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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by SLS on March 11, 2005, at 7:35:51
Regarding SRI antidepressants and withdrawal:
Short half-life = multiple doses per day
It is silly to assign exclusively the reason for the difficulties withdrawing from drugs like Effexor and Paxil to their relatively short half-lives. It has more to do with their pharmacodynamics (how the drug interacts with the physiology of the brain) than their pharmacokinetics (how the drug is transported through and out of the body).If you want to help mitigate the withdrawal syndrome, it seems obvious that one must take smaller amounts of these drugs several times a day. I don't think this is an inappropriate generalization, and I recommend that people at least try a flexible dosing schedule. I prefer dosing three times a day.
- Scott
Posted by SLS on March 11, 2005, at 9:50:21
In reply to Short half-life = multiple doses per day, posted by SLS on March 11, 2005, at 7:35:51
> Regarding SRI antidepressants and withdrawal:
>
> Short half-life = multiple doses per day
My first post must have been confusing.I was attempting to account for why some drugs do not produce a withdrawal syndrome, despite having short half-lives (e.g. Buspar). I should not have tried to address two issues in the same post. So, never mind. :-)
The bottom line is that for those drugs that do have short half-lives, it is necessary to compensate for this by dosing several time a day. This becomes increasingly important once one reaches the lower dosages.
Instead of taking 75mg of Effexor once a day, try taking 25mg three times a day. It would be easier to work with the 25mg tablets of the regular immediate release version of Effexor. If you can split it into quarters, that would be ideal. One can work down to 6.5 three times a day; then twice a day; then 0mg. I don't think it is worth reducing the dosage to 6.5 once a day. It probably sets up for an unnecessary period of withdrawal syndrome for which this dosage will no longer prevent. Of course, if you want, you can try 3.25 twice a day before discontinuing it entirely. I don't know if there is any advantage to this yet, since no one else here has followed this protocol but for me. Once one goes down to 0mg, there is likely to be a short and mild withdrawal that is very tolerable. It might not be necessary to remain at each dosage for more than a week.
- Scott
Posted by Phillipa on March 11, 2005, at 20:30:30
In reply to Re: Short half-life = multiple doses per day, posted by SLS on March 11, 2005, at 9:50:21
I think half-life has something to do with it. For example while withdrawing from a drug like xanax, which has a short half-life, you add a longacting benzo as klonopin, or valium. Then it is usually advised to take a small amt of xanax for rebound anxiety. Fondly, Phillipa
Posted by SLS on March 12, 2005, at 5:36:59
In reply to Re: Short half-life = multiple doses per day » SLS, posted by Phillipa on March 11, 2005, at 20:30:30
> I think half-life has something to do with it. For example while withdrawing from a drug like xanax, which has a short half-life, you add a longacting benzo as klonopin, or valium. Then it is usually advised to take a small amt of xanax for rebound anxiety. Fondly, Phillipa
To me, it appears that withdrawal from benzodiazepines and SRI antidepressants have much in common. In fact, I use the same flexible dose strategy to discontinue a short acting BZD like Ativan as I do with SRIs. I haven't needed to switch over to Klonopin.
- Scott
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Common withdrawal symptoms of benzodiazepines:Abdominal pains and cramp
Agoraphobia
Anxiety
Breathing difficulties
Blurred vision
Changes in perception (faces distorting and inanimate objects moving)
Depression
Distended abdomen
Dizziness
Extreme lethargy
Fears
Feelings of unreality
Flu-like symptoms
Heavy limbs
Heart palpitations
Hypersensitivity to light
Indigestion
Insomnia
Irritability
Lack of concentration
Lack of co-ordination
Loss of balance
Loss of memory
Muscular aches and pains
Nausea
Nightmares
Panic attacks
Rapid mood changes
Restlessness
Severe headaches
Shaking
Seeing spots before the eyes
Sore eyes
Sweating
Tightness in the chest
Tightness in the head
Posted by Phillipa on March 12, 2005, at 15:10:28
In reply to Re: Short half-life = multiple doses per day, posted by SLS on March 12, 2005, at 5:36:59
That would be my way of doing it. I just posted what I've seen most of the pdoc's I've delt with do. Have you experienced all these side effects Scott, or have you avoided them with your method? Fondly, Phillipa
Posted by SLS on March 12, 2005, at 19:29:49
In reply to Re: Short half-life = multiple doses per day » SLS, posted by Phillipa on March 12, 2005, at 15:10:28
> Have you experienced all these side effects Scott, or have you avoided them with your method?
That is an excellent question, Phillipa. I was able to avoid all of the symptoms that present as a withdrawal syndrome, except that I sometimes purposely allowed them to appear briefly before taking my next tapering dose. I did not allow withdrawal symptoms to persist for any more than one hour before dosing again. I generally waited 1/2 hour or until I was convinced that it was the withdrawal syndrome that I was experiencing. I took only enough medication to prevent withdrawal symptoms from appearing for 6-10 hours. This might mean dosing 3-4 times a day. I do this more towards the end of the tapering process than towards the beginning. I think it is important to allow the system to operate near the threshold of the appearance of withdrawal symptoms. Hopefully, in this way, the system is pressured to re-regulate itself towards a normal unmedicated state.
This flexible dosing strategy is the result of self-experimentation and may not extrapolate to all individuals. I'm hoping that it applies to the majority, though.
- Scott
Posted by Phillipa on March 12, 2005, at 19:47:30
In reply to Re: Short half-life = multiple doses per day » Phillipa, posted by SLS on March 12, 2005, at 19:29:49
Scott, Maybe you can present your method to some psychiatric committee and become famous! Fondly, Phillipa
This is the end of the thread.
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