Jump to content
Lilu

How do you talk to a doctor about tapering and withdrawal?

Recommended Posts

Lilu   
Lilu

ADMIN NOTE Also see What should I expect from my doctor about withdrawal symptoms?

 

Useful Excerpts from the thread

 

Alto  
When speaking to a doctor, do not yell, scream, beg, cry, whimper, or weep. It confuses them and they start thinking of psychiatric drugs to give you. 

 

Speak clearly, firmly, and insistently -- but politely. Make a specific "request" that is actually a direction.

 

Rhi 
There are a few tricks that I've found that sometimes help when dealing with doctors.

 

One is, instead of saying "I want off my meds" say "I want to see how I do at a lower dose." Because all doctors know that the lowest effective dose is what you want to shoot for. So "let's find out my lowest effective dose" doesn't set off their alarms as much as "I want to stop taking the drug."

 

Also, they believe these drugs actually are beneficial, and you can use that. Maybe your doc will continue to give you prescriptions and not rush you so much if you say, “Hm, I want to see how I do staying on this dose for a while. I sure don't want that doggone depression to come back, so I want to just hold here for a while and make sure it doesn't come back because golly gee willikers, maybe this drug is good for me.” (At the lowest possible effective dose.)

 

You know, basically, just kind of speak their language so you can get them to give you what you need to do the taper at a speed that works for you.

 

Having that pressure of "I have to get off before I run out" usually leads to trouble, and/or disaster, for people. Much better to have the freedom to taper at the pace your body is telling you is right for you.

 

InvisibleUnless 

Detailed information on a package to show doctors.  http://survivingantidepressants.org/index.php?/topic/4463-how-do-you-talk-to-a-doctor-about-tapering-and-withdrawal/&do=findComment&comment=161628

 

http://survivingantidepressants.org/index.php?/topic/4463-how-do-you-talk-to-a-doctor-about-tapering-and-withdrawal/&do=findComment&comment=163728

 

JanCarol  

A concise information page which can be shown to doctors. http://survivingantidepressants.org/index.php?/topic/4463-how-do-you-talk-to-a-doctor-about-tapering-and-withdrawal/&do=findComment&comment=267642

 



 

This site is so full of information and clinical studies. I read quite a few in the journals section, but none really acknowledge withdrawal syndrome and the fact that it can last past the 2 weeks commonly believed by most psychiatrists.  Including mine, who recently told me that withdrawal lasts 7-16 days and after that it's considered a recurrence.

 

How do I educate my psychiatrist without her being offended or dismissing this information.  What would be the most helpful studies, write ups from this site or elsewhere to print out and give to her?

 

I'm overwhelmed by all this information and all this reading.  It would be helpful if there was a topic that compiled the most recent studies or links that would be the most effective in getting her over to my side?

 

It's hard enough to deal with reality while going through withdrawal and/or severe depression, than to also have to fight your own doctor and their pharmaceutical brainwashed beliefs.

 

I just don't have the energy to keep searching and reading over and over, wondering if an article is credible enough for my psych to consider it.

 

Is there proof of withdrawal syndrome? And what is the best literature on that?

 

The same with taperin.  Psychiatrists idea of tapering is pretty ridiculous.  Out of all the topics an studies on this site, what would be the most helpful one to give to my doc?

Thanks!

Edited by KarenB
added useful excerpts

Share this post


Link to post
Share on other sites
cymbaltawithdrawal5600   
cymbaltawithdrawal5600

Hi sweetie, this is harder than you thought, isn't it. I have been watching you try to follow my suggestion and you've run with it admirably. Sites like SA are amassing a large body of 'anectodal' evidence in favor of tapering AD's to reduce the amount of disruption on sensitive nervous systems. The studies posted by Alto and others give weight to what is suggested here.

 

Look what I found when I took the title of your post, changed it a bit, and typed it into a search engine:

 

https://startpage.com/do/search?language=english&cat=web&query=How+do+you+introduce+your+psychiatrist+to+the+concept+of+antidepressant+withdrawal+syndrome

 

Just a quick look at the summaries below the links shows me that there are many links on credible sites, and SA comes up in the top 10.

 

Until you are able to show your doc your MD license, you will have trouble 'convincing' him of the 'rightness' of your position. The people on these boards are pushing ahead in spite of their Dr's reluctance and many are coming out the other side successfully.

 

For now, I think many of us are in this fight alone. It may be many years before the studies are formed, tested, then published in peer-reviewed journals before the tide of medicating 'psychological' discomforts turns the other way.

 

Keep up the good work!

Share this post


Link to post
Share on other sites
Barbarannamated   
Barbarannamated

This might help lend credibility by showing the respect given by researchers to this site:

 

http://survivingantidepressants.org/index.php?/topic/4021-alarming-report-on-persistent-side-effects-of-antidepressant-drugs/?fromsearch=1

 

There is also an article comparing SSRI and benzodiazepine withdrawal. Many doctors agree that benzos are problematic and this article draws parallels.

Share this post


Link to post
Share on other sites
alexjuice   
alexjuice

I have found only tepid interest in the topic from a number of psychiatrists. I have my theories for this but I think the luke warm reaction is largely due to simple human motivations which effect doctors. Doctors make a nice living "doing good" and are rather invested in maintaining this self-perception. I don't think most psychiatrists are willing to retool their practices as would be ethically necessary if they acknowledged problems with their Rx interventions so they therefore are reflexively uninterested in considering protracted withdrawal.

 

The positive is that since your doctor will no nothing about withdrawal except what you teach them, then you are actually very much in charge of your treatment, something I found very rewarding to consider.

 

So if your doctor isn't interested in learning about withdrawal simply inform him or her of your desire to reduce your medication by a small amount and let them follow along on your journey... Maybe she'll learn something too!

Share this post


Link to post
Share on other sites
Lilu   
Lilu

After several tries, trying to convince someone else of something that they refuse to believe is a waste of time in my opinion. Look how long it took to get the "church" to accept the fact that the planets revolved around the sun & not the sun around the planets? Especially when you are trying to change the minds of people who almost consider themselves "Gods" .... well you might just as well piss in the wind.

 

RU

 

I have the same feeling...and yet I've always been one of those people who just tries and tries and tries to convince someone of MY truth, THE truth...with plenty of evidence behind it...BUT they just revert back to their thinking. I've been trying to do this with my own mother for over a decade.  She just doesn't get it.  Doesn't WANT to get it.  Maybe just like Alex suggested above, that to admit the truth to themselves would be to admit their own failure.  She just wants to believe that she gave birth to a perfectly healthy child - not one who's prone to depression!

Share this post


Link to post
Share on other sites
cymbaltawithdrawal5600   
cymbaltawithdrawal5600

The 'why' and 'why not' sidetracks you from your primary goal which is to get better. Your results may or may not ever be a convincing enough example for them. And all you want to do is have a better life from here on in, right?

Share this post


Link to post
Share on other sites
Lilu   
Lilu

Here's something that might be helpful:
 
http://www.aafp.org/afp/2006/0801/p449.html
 
DIFFERENTIATION FROM RELAPSE
The symptoms of antidepressant discontinuation syndrome that are associated with most antidepressants share features of major depression, including dysphoria, appetite changes, sleep problems, cognitive problems, and fatigue. By focusing on symptoms that distinguish antidepressant discontinuation syndrome from depressive illness relapse (e.g., dizziness, “electric shock” sensations, “rushing” sensations in the head, headache, and nausea) and observing for rapid (i.e., within a few days) reversal of symptoms after restarting the antidepressant or complete resolution of symptoms in one to two weeks (highly uncharacteristic of a depressive relapse), a definitive diagnosis is fairly easy to make.19,27 Depressive relapses or recurrences typically occur after at least two to three weeks or longer after cessation of medication and are most often marked by gradual worsening of depression, insomnia, and psychomotor symptoms.28

Share this post


Link to post
Share on other sites
Barbarannamated   
Barbarannamated

I also feel the desire to protect others from going down this horrible road... learn from my mistakes, so to speak. I haven't attempted to convince doctors about withdrawal although I have been able to show a few how poor the "science" behind these drugs is. When they think about the brevity of the FDA studies (several weeks) for treatment that is often prescribed for life, it makes them think.

 

There are many parallels between steroids and SSRIs also. That tends to get attention.

Share this post


Link to post
Share on other sites
strawberry17   
strawberry17

I recently made a conscious decision to never discuss my withdrawal/taper with a doctor in my practise again unless I absolutely have to, it seems like a complete waste of time, I've shared a book and my blog with them and it feels like banging my head on a brick wall and is too upsetting. I make my own decisions and do my own research, I think they don't want to know, it's just too much trouble.

Share this post


Link to post
Share on other sites
Barbarannamated   
Barbarannamated

Lilu,

 

I empathise with your feelings and don't think they are at all unusual. To want acknowledgement, an apology, vindication... very natural but also very unlikely as this would be admitting that they did something wrong and possibly set them up for legal action.

 

I did quite a bit of CBT over the years and found it to be ineffective because it didn't address the roots of my problems. I've only recently recognized some very serious issues and losses in my life that have created bad patterns and perpetuated further problems. Skyler has posted great info on psychodynamic / depth therapy vs. CBT:

 

http://survivingantidepressants.org/index.php?/topic/2042-cbt-vs-psychodynamic-pros-and-cons/?fromsearch=1

Share this post


Link to post
Share on other sites
Lilu   
Lilu

4 days.  That's how long it took for me to come back to "normal" and for most of the withdrawal symptoms to disappear.   4 days.  

 

How can educated experienced psychiatrists insist that my symptoms are a result of my "depression returning"?  

 

It makes me so angry!  I want to throw every bit of evidence into my psychiatrist's face and "make her see the truth"!!!

 

I am obsessed with it.  But at the same time, I'm afraid of ruining my relationship with her.  Afraid that she will react the way all the others did.  Afraid that I'll wind up just feeling hurt and demeaned, without having been heard.

 

She did give me permission to email her.  Should I do it?

Share this post


Link to post
Share on other sites
Rhiannon   
Rhiannon

Lilu, I'd recommend that at some point you read Anatomy of an Epidemic by Robert Whitaker, to get a sense of the how the profession of psychiatry got to where it is today, and what kinds of pressures and miseducation psychiatrists are experiencing, pushing them to believe the claims of pharmaceutical companies over the reported experiences of their patients.

 

There are a lot of studies referred to in the book as well that you can probably follow up. But mostly I think it will give you a context for what you're experiencing with your own psych that may help you in your journey.

Share this post


Link to post
Share on other sites
Jemima   
Jemima

hi there lulu, I know how you feel when it comes to doctors listening.. It use to really annoy me that because I have a history of having had depression five years ago, any time I went to a doctor with a sickness complaint it always would revert back to my depression being the problem.. in my first withdrawal from Effexor, when I managed to get to zero I felt really ill six weeks later and my doc put me straight back on the 150mg tablet, she obviously had no clue about withdrawal (as apparently it would have been better and safer to be put back on a low dosage)

 

luckily  this time around I have changed doctors, my doctor is same age as me 31 and is very helpful.. He seemed to understand withdrawal, said "if it takes me a year or even two years to get off it, that's ok, do it slowly with as little symptoms as you can".. Luckily last time around I kept a very thorough diary of all my symptoms, dosage reduces etc and was able to show him how bad it was.. I have a diary for this time around too and even though I have only withdrew down to 120mg from 150mg over four months period, he has been able to see how the symptoms still occur on even a small reduction at a time.. he even said its important for me to keep coming back for regularly check ups, because withdrawal can affect your body in lots of ways and he will keep an eye on it to make sure its withdrawal symptoms and nothing else im going through.. I swear I felt like hugging him lol because he was so understanding... I could be totally wrong, but maybe the younger doctors are becoming more aware of anti depressant withdrawal  through their medical training who knows, I just felt listened to for the first time in a long time..

 

another thing he did say is " when I told him about the tiredness, and how I wanted to go to the gym, socialising, shopping etc but some days I just felt so tired I didn't have the energy even tho I really want to. straightaway most doctors would say this is your depression coming back.. but he said" the fact that your even thinking of the gym and really wanted to go to the gym etc you can see the benefits of it but you just felt  physically exhausted through the withdrawal symptoms lack of sleep etc,, tells me its not your depression, because most people who are getting depression again couldn't care less if they never did anything they have no desire to, they want to do very little, they rarely even want to leave the house and very little gets them motivated to do anything"

 

Hopefully through this withdrawal I will be luck enough that the doctor stays the same and continues to listen to me.. I will continue to keep my recovery in my diary of proof of withdrawal symptoms as evidence of how hard it really is..

 

I wish you all luck in your recovery

god bless x

 

If your doctor is willing, please add him to our list of doctors who understand antidepressant withdrawal:

 

http://survivingantidepressants.org/index.php?/topic/988-recommended-doctors-therapists-or-clinics/

 

I'm very impressed with what you've said about this man.  He's head and shoulders above the mainstream medical crowd!

Share this post


Link to post
Share on other sites
compsports   
compsports

I realized pretty that I couldn't introduce the concept of withdrawal symptom to my psychiatrist.  Fortunately, he was willing to cooperate with my tapering plan even I know he thought it was a bunch of BS.  But I really didn't care as my only goal was to get off of the meds and out from his care.

 

CS

Share this post


Link to post
Share on other sites
TaperQueen   
TaperQueen

I am unable to educate my shrink as well.  The problem is that they're not neurologists, and they believe everything big pharma tells them.  I cannot convince my doc that withdrawal exists nor will she educate herself.  Their blatant ignore is staggering and deadly for their patients.  Neurologists would never even prescribe these death pills.  Eugenics at its best.  I'm doing an excrutiatingly slow taper and then plan to RUN!

 

Share this post


Link to post
Share on other sites
Altostrata   
Altostrata

It can be very, very difficult to change a doctor's mind. It can be easier to find a new doctor with better listening skills, if not more knowledge about withdrawal.

 

But....even though a doctor might put up a wall of denial to you, you can bet the next time someone has a similar complaint, the doctor will remember what you said. So don't be shy about letting your doctor know what you think -- in a firm, calm voice. (Any emotion will be construed as mental imbalance.)

Share this post


Link to post
Share on other sites
strawberry17   
strawberry17

Doctors are probably afraid of opening themselves up to litigation as well so denial is the best policy, I think that's why mine never makes a fuss about prescribing the liquid Prozac.

Share this post


Link to post
Share on other sites
Lilu   
Lilu

Try a respectful "you may be interested in this" approach.

 

I am too passionate and enraged about this topic, for the non-chalant  "you may be interested in this" approach. But after thinking about this for a month, I finally did it.  I wrote my doctor a letter, and presented her with lots of information, both anecdotal and clinical.  We'll see what her reaction will be. I see her on Wed. I included the article on Psychology Today which references your story and this website. It's a great article and you should PIN it somewhere, since most of us have no idea about how you got to know so much and what your case history is.

http://www.psychologytoday.com/blog/side-effects/201107/antidepressant-withdrawal-syndrome

Share this post


Link to post
Share on other sites
Lilu   
Lilu

I tend to think of it like I'd been onboard a sinking ocean liner that the crew adamently insists is not sinking. Included in the crew are the custodians od the life vests. At first I tried to persuade the custodians that the boat was sinking because I wanted everyone to know what I know so they wouldn't thinkk I was nuts and also so they could save themselves but I could not convince them.

 

Later on, having acquired a more natural sense of my own value, I returned to the custodians and asked them for a lifevest because I told them I thought I'd feel safer with a life vest. Since I had stopped trying to prove them wrong they were not invested in winning the argument and they gave me a lifevest and sent me on my way. I'd also realized I didn't need anyone's permission to save my life.

 

And while I am upset at the circumstance that made me dependent on the custodians, I am grateful enough to have gotten my lifevest and gotten off of the ship before I drowned to death.

 

The end.

 

That is an excellent analogy Alex.  I guess I am not at that point yet.  Or maybe I just have a different personality.  I've spent 30 years of my life trying to get my mother to really understand me...only to recently realize that she is not an understanding person.  And unless she can personally relate to something, she just cannot understand it.  But I still keep on trying... Maybe I will eventually stop.  Unfortunately, with all my knowledge and experience, I still have no credibility - not with  my  mother, and certainly not with the doctors.  How can we convince doctors of what we know is true, when their own peers, who speak out against the mainstream, the ones that have the MD or PhD or both behind their names, cannot convince them either?

Share this post


Link to post
Share on other sites
Lilu   
Lilu

Thanks, Lilu. Feel free to start a topic in the Media forum.Can you list here the items you sent to your doctor? Others might find that helpful.

 

First I wrote my doctor a letter with evidence from my own experience. Having kept a diary since I was 15, I went back to the time when I was severely depressed, and yet had not started medication.  I was shocked to find that my tone and state of mind, was very different than in my diaries post drugs.  Rereading that diary showed me that even during a major depression I was able to cope, function, and live life, far better than when on antidepressants or post antidepressants.   There is no question that these drugs have affected my ability to cope and function! ( I think I'll start a separate topic on this, as reading my past was quite revealing.)

 

Then I included excerpts from Chapter 9 of Dr. Breggin's book "Your drug may be your problem", as well as excerpts from Robert Whitaker's article about antidepressants causing chronic depression.  And then excerpts from the article on Psych Today, about your case with all the links in it.

Since most doctors won't give you their email address, I would have to alter the document so that it can be printed, with references at the end.  I'll work on it.  

 

The thing is that when I saw my doctor  yesterday, she hadn't had a chance to read my email and all the documents attached to it.  And I'm not sure if she ever will or if she will take it seriously. But she is definitely different from all the other psychiatrist that I have encountered.  Very laid back. No ego. No feeling of superiority.  She readily agreed to prescribe liquid lexapro and said that it would have been her suggestion as well.  She also suggested that I try taking fish oil, that she takes it herself and finds it that it makes her feel happier.   She is not super educated about withdrawal syndrome, but at least she was in agreement that a slow taper is the best way to go since I've been taking these drugs for so long.

 

It would be really great if she takes the info that I presented her with, and decides to learn more.  She is an associate professor at UMDNJ - how great would it be if she can start teaching the truth about antidepressant withdrawal syndrome to her students?  

Alto, this makes me wonder - have you ever been invited to any speaking engagements?  What if you requested to speak to Psych students at UCSF, do you think they would be interested?

 

I will keep you all posted on my further dialog about withdrawal with my doc.  I also plan on presenting this information to my primary care doctor who, while being very nice and caring, was the one who started me on antidepressants, and kept convincing me to stay on them.

Share this post


Link to post
Share on other sites
Altostrata   
Altostrata

When I'm up to speaking, those are avenues I'd like to try. I'm in discussions with faculty at UCSF now.

 

Everyone should take a shot at educating psychiatrists in the ways you have, Lilu. Good job.

Share this post


Link to post
Share on other sites
mammaP   
mammaP

Well, I went to see my gp and he was NOT HAPPY! Was quite annoyed that I am tapering slowly 

and said that isn't the way that is recommended. I reminded him that I tried that way and was in hell with

withdrawal. I didn't say I was down to 5 beads, just that I was under 37.5 and couldn't calculate exactly in

mgs. He said he was reluctant to prescribe the liquid because, he said at that dose it is not needed. 

I kept my cool and said no, he was right I don't need it for the depression

, and that it stopped working for me years ago but I want off it because of the side effects.

Said I had no life and couldn't feel anything, just dead inside with no motivation or energy.  

 . I told him that I had shocking withdrawal his way  but that this way it was steady and gentle.. 

 

He showed that he wasn't listening and didn't get it because he said that I'm having problems because

it's too slow and I should just stop it, there wouldn't be any problems after the first week. The point I was making was that I felt BETTER after each tiny drop, not worse with withdrawal. ( Bangs head on wall)  I kept to myself the last few weeks of hell because without the extremely stressful situation I'd been in I would probably have been fine.

 

Then I explained that although people do manage to stop without problems, I am so 

sensitive that it just didn't work for me. I then told him I'd spoken to the pharmacist who had recommended the

liquid and slow titration. After several minutes of reasoning I GOT MY SCRIPT! 

RESULT !  1ml 4x daily is what's prescribed, which is way too much but I will work out what I should be taking

when I can get my head clear enough. I don't think I've convinced him really, just fought my corner but it's a start. 

Share this post


Link to post
Share on other sites
compsports   
compsports

Well at least you got your script even though you will have convert it to the right dose. But as I am reading your post, I am going WTF?  I want to say to your doctor, "WTF don't you understand?"  I mean, you're telling him that you are suffering and he is denying your reality.

 

Sadly, I had a similar experience with my psychiatrist when I told him I wanted a compound prescription for Wellbutrin XL since I didn't see an easy way to taper the convention way. His response was that no one does it that way.

 

But unlike your doctor, his attitude was even though he thought what I was doing was the stupidest thing on earth, his attitude was that as long as it wasn't dangerous, he would do whatever I wanted.  I actually think near the end of my visits, he grudgingly accepted that tapering slowly might be a viable alternative.

 

By the way, unlike the pharmacist you dealt with, the guy who made the Wellbutrin prescription also thought I wasn tapering too slowly. So I asked him if there was anything dangerous about what I was doing.  He hemmed and hawed and said no but still stuck to his position.

 

I just think these guys get so arrogant that if a patient challenges the conventional way of doing something, even though they obviously get worse doing it that way, they perceive it as a threat. All rational thought goes out the window.

 

CS

Share this post


Link to post
Share on other sites
mammaP   
mammaP

He was visibly very annoyed that I refused to stop right now, and I am so so glad that I didn't

speak to him when I was suffering and suicidal, he would have been worse than useless and

would have made things much much worse. I'm glad the folk here helped me through and helped

me see it would not be a wise move at the time. He has been very understanding in the past 

and I hoped he might be on my side because he was agreeable to my coming off the AD's and

didn't try and get me to stay on them.  I don't know how long my 100ml bottle will last but am hoping

it might see me through to the end because I don't fancy going back for more! 

Share this post


Link to post
Share on other sites
mammaP   
mammaP

Another thing that really annoyed me was that I said how sensitive I am to drugs after 40 years of psychiatric medications,

and that I also have to watch what I eat because of additives, and that I can't even have more that 1 cup of coffee a day

without being affected by the caffeine. He stifled a laugh and shook his head like I was a paranoid hypochondriac.   :angry:

Share this post


Link to post
Share on other sites
MaryKA   
MaryKA

RESULT !  1ml 4x daily is what's prescribed, which is way too much but I will work out what I should be taking

when I can get my head clear enough. I don't think I've convinced him really, just fought my corner but it's a start. 

 

BINGO!!!!! Well done MammaP! If it's too concentrated, at least it will keep you going a longer time!! Could say it gives you plenty of time for your head to get clear before you go back to your GP for some more!!! I'm in Scotland like you, so this is heartening. I've already broached with my GP the idea of a slower taper with liquid -- rather than crushing/splitting tablets that I posited was so much less reliable than a solution/suspension -- and my GP has cautiously said  that it can be considered. I'm not ready for it quite yet. So YEAH, WELL DONE YOU!!! AND ENJOY!!!

Share this post


Link to post
Share on other sites
Lilu   
Lilu

My pdoc never responded, addressed, or commented on the email I sent her about Antidepressant Withdrawal Syndrome.  She probably never even read it.  She seems to see it as "your tapering thing"...as if I'm the only one she's encountered...ugh...the story of my life - ignorant people who think that "i'm the only one" who is like this or like that.

 

Anyway, I probably wont bring it up...I need her too much at this point.  At least, she readily agreed about the liquid taper.  Unfortunately, I need to put that off for now.  I desperately need to find work right now.  I'm completely broke. Just can't risk withdrawal right now.

Share this post


Link to post
Share on other sites
Lilu   
Lilu

I agree with the pragmatic approach.  It doesn't matter if the psych doc "get's it".  You just need him to institute a slow taper for you.  

 

He'll go on making several hundred thousand dollars a year while harming the community (in addition to some good, that we shouldn't forget, they do also).  Unfortunately, this is just the way it is.  Some battles are larger than we are.

 

Drops of water, over time will erode even the hardest rocks.  We are the drops of water, as long as we all continue the fight, and get the truth out there, eventually we will make "a dent" and psychiatry as we know it, will erode.

 

We might be little ants in the land of giants. No one pays attention to one ant, but thousands of ants all marching together, will always get noticed.  Do your part.  I plan to do mine.

Share this post


Link to post
Share on other sites
dalsaan   
dalsaan

People's opinions here are based on their own experiences, reading and knowledge that comes from engaging with lots of people in withdrawal. Many people here have experience with Prozac.

 

I am not medically trained. However, I am positive that I have read more research on withdrawal and seen more cases of it that any medical practitioner I have ever engaged. I share an opinion here based on that foundation. It is not medical advice and you need to make your own decisions based on that fact.

 

Re how to know about a Drs understanding of withdrawal.? I would ask them. It is well documented now that ads cause withdrawal and for some protracted wd. If a dr won't acknowledge that, no point going further in my view. In fact I don't ask anymore I tell them and if they can't handle that I won't engage with them.

 

I haven't had a risk report, others might contribute on that point

 

As a final comment, I would say that the gaps in knowledge of the medical profession combined with the power and vested interests of pharmaceutical companies means that we have to become experts of our own conditions and drive our care. That's a very challenging and scary idea but it's true.

Share this post


Link to post
Share on other sites
Altostrata   
Altostrata

Words of wisdom from Rhi:

 

 

....I did just want to jump in with some thoughts about "doctor management." There are a few tricks that I've found that sometimes help when dealing with them.

 

One is, instead of saying "I want off my meds" say "I want to see how I do at a lower dose." Because all doctors know that the lowest effective dose is what you want to shoot for. So "let's find out my lowest effective dose" doesn't set off their alarms as much as "I want to stop taking the drug."

 

Also, they believe these drugs actually are beneficial, and you can use that. Maybe your doc will continue to give you prescriptions and not rush you so much if you say, hm, I want to see how I do staying on this dose for a while. I sure don't want that doggone depression to come back, so I want to just hold here for a while and make sure it doesn't come back because golly gee willikers, maybe this drug is good for me. (at the lowest possible effective dose.)

 

You know, basically, just kind of speak their language so you can get them to give you what you need to do the taper at a speed that works for you.

 

Having that pressure of "I have to get off before I run out" usually leads to trouble, and/or disaster, for people. Much better to have the freedom to taper at the pace your body is telling you is right for you.

Share this post


Link to post
Share on other sites
chicken   
chicken

 I don't try to convice them.

 

In my case I told my doc that I wanted to get down to the lowest dose possible. My doc agrees that one should be on the lowest effective dose and least amount of drugs as possible.

I told him that I was converting mine to liquid and using a syringe.

He said that if I was doing that I should have the liquid so he prescribed the liquid, though I haven't fille the script yet.

 

I think that trying to convince them that you would like to be on the lowest dose possible helps them to work with you on tapering.

Not sure how to handle the work situation. I used a another doc that understood withdrawal and tapering to get my time off from work until I got better.

My current doc doesn't do open ended FMLA requests but I found a doc that did.

 

Opps. I see you're in Ireland so the FMLA thing doesn't apply.

Share this post


Link to post
Share on other sites
InvisibleUnless   
InvisibleUnless

after being ignored and brushed aside by psychiatrists, GPs, counselors, and everyone else, i made a packet composed solely of solid information that i could use for any future appointments with professionals.  ive already given one to three new doctors of mine.  it had a few sections:

 

-the symptoms i have been experiencing since withdrawal (bulletpoint, brief, and not fully comprehensive, but rather specific and also categorized)

-my medication history (the psych meds, and anything concurrent)

-my diagnosis and treatment history (all conditions, and listing all the professional help i have ever sought for the psych med situation---so counselors, emergency room staff, GPs, etc)

-a miniature, diplomatic, reference-citing discussion about the potential for psych meds to be causing my issues, and noting the interesting coincidence that i never had any of these problems before and only had them once quitting the psych meds, and that every single one is a commonly accepted and documented side effect of the psych meds

 

it had a table of contents in front, and a cover page for each section with summaries of content in a few words/phrases.  it was highly organized, targeted, broad enough to account for all the preliminary questions or quibbles that could arise, and did not specifically tell them i should/shouldnt be diagnosed any one thing (withdrawal or anything else).  at like 20-25 pages, it was not a quick or easy read, but it was helpful because i could point to answers to their intake questions in writing, and explain in detail the connections between the various data.  i imagine yours would be quite a bit shorter (2-3 pages max), which is good for your ability to present.

 

my goal was not to say "treat me like you have diagnosed me as being in withdrawal", but rather a challenge: this scientific theory (originated by medical researchers, not myself) seems to explain my situation, but you are the doctor and i am asking your opinion.  pitch me something better if you have it, and we can see how well it fits and if there are any tests that can prove you right.

 

 

 

prescribing medications without definitive tests is not a valid and ethical diagnostic tool.  filtering symptoms into the lowest common denominators and completely ignoring the pronounced usage of brain-altering medications is not a valid diagnostic method for people experiencing issues directly encompassing the brain.  i dont know what kind of range you have, in terms of what doctors you are allowed to see, and how you can make appointments, but if you are capable of seeing a different physician if the one you are seeing right now is both unhelpful and uncooperative, i would recommend interviewing these schmucks until someone is willing to be on your side---with regards to working towards your health---instead of the medical institutions or big pharmas.  even if you have to have your healthcare insurance provider redraw your coverage boundaries (like reassigning your primary GP or place of care, etc), i would recommend it if it will enable you to get the proper certification and respect as a patient and individual.

 

you dont have to be standoffish (and i dont imagine you put yourself to be, of course), but you can let them know during the appointment that if they cannot give you a good theory, you will find someone who can.  you can couch that ultimatum in whatever soft terms they will consider---either come up with a better theory, or prove me wrong.

 

i dont know about the requirements there, but if it would help your image to get aid in writing your list of issues or journal references (so you dont look "too well"), that might be a good idea.  keep it simple, keep it substantiated, and draw on the corroborative support of whoever you have there with you, if you are blessed with such aid.

 

 

 

my method has gotten me federal disability status, a diagnosis of protracted psychotropic withdrawal from a GP that had never heard of such a thing before, a referral to a rheumatologist (who will send me to a neurologist, in turn, if a sleep doc doesnt pan out---and probably wont), and i just had a doctor complete my in-home support forms that will hopefully help me get a rides to purchase groceries and necessities while i am too sick to drive.  i dont assume this method can work for you, but i really hope it does, and i empathize with your situation.  buy my book for only 10 easy payments of $9.99!  :P

Share this post


Link to post
Share on other sites
Altostrata   
Altostrata

When speaking to a doctor, do not yell, scream, beg, cry, whimper, or weep. It confuses them and they start thinking of psychiatric drugs to give you.

 

Speak clearly, firmly, and insistently -- but politely. Make a specific "request" that is actually a direction. Chicken has it figured out.

Share this post


Link to post
Share on other sites
InvisibleUnless   
InvisibleUnless

What were your doctor's theory on the subject?  Did they offer you any insight into why you might be experiencing these symptoms?  That is, did they provide you with a  specific MECHANISM for why you're having these issues related to medications?

 

I found this to be extremely helpful, more helpful than most posts.  This should be a stickied post, it's extremely important what you have just written here and everyone on this website needs to see that this is how you approach doctors.  It's important because they spend like 15 minutes with you, and also because we're often incapacitated and can't articulate exactly what we need in a short visit.

 

You may be helping more people than you realize with this piece of advice.

the official opinion was brainfry. after physical examination and a blood & urine test, he said he figures its just my brain rewiring itself after all the meds. i asked if he would go on record as it being protracted psychotropic withdrawal for forms i would have to be filling out, or the settling of informal contests, and he said yes.

 

i didnt go in there specifically trying to sell a diagnosis---i presented him with some key connections, and asked what hed want to do to investigate what he could---it was, essentially, a diagnosis of exclusion. i did ask him about methods of direct detection and had researched the potential applicability of the most common tests. we resolved that nothing would probably show a meaningful amount of change, in my condition, and that the most conclusive test (testing hair samples) would be very expensive and also pretty much never covered by insurance. he said testing positive in that would probably do nothing for my case anyway, so the matter was basically settled.

 

ultimately, there was a lot of discussion involved, like analyzing the nature of blood test results (what is the 'normal' range and how does it apply to someone in my state, for example). as for 'specific mechanism'...its all the same mechanisms cited in the literature as to why these drugs are so "valuable" and "effective". most of the doctors or counselors ive seen in the past year (in contrast to previous years) have not been dismissive of the seriousness of psych meds, and many agreed that they are not ideal under many circumstances. putting on forms that im in withdrawal, doing new patient intake or government stuff, still turns heads, but im forming, month by month, a nucleus of professionals that are willing to vouch for the disabling and clinical nature of my condition.

 

as i mentioned via PM, i recommend having an agenda written beforehand, with notes that might help you explain the particulars of your experiences in case you feel inarticulate or cant remember all the aspects you wanted to cover. as they are filling out their folder or laptop spreadsheet, im jotting on my binder paper notebook---recording interaction responses (answered questions, medical recommendations, etc) and checking items off the agenda for that appointment. if you are seeing a series of doctors for the same condition, i also advise carrying your treatment logs for each of them in a single folder that you can take to each appointment, and having a section for corroborative information (like research studies or excerpts of medical text that dont require further context to clearly apply to your situation) that can be whipped out in case of pressing need, or friendly curiosity.

 

 

 

if anyone is interested in the packet i compiled for my continual visits, i created a condensed version (with a bit of annotation to help people looking to create their own), specifically to be distributed to members of SA. i can send a zipped file to private email addresses or PM you with a link to a free hosting download. its just a structured referencebook with my immediate symptoms, relevant medication and doctor history, past diagnoses and treatments, and some quick go-to sources of information regarding the persistent and potentially disabling effects of psychotropic medications (with a handy bullet-point rephrasing before actual citations).

Share this post


Link to post
Share on other sites
JanCarol   
JanCarol

I have a friend who got put on Paxil, generic. (face palm - I thought this drug was off the favored list)

 

It was claimed that the reason it was paroxetine, was that the other drugs interfered with her Voltaren (diclofenac) for pain (????)

 

Anyhow, the doctor (Australian) is conscientious enough that she will start tapering after 6 months of use.

 

I wanted to give my friend (and her doctors) the very basics of information in a form that she can use - and that will not take up too much of the doc's time.  So I made up a single page as to "why we taper 10%"  (with the exception that the first cut, under a doctor's care, can be 25%, like Dr. Brogan does)

 

It's probably the most concise thing I've ever written!

 

* * *

Tapering Primer.

Low doses of drugs affect a higher percentage of receptors than high doses of drugs.

In a curve, like this:

Plasma%20Concentration%20Fluoxetine_zpsj

 

https://ils.unc.edu/bmh/neoref/this.dir.unneeded/schizophrenia/review/tmp/352.pdf

 

This drug is similar in strength to your drug.  (Yours, paroxetine, is slightly stronger)

 

So you see, you get a lot of change from 0-10 mg of the drug.  (That goes for going on, and more importantly, coming off)

 

If you were start at 60 mg, the first 40 mg will taper easily.  Then, when you hit around 20 mg, there’s an “Ut-oh” point where the Concentration of the drug on the Receptors drops off rapidly.

 

So sometimes it’s okay (under doctors’ care) to cut 25% the first cut for the first month.  We wait a month for symptoms to settle down before deciding how to continue the taper.

 

But after the first big cut, it is important to slow down, if you wish to minimize symptoms.  Harm reduction (fewest symptoms) practice recommends a 10% of previous dose taper per month, to match these curves.  And we hold, or stop tapering, any time the symptoms flare up.  The goal is a symptom free taper.

 

From information at:  http://www.survivingantidepressants.org

 

Please feel free to show this to your doctor.

Edited by JanCarol
Edited to add Surviving Antidepressants link for doctors

Share this post


Link to post
Share on other sites
JanCarol   
JanCarol

First feedback on my little "info sheet" (now I wish I had put the survivingantidepressants.org link on it!):

 

Daughter of the woman I wrote it for took it to her doctor, who was impressed.  Daughter is pregnant, on lexapro.  

 

Doctor said - this is good - where did you get this?  (hence I wish I'd put our link on it)

 

So - feel free to use what I wrote if you need to teach a doctor how to taper, and why.  It is just short enough, and just scientific enough that a doctor can "get it."

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.