Medication Withdrawal Effects

I've been searching the web lately trying to better understand potential adverse health effects from psychiatric drug withdrawal.   Why can one person get off a psych med without hardly an ill effect while another will suffer for months during the process?  Hmmm, this looks interesting.

Each person's brain/body responds differently to drug withdrawal, just as each brain/body reacts differently to a new drug.  In the latter the process can produce adverse reactions we call side effects.  For drug withdrawal, troublesome symptoms are usually called withdrawal effects.  A more fancy term being used is discontinuation syndrome.

Withdrawal Effects.  Withdrawal from psychotropic medications can include flu-like symptoms such as fatigue, lethargy, aches, insomnia, diarrhea, nausea, and dizziness.  Some people become hospitalized because of the withdrawal process.  The experience can be horrible and last months or even years according to those who've been through a bad withdrawal.

In an online web forum one practicing M.D. was quite critical of the withdrawal effects from psych meds.  He lamented that there are some patients who's experiences are so bad that they end up deciding to stay on the drug, even when they have determined it has no therapeutic value for them.  They were stuck on a drug that wasn't working because withdrawal was too excruciating.  What's worse, some unfortunate souls in this situation continue to experience withdrawal effects even after getting back on the drug!

From an article on antidepressant withdrawal, the writer says withdrawal effects are more likely to occur (a) if you have been on the medication for six weeks or longer and (b) if you are within the first two weeks of the tapering off process.

Drug withdrawal symptoms are reported across the psychiatric spectrum.  An article in the journal Medical Hypothesis reports withdrawal effects in antidepressants, antipsychotics, lithium, and benzodiazepines such as Xanax.

I was quite concerned about withdrawal effects from the antipsychotic Abilify (aripiprazole) during my recent tapering off from it (see my last post on 12/12/11 about this).  I didn't do much research before stopping.  I just hoped for the best.  Fortunately things worked out well for me.

Some personal websites were particularly grave about the withdrawal effect.  I bet these folks are the unfortunate ones who have debilitating symtoms that can last for many years.

We certainly need more research in this area.  Without more information it is difficult to compare the risks and benefits of stopping.  Perhaps there are other medications or practices we can do to minimize the withdrawal effect?

One big step in the right direction comes from a new company adverseevents.com.  They are making it possible to readily find information about the toxic effects of medications including psych drugs.  Their process uses a propriety algorithm to extract data from the FDA's Adverse Events Reporting System (AERS) and assemble the information into a useable and understandable format for patients and healthcare professionals.

Paxil. One drug that kept coming up was the SSRI antidepressant Paxil (paroxetine).  According to a the Mayo Clinics Medical Edge Newspaper Column, Paxil is in a group of SSRIs that are the most difficult to quit.  This is because certain SSRIs are metabolized (removed from the body) more rapidly than other SSRIs.

In one blog post the author explains her experience with Paxil withdrawal effects.  Her reaction was so severe that they had to allow seven months for her to taper off.   Withdrawal effects included headaches, lethargy, depression, dizziness, the "zaps" (whatever those are) and nausea.  At the same time she says a close friend withdrew from Paxil with only headaches.

Adverseeffects.com reports withdrawal effect information about Paxil.  Data they have from consumers between 1/1/2004 to 6/30/2011 that shows withdrawal from Paxil has a hospitalization rate between 5 and 7 percent!  Wow, who knew?

I don't remember any withdrawal effects when I got off Paxil about 10 years ago.  Maybe I was too depressed to notice.  I remember I didn't respond well to the drug therapeutically.

Takeaway message.  The symptoms from tapering off vary a lot from person to person and drug to drug.  Trying to determine who will experience withdrawal effects and how severe those effects will be is really anybody's guess at this point.

We need to explore whether the long-term recommendation for bipolar disorder treatment should be indefinite use of psych meds?  Should medication for life really be the presumptive remedy?

Finally, when stopping a medication it is critical to work with your psychiatrist so that the tapering off period is as gradual as necessary to control the withdrawal effects.  You need to start low and go slow.