unsure:

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Thank you for this. I just learned that a family member has been rx'd  Contrave for weigh loss- it contains bupriprion.  Such a bummer....

neurologically challenged

Copaxone, Baclofen Oxybutynin and L.D.N. for multiple sclerosis and on Dilatin for seizure disorder Celexa 20 then 40 for at least 7 years Started first reduction in Jan 2015, but with generic- bad idea. Lasted 3 days

Started again Feb 1 2015. 

Feb 1-  40 to 37.5

Feb 24-  37.5 to 35

March 24- 35 to 32.5

April 28- 32.5 to 30

June 9- 30 to 27.5

July 1- 27.5 to 25

July 27-25 to 22.5

Aug 18- 22.5 to 20

 

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  • 2 weeks later...
  • Moderator Emeritus

Think I'll print this out too, though I found it difficult to understand all of it.  My favourite part:

 

"...Clinicians should understand why it is difficult to decrease a given drug treatment for a patient, for example, due to the presence of a persistent postwithdrawal disorder. Giving low doses of SSRIs and decreasing the lengths of SSRI maintenance treatment by using adjunct treatments, such as CBT, should be considered whenever possible to try to minimize long-term receptor changes. After 2 years of maintenance treatment, many types of persistent postwithdrawal disorders may be observed. We recommend re-evaluation of overall treatment and management after 2 years of continuous SSRI use, considering the possible use of other therapies, whether as adjunct or alternative treatment."

 

Good to show doctor, husband and counselor.  They all think I just need more, or for longer...

2010  Fluoxetine 20mg.  2011  Escitalopram 20mg.  2013 Tapered badly and destabilised CNS.  Effexor 150mg. 

2015 Begin using info at SurvivingAntidepressants.  Cut 10% - bad w/d 2 months, held 1 month. 

Micro-tapering: four weekly 0.4% cuts, hold 4 weeks (struggling with symptoms).

8 month hold.

2017 Micro-tapering: four weekly 1% cuts, hold 4 weeks (symptoms almost non-existent).

2020 Still micro-tapering. Just over 2/3 of the way off effexor. Minimal symptoms, - and sleeping well.
Supplements: Fish oil, vitamin C, iron, oat-straw tea, nettle tea.

My story of healing:ContinuedHealing

***I am not a doctor; please do your own research and be able to take responsibility for decisions you make.*** 

           'The possibility of renewal exists so long as life exists.'  Dr Gabor Mate.

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I am glad to see this too, and think I will print it off along with some others that might help doctors to understand and finally accept withdrawal syndrome. 

**I am not a medical professional, if in doubt please consult a doctor with withdrawal knowledge.

 

 

Different drugs occasionally (mostly benzos) 1976 - 1981 (no problem)

1993 - 2002 in and out of hospital. every type of drug + ECT. Staring with seroxat

2002  effexor. 

Tapered  March 2012 to March 2013, ending with 5 beads.

Withdrawal April 2013 . Reinstated 5 beads reduced to 4 beads May 2013

Restarted taper  Nov 2013  

OFF EFFEXOR Feb 2015    :D 

Tapered atenolol and omeprazole Dec 2013 - May 2014

 

Tapering tramadol, Feb 2015 100mg , March 2015 50mg  

 July 2017 30mg.  May 15 2018 25mg

Taking fish oil, magnesium, B12, folic acid, bilberry eyebright for eye pressure. 

 

My story http://survivingantidepressants.org/index.php?/topic/4199-hello-mammap-checking-in/page-33

 

Lesson learned, slow down taper at lower doses. Taper no more than 10% of CURRENT dose if possible

 

 

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  • 9 months later...

JayPea, how did she do on the Contrave?

 

 

2009: Cancer hospital said I had adjustment disorder because I thought they were doing it wrong. Their headshrinker prescribed Effexor, and my life set on a new course. I didn't know what was ahead, like a passenger on Disneyland's Matterhorn, smiling and waving as it climbs...clink, clink, clink.

2010: Post surgical accidental Effexor discontinuation by nurses, masked by intravenous Dilaudid. (The car is balanced at the top of the track.) I get home, pop a Vicodin, and ...

Whooosh...down, down, down, down, down...goes the trajectory of my life, up goes my mood and tendency to think everything is a good idea.
2012: After the bipolar jig was up, now a walking bag of unrelated symptoms, I went crazy on Daytrana (the Ritalin skin patch by Noven), because ADHD was a perfect fit for a bag of unrelated symptoms. I was prescribed Effexor for the nervousness of it, and things got neurological. An EEG showed enough activity to warrant an epilepsy diagnosis rather than non-epileptic ("psychogenic") seizures.

:o 2013-2014: Quit everything and got worse. I probably went through DAWS: dopamine agonist withdrawal syndrome. I drank to not feel, but I felt a lot: dread, fear, regret, grief: an utter sense of total loss of everything worth breathing about, for almost two years.

I was not suicidal but I wanted to be dead, at least dead to the experience of my own brain and body.

2015: I  began to recover after adding virgin coconut oil and organic grass-fed fed butter to a cup of instant coffee in the morning.

I did it hoping for mental acuity and better memory. After ten days of that, I was much better, mood-wise. Approximately neutral.

And, I experienced drowsiness. I could sleep. Not exactly happy, I did 30 days on Wellbutrin, because it had done me no harm in the past. 

I don't have the DAWS mood or state of mind. It never feel like doing anything if it means standing up.

In fact, I don't especially like moving. I'm a brain with a beanbag body.   :unsure:

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I found a study on meth withdrawal. I can't figure out why it was done.

 

Background: Methamphetamine dependence has become a significant problem, but methamphetamine withdrawal symptoms have not been well studied.  (Because there aren't any?)

 

Results:

Methamphetamine withdrawal symptoms*, mood, and anxiety symptoms all resolve fairly quickly within 2 weeks of cessation of methamphetamine. Sleep was disrupted over the course of the 4-week study. No clinically significant alterations in blood pressure or heart rate were identified. This study did not demonstrate any alterations in cognitive function over the 4 weeks of the residential stay.

 

[Amphetamine withdrawal is described as lasting up to two weeks and includes "total sleep length that increased for several weeks."  <_<  

 

[No, this: "The duration of amphetamine withdrawal is generally considered to be much longer than cocaine withdrawal, reportedly lasting from 5 days to more than 2 weeks."  :o 

 

Conclusions: This pilot study points toward the need for a double-blind, placebo-controlled amphetamine withdrawal paradigm in humans where changes in sleep, cognitive function, and withdrawal measures can be explored more fully.

 

Scientific Significance: This study extends the literature by pointing toward a methamphetamine withdrawal syndrome that includes alterations in measures of sleep quality and refreshed sleep, early improvement in depression and anxiety symptoms, most striking during the first week, but persisting into the second week. :lol:

 

methstudy.png

*(i) drug craving; (ii) dysphoric** mood; (iii) loss of pleasure; (iv) loss of interest in activities previously enjoyed; (v) anxiety; (vi) slowing in movement; (vii) agitation; (viii) decreased energy or fatigue; (ix) increased appetite or eating too much; (x) decreased appetite; (xi) vivid or unpleasant dreams; (xii) sleeping too much; and (xiii) insomnia

 

**Dysphoria (from Greek: δύσφορος (dysphoros), δυσ-, difficult, and φέρειν, to bear) is a profound state of unease or dissatisfaction. In a psychiatric context, dysphoria may accompany depression, anxiety, or agitation.

 

Full text:

https://www.researchgate.net/publication/49740875_Characterizing_methamphetamine_withdrawal_in_recently_abstinent_methamphetamine_users_A_pilot_field_study

 

The American Journal of Drug and Alcohol Abuse, 37:131–136, 2011 Copyright © Informa Healthcare USA, Inc.

 

ISSN: 0095-2990 print / 1097-9891 online

 

DOI: 10.3109/00952990.2010.543998

 

Characterizing methamphetamine withdrawal in recently abstinent methamphetamine users: a pilot field study

 

Michael J. Mancino, M.D.1, Brooks W. Gentry, M.D.2, Zachary Feldman, M.S.1, John Mendelson, M.D., Ph.D.3 and Alison Oliveto, Ph.D.1

 

1Department of Psychiatry, Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA, 2Department of Anesthesia, University of Arkansas for Medical Sciences, Little Rock, AR, USA, 3Department of Internal Medicine, Drug Dependence Research Laboratory, Langley Porter Institute, University of California at San Francisco, San Francisco, CA, USA

2009: Cancer hospital said I had adjustment disorder because I thought they were doing it wrong. Their headshrinker prescribed Effexor, and my life set on a new course. I didn't know what was ahead, like a passenger on Disneyland's Matterhorn, smiling and waving as it climbs...clink, clink, clink.

2010: Post surgical accidental Effexor discontinuation by nurses, masked by intravenous Dilaudid. (The car is balanced at the top of the track.) I get home, pop a Vicodin, and ...

Whooosh...down, down, down, down, down...goes the trajectory of my life, up goes my mood and tendency to think everything is a good idea.
2012: After the bipolar jig was up, now a walking bag of unrelated symptoms, I went crazy on Daytrana (the Ritalin skin patch by Noven), because ADHD was a perfect fit for a bag of unrelated symptoms. I was prescribed Effexor for the nervousness of it, and things got neurological. An EEG showed enough activity to warrant an epilepsy diagnosis rather than non-epileptic ("psychogenic") seizures.

:o 2013-2014: Quit everything and got worse. I probably went through DAWS: dopamine agonist withdrawal syndrome. I drank to not feel, but I felt a lot: dread, fear, regret, grief: an utter sense of total loss of everything worth breathing about, for almost two years.

I was not suicidal but I wanted to be dead, at least dead to the experience of my own brain and body.

2015: I  began to recover after adding virgin coconut oil and organic grass-fed fed butter to a cup of instant coffee in the morning.

I did it hoping for mental acuity and better memory. After ten days of that, I was much better, mood-wise. Approximately neutral.

And, I experienced drowsiness. I could sleep. Not exactly happy, I did 30 days on Wellbutrin, because it had done me no harm in the past. 

I don't have the DAWS mood or state of mind. It never feel like doing anything if it means standing up.

In fact, I don't especially like moving. I'm a brain with a beanbag body.   :unsure:

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  • 9 months later...

I was going to post this study but I searched and it's already here. I think this is the first time I've seen any paper talk about "persistent postwithdrawal disorders" for SSRIs. Most of the time when I see withdrawal mentioned it is referring to an acute period that lasts days or weeks. Lets hope one day it is common knowledge that these drugs can cause such lasting harm.

December 2010: 10mg Citalopram

April 2011: 5mg for 2 weeks then cold turkey withdrawal - Extremely bad depression / no emotions

June 2011: Reinstated 10mg - After 3 weeks started getting impulsive suicidal thoughts

July 2011: Cold turkey - Withdrawal hell begins...

 

January 2021: Reinstated 0.1mg Citalopram as last resort

February 2021: 0.2mg Citalopram for 2 days had bad foggy head so went back down to 0.1mg

Upon reducing I experienced low mood, suicidal thoughts, burning up, low appetite, very bad insomnia, mild diarrhoea

22 Feb 2021: Stopped all Citalopram after panic / depression attack and crying similar to when I reinstated back in June 2011.

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