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Henosis

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

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Henosis

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.com/Article/FullText/371865

 

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

http://www.karger.com/Article/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
added additional spacing for ease of reading

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ChessieCat

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!

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stan

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

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KarenB

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! 

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Altostrata

Very well put, Henosis.

 

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

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DrugfreeProf

 

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

 

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nz11

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.

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compsports

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.

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fema4psychiatrists

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
removed offensive term

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Lilu

Wow. Bravo.  I'm so impressed with your "industry terminology" and how calm you were.  And your letter is so impressive, I would give it to other doctors. 

But how sad that he won't even admit that you're making a good point.  And the fact that he's being paid by all those pharmaceutical companies... ugh... the whole thing makes me feel so hopeless and sad.

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