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My interaction with a *highly-credentialed* academic psychiatrist RE antidepressant withdrawal


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#1 Henosis

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Posted 14 May 2017 - 06:50 PM

Mods: I wasn't sure where this topic belonged. Please move if necessary.

 

 

Last week I had the pleasure of being evaluated for a second opinion by an academic psychiatrist. For some background, this individual was the chair of psychiatry at a major research university in the USA, was the director of psychiatry at said University's hospital system, is an internationally recognized anxiety disorder specialist, and is the editor of an array of academic publications. You literally can't find someone with a more impressive CV.

 

Here is a condensed version of our session:

 

Psychiatrist: 
"There's just no way a Paxil withdrawal syndrome could be affecting you months or years later. It's impossible!"

Me:
"Hypothetically, could there be a complex set of genetic differences in a subset of the population that leads to a very slow homeostatic process to properly recover after stopping an SSRI?"

Psychiatrist:
"Perhaps it is possible, but infinitesimally small. Much more likely it's indicative of an underlying bi-polar spectrum disorder"

Me:
"So, the thousands of individuals who are experiencing disruptive neurological and psychological symptoms months or years after ceasing an SSRI actually just have a mood disorder. Even symptoms such as loss of concentration, akathisia, memory loss, blurred vision, vestibular issues, gastrointestinal issues??"

Psychiatrist:
"Bi-polar spectrum illness can manifest with cognitive/physical symptoms"

Me:
"Putting aside my extreme incredulity, what would you recommend?"

Psychiatrist:
"Lamictal, Lithium, maybe an atypical antipsychotic like Latuda or Zyprexa"

Me:
"..."

He spent the rest of our appointment in a fruitless effort to "convince me" that the symptoms I was experiencing were caused by an underlying, previously undiagnosed bi-polar condition. I thanked him for meeting with me and headed home. I sent the following email a few days later:
 

 

Dr. XXXXX, 

 

Thank you again for taking the time to meet. I appreciate your attempts to assist with a difficult situation. Certainly, having someone with your professional background share their insight was a rare experience. Now that I've had some time to fully reflect on our conversation, I wanted to share some thoughts. Although I don’t doubt it is unlikely to fundamentally alter your diagnosis, I wanted to outline my thought process when evaluating the road ahead.

 

Accepting your theory that what I have been experiencing is due to an untreated bi-polar spectrum condition would require acknowledging the following axioms:

 

1) The strange cluster of psychological, cognitive, and neurological symptoms I experienced upon Paxil cessation arose due to an underlying mood disorder.

 

2a) These symptoms appearing solely after stopping long-term Paxil treatment was a coincidence.

 

2b) While acknowledging a history of intermittent depression and perhaps hypomania, the utter lack of previous history of these new symptoms (particularly those of a cognitive, physical, or neurological bent) -- either prior to or during treatment with Paxil -- is another coincidence.

 

2c) Immediate relief from these symptoms upon re-instatement of Paxil or a similar SSRI (vilazadone, sertraline) is yet another coincidence or simply due to the placebo effect.

 

3a) The documentation of these very same symptoms when stopping long-term SSRI treatment, both in anecdotal patient accounts and academic research literature, is a further coincidence or those reporting them also have a bi-polar spectrum illness.

 

3b) That many of those reporting these same symptoms when stopping SSRI treatment had no history of mental illness and were taking the medication for any of a number of non-psychological conditions (menopause, gastro-intestinal condition, etc) is another coincidence.

 

Meanwhile, the hypothesis that I'm experiencing a protracted SSRI discontinuation syndrome requires that:

 

1) The strange cluster of symptoms I experienced after stopping long-term Paxil treatment is a direct result of stopping the medication.

 

2a) Long term treatment with SSRIs can lead to complex neurophysiological adaptations.

 

2b) These complex neurophysiological adaptations are not quickly reversed in some vulnerable populations.

 

2c) Cessation of long-term SSRI treatment in these populations can lead to some type of homeostatic dysregulation that can cause a wide array of symptoms that slowly dissipate over many months or years.

 

With some effort, I was able to locate two enlightening academic papers. Are they conclusive? Perhaps… perhaps not. But they describe a condition eerily similar to my own, with an array of possible mechanisms suggested:
 

# New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal

http://www.karger.co...FullText/371865

 

# Withdrawal Symptoms after Selective Serotonin Reuptake Inhibitor Discontinuation: A Systematic Review

http://www.karger.co...FullText/370338

 

"[...] provides substantial evidence for SSRI withdrawal prompting the need for a new classification of withdrawal phenomena associated with SSRIs. [...] New and rebound symptoms can occur for up to 6 weeks after drug withdrawal, depending on the drug elimination half-life, while persistent postwithdrawal or tardive disorders associated with long-lasting receptor changes may persist for more than 6 weeks after drug discontinuation"

 

"[...] Persistent postwithdrawal disorders or tardive receptor supersensitivity disorders have been described with the use of antipsychotic medication. Tardive dyskinesia and supersensitivity psychosis are well-known postwithdrawal disorders (also called supersensitivity syndromes). [...] We now have increasing evidence for postwithdrawal disorders with SSRI long-term use"

 

"[...] The withdrawal syndrome typically occurs within a few days from drug discontinuation and lasts a few weeks. However, many variations are possible, including late onset and/or longer persistence of disturbances Bhanji et al. and Fava et al. documented the persistence of symptoms up to 1 year following paroxetine discontinuation. Belaise et al. described 3 cases of what they defined as ‘persistent post-withdrawal disorders induced by paroxetine'. Such disturbances appear to be quite common on patients' websites but await adequate exploration in clinical studies."

 

What that in mind, I don’t see how it would be prudent to take further risks with my condition by supplementing mood stabilizers and/or atypical anti-psychotics in a speculative treatment of a bi-polar spectrum condition. I’ve been through an unimaginable torture already, and each new medication only seems to exacerbate the problem in some fashion.

 

That being said, I welcome your thoughts and any further insight you wish to provide.


 

This was his response I received today (emphasis is mine):

 

"I've completed my report and will send it to you doctor. I have nothing more to say on this. You are free to do whatever you think is best. I've made the best recommendation that I can. I wish you luck in whatever direction you decide to go."

 

I can't say I'm entirely surprised. With each physician I talk to, the true depths of the denial become more clear. It was only after some digging that I found his financial disclosure on one of his academic studies:

 

"Grant and research support from GlaxoSmithKline, Pfizer, and Forest; is a consultant for Alza, Cephalon, GlaxoSmithKline, Forest, Eli Lilly, Janssen, Pfizer, Pharmacia, Roche, and Wyeth; has received honoraria from GlaxoSmithKline, Forest, Novartis, Pfizer, Pharmacia, and Wyeth."

:angry:
  :angry:  :angry: 
 

Edited by ChessieCat, 14 May 2017 - 07:02 PM.
added additional spacing for ease of reading

Medication before problems: Took Paxil 60-100mg from 2003 to 2014 for OCD.
1) Last pill taken November 2014, horrendous withdrawal started six weeks later.

2) Re-instated successfully @ 20mg May 2015, but accompanied by severe anhedonia, loss of emotion, apathy, and fatigue

3) Switched to Prozac, Viibyrd, Zoloft, Nefazadone, Cymbalta, Nardil in attempt at abating WD symptoms while not re-introducing anhedonia. Each one either failed to relieve WD or brought back anhedonia (the serotonergic ones)

4) Re-stabilized on Paxil at 15mg

5) Tried augmenting Wellbutrin (only increased anxiety), Vyvanse/Adderall (works for anhedonia, but the crash is brutal) low-dose Zyprexa (bad rxn), low-dose abilify (no effect), cyproheptadine (precipitated withdrawal), mirtazapine (knocked me out), Tianpetine (no effect) in attempt at relieving anhedonia through boosting dopamine directly or indirectly through targeted serotonin receptor blockade)

6) Tapered down to 7.5mg as of October 2016. More energy, anhedonia/loss of emotions remains apart from short windows.

7) Attempted Nortriptaline to paxil trapper to boost motivation and reduce anhedonia (it acts like an NRI, with target serotonin blockade at the "bad" receptors)

8) Stopped Nortriptaline after increased anxiety, no effect on anhedonia, and increased withdrawal symptoms. Only positive was alleviating ADHD symptoms.

9) May 2017 - down to 3.5mg of Paxil (no other meds)

 


#2 ChessieCat

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Posted 14 May 2017 - 07:14 PM

Henosis, congratulations on the well-written letter to this person.  I think we all would have fallen off our chairs if you had received anything other than the reply that you did.  I think the financial disclosure says it all.  However, we can only hope that this interaction might make a difference to someone at some time.  Gwen Olsen, pharma rep for 15 years, finally realised the truth so there is hope.

 

My own general doctor knows that I am tapering and I have told him of this website.  I have been meaning to write to the psychologist who put me onto Pristiq after I chose to cold turkey my previous AD and then was told the diabetic/insulin myth.  I think that time is now!


Reminder to self:      P A T I E N C E       I want to go faster    but I won't

 

Antidepressants:  25 years - 1 unknown, Prozac (caused muscle weakness), Zoloft; Cipramil CTed (very sick for 2.5 wks soon after)

Pristiq:  50mg mid 2012, 100mg beg 2014 (mild Serotonin Toxicity)     Current:  Pristiq 24mg (from 19 May 2017)

 

Tapering history & graph

My website - includes my brief history + links to videos & information on the web

 

Podcasts:    Let's Talk Withdrawal

 

PLEASE NOTE:  I am not a medical professional.


#3 stan

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Posted 15 May 2017 - 01:15 AM

hi

 

my opinion

 

 

the system is strong nailed

 

better spending your time to inform your  family of the true that they not fall in the trap than trying to make a professional say he makes criminal crap work , what he knows since long time, it is a waist of time


for anxiety 

12 years paxil - cold turkey 1,5 month - switch celexa 1 year taper; total 13 years on brain meds 

66 years old - 8 years  med free

 

in protracted withdrawal syndrome

 

chronic fatigue syndrome...off balance and dizzy...sleep very bad...dryness syndrôme...prostate...derealization...itching psoriasis...unable to be quiet inside... to rest though improvements akathisia...dilate bronchitis ...auto-immune disorder...conversion disorder...strong back pains...permanent stress...emotions no control...my senses are false... many feelings are false since beginning...locomotor disorder ...

 


#4 KarenB

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Posted 15 May 2017 - 08:09 PM

Great work Henosis - I reckon you should fire off letters like that whenever you can.  Intelligent, concise - eventually one may hit it's mark.  I've had good results writing to my own doctor - she just happened to be 'ready' at the time I happened to write, and now she wants to work with me to make changes about antidepressants at her clinic.  So keep at it :)

 

I especially love your words "strange cluster of symptoms..."  Classic! 


2010 May Fluoxetine 20mg. Raging mostly stops, become more functional.
2011 February Escitalopram 10mg (sudden switch). 2012 January Escitalopram 20mg.  2013 Early June Feeling great, decide to taper. Doc advises alternate days 20mg/10mg for 4 weeks.  Late June Steady. Drop to 10mg daily. Early July Not coping, raging, flu symptoms, shaky, anxious, low, spaced-out, self-destructive.  Mid July Return to alternate days 20mg/10mg - minimal improvement. Early August Return to full dose 20mg. Lost.
2014 February Switch to Venlafaxine. (First reduced Esc. to 10mg/day for a week) Feb-April Lost, 'light' self-harm, exhausted.
April Increase Ven. to 150mg/day. Dizzy. July 75mg twice a day to improve dizziness. Deep depression remains.  2015 Feb Vigilant dose spacing partially eases dizziness. Mar Switch to Effexor 75mg 2x/day. May Cut 10% to 135mg - bad w/d 2 mths, held 1 mth.  Aug 1.3% cut - bad 1mth, held 1mth. Oct 4 wkly 0.4% cuts held 6 weeks. Jan 2016 2 wkly 0.4% cuts. 8 month hold. Sept Wkly cuts: 0.5%, 3 1% cuts.  Oct 4 wkly 1% cuts, hold 3-4 weeks.
Supplements: Fish oil, vitamins E & C, magnesium, iron, MSM, oat-straw tea, nettle tea.  My story of healing: ContinuedHealing

***I am not a doctor or counselor; please do your own research and be prepared to take responsibility for decisions you make.*** 

           'The possibility of renewal exists so long as life exists.'  Dr Gabor Mate.


#5 Altostrata

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Posted 15 May 2017 - 09:32 PM

Very well put, Henosis.

 

Very few physicians know anything about adverse reactions, still fewer know anything about withdrawal syndrome.


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

#6 DrugfreeProf

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Posted 17 May 2017 - 05:58 PM

"It is difficult to get a man to understand something when his salary depends upon his not understanding it."

Drugfree Prof

Psychologist and Psychotherapist

Prozac 20 mg for approx 3 months during 2000, withdrew, no w/d sx

Prozac 10 - 30 mg Jan. 2008 - Dec. 2014

Ritalin 30-40 mg Jan. 2008 - Mar. 2015

W/d sx from Prozac started around 3 months after cessation--crying spells, depressed mood, lethargy; resolved in 8 - 12 mos. post cessation

Used and continue to use a TON of alternative methods--meditation, mindfulness, nutrition. supplements, exercise, etc.


#7 nz11

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Posted 17 May 2017 - 08:31 PM

Just spotted this thread

Henosis, I compliment you on your great letter.

Great effort.

 

I have nothing more to say on this.

This is just so typical when faced with the undeniable obvious they simply choose to remain silent.

They have nothing to table to support their BS.

This mans voice is clearly influenced by his financial ties to pharma.


2000 amitryptaline, nortriptaline venlafaxine clonazepam for  arm pain from keyboard use, told I had a chemical imbalance it would fix my arm was just a matter of finding the right med for me not informed of the nature of these drugs assured safe and not addictive, CT off Effexor after being told to double the dose on reporting adverse effects...later ..uncharacteristic psych panic tearful presented to doctor to get answers. Given paroxetine no questions asked 'safe and not addictive' next please.2001-2010 paroxetine (paxil) 2 failed attempts to quit, a learned helplessness set in. Feb 10 - Sept 10,  8 month clueless taper, hell. Doc said I had underlying depression .. I said that's not right' then found online support group and the truth!...overcome with inconceivable humiliation and outrage. 28 Sept 10 drug free ...  daily psych and emotional torture beginning in the waking hours of the morning receding somewhat in the evening only to start up again the next day. 28 Sept 12 (24 months) Stabilizing  (What an indescribable unimaginable non-functional nightmare). sleep issues start up at 3 yrs  waking daily at 2am -4.30am), April 2016 return to sport for the first time since drug free, Sept 16 return to work on casual basis.  28 Sept 16 (6yrs drug free), still cant sleep with any regularity, pssd continues no sign of improvement, still feel Rip van Winkle-ish, brain fog still improving, psoriasis concerns.

 

"It is unsafe for people who suffer from something that could be treated with an ssri to consult a psychiatrist." Gotzshe 2015. [ I think Gotzsche could have easily meant to say 'to consult anyone with prescribing privileges']. "Going to a psychiatrist is one of the most dangerous actions a person can take." Breggin

 

“Paroxetine is not safe, it is not effective and it meets every known definition of addictive.” McLaren, N, (2016) 'Psychiatry as bullsh*t’ p55..."Psychiatry is stuffed full of 'deep nonsense' better known as bullsh*t." McLaren 2016

 

"Within the first week of when you go on an antidepressant you may have a sexual dysfunction, it can go on forever, often only appearing when you go off the drug ...its extraordinarily common" Healy 2015

 

See  my intro post #451 for the xanax back story and for a CV -GSKs.  Come on guys get taperwise see a TaperMe Schedule

 For a staggeringly shocking 'prozac back story' see the truth post #523

 

"If I were an enemy combatant and the NZ army did this to me someone would be dragged to the Hague and jailed!"  nz11


#8 compsports

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Posted 18 May 2017 - 02:52 AM

NZ11,

 

I hate to sound like a cynic but I am guessing that even if this guy didn't have drug company ties, he would have still reached the same conclusions. The issue is most psychiatrists and regular medical professionals look at any withdrawal problems from psych meds as a return of the illness.

 

Also, psychiatrists deny many other non-psych med side effects and attribute those to psych issues.

 

Now as an exception, I have had had good luck getting anesthesiologists to take my concerns about med sensitivity when I have spoken to them prior to my undergoing general anesthesia.   But interestingly, when I told the anesthesiologist who would be doing my anesthesia that I had been twice advised to skip versed which is given routinely before procedures under general anesthesia to relieve anxiety, she tried to justify it as a safe drug.  Of course, she abided by my wishes but it is like these folks just don't realize there is a subset of patients who are quite sensitive to meds.


Drug cocktail 1995 - 2010
Started taper of Adderall, Wellbutrin XL, Remeron, and Doxepin in 2006
Finished taper on June 10, 2010

Diagnosed with sleep apnea 2012 and on pap machine

Dealing with protracted sleep issues


#9 fema4psychiatrists

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Posted 18 May 2017 - 03:51 AM

how would HE like another human being to make his genitals go numb forever. sounds fun huh? imagine if somebody did that to him when he was a child or did that to his child?

 

What scumbags these people are. All evil people have their great excuses. dont kid yourself. It is pure evil. They are sponsored by drug companies to kill harm and maim innocent defenceless and desperate people.

 

Youtube this as a video called "your psychiatrist"

 

 

it is done to unbiased unbipolar lab rats. simple.


Edited by ChessieCat, 18 May 2017 - 01:14 PM.
removed offensive term

Cocktail drugged since 9

Genitals went numb

Extreme intestinal gas and pain

Extreme anxiety cant concentrate

All permanent

 

Post-SSRI Sexual Dysfunction (PSSD)

http://pssdblog.blogspot.com