The Part They Don’t Tell You: SSRI Discontinuation Syndrome

eric March 7, 2012 3

antidepressants ssri withdrawal discontinuation syndrome e1331179571533 The Part They Dont Tell You: SSRI Discontinuation Syndrome

It’s been three days since I took my last dose. I’m slightly dizzy, nauseous, extremely fatigued, and feel like I’ve fell ill to a mild case of the flu. This isn’t a new occurrence, but hopefully it’s the last.

The dose I am referring to is citalopram, the generic form of Celexa. Citalopram is a SSRI antidepressant medication used mostly for depression or anxiety. It’s the sister drug of Lexapro, a commonly prescribed antidepressant. SSRI stands for selective serotonin uptake inhibitor. A common misconception is that these drugs increase the amount of serotonin in your brain thus making you feel more normal. This is not the case exactly. SSRIs actually just keep the serotonin that’s already there available for longer, essentially making it more active in your brain’s synapses. The theory is that people who are depressed or anxious most likely have lower levels of serotonin than their “normal” counterparts, and they would benefit from the increased brain availability of serotonin. This may be true, however the opposite is not true. If you take a person who isn’t “depressed” and doesn’t experience anxiety attacks, and artificially lower their serotonin levels, they are not automatically put into a state of depression or anxiety. They are also meant to be used short-term, and not something relied on forever. It is very common for the drugs to work for a while, and then seem to plateau. While “chemical imbalances” in the brain definitely play a role, our thoughts and general state of mind play a huge part as well. In my case, my thoughts and internal dialogue played a major role in why I felt the way I did.

I’ve taken citalopram for the past 6 months because of anxiety and daily tension type headaches. I became a person prone to anxiety after having my first panic attack at the age of 18. I was driving by myself, and suddenly was overcome by a feeling of faintness. My heart began to race and I blacked out for a split second. I felt like something was seriously wrong…but it all happened so suddenly out of nowhere. I managed to get home in one piece, and I insisted to my father that he take me to the hospital. A blood pressure reading of 200/100 and 5 hours later I was given the diagnosis: Panic Disorder. Fun stuff. I was told to see my primary care doctor, and was also given a referral to a psychiatrist. I thought, “A PSYCHIATRIST?!? BUT I’M NOT CRAZY! I’M DYING!” My doctor nonchalantly told me that I was depressed and I needed to take Zoloft. I was willing to give it a try. I’d try anything to make these feelings go away. A few days into it, all hell broke loose. I felt worse. I felt like I wanted to jump out of my own skin. I for the first time had the thought, “Now I know why people would want to kill themselves.” That really terrified me. I knew it was the medicine, and I didn’t want to take anything that made me feel even remotely suicidal. I was convinced Zoloft was the devil and I needed to stop taking it immediately. So it began, a 5 year stint of avoiding the doctor’s office out of fear they would insist on me take these pills again. After a few months of near constant panic attacks, I was better. I experienced a spontaneous recovery. I was back to my normal self for the most part. I beat those bastard panic attacks. I was in the clear. However, once you experience the feeling of pure panic, you never forget how terrible that is. It remains buried in the back of your mind.

About 4 years later, it happened. A car ride coupled with an immediate feeling of panic and dizziness. This time I was a passenger. I knew what was going on. I couldn’t imagine going through what I went through before. Fast forward three years, and it wasn’t letting up. This time, I wasn’t having panic attacks. I was having more of what is considered generalized anxiety disorder. I was also having daily headaches. They were like tension headaches, but didn’t really go away with any of the traditional remedies. I tried acupuncture, massage, herbs, Advil, sleep, hot showers, gadgets, meditation, hypnosis…but no dice. Everything offered some relief, but nothing ever got me back where I wanted to be. I was stuck in a vicious cycle: anxiety causing stress and worry, and stress and worry causing anxiety. I was trying so hard but my efforts always seemed to fall short of a complete recovery. One day while on the gym elliptical, I decided enough was enough. I think it was the song I was listening to; a Three Days Grace song, maybe? I called my doctor the next day and scheduled an appointment. Just picking up the phone and dialing gave me an immediate panic attack. I dreaded what she was going to say, but I tried to mentally prepare myself as much as possible. The week leading up to it, I was a big ball of nerves. Because of my earlier bad experiences with my doctor, and a failed attempt at Zoloft, I decided to choose a new doctor all together. It worked out well for me as she was very nice and understanding…and kind of attractive. I made sure to express my uneasiness and absolute terror about going on another SSRI antidepressant, and shared my prior experiences. She assured me that the first time was a fluke, and there’s no guarantee it would happen again. She recommended a different medication, starting out on a lower dose. She prescribed 10mg of citalopram for my anxiety issues. Kicking and screaming (not literally, that’s not nice), I decided to suck it up and listen to the doctor. I surrendered my life to a little pink pill smaller than a tic-tac.

The first week or two were absolute hell. Whatever anxiety I was having was magnified twofold. I couldn’t sleep at night, and I couldn’t stay awake during the day. I felt jittery and couldn’t concentrate. My supreme sexual abilities were severely diminished. I couldn’t help but think I made a huge mistake. At the time I was also going through talk therapy, so my therapist definitely helped me through the initial fears and coping with the side effects. He was a godsend, because I would of been stranded without having a therapist during those tough times. Most likely I would of stopped taking the medication due to initial side effects, just like zoloft. And the best part? Seeing a psychologist was free. Thank you ObamaCare…put a check in the win column. After a month or two, I actually started to feel normal again. Maybe this was the answer I was looking for, and I was avoiding it all along. After six months of use, I had significant improvement in my anxiety as well as an almost complete elimination of my daily headaches. When I was anxious or had a headache, I knew how to control my wandering mind and not expect the worst or focus on doom and gloom scenarios. Meditation and relaxation techniques definately played a huge role in that, as well as the supplements I take. The Alpha Stim is also a little miracle device that has helped tremendously. My doctor, without me even mentioning it, recommended that I taper myself off the drug during a routine checkup. More glorious words have never been spoken. I was excited to not have to take an antidepressant anymore. I felt like I had accomplished something. I had jumped over a hurdle that has taken me years to clear. Things were looking up. That was until I made my first dose reduction.

SSRI discontinuation syndrome, or withdrawal, is the part doctors don’t really seem to tell you about. If they do, they downplay how extremely common it is, and how much it sucks. If you ever try to quit cold turkey, good luck…you are a better person than I. But you’re also very stupid…because doctors tell you to NEVER STOP TAKING AN ANTIDEPRESSANT ABRUPTLY. The correct way its to wean yourself off slowly. My doctor said if I take it slow, I should be okay. Reading the online horror stories, I consider myself pretty lucky. I’ve experienced what could easily be mistaken with the flu or a bad cold. I actually keep finding myself thinking that I’m just sick, and it’s not my body crying out for a drug it’s become accustomed to for the past few months. Who knows, maybe it’s coincidence. What I do know is feeling sick is miserable, regardless of the cause. My initial dose was 10mg for 6 months. My doctor suggested I cut that in half to 5mg for 2 weeks. If I still feel relatively okay at the end of 2 weeks than stop all together. Seemed simple enough. The first two days on 5mg I felt normal. The 3rd day, not so much. I experienced chills, a terrible headache, fatigue, and an overall feeling of malaise. I thought I was getting sick, but then I realized it was most likely SSRI withdrawal. After a few days I felt fine again. Then, into the second week, I started to feel it again but much milder. I decided that as a result of the symptoms I was experiencing, I would extend my tapering schedule by a week or two. This would give my brain and body a chance to recover, and hopefully diminish the symptoms. I went from 5mg to 2.5mg for a week. I experienced the same thing about 2 days after dropping the dose again, like clockwork. I felt like absolute shit. This time, it went away after a day or so. After a week, I went from 2.5mg to nothing. As I’m writing this, it’s been 3 days since I took my last dose. I didn’t expect to experience any substantial symptoms considering the dose was so small, but the past three days I’ve felt pretty rough. For the first time, I’ve experienced the dizzy sensations that people online describe when moving their head too fast. It’s not terrible though…more of a temporary discomfort. I’m extremely grateful I haven’t experienced the brain zaps I hear so much about. Doesn’t sound like fun at all. If you are reading this because you are experiencing similar things as me right now, keep one thing in mind: this is all temporary. For me, the “withdrawal” symptoms have never progressed past feeling like a mild case of the flu. I’ve still been able to work, but I have to push myself a little harder. For the most part, I’ve been able to carry on with my normal routine.

There are few pieces of advice I’d like to offer to others going through a similar circumstance. There are ways you can reduce these symptoms and recover more quickly. Exercise. Exercise. Exercise. I know the thought of that might make you cringe, but that might be the single most important thing you can do to ease the symptoms of SSRI discontinuation syndrome. More specifically, cardio exercise. I’ve done at least 30 minutes of cardio for the last 3 weeks, even the days I felt the worst. Cardio releases feel good chemicals, like endorphins, and actually increases the neurotransmitters in the brain like serotonin and dopamine. Plus, it’s a great stress reliever. Stress is the reason you took the antidepressant in the first place. So do yourself a favor and make it a habit to get regular exercise. Also, I’d strongly suggest some form of meditation to clear your mind. What’s worse than feeling like shit? Feeling like shit and mentally obsessing how much you feel like shit. Yes, this is from an experienced hypochondriac, so take that to heart. Develop a meditation practice of your choosing and make it habit to relax yourself every chance you get. Hypnosis is also a valuable resource. I’d also highly recommend seeing a therapist. It is not a sign of weakness, and you are not crazy. Anxiety and depression are very common and these people can help you work through it. They will give you insight as to why you feel this way, and offer pretty successful ways to overcome it. Another important topic is nutrition. Vitamins and herbal supplements are a huge asset to me, and I feel much more comfortable taking natural substances verses a chemical produced in a lab. There are many resources to point you in the right direction, but here are a few supplements to consider: Kava Kava, L-Theanine, B-Complex, L-Tryptophan, L-Tyrosine, chamomile, and a dozen others. I take these and many others daily and have gotten great results. Check with your doctor first though. I made sure to clear my vitamin regimen with her before going on citalopram. Last thing, but this one is not for everyone because of the price tag, research the Alpha Stim device! Cranial Electrotherapy Stimulator, or CES, is used to successfully alleviate the symptoms of anxiety and depression, sometimes just as or even more effective than antidepressants. I got one from a dentist who specializes in TMJ treatment. You need a prescription to buy one in the United States, but the thing WORKS. Some insurance plans may even cover it. You put clips on your earlobes and it sends gentle electrical impulses through your head. This sounds scary, but it’s a proven science. I use it almost daily, and it has really helped during times when I need to keep my anxiety at bay. It relaxes you, and over time actually helps to re-balance the amount of neurotransmitters in the brain.

To make a long story short, antidepressants can be helpful. Celexa helped be get over a 4 year span of anxiety and constant headaches. Looking back I probably should of done it sooner. However, it’s not all fun and games, and it’s not a pill that will make you instantly happy or solve all your problems. The severe initial side effects coupled with the substantial withdrawal, or SSRI discontinuation syndrome, should be taken into account before deciding to go on this medication. While everyone is aware of the initial side effects that may occur, not many people are aware of the withdrawal effects until it’s too late. Doctors need to be more informed, and be more honest with their patients when it comes to their mental health.

  • Debbi Marie McDermott

    I’m sorry that you’ve had so much trouble with both anxiety and psychiatric medication. But there are two things about your story that I’ve heard over and over by people who feel depressed or anxious, although not necessarily as anxious as you described your symptoms. First of all I must add my own upper case opinion: DON’T LET A PRIMARY CARE PHYSICIAN DIAGNOSE A PSYCHIATRIC CONDTION UNLESS IT IS BEING CAUSED BY A PHYSICAL ILLNESS YOU ARE BEING TREATED FOR! So many people tell their primary care doctors about their anxiety or severe headaches and/or depressed feelings. That’s fine but any doctor with whom you’ve discussed these problems more than once is wrong to give you any sort of psychiatric medication other than a temporary (few days at most) dose of a tranquilizer. They should refer you to a psychiatrist for an evaluation and tests before determining that you have any psychiatric disorders. So many people are afraid of psychiatrists or fear they will be overmedicated and rendered incapable of functioning. This is such a backwards belief system that it always makes me laugh. I was born with Low Mood Disorder, clinical depression and Generalized Anxiety Disorder and I suffered until the age of 22 when I was finally diagnosed by a psychiatrist who gave me medication for both depression and anxiety. I’m still taking one of those first antidepressants and it still works, but over the years I tried many of the SSRI’s with either really bad side effects or pills that did nothing at all to help. But it’s been a journey through medications as they were being created. I also had to accept that what goes on in my brain isn’t normal and it really is because of a chemical imbalance. Trying to fight it on my own got me nowhere, just like trying to cope with diabetes by yourself throws your control off. I hope you do well in the future with your anxiety, but don’t forget that new drugs are always coming out and the one that works for you without all the side effects may be the next new thing.

  • nkirby

    You wrote this post a while ago, so I am wondering how long did your symptoms last? Also, did any of the supplements directly relieve any of your symptoms? I am going through the withdrawal right now after taking lexapro for 3 years. My doctor decided that it was at the point where it was safer to have me just stop taking it than it was to continue it…but this is really hard and I am finding it really hard to find people’s advice on how to reduce the symptoms.

    • Eric A

      The symptoms didn’t last much after I stopped the medication. I’d say maybe a week or two after cutting it down to zero? It took me a bit of time to re-acclimate and get back to feeling “normal”, but after a bit I felt the same off the medication as I did when I was on it. Have you tapered your dosage down or gone off cold turkey?

      I’d say the supplements that helped me the most were Kava Kava and Theanine. I still take them to this day from time to time under times of stress or anxiety. They are subtle though. It’s not near the intensity of taking a Xanax or anything. Honestly though, the best thing that helped relieved the withdrawal symptoms was exercise. 30 or 40 minutes a day of some kind of cardio…and not just walking. Something that raises your heart rate up. You have to push yourself a bit and tire yourself out.