Why can one be put on so much medication so quickly but take so long to come off?

[acetyl]

I'm just interested in whether anyone has done research in to why most of us can be rapidly titrated up to a large dose of an AD or AP without the brain having the complete melt down that it does if these drugs are rapidly removed? Surely the initial introduction of them throws just a bigger wrench in the gears of our brains' delicate neurochemistry, yet if this caused the dilemma that rapid removal does, none of use would have ever tolerated any psychoactive drug for more than a week. 

[bubble]

Did I share with you my favourite piece by Rhi?

 

I usually use it to try to explain to people why CT is a very bad idea but I think it might answer your very interesting question. It simply takes some time (usually a month for these meds to become a part of the "brain structure". Which is something even psychiatrists recognize when they tell us if will take us some time to feel the "benefits" (that is numbing) of an AD. I could never understand why the same doctor would tell me to stop taking them just like that and was even surprised at brutal physical symptoms I would then experience...

 

Anyway, here goes Rhi:

 

A lot of people, including healthcare practitioners; in fact, I guess, most people-- are operating from entirely the wrong paradigm, or way of thinking, about these meds. They're thinking of them like aspirin--as something that has an effect when it's in your system, and then when it gets out of your system the effect goes away.

That's not what happens with medications that alter neurotransmitter function, we are learning.

What happens when you change the chemistry of the brain is, the brain adjusts its chemistry and structure to try to return to homeostasis, or biochemical and functional balance. It tries to restabilize the chemistry. 

For example: SSRI antidepressants work as "serotonin reuptake inhibitors." That is, they cause serotonin to remain in the space between neurons, rather than being taken back up into the cells to be re-used, like it would be in a normal healthy nondrugged brain.

So the brain, which wants to re-establish normal signaling and function, adapts to the higher level of serotonin between neurons (in the "synapse", the space between neurons where signals get passed along). It does this by removing serotonin receptors, so that the signal is reduced and changed to something closer to normal. It also decreases the amount of serotonin it produces overall. 

To do that, genes have to be turned on and off; new proteins have to be made; whole cascades of chemical reactions have to be changed, which means turning on and off OTHER genes; cells are destroyed, new cells are made; in other words, a complex physiologic remodeling takes place. This takes place over time. The brain does not grow and change rapidly. 

This is a vast oversimplification of the amount of adaptation that takes place in the brain when we change its normal chemistry, but that's the principle.

When we stop taking the drug, we have a brain that has designed itself so that it works in the presence of the drug; now it can't work properly without the drug because it's designed itself so that the drug is part of its chemistry and structure. It's like a plant that has grown on a trellis; you can't just yank out the trellis and expect the plant to be okay.

When the drug is removed, the remodeling process has to take place in reverse.

SO--it's not a matter of just getting the drug out of your system and moving on. If it were that simple, none of us would be here. 

It's a matter of, as I describe it, having to grow a new brain. 

I believe this growing-a-new-brain happens throughout the taper process if the taper is slow enough. (If it's too fast, then there's not a lot of time for actually rebalancing things, and basically the brain is just pedaling fast trying to keep us alive.) It also continues to happen, probably for longer than the symptoms actually last, throughout the time of recovery after we are completely off the drug, which is why recovery takes so long. 

With multiple drugs and a history of drug changes and cold turkeys, all of this becomes even more complicated. And if a person is started on these kinds of drugs at an early age before the brain has ever completely established normal mature functioning--well, it can't be good. (All of which is why I recommend an extremely slow taper particularly to anyone with a multiple drug history, a history of many years on meds, a history of past cold turkeys or frequent med changes, and a history of being put on drugs at a young age.)

This isn't intended to scare people, but hopefully to give you some idea of what's happening, and to help you respect and understand the process so you can work with it; ALSO, because you are likely to encounter many, many people who still believe these drugs work kind of like aspirin, or a glass of wine, and all you need to do is stop and get it out of your system. 

Now you can explain to them that no, getting it out of your system is not the issue; the issue is, you need to regrow or at least remodel your brain. This is a long, slow, very poorly understood process, and it needs to be respected. 

[Meimeiquest]

I had to taper up on several and had WD-like symptoms when I started Celexa....that should have been my first clue to stop!

[Altostrata]

A lot of people have awful symptoms when starting a psychiatric drug and titrating upward. The dropout rate for "intolerable side effects" in clinical trials lasting maybe 6 weeks was about 30%.

[alexjuice]

Because it's the exact opposite! If you build a mountain of rocks alongside a mountain range, there is no snow on top of the rocks. But once the rockmountain is built, snow will accumulate on the fake rock mountain and all this snow on top will come crashing down if you suddenly pull out the rocks!

 

There is no snow to crash if you simply build the rockmountain too fast. You see?

[acetyl]

I like the analogy Alexjice. 

 

Definitely some people react extremely badly initially to ADs. My mum went on escitalopram for 2 weeks and became psychotic, suicidal and completely irrational, especially if she had anything to drink, so she very quickly stopped that drug. I often wonder why it didn't click sooner that not being able to walk without holding on to the walls because I felt so sedated and dizzy meant the AP I was taking was seriously messing around with my brain.

 

For a decent percentage of us it's just interesting that we probably had no idea on a day to day basis whilst taking the drug that our brains were frantically altering gene expression, up or down-regulating receptors, altering neurotransmitter biochemical synthesis, desperately trying to reclaim homoeostasis. Yet this is oh so very apparent when the drug is removed. Imagine if ADs caused the bad brain zaps for the first 2 months when they were commenced, no one would stay on them ever.

[GreenFlameTiger]

As the topic title says, why can one be put on so much medication so quickly but take so long to come off? For myself, my dose of Olanzapine was doubled in the course of a day or so and it took seven months to taper it back to where it was. I have a friend who has schizophrenia and was on no medication for about ten months. She did very, very well. At university, socially etc. She then had an episode and is now on three different medications. She's only been on these medications for a month or so but instead of being able to drop the medications cold turkey, it seems the only sensible approach is a 10% or less a month taper of one medication at a time. This would probably take her at least three years, probably five years with the medication she's on to taper off completely. She really doesn't want to have these harmful substances in her body all this time. Again, why is it that one can be put on so much medication so quickly but take so long to come off? And in her case, especially when they've only been on the medications for a month or so?

 

Thank you for your time. I look forward to your responses.

[Jemima]

A great deal depends on the individual.  A person who's taken a psychiatric medication--for the first time--may very well be able to get off quickly after only a month on the drug. If your friend has a history of being on psychiatric drugs, she may very well be sensitized to them and would be better off doing the slow, 10% taper. Did she, by any chance, have her "episode" after going off psychiatric drugs at a faster rate than 10% a month?  So often, especially with the stronger drugs like atypical antipsychotics, the withdrawal symptoms are delayed for weeks or even months.  This is also a problem with many antidepressants, such as Effexor and Paxil.

 

Psychiatric drugs make actual physical changes in the brain which are abnormal, and these changes are what cause problems when the drugs are withdrawn too abruptly. The nervous system has become dependent on these chemicals to function in its new, abnormal state, and flounders around trying to get back to normal if the drug is completely withdrawn all at once.  Antidepressants and other psychiatric drugs are a fairly new development in the history of human beings and the nervous system has no inherent way of coping with the changes they make. And so the nervous system gradually gets back to its normal state, but it takes a lot of time to destroy the abnormalities and re-grow the brain into its normal structure. For most people, it's best to very gradually reduce the drug rather than quitting cold turkey or doing a rapid taper.  This supports the brain while it renormalizes.

 

I hope that helps.

[Altostrata]

Merged similar topics. See discussion at the beginning.

[GreenFlameTiger]

Did I share with you my favourite piece by Rhi?

 

I usually use it to try to explain to people why CT is a very bad idea but I think it might answer your very interesting question. It simply takes some time (usually a month for these meds to become a part of the "brain structure". Which is something even psychiatrists recognize when they tell us if will take us some time to feel the "benefits" (that is numbing) of an AD. I could never understand why the same doctor would tell me to stop taking them just like that and was even surprised at brutal physical symptoms I would then experience...

 

 

First, thank you for merging the topics Altostrata. I have found the older topic extremely valuable. 

 

What does CT stand for? Does it stand for ECT, Electroconvulsive Therapy? What is your guys' stance on ECT? I strikes me as a horrible idea. But I believe it is still used to this day. They claim they have refined the procedure.

 

I imagine AD stands for AntiDepressant. Sorry sometimes abbreviations throw me for a loop. 

[bubble]

Hello GFT,

 

yes abbreviations such as the one of your name just now can be tricky It's just that our friends from the States are very fond of them and they are actually very useful. CT is abbreviated for cold turkey which I'm sure you'll know is used to describe stopping your medication abruptly from one day to the next or with a minimum of tapering. ADs are indeed antidepressants

 

My personal opinion on ECT is that it should be banned. I see it as a form of torture actually and helplessness of psychiatry in the face of human distress as well as a mark of their ignorance along with other awful methods which have been banned now.