Mental Health Coming off psyche MEDS?

[Markomarkh]

Hi all, I have a history of using psyche meds and having anxiety, depression, mild skitzo disorder, due to heavy drinking in my teens and smoking cannabis, can't totally blame that but didn't help. Started taking respiradone in 1998 and sertraline SSRIs in 2005 and quit my SSRIs in 2014, didn't feel they were doing anything. But I'm still stuck on respiradone and thinking of quiting that but not sure just in case I get another skitzo episode flare up again? I know I should go to my doctor but I feel he'll just talk me out of it again. Have any of you experienced quiting these types of meds?

Cheers

Mark.

 

[AlphaMethylPhenyl]

Whoa, that's a long time.

I don't want to scare you, but a lot of the time, people start feeling a lot better when they're on their meds, then get off of them, after which symptoms fully return.

I would talk it over with your doctor, which you don't want to do. Worst case scenario, you disagree, right?

I just have this fear that you'll get off of your medication, then a few weeks or months down the line suffer an extreme episode, and have to be put on more medication than you initially were on.

 

[Markomarkh]

How do we know these things are really working at all? No one really understands the chemicals of our brains do they?

 

[Cotcha Yankinov]

I withdrew from taking 2mg Risperidone a day for a bit over 6 months and there was definitely a lot of rebound symptoms, especially insomnia for me. I would expect things like weight gain and low blood pressure upon standing to get a bit better, but your mental health can definitely go down hill. I was getting some hallucinations, worsened insomnia, and in general a really noisy head with lots of "word salad" voices. I tapered over about 2 weeks but in retrospect I would've gone slower, as I wasn't getting back to baseline-ish for about 2 months. Anti-psychotic withdrawal is no joke, 2mg for 6 months is a wimpy dose/length of time too. I would be very cautious about higher dosages and/or being on it for a longer period of time. I think rebound symptoms is a guarantee.

I think what happens is that when we're on a drug we feel better so then we think "Well I feel better so I don't need this drug anymore", when really its the drug that is helping us.

To understand whether a drug is effective or not, we run a trial that is placebo controlled - so while some schizophrenics are receiving a sugar pill, the other schizophrenics are receiving xyz drug. If 6 months later more schizophrenics have remitted while on the active control (the anti-psychotic) compared to the schizophrenics on placebo then that is enough to say that it is effective. Clozapine notwithstanding, I believe we can get about 30% remission with antipsychotics. With clozapine, that number increases to about 50-60% (correct me if I'm wrong Ho-Chi).

But as far as the exact mechanisms of the drugs we are indeed still in the dark. Schizophrenics generally don't respond to anti-psychotics until a few weeks in, hinting that there is more going on than the acute effects of the antipsychotic - dopamine receptor blockade - there are probably genetic mechanisms downstream of dopamine receptor blockade that are truly responsible for the efficacy of antipsychotics. In general, most meds take a few weeks to respond to, so to a large degree most meds are thought to have a genetic component to them, which we haven't quite unraveled.

 

[AlphaMethylPhenyl]

Hey Cotcha,

I'm not so sure about those particular statistics. What I know regarding people with schizoprhenia becoming well is that ~33% are able to handle their symptoms very well have normal lives; another third have symptoms but are level and recovered enough to do most of what your average citizen can with decent comfort; the last third don't really get better, and may get worse.

Of course you have to factor in things like compliance and recreational drug use. Abiding by the first, and staying away from the latter, increases remission chances by boatloads. Also the time elapsed from when symptoms began to when treatment began, and the age at which someone became sick. So there are a lot of variables here.

There's no doubt that clozapine is something to be grateful for!

Positive symptoms remit largely after several days or a few weeks. Negative/cognitive symptoms can take half a year to reach the potential of the medication.

 

[Cotcha Yankinov]

I suppose "remission" is obscure - and I imagine there is a focus on the flamboyant positive symptoms when it comes to remission.

And indeed I have also heard that schizophrenia in particular has better outcomes if you medicate early on, which is unfortunate considering how many people are thoroughly against medication.

 

[Erikmen]

How do we know these things are really working at all? No one really understands the chemicals of our brains do they?

People understand behaviour though. I can tell when my niece doesn't take her meds although she doesn't feel the difference. We all see how she changes. Of course it varies between different individuals but normally people feel better, even though that does not necessarily mean you are happier or more euphoric. I believe one of the goals when taking these meds is to become more functional in life. I can understand that for some people it takes time for them to get used to certain meds, especially those which makes you feel lethargic, sleepier or even unmotivated.