SSRI Withdrawal and Expectations

[MontysGal]

Hi All,
I took a genetic test at CAMH (Center for Addiction and Mental Health in Toronto) which uses a cheek swab to recommend anti-depression/anxiety meds that will work best with your genetics.

The results categorize specific meds into “Use as Directed”, “Use with Caution” and “Use with Increased Caution and Monitoring”.

After being on 20 mg/day of SSRI (Cipralex aka Lexapro) for 8 years, that one is listed on the mid-range “Use with Caution”, so working with a GP I am tapering off of Cipralex to be able to start to take a (ideally lower dose) of one of the more recommended drugs! I made sure I was in a good place mentally before doing so - I was well-prepared and well informed.

All great so far, good team good info. Then I start tapering and holy hell this is a nightmare. Increased heart rate, anxiety, mood swings, irritability, muscle tension, panic, oh my!

I know this is normal, and I know it will suck for a while, but be better in the end. My questions, for those of you that have gone through it are:

1. Any advice? Things you wish you’d have known ahead of time?

2. Any hints on when I can expect these symptoms to abate? It does not seem to be consistent person to person based on my research.

3. Any advice on what to tell people around me?
   I know sometimes I am coming off like a crazy lady, but honestly I don’t want to tell everyone what’s up. I have a good solid base of people I am telling so they are aware/informed.
   But the random other boarders at the barn, they do annoying stuff but I can tell I’m overreacting. Do I inform someone? Just keep my mouth shut and bear through it and hope I don’t do irreparable damage in the interim?

What about work and coworkers/bosses? I don’t think I’m obligated to tell them anything about my health but what if it begins affecting my work?

In the meantime I’m all over that self-care thread (well timed!) and working my steps that I know work hard. It just… well it kinda sucks.
:no:

[Donkaloosa]

Two weeks or so, maybe longer. You may have to do a longer taper. I am not sure that you have to be totally cleared or off of one before switching to a new SSRI.

[Ceylon_Star]

Escitalopram (generic name of cipralex/lexapro) is pretty safe in that once you’re down to about half the dose, you can usually start on the new SSRI. It doesn’t have as many drug interactions as other classes of drugs, or even as some of the other SSRIs. Then, as you slowly decrease the dose further, you can slowly up the dose of the new one.

That said, if the new drug is an MAOI, you will need to be 100% off of the escitalopram for a minimum of 14 days before you can safely start the base dose of the MAOI because the drug interactions can be fatal. (Long story short, avoid MAOIs unless you have literally NO other choice. They interact dangerously with not only other drugs, but also with a LOT of different foods. They’re not fun to be on, that’s for sure)

The anxiety and muscle tension can be reduced a bit by taking a magnesium/calcium supplement. I take one to combat the effects of my testosterone shots, and I find that taking it also helps reduce discontinuation syndrome effects when I am tapering off of my own meds as my psychiatrist and I work to find a combination that works for me.

You don’t need to tell anyone you don’t want to about why you’re extra moody lately, but you may want to apologize and say that you’re under a lot of extra stress (or that there are issues in your family life if your employer starts to question any potential work impairment) and it’s making you snappy. Most people are understanding about that sort of thing, and it can prevent any serious strain on relationships.

Discontinuation syndrome sucks, but it doesn’t last all that long. It just FEELS like it does! Just be kind to yourself, make sure you’re performing all the basic self care that sets you up for a good day, and you’ll be fine. My inbox is always open too. I know alllllll too well what it’s like to have to come off of psych meds (from antidepressants to anxiety meds to antipsychotics, all with differing severity of discontinuation symptoms). It’s not fun, but you’ll get through it! Starting the new med will also help alleviate a lot of the symptoms, which is a bonus.

[Renn_aissance]

SSRI discontinuation syndrome sucks. Hang in there, and fingers crossed you don’t get brain zaps, those were fun. Most people feel much, if not completely, better 2-4 weeks out from discontinuation.

Depending on your new medication, your doctor may approve transitioning onto a low dose of your new medication and tapering up on that while tapering down on the Lexapro.

If you are worried about this affecting your work, or your relationships with others, in one of the moments you feel well, try approaching your barnmates or your manager with a pre-emptive apology that due to a temporary medical condition you’re finding that you have a shorter fuse than normal. You’re working on it and it should be better very soon. If I were your manager, I’d want to know (generically) that you were having an issue before it compromised your performance. If you told me afterwards, it would sound like an excuse for a performance issue. Your mileage may vary depending on your boss.

Hang in there! It sucks but it DOES pass.

[Simkie]

Ugh, it sure does suck. I’m sorry

FOR ME, symptoms peaked about 3 days post last dose, and slowly got better until I was normalish about 2 weeks post.

Definitely recommend a good magnesium supplement as well as a good omega 3 supplement. Starting those a week or two before you stop might be ideal.

I didn’t have a conversation with my boss, but there was a day where I went home early (3 days out, IIRC.) Didn’t need to say anything other than “I wasn’t feeling well.”

Best of luck!!!

[MontysGal]

Thank you all for your kind words of support and wisdom.

I am going onto Effexor (sp?) so the plan is to taper to I think 5 mg of Cipralex then begin the Effexor. According to the genetic test (which is super cool), Cipralex sometimes can require higher dosages with my genetics due to serum levels (I am going from memory, I have the full report at home). So I am hoping that I will end up at a much lower overall dose of Effexor. As far as I know, Effexor is a standard SSRI not a MAOI.

Thank you guys so much for the idea of the magnesium supplement! I was already on vitamin D, but that was just such a good idea I read this last night, climbed back out of bed and dug out the Mg supplements I tried (and failed) for anxiety. They are now sitting beside my Vit. D on the counter to remind me to take daily regardless of how I’m feeling. Thank you!

And thank you for the ideas on how to bring it up to my boss. We are a very structured, large corporation, so maybe I will just pop by HR and tell them something generic about changes and it having a duration of a few weeks - that way as you say I can preempt it and not be making excuses after the fact, but it also gives them a time range so they know this is temporary. That is a comforting thought to me.

And thank you for the ideas of timelines. I think (hope) it peaked on Saturday which would be 6 days after reducing dosage, it came on so suddenly after a few days of no effects that it was downright terrifying.
A lot of internal dialogues with the general self-talk of “what are you doing?!”.

I like the idea of leaving work sick if it gets too bad. Why didn’t I think of that? This is clearly a sickness.

If anyone wants info on the test I took I copied & pasted their details here. Not sure how you qualify, my Canadian GP submitted me for it:

To learn more about this exciting opportunity, please visit our website by clicking here or call 1-800-928-3316 to speak to a member of the IMPACT team.

Sincerely,

The IMPACT Team
Centre for Addiction and Mental Health (CAMH)
250 College Street
Toronto, ON M5T 1R8
Phone: 416-535-8501 ext. 30240
Phone: 1-800-928-3316
Fax: 416-979-4666

IMPACT! Individualized Medicine: Pharmacogenetic Assessment & Clinical Treatment
impact@camh.ca
www.im-pact.ca | www.camh.ca

[kremeroyale]

I got the brain zaps coming off Lexapro, but they went away after 4-5 days if I remember correctly. I cross-tapered as you are doing. My workplaces are fairly casual and I have a good relationship with both my supervisors, so it wasn’t a huge deal to say “hey, dealing with some stuff, should be settled in a couple weeks.” But if you don’t want to say anything more specific than “I’m taking a sick day,” I don’t think anything else should be necessary.

Effexor is an SNRI, so it works on norepinephrine in addition to serotonin. Not to scare you, but should you not find the Effexor effective, they can be harder to come off of than the SSRIs. I was on Cymbalta not Effexor, but it was a BITCH to withdraw from. Sorry you are dealing with this fun, inexact science… hang in there!

[BigPaintHorse]

effexor was a wonder drug for me until i took the genetic test that told me that i should not be taking it at all due to the risks being so high. I agree the taper off of Effexor were horrible and I haven’t found a replacement that works half as well as effexor.

Psych meds are the bane of my existence it seems. I find ones that work that I cant take due to side effects or risks and the others don’t work.

[sketcher]

I had a genius of a p-doc who told me to taper down as far as I could go and then take one 20 mg Prozac. I was down to 1/4 of a pill of the smallest dose but when I stopped the brain zaps and other effects were intolerable. Prozac has a very long half life and keeps the withdrawal away. At least it did for me when I was having an awful time getting off Paxil.

[Frog_Pond]

Hi OP, I have no experience as a patient, but as a counselor and someone with friends who have experienced this, I’ll add my 2 cents:

1. Ask for help if you need it. Call the person who prescribes and ask questions as needed - don’t suffer in silence or hit up Dr. Google too hard. If they’re not great, consider talking to your primary care doctor or their staff. If you’re part of a faith community, talk to a pastor. You get the picture – find support. Not necessarily advice or a change to your plan, but good shoulders to lean/cry on. Avoid people who you know might be . . . less useful in this situation.

2. There is no normal experience here, so just do what you can to minimize the worst possibilities. No one ever felt worse by eating healthy, avoiding booze, exercising hard enough to help you sleep, and practicing great self-care. Don’t expect to feel great – just remind yourself you’d feel worse if you weren’t doing these things! You’re a horse person, clearly, so include peaceful horse contact. No hard clinics right now!

3. Disclosure is a deeply personal thing. No one – especially not your employer – deserves to know the details of your health. The only reason to share health info is to get help, support or resources. There’s no obligation to be “honest” – most of us are surrounded by people who have not shared their losses and struggles. There’s a ton of stigma about all sorts of health & life issues – why take that on if you don’t have to? Wait til you feel good if you want to become an activist. You don’t owe anyone an explanation other than “got a lot going on right now.”

Best of luck.

[MontysGal]

Thanks guys, I’m reading each and every one of these and really appreciate the response.

All I have to say today is that muscle tremors/spasms just SUCK

[CorazonLock]

Montys Gal, I am so sorry to hear about your withdrawals! They are absolutely no fun!

This is my story:
I was on Effexor (which is something I would never take again, purely because the half-life is so short and if you miss a day, you will get the withdrawal feeling), and it wasn’t working the way I needed it to. So I stopped it cold turkey. Bad idea. I began having withdrawals. I was completely over-the-threshold anxious, shaky, and I could hear my eyeballs move. This lasted for maybe three days.

I told my workplace that I was in the process of changing medications, and I was experiencing withdrawal symptoms. I found that this explains that you are really under the weather without revealing your medical condition. If you aren’t feeling well, I encourage you to take a day or more off of work. It is likely that you are not nearly as effective anyway because of these symptoms (at least, that’s what I tell myself). Know that this isn’t going to last forever!

Interestingly, my doctor placed me on Prozac, and after doing some research, I found that Prozac can be useful in helping you wean off another antidepressant and can help withdrawal symptoms. It has a very long half-life, meaning it stays in your system much longer, and it is an older medication that isn’t quite as potent.

I wish I would have done more research on the medications I was taking. I steer clear of any medications that have a short half-life or are very potent (like Paxil - they even coin the withdrawals from that the Paxil flu!). Also, stopping cold turkey is probably not the smartest idea. However, don’t let those things completely sway you on a decision. Just remember to be informed.

[MontysGal]

Hm, seems like a bunch of you have had issues with Effexor. Damn. I have been so consistent on Cipralex (mind you the highest dose…) makes me wonder if it’s worth the change. I guess only time will tell.

Today I had so many anxious restless feelings I literally walked the stairwell up and down at work for 10 mins.
It helped though.

[Ceylon_Star]

Effexor is one of few antidepressants I have not been on, due to its high likelihood of triggering mania in bipolar individuals. But I have heard that it’s one that either works REALLY well, or doesn’t work at all, kicks in fairly quickly, and that yes, coming off of it is brutal. But I’m hearing more and more psychs prescribing low doses of Prozac to help make the weaning off process much easier.

I highly recommend going out and getting yourself a “fidget”. Something you can mindlessly fiddle with in one hand, while you work with the other. A spinner ring, stress ball, dollar store jar of playdough, anything that appeals to you. Keep a full water bottle at your desk/workstation, and make sure you stop to drink regularly. I find that when I’m having restlessness issues, I forget to stay hydrated, and getting dehydrated only makes the restlessness worse and it develops into an aggressive state of anxiety where I am much more likely to go off on anyone who crosses my path.

But above all, be kind to yourself. Take some time out of your day to do something for yourself, whether that’s taking a hot bath, or taking the “scenic route” home from work, or buying yourself a little treat.

Hug!

[neversaynever]

I was prescribed Effexor for menopausal symptoms (hot flashes) because HRT is not recommended for BC survivors. I was on it as I went through perimenopause. It did help with the hot flashes, but it tended to “flattened” my moods - not happy, not sad, not angry, just kind of meh. Like others have stated, if you miss just one dose, you will know it. I came off it after being on it for years. Even tapering slowly, I did get some pretty intense “brain zaps” that made me momentarily disoriented and dizzy. Just something to be aware of and discuss with your doctor.