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Phases of SSRI withdrawal - is there a pattern?

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Lilu

Good description of antidepressant withdrawal:

 

http://npanth.wordpress.com/2012/03/14/phases-of-ssri-withdrawal/

Phases of SSRI Withdrawal

March 14, 2012 — npanth

 

Not all people experience withdrawal symptoms when trying to stop taking a Selective Serotonin Reuptake Inhibitor. In clinical trials, the percentage is placed between 2 and 10 percent of patients. These studies are sponsored by pharmaceutical companies. In independent research that looked at several different company studies, the percentage of patients who experienced withdrawal symptoms from SSRI was placed between 40 and 60 percent. It’s difficult to ascertain which number is right, most studies are held privately by the drug manufacturers and not available for public scrutiny. The term used by the pharmaceutical companies for withdrawal is “Discontinuation Syndrome”. SSRI work by blocking receptors that absorb Serotonin between neurons, thereby increasing the available Serotonin in the brain. The theory is that depression, obsessive behavior, anxiety, and psychotic behavior are caused by a lack of sufficient Serotonin in the brain. This theory was first developed in the 1950′s when it was noticed that patients’ mood improved when their levels of Serotonin was increased. It is currently impossible to measure the levels of Serotonin in a living brain. 90% of the body’s Serotonin exists in the gut, so researchers measure that amount, and extrapolate a concurrent increase in levels in the brain. Ironically, studies have also proven that reducing Serotonin in the brain can lead to improved mood. These results have brought the chemical imbalance theory under question in recent years. It is beginning to appear that artificially adjusting Serotonin levels in the brain does not have the intended effect, and may be the cause of some of the symptoms that SSRI were originally developed to treat.

 

The method that SSRI use to increase Serotonin levels in the brain is at the heart of the withdrawal problem. By blocking Serotonin receptors on neurons, the brain becomes dependent on the drug to maintain consistent levels of Serotonin. As the brain becomes accustomed to the drug, it no longer has to produce or regulate Serotonin as it did before. When the drug is removed, the receptors that stimulate Serotonin production are still blocked, and levels of this neurotransmitter begin to fluctuate. Since Serotonin is closely involved in mood and the ability to cope with emotions, this fluctuation causes wide mood swings and uncontrollable emotions. It seems that the level of Serotonin in the brain is not as important as consistent levels. As the brain adjusts to the need to self regulate levels of Serotonin, many patients experience a cascade of extreme emotional and physical symptoms. Analogous to the stages of grief or joy, these symptoms don’t always come all at once. In most cases, withdrawal symptoms come and go as the user lowers their dose of the drug. Some common emotion symptoms include depression, anxiety, anger, confusion, insomnia, and memory loss. For most people, these are symptoms that they experience in every day life. Usually, they are manageable and temporary. The difference for the withdrawal sufferer is that these emotions become unmanageable and intense. The regular mechanism that we use to control our emotions no longer works during withdrawal. It’s hard to imagine the loss of control that accompanies withdrawal symptoms. When a normal person succumbs to anger, it is still a conscious decision. In withdrawal, there is no spiral that precipitates the uncontrollable rage, it springs fully formed in the mind and propels itself without any input from the person experiencing it. The other emotional symptoms of withdrawal act in a similar way. Even when the patient exercises mindfulness and self awareness, anxiety, depression, and the other symptoms come on with little warning. They have a realness and power that most people are not used to. Since the brain’s balance has been disrupted, reality itself has been changed for the patient. Instead of an emotional wave that must be conquered or endured, these emotions become reality, with no alternative.

 

As time goes by, the patient will eventually be able to self regulate each emotion at a level similar to before they began taking an SSRI. One of the frustrating things about weaning off an SSRI is that the patient is only aware of progress after a phase has passed. They may feel extreme anxiety, but realize that the rage they experienced a few months before no longer bothers them. While they are experiencing a phase, there is no context to compare their emotions to. Since the emotions are so powerful and uncontrollable, emotional self awareness is short circuited, leading to mental relativism. The patient doesn’t realize the whole range of emotions, just the small extreme range that they are experiencing at the moment. The alternative to blind rage isn’t calmness, as it would be in a normal person. Instead, irrational anger is the lower end of the emotional range.

During withdrawal, these realities change and evolve as some emotions become dominant. Patients may experience uncontrollable rage for a few weeks, then enter a stage where depression dominates. These emotional tides are outward signs of the brain readjusting to the need to self regulate neurotransmitter levels. It is almost as if the mind is going through the entire inventory of emotion trying to catalog what’s necessary to regulate each one. Some people will experience several uncontrollable emotions at the same time, but the uncontrollable aspect of them will fade away one at a time. The variety and severity of symptoms often lead doctors to prescribe other drugs to mitigate the effects. This strategy compounds the problems of withdrawal by adding a second effect to an existing condition. The patient now has to deal with withdrawal as well as the effects of a new drug and perhaps a new set of withdrawal symptoms. The best strategy for dealing with SSRI withdrawal symptoms is time and slow weaning. A prolonged weaning schedule will reduce the severity and number of withdrawal symptoms. The brain requires a certain amount of time to adjust back to a natural balance of neurotransmitters which can’t be rushed. By slowly weaning off an SSRI, the brain does not have to deal with a sudden change to Serotonin levels, and can adjust at a natural rate. It takes a great deal of time for receptors in the brain to regenerate. A schedule that reduces the drug by 10% each month is usually sufficient. Schedules can vary depending on the patient. Some will be able to reduce their dose more quickly, others may have to go more slowly.

 

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Rhiannon

This is actually very good, except that for many people (especially people with multidrug histories, long histories on the med, previous attempts to CT or rapid taper, and/or started as teenagers before the brain was mature) 10% a month may be too fast.

 

Still, this is a very good piece. And I appreciate the discussion of the uncontrollable mood/emotion swings and the way, when in them, we can't "see outside" of them.

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Sweetcreature

I agree. I like it also. It explains a lot of what I went through and confirms that neuro emotions come and go we need more people who are patient and understand this instead of running back to the doctors ( when at our most vulnerable)

 

SC

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areyouthere

Thanks for sharing this. It is good information. RU

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mammaP

Excellent article! Thanks Lilu for sharing it. 

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Altostrata

npanth's blog is very good. We have other posts by him here as well.

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Lilu

This is my first post so I do not know if I am entering this in the correct section. I began tapering from Lexapro last fall and my last dose was in April of this year. I actually felt good for four months. I was sleeping well and had energy. Then I noticed I began to experience fatigue and began to wake up in the middle of the night and could not go back to sleep. I began experiencing constant adrenalin rushes. After going four nights without any sleep, I had to go to the ER to get some relief. Now I am taking herbs, amino acids, and sometimes Klonopin (which I hadn't taken in years). I am seriously thinking of calling the doctor to get back on Lexapro, but am so disappointed I made it this far only to have to get back on. Not sure what to do, but I can't take this much longer. I knew to taper slowly but I did not know about protracted withdrawal. Any suggestions or advice? I can't hang on much longer.

Hi bgail, you first post should be in the Introductions page. One of the mods can move it for you later.  But I can definitely relate to what you're going through. Although I didn't have four good months after finishing my taper of Lexapro, which I did over a year and finished in August. Insomnia has been a huge problem. I'm also using Klonopin and Ambien to help me sleep, but then I feel like a total zombie and have crying spells afterwards.

What did they do for you at the ER?

What do the adrenaline rushes feel like?

What amino acids are you taking? L-Tyrosine and SAMe can be powerful norepinephrine activators, if that's what you're taking. 

I'm finding that I've become, like many people on this site, hyper-senstive to all neuro-active substances.

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erer

I have a question to people who have been tapering ADs for years and have reached about the last 30-10% of the initial dose.

 

Are the symptoms you get in withdrawal always the same and very specific to you or do they change over time?

 

  • After tapering over 2 years off Cymbalta I started thinking/noticing whether at first my symptoms of WD brought on such things as severe depressive episodes, extensive crying, sensory overload and also very physical notions as brain fog, brain zaps and extreme sleepiness.
  • Now I suspect that the tables are turned and instead the prevalent WD symptom is intense panic and anxiety together with fear and all physical sensations that can happen during a panic attack (only they are constant).

Is such a turn possible? Has anyone experienced anything like this? How have you managed?

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primrose

Hi

 

It took me about 6mths to taper trazodone.

I got lazy in the end, as you have to eat before trazodone and the taper went a bit off, and I just came off them.

I was failing to take them.

I do get more depression even though the traz didnt help my depression, but anytime I get a negative thought, i know it's only the traz.

Im getting better though, as I am on a higher dose menopause HRT and waiting fot that to kick in.

I did three tapers valium, seroquel and traz and the menopause complicated them.

Some people can get off ad's and psych meds quicker but you never know how you will react.

I dont advise people tapering my way, as I was lazy and couldnt be bothered with the hassle after the milk valium taper.

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erer

I would like to know more specifically if anyone has experienced that for example starting to taper they had one set of withdrawal symptoms and perhaps after a while the symptoms they get when they reduce the medicine are totally or partially different.

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merry

Yes, the symptoms that I attribute to withdrawal change quite regularly, usually after I stabilize.  It's always a bit terrifying to wait and see what the new WD will bring, but good to know they will slowly dissipate as well.

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ladybug

I have definitely noticed this to be the case throughout my years of tapering. For instance, when I first began tapering body whooshes/zaps were my biggest symptom whereas now they are very rare. Also, in the beginning of my taper the duration of my symptoms held a definite pattern. Symptoms would show up around day 3 and start resolving by day 10. Now, it is much more unpredictable as to when they will arrive and when I will stabilize.

 

I have also noticed that new symptoms can arrive suddenly, stick around for anywhere from a few weeks to a year or so, and then disappear as quickly as they arrived.

 

I seem to remember others talking about how on higher doses their symptoms were more physical, and when they reach lower doses their symptoms were more mental. I'm not sure if anyone here can attest to that being the case in their situation. I can't say that has been the case in mine.

 

So to answer your question, yes I think think it is quite normal for symptoms to change over time and as your dose gets lower.

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rapunzel2

quite hard to answer that question but it seems that symptoms are changing. but they are even changing during shorter time and not following any clear pattern (such as, towards the end, clearly different direction). 

 

I would say the same thing as ladybug, that previously my withdrawal had more clear pattern. lately it has been less predictible. but I'm not sure if it's withdrawal that is changing or the fact that so much things have changed in my life and maybe also in my body due to some things (acupuncture, etc). 

 

I used to have very clear physical symptoms such as tiredness and oversleeping, but during the last drop it was less clear, but the mental symptoms were maybe more than previously and they didn't appear as clear pattern, they came and went. 

 

I'm just about to make the next drop and I have no idea what is waiting for me now. 

 

sorry, tried to answer the question, but this issue is unclear for me, and it's very hard to answer. I'm very interested in more answers from others. 

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erer

I seem to remember others talking about how on higher doses their symptoms were more physical, and when they reach lower doses their symptoms were more mental. I'm not sure if anyone here can attest to that being the case in their situation. I can't say that has been the case in mine.

Thank you for your answer. This is also I tendency I have been noticing. I just wanted to ask what sort of mental symptoms are they that these people report to be having at the lowed doses? For me it has been extreme panic.

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ladybug

 

I seem to remember others talking about how on higher doses their symptoms were more physical, and when they reach lower doses their symptoms were more mental. I'm not sure if anyone here can attest to that being the case in their situation. I can't say that has been the case in mine.

Thank you for your answer. This is also I tendency I have been noticing. I just wanted to ask what sort of mental symptoms are they that these people report to be having at the lowed doses? For me it has been extreme panic.

 

 

I believe they were referring mostly to anxiety and depression type symptoms.

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freespirit

My symptoms did not fit any kind of pattern while tapering. Sometimes, they were more emotional and others, more physical. I didn't have much depression, and in fact, stopped having most of it as soon as I started reducing. I had some waves of anxiety, but they'd be short periods. The most difficult emotional aspects were irritability and anger, which I had plenty of...as well as repetitive thoughts.

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erer

For me at first the symptoms included a lot of brain zaps and neurological difficulties, I had a lot of neural pains and extreme sleepiness plus heavy  brain fog and dizziness. But I also experienced huge mood swings, lots of crying and very-very depressed moods. 

Now with my last faux pas when I tried rapid reduction (and with one WD before that) symptoms changed a lot. Now I am paralysed by panic, I cannot get to crying for all the fear, I get a lot of the cortisol flushes both morning and day and many other physical symptoms that can be associated to anxiety and panic on some level. I feel intense fear and I have trembling in my hands and legs. I also got a really bad case of akathisia for whic I quickly started taking medication for so hopefully this will not last (currently on the med and doing better). I also get a lot of derealisation feelings this time (to me they have always been connected to severe anxiety).

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rapunzel2

in my worst withdrawal episode I had at first neurological symptoms like dizziness, vertigo, vision problems, etc. they were minor and didn't bother me that much. after about 3-4 months I started to have mood swings, that increased in time and got really wild. until at some point my mood just crashed. in a matter of week I became from sane, functioning human being to utterly broken and crazy, nonfunctioning painful mess. I even don't remember exact symptoms very clearly, but it was extreme emotional pain, suicidal thoughts, extreme fear and sense of not feeling secure at all, all feeling of security was gone and I was left in a terrifying world.I remember that every second was pain, and that went on for two months. when i think back to it, I don't remember much physical symptoms, it was mainly emotional.

 

I'm thinking right now that your change of symptoms may have been from reaching the end.. and the crash you had may have been from jumping the last bit. but it's also an option of late-onset withdrawal syndrome - that you moved to fast with all the cuts and didn't leave enough time inbetween to correctly stabilize, so you run ahead of your nervous systems ability to heal. just a thing to consider...

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primrose

I would like to know more specifically if anyone has experienced that for example starting to taper they had one set of withdrawal symptoms and perhaps after a while the symptoms they get when they reduce the medicine are totally or partially different.

Thinking about it, I think i got psychiatric symptoms coming off the last of my tapers, seroquel and trazodone.

I think I got a psychotic delusional state, as mentioned in another post. I think I am going through one now, about some practical issues.

I am aware it is delusional though and that helps massively.

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aberdeen

i would say my symptoms early on were more physical too...swooshy head and more of a physical anxiety (stomach upset, diarrhea, shakes, vertigo, breathless feeling), there were also mental symptoms too, like depression and DR and a nervous unsettled anxiety in the mind, fearful of every bad thing possible. Towards the middle of my taper it was mostly just DR and anxiety (always worse upon waking) and now i find some drops i have no symptoms at all, and some bring on some anxiety/DR. However, i began my taper in an unstable state because i had practically CT'd a high Effexor dose some months prior and was already in rough shape. That has been a background hum for the duration of my taper...and i would get waves and windows throughout that seemed to have more to do with that, than my paxil taper (make sense,lol?). Its a mixed bag...and from what Ive read symptoms can vary and change throughout. But for me I have definately noticed the impact of my drops is no longer as predictable...and appears to take longer to register (almost two weeks post drop now as opposed to a matter of days).

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clarabella79

Hi!

 

This is my 2nd gradual taper and my symptoms are the same this time as last time (fortunately, they're pretty mild), but they have changed as time's gone on. I've noticed more in the way of muscular aches/pains/twinges, tiredness, increased sensitivity to loud noises as I've decreased my dose further. During the early stages (between, say, 18mg and 13mg), I noticed I felt more calm and on an even keel emotionally than I had when I was taking the so-called "therapeutic" 20mg dose (anxiety, mood swings and derealisation were side effects for me at the therapeutic dose - not exactly ideal!). I was also experiencing night sweats during the early stages (bearing in mind it was during an English autumn and winter, so not exactly the warmest place on the planet!).

 

Last time around, I remember the emotional instability starting to kick in at around the 6mg mark and for me it was very much as others (particularly ladybug, rapunzel2 and freespirit) have described. Lesson learned: taper more slowly this time!

 

Hope that helps!

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sky68

Over the past year my WD effects were not always the same. I experienced headaches, vertigo, a feeling of a tight band wrapped around my head, nausea, panic attacks (especially at night in bed). Could never got my finger on it, mostly they came as a surprise. As in: what's next?

However, I found that during stressful times (for example during the time I had problems at work) the anxiety at night were dominant.

The nausea would come and go during the day. But only for a period of about a week after tapering. But also not after every tapering.

So for me it was a wait and see every time.

The starting period of tapering (coming from 100 mg to 75 mg and then 50 mg) gave me the least problems. The futher and the smaller the tapering, towards the end, were prone to show the most problems.

I suppose it's different for everybody how it goes. And maybe it has also to do with the kind of AD you're using.

Try to figure out if there's a pattern, in how your life goes at those moments. Just my 2 cents.

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Hellbutrin

I've read many first hand accounts of individuals who have temporarily returned to acute symptoms after 4-6 months (this was certainly the case for me). I developed significant depressive symptoms and suicidal ideation at the beginning of November and it lasted through the beginning of December. I was wondering if anyone has accounts or links related to why this occurs at the 4-6month mark. I've also read that there seems to be regular set backs around month 12 for a lot of individuals, but that the most common set back is around 4-6- months. What does this mean for recovery? Any feedback is appreciated!

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brassmonkey

It is commonly referred to as the 'ten month wave' and happens to most people after they have discontinued their medication.  There actually are three different timings for this to happen. Six, ten and twelve months.  Frequently it only happens at one of those time, but can happen at any or all of them.  It usually is a very positive sign of healing with the following window being a very large improvement and the any subsequent waves being of lesser intensity.  People who have done slow tapers tend to get off more easily, while for people who have fast tapered, CTed or jumped at too high of a dose, they can be pretty brutal.  They can last anywhere from a week to several months. As to why it happens, it's like the rest of WD, we don't have a clue. In my case I got hit at about 8 months and it lasted just over two weeks.  I will be interested to see what happens at 10 and 12 months.

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Hellbutrin
1 hour ago, brassmonkey said:

It is commonly referred to as the 'ten month wave' and happens to most people after they have discontinued their medication.  There actually are three different timings for this to happen. Six, ten and twelve months.  Frequently it only happens at one of those time, but can happen at any or all of them.  It usually is a very positive sign of healing with the following window being a very large improvement and the any subsequent waves being of lesser intensity.  People who have done slow tapers tend to get off more easily, while for people who have fast tapered, CTed or jumped at too high of a dose, they can be pretty brutal.  They can last anywhere from a week to several months. As to why it happens, it's like the rest of WD, we don't have a clue. In my case I got hit at about 8 months and it lasted just over two weeks.  I will be interested to see what happens at 10 and 12 months.

Hi Brassmonkey,

 

Thank you so much for all of the information. Do you have links that you can share with me that have more information/reports of this occurring with others? I appreciate any feedback you can offer.

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brassmonkey

There are no official studies on these subjects.  All we have is what we've gleaned from working with thousands of members on this and other sites.  Over time we are trying to pull it all together into one unified whole, but that is taking a lot of doing.  The best bet is to read through all the threads you can and see what they are experiencing. There is a wealth of information here it just takes a little digging.

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LexAnger

Great thread! Thank you Brassmonkey for the great information! 

 

As its so confusing and terrifying after you feel somewhat ok or better for the first few months after being off completely then suddenly all sxs ramp up in full force like never.

 

i tapered for 4.5 years with some updose in the middle and been off since 09/23/2017. I felt a bit better in the first 2 + months before all the old sxs worsened significantly and new sxs added on (extreme neuro emotion, severe anxiety), I'm now 100 day off, have been in the most brutal WD physically, mentally and emotionally. Being very strong going through the very tough long taper, I still feel Im losing it all now and need urgent help for relief.

 

i so hope it's true that this won't last long!

 

I hope to hear from anyone that this is indeed a sign of healing and will be followed by significant improvement!

 

thanks for sharing your thoughts and experience!

 

lex

 

 

 

 

 

 

 

 

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Undiagnosed1

My personal experience ( note I was not on long term ) 

2 weeks after mirt cold turkey I got the " honeymoon" that lasted a month or so.

I then fell into the depths of hell with si "black hole" depression along with horrible physical symptoms that lasted a couple of months. Then things seemed to lift some.

 

At almost exactly 6 months I was slammed with the most intense anxiety, akathisia, sweating and si I could have possibly imagined. This lasted a month 

and I was unsure I was going to make it. If not for the love of my beautiful wife 

I may not have. 

 

I'm the poster child for doing things all wrong.

 

I'm almost 11 months out from 15v mirt cold turkey.

5 months from 25mg trazodone cold turkey

2 months off coreg taper 

On my last 100 mg gabapentin

 

Now for the positive 

I'm seeing some huge improvements 

Anxiety much better 

Depression minimal 

Si almost non existent 

Better appetite 

Showering daily " im happy about this"👍

Starting to work some

A desire to try and get things done 

Spilt fire wood, repair cars, shovel east coast snow "yuk" 

 

I finally have hope which I had lost for a long time. Do I still have issues heck yeah but improvement is undeniable. 

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LexAnger

Thank you so much undiagnosed for sharing your positive healing process!

cant believe these drugs can cause that much harm even after a very short use!

 

i want to say you are so smart getting off these poisons quickly! I'm so happy for you seeing significant improvement!

 

sending more healing vibes to your way!

 

lex

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Undiagnosed1

Lex I've read your story and followed you from a distance for quite sometime. All the while hoping I could be as strong as you have been throughout this process.

It's sad that no matter cold turkey or slow taper we suffer. 

 

Only we understand the absolute horror of this process.

 

I still question total healing and more lean towards the vast majority of the suffering ending and we become more tolerant and happy for that. 

 

Healing vibes for you as well madam

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Terry4949

I was c/t in March of several meds so it’s 10 months now after 2 months my mood was better but still had a lot o physical anguish then at 6 months I descended into a pit of despair suicidel depression and. Everything that I was suffering became 10 fold this lifted after 6 weeks and I could at least function eat properly got a little more sleep even managed a little work , now at 10 months I have crashed in to that pit again but even worse than before , deep dark depression , apathy anhendonia waking at 2 am body filled with fear cortisol and adrenaline overload , tremors and chronic fatigue , I feel hopeless but I am hoping that I can get to twelve months and it may lift like it did at 6 months I am hoping that these 2 waves maybe the worst . I just need to find the strength to get to twelve months as I have just got my head above water at the moment . I hope we all find that relief that we deserve 

 

 

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Altostrata

I sure hope it works as brassmonkey speculates:

 

On 12/22/2017 at 12:33 PM, brassmonkey said:

It is commonly referred to as the 'ten month wave' and happens to most people after they have discontinued their medication.  There actually are three different timings for this to happen. Six, ten and twelve months.  Frequently it only happens at one of those time, but can happen at any or all of them.  It usually is a very positive sign of healing with the following window being a very large improvement and the any subsequent waves being of lesser intensity.  People who have done slow tapers tend to get off more easily, while for people who have fast tapered, CTed or jumped at too high of a dose, they can be pretty brutal.  They can last anywhere from a week to several months. As to why it happens, it's like the rest of WD, we don't have a clue. In my case I got hit at about 8 months and it lasted just over two weeks.  I will be interested to see what happens at 10 and 12 months.

 

For what it's worth, I do not believe we can say recovery from withdrawal takes place in stages of x number of months or that there is any pattern of post-discontinuation symptom severity after 6 months or 10 months or any number of months.

 

What happens is that people go along feeling fairly stable and not knowing their nervous system have become hypersensitive, but then do something, such as take an antibiotic, have some drinks, or undergo a stressful life event which destabilizes them for a time.

 

It's also true that when the nervous system is presented with a challenge -- but not too great of a challenge! -- it can become stronger and more stable.

 

There also might be a cumulative effect of what were little withdrawal symptoms that were overlooked coalescing into a more noticeable pattern. I think this is very common -- people go off drugs, experience relatively minor symptoms at first, figure that will last only a few weeks, and then, as the symptoms change and become more serious,  blame them on the flu, life stress, etc. for a while. It's only when the symptoms become unmistakably severe and not-normal that they begin looking for the reason.

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LexAnger

Thank you so much undiagnosed for reading my thread! 

I know it's hard especially when we are in too much agony and pain for so long without a sign of improvement, but please don't lose hope. Hope is the only thing carries us to the end of this horredous lengthy battle. When I am in total despair I would read the success stories again and again and they keeps me continue fighting! 

 

we just go one day at a step and keep going like that. There will be an end as long as we don't giving in to these poisons. 

Also remember you are not alone and we are all walking together.

hugs,

lex

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LexAnger

Thank you terry for sharing your experience!

Congratulation to you for being off the meds for 10 months! Be proud of yourself for winning the battle of being free of these most dangerous substances!  You are so close to the turning point! And believe you will see that big improvement any day!

 

 

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