Cipralex/Mental Health Professional and Client Relationship

June 12, 2012 2:36 PM

I stopped taking my Cipralex a week ago, but noticed that I did not have any particular withdrawal symptoms. Does that mean that Cipralex didn't have any effect on me even while I was taking the medication daily? How do I approach the topic with my psychologist since this was not something that the psychiatrist approved? How do I stop feeling so sad about no longer working with my psychiatrist or psychiatric nurse?

Background Information:
On June 3rd, I forgot to take my daily dose of Cipralex 20mg. I didn't think it would be a big deal since I figured it would be okay and I could just continue taking the medication the following day.

However, on June 4th when I went to see my psychiatrist he told me that he would be cutting down his practice and basically wouldn't be able to see me anymore.

I decided that because my work with the psychiatrist and psychiatric nurse had officially come to an end that I might as well stop taking my medication which I had been taking since January.

I know that this was not a wise decision and in hindsight, I realize that I shouldn't have done this without a professional's approval. But, I knew that this session with my psychiatrist was the final one. Please don't lecture me about how I shouldn't have done this as I am already well aware that I should have talked to my psychiatrist about this...

Questions:
In regards to my mental health, I have noticed that I did not have any particular withdrawal symptoms that a lot of other people have. I'm relieved to know that I didn't have to deal with what appears to be very painful and uncomfortable withdrawal symptoms.

But, if I never experienced withdrawal symptoms then does that mean that the Cipralex didn't have any effect on me? For the most part, I feel the same way that I did when I was taking my Cipralex on a daily basis. Sometimes my mind feels very agitated though and it's very unsettling, but other than that I feel like I am more in my head than before although I still feel sad.

How do I approach the topic with my psychologist? Should I tell him that I stopped taking my Cipralex?

How do I get over the feeling of missing the psychiatric nurse and psychiatrist that I worked with for the first half of this year?

I stopped working with the psychiatric nurse about a month ago and the psychiatrist about a week ago, but I feel sad about not seeing them anymore. I know that this is how life goes and I have moved on, but it still hurts.

I talked to the psychologist about this and he said that it's normal to feel this way after a relationship with a professional ends because I had developed a relationship with both professionals. But, I still don't understand this because it's not like I knew anything about these professionals or the one that I worked with before.

P.S. Sorry for asking so many questions...

posted by livinglearning to Health & Fitness (13 answers total)

if I never experienced withdrawal symptoms then does that mean that the Cipralex didn't have any effect on me

Not necessarily. However, if you don't feel your mood is different without it, it may well not have been effective for you.
posted by Sidhedevil at 2:42 PM on June 12, 2012 [1 favorite]

You're asking a TON of pretty much unrelated questions, so this is going to be pretty hard to answer. I'm just going to stick to the meds angle and make it short and sweet:

- Not experiencing withdrawal symptoms does not in any way mean your meds weren't working when you were taking them. It just means you haven't experienced withdrawal. Some people are different than others in that regard. I've had withdrawal from meds that absolutely *weren't* working for me. It's a crapshoot. Feeling "in your head" and "sad" are signs that you might want to consider a different medication.

- You absolutely need to tell your psychologist about any med changes. Your mood can (obviously) be effected by this and that's something that he needs to be aware of, even if just to make a note of it.

- Regardless of your relationship with your previous psychiatrist, you need to ask for a recommendation for a replacement. You need to continue your care from this point on. You can't let your mental health be tied to one doctor's career choices.
posted by sonika at 2:42 PM on June 12, 2012 [4 favorites]

And yes, you should absolutely tell your psychologist that you have stopped taking your medication. It's important information.

Do you feel that you stopped taking the medication to "punish" the psychiatric practice you were no longer working with? Because that's kind of odd (which you acknowledge).
posted by Sidhedevil at 2:43 PM on June 12, 2012

Response by poster: Sorry, don't mean to threadsit, but just to clarify that the psychiatrist didn't recommend seeing another person so that's why I thought that I wouldn't need a replacement or to continue taking medication.

Sidhedevil, in regards to the second response-I definitely did not do it to "punish" the psychiatric practice. I don't feel hostile or angry about the situation, I just feel sad about the circumstances but completely understand the situation.

I stopped taking my medication because I didn't think it was necessary anymore. I didn't feel like I was benefiting from the medication anymore and I no longer feel in distress. I feel much better than before even after not taking the meds for over a week...
posted by livinglearning at 2:53 PM on June 12, 2012

Even if you feel *better* follow-up with another psychiatrist. You're right that you shouldn't have done this without medical supervision, and it sounds like you've handled it fine, but the right thing to do from here is just lay it out there with a doctor that you've done this in case you need to go back on meds at any point in the future.

If not a psychiatrist, at least talk to your primary care doc.
posted by sonika at 2:56 PM on June 12, 2012 [1 favorite]

Don't sweat it. Definitely tell the psychologist. You don't need "permission" to stop taking a medication. It may be ill-advised to stop -- especially to stop suddenly without a plan for tapering off, depending on the situation -- but that's your choice. You took a chance and things went fine. So while you might want to consider professional advice next time you plan on stopping a med, it's nothing to feel bad about. The reasons for not stopping abruptly are for your benefit and no one else's.
posted by the jam at 3:03 PM on June 12, 2012 [4 favorites]

Your psychologist should be able to give you a referral to another psychiatrist.

Glad to hear you're doing so well without the meds; maybe you were ready to come off them, and if you didn't have withdrawal symptoms from going cold turkey, that's great.

If this were me, I would meet with a psychiatrist just to review my going-off-the-meds experience (as sonika suggests) but I am hypercautious about this stuff. Talk with your psychologist and get feedback from them about whether that's indicated in your case.

In general, if a psychiatrist doesn't actually say "Let's get you off those meds, and here's a plan" it's probably best to assume that they expect you to keep on with the meds as prescribed. "I'm not going to be able to meet with you anymore" really doesn't say anything about whether they feel the course of medication is completed or not.
posted by Sidhedevil at 3:04 PM on June 12, 2012 [2 favorites]

I've never had withdrawal symptoms... except for my mood going back to anxiety ridden and depressed.
Some people have more side effects to medications and/or withdrawal than others.
posted by KogeLiz at 3:18 PM on June 12, 2012

The side effects and withdrawal symtoms are not (as far as I know) correlated at all with effectiveness. You can take an SSRI like Cipralex, have it be very effective, and never have any side effects or withdrawal once you stop taking it. Conversely, you can take one, have terrible side effects, it doesn't help at all, and then an awful withdrawal.

But, it's definitely possible that Cipralex didn't work for you, or worked a little but didn't work well enough. The good news is that there are lots of different anti-depressants (and anti-anxiety drugs), both SSRIs and other types. If you aren't happy with the results from the Cipralex after several months, it makes sense to try something else.

I would absolutely, definitely, tell your psychologist that you stopped taking the medication. It's relatively common for people to stop taking their psych meds (though it's not generally a good idea), and a good psychiatrist will not be judgmental about it.
posted by insectosaurus at 4:41 PM on June 12, 2012 [1 favorite]

Tell your psychologist about the med changes - their job is to help you, not judge you. They need to know about the med changes because if they see changes in your attitude or behavior they will have context to understand it and make their own recommendations.

I would also get a recommendation for a new psychiatrist. I find it odd that your former doctor did not make a plan with you to continue your care beyond him. The questions you ask are ones you really need to ask of a doctor who knows your history and can order blood work if necessary or whatever.

Unfortunately a lot of the responsibility of managing mental health treatment gets assigned to the patient at times when they can least handle the responsibility. Plan ahead, make sure there is a doctor whose office you can get into in an urgent situation, and be honest about everything with your providers because a lot of the details (is he still taking meds?) can make a big difference.
posted by newg at 4:48 PM on June 12, 2012 [2 favorites]

I didn't really notice when I stopped taking Paxil, Wellbutrin (the first time,) or Lexapro - I know the Wellbutrin and Paxil had a significant impact on my quality of life both when I took them and when I stopped taking them, but I didn't feel any different right off or anything. Even drugs that have a hugely negative impact (which Wellbutrin did the second time, as did Abilify and Geodon when I took them), for me it was more like gradually noticing I quite clearly felt less crappy than I had two weeks earlier. I always have to think about it, and usually rely on stuff like "well, all of a sudden I'm not sleeping 18 hours at a time, so," rather than an internal "WHOA I felt that." After five lifetime doses I can't even tell for sure that I've taken Ativan until I'm thrust into a normally intensely anxious situation and I'm not freaking out. For the antidepressants, it's more like "it's been three months since I stopped taking those pills the doctor gave me and I'm starting to think it was a bad idea not to ask for more." By the way, I almost invariably follow that up with "and I'm too embarrassed to ask for help so instead I'll suffer pointlessly for a few years until things get really bad." I don't recommend that.

You're just one of the lucky folks who doesn't get the SSRI discontinuation syndrome (so far,) which is awesome. The people who get it are often miserable for extended periods of time.

It seems to me your doctor did a very dangerous thing - not that it's uncommon - in not proactively finding you a new doctor or making sure you had one. When my nurse practitioner decided to get out of private practice, she spent almost a month doing nothing but transitioning people to other providers. Things didn't work out between me and the doctor she found, but at least she tried, and gave me and my therapist time to find a better provider.

If I were you, I'd ask my therapist or my primary care provider for a referral - and I'd be sure to tell them both about what I was taking, and inform them any time it changed. That's just good sense. They see it a lot, but they need to know for sure that this is what's happening.

On to question two:

For me, being on (the right) meds is part of the difference between having a complete meltdown when stopping being with a provider. ;)

It's very natural to feel an attachment to people who try to help you - especially if you keep being exposed to them over many different days. Also, doctors are in a position of authority, of trust: you give them a lot of intimate information about yourself, they tell you what to do and you do it (messing around with your brain and body!) They have all this information, and they dole it out to you selectively (they have to do it that way, but it is another example of the power differential between you.)

And it sounds to me like you didn't have a proper period of transition - you would probably be less freaked out if you'd had a few sessions' warning about the termination of their services. That's what they usually try to do, in my experience: patients can quit any time without notice, but providers really shouldn't.

Plus, well, you've been put in a position where you don't really know what you're supposed to do - they've been telling you what you're supposed to do for months, and now you don't have that - and on top of that you chose to do something that in retrospect you believe was ill-advised. Not only are you not getting outside instruction, but you have reason not to trust your own choices! Ack!

ANYWAY. I suggest you try to write out all your thoughts about your old nurse and doctor - the good and the bad. "His breath smelled funny and he had tacky art on the walls" as well as "she made me feel listened to." Write out what you feel and think about the way your whole relationship went, from beginning to end. Maybe write them a letter - you don't have to send it, but you might have things you wish you could have said but didn't get the chance/courage to do so. Then, try to picture what kind of doctor you'd like to see, if you had the ability to create them out of thin air. Imagine what kind of first meeting, monthly sessions, etc., you would like to have with them. Figure out what you'd want to ask them (assume they know everything, just for fun.)

I strongly suspect that at the end of that process you'll feel less sad, and maybe know what you want to do about future meds/doctors/etc. If nothing else, though, it'll give you something to do between now and your next meeting with your psychologist.

(And you know this, but feel free to MeMail me.)
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 4:58 PM on June 12, 2012 [1 favorite]

Response by poster: I just wanted to say thank you for providing such helpful answers! I will make sure to let the psychologist know about the meds when I see him in two weeks.
posted by livinglearning at 5:51 PM on June 12, 2012

Depending on your exact life situation (are you stable? Or in the middle of a move or a breakup?), you may want to consider starting the medicine again until you can make a new plan with a new MD/NP. Though Cipralex is not on the list of long half-life stuff, I find that it takes 2-3 weeks for me to feel the effects of being off it.

These effects range, for me, again depending on one's personal habit, from suddenly feeling suicidal during a routine frustration to a less-scary but still demoralizing feeling of "dragging the bottom" in mood. I'd hate for this to happen to you while you're waiting for another MD appointment.

Best practice would be to call your (former) psychiatrist and ask him to call back, or leave a message, re: whether or how to taper back up. I would not give, or especially take, medical advice from internet strangers, but if you are not going to call the Dr., I would consider repeating whatever the tapering pattern was when you started the medicine.
posted by skbw at 8:41 PM on June 12, 2012