This is one of the most common, and hardest to answer, questions about SSRI withdrawal. Withdrawal from psychiatric medications is still officially a mystery. According to the manufacturers, SSRI do not cause severe withdrawal. Instead, symptoms from “discontinuation syndrome” are mild to moderate and last one to three weeks. This is in direct contrast to some patients that experience prolonged, severe, symptoms. The disparity between experience and official information causes a lot of confusion for patients. When we break a bone or pull a muscle, there are long established timelines for recovery. Individual recoveries can vary in time and intensity. Overall, most patients follow the timeline and recover close to the time expected.
The lack of information about SSRI may be part of the reason why it is so hard to predict how long withdrawal symptoms will last. Most studies of SSRI are limited to 8-12 weeks and do not address cessation of the drug. Manufacturers study their drugs in this manner to gain regulatory approval for sale, not so much to study the effects of the drugs. Studies of the effects and withdrawal would be more of an academic pursuit and wouldn’t contribute to the commercial application of the medications. Fewer people would begin prescriptions for SSRI if they knew that there was a chance that they would become dependent on the drug and have to go through an extended withdrawal period when they decide to stop taking it.
From the symptom perspective, it’s very hard to say which patients will experience withdrawal. Some patients do follow the accepted tapering schedule and are able to stop taking the medication with minimal symptoms, despite taking the drug for a long time. Other patients experience extended symptoms after taking the drug for a short period. The underlying predictors of which patients are sensitive to SSRI and which ones aren’t are not well understood. Without enough knowledge to predict which patients will experience withdrawal, it is even harder to predict how long those symptoms will last. It becomes a very personal, individual, struggle for each patient. That being said, there are some ways to gauge progress and predict how long an individual will experience withdrawal.
When a patient first experiences withdrawal symptoms, they can be quite frightening. Since the mind creates reality in real time, withdrawal can seem like it will become permanent and debilitating. That is the reality that withdrawal creates, though, not reality as an impartial observer would see it. We live in a relative state of mind, though, so that’s all we see. If we could step back from withdrawal symptoms, we would realize that this is a temporary crisis and not a permanent state of mind. Withdrawal forces the mind to act more on instinct than it normally would. In normal thought, the intellect regulates instinctual responses, moderating them to match social situations and our own moral beliefs. Withdrawal disconnects the intellect from its normal regulatory function. Instead of moderating behavior, anger, fear, and anxiety are allowed to come to the conscious mind. As an example, take a trip to a supermarket and pay attention to your reactions. When another shopper blocks an aisle or cuts you off at an intersection, anger is a possible reaction. Normally, that anger is easily suppressed and you let the incident go without any reaction. Withdrawal removes that moderating behavior and allows anger to become the acceptable response. For a person not experiencing withdrawal, it takes a great deal of introspection to even detect the anger that arises from the incident. It’s almost automatic to suppress the anger because reacting to such a trivial interaction is socially inappropriate.
Reasserting the intellect during withdrawal is the best way to control symptoms and mitigate the power they have. Being mindful of how you would normally react to a situation and forcing yourself to follow that course of action can help. It’s easier said than done. Because of the mental relativism that withdrawal causes, it can be very hard to separate yourself from the immediate symptoms you’re experiencing. Mindfulness is the process of stepping back from a situation and evaluating the emotions that you are feeling, and then changing your behavior based on what you think rather than your immediate emotions. Essentially, it’s replacing the automatic moderating behavior that’s suppressed in withdrawal with conscious effort. It can slow down the flow a conversation quite a bit second guessing every thought, but it’s better than acting out in a way that you might regret later. It’s not necessary to think your way through every interaction forever, just until the automatic moderating function reestablishes itself.
Taking a longer view of withdrawal can help as well. It’s very hard to envision how you will feel in two months when you’re living with symptoms minute by minute. SSRI withdrawal happens in waves and windows. Those are the names that veterans give to the cycle of withdrawal symptoms. Waves are periods of time when symptoms are more severe. Windows are periods when symptoms are not as bad. As withdrawal progresses, waves come and go. In the long term, the waves become shorter and milder, while the windows become better and longer. Eventually, you enter a “window” that doesn’t end. Mindfulness allows you to see that waves are not permanent and not put too much hope in the permanency of windows. It sounds fatalistic to acknowledge that windows do not represent a cure, but it’s more realistic. It’s a delicate balance between hope and pragmatism. Being aware of how you are feeling during a window is just as important as being aware of your feelings during a wave. Just as you need to consciously moderate your feelings in a wave, you have to bank the good parts of a window to use when you enter the next wave. It’s an intrinsic exercise that you can’t really start to practice until you have the experience of a couple cycles behind you. In the beginning, it’s very hard to see the larger picture because all there is is the immediate symptoms. Some faith that symptoms will get better is required. Faith is one of the first things to be shaken in withdrawal. Family and friends don’t understand, doctors don’t believe it’s withdrawal. You can’t “suck it up”, either, it doesn’t work like that. All that can shake anyone’s certainty. The wave/window pattern is part of withdrawal, though. Just as you will enter waves during withdrawal, they will also end at some point.
As time goes by and you become accustomed to the cycle of waves and windows, the question becomes less about how long will withdrawal last. Mindfulness becomes a habit, something that is almost second nature. It’s something that you can apply to your life after withdrawal. Most people started taking an SSRI to treat an existing condition. The decision to stop taking an SSRI usually comes after the drug has lost efficacy or the side effects outweigh the benefits. That requires some way of dealing with the symptoms of the condition after withdrawal is over. It’s hard to see the mindfulness that withdrawal forces on you as a benefit of that trauma, but it does give you a good way to handle an existing condition. In the long term, the goal becomes less about getting off the drug as fast as possible, and more about getting off the drug with as much quality of life as possible. In a way, a good way, the coping tools you develop during withdrawal will serve you for the rest of your life. The adage that alcoholics use to describe recovery is apt for people suffering from SSRI withdrawal. “One day at a time” is the best way to approach recovery.
October 10, 2012 at 10:27 am
nicely said…boosted me from inside…i will defnitely follow this
November 17, 2012 at 5:11 pm
Very relevant… and a well put together article that really nails the whole fear issues that everyone is up against.
November 27, 2012 at 10:53 pm
James,
I’m roughly 6 weeks out from Zoloft discontinuation (after a 5-6 year period of 50mg/day usage) and I’ve still been experiencing some pretty heavy bouts of anxiety followed by hopelessness and depression. It’s very uncharacteristic of me, yet when these symptoms arise, they are all too real, and they feel as though they are permanent. I’ve spent the better part of an evening browsing the web, looking for some reassuring words that may help me cultivate a frame of mind that will get me through these tough times, and your words have been the most positive and helpful I’ve found thus far. Thank you! My best to you.
November 27, 2012 at 11:18 pm
Thanks. Withdrawal symptoms can be very hard to deal with, sometimes. They’re unpredictable and have such a profound effect on the mind that it closes off everything else. They’re not permanent, though. Even though it feels like it will last forever, it will slowly start to get better. Progress can seem uneven at first, but it does become more steady as time goes by.
If your symptoms increase over the next couple weeks, you might consider reinstating on Zoloft at a lower dose and tapering slowly from there. For people who are sensitive to these drugs, 10% reductions every 4-6 weeks is a good pace to minimize symptoms. It’s a diminishing schedule. For example, 40mg/day, 36mg/day, 32.4mg/day, 29.2mg/day, etc. It takes a long time to get off the drug on this schedule, but it minimizes symptoms. I hope you feel better soon.
December 23, 2012 at 5:54 pm
As a fellow protracted withdrawal sufferer, now nearing three years, I agree with your description that we are somehow disconnected from our brains and this in itself is terrifying, especially if it is prevalent for months and months. I found that I did not fit the protocol of many ‘withdrawal board veterens’ where experience of waves and windows gave at least a glimpse of hope. Improvements were miniscule and not at all noticable on a day to day or month to month basis. I wonder if you know why some people have these and others don’t? I did c/t from 40mg prozac and am wondering if this may be the reason.
December 24, 2012 at 11:51 am
I’ve talked to several people who have had a similar experience with withdrawal. Instead of having windows, they have one long wave that ever so slowly gets better. I’m not sure what the difference is. The only explanation I’ve heard is “Withdrawal in unique to the individual” which isn’t very satisfying. One thing about withdrawal is that it can change over time, too. For the first 8-9 months, I had unremitting symptoms. It didn’t seem like it would ever get better. Then it started to break up into waves and windows. I think there may be another category of withdrawal where the symptoms don’t let up, then largely resolve at once. I think both types of recovery are difficult in their own way. In the wave/window cycle, there’s always the fear of slipping backwards. In the prolonged wave cycle, there’s no letup to provide hope. Recovery has happened for everyone I’ve talked to who has gone through it, though, so I think it will happen for all of us.
January 10, 2013 at 5:03 am
Thank you James, nicely researched and nicely put together. May I share my exprerience with SSRIs, I was put on SSRIs for 3 months in September, with subsequent tapering for 2 weeks to treat burnout syndrome. I was on Xanax, as breakthrough anxiety treatment for all that time and came out of it gradually end of December. The reason I insisted I came off SSRIs and Xanax was the emotional blunting I experienced throughout treatment which still continues 4 weeks after SSRI discontinuation and 1 week following Xanax withdrawal. Also, depression sets in, to a degree that makes me wonder what is going on, I can realize this is not at all me. It is an interesting state, physicians have a tendency to believe symptoms of depression are coming back, and that it is unlikely for medicines to have created such a confusing state to my body. I have serious doubts though that this is the case, I am a generally very positive and optimistic person, I know my self pretty well, so I am ready to accept that even in short period treatments and small doses withdrawal can be very upsetting. Thus, I was very releived to read your article, I was just wondering whether anybody else had a combined withdrawal period from SSRIs and benzos after such a short period treatment, and, yes(!), if anyone can guess how long it takes for this brain system to get back to normal state!
January 10, 2013 at 10:11 am
My doctor also diagnosed my withdrawal symptoms as a new problem that required Paxil to treat. He had to stretch diagnosis quite a bit to do it. I went to him in the middle of withdrawal. He tried to tell me that I had a latent psychosis, even as he paged through my history of mild social anxiety. By that time, I knew my symptoms couldn’t be what he said. If I had followed his advice, I’d be on a fistful of pills by now. Who knows what state I’d be in. That’s the irony of withdrawal. In order to get off these drugs, patients have to become medically non compliant. Who would have thought that doctors would be the ones trying to keep people on drugs. My life has improved dramatically since getting down to a small dose of Paxil. While I was taking the drug, I was depressed, insular, irritable. Other than the episodic and acute depression I experienced in withdrawal, all of those problems have faded away.
I’ve talked to several people who have had prolonged withdrawal symptoms after relatively short treatment periods. I’m not sure why it happens. I can understand why long term use would cause long term withdrawal, but not short term use. It may be some kind of sensitivity to the drugs that other people don’t have. It’s possible that you started to taper off the benzo too soon after tapering off the SSRI. It’s hard to say if it would be better to reinstate and try a slower taper. Tapering should usually be shorter than the original treatment period. I hope you start to feel better soon.
February 23, 2013 at 8:08 am
Have never posted on anything like this before but I wanted to ask about my situation. I was on Citalopram (UK name for Celexa) for 5 years, originally at 20mg then increased to 40mg 2 years later. I came off *incredibly* slowly after reading about the withdrawal effects, especially as I got to the lower doses. Even a 5mg drop from 15mg to 10mg gave horrible symptoms so I bought some gem scales off Amazon and gradually cut my 10mg tablets into smaller & smaller pieces to simulate 1mg decreases and spent a month at each level. I came down from the equivalent of 2mg to nothing at the start of January as the shards were getting ridiculously small but suffered some withdrawal symptoms even then! (I had read elsewhere that the last bit can be the most difficult but was amazed this could still happen at this level).
Anyway – about 3 months ago I started getting digestive problems (mostly diarrhea/looseness which are being investigated to rule out anything ‘sinister’) and was wondering if this could have anything to do with withdrawal? It seems crazy that I’m still suffering withdrawal but I’m still having bouts of crying and waves of anxiety from time to time so maybe it’s possible? It’s just that this hasn’t been a symptom before and only started during the last dregs stage of tapering. But then you read that 90% of serotonin is in the gut and I wondered if that meant that ssri’s have an effect there too?
Thank you to everyone who has posted here. If I hadn’t found this I’d never have known that ‘prolonged withdrawal symptoms from ssri’s’ were even recognised. Like the US, the doctors here in the UK are hopelessly ignorant of any of this stuff.
February 23, 2013 at 1:03 pm
Gastrointestinal problems are very common in SSRI withdrawal. I still have some issues with it now. It was very bad for a long time. I never thought it was possible to have the runs and be constipated at the same time, but it is. Serotonin is produced in the gut, and the migrates to the brain where it is used as a neurotransmitter. The brain isn’t the only place where Serotonin is used as a neurotransmitter. There are neuron like cells in many parts of the body. Those cells aren’t as organized as neurons in the brain, and they serve different purposes, but they operate in similar ways. Changing the way that serotonin is regulated affects them in various ways. In the gut, it disrupts the normal digestive process.
One of the mistakes that most people make when tapering off an SSRI is to make large tapers too quickly. Indeed, I did it. Tapering should be done in percentage amounts, not static milligram chunks. Going from 15mg/day to 10mg/day is a 33% reduction in dose. Dosage drops should be done 10-15% each time. It’s good that you changed your tapering method to go at a slower rate. I just jumped off the cliff, and had to reinstate two months later. I’m still shaving the pills down at this point, but withdrawal is going much better. After reaching zero, it may take some time for your symptoms to go away. They usually don’t just disappear, they slowly fade over time. The emotional issues will probably come and go in waves and windows until the waves get shorter, and the windows get longer. hang in there. It sounds like you tapered more slowly than most people, and that will help make the symptoms shorter at this point.
February 25, 2013 at 4:33 am
Thanks so much for that npanth – I didn’t expect such a quick response! So, should I just ride with the digestive symptoms for a while longer (it’s been 3 months so far)? I keep thinking ‘should I change my diet?’; ‘should I take supplements?’ (suggestions? Someone suggested Triphala – anybody have any experience of this?).
Incidentally, I haven’t had any anger stuff at all, is that common? Was *really* interested to read on someone else’s entry about obsessive thoughts – I had no idea this might be linked to withdrawal – I have this problem too, as well as concentration & short-term memory probs which I hate. You have a conversation with someone and what they’re saying is really interesting and you’re really listening and taking part in the convo but half an hour later you cannot recall many of the details. I’m not *quite* of the age where this would be expected, at least not at this level.
Anyway, thanks again – it really helps to have found someone out there who has clearly done some in-depth work on this stuff.
February 27, 2013 at 10:09 am
It’s hard to say how long the gastrointestinal symptoms will last. I reinstated on Paxil after about two months off of it. Most of the bigger symptoms dissipated, but I still have GI problems. They’re not as bad as they were before. It seems like the GI problems are a marker for other problems within the body. They’re just more noticeable… we really do live on our stomachs. My digestion is slowly going back to normal. I was almost constantly constipated for 10 years while I was on Paxil, so it figures that it’s going to take a little while for it to reach equilibrium again.
It took me a long time to associate obsessive thoughts with withdrawal, and recognize them when they came. That kind of introspection isn’t something most people are used to doing. We’re accustomed to having an automatic filter in our minds that shields our conscious mind from the weirder thoughts that are always floating around in there.
As an example, say someone cuts you off in traffic. Even in normal thought, the whole range of thoughts, from passive to psychotic, go through our minds. Don’t respond, speed up, slow down, cut them off, even ram them from behind. We’re not used to having the more extreme thoughts come to our conscious minds because our personalities usually filter them out before they reach our conscious minds. That filter is disabled in withdrawal. The thoughts that reach the conscious mind are the most powerful, not the most rational.
Since we’re not accustomed to having to grapple with psychosis, obsession, or rage all the time, we assume that we’re still thinking like we always have and accept those thoughts. They do fade away over time. It can be helpful to pay attention to what you’re thinking and actively select thoughts that you have until the normal filter reasserts itself.
April 19, 2013 at 3:01 pm
My affair with ssri’s began in 2006. When I had an episode of depression in my life. I went to therapy, I tried so hard to avoid using an antidepressant. But ultimately, gave in and that’s where Lexapro 10mg/day came into my life. I did ok on it. Then about 3 yrs ago got diagnosed with hypothyroidism. Which one of the symptoms is depression symptoms. Makes me wonder if 10 years ago, it was my thyroid acting up and wasn’t caught. Needless to say, Lex and I have been associates for a long time. At this point in my life, I am ready to embrace the “joy of motherhood”. I’m 35, and lets be honest, time is passing by… OBGYN strictly said, should I become pregnant, I would have to get rid of Lex. So I considered getting off before pregnancy even happens. I’m on day 56 since my last dose. ~2.5mg. Went through physical withdrawals. Plus, hot flashes during my “rage” phase (as I call it) which began about 2-3wks after last dose. That lasted about 2wks. Now I’m in the panic/anxiety phase. I’m forgetful, my mind feels foggy. When I realize I’m forgetting things, it feeds my anxiety/panic and makes me think I’m going crazy… It’s a vicious cycle. Personally, I feel this is the ugliest phase. I understand that biologically the brain has to do its thing (I’m a scientist, for cryin’ out loud) but it sure feels like the light @ end of tunnel is no where close. The science in me says its normal, this shall pass, it’s temporary, do not go back to Lex. But the emotional side of me is really making me reconsider… Yikes. I have good days and bad days. Drink teas, practice yoga as often as I can. Thank you for your article. It explains a lot.
April 20, 2013 at 9:48 am
Thanks, Edna. I went through similar phases. Anger, depression, anxiety, insomnia. It sometimes seemed like there was no break between them. It does eventually get better. Hang in there. I hope you feel better soon.
April 28, 2013 at 4:08 pm
Just as a side note, I was on ssri’s for my first two babies, and for nursing. I’m now pregnant with my third and trying to get off. You can be on anti-depressants, if necessary while preg and nursing. Some are considered safer than others for this. However, in an attempt to have me on the safest drugs for pregnancy, and then nursing, I was switched around so much, had bad reactions to some (effexor), recently came out that citalopram causes heart problems at the dosage I was at, that I’m just trying to quit. I’ll use MMJ as needed to get to sleep, which is likely a lot safer for the kids.
I wish you luck!
April 28, 2013 at 4:13 pm
Thank you so much for this article. Very helpful for me as I try to get off meds. I’ve been on SSRIs for the last 10 years. The last year has been a merry go round of trying different ones, and after too many bad effects, and little good ones, I’m quitting. I’m curious as to whether you know anything about whether being on about 4 different SSRIs in the last year could be part of what is making withdrawal so hard… I tend to be very sensitive to the drugs, and would go through withdrawal with even one missed dose.
April 29, 2013 at 9:06 am
Yes, the drug merry go round can make withdrawal harder. Even though SSRI as a drug class have similar effects, each one has unique aspects and withdrawal symptoms. Rapidly switching, which is common practice, has a tendency to exacerbate the differences between the drugs. You don’t have a chance to consolidate withdrawal from one before you start to withdrawal from the next.
Usually, the best way to get off the merry go round is to wait until you are very stable on one, then slowly taper off of that one. If you’re taking more than one drug, slowly taper off one before trying to get off the next.
May 22, 2013 at 8:33 am
I was put on 10mg of lexapro in November 2004 when I was pregnant with my son (found out September 1) by my PCP. I can’t take birth control pills because the excess of hormones doesn’t mentally go over well. So now pregnant with raging hormones my anxiety was out of control…especially with self harm intrusive thoughts. The lexapro did help me. I was supposed to come off of it 6 months post partum but surprise….I found out I was pregnant again in November 2005 so the Dr had me stay on it just in case. I was supposed to come off at 6 months post partum. Well I had post partum depression with my daughter so I was told to stay on the lexapro with xanax. In 2006 I found out I have pcos and spoke to my Dr about coming off of lexapro. Out of nowhere he said I think you should stay on it being that you have GAD. Wtf??? I was so confused as to where that came from because i don’t meet the criteria for that, but I trusted the medical professional and stayed on it. Fast forward to last year still on the lexapro ranging from 10-20mg. I had gone to the emergency room because i had a massive anxiety attack in February to the point that I couldn’t breathe. After that i switched to a psychiatrist because obviously they should know these drugs better. My anxiety went through the roof in the winter of last year!!! It was as if my body was all of a sudden rejecting the lexapro.(started to feel overstimulated on both 10 or 20mg) So now over 7 years older I started to think for myself and requested to be taken off. My pdoc wanted me to stay on it because I was still having anxiety. Now getting diagnosed with ocd…no rituals just obsessive thinking. Wtf again??? I started to wean myself…went from 10mg to 5mg. After about a week I called my pdoc and told him I was on 5mg and ready to take the steps necessary to come off. He told me to drop it to 2.5mg for a week and stop and I won’t suffer withdrawal at all. Holy FML because I felt awful. Intrusive thoughts, anger, no patience, anxiety….just to name a few. I changed pdocs again and this Dr put me on a mood stabilizer 150mg of trileptal (anti-convulsant typically given to bipolar patients)(75mg in morning and at night) to help with withdrawal. I was off the 2.5mg within 3 days of taking the trileptal and the Dr was aware. I felt good on this for about a week and downhill I went. I was to wean off of the trileptal a month after starting it and I did try. Started feeling massive anxiety again and I went back to see the pdoc. She told me a month was long enough for the lexapro to be out of my system which seems odd considering I was on it for 8.5 years. She has now upped the trileptal to 300mg. I am not bipolar and don’t fit the criteria but supposedly trileptal helps with anxiety also. I feel crappy even on this new dosage and am wondering if the withdrawals could be breaking through even though I should be withdrawal free at this point. I don’t know what to believe anymore because all of my research differentiates from what the Dr said. Any thoughts? Sorry so long. I am sensitive to medications. The lexapro did help effectively for years but being diagnosed for these things is so strange. Fine I had intrusive thoughts in the past but not this strong and more hormonal based. After 8.5 years of usage and being off for a month I’m wondering if my brain has seriously stabilized by now??? I have an appointment with a new psychologist tomorrow.
May 22, 2013 at 8:38 am
My symptoms now are anxiety, trouble sleeping, depression, etc. Worse then I have ever felt. I have 3 beautiful children and a great husband….I know I need better coping skills and positive thinking but it’s hard when you want to curl up in a ball. Socially I am having issues which is so funny to me because I majored in public relations in college. I love people….well not now. In hope you can shed some bright light on this!
May 22, 2013 at 6:25 pm
You’ll get yourself back. Anxiety, social withdrawal, anger, and insomnia are all very common withdrawal symptoms. It’s hard to believe, but you will get better. There will be some tough times, feeling better happens slowly and in frustrating ups and downs, but it does happen. And! You have not permanently damaged your brain! That thought comes to dominate thought at times in withdrawal. Hang in there
May 22, 2013 at 6:22 pm
The conventional wisdom is that SSRI, anticonvulsants, and stabilizers do not cause tolerance. I reached Paxil tolerance after about 5 years, but stayed at my full dose for another 5. My doctor tried to diagnose me as psychotic while I was in withdrawal. He gave me a couple new prescriptions. If his diagnosis was correct, my symptoms would have gotten worse as my Paxil dose went down. The opposite has been true. I feel better as my dose goes down. I am really hesitant to tell people to ignore their doctor’s advice. The only way I got off the psych drug spiral was to become medically non compliant, though. It’s a huge catch-22. My symptoms would have progressed, my doctor would have prescribed more drugs, my symptoms would have progressed, and so on. I had to get off somewhere.
Most doctors prescribe more of the current drug, or new drugs, when the efficacy of the first drug starts to wear off. That in itself points to tolerance. I’m still not sure why the belief that psych drugs don’t cause dependence or tolerance is still the majority view.
Usually, the best way to get off a string of psych meds is to wait until you reach a stable place on your current one, then slowly wean off that drug. If you’ve switched drugs recently, you should go back to the last drug, get stable, then wean. I think your best bet would be to get as stable as you can on Lexapro, then wean off from there. You might want to paste this post to http://www.paxilprogress.org or http://www.survivingantidepressants.org. There are folks at those sites who are much more knowledgable about the interactions of multiple drugs. They also have more experience weaning off of multiple drugs. I hope you feel better soon… It sounds like you’ve started to research withdrawal before you got too far into the drug spiral, which is a really good thing.
May 23, 2013 at 8:10 am
I started the weaning process with the trileptal. The doctor explained how on Monday when in saw her if in the event I decided to go to back to lexapro. I reinstated 5mg of lexapro last night. I was sweating…couldn’t sleep, heart was racing, etc. I know reinstating takes takes time and once I stabilize I will hang on that does for a little while before I begin to wean again. I’m so exhausted I think from the toll all of this crap has put me through. My heart hurts but I am sure its stress induced from the emotional rollercoaster. I still feel on my own but low and behold the pharmacist from my local pharmacy talked to me for an hour and was more informative and caring then any of the pdocs I have seen. I got to the point where I needed to involve impartial people because the doctors were confusing me. I also spoke to my PCP. She was helpful but the pharmacist was amazing. Finally someone who understood my troubles and even went as far as to tell me about a family members experience on being on paxil and coming off to go back on and wean more slowly. She totally got it! Such a shame that we are not properly guided through these processes but more given pills hand over fists. My only issue right now is my taking xanax for breakthrough. I am by no means a pill popper…hence really wanting off this stuff, but it seems to be an unnecessary evil being that I have children to care for and need clarity. I feel a little better coming off of last night except for the chest issues but hopefully that will pass soon. I also took my lexapro this morning instead of at night being that maybe I will sleep better. Do you think there is a huge difference between generic and name brand SSRIs?
May 23, 2013 at 8:14 am
Don’t get me wrong the anxiety is still prevalent but I’m hoping this will be the start of setting it straight. Do you think reinstating after almost 5 weeks off will be rough?
May 23, 2013 at 8:18 pm
I reinstated after two months. I know some people who have gone several months before reinstating. It’s an individual thing. Don’t decide if reinstating has worked for a while. When you first start taking an SSRI, it takes about 6-8 weeks before you start to see effects. In that time, you can get some startup symptoms of anxiety, depression, etc. I had to plow though some of those things before I started to feel stable. Reinstating is a strange experience. Some of the symptoms go away within a couple days. Others linger for a while, and some remain throughout.
The overwhelming anxiety and severe depression went away within a couple days. The irritability took a month or two to subside. The brain fog lasted a lot longer. Cognitive slowness is a common side effect of the drug, so it makes sense that it would remain while I was on a higher dose of the drug. It’s strange. I can feel the fog lifting ever so slowly as my dose goes down. Little by little, my brain is starting to come back to me. Man, how I’ve missed it
May 23, 2013 at 8:11 pm
I’ve run into something similar. SSRI seem to be at that weird phase of knowledge where nurses and pharmacists are more knowledgable than the doctors. I think it is because they interact with patients more, and can see past the literature more easily than doctors. I don’t trust them more than doctors because they say what I want, but because they say what I’ve experienced. My doctor has been so wrong about withdrawal and what I can expect from SSRI, that it is eroding my confidence in him in other areas.
The pounding heartbeat could be related to the drug. I had irregular and pounding heartbeats while I was on Paxil. SSRI have effects on the cardiac muscle and the regulatory system that controls heart pace. I’m not very familiar with the cardio system, but I did experience something similar to what you describe. I’ve talked to other people who have had it, too. It may be worth having it checked. From the anecdotal conversations I’ve had with people who’ve had it, it doesn’t seem to be a detectable problem with the heart. They have all said that their heart tests have come back normal, despite having racing heartbeats. Honestly, I don’t really understand why that would be.
I’m not sure about generics. Laws prescribe how much active ingredient is in each pill and how that ingredient is distributed within the tablet. The things that the manufacturers can change are mostly in the fillers they use. Other than being “inert” they have a lot of latitude in what they use.
It’s a little fuzzy at this point, but I did reach tolerance for Paxil around the time that I switched to the generic version of Paxil. I can’t say that the generic was the cause, just that it happened around the same time. The price difference between the generic and the patent med is so great that I couldn’t afford to go back to patent Paxil even if I wanted to. I’m having success tapering off generic Paroxetine, so I’m not going to rock the boat at this time. I’ve talked to some people who couldn’t tolerate generics, but that hasn’t been my experience. I think the price difference is worth the effort and the risk of a temporary setback.
May 23, 2013 at 8:53 pm
Do you think 2.5mg or 5mg would be a better reinstatement of the lexapro?
May 24, 2013 at 7:32 am
I can’t get over also that the doctors wanted me to reinstate at 10mg…the dosage I was on. I didn’t think that was a great idea.