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Dr. Bob is Robert Hsiung, MD,
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Posted by gilbert on June 21, 2001, at 18:32:35
In reply to Re: withdrawal symptoms coming off zoloft » Linda C, posted by KMC on June 20, 2001, at 22:43:25
Linda,
I have been on all of the ssris and have had to use xanax for start up effects and xanax for withdrawal. The only one without withdrawal was prozac....came of that farily easy. I have quit benzos easier than stopping ssris. But let the benzo tapering method be a guide for ssri users. Don't rush off the drug. taper down by 12.5mg per week. I have come off and on xanax over the last 2 years without any withdrawal symptoms by simply following some good advice from this board......Stop slowly so your system isn't shocked by a lack of seratonin. The rebound depression and anxiety from stopping quickly will make you feel like running for Betty Ford Clinic. I think we are beginning to realize that drug dependency has many forms and that those dirty little benzos are not the only drugs out there with rebound and withdrawal problems......So go sloooooow. Or get some xanax to help you through it but you may prefer to just go slow.
Gil
Posted by help on July 19, 2001, at 0:28:14
In reply to Re: withdrawal symptoms coming off zoloft, posted by dina on May 4, 1999, at 21:06:42
My friend has been on zoloft for 3 years now and takes 200mg and 250mg a day, are there any side effects, are there any life threathing issues that should be thought about. Her dosage has not changed since she started usuing the drug. Please get back to me cause I really love her.
Andrew
andrew@malvernprep.comHave a wonderful day and there is hope for everyone out there.
Posted by SalArmy4me on July 19, 2001, at 0:32:28
In reply to Zoloft Dangers (help), posted by help on July 19, 2001, at 0:28:14
I once took 400 mg of Zoloft per day and turned out alright.
from: http://www.dr-bob.org/tips/split/SSRI-maximum-doses.html
Date: Mon, 15 May 1995 22:13:39 +0059 (EDT)
From: scole@world.std.com (Stanley Cole)
Subject: SSRI maximum dosesOn Mon, 15 May 1995, Sergio Henao wrote:
It has been said in this group that patients sometimes respond to SSRI doses beyond the usually recomended ones. For instance, sertraline has been given in doses of up to 600 mg a day with success. I checked with some of my colleagues (psychopharmacologists) in Houston and they never heard of it and would not recomend it. In view of this I decided to call the medical information department at the manufacturing company. Their physician told me that for that particular drug the response curve has been flat and for this reason they would not recomend or support going beyond 200.
I have a number of patients who respond only to relatively high doses of SSRIs. One patient walked in one day and finally reported relief from his depression only after reaching fluoxetine 120 mg qd. I have other patients on sertraline who respond only to 350 mg. I have checked levels frequently to see if I was really giving toxic doses of meds, but the combined levels (including the nor-metabolite) were relatively low. Either these are rapid extensive metabolizers, or they are not absorbing the meds or there is an unmearsured metabolite that is very high. (These are patients whose compliance I trust.)
Posted by JK on August 17, 2001, at 13:13:27
In reply to withdrawal symptoms coming off zoloft, posted by Shelly on May 4, 1999, at 17:37:51
> >I've been on Zoloft for about 8 months. Man, what a strange experience this whole thing has been. My doc put me on this after I complained of anxiety, nervousness, panic feelings, and jumbled thoughts. I had gone through a number of life changes (moving, changing jobs, having another child, my dad getting sick). Now I know why I was such a mess and if I would have realized it then, maybe I could have avoided the drug altogther by "right" thinking. Anyways, I have just weaned myself off for the past month or so and have just recently (the past day) felt the side effects. The nerves have returned and the head rushes are unique to say the least. But the beauty of all of
this is that I KNOW what it is now! This realization eliminates much of the fear that was eating me up inside. For me, positive thinking and keeping busy have opened the door for me and provided hope (without the aid of drugs). I've grasped whatever it takes to sooth your mind. I never was a big "self help" person but now I
love hearing about methods to live and think healthier. Thanks for showing me that these pesky symptoms are normal and even better that they WILL GO AWAY--remember that! As you can tell, I'm trying to be very confident.
Posted by tsean on August 21, 2001, at 7:45:09
In reply to Re: withdrawal symptoms coming off zoloft, posted by Laura Jane on September 3, 2000, at 10:56:07
> I have been off of Zoloft completely for about a week. I am getting these weird head spins and they are making me nauseous. My sex life has been great since I stopped (the Zoloft put a damper on it). But, these spins are making me sick! Is this from Zoloft? HELP!
Posted by sjharve62 on September 2, 2001, at 22:33:03
In reply to Re: withdrawal symptoms coming off zoloft, posted by tsean on August 21, 2001, at 7:45:09
I took zoloft for about 18 months, and got off with the help of Pfizer. My withdrawls were what they called "rare" and I filled out a questionaire for them. My withdrawls were what I could only describe as "shocks" that radiated from my chest to the tips of my fingers, and out the top of my head. Now, even six years later, I am still having them if I don't get anough sleep, If I get too much sleep, and especially if I get awakened suddenly. I cannot afford tests, so if anyone has any suggestions, I would greatly appreciate it. My head also feels like it is "full", like I cannot possibly take in anymore information for about 20-30 minutes after the shocks start. HELP!!!
Thanks
Posted by SalArmy4me on September 3, 2001, at 7:34:52
In reply to Re: withdrawal symptoms coming off zoloft, posted by sjharve62 on September 2, 2001, at 22:33:03
There's no way to get rid of what you have without getting diagnosed for an illness, possibly Myoclonic/Myoclonus type stuff. You may be able to use cyproheptadine to control the shocks: http://www.dr-bob.org/tips/split/Cyproheptadine-for-myoclon.html
Posted by glass_snake on October 2, 2001, at 11:41:45
In reply to Re: withdrawal symptoms coming off zoloft, posted by sjharve62 on September 2, 2001, at 22:33:03
Don't believe what they're telling you. I have a friend that works in the Psychiatric ward of one of the top 10 hospitals in the US. He got all of the data he cool from Psychiatry and pharmacy on the drug. According to the company line there is no withdrawal symptom. I had been taking Zoloft for anxiety and was tired of it messing with my life. So, being as bold as I am, I went cold turkey. I was ok for a day or two and then started to show symptoms that I've seen posted a hundred times over since I went looking for them: dizziness, tingling across the body, "shockwave" sensations, fatigue, headache, etc. I called some people I knew in the medical field and they thought it sounded like severe hypotension (a sudden drop in blood pressure). After it persisted for several days I searched the Internet for two simple words "Zoloft withdrawal". You would not believe the number of hits that flew right up - all from people complaining of the exact same symptoms. About two weeks later everything got pretty normal again, but that may vary from person to person. Either way, don't believe Pfizer, et al. Zoloft DOES have withdrawal symptoms. Don't be too alarmed by them, they will pass. If it looks too bad, see a doctor.
FYI, I am NOT a doctor just someone that's done a little research, so don't take this as anything more than the advice of a peer lay person :)> I took zoloft for about 18 months, and got off with the help of Pfizer. My withdrawls were what they called "rare" and I filled out a questionaire for them. My withdrawls were what I could only describe as "shocks" that radiated from my chest to the tips of my fingers, and out the top of my head. Now, even six years later, I am still having them if I don't get anough sleep, If I get too much sleep, and especially if I get awakened suddenly. I cannot afford tests, so if anyone has any suggestions, I would greatly appreciate it. My head also feels like it is "full", like I cannot possibly take in anymore information for about 20-30 minutes after the shocks start. HELP!!!
> Thanks
Posted by bingo on October 9, 2001, at 15:14:09
In reply to Re: withdrawal symptoms coming off zoloft, posted by SalArmy4me on April 18, 2001, at 15:22:40
> Read the Los Angeles Times front section today for the announcement of the ultimate study which proves that St. John's Wort has no efficacy in treating depression.
>That's nonsense. I was on St. John's Wort alone for some months, and it helped me a great deal. I only left it for prescription meds because the efficacy of the Wort varied too much according to how empty my stomach was when I took it (have an eating disorder).
Posted by Daveman on October 13, 2001, at 23:27:07
In reply to Re: withdrawal symptoms coming off zoloft » SalArmy4me, posted by bingo on October 9, 2001, at 15:14:09
Well, I've been reading the posts about Zoloft withdrawal and there is definitely a common thread here; stopping "cold turkey" leads to a series of reactions such as electric shocks, also called "zaps"; flu-like symptoms, etc.
What I'm curious about is: Does tapering down help avoid these problems, and if so, how slow a taper is generally utilized? I've been on Celexa 40 mg/day since about last February and am doing so well that my doc and I are beginning to talk about reducing the dose and perhaps trying to stop it altogether. I admit to having some concerns about the potential withdrawal problems; elsewhere on the web, there is much discussion over the lawsuit filed against Paxil regarding withdrawal problems.
Are Paxil and Zoloft worse to withdraw from than Celexa due to their shorter half life (Paxil-15-20 hrs; Zoloft 24 hrs; Celexa 35 hrs; all according to Rx List). Have people found tapering to be an effective way to avoid withdrawal problems? I'd be interested in any responses.
Dave
Posted by Cam W. on October 14, 2001, at 0:48:27
In reply to SSRI Withdrawal-Does tapering help?, posted by Daveman on October 13, 2001, at 23:27:07
Dave - While I have heard of a few people who have seemingly gone through SSRI withdrawl while stopping Celexa™ (citalopram), the numbers have been nowhere near that seen with Paxil™ (paroxetine) or Zoloft™ (sertraline). Effexor™ (venlafaxine) regular (not XR) is by far the worst offender. Still, it best to taper down any SSRI fairly slowly. SSRI withdrawl affects those who have a polymorphism for the cytochrome P450-2D6 (many repeating copies of the gene in their DNA) metabolizing enzyme. This polymorphism seems to affect about 5% of those of European descent.
Tapering of the dose of an SSRI allows the body to adjust to lower levels, and allow the body to adjust to slightly lower levels of this neurotransmitter. More serotonin is being forced to be produced than at pretreatment time (ie. when you were depressed). SSRI therapy does force the body to produce more serotonin because the mechanism conservation of serotonin, via the reuptake pump, is blocked. It is hoped that by forcing the body to produce more serotonin, the body will naturally keep producing serotonin at a higher once the SSRI is withdrawn (ie. stopped). The body does need to adjust to the slightly lower level of serotonin in the gap (ie. the synaptic cleft - the space between neurons) because the reuptake pump is again drawing back into the presynaptic nerve ending from which it is released. The slower the block is taken off the reuptake pump, the more time the body has to adjust.
In your case, I believe dropping the dose of Celexa by 10mg per week is more than slow enough. Do confirm this with your doctor (or show him this post. In any case, your doc will probably only want you to decrease your dose to 30mg (possibly 20mg), so you could, in reality, drop directly to 30mg (or even directly to 20mg) without any problem. Usually, any drug that is taken once daily, and has a half-life of longer than 24 hours can be tapered fairly quickly.
I hope that this post will assuage (cool word, huh?) any fears that you may have. - Cam
Posted by Daveman on October 15, 2001, at 23:56:58
In reply to Re: SSRI Withdrawal-Does tapering help? » Daveman, posted by Cam W. on October 14, 2001, at 0:48:27
Cam:
Thanks for your resonse. As usual, it was precise and to the point. I have printed it out for future reference.
It got me thinking- is this absence of serotonin in the synaptic "gap" responsible for the "electric shocks" or "zaps" that seems to be such a commonly reported side effect of withdrawal from Paxil and Zoloft? If so, what would be the phsyiological explanation for this? Just wondering I guess.
Anyway, thanks again for the response.
Dave
Posted by Cam W. on October 16, 2001, at 0:35:03
In reply to Thanks, Cam:) and a thought of my own » Cam W., posted by Daveman on October 15, 2001, at 23:56:58
Dave - I haven't seen any good explanation of the electric zaps, yet. My feeling is, is that most clinicians and researchers either don't believe that they really exist, or feel that they are unrelated to withdrawl. This is similar to the instances when I first heard complaints of delayed weight gain with Paxil. A few years ago, when I would broach the subject with clinicians, they would say that there was no connection. This was when the scientific community believed that just as many people lost weight with Paxil, as gained weight. Now we know (because it has been "proven" scientifically) that some people lose weight in the short term with Paxil, but a majority will gain that weight back (and then some) in the subsequent 3 or 4 months of therapy.
Most psychiatrists have no idea what I am talking about when I mention "brain zaps". That is the problem with Psycho-Babble; we are just too damn current with what medications actually do. Clinically, we are way ahead of the research.
My hypothesis of what is going on with the brain zaps is that during withdrawl, the lack of serotonin in general, is causing random, unsychronized firing of serotonergic neurons. I am not totally sure in which part of the brain or which serotonergic pathway this is occurring, but I would hazard a guess that it is in one of the pathways leading out of the raphe nuclei (possibly enroute to the frontal cortex). I really don't know what is going on, though. It could also be a temporal lobe thing, similar to the feeling people get before an epileptic seizure, or maybe like the prodromal symptoms of a migraine headache.
Every time I think I am getting a grasp on the brain's circuitry, a question like this arises, and I realize that I don't understand the brain, as well as I think I do.
I guess that we have to organize and make more noise within the research community, so that someone takes our observations seriously. Perhaps Dr. Bob could get one of the depression experts to give a presentation so that we could lob our observations at him/her.
As confused as ever - Cam
Posted by SLS on October 16, 2001, at 15:45:44
In reply to Re: a thought of my own » Daveman, posted by Cam W. on October 16, 2001, at 0:35:03
In re: brain-zaps.
It has been well over a decade since I had to undergo a withdrawal syndrome due to the discontinuation of clonazepam, but I recall experiencing brain-zaps that were very similar to those I experienced when discontinuing Effexor. I would be curious to know if this is an occurrence common to benzodiazepines in general or something specific to clonazepam. As I recall from early studies, clonazepam was often separated from the others by being ascribed pro-serotonergic properties. Perhaps this is the reason why it tends to be more effective for social-phobia and OCD. Clonazepam is also noted to have certain anticonvulsant (and perhaps anti-manic) properties not displayed by the other benzodiazepines. While searching Medline in an effort to confirm my recollections, I found some rather interesting relationships between myclonus, GABA, and 5-HT that I think support Cam W.’s ideas.
- Scott
------------------------------------------------------------
Adv Neurol 1986;43:629-43
Mechanism of action of clonazepam in myoclonus in relation to effects on GABA and 5-HT.Jenner P, Pratt JA, Marsden CD.
“Clonazepam is a potent anticonvulsant 1,4-benzodiazepine that controls some types of myoclonus. Its primary mode of action is to facilitate GABAergic transmission in the brain by a direct effect on benzodiazepine receptors. GABA receptors lie on the cell bodies of dorsal raphe neurons, and GABA acts to inhibit raphe cell firing, an action potentiated by benzodiazepines.”
Posted by annamarie on October 17, 2001, at 21:44:12
In reply to Re: SSRI Withdrawal-Does tapering help? » Daveman, posted by Cam W. on October 14, 2001, at 0:48:27
Hi, I'm in the process of tapering off myself right now. I'm coming from 150 mg of Effexor and I went down to 75 mg. I had a horrible time for 3 days and I added the 37.5 mg for a total of 112.5 mg. This really helped and I plan on staying her for a week or two before I head down to 75 mg and then to 37.5 mg and then off.
If I didn't taper I believe the pain, nausea and feeling that I wanted to be out of my skin would be too overwhelming.
My attitude is great and I feel no depression sneaking into the picture. Good luck.
Posted by Brenna on October 18, 2001, at 3:39:23
In reply to Re: SSRI Withdrawal-Does tapering help?, posted by annamarie on October 17, 2001, at 21:44:12
I found a way to go off the zoloft with NOOO side effects.....Once you taper down to 25mg, go onto Lovan (prozac) (1/2 tablet) for one week, then every second day for another week. Then go off it completely. There are absolutely no withdrawels! :-)
Posted by MaddieGrace on October 18, 2001, at 11:56:00
In reply to Re: withdrawal symptoms coming off zoloft » AW, posted by onlooker on August 31, 2000, at 15:30:47
I was prescribed Zoloft when I was diagnosed with a chronic pain condition in March, 2000. It helped me tremendously, but now that my medical condition is improving I don't need the Zoloft as much. I just recently went off it by phasing myself from 100mg, to 50 mg, and then nothing, over 2-3 weeks. Although it was very helpful, the main side effect that I just could no longer deal with was the inability to reach orgasm. I got so tired of feeling guilty because no matter how hard he tried I could never climax. The only withdrawal I have experienced was one bad emotional episode where I was crying out of control for no good reason, and my short term memory and ability to concentrate are lacking compared to what they were when I was on Zoloft. Overall, I am happy to be off the drug. I felt like I no longer had a good reason to be on it and I just felt too young to be taking a drug regularly (without REALLY needing it).
My question is this: for those of you who had sexual side effects while on Zoloft, but are no longer taking it, how long did it take you, after stopping the medication, to get back to normal and able to reach orgasm?
Posted by Daveman on October 19, 2001, at 1:23:47
In reply to Re: a thought of my own » Daveman, posted by Cam W. on October 16, 2001, at 0:35:03
Cam:
I gather you're having trouble convincing some clinicians of the existence of "brain zaps". I turned up the following research paper- by two Canadian pharmacists!- documenting the phenomenon. Here's the link:
http://www.pharmacyconnects.com/content/phpractice/2000/04-00/php040002.htmlLet me know what you think.
Dave
Posted by Cam W. on October 19, 2001, at 2:29:14
In reply to Cam-here's an article that mentions zaps!, posted by Daveman on October 19, 2001, at 1:23:47
Thanks Dave - I can't believe that I missed that article. I wrote the "Have Your Say" column in the March, 2000 issue of Pharmacy Practice (the month before the article that you quoted came out).
Also, I have downloaded on my computer the 1997 Journal of Clinical Psychiatry, but not the Supplemental Issue that contains the original article from which the "brain zaps" are referenced < doh! >. I'll have to hit the University Science Library and photocopy the article.
Thanks again, Dave! - Cam
> Cam:
>
> I gather you're having trouble convincing some clinicians of the existence of "brain zaps". I turned up the following research paper- by two Canadian pharmacists!- documenting the phenomenon. Here's the link:
>
>
> http://www.pharmacyconnects.com/content/phpractice/2000/04-00/php040002.html
>
> Let me know what you think.
>
> Dave
Posted by cgh on October 19, 2001, at 11:12:04
In reply to Re: a thought of my own, posted by SLS on October 16, 2001, at 15:45:44
I have frequently noticed brain zaps after I tapered Xanax (a benzodiazepine) for panic attacks, from a low dose of .75 mg per day to 1/2 of a .25 mg pill per day divided into "crumbs". I did this taper over a period of about 3 months.The zaps seem to occur mostly on awakening, and frequently come in "clusters", lasting only microseconds and continuing for several minutes to an hour. Often the disappear for several days or a week.I feel them mostly in the back part of my brain. I would like to know if they will eventually disappear, or if they are a permanent affliction. Does anyone have experience with this?
Posted by Erich on October 19, 2001, at 11:27:38
In reply to Re: zaps and benzodiazepines, posted by cgh on October 19, 2001, at 11:12:04
Posted by cgh on October 19, 2001, at 11:44:26
In reply to Re: zaps and benzodiazepines, posted by cgh on October 19, 2001, at 11:12:04
I am not able to access Erich's reply to the above post by clicking on it. What am I doing wrong?
Posted by kid47 on October 19, 2001, at 12:12:47
In reply to Re: zaps and benzodiazepines erich, posted by cgh on October 19, 2001, at 11:44:26
Erich must have unintentionally selcted the "no message" (nm) box on the reply options.
> I am not able to access Erich's reply to the above post by clicking on it. What am I doing wrong?
Posted by cgh on October 19, 2001, at 15:24:31
In reply to Re: a thought of my own, posted by SLS on October 16, 2001, at 15:45:44
Erich, can you repost your response. It didn't come through.
Posted by Daveman on October 20, 2001, at 2:29:40
In reply to Re: Cam-here's an article that mentions zaps! » Daveman, posted by Cam W. on October 19, 2001, at 2:29:14
Hi Cam:
I accessed and read your column. Very well said. It is interesting, when I went to fill my first prescription for psychiatric meds (at the time it was for Paxil, Xanax and Ambien all at once- I was in bad shape!) I was very embarrased and could not even bring myself to look at the pharmacist, I just took the meds and ran out of the store. I felt "defective"- funny I had never felt that way filling prescriptions for antibiotics or painkillers! Since then, however, I've come to terms with it (also I'm a heckuva lot better, thanks in no small measure to these very meds) and I now fill my Celexa and Remeron prescriptions cheerfully.
I must admit though, it is a bit strange being recognized and greeted by name by my pharmacist!
Dave
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