Does going off psychiatric meds make me more crazy, or less?

October 14, 2009 11:00 AM

Another depression meds question

Currently I am on 100 mg of zoloft and 200 mg of lamictal. I have been on cymbalta in the past (60 mg). I just switched psychiatrists and my new psychiatrist has suggested that I try going off of meds, first zoloft (very slowly- 1/2 dose for 14 days, half that 14 days, etc) and then the lamictal (very slowly as well).

I definitely feel over-medicated, like there is a layer of lacquer over me keeping me from really feeling anything. I also really don't have much drive, other than to sleep, right now.

This seems like a good idea, but it also really scares the hell out of me!

I have had a really bad 6 months and have finally started to get my life back in order- going to a therapist once a week, not drinking any more, finally moving closer to my wife, etc.

I was in a great place a year ago, but this past year was really bad, mentally, emotionally and physically.

I know you are not my psychiatrist and you are not my doctor, but am looking for anectdotal information on coming off of these drugs and how you best handled it. What were your issues with each drug, what went well.

Any sort of reassurance, or scary stories, would be great.

Thanks!

posted by TheBones to health & fitness (14 comments total)

It might be helpful to remember that none of these decisions are final, and that if it doesn't seem to be working out or feeling good when you are off meds, you can go back on.
One of my friends explained psych medication to me as a process, not a cure; so it's something you can always play with and adjust and switch up instead of an anti-biotic that will fix you and then you're done.

Don't do anything you're uncomfortable with, and if you don't feel stable enough to make changes now then don't. You can always do it later, or you can try it now and then go back on if you aren't happy. This isn't a decision that you can't reverse!
posted by rmless at 11:13 AM on October 14 [1 favorite has favorites]

YMMV, but I found that when I got off anti-depressants, I had to learn to make a conscious and concerted effort to do the things that the drugs helped me to do without such effort (e.g. interacting with human beings). It was pretty difficult at times, and still is a bit of a slog with some awkward stumbles here and there, but there's nothing more rewarding than trying and succeeding, even with the odd failure in the mix.

Just remember to report any and all mental and physical weirdness to your doctor as you're weaning off, no matter how antsy you are to be free and clear once and for all or whatever.
posted by Sys Rq at 11:19 AM on October 14

My situation was not exactly parallel; I was on 20 mg of Prozac and decided to go off it halfway through my pregnancy because of a cohort study released that indicated an increased chance of newborn problems with women who were on SSRIs through their whole pregnancy. I wasn't overmedicated, and absent that study, I would have never gone off my meds.

Prozac is self-tailing, so I was able to just cut them cold turkey and then wait as the drug washed out of my system over about six weeks. I won't lie to you, it was hard. What it was most like is. . . like a plane coming in to land. Bear with me! When you're in an airplane, looking out the window, you have a very big-picture view of what's going on, you're kind of distant from the landscape, and the details are fuzzy and obscured. But as the plane descends and you start to land, you begin to get more and more details of what's going on and you, well, lose your elevated perspective, until the plane finally lands and then you're PART of it, not above it any more. This is good in some ways, and kind of sucky in others. I definitely felt way more immediately part of my life, both the good parts and the bad parts.

What I did not expect was that all the coping skills I'd learned in my therapy would stay with me to such a great extent. I found that I was able to verbalize my feelings and the fact that I was running out of spoons much faster, and able to hold on to my perspective if I tried hard enough. I ran depression self-assessments every week, and I asked my husband to do so as well, to make sure that I wasn't losing my grip so fast I wasn't realizing it. And, well, I made it to the end of my pregnancy with my sanity and my marriage intact, and my husband agreed that though it was a lot more work on his part (and mine), it was totally doable and I was not terribly unpleasant to be around all things considered.

but I still took my meds with me when I went to the hospital, and started taking them immediately post-partum. Like, before the epidural wore off. Suffice it to say that if you end up under-medicated, you'll know it, and you'll know it fast enough to be able to fix the problem.

Sorry for the novel; this is an issue near and dear to my heart.
posted by KathrynT at 11:29 AM on October 14 [1 favorite has favorites]

Yes, rmless, I have scheduled some more time with my psychiatrist and my wife. She wants to know what the game plan is and what he is trying to achieve- what the goal is.

I always hated the idea of meds to cure my craziness, didn't believe in them so much, but now that I know what they can do, I am not so against them, but believe that I am not necessarily on the right ones/too much of them.

I don't really know if I'm stable enough now or not- I guess that should answer my question in the negative then.
posted by TheBones at 11:44 AM on October 14

KathrynT, that was fantastic, thank you. Currently, I feel like I have tunnel vision and I don't know where the medication stops and "I" start. I have no idea who I really am and how things will change if I do decide to go off the meds, readjust them.
posted by TheBones at 11:47 AM on October 14

TheBones, I'd suggest keeping a depression journal. You can find self-assessment guides on the web that will give you some good ideas of things to be aware of; if you can journal, daily, about how you feel about your ability to handle various areas it can give you an objective measure of subjective experiences.

Really, it could be a numerical scale on how you feel about various things, like energy, appetite, self-worth, interest/curiosity, connection with your wife, sex life, &c, so even if you don't feel like writing a huge essay every day you can still get the data points down. (For that numerical scale, btw, I'd recommend just three points, or maybe not even numbers, just "Bad/Meh/Good." More granularity than that is frequently wasted.)

Do it daily (or even twice daily) for a while, then space it out if you don't see a lot of variability on that scale. And maybe have your wife do the same thing to get an outside perspective. Following up on the plane metaphor, this is like an altimeter so you don't have to just trust your own subjective experience.
posted by KathrynT at 12:45 PM on October 14

My experience with SSRIs has been for anxiety and social phobia.

I went off of Zoloft cold-turkey a couple of years ago, for reasons similar to yours, and had just about every withdrawal symptom you can imagine. It was hell. So, if you do it, taper slowly. I felt nauseated, headachy, dizzy, and got these horrible brain zaps that probably continued for the better part of a year. And on top of this, I was pretty depressed, probably in part from the withdrawal and in part because I felt so lousy.

During this time, I was in grad school and really didn't feel the need to be medicated. I felt like I was coping well until I graduated and ended up in cubicle-land again (a place that I really hate, in general). At that point, I chose to go on Lexapro. I take only half of what's considered a therapeutic dose, and unlike when I was on Zoloft, Luvox, etc I think I can still feel things and I don't have the brain-foggy feeling that other SSRIs caused.
posted by chez shoes at 12:49 PM on October 14

I've gone off both those drugs. Zoloft was rough, but lamictal was easy.

Don't be afraid to go back on something if you think you need it later. Welbutrin works for many folks, doesn't make you drowsy and there aren't sexual side effects (actually, quite the opposite.) It MAY make you feel a bit jumpy when you first try it but that effect wears off in a bit.

If you prefer drug free, talk to your doc about fish oil. My docs always recommended it. Also, I can vouch for making sure you get plenty of sunlight.

Finally, if you can make the time for it, regular aerobic exercise really really helps with both mood and stress relief. I can definitely vouch for that.
posted by St. Alia of the Bunnies at 1:41 PM on October 14

Follow the advice of your psychiatrist and scale back as recommended. Whatever you do don't stop cold turkey. Stopping Celexa cold turkey cause me to black out and hallucinate. Just take it slow like the doctor says and be willing to stay with a lower dosage for as long as you (both) feel its necessary.
posted by motsque at 2:01 PM on October 14

Echoing the above, I cannot emphasize the importance of tapering off gradually--your Dr's schedule might be too aggressive. SSRI withdrawal syndrome is not experienced by all people when they stop taking their drug(s), but for those of us who do experience it, it sucks (remember when you were a kid and you touched a 9 volt battery to your tongue? It feels like that, but in your head).
posted by Izzy at 2:31 PM on October 14

I came off antidepressants accidentally when a business trip got unexpectedly and substantially extended. I had only brought enough of my colorful cocktail of pills for a few days. So I ran out and couldn't get more. But I had been wanting to quit anyway after years of taking different combinations and getting crappy results. So when I got home I just kept the cold turkey going. You're totally not supposed to do that with most of those meds and I found out why. The Paxil head zaps are scary bad, for example. Yikes. But mine passed relatively quickly. Officially I don't recommend it.

Your two meds are among the few I never tried, but the effects sound the same as what I was having. I couldn't feel anything. I only slightly realized that when I was on them, because you build up your dosage so slowly at first that the changes are so gradual that you don't really notice or have something stark to compare to. Quitting cold turkey showed me that stark difference and I was horrified that I had spent years feeling nothing.

I literally thawed. That's what it felt like. I could feel my own emotions again and the world around me. It was so nice, like coming home after a long time. The whole point of taking antidepressants was not to feel the constant palpable sorrow and yet when I thawed, suddenly that sadness actually felt good. It felt real. Feeling just feels good. I figured out that for me, at least, feeling sadness was better than feeling nothing and I never went back on them except for one abortive week much later.

It took a week or so to get used to feeling again and it was actually kind of funny when the end of a stupid, stupid, tired B movie on afternoon tv made me just sob my head off. It was even funny while it was happening. I think a Kleenex commercial did it too. The other bonus for me, having had the awful sexual side effects, was a thawing downstairs too! I had wet dreams for a week solid. It was fantastic! Free orgasms left and right! My loins later sent a memo upstairs and said "Please never ever do that to us again. No pills." Can't argue with the guys.

At the very least you can take a med holiday. It's a good way to get a different perspective for a while and hit the reset button. And you can start up with the same or different meds later as needed. Have a lovely vacation.
posted by kookoobirdz at 3:27 PM on October 14 [1 favorite has favorites]

Thank you everybody, kookoobirdz, that was great!
posted by TheBones at 6:33 PM on October 14

Do you have a bipolar dx (I only ask because of the lamictal, but I assume a doc wouldn't put you on an SSRI if you are bipolar, so I'm confused). Are you simply doing this to get a base-line reading of how you are when completely unmedicated? If you have been on medication for a long time and you feel over-medicated, then this is probably a good thing for you to do.

I have been on all the medications you listed. Everyone is different, but I found that Zoloft was the hardest for me to come off of. I had a tough time sleeping (falling and then staying asleep) because the zoloft was great at getting me to bed at night (and my anxiety increased as I tapered, I think). Also, I swear (and my doc thought this was coincidence) that I was needing to drink a LOT more water when tapering the zoloft. I felt dry all the time.

Is your doc telling you to stay on the lamictal for a while after you taper the zoloft? I had some residual effects for a good 2-3 weeks after I was totally off the zoloft. I don't think it's a good idea to immediately start cutting the lamictal down. Don't rush this, you have plenty of time. But keep in mind that these meds don't clear your body after your very last pill, and you'll need to take care of yourself while everything leaves your system.

IANYD but IHBOALOD (I have been on a lot of drugs.)
posted by Lullen at 6:38 PM on October 14

Lullen, yes I am going to stay on the lamictal while I taper off the zoloft. The doc who suggested this has only seen me once for 30 minutes, which is why I want to have my wife talk to him before I do anything. I definitely feel overmedicated, but am scared to come off of anything.

Does anyone know if there is anything to help the side effects for coming off of zoloft? I have read that omega 3 helps, I'm taking 1000 mg a day now anyway. Also I've read that Malic acid and Magnesium helps as well.

Has anything helped you get through the withdrawal symptoms if I decide to cut down?

I am guessing that going from 100 mg to 75 mg over 2 weeks and then down to 50 mg for 2 weeks and then down to 25 for 2 weeks will help, and am definitely going to do everything I can to help alleviate these symptoms.
posted by TheBones at 7:09 PM on October 14