Wednesday, December 19, 2007

Discontinuation Syndrome

It's almost the beginning of the New Year - where many of us want to start fresh with resolutions and changes. I've done posts on this before but want to focus on another issue - the discontinuation of medications for mental illness.

Not many people understand, some professionals included, that there is a great need to come off medications in a specific way. If not, a variety of physiological and psychological issues may punctuate your experience. This is known as Discontinuation Syndrome . Though there are few studies on this phenomenon, it is REAL!

I have seen Discontinuation Syndrome in generally mild and short-lived forms, but have also witnessed patients who really suffered as they stopped or lowered their medications. What made coming off medication easiest was keeping communication open among doctor, patient and therapist. In this way, all are on the same boat, and can be readily available as you move through the experience.

Personally, I have come off my SSRI medication twice in my life. I made the decision to do so not as a marker of a New Year, but in the summer months, when I was off from work and on vacation. (The reasons for my discontinuation was to see if my neurobiology "repaired" itself - which I came to discover did not). I followed my doctor's instructions and had dizziness, sweating and fatigue as I came off the medication. Within three weeks, there were no other Discontinuation Syndrome effects. However, my depression crept back in and I returned to the SSRI medication before returning to work.

So if you are thinking of starting the New Year coming off your medication, here's what you can do to prevent or minimize Discontinuation Syndrome:

1) Never stop taking your medications without talking with your doctor. An open and honest forum can ensure that you come off your dosage in a safe manner.

2) If lowering your dosage, follow your doctor's instructions to-the-letter. If you begin experiencing symptoms of Discontinuation Syndrome, contact your doctor ASAP. You may need to take a higher dosage for a longer period of time before weaning your body off of the medicine completely.

3) If *not* being on medication causes previous psychological or psychiatric issues to resume, consider returning back to medication as a treatment. There is no shame in having neurobiology that requires pharmacological help.

4) And if your doctors or therapists have never heard of Discontinuation Syndrome, hit them over the head, and drag them to the nearest computer.



~Deb said...

I've been on ativan (Lorazopam) for ten years now on a very low dosage, but now, I feel it isn't doing anything for me--I've come to that plateau where it doesn't work as it used to. I don't want to increase the dosage and I have spoken to my doctor about it. He said that right now while I still do have the anxiety, to up it for a little while, and then we're going to find solutions to wean off gradually.

The side effects of discontinuing my medication are convulsions. That's some scary stuff right there! But when I have lowered the intake on my own, I did experience these symptoms!

Thanks for this useful information!

DrWes said...

We've got our own such syndrome in cardiology caused by abruptly stopping beta blockers and calcium channel blockers leading to an overabundance of adrenalin that can cause similar symptoms.

Thanks for educating us psychologically-challenged physicians. I've been appropriately clubbed.

Casdok said...

Great advice.

Deb said...

Dear Deb,
Knowing your body and what works best for it is SO important. Sounds to me like you have a good working connection with your doc.

Dear Dr. Wes,
I think it's great to share knowledge about all things our bodies and minds experience. I read about the syndrome your link provided. Wow. BTW, I doubt very much that you are a psychologically-challenged physician.

Dear Casdok,
Hey, Thanks.


The Lone Beader said...

This is also good advice for things other than medications. Haha.

Scott said...

I am on a low dose of the atypical SSRI Prozac. I have abruptly stopped taking it twice over the years and didn't have Discontinuation Syndrome. However, once a couple months had purged all the good effects of the sweet, sweet 'zac from my system, I was in depression again. I guess I just need to live on 20 mg of 'zac a day!

Also, I know about what Dr. Wes mentioned, because I am also on a beta blocker. I am kind of scared to stop that one! Especially because my pressure would soar if I quit it and I don't want to pop an artery in my head!

Ian Lidster said...

It's essentially a milder version of hard drugs withdrawal. Where we had to be very careful was with clients being weaned off methadone. Some would want to jump the gun and the consequences can be disastrous. Excellent piece, Deb and welcomed by many, no doubt.

STAG said...

After the insect bit me and I died, the docs brought me back to life again with electricity and prednezone. The pred made me pscychotic and "interesting" and it was VERY difficult to come off it gradually, as you are supposed to do. They finally decided to cold turkey me rather than have me continue to hold up traffic on the freeway in the name of God!
Not that I recommend the experience,I mean, often dying is a fatal thing, but it WAS pretty interesting at the time. As can be attested to by my wife, my room mate, and the local talk show radio host!
So I know that pred is not generally considered a pschoactive drug, but in MY case, it beat LSD hands down! Getting off it was really painful, and probably had permanent effects on my liver and kidneys, among others. So I can surely vouch for the fact that yes kids, listen to your doctor...she knows!

Merry Christmas everybody.

Sid said...

Since I'm so tired of everything being a "syndrome" these days, I'm just going to call it what it really is...withdrawal; and Paxil is absolutely the worst of the psychotropic meds when it comes to withdrawal symptoms when you're trying to get off of it.

jumpinginpuddles said...

its the same with people trying toi quit smoking without thought for what might happen, this is a brilliant blog and one we havent seen done before. We arent on meds but we know of some people who have stopped in the new year with tragic results weeks later.
As they say please consult your doctor first

Enrico said...

This is so true. As DrWes said, it's not at all unique to psychotropic drugs. Our bodies are amazing at adapting--for good and bad. The mechanisms why this happens can be well known (depending on the drug), yet the message isn't nearly as universal as it should be. (who reads those pharmacy stickers on the side of the bottle? LOL)

Talking to one's doctor also allows the possibility of using a similar medication in the same family for a short period of time to ease the withdrawal complications. Using clonazepam (Klonopin) to help people taper off of alprazolam (Xanax) comes to mind here. The theory is that it's easier and faster to taper off the "helper" drug since the body hasn't had as much time to adapt to it. Eventually you're freed of both, but in a "gentler" fashion.

It's all about talking to your doctor(s) to know the whole spectrum of one's options. Kudos, Deb.

Guilty Secret said...

Very good advice. I came off seroxat cold turkey when I was eighteen. That was a BIG mistake. Don't do it, people!

Marj aka Thriver said...

I have experienced some of this first hand. Good information to get out there!

IntelligentLayPerson said...

The only medication I had terrible withdrawl symptoms from was Cymbalta. I had forgotten to fill my scrip and in only one day I had a horrible headache, nausea and sweats.

I'm glad you have touched on this topic. It's good timing too. I hope nobody plans to discontinue their medications.

If you do not have a good relationship with your physician and you do not agree with the medications you are on or the physicians diagnosis, please find a new physician! Do not just abruptly stop your medications. This could be disastrous for a person to do.

Deb said...

Dear Lone,
Yes, it's good advice - keeping an open forum of communication - for many things.

Dear Scott,
I also take 20mgs of Prozac - and will be a life long user as well. The two times I came of meds showed me that my neruobiology needs the SSRI. No shame in that. We can be Prozac buddies as we move into our golden years.

Dear Ian,
It is withdrawal, plain and simple. But many people feel that only hardcore drug use is the worry. Anything we put in our body like aspirin, coffee and the more serious precptions meds, require our focused respect and attention. I am sure you have seen a great deal of this in your work, my wise friend.

Dear Stag,
My sister is on pred for Sarcoidosis and is having a terrible time with it as well. What a horrendeous journey you've had!!! So glad you are here to tell us all about it. Wow.

Dear Sid,
It is indeed withdrawal. But the interesting thing about coming off SSRI's has shown a series of symptoms - that's why they are grouped as a syndrome (yeah, I know,there's always a name for something). The most extreme symptom I witnessed was the sensation that electrical shocks moving through a patient's body. As many of the medical bloggers commented, the kind of medicine and a person's unique physiology will determine how the discontination will progress. The best we can do is be informed, empowered and responsive to ourselves.

Dear JIP,
Quitting smoking, stopping caffeine - all things we put into our body require use to be careful as we try to limit them. I've seen good things happen when people come of meds and not so good things as well. Being careful and keeping open communication are what I advise.

dear Enrico,
I'm so glad my med blogger friends offer their expertise on this. Your comment is so important for us all to remember.

Dear Guilty,
I have never come off anything cold turkey. Too scared to do so!!!

Dear MArj,
Passing info along is what I love best about blogging.

Dear Intelligent
The relationship between doctor and patient is SO important, as you say. And if you don't have a good one, search until you can find one.


Candace said...

Happy holidays to you and yours, Deb!

Muser said...

I'm with the blogger who calls it "withdrawal" rather than a syndrome... but that's based more on personal experience rather than a review of the current relevant literature. I've found for myself that I can tell when I have missed my meds for a few days... I get "wired," dizzy, and VERY clutzy. No fun, but helpful to ensure medicine compliance!

On the other hand, I've had no difficulties reducing medicines gradually when switching meds (taken for depression, anxiety, or both, depending). Just lucky, I guess!

IntelligentLayPerson said...

The term withdrawal has many meanings whereas syndrome applies to a pattern of symptoms that are consistent and occur under specific conditions.

S'onnie said...

I know I have tried going off drugs without the doctors consent before and it was a terrible time. you don't often see what you are like until you crash and by then its a little too late to be able to correct quickly and easily. Last time I went off medication I did it following the drs guidelines and while I still had some withdrawal symptons so to speak, it was nothing like when I just went cold turkey

Deb said...

Dear Candace,
Back atcha.

Dear Muser,
If I forget a dose of my Prozac, I can feel it's effects as well. Amazing how the body works - what the nervous system habituates to, etc. Kudos to you for not having any bad experiences lowering or coming off meds. Please come back and visit again.

Dear Intelligent,
You are a smarty. You worded it so well.

Dear S'Onnie,
Thanks for sharing your personal story about this. And I'll be thinking of you during the Christmas holiday. Peace, my friend.


Wendy C. said...

Wow - really timely post. I decided to try antidepressants during the lead-up to my daughter graduating from high school and moving away last June (I kept suffering from crying jags at the worst possible work, at the grovery store...blah!) I was greatly helped by the medicine..and just recently decided that it felt like time to stop. I talked to my doctor, and she said that there should be no problem "just stopping" the I figured I would just stop :-)
Big mistake! I felt like a complete loon for about four days! I felt weak, dizzy - and had a really hard time concentrating. I couldn't even read! I mentioned it to a social worker in my office - she told me about discontinuation syndrome and gave me some good advice to help cope until it passed...which it did. I feel fine now. It's surprising how much my doctor did not know!

Kim said...

Boy, did you hit the nail on the head with this one. I once came off xanax cold turkey - I had been taking 2 mg a day in divided doses for two months (EXTREMELY stressful period in my life) and decided one day to go off it all at once. Dumped it down the sink.

Can you say withdrawl? Holy cow, I thought I was going nuts, but I knew what was happening to me.

Coming off Paxil is downright dangerous. Who would have thought? I had what is known as "Paxil Rage" and will never get near that drug again.

But, like you, I have to be on an SSRI - I've tried coming off and the depression comes back. Still, my doctor believes in a "drug holiday" after a year or so....

Anonymous said...

I always get those zaps each time i go off my antidepressants :(

therapydoc said...

Never heard of it per se.

BUT! Straight talk. Any therapist who has a pulse has SEEN this in patients who abruptly go off their meds or "forget" to take them, and it's really hard to watch.

So of course, it's very important to wean off meds with medical supervision.

Even then, taking a vacation isn't necessarily going to mean a good time.

I'm bookmarking this post and am going to refer to it in my back'acha' December post (assuming I ever get to that)-- that's how important it is.

Way to go, DR. DEB!

chana said...

Made my way over here thanks to therapydoc's link...

For a couple years I've been on Effexor, which is up there with Paxil as far as withdrawal nastiness. Once I couldn't get a refill called in and spent a weekend hiding from my family in bed because of the brain shocks and fear that I would explode at anyone for looking at me cross-eyed.

OTOH, about a month ago my MIL "disowned" DH and told him she never wants to see our kids - her only grandkids - ever again! Ironically, while that has caused DH huge stress, I have been able to come down from 375 to 225/day on the Effexor, because now I'm vindicated for all the crap that I've taken over the years...

No brain shocks! No funky withdrawal weirdness! I've tried coming of Effexor beore, 75 mg at a time, but it did NOT last more than a day or two. But, the environmental stressors were alive and well.

Then there's "Continuation of Marriage Syndrome"... *sigh*

Anonymous said...

I have just tappered off mirtazapine (Avanza) and about a week after my last dose I started feeling very ill, at first I was mentally fatigued then that faded and a constant nausea with random moments of sweats, I thought I had a virus - I've felt this way for nearly a week now.

My tappering plan was -2 weeks 45mg, 2 weeks 30mg, 1 week 15mg. Obviously this did not work. So anyone tappering off this should maybe consider 3 weeks at each dose level.