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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Sunnely on July 11, 2000, at 21:26:02
A MNEMONIC FOR SRI WITHDRAWAL SYMPTOMS (not all symptoms may be present):
F = Flu-like symptoms (lethargy, fatigue, headache, achiness, sweating)
I = Insomnia (with vivid dreams or nightmares)
N = Nausea (sometimes vomiting)
I = Imbalance (dizziness, vertigo, lightheadedness)
S = Sensory disturbances ("burning," "tingling," "electric-like" or "shock-like" sensations)
H = Hyperarousal (anxiety, irritability, agitation, aggression, mania, jerkiness)
OTHER FEATURES:
1) Onset = Usually begin between 2 and 5 days after the last dose of medication; in some cases, even before the medicine is totally discontinued. (Note: Withdrawal symptoms from Effexor can occur even after missing a single dose.)
2) Withdrawal symptoms occur more quickly than recurrence of depression.
3) Duration = Withdrawal symptoms can last up to several weeks; typically mitigated by reintroducing the withdrawn antidepressant.
4) Cause = Unclear. Hypothesis: Patients on long-term serotonin-boosting antidepressants have "down-regulation" (decreased number) of postsynaptic serotonin receptors. When medication is stopped abruptly, less serotonin is present in a "down-regulated" state ----> withdrawal symptoms.
5) Most common with shorter acting antidepressants (practically all SRIs except Prozac; Effexor, most rapid and severe), those without active metabolites (daughter compounds), and when treatment has lasted at least a month.
6) May occur if a patient is switched from an antidepressant that boosts serotonin to one that does not have this action. For example: Paxil ----> Wellbutrin.
7) May be hard to separate from infectious causes. (No fever or elevated white cell count with SRI withdrawal, however.)
All f i n i s h e d!
References:
1) Primary Psychiatry, August 1999.
2) SRI Withdrawal Reactions. In: Biological Therapies in Psychiatry Newsletter, AJ Gelenberg, MD (editor), June 1998.
Posted by Noa on July 12, 2000, at 15:36:18
In reply to F I N I S H = SRI Withdrawal Symptoms, posted by Sunnely on July 11, 2000, at 21:26:02
Wow, thanks, Sunnely! This is extremely useful and handy.
Why don't you start a folder on withdrawal symptoms? It would be nice to know how to find your post in a handy place.
Posted by Kath on July 12, 2000, at 16:04:43
In reply to F I N I S H = SRI Withdrawal Symptoms, posted by Sunnely on July 11, 2000, at 21:26:02
Thanks for this Sunnely - Are SRI's the same as SSRI's?? I'm taking an SSRI & this information is certainly important. Can't say that I'm looking forward to it if it applies to SSRI's. (Nobody mentioned this! I thought initial side effects were crummy enough. Oy well... :-(
I agree with Noa about the folder. It would be good to have a handy reference place for this.
Kath
> A MNEMONIC FOR SRI WITHDRAWAL SYMPTOMS (not all symptoms may be present):
>
> F = Flu-like symptoms (lethargy, fatigue, headache, achiness, sweating)
>
> I = Insomnia (with vivid dreams or nightmares)
>
> N = Nausea (sometimes vomiting)
>
> I = Imbalance (dizziness, vertigo, lightheadedness)
>
> S = Sensory disturbances ("burning," "tingling," "electric-like" or "shock-like" sensations)
>
> H = Hyperarousal (anxiety, irritability, agitation, aggression, mania, jerkiness)
>
> OTHER FEATURES:
>
> 1) Onset = Usually begin between 2 and 5 days after the last dose of medication; in some cases, even before the medicine is totally discontinued. (Note: Withdrawal symptoms from Effexor can occur even after missing a single dose.)
>
> 2) Withdrawal symptoms occur more quickly than recurrence of depression.
>
> 3) Duration = Withdrawal symptoms can last up to several weeks; typically mitigated by reintroducing the withdrawn antidepressant.
>
> 4) Cause = Unclear. Hypothesis: Patients on long-term serotonin-boosting antidepressants have "down-regulation" (decreased number) of postsynaptic serotonin receptors. When medication is stopped abruptly, less serotonin is present in a "down-regulated" state ----> withdrawal symptoms.
>
> 5) Most common with shorter acting antidepressants (practically all SRIs except Prozac; Effexor, most rapid and severe), those without active metabolites (daughter compounds), and when treatment has lasted at least a month.
>
> 6) May occur if a patient is switched from an antidepressant that boosts serotonin to one that does not have this action. For example: Paxil ----> Wellbutrin.
>
> 7) May be hard to separate from infectious causes. (No fever or elevated white cell count with SRI withdrawal, however.)
>
> All f i n i s h e d!
>
> References:
>
> 1) Primary Psychiatry, August 1999.
>
> 2) SRI Withdrawal Reactions. In: Biological Therapies in Psychiatry Newsletter, AJ Gelenberg, MD (editor), June 1998.
Posted by Sunnely on July 12, 2000, at 20:25:46
In reply to Re: F I N I S H = SRI Withdrawal Symptoms » Sunnely, posted by Kath on July 12, 2000, at 16:04:43
> Thanks for this Sunnely - Are SRI's the same as SSRI's??
==================
ANSWER: SRIs are not exactly the same as SSRIs. All SSRIs are SRIs but not all SRIs are SSRIs. (Did I get you more confused?) SRIs stand for serotonin reuptake inhibitors which include all antidepressant with serotonin effects. SRIs, therefore, include all the SSRIs (selective serotonin reuptake inhibitors) such as Prozac, Zoloft, Paxil, Luvox, and Celexa); the nonSSRIs such as Effexor which is both serotonin-booster (at lower doses) and norepinephrine-booster (at higher doses), and Serzone which is a serotonin booster with concomitant blocking effect on one of the serotonin receptor subtype called 5HT2 (reduces sexual disturbances). Technically speaking, Remeron is not an SRI even though it boosts serotonin (and norepinephrine) because it boosts these brain chemicals via a different mechanism, not through serotonin reuptake inhibition. However, the result is the same and serotonin withdrawal can also occur with this drug. BTW, Remeron also blocks the action of 2 subtypes of serotonin receptors 5HT2 and 5HT3, reducing sexual disturbances and gastrointestinal distress, respectively. Clomipramine (Anafranil) is also an SRI since it has serotonin effect and a tricyclic antidepressant, to boot.
Wellbutrin (and Zyban) is not an SRI because its antidepressant action is said to be due to NOREPINEPHRINE and DOPAMINE reuptake inhibition. This makes it a norepinephrine- and dopamine-booster. Reboxetine (Vestra, Edronax) is not an SRI because its main antidepressant action is due to its selective NOREPINEPHRINE reuptake inhibition.
A bit clearer?
Posted by Kath on July 12, 2000, at 20:48:02
In reply to Re: F I N I S H = SRI Withdrawal Symptoms, posted by Sunnely on July 12, 2000, at 20:25:46
> > Thanks for this Sunnely - Are SRI's the same as SSRI's??
>
> ==================
>
> ANSWER: SRIs are not exactly the same as SSRIs. All SSRIs are SRIs but not all SRIs are SSRIs. (Did I get you more confused?) SRIs stand for serotonin reuptake inhibitors which include all antidepressant with serotonin effects. SRIs, therefore, include all the SSRIs (selective serotonin reuptake inhibitors) such as Prozac, Zoloft, Paxil, Luvox, and Celexa); the nonSSRIs such as Effexor which is both serotonin-booster (at lower doses) and norepinephrine-booster (at higher doses), and Serzone which is a serotonin booster with concomitant blocking effect on one of the serotonin receptor subtype called 5HT2 (reduces sexual disturbances). Technically speaking, Remeron is not an SRI even though it boosts serotonin (and norepinephrine) because it boosts these brain chemicals via a different mechanism, not through serotonin reuptake inhibition. However, the result is the same and serotonin withdrawal can also occur with this drug. BTW, Remeron also blocks the action of 2 subtypes of serotonin receptors 5HT2 and 5HT3, reducing sexual disturbances and gastrointestinal distress, respectively. Clomipramine (Anafranil) is also an SRI since it has serotonin effect and a tricyclic antidepressant, to boot.
>
> Wellbutrin (and Zyban) is not an SRI because its antidepressant action is said to be due to NOREPINEPHRINE and DOPAMINE reuptake inhibition. This makes it a norepinephrine- and dopamine-booster. Reboxetine (Vestra, Edronax) is not an SRI because its main antidepressant action is due to its selective NOREPINEPHRINE reuptake inhibition.
>
> A bit clearer?Wow - I'll have to print this off and read it VERY SLOWLY!!! Thanks very much. It'll take some slow concentration to get it absorbed. How in the heck do they know which med to give people. Is this why sometimes people have to try so many?
Thanks alot. Kath
Posted by Sunnely on July 13, 2000, at 20:10:03
In reply to Good Heavens! » Sunnely, posted by Kath on July 12, 2000, at 20:48:02
>
> Wow - I'll have to print this off and read it VERY SLOWLY!!! Thanks very much. It'll take some slow concentration to get it absorbed. How in the heck do they know which med to give people. Is this why sometimes people have to try so many?
>
> Thanks alot. Kath=====================
My pleasure.
No hard-and-fast rules to follow regarding the choice of antidepressant. Doctors usually follow certain guidelines such as the following (mnemonic "STEPS"):
1) SAFETY - e.g., in overdose, drug-drug interactions.
2) TOLERABILITY - acute and late-emergent side effects.
3) EFFICACY - overall effectiveness, onset of action, maintenance treatment and prophylactic treatment.
4) PAYMENT - cost-effectiveness. Should be the least criterion. However, for those people who pay their own meds, this ranks up there.
5. SIMPLICITY - ease of use, need for titration (gradual increase in dose), divided daily dose, and blood level monitoring.
Others:
1) Past response to a medication indicates future response (well, not always). So doctor may ask you what antidepressant worked for you in the past.
2) Family history of response to a medication is also a good indicator of possible response (not always). So doctor may ask you who among your close relatives have taken and responded to a certain antidepressant.
3) Doctors will almost always avoid a medication that you have experienced intolerable or serious side effects from past use.
Unfortunately, there is no laboratory or diagnostic test in existence, yet (this may change in future with the applicatioin of human genome to medicines) to determine who among the depressed patients will respond to a particular medication. Sad to say, we are still in the era of "trial and error" when it comes to prescribing antidepressants (and other psychotropics) and yes, this is why sometimes people have to try so many meds before arriving at the right one(s).
Posted by Kath on July 13, 2000, at 21:08:15
In reply to Re: Good Heavens! » Kath, posted by Sunnely on July 13, 2000, at 20:10:03
Thanks so much Sunnely, I'll print that off too for future reference.
Take care, Kath> >
> > Wow - I'll have to print this off and read it VERY SLOWLY!!! Thanks very much. It'll take some slow concentration to get it absorbed. How in the heck do they know which med to give people. Is this why sometimes people have to try so many?
> >
> > Thanks alot. Kath
>
> =====================
>
> My pleasure.
>
> No hard-and-fast rules to follow regarding the choice of antidepressant. Doctors usually follow certain guidelines such as the following (mnemonic "STEPS"):
>
> 1) SAFETY - e.g., in overdose, drug-drug interactions.
>
> 2) TOLERABILITY - acute and late-emergent side effects.
>
> 3) EFFICACY - overall effectiveness, onset of action, maintenance treatment and prophylactic treatment.
>
> 4) PAYMENT - cost-effectiveness. Should be the least criterion. However, for those people who pay their own meds, this ranks up there.
>
> 5. SIMPLICITY - ease of use, need for titration (gradual increase in dose), divided daily dose, and blood level monitoring.
>
> Others:
>
> 1) Past response to a medication indicates future response (well, not always). So doctor may ask you what antidepressant worked for you in the past.
>
> 2) Family history of response to a medication is also a good indicator of possible response (not always). So doctor may ask you who among your close relatives have taken and responded to a certain antidepressant.
>
> 3) Doctors will almost always avoid a medication that you have experienced intolerable or serious side effects from past use.
>
> Unfortunately, there is no laboratory or diagnostic test in existence, yet (this may change in future with the applicatioin of human genome to medicines) to determine who among the depressed patients will respond to a particular medication. Sad to say, we are still in the era of "trial and error" when it comes to prescribing antidepressants (and other psychotropics) and yes, this is why sometimes people have to try so many meds before arriving at the right one(s).
Posted by Cam W. on July 16, 2000, at 17:27:12
In reply to F I N I S H = SRI Withdrawal Symptoms, posted by Sunnely on July 11, 2000, at 21:26:02
Sunnely - Like the mneumonic. I have been using F L U S H - shorter & easier for the docs to remember ;^)
F - flu-like (fatigue, myalgia, loose stools, nausea, sinus congestion)
L - lightheadedness (dizziness)
U - uneasiness (restlessness)
S - sleeplessness, sensory disturbances (feeling abnormal, tinnitis)
H - headache
FLUSH seems appropriate because serotonin withdrawl syndrome is the sh**s, but yours is more complete - Cam
Posted by Oddzilla on July 16, 2000, at 18:01:02
In reply to Re: F I N I S H vs F L U S H » Sunnely, posted by Cam W. on July 16, 2000, at 17:27:12
> Sunnely - Like the mneumonic. I have been using F L U S H - shorter & easier for the docs to remember ;^)
>
Cam this version is even shorter!> F - feels
> L - like
> U - utterly
> S - shitty
> H - hell
>
Welcome back! Hope you had fun dosey-doeing:o)
Posted by Sunnely on July 16, 2000, at 22:37:08
In reply to Re: F I N I S H vs F L U S H » Sunnely, posted by Cam W. on July 16, 2000, at 17:27:12
> Sunnely - Like the mneumonic. I have been using F L U S H - shorter & easier for the docs to remember ;^)
Cam,
Love that FLUSH mnemonic. I'll print a copy for myself.
Speaking of mnemonics here are a couple of them that docs use a lot (for depression):
CEASE SAD
SIG E CAPS
SAD A FACES
----------------------------------------
CEASE SAD
C - concentration (poor)
E - energy (low)
A - anxiety
S - spontaneous (crying)
E - early morning awakenings
S - suicide
A - appetite (poor or sometimes too good)
D - deprecatory thoughts of self
---------------------------------
SIG E CAPS
S - sleep (insomnia or hypersomnia)
I - interest (lacking)
G - guilt
E - energy (low)
C - concentration (poor)
A - appetite (poor or sometimes too good)
P - psychomotor (retardation or agitation)
S - suicide
----------------------------------
SAD A FACES
S - sleep (insomnia or hypersomnia)
A - appetite (poor or too good)
D - dysphoria
A - anhedonia (inability to attain pleasure from any form of activity)
F - fatigue
A - agitation (or retardation)
C - concentration (poor)
E - esteem (poor)
S - suicide
-----------------------------------------
How about this mnemonic for bordeline personality disorder? (Not my original. Please, don't shoot the messenger.)
I'M A SAP
I - impulsivity
M - manipulation
A - anxiety/anger
S - suicidality/splitting
A - alcohol and/or other substance abuse
P - promiscuity
Posted by Cam W. on July 16, 2000, at 23:50:34
In reply to Re: F I N I S H vs F L U S H, posted by Sunnely on July 16, 2000, at 22:37:08
Sunnely - I love these. I'm making copies; hope you don't mind - Cam
> CEASE SAD
> SIG E CAPS
> SAD A FACES
> I'M A SAP
Posted by noa on July 17, 2000, at 6:24:38
In reply to Re: F I N I S H vs F L U S H » Cam W., posted by Oddzilla on July 16, 2000, at 18:01:02
LOL!!!
Posted by Laurie_from_MA on August 20, 2000, at 10:00:32
In reply to F I N I S H = SRI Withdrawal Symptoms, posted by Sunnely on July 11, 2000, at 21:26:02
Sunnely,
I found this post by you. Are you familar with any other referred journal references on this topic? I'm having this reaction after coming off Celexa (was on Zoloft for a year & switched to Celexa early last spring).
I am also particularly interested in how to mitigate the symptoms. I'm in my 6th week of inability to function much including working.
Any other advice?
Laurie
> References:
>
> 1) Primary Psychiatry, August 1999.
>
> 2) SRI Withdrawal Reactions. In: Biological Therapies in Psychiatry Newsletter, AJ Gelenberg, MD (editor), June 1998.
This is the end of the thread.
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