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

    This is a most informative and helpful post 😊 I'm currently tapering from 50mg which I've been taking for three years. I have now got down to 25mg daily after tapering slowly. I feel pretty rubbish currently, emotional, over sensitive, moody and unmotivated 😞 I am going to stay on 25mg for at least a month to stabilise on that... Any suggestions on what the next reduction should be?? I'm beginning to wonder if it is possible to get off sertraline?!
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    • Posted

      Hi Rachel, thank you and I'm glad I was able to give you some guidance.  I recommend joining the Surviving Antidepressant forum because they are so informative and give such great guidance from experience, and there are many there who have been through the process with your particular drug.  Yes, it is possible to get off of sert, but how you proceed from here will make or break you LOL!

      So good, you can see that even now you are having withdrawal so yes, hold at this dose for a month minimum.  The ideal is to have a good solid month of feeling NO withdrawal after the ups and downs you've had, only tapering when you are on solid footing.  Then, to minimize the risk of future upset, the ideal is to taper no more than 10% of your previous dose for 3 to 4 weeks before the next taper.

      We recommend keeping a journal of everything from dosages, when you make a cut, how you are feeling each day,  and any other changes.  The only supplements that are recommended are 2 g of fish oil/day and magnesium (glycinate is a very good version). Some take B vitamins but others find it too activating.  After you have journaled awhile you will start to see a pattern of when after a cut you have any symptoms, and that way you can know what to expect from future cuts. 

      The next thing to know is that as you get into the lower dosages, the same size cut will have a bigger impact.  The minimum effective dose of many SSRIs causes 80% receptor occupany (blocking 80%), so when you start getting below that dose, suddenly a lot more receptors are unblocked.  It may become necessary to make cuts less than 10% depending on how you are feeling.  The other thing to know is that if you decide to just take a chance with a bigger cut and you have big upset from it, reinstating to the previous dose may no longer work because your system has become so sensitized.  I've read many horror stories to that effect.  It is much safer to go too slow than to risk that kind of situation!

      I think you have to create an account to surf around SA, but once you, go to the "tapering" topic and then enter sertraline in the search box up above.  It will bring up a bunch of results but one will be "How to taper sertraline..."

      I hope this helps!

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    • Posted

      Hi, I only managed to take 50mg for 6 days due to horrible side effects I couldn't take. I felt 50mg was to much for me, I forgot to take one and felt better the next day and them days have now tuned into a week now, It's just worried me that I stopped after only 6 days, would it of had any impact on me? I'm wanting to try something natural as I don't respond very well to ADs, im back at the doctors tomorrow I hope my gp is understanding. I only suffer with anxiety and it got a bit much to handle but then since stopping the medication I've managed to overcome some of my fears, as I fear sertraline so much.
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  • Posted

    I will add that in addition to the fish oil and magnesium, another supplement that has been garnering attention is inositol.  Buy it as a bulk powder.  It is a B vitamin that has a calming affect.  It is sweet, so goes well with tea, coffee, juice, etc.  12 to 18 grams a day, spread throughout, is about 1.5 tsp, I believe.  
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  • Posted

    Thank you very much for this posting.  My doctor thinks withdrawal symptoms are in my imagination as a result of having read about them on the internet.  What you say makes sense to me as it fits with my experience.  Wanted to come off venlafaxine because excessive sweating makes me so uncomfortable I don't want to go out.  Feel very trapped between knowing I am now pretty depressed as a result of withdrawal to half my usual dose but don't want to up my dosage again for fear of having further to come down eventually.  Will get some supplements tomorrow as it seems the one thing I can do to help myself, and otherwise feel so helpless.  Talking to other people mostly doesn't help, or only for a short while.
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  • Posted

    Hi Betsy,

    Being over 60, I have lots of experience being on and withdrawing antianxiety/antidepressant drugs....I quit Prozac 40 mg. cold turkey 2 months ago and had my usual symptoms; nauseau, shocks etc. Last week, I started experiencing intense body pain at night; the pain is never in the same area; can be legs, wrists, underarm, fingers. I have never experienced this before and am very afraid. I've considered MS, Lyme Disease,bone cancer... Could this be related to withdrawal? Thank you!

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    • Posted

      Yes, muscle and joint pains, sharp mystery pains, and muscle twitches/spasms are all common in withdrawal.  We read about it all the time on the withdrawal forum.  People get tested up one side and down the other for this stuff and always come back as "normal."  The more times you go on/switch dosages/change meds/go off/go back on with these drugs, the more sensitized your nervous system becomes to future changes, and withdrawal is more likely.

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  • Posted

    Thanks for posting this thread. I would like to share my experiences withdrawing from antidepressants.

    I had been taking them for a year, but had to stop as they were giving my some very adverse effects (hostility, hyperactive, racing mind, I would go on crazy rants, verbal aggression), and as I wanted them out of my system immediately, I stopped cold turkey (NOT recommended). This was a year ago (to the day in fact) 

    1-2 months: flu like symptoms, extreme tiredess, shakes, brain zaps, cold sweats, vertigo. Tbh I have little recollection of those months, but it was not far off like the scene in the film Trainspotting. I even nearly went back to taking the ADs as it felt like an addiction.

    2-4 months: severe mood swings, tearfulness, angry outbursts, insomnia, I felt like I had damaged my brain, foggy minded. I started taking omega oils, magnesium, krill oil supplements, and Sharp Mind tablets (from Boots) 

    4-6 months: still emotional, up and down, physical symptoms all clear, went to CBT but I couldn't take any of it in, very hyper, restless, incredibly hostile, resentful, bitter. 

    6-8 months: anxious, paranoid thoughts (like being watched, fear of people overhearing my conversations, being spied on with hidden cameras), nervousness, overthinking. 

    8-present: still changeable moods, but my mind feels like it's stabilised to how it was before I took the ADs, I now cringe looking back at some of the mad s*** I did last year when on the ADs. I'm over the paranoia as well, one thing I did learn from CBT, monitoring thoughts and questioning how factual they are. 

    Thing is, people may say I might have relapsed into depression, but I don't feel it, I'm genuinely enjoying things like socialising, hobbies, I'm working, dating, etc. 

    I'm not even sure I was clinically depressed in the first place, it feels more like reactive depression to a series of sh**y events in rapid succession. 

    I think the thing I feel sad and upset about is that I didn't feel supported, especially by the medical system, there's absolutely NO after care, or check ups, reviews, I felt like I was left to my own devices to deal with it, even to be told what was happening to me, I had to figure it all out on my own .... that it was purely the withdrawal symptoms, and not me going crazy. 

    Then again, even the doctors themselves told me the NHS was terrible, understaffed, badly run, inefficient, etc, so I can't blame them, or anyone really. It's just life. 

    Thank goodness for my tendency to 'overthink', which led to a ton of googling and extensive research, leaving no stone unturned, otherwise I would have probably thought about topping myself. 

    Hope the above helps! 

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    • Posted

      I should also add that I was originally put on 20mg Citalopram, but had to reduce it to 10mg, as 20mg was far too strong for me, I couldn't function and I was too unfocused, I could hear myself talking but my brain wasn't registering what I was saying. 

      Probably around 3-4 months into it, I switched to hyper mode, hostile, aggressive, bitter, etc. 

      So I told my docs this, and they switched me to 20mg Prozac. I only took it the once, and I had some kind of weird meltdown, it felt like a bad trip. Intense anxiety mixed in with intense aggression, and my insides felt like they were melting. 

      That's when the docs told me I had to come off ADs full stop. They did tell me to taper off gradually, and put me back on 10mg Citalopram, but by that time I had had enough, and just went cold turkey. 

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  • Posted

    Hi betsy...fantastic write up!!heres my story of how the medical side messed up in a big way with me...I was Paxil for 3 years at 40 mg,they pulled me off them in 4 weeks!!they gave me diazpam to help with the with drawals...8 month of Paxil,but now am stuck with a diazpam addiction.at times I am questioning my own sanity.do you think 8 month off the Paxil would be a bad idea to reinstate??am having waves an Windows a lot!!my doctor is wanting me to taper 1mg every fortnight off the diazpam..I do not think my mind an body can cope with this!!any advice would be appreciated thank you....am really scared an am a single mum with no family xxx
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  • Posted

    Hello Betsy,

    Where can i find the recommended tapering schedule. My dad came of Prozac cold turkey after taking 10mg a day for about 10 years. He is currently suffering from many withdrawal symptoms the worst being insomnia. Thank you

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