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Fava, 2015 Withdrawal Symptoms after Selective Serotonin Reuptake Inhibitor Discontinuation: A Systematic Review

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Psychother Psychosom 2015;84:72-81

(DOI:10.1159/000370338)

Withdrawal Symptoms after Selective Serotonin Reuptake Inhibitor Discontinuation: A Systematic Review

Fava G.A.a, b · Gatti A.a · Belaise C.a · Guidi J.a · Offidani E.c

 

Abstract at http://www.karger.com/Article/FullText/370338 Fulltext PDF (116 Kb)

 

Background: Selective serotonin reuptake inhibitors (SSRI) are widely used in medical practice. They have been associated with a broad range of symptoms, whose clinical meaning has not been fully appreciated. Methods: The PRISMA guidelines were followed to conduct a systematic review of the literature. Titles, abstracts, and topics were searched using the following terms: ‘withdrawal symptoms' OR ‘withdrawal syndrome' OR ‘discontinuation syndrome' OR ‘discontinuation symptoms', AND ‘SSRI' OR ‘serotonin' OR ‘antidepressant' OR ‘paroxetine' OR ‘fluoxetine' OR ‘sertraline' OR ‘fluvoxamine' OR ‘citalopram' OR ‘escitalopram'. The electronic research literature databases included CINAHL, the Cochrane Library, PubMed and Web-of-Science from inception of each database to July 2014. Results: There were 15 randomized controlled studies, 4 open trials, 4 retrospective investigations, and 38 case reports. The prevalence of the syndrome was variable, and its estimation was hindered by a lack of case identification in many studies. Symptoms typically occur within a few days from drug discontinuation and last a few weeks, also with gradual tapering. However, many variations are possible, including late onset and/or longer persistence of disturbances. Symptoms may be easily misidentified as signs of impending relapse. Conclusions: Clinicians need to add SSRI to the list of drugs potentially inducing withdrawal symptoms upon discontinuation, together with benzodiazepines, barbiturates, and other psychotropic drugs. The term ‘discontinuation syndrome' that is currently used minimizes the potential vulnerabilities induced by SSRI and should be replaced by ‘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

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Barbarannamated

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

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Altostrata

My comment on http://www.thementalelf.net/mental-health-conditions/depression/antidepressant-withdrawal-syndromes-time-to-grasp-the-nettle/#comment-630830

 

Andrew, thank you for taking this issue seriously.

Tapering is the only way we know to lessen the risk of severe withdrawal syndrome lasting weeks, months, or years.

If you look closely at the studies showing little advantage to tapering, you will see they tapered over very short intervals: for example, comparing abrupt discontinuation to a week’s taper.

Dr. Fava’s own study on this used a “most gradual possible” taper based on available drug dosages. However, the dosages available from the drug companies are not of sufficient range for a properly gradual taper.

On my peer support Web site, SurvivingAntidepressants.org, we suggest tapering much more gradually, at a rate of 10% per decrement based on the last dosage — the absolute amount of decrease gets continually smaller. (People use pill cutters, liquids, powders, and digital scales to create interim dosages.)

Most people start out at making decreases every month to test their tolerance for dosage reductions — withdrawal symptom should be none to minimal and lasting only a few days.

If all goes well, they might speed up the taper to decrements every 2 weeks. With 10% reductions, the fastest taper would be about 6 months.

The reason we suggest such long intervals between dosage reductions is because, contrary to popular assumptions, it can take withdrawal symptoms some time to manifest. If one is tapering too fast, the additional dosage reductions compound the severity of the withdrawal symptoms.

We advise people that the emergence of withdrawal symptoms means they have been reducing too fast, and to a) stop any dosage changes, OR B) updose slightly and stabilize for as long as it takes. Subsequently, they taper more conservatively — sometimes 5% or less per month.

Unfortunately, once severe withdrawal symptoms set in, it can be very difficult for the nervous system to regain equilibrium again. That is why we advise the very conservative starting point of 10% reductions monthly.

Many people come to my site after one or more failed tapers. Having experienced the torment of withdrawal, they are conscientious about taking a slower route off — sometimes tapering for years, one drug at a time.

We do have people who have successfully come off massive drug cocktails in this fashion and are doing much better.

Unfortunately, it seems there are a small number of people at the extreme end of the normal curve for withdrawal, who find they cannot completely go off an antidepressant or other psychiatric drug at all because of withdrawal syndrome — NOT relapse.

This only indicates how very powerful these drugs are. They are overprescribed and overdosed without regard to the resulting adverse effects. This truly is a failure of medicine.

 


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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Rhiannon

Nice, Alto! Thanks for your unflagging dedication and commitment on behalf of victims of psych med drugging everywhere.


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 

 

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

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GiaK

I left this comment which is currently in moderation:

 

Glad to see your comment Alto Strata. I thought I might add a link to some comments about another study also done by those affiliated with Fava and others. I am including this because it seems that people might come away from the above article not understanding that long-term disabling syndromes occur from withdrawal much more frequently than is commonly understood...and not  just from SSRIs but really all the psychotropics that impact the nervous system can be part of what amounts to broad dysregulation in the autonomic nervous system.
 
"Alarming report on persistent side effects of antidepressant drugs published online"   http://beyondmeds.com/2013/03/22/alarming-report/
 
and, yes, thank you Andrew for highlighting this issue. 

 

 


Everything Matters: Beyond Meds 

https://beyondmeds.com/

withdrawn from a cocktail of 6 psychiatric drugs that included every class of psych drug.
 

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compsports

Nice, Alto! Thanks for your unflagging dedication and commitment on behalf of victims of psych med drugging everywhere.

Totally agree with this.

 

CS


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

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

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

April 2017 - Increased to taking it full time for insomnia

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compsports

 

I left this comment which is currently in moderation:

 

Glad to see your comment Alto Strata. I thought I might add a link to some comments about another study also done by those affiliated with Fava and others. I am including this because it seems that people might come away from the above article not understanding that long-term disabling syndromes occur from withdrawal much more frequently than is commonly understood...and not  just from SSRIs but really all the psychotropics that impact the nervous system can be part of what amounts to broad dysregulation in the autonomic nervous system.
 
"Alarming report on persistent side effects of antidepressant drugs published online"   http://beyondmeds.com/2013/03/22/alarming-report/
 
and, yes, thank you Andrew for highlighting this issue. 

 

 

Great comment GIa K.


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

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

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

April 2017 - Increased to taking it full time for insomnia

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Altostrata

I wish I knew who that Harvard-educated expert on withdrawal is.


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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oskcajga

I think it's Peter Breggin who that poster is referring to - based on reading some of that posters other reddit messages - all public information via reddit.

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