Tapering of SSRI treatment to mitigate withdrawal symptoms
thelancet.com
thelancet.com
After trying to quit cold turkey a couple of times, I researched about tapering strategies online, bought some pill cutters and started a very gradual dose reduction. So long as I only halved the dose every 2-3 days, I was fine. But I had to go down to a minuscule fragment of a pill before I could quit completely. Until that point, missing one of the reduced doses would still induce withdrawal symptoms just as intense as the full one had.
Recently, I've also begun experimenting with microdosing. I know almost nothing about the science of psychedelics but I've heard that they mimic the chemical structure of serotonin. I've also had a couple of intense nightmares recently. I wonder if there's somehow a connection between the effect of serotonin or things like it and the tendency to experience intense imagery in dreams.
Perhaps it's not exactly the quality (negative or positive) of the content but the intensity that is magnified. I think I could just as well say that I've had a number of intensely positive dreams while taking these substances but I can't speak objectively about it.
Never got withdrawal symptoms from the first round some time ago, unless you call a second bout a withdrawal. Sleeping at night has become a bit of an adventure.
In my experience, all of these drugs can bring on intense very visually pleasant trippy dreams, with the occasional intense violent nightmare. Aside from the mood and sleep architecture effects, I wish I knew more about the neuroscience separating the positive from negative experiences.
My dose is only 10mg though (used to be 20mg).
I wish I had never started to begin with. I feel like a part of me is gone now. It is hard to describe.
I just read a book the other day that I’ve had for awhile but hadn’t read—or so I thought. While reading it, some of it seemed familiar but I just assumed I had started it but never finished. I went to post it to my Goodreads account only to find it already there complete with a review that I had written. I have no memory of writing that review, much less of ever actually finishing the book.
I realized I had read it towards the end of my time on my medication.
That’s a prosaic example compared to the conversations my wife and I have where she’ll mention something funny or endearing about our children who were toddlers at the time but I simply can’t remember them.
If you’re thinking about using SSRI’s for anxiety I encourage you to find a therapist who has an evidence-based practice like ACT.
Also, sample size=1, CBD oil for me appears to have many of the anti-anxiety affects that the other SSRI's have provided me, with much less side affects. Although, the dosing is all over the map and varies from manufacturer, so that's a challenge. But it does seem to provide me some relief. I just hope I’m not doing long term damage..
I’ve used the American Shaman water soluble full-spectrum and Medterra isolate CBD oil. Both were effective for me with a slight preference towards the Medterra isolate.
It’s about the most “normal” feeling I’ve ever had. Definitely by far the most effective treatment I’ve had for anxiety, and that’s including the SSRI’s. Probably beats Lexapro because of the near non-existent side effects for me. But again, sample size 1.
The /r/cbd group is a good starting place.
It's quite possible that similar mutations exist that affect SSRI metabolism.
Also, it took decades for studies to be done on minimally effective doses for SSRIs leading to uncounted (and unlitigated) cases of people suffering and dying needlessly.
I hope people here are aware of the sheer number and scale of issues in this industry, from bribing prescribers to false advertisement and covering up of studies, with vast wings of the companies dedicated to 'PR' "managing" these issues.
The explanations I've heard from medical professionals of "why" these drugs work are comically full of holes. They don't really know what's happening with them, and this institutional arrogance, and the 'incidental' buckets of money, are why it's taken 5 decades for this basic, basic, basic fucking research to begin to come out.
And B, that hasn't stopped these guys from coming out with ridiculous stories as to how they work, speaking them with the utmost confidence, which is what I took issue with there specifically.
https://www.genengnews.com/news/depression-and-gut-bacteria-...
that said, a concerning issue with antidepressants is that doctors don't really understand how or why they work. the condition they treat, depression, is also not very well understood and does not seem to have a single root cause. out of twenty or so major drugs, a doctor has very little ability to predict which one will work for a particular patient. when you put all these factors together, being prescribed drugs for depression feels a lot more like "pulling random levers until something works" than most other forms of medical treatment.
I don't share your suspicion that most of this is alternative-medicine shilling. enough of my close friends have experienced the same positive and negative effects described here that I will take most accounts as genuine.
Is this what you actually think, or just what the drug is telling you to think though? I would much rather just be depressed than chemically castrate my brain.
If you'd "rather be depressed" then you've never suffered from depression.
I've been with two partners that stopped SSRI's after a long time. The brain zaps lasted for months, and the memory, mood issues, and sex drive changes were also severe. Both times it left an irreparable change to our relationship.
I got put on SSRIs because it was the only thing that helped my IBS after getting some kind of GI infection while traveling in Europe.
IBS has many causes one main of is people having an autoimmune disease due to the bodily production of anti-vinculin from molecular mimicry of the toxin causing food poisoning anti-cdtb.
The remaining causes are related to MAST cell destabilization, SIBO, etc. Anxiety is thought to play a role in symptom management in the same way having being anxious about a broken foot will make you foot hurt more.
Recently I got an autism diagnosis and got Fluoxetine prescribed.
Getting on it was a living hell. I was extremely tired, could barely walk the stairs, my body was in pain, I could not drink coffee anymore, just to mention some effects.
I endured, and I am much less edgy, more social, less depressed, and less anxious
The only remaining side effect is that alcohol effect is nearly 2x as strong as it used to be. And it already was strong for me. So one glass is the max for me... tho I had a similar effect from Citalopram.
My point being, for me Prozac works with making my autism's effects less severe allowing me to function better in our NT society. According to my psychiatrist (specialised in autism) I was not the first whom she described [Edit: prescribed] that ie. I wasn't an isolated case.
To me, that defines a dystopian nightmare. I'd sooner go without than be shackled to the pharmaceutical industry.
I’m continually reliant on prosthetics for the rest of my life just to see normally. Other people are forever reliant on wheelchairs or pacemakers or medication that stops their immune system from tearing up their organs. And that’s ok!
After having spent a few years studying the neurology of aging, and having my life saved by SSRIs at age 33, I've concluded that SSRIs are very much in the same category as eyeglasses, especially since 1/6 of the population takes them.
The human brain is the most complex thing in the universe. Its not perfect. We can make it better, stronger!
Imagine saying to a diabetic, "Why would you want to be continually reliant on a designer drug for the rest of your life just to feel normal?" Or closer to target, to an anorexic/body image patient, "Just eat!"
For some people it truly is life or death with anti-depressants. Some people are in shitty situations with dysfunctional brains that are actively working against their best interests. Is it really that bad that literally taking a pill solves some people's issues. Perhaps anti-depressants are over-prescribed, but damn, a pill that aligns your brain to be able to rationally handle day to day issues seems pretty neat!
If you're successfully treated by a generic anti-depressant, please ignore the hyperbole of the above commenter. If you feel you no longer need the support of your medications, work with your psychiatrist to safely wean off them. There is no impending dystopian nightmare nor is there any shame is taking anything daily to manage your mental health.
EDIT: I should add, if I got diabetes and had to take insulin, I would be pissed to the point that I'd make it my sole goal in life to find a way to live without having to take insulin.
To me, it is absolutely infuriating that I can be required to take a drug just to live. I fully understand this stuff works great for people - by all means use them! For me? I'd rather get sick and fail than live with it forever.
(Yes, I'm irrational, excessively autistically stubborn, and all the other negative things you're thinking about me. :)
I feel like you're ascribing it to some sort of moral failing then that someone would turn to medication for help. These things aren't always under people's control.
> I'd rather get sick and fail than live with it forever.
In the case of type 1 diabetes that could literally mean death. These hypotheticals are very easy to lay out, but much, much harder to live with.
It came on so slowly that I didn't really notice, and most people around me who you would imagine should have noticed also did not. I finally hit a breaking point, and started therapy and medicine again. It has completely changed my life around, and possibly saved it.
Would I like to live without it? Well, I would like to not need it, but if it is a given that I do, then I most certainly will continue using it. I've experienced the alternative, and there is nothing preferable about it.
It _is_.
> I'd rather get sick and fail than live with it forever.
It's easy to say that now. When you've not slept for three days, and that happens so often it's become routine, or you've not used the phone in _months_ due to the anxiety it causes, it's not so easy.
- Cost: drugs are not free, neither are doctors, though with proper health care, it is rarely an issue.
- Time: these are prescription drugs, and you may need regular visits to a doctor
- Convenience: not having to carry meds with you is one less thing to think about
- Unavailability: you may find yourself without access to your meds at the very worst time (ex: stuck in a foreign country). You definitely don't want to experience withdrawal in an already stressful situation.
- Tolerance (if applicable): You may need to up the dose regularly in order to have an effect, until you can't go further.
I have to say though that venlafaxine didn't really do anything positive for me, nor did the previous SSRIs. I still got the side-effects and withdrawal symptoms when I missed a dose though. I assume they don't work for me because that wasn't my problem in the first place. My own guess is that my issues are from ADHD, but I've only intermittently had insurance since then so I haven't been able to find out.
My experience wasn't like yours, but the withdrawal was terrible. I've read about it online and it seems that many other people seem to have found withdrawal from venlafaxine to be really bad.
I blame the doctor, who switched me immediately to Lexapro with zero tapering on either side. Effexor is something that really should be tapered very slowly.
If its making life awesome though, why get off of it? The stuff gave me lots of confidence and was the only thing that ever regulated my weight and energy levels.
I've been on Venlafaxine (the generic name for Effexor) and went from I believe 300 mg to 200, 100, 75 - I was able to drop the dosage once a week, but that's my experience. It could take you longer, or you might need to work with your doctor to switch to another medication that you may have better results tapering off on.
And if you're not really ready to get off of it, don't rush it. Better to deal with the side effects of being on it rather than being hospitalized or worse.
Doctors mostly advertise it as a tool to help get a leg up in overcoming depression with the idea being that it helps you get your shit together and somehow become not depressed. But when you actually get diagnosed, they just prescribe an SSRI and move on. If you ask what you're meant to do, they'll recommend therapy if you're lucky.
And then we come to posts like this and comments like here, about people who have become dependent on SSRI just to have the same quality of life as they did before ever touching it. But now they have to go through hell to get off it.
What's the idea here..? Is there an actual success path for SSRI? What percentage of patients lands on that success path?
Even if you do get medication first, the path that I expect is that you get "soft" treatment as well. The medication is supposed to get you through the really rough seas that you might succumb to otherwise, with other therapy helping you in the long term. If you go to a doctor and they just give you medication and send you on your way, you need to get a second opinion.
There is no freaking way I'm going to talk to a therapist, for example. Not without medication. A therapist is someone that I don't trust, and yes, I'd be honest about it. I might walk away from all treatment if I had to talk to someone regularly first.
More broadly, though, it depends on what is going on with the person. There are medications that have depression or anxiety as side effects and some folks are simply going through tough situations that they cannot change. My mother took a drug for years because lowering her stress levels helped with migraines (for my mother, a tension headache triggered a migraine. Same with sinuses).
Therapy has its benefits(like a great side effect profile), but it's good to remember that therapy has a lot of drawbacks too. It expensive(SSRI $3/month vs therapist $500/month), it requires a flexible schedule, and the evidence of effectiveness isn't quite as clear as medication.
SSRI's are completely unrelated to getting your shit together except for the fact they make you less depressed which makes it easier to get your shit together. Doctor's talk about it the way you mentioned to feed into American moralization about drugs. But truth of it is we don't really know how they work(we have a couple of tenuous guesses), we just know they reduce depression and relapse risk.
>And then we come to posts like this and comments like here, about people who have become dependent on SSRI just to have the same quality of life as they did before ever touching it. But now they have to go through hell to get off it.
We don't necessarily know what their life would be like if they hadn't taken the SSRI's. Judging from the studies they'd be marginally less happy, have a greater risk of relapsing, and an increased sex drive.
I'd be interested if people drawn to tech were for whatever reason more likely to be on them - or if there is some other casual relationship that works in the opposite direction.
I'm not saying you are, but to destigmatize that statistic a bit, ~60% of Americans need corrective vision of some sort, and 33% have high blood pressure. Just because someone needs help for something doesn't mean that anything is fundamentally wrong with them.
Beyond solving a massive sudden depression, it was actually quite enhancing. I felt like I was in the movie limitless. Given the pathways SSRIs target in the brain, I'd say they have similar benefits to all of that SV legacy around psychedelic use....
Sadly, things normalized and the burst of awesome tapered off. Now the medication is the new normal, and skipping doses brings the depression back, just not nearly as bad as it was. Hopefully some day we will learn how to tweak it so the immensely positive experiences last forever.
These days, I no longer think of antidepressants as any kind of crutch. If anything, it is another tool in the transhumanists toolbox allowing the human body to perform better than nature has provided.
The suicidal ideation listed as a side-effect on packets of SSRI's is almost entirely due to people deciding to go "cold turkey".
edit: I am not looking for a moral equivalence here but didnt have another example where addiction and physical withdrawal is accepted beforehand for a treatment.
Apparently you get SSRI withdrawal from normal prescribed use. And its not surprising if you consider how long people have to take antidepressants.
I am a bit shocked, that something as commonly prescribed as SSRI have such severe withdrawal symptoms from normal use. Of the top of my head, i dont know of many kinds of prescription drugs that cause a withdrawal once you finish your regiment.
As I wrote having first and second hand experience with both kinds of withdrawal I think talking the danger of opioids down while talking ssri's up is wrong and dangerous.
Sure they are not comparable in risk, but the hurdle for a SSRI prescription is also quite a bit lower then the one for Opiod prescription.
[1] SSRIs _can_, but rarely https://www.ncbi.nlm.nih.gov/pubmed/9786310
SSRI apparently has a withdrawal problem even with proper usage
I was shocked to see how much it benefited me for chump change sum of 600 dollars.
SSRIs never worked for me to begin with. I did many other illegal drugs like Amphetamine, Weeds, Meta amphetamine they helped but only in short term.