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hippopotamus

Delayed onset of withdrawal symptoms

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hippopotamus   
hippopotamus

I was wondering if anyone has an explanation for the mechanism behind delayed withdrawal. From what I've read people can go off their meds without any problems and then, after a couple of months, *poof* withdrawal kicks in.

 

I reckon this can also happen whilst still tapering. Meaning the WD-symptoms of cutting to a lower dose only become noticeable after a while, maybe even months.

 

Anyone has any thoughts on this?

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hippopotamus   
hippopotamus

No I hadnt read it, thank you for that link, I found it very interesting!

 

I do wonder in which way this theory would be compatible with getting off of atypical antipsychotics..

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Altostrata   
Altostrata

Reasons why withdrawal symptoms may not be immediately apparent:

  • "Washout," related to drug half-life, takes some time; minute amounts of drug in the body holding off withdrawal symptoms (particularly with long half-life drugs such as Prozac, where washout takes weeks).

  • Outright misdiagnosis and mistreatment of withdrawal symptoms, causing worsening of condition.

  • Symptoms are attributed to something else, such as the flu or situational stress.

  • Symptoms may be mild initially and the person doesn't pay any attention to them.

  • Symptoms of nervous system instability might initially be very mild with the homeostasis gradually deteriorating over time, producing more severe, noticeable symptoms.

  • Other ???

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Outshined   
Outshined

No I hadnt read it, thank you for that link, I found it very interesting!

 

I do wonder in which way this theory would be compatible with getting off of atypical antipsychotics..

 

You're welcome. I wonder the exact same thing since I'm tapering off of an atypical antipsychotic (I guess Sodium Valproate/Valproic Acid is considered one of those).

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Altostrata   
Altostrata

This may apply to all psychiatric drugs, including atypical antipsychotics:

 

Reasons why withdrawal symptoms may not be immediately apparent:

  • "Washout," related to drug half-life, takes some time; minute amounts of drug in the body holding off withdrawal symptoms (particularly with long half-life drugs such as Prozac, where washout takes weeks).

  • Outright misdiagnosis and mistreatment of withdrawal symptoms, causing worsening of condition.

  • Symptoms are attributed to something else, such as the flu or situational stress.

  • Symptoms may be mild initially and the person doesn't pay any attention to them.

  • Symptoms of nervous system instability might initially be very mild with the homeostasis gradually deteriorating over time, producing more severe, noticeable symptoms.

  • Other ???

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peggy   
peggy

i have been thinking a bit about this lately - with a slow taper, what do you think the likelihood of the two, three or four month delayed withdrawal effects might be?

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Altostrata   
Altostrata

Good question. My guess is if you taper so you don't get withdrawal symptoms by paying attention to your body, you won't have delayed withdrawal. Nervous system accommodation is built into the taper.

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peggy   
peggy

thanks Alto, they were kind of my thoughts too.

 

When i look back at my tapers (never went CT but certainly tapered too fast over 6 weeks or so) my well time between last dose and onset of withdrawal anxiety/depression (they were my only delayed symptoms) became shorter each time - first time was about 4 or 5 months, second time 2 or 3, third time 7 weeks, fourth time 3 weeks, and then fifth time (and subsequent) whilst i was still tapering... it was probably not until the fourth or fifth time that i actually thought they were withdrawal - but i always thought that effexor had done something because prior to taking it my depressive episodes were 4 years apart - and they gradually built up - not like the post effexor symptoms - BAM!

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basildev   
basildev

Hi guys,

 

I'd like to chime in on this because this is EXACTLY what happened to me.

 

I was tapering over 4 months since End October 2012.

 

Extremely mind WD symptoms, but nothing too noticeable (especially after I switched to decaf; WD symptoms were virtually non-existent). Sleeping was perfect.

 

Then mid Feb I had some highly stressful situational anxiety that lasted about a week. During that time I was waking at 4AM and not falling back asleep. Had trouble falling asleep too.

 

After I resolved the situation, my sleeping never normalised. I'm still experiencing early morning waking and not falling back asleep and very broken, unrefreshing sleep. I'm no longer anxious (except about my sleeping now) but just cannot get a good night's sleep.

 

So I think that maybe (for some people) a stressful event could possibly 'trigger' withdrawal symptoms, even if they were going along pretty well. Maybe it's got something to do with the cortisol not being able to get back to normal or something.

 

What do you think?

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dalsaan   
dalsaan

I think you're right basil dev. I think we all have a limit to the amount of stress our body can tolerate during withdrawal and if we go past that point by withdrawing too fast or having significant stress we can tip our nervous system and experience the effects of that.

 

I also think those width a history of trauma have a lower stress threshold and significant autonomic effects

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tezza   
tezza

Stressful situations or events do keep me from sleeping well. I wake several times during the night and if a stressful situation crosses my mind, sometimes I can forget about sleep for the rest of the night. Depending on the degree of which I'm stressing, I may be able to get back to sleep but it takes longer than usual.

 

I've always been a bit of an insomniac, so I think that makes me fear the loss of sleep even more now. If my husband sits down for five minutes, he's out like a light bulb and I envy that.

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jmim   
jmim

i've been wondering about this a lot lately... i've been off of meds for over a year and a half (was on antidepressants for 17 years) and up until about 8 months ago was doing ok. my withdrawal was moderate to mild. then i had a really bad 6 months, situationally. moved across the country from my friends and family, couldn't sleep well because my partner has restless legs at night, was sad and lonely, stressed out trying to work on my graduate thesis from across the country, fighting with my fiance.... basically a perfect storm of stress. i had also lost my father right before i went off of medication. so now, my body is a MESS. i'm flushed all the time, exhausted, hair loss, muscle aches. they tested me for lupus and while i had a positive ANA, the rheumatologist doesn't think i have it, as the symptoms don't quite fit. but no one can tell me what's wrong with me, whether it's fibro, CFS, something hormonal, etc. my nerves are a disaster and i'm living back in boston for a couple of months while i finish my thesis (my fiance is in LA). everyone tells me to minimize stress, but how?? this past week my mother had back surgery and was in screaming pain for days - i was the only one with her and it sent me backwards physically big time, just from the stress of being there. i was functioning before but now my body is falling apart again. i don't know how much to blame on antidepressant withdrawal if any, it's been a really long time for that to still be an issue. but clearly lack of sleep and stress have a severe effect on me that they didn't before. i don't want to go back on medication but i'm getting desperate to feel better both physically and emotionally...

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basildev   
basildev

Hi jmim,

 

I'm sorry you're going through such an awful time.

 

You really do have the 'big cohuna' of stress going on in your life - the whole gamut. It's hard to say whether all that stress sent your nervous system haywire. I'm not an expert so I can only hypnothrsise but I think for me, being on medication for so long has probably made my body (and brain) hypersensitive to stress, so that where I would normally settle back down really quickly after the stressful time resolved itself it's like my brain is on hyper-alert and the 'chemical' side of me just doesn't seem to want to catch up.

 

You're situation is different again because you're still experiencing high volumes of situational stress. It would be interesting to see how your nervous system reacts when things settle down(and I really hope they do soon).

 

Just another thing about your fiance and restless legs. I discovered long ago that I sleep best on my own. My husband and I have been together for 10 years and we both agree that nothing is more important than sleep. So we decided on separate bedrooms and that works great for us. For one thing I get too hot with someone else in the bed. But I'm a very light sleeper so any movement wakes me. Anyway it hasn't impacted our relationship in any negative way (in terms of intimacy, etc...). Not an option for everybody but something to think about.

 

Take care

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Altostrata   
Altostrata

If you fed him magnesium, his restless legs might go away. True!

 

It might help you, too, jmim. See the magnesium topics in this forum.

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jmim   
jmim

Thanks for the response, Alto... it's been so hard lately! Knowing everything going on is supposed to make me stressed out is comforting in some ways, but when my body is freaking out it only goes so far. I totally agree that sleep is the most important thing, and the lack of it is probably what kicked all of this off. I just don't feel like I'm rested even when I sleep 9 hours a night these days. I'm so frustrated :\ i'll check out the magnesium thing...

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Hexal   
Hexal

Is it common to have delayed withdrawal symptoms or is it something of a rarity?

 

I noticed no problems whatsoever when I was tapering off Sertraline and was a bit surprised by it. 2 1/2 months had gone by before the symptoms slowly started emerging and they have continued to evolve ever since.

 

This delay makes it even harder to convince my doctor in any way about this stuff (probably an exercise in futility, anyway). Even friends and family are asking me; are you sure this is not just stress or anxiety expressing itself in a weird way? Why would the drug start causing these problems months after stopping?

 

Sorry if this topic has been discussed already.

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mattinsmom   
mattinsmom

Someone with more knowledge will be along. In the meantime yes withdrawal symptoms can be delayed. You might want to type protracted withdrawal into the search box. You'll find many stories.

 

Wish I had more to offer. You are in the right place and will get much support.  

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UnfoldingSky   
UnfoldingSky

I don't know if it is common; however, after stopping a drug abruptly (due to a drug reaction) I had a period of feeling mildly "better than well" and then a harsh crash.  Probably about a month and half after stopping the drug.

 

Doctors didn't believe me either when I said it was the drug--however it was quite clear in my case to me it was.  I had symptoms like twitching, akathisia, and electrical shock sensations, all of which are not part of "mental illness".  If you have any of these then it's probably safe to say it's withdrawal. 

 

Oh and nausea, and flu-like symptoms are also not "mental illness" so if you have those it's likely withdrawal as well.
 

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UnfoldingSky   
UnfoldingSky

Hexal, how did you taper?  Can you put up a signature so we can help you out? 

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rapunzel2   
rapunzel2

I ended zoloft within a few months, and then also had a very good period - totally well and grounded. after it started going bad - at first with wild fluctuations (waves), until I totally crashed, big time. the crash came about 4-5 months after the quit.

 

brain accostumes to taking SSRI by reducing it's serotonin receptors and reducing their sensitivity. if drug is removed, it has to restore the receptors and start working in a totally different way. the pace of this restoration is slow, and it probably just runs into havoc after trying and trying to gain some new equilibrium. 

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Claudius   
Claudius

As we know, the leaflets, for as far they offer any information about withdrawal, mostly state that WD starts within one or a few days after stopping the daily intake. For some people this appears to be true, on this and other support sites I read many testimonies from people who get sick after missing even one dose.

But also there are many stories of WD hitting much later, weeks or even months.

 

For me, when quitting Paxil cold turkey from 10 mg, I felt perfectly fine for exactly 6 weeks when suddenly the brain zaps started and I became very ill within a few minutes. Most attempts went this way, and it was this time delay which made that it took years before I finally realized that is was withdrawal anyway.

 

Paxil is notorious for its short half-life and even the doctors who do recognize withdrawal mosty tell that Paxil withdrawal will hit pretty soon after quitting because of this short half-life.

But it didn't for me, and I know several people for which it took 2-4 weeks, my own 6 weeks appear to be on the long side.

 

What made it increasingly complicated, I tried one time to cut my dose by splitting the half tablet, and one other time to alternate between a half and a quarter tablet.

We know now that this is a very bad scheme, but what I still do not understand is that on those cases, I got sick WITHIN ONE DAY instead of after 6 weeks! I would rather tend to believe that WD would hit later because the body still receives the drug, albeit in a lower quantity, so the "buffer" which causes the delay in WD symptoms would last a longer time and the delay time for the start of WD symptoms should be longer instead of much shorter!

 

My own explanation would be that alternating throws the brain in chaos immediately, while quitting cold turkey gave a delay of 6 weeks. This however does not explain why OI got sick immedaitely after taking a quarter tablet (5 mg) daily instead of my normal dose of 10 mg.  A poosible reason could be that dividing the half tablet casues too much deviation in dosages because the half tablet has no splitting line anymore on it.

 

Of course, now 6 years after quitting is does not make any difference for me anymore but I still wonder what kind of strange mechanisms are invovled here.

Any ideas?

 

 

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Hexal   
Hexal

Thanks for your responses.  :)  Seems I'm not the only one with this type of experience. It definitely does not seem to be mental illness acting up. I've had enough experience with anxiety and stress to know that it does not feel this way at all in my body. I also get the electrical shock sensations and twitching.

 

Hexal, how did you taper?  Can you put up a signature so we can help you out? 

 

Sure. I tapered in an unusual way, as you can see.

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skybert   
skybert

Sounds just like me. I was fine for 7 weeks after I quit. 

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Claudius   
Claudius

OMG, I started a similar discussion about this subject today too!

My misery started 6 weeks after each cold turkey attempt, but immedately after my attempts to reduce dose or alternating doses. Due  to this strange phenonema it took years before I realized what was going on and almost became the end of me...

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mammaP   
mammaP

Haven't a clue Claudius! I would get symptoms if I missed or was late with a single dose,

and a bout of tummy trouble with D&V saw me being admitted to hospital twice with what I 

now know to be withdrawal when the effexor wasn't absorbed. One time they were convinced

I had a brain bleed and I had scans and lumbar puncture. All I needed was my 'fix' ! 

 

Then I started to taper and it went very well, very smooth with little discomfort over about a year.

Then stopped at just 5 beads. I forgot one day and didn't feel a thing so thought I must be ready. 

 

4/5 weeks later I was hit by horrendous withdrawal, ended up here and took 7 months to stabilise again.

 

Everyone seems to be different, no 'normal' where withdrawal is concerned! I am just glad I found SA and

wish I'd found it before my taper. I didn't cut by 10% of the current dose, just stuck to the same reduction

thinking it was right. We live and learn! 

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mammaP   
mammaP

OMG, I started a similar discussion about this subject today too!

My misery started 6 weeks after each cold turkey attempt, but immedately after my attempts to reduce dose or alternating doses. Due  to this strange phenonema it took years before I realized what was going on and almost became the end of me...

Claudius I have merged your topic with this one, great minds think alike huh?  ;)

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Claudius   
Claudius

 

Claudius I have merged your topic with this one, great minds think alike huh?  ;)

 

Yes probably that was the cause... :-D

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Hexal   
Hexal

OMG, I started a similar discussion about this subject today too!

My misery started 6 weeks after each cold turkey attempt, but immedately after my attempts to reduce dose or alternating doses. Due  to this strange phenonema it took years before I realized what was going on and almost became the end of me...

What a coincidence :). I had no idea you had created this discussion today. Sorry to hear about your situation, Claudius. You make a lot of good points, although contrary to your experience, I did not quit cold turkey and still got the delayed reaction. I tapered with alternating doses, and experienced no problems during this period. On days where I forgot to take the medicine I did not experience problems either.

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UnfoldingSky   
UnfoldingSky

 

Sure. I tapered in an unusual way, as you can see.

 

I'd chalk it up to that then.  Sorry your doctor gave you such a bad tapering schedule.

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btdt   
btdt

As we know, the leaflets, for as far they offer any information about withdrawal, mostly state that WD starts within one or a few days after stopping the daily intake. For some people this appears to be true, on this and other support sites I read many testimonies from people who get sick after missing even one dose.

But also there are many stories of WD hitting much later, weeks or even months.

 

For me, when quitting Paxil cold turkey from 10 mg, I felt perfectly fine for exactly 6 weeks when suddenly the brain zaps started and I became very ill within a few minutes. Most attempts went this way, and it was this time delay which made that it took years before I finally realized that is was withdrawal anyway.

 

Paxil is notorious for its short half-life and even the doctors who do recognize withdrawal mosty tell that Paxil withdrawal will hit pretty soon after quitting because of this short half-life.

But it didn't for me, and I know several people for which it took 2-4 weeks, my own 6 weeks appear to be on the long side.

 

What made it increasingly complicated, I tried one time to cut my dose by splitting the half tablet, and one other time to alternate between a half and a quarter tablet.

We know now that this is a very bad scheme, but what I still do not understand is that on those cases, I got sick WITHIN ONE DAY instead of after 6 weeks! I would rather tend to believe that WD would hit later because the body still receives the drug, albeit in a lower quantity, so the "buffer" which causes the delay in WD symptoms would last a longer time and the delay time for the start of WD symptoms should be longer instead of much shorter!

 

My own explanation would be that alternating throws the brain in chaos immediately, while quitting cold turkey gave a delay of 6 weeks. This however does not explain why OI got sick immedaitely after taking a quarter tablet (5 mg) daily instead of my normal dose of 10 mg.  A poosible reason could be that dividing the half tablet casues too much deviation in dosages because the half tablet has no splitting line anymore on it.

 

Of course, now 6 years after quitting is does not make any difference for me anymore but I still wonder what kind of strange mechanisms are invovled here.

Any ideas?

I am not sure if this qualifies but I got immediately even more severely ill when I tried to reinstate Effexor.  Go to the hosp ill. 

 

I quit cold turkey 6-7 wks later started with what I thought was the flu... it had started.  One doctor talked me into trying E again to get stable... I was severely ill from one pill and never tried another. 

 

"This however does not explain why OI got sick immedaitely after taking a quarter tablet (5 mg) daily instead of my normal dose of 10 mg"

 

I am going to throw you a long shot carrot on a stick.. there was this idea at one point on pp that the drug changed how the liver works ... it was an explanation as to why the drugs react differently as people tapered off... 

 

I am trying to think of another process by which the thing being processed affect the function of the machine and I am drawing a blank.....understand?

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Mikey1975   
Mikey1975

Is there many of you out there who have had delayed onset of symptoms mine didnt really start until about a year after and then they were managable until about 18 months later and has got worse and worse

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RockSie   
RockSie

Hi Mikey,

 

here I am. My ct withdrawals started 9-11 month off citalopram and the second time 5-6 month off.

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Mikey1975   
Mikey1975

Hello it strange how this happens with somepeople isnt it

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RockSie   
RockSie

Yes it is! But that is the reason why my doubts if this is really withdrawal are so big :(

Nothing makes more sense than wd, but my anxiety being just seriously ill are still there...

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