[Hopeful 285]

Hairyarmadillo,

Page 113 is actually the last page.

I am very sorry you are feeling so low. I was reading today on the Wicipedia (online encyclopedia) that what we have has a name it is Post Acute Withdrawal Syndrome and they call it PAWS. Anyone that has this should not go faster than reducing .5 mg per week. You may want to reduce the .5 every 2 or three weeks. Taper very slowly as Aunty and the others have been telling everyone.
I wish I would have read all the informative information that is posted on this site before I quit cold turkey.

I get sudden onsets of despair. I actually feel it coming on. Please remember you are not alone. There are so many of us. There are many people on this drug or are contemplating getting on antidepressants. If we can help others to prevent them from going through this, it gives us great purpous. Someone told me they quit effexor cold turkey yesterday. I was able to share what I learned with him. I was very thankful. He now is going to taper very slowly.
We are the voice for others. We have to go on to help.
Please don't lose hope. I know it isn't easy but you have to grab on to all you can. We have a mission.
I am glad you exercised. This will help you to release endorphins to make you feel better. You know even smiling releases endorphins. They say laughter is the best medicine. A lot of us have gained weight. We are still healing and we can work on losing our weight but it'll probably be easier once we get past our hardest part of this, which I understand it to be between 3 and 9 months off.
We all need each other on this site. Keep writing.

Here are some sites that have stories and more information.

http://www.ssristories.com/index.html


http://en.wikipedia.org/wiki/SSRI_di...ation_syndrome

Prevention and treatment
Patients should be advised of the elimination half-life times on their specific medication, and patients should be aware if changing from a long half-life medication such as fluoxetine, to a shorter one, that taking their dose regularly becomes much more important. Patients taking fluoxetine can often miss several doses without noticing any discomfort, but the shorter halflife of other SSRIs such as venlafaxine, paroxetine, duloxetine, escitalopram oxalate and setraline (ranging approximately 10 hours) means that a single missed dose may cause withdrawal symptoms.
The condition may be avoided by either recommencing the original, and/or lesser dose of the SSRI (or a similar SSRI), or slowly reducing (titrating) the dosage over several weeks or months. While slowly reducing the dosage does not guarantee that a patient will not experience the discontinuation syndrome, it is considered a safer method than abrupt discontinuation.
Treatment is dependent on the severity of the discontinuation reaction and whether or not further antidepressant treatment is warranted. In cases where further antidepressant treatment is required then the only step required is restarting the antidepressant; this is usually the case following patient noncompliance with the drug. If antidepressants are no longer required, treatment depends on symptom severity. Mild reactions may only require reassurance. Moderate cases may require symptom management, for example benzodiazepines can be used for insomnia. If symptoms are severe, or do not respond to symptom management, the antidepressant can be reinstated and then withdrawn more cautiously.[12]
For severe withdrawals, many doctors have patients taper their medication no more than 5% per week, as to avoid a drastic drop in serotonergic activity. This slow taper can be done either by purchasing oral suspension versions of the drug (if available), cutting pills, or dissolving capsules of the medication in orange juice.[13]

Persisting adverse effects
Some patients, especially those who have used the medicines for a long period of time or at a higher dosage, can experience persistent adverse effects on discontinuing an SSRI, which last well beyond the initial period of discontinuation syndrome. These can vary from mild (poor short-term memory, poor concentration, tinnitus) to more severe (akathisia, tachycardia, depersonalization, Post SSRI Sexual Dysfunction). Although some research has been done into the phenomenon, reliable scientific analysis is limited.
Most patients complaining of persisting post-SSRI effects experience significant improvement within two years, although some symptoms have been known to persist indefinitely. Recent case reports describe four young men and women who experienced serious sexual dysfunction that continued to be symptomatic despite medication discontinuation years previously[14][15].
The persisting adverse effects seen with SSRI discontinuation may be a part of Post Acute Withdrawal Syndrome (PAWS). PAWS is a set of impairments that occur after withdrawal from addictive substances. The condition lasts from six to eighteen months after the last use and is marked by a fluctuating but incrementally improving course. It has importance to the recovering pateint's ability to benefit from recovery, treatment, function effectively on the job, interact with family and friends, and regain emotional health. Most individuals find the first six months to be the most PAWS impacted with decreasing severity over the next six-month period. By the end of one year, most persons have returned to their respective levels of functioning.
In the addict, symptoms appear approximately seven to fourteen days into abstinence, after stabilization from the acute withdrawal. Post-acute withdrawal is a bio-psycho-social syndrome. It results from the combination of damage to the nervous system caused by drugs and the psychosocial stress of coping with life without the drug that has been discontinued. The symptoms of PAWS typically grow to peak intensity over three to six months after abstinence begins. The damage is usually reversible, meaning the major symptoms go away in time if proper treatment is received. Symptoms most often seen in PAWS are emotional lability, physcomotor problems (cognitive impairment, movement disorder, dizziness), sleep disturbances, and anxiety.

Summation
Most SSRIs are indicated for Major Depressive Disorder (MDD) and their efficacy and safety has not been shown by clinical studies or FDA-approved for long term use. Still many physicians prescribe SSRIs for patients off-label, and many are not diagnosed with (MDD) or other conditions recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM) for which the drugs are indicated. Furthermore, the all too common practice of antidepressant prescriptions written after a brief consultation by general practice or family doctors who are not thoroughly informed of the significance of all the side effects or have the right monitoring system in place compounds the problem.
To facilitate proper diagnosis and avoid unnecessary therapeutic or diagnostic interventions, it is advised that all physicians who prescribe SSRIs should become familiar with the symptoms of SSRI discontinuation syndrome, in addition to hospital staff. The most appropriate approach to therapy for discontinuation syndrome involves educating physicians of the syndrome, and educating patients and reassuring them that this is a reversible condition, reinstating the original SSRI, or instituting a new SSRI, and further slowing the rate of tapering.

[Seefour1]

Thread seems fixed,but is missing 100+ pages :/

this is strengthening my resolve to get off and stay off these types of medications.

I hear that, I'll never touch an antidepressant again, For me the experience was something akin to a 4 year old sticking a fork into an electrical outlet
lol. I just want to say that ALL of you have been great, These pills had me going crazy, made me think I was going to die everyday, I don't think I could have made it through without you guys, seriously.

I think I'm coming off of the withdrawals, took about 2 months for 3 weeks worth of pills (gheck) I'll be sticking around though to root you guys on.

Felly, thanks for the suggestions. Think I'm just going to stick it out, I have to really remind myself that my stomach and throat problems are still from the withdrawals. (yes there are still problems swallowing, but I am back to eating full meals and most meats again) specially since I'm at the point where everyone I know all think I'm imagining all of it at this point, and I don't blame them, it's been 60 days lol.

SEEFOUR: What you described is depersonalization...you do not have to have panic with it. It just makes people panic sometimes because it is so weird and alarming. I had it very bad when I was ON the drug. I still have it but it does seem to be better.

Thought so, It really didn't bother me too badly actually, in fact, and this might sound odd, I kind of liked it! lol. I think I really only had it once though, and hope to keep it that way, I'm sure it'd get less fun

[Justapill]

Been reading the entries and and encouraged and disouraged at the same time. Excited the some are off and doing well and bit down when I compare how much I have to come down from. Took prozac for about 7 years; Citalopram (Celexa generic) for ~ 3. 80mgs both drugs. Tried to kick more or less cold turkey but couldn't handle it and am now down to 30mgs - not feeling great but no zaps or nausea. When I spoke to my doctor I asked for 10 mg pills and in my last prescription got two kinds - Dr Reddy's 10mg and Aurobindo 10mgs. These pills are little dots almost when you get down to 5 and 2.5 how do you even cut them?

Also is the general consensus that the supplements from the ROADBACK.org the way to go. Power Barley, Cherry Extract, Omega-3's the whole match???

[Seefour1]

Omega 3 helped me cope some, even if it was just a placebo effect.

[skyer]

Hi Patience! I made a new email account for you to write me...nolexapro@gmail.com. Hope you are doing well. Any relief yet from the muscle aches?

I don't want to jinx it, but ever since the 15th I've been physically feeling a lot better and haven't had the dark depression. I'm still tired...6 p.m. feels more like 10 or 11 p.m. to me. I sleep all night, but still have such vivid dreams. My depersonalization is there, but again, is much better. I also went out this weekend (not too far) and my anxiety level is way down now. I still feel like I have a long way to go, but I think I'm finally past the suffering. I think I really suffered mentally and/or physically every single day during months 1 - 4.5 in some way. I'm out of pain now, but OMG I don't care about anything. I'm fine watching TV all day and that in itself scares me. I usually have so much passion and am a go-go-go kind of person. I hope this is just part of the "emotional withdrawals" and that it will get better soon. Also, my eyes are giving me a lot of trouble. It's like they're dry or something. I can no longer wear my contacts.

Hi Tavee! How are you?

Hopeful...are you hanging in there? It gets really tough at the point you are at. Be strong. Thanks for the information you posted...good stuff. I just wish I knew about it BEFORE I took this poison. We all had the right to know before we were prescribed this. How can so many doctors be in such denial about these drugs? I keep seeing ads on TV for Paxil birth defects with a number to call for legal information. This type of thing should never happen in this country.

[elizabethmaria]

Hello!
I, (like so many of us out there!!) have been reading these posts for the last couple of months - thank you so much for all of your stories, and everything -- ! It's been so much of a lifeline, can't even say how much it has meant!
I just wanted to ask a couple of questions...
My doctor had given me amitryptyline (sp??) back in October, at (according to him) a really low dose to help with some sleep trouble - that's it (so I thought) - actually, my sleep problem had developed because I had been using over the counter sleep medication on and off (now I know this) - which really messes up your sleep cycle... SO, long story short, he told me just to take it when I needed it (even though it was an antidepressant, didn't say I had to take it every day, or be careful about mixing it with anything else...) So, I had taken it some, on and off, but as time went on, I started to feel stranger and stranger, I couldn't eat, could NOT think, couldn't sleep, developed horrible anxiety, and gradually became incoherent -- In this state, I went back to my doctor, who looked at me, and said I had a major mental depression, or something, and put me on Xanax, Celexa, and Trazodone all at the same time... Well, the first day I was so incoherent, I took them, and it was like something EXPLOded in my poor head - I ended up taking another 2 days, (I was already so out of it, I couldn't tell right from wrong, and my doctor told me something was wrong with my head , so I believed them! bad bad bad (()... By the third day I was nearly paralyzed, throwing up, completely unable to sip even water, or anything - horrible depression (I knew I never had depression before because THAT was the most terrible thing in the world!!!) suicidal, etc... my family rushed me to the emergency - was there all day, nearly in a coma... finally they said to get me off all those drugs, and sent me home.... Needless to say, since that day, I've been actually sleeping more or less like a baby, with all the drugs gone... but have had some damage to the head... ... That event was in the first week of December...
Of course, my doctor says that I should not have had any symptoms, or reacted in that way (she still thinks there is something wrong with me I think, because she said she just gave me a 'baby dose' - well... that sure didn't feel like a baby dose!!!!!
Since then, like most everyone else, have had the jerking movements, muscle tightness (actually, like dystonia or something, hands curl up and feet tap and neck gets tight and twists to the side..) depersonalization (mostly gone for now), inability to think, lots of difficulty with lights, tv screens, night lights, loud sounds - emotional problems, etc...

I'm sorry to take up so much space here, I know everyone has this problem - but does anyone have experience with a major reaction like that, over just a short time?

There was no way I could taper at all, and didn't know about that, because my reaction was so horrible - I'm sure if I took any amount one more day I would either have been in a coma, or permanent brain damage or (hopefully not) committed suicide... scary... But I really only had 3 days worth...

I spent weeks just staring at the wall - and wandered about a bit -
Now I'm at the 3 month mark, and I have almost no connection with others, I'm so OUT of it - I feel like nothing, I'm such a smiley person normally, always smiling, even if I don't feel like it - now I CANT smile, it hurts my brain - I feel like I am hurting those I am around because I have no emotions at all - no depression, no anxiety, no happiness, no anger no nothing, just blankly wiped out -- and it's been this way for several weeks - I'm afraid of losing friends and family , because they don't think it should still be causing problems... ahhh! Does this part ever end - ? My head hurts in the front too ...
Other things are better - I don't feel so depersonalized, at least to the same extent, the muscle dystonia or whatever is much more mild or not there, my capacity to think is increasing more to normal some of the time, and my body is stronger overall and not sooo hypersensitive ....

One thing that I have discovered - I too had the pain in back where your kidneys are, and I believe it is your adrenal glands, exhausted, that are causing the pain - they sit right on top of the kidneys, and from another illness I had, that is what the explanation was -- Aunty here (thank you soooooooo much for all your advice)!!! said that the adrenals get exhausted at some point, and need to rebuild - I think that is what the pain many of us feel there is...

I'm sorry for rambling so, and hope I am not short - just feel very strange - I think and pray for all of you here - lots of blessings and love,

elizabethmaria....

[elizabethmaria]

Just apologizing for the length of that -- goodness, didn't realize it was so long!
take care all,
elizabethmaria

[auntybiotic]

ElizabethMarie,

Nothing is ever TOO long. Think how many your very descriptive explanation has helped.

The pain could be your adrenal glands. Lexapro can also cause gall an or kidney stones but I doubt only three days of use will cause that.

I am betteing that you are a slow metabolizer in your P 450 system from your reaction to the lexapro.........................you can be tested for this but I would mention this because there will be SO MANY medications that you will not be able to take that are metabolized using the pathway P450 systems..

[auntybiotic]

Did anyone find out where the missing 100 pages are?

aunty

[elizabethmaria]

Thank you for your reply and help -- Do we just ask our doctor for the test?? does it have a name, or just ask for test on P 450 system?
lots of blessings,
elizabethmaria

[skyer]

Elizabethmarie: I was also going to assert that you are a slow metabolizer. I really think I am, but have yet to get the test. Also, having all three of those drugs in the system at one time, especially if you are sensitive, is a lot. Interestingly, you sound like you are at the same stage as me and that perhaps you just got there faster than I did. For me, I just started to feel a little better at the 4.5 month mark off the Lexapro. I'm finally getting a little clarity, reduced anxiety and physically better, but am really struggling with the emotional side. Like you, I find it hard to smile and laugh...something that always came naturally for me. Glad you found us.

Aunty...I don't know where those pages went. I think you can still read them on the old site when you google "lexapro withdrawals".

[tavee]

Elizabeth Marie-
Ure Story Reminds Me Of When My Doctor Originally Put Me On Lex And I Had Asked Him If It Would Be Hard To Get Off It. He Said To Me Oh No I Have Alot Of Patients That Get Off It And Are Fine. When I Tried Going Off It One Year Ago Cold Turkey I Thought I Was Going To Die. He Couldnt Figure Out What Happened. Duhhhhhh He Couldnt Understand So He Said I Needed To Go Back On It.

Ill Tell Ya, If It Wasnt For Aunty And Everyone I Would Still Be On This Damn Pill. Im On 2.6 Ml And I Have Been Tapering For 4 Months Or So. I Was On This Pill For 3 Yrs.

Keep In Touch With Us And We Will Help U Thru This. Especially Aunty. She Is Our Angel!!!

Hang In There

Tavee

[Patience]

Skyer: Thanks for the email address, love the name! hah! I will emial you tomorrow Really glad thatyou're feeling better! My eyes are getting a little better, but it could be a late set-in symptom or something...get that book below and read it...wow...its great with great info for us with anxiety etc....

elizabethmaria:
I am horrified at what your doctor gave you! That is absolutely rediculous and crazy. I guarantee you suffered a brain injury from that. People can suffer no matter how long they were on the medication, especially if it affects you so poorly.

I really urge you and everyone to get the book "The Mood Cure" by Julia Ross. It is awesome. I am reading it right now and just started the amino acid supplements. They will help you to re-build your serotonin, endorhphins and adrenaline. When you are apathetic/dont really care about much you are missing these key hormones. This book explains how and what supplements to take and believe me they work. They are simply amino acids that yor body already makes, but is depleted from now at this time. The book talks about thyroid, cortisol and adrenal burn--out as well.

Also read this article:

http://www.antidepressantsfacts.com/reaction.htm

[skyer]

Patience! No offense, my dear, but you forgot to tell her (elizabethmarie) that she will recover from the brain injury as that is what we have all have to some degree because of these drugs. Just had to mention that because "brain injury" sounds a bit scary if you just joined the boards. Good job on the research...the book, antidepressantfacts.com, etc...we'll beat this disorder!

[tavee]

Patience
Thank U So Much For That Article. Wow !!i Was Amazed To Read All That.

Aunty-i Dont Know If U Read That But It Says Something About Staying Away From Synthetic(supplements). What Do U Think About That?i Mean I Have Been Taking Omega And A Multivitamin And I Am Fine. I Also Think That It Has Helped Me With Any Withdrawal Symptoms.
Let Me Know What U Think.

Tavee

[Patience]

oh my god, you're sooooo right Skyer!! So sorry elizabethmaria! Yes, any "brain injury" heals hitself fine! sorry to sound so scary, we have been talking about this for awhile...

[Patience]

Glad you liked the article Tavee! I went off vitamin B for awhile, because it is timulating, but in the other hand it does repair nerve damage ....?

Def. stay on the omega 3's and get on a good mineral like Cal Mag Bone Health. It is a very "simple" food supplement that puts the minerals directly back into your body. Very Good.

Mostly time just heals, there isnt much you can do besides: stay off caffeine, alcohol and sugar. Go to bed around 10-10:30. keep your stress down.

Redbled, an old poster, took it for only 10 days and was feeling poorly for 6-7 months!

[Seefour1]

For anyone looking for the old pages, I have a theory, I think there are more post for page under this new forum software, so therefore, less pages, if i'm right, everything is still right in this thread.

[elizabethmaria]

Hello everyone (Tavee, Seefour, Patience, and Aunty and Skyer)...
Thank you for your advice and encouragement there -- it is so awesome to have this site here! I don't know what would happen without it, as it seems like most doctors haven't any clue about this...
Did any of you report your case or anything? I've read a few things that say you are supposed to report it or something, but haven't done that... seems like a good idea ..
I hope that those that are tapering have an easier time (Tavee, that sounds like it's so hard!! I hope you do well as you finish the drug and don't have more symptoms afterward...) Skyer, you are getting more clarity again ? that is soo great.. I hope to soon...thanks Patience too -- brain injuries will heal someday...
does anyone have trouble opening their eyes, or looking half asleep, or 'out there' most of the time? look like I'm on something powerful, all drugged out, but am on nothing!!
take care all, and in my prayers..
lots of blessings
elizabethmarie

[auntybiotic]

Hi,

When shopping for vitamins............ask for natural not synthetic brands...............Vitamin Shoppes have both kinds. The synthetic just load more toxins/chemicals into the liver which is already overtaxed due to the lexapro detox going on. Some cannot even be in a room with perume or dye their hair the system is so overloaded after SSRI use.

Take a hot Epsom Salt bath with 2 cups of Epsom salts and soak in very hot water for 20 minutes. The last 5 minutes poor in a bottle of hydrogen peroxide. ...................the oxgenation in the hydrogen peroxide will enable the magnesium in the epsom salt to really penetrate the skin and it will help with anxiety and muscle spasms. This also heps detox the body thru the skin........... once a day if possible............and you should notice a difference in a few days.

[felly]

Hey guys

Thank you so much for sharing your experience with this drug and the wisdom youve gained.

Elizabethmarie and Skyer: I am really sad to hear that lex has made it hard for you to smile, and made you feel like not yourself. GPs soooo overprescribe drugs that the aren't informed about.. makes me so angry!

Tavee: How are you going girl? Sounds like we are pretty the same in terms of tapering, I am down to 2.7mg. This slow tapering is def the way to go but it is so hard to be patient!! I just want to be off the poo of a thing! Are you having any withdrawals Tavee? I am pretty good, but still seem to get very sweaty for a girl and have all these gut issues and seem to be getting a tubby tummy! Ha! Oh well, its pretty insignificant in the scheme of things.

[elizabethmaria]

Dear all,
that article - from antidepressantsfacts.com is sooo great-- but is it going to take 18 months for real? oh my goodness... I've been fighting chronic fatigue syndrome for 3 years, and was just getting over it all at long last, when this happened - the other took all my strength and will I feel like, and have been out of everything for soooo long...I don't have much left
I'm so sorry to complain here...just very, very tired...
thanks to all...
elizabethmarie

[Patience]

elizabethmaria: It probably will not take 18 months! I swear. That is just the amount of time to feel completely normal and is rare. I have taken about 6 months to feel pretty good again and I was on it 2.5 months.

You can try to get your magnesium levels up from a highly absorbable magnesium or magnesium shots. I read on a magnesium site that this is good for people with chronic fatigue syndrome. Low magnesium levels contribute to so many chronic disorders. Chronic Fatigue is also can be worse because of low serotonin, so get that book "The Mood Cure" and read about getting your serotonin levels up with 5-htp and tryptophan. The book says that in the 80's trytophan was given to depressed people for depression and Eli Lily could not get doctors to prescribe prozac to save their lives because the tryptophan worked so well. So...a bad batch of trytophan came into the US from japan and it made some people reallly sick, so the FDA got freaked and pulled it from the market. That is when doctors started prescribing prozac.

[Vcamo]

Originally Posted by tavee

Elizabeth Marie-
Ure Story Reminds Me Of When My Doctor Originally Put Me On Lex And I Had Asked Him If It Would Be Hard To Get Off It. He Said To Me Oh No I Have Alot Of Patients That Get Off It And Are Fine. When I Tried Going Off It One Year Ago Cold Turkey I Thought I Was Going To Die. He Couldnt Figure Out What Happened. Duhhhhhh He Couldnt Understand So He Said I Needed To Go Back On It.

Ill Tell Ya, If It Wasnt For Aunty And Everyone I Would Still Be On This Damn Pill. Im On 2.6 Ml And I Have Been Tapering For 4 Months Or So. I Was On This Pill For 3 Yrs.

Keep In Touch With Us And We Will Help U Thru This. Especially Aunty. She Is Our Angel!!!

Hang In There

Tavee

Back in 2002 my doctor put me on 10 mil of Lexapro a day and I was also taking Elavil and Klonopin. I took the Lexapro for around 5 months and decided I didn't want to take it anymore so I went cold turkey and had no withdrawel symptoms whatsoever. I still take 100 mil of Elavil at bedtime to help me sleep and am taking 6 mil of Klonopin a day which really helps my anxiety.

I've been on several of the SSRI's the first one being Paxil, then Prozac, Effexor, Celexa, Zoloft but even though my doctor switched me straight over to a new one I never had any withdrawel symptoms. The Paxil helped my depression but caused me to gain a lot of weight so I only took it for around 6 month's. Even though I had no problem stopping the Lexapro I would never take another SSRI again.

[Hairyarmadillo]

"actually, my sleep problem had developed because I had been using over the counter sleep medication on and off (now I know this) - which really messes up your sleep cycle"

ElizabethMaria, I can empathize with this! I am just now getting straight from this myself. A doctor had prescribed Seroquel for my insomnia which was a whole other thing to get off. Not anything like the Lexapro, but it was hard getting to sleep without it.
I keep learning so much from everyone. Aunty, you are the best! Never thought about synthetic vitamins. Makes sense!
Things are going much better this way but I am keeping watchful for the other shoe to fall, I know thte last time that I thought I was off the Lexapro I was hit with the rebound depression. this time my guard is up, though I am enjoying having more energy and feeling more positive. Isn't that ironic? I feel happier off the antidepressant! Am still on 5 mg and am giving my body time to adjust to this level as fully as possible before I drop it again. Mind you, I am dying to just quit but want to be successful this time.
From the way I am feeling, this withdrawl was definitely worth it. Wanted to share some encouragement, since only last week I really needed it myself. Thank you everyone.

[skyer]

Patience...no hurry on writing to me...just thought it would be fun to stay in touch! Tavee...you too...use that email address I posted earlier to stay in touch in the future if you want to. Also, in case the forum goes away (hope not!) we'll find each other!

Also, Patience...are you still tired or is that better? I have more energy than I did, but I force myself to sleep about 10 hours or else I'm really tired...like today. I had so many bad dreams last night that I kept waking up. I'm so frustrated. This recovery is like watching something grow. It's so slow that it's takes a while to realize any change. It's been 5 months now after being on 10mg of Lexapro for 6 weeks.

[auntybiotic]

Hi,

A word of warning about supplements that raise serotonin levels............you could kill yourself.......................literally. DO NOT TAKE ANY for at least a year after stopping Lexapro. NO TRYPHOPHAN!!!! NONE!!!!! Serotonin Syndrome can kill.
Here's a article and I will dig up a very long list of what NOT to take with lexapro.

February 27, 2007
Personal Health

A Mix of Medicines That Can Be Lethal
By JANE E. BRODY

http://www.nytimes.com/2007/02/27/he...syahoo&emc=rss

The death of Libby Zion, an 18-year-old college student, in a New York
hospital on March 5, 1984, led to a highly publicized court battle and
created a cause célèbre over the lack of supervision of inexperienced
and
overworked young doctors. But only much later did experts zero in on
the
preventable disorder that apparently led to Ms. Zion’s death: a form of
drug
poisoning called serotonin syndrome.

Ms. Zion, who went to the hospital with a fever of 103.5, had been
taking a
prescribed antidepressant, phenelzine (Nardil). The combination of
phenelzine and the narcotic painkiller meperidine (Demerol) given to
her at
the hospital could raise the level of circulating serotonin to
dangerous
levels. When she became agitated, a symptom of serotonin toxicity, and
tried
to pull out her intravenous tubes, she was restrained, and the
resulting
muscular tension is believed to have sent her fever soaring to lethal
heights.

Now, with the enormous rise in the use of serotonin-enhancing
antidepressants, often taken in combination with other drugs that also
raise
serotonin levels, emergency medicine specialists are trying to educate
doctors and patients about this not-so-rare and potentially
life-threatening
disorder. In March 2005, two such specialists, Dr. Edward W. Boyer and
Dr.
Michael Shannon of Children’s Hospital Boston, noted that more than 85
percent of doctors were “unaware of the serotonin syndrome as a
clinical
diagnosis.”

In their review in The New England Journal of Medicine, Dr. Boyer and
Dr.
Shannon cited a report based on calls to poison control centers around
the
country in 2002 showing 7,349 cases of serotonin toxicity and 93
deaths. (In
2005, the last year for which statistics are available, 118 deaths were
reported.)

The experts fear that failure to recognize serotonin syndrome in its
mild or
early stages can result in improper treatment and an abrupt worsening
of the
condition, leading to severe illness or death. Even more important, in
hopes
of preventing it, they want doctors — and patients — to know just what
drugs
and drug combinations can cause serotonin poisoning.

A Diagnostic Challenge
Serotonin syndrome was first described in medical literature in 1959 in
a
patient with tuberculosis who was treated with meperidine. But it
wasn’t
given its current name until 1982.

Recognizing the early signs is tricky because it has varying symptoms
that
can be easily confused with less serious conditions, including tremor,
diarrhea, high blood pressure, anxiety and agitation. The examining
physician may regard early symptoms as inconsequential and may not
think to
relate them to drug therapy, Dr. Boyer and Dr. Shannon noted.

In its classic form, serotonin syndrome involves three categories of
symptoms:
¶Cognitive-behavioral symptoms like confusion, disorientation,
agitation,
irritability, unresponsiveness and anxiety.

¶Neuromuscular symptoms like muscle spasms, exaggerated reflexes,
muscular
rigidity, tremors, loss of coordination and shivering.

¶Autonomic nervous system symptoms like fever, profuse sweating, rapid
heart
rate, raised blood pressure and dilated pupils.

Widespread ignorance of the syndrome is another diagnostic impediment.
But
even when doctors know about it, the strict diagnostic criteria may
rule out
“what are now recognized as mild, early or subacute stages of the
disorder,”
Dr. Boyer and Dr. Shannon wrote.

Perhaps adding to the diagnostic challenge is the fact that a huge
number of
drugs — prescription, over the counter, recreational and herbal — can
trigger the syndrome. In addition to selective serotonin reuptake
inhibitors
like Zoloft, Prozac and Paxil and serotonin/norepinephrine reuptake
inhibitors like Effexor, the list includes tricyclic antidepressants
and
MAOIs (for monoamine oxidase inhibitors); narcotic painkillers like
fentanyl
and tramadol; over-the-counter cough and cold remedies containing
dextromethorphan; the anticonvulsant valproate; triptans like Imitrex
used
to treat and prevent migraines; the antibiotic Zyvox (linezolide);
antinausea drugs; the anti-Parkinson’s drug L-dopa; the weight-loss
drug
Meridia (sibutramine); lithium; the dietary supplements tryptophan, St.
John’s wort and ginseng; and several drugs of abuse, including ecstasy,
LSD,
amphetamines, the hallucinogens foxy methoxy and Syrian rue.

Although serotonin poisoning can be caused by an antidepressant
overdose, it
more often results from a combination of an S.S.R.I. or MAOI with
another
serotonin-raising substance. Patients at particular risk, some experts
say,
are those taking combinations of antidepressant and antipsychotic drugs
sometimes prescribed to treat resistant depression. All it may take is
a
small dose of another serotonin-inducing drug to cause the syndrome.

One patient, a 45-year-old Bostonian, had been taking four drugs to
treat
depression when he had surgery on an ankle last December. He developed
several classic signs of serotonin syndrome while in the recovery room,
where he had been given fentanyl when the anesthetic wore off.

As described by his wife, he suddenly developed tremors and violent
shaking
and started cracking his teeth. He was moved to the intensive care
unit,
where he thrashed and flailed, was oblivious to those around him, and
had to
be restrained to keep from pulling out his tubes. Two weeks later, he
was
still in intensive care and still very confused, despite being taken
off all
medications that could have caused his symptoms.

Serotonin syndrome can occur at any age, including in the elderly, in
newborns and even in dogs. Since 1998, the poison control center at the
American Society for the Prevention of Cruelty to Animals has gotten
more
than a thousand reports of the ingestion of antidepressant medications
by
dogs, which can develop symptoms rapidly and die. The syndrome can also
occur weeks after a serotonin-raising drug has been discontinued. Some
drugs
remain active in the body for weeks, and the MAOIs disable an enzyme
involved in serotonin metabolism that does not recover until weeks
after the
drugs are stopped.

Prevention and Treatment
Most cases of serotonin syndrome are mild and resolved within 24 hours.
But
if the doctor fails to recognize them and prescribes either a larger
dose of
a serotonin enhancer or another serotonin-raising drug, the
consequences can
be rapid and severe.

Most important to preventing the syndrome is for patients to give each
of
their doctors a complete list of drugs they regularly take — including
prescriptions, over-the-counter medication, dietary supplements and
recreational drugs — before a doctor prescribes something new.

Indeed, if you are taking any of the drugs described above, you might
ask
whether a new prescription is safe. And when filling a new
prescription,
it’s not a bad idea to also ask the pharmacist whether the medication,
or an
over-the-counter remedy you are considering, is safe to combine with
any
other drugs you take.

Once the syndrome develops, the first step is to stop the offending
drugs.
It is crucial to seek immediate care, preferably in a hospital. Most
cases
require only treatment of symptoms like agitation, elevated blood
pressure
and body temperature, and a tincture of time.

More severe cases are treated with drugs that inhibit serotonin and
chemical
sedation. Dr. Boyer and Dr. Shannon cautioned against using physical
restraints to control agitation because they could enforce isometric
muscle
contractions that cause a severe buildup of lactic acid and a
life-threatening rise in body temperature.

Copyright 2007 The New York Times Company

[elizabethmaria]

Hairyarmadillo (great name!!): Yes, those sleeping drugs are scary things.. - I finally realized that without everything, our bodies DO know how to sleep, I mean, that's what they have been doing for the past thousands of years anyways .. if we just let them! sometimes its really hard for a few weeks, as your body gets back to 'normal', but then it gets better if you're not on anything at all.. Hope all are sleeping better soon too here... it's no fun not to sleep - I sympathize sooooo much!

Does anyone have these muscle contractions from the drugs? Like hands curling up like a knot, neck twisting, sometimes face gets twisted ??? Haven't heard anyone having these problems - started after the SSRI 'incident' and seems to come in 'episodes' especially if there are bright tv lights, or stress... quite embarrassing, so I retreat to the bathroom... but really weird..
anybody have anything like that?
Hope you are all doing better, better and better every day )

elizabethmarie

[elizabethmaria]

Hello everyone again,

I just wanted to write in for all who are struggling with this - some things that we should be aware of (or be careful of...) that I learned from recovering from Chronic Fatigue syndrome over the past few years...

Chronic fatigue syndrome (CFS) is often a reaction that happens to you when you have gone through a major stress, or trauma, or illness.. it's like the body gets hit so hard with something that it knocks it out of joint (your biological clock which controls not just your sleep, but appetite, hormones/endocrine system, adrenal system, immune system, everything...) What happens to many people, is once they take a major hit, (could be a major drug reaction, surgery, illness, stress), their body goes into some shock, and their 'bio clock' gets way askew... so you feel like sleeping all the time, etc. or at different hours, can't exercise, etc... feel very sick and not normal at ALL... ( I was really healthy and strong beforehand, and the way I came to feel was sooo off, but didn't recognize what was wrong, it's very strange)...What developes into chronic fatigue syndrome, is that you are 'unable' to reset your clock again... so the body doesn't 'get back together' --- However, you CAN heal this system, by maintaining a regular schedule, building exercise slowly but steadily back into your daily routine, etc. etc.. but it is very, very hard... I've recovered (mostly) through the excellent clinic at Harborview Medical center in Seattle -- they are the top place for treating that condition, and they have research going all over the world -- so it's really important to be aware of the causes....

I wanted to write this here , because a drug reaction like this that throws your body so out of joint, could put someone in danger of developing the sydrome -- to prevent this, and to help yourself heal, you NEED to try to maintain a normal sleep/wake time schedule, (avoiding naps), keep exercising as much and REgularaly as you can, eat at regular times even if you don't want to... to keep your body, or give your body all the 'cues' it needs... even if it's really hard -- my CFS developed without really knowing, but if I had known the triggers beforehand, it may have been avoided - but learned a lot from it, and hope to help/prevent others from getting it as well..!
It's really hard to do this when we feel so sick and tired, and out to lunch .. but being aware of it can be a life saver -- some people are more prone than others I know... but all kinds of people come down with it... It also just helps your body to heal better in general...

I don't know, but if this can help even one person, then that is WONDERFUL!! If anybody has any questions about it, or ? just ask --
yay!! the brain is working a little better today, so wanted to put this out to you,,
you are all in my prayers -- take lots of care!!
elizabethmaria

[stellalu]

I am currently entering my sixth day off lexapro - well almost, but I will explain that later. Basically I have been on 20 mgs for a little over 2 years. I have always had issues with depression but became extremely depressed when I started graduate school 2 years ago after having been out of school for several years. I had been on zoloft before (about a year - no problems with w/d) with great success, but when I tried it again had some side effects. The school psychiatrist suggested that I try lexapro. I found the lexapro to be very helpful but decided about a 2 months ago that I did not need it anymore. I had just entered therapy and figured, what's the point of talking about my feelings when I barely feel anything.

I had missed doses of lexpro before and noticed strange symptoms that went away as soon as I took a pill. So I decided to do a little internet research prior to stopping the meds. I must admit that reading this site frightened me, but I figured it was better to know what was happening to me than not. I did talk to another school psychiatrist before I started to taper. She recommended that I go down 20, 10, 5 over the course of 6 weeks or so. I am impatient and started to taper down fast. Before I went to see her I had only been taking the 20 mgs every 2-3 days, so immediatly went down to 10. I didn't have any w/d doing that for about 2 weeks so I went down to 5. Then... overconfidence took over and I stopped taking the meds after about a week, maybe even less, of being on 5. The first couple of days I didn't feel anything except mood swings and crying (which I generally never do) but none of the physical symptoms and pain which is what scared me the most. The crying I also chalked up to being dumped at about the same time as I went off the meds - good timing huh? So now I am entering day six of being off the medication. I only started to feel headachey and sore yesterday though oddly enough the crying has subsided somewhat. Earlier tonight I felt so achey that I took a sliver of a 10 mg pill, hence the "almost." Maybe it was 1-2 mg? Anyway, I feel better, but I also took some advil and have been sitting here with a heating pad on my neck.

So now I wonder what I should do? Should I suck it up and stay of the meds or try to start taking 5 mg and taper off more slowly? Also if I do go back on five how long would you all recommend I stay on the 5 then go to 2.5 and then off completely? How long can I wait before I make this decision? Also what else can I expect to happen after the physical stuff wears off? Depersonaliztion, memory loss (I've read so many post that I don't remember if people have memory loss or gains in memory post w/d... hmm not remembering that can't be a good sign!), depression?

Anyway, sorry for the long post and my best to everyone out there.