On another note. Neuro programs now although teach some old curriculum speaking of serotonin for activating frontal cortexes in depression, but these programs also add a disclaimer that the monoamine hypothesis is now being abandoned. They don’t know how SSRI work. It’s not possible that benzo withdrawal, SSRI withdrawal, post concussion syndrome, long covid, fibromyalgia, visual snow syndrome, hallucinationogenic persistent perceptual disorder present in a similar fashion, yet only one is connected to serotonin. I agree with high activity in limbic system. I’m not sure if it can be easily hypothesized as a separate disorder. Ultimately, all these disorders have been hypothesized based on the basis of biological monoamine hypothesis. Yet, it’s none of it is that simple. A highly alert fear center of the brain from injury, infection, abnormal psychological experience can produce thousands of symptoms via various sensory, auditory, vestibular, perceptual, visual cortexes. Anyhow, I quite enjoy watching your videos. I think they provide great value with possibilities for treatments. Clonidine is recorded in anecdotal experiences for being utilized in akathisia, HPPD, ptsd and several similar conditions. Maybe there is a noradrenaline connection after all. But that would mean that one size fits all. As you know nearly everyone responds differently.
Day 20 of my dose reduction, there are important changes, so I didn't hide this post in the replies as usual. I have found a clarity of thought I haven't felt for a long time!, I feel clear headed and alert to my surroundings. I am out of my comfortable 'cocoon' of indifference and lethargy which had become something of a crazy 'Catch 22' situation, I wanted to recover but didn't have the energy or compulsion to do so, I was just happy to drift along in life unaffected by anything. My emotions have not been tested yet (I live a boring life!) and yes I am worried about any unexpected stress or anxiety and how well I will be able to cope with that. This is a significant change for me and I'm pleasantly surprised at such a positive development. 🙂
You can make your own thread to document your body's withdrawal (jumping off a cliff or % reductions) and how you ended up on a Psychotropic Pharmaceutical(s), documenting your frustration at uninformed GP's/Psychi's, Therapists, etc. Just everything, really. It's incredibly important for as many people as possible to specifically show iatrogenic injuries while on these Pharamceuticals and the Withdrawal (NOT relapse) from them. Maybe that will help people stop losing money, jobs, etc.
Great video. Another important aspect is protracted withdrawal, which can last for many months and often even years after discontinuation of SSRI/SNRI. This is due to an autonomic dysregulation. Unfortunately, the etiology of both acute and protracted withdrawal is not yet fully understood.
Protracted withdrawal is a functional neurological disorder. Which essentially begins from hyperarousal and over excitation of amygdala. So this explains somewhat. I had serotonin syndrome and then cold Turkeyed that led to protracted withdrawls/fnd. Now I don’t know how to get better. Any recommendations?
@@PsychiatrySimplified yes it has. I was diagnosed with ptsd and FND at neurology clinic. Along with that I received a couple of other labels such as visual snow syndrome and fibromyalgia. They couldn’t offer any advice, other than EMDR and John sarno’s books.
Thank you for validating and explaining the reality of withdrawal. The extreme agitation you mention is akathisia. Antipsychotics are the number 1 cause of akathisia so not sure why you’d give that to someone already suffering from it.
No akathisia and agitation are different phenomenologically and in their history. Labels create a lot of confusion. Hence the phenomenology I.the specific assessment of the experience matters in treatment. Akathisia is not agitation. Both are very treatable and require different approaches
I have the rebound anxiety now. Also horrible anhedonia... I don't feel any positive emotions. I've been off SSRIs for 11 months. It's kind of like a living hell, feels like being trapped in a void. I just hope I heal and get better. Good video.
Going through same hell 12 months off SSRI. No positive emotions. Depression-like. Also horrible neurological dysregulation. Severe brain pain and pressure.
Does clonazepam use 1.0mg for 3 month and tapering for 2 month cause withdrawl symptoms. Rebound Anxiety, tachycardia, hyperthermia 100°F fever,vibration in hand body,Insomnia, decreased appetite are withdrawl symptoms?
I have told my doctor that i experienced this, i got anxiety over the feeling of physical scratches, even those give me anxiety, and doctor keep adding up trifluoperazine dose i dont understand
Those withdrawal symptoms are the exact same withdrawal symptoms I had with Gabapentin. I was first prescribed Gabapentin in 1997 at 13yrs old after blowing out my knee and took it continuously until after recovering from my 7th surgery on that knee 6yrs ago at age 34. I'd been on the highest dose my doctor could legally prescribe for 2yrs prior to the last surgery. I hated the way it made me feel....icky is the only way I can describe how Gabapentin made me feel and it wasn't really helping anymore so without talking to my doctor or doing any research I just stopped taking it. I don't recommend quitting that way. I had the exact same withdrawal symptoms as the ones in this video...FOR A WHOLE MONTH. On the plus side(I guess?) after going through that it made the 7 days of absolute Hell of withdrawals from quitting heroin cold turkey seem like a cake walk(in retrospect, not at the time lol)
Please discuss the phenomenon with the doctor so they can treat it. For example if someone has had high Bp and previously they had headaches and then they treat the Bp and headaches cease. Then when they withdraw the medication and stop it - the return of the Bp elevation which can happen may present as other symptoms besides headchaes as well - chest pain, exertional breathlessness, migraine, blurred vision etc. we go to the doctor and express the symptoms - based on the expression , they will investigate and treat . The answer may not be just an anti hypertensive. It could be something else depending on the symptoms
Protracted withdrawal is a label. The video covers protracted withdrawal in terms of the mechanism. It’s ultimately the symptoms that guide treatment. The video covers The steps needed to address the changes that occur after discontinuing SSRIs or if tapering is difficult. So applicable for all changes
I still experience streaks of light out of the corners of my eyes on occasion. I never had this before treatment. It’s not painful but it definitely spooks me at times, but when I try to move my eyes to look at the lightning bolt-like lights I see, they disappear.
Now that have been specifically evidence based or recommended. However one may consider Zn, Mg B6 which helps in production of serotonin and melatonin. B6 in high doses can be neurotoxic so one has to be cautious. Other spectators to help sleep can make a difference
Thanks. Your video is so complete in this field. Could you please prepare another video about the psychological aspect of whidrawal like racing thoughts. Looping intrusive thoughts more severe than my OCD, flasback thoughts, and derealization. Why is your brain reacting to every thought and catastrophizing
Day 31 of dose reduction (alternating 100mg and 50mg each day) I seem to be stuck in the same zone as mentioned previously, time to adjust the dose further with the help of my GP who is aware of my situation.
Great video ! I have to keep watching it to understand how to help my son . He tried Zoloft had very bad side effects, he can’t talk normal, only repeating words and very bad ocd. Can NAC help or other supplements? I just want him to be back to normal that he can talk normal . Thank you
The principles of allostatic load and homeostasis apply to all situations where we are making pharmacological changes. Mirtazapine has prominent antihistaminergic activity hence historic rebound can occur as opposed to Serotonergic rebound. Having said that Mirtazapine also has anti anxiety effects via serotonin antagonism so removal of that can lead to a rebound. Bupropion is activating via NA and DA potentiation with nicotinic receptor antagonism - so activating agents when removed tend not to have a rebound - but a deficit . Hope that makes sense. So bupropion does not typically have a rebound withdrawal like SSRIs do
Are you aware of anyone who’s fully recovered from withdrawals using this method? Curious. Protracted withdrawal syndrome is FND. But if there’s a way to rescue it, then why not. After all FND itself is fully reversible.
Which method? There isn't one method - its applying basic principles of treatment. And yes, individuals improve and can be treated better. In many cases, what is being considered withdrawal can be agitation - and treatment of agitation is effective.
Excellent video, very informative and high quality! I had that "toxic" effect from increasing Mirtazapine dose after a gradual decrease. My supportive therapy is Pregabalin 150mg.
Excellent video. I am suffering from withdrawl symptoms from desvenlafaxine even being switched to prozac to mitigate the symptoms. My Dr don't believe me. What can I do? I am terribly lost. I give all my money to find a solution. Hugs from Spain. Please I need help.
Its difficult to provide advice as its an individualised approach. 1. Focus on sleep 2. In second part of video i discuss medications such as mood stabilizers or clonidine, prazosin etc which can be used depending on the symptoms one has 3. Discuss the above with the doctor - as it is important to differentiate between when withdrawal symptoms are becoming worse and may be overlapping with hyperarousal and agitation
It's for real. 1 year off SSRI. Long term use. It's like nothing normal, hard to describe in words. Inhumane thing. My worst symptoms are severe head sensations, pressing, burning, pain, electricity, vibrations, terror. Pulsating along the spine and muscle pains. Can only walk shorter distances. Rapid taper almost c/t. It feels like brain injury. Is it possible? Or neurological injury. Can we heal? Thanks for important information!
@@Snowflake1374 please have a listen to the video again. Labels like protracted withdrawal dont need to a management plan. Reinstating in context of anxiety and agitation worsens the situation. Often it’s not pure withdrawal anymore - likely a combination of hyperarousal and agitation which needs to be treated accordingly. If anything provide the doctor will all symptoms so they can address them with a significant focus on sleep. Ps not advice
Not treatable, no cure. I have talked to Dr’s. They said nothing helps (exept reinstatement if you’re too far out) and it can takes years. Tried reinstate, too late, got worse. Once you crash and is neurological dysregulated/injured. Only time can hopefully heal. In my case also iatrogenic injury. You can also call it neurotoxic injury or temporary brain injury.
Its not treatable. I have talked to Dr’s. Once you’ve crashed and is neurological dysregulated/injury. Only time can hopefully heal. In my case iatrogenic injury as well.
Considering that SSRI withdrawal enhances noradrenaline, wouldn’t withdrawal from tapering an SNRI be worse since serotonin levels will drop while noradrenaline reuptake is inhibited at the same time as low serotonin increases noradrenaline?
@@jimwillmott6050 not necessarily. Venlafaxine as an SNRI has amongst the most prominent withdrawals as its SERT affinity is high. An SSRI after stopping or SNRI leads to a rebound NA increase via LC rebound. An SNRI such as duloxetine or desvenlafaxine has a SERT:NAT ratio of 10:1. After ceasing the SNRI the noradrenergic levels drop via the NAT activity being ‘restarted’.
Well what you described concerning increased noradrenaline explains my current withdrawal symptoms from a slow taper of duloxatine to 16.5mg (taken 1X/day 8:00AM). My anxiety is unbearable on awakening in a sweat. BP is elevated along with GI distress. Seems serotonin is too low relative to noradrenaline.
@@jimwillmott6050 sorry to hear. Was it prescribed for anxiety? With sweats yes it does sound like a noradrenergic rebound. Ultimately its the symptoms that we should focus on as the response to discontinuation is very heterogenous- in this case ensuring that sleep, Hyperarousal is addressed becomes important.
I’ve taken many different psychotropic drugs for 22 years for depression. More recently adderall, duloxatine and trazadone. I tapered off adderall and limit caffeine. Over 17 months I followed hyperbolic tapering for duloxatine from 60 to 16.5 mg. Trazadone from 100 to 15mg. My symptoms are almost exactly those of the young lady you showed in video except sleep has been good. Thanks for your concern and interest.
The description I've highlighted is the progression towards agitation - its likely not agitation as sleep is good -have a look at the video on anxiety vs Hyperarousal vs agitation
Thank you for this very informative video. I was prescribed an anti-emetic (compazine - an anti psychotic) during my SSRI discontinuation for the severe dizziness, and got severe akathisia which persists two years later. I am wondering if you can give more detail on why you have recommended D2 blocker anti psychotics to address agitation, as the opposite happened for me. Could you address the akathisia risk with these medications? Clonidine has been recommended to me but I'm too terrified to try anything now. Would love to know your thoughts, thank you.
Prochlorperazine is a D2 antagonist - ones to reduce agitation are low dose D2-5HT2A antagonists with antihistaminergic effects - such as quetiapine , olanzapine mainly. Severe akathisia may be part of the agitation- the motor agitation. Issue is akathisia has a very specific definition and if it’s persisted after AP has ceased this is unlikely to be akathisia by the definition of a AP induced SE . In these situations it becomes crucial to address symptoms based on phenomenology and not labels. There is no one size fits all here and it’s very individualised
@@PsychiatrySimplified thank you for taking the time to reply. 🙏 I am in Australia and have been unable to find a psychiatrist or neurologist who knows about this and can help me. I am one of the cases who have cascaded and I'm unable to taper. Can you recommend anyone who would see me in Aus? There are a community of akathisia sufferers who have not been able to resolve their symptoms after drug cessation, while less common Seroquel and Olanzapine have caused akathisia for some, along with Abilify, Latuda, benzo and SSRI withdrawal. More drugs seem to make most of us worse. It's a dire situation and any attention to it is much needed. 🙏
You have said this is highly individualised but most psychiatrists have absolutely zero idea about this and so certainly cannot tailor an individual plan, and you don't take patients or have a list of recommended psychiatrists. Where do we go with this valuable information? Chat gpt has given me more information than any psychiatrist ever has been able to give on my situation. There are some dopaminergic properties to Clonidine that make it a risky option if your akathisia is caused by dopamine depletion and there is no doctor to clarify this with because they don't understand this level of detail.
I have a variant of tardive akathisia (inner agitation with depression) from Venlaflaxine. I tapered 5 years ago and it started after I tapered. Clonidine is useless for me. It's nice to have for nights you can't sleep or something like that. No meds, exercise, meditation, good diet, anything, helps long term except a benzo. Exercise helps while I'm training but the effect doesn't last. Lorazepam completely stops the agitation/depression and anxiety. I just take it in the evening and suffer a bit during the day. Being active during the day helps minimize it but it's completely impossible at night to sit and focus on a task mentally without some help. So search up Dr Stewart Shipko, he has 9 articles on Mad in America. All about this topic and his experience treating people who feel they have some sort of long term condition after tapering SSRI. So it's an informed position based on experience. He gained a reputation as a specialist in this so people sought him out. I find he is exactly correct on every single aspect. It's like he was reading my mind. I was on a waiting list for a psych after my doc had me try Buspirone and Clonadine and then was like "see ya" after that didn't work. I told her only Ativan helped but she wasn't interested. At the time I was only taking it every 2-3 days because I had to ration it. I knew it worked because I had some from an old script for flight anxiety. Then had to do what I had to do to get it. There is no other option. Thankfully my psych had a sense of ethical responsibility to not let people suffer.
Also I disagree regarding clondiine. Yes onboarding the SSRI can increase agitation initially but that’s short term. Long term it reduces it. That’s why clonodine is just making the symptoms while the SSRI reduces them long term
Thanks for your comment. I’m not sure what you mean by disagree? With which part? SSRIs do not treat agitation and can worsen it. They treat the anxiety paradigm. Big difference. That’s why in treating depression guidelines clearly say - caution with SSRI or ADs as can increase agitation. Pls see the video on anxiety vs hyperarousal vs agitation. 3 different constructs. Every single person’s withdrawal experience is unique. Did you see the common neurobiology of NE rebound. It’s the symptoms that tell us the expression of the underlying dysfunction and clonidine targets the most prominent one of sleep dysfunction , REM rebound. It’s not about agreeing or disagreeing - it’s what is infront of us and what we need to target. Not every single person can substitute an SSRI and reach the state they desire during withdrawal. I’ve seen the sever end of the spectrum when the cascade continues to worsen.
Day 6 of my dose reduction and I'm feeling slightly light headed and fuzzy headed at the same time, my general mood has lifted slightly, there is some slight nausea but not drastic, I did wonder if the thought (even subconsciously), of dose reduction, which I have associated with the chance of an improved lifestyle, if there is some sort of placebo effect in play?. I intend to include the sugar reduction and exercise regime (afarp) in my plan based on what others have said, watch this space!
Day 9 of dose reduction, I'm not sure alternating 50mg and 100mg is proper tapered withdrawal but it was recommended by my GP who asked me to contact him after 2 weeks, I still have light headedness and slight nausea, a touch of irritability on occasions. Sleep is still good although I'm waking very early, there does not appear to be much difference in emotions or libido yet (still blunt) but I'm assuming its down to the long term conditioning of 100mg over 14 years. It's actually, on the whole, quite promising at the moment, as I half expected neural fireworks and psychotic crashes, but I still have a fairly boring life (which is actually a good thing in these circumstances!)
Day 15 of dose reduction and I'm having some notable changes. The irritability is still there much of the time and often this leads to angry thoughts, which do seem to be overreactive and not driven by any significant emotional response, these instances also can lead to increase in headaches. One worrying development is the bouts of despair I feel, which seem to be increasing, I first thought it might be the depression returning but the feeling is not deep and is usually a momentary thing, as my well established philosophical reasoning (SSRI disassociation) resolves the issue (anxiety and poor mood). Sleep is being disturbed by waking very early and not being able to simply drift back into it as most people do, I have to lie awake and wait for self meditation to work or if that fails simply get up and have a nap later in the day.
I'm dying every day. I was on many drugs for my OCD and then they misdiagnosed me with bipolar put me on many other drugs my life is over. It's been nine months. I am off my meds, but it's like nightmare😢 Akhatisia,anhedonia, cognitive impairment, insomnia, DPDR, racing thoughts, and severe mood swings،Hyper sensitive nervous system. Hyper salivation,horrofic nightmare.looping intrusive thoughts ,weird flash back from old memories and negitive feeling I never had them before starting medication. I'm getting worse every day. I can't take it anymore 😢😢 I really want to live, but I can't take it anymore. I am so close to suside everyday. Could you please help me? Most of my physical symptoms are gone, but mental ones are so severe and are changing every hour. I am afraid the reinstate can make things worse . To your knowledge what can I do?
Im sorry to hear. Please see a psychiatrist or a doctor to assess and treat the symptoms. The Hyperarousal or agitation is distressing and seeing a doctor / psychiatrist to discuss the severith may help. Pls seek medical advice
@PsychiatrySimplified I did in the past, and they misdiagnosed me with bipolar disorder and put me on more meds that detoriate my situation. Also, I made tolerance poopout whodrawal medications made me like a robot and bl9cked my positive emotions.
Please listen to the latter half of the video - the patient experience and management . The trajectory of discontinuation that is not resulting in significant allostatic load should be a downward trajectory. If it’s not improving or getting worse- look at the key aspects to look at - sleep, arousal, agitation etc. one may need to address that to ease the process . Otherwise this distress acts as a load worsening the cascade
@@PsychiatrySimplifiedcan you somehow simplify what did you mean with this, i am croatian, even when I translate can not understand what you mean to say. Hoppefully not to treat simptoms with other drug? Much love from Croatia
Does this help ? Ako doživljavate prestanak uzimanja SSRI-a, obratite pozornost na drugu polovicu videa u kojoj raspravljamo o iskustvima pacijenata i kako upravljati simptomima. Idealno bi bilo da proces povlačenja s vremenom postane lakši. Ako se vaši simptomi ne popravljaju ili se pogoršavaju, usredotočite se na ključne čimbenike poput spavanja, uznemirenosti i tjeskobe. Rješavanje ovih problema može olakšati proces odvikavanja, inače bi stres mogao pogoršati stvari.
@@PsychiatrySimplified omg, you are the best! Can I make up somehow? Here doctors are brutal, they blame patience for everything, never mentioned side efects, so thanks from bottom of my heart. If you ever go to Croatia, you have to stay in me! Lovr
Hey, Dr. Sanil, have you ever considered making a video about Viloxazine (Qelbree)? It seems to have an interesting mechanism of action, but there are not many videos about it.
Could it be that adding bupropion to sertraline before I reduced sertraline and then stopped eases my withdrawal then, given that bupropion should activate noradrenaline?
Difficult to say. Noradrenergic potentiation plays a part in withdrawal so adding bupropion in the context of noradrenergic withdrawal may worsen things but also noradrenergic and dopaminergic potentiation allows one to control the emotional heightening.
@@PsychiatrySimplified yes i see, i guess timing may be crucial here. My dreams have been incredibly vivid as you suggest in the video. Not nightmares but real enough to wake me several times int he night.
I did. I too have experienced these symptoms in the past however Cymbalta is on a different level of pure hell. Thankyou for sharing your knowledge on antidepressants ☺️🙏☮️
I'm hoping I can ask my GP to watch your video, I've been on maximum dose venlafaxine and Pregabalin and also tramadol, I live with severe withdrawal symptoms even though I'm taking the medication and so he wants to take me off all meds I have to say I'm petrified 😪 have a wonderful weekend and thank you so much for your videos 🫂
I fought with my psychiatrist to taper extremely slowly off Effexor..in a titration type of way. I already deal with fibromyalgia, and the fact that my GP who originally had me on the how to take care of my thyroid for at least eight years … so they were very bad things that happen. I know it’s been very scary… so that’s why I fought with my psychiatrist to allow me to taper and how I needed it, which was the smartest thing to do versus telling me to stop at 37.5 mg and then just giving me Prozac..😵💫😑
I fought with my psychiatrist to taper extremely slowly off Effexor..in a titration type of way. I already deal with fibromyalgia, and the fact that my GP who originally had me on the how to take care of my thyroid for at least eight years … so they were very bad things that happen. I know it’s been very scary… so that’s why I fought with my psychiatrist to allow me to taper and how I needed it, which was the smartest thing to do versus telling me to stop at 37.5 mg and then just giving me Prozac..😵💫😑 FYI, so many women are just tossed antidepressants when really they should be on hormone replacement therapy. It’s disgusting how many GPs will just toss antidepressants at women going through hormonal changes and really so many women have benefited from going on hormone replacement therapy and what they actually needed because that’s what was going on within their body. .. hormone changes. With the right hormone as you can equally get your dopamigetic and serogenic properties plus the added benefit of heart saving health ( unlike antidepressants that could actually put more strain on the heart), less joint pain, etc etc etc. Where is the antidepressant could just not do anything at all regarding so many different organs and systems in the body and just add more frustration for the things it’s not taken care of.
Which out of the medications you recommended works on noradrenaline pathway reduction? My GP asked, I showed him the video, he asked if I could message you to clarify.
I would recommend focusing on the symptoms. If nightmares, sleep disorientates. Vivid dreams , unrefreshed sleep - prazosin or clonidine Note benzodiazepines also do this but come with their own issues If agitation is present - this is the severe psychomotor restlessness - then low dose AP may be needed. Please also see video on anxiety vs hyperarousal vs agitation Moreover please note the entire symptomatology needs to be addressed - I.e if depression is present then simply addressing sleep won’t resolve situation. Ps not advice
Yes dysthymia - often tends to have underlying psychological aspects - this requires an understanding of childhood experiences for a formulation. MDD itself is heterogenous and has various presentations
I’ve covered that in the video - it’s the symptoms that should be discussed with the doctor . Ultimately it’s not about labels but how to address the symptomatology and distress.
I was able to quit sertraline with zero withdrawals thanks to exercising and drastically reducing sugar consumption. I had tried to quit sertraline at least 7 times over the course of 13 years, and had horrible withdrawals every time. When i finally succeeded, I was on my diet and exercise regimen and simply ran out of my medication because of procrastination. The withdrawals were completely gone. It was an unexpected result. I've been off the medication for four years now.
@@georgebordeaa What really seems to do the trick for me is cutting out sweets and doing cardio. Cardio does something for me that weights just can't. But that is just my own experience.
This is why people like mark horowitz are wrong. Hyperbolic tapering can be dangerous for some. The people who successfully come off their meds are because they do the underlying work while on meds and know how to keep calm during withdrawal symptoms. The withdrawal itself doesn’t dramatically increase allostatic load it’s our reaction to it that does
Yes it is correct - but the reaction to it however is embedded in our fear responses which may have multiple other etiologial underpinnings - personality styles, trauma , medical conditions etc
The expression of symptoms is heterogenous. There can be multiple expressions within the FINISH domains. Also it’s not for us to decide how the amygdala rebound expresses itself. The symptom expression in a video or in. Textbook will never be exhaustive
@@rosmarbal Yes he spreads alot of bad information online in my opnion. His maudsley deprescribing book has bad info in it. The rate at whcih he recomends comming off these meds is so unnecessary and can cause alot more harm
It's insane that we have to inform ourself by the internet while being gaslighted by doctors
On another note. Neuro programs now although teach some old curriculum speaking of serotonin for activating frontal cortexes in depression, but these programs also add a disclaimer that the monoamine hypothesis is now being abandoned. They don’t know how SSRI work.
It’s not possible that benzo withdrawal, SSRI withdrawal, post concussion syndrome, long covid, fibromyalgia, visual snow syndrome, hallucinationogenic persistent perceptual disorder present in a similar fashion, yet only one is connected to serotonin.
I agree with high activity in limbic system. I’m not sure if it can be easily hypothesized as a separate disorder. Ultimately, all these disorders have been hypothesized based on the basis of biological monoamine hypothesis. Yet, it’s none of it is that simple.
A highly alert fear center of the brain from injury, infection, abnormal psychological experience can produce thousands of symptoms via various sensory, auditory, vestibular, perceptual, visual cortexes.
Anyhow, I quite enjoy watching your videos. I think they provide great value with possibilities for treatments. Clonidine is recorded in anecdotal experiences for being utilized in akathisia, HPPD, ptsd and several similar conditions. Maybe there is a noradrenaline connection after all. But that would mean that one size fits all. As you know nearly everyone responds differently.
Day 20 of my dose reduction, there are important changes, so I didn't hide this post in the replies as usual. I have found a clarity of thought I haven't felt for a long time!, I feel clear headed and alert to my surroundings. I am out of my comfortable 'cocoon' of indifference and lethargy which had become something of a crazy 'Catch 22' situation, I wanted to recover but didn't have the energy or compulsion to do so, I was just happy to drift along in life unaffected by anything. My emotions have not been tested yet (I live a boring life!) and yes I am worried about any unexpected stress or anxiety and how well I will be able to cope with that. This is a significant change for me and I'm pleasantly surprised at such a positive development. 🙂
Thanks for sharing and am pleased for you
You can make your own thread to document your body's withdrawal (jumping off a cliff or % reductions) and how you ended up on a Psychotropic Pharmaceutical(s), documenting your frustration at uninformed GP's/Psychi's, Therapists, etc. Just everything, really.
It's incredibly important for as many people as possible to specifically show iatrogenic injuries while on these Pharamceuticals and the Withdrawal (NOT relapse) from them. Maybe that will help people stop losing money, jobs, etc.
Great video. Another important aspect is protracted withdrawal, which can last for many months and often even years after discontinuation of SSRI/SNRI. This is due to an autonomic dysregulation. Unfortunately, the etiology of both acute and protracted withdrawal is not yet fully understood.
Thanks for the feedback 🙏🏻
Protracted withdrawal is a functional neurological disorder. Which essentially begins from hyperarousal and over excitation of amygdala. So this explains somewhat.
I had serotonin syndrome and then cold Turkeyed that led to protracted withdrawls/fnd.
Now I don’t know how to get better. Any recommendations?
Has an assessment been carried out - psychiatry or neuropsychiatry?
@@PsychiatrySimplified yes it has. I was diagnosed with ptsd and FND at neurology clinic. Along with that I received a couple of other labels such as visual snow syndrome and fibromyalgia. They couldn’t offer any advice, other than EMDR and John sarno’s books.
fndaustralia.com.au/resources/FND-Learning-guide-for-nurses.pdf
Thank you for validating and explaining the reality of withdrawal. The extreme agitation you mention is akathisia. Antipsychotics are the number 1 cause of akathisia so not sure why you’d give that to someone already suffering from it.
No akathisia and agitation are different phenomenologically and in their history. Labels create a lot of confusion. Hence the phenomenology I.the specific assessment of the experience matters in treatment. Akathisia is not agitation. Both are very treatable and require different approaches
@@PsychiatrySimplified ok! Then would love you to make a video about Akathisia , it doesn’t seem treatable to me (i have it)
@Qwerty-nm6qi I wonder what the treatment for it is?
Something you have to pay to find out maybe?
Wonderful as always! Cheers from Brazil, Dr. Rege!
Obrigado 🙏🏻
I have the rebound anxiety now. Also horrible anhedonia... I don't feel any positive emotions. I've been off SSRIs for 11 months. It's kind of like a living hell, feels like being trapped in a void. I just hope I heal and get better. Good video.
Hope you can speak to someone about the issues you are having . Thanks for the feedback
Going through same hell 12 months off SSRI. No positive emotions. Depression-like. Also horrible neurological dysregulation. Severe brain pain and pressure.
Does clonazepam use 1.0mg for 3 month and tapering for 2 month cause withdrawl symptoms.
Rebound Anxiety, tachycardia, hyperthermia 100°F fever,vibration in hand body,Insomnia, decreased appetite are withdrawl symptoms?
I’m suffering over 8 years and it’s horrific , I’m afraid to move sometimes
@@lam7402 please see a doctor for a full evaluation. I’m sorry to hear
I have told my doctor that i experienced this, i got anxiety over the feeling of physical scratches, even those give me anxiety, and doctor keep adding up trifluoperazine dose i dont understand
Difficult to know the rationale but please have a discussion asking about the rationale.
@@PsychiatrySimplified btw god bless you, you responded to all the comment😊
Those withdrawal symptoms are the exact same withdrawal symptoms I had with Gabapentin. I was first prescribed Gabapentin in 1997 at 13yrs old after blowing out my knee and took it continuously until after recovering from my 7th surgery on that knee 6yrs ago at age 34. I'd been on the highest dose my doctor could legally prescribe for 2yrs prior to the last surgery. I hated the way it made me feel....icky is the only way I can describe how Gabapentin made me feel and it wasn't really helping anymore so without talking to my doctor or doing any research I just stopped taking it. I don't recommend quitting that way. I had the exact same withdrawal symptoms as the ones in this video...FOR A WHOLE MONTH. On the plus side(I guess?) after going through that it made the 7 days of absolute Hell of withdrawals from quitting heroin cold turkey seem like a cake walk(in retrospect, not at the time lol)
Thank you for your time explaining pls do continue especially methods on tapering benzo and clozapine tks
Got off Zoloft 50mg after 14 years over 2 months ago still having withdraws
Please discuss the phenomenon with the doctor so they can treat it. For example if someone has had high Bp and previously they had headaches and then they treat the Bp and headaches cease. Then when they withdraw the medication and stop it - the return of the Bp elevation which can happen may present as other symptoms besides headchaes as well - chest pain, exertional breathlessness, migraine, blurred vision etc. we go to the doctor and express the symptoms - based on the expression , they will investigate and treat . The answer may not be just an anti hypertensive. It could be something else depending on the symptoms
I've noticed that many, many people using hyperbolic tapering get stuck.
True . Also the reason for doing this video
thanks for your explanation, could have a column to discuss protracted withdrawals in psychiatry ? thanks
Protracted withdrawal is a label. The video covers protracted withdrawal in terms of the mechanism. It’s ultimately the symptoms that guide treatment. The video covers The steps needed to address the changes that occur after discontinuing SSRIs or if tapering is difficult. So applicable for all changes
I still experience streaks of light out of the corners of my eyes on occasion. I never had this before treatment. It’s not painful but it definitely spooks me at times, but when I try to move my eyes to look at the lightning bolt-like lights I see, they disappear.
Are there any supplementation strategies that can help alleviate SSRI tapering symptoms?
Now that have been specifically evidence based or recommended. However one may consider Zn, Mg B6 which helps in production of serotonin and melatonin. B6 in high doses can be neurotoxic so one has to be cautious. Other spectators to help sleep can make a difference
Thanks. Your video is so complete in this field. Could you please prepare another video about the psychological aspect of whidrawal like racing thoughts. Looping intrusive thoughts more severe than my OCD, flasback thoughts, and derealization. Why is your brain reacting to every thought and catastrophizing
I’ve just released a video on overthinking.
ua-cam.com/video/1BM8D7K8DXY/v-deo.htmlsi=v5SlSdKZcyisiTMe
Day 31 of dose reduction (alternating 100mg and 50mg each day) I seem to be stuck in the same zone as mentioned previously, time to adjust the dose further with the help of my GP who is aware of my situation.
Could you make a video on non medication based treatments for this condition?
No medication aspects I’ve touched on - sleep being the most crucial. One can try exercise, meditation , mindfulness or emotional regulation .
Great video ! I have to keep watching it to understand how to help my son . He tried Zoloft had very bad side effects, he can’t talk normal, only repeating words and very bad ocd. Can NAC help or other supplements? I just want him to be back to normal that he can talk normal . Thank you
I got that feeling for no reason. Live with it everyday and night for years.
Does this information also apply to withdrawal from mirtazapine and bupropion?
The principles of allostatic load and homeostasis apply to all situations where we are making pharmacological changes. Mirtazapine has prominent antihistaminergic activity hence historic rebound can occur as opposed to Serotonergic rebound. Having said that Mirtazapine also has anti anxiety effects via serotonin antagonism so removal of that can lead to a rebound. Bupropion is activating via NA and DA potentiation with nicotinic receptor antagonism - so activating agents when removed tend not to have a rebound - but a deficit . Hope that makes sense. So bupropion does not typically have a rebound withdrawal like SSRIs do
Are you aware of anyone who’s fully recovered from withdrawals using this method? Curious.
Protracted withdrawal syndrome is FND. But if there’s a way to rescue it, then why not. After all FND itself is fully reversible.
Which method? There isn't one method - its applying basic principles of treatment. And yes, individuals improve and can be treated better. In many cases, what is being considered withdrawal can be agitation - and treatment of agitation is effective.
Excellent video, very informative and high quality!
I had that "toxic" effect from increasing Mirtazapine dose after a gradual decrease. My supportive therapy is Pregabalin 150mg.
Thanks for the feedback. 🙏🏼
Excellent video. I am suffering from withdrawl symptoms from desvenlafaxine even being switched to prozac to mitigate the symptoms. My Dr don't believe me. What can I do? I am terribly lost. I give all my money to find a solution. Hugs from Spain. Please I need help.
Its difficult to provide advice as its an individualised approach.
1. Focus on sleep
2. In second part of video i discuss medications such as mood stabilizers or clonidine, prazosin etc which can be used depending on the symptoms one has
3. Discuss the above with the doctor - as it is important to differentiate between when withdrawal symptoms are becoming worse and may be overlapping with hyperarousal and agitation
It's for real. 1 year off SSRI. Long term use. It's like nothing normal, hard to describe in words. Inhumane thing. My worst symptoms are severe head sensations, pressing, burning, pain, electricity, vibrations, terror. Pulsating along the spine and muscle pains. Can only walk shorter distances. Rapid taper almost c/t. It feels like brain injury. Is it possible? Or neurological injury. Can we heal? Thanks for important information!
@@Snowflake1374 sorry to hear. this is treatable . Please discuss this with your doctor
@@PsychiatrySimplified How? I tried reinstating too late got worse. As far as I know, protracted WD is not treatable.
@@Snowflake1374 please have a listen to the video again. Labels like protracted withdrawal dont need to a management plan. Reinstating in context of anxiety and agitation worsens the situation. Often it’s not pure withdrawal anymore - likely a combination of hyperarousal and agitation which needs to be treated accordingly. If anything provide the doctor will all symptoms so they can address them with a significant focus on sleep. Ps not advice
Not treatable, no cure. I have talked to Dr’s. They said nothing helps (exept reinstatement if you’re too far out) and it can takes years. Tried reinstate, too late, got worse. Once you crash and is neurological dysregulated/injured. Only time can hopefully heal. In my case also iatrogenic injury. You can also call it neurotoxic injury or temporary brain injury.
Its not treatable. I have talked to Dr’s. Once you’ve crashed and is neurological dysregulated/injury. Only time can hopefully heal. In my case iatrogenic injury as well.
So how can this be treated? The biggest mysteries of all?
I've covered the principles of treatment in the second half of the video
Considering that SSRI withdrawal enhances noradrenaline, wouldn’t withdrawal from tapering an SNRI be worse since serotonin levels will drop while noradrenaline reuptake is inhibited at the same time as low serotonin increases noradrenaline?
@@jimwillmott6050 not necessarily. Venlafaxine as an SNRI has amongst the most prominent withdrawals as its SERT affinity is high. An SSRI after stopping or SNRI leads to a rebound NA increase via LC rebound. An SNRI such as duloxetine or desvenlafaxine has a SERT:NAT ratio of 10:1. After ceasing the SNRI the noradrenergic levels drop via the NAT activity being ‘restarted’.
Well what you described concerning increased noradrenaline explains my current withdrawal symptoms from a slow taper of duloxatine to 16.5mg (taken 1X/day 8:00AM). My anxiety is unbearable on awakening in a sweat. BP is elevated along with GI distress. Seems serotonin is too low relative to noradrenaline.
@@jimwillmott6050 sorry to hear. Was it prescribed for anxiety? With sweats yes it does sound like a noradrenergic rebound. Ultimately its the symptoms that we should focus on as the response to discontinuation is very heterogenous- in this case ensuring that sleep, Hyperarousal is addressed becomes important.
I’ve taken many different psychotropic drugs for 22 years for depression. More recently adderall, duloxatine and trazadone. I tapered off adderall and limit caffeine. Over 17 months I followed hyperbolic tapering for duloxatine from 60 to 16.5 mg. Trazadone from 100 to 15mg. My symptoms are almost exactly those of the young lady you showed in video except sleep has been good. Thanks for your concern and interest.
The description I've highlighted is the progression towards agitation - its likely not agitation as sleep is good -have a look at the video on anxiety vs Hyperarousal vs agitation
Thank you for this very informative video. I was prescribed an anti-emetic (compazine - an anti psychotic) during my SSRI discontinuation for the severe dizziness, and got severe akathisia which persists two years later.
I am wondering if you can give more detail on why you have recommended D2 blocker anti psychotics to address agitation, as the opposite happened for me. Could you address the akathisia risk with these medications?
Clonidine has been recommended to me but I'm too terrified to try anything now.
Would love to know your thoughts, thank you.
Prochlorperazine is a D2 antagonist - ones to reduce agitation are low dose D2-5HT2A antagonists with antihistaminergic effects - such as quetiapine , olanzapine mainly. Severe akathisia may be part of the agitation- the motor agitation. Issue is akathisia has a very specific definition and if it’s persisted after AP has ceased this is unlikely to be akathisia by the definition of a AP induced SE . In these situations it becomes crucial to address symptoms based on phenomenology and not labels. There is no one size fits all here and it’s very individualised
@@PsychiatrySimplified thank you for taking the time to reply. 🙏 I am in Australia and have been unable to find a psychiatrist or neurologist who knows about this and can help me. I am one of the cases who have cascaded and I'm unable to taper. Can you recommend anyone who would see me in Aus?
There are a community of akathisia sufferers who have not been able to resolve their symptoms after drug cessation, while less common Seroquel and Olanzapine have caused akathisia for some, along with Abilify, Latuda, benzo and SSRI withdrawal. More drugs seem to make most of us worse. It's a dire situation and any attention to it is much needed. 🙏
I have emailed your clinic although I am not sure if you are still consulting . Thanks .
You have said this is highly individualised but most psychiatrists have absolutely zero idea about this and so certainly cannot tailor an individual plan, and you don't take patients or have a list of recommended psychiatrists. Where do we go with this valuable information? Chat gpt has given me more information than any psychiatrist ever has been able to give on my situation. There are some dopaminergic properties to Clonidine that make it a risky option if your akathisia is caused by dopamine depletion and there is no doctor to clarify this with because they don't understand this level of detail.
I have a variant of tardive akathisia (inner agitation with depression) from Venlaflaxine. I tapered 5 years ago and it started after I tapered. Clonidine is useless for me. It's nice to have for nights you can't sleep or something like that. No meds, exercise, meditation, good diet, anything, helps long term except a benzo. Exercise helps while I'm training but the effect doesn't last. Lorazepam completely stops the agitation/depression and anxiety. I just take it in the evening and suffer a bit during the day. Being active during the day helps minimize it but it's completely impossible at night to sit and focus on a task mentally without some help.
So search up Dr Stewart Shipko, he has 9 articles on Mad in America. All about this topic and his experience treating people who feel they have some sort of long term condition after tapering SSRI. So it's an informed position based on experience. He gained a reputation as a specialist in this so people sought him out. I find he is exactly correct on every single aspect. It's like he was reading my mind.
I was on a waiting list for a psych after my doc had me try Buspirone and Clonadine and then was like "see ya" after that didn't work. I told her only Ativan helped but she wasn't interested. At the time I was only taking it every 2-3 days because I had to ration it. I knew it worked because I had some from an old script for flight anxiety. Then had to do what I had to do to get it. There is no other option. Thankfully my psych had a sense of ethical responsibility to not let people suffer.
Also I disagree regarding clondiine. Yes onboarding the SSRI can increase agitation initially but that’s short term. Long term it reduces it. That’s why clonodine is just making the symptoms while the SSRI reduces them long term
Thanks for your comment. I’m not sure what you mean by disagree? With which part? SSRIs do not treat agitation and can worsen it. They treat the anxiety paradigm. Big difference. That’s why in treating depression guidelines clearly say - caution with SSRI or ADs as can increase agitation. Pls see the video on anxiety vs hyperarousal vs agitation. 3 different constructs. Every single person’s withdrawal experience is unique. Did you see the common neurobiology of NE rebound. It’s the symptoms that tell us the expression of the underlying dysfunction and clonidine targets the most prominent one of sleep dysfunction , REM rebound. It’s not about agreeing or disagreeing - it’s what is infront of us and what we need to target. Not every single person can substitute an SSRI and reach the state they desire during withdrawal. I’ve seen the sever end of the spectrum when the cascade continues to worsen.
Day 6 of my dose reduction and I'm feeling slightly light headed and fuzzy headed at the same time, my general mood has lifted slightly, there is some slight nausea but not drastic, I did wonder if the thought (even subconsciously), of dose reduction, which I have associated with the chance of an improved lifestyle, if there is some sort of placebo effect in play?. I intend to include the sugar reduction and exercise regime (afarp) in my plan based on what others have said, watch this space!
Good luck
Day 9 of dose reduction, I'm not sure alternating 50mg and 100mg is proper tapered withdrawal but it was recommended by my GP who asked me to contact him after 2 weeks, I still have light headedness and slight nausea, a touch of irritability on occasions. Sleep is still good although I'm waking very early, there does not appear to be much difference in emotions or libido yet (still blunt) but I'm assuming its down to the long term conditioning of 100mg over 14 years. It's actually, on the whole, quite promising at the moment, as I half expected neural fireworks and psychotic crashes, but I still have a fairly boring life (which is actually a good thing in these circumstances!)
Day 15 of dose reduction and I'm having some notable changes. The irritability is still there much of the time and often this leads to angry thoughts, which do seem to be overreactive and not driven by any significant emotional response, these instances also can lead to increase in headaches. One worrying development is the bouts of despair I feel, which seem to be increasing, I first thought it might be the depression returning but the feeling is not deep and is usually a momentary thing, as my well established philosophical reasoning (SSRI disassociation) resolves the issue (anxiety and poor mood). Sleep is being disturbed by waking very early and not being able to simply drift back into it as most people do, I have to lie awake and wait for self meditation to work or if that fails simply get up and have a nap later in the day.
@@jerryholdcroft4607 any update
Do you know the cause of Brain Zaps during SSRI/SNRI withdrawal? They're quite worry some at times.
They dont. Theyre clowns within the medical profession.
I'm dying every day. I was on many drugs for my OCD and then they misdiagnosed me with bipolar put me on many other drugs my life is over. It's been nine months. I am off my meds, but it's like nightmare😢 Akhatisia,anhedonia, cognitive impairment, insomnia, DPDR, racing thoughts, and severe mood swings،Hyper sensitive nervous system. Hyper salivation,horrofic nightmare.looping intrusive thoughts ,weird flash back from old memories and negitive feeling I never had them before starting medication. I'm getting worse every day. I can't take it anymore 😢😢 I really want to live, but I can't take it anymore. I am so close to suside everyday. Could you please help me? Most of my physical symptoms are gone, but mental ones are so severe and are changing every hour. I am afraid the reinstate can make things worse . To your knowledge what can I do?
Im sorry to hear. Please see a psychiatrist or a doctor to assess and treat the symptoms. The Hyperarousal or agitation is distressing and seeing a doctor / psychiatrist to discuss the severith may help. Pls seek medical advice
@PsychiatrySimplified I did in the past, and they misdiagnosed me with bipolar disorder and put me on more meds that detoriate my situation. Also, I made tolerance poopout whodrawal medications made me like a robot and bl9cked my positive emotions.
ua-cam.com/video/X6-y9kl0Ezo/v-deo.htmlfeature=shared
Any advice when quiting luvoxamine, i am on 4th day. This is hell!
Ty ony any advice
Please listen to the latter half of the video - the patient experience and management . The trajectory of discontinuation that is not resulting in significant allostatic load should be a downward trajectory. If it’s not improving or getting worse- look at the key aspects to look at - sleep, arousal, agitation etc. one may need to address that to ease the process . Otherwise this distress acts as a load worsening the cascade
@@PsychiatrySimplifiedcan you somehow simplify what did you mean with this, i am croatian, even when I translate can not understand what you mean to say. Hoppefully not to treat simptoms with other drug? Much love from Croatia
Does this help ? Ako doživljavate prestanak uzimanja SSRI-a, obratite pozornost na drugu polovicu videa u kojoj raspravljamo o iskustvima pacijenata i kako upravljati simptomima. Idealno bi bilo da proces povlačenja s vremenom postane lakši. Ako se vaši simptomi ne popravljaju ili se pogoršavaju, usredotočite se na ključne čimbenike poput spavanja, uznemirenosti i tjeskobe. Rješavanje ovih problema može olakšati proces odvikavanja, inače bi stres mogao pogoršati stvari.
@@PsychiatrySimplified omg, you are the best! Can I make up somehow? Here doctors are brutal, they blame patience for everything, never mentioned side efects, so thanks from bottom of my heart. If you ever go to Croatia, you have to stay in me! Lovr
No problem! Hope you feel better soon
Hey, Dr. Sanil, have you ever considered making a video about Viloxazine (Qelbree)? It seems to have an interesting mechanism of action, but there are not many videos about it.
I’ll add to the list. Thanks for the suggestion
Could it be that adding bupropion to sertraline before I reduced sertraline and then stopped eases my withdrawal then, given that bupropion should activate noradrenaline?
Difficult to say. Noradrenergic potentiation plays a part in withdrawal so adding bupropion in the context of noradrenergic withdrawal may worsen things but also noradrenergic and dopaminergic potentiation allows one to control the emotional heightening.
@@PsychiatrySimplified yes i see, i guess timing may be crucial here. My dreams have been incredibly vivid as you suggest in the video. Not nightmares but real enough to wake me several times int he night.
I have all those symptoms, all the time, after stopping meds. Their utter uselessness for menopause is well known among my friends.
Sorry to hear
A breeze ? Did you listen to the patient presentation later ?
I did. I too have experienced these symptoms in the past however Cymbalta is on a different level of pure hell.
Thankyou for sharing your knowledge on antidepressants ☺️🙏☮️
I'm hoping I can ask my GP to watch your video, I've been on maximum dose venlafaxine and Pregabalin and also tramadol, I live with severe withdrawal symptoms even though I'm taking the medication and so he wants to take me off all meds I have to say I'm petrified 😪 have a wonderful weekend and thank you so much for your videos 🫂
I fought with my psychiatrist to taper extremely slowly off Effexor..in a titration type of way.
I already deal with fibromyalgia, and the fact that my GP who originally had me on the how to take care of my thyroid for at least eight years … so they were very bad things that happen. I know it’s been very scary… so that’s why I fought with my psychiatrist to allow me to taper and how I needed it, which was the smartest thing to do versus telling me to stop at 37.5 mg and then just giving me Prozac..😵💫😑
I fought with my psychiatrist to taper extremely slowly off Effexor..in a titration type of way.
I already deal with fibromyalgia, and the fact that my GP who originally had me on the how to take care of my thyroid for at least eight years … so they were very bad things that happen. I know it’s been very scary… so that’s why I fought with my psychiatrist to allow me to taper and how I needed it, which was the smartest thing to do versus telling me to stop at 37.5 mg and then just giving me Prozac..😵💫😑
FYI, so many women are just tossed antidepressants when really they should be on hormone replacement therapy. It’s disgusting how many GPs will just toss antidepressants at women going through hormonal changes and really so many women have benefited from going on hormone replacement therapy and what they actually needed because that’s what was going on within their body. .. hormone changes. With the right hormone as you can equally get your dopamigetic and serogenic properties plus the added benefit of heart saving health ( unlike antidepressants that could actually put more strain on the heart), less joint pain, etc etc etc. Where is the antidepressant could just not do anything at all regarding so many different organs and systems in the body and just add more frustration for the things it’s not taken care of.
Thanks!
Thanks for your generosity! Appreciate it 🙏🏼
So which rebound is more likely on paroxetine withdrawal? noradrenaline or acetylcysteine ? Or is all about receptor 5-ht1a ?
Paroxetine as I mentioned in the video also has anticholinergic effects so cholinergic rebound occurs along serotonergic aspects
Ok but what should i do doctor ,please help me 😢
Which out of the medications you recommended works on noradrenaline pathway reduction? My GP asked, I showed him the video, he asked if I could message you to clarify.
I would recommend focusing on the symptoms. If nightmares, sleep disorientates. Vivid dreams , unrefreshed sleep - prazosin or clonidine
Note benzodiazepines also do this but come with their own issues
If agitation is present - this is the severe psychomotor restlessness - then low dose AP may be needed.
Please also see video on anxiety vs hyperarousal vs agitation
Moreover please note the entire symptomatology needs to be addressed - I.e if depression is present then simply addressing sleep won’t resolve situation.
Ps not advice
@@PsychiatrySimplified okay, what would one do for comorbid depression with SI’s?
I know I have missed a dose or lost a bottle when these sensations begin to come on.
Yes for many that is the case
Would this be problematic for mirtazapine abrupt discontinuation via 5ht2c or the alpha 2 antagonism or are they both problematic
Dr is there a difference between MDD and PDD in management?
Sorry whats PDD? Persistent delusional disorder? Or...
@@PsychiatrySimplified Dysthymia
Yes dysthymia - often tends to have underlying psychological aspects - this requires an understanding of childhood experiences for a formulation. MDD itself is heterogenous and has various presentations
So it's different to person to person?also will this resolve in short term? What about protracted wd?
I’ve covered that in the video - it’s the symptoms that should be discussed with the doctor . Ultimately it’s not about labels but how to address the symptomatology and distress.
I was able to quit sertraline with zero withdrawals thanks to exercising and drastically reducing sugar consumption. I had tried to quit sertraline at least 7 times over the course of 13 years, and had horrible withdrawals every time. When i finally succeeded, I was on my diet and exercise regimen and simply ran out of my medication because of procrastination. The withdrawals were completely gone. It was an unexpected result. I've been off the medication for four years now.
Thanks for sharing! Interesting. So the diet and excercise is what you attribute helped you?
@@PsychiatrySimplified Absolutely. I've had a sweet tooth my whole life and had never been into exercise. Those were the two variables that changed.
@@lifeAfterSSRIsI have always been on a diet being a bodybuilder but WD hit me hard anyway. I am 23 months in protracted.
@@georgebordeaa I'm really sorry to hear that man.
@@georgebordeaa What really seems to do the trick for me is cutting out sweets and doing cardio. Cardio does something for me that weights just can't. But that is just my own experience.
Size more. Famuly
This is why people like mark horowitz are wrong. Hyperbolic tapering can be dangerous for some. The people who successfully come off their meds are because they do the underlying work while on meds and know how to keep calm during withdrawal symptoms. The withdrawal itself doesn’t dramatically increase allostatic load it’s our reaction to it that does
Yes it is correct - but the reaction to it however is embedded in our fear responses which may have multiple other etiologial underpinnings - personality styles, trauma , medical conditions etc
These are only a few symptoms you've mentioned
The expression of symptoms is heterogenous. There can be multiple expressions within the FINISH domains. Also it’s not for us to decide how the amygdala rebound expresses itself. The symptom expression in a video or in. Textbook will never be exhaustive
Mark is a psych registrar. Still training with limited real world experience. Makes a lot of claims that in practice don't compute/work.
@@rosmarbal Yes he spreads alot of bad information online in my opnion. His maudsley deprescribing book has bad info in it. The rate at whcih he recomends comming off these meds is so unnecessary and can cause alot more harm