Can cessation of an SSRI cause new issues?
June 20, 2016 8:38 AM Subscribe
Since quitting Zoloft, I am experiencing issues that are arguably more debilitating than the issue that I was prescribed this medication for in the first place. I am wondering if anyone has had similar experiences with new mental health issues emerging after quitting a psych medication.
I (female, 25) was prescribed Zoloft for social anxiety as I would get very nervous socializing with people at work and basically anyone outside of my small circle. After nine months on the meds and a career change, I decided I wanted to get off them. The weaning process was extremely difficult for me mentally. I felt very depressed, scared, and hopeless. I also starting experiencing intrusive thoughts, mainly of horrible things happening to my young child. Luckily, I was able to overcome that particular issue after a few months but still after nine months off the meds, I am dealing with obsessive/irrational worries. Lately, these thoughts have been directed toward my husband and are causing me to have unwarranted distrust of him. Looking online, it appears that I may be exhibiting symptoms of obsessive compulsive disorder. However, the social anxiety is gone. Anyone else had a similar experience with a transfer of anxiety issues after quitting psych meds? Also, I think I should mention that I have no desire to get back on any type of medication. This experience has left me with a lot of distrust for Big Pharma and doctors’ over-prescription of psych meds.
I (female, 25) was prescribed Zoloft for social anxiety as I would get very nervous socializing with people at work and basically anyone outside of my small circle. After nine months on the meds and a career change, I decided I wanted to get off them. The weaning process was extremely difficult for me mentally. I felt very depressed, scared, and hopeless. I also starting experiencing intrusive thoughts, mainly of horrible things happening to my young child. Luckily, I was able to overcome that particular issue after a few months but still after nine months off the meds, I am dealing with obsessive/irrational worries. Lately, these thoughts have been directed toward my husband and are causing me to have unwarranted distrust of him. Looking online, it appears that I may be exhibiting symptoms of obsessive compulsive disorder. However, the social anxiety is gone. Anyone else had a similar experience with a transfer of anxiety issues after quitting psych meds? Also, I think I should mention that I have no desire to get back on any type of medication. This experience has left me with a lot of distrust for Big Pharma and doctors’ over-prescription of psych meds.
I have been on several SSRIs as well, including Zoloft, and I think this is just a migration of symptoms from one focal point to another. The best part about SSRIs is that they can stabilize your brain chemistry to the point that you are able to deal with and create coping strategies around your depression and anxieties. They don't zap away the problem, they just make it so that you can deal with the problem. It sounds like while you were on the Zoloft, you were able to deal with your social anxiety to the point that you didn't need the Zoloft any more to manage it. That's great!
If you have a chemical imbalance in your brain, though, that will always be there. So to me it seems like your anxiety has moved on to your child and husband, since you are confident in your social abilities now.
Since Zoloft worked so well for you before, why not go on it again for a bit to help you normalize your brain chemistry so that you can work through your obsessive thoughts? Another option would be to try a different SSRI with an easier weaning period for when you eventually stop taking it. Prozac might be better for you due to its long half-life.
Please note: I'm not your doctor, or even a doctor at all, just someone who has struggled with anxiety and bad brain chemistry all her life. Please go see your doctor to talk about this.
posted by chainsofreedom at 8:58 AM on June 20, 2016 [4 favorites]
If you have a chemical imbalance in your brain, though, that will always be there. So to me it seems like your anxiety has moved on to your child and husband, since you are confident in your social abilities now.
Since Zoloft worked so well for you before, why not go on it again for a bit to help you normalize your brain chemistry so that you can work through your obsessive thoughts? Another option would be to try a different SSRI with an easier weaning period for when you eventually stop taking it. Prozac might be better for you due to its long half-life.
Please note: I'm not your doctor, or even a doctor at all, just someone who has struggled with anxiety and bad brain chemistry all her life. Please go see your doctor to talk about this.
posted by chainsofreedom at 8:58 AM on June 20, 2016 [4 favorites]
Yikes, that does sound very OCD-like. And you didn't experience anything like this before?
A brief, oversimplified lesson about neurotransmitters—neurons that synapse in your brain, in various ways, are always (very roughly speaking) monitoring the amount of neurotransmitters that are released into the synaptic cleft (i.e., are used so one neuron can talk to the other). The neurons are (sort-of) trying to make sure that they are releasing the "right" amount of neurotransmitter (which, for many people, might functionally be the wrong amount of neurotransmitter). To use an example you might be more familiar with: when a person takes heroin on a regular basis, their brain begins to downregulate its native, endogenous, normal neurotransmission of opioids (which heroin not only mimics, but, like, super-mimics), in different manners (e.g., causing less opioids to be released; getting rid of opioid receptors). And if you stop taking heroin, good god, life is going to suck for awhile, as your brain has adjusted itself to be used to the huge amount of opioid that were being pumped into the system. It will take awhile.
SSRIs are not heroin. And they have a different mode of action than just mimicking a particular neurotransmitter flat out. But, even if you don't have a "chemical imbalance," you could very well experience substantial withdrawal symptoms that bring new experiences that you haven't had before; even in such a case, parts of your brain that were originally "balanced" pre-drug (to use a bit of nebulous term) might become (temporarily?) "unbalanced" as psychotropics are blunt tools that don't just "fix" the "right" areas in your brain, and those "balanced" areas also adjusted to the higher levels of [serotonin and the neurotransmitters it regulates].
If it's simple withdrawal the OCD-like symptoms may go away, but the brain is complex, and long-term use of psychoactive drugs of any kind can definitely have lingering neuronal effects that do not totally go away with simple removal of the substance. I hope they go away on their own accord, though I can't quite tell from the timeline how long it has been.
(If your OCD symptoms persist, I would strongly recommend seeking out a cognitive-behavioral clinician trained in exposure and response prevention therapy to help you with them, because they can become [and may already be] quite awful, and it's arguably easier to nip that in the bud ASAP. For many problems, there aren't substantial differences between bona fide therapies; OCD is one big big exception.)
posted by Keter at 9:30 AM on June 20, 2016 [2 favorites]
A brief, oversimplified lesson about neurotransmitters—neurons that synapse in your brain, in various ways, are always (very roughly speaking) monitoring the amount of neurotransmitters that are released into the synaptic cleft (i.e., are used so one neuron can talk to the other). The neurons are (sort-of) trying to make sure that they are releasing the "right" amount of neurotransmitter (which, for many people, might functionally be the wrong amount of neurotransmitter). To use an example you might be more familiar with: when a person takes heroin on a regular basis, their brain begins to downregulate its native, endogenous, normal neurotransmission of opioids (which heroin not only mimics, but, like, super-mimics), in different manners (e.g., causing less opioids to be released; getting rid of opioid receptors). And if you stop taking heroin, good god, life is going to suck for awhile, as your brain has adjusted itself to be used to the huge amount of opioid that were being pumped into the system. It will take awhile.
SSRIs are not heroin. And they have a different mode of action than just mimicking a particular neurotransmitter flat out. But, even if you don't have a "chemical imbalance," you could very well experience substantial withdrawal symptoms that bring new experiences that you haven't had before; even in such a case, parts of your brain that were originally "balanced" pre-drug (to use a bit of nebulous term) might become (temporarily?) "unbalanced" as psychotropics are blunt tools that don't just "fix" the "right" areas in your brain, and those "balanced" areas also adjusted to the higher levels of [serotonin and the neurotransmitters it regulates].
If it's simple withdrawal the OCD-like symptoms may go away, but the brain is complex, and long-term use of psychoactive drugs of any kind can definitely have lingering neuronal effects that do not totally go away with simple removal of the substance. I hope they go away on their own accord, though I can't quite tell from the timeline how long it has been.
(If your OCD symptoms persist, I would strongly recommend seeking out a cognitive-behavioral clinician trained in exposure and response prevention therapy to help you with them, because they can become [and may already be] quite awful, and it's arguably easier to nip that in the bud ASAP. For many problems, there aren't substantial differences between bona fide therapies; OCD is one big big exception.)
posted by Keter at 9:30 AM on June 20, 2016 [2 favorites]
Most of the issues I've had in the past with SSRIs (not on them for 10+ years) or other long-term meds was limited to the short period of time when I was titrating off them. So like 10-30 days. I would talk to a doctor for sure in your case. Things that happened to me were horrible itching, terrifying dreams, sleep issues - that would frequently happen even if I missed one dose. I knew it was a real physical effect because I'd have the symptoms and only later figure out I missed a pill by finding it in my pill box. I am generally super sensitive to that sort of medications though.
I also found my eventual relief from my original symptoms in the form of lifestyle, job and other changes, but that's not true of everyone.
posted by freecellwizard at 10:04 AM on June 20, 2016
I also found my eventual relief from my original symptoms in the form of lifestyle, job and other changes, but that's not true of everyone.
posted by freecellwizard at 10:04 AM on June 20, 2016
It sounds as though no doctor was involved in your decision to go off Zoloft; at least, none was mentioned in your post. Meanwhile, you are suffering more off the medication than on it. I am not clear on how this leads you to mistrust meds more, when your problems have been exacerbated not by the drug but by the absence of it.
This article suggests that anxiety can appear as a result of stopping a med, but in a period closer to 20 days after discontinuation. But, this is an older review.
It may simply be that your anxiety, which had been controlled by Zoloft, has returned now that you are off it, but is taking a form you had not previously experienced.
Please see a doctor for a full workup and discussion.
posted by Riverine at 10:17 AM on June 20, 2016 [1 favorite]
This article suggests that anxiety can appear as a result of stopping a med, but in a period closer to 20 days after discontinuation. But, this is an older review.
It may simply be that your anxiety, which had been controlled by Zoloft, has returned now that you are off it, but is taking a form you had not previously experienced.
Please see a doctor for a full workup and discussion.
posted by Riverine at 10:17 AM on June 20, 2016 [1 favorite]
Anyone else had a similar experience with a transfer of anxiety issues after quitting psych meds?
I experienced blunted affect, apathy, etc., on the med I was on; this carried on for a good while afterwards, though it seemed to decrease over time. Also experienced many of the discontinuation effects mentioned here, during withdrawal (zaps, vertigo, etc). That wiki does mention that "Mood disturbances such as dysphoria, anxiety, or agitation are also reported, as are cognitive disturbances such as confusion and hyperarousal".
Today, some psychiatrists will do a switcheroo and put people on something else for the taper off the side-effect-causing drug, and then (maybe) later taper them off the alternate. (Have no experience of this approach.)
posted by cotton dress sock at 10:27 AM on June 20, 2016
I experienced blunted affect, apathy, etc., on the med I was on; this carried on for a good while afterwards, though it seemed to decrease over time. Also experienced many of the discontinuation effects mentioned here, during withdrawal (zaps, vertigo, etc). That wiki does mention that "Mood disturbances such as dysphoria, anxiety, or agitation are also reported, as are cognitive disturbances such as confusion and hyperarousal".
Today, some psychiatrists will do a switcheroo and put people on something else for the taper off the side-effect-causing drug, and then (maybe) later taper them off the alternate. (Have no experience of this approach.)
posted by cotton dress sock at 10:27 AM on June 20, 2016
Nine months is a long time to put up with OCD or anxiety symptoms, so I'd definitely want to see a therapist who is well-versed in OCD/anxiety-specific techniques like exposure and response prevention (ERP) therapy. I would definitely not assume those feelings are temporary or that they will go away on their own with time.
From what I've read (and experienced), it's not uncommon for people with OCD and anxiety problems to relapse after going off medication (particularly if they weren't also going to therapy), and it's also not so uncommon for people's loci of anxiety/obsessions to shift from "theme" to "theme", even for people who've never tried SSRIs. I'm not a doctor or therapist, but I think the most parsimonious explanation may be that you just had a relapse of some kind, maybe exacerbated by the stress of coming off the SSRIs. Fortunately I suspect it doesn't actually make a big difference whether or not it was ultimately precipitated by the SSRI, since in either case therapy should help you stop suffering so much. Therapy should also help prevent relapse if you ever do try an SSRI or related drug again.
Permanent changes from psych meds is honestly something I've had worries about also, but I'll also note that when you have some kind of anxiety problem I think it can be tempting to 1. idealize the past, where things may seem simpler/clearer because of hindsight bias, and 2. to focus one's anxiety on intrinsically ambiguous things, like possible but unknown long-term effects of a course of drug treatment. I've found that these mindsets sometimes distract me from focusing on what I can actually do in the situation (e.g., seeking counseling, trying to be healthy in the present).
posted by en forme de poire at 12:51 PM on June 20, 2016
From what I've read (and experienced), it's not uncommon for people with OCD and anxiety problems to relapse after going off medication (particularly if they weren't also going to therapy), and it's also not so uncommon for people's loci of anxiety/obsessions to shift from "theme" to "theme", even for people who've never tried SSRIs. I'm not a doctor or therapist, but I think the most parsimonious explanation may be that you just had a relapse of some kind, maybe exacerbated by the stress of coming off the SSRIs. Fortunately I suspect it doesn't actually make a big difference whether or not it was ultimately precipitated by the SSRI, since in either case therapy should help you stop suffering so much. Therapy should also help prevent relapse if you ever do try an SSRI or related drug again.
Permanent changes from psych meds is honestly something I've had worries about also, but I'll also note that when you have some kind of anxiety problem I think it can be tempting to 1. idealize the past, where things may seem simpler/clearer because of hindsight bias, and 2. to focus one's anxiety on intrinsically ambiguous things, like possible but unknown long-term effects of a course of drug treatment. I've found that these mindsets sometimes distract me from focusing on what I can actually do in the situation (e.g., seeking counseling, trying to be healthy in the present).
posted by en forme de poire at 12:51 PM on June 20, 2016
Don't know if it helps in your level of trust (or not) for Big Pharma, but Zoloft went generic over 10 years ago. Whatever happened with your Zoloft prescription, it wasn't motivated by profit.
posted by treehorn+bunny at 10:27 PM on June 20, 2016 [3 favorites]
posted by treehorn+bunny at 10:27 PM on June 20, 2016 [3 favorites]
This thread is closed to new comments.
In the anecdotal area, I have been on three different kinds of SSRI's, (and am currently on Zoloft) and I have suffered no prolonged changes like you're describing here.
posted by INFJ at 8:51 AM on June 20, 2016 [1 favorite]