going off anti-depressants

Question:

Lucky you I’m hoping it’s just the Luvox I’m sensitive to going off – then perhaps I can swap over to something else and come off that. But I seem to be quite sensitive to side-effects from the medications I take – eg I’m only on 20mg Oxycontin BID, have been for over a year, but need at least four sennakot and 5 softeners per day to get the bowels vaguely normal. — Katharine S.   Opportunity knocks once.  Temptation leans on the doorbell.

– Hide quoted text — Show quoted text -> I have been on several antidepressants and stopped them without any problem. > I have been on celexa and they say you have problems coming off of them but > not me.  Been on prozac and stopped it without problems. > Bonner > Just thought I would add my 2cents in here. > I came across this while looking for something else, something to be aware > of for those whose doctors don’t bother to tell them when going on > anti-depressants how difficult it can be coming off them! > — > Katharine S. > boston globe > HEALTH SENSE > Rushing off antidepressants can bring more distress > By Judy Foreman, Globe Staff, 6/5/2001 > At first, Zoloft seemed like ”manna from heaven,” says this 53-year-old > woman, a teacher who lives in Watertown.

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Response:

- Hide quoted text — Show quoted text – > I have been on several antidepressants and stopped them without any problem. > I have been on celexa and they say you have problems coming off of them but > not me.  Been on prozac and stopped it without problems. > Bonner > Just thought I would add my 2cents in here. > I came across this while looking for something else, something to be aware > of for those whose doctors don’t bother to tell them when going on > anti-depressants how difficult it can be coming off them! > — > Katharine S. > boston globe > HEALTH SENSE > Rushing off antidepressants can bring more distress > By Judy Foreman, Globe Staff, 6/5/2001 > At first, Zoloft seemed like ”manna from heaven,” says this 53-year-old > woman, a teacher who lives in Watertown. > It was the summer of 1999 and, for reasons she still doesn’t fully > understand, she had slipped into a ”terrible slump.” Her doctor > suggested > Zoloft, America’s second most popular antidepressant, after Prozac. And > for > a while, it was great, says the woman, who does not want her name used. > But after nearly a year on the drug, she developed a twitch in her left > eyelid. It may not have been related to the Zoloft, but since she was > feeling fine, she decided to stop taking the drug. > And, unlike many people who quit antidepressants, she did it the right > way: > very slowly – cutting the dose little by little over six weeks. > Even so, she wound up with three months of withdrawal hell, or > discontinuation syndrome, the term psychiatrists prefer because withdrawal > suggests that antidepressant drugs are addictive (like cocaine or heroin), > which they are not. > Discontinuation syndrome is not a recurrence of the original depression, > though that can happen, too. It’s a brand new set of problems, in this > woman’s case, bad headaches, vertigo, and dizziness. At one point during a > walk, she says, ”my body felt like it was tipping to one side. I had to > keep lying down. It was terrible.” > Could a drug that was no longer in her system somehow be causing weird > symptoms she’d never had before? > ”That was the thing that got me the most creeped out,” she says. ”The > drug clearly is out of your body. So what was it that lasted for three > months?” > What lasted so long for this teacher, and many others who stop taking > antidepressant drugs, is what scientists now think of as a prolonged > period > of re-adjustment during which the chemistry of the brain settles into a > kind > of new, non-depressed normal. > To be sure, many of the millions of people worldwide who take > antidepressants experience no withdrawal symptoms when they stop. But some > studies suggest that one in every 10 have some symptoms and one in 20 > suffer > significant distress, says Dr. Jerrold Rosenbaum, chief of psychiatry at > Massachusetts General Hospital. > Others, among them Dr. Andrew Leuchter, director of the division of adult > psychiatry at the UCLA Medical Center, believe the actual figures are much > higher. > Yet even doctors who should be on the lookout for withdrawal symptoms – > such > as dizziness, increased nervousness, irritability, insomnia, and a > dramatic > increase in vivid dreams – often aren’t paying close attention. > A 1997 study in the Journal of Clinical Psychiatry showed that 70 percent > of > general practitioners and, surprisingly, a third of psychiatrists don’t > know > that significant withdrawal symptoms can occur when people stop taking > antidepressants called selective serotonin reuptake inhibitors, or SSRIs, > including Prozac, Zoloft, Paxil, Luvox, Celexa, and a similar drug, > Effexor. > (Withdrawal syndromes can also occur with antidepressants that work > differently from the SSRIs, including older drugs such as Elavil and > Tofranil) > ”It’s an under-recognized problem,” says Leuchter, because when people > stop taking a drug and then develop new symptoms, they can’t believe it > has > ”anything to do with the medicine because, if they’re not taking it, how > can it affect them?” > But withdrawal clearly does happen, though researchers still aren’t sure > why. The basic thinking is that depression is caused by a deficiency of > serotonin, a key neurotransmitter in the brain. SSRIs boost serotonin by > stopping its re-absorption into brain cells, thus keeping more serotonin > where it’s needed, in the synapses, or gaps, between nerve cells. > As the brain adapts to increased levels of serotonin, some neuroscientists > think there is a decline in either the number or sensitivity of the > brain’s > molecular gateways that can put serotonin to work. Then, when SSRIs are > discontinued, withdrawal symptoms may occur as the nervous system, now > primed for lots of serotonin, isn’t getting enough, says Dr. Alexander > Bodkin, chief of clinical psychopharmacology research at McLean Hospital > in > Belmont. > One thing researchers are sure of is that the severity of withdrawal > symptoms from SSRIs is closely correlated with how long the drug remains > in > the body. The longer the drug or its active metabolic breakdown products > stay in the body, the less severe the withdrawal. > ”The faster-clearing the drug, the worse the withdrawal,” says Dr. > Michael > Craig Miller, a psychiatrist who edits the Harvard Mental Health Letter. > Prozac is least likely to cause withdrawal because its metabolic breakdown > products linger in the body for as long as five weeks. In fact, precisely > because of this, one strategy for people who have trouble getting off > other > SSRIs is to switch to Prozac and then taper slowly off of that. > By contrast, Paxil, Luvox, and Celexa may trigger withdrawal because they > are faster-clearing, lingering in the body for just four to five days. > Zoloft lingers slightly longer. Effexor, a variant of standard SSRIs, has > the shortest half-life of all, about 5 hours, which means it is highly > likely to cause withdrawal symptoms. > Recent studies have bolstered the idea that faster-clearing drugs lead to > worse withdrawal. > In 1998, Rosenbaum of MGH and his team studied 220 patients and found that > those who abruptly stopped taking Paxil, and to a lesser extent, Zoloft, > had > significant withdrawal symptoms, while those who stopped taking Prozac did > not. Another study published last year in the British Journal of > Psychiatry > found essentially the same pattern. > Yet another study, sponsored by Lilly Research Laboratories (Eli Lilly > makes > Prozac) and published last year in Psychoneuroendocrinology, showed that > people who suddenly stopped taking Paxil had a significant increase in > heart > rate and stress hormone levels, while those taking Zoloft or Prozac did > not. > The bottom line is that if you want to wean yourself from antidepressants, > do so slowly, by decreasing your dose by half every one to two weeks. It > may > take weeks or even months to discontinue completely, but that doesn’t > really > matter. > ”There’s never a rush in getting off these medications,” says Leuchter > of > UCLA. ”What’s the hurry? If you have been on them for six to 12 months > and > you’re tolerating them well, there’s no point in going too quickly.” > And if you do develop withdrawal symptoms despite tapering off slowly, try > going back to the previous dose, then switching to Prozac and weaning > yourself from that. > The most important lesson, says the teacher from Watertown, who is now > symptom-free, is that antidepressants – despite the recent backlash in the > media – significantly help millions of people. ”I would never say, `Don’t > go on it,”’ she says. ”I would just say be very aware that when you want > to get off it, go to a doctor who knows about this.” > This story ran on page C1 of the Boston Globe on 6/5/2001. >

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