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peggy

Antidepressant Tolerance Withdrawal or "Poop Out" While Tapering

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peggy

What do people think about the possibility of 'poop out' happening during a slow (several years) taper?

 

I have always had this fear of effexor not working - everytime i came off and then went back on again i would be obsessing over 'will it work this time' This idea came about after spending countless hours on some of the pro med sites - the sites that prescribe to the chemical imbalance theory. So, i have a lot of de-programming to do!

 

Poop out seems to be an accepted phenomenon, correct me if you think it is not.. so, what is the consensus about reaching this in a very slow taper?

 

Thanks

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jr1985

Ive had similar fears, but then I read poop-out happens because all of your serotonin receptors have downregulated in response to the increase in serotonin from the SSRI's. It seems unlikely that it would happen during a slow taper, as you are slowly removing the drug, which causes your brain to unregulate serotonin receptors (i.e. the opposite of what causes poop-out).

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Altostrata

Exactly. I think it's unlikely you would experience poop-out during tapering. Withdrawal symptoms are bad enough.

 

peggy, there is some evidence that going on and off antidepressants results in "treatment-resistant depression," in which no psychiatric drug relieves the symptoms and psychiatrists resort to natural means (supplements, exercise, etc.) to try to help people.

 

However, it's unclear whether those suffering the iatrogenic condition of "treatment-resistant depression" may in fact be suffering prolonged withdrawal syndrome.

 

Either way, it's a good idea not to go on and off and on and off these medications. You also risk sensitizing your nervous system to a lot of things, not only psychiatric medications.

 

Every person's future on psychiatric medications is limited by the tolerance of the nervous system to chemical stress. You cannot keep on bouncing around on these drugs forever.

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peggy

thanks, that does make sense..

 

treatment resistance was another thing that i used to get unreasonably scared from - it seems to me, since learning about w/d that maybe it is a case more of prolonged withdrawal

 

hopefully i won't keep bouncing around - and i certainly wont be trying other medications

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machawolf

Hey everyone, I was looking for some input on antidepressant tolerance or more commonly referred to as antidepressant “poop out”.  Can this happen while attempting to stabilize on a dose while tapering?

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brassmonkey

Hi Macha-- It can happen but it's not very common.  Poopout tends to happen when you've been on a dose for a long time and the body gets use to having that amount in it and starts to work around it.  The symptoms of poopout will grow on you gradually  over a period of months and not start up suddenly over a few days.

 

Did you start taking the Sam-e that the doctor recommended.  That could be the source of the problems. Sam-e does not play well with ADs and APs and shouldn't be used while tapering.

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machawolf

I took the Sam-e for a while and it didn’t help, possibly made worse. The last three months I have been on the same 150mg dose of Sertraline and Rhodeola. It has been helping and I thought I was stabilized finally at the beginning of last month, now with no change in meds I seem to be having issues again. Maybe I had a long window or something? I wasn’t sure if “poop out” could happen in three months.

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brassmonkey

This is sounding more like a bad wave brought on by all the dose changes over the summer.  Given a bit more time it should settle down.

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SquirrellyGirl

Wanting to understand the process of tolerance withdrawal...

 

Someone was on Effexor 75 mg for several years, and tapered off over a year, though probably making relatively large cuts rather than 10%..."Relapsed" 6 months later and went back on 75 mg.  Has been at that dose for four plus months and has been having windows and waves, a good week or two followed by a bad week or two.

 

I'm thinking he has reached tolerance at 75 mg but is it possible to have windows and waves in tolerance?  Is that pretty normal?  And what is happening there?  The dosage is not reduced or removed so what do the windows and waves represent?  I thought W&W represented healing, but how can healing take place when the drug level remains the same?

 

So, the options are to 1) increase with the risk being adverse symptoms, but if it helps then likely tolerance will be reached again or 2) start reducing with a 10% taper, with the hope that WD symptoms would be relieved by reducing.  

 

Is there a proposed mechanism by which tapering relieves tolerance withdrawal symptoms?

 

Just wanting to understand...

SG

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ccb73

Sorry for your suffering. I do see you jumping back and forth in your psych med history!

 

I had doctors do subtle switchovers, withdrawals and I suffered. The suffering seems to compound, meaning, first hop, some temporary trouble, second hop, little more, third hop, brain changes, etc...

 

I actually developed chronic anxiety and depression because of compounded hopping.

 

Well, I'd advise to get to something that works, reasonable doses please, and do safe taper.

 

Remember that there is payoff time and if gor example you decide to do 40mg of viibryd (a drug I'm on), you'll need to 10% or whatever works off 40mg making the journey harder and longer.

 

Good luck. Peace ad love.

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SquirrellyGirl

Sorry for your suffering. I do see you jumping back and forth in your psych med history!

 

I had doctors do subtle switchovers, withdrawals and I suffered. The suffering seems to compound, meaning, first hop, some temporary trouble, second hop, little more, third hop, brain changes, etc...

 

I actually developed chronic anxiety and depression because of compounded hopping.

 

Hi ccb73, 

I'm sorry you developed chronic anxiety and depression because of all of this.  I wasn't referencing myself above, someone else's case that i am trying to understand.  

 

I've had my own hoppy history, though.   Went from Prozac to Wellbutrin to Effexor. 12 years on Effexor during which I went probably to 225, and then dropped back down by pill sizes (37.5 mg at a time, maybe even 75, don't remember!) culminating in coming off too quickly over a year ago.  10 months of protracted withdrawal before reinstating 37.5 mg.  I'm doing a micro taper on Effexor, and I mean MICRO since I am also tapering off of mirtazapine primarily.  I am down to 27.5 mg Effexor and feeling more stable than I probably ever was on any higher dose!

 

For this person, his dilemma was what to do, and what was going on with the periods of feeling good and bad.  I'm just trying to uderstand it so I can advise him better.  It sounded like windows and waves, but I'd never heard of that during tolerance.

 

Of course, if I were him, I'd do the 10% or less taper and work towards getting off, rather than updose in hopes of overcoming tolerance. But it is each person's decision to make, hopefully informed.

 

 

 

I see that you are on quite the cocktail, and I am so sorry you ended up with that situation, an all too common one.  Before my crash, I spent a lot of time on the boards at PsychCentral, and I was blown away by how many people on the depression board were polydrugged similarly.  It occurred to me, if you are on so many drugs, why are you still so depressed?  What's up with that?  Now I know!

 

SG

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ccb73

Point well said.

 

I am actually withdrawing too with mood swings and a variety of complaints.

 

I also confer with top professionals and the concensus seems to be "We don't have the foggiest idea how withdrawal effects a person and there are no experts".

 

Suffices for now... For further discussion.

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KarenB
I also confer with top professionals and the concensus seems to be "We don't have the foggiest idea how withdrawal effects a person and there are no experts".

 

 

Ah - they haven't heard of Alto....

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SquirrellyGirl

So what do we call it then, when a person takes a particular dosage of an AD for some time and it helps, but then they seemingly "relapse" despite the drug and so the dosage is increased?  What causes that phenomenon?  I see it referenced all the time for people on these drugs for anxiety and depression, with those symptoms popping up again, leading to an increase.  "Poop out?"  If "poop out" isn't tolerance withdrawal, then what is it?

 

Reading Anatomy of an Epidemic, we know that the nervous system pushes back against the action of the drug by up- regulating receptors among other things, so trying to wrap my brain around what is happening when the drug seems to stop working?  Is it just that they really don't work to begin with, because the problem isn't caused by low serotonin?

 

I can be a real pain in the #$%@  LOL!

 

SG

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Petunia

At the moment, I think its impossible for anyone to know what's happening when the drug stops 'working' because we don't even know everything its doing while it still is working.

 

To further complicate the issue, these drugs effect different people in different ways.... side effects, personality changes, usefulness, effects on stopping. :wacko:

 

The word tolerance may be appropriate, but not withdrawal, not if the drug isn't being decreased. To me, withdrawal is what happens when the body has to start adapting itself to functioning in the absence of a substance it had become accustomed to. Any new unwanted effects which arise when the drug is no longer providing beneficial effects at the current or increased dose are not withdrawal symptoms, but new effects which have developed over time caused by ongoing exposure to a toxic substance, either that or its no longer doing such a good job at disabling emotions any more and some of the unpleasant ones are coming back to annoy us.

 

I actually prefer 'poop-out' because it sounds as silly as believing these drugs were actually curing something in the first place :)

 

 Is it just that they really don't work to begin with, because the problem isn't caused by low serotonin?

 

I guess that depends on what the underlying problem really is, my guess is that most of the symptoms which get diagnosed as anxiety and or depression are caused by previous, unrecognized childhood trauma, having developed self-defeating ways of thinking and behaving in life or current, ongoing stress.... maybe a combination.

 

In the case of a diagnosis after the loss of a loved one or another kind of loss, really, its a normal human reaction to feel sad, and anxious about what the future may hold.... does this mean we have an illness?  That somehow our brain stopped working properly and was no longer able to produce the correct balance of chemicals? I would think it was producing the appropriate balance of chemicals for the situation, to enable us to go through a grief process, adapt to the loss or make the changes we need to make. 

 

But this is inconvenient, so taking a pill which effects our brain in mostly unknown ways sometimes makes the bad feelings go away for a while, for some people, some of the time.... does that mean we had low serotonin? Maybe, it depends on the time of the day and what we were doing at that particular time, I don't know and neither does anyone else. According to some research, some people with depression have high serotonin. But seeing as you can't measure serotonin in a living brain, I don't know how they knew that.

 

I understand your frustration SG, I used to spend a lot of time speculating about brain chemistry, trying to figure out what was going on up there so I could have some control over it... but that's what got most of us into trouble in the first place.

 

Also see:  Again, chemical imbalance is a myth. Stop the lies, please ...

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SquirrellyGirl

I've been reading Antatomy of an Epidemic, and was astonished to learn that only 1/3 of people with depression had low serotonin, but also 1/3 or so had HIGH serotonin!  More astonishing was to learn that the control group, healthy people, also had 1/3 low, 1/3 high, and 1/3 in the middle! Good ol' bell shaped curve!  So, you can't even infer that low serotonin caused the depression in the low group, because it didn't cause it in the normal low group!  But the drug companies cherry pick what they want from these studies and make something out of nothing.

 

Given the article I just read by Robert Whitaker (ok, it was from 2011 but I'm slow to get caught up!  https://www.psychologytoday.com/blog/mad-in-america/201106/now-antidepressant-induced-chronic-depression-has-name-tardive-dysphoria),the process of ADs working but then symptoms re-emerging seems to be a phenomenon of chronic AD use, and so "iatrogenic," caused by the drugs.  It would seem, then, that the chronic use causes our systems to push back so hard by dropping serotonin production and pruning back receptors as to become insensitive to serotonin, no matter how much is around.  Much like insulin resistance, but in this case the drugs CAUSED the problem and can no longer be looked at as the "cure."  

 

I hesitate to bring insulin and diabetes into the discussion, because we are trying to debunk the notion that these drugs are like insulin to a diabetic.  Insulin does not cause the diabetes!  Also, it is possible to reduce the need for insulin and even the need for the drugs that help control diabetes by losing weight, eating the right kinds of foods,exercising, etc.  Many a diabetic have been able to dispense with the drugs and insulin by adopting these strategies, in essence helping their body become sensitive to insulin again.  

 

And so I believe it is possible for us to wake our nervous system up to produce more serotonin and add receptors to become sensitive to it again, through very slow tapering.  I wish El-Mallakh, Andrews and the rest would look at how the coming off affects the nervous system, slow versus cold turkey for instance.  Of course, there isn't any money in that.  However, what has happened to us is epidemic, and with doctors doing depression screens at every visit and putting more and more people on these drugs, these studies may end up being done out of necessity as more and more people sign on for disability!

 

SG

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Susanne

I've been reading this thread, trying to understand about poop-out.
Can't really work my head around what actually happened to me in the last year. I don't know -at this moment- if it's important for me to know every thing about it. I'm not a doctor or a scientist.
It might be that i just want to tell some one my frustration about it, because it doesn't seem any doctor or therapist has the answer. And the people on SA can't look into my brain...but still, it might help if I just write it down. 

In 2008 I started with a dose low dose of Luvox. It worked well for my intrusive thought. The thought has its origins in panic attacks. I was in therapy for a few years already but never dared to try medication. My psychotherapist advised me to combine therapy and an SSRI.
I didn't actually taper gradually in 2009/2010. The Luvox 'fixed' me and after a while I just thougt I didn't need it anymore. One day I forgot to pick up a prescription and nothing bad happened. So from that day I just took my dose every other day and then stopped. My life was wonderful, felt really free.

I suddenly relapsed in 2010 and went to see my doctor again. Again medication, but 9 weeks of Luvox and no improvement. I felt more depressed because it wasn't working for me like the first time. I just wanted it to work so badly!
My doctor advised to switch to another drug and we picked Lexapro as a good candidate.
After 3 weeks it started working. My intrusive thought went away again. 

In the past 6 years I took my medication every day. I slowly tapered from 20 mg to 5 mg. Didn't use the 10% taper schedule. Didn't know anything about withdrawal and no therapists or doctors advised me to taper. I just figured I could lower my dose every year and the last two years I took 5 mg. I do have to mention that I had a rough year, a lot of stress on work as well as personal stuff, but it didn't have anything to do with OCD.
Then...two months ago, I thought it was a good idea to take 5 mg every other day. I figured I was supplying my brain with 2,5 mg per day. I've read somewhere that this was a good way of getting off these kind of medications. 

May 2016: mild panic, suddenly. I was having the same intrusive thought again and it didn't go away! Couldn't focus, got scared. "Oh no it's back!"

No one to consult about it. My general doctor on vacation and I wasn't in therapy. I updosed to 10 and then 15 mg but after 4, 5 weeks nothing changed.
Trying to figure out what actually happened and can't find another explanation then: my brain isn't sensitive anymore for this drug. A poop-out?

Began to research this and at the same time: "Stupid Lexapro not working, what to do next?"
I got frustrated and want to 'reset'.

My fear is: as long as I'm on the drug my own brain can't reset. That's probably a wrong assumption, but I just can't figure out how it works.
In other words: Can I make my brain sensitive again when still on this (low) dose? I want to work on it from the inside instead of letting an SSRI do the work for me. I do want to taper very slow because I know now it is better not to risk any WD symptoms.

Any thoughts? Thanks!


 

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Altostrata

Susanne, people often come here having tried to go off drugs by skipping doses. This can trigger terrible withdrawal symptoms.

 

That is what happened to you when you got "mild panic." It might also have triggered your earlier habit of intrusive thoughts.

 

These drugs have fairly short half-lives, less than a day. When you skip doses, the amount in your bloodstream goes up and down. This is destabilizing to your nervous system.

 

Withdrawal symptoms are signals from your nervous system that something is not right.

 

Let's talk more about your particular situation in your Intro topic Susanne: from the Netherlands, tapering and feeling :-(

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Susanne

Thank you Altostrata. Your reply was actually really useful. I've posted my last question in my intro topic as well.

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wantrelief

Hello all,

 

I am not sure this is the right place to ask this question but it is in regards to tolerance so I thought it pertained.  Feel free to move it to my individual thread if that would be more appropriate.

 

My question is what happens if someone is in tolerance  - so experiencing withdrawal like symptoms because the drug isn't working for them anymore and they cannot stabilize at a higher dose?  Mostly I am wondering if it is possible to taper when you are really unstable - someone in tolerance would have to be in this position, yes?  Is it even feasible to try doing this when not stable?  Would symptoms just worsen if a cut is made?  Just thinking ahead as I may be in a tolerance situation and am thinking through my options.  I am not sure I've read about anyone on here who was in a really unstable place when they started tapering but maybe there is an example out there.....

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Altostrata

This depends what you mean by "unstable." Your Intro topic is probably the best place for that discussion.

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wantrelief

Thanks, Alto - I will pose the question in my topic.

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reachingforthestars

I'm wondering is "poop out" similar to "adverse reaction to AD"? Is the result in both cases the same--> brain downregulates the serotonin receptors? 

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brassmonkey

They're actually two very distinctly different things.  An adverse reaction is a very rapid onset of acute side effects caused by an increase or reinstatement of dosage.  Where as poopout or tolerance is the slow loss of effectiveness that precipitates the onset of WD symptoms while maintaining a steady dose.

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reachingforthestars

They're actually two very distinctly different things.  An adverse reaction is a very rapid onset of acute side effects caused by an increase or reinstatement of dosage.  Where as poopout or tolerance is the slow loss of effectiveness that precipitates the onset of WD symptoms while maintaining a steady dose.

 

 Hi Brassmonkey :)

 

I was just thinking that maybe in both cases the result is the same-->downregulation of the serotonin reseptors. but in an adverse reaction due to flooding with ssri it only happens faster? Or i guess nobody knows what is really happening in the brain in an adverse reaction...

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brassmonkey

"Or i guess nobody knows what is really happening in the brain in an adverse reaction..."

 

That's pretty much it. Even Big Pharma will admit that they have no idea how these drugs actually work. There are so many interrelationships and systems within the body that get affected and many of those systems etc we still don't even understand.  We make educated guesses about receptor occupancy, cortisol spikes, akathesia, and the like, but it's all based on what we've seen and experienced with working with several thousand people, not on hard scientific knowledge.  One of the hardest questions we get here is "why is YYY happening".  WE don't know, we've seen it before and trying this XXXX usually helps, but there's a chance the OOO might happen instead.

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