![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 4 to 28 of 28. Go back in thread:
Posted by Nathan_Arizona on June 27, 2007, at 14:14:36
In reply to problems after quitting SSRI's, posted by jessers11581 on June 27, 2007, at 7:37:44
I came off of prozac ~3 months ago after a long long washout.
I, too started to experience anxiety - I would call it mild to moderate for the first two months after my last dose. Klonopin as needed did wonders for that. And now, after several weeks off klonopin I feel good.
However, the depression is just gone.I still keep the klonopin around just in case.
But it took awhile to normalize.
Good luck.
Posted by mike lynch on June 27, 2007, at 23:23:26
In reply to Re: problems after quitting SSRI's, posted by Nathan_Arizona on June 27, 2007, at 14:14:36
SSRI's left a long lasting mark on me that I don't think I can ever get passed. They're worse then most illegal drugs out there in my opinion.
Posted by chiron on June 28, 2007, at 6:49:53
In reply to problems after quitting SSRI's, posted by jessers11581 on June 27, 2007, at 7:37:44
I find this thread very interesting. I have been on SSRIs for most of my life, over a span of about 20 years. I think they have been helpful in the past, but then of course the unanswered question is, what are the long-term effects? There is a lot of thought out there that they can induce cycling, which seems to be my case.
Months ago I went off everything to try Emsam, which seemed to make me feel more crazy, and more depressed when I went to 9mg. So after a fair 6 week trial I discontinued it, and was taking nothing. I felt better for maybe a week, but then decided I needed something. My dr. suggested trying Neurontin because it is different than most meds. I took 2 small doses, and have never been the same. But not being on anything for serotonin (or whatever unknown neurotransmitters could also be involved) could have probably been a factor.
I initially had a lot of weird scary sensations, like waves flowing through my body and head. One day it got really bad and I ended up in the ER. I also had a lot of depersonalization (which they say is an anxiety thing). Then I started having extreme anxiety along with the depression- especially in the mornings. I have been taking xanax regularly, which has helped. I then started back up on small doses of lamictal, celexa, and synthroid. I had a couple of improved weeks, but this last week I have really crashed, I am hoping it is hormone related.
Have you tried any benzos? If you are set on seeing if your brain will adjust, maybe they can help you get through it. Some people successfully take them for short periods of time (of course with weaning off of them).
Posted by chiron on June 28, 2007, at 6:54:13
In reply to Re: problems after quitting SSRI's, posted by linkadge on June 27, 2007, at 9:21:03
> In short, I have never felt the same after discontinuing SSRI's. This is years after, my brain still does not function without them.
Linkadge,
Did you go back on them? If so, are you on a stabilizer as well?
Did you feel like they made your mood cycle?-thanks
Posted by nathan_arizona on June 28, 2007, at 7:47:01
In reply to Re: problems after quitting SSRI's, posted by chiron on June 28, 2007, at 6:49:53
"...Have you tried any benzos? If you are set on seeing if your brain will adjust, maybe they can help you get through it. Some people successfully take them for short periods of time (of course with weaning off of them)...."
That's what I did - went on the benzos for a while to deal with the anxiety.
Thinking about it, I had to go on the benzos for a while when I STARTED prozac because of anxiety. Maybe there is concentration of prozac/metabolites that CAUSE anxiety in some people and we just have to get above that concentration or below it for it to subside.
Don't know??
Posted by linkadge on June 28, 2007, at 13:24:32
In reply to Re: problems after quitting SSRI's, posted by chiron on June 28, 2007, at 6:49:53
Thats the thing, I have had no problems with benzo's. I've taken benzos for months and been able to ween myself off with little or no lasting consequences.
SSRI's use on the other hand, has left me permanantly weird. Its like I am not depressed, yet everything that interested me while on SSRI's no longer interests me. I have a hard time finding pleasure in anything.
I was reading some articles that suggest that, in response to SSRI exposure, the brain starts to produced more serotonin transporter to take away the serotonin (much in the same manner that the brain produces more DAT in response to cocaine exposure). Well, serotonin exerts pleasurable effects in certain brain regions, infact cocaine's principle effect is by inhibiting the serotonin transporter. (cocaine has stronger effect on the serotonin transporter than on the dopamine transporter).
Some mice studies show that the serotonin transporter upregulation can persist long after SSRI's are discontinued.
Its funny, because I can periodically take test doses of SSRI's, and I will actually feel better.
One of the effects that plagues me the most (sorry for the graphic detail) is this:
Even though SSRI's gave me sexual problems (ejaculation etc), they in some ways enhanced the sexual experience.
Off SSRI's, I have very little interest. When I "imagine" being with somebody, I can't hold the though long enough in my head, without a competing thought telling me that it will never be. Hence, I usually give up.
Anyhow, if I take a test dose of SSRI, I can "fanticize" longer, holding that "possability" in my head. Its like I am able to believe in things (which may never be) for longer.
SSRI withdrawl has left me perminantly pessimistic. The glass is always half empty to the point of unrealistic pessimism.
More fear, more paranoia, definately less trusting. The list goes on.
Again, most of which are relived by a single test dose of an SSRI.
Anyhow, thats my take.
There more to it, but I won't bore you anymore.
Linkadge
Posted by linkadge on June 28, 2007, at 13:27:18
In reply to Re: problems after quitting SSRI's » linkadge, posted by chiron on June 28, 2007, at 6:54:13
Yes, I would say that they did make my mood cycle (at times).
I am no longer taking SSRI's.
SSRI + mood stabilizer just felt dirty and unproductive. Depakote + SSRI gave me terrable insomnia, and suprising irritability (neither drug alone produced irritability)
Linkadge
Posted by linkadge on June 28, 2007, at 13:29:22
In reply to Re: problems after quitting SSRI's » chiron, posted by nathan_arizona on June 28, 2007, at 7:47:01
Serotonin can be anxiogenic at certain serotonin receptors. The notion that serotonin is the "calming chemical" is kind of simplistic. Serotonin at 5-ht2a, and 5-ht2c, for instance can cause anxiety.
After these receptors downregulate (after prolonged exposure) the anxiety can subside.
Linkadge
Posted by jessers11581 on June 28, 2007, at 13:47:41
In reply to Re: problems after quitting SSRI's, posted by chiron on June 28, 2007, at 6:49:53
Hi and thanks for the responses, everyone! I have never taken Benzos. What is a good example of a benzodiazapine? Also, what are it's side effects?
> I find this thread very interesting. I have been on SSRIs for most of my life, over a span of about 20 years. I think they have been helpful in the past, but then of course the unanswered question is, what are the long-term effects? There is a lot of thought out there that they can induce cycling, which seems to be my case.
>
> Months ago I went off everything to try Emsam, which seemed to make me feel more crazy, and more depressed when I went to 9mg. So after a fair 6 week trial I discontinued it, and was taking nothing. I felt better for maybe a week, but then decided I needed something. My dr. suggested trying Neurontin because it is different than most meds. I took 2 small doses, and have never been the same. But not being on anything for serotonin (or whatever unknown neurotransmitters could also be involved) could have probably been a factor.
>
> I initially had a lot of weird scary sensations, like waves flowing through my body and head. One day it got really bad and I ended up in the ER. I also had a lot of depersonalization (which they say is an anxiety thing). Then I started having extreme anxiety along with the depression- especially in the mornings. I have been taking xanax regularly, which has helped. I then started back up on small doses of lamictal, celexa, and synthroid. I had a couple of improved weeks, but this last week I have really crashed, I am hoping it is hormone related.
>
> Have you tried any benzos? If you are set on seeing if your brain will adjust, maybe they can help you get through it. Some people successfully take them for short periods of time (of course with weaning off of them).
Posted by nathan_arizona on June 28, 2007, at 14:22:20
In reply to Re: problems after quitting SSRI's » chiron, posted by jessers11581 on June 28, 2007, at 13:47:41
Well, the benzodiazepines are a class of drugs typically used as sedatives. Valium (mom's little helper) is probably the most famous (notorious) of the bunch.
Other benzos include ativan, klonopin and xanax.
They are usually prescribed as anxiolytics (reduce anxiety) or sleep aids.
They ARE addictive and the body can and often will go through withdrawal after stopping the drug. Tolerance can also be a problem that leads to increased dosing to achive the same effect.
They are, in my opinion, NOT to be prescribed or taken lightly.
However, when used properly, they can be lifesavers.
The benzo that I personally prefer is klonopin. It has relatively slow onset of action and slow decay in the body. It's not particularly long acting, but there isn't this jarring anxienty "rebound" when the drug wears off.
However, a lot of people prefer xanax as it can work pretty quickly and provide a lot of relief for acute anxiety.
Neither xanax nor klonopin at low doses were particularly sedating for me.
Some people can just glide on and off the benzos with no problems, whereas others experience a lot of problmes coming off the drug.
Don't know, talk it over with your doc.
Posted by jessers11581 on June 28, 2007, at 14:36:42
In reply to The Benzos, posted by nathan_arizona on June 28, 2007, at 14:22:20
Thanks! I did take Xanax for a very short stint back in '97, but it definitely made me super out of it and unable to function. I basically just slept. Maybe the dose was too high? By the way, your screen name is awesome-- Raising Arizona is one of my all-time favorites. :)
> Well, the benzodiazepines are a class of drugs typically used as sedatives. Valium (mom's little helper) is probably the most famous (notorious) of the bunch.
>
> Other benzos include ativan, klonopin and xanax.
>
> They are usually prescribed as anxiolytics (reduce anxiety) or sleep aids.
>
> They ARE addictive and the body can and often will go through withdrawal after stopping the drug. Tolerance can also be a problem that leads to increased dosing to achive the same effect.
>
> They are, in my opinion, NOT to be prescribed or taken lightly.
>
> However, when used properly, they can be lifesavers.
>
> The benzo that I personally prefer is klonopin. It has relatively slow onset of action and slow decay in the body. It's not particularly long acting, but there isn't this jarring anxienty "rebound" when the drug wears off.
>
> However, a lot of people prefer xanax as it can work pretty quickly and provide a lot of relief for acute anxiety.
>
> Neither xanax nor klonopin at low doses were particularly sedating for me.
>
> Some people can just glide on and off the benzos with no problems, whereas others experience a lot of problmes coming off the drug.
>
> Don't know, talk it over with your doc.
Posted by nathan_arizona on June 28, 2007, at 15:15:01
In reply to Re: The Benzos » nathan_arizona, posted by jessers11581 on June 28, 2007, at 14:36:42
well, technically, I should call myself nathan Huffines...
Posted by linkadge on June 28, 2007, at 17:24:30
In reply to The Benzos, posted by nathan_arizona on June 28, 2007, at 14:22:20
>They ARE addictive and the body can and often >will go through withdrawal after stopping the >drug.
I don't know if thats the rule. I was using clonazepam 1.5mg for about 4 weeks during exam time at school. After exams were over, I tapered down to 0.75 for 3 days then off of it. I didn't experience much withdrawl.
I would far much rather use clonazepam in this manner then get myself hooked on an SSRI. SSRI withdrawl was much worse (IMHO) than benzo withdrawl.
>Tolerance can also be a problem that leads to >increased dosing to achive the same effect.
Again, not everybody needs to continually increase their benzo dose. Many people use consistant doses of benzodiazapines for many years without any form of compulsive dose increase.
Also, SSRI's can loose their effiacy (poop out), requiring ever increasing doses, to regain efficacy.
>They are, in my opinion, NOT to be prescribed or >taken lightly.
I would much rather see a benzo prescribed than an SSRI. SSRI's are dispersed like candy.
>Some people can just glide on and off the benzos >with no problems, whereas others experience a >lot of problmes coming off the drug.I have much less problem withdrawing from benzo's than from SSRI's (sorry for restating), you are right, it is highly individualized.
Linkadge
Posted by linkadge on June 28, 2007, at 17:30:41
In reply to Re: The Benzos, posted by nathan_arizona on June 28, 2007, at 15:15:01
Another thing about benzos is that they work "quickly".
One school doctor (for example) refused to prescribe benzodiazapines for anxiety. He ramped me slowly up on effexor, insisting that this was the way to go. Not only didn't the effexor help my anxiety, it may have made it worse. In addition, I was forced to endure this drug for months waiting for it to "kick in". The drug caused insomnia, heart palpitions, and other side effects which only served to worsen my situation. After determining that the drug wasn't going to work, I endured an excrutiating withdrawl!
Needless to say things would have likely been better had a doctor initially prescribed a benzo.
I think newer doctors are more likely to want to utilize antidepressant monotherapy for anxiety disorders, but they are not necessarily the best option.
Linkadge
Posted by Phillipa on June 28, 2007, at 21:13:22
In reply to Re: The Benzos, posted by linkadge on June 28, 2007, at 17:30:41
I agree fully as one young doc tried and I ended up at a neurologist's who urged me to get a doc who is not benzophoic. The neurologist prescribed benzos for me til I got an appointment and saw one who prescribes them. In 35 year take less now than in the beginning so we are all different. Love Phillipa
Posted by nathan_arizona on June 28, 2007, at 21:15:37
In reply to Re: The Benzos » nathan_arizona, posted by linkadge on June 28, 2007, at 17:24:30
You know, I'm really sorry that you have had a terrible time with the SSRI's. I did not.
Every drug can be different for every person.
The benzos can be VERY problematic for some and both dose escalation AND withdrawal can happen, just not for you.
If you wish to make the point that NO drug should be administered lightly, fine, that is an excellent point.
...
Posted by linkadge on June 30, 2007, at 8:02:52
In reply to Re: The Benzos, posted by nathan_arizona on June 28, 2007, at 21:15:37
>The benzos can be VERY problematic for some and >both dose escalation AND withdrawal can happen, >just not for you.
I agree. Any drug can be problematic for some people.
I would say that, in general though, that it would be a mistake to assume that all people are going to abuse benzodiazapines.
Its like alchohol. Over time, some will grow tollerant of the sedative properties of alcohol, and require ever increasing doses to achieve the desired effect, but that doesn't mean that everybody becomes and alcoholic. A lot of people use alchohol responsably.
Linkadge
Posted by marshall26 on July 3, 2007, at 3:21:23
In reply to Re: The Benzos, posted by linkadge on June 30, 2007, at 8:02:52
> I agree. Any drug can be problematic for some people.
>
> I would say that, in general though, that it would be a mistake to assume that all people are going to abuse benzodiazapines.
>
> Its like alchohol. Over time, some will grow tollerant of the sedative properties of alcohol, and require ever increasing doses to achieve the desired effect, but that doesn't mean that everybody becomes and alcoholic. A lot of people use alchohol responsably.
>
>
> Linkadge
>
>
>You don't have to "abuse" benzos for them to turn on you should you wish to discontinue. It can happen to anyone who takes a prescribed therapeutic dose every day for more than a month or two (this is from personal experience). There’s no good predictor of who will become physically dependent on a benzo just like there’s no good predictor of who will become physically dependent on an SSRI. The “addictive” personality theory is a bunch of BS. Do the people who have withdrawals from SSRIs “abuse” their meds?
Posted by linkadge on July 3, 2007, at 9:10:08
In reply to Re: The Benzos, posted by marshall26 on July 3, 2007, at 3:21:23
>There’s no good predictor of who will become >physically dependent on a benzo just like >there’s no good predictor of who will become >physically dependent on an SSRI. The “addictive” >personality theory is a bunch of BS. Do the >people who have withdrawals from SSRIs “abuse” >their meds?
Well this is what I am saying. Yes people can become dependant on benzo's, but they can also become dependant on SSRI's.
Being dependant on a benzodiazapine is not benzodiazapine abuse. I would say that the percentage of benzodiazapine users who actually outright "abuse" the benzodiazapines is fairly small.
All I am saying is that doctors come in with this new wave of logic. Generalized anxiety disorder is not to be treated with benzodiazapines as they are addictive, so we will now prescribe SSRI's.
Now they are seeing the rehash of that. When a new drug comes out, they will abandon the SSRI's on the grounds that they are addictive.In fact, one cliical trial for agomelatine, (a 5-ht2c antagonist + melatonergic) claimed that unlike the comparitor drug (effexor) agomelatine produced no withdrawl in clinical trials.
Linkadge
Posted by Klavot on July 3, 2007, at 10:10:29
In reply to Re: The Benzos, posted by marshall26 on July 3, 2007, at 3:21:23
Both benzodiazepines as well as SSRIs can cause withdrawal when discontinued. But SSRIs are not drugs of abuse, whereas benzos are.
The phenomenon of benzophobia is simply a case of learning from history. Why did doctors become benzophobic in the first place? Because back in the days when benzos were freely dispensed, there was too much benzodiazepine abuse taking place.
I've never seen anybody abuse SSRIs. In my own family, I know of two people who have abused benzos to the point where their quality of life was impacted. They would spend entire weekends in a benzo-induced haze, having little recollection afterwards of anything they had done over the weekend.
If I were a doctor, I too would be benzophobic.
Klavot
Posted by marshall26 on July 3, 2007, at 10:59:59
In reply to Re: The Benzos, posted by Klavot on July 3, 2007, at 10:10:29
I don't have a problem with benzos being prescribed. I just think there needs to be full disclosure to the patient of the severity of physical dependence that can occur. People have the misconception that if they don’t abuse a drug or get a euphoric effect from it they won't have any difficulty quitting. This misconception is promoted by a lot of doctors.
I’m just as critical of SSRIs being handed out like candy. Both classes can lead to such severe withdrawal reactions that people have to take disability leave or lose their job.
Posted by linkadge on July 3, 2007, at 12:51:10
In reply to Re: The Benzos, posted by Klavot on July 3, 2007, at 10:10:29
>Both benzodiazepines as well as SSRIs can cause >withdrawal when discontinued. But SSRIs are not >drugs of abuse, whereas benzos are.
Yes, but that doesn't mean everybody abuses benzodiazapines, it just means there is a potential for abuse. The potential for abusing stimulants has not been a reason to halt prescriptions. It is just another consideration.
>The phenomenon of benzophobia is simply a case >of learning from history. Why did doctors become >benzophobic in the first place? Because back in >the days when benzos were freely dispensed, >there was too much benzodiazepine abuse taking >place.
Benzophobia is multifacited, and not entirely based upon the true incidence of benzodiazapine abuse. The incidence of true benzodiazapine abuse
has been overemphasized on account of the way that it helps market SSRI's.There are other aspects too such as benzodiazapine misue, such as lending valium to friends, using valium to smooth out minor anxieties etc. In this sense SSRI's are subject to misuse too.
>I've never seen anybody abuse SSRIs.
It certainly does happen. Prozac is sometimes outright abused. Somtimes it is combined with other drugs such as amphetamines to increase the high, or lower doses required to get a buzz. I know it is abused as their is some street value for SSRI's.
>In my own family, I know of two people who have >abused benzos to the point where their quality >of life was impacted. They would spend entire >weekends in a benzo-induced haze, having little >recollection afterwards of anything they had >done over the weekend.
I have several family members who have greatly benifited from benzodiazapines. Both my mother, father, aunt, uncle, and grandfather and myself benifited greatly from benzodiazapine use for severe periods of anxiety in their lives. They used them appropriately, and tapered off them later. In comparison, most of these family members found antidperessants for GAD to be essentually useless.
>If I were a doctor, I too would be benzophobic.
I don't think phobia is necessary, just caution, they can be lifesavers when little else works. Antidepressant resistant GAD is fairly prevalant, and can be very serious and life disrupting. There is actually very little else that can be used for such severe anxiety.
Linkadge
Posted by linkadge on July 3, 2007, at 12:57:24
In reply to Re: The Benzos, posted by marshall26 on July 3, 2007, at 10:59:59
>People have the misconception that if they don’t >abuse a drug or get a euphoric effect from it >they won't have any difficulty quitting. This >misconception is promoted by a lot of doctors.
In many cases, a few patients ruin it for everbody. I would argue that opiates are more widely abused, yet no warning is routinly given to say a dental patient given codiene after surgery.
But on the same line, no doctor could ever (in a single session) describe the kind of withdrawl a SSRI patient might go through. It may also be counterproductive. You want to alert the patient to the possability, but not scare them from considering treatment.
>I’m just as critical of SSRIs being handed out >like candy. Both classes can lead to such severe >withdrawal reactions that people have to take >disability leave or lose their job.
True. I personally found benzo withdrawl much less painfull than SSRI withdrawl. SSRI's for example (seemingly permanantly) deleted my sex drive. I would not say that I am currently suffering any consequences of previous benzodiazapine use.
Linkadge
Posted by marshall26 on July 3, 2007, at 20:24:17
In reply to Re: The Benzos, posted by linkadge on July 3, 2007, at 12:57:24
> In many cases, a few patients ruin it for everbody. I would argue that opiates are more widely abused, yet no warning is routinly given to say a dental patient given codiene after surgery.
I would agree that opiate derivatives are more likely to be _abused_ than benzos. However benzo withdrawal is _much_ more serious than opiate withdrawal. It can be life threatening, cause seizures, psychological shock, etc. Not to mention it's absolute torture.
> But on the same line, no doctor could ever (in a single session) describe the kind of withdrawl a SSRI patient might go through. It may also be counterproductive. You want to alert the patient to the possability, but not scare them from considering treatment.But most doctors and psychiatrists don't even mention withdrawal, or deny that it exists when questioned. Yet they give SSRIs out to the masses for relatively mild depression or anxiety where even the effacacy is questionable.
In my case antidepressants were helpful when I was severely depressed (i.e. not able to get out of bed most days). In my case there was clearly something very wrong. I had no interest in anything and found all of life’s endeavors to be utterly meaningless drudgery. This was back in the early 90s. Yet today SSRIs are given out to anybody for almost any ailment. Often SSRI treatment may not be in the person’s best interest, but many risks are either downplayed or not even mentioned.
>
> >I’m just as critical of SSRIs being handed out >like candy. Both classes can lead to such severe >withdrawal reactions that people have to take >disability leave or lose their job.
>
> True. I personally found benzo withdrawl much less painfull than SSRI withdrawl. SSRI's for example (seemingly permanantly) deleted my sex drive. I would not say that I am currently suffering any consequences of previous benzodiazapine use.
>That’s probably because only 5% of people are likely to have severe reactions discontinuing a benzo. Likewise a minority of people have severe problems discontinuing SSRIs. Since the likelihood of having trouble with either one is independent of the other, most people won’t experience both problems. However when you consider the fact that millions of people are prescribed antidepressants and/or benzos, there’s going to be a lot of people who do have problems. It’s simple statistics.
I just don’t think its right for doctors to assume something isn’t a problem just because it only has a small chance of occurring.
Posted by Phillipa on July 3, 2007, at 22:07:58
In reply to Re: The Benzos, posted by marshall26 on July 3, 2007, at 20:24:17
Back in the 70's when having severe anxiety and panic what choices were there? A barbituate or a benzo? I know that when I have first panic attack valium was prescribed with Miltown. As the anxiety got less I just stopped the Miltown. The doc couldn't believe I could just stop it but I did with no withdrawal at all as I felt much better once the anxiety was not of panic proportions anymore. I took then 5 mg of valium. Over the years I've been benzo free for periods of time and no problem stopping them at all. During nursing school if a very stressful day might take 5mg of valium. When I moved to North Carolina about l2 years ago I was on .125 of xanax only. Then the thyroid issue and the internist said that I would need more or less of a benzo. Many times it was suggested to take more or a higher dose I said why? As I feel fine why should I take more. So I've never abused benzos never would and after 35years am still on less benzos than I started out on 35 years ago so I think it depends on the person. Love Phillipa. And they have proven safe over the years. I don't think you can even overdose on a benzo. Not sure of that one though.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
[email protected]
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.