HI Surfergirl
I think many people who have worked on coming off the SSRI would relate to your experience. It seems that there is a variable amount of time that the depression symptoms come back after the drugs are stopped. The time does seem to decrease in subsequent attempts to stop the drugs. In your case (if I read it right) - first 6 months, 3 months, 6 weeks, 10 days. Probably both the things you mention are in play - the drug effects taking a few weeks to clear out of the system (leaving the "factories" to cope the best they can. or not in this case) and I think we do become very attuned to the initial symptoms of depression.

We have a similar time on these drugs - 11 years for me, 12 for you. I smiled when I saw you had come off the drugs 4 times in 12 months. I am on my first try to come off, started 8 months ago. Was 40mg, now 2.5mg (1/8 tab). So crazy that the microscopic pile of dust can be important to keeping the chemical balance stable.

To your question: re-emergence, new episode or give it time. Re-emergence or a new episode would mean you still need the meds. If this is the case “give it time” would not be any more helpful than trying to get by without the meds while depressed.

If the new symptoms are caused by serotonin withdrawal syndrome it means that you came off too fast *or* your own “factories” can’t take on the role of keeping your serotonin levels balanced yet. In this case “give it time” would work. Just might be very depressing until the balance was reached and may not work anyhow. Working out if it was not working or the "give it time" was just not long enough yet would be hard.

In my case I have chosen a very slow cut down (currently 8 months) rather than going through “give it time”. This eliminates the classic withdrawal syndrome as a factor. Leaving, “factories are stuffed” and too many initiating causes (of stress) going on as the remaining causes of recurrent depression. At this stage it looks like, for me, it will be a continual choice. Get rid of the stressors (or acquire a zen monk attitude to them) which would allow my own “factories” to handle things *or* keep taking the tiny pile of dust which supports enough to keep depression symptoms away.

Hi Herald!
Thanks for your thoughts!
I have had an up and down week - which kind of makes me feel it is withdrawal related as usually when it is depression for me i go down pretty quick - my thoughts crowd and it just gets worse-i think i am pretty good at it by now!

So, i am still waiting and seeing - each day i get glimpses of hope and a little more courage

Hey Surfergirl

I hear you. Best of good wishes.

<------ Surfergirl in a good space

that is really LOL!!!!

Hello all, like surfergirl, i have also been watching this post with immense interest... I tried coming off meds back in May/June, having been on numerous different ones for over a decade (prozac 7yrs/citalopram 1-2yrs/effexor 1yr/mirtazapine approximately 4 months first time around, and am now back on it)....
I weaned off mirt very slowly over about six weeks, cut the pills up real tiny and everything (some wicked night terrors but managed to get through it) felt great for about a week after and thought i was in the clear...but then i just slipped into this completely dysphoric state, it was weird...i had this fixed expression on my face all the time, like a permanent frown, along with some weird panicky spells....just felt completely out of it, another week went by, and it felt like i had been lobotomized; could not pay attention to ANYTHING; had a very hard time following conversations...and had to look both ways like 6 times before crossing the street! It just was not right, it was like half my brain went missing (taking any pleasurable feelings with it) another couple weeks, still just as bad, with progressive apathy....I wouldn't say i was depressed in a sense, but more disconnected- no passion, no humor, it was like my personaltiy had completely vanished...... ( thankfully i was not at work during this period, i dont think i would have been to handle work in any way) So at the 6 week mark, things were not getting any better, anxiety was getting worse as i knew i had to go back to work... went back on prozac ...things went from bad to worse, it completely fried my nervous system ( pretty unlucky as i had been on it for so many years )...insominia, panic attacks, tinnitus ( it literally felt like i was on speed for the three weeks i was on it, and almost akin to a bad acid trip)... so out of desperation,(it not only felt like i was in hell, but i really needed to get back to work!) i ended up back on mirtazapine as i couldnt sleep at all without the help of sleeping pills or benzos..and they are not a long term solution. I assume it must have been discontinuation syndrome...but it lasted for 6 weeks with no signs of improvement, leaving me wondering if i am going to be stuck on meds forever? Sometimes it seems like im part of a generation of people that got put on these meds when they were new and the medical profession coined them as these safe and wonderful drugs.... it just distrubs me quite a bit, thinking about when i was 16 and put that first pill in mouth, i had no idea that it might mean id be having to take them forever...
Needless to say, i am really glad ive found this thread, and to be learning about other peoples experiences with long term usage of these types of medications, the more information out there the better (certainly havent been able to get any straight answers from my GP).... great post Herald! good vibes to all

Hey Little Earthquake

Thank you for putting up your experience. It does sound like a hell. Even the mild (in comparison) times I have had were/are hard so glad you made it through to what hopefully is a somewhat stable base.

All the symptomology you describe is well in the boundaries of, and almost 100% certainly, the messed up actions of neurotransmitters. Quite a serious discontinuation syndrome. Another feature I see in your experience, and seeing fairly commonly on the forums, is that SSRI which have been successful in previous times to fail to act when re-started after attempting withdrawal. In your case re-starting seemed to tip you into an over-dose symptomology. One explanation is that all your "Factories" had ramped themselves up to the maximum capacity of their capacity and all "vacuum cleaners" shut down to keep the serotonin in the pool high. The in comes an SSRI which tips the balance into over-dose. I had similar thoughts to yours re how little was known of the drugs when I started. For me I balance that with the memory of the miracle that they worked for me. I am sure you have read in this post that it may be that the meds are a long term need. For many of us, myself at this stage included, reluctantly come to that conclusion. I don't think it is the drug's fault in my case that I need it, I just need it.

I am going to step out of the boundaries of no advice a little here and make some fairly straight comments. You can see how straight my straight comments are lol. Obviously I get straight to the point.... NOT! This is not targeting you Little Earthquake, I have been wanting to say it for a while. Using "You" is just a convenient way of saying anyone reading this or anyone wanting to try getting off the meds Now I get an excuse as I see similar things happening over many times, forgive me for tacking it into your post

Straight Talk

Check with your PDoc and keep them updated through the whole process

To avoid discontinuation syndrome as a factor in coming off the meds you must go SLOW. SLOW is verrry slow. If you want to be almost certain Discontinuation Syndrome is not a factor then my experience is No More than an absolute maximum of 25% of the current dose , and

stay on that dose for a month before reducing it again. If you choose not to do this then it is very difficult to be able to distinguish discontinuation syndrome from under-dosage.

If you do this you will be more likely to logically be able to assess the responses you have and to realistically assess whether you are able to get off the meds. If you chose not to the risk is multiple - firstly discontinuation syndrome can be a very serious medical condition, secondly it is very unpleasant and unwise to go through with a compromised mood in the first place and third, it looks as if failure in coming off the meds can mess up your response to the very drugs which have worked in the past.

Best of good wishes

P.S. Current dose means the dose you are reducing. So it gets smaller amount decreases each time as the total dose you are taking gets smaller.

This post has been edited by Herald: Nov 16 2009, 05:23 AM

Thanks for the reply Herald, yeah, that does make a lot of sense....Even though i tapered off properly by general standards, the fact ive been on meds ten years as opposed to 2-3, should make a considerable difference in the amount of tapering needed to prevent discontinuation syndrome(ie. several months as opposed to weeks)....shame GPs dont see it that way!!... its been about four months and i am only just now starting to feel a bit like my old self....sometimes i wonder if i will ever recover completely... mirtazapine has never been my anti-D of choice, but i was so desperate to get rid off the severe insominia and anxiety the prozac brought on ..I came to the conclusion, it would best fit my needs for this trying time( and luckily because of its rare side effects profile(very sedating), it did provide some relief, though it has taken a long time)....if i have to stay on meds for the long, long term...this really isn't the one i want to be on...but im just worried in trying any new anti-depressants (not now, but maybe 6-12 months from now, when ive been stable for a while)...that they might activate my system and id have to relieve this nightmare all over again! I know for sure that if I ever try to kick meds completely again, i will only do so if i have access to a Pdoc, unfortunately, I can't afford one, and you won't get refered on the NHS unless you are suicidal or are exhibiting psychotic features.:( Thanks again for the quick response, I hope everything is going well with you... warm regards, Little E

Hey Little E,

Glad you are feeling stable. I completely relate to your thoughts as they are very similar to those I have had myself. I have read, and believe, that the majority of GPs do not allow for the time it takes to come off the SSRIs. I remember asking the Pdoc specifically about 4 months into the drop of dosage "Do you know anyone who has come off these?" so understand that feeling of thinking it is a hopeless cause.

From a pharmacological and clinical perspective if someone were to give enough time to either come off (or go on) a medication there is no reason to expect that "they might activate my system and id have to relieve this nightmare". When the body systems are stable and not in a rapid period of change (as they are in discontinuation syndrome) there is no logical reason why it should happen. The cellular systems just can't activate fast enough if they are not already pre-primed. The only cause of rapid change that I can think of would be an allergic response which is another whole neuro-endocrinological system.

So, in summary, very slowly come off the meds allows lots of time for cellular building and renewal and for the delicate chemical balances to be set in place. This eliminates discontinuation syndrome. This is essential for logical assessment and differentiation of symptoms. Otherwise there will always be the question "Is this discontinuation syndrome or depression coming back" And there is no answer to this from the symptoms alone. When discontinuation syndrome is not a factor the answer is "the depression is coming back".

With discontinuation syndrome out of the picture then THE ONLY OTHER usual CAUSE of symptoms left are renewal of depression. From here someone can make an assessment of whether the meds are necessary. It takes so much longer to do it this way, it does give a clear clinical picture at the end and ultimately a lot of control and understanding of your own condition.

Thank you for asking after my situation. I have DOUBLED my dose! From 2.5mg to 5mg as there was break through signs of depression symptoms. Currently feeling the hyper jumping that I do when increasing dose so I am going to back off again. The reason for the need? Way to much extra stress due to my father's dementia. I am still not Zen enough to handle it all. So am farming off everything I usually do which I am not essential for (I.e.) for the other 2.5 jobs. Seems to be a good plan.

Have you ever had things slowly add up until finally you see them from a whole new perspective?

Here is one which has been sneaking up on me for a month or so. These are a few of the factors to the sum. Pdoc, when I told him I was working on the dose to nothing said "Don't take on too much (more)". The gal who inspired the horse in the paddock scenario has been made redundant from her position, was offered another, less advantageous position. Her Pdoc said that he would not release her medically for the position unless she agreed to start medication for depression. An overworking buddy needs a serious shoulder massage every week to undo the stress-related knotted back muscles which give him dynamite headaches. I used to run, a lot. My ankles started to give so I went to an orthotic specialist and got custom shoes.. then my knees started to go.. went to an orthopedic surgeon who said give up running...took anti-inflammatory meds an hour before running and pain killers after running...hip started going... I assessed this somewhat annoying complication and made the decision than I would still like to be able to walk when 60 and to actually be able to climb stairs without pain at the current time. Gave up the running.

I put all these together and finally got the picture. I had been looking meds from the perspective that I need them to keep going, keep pushing, keep balancing and juggling. Just as I needed to keep running. To keep doing either I needed the meds. I saw that most clearly in the gal who has the choice - take the job and take meds *or* don't take the job. That is the decision many of us make. Not necessarily with a job. Many other areas of life - do this or don't do this, I must, I should, I have to. Any of these are the mental marathons we run. When the mental pain sets in, just as the physical pain of my running set in we do have a choice. We usually don't like the option of giving up the job, facing down the bully, leaving town, dealing with a marriage which isn't working... whatever it is. Most of those I know lol. So we chose the drugs, as I did the pain meds, to keep us going. It may, but it doesn't deal with the underlying cause. Probably can hold us as long as we don't keep on running or finding new marathons.

I chose to change my perspective. As I said I was looking at the situation of final withdrawal from the drugs from the opposite end to where I currently see them. I have been choosing the drugs to help me handle the lifestyle choices I am making. I choose instead to see that I am overdoing my threshold for stress when I need the upgrading of the drugs to keep my mood stable. From there I could top up the drugs, I am going to run with reducing the stressors.

Everyone will have a different threshold for excessive stress. Each a different set of circumstances which reach that level. Each of us are different in how much we feel able to reduce the stress in our circumstances. I am fortunate in that the majority of stressors for me are simple at the moment. I.e. no major issues with money or spouse. I have been through all or the previous, I know how hard it is to move past them. I also know, even although there seems no choices in those situations that there are, just not nice ones. Usually doesn't stop the final outcome, just stretches it to the future. Hence the drugs to cope.

So.. today.. a good start to the new plan - cancelled a business meeting and dinner. Knowing it would disappoint a few, inconvenience a few... was the right thing for me and that was how it has to be. Feel better already.

Stop running lil doggie :::::::

This post has been edited by Herald: Yesterday, 08:42 PM