Doctors Lounge - Psychiatry Answers
"The information provided on www.doctorslounge.com is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her physician."
Forum Name: Antidepressants
Question: Discontinuation syndrome
|4PtSake - Thu Jul 27, 2006 12:35 am|
I am a female, age 44, am currently on Lexapro, have a history of fairly severe degenerative issues in my neck and depression from a very early age...though I didn't seek treatment for the depression until my early 30's.
I had been on and off Zoloft for about 7 years with a couple times on Prozac when the Zoloft stopped working. Several years ago I tried Wellbutrin in an attempt to quit smoking and went off the Zoloft over two weeks while working my dose up on Wellbutrin...that's when I found out I had MAJOR discontinuation syndrome. I spent an entire month with the dizziness, nausea, and other symptoms I hear people talk about but my worst symptom was the "zapping"...for lack of a better description. I literally felt like someone was poking me with a cattle prod (can't tell I'm out west, huh?)...it started in the middle of my chest and ran in every direction from the top of my head to the tips of my toes and fingers about every 10 to 15 seconds. I waited for almost a month for the symptoms to show any sign of diminishing but I finally had to beg my doctor to put me back on Zoloft because I couldn't stand it any more...the symptoms went away within 48 hours of restarting. A little over a year ago I decided I wanted to go off the Zoloft because I didn't want to be held hostage and I was told Lexapro had less chance of the same issues I had with the Zoloft. My psychiatrist started me on Lexapro and, over the course of about a year, weaned me off the Zoloft. I had some minor issues each time the dose was changed for a day or two but successfully made the change completely about 6 months ago. About a month ago my work schedule became irratic and I managed to miss a dose but didn't realize it until about 12 hours after the missed dose when the zapping started again. Is it very common for people to have this much trouble even when they've done everything right...in terms of weaning off the meds VERY slowly...and for the symptoms to hang on as long as they did that first time? Is it possible for these kinds of antidepressants to be covering up nerve issues? I ask that because of the neck problems and the fact that I do have (as of my last MRI a year ago) some stenosis in my neck. I also had an uncle who died last September from peripheral nerve sheath sarcoma (my mothers brother)...not that I think I have it but it makes me wonder about nerve issues since he had trouble with mild discomfort when people rubbed his skin even before the cancer and I seem to have similar issues on occassion.
Any information, suggestions, or comments would be greatly appreciated.
Thank you for offering this forum...it's nice to be able to ask questions and get a variety of information.
|DeLWolcott - Thu Dec 21, 2006 11:52 pm|
Discontinuation syndrome can rear its ugly head in many ways. According to a study performed several years ago at Harvard, around 70% of patients will experience moderate to severe withdrawal symptoms if they stop the medication abruptly. As you have come to learn, slow withdrawal can ease the symptoms to a tolerable state.
The cattle prod - always my exact description of the zaps. In my experience and many I know in Paxil-related cases feel these starting in their head and eventually zapping throughout the body at the frequency you describe.
Everything you describe is not unusual. You have to listen to your brain and body during the withdrawal process, possibly going slower, with smaller drops or even at times being able to go a little quicker. There is no magic time schedule.
Fatigue also triggers withdrawal symptoms. Be sure to get plenty of rest - even a catnap of about 20 minutes during the day if you are able. Controlled breathing. Removing yourself from a difficult situation until your nerves and symptoms have calmed down.
As for the skin issues - Extended use of these medications 'can' bring on symptoms of fibromyalgia and/or rheumatoid arthritis - although testing will prove that neither exist in the patient. During withdrawal all senses become over-sensitive - especially light, sound and touch. There are also reports of phantom smells and tastes. Odd, but true. There can be a restlessness felt (akathisia), or the feeling that something is crawling all over and under the skin. Again, this diminishes over time.
On a good note, successful tapering is attainable. The further away from your last dose, the more the symptoms diminish. There will be ups and downs, but the ups become longer and you have to hold on to the memories of the 'ups' to get through the down times. Psychotherapy and/or counseling should be utilized during this time to learn coping skills.
Anyone going through this should keep in very close contact with their physician. Others may have no problems at all, but those who do experience discontinuance syndrome need to know that it's not all in their head - it is very real, but can be overcome with proper support and education.
|4PtSake - Mon Dec 25, 2006 5:12 am|
Thank you De Lyn for the reply.
It's always nice to know you're not alone when something like this comes up. I had been told by one doctor it was simply anxiety and another it was the side effects from the Wellbutrin (one at an urgent care clinic and the other a family doctor).
I do have one other question if you find this and have a moment...and have an answer. Is it likely that having discontinuation syndrome on one medication can make me more suseptible to it on another? My psychiatrist, while she didn't doubt my telling her I also had it on Lexapro, said she had never heard of anyone having it with this particular medication.
Thank you again De Lyn for your reply and reassurance and have a Merry Christmas and a Happy New Year!
|DeLWolcott - Tue Dec 26, 2006 2:09 am|
Tapering is necessary on all of these medications after they have been taken for more than a couple of weeks. The shorter time a person has been on them, the shorter time it should take to taper off.
No, I cannot say that the occurence of discontinuation syndrome from one medication signals that the person will have it with all of these medications. There are some medications that have worse track records than others. Wellbutrin is actually a different class of drug than Lexapro, so the effects and withdrawal may not be similar, but it does have to be tapered also. It seems hypocritical that an anti-anxiety/depression medication could cause the symptoms to increase, but it is true. Also, it must be noted that switching medications will not ease withdrawal from the one being stopped.
Lexapro seems to one of the medications with the least reported cases of moderate to severe withdrawal symptoms, although there have been numerous cases reported. The key is to educate yourself on what could happen, but do not 'expect' them to happen. Know that rest is important when tapering off of any of these medications. Keep tabs on how you are feeling and don't rush yourself. You will have a good idea when you are ready for a drop and you can always slow down if needed.
I hope I helped more than confused with my answers. Best wishes to you and thank you for the good wishes!
|Dr. K. Eisele - Tue Dec 26, 2006 4:32 pm|
Hello, and Merry Christmas! I'm sorry I wasn't able to get to your post sooner, it did not show up on my list of "unanswered questions."
Very slow tapering off antidepressants that utilize serotonin for their mechanism of action is indeed necessary. The antidepressants in this category that are in common use today include the SSRIs and a new class called the SNRIs.
citalopram (Celexa), and
The SNRIs include:
The discontinuation syndrome that is commonly experienced is actually properly called the serotonin discontinuation (or withdrawal) syndrome (not the same as serotonin syndrome, which refers to excess serotonin in the system).
Notice that bupropion (Wellbutrin) is not on either list. This is because it has no action on serotonin. It works by increasing the amount of norepinephrine and dopamine that is available to nerve cells. There is no discontinuation syndrome associated with this medication, and it would not be of any use to help ease the withdrawal symptoms of a medicine that has serotonergic actions.
Other antidepressants that use serotonin in their mechanism of action can help ease the symptoms of withdrawal from another of this class of medications. For example, a switch to a medicine within the same class that has a longer half-life is often used to help. One anti-depressant with a VERY long half-life is fluoxetine (Prozac). However, because it's half-life is so long, you would have to take Prozac for approximately 2 weeks before you stopped the other anti-depressant. At that point, one could decrease the first anti-depressant relatively quickly (4 weeks vs. 6 months), because the Prozac is on board and it does use serotonin for its action. After the first anti-depressant has been completely tapered off, the Prozac can be discontinued, with no tapering. No taper is required because it has such a long half-life--it tapers itself, so-to-speak, and it does it very slowly.
This method works so well that it is common practice in the area in which I practice. Some doctors don't like this method, however, and you would need to consult with your physician to find out her preferences.
Escitalopram (Lexapro) does not commonly produce a discontinuation syndrome because it's half-life is much longer than that of paroxetine (Paxil) or venlafaxine (Effexor).
I will answer your other questions about the nerve problems a little bit later. I'm afraid I've run out of time for right now.
|Dr. K. Eisele - Tue Dec 26, 2006 7:31 pm|
I am now addressing your concers about nerves. Generally, the SSRIs are thought to act mostly in the central nervous system (CNS), which refers to the brain and spinal cord. We do know, however, that there are effects in other parts of the body, for example, in the platelets.
The newest of the antidepressants, duloxetine (Cymbalta), of the SNRI class, does have the additional indication of treatment of diabetic peripheral neuropathy. For the purposes of this discussion, I am simply pointing out that Cymbalta is known to have widespread effects on the nervous system--both CNS and peripheral nervous system (PNS).
I think there is a possiblity that the condition you mentioned having to do with your neck may have sensitized you to the serotonin discontinuation syndrome. I think you should see your physician as soon as possible--whoever follows up with nerve condition. In addition, unless there is a compelling reason for you to stop escitalopram (Lexapro), I think staying with that medicine as regularly as you can would be worthwhile, at least until you are advised about the nerve condition.
Please drop back in and let us know how you're doing.
|4PtSake - Wed Dec 27, 2006 12:57 am|
Thank you to both of you for all the information...I'm going to have a lot to speak to my new doctor about. Gives me quite a bit to think about a research until I can get in for an appointment.
Hope you both had a wonderful Christmas and have a Happy New Year.
|Told me it was TMJ - Mon Jul 19, 2010 3:33 pm|
I just found out after 2 YEARS that it's not TMJ after all. The feelings I am having from my recent cease in Paxil use happens to be "discontinuation syndrome" not TMJ after all. I wish the Dr. would have told me that before the $2000 + spent on the oral surgeon and night guard!
|Faye Lang, RN, MSW - Sun Jul 25, 2010 11:01 am|
Hello Told me it was TMJ,
I'm glad you were able to finally discover the reason for your symptoms. It can be frustrating when medical science still requires "trial and error" in ruling out what might be happening, but it sometimes is necessary in order to identify exactly what is happening. I hope your discontinuation syndrome is resolved as quickly as possible.
Good luck to you!
|| Check a doctor's response to similar questions|
Are you a Doctor, Pharmacist, PA or a Nurse?
Join the Doctors Lounge online medical community
Editorial activities: Publish, peer review, edit online articles.
Ask a Doctor Teams: Respond to patient questions and discuss challenging presentations with other members.