
Antidepressant withdrawal: reviewing the paper behind the headlines - DanBC
https://www.nationalelfservice.net/treatment/antidepressants/antidepressant-withdrawal-reviewing-the-paper-behind-the-headlines/
======
GordonS
I recently tapered off a dosulepin, a tricyclic antidepressant.

Holy christ, I was _not_ prepared for the 2 weeks of absolute hell that ensued
- intense vomiting, headache, small visual and aural hallucinations and
malaise like I've never felt before. I barely got out of bed for the first
week, and ate nothing. Several times I was on the edge of going to hospital
because I felt like I was dying. Honestly, possibly the worst 2 weeks of my
life.

I later learned that it seems it's actually well known amongst patients that
coming off of antidepressants can cause withdrawals - tricyclics, SSRIs,
SNRIs, NRIs, anti-convulsants, all of them.

The thing is, out of ignorance a lot of doctors simply deny it's possible.
This kind of thing infuriates me - when doing pharmaceutical trials, the
manufacturers _must_ have come across instances of patients going through
withdrawals upon cessation, but somehow that information never makes it to the
papers, the leaflets or the doctors.

~~~
AdamSteel
I'm consistently amazed at how doctors aren't required - at least in Australia
- to talk about side effects or withdrawal symptoms when prescribing
medication. I'm capable of googling things, but it shocks me how none of this
has ever been discussed with me when getting medication. Pharmacists will ask
you questions to determine any contraindications, but I've never been spoken
to about withdrawal or side effects. Half the time people find out about them
by experiencing them.

~~~
Gatsky
This isn't amazing. It is just a matter of priorities. There are many other
things that need to be addressed first to ensure the patient gets onto the
therapy they need. In my experience counselling people about interventions far
more complex and risky than starting an anti-depressant, it is clear that 99%
of people don't want a branching tree exploration of every eventuality. They
get information fatigue very quickly. Ultimately, there needs to be some trust
between doctor and patient for things to function in any real sense. This is
why I personally loathe the word 'client' in lieu of patient - it recasts the
relationship in harmful terms in my opinion, splitting the therapeutic
alliance that should exist into some slightly adversarial union of compliance
on the provider's part and due diligence on the client's part.

~~~
GordonS
Well, information overload has never been an issue with my doctors - quite the
opposite.

My doctor has _no idea_ how the meds he prescribes me actually work. You talk
of information overload, but my doctor provided _no_ information about the
meds, their effects, side effects or withdrawals. For one of the tricyclics he
said "these will kill you if you take too many", but that has literally been
the total information conveyed.

Regardless of information overload, doctors should at least understand the
_basic mechanics_ of how the drugs they prescribe actually work, and
understand the body's mechanics of tolerance and withdrawal - and be capable
of having a brief conversation about them with patients.

------
holman
Withdrawal is a really crap thing to go through, but I also want to point out
that sometimes it can be a fairly non-event, too. I tapered off of Zoloft for
weeks, and I really didn’t feel much of a change. Going slow and deliberate
(if you have the freedom to do so) will help, as well as having lucky
genetics.

I just want to underline that you shouldn’t be turned off to this possible
solution because you’re nervous about the side effects or withdrawal.
Definitely talk with your doc about them and see if it makes sense to go on
them, and if there are ways to mitigate some of the side effects. But meds —
in my case, at least — definitely have been some of the best decisions I’ve
made in my life.

~~~
gtirloni
Exactly. The 1-2 weeks of inconvenience is nothing for some people, specially
when the alternative to not taking them is death, in some cases.

It's also much less of a problem because you know the symptoms will go away.
Just taper it off slowly (where "slowly" varies a lot, sorry).

~~~
pugworthy
Brain zaps lasted for years, we don't always all get so lucky.

------
throwawaywayay
I've been on SSRI for almost 20 years. It stopped working after about 6-7
years and attempted to stop talking it, not cold turkey but by gradually
weaning off it. I had such a bad experience that, now I'm still on it. I asked
my doctor when I could stop taking it and she recommended me a time in my life
when I don't need to come in to work for a couple of good months, basically to
take some time off and deal with this. The problem was that I never had that
time and life got in the way, got a child now, a wife, and I project that I
will postpone getting of it ad infinitum.

I'm on Paxil 20mg, and every once in a while I skip a dose I am reminded of
that feeling of melting into a painful death and excruciable headaches,
nausea, palpitations, sweating, very comparable with the withdrawals of an
opiate addict.

Other than that, after almost 20 years on it, I feel mostly good except for a
once a month dip into 1-3 days of flu like simptomps, lethargy, lack of energy
that I cure with 2-3 days of sleep. It keeps on repeating around once a month.

I should find time to get off this but am afraid I can't afford at the time
such luxury. I have people depending on me...

~~~
themarkn
Hey friend. Sorry to hear about this. It's a real predicament and in your
shoes I'd probably do what you are doing. Hope you can find that time.

------
ricksanch88
ANECDOTAL: I went off of the lowest dose (37.5 mg) of Venlafaxine (effexor xr
- SNRI) earlier this year. I felt like I was hungover most days, and a general
vertigo feeling. It sucked ass, so I reached out to my doctor and he suggested
I try to use CBD oil to help with the symptoms.

I tried it and it literally dulled the withdrawal by at least half. It made my
days tolerable to the point that I could go to work and function like a human
being.

~~~
culot
Effexor is one of the nastiest ones, even when not tapering off of it. A
missed dose can mean brain shocks, and withdrawals can mean months of that,
sometimes strong enough to knock you down.

I am ever surprised that they continue prescribing that one. Of the 10 I've
been on that one was the harshest by far (though many others also had severe,
dangerous side effects).

~~~
hercynium
I agree, as I've missed a dose here and there over the years and experienced
the intense paresthesia and headaches and nausea from withdrawal.

Background: I've lived my entire adult life (and most of my teens) with severe
chronic depression. In my early 20's I started taking pharmaceutical
treatment, and once I found the right drug (after trying _many_ over the
course of _years_ ) my life became manageable. SSRIs helped but I experienced
severe nausea on most of them, or worse. It was only when I tried SNRIs like
Effexor that things started to get better. YMMV, IANAPsychiatrist, etc, etc.

A few years ago I switched from Effexor to Cymbalta. Same class of drug - The
Effexor simply wasn't helping as much as it used to and the switchover was
done with a long taper-down and replace period. I even bought a lab-grade
scale to measure out the contents of the capsules so I could cross-over
smoothly.

All that said, Cymbalta has the same withdrawal effects, on about the same
time scale - a single missed dose. But I wouldn't give it up unless something
better comes along. I still struggle with my depression and the SNRI is just
one tool in my toolbox for managing it.

~~~
ozmaverick72
I have been taking Effexor for more than 10 years. Two years ago I thought it
was no longer being effective for me so I tried to taper down and stop taking
the mediation. Over a period of weeks I dropped down from 150 mg to 37.5 mg. I
could not drop from 37.5 mg - I experienced complete insomnia and terrible
anxiety and I started to experience tinnitus. I went back to see a
psychiatrist who initially didnt believe that everything I was experiencing
was due to withdrawal - I had to fill one of my old scripts and prescribe
myself my original dose of Effexor to get back to some semblance of normality.
My anxiety and sleep levels returned to normal but although the tinnitus
lessened its still there today. I worked with my doctor and eventually decided
to increase the Effexor dose and it has helped greatly with my anxiety and
depression. Apparently there arent many people who have reported tinnitus as
an Effexor sessation side-effect. My doctor says it must just be coincidence -
anyone else experience the same thing ? Just a word of caution to anyone
thinking of stopping their medication - do it slowly and with the support of a
doctor. I thought I knew what I was doing but I probably reduced my dosage too
quickly and maybe this ringing in my ears is the price I pay.

~~~
coolthrowaway
I experienced tinnitus when I started either Celexa or Lexapro. It started on
the second day. It was pretty bad and I quit it the next day. My doctor said
that she had never heard of that happening.

------
chobytes
Doctors do a really poor job explaining to patients just how hard it can be to
get off of some of these drugs.

Personally it took me over a year to taper off of venlafaxine due to intense
discontinuation.

While youre on it at full dose, forgetting to take it even one day is a
miserable experience.

------
poidos
I’m currently on day five off my previous antidepressant, Zoloft. (For
reference, I’m 23 and weigh ~225 lbs.) Nothing too bad, minus a panic attack
last night. I certainly don’t feel “normal”, though— I feel somewhat
lightheaded basically constantly, and have been experiencing a strange
tingling sensation on my lips. I was taking the lowest dose recommended for
adults, 50 mg.

------
bradhe
Didn't read the underlying paper, and definitely not a medical expert, but I
do wonder how they define "withdrawal?" Is there a standard definition?

If you start taking a drug that modifies how your body works, isn't it
logically obvious that if you STOP taking that drug, your body will revert to
it's previous state and that state change will likely be negative, therefor
you're withdrawaling?

~~~
dbt00
Your second paragraph is incorrect. Withdrawal is not an orderly transition to
a previous physical state, it's the presence of previously unseen symptoms,
typically due to biochemical adaptations to the presence of the foreign
substance.

For example, if you drink a lot, some normal neural pathways are repressed by
the regular presence of alcohol and your body compensates by increasing the
affected neurotransmitters (GABA in this case). As a result, when you stop
drinking, you have a corresponding oversupply of GABA, causing the physical
symptoms of Delirium Tremens.

I was on Lexapro for 3 years. When I tapered off according to the standard
protocol (already in place to avoid withdrawal issues), I experienced
debilitating vertigo symptoms and had to change my process from a 2 week
reduction to a 3 month process. It was intense.

~~~
schrodinger
>your body compensates by increasing the affected neurotransmitters (GABA

>you have a corresponding oversupply of GABA

Isn't it the other way around? I had thought that alcohol was a GABA agonist,
so your body adapts to produce less of it. Then when you stop, you're
_undersupplied_ which produces the DTs.

~~~
incidentnormal
Yeah correct, alcohol is technically a positive allosteric modulator of the
GABA-A receptors, which means it potentiates the effects of GABA in those
receptors. Over time, the receptors downregulate to compensate for being over-
stimulated. Upon withdrawal from alcohol, the GABA-A receptors are unable to
respond strongly enough to the GABA which exists, so in effect you're
undersupplied and that contributes to the DTs. Alcohol is actually a very
messy drug that acts on a huge range of receptors but the effect on the
GABAergic system is probably the most significant.

------
anon2775
Anecdotal FYI: missing one dose of mirtazapine feels _exactly_ like a moderate
hangover the next morning. I would vaguely hypothesize depression accrues in
sleep, ethanol is indeed a CNS depressant with long-term effects and missing
doses of medications causes much more harm than previously thought.

Also, I had some nasty vestibular dysfunction from withdrawing from
vortioxetine... eyes randomly moving around quickly in all directions on their
own, limbs twitching randomly, and any horizontal eye movement causing
instantaneous nausea/vertigo.

And, I once titrated off mirtazapine and had some serious nausea... recommend
ginger and weed.

------
Paraesthetic
I'm currently on valdoxan, and have missed a dose once or twice. I was super
anxious, but havn't had any withdrawl symptoms. Spoke to my psychiatrist and
He said that it should have much lower withdrawl symptoms, but still
recommended I taper things off when i come off it in March next year. The
symptoms can be all the things the drug is trying to treat if you don't.

------
fsloth
I'm taking SSRI:s and going to therapy due to a diagnosed major depressive
disorder. I'm feeling a lot better. I have no idea would I have responded
equally well with or without SSRI:s, but the most important thing for me is
that my symptoms have eased considerably.

I don't really care if there is a withdrawal period at this point. I'm feeling
so much better.

~~~
DanBC
Yes. It's really important to remember that many people get their life back
through medication and therapy.

------
satysin
Note: Not off-topic but not directly related to this exact article. Just
sharing my personal story of withdrawal from an anti-depressant as I am in
withdrawal _right now_. I figure it might be helpful to anyone else about to
or in the process of coming off an anti-depressant. Feel free to get in touch
if you want to talk outside of HN. See profile.

It has been almost three months since I stopped Sertraline (Zoloft) and it has
been hard but I think harder for my wife. I have been a really moody, angry
bastard. Withdrawal otherwise hasn't been too bad. Headaches and bowels for
the first two weeks or so but nothing _awful_ just unpleasant. I think I am
lucky there.

I had been on Sertraline for over 9 years at 200mg/day for most of that. I
decided _two years_ ago I was ready to come off them so I spoke with my doctor
(UK NHS) and we designed a reduction programme. Initially I had hoped to be
off them in ~12 months but with some life events I decided not to "rock the
boat" as it were which is why it is one month shy of being two years since I
first start to reduce my daily dose.

I was on 25mg/every-other-day when I stopped fully. Things were a _little_
more complicated as I moved to France in August of this year so I am not under
the care of my lovely NHS doctor however we discussed this at length and she
and I agreed I should continue with the plan to come off them and I am glad I
did. Worst case I would start taking them again (she gave me two months supply
before I moved) and make an appointment with a French doctor.

Anyway I am happy to say so far everything is excellent. I feel much more
awake. I am not tired _all-the-time_. Honestly I hadn't realised just how
tired I have felt for the past 9 years. I am not complaining as in many ways
Sertraline saved my life, it is just a realisation that in order to get better
part of my brain was being kept not-quite-awake-not-quite-asleep.

However the anger has been an issue. And still is an issue. Before needing
anti-depressants I was pretty chilled out and on them I was much the same. But
now the smallest thing can piss me off like never before. I am _aware_ of this
though so I am trying to process the anger rather than explode. Not in a
violent way just as a miserable asshole. I _know_ I am a moody bastard at the
moment and my wife has been an angel. I know I am not easy to live with at the
moment. But I am trying by being acutely aware of my thought patterns and
emotions. It is hard to stop myself getting in a serious mood though.

However things are getting better. I don't get in a mood for the _whole_ day
because I dropped a fork when loading the dish washer (this seriously happened
back in September!). I am getting better at managing when something angers me.
I think part of it is a recalibration of how my brain reacts emotional to
events.

My doctor did mention the anger issue but put more emphasis on things like
headaches, dizzy spells, diarrhoea, etc. and obviously relapse of depression
so while I was casually aware anger might be an issue it ended up being much
more of an issue than I thought it would be.

As my doctor did not go into much detail over the anger related side-effect I
have read up on others personal experiences and it seems it can take up to six
months to be "back to normal" (for want of a better term) which is fine. I am
already half way :)

I have been keeping an (almost) daily withdrawal journal that I plan to edit
and send to my doctor (in the UK). Not sure if she really wants it but maybe
it will offer some insight into withdrawal. Who knows but I figure it can't
hurt to help. Plus it is quite helpful for me to document it all as I can
track the number of "anger events" and I can see a steady downward trend which
is extremely reassuring!

~~~
eric-hu
Thank you for taking the time to write that up. I transitioned from Zoloft to
Valdoxan earlier this year. I was taking Zoloft for a little over a year, up
to a 100 mg daily dose. It took me several months to taper off from Zoloft. I
remember smoking cigarettes hard and being grumpy and tired. I didn't smoke
habitually before taking Zoloft, but it made the brain zaps more manageable.

I guess I never thought the grumpiness was a withdrawal side effect, I thought
circumstances could just be better in my life. I was just counting down until
I stopped getting brain zaps. I tapered down really slowly. I was down to
taking an eighth of a tablet every other day. Trying to stop entirely before
that (I.e. Stopping after a fourth of a tablet every other day) led to brain
zaps that were just too tiring to deal with.

~~~
satysin
Yeah brain zaps are pretty nasty. I had them when I first started to reduce
the dose. If I remember correctly it was around the 75 to 100mg/day level that
I had the worst/most zaps. Felt like a lightning bolt inside my brain followed
by the a very uncomfortable warmth moving around inside my head. I got pretty
damn concerned about it as it almost felt like my brain was leaking inside and
I thought god what if I had a stroke or something?! Very nasty things.

The reason I wrote my comment was because I wanted to mention the anger as
part of the withdrawal as it isn't something discussed much by mental health
professionals, at least not in my experience. They just briefly say "you might
be more easily irritated" or something vague like that. However it was _by
far_ the biggest symptom of withdrawal I have experienced and the one that has
had the biggest effect not just to me but those around me.

Several times my wife has commented "god you're a moody sod today can't you
just keep taking the damn tablets?!" and without realising the anger is a
side-effect of coming off the tablets I think it would be very easy to get
into the mindset of "hmm maybe I _would_ be better off going back on the
tablets" and so they do just that.

I wanted to say that while the anger is frustrating it does get better. Like
all withdrawals you need to fight through it.

~~~
eric-hu
Yeah I broke up with my (now) ex in that patch. It's been about a month since
I took my last Zoloft, so I'm pretty sure I was experiencing that irritability
as a withdrawal symptom too... and maybe I still am?

This seems like a more insidious side effect, because it didn't _feel_like a
withdrawal symptom, whereas the brain zaps clearly were. I guess I won't ever
know for sure if the fights with my ex were because of withdrawal or
personality incompatibilities.

------
paulrpotts
When I went off Effexor more than twenty years ago, it was very hard. I had a
bad case of the "zaps." It was really disturbing to be walking around just
doing ordinary things and, many times a day, be hit with what felt like a
sudden electric shock. It lasted for over a month if I recall correctly. And
at the time I don't think this effect was well-documented.

------
filmgirlcw
I was diagnosed with Major Depression when I was 14 (but I self-diagnosed at
age 9 and probably first showed signs at age 6) and over the last ~20 years
have had the distinct displeasure of trying dozens of different types of
antidepressants over the years, with varrying levels of withdrawal.

I can't remember the name of the first anti-depressant I ever took -- but I do
remember the migraine headache so bad it woke me from sleep and the inability
to open my eyes -- and when I was able to open my eyes, the inability to see
anything but black splotches because the pain was so intense.

And I remember the first real withdrawal I had, when coming off of Paxil. I
was 14 and I was hot and cold at the same time, nauseated, and utterly unwell.

Most of the time, my withdrawals were staged and designed to taper off -- but
that didn't make them all go away. Some drugs didn't have any withdrawal
symptoms at all -- though in my teenage years as I searched for a workable
medication, that was more often than not NOT that case.

There were drugs that had short half-lives (Effexor being one), where I would
start to feel the symptoms of withdrawal if I took a pill even an hour or two
later than expected. There were others that would sink in only after a day or
two, but be truly terrible.

As a teenager and then college student, withdrawals were terrible -- but in
some ways, survivable. I missed six and a half weeks of school my sophomore
year of high school because of acute depresssion (which was most certainly not
helped by the various withdrawals and side-effects of the drugs my various
psychiatrists were trying on me) and had to take time off in college too. But
at least I had that luxury.

Four years ago, I got into a depression, and stupidly stopped talking to my
shrink, and let my medication prescriptions lapse. I had to go through cold-
turkey Effexor withdrawal, and aside from being 21 and coming off of a
tricylic, it was the worst experience of my life. But this time, I didn't have
the luxury of taking time off of school. I had to go into work each day.

Last year, when I reconnected with my shrink and got back on meds, he was
legitimately shocked I got through the withdrawal. In retrospect, I am too. I
had a boss who was not understanding (I was told "everyone has problems") and
clinicians have compared the type of withdrawal I was going through with
opiates or cocaine detox.

I went back on the Effexor last year but earlier this year, decided to switch
to something else. It took MONTHS to actually come off of it -- even at its
lowest dose. I honestly cannot believe I did it cold-turkey last time.

The worst part? As terrible as the withdrawal is and can be -- for me, it's
still better than the alternative -- which is not be on a medication that
works and to suffer a debilitating depression, which is honestly, even worse.

~~~
loceng
Thank you for sharing that. I feel it's important more people share their
stories. I am planning to write a book to share my experiences including the
solutions I found that helped me, the problems with the healthcare system that
I have encountered along the way, and my proposed solutions for that as well.

I am grateful to be able to say I survived and learned my lesson regarding
medications in my early 20s (35 now), after an SSRI caused me to develop
severe hyperacusis (hypersensitivity to sound) - where I could hear at -14 Dbs
at different frequencies, could hear through a soundproof sound room, etc. I
was in what I considered a torture state for 8 months, after which I had years
of post-traumatic stress from the experience to try to deal with - which is
mostly what got me into yoga.

Prior to that a different medication had given me intense burning sensation
through my body, however the doctor to counter that (not believing me either)
just put me on 4mg of benzodiazepine per day - which eventually the burning
sensation caught up and surpassed the numbing of the benzos. I had other very
negative experiences from medications. They all made everything worse - with
doctors not listening, while essentially lying and continuing the medication
experiment on me - until I stopped trusting doctors. There is a very real
problem of indoctrination and of industrial complex influencing the healthcare
system including inherently being integrated into the education system.

The first medication I was put on was at 17, it's always shocking to hear
about children and young teenagers being medicated - and I know it's common
that medications are the first thing tried without even much basic testing
other than to do blood work to see if nutrient levels et al are within a
normal range.

I have a complex history more than relating to depression. I had been
diagnosed with depression - though I later learned from my own research and
seeking answers/solutions - my depression was caused by a disconnect to
emotion/a developmental block likely caused by painful childhood ear
infections, and that was only unblocked through a sound therapy called
Auditory Integration Training; at 1,000 Hz frequency if a person has an
imbalance showing there then they 100% will be depressed: medication won't
help them, talk therapy won't help - they're just stuck in that state. There's
a book called "Hearing Equals Behaviour: Updated and Expanded" that shares the
science, case studies, research on it all. The neat part is you can do a
diagnostic through an audiogram and get concrete evidence of the imbalance
before actually doing the sound therapy - and it's non-invasive and it will
help development continue properly for at least 6 months - so you continue to
get improvement.

There were also food sensitivity issues that caused some of my problems, one
of those foods being wheat - where interestingly there is also an association
to wheat and ear infections. Wheat fully acts like an opiate for me, where if
I had even a single slice of bread made with wheat within 20 minutes I'd start
to feel relaxed/almost euphoric - and then within 45 minutes I'd start going
through withdrawal, irritated/irritable; imagine eating wheat (hits of an
opiate) 2-3 times per day during your body-brain development, and how that
could impact development of your nervous system/brain. It was in fact the
audiologist who helped me with the hyperacusis who told me to stop eating
wheat, and so eventually once I was healthy enough and not eating it - I could
really notice the impact of when I would accidentally eat it.

My journey of pain and suffering unfortunately didn't end there though with
medications. Fast forward to about 3 years ago, skipping plenty of details: as
I did more and more holistic health practices I eventually stumbled into
Ayahuasca ceremonies. Ayahuasca is considered a plant medicine and my overall
experience is that it is healing. Many people describe a single ceremony as to
being the equivalent to 100 therapy sessions - for how much emotion you
process in a single night, the insights you can gain about yourself, your
environment, the universe; Ayahuasca's main mechanism is breaking down the ego
mind, meaning that it can breakdown layers of coping - suppressed/repressed
memories - while having you in an environment and state that allows you to
process those emotions/experiences that at the time of the
suppression/repression the person wasn't able to process them for whatever
reason. I had emotional benefit from the ceremonies - among giving me clarity
on , unfortunately I wasn't only exposed to emotional pain - however I was
also exposed to physical pain from a series of old injuries throughout my life
- starting at the age of 5 or 6.

The past few years I have been slowly healing the pain mostly through stem
cell injections. It's been a slow process for a few reasons, partly that
regenerative medicine is relatively new - and because my case seems to be
quite unique and how debilitating/disruptive the amount of physical pain I had
severely impacted my executive function. I'm normally in Toronto and area,
though currently in San Francisco to pass some time and be in a warmer
climate, needing to wait another 2 months for the next stem cell treatment in
Colorado; it's hard to quantify though the last treatment I had ~2 months ago
reduced the pain overall by ~60%.

It looks like we already follow each other on Twitter - can't remember where
we know each other - maybe through AVC or where we would have met? I remember
your name though! Maybe it was at a Mashable conference many years back..

------
the_jeremy
anecdotal counterpoint to the anecdotal issues: I've tapered off Prozac,
Wellbutrin, and 1 other SSRI without problem.

~~~
loceng
Age, dose, length of time on it, the person's natural sensitivity level, and
other factors will certainly factor into how a person responds to getting off
of a medication.

------
ArrayList
Another really scary thing about SSRI usage is post-SSRI sexual dysfunction
(PSSD). It can be permanent. Google that and read, it's a nightmare.

------
choot
I was on flux. Then i dropped it and started taking withania somniferia 500mg.
I've nearly same effect.

~~~
GordonS
For others reading this, you probably know this as ashwagandha.

~~~
contingencies
Fascinating to see the difference between English and Chinese wikipedia
content on this species.

------
poelzi
I suggest searching for a phage that infects this bacterium.

