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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by Abductee Wannabe on September 29, 2003, at 19:02:16
Well, at the moment I am in the middle of a nasty celexa withdrawal that has been going on for weeks. I was on 20mg of celexa for the past year or so after being at 40mg for a few months, and then decided to taper off, going to 10mg for a week, then 5 mg for a week, then 2.5mg for a week (yes I got the liquid form of Celexa for this), then off. The taper didn't help. SSRI discontinuaton syndrome symptoms are fairly well known so I won't bother listing them all here. The worst symptoms are the "brain zaps" and the suicidal urges and deep depression.
I am still taking klonopin. I have stopped taking wellbutrin for the moment in an attempt to reduce the anxiety the withdrawal is generating. Stopping the wellbutrin has had no noticeable effect one way or the other though.
The only interesting thing about this withdrawal is that now that I am getting to experience the infamous "brain zaps," waves of dizziness, disorientation and weird sense of unreality when I turn my head, etc. I recognize them: these are exactly the type of feelings I would get during a bad episode of social phobia, before I started taking klonopin.
I find it interesting that others only experience this during a ssri withdrawal. This was pretty much my normal state under any kind of stressful social situation before klonopin! So if you have had withdrawal "brain zaps," imagine having them every time you made eye contact with someone and you know what my world has been for the last 15 years or so until Klonopin.
Anyway, with nothing better to do I was doing some net research on discontinuation syndrome and I came across some references to the effect that it was caused, not by low serotonin levels, but by an anticholinergic rebound. I don't understand this, since I have taken imipramine in the past and know what anticholinergic symptoms (dry mouth, night terrors, constipation, etc.) feel like and they are nothing like ssri discontinuation syndrome symptoms. But anyway...
Some sites suggessted taking choline and B vitamins could be of help in helping the brain re-establish a healthy level of acetylcholine.
Well, most B vitamins don't have much choline at all (50 or 100 mg, in the form of choline bitartrate, and I am not a big fan of diarrhea) so I looked for something purer. I could not find any choline chloride liquid around here but I did find a "choline cocktail" powder made by Twinlab which has a bunch of ingredients including 1500mg of Choline Dihydrate Citrate per dose. As per the instructions on the bottle I have been taking two doses (the powder makes an orange drink) daily.
After 5 days of this, I can report it has had no beneficial effect whatsoever.
Posted by Dr. Bob on September 30, 2003, at 19:14:49
In reply to Celexa withdrawal - choline hasn't helped, posted by Abductee Wannabe on September 29, 2003, at 19:02:16
> Well, at the moment I am in the middle of a nasty celexa withdrawal that has been going on for weeks.
Sorry, but would you mind re-registering under a different name? Being abducted is something serious. Thanks,
Bob
Posted by Joe Schmoe on September 30, 2003, at 19:48:02
In reply to Re: please re-register » Abductee Wannabe, posted by Dr. Bob on September 30, 2003, at 19:14:49
> Sorry, but would you mind re-registering under a different name? Being abducted is something serious. Thanks,
Sorry, I had registered in the past but I forgot my password and there is no "if you forget your password" feature. I finally managed to guess it again so I can use my original registration name now.
Posted by Dr. Bob on October 1, 2003, at 17:59:18
In reply to Re: please re-register » Dr. Bob, posted by Joe Schmoe on September 30, 2003, at 19:48:02
> Sorry, I had registered in the past but I forgot my password and there is no "if you forget your password" feature.
Well, there's a "reset your password" feature:
https://dr-bob.securesites.com/cgi-bin/pb/newpwd.pl
Bob
Posted by Joe Schmoe on October 1, 2003, at 21:02:07
In reply to Re: 'forget your password' feature, posted by Dr. Bob on October 1, 2003, at 17:59:18
> > Sorry, I had registered in the past but I forgot my password and there is no "if you forget your password" feature.
>
> Well, there's a "reset your password" feature:
>
> https://dr-bob.securesites.com/cgi-bin/pb/newpwd.plThanks. I didn't see anything like that, but in any case I was registered under an old e-mail address which means I couldn't use that procedure anyway. I was basically up a tree, which was why I registered a new name in the first place, but fortunately I did eventually figure out my old password so I could update my old account with my new e-mail and post under this name again.
Celexa withdrawal continues. I think it is actually less severe now that I have stopped taking that choline cocktail drink, but it is still difficult to drive since every eye or head movement brings on a surge of disorientation and dizziness. Needless to say I am minimizing my driving as much as possible.
Posted by linkadge on October 2, 2003, at 15:39:12
In reply to Re: 'forget your password' feature, posted by Joe Schmoe on October 1, 2003, at 21:02:07
When you are coming off a SSRI the LAST think you want to do is boost dopaminergic transmission. This will make you feel worse.
What will help are folic acid, 5-htp, blueberry extract, exercise, and time
Linkadge
Posted by Joe Schmoe on October 2, 2003, at 16:19:59
In reply to Choline idea is BS, posted by linkadge on October 2, 2003, at 15:39:12
> When you are coming off a SSRI the LAST think you want to do is boost dopaminergic transmission. This will make you feel worse.
Actually the idea was to boost cholinergic transmission, the lowering of which is supposedly what causes discontinuation syndrome.
Here is a typcial page discussing this:
http://www.bipolarsurvivor.com/ssri.html
The reference is:
Biological Psychiatry Vol. 54, page 534
Selective Serotonin Reuptake Inhibitor Discontinuation Syndrome Is Associated with a Rostral Anterior Cingulate Choline Metabolite Decrease: A Proton Magnetic Resonance Spectroscopic Imaging Study
Marc J. Kaufman, Michael E. Henry, Blaise deB. Frederick, John Hennen, Rosemond A. Villafuerte, Eve P. Stoddard, Mark E. Schmidt, Bruce M. Cohen, and Perry F. Renshaw
> What will help are folic acid, 5-htp, blueberry extract, exercise, and time
Why would 5-HTP (serotonin) help? That is like climbing back on the merry-go-round. I might as well take more Celexa. How will that help my brain get used to lower levels of serotonin again?
Posted by stjames on October 2, 2003, at 19:30:45
In reply to Re: Choline idea is BS?, posted by Joe Schmoe on October 2, 2003, at 16:19:59
> Why would 5-HTP (serotonin) help? That is like climbing back on the merry-go-round.Adding 5-HT is not going to increase serotonin,
at least not in the way you think.I might as well take more Celexa. How will that help my brain get used to lower levels of serotonin again?
>Well, depression is not an issue of too much or too little serotonin. Time is the only thing I know that will allow your nervous system to return
to it's old ballence.
Posted by Joe Schmoe on October 2, 2003, at 20:30:32
In reply to Re: Choline idea is BS?, posted by stjames on October 2, 2003, at 19:30:45
> > Why would 5-HTP (serotonin) help? That is like climbing back on the merry-go-round.
>
> Adding 5-HT is not going to increase serotonin,
> at least not in the way you think.Isn't 5-HT just another name for serotonin? The serotonin receptors are all named "5-HTx" where x is the receptor number.
>> I might as well take more Celexa. How will that help my brain get used to lower levels of serotonin again?
> Well, depression is not an issue of too much or too little serotonin.I was referring to discontinuation syndrome, which obviously seems to be related to lower serotonin levels after serotonin-raising drugs are withdrawn. I don't want to take anything which would undue what progress I have made in getting over this discontinuation.
Posted by linkadge on October 3, 2003, at 8:42:57
In reply to Re: Choline idea is BS?, posted by Joe Schmoe on October 2, 2003, at 20:30:32
The cholinergic theory is just a theory.
The discontinuation happens for this reason.
When you boost serotonin levels, there is a corresponding drop in dopamine levels (through activation of 5ht2 receptors) Anyhow, over time the dopamine receptors increase their sensitivity in order to compensate for less dopamine.
Anyhow when you discontinue, process happens in reverse. Dopamine levles resume to predrug status, which is only intesified by supersensitive receptors. This is why you can actually have a high shortly after discontinuing.
Anyhow, low serotonin and high dopamine causes the symptoms of discontinuation such as depression, anger, rage, panic, crying, feeling hot all of a sudden, feeling so utterly wronged.
Boosting cholinergic transmission can intesify that by increasing dopaminergic transmission.
Not to mention that choline itself can perpetuate depression and is generally an ill-advised nutrient for people suffering from depression.
The only way to get off an SSRI sucessfully is to slowly let the system adjust to less serotonin.
To avoid withdrawl symptoms you must taper the drug over the course of weeks to months.Other ways are to try an support the serotogenic system in other ways - perhaps more taperable ways - such as supplements like magnesium, folic acid, 5htp, exercise.
The problem is that when you discontinue an SSRI you get biologically angry, and you project that anger onto the drug that you took. If your withdrawl is severe, you need to resume some of the initial dose. And taper more slowly.
Withdrawl sucks, I just got off of celexa about 3 months ago, and am now doing fine, but these are the things that helped me.
Oh - and I forgot to mention blueberry extract, boosts neurogenesis which can help you cope while the system adjusts.
Linkadge
Posted by Joe Schmoe on October 3, 2003, at 9:19:28
In reply to Re: Choline idea is BS?, posted by linkadge on October 3, 2003, at 8:42:57
Thanks for the interesting discussion.
> The discontinuation happens for this reason.
>
> When you boost serotonin levels, there is a corresponding drop in dopamine levels (through activation of 5ht2 receptors)I should note I have also been taking Wellbutrin for some time, and my Celexa dose was only 20mg, so I suspect my dopamine levels may not have been that low. I stopped taking Wellbutrin during the Celexa withdrawal just to see if it made any difference - it didn't, and I haven't resumed it yet. I like Wellbutrin because I can go on and off it at will with no side effects.
>Anyhow, over time the dopamine receptors increase their sensitivity in order to compensate for less dopamine.
Well, if that is true, I have to wonder why, after two years of Celexa, I still had virtually no libido.
> Anyhow when you discontinue, process happens in reverse. Dopamine levles resume to predrug status, which is only intesified by supersensitive receptors. This is why you can actually have a high shortly after discontinuing.I did not experience this. I know what a dopamine surge feels like from the first few weeks of taking Wellbutrin and I felt nothing like that during this withdrawal. My appetite was not affected, I did not lose weight, and I felt no increase in libido either. I am still waiting for my libido to return actually.
> Anyhow, low serotonin and high dopamine causes the symptoms of discontinuation such as depression, anger, rage, panic, crying, feeling hot all of a sudden, feeling so utterly wronged.Well it seems obvious low serotonin has something to do with it, but the scientific report I cited made reference to low acetylcholine, not high dopamine, during SSRI withdrawal. Is there a paper that advocates the high dopamine theory? I certainly did not feel any speed-like effects over the last several weeks.
> Boosting cholinergic transmission can intesify that by increasing dopaminergic transmission.I admit I have never read anything about this one way or the other. Is choline given to Parkinson's patients?
> Not to mention that choline itself can perpetuate depression and is generally an ill-advised nutrient for people suffering from depression.
That may be, but depression is not the problem at this point - discontinuation of Celexa is, despite a gradual taper. In the last 24 hours I have finally started to feel some improvement and can walk in a (mostly) straight line.
> The only way to get off an SSRI sucessfully is to slowly let the system adjust to less serotonin.
That sounds reasonable.
> To avoid withdrawl symptoms you must taper the drug over the course of weeks to months.
I did taper it, starting at 20, which is a low dose to begin with, and going to 10mg for a week, then 5mg for a week, then 2.5mg for a week. I was surprised by the severity f the withdrawal. I am also on Klonopin so I was surprised by the amount of anxiety and phobia-like symptoms I have experienced.
> Other ways are to try an support the serotogenic system in other ways - perhaps more taperable ways - such as supplements like magnesium, folic acid, 5htp, exercise.I guess my point is that if you boost serotonin levels you are in effect going backwards in the taper process. At this point I just want to get it over with.
> The problem is that when you discontinue an SSRI you get biologically angry, and you project that anger onto the drug that you took.Well, onto the drug companies anyway. :-)
>If your withdrawl is severe, you need to resume some of the initial dose. And taper more slowly.
Unfortunately I have come to regard these things as something of a poison to be gotten out of my system at all costs.
> Oh - and I forgot to mention blueberry extract, boosts neurogenesis which can help you cope while the system adjusts.Sounds like an interesting subject in itself.
Posted by stjames on October 3, 2003, at 9:31:49
In reply to Re: Choline idea is BS?, posted by Joe Schmoe on October 2, 2003, at 20:30:32
>
> I was referring to discontinuation syndrome, which obviously seems to be related to lower serotonin levels after serotonin-raising drugs are withdrawn. I don't want to take anything which would undue what progress I have made in getting over this discontinuation.Actually we don't know the cause of this syndrome.
It is the regulation at specific sites that changes, not the overall levels.
Posted by stjames on October 3, 2003, at 12:07:38
In reply to Re: Choline idea is BS?, posted by Joe Schmoe on October 2, 2003, at 20:30:32
> Isn't 5-HT just another name for serotonin? The serotonin receptors are all named "5-HTx" where x is the receptor number.
>No it is a precursor (the product sold), and you cannot take serotonin directly as it would not pass the blood/brain barrier.
Posted by linkadge on October 3, 2003, at 14:15:36
In reply to Re: Choline idea is BS?, posted by Joe Schmoe on October 3, 2003, at 9:19:28
>I should note I have also been taking Wellbutrin >for some time, and my Celexa dose was only 20mg, >so I suspect my dopamine levels may not have >been that low. I stopped taking Wellbutrin >during the Celexa withdrawal just to see if it >made any difference - it didn't, and I haven't >resumed it yet. I like Wellbutrin because I can >go on and off it at will with no side effects.
This can change the nature of Celexa withdrawl
>Well, if that is true, I have to wonder why, >after two years of Celexa, I still had virtually >no libido.
The libido effect is only partially explained by low dopamine. Even with psychostimulants/ and or wellbutrin, there tends to be a degree of genetal anesthesia.
>I did not experience this. I know what a >dopamine surge feels like from the first few >weeks of taking Wellbutrin and I felt nothing >like that during this withdrawal. My appetite >was not affected, I did not lose weight, and I >felt no increase in libido either. I am still >waiting for my libido to return actually.It is of course very short lived. Dopamine is useless if serotonin levels are low. When I say a rush, I perhaps mean more of a feeling of clarity.
This experience is the same for missing a dose of long half-life SSRI. You still have 5ht boosting going on, but you also get a dopamine boost during a short time of missed dose.
Well it seems obvious low serotonin has something to do with it, but the scientific report I cited made reference to low acetylcholine, not high dopamine, during SSRI withdrawal. Is there a paper that advocates the high dopamine theory? I certainly did not feel any speed-like effects over the last several weeks.>The dopaminergic and cholinergic systems are intricately intertwined. The drop in acetylcholine may be responsible for certain aspects of SSRI withdrawl, but I wouldn't think it would ameleorate the emotional response to SSRI withdrawl. I certainly don't mean a long lasting euphoria in any sense. My withdrawl went like this. For the first 15 hrs or so of missing celexa, I felt great (better than average day on celexa), like I didn't need it and like I could conquer the withdrawl. However shortly after I experienced effects such as.
Anger, and extreme irritability. [felt like smashing things that weren't working] and extreme stubbornness [could not stop doing things that had no relavence at all] both of which are consistent with high dopamine - low serotonin model.
>{Boosting cholinergic transmission can intesify >that by increasing dopaminergic transmission. }
>I admit I have never read anything about this >one way or the other. Is choline given to >Parkinson's patients?I have seen it recomended to parkinsons patients.
There was a study done which showed that choline is contraindicated in those with depression. It noted that in addition to mildly enhancing acetylcholine neurotransmission, it had an enhancement effect on dopaminergic neurotransmission. It theorized that part of the reason choline perpetuated depression was by enhancement of dopaminergic system and subsequent attentuation of the serotogenic system.
>That may be, but depression is not the problem >at this point - discontinuation of Celexa is, >despite a gradual taper. In the last 24 hours >have finally started to feel some improvement >and can walk in a (mostly) straight line.Yes but you must that you problems are compounded by a somewhat low mood. The brain zaps you get (or most people get) when you move suddenly are because of noradenic releas onto hypersensitive noradrenic receptors.
>I did taper it, starting at 20, which is a low >dose to begin with, and going to 10mg for a >week, then 5mg for a week, then 2.5mg for a >week. I was >surprised by the severity f the >withdrawal. I am >also on Klonopin so I was >surprised by the amount >of anxiety and phobia->like symptoms I have >experienced.This is common. The reason you felt good enough to get off Celexa was because your brain was in good balence. It can take a while for the brain to reset itself. It is easy while on an AD to forget pre-AD life. Thats why I recomend implementing anything and everything that can help stave off a relapse.
>I guess my point is that if you boost serotonin >levels you are in effect going backwards in the >taper process. At this point I just want to get >it over with.
I know what you feel. When you're on the downhill you don't want to stay there. So you think that by running faster down the railroad tracks you will avoid the train.
What I am saying is that there is a high insidence of relapse when coming off AD's. You do have a predisposition to depression, or you wouldn't be on AD's in the first place. You took them for one reason alone - you needed them.That is why I recomend implementing suplements, and other things like exercise (to partake in - indefinately) that will help stave off the chances of relapse. I know what you want - just to be free from everything - for me that wasn't an option. THats also why I built my own rTMS device.
>Unfortunately I have come to regard these things >as something of a poison to be gotten out of my >system at all costs.
When we feel good - the drug companies are miracle workers, when we feel lousy they are low life backstabbers with only one intent.
That is the common mechanism of all AD treatments, rTMS, vitamin D, lithium ECT
etc... neurogenesis.
Linkadge
Posted by Joe Schmoe on October 3, 2003, at 14:47:17
In reply to Re: Choline idea is BS?, posted by linkadge on October 3, 2003, at 14:15:36
My situation is somewhat different than yours I think. Wellbutrin did an excellent job for my depression - the main reason Celexa was added was to counteract the chest pains and other musculoskeletal side effects the Wellbutrin was creating (like easily tearing ribcage muscles). The Wellbutrin seemed to wind up the muscles in my ribcage like a spring, leading to pain and frequent muscle pulls. The Celexa stopped that. Unfortunately it also had a negative impact on my libido. Meanwhile the klonopin did and continues to do a great job on my major complaint, social phobia.
I started to feel poorly again at some point and went up to 40mg of Celexa but it had no additional effect so I dropped back down to 20.
I went off Celexa recently, not because I felt great, but because I was starting to become depressed again and the lack of libido was definitely too high a cost to pay for any benefit I was getting from the Celexa. I didn't see any point to continuing with it. I would rather just see how Wellbutrin by itself works as an AD and take a smaller dose if necessary, skipping doses when necessary, to avoid chest pains, assuming I have not developed some tolerance to them by now.
To my knowledge Celexa and other SSRIs were approved for short term treatment of depression (up to a year or two). I am not aware offhand of any studies claiming long term efficacy.
Don't know what "rTMS" stands for.
Posted by linkadge on October 3, 2003, at 19:30:15
In reply to Re: Choline idea is BS?, posted by Joe Schmoe on October 3, 2003, at 14:47:17
Yes your situation is definately different. Your original syptoms of depression (I could be wrong) probably included apathy, lack of motvation, oversleeping, and lack of energy. Wellbutrin is great for these symptoms.
This also could make your withdrawl side effects different from the typical person. How long did you say you've been taking Celexa?
Linkadge
Posted by Joe Schmoe on October 3, 2003, at 22:34:19
In reply to Re: Choline idea is BS?, posted by linkadge on October 3, 2003, at 19:30:15
Yes I have the "15%" version of depression - oversleeping, overeating, etc. On the standard depression questionnaires it always looks like I am doing great because I do not suffer from insomnia or lack of appetite. You'd think there would be two versions of that thing.
I have been on Celexa around two years, on Wellbutrin and Klonopin a few months longer than that. Paxil was intolerable and Serzone was a failure, and took forever to taper down from. No withdrawal effects though per se, although I did notice when, rather abruptly, a certain obsession (with a girl) came back that the Serzone had gotten rid of while I was on it at a high dose.
Posted by stjames on October 3, 2003, at 23:47:28
In reply to Re: Choline idea is BS?, posted by Joe Schmoe on October 3, 2003, at 22:34:19
Yes I have the "15%" version of depression - oversleeping, overeating, etc.
Those are some of the criteria for atypical depression
Posted by Joe Schmoe on October 5, 2003, at 18:10:22
In reply to Re: Choline idea is BS?, posted by linkadge on October 3, 2003, at 14:15:36
linkadge wrote:
> The brain zaps you get (or most people get) when you move suddenly are because of noradenic releas onto hypersensitive noradrenic receptors.
This is very interesting. Is there some resource on the Web you could direct me to for more information? I have never heard an explanation for what causes "brain zaps" before.
I find this particularly interesting because these "brain zaps" feel exactly what my social phobia felt like before I started using Xanax and then Klonopin to control it. It has been facinating to discover other people at last describing the same symptoms I have had - except they have it during SSRI withdrawal, instead of in situations which would trigger my social phobia.
Posted by T_R_D on October 6, 2003, at 15:34:12
In reply to Re: Brain zaps = noradrenic release, posted by Joe Schmoe on October 5, 2003, at 18:10:22
> linkadge wrote:
>
> > The brain zaps you get (or most people get) when you move suddenly are because of noradenic releas onto hypersensitive noradrenic receptors.
>
> This is very interesting. Is there some resource on the Web you could direct me to for more information? I have never heard an explanation for what causes "brain zaps" before.
>
> I find this particularly interesting because these "brain zaps" feel exactly what my social phobia felt like before I started using Xanax and then Klonopin to control it. It has been facinating to discover other people at last describing the same symptoms I have had - except they have it during SSRI withdrawal, instead of in situations which would trigger my social phobia.Yeah, any other information would be awesome...this latest bout of Effexor withdrawal has my brain feeling like scrambled eggs thrown up against a brick wall...
This is the end of the thread.
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