something from summer

[summer]

This is the story, my friends...

 

Today I saw my pdoc... he is an old time psychiatrist and doesn't (won't) see patients just to give them scripts. I saw him in the seventies for two years, and then moved to another state. I moved back to this area in 2006, and was delighted to find that he was still practicing three days a week. He is an upstanding human being in every way. He is the pdoc that everyone would like to find, but can't seem to. He never aspired to be a rich doctor... instead spent half his time involved with clinics that see people on a sliding scale fee. He isn't involved with clinics any longer, but sees people on medicare/medicaid and is on the list of most insurance companies. I just have to throw in here that he drives a car that is around 15 years old, and is too banged up for my taste.

 

Now, all that said, I mentioned to him today that I was thinking of switching to the liquid Celexa. He said fine... but why, and I told him. From there we talked about switching to Prozac, which a few years ago was easy for me to wean. We talked about the internet, doctors, etc., and that so much is said about antidepressants, both pro and con. Mostly, we talked about withdrawal and his belief that withdrawing slowly was a good idea, but after a certain point, how much of what people feel while withdrawing is real, and how much is psychological. (In other words, he thinks it becomes psychological if people think there is a huge difference between 13.5mg and 10mg). I found myself thinking about all the things we talk about here... and over there, all of which I told him. We also talked about doctors who use other methods, like prescribing a drop or two of this and a drop or two of that.

 

Bottom line, he said we could and should do exactly what I wanted to do... keep cutting the Celexa, try the liquid, switch to Prozac, drop by 1mg; that we should do whatever I thought would be right for me. That's how I left... not sure what I wanted to do or what was "right".

 

I've been thinking of doing an experiment - like dropping to 10mg of Celexa, and then see what happens. The worst is that I go back up to 15. Is this totally insane thinking? I have been able to get off ADs before, without too many problems. The only real prob I had was when I CTd Paxil years ago b/c I didn't know any better. Is he right... will I make myself a psychological wreck if I drop to 10mg b/c I'm worried I'll feel awful? (My words not his).

 

I'll end this now, basically b/c I don't know what else to say. Any and all thoughts gratefully appreciated.

[Brandy]

Summer, correct me if I'm remembering wrong, but I thought you ran into problems during your last taper and that was why you went on the celexa. Forgive me if I don't recall the situation correctly.

 

I never did a slow taper (unfortunately) but from what I've read, going back up in dose after dropping too much is sometimes necessary when people unwittingly dropped too much and didn't expect for whatever reason the problems it ended up causing them.

 

But although that's sometimes the only or best option, it does seem that going up and down (or on and off) these meds too fast increases the sensitivity to them and causes new or increased problems for people, even if they could go off easily before. There doesn't seem to be any way to predict when or if that will occur, but it seems like Russian roulette to me to knowingly put oneself in a position where it might happen.

 

What's the reason you want to hurry it?

 

Since you just recently posted that you were feeling so good you were reluctant to drop, I honestly don't understand why you'd risk needless problems. A very tiny drop you probably wouldn't even feel or just feel briefly and slightly. What would be the purpose of doing a larger drop?

 

I'm not arguing. Please know that. I can't know what's right for you. I'm just baffled.

 

By the way, I think you're very lucky to have a doctor who will cooperate with you on tapering in any way you feel is best, even if he (like most doctors) isn't as knowledgeable about very slow tapering as we are. Great that you can count on his cooperation!

[summer]

I understand why you would be baffled.

 

I'm thinking about what my pdoc said about the psychological issue of withdrawing. I hope that makes some sense now.

[Altostrata]

With all due respect to your pdoc, who seems like a stand-up kind of guy, he's wrong. Some people do, indeed, feel the difference between a .5mg drop and a 2.5mg drop, at any level of the medication.

 

It's not a merely psychological distinction, although some people undoubtedly give themselves the willies over nothing. You might, politely, tell him there's plenty of anecdotal evidence to the contrary about his theory.

 

It depends on individual sensitivity. If you are sensitive to the cuts you make now -- and you've posted that you are, it takes you a month to recover -- larger cuts will affect you more.

 

Now, you can experiment. But once you've given your nervous system a pounding with a larger cut, I would not count on being able to get back to easier sailing by backing up the dosage and decreasing more gradually.

 

(BTW, I believe backing up the dosage has to be done within a day or two, at most, or it doesn't help at all. See Ashton's comments on this.)

 

So, it's always a dilemma for the patient: faster or less risky? You pays your money and you takes your choice.

[Healing]

Not to dogpile you, summer, but I have similar thoughts!

 

Your doc sounds like a wonderful doc in many ways, most of all his genuine respect for your wishes and his not being controlling!

 

Personally, I do think he is missing *some* of the truth when he over-attributes w/d worry to psychology. He's partially right -- psychological worry *is* a factor. But it is not the whole explanation for w/d. This is what makes it confusing! He sounds reasonable because he *is* partially right -- but he's still missing part of the story.

 

I also want to offer a new perspective to you. You say you have had no trouble getting off meds, but, if I'm remembering your history right, what happens is you get off, feel fine for a few months, and then start to feel bad -- bad enough that you eventually get on another med.

 

So, my theory is that you have been experiencing w/d without really knowing it. When I got off the Paxil, I felt pretty good for about two months, then I started a slow slide, which got worse and worse.

 

This happened to me twice -- once in 1997, at which point it never occurred to me that this was a withdrawal of some sort (and I got on Zoloft). And once in 2005, at which point I hit the Internet and found out, lo and behold, the end of the taper is not the end of the recovery, and there is often a honeymoon period right after the last dose.

[Brandy]

Healing makes a very important point!!!!!

 

When I was on paxil 20 mg for many years, I dropped down to 15 because I don't like to take any more medication than I need to and also didn't even know if I needed it anymore.

 

I thought I was fine on 15 and only much, much later realized the only change in my life or circumstances to account for vague depression commencing three months later, when actually the problems in my life (life circumstances) were actually less acute and more stabilized than in a long time, and I was not on paxil for depression and hadn't been depressed when put on it, was that I'd gone from 20 to 13.

 

By the time I realized that, I was doing better, just had something else (medically) have me going through my medical notes and trying to figure out what had caused that totally unwarranted vague depression I couldn't explain at all but couldn't quite shake off. I stayed on the med (at 15 mg) many more years because I didn't know it was addictive and didn't fully put the pieces together, and by then it wasn't an issue. This was quite some time later.

 

And at the separate times I went off variously benzo and paxil completely after too-fast tapers in each case, I felt great for a couple of weeks or so, then bad withdrawal symptoms - but got much worse three months later... (And even much worse than that at subsequent intervals with the paxil. No idea what would have happened with the benzo because I was so much worse at about three months off (don't remember exact timeframe) that for medical reasons I had to be put back on a benzo, then tapered, although never able to finish (the slower but still much too fast) taper because I wouldn't have been able to even minimally take care of myself.

 

So even though I never did a very slow taper, I strongly advise them because there really can be delayed reactions, and it's hard to put it together after so much time elapses.

 

And I think this may be significant - Although most people seem to be hit hard very quickly by too-large or too-fast drops and especially cold turkeying, I've thought for some time that maybe such delayed reactions are a big reason doctors and also patients don't realize that it's from going off a med and think they're just depressed, or new or return of original condition, and are put back on or put on new meds.

 

Very hard to connect the dots in most cases like that.

[stan]

my dear Summer,

 

you are on celexa since 20 years,

[(Brandy, Sur, Healing, who have answered you here) Stan)]these people, your friends, have been there, your wonderful pdoc no , you prefer trust your pdoc while you are on this site ?

If you play with these meds, you will pay it big price, you have never been in chemical anxiety/depression, so if you make the bad choice, you will live this

and the big problem of this crap is it takes months to go back or stabilize, and sometimes you cannot stabilize

do not underestimate the destructive power of 20 years antidepressants !

follow the wisdom, it is not your pdoc who will be in the hole, it is you !

[summer]

Thank you all for your thoughts and support... now I have to decide what I want to do.

 

Woke up with one of my intense headaches, so not really thinking about much of anything today.

[Healing]

Sending soothing energy, summer!

[Punarbhava]

Thank you all for your thoughts and support... now I have to decide what I want to do.

 

Woke up with one of my intense headaches, so not really thinking about much of anything today.

 

 

ooh I know how those headaches can feel. Hope it's short-lived Ms. Summer.

 

 

In the meantime, be kind to yourself.

 

Sending you calm, healing and pain releasing energy.

 

Pun

[summer]

Awwwwww... thanks Pun... and, you too, Brandy! xo

 

I always feel a little better in the evening... strange... but don't try to figure out why any more. It is what it is what it is. I see them coming after me...

[stan]

dear Summer,

 

had you headaches 20 years ago, before antidepressants ? and as intense and frequent as today ?

[summer]

dear Summer,

 

had you headaches 20 years ago, before antidepressants ? and as intense and frequent as today ?

 

Yes, Stan... I've always had headaches. I think I got my first really bad headache when I was around 12.

 

The intensity started getting worse around 20 years ago. The frequency is pretty much the same. Sometimes I can go a week, or even two or three without one. Then there are times I'll get a bad one that will last several days. Or, I'll have a headache 3 or 4 days out of a week.

 

Yesterday I had an awful headache. Today, I feel fine. There is no rhyme or reason. It's different every time.

[Rhiannon]

With all due respect to your pdoc, who seems like a stand-up kind of guy, he's wrong. Some people do, indeed, feel the difference between a .5mg drop and a 2.5mg drop, at any level of the medication.

 

I agree and probably don't need to say any more, but I've never let THAT stop me.

 

He does sound like a wonderful guy but unfortunately that doesn't make him an expert on helping people get off meds. There are very few doctors who understand the science behind what these meds do; and if he's been around a while he probably hasn't spent a lot of time contemplating neuroplastic processes, since they were only discovered recently. Probably for most of his practice years he was operating--compassionately, humanely, brilliantly--from the old "static brain" paradigm.

 

The "it's psychological" thing just doesn't fly with me, sorry. It's turning out that "just psychological" isn't even a valid category; "psychological" always has a neurological correlate. It's another outdated paradigm.

 

I can really understand the temptation to assume that someone who's right on about so many things must be right on about everything.

 

But....ouch. I sure hate to see you do this. Of the various patterns I think I've discerned about drug withdrawal, one of them is that switching meds and dosages up and down a lot leads to poor outcomes, while small cuts and slow tapers generally lead to less painful tapers and smoother and shorter recovery periods once off the drugs. And I think that reflects the underlying neurophysiological processes in ways I think I may understand somewhat.

 

Sorry, I want to go on and on about neurophysiology and healing, but bottom line really Summer is, I like you, and I don't want to have to put up those walls around my heart that I have to put up whenever I meet someone I like who does things that I am pretty sure are going to cause them a lot of suffering. It's hard for me to watch people suffer unnecessarily. I'm not good at it.

 

That said, you have every right to do whatever you think is best for yourself, and I'll quit yakkin' at ya.

 

PS one more thing, I was going to suggest as Stan did, 15 to 13.5 sounds "ouch" to me, why not just drop 1 mg and see how that goes? at 15 mg, 1 mg sounds like plenty to me, or even half a mg. I like the "smaller cuts more often with occasional intermittent longer holds" method, mostly because I think it works best with the underlying neurophysiological processes.

[Rhiannon]

 

 

And I think this may be significant - Although most people seem to be hit hard very quickly by too-large or too-fast drops and especially cold turkeying, I've thought for some time that maybe such delayed reactions are a big reason doctors and also patients don't realize that it's from going off a med and think they're just depressed, or new or return of original condition, and are put back on or put on new meds.

 

Very hard to connect the dots in most cases like that.

 

this is the crux of the matter of antidepressant drugs.

 

http://www.psychologytoday.com/blog/mad-in-america/201010/do-antidepressants-worsen-the-long-term-course-depression-giovanni-fava-p

 

I am hoping that a long slow taper will give my brain time and space to reverse whatever changes these drugs cause that lead to "relapse"(I actually never experienced classic severe depression before taking Prozac so I'm not sure "relapse" is the right word, although it certainly became a chronic relapsing condition for me once started on antidepressants.)

[Altostrata]

...I like the "smaller cuts more often with occasional intermittent longer holds" method, mostly because I think it works best with the underlying neurophysiological processes.

 

I like that method, too -- smaller cuts, even ridiculously small cuts, more often.

 

...this is the crux of the matter of antidepressant drugs.

 

http://www.psychologytoday.com/blog/mad-in-america/201010/do-antidepressants-worsen-the-long-term-course-depression-giovanni-fava-p

 

I am hoping that a long slow taper will give my brain time and space to reverse whatever changes these drugs cause that lead to "relapse"....

 

Giovanni Fava is one of my heroes but not even he has observed recovery from antidepressant withdrawal syndrome long enough to distinguish it from relapse. I'm afraid he's calling it relapse for want of anything else to call it.

 

I do think he has observed susceptibility to neuro-emotion, particularly anxiety, in people with prolonged withdrawal syndrome.

 

I am in touch with Dr. Fava. I hope some day that this site will have a repository of cases he can follow -- the Intro topics are rough drafts -- to advance his understanding of the recovery arc.

[Rhiannon]

 

...I like the "smaller cuts more often with occasional intermittent longer holds" method, mostly because I think it works best with the underlying neurophysiological processes.

 

I like that method, too -- smaller cuts, even ridiculously small cuts, more often.

 

...this is the crux of the matter of antidepressant drugs.

 

http://www.psychologytoday.com/blog/mad-in-america/201010/do-antidepressants-worsen-the-long-term-course-depression-giovanni-fava-p

 

I am hoping that a long slow taper will give my brain time and space to reverse whatever changes these drugs cause that lead to "relapse"....

 

Giovanni Fava is one of my heroes but not even he has observed recovery from antidepressant withdrawal syndrome long enough to distinguish it from relapse. I'm afraid he's calling it relapse for want of anything else to call it.

 

I do think he has observed susceptibility to neuro-emotion, particularly anxiety, in people with prolonged withdrawal syndrome.

 

I am in touch with Dr. Fava. I hope some day that this site will have a repository of cases he can follow -- the Intro topics are rough drafts -- to advance his understanding of the recovery arc.

 

Nice! Cool! Awesome!

 

Given everything I've seen, I think a good rule of thumb would be not to diagnose a "relapse" until three years after the last dose of drug. And even then to be suspicious and to be extremely cautious about treating the "relapse" with another drug, to try everything else first, including giving the person support to just ride the episode out if possible.

 

Too bad I'm not a doctor so my rules of thumb don't really matter. Frustrating.

[Altostrata]

I agree about diagnosing relapse.

 

These drugs remodel the nervous system so much that I deeply doubt any relapse happens right away, which means ALL the studies on antidepressant efficacy are wrong -- they're contaminated by misdiagnosis of withdrawal syndrome for relapse.

 

But back to the topic -- summer, how are you doing?

[summer]

Hi Sur... well, decided to go down to 12 1/2 mgs from 15. That was on May 6.

 

The past four days have been somewhat rough, tho I'm trying not to make too much of it. It seems that a few weeks after a drop (of any amount), I have several days where I don't feel like myself. I can live with it though. I recognize I'm having various symptoms but they aren't intense... just annoying... and I feel strongly it will pass.

 

I'll prob stay at this dose for at least two months, to give myself a chance to adjust.

 

Thanks for asking.

[Neuroplastic]

Keep bravely walking on, Sum! One step at a time.

[Healing]

Summer -- How is the most recent drop going?

[summer]

Some days better than others, but nothing I can't handle. I am woman! I am strong!

 

Thanks, Healing.

[Healing]

You are definitely strong! Let us know if you need anything....