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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by mattye on September 8, 2008, at 14:46:10
Hi guys,
Its been a long time since I've posted.
I've been on meds for about two years now. Lexapro and Ambien for a year.
I feel like its time to get off them. I haven't had depression and anxiety for a long time.
I just feel BLAH is the best way to describe it. Trouble summoning enthusiam, flat. Do you think its the meds doing this?
I really feel like I should try and get off them. I have a doctor's appt. tomorrow - should I bring it up?
Posted by bulldog2 on September 8, 2008, at 15:22:03
In reply to Time to get off meds?, posted by mattye on September 8, 2008, at 14:46:10
> Hi guys,
>
> Its been a long time since I've posted.
>
> I've been on meds for about two years now. Lexapro and Ambien for a year.
>
> I feel like its time to get off them. I haven't had depression and anxiety for a long time.
>
> I just feel BLAH is the best way to describe it. Trouble summoning enthusiam, flat. Do you think its the meds doing this?
>
> I really feel like I should try and get off them. I have a doctor's appt. tomorrow - should I bring it up?Either time to get off or try new ones. The old ones are not doing the job.
Posted by Racer on September 8, 2008, at 17:05:37
In reply to Time to get off meds?, posted by mattye on September 8, 2008, at 14:46:10
You'll hear a lot of differing opinions on this, so be prepared to weigh a number of very diverse views in making this decision.
Here's my answer, worth only as much consideration as you choose to give it:
Yes, the flat feeling is reported not infrequently with SSRIs like Lexapro. That probably is part of the problem. If you do discontinue the medications, you may experience some rebound depression/anxiety/insomnia. Knowing in advance that this is a possibility may make it easier for you to tolerate discontinuation.
That said, there's also the question about whether you should discontinue them at all. Over the 20+ years I've taken antidepressants, the view on that has changed. The first time I took meds, back in the '80s, the recommendation was to stay on meds for about six months post remission. Then, by the time I was on meds in the early '90s, that had changed to remaining on meds for at least six months post remission -- unless you had a history of recurrent episodes of depression, in which case a minimum of two years post remission was strongly recommended.
These days, some people are told flat out that if they ever go off meds, they're virtually certain to experience a recurrence of depression, and the recommendation is to stay on meds indefinitely as prophylaxis. Whether or not we act according that advice is our choice, of course, and I've chosen at times to discontinue meds because the adverse effects outweighed the benefits, knowing that eventually I'd experience another depression, and expecting to go back on meds at that time. I just crossed my fingers and hoped it was a good long time before that happened. (It wasn't.)
Even if I were tempted to go off meds right now -- if I had achieved that theoretical state called "euthymia" -- I know that the circumstances of my life are too stressful for that to be a good idea. In fact, at this point my life circumstances are so stressful that even on meds I'm nowhere near remission. My doctor describes it as being beaten up by life, and says that there really aren't any meds likely to stand up to that. So, life circumstances are also an issue to consider.
Bottom line:
If this is your first episode of depression, if the medications you've taken have brought you to remission, if your life circumstances are manageable for you, then I'd say it's worth a try. I don't know if the two year rule really makes that much difference, but if your depression was extended before going on meds, then I'd say stick it out the full two years.
And, if you have a history of chronic, recurrent, and/or treatment resistant depression, talk to your doctor and be guided by his advice.
Good luck.
Posted by Zyprexa on September 8, 2008, at 17:06:24
In reply to Time to get off meds?, posted by mattye on September 8, 2008, at 14:46:10
If I were you I would skip a dose or two, and not tell the doctor.
Posted by Phillipa on September 8, 2008, at 20:10:43
In reply to Re: Time to get off meds?, posted by Racer on September 8, 2008, at 17:05:37
Talk to your doc and see what he says and yes a stable enviornment is so important. Are you happy content with your life? Love Phillipa
Posted by bleauberry on September 8, 2008, at 21:12:18
In reply to Time to get off meds?, posted by mattye on September 8, 2008, at 14:46:10
The flat effect is common with ssris. It is theoretically due to longterm serotonin potentiation squashing out dopamine/norepinephrine somewhat. Popular remedies include adding things like wellbutrin, ritalin, modafinil, or pramipexole. Mileage varies a lot from person to person, but one of those meds can enhance the DA/NE function to balance out the serotonin function and restore some feeling to your emotions.
Some people get off their meds and do ok. Some do not. I was fine off Paxil for about 6 months. Original problems gently deceptively crept up on me again.
It is not as if your brain stays the same. These drugs change things in you brain and biochemistry. It is not known whether they are longterm or permanent. A brain may bounce back to where it originally was, but with time past and the changes caused by the meds, that may not be so. Depression and psych illnesses are moving targets. Biochemistry, aging, stress, etc are all in motion.
Hard to say. My honest best advice would be to cut the dose back by 10% (you can cut pills with a razor blade or pill splitter as needed)for a week, another 10% for two weeks, and then settle at a dose 25% less than your original dose for about 6 weeks to 8 weeks. At that time, reassess. Either stay there, go down some more, or go back up. It might be you still need the med to protect you from problems taking over again, but that you can do fine with less, and that with less you'll have more emotions.
Posted by 49er on September 10, 2008, at 17:04:16
In reply to Re: Time to get off meds?, posted by Racer on September 8, 2008, at 17:05:37
Hi Racer,
> These days, some people are told flat out that if they ever go off meds, they're virtually certain to experience a recurrence of depression, and the recommendation is to stay on meds indefinitely as prophylaxis. >>That is totally incorrect as withdrawal symptoms are confused as a return of the illness. Joseph Glenmullen, who is not antimeds, discusses this in his book about withdrawing from ADs.
In 2001, I stupidly cold turkeyed Prozac and out of the blue, became depressed for no reason at all. I now realize I was dealing with withdrawal symptoms.
The key is a slow taper. In my opinion, most doctors psychiatrists advocate a way too fast tapering schedule even though they have good intentions.
It is best to taper antidepressants at 5 to 10% of current dose. I have mostly followed this recommendation and have not had a recurrence of depression in spite of tapering off of my meds.
49er
Posted by 49er on September 10, 2008, at 17:07:28
In reply to Time to get off meds?, posted by mattye on September 8, 2008, at 14:46:10
Hi
Taper the meds very slowly at 5 to 10% of the current rate to avoid cripping withdrawing symptoms.
The Lexapro can be obtained in a liquid form which will make tapering easy. You would need a syringe to measure the dose.
I am not as sure about how taper Ambien at the slow rate but I would help you figure it out if you want.
Taper one med at a time.
You might get resistance from your doctor as most of them are not familiar with how to taper slowly.
Good luck
49er
Posted by 49er on September 10, 2008, at 17:08:57
In reply to Re: Time to get off meds?, posted by Zyprexa on September 8, 2008, at 17:06:24
> If I were you I would skip a dose or two, and not tell the doctor.
Cold turkey withdrawal is very dangerous. I became very depressed doing that with Prozac.
Even drug companies don't advise that
49er
Posted by Phillipa on September 10, 2008, at 20:06:07
In reply to Re: Time to get off meds?, posted by 49er on September 10, 2008, at 17:08:57
49er you give excellent advise. Do you feel that the .25 of valium from total l5 and .5 of xanax was too much to cut? Thanks Phillipa
Posted by Racer on September 11, 2008, at 0:54:22
In reply to Re: Time to get off meds? » Racer, posted by 49er on September 10, 2008, at 17:04:16
> Hi Racer,
> > These days, some people are told flat out that if they ever go off meds, they're virtually certain to experience a recurrence of depression, and the recommendation is to stay on meds indefinitely as prophylaxis. >>
>
> That is totally incorrect as withdrawal symptoms are confused as a return of the illness. Joseph Glenmullen, who is not antimeds, discusses this in his book about withdrawing from ADs.
>Actually, no -- I was talking about recurrence of depression, not rebound depression. (I didn't reread my post, but I thought I said something about mistaking rebound for recurrence? If I didn't, I meant to...)
Some people -- myself amongst the number -- have recurrent episodes of depression. I know that if I go off meds, even after an extended period of euthymia, at some point in the future I will have a recurrence of depression. I knew that last time I went off meds -- which were no longer working, and I hoped that I'd have a couple of years before the next episode hit -- and made the decision with my eyes very wide open. I tapered slowly -- Effexor, anything else wasn't an option -- over nearly eight months. The following episode began about eight months later, so not withdrawal, and not rebound. Just simple recurrence.
But you're absolutely right -- often even doctors don't know the best choices for tapering down. My husband was prescribed -- I think it might have been Effexor, come to think of it. Dr said to end his taper by taking one every other day -- which, as far as I can see, would actually make things worse. (He'd only been taking it a few weeks, so it wasn't a problem.)
Thanks for the reminder, though -- withdrawal can look like rebound depression at times.
Posted by 49er on September 11, 2008, at 19:26:39
In reply to Re: Time to get off meds? » 49er, posted by Phillipa on September 10, 2008, at 20:06:07
> 49er you give excellent advise. Do you feel that the .25 of valium from total l5 and .5 of xanax was too much to cut? Thanks Phillipa
Hi Philipa,
Thanks.
Thanks to insomnia from some multivitamins, I am not sure I am following your post.
How much valium and zanax was the person on initially. Only taper one drug at a time.
Sorry if I am missing something obvious.
49er
Posted by Phillipa on September 11, 2008, at 20:01:51
In reply to Re: Time to get off meds? » Phillipa, posted by 49er on September 11, 2008, at 19:26:39
It's me I'm talking about initially on 15mg of valium with .5 of xanax at night. But they have seemed to turn on me and I cut .25 off valium. Are you saying MVI's cause insomnia in you? Seriously as I just ran out of them and haven't refilled. Taken them for many years. Do you know what the connection is ? Thanks Phillipa
Posted by 49er on September 13, 2008, at 9:35:39
In reply to Re: Time to get off meds? » 49er, posted by Phillipa on September 11, 2008, at 20:01:51
> It's me I'm talking about initially on 15mg of valium with .5 of xanax at night. But they have seemed to turn on me and I cut .25 off valium. Are you saying MVI's cause insomnia in you? Seriously as I just ran out of them and haven't refilled. Taken them for many years. Do you know what the connection is ? Thanks Phillipa
Hi Philipa,
Ok, now I understand. Thanks.
If you cut valium, it should only be 1.5mg. If you cut Zanax, it should be .2.
The logistics are another issue as it depends on the med.
With the multivitamin, I am taking, I suspect it may be the vitamin D as I read somewhere that it inhibits melatonin production, which is needed for sleep.
So I took just 3/4 of the dose instead of 100% and slept. Unfortunately, I didn't feel so good in the afternoon.
Geez, balancing supplements is like what I did with meds. It never ends (smile). But in all seriousness, compared to my experiences with meds, I will take this problem any day.
To answer your question, I think it depends on the multivitamin as whether it causes insomnia or not. The one I was taking previously never did. But I really think it was ineffective.
49er
Posted by Phillipa on September 13, 2008, at 11:02:09
In reply to Re: Time to get off meds? » Phillipa, posted by 49er on September 13, 2008, at 9:35:39
My endo put me on vita d for bones instead of fosamax or boniva. And I'm more tired don't get it? Love Phillipa
Posted by Phillipa on September 13, 2008, at 19:54:13
In reply to Re: Time to get off meds? » Phillipa, posted by 49er on September 13, 2008, at 9:35:39
Here's one I found most say about the same. Love Phillipa
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Vitamin D and Your HealthTreatmentTreating Disease With Vitamin DWe predict the future recommended daily allowance (RDA) for vitamin D, for otherwise healthy people, will be at least 1000 IU/day (in the new official units for vitamins, this translates to 25 ug/day). This amount is already the consensus of nutrition experts in the field of osteoporosis and vitamin D. Such recommendations only apply to healthy people. If you have vitamin D deficiency, or the diseases of vitamin D deficiency, you need to be under the care of a physician.
Monitoring 25(OH)D LevelsWe predict that treatment with physiological doses of vitamin D3 (between 4,00010,000 IU/day from all sources, including sun, food and supplements) with periodic monitoring of blood 25(OH)D (calcidiol) levels and calcium levels will become routine. There is reason to think it will help Zittermann AVitamin D in preventive medicine: are we ignoring the evidence?Br J of Nutr. 2003;89:552572. Holick MVitamin D: A Millennium Perspective.J Cell Biochem. 2003;88:296307. several vitamin D deficiency-associated diseases such as:
autism
autoimmune illness
cancer
chronic pain
depression
diabetes
heart disease
hyperparathyroidism
hypertension
influenza
myopathy (neuromuscular disorders)
osteoporosis
At this time, we advise even healthy people (those without the diseases of vitamin D deficiency) to seek a knowledgeable physician and have your 25(OH)D level measured. If your levels are below 40 ng/mL you need enough sun, artificial light, oral vitamin D3 supplements, or some combination of the three, to maintain your 25(OH)D levels between 4065 ng/mL year around.
How Much Vitamin D?If you refuse to see a physician, or can't find a knowledgeable one, purchase the 1000 IU/day vitamin D3 cholecalciferol pills that are available over-the-counter in North America. Take an average of two pills a day (50 ug or 2,000 IU) year around if you have some sun exposure. If you have little or no sun exposure, you will need to take more than 2,000 IU per day, how much more depends on your latitude of residence, skin pigmentation, and body weight. Generally speaking, the further you live away from the equator, the darker your skin, and the more you weigh, the more you will have to take to maintain healthy blood levels. For example, Dr. Cannell lives at latitude 32 degrees, weighs 220 pounds, and has fair skin. In the late fall and winter he takes 5,000 IU per day, in the early fall and spring he takes 2,000 IU per day, and in the summer he regularly sunbathes for a few minutes most days, and thus takes no vitamin D most days in the summer. The only way you can know how much you vitamin D you need to take is by repeatedly getting your blood tested, called a 25(OH)D test, and seeing what you need to do to keep your level around 50 ng/mL.
Infants and ChildrenInfants and children under the age of one, should obtain a total of 1,000 IU (25mcg) per day from their formula, sun exposure, or supplements. As most breast milk contains little or no vitamin D, breast-fed babies should take 1,000 IU per day as a supplement unless they are exposed to sunlight. The only exception to this are lactating mothers who either get enough sun exposure or take enough vitamin D (usually 4,0006,000 IU per day) to produce breast milk that is rich in vitamin D. Formula fed babies should take an extra 600 IU per day until they are weaned and then take 1,000 IU a day, as advised below.
Children over the age of 1 year, and less than 4 years of age, should take 1,500 IU vitamin D per day, depending on body weight, latitude or residence, skin pigmentation, and sun exposure.
Children over the age of 4, and less than 10 years of age, should take 2,000 IU per day, unless they get significant sun exposure. On the days they are outside in the sun, they do not need to take any; in the winter they will need to take 2,000 IU every day.
Children over the age of 10 years old should follow instructions for adults detailed above.
Vitamin D Upper LimitIf you absolutely avoid the sun, you should have your 25(OH)D level measured and remember that a maximum of two pills a day (50 ug or 2,000 IU) is the upper limit (UL) currently listed by the Food and Nutrition Board as the amount not to exceed unless under the care of a physician. When it comes to vitamin D, the right amount is good, but a lot is not better and can be dangerous. However, 2,000 IU a day is simply not enough for many people to get the full benefit of vitamin D, nor is it enough to keep vitamin D levels around 50 ng/mL, especially in the winter.
Maintaining 25(OH)D LevelsIf you are suffering from any of the diseases associated with vitamin D deficiency you need to be under the care of a knowledgeable physician. Your physician needs to replete your vitamin D system with sunlight, artificial light, oral vitamin D, or a combination of the three, while treating your vitamin D deficiency illnesses using conventional means. Regardless of the method used, we believe your physician should be certain your 25(OH)D levels are maintained between 3565 ng/mL.
For those who do not fear the sun, judiciously expose as much skin as possible to direct midday sunlight for 1/4 the time it takes for one's skin to turn red during those months when the proper ultraviolet light occurs at one's latitude (usually late spring, summer and early fall). Do not get sunburned. Vitamin D production is already maximized before your skin turns pink and further exposure does not increase levels of vitamin D but may increase your risk of skin cancer. Black patients may need five to ten times longer in the sun than white patients, depending on skin type. After several months of judicious sun exposure, a 25(OH)D level should again be obtained to ensure levels between 3565 ng/mL.
Several artificial light sources are commercially available that provide the proper wavelength for vitamin D production. Sperti makes a good UVB lamp and even has data available on the vitamin D production of its sunlamps.
As far as vitamin D supplements are concerned, we believe cholecalciferol is the preferred oral form of vitamin D, as it is the compound your skin makes naturally when you go in the sun. It is more potent and perhaps even safer than the synthetic analog, ergocalciferol, in more common use. Vieth R, Chan PC, MacFarlane GDEfficacy and safety of vitamin D3 intake exceeding the lowest observed adverse effect level.Am J Clin Nutr. 2001 Feb;73(2):28894. Cholecalciferol is 1.7 times more efficient at raising 25(OH)D levels than is ergocalciferol. Trang HM, Cole DE, Rubin LA, Pierratos A, Siu S, Vieth REvidence that vitamin D3 increases serum 25-hydroxyvitamin D more efficiently than does vitamin D2.Am J Clin Nutr. 1998 Oct;68(4):8548.
Calcitriol Contraindicated in VDDSErgocalciferol has been used safely by physicians for years for a variety of indications. Unfortunately, when doctors don't prescribe ergocalciferol, they sometimes prescribe calcitriol or newer analogs of calcitriol, costing thousands of times more than cholecalciferol. Calcitriol, and its analogs, are contraindicated in vitamin D deficiency because they may cause hypercalcemia and they fail to address the real problem: low stores of 25(OH)D. Cholecalciferol repletes the vitamin D system by filling up your vitamin D tank with 25(OH)D, the vitamin D fuel. Vieth RThe pharmacology of vitamin D, including fortification strategies.In: Feldman D, Glorieux F, eds. Vitamin D, Chapter 61, in press, 2nd ed. Academic Press, San Diego.
Giving calcitriol, or its analogs, for vitamin D deficiency is like shooting ether into your engine to keep your car running. In addition, they pose a significant risk of hypercalcemia (high blood calcium). If you have a simple vitamin D deficiency and your doctor insists on prescribing calcitriol or an expensive analog of vitamin D (other than cholecalciferol or ergocalciferol), find another doctor.
Hypersensitivity Not ToxicityVitamin D hypersensitivity syndromes are often mistaken for vitamin D toxicity. This rare syndrome occurs when abnormal tissue subvert the kidney's normal regulation of endocrine 1,25(OH)2D3 (calcitriol) production. Aberrant tissues, usually granulomatous in nature, convert 25(OH)D into 1,25(OH)2D3 causing high blood calcium. The most common of such conditions are sarcoidosis, oat cell carcinoma of the lung, and nonHodgkin's lymphomaalthough other illness, such as primary hyperparathyroidism, can cause the syndrome. Periodic measurements of 25(OH)D levels and serum calcium will alert the physician to the need to do more tests, such as 1,25(OH)2D3 or PTH.
Toxicity is simply not a concern in doses below 10,000 units a day. Restoring physiological serum levels of 25(OH)D will help many more patients than it will hurt.
John Jacob Cannell MD
Executive Director
2004.12.14
Posted by 49er on September 13, 2008, at 20:15:08
In reply to Re: Time to get off meds? » 49er, posted by Phillipa on September 13, 2008, at 11:02:09
> My endo put me on vita d for bones instead of fosamax or boniva. And I'm more tired don't get it? Love Phillipa
Well, I seem to have the paradoxical reactions. And maybe it is the other ingredients? It is so frustrating to figure it out.
I saw your other post about the article. Thanks for the link. I will read it tomorrow when I am more wide awake (smile)
49er
This is the end of the thread.
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