
Tapering of SSRI treatment to mitigate withdrawal symptoms - bookofjoe
https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(19)30032-X/fulltext
======
stupidcar
I discovered this when coming off Citalopram. The waking nausea and discomfort
were unpleasant, but the worst part was undoubtedly the lucid, extraordinarily
intense and violent nightmares that would begin the moment I fell asleep and
continue, for hours at a time, for the entirety of my sleep.

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.

~~~
davesque
It's really interesting to hear someone else say this. I too have suffered
occasionally from intense, violent nightmares. They don't necessarily continue
all night, but the imagery is extremely disturbing, like a Hellraiser movie. I
also took SSRIs like Paxil and Celexa in my early to mid twenties.

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.

~~~
subcosmos
Serotonergic signalling is a really important regulator of sleep architecture,
and this is why psychiatrists are increasingly prescribing trazadone as a
sleeping aid. It was previously used as an antidepressant, but lower doses and
it is a remarkably effective sleeping pill. 5-htp has similar effects, and
this is why its sold as a sleep-aid supplement.

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.

~~~
johnisgood
Yeah, I take GABA before sleep to induce intense dreams. It works all the time
for me.

------
time0ut
I was on sertraline for almost 15 years. It took multiple tries to get off. I
finally slowly tapered off. The worst withdraw symptom was the zaps for me.

I wish I had never started to begin with. I feel like a part of me is gone
now. It is hard to describe.

~~~
dqv
How long ago did you finalize your tapering and stop altogether?

~~~
time0ut
It has been about two years now.

~~~
dqv
I know someone who was on diazepam for only a year and he says that it took
him longer than a year from the point of final dose to start feeling himself
again. I know diazepam is not the same class of drugs, but hopefully the same
is true for you - the longer you go from the final dose the more yourself you
feel.

~~~
aaaaaaaaaaab
Well for one, you’re not supposed to take benzodiazepines longer than a few
weeks. Benzo withdrawal can be life-threatening if you’re accustomed to a high
enough dose.

------
aantix
Strangely, I've gone cold turkey off of SSRI's and with the exception of
Paxil, have never experienced the Brain Zaps or extreme withdrawal symptoms
others report. I wonder why it would vary?

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..

~~~
mrfusion
What dose for cbd? Does it get expensive?

~~~
aantix
It is expensive. Usually 45-60 dollars for a months supply.

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.

~~~
throwaway5d097
CBD isolate by itself can be a lot cheaper. The cheapest I've found is online
from Fully Activated, around $20/g. You should be able to mix your own
tinctures with liquid coconut oil, and optionally sunflower lecithin.

------
viivaux
Patients have been saying this for literally decades. I remember blogs written
by people who learned to do this themselves without any support from their
medical professionals, networking and sharing info with each other on the best
way to do it, in the early fucking naughties.

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.

~~~
subcosmos
The currently best-accepted theories to why antidepressants work involve slow
but measurable changes in grey matter densities in key parts of the brain. We
haven't had this kind of high-resolution MRI technology for very long.

~~~
viivaux
A, that doesn't actually explain :how they work:.

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.

------
JohnTHaller
Someone I love had to stop an SSRI and I helped her hack her capsules. I
bought empty capsules online and we counted out the beads to allow her to
taper mg by mg. Basically this but about 10 years ago:
[https://www.newscientist.com/article/2140106-people-are-
hack...](https://www.newscientist.com/article/2140106-people-are-hacking-
antidepressant-doses-to-avoid-withdrawal/)

------
nyxtom
I am excited for the day when we can fully understand just how the gut-brain
connection actually works and where depression/anxiety come from. Giving
people real genuine long-term relief over the course of their life.

[https://www.genengnews.com/news/depression-and-gut-
bacteria-...](https://www.genengnews.com/news/depression-and-gut-bacteria-
link-strengthened/)

------
maxehmookau
Some of the comments on here are scary. I've been using Sertraline on and off
for 13 years and have never suffered any ill effects other than minor nausea
and tiredness. This is, according to the vast body of research done, the
majority of people's experiences. Most importantly, I feel better when I take
it. If you're thinking of taking SSRIs, please don't let the comments here
scare you. They can have a massively positive effect.

~~~
odiroot
Exactly. I never understood why is there such a witch hunt against SSRIs and
not only on HN. I have a strong suspicion alternative-medicine folks are just
pushing it.

~~~
jacobush
There may be, but on this forum I just see people sharing shit that happened
to them. It's a self selected group. If you see a headline and some bad stuff
has happened to you, it's only natural that you may want to tell about it.

~~~
maxehmookau
True. Well this is me diluting it. SSRIs saved my life.

------
therealx
SSRI discontinuation is really horrible and most doctors don't tell you up
front the hell that it is. To me, its a sin up there with not telling opioid
patients what that'll be like to stop.

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.

~~~
maxehmookau
For the majority of people, this isn't the case. The body of evidence backs
this up. I'm sorry you and your partners had a bad experience, but comparing
it to opioid withdrawal is an unfair comparison and could discourage people
from getting help who need it.

~~~
therealx
I'm willing to concede to evidence, but it wasnt just those two stories. I
must know a lot of bad luck people.

------
ipunchghosts
Many folks are on these drugs not because of depression or anxiety.

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.

~~~
anisppp
IBS (at least some types) are very likely closely related to anxiety disorders
(but with a visceral motor component). Low FODMAP has been shown to help,
though it’s not clear that it is treating the psychomotor cause , but one of
the best interventions is increase in physical activity... similar to GAD.

~~~
ipunchghosts
I want to nip this falsehood in the butt as I am studying this for my PhD.

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.

~~~
aergaegr
I have IBS because of severe social anxiety, but I don't have any anxiety
because of IBS.

------
joflicu
I hope someone can help me. I was slowly tapered off Effexor (started at 225mg
and then slowly to 125, 75, 25). I was overcome by an existential dread that
colored every living moment. I landed up in the hospital - only to resume. Has
anyone had experiences like this to share? I want to get rid of this
medication again this year but am afraid to start. I am well-balanced and
happy at work and life atm.

~~~
dillondoyle
Just curious - you do you - but if you are well-balanced and happy on the meds
why do you want to taper off?

~~~
b1r6
Flip that around: Why would you want to be continually reliant on a designer
drug for the rest of your life just to feel normal?

To me, that defines a dystopian nightmare. I'd sooner go without than be
shackled to the pharmaceutical industry.

~~~
mikeash
Whether or not you want to be, maybe you are. And if it helps you function
better, why is that bad?

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!

~~~
Asooka
Because then you're not human, you're a chemical zombie.

~~~
mikeash
Do you say that about people taking daily heart medication, or people with
cochlear implants?

------
kuzehanka
Can someone explain what the 'proper' treatment plan is supposed to be for
SSRI?

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?

~~~
krageon
As I was given to understand it, the first line should be CBT or something
similar (ie a therapy that doesn't involve drugs that will help you live your
life). On top of this, unless you get referred directly to a psychiatrist (for
example because you have made a suicide attempt) you get referred to a
psychologist that will try a bunch of different "soft" approaches that will
help you deal with your problems. The medication comes during this process, if
it is indicated.

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.

~~~
JamesBarney
There's no reason medication requires therapy.

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.

~~~
jacobush
Both cognitive therapy and classic "shrink" therapy is on some level, you just
talking about shit going on in your life. At the very least, if you are at the
end of your rope with no (constructive) talking to be found amongst your peers
in life, I am dead certain talking to a therapist is a good thing to try.

------
SlowRobotAhead
Wow. I'm quite interested in how many people at HN seem to have experience
with SSRIs.

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.

~~~
SketchySeaBeast
A quick google search told me that ~15% of American's take anti-depressants.
Depression is quite common among the general populace. I think tech sector
people have access to the health care they need to get the help they need.

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.

~~~
subcosmos
I'll add to this by saying that going on zoloft a year ago has been like the
best nootropic experience of my life. In many ways, the first 6 months were
like a persistent 24/7 microdose on MDMA ..... it was incredible. I also
turned my life around and accomplished some of my life's most impressive work,
all while not trying to kill myself anymore!

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.

------
jpovenden
Tapering to mitigate discontinuation syndrome is standard practise in country
of publication and has been for a long time, why is this news.

The suicidal ideation listed as a side-effect on packets of SSRI's is almost
entirely due to people deciding to go "cold turkey".

------
cf141q5325
Reading about the withdrawal symptoms I have to wonder why people arent up in
arms about it as with the so called opioid crisis. Different to opiods, SSRI
are meant to be taken for long periods. The SSRI withdrawal seems to just be
accepted as a part of the treatment.

~~~
tokai
Having experienced antidepressant withdrawal syndrome and having lost a friend
to opioid addiction. I would say that comparing the two is preposterous.

~~~
cf141q5325
Thats comparing the effects on friends an family with the effects on the user.
Which in turn, is a bit unfair. It wouldnt be much usefull to talk about
people who got suicidal because of SSRI side effects either. It is a rare side
effect that might happen and not something that apparently happens regularly
like withdrawal.

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.

~~~
tokai
Sorry I don´t follow you.

~~~
cf141q5325
If you take properly prescribed opioids it is unlikely you get addicted,
withdrawal symptoms or die. Those are issues stemming from miss use.
Personally induced or by a careless physician. The exception is in palliative
care and chronic pain where it still beats the alternative.

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.

~~~
tokai
You view of these things don't converge with my experiences at all. The flue-
like 'withdrawal' from ssri's is not nice, but it is peanuts compared to drugs
with a misuse potential like opioids. Opioids rewrite your brain's reward
system, the withdrawals are excruciating, and your former addiction will be a
part of you for the rest of your life.

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.

~~~
cf141q5325
And I think its wrong and dangerous to lump together the side effects of opiod
miss use and the side effects from proper prescribed regiments. By all means,
Opiod miss use is dangerous. Nothing new here, we as humanity have known that
for centuries by now. But I think its only reasonable to point out, that
withdrawal being an expectable side effect of a SSRI regime is extremely
scary. That there is a insane panic about even medical use of Opiods while no
one blushes an eye about that kind of severe expectable side effects is
worrying.

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.

------
savgeborn
I was super depressed until I discovered Ketamine, so I took my credit card
and started getting Ketamine sessions which costs roughly 600 dollar per
session.

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.

~~~
Traubenfuchs
How long does one "ketamin session" work? Is it normal for this to be so
expensive?

