Gregorio888
Bluelighter
- Joined
- Nov 9, 2018
- Messages
- 55
Hey,
I'm not sure I should make this thread as I'm assure it's addressed elsewhere, though I haven't seen it directly. That said, while it's getting better, many/(most?) people are unaware of, ugh, "discontinuation syndrome" (aka withdrawal, dependent or addicted.) I have my opinion about various drug efficacies and such, but I'm not going into my thoughts in this tread to avoid an inevitable debate.
Anyway, here in the USA, Drs are trained to taper patients off their meds over the course of 1 month (all anti-depressants, SSRI's, SNRI's, SDRI's, MAOI's, Tricyclics, whatever else I'm forgetting (not including Ketamine as it's totally different and doesn't have long term data yet.) If you've only been using it a couple months this is unlikely an issue. Also a significant minority (about 1/3) don't have trouble tapering off at that rate even if they've been using for many years. About 1/3rd get medium w/ds, and the last get strong and some of them severe, with a % of those being unable to every fully taper off.
I just wanted to let people to know that's how Drs are trained (or at least they were, hopefully it's improving, but most general practitioners or even psychiatrists for that matter are not up to date,) so that's the guide they'll follow. However, leading research has long since proven that, depending on the person, the drug, the dose, the time on the drug, and which drug, a safer tapering schedule (safer as in less negative effects and less damage to your brain (minor but still)) is 3-12 months (again excluding people who've only been on short term.) While your Dr will probably start you with a one month taper, if you go back/call and tell them the problems you're having (if any,) they should plan a longer taper for you (they may also try to convince you to need to be back on the medicine, more on this later.)
People often forget that one of if not THE first w/d symptom is depression/sadness/apathy. It's at this point that many Dr's will try to convince you your depression is re-surging, and that you should go back up to your normal dose. If beginning a taper, I highly recommend a simple journal, just an easy end of the day, what was my dose, how was my depression, sadness, anxiety, and any other w/d symptoms you may have felt (brain zaps, etc.) With this information you can make a better informed decision, and work with your doctor, to see if your depression is still bad and you feel the med is needed, or if there's a pattern showing it's "just" withdrawals.
For example, I did 6 months on Zoloft, then switched to 6 months on Celexa, then tapered over 2 months (after my Dr told me 1.) I made a small cut every 1-2 weeks depending on how I was feeling. A clear pattern emerged, 3 days after cutting a dose, an overwhelming sense of sadness, darkness, dread, and crying spells would start, ending 2-3 days later. It was a clear pattern, which showed it was a w/d effect not a problem with my depression coming back or something. Additionally, the depression I felt withdrawing was nothing like what I've ever experienced before or since. I was unhappy before, but I never cried about things (I'm not trying to be macho I just didn't.) But when in the w/ds I would have this overwhelming sadness and cried frequently, something that never happened before, and hasn't happened since. If you experience brain zaps, dizziness, other w/d effects, these are all evidence you're in withdrawal, and going back on medicine isn't necessarily warranted (though could still be, and also you may want to increase the dose to taper more slowly, but do this with your Dr.)
Another serious problem people have is that many medications do not come in sizes to taper off. The worst example of this I can think of is Effexor. The lowest dose is 37.5mg, and it's a capsule. There should be at least two lower doses at 1/2 each. If you feel you want off the med, but the cuts are too big. Try to work with your Dr to extend your taper. Additionally, if you can convince your dr to switch you to prozac that is by far the best to taper off due its long half life. You don't switch instantly, you reduce your previous med as you add in equivalent prozac doses. This can take time and should also not be rushed. Depending on the switch, it can usually be done in a month, but from some meds and high doses you might need 3 months just to switch, but then you'll be in a much better position to taper with.
There's other tricks too, like opening your capsule and counting the beads, but I still recommend you work with your Dr about this. The biggest take away is to record your day to day emotions (and outside effects that could explain something, like getting yelled at by your boss or whatever,) and look for patterns, and record all other side effects, if there's a patterns from your cut to feelings of depression show you Dr the journal, you're more likely to be believed and you can maintain a better relationship with the Dr.
Some Dr.s are improving in this area, but most psych med prescribers are general practitioners, who don't have the time to study every system of the body intensely (and psychiatrists aren't really any better in this particular area anyway, well, that depends, many are good, I've just had terrible luck.) The main thing to do is not lose hope. My sister had to do a 3month taper off Cymbalta, and had persisting w/d symptoms for another 3 months (she should have been someone tapered over longer than 3 months.) However, she did get through it and is fine, it's more dangerous to try to do a rapid taper.
Again, the point of all this wasn't to scare you off psych meds, or encourage you to quit as long as you feel you're benefitting. I meant it more as a guide as to how to taper off when you're having trouble, but the Doc doesn't believe you, which is why you record symptoms/dose daily. Given evidence most Dr's will work with you. Be kind to the Doctor, even if you're sick of them, you can try to make it seem like their idea to do a slower taper. Incept their mind, lol. Also, try not to jump to conclusions during the taper from a single day, just look for the patterns and adjust. I also want to remind everyone that about 1/3 of people have no trouble whatsoever, another 1/3rd have mild to moderate problems, and only 1/3 have the more serious effects. So no one should take this post as scary, many people will have 0 problems. My main concern is that there are huge #s of people out there who stay on Andi-depressants because they get "depressed" when they start the taper, when it's really a w/d effect and not underlying depression. And then they stay on a med with its side effects, unnecessarily. And I should re-state what happened with my sister here, she was on a powerful med for years, then tapered over 3 months, then continued to have w/ds for 3 more months. Ideally, she'd have tapered much slower, but you do have to be ready for w/d's that last longer than you expect after quitting completely (this is MUCH worse the faster you taper.)
Anyway, I doubt anyone will read all this, but this is a bit of a rant for me. I've had to explain to too many Dr's the prevalence and severity of w/ds from Anti-Depressents who seemed utterly oblivious that there was such a problem. Again, while it may feel like it, it may not actually be your Dr's fault, especially if they're a GP (GP's are extremely underpaid, yes, even though they're Drs, with student loans GPs can have a lot of trouble paying off debt, and they have to know every system of the body to refer you out, it's a very tough job, as long as they're willing to look at your evidence and work with you. Anyway /rant I guess, lol. I hope this at least helps someone, though just shouting into a forest is cathartic for me as well, lol. Peace, good luck everybody.
TL/DR - if trying to taper from antidepressants, keep a daily journal with your dosage, emotional well being, withdrawal effects, external factors. Look for a pattern, don't jump back to the conclusion, and don't let your Dr. jump to the conclusion that your meds should be added back (not that that may be needed.) Look for patterns in your emotion's related to when you made a cut, and communicate with your Dr. if you think you need more time than the schedule they've set up. Armed with your evidence you're much likely to have a better relationship with your Dr, and make an informed decision if any emotional problems you have are because you need to be back on the med, or it they are an effect of w/d from too rapid of a taper. Most Drs will start a 1 month taper, but depending on your med, dose, duration of use, and body chemistry, it may be better to taper over 3-12 months, this is according to the most recent science, but is not how many Drs are trained. Goodluck
Mods - I hope this was an ok thread. I kinda started ranting to myself, and turned it into a thread. If this isn't acceptable for the forum I apologize and feel free to delete.
I'm not sure I should make this thread as I'm assure it's addressed elsewhere, though I haven't seen it directly. That said, while it's getting better, many/(most?) people are unaware of, ugh, "discontinuation syndrome" (aka withdrawal, dependent or addicted.) I have my opinion about various drug efficacies and such, but I'm not going into my thoughts in this tread to avoid an inevitable debate.
Anyway, here in the USA, Drs are trained to taper patients off their meds over the course of 1 month (all anti-depressants, SSRI's, SNRI's, SDRI's, MAOI's, Tricyclics, whatever else I'm forgetting (not including Ketamine as it's totally different and doesn't have long term data yet.) If you've only been using it a couple months this is unlikely an issue. Also a significant minority (about 1/3) don't have trouble tapering off at that rate even if they've been using for many years. About 1/3rd get medium w/ds, and the last get strong and some of them severe, with a % of those being unable to every fully taper off.
I just wanted to let people to know that's how Drs are trained (or at least they were, hopefully it's improving, but most general practitioners or even psychiatrists for that matter are not up to date,) so that's the guide they'll follow. However, leading research has long since proven that, depending on the person, the drug, the dose, the time on the drug, and which drug, a safer tapering schedule (safer as in less negative effects and less damage to your brain (minor but still)) is 3-12 months (again excluding people who've only been on short term.) While your Dr will probably start you with a one month taper, if you go back/call and tell them the problems you're having (if any,) they should plan a longer taper for you (they may also try to convince you to need to be back on the medicine, more on this later.)
People often forget that one of if not THE first w/d symptom is depression/sadness/apathy. It's at this point that many Dr's will try to convince you your depression is re-surging, and that you should go back up to your normal dose. If beginning a taper, I highly recommend a simple journal, just an easy end of the day, what was my dose, how was my depression, sadness, anxiety, and any other w/d symptoms you may have felt (brain zaps, etc.) With this information you can make a better informed decision, and work with your doctor, to see if your depression is still bad and you feel the med is needed, or if there's a pattern showing it's "just" withdrawals.
For example, I did 6 months on Zoloft, then switched to 6 months on Celexa, then tapered over 2 months (after my Dr told me 1.) I made a small cut every 1-2 weeks depending on how I was feeling. A clear pattern emerged, 3 days after cutting a dose, an overwhelming sense of sadness, darkness, dread, and crying spells would start, ending 2-3 days later. It was a clear pattern, which showed it was a w/d effect not a problem with my depression coming back or something. Additionally, the depression I felt withdrawing was nothing like what I've ever experienced before or since. I was unhappy before, but I never cried about things (I'm not trying to be macho I just didn't.) But when in the w/ds I would have this overwhelming sadness and cried frequently, something that never happened before, and hasn't happened since. If you experience brain zaps, dizziness, other w/d effects, these are all evidence you're in withdrawal, and going back on medicine isn't necessarily warranted (though could still be, and also you may want to increase the dose to taper more slowly, but do this with your Dr.)
Another serious problem people have is that many medications do not come in sizes to taper off. The worst example of this I can think of is Effexor. The lowest dose is 37.5mg, and it's a capsule. There should be at least two lower doses at 1/2 each. If you feel you want off the med, but the cuts are too big. Try to work with your Dr to extend your taper. Additionally, if you can convince your dr to switch you to prozac that is by far the best to taper off due its long half life. You don't switch instantly, you reduce your previous med as you add in equivalent prozac doses. This can take time and should also not be rushed. Depending on the switch, it can usually be done in a month, but from some meds and high doses you might need 3 months just to switch, but then you'll be in a much better position to taper with.
There's other tricks too, like opening your capsule and counting the beads, but I still recommend you work with your Dr about this. The biggest take away is to record your day to day emotions (and outside effects that could explain something, like getting yelled at by your boss or whatever,) and look for patterns, and record all other side effects, if there's a patterns from your cut to feelings of depression show you Dr the journal, you're more likely to be believed and you can maintain a better relationship with the Dr.
Some Dr.s are improving in this area, but most psych med prescribers are general practitioners, who don't have the time to study every system of the body intensely (and psychiatrists aren't really any better in this particular area anyway, well, that depends, many are good, I've just had terrible luck.) The main thing to do is not lose hope. My sister had to do a 3month taper off Cymbalta, and had persisting w/d symptoms for another 3 months (she should have been someone tapered over longer than 3 months.) However, she did get through it and is fine, it's more dangerous to try to do a rapid taper.
Again, the point of all this wasn't to scare you off psych meds, or encourage you to quit as long as you feel you're benefitting. I meant it more as a guide as to how to taper off when you're having trouble, but the Doc doesn't believe you, which is why you record symptoms/dose daily. Given evidence most Dr's will work with you. Be kind to the Doctor, even if you're sick of them, you can try to make it seem like their idea to do a slower taper. Incept their mind, lol. Also, try not to jump to conclusions during the taper from a single day, just look for the patterns and adjust. I also want to remind everyone that about 1/3 of people have no trouble whatsoever, another 1/3rd have mild to moderate problems, and only 1/3 have the more serious effects. So no one should take this post as scary, many people will have 0 problems. My main concern is that there are huge #s of people out there who stay on Andi-depressants because they get "depressed" when they start the taper, when it's really a w/d effect and not underlying depression. And then they stay on a med with its side effects, unnecessarily. And I should re-state what happened with my sister here, she was on a powerful med for years, then tapered over 3 months, then continued to have w/ds for 3 more months. Ideally, she'd have tapered much slower, but you do have to be ready for w/d's that last longer than you expect after quitting completely (this is MUCH worse the faster you taper.)
Anyway, I doubt anyone will read all this, but this is a bit of a rant for me. I've had to explain to too many Dr's the prevalence and severity of w/ds from Anti-Depressents who seemed utterly oblivious that there was such a problem. Again, while it may feel like it, it may not actually be your Dr's fault, especially if they're a GP (GP's are extremely underpaid, yes, even though they're Drs, with student loans GPs can have a lot of trouble paying off debt, and they have to know every system of the body to refer you out, it's a very tough job, as long as they're willing to look at your evidence and work with you. Anyway /rant I guess, lol. I hope this at least helps someone, though just shouting into a forest is cathartic for me as well, lol. Peace, good luck everybody.
TL/DR - if trying to taper from antidepressants, keep a daily journal with your dosage, emotional well being, withdrawal effects, external factors. Look for a pattern, don't jump back to the conclusion, and don't let your Dr. jump to the conclusion that your meds should be added back (not that that may be needed.) Look for patterns in your emotion's related to when you made a cut, and communicate with your Dr. if you think you need more time than the schedule they've set up. Armed with your evidence you're much likely to have a better relationship with your Dr, and make an informed decision if any emotional problems you have are because you need to be back on the med, or it they are an effect of w/d from too rapid of a taper. Most Drs will start a 1 month taper, but depending on your med, dose, duration of use, and body chemistry, it may be better to taper over 3-12 months, this is according to the most recent science, but is not how many Drs are trained. Goodluck
Mods - I hope this was an ok thread. I kinda started ranting to myself, and turned it into a thread. If this isn't acceptable for the forum I apologize and feel free to delete.
