Far be it from me, a blogger, to give doctors a lesson in managing antidepressant withdrawal... but I'm going to anyway.
I've been writing this blog for 8 years now and, over this period of time, have been inundated with emails from patients struggling with withdrawal issues from their medication. Most popular question is along the lines of "How long does it take before these terrible side-effects go away?"
A good 90% of the emails start off by telling me the side effects, crying, sweating, electric-like zaps in the head, shaking, most of these conditions, if not all, appear when the patient starts to taper off the drug on the advice given by their healthcare 'professional'.
When I have told those who have contacted me about their medication being available in a liquid form they are flabbergasted. Why didn't my doctor tell me this? is the normal reply.
The liquid formulation for SSRi type medication came about as a result of pharmaceutical companies being able to persuade doctors [via their reps] that patients who had difficulty in swallowing their medication could always use the liquid. These 'patients' were the elderly and children. The liquid was never intended to be used as an aid to help people wean off the medication.
Wait a minute, these medicines aren't meant for children. Correct, but that has never stopped the pharmaceutical industry reps in their quest to boost company sales in return for that big bonus at the end of each month or quarter.
So, what about adults who have no trouble swallowing tablets? Well, the gist I'm getting from the emails I've received is that doctors tend to read the company spin on withdrawal.
Pharmaceutical companies never liked the word 'withdrawal' as it implied giving the patient a hard time so they changed it to 'discontinuation'. Doctor's when reading the product monograph for any of the SSRi's will read that 'discontinuation syndrome should only occur for around two weeks'. There is no information given to the doctor or patient about how much he/she should reduce their dosage by.
Contact the manufacturer of your particular SSRi and you are taken on a frustrating journey.
Pharmaceutical companies will tell you that they are not allowed to discuss individual patient cases and will refer you back to your healthcare professional, who remember has at his disposal the product monograph that claims 'discontinuation should only last around two weeks'.
Truth of the matter is, discontinuation/withdrawal can last months even years. Your healthcare professional won't acknowledge this because all he has to go on is what the pharmaceutical company have provided him [product monograph]
Some of the advice given by doctors that I've seen personally has ranged from the ridiculous to the sublime. Here's some:
- Cut your tablet in half
- Take 20mg Monday, 10mg Tuesday, 5mg Wednesday then stop.
- Try stopping altogether at the weekend as there will be less stress in your life, ie; work, dropping the kids to school. If you still feel bad then start again on Monday.
One patient, a 17 year old, was told by his trainee psychiatrist, to stop taking his Prozac at weekends so he could enjoy up to six bottles of beer then restart again after the weekend. That patient, Toran Henry, killed himself shortly after being prescribed a generic form of Prozac [Fluox]
So, where can doctor's go for their information on antidepressant reduction?
Product Monograph [Written by the manufacturers of the drug]
Patient Information Leaflet [Written by the manufacturers of the drug]
Medicines Regulator [A body fully funded by the pharmaceutical industry]
Where do patients go?
Well, they go to the one person they can trust, their doctor. It may take a while for the patient to realise that the doctor is as clueless as they are when it comes to withdrawal help, it's then that they turn to either friends or, more commonly these days, Google.
Many patients find themselves using search terms such as 'Escitalopram aggression', 'Seroxat Brain Zaps', 'Cipramil Agitation'. The hits, when I first started this blog, were few and far between. That's when I learned that Seroxat isn't called Seroxat in the USA, it's called Paxil. Back then I Googled the words 'Paxil + Withdrawal' - I hit the jackpot. Website after website, forum after forum appeared. Stories about brain-like zaps, aggression, suicidal thinking, self-harming. The same can be said today for Cipramil and Escitalopram [both brand names for drugs known in the US as 'Celexa' and 'Lexapro' - Try a Google search yourself and you will see much more can be learned by typing in the US brand names opposed to the British/European brand names.
Even if you do find evidence that you are not alone in this withdrawal hell don't expect your healthcare professional to thank you for bringing the evidence to his/her attention. More than likely you'll be told that it was he/she who went through med school, if he/she does tell you this then ask him/her how long he spent covering SSRi withdrawal.
He/she may also tell you not to do your own research as you are either not qualified in such matters or the information on the internet about SSRi's is just conspiracy theories.
What you, as a patient, must do is TELL your doctor that you need a liquid version of your antidepressant so you can taper safely and effectively. Remember, this is YOUR body.
Tapering by using the liquid is a very slow process but it is much safer than skipping doses or drastic reductions in dosage.
You may find the taste somewhat off-putting, Glaxo's Seroxat liquid is orange flavoured and tastes like 5 cups of sugar has been added. If you can get through the bad taste then it's better than having to endure mind-bending electric jolts through your head.
Apparently the liquid formulations of SSRi's cost more, probably one of the main reasons doctors won't write scripts for them.
Remember that SSRi withdrawal is your own experience, it does not belong to your doctor or anyone else for that matter. Don't frustrate yourself because the manufacturers of your medication won't help you - that's just their way of avoiding litigation. If they acknowledge you are having a bad time on their drug then they'd have to acknowledge that other people are too - that would just open the door and they'd be flooded with personal injury lawsuits.
So, how slow do you taper once you have the liquid? As slow as you need to is the answer. I came down 0.5mg per week. [20mg dose of Seroxat = 10ml of Seroxat liquid] It took me over a year to drop from 40mg per day to 22mg per day. I then quit cold turkey - not recommended.
So, if you are a healthcare professional using Google and you have stumbled on this post then I suggest you put your BNF to one side, disregard all the pharmaceutical propaganda you have at hand, take off your God hat and start listening to patients.
The pharmaceutical industry will get richer from you, the patient, snapping up their sickly, foul-tasting liquid but at least you will be reducing the money going in their pocket. What's it to be, a slow taper or a life-time hooked on SSRi's?
At the time of writing this I'm only aware of four SSRi's that are available in liquid. Namely, Fluoxetine, Sertraline, Paroxetine and Citalopram .
Bob Fiddaman
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