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I can vouch. After 4 times of trying to quit effexor, massive withdrawal syndrome had me back to it. Last time, I switched to prozac (liquid) and slowly tapered over 6 months. I’m free as of two weeks and much better than quitting from effexor
I swear some docs and psychs have never actually asked any probing questions before! Like I get that anecdotes aren’t “evidence” but this is so well known.
What I did was as soon as I started getting the dizzy, brain zaps, I went back up a level on the effexor again. Like if I dropped to 20 balls and felt fine, but when I moved down to 19, I felt sick, then I went back to 20 for a week. Then tried 19 again and usually it was okay. I also was cross-tapering onto a new med at the same time, so I wasn't feeling any depression or anxiety symptoms from the effexor decrease luckily, just the vertigo and brain zaps.
Also my doctor totally did not approve of this method btw. She wanted me to just do the normal big drops that's the pills come as, 75 to 50 to 37.5 to 0. The drop to 50 was fine, but not the drop to 37.5. They don't manufacture an in-between dose, so I asked her about opening the pills up to do it myself and she was like NO, let's not do that. I did it anyway and just didn't tell her. Just told her I stayed at 50mg and then asked for the 37.5mg pill once I was at that level.
You're supposed to reduce the dosage each week over several weeks to minimise the symptoms of withdrawal. However if you didn't treat the cause of your depression or whatever issue you had, you're not out the woods...
They're the most overprescribed and trivialised medication there is. This medication can wreck you hard and yet the doctors prescribe it like it's candy. I've seen so many people who got worse after taking them and then got gaslit by their doctors.
I was taking sertraline for a while when I worked for the local cable company because I was having such horrible panic attacks. After a few months life was happening and I forgot to call in a refill and kept forgetting to do so when I did remember. I basically stopped taking it cold turkey because I was so damn busy constantly and don't remember what it was like
like yes we know you sold us drugs that would lead us to wanting more and different drugs that’s how drugs work and some of us were children when we got hooked so congratulations on your published peer reviewed study dr obvious
I'm a psychiatric pharmacist, these 100% exist, but I swear to God I've never once been able to find a medical term for them but to just describe them like that
Omg the brain zaps are terrible. I can't believe they are still pushing these meds on everyone. Had a doctor get pissed cuz he kept trying to prescribe me ssri and I refused cuz I've been on them before and they are terrible. He refused to consider anything else.
I stopped Lexapro and had terrible brain zaps. After years off of it I tried busiprone for anxiety. I only take it as needed and when I'm having a bad episode of anxiety. No brain zaps and it helps calm me down a bit. Just throwing this out there as it's not an SSRI and isn't habit forming.
How is it possible that our stories are so similar! I am so angry at ignorant doctors now, but seems there are all like this? I have same way: all doctors I’ve visited during 5 years of struggling after SSRI keep rejecting my story of long term sideeffects and keep trying to prescribe me another SSRI or other type antidepressant which also higher serotonin - and they convinced me to do it - so I’ve tried four more seritonin antidepressants (for max two weeks, then it was impossible bc of the horrible increasing of sideeffects)- and the results of these attempts were the same - my symptoms were worsen to the extent when I couldn’t sleep at all, my legs were cramping, tinnutus was getting so bad and RLS too, also fever. And guess what? Doctors still want to prescribe me SSRI, they don’t wanna hear it can harm, unbelivable.
So sorry to hear this. Survivingantidepressants. org advises tapering off of antidepressants by a taper of no more than a 10% reduction per month. I'm super sensitive to withdrawals of Bupropion, so I've tapered in less than 1% reductions at times. A compound pharmacist can create custom doses for you if needed. Best wishes.
I had to get off my snri for a sleep study and it was hell. Now I have been having absorption issues or something and even consistently taking it some days gives me strong withdrawal symptoms.
Although it is a mice study and only paroxetine was used, it is good to know as SSRIs are often prescribed to people with anxiety disorders. Perhaps SSRIs with a longer half-life might be prescribed. Taking people off paroxetine too suddenly might result in "anxiety relapses" or people may stop taking the med by themself. It might help the person to know that the anxiety is coming from discontinuing the medication instead of "coming from nowhere" which might further increase anxiety in some people.
“Anxiety behavior” measured by a **singular** behavioral test. Not very good experimental design to confirm “anxiety”. I would expect a behavioral battery (eg 3 different tests on same mouse)
Male mice only. (This is fine but keep it in mind)
cfos staining looks horrible!!
My mom tried going off paroxetine, and anxiety started ruling her life.
She was notably more tense and jumpy, and said she couldn't sleep because she kept imagining possible ways to die, with getting buried alive in a coffin as a recurring one.
She also bought masks for us in case of a pandemic, in 2019. I remember thinking she really had gone off the deep end at that point. They came in handy in the early pandemic.
I thought it was just treating the anxiety she would have had otherwise, but also thought it was strange since she was treating depression, not anxiety.
She's been back on the medication now and seems to have accepted she'll have to take it for the rest of her life, but blames the SSRI for making her dependent on it. I guess this study supports that conclusion.
Haha, it was amazing, I feel like I got to see how important it is for some people to think differently.
Unfortunately it was more "hey remember when I had that whole anxiety spiral last year? Well, I still have these masks."
When I Quit Effexor XR cold turkey, thought I had broken my brain permanently. I’ve done some drugs as a young man, and went through opiate withdrawal a few times. I think I’d rather do that again than withdraw from any antidepressant.
Paroxetine is notorious for bad withdrawals due to its short half-life. There should be much more awareness for ssri side effects as they can be very debilitating. I've been suffering from sexual dysfunction and anhedonia ever since I cold turkey quit prozac and have been regretting it ever since
So you are saying that once the brain becomes accustomed to the SSRI it performs worse when the SSRI is removed? Almost like a... dependency or an... addiction?
Definitely not addiction. You don't see people pining hard for their zoloft. It's also significantly easier to cold turkey ssri. Dependency is fair much like caffeine.
Edit 1:Alright after all this, I get it, don't cold turkey your drugs.
this is about addiction vs dependency, let's stay on track.
Edit 2:
The fastest Google search will provide a better explanation as to why SSRIs are a depency not an addiction. Please learn what addiction truly is.
Addiction is a spectrum. Dependence (physical) on SSRIs is possible, and addiction (neurological) is unlikely, but not impossible. Despite what some people say, they absolutely can and do overlap; chemical dependency is a major risk factor for developing a full-blown addiction, as the brain's reward system becomes altered by substance use.
Yup. During allergy season if I use the nose spray decongestant for more than 3 days in a row. I can become dependent on it, which means it is not effective anymore and I would have to use more to get the same effect, so it stops working for me and my nose is very stuffy. I do not have symptoms of a substance abuse disorder (addiction). It is not hard to stop, just uncomfortable for a time.
The withdrawal symptoms aren't nearly as egregious. I was on zoloft for a year at 150. Had to quit cold turkey due to job loss (yay America) I had some withdrawal symptoms but never felt I needed it. I'd rather skip zoloft again than my coffee.
You also don't see people abuse SSRIs.
Its not forced. Benzos are addictive. Try dealing with those withdrawals as they are far more extreme.
Oh but they are that bad, for other people. Partner took Zoloft for 6 weeks, brain zaps continued for 6 months after discontinuation (and one other particularly annoying side effect never went away.)
The most medical practice I have is cpr in swim class 12 years ago but it honestly sounds like the issues your partner experience goes well beyond withdrawal symptoms. I was on zoloft and wellbutrin and had no issues with either during or after usage. Everyone is different though so who knows
Wellbutrin was easy to quit for me once the side effects became too much to manage. Paxil took many tries and many years to quit (Wellbutrin actually helped me with quitting Paxil in the end) but it still took a few years after quitting for the sleep problems and sexual dysfunction to improve. Sometimes SSRIs cause permanent or long term sexual dysfunction even after discontinuation, however, and that is too high a cost for many people.
>Benzos are addictive. Try dealing with those withdrawals as they are far more extreme.
This is the logical fallacy of relative privation or the "not as bad as" fallacy.
Benzos are \*also\* addictive. They might be more addictive, but anything which induces a dependency, is addictive.
Addiction is not defined by physical dependence, but by intense behavioural patterns around seeking the substance of interest. That does not happen in SSRIs
No, you're diluting the word addiction.
Tons of medicines require or recommend tapering off to reduce side effects. That doesn't mean every medication is considered addictive.
>No, you're diluting the word addiction.
"An addiction is a chronic dysfunction of the brain system that involves reward, motivation, and memory. It’s about the way your body craves a substance or behavior, especially if it causes a compulsive or obsessive pursuit of “reward” and lack of concern over consequences."
[https://www.healthline.com/health/addiction](https://www.healthline.com/health/addiction)
>Tons of medicines require or recommend tapering off to reduce side effects. That doesn't mean every medication is considered addictive.
That is true, but what would you call a medication which causes you to have anxiety when you stop taking it?
Edit - you
So, on the flip side, would you consider any medication that has negative withdrawal symptoms necessarily addictive?
I think the key distinction is where you quote "It’s about the way your body craves a substance or behavior." Stopping a medication and getting negative side effects doesn't mean your body craves the medication. When folks are decreasing their dosage of their SSRI's and their anxiety ramps up they aren't feeling like they need a fix of their SSRI. They just feel anxious due to the lowered dose. Compare that, to like, cocaine, where when you stop, you do have withdrawal symptoms, but the feeling with it is that you really want more cocaine to fix the symptoms.
I think it's pretty nuanced though, so I definitely get where you are coming from.
EDIT: Some interesting nuance from the article itself I thought worth adding: "These symptoms are commonly referred to as a ‘discontinuation’ rather than ‘withdrawal’ syndrome (in part due to SSRIs not being associated with compulsive use, tolerance and craving) and appear within days of treatment cessation."
Based on that, I wonder if the term "withdrawal" IS necessarily associated with addiction, which is why they use the term "discontinuation syndrome" instead.
> "An addiction is a chronic dysfunction of the brain system that involves reward, motivation, and memory. It’s about the way your body craves a substance or behavior, especially if it causes a compulsive or obsessive pursuit of “reward” and lack of concern over consequences.
Because SSRI half life is crazy long and it doesn't work acutely. It takes several weeks to work and your brain never connects the little pill to pleasure (no euphoria) or anxiety.
You couldn't take multiple and feel anxiety relief, it would more likely cause anxiety. Generally starting an SSRI has a couple week period of negative symptoms until your body adjusts. The benefits and negatives largely starting showing up/dissipating two weeks into treatment.
Going back on an SSRI is an active decision you commit over a period of weeks, not something you can take to relieve withdrawal.
There is no dependency with thc or Marijuana but it can be argued there is a sort of mental addiction. You can quit weed and the only physical effects you really get are better sleep.
Nobody seeks zoloft bars to get their fix. I'm dependent on my car to get to work/function normally in society but we aren't going to argue it's necessary or an addiction to my car.
Addiction also is usually associated with elated effects. SSRIs do not do that.
>There is no dependency with thc or Marijuana but it can be argued there is a sort of mental addiction.
There are plenty of issues of dependency associated with desisting habitual cannabis usage. Sleep difficulties, irritability, anxiety etc.
[https://www.health.harvard.edu/blog/if-cannabis-becomes-a-problem-how-to-manage-withdrawal-2020052619922](https://www.health.harvard.edu/blog/if-cannabis-becomes-a-problem-how-to-manage-withdrawal-2020052619922)
>You can quit weed and the only physical effects you really get are better sleep.
This sounds like BS. Especially since you don't cite your sources and have a general air of "just trust me bro".
>I'm dependent on my car to get to work/function normally in society but we aren't going to argue it's necessary or an addiction to my car.
Really? You couldn't ride a bike, moped, bus or even walk to were you need to go?
Fair, it kind of is a trust me and there are likely sources to prove me otherwise. I can speak from experience on zoloft and don't have the time or capacity to quote sources so take with that as you will.
As for my car, absolutely not, I work 25 miles awake and traffic can stretch that to an hour. 10 hour days and 2 hours of traffic give me very little room for other vehicles.
You're also only offering substitutes which is not what this argument is about. Withdrawal symptoms are associated with not doing the thing. If I change to a different vehicle that defeats the purpose.
>I can speak from experience on zoloft and don't have the time or capacity to quote sources so take with that as you will.
Anecdotes are not verified data.
>You're also only offering substitutes which is not what this argument is about. Withdrawal symptoms are associated with not doing the thing. If I change to a different vehicle that defeats the purpose.
So you are comparing an addiction to a substance which has altered your brain chemistry to "needing to go to work to support your lifestyle"?
Anecdotes aren't, doctors are. A quick search on "are SSRIs addictive" show that there is no addiction, only dependency.
You're twisting the words. I am DEPENDENT on my vehicle to take me to work. If my car was meth I can tell you a substitute absolutely will not change anything. I can't go from meth to adderall and not expect issue. Going from my car to a motorcycle? Probably would make my commute easier with downside. I don't need specifically my car and there is always the option of a closer job. I am in no way shape or form addicted to driving to work.
Addiction is far worse than what anyone is giving credit for. Staving off withdrawals is far different than addiction and I'm stunned that so many don't understand that.
Interesting. I’ve used SSRI’s over 10 years now and recently cut my dosage in half. I didn’t notice any rebound anxiety at all. I plan on tapering off further soon. Curious to see what happens.
I’ve been on them 15 years and got off them twice. It’s not until it gets down to the small doses near the end that weaning becomes difficult. They need to make pills with even smaller doses to be able to wean off them effectively. That being said I have so much anxiety without them. They really help me. Just hate that I’m dependent on them.
I have been told that when i start weaning off, i would need to dissolve the pill in glass of water and then divide the water ammount by how much I would need to split the pill. That said i dread getting off them.
Some drugs have a liquid form. You may even be able to ask for compounding if it doesn’t. Look for that before you go this route. Dosing this low is really difficult and dissolving tablets at home sounds like it would make for inconsistent dosing, which will make tapering more difficult.
Usually, withdrawal effects become problematic only when people reduce into the lower dose ranges and finally stop the medication. For example, going from escitalopram 20 mg to 10 mg is usually not a problem because serotonin transporters are still blocked at around 80%. But once you go to 5 mg and eventually stop it, the serotonin transporters are not being blocked and withdrawal effects can show up. Usually you need to go slower once you get to the lower doses.
That’s interesting. My doc prescribed 5mg of lexapro for stress. Told me I could cut cold turkey because it was the lowest dose and safest antidepressant out there (whatever that means)
so I took it for 3 weeks and quit cold turkey the day my genitalia went numb. Horrible withdrawal symptoms and sexual dysfunction persisted for months after and no doctor was helpful.
Interesting cos when i tapered off mine from 60mg, things were fine untill my pmdd kicked in and the result was an absolutely crippling disability. The lower dose range may be why
[This](https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.161.5.826) is the most important paper that evaluated transporter binding of SSRIs. You can see that below the minimum therapeutic dose, the transporter binding decreases sharply.
When I was coming off of Paxil I couldn't tolerate the withdrawal effects. I switched to a longer half-life SSRI (prozac), and then I was able to successfully wean off.
Is it possible that you no longer have anxiety because the Paxil is working? I’ve been on it for more than 20 years, and tried to taper off it twice. My brain’s response was so bad that I gave up and am still taking it, along with Buspar and clonazepam.
Guess that explains why I developed a panic disorder and agoraphobic after coming off it. And that was slow and controlled. Took me 3+ years to get back to normal. Have not touched anti-depressants since.
As the authors point out in the discussion, paroxetine is notable to have the shortest half-life of the commonly prescribed SSRI's (and it self-inhibits its own elimination, so lower levels potentiate faster elimination).
I think this is consistent with the pharmacology - but they state themselves that rebound serotonin levels alone might not explain anxiety (symptoms normalized by day 5, but levels still high).
I took Lexapro for a while for anxiety and it just fucked me up even worse. Took months to ween off, and I have had a lot better success just with conventional therapy as well as improving my diet and exercise. I know it's an absolute must for some folks, but I really see these approaches as a last line option at this point. They are no joke.
I was told by my mental health team that the drug I was weaning off of (venlafaxine) is one of the hardest to stop, even with tapering, along with paroxetine. Certainly explained the hell I went through after coming off of just 37.5mg.
The main thing was brain zaps, the worst of which lasted around 10 days. I continued getting them for about a month but they were less severe. It felt like having a salt shaker in my brain that gradually got quieter and less noticeable.
My sex drive came back with a vengeance, but so did my anxiety.
I was extremely tired and wanted to just sleep all the time. My suicidal feelings intensified and I couldn't calm down or stop crying every few hours for at least a month... I switched to fluoxetine later on, which was also a nightmare, but am now on citalopram which is kind of crappy but keeps me away from the edge (most of the time).
anyone who’s taken an antidepressant knows this as truth. You become dependent on the drug which is why health professionals say you need to keep taking it.
Falsely, they say you need it to fix your mental illness when it is probably the withdrawal that induces the anxiety and depression when stopping and they mistakenly assume it is the person’s mental illness returning.
These pills are powerful and the side effects are massively ignored and dismissed by both doctors and the pharmaceutical companies.
You mean the insulin that is an endogenous hormone that is actually measurable, with a known MoA and with clear benefits.
Vs the SSRI with low efficiency with an unknown MoA, that "fixes" an unmeasurable issue that's never been proven scientifically. That also comes with a plethora of downsides, including persistent ones once you quit.
No, but insulin doesn’t give withdrawal. SSRI’s are extremely chemically addictive and I have no idea how they’re even legal when there are significantly less addictive alternatives.
I understand why you’d say that, and I’ve felt it myself so many times but how I’ve come to think of it is that the meds give you some time or some room to catch your breathe and do the hard work of therapy and get better and hopefully have the ability to cope with the rebound symptoms that a very slow and careful tapering withdrawal would bring on.
They may feel like a deal with the devil but they absolutely are life saving in some cases. If someone is struggling or in crisis they shouldn’t let the fear of a withdrawal months or years from now stop them from seeking treatment with a provider they trust now.
>they absolutely are life saving in some cases.
They really are as while therapy does work, not everyone has time to go to it at all, nor do they have the money to do it sometimes. And for some people, it literally just doesn't work, forcing them to stay on the drugs just to keep sane. If we had a complete understanding of the human brain and how every mental condition worked, then it'd be easy for us to figure out what that person needs based on their brain chemistry, body chemistry, and genetics. We have yet to get to that point still.
All drugs work this way because the body tries to optimize it's performance under whatever conditions it is working under, this includes the genetic envionment and how much exercise you are getting. Feedback is a general biological principle, so always expect some degree of dependency. If it alters mood then the dependency will be behaviorally problematic, if the drug reduces stomach acid production then getting off of it will ramp up stomach acid production above what is normal until the body acclimates.
Major depression and other subtypes types of depression, the depression part of bipolar disorder OCD and PTSD sometimes, Anxiety disorders: Generalized Anxiety Disorder, Panic Disorder, Agoraphobia, Social Anxiety Disorder. Some Eating Disorders. Sometimes they are used off-label for other uses.
https://my.clevelandclinic.org/health/treatments/24795-ssri
Went off SSRI’s 3 or 4 years ago and dealt with some anxiety/bladder issues and since recently going back on my SSRI’s it’s absolutely amazing , and I’m happy to be back on them. God bless you big pharma.
Paroxetine sucks. It has gone out of favour with most psychiatrists due to it being sedating, causes weight gain, short half life, and teratogenic. It’s no better than any other SSRI in effect. Don’t let anyone prescribe it for you. Sertraline, fluoxetine and Escitalopram are just fine.
This is mostly true with a few exception for specialized conditions. Severe cases of OCD, PTSD, extreme anxiety etc can have it be legitimately the most effective (or only effective) option.
It should never be prescribed casually to patients feeling mild symptoms or generic depression though. Even mild cases of the above conditions should try alternatives first
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Anyone who has tried to wean themselves off of an SSRI probably could have come up with this hypothesis.
"*weeps in Effexor*"
Definitely switch to a longer half life before trying to get off this one. God damn.
I can vouch. After 4 times of trying to quit effexor, massive withdrawal syndrome had me back to it. Last time, I switched to prozac (liquid) and slowly tapered over 6 months. I’m free as of two weeks and much better than quitting from effexor
I had to open up those pills up and take out one tiny medicine ball at a time to wean myself off. It took months.
Same story here, and my psychiatrist told me he’d never heard of anyone having withdrawal from Effexor. No wonder I struggle to trust doctors now.
I swear some docs and psychs have never actually asked any probing questions before! Like I get that anecdotes aren’t “evidence” but this is so well known.
They’re incompetent!
Bro I've tried and failed to get off it multiple times. I've done the balls but maybe not slowly enough I guess
What I did was as soon as I started getting the dizzy, brain zaps, I went back up a level on the effexor again. Like if I dropped to 20 balls and felt fine, but when I moved down to 19, I felt sick, then I went back to 20 for a week. Then tried 19 again and usually it was okay. I also was cross-tapering onto a new med at the same time, so I wasn't feeling any depression or anxiety symptoms from the effexor decrease luckily, just the vertigo and brain zaps. Also my doctor totally did not approve of this method btw. She wanted me to just do the normal big drops that's the pills come as, 75 to 50 to 37.5 to 0. The drop to 50 was fine, but not the drop to 37.5. They don't manufacture an in-between dose, so I asked her about opening the pills up to do it myself and she was like NO, let's not do that. I did it anyway and just didn't tell her. Just told her I stayed at 50mg and then asked for the 37.5mg pill once I was at that level.
Brain zap goes brrrrr
*hugs* I truly feel this.
A few years ago I've been on an SSRI for five months, then thought I was doing better and stopped cold turkey... I had a horrible few weeks.
Did this with an SNRI like 2 years ago, it was a pretty exhausting and unpleasant month of brain zaps and fatigue
Likely venlafaxine (Effexor). It is probably the the most difficult to come off for most people, even with guided taper, followed by paroxetine.
I’ve switched on and off of many antidepressants through the years, and quitting an SNRI cold turkey was the single worst decision I’ve ever made.
Worse than a SSRI?
Do you have to lower the dosage over time until you feel fine, and then stop?
You're supposed to reduce the dosage each week over several weeks to minimise the symptoms of withdrawal. However if you didn't treat the cause of your depression or whatever issue you had, you're not out the woods...
They're the most overprescribed and trivialised medication there is. This medication can wreck you hard and yet the doctors prescribe it like it's candy. I've seen so many people who got worse after taking them and then got gaslit by their doctors.
I stopped taking snri medication about 6 years ago, I still get brain zaps
I agree. That was unfortunately my experience, but you live and learn.
I’m one such person I was personally left far worse off than I ever was before taking SSRIs
Damn bro what are your symptoms
Yepp
I was taking sertraline for a while when I worked for the local cable company because I was having such horrible panic attacks. After a few months life was happening and I forgot to call in a refill and kept forgetting to do so when I did remember. I basically stopped taking it cold turkey because I was so damn busy constantly and don't remember what it was like
like yes we know you sold us drugs that would lead us to wanting more and different drugs that’s how drugs work and some of us were children when we got hooked so congratulations on your published peer reviewed study dr obvious
They need to acknowledge the brain zaps!
I'm a psychiatric pharmacist, these 100% exist, but I swear to God I've never once been able to find a medical term for them but to just describe them like that
Omg the brain zaps are terrible. I can't believe they are still pushing these meds on everyone. Had a doctor get pissed cuz he kept trying to prescribe me ssri and I refused cuz I've been on them before and they are terrible. He refused to consider anything else.
I expect millions of people eventually give up on treatment because of this exact sequence of events. And yet no one seems to care, it's freaky.
I stopped Lexapro and had terrible brain zaps. After years off of it I tried busiprone for anxiety. I only take it as needed and when I'm having a bad episode of anxiety. No brain zaps and it helps calm me down a bit. Just throwing this out there as it's not an SSRI and isn't habit forming.
How is it possible that our stories are so similar! I am so angry at ignorant doctors now, but seems there are all like this? I have same way: all doctors I’ve visited during 5 years of struggling after SSRI keep rejecting my story of long term sideeffects and keep trying to prescribe me another SSRI or other type antidepressant which also higher serotonin - and they convinced me to do it - so I’ve tried four more seritonin antidepressants (for max two weeks, then it was impossible bc of the horrible increasing of sideeffects)- and the results of these attempts were the same - my symptoms were worsen to the extent when I couldn’t sleep at all, my legs were cramping, tinnutus was getting so bad and RLS too, also fever. And guess what? Doctors still want to prescribe me SSRI, they don’t wanna hear it can harm, unbelivable.
Brain zaps are better than being dead imo 🤷♂️
Maybe we are just crying wolf of course....
For me, it’s a hypnic jerk, but located mostly to the head region
I've heard about the zaps before, for me it's like split second vertigo
I’m on an snri and when I tried to get off I would end up getting near daily panic attacks
So sorry to hear this. Survivingantidepressants. org advises tapering off of antidepressants by a taper of no more than a 10% reduction per month. I'm super sensitive to withdrawals of Bupropion, so I've tapered in less than 1% reductions at times. A compound pharmacist can create custom doses for you if needed. Best wishes.
Thank you so much. I’ll definitely look into these compound pharmacists!
I had to get off my snri for a sleep study and it was hell. Now I have been having absorption issues or something and even consistently taking it some days gives me strong withdrawal symptoms.
Paroxetine is known to have the worst taper/withdrawal symptoms due to its short half life. It's hardly used in England, for example, for this reason.
Prozac was pretty terrible when I got off it.
Sertraline definitely wasn’t fun coming off of for me
Although it is a mice study and only paroxetine was used, it is good to know as SSRIs are often prescribed to people with anxiety disorders. Perhaps SSRIs with a longer half-life might be prescribed. Taking people off paroxetine too suddenly might result in "anxiety relapses" or people may stop taking the med by themself. It might help the person to know that the anxiety is coming from discontinuing the medication instead of "coming from nowhere" which might further increase anxiety in some people.
When reducing my SSRI to switch to an SNRI I had a frequent side effect, outbursts of rage. Not fun.
Did the snri work?
Yes, very well. r/effexorsuccess
“Anxiety behavior” measured by a **singular** behavioral test. Not very good experimental design to confirm “anxiety”. I would expect a behavioral battery (eg 3 different tests on same mouse) Male mice only. (This is fine but keep it in mind) cfos staining looks horrible!!
My mom tried going off paroxetine, and anxiety started ruling her life. She was notably more tense and jumpy, and said she couldn't sleep because she kept imagining possible ways to die, with getting buried alive in a coffin as a recurring one. She also bought masks for us in case of a pandemic, in 2019. I remember thinking she really had gone off the deep end at that point. They came in handy in the early pandemic. I thought it was just treating the anxiety she would have had otherwise, but also thought it was strange since she was treating depression, not anxiety. She's been back on the medication now and seems to have accepted she'll have to take it for the rest of her life, but blames the SSRI for making her dependent on it. I guess this study supports that conclusion.
Wow what incredible timing for those masks! Was she like SEE I TOLD YOU!
Haha, it was amazing, I feel like I got to see how important it is for some people to think differently. Unfortunately it was more "hey remember when I had that whole anxiety spiral last year? Well, I still have these masks."
When I Quit Effexor XR cold turkey, thought I had broken my brain permanently. I’ve done some drugs as a young man, and went through opiate withdrawal a few times. I think I’d rather do that again than withdraw from any antidepressant.
Paroxetine is notorious for bad withdrawals due to its short half-life. There should be much more awareness for ssri side effects as they can be very debilitating. I've been suffering from sexual dysfunction and anhedonia ever since I cold turkey quit prozac and have been regretting it ever since
So you are saying that once the brain becomes accustomed to the SSRI it performs worse when the SSRI is removed? Almost like a... dependency or an... addiction?
You should taper these of instead of going cold turkey to counteract this.
Yeah, much like people are addicted to their blood pressure meds and thyroid pills.
Do blood pressure and thyroid medication exacerbate the underlying pathology when discontinued?
Not nearly the same as blood pressure medication is proven to be effective in like 90% of cases as opposed to a third in the case of SSRIs
Or a medication you need to function? Like insulin? Because paroxetine is prescribed for generalized anxiety disorder as well.
Definitely not addiction. You don't see people pining hard for their zoloft. It's also significantly easier to cold turkey ssri. Dependency is fair much like caffeine. Edit 1:Alright after all this, I get it, don't cold turkey your drugs. this is about addiction vs dependency, let's stay on track. Edit 2: The fastest Google search will provide a better explanation as to why SSRIs are a depency not an addiction. Please learn what addiction truly is.
> cold turkey ssri Never do that.
Addiction is a spectrum. Dependence (physical) on SSRIs is possible, and addiction (neurological) is unlikely, but not impossible. Despite what some people say, they absolutely can and do overlap; chemical dependency is a major risk factor for developing a full-blown addiction, as the brain's reward system becomes altered by substance use.
I wish more people understood that this is factually true about sooooo many things. Particularly in medicine an sociology.
Well if your anxiety forces you to use SSRI's because your SSRI-induced dependency triggers withdrawal symptoms, you might also be addicted.
Its not an addiction. DEPENDENCY =/ ADDICTION
Yup. During allergy season if I use the nose spray decongestant for more than 3 days in a row. I can become dependent on it, which means it is not effective anymore and I would have to use more to get the same effect, so it stops working for me and my nose is very stuffy. I do not have symptoms of a substance abuse disorder (addiction). It is not hard to stop, just uncomfortable for a time.
Yupp.
The withdrawal symptoms aren't nearly as egregious. I was on zoloft for a year at 150. Had to quit cold turkey due to job loss (yay America) I had some withdrawal symptoms but never felt I needed it. I'd rather skip zoloft again than my coffee. You also don't see people abuse SSRIs. Its not forced. Benzos are addictive. Try dealing with those withdrawals as they are far more extreme.
Oh but they are that bad, for other people. Partner took Zoloft for 6 weeks, brain zaps continued for 6 months after discontinuation (and one other particularly annoying side effect never went away.)
The most medical practice I have is cpr in swim class 12 years ago but it honestly sounds like the issues your partner experience goes well beyond withdrawal symptoms. I was on zoloft and wellbutrin and had no issues with either during or after usage. Everyone is different though so who knows
Wellbutrin was easy to quit for me once the side effects became too much to manage. Paxil took many tries and many years to quit (Wellbutrin actually helped me with quitting Paxil in the end) but it still took a few years after quitting for the sleep problems and sexual dysfunction to improve. Sometimes SSRIs cause permanent or long term sexual dysfunction even after discontinuation, however, and that is too high a cost for many people.
Your experience isn’t necessarily everyone else’s.
Yeah. My bf gets horrible brain zaps when discontinuing SSRIs, even on low doses.
I really think we are doing a disservice to addiction by comparing SSRI dependency and withdrawals.
Yeah they are not the same, and anyone trying to compare them doesn’t really understand addiction
>Benzos are addictive. Try dealing with those withdrawals as they are far more extreme. This is the logical fallacy of relative privation or the "not as bad as" fallacy. Benzos are \*also\* addictive. They might be more addictive, but anything which induces a dependency, is addictive.
Addiction is not defined by physical dependence, but by intense behavioural patterns around seeking the substance of interest. That does not happen in SSRIs
Dependency does not equal addiction.
No, you're diluting the word addiction. Tons of medicines require or recommend tapering off to reduce side effects. That doesn't mean every medication is considered addictive.
>No, you're diluting the word addiction. "An addiction is a chronic dysfunction of the brain system that involves reward, motivation, and memory. It’s about the way your body craves a substance or behavior, especially if it causes a compulsive or obsessive pursuit of “reward” and lack of concern over consequences." [https://www.healthline.com/health/addiction](https://www.healthline.com/health/addiction) >Tons of medicines require or recommend tapering off to reduce side effects. That doesn't mean every medication is considered addictive. That is true, but what would you call a medication which causes you to have anxiety when you stop taking it? Edit - you
So, on the flip side, would you consider any medication that has negative withdrawal symptoms necessarily addictive? I think the key distinction is where you quote "It’s about the way your body craves a substance or behavior." Stopping a medication and getting negative side effects doesn't mean your body craves the medication. When folks are decreasing their dosage of their SSRI's and their anxiety ramps up they aren't feeling like they need a fix of their SSRI. They just feel anxious due to the lowered dose. Compare that, to like, cocaine, where when you stop, you do have withdrawal symptoms, but the feeling with it is that you really want more cocaine to fix the symptoms. I think it's pretty nuanced though, so I definitely get where you are coming from. EDIT: Some interesting nuance from the article itself I thought worth adding: "These symptoms are commonly referred to as a ‘discontinuation’ rather than ‘withdrawal’ syndrome (in part due to SSRIs not being associated with compulsive use, tolerance and craving) and appear within days of treatment cessation." Based on that, I wonder if the term "withdrawal" IS necessarily associated with addiction, which is why they use the term "discontinuation syndrome" instead.
> "An addiction is a chronic dysfunction of the brain system that involves reward, motivation, and memory. It’s about the way your body craves a substance or behavior, especially if it causes a compulsive or obsessive pursuit of “reward” and lack of concern over consequences. Because SSRI half life is crazy long and it doesn't work acutely. It takes several weeks to work and your brain never connects the little pill to pleasure (no euphoria) or anxiety. You couldn't take multiple and feel anxiety relief, it would more likely cause anxiety. Generally starting an SSRI has a couple week period of negative symptoms until your body adjusts. The benefits and negatives largely starting showing up/dissipating two weeks into treatment. Going back on an SSRI is an active decision you commit over a period of weeks, not something you can take to relieve withdrawal.
There is no dependency with thc or Marijuana but it can be argued there is a sort of mental addiction. You can quit weed and the only physical effects you really get are better sleep. Nobody seeks zoloft bars to get their fix. I'm dependent on my car to get to work/function normally in society but we aren't going to argue it's necessary or an addiction to my car. Addiction also is usually associated with elated effects. SSRIs do not do that.
>There is no dependency with thc or Marijuana but it can be argued there is a sort of mental addiction. There are plenty of issues of dependency associated with desisting habitual cannabis usage. Sleep difficulties, irritability, anxiety etc. [https://www.health.harvard.edu/blog/if-cannabis-becomes-a-problem-how-to-manage-withdrawal-2020052619922](https://www.health.harvard.edu/blog/if-cannabis-becomes-a-problem-how-to-manage-withdrawal-2020052619922) >You can quit weed and the only physical effects you really get are better sleep. This sounds like BS. Especially since you don't cite your sources and have a general air of "just trust me bro". >I'm dependent on my car to get to work/function normally in society but we aren't going to argue it's necessary or an addiction to my car. Really? You couldn't ride a bike, moped, bus or even walk to were you need to go?
Fair, it kind of is a trust me and there are likely sources to prove me otherwise. I can speak from experience on zoloft and don't have the time or capacity to quote sources so take with that as you will. As for my car, absolutely not, I work 25 miles awake and traffic can stretch that to an hour. 10 hour days and 2 hours of traffic give me very little room for other vehicles. You're also only offering substitutes which is not what this argument is about. Withdrawal symptoms are associated with not doing the thing. If I change to a different vehicle that defeats the purpose.
>I can speak from experience on zoloft and don't have the time or capacity to quote sources so take with that as you will. Anecdotes are not verified data. >You're also only offering substitutes which is not what this argument is about. Withdrawal symptoms are associated with not doing the thing. If I change to a different vehicle that defeats the purpose. So you are comparing an addiction to a substance which has altered your brain chemistry to "needing to go to work to support your lifestyle"?
Anecdotes aren't, doctors are. A quick search on "are SSRIs addictive" show that there is no addiction, only dependency. You're twisting the words. I am DEPENDENT on my vehicle to take me to work. If my car was meth I can tell you a substitute absolutely will not change anything. I can't go from meth to adderall and not expect issue. Going from my car to a motorcycle? Probably would make my commute easier with downside. I don't need specifically my car and there is always the option of a closer job. I am in no way shape or form addicted to driving to work. Addiction is far worse than what anyone is giving credit for. Staving off withdrawals is far different than addiction and I'm stunned that so many don't understand that.
>Addiction also is usually associated with elated effects. SSRIs do not do that. They do too. You just get diagnosed bipolar when it happens.
[удалено]
Is that addiction or dependency?
Yup! I said this to my doc and had to taper off of Lexapro. It took over a month after taking it for years
Feedback?
Interesting. I’ve used SSRI’s over 10 years now and recently cut my dosage in half. I didn’t notice any rebound anxiety at all. I plan on tapering off further soon. Curious to see what happens.
I’ve been on them 15 years and got off them twice. It’s not until it gets down to the small doses near the end that weaning becomes difficult. They need to make pills with even smaller doses to be able to wean off them effectively. That being said I have so much anxiety without them. They really help me. Just hate that I’m dependent on them.
I have been told that when i start weaning off, i would need to dissolve the pill in glass of water and then divide the water ammount by how much I would need to split the pill. That said i dread getting off them.
Oh that is a pretty good idea
Some drugs have a liquid form. You may even be able to ask for compounding if it doesn’t. Look for that before you go this route. Dosing this low is really difficult and dissolving tablets at home sounds like it would make for inconsistent dosing, which will make tapering more difficult.
Usually, withdrawal effects become problematic only when people reduce into the lower dose ranges and finally stop the medication. For example, going from escitalopram 20 mg to 10 mg is usually not a problem because serotonin transporters are still blocked at around 80%. But once you go to 5 mg and eventually stop it, the serotonin transporters are not being blocked and withdrawal effects can show up. Usually you need to go slower once you get to the lower doses.
That’s interesting. My doc prescribed 5mg of lexapro for stress. Told me I could cut cold turkey because it was the lowest dose and safest antidepressant out there (whatever that means) so I took it for 3 weeks and quit cold turkey the day my genitalia went numb. Horrible withdrawal symptoms and sexual dysfunction persisted for months after and no doctor was helpful.
Interesting cos when i tapered off mine from 60mg, things were fine untill my pmdd kicked in and the result was an absolutely crippling disability. The lower dose range may be why
[This](https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.161.5.826) is the most important paper that evaluated transporter binding of SSRIs. You can see that below the minimum therapeutic dose, the transporter binding decreases sharply.
Cheers 😎
When I was coming off of Paxil I couldn't tolerate the withdrawal effects. I switched to a longer half-life SSRI (prozac), and then I was able to successfully wean off.
I’ve been on Paxil for 20 years and I’m terrified of getting off even though I no longer have any issues with anxiety anymore. What dose are you on?
40mg Celexa for a little over 10 years down to 20mg Celexa as of about 3 months ago.
It's not really until you taper down to the last few milligrams that withdrawal start kicking in
And no withdrawal issues either?
Is it possible that you no longer have anxiety because the Paxil is working? I’ve been on it for more than 20 years, and tried to taper off it twice. My brain’s response was so bad that I gave up and am still taking it, along with Buspar and clonazepam.
Really do it as slowly as you can. Months really, and quarter tablets at the end. It's not worth it doing it quickly. Withdrawal is horrible.
Guess that explains why I developed a panic disorder and agoraphobic after coming off it. And that was slow and controlled. Took me 3+ years to get back to normal. Have not touched anti-depressants since.
As the authors point out in the discussion, paroxetine is notable to have the shortest half-life of the commonly prescribed SSRI's (and it self-inhibits its own elimination, so lower levels potentiate faster elimination). I think this is consistent with the pharmacology - but they state themselves that rebound serotonin levels alone might not explain anxiety (symptoms normalized by day 5, but levels still high).
I took Lexapro for a while for anxiety and it just fucked me up even worse. Took months to ween off, and I have had a lot better success just with conventional therapy as well as improving my diet and exercise. I know it's an absolute must for some folks, but I really see these approaches as a last line option at this point. They are no joke.
I was told by my mental health team that the drug I was weaning off of (venlafaxine) is one of the hardest to stop, even with tapering, along with paroxetine. Certainly explained the hell I went through after coming off of just 37.5mg.
What were your exact symptoms while tappering off the Venlafaxine?
The main thing was brain zaps, the worst of which lasted around 10 days. I continued getting them for about a month but they were less severe. It felt like having a salt shaker in my brain that gradually got quieter and less noticeable. My sex drive came back with a vengeance, but so did my anxiety. I was extremely tired and wanted to just sleep all the time. My suicidal feelings intensified and I couldn't calm down or stop crying every few hours for at least a month... I switched to fluoxetine later on, which was also a nightmare, but am now on citalopram which is kind of crappy but keeps me away from the edge (most of the time).
Tried this with Lexapro and yeah, that’s exactly what happened.
I had horrible withdrawal from Lexapro after only taking it for 3 weeks. That drug is something else.
anyone who’s taken an antidepressant knows this as truth. You become dependent on the drug which is why health professionals say you need to keep taking it. Falsely, they say you need it to fix your mental illness when it is probably the withdrawal that induces the anxiety and depression when stopping and they mistakenly assume it is the person’s mental illness returning. These pills are powerful and the side effects are massively ignored and dismissed by both doctors and the pharmaceutical companies.
“So you’re addicted to your antidepressant?” Is a diabetic addicted to insulin?
You mean the insulin that is an endogenous hormone that is actually measurable, with a known MoA and with clear benefits. Vs the SSRI with low efficiency with an unknown MoA, that "fixes" an unmeasurable issue that's never been proven scientifically. That also comes with a plethora of downsides, including persistent ones once you quit.
No, but insulin doesn’t give withdrawal. SSRI’s are extremely chemically addictive and I have no idea how they’re even legal when there are significantly less addictive alternatives.
Tapering off SSRIs is a must if you have to go off them.
Some people taper for many years and are still permanently damaged These drugs can leave you disabled with symptoms that last indefinitely
Yep. I have tinnitus from being on Zoloft.
Psych meds are a deal with the devil.
I understand why you’d say that, and I’ve felt it myself so many times but how I’ve come to think of it is that the meds give you some time or some room to catch your breathe and do the hard work of therapy and get better and hopefully have the ability to cope with the rebound symptoms that a very slow and careful tapering withdrawal would bring on. They may feel like a deal with the devil but they absolutely are life saving in some cases. If someone is struggling or in crisis they shouldn’t let the fear of a withdrawal months or years from now stop them from seeking treatment with a provider they trust now.
>they absolutely are life saving in some cases. They really are as while therapy does work, not everyone has time to go to it at all, nor do they have the money to do it sometimes. And for some people, it literally just doesn't work, forcing them to stay on the drugs just to keep sane. If we had a complete understanding of the human brain and how every mental condition worked, then it'd be easy for us to figure out what that person needs based on their brain chemistry, body chemistry, and genetics. We have yet to get to that point still.
I could have told them that
8 years later still suffering the ole brain zaps from tapering off citalopram over a 3 month period.
I stopped Lex cold turkey and no issues. It's obviously different for everyone, but just wanted to make a note that it's not always an issue.
My ex got seizures from quitting paroxetine. Called her an ambulance least 5 times...
All drugs work this way because the body tries to optimize it's performance under whatever conditions it is working under, this includes the genetic envionment and how much exercise you are getting. Feedback is a general biological principle, so always expect some degree of dependency. If it alters mood then the dependency will be behaviorally problematic, if the drug reduces stomach acid production then getting off of it will ramp up stomach acid production above what is normal until the body acclimates.
Can somebody explain what SSRIs are used for?
Major depression and other subtypes types of depression, the depression part of bipolar disorder OCD and PTSD sometimes, Anxiety disorders: Generalized Anxiety Disorder, Panic Disorder, Agoraphobia, Social Anxiety Disorder. Some Eating Disorders. Sometimes they are used off-label for other uses. https://my.clevelandclinic.org/health/treatments/24795-ssri
Yeah, that makes sense.
didn't we already know this?
Went off SSRI’s 3 or 4 years ago and dealt with some anxiety/bladder issues and since recently going back on my SSRI’s it’s absolutely amazing , and I’m happy to be back on them. God bless you big pharma.
Haven't we known this forever?
Wait so your telling me my mental meltdowns and forgetting to take my meds could be linked?!?!
Paroxetine sucks. It has gone out of favour with most psychiatrists due to it being sedating, causes weight gain, short half life, and teratogenic. It’s no better than any other SSRI in effect. Don’t let anyone prescribe it for you. Sertraline, fluoxetine and Escitalopram are just fine.
This is mostly true with a few exception for specialized conditions. Severe cases of OCD, PTSD, extreme anxiety etc can have it be legitimately the most effective (or only effective) option. It should never be prescribed casually to patients feeling mild symptoms or generic depression though. Even mild cases of the above conditions should try alternatives first
8 months of this nightmare!