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    "Our job in this lifetime is not to shape ourselves into some ideal we imagine we ought to be,
    but to find out who we already are and become it."
    Steven Pressfield, posted by David Baxter

David Baxter

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Health checkup: Stopping antidepressants
July 5, 2006
by Jane Sundberg

Abruptly stopping the use of antidepressants ? by missing a dose, forgetting to get a prescription refilled or deciding on your own to stop the medication ? may trigger unpleasant physical and psychological symptoms. This can happen with the newer classes of selective serotonin reuptake inhibitors and selective norepinephrine reuptake inhibitors, and the older class of tricyclic antidepressants.

Clinical depression affects 10 million to 14 million Americans annually. Many of these individuals are treated with antidepressants, which boost the levels of brain chemicals. Antidepressants also are used to treat social phobia, premenstrual syndrome, panic attacks and obsessive-compulsive disorder.

But suddenly stopping the medication can lead to a constellation of symptoms.

Patients most typically experience gastrointestional distress; headaches or lethargy; sleep disturbances such as insomnia and excessive dreaming or nightmares; and anxiety, agitation and low mood.

Studies have shown that discontinuation symptoms are common among users of tricyclic antidepressants. About 55 percent of patients who stop Tofranil, 80 percent who stop Elavil and 33 percent who discontinue Anafranil will experience these symptoms.

In addition, patients who suddenly stop taking SSRIs (Zoloft, Paxil, Celexa, Lexapro and Luvox) or SNRIs (Cymbalta and Effexor) can experience balance and sensory abnormalities. Dizziness and a feeling of disorientation can sometimes impair coordination to the point where a person can't drive.

Sensory abnormalities include numbness and the unusual sensation of electric shocks, particularly in the head, neck and upper limbs.

The acronym FINISH may help you identify the symptoms: flulike, insomnia, nausea, imbalance, sensory disturbances and hyperarousal.

These reactions usually start within a day after stopping any antidepressant therapy and are more common with longer courses of treatment.

The symptoms usually go away in a couple of weeks, but if therapy is resumed, the symptoms will stop almost immediately. However, when people are off their medication, their initial illness is likely to resurface.

To avoid these symptoms or a relapse of depression, never abruptly stop taking your medication.

Consult with your health care provider about whether you should discontinue these drugs and if so, how to proceed.

Jane Sundberg, doctor of pharmacy, is a psychiatric clinical pharmacist at Strong Health's department of pharmacy.

Caution:
As this article explains, antidepressants should never be stopped 'cold-turkey' but weaned off gradually. Dr. Richard S. Shelton's article Discontinuation of Antidepressant Therapy (pdf, 45KB) is a good guide to minimizing the side effects of discontinuation. Do not stop taking medications without first consulting the prescribing doctor.
 

Halo

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I found this article very interesting Dr. B. Thanks for posting it. What I found that really caught my attention was this part:

Abruptly stopping the use of antidepressants — by missing a dose, forgetting to get a prescription refilled or deciding on your own to stop the medication — may trigger unpleasant physical and psychological symptoms. This can happen with the newer classes of selective serotonin reuptake inhibitors and selective norepinephrine reuptake inhibitors, and the older class of tricyclic antidepressants.

I do have a tendacy to forget to take it on weekends as my routine is so messed up however during the weekdays I take it like clockwork. I never thought of forgetting to take the meds as possibly attributing to side effects. I guess I will have to "try" and remember on weekends.

Thanks again for the info.
 
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David Baxter

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Some of the SSRIs/SNRIs are worse than others in this respect - notably Paxil and Effexor (although Effexor XR is a bit better).
 

Halo

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I have to say that yes for me the affects of withdrawing from Effexor was major. When I was taking it, I knew by mid afternoon if I had forgotten to take it because I always got a major headache. That normally reminded me to take it. :)
 

foghlaim

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i found this article interesting also, because my time schedule has changed, i forge to take them on time, i do take them if i know htat the time between doses is going to be roughly the same as when i used to take them on a clockwork basis.


thanks for the warning Dr. b i was actually going to as about this but you have now answered it i think.

thank you for posting this.

nsa
 

Holly

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Hi everyone,
Very interesting to read, and I am surprised at the numbers involved with people who stopped antidepressants 55% wow, higher than I expected to read!
Thank you for the information Dr. Baxter :)
 

momof5

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Wow, never thought about things that could happen when you stop any medication.

I guess I am lucky as when I went through the gal bladder stuff when liver enlarged, and I had pancreatits a few years ago, the dr that was attending me said it could be related to the amount of meds I was on. Sooo, I stopped all meds without telling my dr for a few months.

(I was on twice the mix of meds then I am on now) Zoloft being one of them. Though I was on the lowest dose, I didn't notice any problems when I did this. Not saying that I did not go through anything, but I just did not notice it at the time. I was more frightened of my liver problems then anything else back then.
 

foghlaim

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Momo5: i am assuming that yur liver prob was sorted, and that's why you can take your meds now.
My daughter had to be taken off her meds because of liver probs as well, but at that time the meds were just starting to afect it. it she said it was a drug called amytriptilene,(sp) that was the culprit to, even so all her meds were stopped, oh and her painkillers also were a contributary factor as well.
Now tho she finds it hard to cope some days as when she comes in from work she is exhausted and sometimes very low in herslf. She gets on very well with her g.p wich is good and the gp continues to minitor her thru blood tests on a regular basis.
this happened a while ago and i could tell the diff straight away in her moods. I hope that one day she will be able to take at least her painkillers as she is in constant pain.

i think yu were very lucky not to have noticed any prob when you stopped your meds..
and i'm glad to hear that you are now able to take your meds again.

take care

nsa
 

momof5

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My liver is still slightly enlarged, though they don't know the cause of it. They are monitoring me.

They found this out due to wanting to put me on additonal cholestrol medication. I told them about the liver and they did an mri which showed it is slightly enlarged. so, no additonal cholesterol meds, just the one that I am on right now which suposedly isn't bad for the liver.

I do take pain meds, but I also watch how much of them I take. More due to these being the last thing before morphine for the pain, so I work at trying NOT to take as many. I do have them on hand and when it gets too bad I take them.

I'm so sorry that your daughter can't take them, I am not sure how I would make it if I didn't have them to numb some of the pain. Doesn't take it all away.
 

foghlaim

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this appears to be the thread to write this...

i have begun to taper the effexor and lithuim... so far all okay.. tho when i wakke first thing in the a.m's.. my system is shaking reall bad.. wears off after a while tho T.G.

will return to this thread if i notice an untoward side effects of the tapering.

nsa
 

Sky

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Hi all!

I take "topamax". It is a VERY expensive medication. I'm currently taking 250mg. (I deal w/ OCPD and cyclothymia). My meds WITH INSURANCE are about $170 a month but since my dose is increasing this WILL go up! ANYWAY. Usually I go off this med here and there because I get frustrated with the FREAKEN HIGH PRICE....you know...in this day and age you start to feel like if you are not rich....you don't get to be sick....even with insurance......but ....I digress and vent. At any rate! ...........I speak from experience. NEVER just up and decide to go off meds "cold turkey". Work with your doctor and taper off slowly. Topamax is one that you should especially not mess around with. I have done this before. Just said "to hell with it...what's the worst that could happen"? Damm near ended up in the hospital...that's what! I literally began to feel like someone took a baseball bat to the back of my head. I could not breathe well. My chest felt heavy. I was sick...diarehhea. That was after the 2nd day. (3rd?) It was about 3yrs. ago that I tried that. Since that time....now when I get frustrated and decide....gee...I have to quit....I work w/ my dr. and we taper me down slow. Topamax is a med that even when you decide to go back on you need to go up in incriments ...you can't just start out at say 250mg.....in other words, your target dose. I start out at 50mgs. and work up. A few years back I needed to be at 400mgs. (yeah...almost $300 a month in meds WITH insurance!) ...this time I'm doing ok at 250mg. ...for now ...lets hope it stays that way).

Sorry...I know my thoughts are all over the board on this issue. Bear with me please....that's part of my cyclothymia where my thoughts just scatter. Hopefully this will subside a few weeks and I can better stay on topic. At any rate....point being here.....work with your doctors and if you feel you want to stop taking a med....be it you want to switch meds or you just flat out want to stop meds altogether....I encourage you to work with your doctor. Every med is different. Yes. There are some meds out there that you can simply stop taking. But TALK WITH YOUR doctor and make sure that you are infact taking a med that works that way. Most meds you need to wean yourself off slowly. And your doctor will be able to tell you what slowly equates out to. Is slowly in YOUR CASE one week or one month, etc.
 

foghlaim

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have tapered the meds now and not doing too bad...
was on 400mgs of lithuim originally.. doc cut this to 200 and i cut it again to 100,mgs. was on 325 of effexor.. doc cut this to 300 and i cut it to 225.
next week will halve them again and the week after cut them out.

still have the stupid tremors but used to them by now.. maybe i'll even miss them when they gone..NOT!!

anyway that's where i'm at.

nsa
 

Halo

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I noticed that you said that your doctor cut the dosage and then referred to cutting it down even more yourself. I was just wondering if you were doing this upon his advice or just taking it upon yourself to do? Please be careful and I would strongly recommend that you speak with your doctor about the tapering off yourself and whether it is a good idea.

Please take care.
 

foghlaim

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HI Nancy.. cutting it myself... i'm being careful.. and tapering down..

will leave docs out of it cause i know they want me to stay on meds for a good while yet.. but i don't want to so i'm not.. if however it transpires that i need them again i will go back on them... rest assured okay.

:)
nsa
 

Halo

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okay, NSA please be very careful with tapering your meds. Although you don't want to be on them forever I think that maybe at least discussing it with your docs wouldn't be a bad idea and telling them what you are doing in case something goes wrong and you need their help.

I am just worried about you and that is all. :)

Please take care and don't rush into decreasing the meds too fast.
 

David Baxter

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nsa said:
will leave docs out of it cause i know they want me to stay on meds for a good while yet

There's a reason for that, nsa. These medications take time to do their work. You may be feeling better now but your system has not been on the medications long enough to be able to maintain the gains. Going off them too soon will almost certainly precipitate a relapse within a few months. Generally, I advise clients that they need to remain on these medications for a minimum of a year to a year and a half, sometimes longer.

You are not doing yourself any favors by going off them too soon, believe me. It will very likely mean just starting over again in a few months.
 

^^Phoenix^^

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Nsa - it may take you a while to feel the effects of getting off your meds too soon - I thought I was fine, came off the meds and felt great for three whole months. Then all of a sudden BAM! instant anxiety - and harsh anxiety where i was terrified all of the time, full of adrenolin for weeks, until My doc finally put me back on them. Then, ofcourse, they still took two weeks to become effective again. I would have to echo the general consenses and suggest a rethink about stopping unless you have been on them for at least a year. While you are on your meds, your brain takes that length of time to re-assimulate your natural chemicals. If you come off them too soon, you haven't given your body the length of time it needs to relearn the levels that you need to function normally.
 

ThatLady

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It might do you some good, and give you a better understanding of how the medications are helping, to go back and read some of your early posts here, nsa. The positive changes since you've been on medication are very obvious to me and, I imagine to others here. While nobody wants to take medication for the rest of their lives, in most cases that's not necessary. The medications help your body learn what it's supposed to do so that it can begin to do it on its own. Well worth the investment of time and "pill-popping", in my estimation. Sure made a difference for me, and I'm now medication free except for the occasional 0.5 milligrams of Xanax when life decides to gang up on me. ;)
 

momof5

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I really caution anyone against going off their meds on their own. Even though you "think" that you are doing ok, you might not be.

Not to mention the problems it could cause within your body, not just physicall emotional stuff.

Please be careful, Doctors do what we pay them to do, watch over us and take care of us, otherwise we would be the ones getting paid the good money ;)
 

foghlaim

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thanks everyone for the concern shown here.. i mean that.. while i still intend to come off the meds.. i will stay on the dropped doses for another week and see how things are.. if still more or less the same.. i will drop another wee bit. not doing anything too suddenly.. i'm aware of that pitfall all too well..

i'm sorry if ppl got alarmed\worried... I do know ye care.. and i really do appreciate it.

thanks again.
nsa
 

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