Posted by Jonathan on August 28, 2000, at 18:55:01
In reply to Re: Withdrawal from Antidepressants 101, posted by Sunnely on August 26, 2000, at 23:18:46
> For some, SRI (selective reuptake inhibitor) withdrawal symptoms can be protracted and very distressing even with very slow taper of the antidepressant, or switching to a drug with a long half-life (e.g., Prozac). The following are a couple of innovative approaches to ease these withdrawal symptoms.
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> 1. An Expensive Proposition.
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> For those who continue to experience nausea, headaches, stomach distress, and diarrhea, despite slow taper of the antidepressant, ondansetron (Zofran) may help. The plausible explanation is that ondansetron relieves the nausea and headache by acting at the central (brain) 5HT3 receptors, whereas it relieves the stomach distress and diarrhea by acting at the gastrointestinal 5HT3 receptors. Ondansetron is a medication more commonly used for the treatment of nausea and vomiting during radiation therapy and chemotherapy. (See reference # 1).
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> References:
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> 1. Raby WN: Treatment of venlafaxine discontinuation symptoms with ondansetron (letter to editor). Journal of Clinical Psychiatry 1998;59:621-622.
>Sunnely,
Thanks for these two interesting new solutions to the common and serious problem of antidepressant withdrawal. Coincidentally, AndrewB has recently posted info on obtaining ondansetron (Zofran) for a different problem, serotonin-induced cognitive impairment.
http://www.dr-bob.org/babble/20000822/msgs/43509.html
An alternative 5HT-3 antagonist that might be less expensive and more accessible than ondansetron (for those whose pdocs will not prescribe meds for off-label uses) is the antidepressant mirtazepine (US Remeron, UK Zispin).
If I'm correct, there may be someone reading this who has switched from Effexor or an SSRI to mirtazepine with no intervening drug-free period and been protected from withdrawal effects by mirtazepine's 5HT-3 antagonism. It's possible, however, that the usual starting dose of 15 mg/day may be too low to block enough 5HT-3 receptors, in which case one would need to escalate quickly to 30 or even 45 mg/day to prevent the previous antidepressant's withdrawal symptoms.
Can anyone out there comment on this from practical experience?
Jonathan.
poster:Jonathan
thread:43762
URL: http://www.dr-bob.org/babble/20000822/msgs/43946.html