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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by SLS on March 28, 2009, at 15:51:12
I would like to suggest that after achieving and maintaining remission using antidepressants, that the rate of discontinuation of medication be gradual. Several studies have shown that the rate of relapse is higher for those people who discontinue their medication abruptly when compared to those who taper gradually.
Does anyone have suggestions as to how long to remain on an antidepressant?
- Scott
Posted by myco on March 28, 2009, at 16:20:09
In reply to Discontinuing antidepressants after remission, posted by SLS on March 28, 2009, at 15:51:12
How often do you think remission can be maintained after discontinuation? Isn't it typical for symptoms to begin setting back in quickly after a med is withdrawn? Do you think maintainence is a better option? curious.
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> I would like to suggest that after achieving and maintaining remission using antidepressants, that the rate of discontinuation of medication be gradual. Several studies have shown that the rate of relapse is higher for those people who discontinue their medication abruptly when compared to those who taper gradually.
>
> Does anyone have suggestions as to how long to remain on an antidepressant?
>
>
> - Scott
Posted by SLS on March 28, 2009, at 16:47:20
In reply to Re: Discontinuing antidepressants after remission » SLS, posted by myco on March 28, 2009, at 16:20:09
> How often do you think remission can be maintained after discontinuation?
It depends on the history of prior episodes.
There are many studies demonstrating the need for 6-9 months of treatment after remission is achieved to prevent relapse. This is for someone's first depressive episode only. For the second and third episodes, 18 months is favored. For chronic of recurrent depressions, treatment may need to be indefinite.
> Isn't it typical for symptoms to begin setting back in quickly after a med is withdrawn?
For people whose depression is chronic or recurrent, relapse is likely to occur within the first 4 months after discontinuation.
> Do you think maintainence is a better option? curious.
Again, this is a question to be answered by assessing patient history and even family history. For someone like me whose depression has been chronic and has persisted for many years despite treatment, I would stay on an effective treatment indefinitely.
The more episodes of depression that occur, the more often they recur and the more difficult they are to treat. So, for someone who is being treated for their first episode, it is imperative not to allow for subsequent relapses by discontinuing treatment prematurely.
- Scott
Posted by Phillipa on March 28, 2009, at 17:23:12
In reply to Re: Discontinuing antidepressants after remission » myco, posted by SLS on March 28, 2009, at 16:47:20
Stayed on the l0mg of paxil and benzos for almost two years first depression before only anxiety. Was fine till thyroid decided to malfunction again then the merry go round began but was still anxiety. Phillipa
Posted by Zana on March 28, 2009, at 18:16:16
In reply to Re: Discontinuing antidepressants after remission » myco, posted by SLS on March 28, 2009, at 16:47:20
I would agree with Scott. Whether or not to discontinue meds depends on your history. If you have had a recurrent, chronic depression, chances are you will be on meds forever. If you have just experienced an episode, slowly tapering off meds may be OK for you. I think going slowly is important. You need to give your brain a chance to adjust to the chances.
Good luck. Let us know what happens.
Zana
Posted by jedi on March 28, 2009, at 20:08:47
In reply to Discontinuing antidepressants after remission, posted by SLS on March 28, 2009, at 15:51:12
> I would like to suggest that after achieving and maintaining remission using antidepressants, that the rate of discontinuation of medication be gradual. Several studies have shown that the rate of relapse is higher for those people who discontinue their medication abruptly when compared to those who taper gradually.
>
> Does anyone have suggestions as to how long to remain on an antidepressant?
>
>
> - ScottHi Scott,
I think I'm a lifer. I have tried so many times to slowly withdrawal from Nardil, only to have the depressive symptoms return a few weeks after discontinuing the medication.I will probably always keep trying, though. I have been lucky in that every time I restart Nardil, after a few weeks, I feel much better.
I have had troubles in the past finding someone who will restart Nardil after I have titrated off of it. I am from a small, semi-rural area, of less than 100,000 people. It seems like most good PDOCs seem to locate in the larger cities. So when I am slowly tapering down, I always save up a stash to get me by until I can find someone to prescribe the medication.
Once, I had a psychiatrist for nine months, who would not put me back on Nardil to save my life. I finally had to start Nardil back myself and luckily I found a GP who would prescribe it before my stash ran out.
Be well,
Jedi
Posted by myco on March 28, 2009, at 20:18:50
In reply to Re: Discontinuing antidepressants after remission » SLS, posted by jedi on March 28, 2009, at 20:08:47
Hey Jedi
Did you lose faith in nardil or did you decide you wanted to go med free....why so many attempts to stop? just curious as Ive yet to make that attempt and no interest at all any time soon. To me this med is so "clean" I dont even notice in my body at all anymore just in my behaviours. Thats an ideal med to me but I do miss the stimulation that it once gave me.
myco
-----------
> Hi Scott,
> I think I'm a lifer. I have tried so many times to slowly withdrawal from Nardil, only to have the depressive symptoms return a few weeks after discontinuing the medication.
>
> I will probably always keep trying, though. I have been lucky in that every time I restart Nardil, after a few weeks, I feel much better.
>
> I have had troubles in the past finding someone who will restart Nardil after I have titrated off of it. I am from a small, semi-rural area, of less than 100,000 people. It seems like most good PDOCs seem to locate in the larger cities. So when I am slowly tapering down, I always save up a stash to get me by until I can find someone to prescribe the medication.
>
> Once, I had a psychiatrist for nine months, who would not put me back on Nardil to save my life. I finally had to start Nardil back myself and luckily I found a GP who would prescribe it before my stash ran out.
> Be well,
> Jedi
>
>
>
Posted by jedi on March 28, 2009, at 20:46:16
In reply to Re: Discontinuing antidepressants after remission » jedi, posted by myco on March 28, 2009, at 20:18:50
> Hey Jedi
>
> Did you lose faith in nardil or did you decide you wanted to go med free....why so many attempts to stop? just curious as Ive yet to make that attempt and no interest at all any time soon. To me this med is so "clean" I dont even notice in my body at all anymore just in my behaviours. Thats an ideal med to me but I do miss the stimulation that it once gave me.
>
>
> myco
Myco,
Nardil has always seemed to work for me; sometimes it works better than others. My main problem has been some of the longer lasting side effects. Even after years on the med, I still get the sweet carbohydrate cravings, which make weight control very difficult. I can lose weight while taking Nardil, but it usually requires a stringent exercise routine along with a low a carbohydrate diet. The other long term side effects I have are insomnia, which I control with low dose(25mg) Seroquel; and delayed orgasm. When I reduce my dosage fom my normal 75 to 90mg, the delayed orgasm goes away. Unfortunately for me, so does the antidepressant effect.When I first started Nardil, after four or five weeks, I had a great hypomanic experience that bordered on euphoria. Many people get this effect when first starting Nardil. After being seriously depressed for so long, this hypomania felt really good. Many people believe that this is the true antidepressant effect of Nardil and spend a lot of time and effort trying to recreate that experience. But alas, the euphoria is just a side effect and disappears fairly quickly.
Nardil is really the only medication that has worked for my treatment resistant atypical depression and social anxiety. I think Parnate may have worked for me, but I had a rare spontaneous hypertensive event while on Parnate. So I had to quit.
Take care,
Jedi
Posted by myco on March 28, 2009, at 21:15:12
In reply to Re: Discontinuing antidepressants after remission » myco, posted by jedi on March 28, 2009, at 20:46:16
Can you be more specific with this Jedi. I mean do you still (after years you said on it?) feel it physically in you, really? For me the physical sense its working has long gone...except a very minor stimulation in my quads about an hour after dosing. Its all in my behaviours now.
I know not the "chase the beast" of euphoria....I just miss the wicked stimulation that would rush through me in the morning basically bouncing me out of bed to my feet with a smile and raring to go for the day. I'm on 75 though...I dont want to feel to feel my meds physically, I just want them there under the surface ideally...in my moods and behaviours.
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> Nardil has always seemed to work for me; sometimes it works better than others.
Posted by desolationrower on March 28, 2009, at 23:11:02
In reply to Re: Discontinuing antidepressants after remission » jedi, posted by myco on March 28, 2009, at 21:15:12
another way to look at it, i think one should stay on the med until you've changed the underlying stressor enough that your coping skills have become very habitual. sorry if hoping my post would be about downregulation.
-d/r
Posted by emme on March 29, 2009, at 0:13:35
In reply to Re: Discontinuing antidepressants after remission, posted by desolationrower on March 28, 2009, at 23:11:02
> another way to look at it, i think one should stay on the med until you've changed the underlying stressor enough that your coping skills have become very habitual.
Ah, but what if the underlying stressor is purely biological? Coping skills are great to have, but what if they are completely swamped by the depression? What if underlying stressor is really only corrected by the proper medication?
I can only speak with certainty about my situation of course. But I have been through therapy, I exercise, I have wonderful friends, etc. I've done all the things one is supposed to do to help oneself. They're all good things to do. But without the right medication, I relapse.
I understand that some people believe that medication is an aid to use while they resolve the "real" and "underlying" (i.e. non-biological or psychosocial) cause of their depression. I have no doubt that for some people that is true. I also believe that there are others for whom medication really is the cure. Or at least the treatment that brings them into remission.
emme
Posted by jedi on March 29, 2009, at 1:32:02
In reply to Re: Discontinuing antidepressants after remission » jedi, posted by myco on March 28, 2009, at 21:15:12
Yes Myco,
I really wish that I was more like you in this regard. I can pretty much always feel the medication in me. If I change my dosage even 15mg, in a couple of weeks I can feel a big difference in my side effects and the efficacy of the medication.The irreversible MAOIs completely destroy the monoamine oxidase, which is an enzyme responsible for the breakdown of many neurotransmitters. They used to call them dirty drugs, because they had effect on serotonin, norepinephrine, dopamine, GABA and many others transmitters. Anyway, it can take several weeks for the monoamine oxidase to regenerate after it has been destroyed by an irreversible MAOI. Examples are Nardil, Parnate, EMSAM and Marplan.
Since my major side effects from Nardil also take several weeks to change after a dosage adjustment, I assume that they are related to the MAO itself. And of course the effect of MAO on the neurotransmitters.
Nardil is the only medication that has worked long term for me. It is not perfect, nothing is, but it is the best for me.
Be well,
Jedi
> Can you be more specific with this Jedi. I mean do you still (after years you said on it?) feel it physically in you, really? For me the physical sense its working has long gone...except a very minor stimulation in my quads about an hour after dosing. Its all in my behaviours now.
>
> I know not the "chase the beast" of euphoria....I just miss the wicked stimulation that would rush through me in the morning basically bouncing me out of bed to my feet with a smile and raring to go for the day. I'm on 75 though...I dont want to feel to feel my meds physically, I just want them there under the surface ideally...in my moods and behaviours.
>
>
>
> ------------------
>
> > Nardil has always seemed to work for me; sometimes it works better than others.
Posted by jedi on March 29, 2009, at 1:45:49
In reply to Re: Discontinuing antidepressants after remission » desolationrower, posted by emme on March 29, 2009, at 0:13:35
Hi guys,
I agree with emme on this one, at least as far as my own experience goes. Even though my depression is atypical with all of the DSMIV criteria, I believe it has a large biological component to it. I have had at least three first cousins who have committed suicide. We shared no common upbringing, some I had only met once or twice.I don't think you can discount the psychological part of depression, but for many of us, the predisposition is set up in our genes.
Jedi
> Ah, but what if the underlying stressor is purely biological? Coping skills are great to have, but what if they are completely swamped by the depression? What if underlying stressor is really only corrected by the proper medication?
>
> I can only speak with certainty about my situation of course. But I have been through therapy, I exercise, I have wonderful friends, etc. I've done all the things one is supposed to do to help oneself. They're all good things to do. But without the right medication, I relapse.
>
> I understand that some people believe that medication is an aid to use while they resolve the "real" and "underlying" (i.e. non-biological or psychosocial) cause of their depression. I have no doubt that for some people that is true. I also believe that there are others for whom medication really is the cure. Or at least the treatment that brings them into remission.
>
> emme
Posted by desolationrower on March 29, 2009, at 7:24:55
In reply to Re: Discontinuing antidepressants after remission » desolationrower, posted by emme on March 29, 2009, at 0:13:35
> > another way to look at it, i think one should stay on the med until you've changed the underlying stressor enough that your coping skills have become very habitual.
>
> Ah, but what if the underlying stressor is purely biological? Coping skills are great to have, but what if they are completely swamped by the depression? What if underlying stressor is really only corrected by the proper medication?
>
> I can only speak with certainty about my situation of course. But I have been through therapy, I exercise, I have wonderful friends, etc. I've done all the things one is supposed to do to help oneself. They're all good things to do. But without the right medication, I relapse.
>
> I understand that some people believe that medication is an aid to use while they resolve the "real" and "underlying" (i.e. non-biological or psychosocial) cause of their depression. I have no doubt that for some people that is true. I also believe that there are others for whom medication really is the cure. Or at least the treatment that brings them into remission.
>
> emmeyes i think we are agreeing...if your depression was from something, don't go off your medication until you've changed things. but if there you had a healthy lifestyle before, you can't do the "make changes->stop AD" process...
-d/r
Posted by bleauberry on March 29, 2009, at 8:58:06
In reply to Discontinuing antidepressants after remission, posted by SLS on March 28, 2009, at 15:51:12
>
> Does anyone have suggestions as to how long to remain on an antidepressant?
>Forever.
Until it stops working.
Until other problems develop directly linked to it.While all the textbooks and general MDs suggest weaning off after remission, you and I both have seen more times than we can count how badly people deteriorated over the next months, and how when they return to meds it is often a different game than the first time.
Is there some kind of unknown risk is staying on meds while in remission? I don't know.
Is there some kind of risk in carefully weaning off meds that worked? Definitely.
The risks of staying on seem less than getting off, in my opinion.
People get a false sense of security believing they are healed. There is a false sense that somehow the meds have permanently fixed something and now that they are fixed the meds are not needed anymore. I totally disagree.
I do acknowledge that some people can and do wean off and live good lives. To put it in perspective however, I only know of one such person.
Posted by SLS on March 29, 2009, at 10:39:21
In reply to Re: Discontinuing antidepressants after remission, posted by desolationrower on March 28, 2009, at 23:11:02
> another way to look at it, i think one should stay on the med until you've changed the underlying stressor enough that your coping skills have become very habitual. sorry if hoping my post would be about downregulation.
>
> -d/rGreat point. I hadn't thought of that. I think this is why the combination of psychotherapy and pharmocotherapy is so effective for many people.
- Scott
Posted by SLS on March 29, 2009, at 10:51:47
In reply to Re: Discontinuing antidepressants after remission, posted by bleauberry on March 29, 2009, at 8:58:06
> > Does anyone have suggestions as to how long to remain on an antidepressant?
> While all the textbooks and general MDs suggest weaning off after remission, you and I both have seen more times than we can count how badly people deteriorated over the next months, and how when they return to meds it is often a different game than the first time.I agree.
But when it comes to treating a first episode of depression, there is a significant possibility that one can remain well after the discontinuation of treatment, as long as the criteria for treatment includes continuing 9 months beyond the achievement of remission. It is a gamble at this point in that everyone who has had a second episode originally had a first. For first time episodes of an affective illness when working with bipolar disorder or depression with a strong family history of illness, I would think about treatment for a longer term. The term of treatment is determined by the details of the case, not just a formulaic expression in a book.
- Scott
Posted by SLS on March 29, 2009, at 11:01:15
In reply to Re: Discontinuing antidepressants after remission » desolationrower, posted by emme on March 29, 2009, at 0:13:35
> > another way to look at it, i think one should stay on the med until you've changed the underlying stressor enough that your coping skills have become very habitual.
> Ah, but what if the underlying stressor is purely biological? Coping skills are great to have, but what if they are completely swamped by the depression? What if underlying stressor is really only corrected by the proper medication?Yes. Even well-adjusted, functional, self-actualized individuals can be stricken by biological brain disorders such as MDD or BD. For these people, it is the illness itself that creates the aberrant affect and mental processes that so greatly warp perceptions. If the individual is treated quickly and successfully, very little psychological damage has been done, and one can just pick up where they left off. However, affective disorders can leave many psychological disturbances in their wake. If prolonged, disturbances might require psychotherapy to resolve, despite the successful achievement of remission.
- Scott
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