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General Medication Discussion This section is to be used for general medication discussion and other medications not broken out in their own respective forums.

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Old 02-11-09, 09:27 AM
jeffpuffer jeffpuffer is offline
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Planning on stopping an SSRI. Read this first!

Be forewarned, this post will be very lengthy, and based off of personal experience, results may vary, but I'm confident this will work very well for the majority of people who try it. I always read threads (not just here) about the hells of SSRI withdrawal, so I wanted to share my experience.

Now I know a lot of people have something against SSRI's for one reason or another, but whatever, they changed my life and helped a tremendous amount. I think that it's ridiculous that some people demonize SSRI's because others have had bad experiences with them. Anyways, this is a thread about stopping SSRI's, not debating them, so I'll save the politics for another time.

First, a little background. I was having panic attacks and anxiety every single night and only managing to get 3-5 hours of sleep because of it. These panic attacks were horrible. The best way I know how to describe them is to tell people to remember the "OH ****" feeling they got the first time they were ever pulled over. My panic attacks felt like that and that feeling stayed around for about 3 hours. After 3 months of this I decided to seek help. I went to a psychologist first who, after wasting my time with CBT, referred me to a psychiatrist. After explaining my situation to the psychiatrist, I was basically given 3 options:

1. Do nothing
2. Take a benzo as needed (which for me meant every night)
3. Start treatment with an SSRI

Option 1 was crap, obviously, and option 2 wasn't happening because benzodiazepine addiction was not a road I wanted to go down. That left me with option 3, SSRI's. I didn't know much about SSRI's at the time, being that I was only fascinated with drugs of abuse, so I wasn't aware of what kind of trouble I was getting myself into. All I knew was that an anti-depressant was going to somehow help me with panic attacks and anxiety. I left the psychiatrists' office with a prescription for Lexapro 10mg, to be taken every day.

I can sum up my first day on Lexapro in one word: "UNBELIEVABLE". I have NEVER felt so good in my life. I was energetic, my focus and comprehension in class were razor sharp, I felt smarter, insanely confident, extremely social, and ready to take on the world. I had more motivation to succeed in life than I think I've ever had before... but even better than all that, I had no anxiety whatsoever. The panic attacks had completely disappeared... Lexapro had the anxiolytic properties (and *only* the anxiolytic properties) of Xanax for me. It truely was a wonder drug in my experience. After about a week, all of the amazing things about Lexapro began to fade, but the anxiolytic properties remained. I didn't care though, afterall, I was taking it for anxiety and panic attacks, not because of social phobia, ADHD or mood problems.

After about 6 months on Lexapro, I noticed that I was starting to feel very apathetic towards everything. Things that were normally very important didn't matter as much, and I didn't react as emotionally to certain events as I normally would have. I don't mean I was emotionally blunted, but just that things didn't bother me at all. For example, if I missed a test in a class because I overslept, I didn't freak out, I just said "eh, **** it I'll email the teacher and tell her I'm sick", and then went back to sleep. I believe this to be a big problem, since I think it's actually important to care about things in your life like that. So I made the decision to stop taking Lexapro.

At this point in time I had done a ton of research on SSRI's, was very familiar with what they did, why they worked, how they worked, and even what would happen if you quit using SSRI's cold-turkey. I must have read thousands of posts on thousands of forums about patients who were distraught with the withdrawal they were having from their SSRI. From what I had read, SSRI withdrawal sounded a lot worse to me than more other things, including opiate withdrawal. If I were to stop taking Lexapro cold-turkey, I could expect to have severe anxiety, severe depression, severe bouts of crying, severe sexual disfunction, severe insomnia, severe aches and pains, and even some bull**** symptom identified only by the term "brain zaps", which apparently could be described as "having someone give you an electric shock... in the brain". What the ****? And as if the withdrawal symptoms weren't bad enough, they were lasting anywhere from 3 months to 2 years for some people. If my psychiatrist had told me about this before I started taking Lexapro I probably would never have taken it. But alas, there was a reason he never told me about SSRI discontinuation syndrome, and that was because he didn't know it existed. I guess I should be more specific. He knew that you should taper off of SSRI's, but believed that half your dose for 1 week followed by going cold-turkey was a sufficient taper. Also, the only withdrawal symptoms he had heard of were minor anxiety, and minor insomnia. It seems most doctors are in the same boat as he, infact, I would estimate that 30% of doctors are completely oblivious to the fact that SSRI's produce physical withdrawal symptoms, and somewhere in the neighborhood of 69% of doctors are unaware of just how severe SSRI withdrawals are. Needless to say, I discussed all of these withdrawal symptoms with my psychiatrist and he proposed the theory that perhaps what most people were experiencing wasn't withdrawal, but a return of their original symptoms that they were attributing to the cessation of their SSRI. An interesting theory, and he's probably right for about 60% of people complaining of SSRI withdrawal, but either way, I didn't want to risk experiencing these god-awful physical withdrawal symptoms and discussed an SSRI taper with him.

He told me the standard SSRI taper schedule was to, and I quote, "take half the dose for 5 days, then stop taking it all-together." That was funny to hear because the people online who were complaining about SSRI withdrawal were following that exact taper schedule and it clearly was not working.

Thus, we now arrive at the main reason for the creation of this thread: my SSRI taper schedule. I came up with this schedule of my own volition, and while I like to think I'm very intelligent and know more than most doctors do in regard to psychoactive drugs, I'm still not a doctor (yet), and you shouldn't take my word as gospel. As I said at the beginning of this thread, I feel like this taper will work for a majority of you... but as my psychiatrist told me (and I have to agree with him), some people simply have a return of their original symptoms which necessitated the use of an SSRI in the first place, and that return of symptoms is not SSRI withdrawal. Unfortunately, some of you may fall into that category. Without further ado, here is my taper schedule.

Note: 1 week = 7 days, not 5 (I shouldn't have to state this, but for the sake of clarity, and the fact that this is a drug forum, I will).

1. Figure out what 25% of your original dosage is. This 25% will be the amount of mg that you taper down by at each dosage-change period. To clarify, you only find this number once, and then reduce by that number at the beginning of every new dosage-change period. We will call this 25% "your dose reduction" or YDR for short.

For example, I was taking Lexapro 10mg every day. 25% of 10mg is 2.5mg. For my first taper period, I would take 7.5mg (10 - 2.5) every day. On my next taper period, I would take 5mg (7.5 - 2.5) every day. My next taper period would entail taking 2.5mg (5 - 2.5) every day. Finally, I would stop taking Lexapro since 2.5 - 2.5 = 0mg every day. As you can probably figure out, you will always only have 3 taper periods, since no matter how many mg you take every day, you reduce the dosage by 1/4th the original dosage each time.

2. Reduce your current dosage by YDR, and take this new dosage for 2 weeks.

3. Reduce the dosage from step 2 by YDR, and take that new dosage for 1 week.

4. Reduce the dosage from step 3 by YDR, and take that new dosage for 2 weeks.

5. Be free of your SSRI!

The reason I chose a reduction of 25% for the taper was because of two reasons. First, if you do anything more than 25%, you will most likely experience some degree of withdrawal, and second, Lexapro pills are easy to divide into 1/4ths. I can't say the same about taking 10% of a Lexapro dosage since I can't cut pills into 1/10ths with any amount of accuracy... not to mention doing a 10% reduction each time would lead to a very long taper time, and no one wants that.

The reason I decided to make my taper time-frame 2 weeks, followed by 1 week, followed by 2 weeks, is due to what I know about up and down-regulation of receptors in your brain. The initial reduction period needs to last 2 weeks because 2 weeks gives your brain ample time to down-regulate the number of serotonin receptors in your brain, which in turn leads to less physical symptoms when you reduce your dosage even more at the end of the 2 week period. When I reduced Lexapro from 10mg to 7.5mg, there were no noticeable withdrawal symptoms, mental or physical.

At the end of the first 2 week period, you move down to your next dose, which should be 50% of your initial dose, assuming your basic math was correct. The reason the second reduction period only lasts 1 week, as opposed to 2 like the first period, is because I believe your brain gets used to down-regulating receptors since it's been doing it for 2 weeks already. By this, I mean your brain is able to down-regulate receptors at a faster rate because of the initial 2 week down-regulation that it experienced. It's almost like your brain is now conditioned to reconfigure itself faster, in a sense. When I reduced Lexapro from 7.5mg to 5mg, I had no noticeable withdrawal symptoms, mental or physical.

At the end of the 1 week period, you go down to your next and final dose, which is 25% of what you were taking before beginning the taper. The reason this final taper period lasts 2 weeks instead of just 1, has nothing to do with down-regulation of receptors. I'm sure you could do 1 week of this final dosage based on my previous assumption about your brain being conditioned to down-regulate quicker, but I chose 2 weeks because I don't know what happens when your brain is no longer being given the SSRI in any amount. I wanted to be safe, rather than sorry, if for some reason my neurons reacted differently when they were getting no Lexapro at all, so I wanted to give them as much time as is reasonable to get used to the last taper dosage. When I reduced Lexapro from 5mg to 2.5mg I had no noticeable withdrawal symptoms, mental or physical.

After that 2 week period is over, you stop taking your SSRI all-together. I am on my 5th day of 0mg of Lexapro and feel completely fine. I can safely say I am not going to have any form of withdrawal, mental or physical. My mood is bright as ever, and my motivation has returned 100%. Best of all, I no longer have anxiety or panic attacks. The Lexapro worked wonders for me and did exactly what it was supposed to... it cured my anxiety and panic attacks while I took it, and now that I'm off of it, they haven't returned at all. I think SSRI's are a wonderful drug with a very bad stigma attached to them. When taken for the right reasons, and with the help of therapy on the side (for those that need it), they can do wonders. I am very glad I took Lexapro because it's made a huge difference in my life. SSRI's are a drug, and just like most other drugs they will produce physical dependence, but be smart about tapering off of them and you should find that not only will you not have withdrawal, but that your original symptoms have been cured.

Best of luck everyone and thanks for reading!
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  #2  
Old 02-27-09, 08:41 PM
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DTownDave22 DTownDave22 is offline
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Re: Planning on stopping an SSRI. Read this first!

I likely will be trying Lexapro. I am really hesitant to try it but anxiety is an issue with me. I want to believe it's more of a problem with A.D.D. and having negaitve emotions attached to a lot of thoughts I have that I believe is due to my wandering A.D.D. mind. The doctor I saw is someon I somewhat trust but not totally. I mentioned passing thoughts of death and suicide at my first appointment last week and it seemed like he really clinged onto that last week and this week. I clarified today that it was largely due to not getting enough sleep which gave me trouble with motivation and functioning and whenever I brought this up, he'd usually mention how depression can interfere with concentration and motivation and then say "What do you think?" He'd ask that several times. I said in response today: "I already told you what I think". It's like he was waiting for me to give in and say "Oh..alright..I'll take something for depression and anxiety and not for A.D.D." Depression isn't even the biggest issue with me. It's anxiety and confidence and feeling closeness to people and staying focused.

Nonetheless, there is just something that scares me about medication. I tried Zoloft, another SSRI a while ago. I found it helped me with my anxiety for about a week, thereafter NOTHING and it kept me up at night. No worrying, just laying in bed unable to sleep. Now that I see that the anxiety reduction was wiped away after a week, that has mee worried.

I also find it a little worriesome and intriguing that a lot of the sections in this forum have little to moderate activity and then I go and look in any various medication forum and there can literally be dozens or a couple of hundred people "viewing" and the large majority of them are guests. It just scares me. Just how many people are on medication or considering it and what the hell is going on in this country?
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Old 03-02-09, 03:44 PM
jeffpuffer jeffpuffer is offline
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Re: Planning on stopping an SSRI. Read this first!

Quote:
Originally Posted by DTownDave22 View Post
Now that I see that the anxiety reduction was wiped away after a week, that has mee worried.
The anxiety reduction wasn't wiped away after a week. Infact it lasted through-out the entire course of treatment and has even continued thereafter. The thing that was wiped away after a week was the extreme mood boost, but I liken the mood boost to a placebo effect, since SSRI's don't tend to start working until ~2 weeks after initiation of treatment.

Quote:
Originally Posted by DTownDave22
It just scares me. Just how many people are on medication or considering it and what the hell is going on in this country?
I'm sure these guests are reading the threads because they were linked to them through google. There's nothing wrong with being on medication, nor is there something wrong with considering medication to help with a problem. I personally believe that the people who take the "any medicine is a bad idea" outlook are stubborn, ignorant fools... but that's just my opinion. If you have a problem and can treat it with medication, why not treat it? We live in the 21st century and have a ton of options now-a-days when it comes to dealing with personal issues... there's no reason not to take advantage of something that can help us out.
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Old 03-03-09, 12:34 AM
blacktiestudios blacktiestudios is offline
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Re: Planning on stopping an SSRI. Read this first!

i am going to start taking lexapro. I had started taking vyvanse and it helped me focus and anxiety seemed to go away for the first week as well. Then after about 2 weeks i had huge issues with urination pain and stomach issues. I mean it was hell.

I stopped taking vyvanse i had a supposed prostate infection. I was taking klonopin and noticed when i take something for anxiety i am better overall, maybe its not my add its anxiety and OCD, i hate OCD and i dont like to talk about it but i have it.

SO here comes lexapro 10mgs a day! I stopped taking klonopin yesterday cold turkey after taking it 2 days a week for about 2 weeks .5 mg so 1.0 mg a day then 1 morning and night. I noticed a withdrawl and it sucks, i never new about the benzo thing wow.

So again i am going to try lexapro, maybe with no medication for ADD. See if it works out for me. If not i will take some type of ADD med just not Vyvanse, as it creates stomach bladder and urination affects with me.

But my anxiety and OCD seems like the major deal, and i am happy i came to this conclusion. That i have always had OCD and anxiety just never really thought about it, i think that makes me have a lack of focus.

wish me luck
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Old 03-03-09, 12:53 AM
KFC in CA KFC in CA is offline
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Re: Planning on stopping an SSRI. Read this first!

So, um, SSRIs usually take a few weeks to work because it takes time for the receptors to get the signalling and the serotonin to trickle down to whatever else it effects. People super sensitive to serotonin like those with bipolar may respond quicker. Other than that, it's generally placebo effect. No disrespect for anyone's experience. Just don't want those first trying SSRIs to be disappointed or concerned when nothing happens right away.

Lexapro is not known as an SSRI with serious discontinuation problems.

General rule for going off is do so no faster than the way you got to the dose you're at. Going slower certainly won't hurt.

Brain zaps are real. They are a good reason to taper off slowly. They also aren't that common, but Effexor is the biggest offending med to my knowledge.
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Old 12-04-10, 01:36 AM
kaddie kaddie is offline
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Re: Planning on stopping an SSRI. Read this first!

Dear Jeff,

Thank you for posting such encouraging and informative information.

Lexapro has been a wonderful reprieve from a lifetime of agonizing lows. What a Godsend Lexapro has been for me these past 2.5 years.

I now want to taper off Lexapro and see what happens. While I am grateful for not having to endure depression, I am also wondering if I am becoming "flat". I no longer care if I return calls or not, and this is unlike me. After all, I am self employed and my business requires that I communicate with clients.
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