Withdrawing from antidepressants and benzos safely

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Since there are so many folks on here trying to get off of antidepressants and benzos, I thought I'd start a topic about tapering safely.  patient is an awesome place to start, but the following resources are the true beginnings of proceding safely with factual information, not hearsay and opinion.

1)  http://www.survivingantidepressants.org

2)  http://www.madinamerica.com/psychiatric-drug-withdrawal/#/home/

That said, never COLD TURKEY (stop taking) any of these meds!  And also consult with your doctor about your wish to get off.  Now, 99% of docs and psychiatrists no nothing of how to safely get you off and will think that the following info is excessively conservative.  They are happy to hand out these drugs like candy but don't have a clue about how to get their patients off successfully!  Just tell your doc you'd like his supervision and scripts for meds but that you would like to take the slow approach to gettting off.

Many folks are desperate to get them out of their system as quickly as possible. Unfortunately, the rare few do so without problems.  As hard as it is to be patient and slow, it truly is for the best to follow the recommendations from the sites above.  Many have declared they could tough it out, but most fail.  Those who do push through usually end up in protracted withdrawal for a year or more, and we're talking debilitating suffering with folks unable to work, leave the house, care for the kids, etc.  There's no award for toughing it out.

Since few truly understand what is going on with taking psychiatric medication, I'd like to give a simplified explanation below.  This is not a discussion about why you should go off medication; everyone is entitled to their own choice in the matter.

The most common falacy about psych drugs is that they work by correcting an imbalance in brain chemistry.  The fact is, there has been no evidence found to support this hypothesis thorugh research - NONE!  Just ask your doctor for some citations to literature proving this!  They can't!  There are people with depression who have high levels of serotonin!  However, the medical profession continues to perpetuate this belief, in part to get their patients willing to take the med.  We are much more compliant if we believe that our brains need these drugs for similar reasons that a diabetic needs insulin, but there is no truth to it!

There seems to be a common misconception that the main thing to getting off these drugs is to get the drug out of your system and then all will be well.  It doesn't work that way.  Psych drugs work by interferring with how the nervous system works, impacting neurons and neurotransmitter levels.  SSRIs, for instance, block the uptake of serotonin in the neuronal gap by occupying receptors and causing an increase of serotonin in the gap.  Initially, this imbalance, among other changes, causes the side effects people encounter while going on these meds.  Meanwhile, we are told the meds won't start working for several weeks.

What happens next is that the body likes homeostasis, and so the nervous system sets about countering this new imbalance by adding or subtracting receptors (a simplified explanation), essentially remodelling the nervous system in an effort to return to your "factory default."  

An interesting fact is that many SSRIs occupy about 80% of receptors at the MINIMUM dose!  And from there, no matter how high a dose you are put on, the maxium occupany is around 93%!  So, on one of the drugs I am on, Effexor, there is only a 12 or so percent increase between 37.5 mg and 225 mg!  I am theorizing that this is in part due to the brain always needing to have a few on-occupied receptors on hand to take up that excess serotonin, otherwise we'd be suffering serotonin poisoning!  So, it's like an arms race!

Anyway, as you can imagine, the longer you are on these drugs and the higher the dose, the more set your system becomes in its new configuration, and all of that will not be undone in the mere 6 weeks most doctors have their patients taper over to come off.  If you have been on a drug less than six months, you may be able to get away with these fast tapers, but if you have been on longer than a year or YEARS, there's no way.

Now, as I said before, once in awhile you will meet someone who did a cold turkey, completely stopped, or did a fast taper and had no trouble at all.  They are the lucky few.  Those same folks might go back on the drug later, and then when they try to quit again, they run into a whole heap of trouble! That is because their system has become sensitized.

I often wonder if in reality, then ended up going back on the drug because they in fact did have withdrawal and didn't realize it, thinking they had relapsed.

In addition to the resources I listed above, do a web search on antidepressant withdrawal symptoms.  There are a host of physical symptoms.  80% or so of the serotonin in your body exists outside the brain, and there are receptors in your gut, so this is why people get nausea, diarrhea, irritable bowel syndrome, cramps, etc with these drugs, both in going on and coming off.  In addition to the physical, withdrawal causes anxiety, suicidality, depression, and insomnia, the very same symptoms that people take drugs to treat to begin with!  Rather than recognize it as withdrawal, the patient and/or doctor think it is a relapse and so go back on the drug or some other drug.  This is often because the emotional withdrawal symptoms are delayed to around the six month mark.  Just as a note, there are many patients put on ADs to treat pain, never had anxiety or depression, who have anxiety and depression in withdrawal, proof that it is due to withdrawal and not a relapse!

When you start tapering by starting with half your dose, that is a 50% drop that your nervous system must adapt to.  As with adapting to the drug, there is now a huge imbalance again, and this leads to the withdrawal symptoms!  If you then cut that half pill in half again a couple of weeks later, that is yet another 50% decrease over the previous 50%, in far too short a period for your system to even adapt to the first cut, so it's the same as cutting by 75% all at once!  It is no wonder that so many people fail to get off these meds and reinstate, declaring that they will never come off again!  It is a sad thing that a person would stay on these drugs for life to avoid the hell they went through trying to come off!

Once you get down to below the minimum therapeutic dose, you are dropping below 80% occupancy, and that's when the trouble can REALLY begin!

Survivingantidepressants and other withdrawal authorities advocate a 10% taper schedule.  This may seem painfully small. The goal is to make such a small change that your nervous system will hardly "notice" it, so the withdrawal symptoms are also less noticeable and disruptive.  Now, you may be saying to yourself, "But, my pills can only be broken in half - how can I do 10%?"  The resources I listed give information about that.  Some drugs are available in a liquid version that can be measured with a syringe.  I am not going to go into the how-to's of tapering here; you can look to the resources given for that information.

What I do want to add here is that the reasons people run afowl with their attempts to taper off these drugs are, among others:

1) making a cut when still suffering from withdrawal symptoms.  You must wait for a period of stability before making the next cut.  SA recommends 10% PER MONTH.

2) making too large of cuts.  Again, 10% is advised, and some are so sensitive that they must do 5% or less.  And, this is 10% of the PREVIOUS DOSE, not the starting dose.

3) taking other prescription drugs to treat withdrawal symptoms, such as sleep or anxiety meds.  These also impact your neurochemistry, complicating the issue and causing further disruption. Many have caused withdrawal to worsen by doing so.

4) taking supplements to treat withdrawal symptoms, or over-the-counter meds.  Problematic for the same reason as #3.  The only supplements recommended are:

- 2 grams or more fish oil/day

- magnesium to help with anxiety and sleep.  Magnesium chelates tend to absorb better and not cause digestive issues.  Epsom salt baths and topical magnesium may be helpful, too

Some foks find a lot of supplements, and even foods, activating, worsening anxiety, for instance.

Reinstatement

If you are already off your drug and in protracted withdrawal, it may be helpful to reinstate a small amount of drug to aleviate symptoms.  SA has a lot of info about that, and the longer you have been off the less likely this will work.  You can try taking 1-2 mg of the drug and see how you feel.  It should help right away.

Do not look at reinstatement as a failure.  If you are suffering greatly in your day to day, only getting a couple of hours sleep, feeling hopeless like you can't go on like this, then reinstatement is the kindest thing you can do to yourself, provided it works!

 

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  • Posted

    Very informative read.  However, your nervous system includes your BRAIN.  The neurotransmitters are in your brain.  These drugs do impact our brains and there is research to prove that.
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    • Posted

      That's right, the drugs do impact the brain.  The remodeling occurs everywhere there are neurons, which includes the brain.  What isn't proven is that depression is caused by an imbalance in neurotransmitters.
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  • Posted

    I should add that after doing a reinstatement, you can then do a more gradual, sane taper from there to get off completely.

    Talk to your doctor about getting a liquid form of the drug so that you can dose much smaller cuts with a syringe.

    If you need help with tapering, please feel free to contact me through replying to this thread; I would then get an email notificaiton.

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    • Posted

      HI Betsy - Thanks for all the info on here its really informative. I just wanted to get some of youadvice if thats ok. I starting taking Venlafaxine a bout a year ago and have been trying to come off them for a few months. I was having night sweats every night to the point where i had to change sheets and clothes inthe middle of the night, althoight they really did help with my anxiety i didnt like this. I was on 37.5 mg and i was told by the doctor that they didnt come in smaller doses. I went on to every other day for about 2 months and then on to every 2nd day and now im taking every 3rd day. I am feeling ok mentally, a little depressed because of my situation, but strangely on the 3rd day without taking the meds i get nausea. Im wondering if this can be related to the lack of meds - i really want to come off them and am not sure where to go from here? thanks so much in advance for any advice. Sarah x
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    • Posted

      Did you find anything to work. I've been off effexor after doing prozac bridge that didn't work. Going through withdrawal bad. Please help

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  • Posted

    This is a wonderful post - thank you. I just wish I'd read it before stopping these meds almost 3 weeks ago!

    I was prescribed them last December for anxiety and depression and they really did help. The 20mg dose was perfect for me and I’m so grateful for that. I also eliminated the root cause by taking early retirement from teaching. I felt amazing and have over the last 3 months tapered down to 10mg every other day. It's been almost 3 weeks since stopping and the physical symptoms kicked in this week - dreadful tightness and painless cramps in my upper abdomen and tearful days.

    I have a wonderful life and meditate daily but just can’t understand these dreadful physical symptoms.

    Has anyone else had these strange tingling and stomach cramps?

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    • Posted

      These are withdrawal symptoms, Hayley.  How long were you at 10 mg every other day?  Alternating days is not a recommended taper strategy for the fact that one day your brain is at zero and then the next day at the full amount again.  I believe your taper was too fast and steep.  

      The good news is you can still reinstate 10 mg, stabilize and then do a much slower taper that will be more comfortable.  You were on the drug for a year so your system will need a more gradual reduction to get back to normal functioning.  Going off too fast can lead to a building of WD symptoms that can get worse the longer out from the drop rather than getting better.  So, I strongly encourage you to reinstate and then do a more gradual taper.  You can get lots of help from the support forum Survivingantidepressants that I put in the withdrawal post you mentioned.  They can advise you on the details of how to do this with.

      Good luck!

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    • Posted

      I just rethought this, and again, how long were you doing the every other day with the 10 mg?  If you are able to break a 10 mg in half, you might try that every day.  Depending on how long you were doing that, your system may have remodeled to a degree in which case 10 mg might be too much!
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    • Posted

      Betsy, thank you so much for replying. My family think that after 3 weeks it must be out of my stystem - today however I thought my upper abdomen organs were going to explode. I've never been so scared. 

      After reading your reply I have taken a 10mg dose and actually feel very relieved to hear that they are withdrawal symptoms. I reduced to 10mg every other day for two weeks before stopping. 

       

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    • Posted

      I hope that that 10 mg gives you some relief.  Everyone thinks that the drug only works while in your system.  What they don't realize is that the nervous system actually remodels around the action of the drug.  SSRIs block the receptors for serotonin, for instance, leaving a higher amount of serotonin in the gap between nerve cells.  The body wants homeostatsis, so it starts adding more receptors in an effort to absorb the excess serotonin.  This process takes time.  Then, when the drug is out of your system, it is no longer blocking those receptors, and so there is too little serotonin in the gap because it is getting resorbed too readily by all those extra receptors that were made!  Now the system must prune back the number of receptors.  That again can take a lot longer than anyone expects.  It's an over-simplified explanation because the level of serotonin also affects the regulation of a bunch of other neurotransmitters, enzymes, etc.  So, there are reverberations throughout the nervous system when you tweak one thing.  So, all of these keeps going on even though the drug is gone.  I hope that helps your family "get it."  It is important that they understand what is going on so that they can support you :-)

      Good luck and I hope your symptoms are aleviated.  Keep us posted here on how that worked.  I just hope it wasn't too big of a dose given the conditions; now you can see why maybe too big of a dose can swing you in the other direction!  Plus, there is the norepinephrine situation as well with Effexor.  Sometimes withdrawal can mimick the start-up side effects because it is the same process in reverse.

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