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Dr. Bob is Robert Hsiung, MD,
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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
Posted by Cam W. on October 20, 2001, at 3:04:25
In reply to Cam- Read your column!, posted by Daveman on October 20, 2001, at 2:29:40
Thanks Dave - I wrote that column because there are a lot of pharmacists out there who still think that mental illnesses are not treatable disorders. The stigma associated with mental illness runs deep in our culture. Many pharmacists are scared of their mentally ill patients.
Even the pharmacist I work with (who is also a Doctor of Naturopathy) says that anyone who takes Prozac is a nutcase and feels that those with schizophrenia should be locked up for the safety of the public (this coming from a guy who believes that water has a memory). I told him that I am taking Effexor, so I must be one of those nutcases he is talking about. He said no, that my depression was understandable, because my daughter had died. When I told him that I had had depressive episodes long long before my daughter's accident, he changed the subject.
This guy also looks down his nose at the boss's sone who was recently diagnosed (2 or 3 years ago) with schizophrenia. He also pushes away the affectionate mentally-challenged patient we have at the store, who often comes in with his mom. He will take this kid's money, but the doesn't warrant any affection back.
Man, I feel sorry for people like my colleague; being close-minded really does rob one of living life to the fullest.
- Cam
Posted by sjharve62 on October 21, 2001, at 0:56:34
In reply to Re: Cam- Read your column! » Daveman, posted by Cam W. on October 20, 2001, at 3:04:25
> Daveman-I cannot thank you enough for the article!!! I have repeatedly tried to explain these "zaps" to people, even doctors, and they just looked at me like I was just hallucinating. I am going to print it and take it to a doctor and see if there is anything that anyone can do for me-my "zaps" have been going on intermittantly for about six years-since I got off of zoloft. They are just so hard to explain that I have stopped trying, and just try to live with it, but I am getting worried because they have lasted so long.
Thanks again for the article.Cam,I am so sorry for your loss.
Janie
Posted by Cecilia on October 21, 2001, at 4:10:02
In reply to Re: Cam- Read your column! » Daveman, posted by Cam W. on October 20, 2001, at 3:04:25
> Thanks Dave - I wrote that column because there are a lot of pharmacists out there who still think that mental illnesses are not treatable disorders. The stigma associated with mental illness runs deep in our culture. Many pharmacists are scared of their mentally ill patients.
>
> Even the pharmacist I work with (who is also a Doctor of Naturopathy) says that anyone who takes Prozac is a nutcase and feels that those with schizophrenia should be locked up for the safety of the public (this coming from a guy who believes that water has a memory). I told him that I am taking Effexor, so I must be one of those nutcases he is talking about. He said no, that my depression was understandable, because my daughter had died. When I told him that I had had depressive episodes long long before my daughter's accident, he changed the subject.
>
> This guy also looks down his nose at the boss's sone who was recently diagnosed (2 or 3 years ago) with schizophrenia. He also pushes away the affectionate mentally-challenged patient we have at the store, who often comes in with his mom. He will take this kid's money, but the doesn't warrant any affection back.
>
> Man, I feel sorry for people like my colleague; being close-minded really does rob one of living life to the fullest.
>
> - CamCam, your article was interesting, but I think the role of the pharmacist in Canada must be very different than in the U.S. I would feel violated if a pharmacist decided to talk to me about my treatment plan or called my doctor about whether my meds were working!
Posted by Jackster on October 22, 2001, at 4:09:56
In reply to Cam- Read your column!, posted by Daveman on October 20, 2001, at 2:29:40
>
> I must admit though, it is a bit strange being recognized and greeted by name by my pharmacist!
>
> Dave
I got the shock of my life when one of the pharmacy assistants addressed me by name when I just walked in with a friend who was buying some pain medication. I guess that's part of being a regular visitor - the pharmicist there is really good - and here I was thinking I was just another customer.Jackie
Posted by Katie Bourdeau on October 23, 2001, at 10:14:15
In reply to Re: withdrawal symptoms coming off zoloft, posted by Merv on April 8, 2000, at 14:50:01
I am 17 years old and am on Zoloft. My Doctor prescribed it to me though I know It is not recommended for people under 18 years of age. I have been on and off Zoloft twice. I was on Zoloft and switched to Paxil which I did not care for due to the fact that my mom is on Paxil and finds it hard to get off. I then switched back to Zoloft which I am quite happy with. I have not experienced any side effects. Though I am scared of withdrawal. I don't believe that I will stop taking Zoloft anytime soon, but this is a concern for me. I also find that if I miss one day without taking my pill I get extreamly depressed. But as of now I am a happy person and haven't been checked into the hospital for six months. Go Zoloft!!!
Posted by Kwind on October 24, 2001, at 9:28:57
In reply to Re: withdrawal symptoms coming off zoloft, posted by SW on October 5, 2000, at 20:07:54
Well,I started weaning myself from Zoloft about 2 weeks ago. I have been feeling horrible. But, that is not reason I am writing.I first came here to find out the exact symtoms to comming off the zoloft, to see if the ones I was having were normal.Because, like everyone else, I am getting no info from my doctor.I had no plan to respond. But, I have to say that I strongly suggest not getting on these happy pills to begin with.(I know,from experience easier said than done.) I have been on them for 2 years.And in those 2 years, I've realized that these pills have NOT helped me at all, only covered up the problems, So, really I suggest getting some other kind of help before even starting these mind alltering DRUGS. I relize that there are people who think these pills help them,I'm guilty of this same feeling,but they don't I still have the same problems,that I had two years ago. I just know now that A pill is not going to take them away.I hope that I'm not offending anyone because, I am not trying to. I just really want people to see this medication for what it is . A temporary solution!!!! I guess unless,you plan to take it forever. I also, know other people who have taken this same medication and had the exact problems actually,worse than mine own experience. The only problem I see now is finding a alternative to taking medication. I really have no plans,But,I do know that I will NEVER take Zolft or any other like it no matter what this crazy life sends my way.
Posted by LyndaK on October 26, 2001, at 23:08:47
In reply to Re: withdrawal symptoms coming off zoloft, posted by Kwind on October 24, 2001, at 9:28:57
Hi Kwind,
I haven't reviewed the whole thread here, just read your message. I've been off and on Zoloft for over 5 years now (tried other AD's here and there). For the most part I agree with what you've said. These pills are not a "cure" much as the insurance companies would like them to be. But I'm not sure I would've done as well in my therapy sessions (or stayed semi-functional in my life) if I hadn't had the meds on-board. I think meds, a good therapist, and the determination to accept-understand-and make changes is the best combination for recovery.
Best wishes in your search for what works for you.
Lynda
> Well,I started weaning myself from Zoloft about 2 weeks ago. I have been feeling horrible. But, that is not reason I am writing.I first came here to find out the exact symtoms to comming off the zoloft, to see if the ones I was having were normal.Because, like everyone else, I am getting no info from my doctor.I had no plan to respond. But, I have to say that I strongly suggest not getting on these happy pills to begin with.(I know,from experience easier said than done.) I have been on them for 2 years.And in those 2 years, I've realized that these pills have NOT helped me at all, only covered up the problems, So, really I suggest getting some other kind of help before even starting these mind alltering DRUGS. I relize that there are people who think these pills help them,I'm guilty of this same feeling,but they don't I still have the same problems,that I had two years ago. I just know now that A pill is not going to take them away.I hope that I'm not offending anyone because, I am not trying to. I just really want people to see this medication for what it is . A temporary solution!!!! I guess unless,you plan to take it forever. I also, know other people who have taken this same medication and had the exact problems actually,worse than mine own experience. The only problem I see now is finding a alternative to taking medication. I really have no plans,But,I do know that I will NEVER take Zolft or any other like it no matter what this crazy life sends my way.
Posted by scutterbut on November 19, 2001, at 12:03:44
In reply to Re: withdrawal symptoms coming off zoloft, posted by MaddieGrace on October 18, 2001, at 11:56:00
My God! This sight has saved my sanity ironically! I've been on Zoloft for about 6 years. I worked my way up to 100mg. per day. Recently, i went to my Dr. with the desire to become "drug free". The reasons for Zoloft no longer existed.I had also gone through therapy for awhile for depression. He agreed, and started my decline. I went down to 50mg/day for one week. Then 25mg./day for 1 week. I even went as far as 12.5 mg/day for a week, just to ensure i was taking every possible precaution of weaning myself off the right way. I took my last dose last Friday. I was experiencing mild "dizzy spells" all along the process, but over the weekend i thought i was losing my mind! The dizzy spells(for lack of a better description)became so intense, i was afraid to leave my house for fear of fainting or blacking out while driving. I also experienced sparadic "crying episodes" for no reason. I think i even frightened my daughters. Then last night, i awoke at least 4 times with the sensation of "drowning and gasping for breath".
I don't want to go back to taking any Zoloft, especially if these symptoms will eventually fade. Does it differ in the length of time it takes?
As far as my sex drive, it came back almost immediately, and it couldn't be better. My boyfriend(God bless him) has been most patient with me over the years, and now he can reap the benefits, but so can I!!! I've tried several different hormonal programs, such as EStratest(which caused severe acne over my entire face & back) and also did not work, and also external creme which was supposed to be applied every night. That didn't work either. My only answer was going off the Zoloft.
Please confirm that these withdrawal symptoms will go away for me. If and when they do, i intend to let everyone know that contrary to what the Doctors say, withdrawal from Zoloft most definitely exists, and warn these poor unsuspecting candidates to what lies in store for them in order to prepare them ahead of time!
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