Jump to content
Altostrata

One theory of antidepressant withdrawal syndrome

Recommended Posts

Altostrata

Yes, it's from personal correspondence.

 

Glutamatergic activity has been suspected for many years to be involved in mood disorders. It's a parallel theory to the monoamine hypothesis, but was eclipsed by the pharma-driven focus on serotonin and norepinephrine.

 

It so happens than my doctor has been more or less following the glutamatergic theory for many years, and has had great success with gentler treatments arising from his understanding of it.

 

Whether heightened glutamatergic activity invokes depression or anxiety may be a function of individual neurology, as so many variations are. What we see in withdrawal syndrome, where glutamatergic hyper-reactivity is so exaggerated, is that panic or anxiety attacks can be induced in people with no prior history of such attacks, and the same people also experience waves of deep melancholia. It may be the difference is a matter of degree: Lower cortisol waves provoke melancholia; higher waves provoke anxiety; higher and more acute waves provoke panic.

Share this post


Link to post
Share on other sites
Nadia

Ah, the thread that started it all for me...

 

Alto, how do you feel about treating withdrawal with Lamictal now? If it's true that it doesn't affect receptors, I can see the logic of stabilizing for a while allowing your mind to get out of the "fight or flight" rut.

 

I've been trying to get myself out of that rut with other methods, but it's so hard sometimes. Especially because of lack of good sleep.

 

I sometimes wonder if going away on a prolonged vacation would help me heal, or if it would just make me less tolerant to stress. Most anxiety therapies stress facing your stressors, not reducing them.

 

My intuition tells me that the way out is to reduce stress, then increase it gradually, like if you were healing a hurt limb.

Share this post


Link to post
Share on other sites
Altostrata

Lamotrigine has worked for me, but I'm being treated by a doctor who knows what he's doing with it.

 

I'm down now to .04mg (from 5.2mg), still slowly tapering.

Share this post


Link to post
Share on other sites
jr1985

I had similar thoughts about serotonin receptors during withdrawal. I wondered if the reason people experience w/d as windows and waves is because, following the initial shock of withdrawal, the brain freaks out at the lack of serotonin activity, so frantically upregulates serotonin receptors to try and compensate. Only it overshoots the mark, causing too much serotonin activity, so now it has to downregulate the receptors. This continues back and forth until the brain finally reaches a balance.

 

Of course, I have no evidence to back this up, it is pure speculation.

Share this post


Link to post
Share on other sites
kerrip

Right, it seems to be a damped oscillation response. Overshooting in both directions, whether it be up or down regulation, but lessening with time...

 

I know I am only 11 months out, but it feels like this is taking forever. And some of the success stories that I am hearing are telling me that you have to wait up to 4 years, sometimes more. I've got my second child coming in March and I want to feel better by then!

 

Sorry, I am emotional this AM.

Share this post


Link to post
Share on other sites
Nadia

The wait is certainly maddening... the windows give you hope, and then the waves are so disappointing! I was hoping to be done with this two years off the meds, but will probably be a while longer since I had one of my worst waves at the end of last month. I think even when we see a lot of improvement we have to be careful about what we put into our bodies and the stress we are under. A lot of things can't be helped, but we can do our best to stay healthy with nutrition and exercise.

 

Whatever the biological reasons behind it, the delay that some of us experience with the worst of withdrawal symptoms (or the presentation of new, more severe symptoms) several months after being completely off the drugs really confounds things for doctors and researchers. It is the main reason that the doctors I have seen refuse to believe it is an effect of quitting the medication. The new symptoms can be considered kindling or a new episode. I hope researchers like Harvey do more work in this area and influence long term studies.

Share this post


Link to post
Share on other sites
Altostrata

This thinking is too serotonin-centric, given that hundreds of hormones are affected by dysregulation.

 

See this new topic http://survivingantidepressants.org/index.php?/topic/3281-neurotransmitters-a-primer/ (Thanks, Barb.)

 

There is overshooting, but it's not in those serotonin receptors, it's in other places. The serotonin receptors slowly and progressively re-regulate. No one has been able to show an abnormal fluctuation in serotonin level.

 

By the way, I have never seen a pattern of recovery so that I can say such happens at 11 months or such happens at 2 years. I wish I could. It seems very individual.

Share this post


Link to post
Share on other sites
alexjuice

By the way, I have never seen a pattern of recovery so that I can say such happens at 11 months or such happens at 2 years. I wish I could. It seems very individual.

 

You probably have a better sense than most everyone, showing the complezity of the current tangle.

 

It seems, based on common sense, that a significant issue is the lack of standards for treatment of depression. Treatment for an individual diagnosed with major depressive disorder might be zoloft 75mg + wellbutrin 300mg while another person, same diagnosis, treated lexapro 20mg + abilify 5mg and so on... Add confounding factors (sex, age, SES) and... tangled up ball of string in the tough d/c cases.

Share this post


Link to post
Share on other sites
Altostrata

Right, there are a lot of conditions that might affect the pattern of recovery.

Share this post


Link to post
Share on other sites
Barbarannamated

"Too 'serotonin-centric'" - EXACTLY. I'd add "too 'brain-centric'" to that.

 

Given that "the exact mechanism of action is unknown", it would be impossible to known how to unravel that, especially after long term exposure and adaptation by all body systems.

Share this post


Link to post
Share on other sites
jr1985

This thinking is too serotonin-centric, given that hundreds of hormones are affected by dysregulation.

 

See this new topic http://survivingantidepressants.org/index.php?/topic/3281-neurotransmitters-a-primer/ (Thanks, Barb.)

 

There is overshooting, but it's not in those serotonin receptors, it's in other places. The serotonin receptors slowly and progressively re-regulate. No one has been able to show an abnormal fluctuation in serotonin level.

 

By the way, I have never seen a pattern of recovery so that I can say such happens at 11 months or such happens at 2 years. I wish I could. It seems very individual.

 

Of course, you are right. I suspect if only serotonin was involved then the withdrawal period would be much more predictable.

 

How are you in your path to recovery? Do you think you will ever fully recover?

Share this post


Link to post
Share on other sites
Altostrata

Today I think I will recover, jr.

Share this post


Link to post
Share on other sites
jr1985

Today I think I will recover, jr.

 

Good. :)

Share this post


Link to post
Share on other sites
Skyler

Today I think I will recover, jr.

 

I'm very glad to hear this Alto, it's been a VERY long haul for you.

 

Hope you have some fine holiday trimmings coming your way..Posted Image

Share this post


Link to post
Share on other sites
Altostrata

Thank you, all. More than enough trimmings, I'm sure, Schuyler.

Share this post


Link to post
Share on other sites
Pandora

I don't know what the waves of w/d symptoms mean for each person, or if people on this topic are talking about physical or emotional symptoms but a part of me thinks that maybe it isn't so much 'another phase of withdrawal', rather it could mean just being human beings with real, deep feelings again - which of course will always be inconsistent, as people tend to be naturally.

 

Sometimes when I feel sad or lonely or in a bad mood I think it's still the withdrawal - but do I really know that? Maybe it's just me being me, being a person who has had a difficult life trying to exist as an adult without the aid of medication?

 

Just a thought.

Share this post


Link to post
Share on other sites
Jemima

I don't know what the waves of w/d symptoms mean for each person, or if people on this topic are talking about physical or emotional symptoms but a part of me thinks that maybe it isn't so much 'another phase of withdrawal', rather it could mean just being human beings with real, deep feelings again - which of course will always be inconsistent, as people tend to be naturally.

 

Sometimes when I feel sad or lonely or in a bad mood I think it's still the withdrawal - but do I really know that? Maybe it's just me being me, being a person who has had a difficult life trying to exist as an adult without the aid of medication?

 

Just a thought.

 

You might find this topic interesting: http://survivingantidepressants.org/index.php?/topic/82-the-windows-and-waves-pattern-of-recovery/page__st__30__p__25365__hl__windows__fromsearch__1#entry25365

 

I definitely went through windows and waves and still am, although to a much lesser degree than in mid-withdrawal. Now I have just occasional spasms of neuro-emotion alongside feeling anywhere from discouraged to apathetic or bored to happy.

 

It's my belief that the windows and waves pattern occurs because neurotransmitters are normalizing, but not in an even, regulated way. Thus the forward-and-back movement of recovery.

 

Of course it's possible that you won't go through this pattern. We know so very little about recovery from antidepressants.

Share this post


Link to post
Share on other sites
Pandora

Don't get me wrong, I definitely go through the windows and waves of w/d! I think it's impossible not to, especially after years on meds.

 

What I am trying to understand is the impossible...when do we know they are no longer windows and waves and accept them as part of being who we are? For me, I am understanding now all the emotional recovery I needed to do and didn't (because I thought taking ADs was enough and no doc told me any differently, of course) and here I am, 12 years later experiencing the gamut of emotions that I never worked through. Sometimes they are extreme - but is that always neuro-emotion due to struggling brain regeneration or is it due to so much unresolved difficult stuff that's been suppressed for so any years?

 

And while we're on the topic of being "me" or not being ME......when do we know when we're "me"? Am I the ME pre-med, or the ME now when the windows are open and clear, or the ME when I'm screaming about something totally ridiculous because being on meds prevented me from learning how not to displace anger?

 

God, my brain hurts just writing this, never mind finding any answers:)

 

Pandora

Share this post


Link to post
Share on other sites
Barbarannamated

Don't get me wrong, I definitely go through the windows and waves of w/d! I think it's impossible not to, especially after years on meds.

 

What I am trying to understand is the impossible...when do we know they are no longer windows and waves and accept them as part of being who we are? For me, I am understanding now all the emotional recovery I needed to do and didn't (because I thought taking ADs was enough and no doc told me any differently, of course) and here I am, 12 years later experiencing the gamut of emotions that I never worked through. Sometimes they are extreme - but is that always neuro-emotion due to struggling brain regeneration or is it due to so much unresolved difficult stuff that's been suppressed for so any years?

 

And while we're on the topic of being "me" or not being ME......when do we know when we're "me"? Am I the ME pre-med, or the ME now when the windows are open and clear, or the ME when I'm screaming about something totally ridiculous because being on meds prevented me from learning how not to displace anger?

 

AGREE!!

Share this post


Link to post
Share on other sites
alexjuice

And while we're on the topic of being "me" or not being ME......when do we know when we're "me"? Am I the ME pre-med, or the ME now when the windows are open and clear, or the ME when I'm screaming about something totally ridiculous because being on meds prevented me from learning how not to displace anger?

 

I think you'll know when you realize it's been months since you've asked the question.

 

At some point, your health will allow you to focus on some emergency (one of life's circumstances) and you'll get too busy, doing things. Only in retrospect, will it hit you.

 

Basically, when some other problem -- totally independent of this one -- is able to demand more of your attention, then you're healed from this one, moreorless.

 

(That may sound cynical but I mean it in the most positive sense. Life will always be full of challenges, for me and you.)

 

Hang in there,

Alex

Share this post


Link to post
Share on other sites
Narcissus

I personally find that the neuro-emotions (at least where I am now, at the two month mark) are always accompanied by other strange cognitive/physical effects (usually a feeling of intense mental/bodily 'strain'), so it's not all that difficult to distinguish between it and a more 'genuine' emotion. Is this not the case with you guys?

Share this post


Link to post
Share on other sites
Pandora

I personally find that the neuro-emotions (at least where I am now, at the two month mark) are always accompanied by other strange cognitive/physical effects (usually a feeling of intense mental/bodily 'strain'), so it's not all that difficult to distinguish between it and a more 'genuine' emotion. Is this not the case with you guys?

 

Definitely felt that at the same point in my w/d - and then some. I should have mentioned I am almost 6 months off. Not that I'm confidently out of the woods yet... the worst of the physical stuff seems to be over for now. I was referring more to distinguishing neuro from natural emotion once the nasty stuff starts to subside.

Share this post


Link to post
Share on other sites
Narcissus

Oh, I see. I guess the upside (the only upside) of being in hell is that it's never ambiguous as to whether or not you're really in it. Good to know even more difficulties lie ahead. God help us!

Share this post


Link to post
Share on other sites
Pandora

Well put! But I think, with all due respect to god, that time will be the real helper.

 

Today, and most days lately, I can say that being in that hell you describe a couple of months ago was worth it. Things are looking up - they will for you, too.

 

I envy the wisdom you've got at your age - if I'd had that I wouldn't be on this forum. Hang in there!

 

Pandora

Share this post


Link to post
Share on other sites
Nadia

I don't know what the waves of w/d symptoms mean for each person, or if people on this topic are talking about physical or emotional symptoms but a part of me thinks that maybe it isn't so much 'another phase of withdrawal', rather it could mean just being human beings with real, deep feelings again - which of course will always be inconsistent, as people tend to be naturally.

 

Sometimes when I feel sad or lonely or in a bad mood I think it's still the withdrawal - but do I really know that? Maybe it's just me being me, being a person who has had a difficult life trying to exist as an adult without the aid of medication?

 

Just a thought.

 

I often have these thoughts as well, Pandora! I think we might have a tendency to want to label ALL our maladies as withdrawal. And certainly we will be in for a real disappointment if we expect to be simply joyful, happy beings when we are free of the damages caused by antidepressants. Particularly those of us who had issues before taking meds.

 

However, even though it is difficult to piece out what is "normal" feeling and what is feeling or symptoms caused by withdrawal (or, in longer cases, what I would call maladaptation to coming off meds), I feel I can tell the difference. For example, I've been doing pretty well the past few days, but it doesn't mean I'm not stressed or don't have bad feelings. Somehow, though, they seem in coherence with my sense of self. It's really hard to pinpoint... what makes "normal anxiety" different from withdrawal anxiety? Is it just a matter of degree? Is it that one seems to come from something organic in my life and the other not? Is one "me" and the other not?

 

Of course, there is no such thing as YOU... your sense of self is something that is built over time and is dependent on your previous experience. And after 15 years of ADs, well... how do I remember who I was? I am not going to be the person I was at 24 when I first started taking meds! And added to that, there are "normal" feelings that I start associating with withdrawal. Sometimes I think my surroundings trigger withdrawal-like feelings as well, just by association. The way my apartment smells, my routine, etc.

 

It's tough to figure out... in the end, I don't think there are any absolute answers. But you are very right that we would all do well to remind ourselves that being free of withdrawal or iatrogenic damage or maladaptation from having taken and come off antidepressants does not mean we will not have issues and difficulties!

Share this post


Link to post
Share on other sites
Pandora

 

I don't know what the waves of w/d symptoms mean for each person, or if people on this topic are talking about physical or emotional symptoms but a part of me thinks that maybe it isn't so much 'another phase of withdrawal', rather it could mean just being human beings with real, deep feelings again - which of course will always be inconsistent, as people tend to be naturally.

 

Sometimes when I feel sad or lonely or in a bad mood I think it's still the withdrawal - but do I really know that? Maybe it's just me being me, being a person who has had a difficult life trying to exist as an adult without the aid of medication?

 

Just a thought.

 

I often have these thoughts as well, Pandora! I think we might have a tendency to want to label ALL our maladies as withdrawal. And certainly we will be in for a real disappointment if we expect to be simply joyful, happy beings when we are free of the damages caused by antidepressants. Particularly those of us who had issues before taking meds.

 

However, even though it is difficult to piece out what is "normal" feeling and what is feeling or symptoms caused by withdrawal (or, in longer cases, what I would call maladaptation to coming off meds), I feel I can tell the difference. For example, I've been doing pretty well the past few days, but it doesn't mean I'm not stressed or don't have bad feelings. Somehow, though, they seem in coherence with my sense of self. It's really hard to pinpoint... what makes "normal anxiety" different from withdrawal anxiety? Is it just a matter of degree? Is it that one seems to come from something organic in my life and the other not? Is one "me" and the other not?

 

Of course, there is no such thing as YOU... your sense of self is something that is built over time and is dependent on your previous experience. And after 15 years of ADs, well... how do I remember who I was? I am not going to be the person I was at 24 when I first started taking meds! And added to that, there are "normal" feelings that I start associating with withdrawal. Sometimes I think my surroundings trigger withdrawal-like feelings as well, just by association. The way my apartment smells, my routine, etc.

 

It's tough to figure out... in the end, I don't think there are any absolute answers. But you are very right that we would all do well to remind ourselves that being free of withdrawal or iatrogenic damage or maladaptation from having taken and come off antidepressants does not mean we will not have issues and difficulties!

 

How thoughtfully and intelligently you address this issue, Nadia. You are absolutely right, and the part about being ME...of course, we can never will be the me we were, even yesterday. Never mind 13 years ago when I started on ADs (god, I hope not!).

 

The last couple of days I've been feeling really up and down with extreme sadness and feeling okay - within hours of each other and wondering again what is w/d and what is ........Christmas looming, family of origin issues becoming clearer, realizing I have nothing in common anymore with some long time friends...everything? As you say, surroundings play a part I think. Here in Canada the weather is getting grayer, colder. The horribleness of things like Black Friday (the day after American Thanksgiving where we claim to be thankful for what we have..?) and Boxing Day and stores jammed with Christmas stuff that will end up in our landfills is so upsetting to me. Forgive me, I'm rambling now.

 

Wow, when I think of all the things I need to do now to keep myself managed. It was so easy on Celexa!

 

Thanks for your input. It helps a lot.

Share this post


Link to post
Share on other sites
Nadia

Ack, Christmas, certainly! They started pushing it down our throats here in August, for goodness' sake! We're not big on celebrating Christmas in my family, but it will still be our first Christmas without my dad. And yet, if I stay as well as I am now, remarkably, I'll be in a better mental space than I was last Christmas. I was having bad anxiety and depersonalization/derealization last year during Christmas and could not enjoy our family being together one bit. I felt like an alien. It's really hard to put your finger on it, and there are overlaps, but on a gut level I can tell the difference.

 

Anyway... I just noticed the quote in your signature about hope being the last thing out of Pandora's box. I love it! I chose the username "Nadia" because it means "hope".

Share this post


Link to post
Share on other sites
Pandora

Anyway... I just noticed the quote in your signature about hope being the last thing out of Pandora's box. I love it! I chose the username "Nadia" because it means "hope".

 

Well, with all this hope circulating around us, things are bound to start looking up!

 

Thank you again for your wise words.

And when you get a moment, could you let me know what "Silver Star" means, or "Platinum Star", and how does one arrive at such a designation? Experience? Really good advice...Cool names...?

Share this post


Link to post
Share on other sites
Nadia

I think it is just based on the number of posts.

Share this post


Link to post
Share on other sites
dalsaan

What a great discussion. Thanks Pandora and Nadia

 

For me neuro emotion comes out of nowhere and that's it's signature. If I struggle to identify a cause I label it neuro emotion. But I have to think about it, examine it and put it in its place. My capacity to do that is the real me. And it's a better me than the person I was before the drugs

 

Even if I could, I don't want to be the person I was before the drugs. I want to be the best me I can be from here on in. And the one blessing I have got from all of this is that I have grown. I'm more emotionally capable. I know and understand myself better and can engage myself mindfully (not always but often)

 

The real me that I try and keep sight of is at peace and makes good decisions to support this. I believe the rest will follow

Share this post


Link to post
Share on other sites
aza

Charlie did a lot of research to understand his own withdrawal symptoms.

 

I respect his theory, but I do not think the pineal gland is the locus of the problem.

 

See http://survivingantidepressants.org/index.php?/topic/1351-charly-g-recovered-from-prozac-withdrawal/

 

Thanks Alto,

 

This was in conjunction with this web page where the "The Simple ABC’s of Antidepressant Withdrawal" is located about 2/3 the way down towards the bottom of the page.

Pineal and I wasn't sure if you had seen it.

 

I wish you the best.

Share this post


Link to post
Share on other sites
Altostrata

You're running into all of the alternative explanations, aza.

 

Yes, I've seen Dr. Lee-Bloem's site before. Unfortunately, the orthomolecular folks do not have any special understanding of withdrawal syndrome, particularly Dr. Lee-Bloem.

 

I don't buy her explanation of withdrawal syndrome on the page you've pointed to.

 

If she is successful tapering people off medications, it's because of the tapering, not the supplements mumbo-jumbo she adds to it.

Share this post


Link to post
Share on other sites
aza

Good to know.

 

Thanks alto take care.

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

×

Important Information

By using this site, you agree to our Terms of Use.