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The Simple ABCs of Antidepressant Withdrawal
By Alice Lee-Bloem, MD, ABIHM – Holistic Psychiatrist, Orthomolecular Psychiatrist, Integrative Psychiatrist – Rockville, Maryland
Antidepressant withdrawal is both complicated and simple. It was complicated back when I first started in holistic psychiatry and didn’t know all the nuances of antidepressant withdrawal, but now that I have it generally figured out, it’s been simple. Well, as simple as a complicated process can be, that is. My learning curve, however, was a gradual one, and it stretched over many years. This article is not meant to be a comprehensive review of everything about antidepressant withdrawal. That would require a more extensive review than I can provide here. The purpose of this article is to alert individuals to key aspects of antidepressant withdrawal that everyone should know before starting out on this journey. If you don’t, you won’t be able to withdraw successfully. What I mean by a successful withdrawal is one in which a person will be able to get off an antidepressant and stay off indefinitely, even under stress.
A. Content & Process
Antidepressant withdrawal can be divided into two aspects: content and process. The content of withdrawal seems to be the main concern for most people looking into withdrawal, i.e. what kinds of supplements or orthomolecular products are necessary to support withdrawal. The process, however, which has to do with how to withdraw and when and at what dosage, is often neglected and poorly understood. In my practice, the process is facilitated from information and feedback contributed by kinesiology. Without kinesiology as an indispensable tool, facilitating the process of medication withdrawal, one has to rely on guessing, medication side effects, and empirical experience to guide the process. This lack of information from kinesiology makes the process more difficult and prone to errors along the way, but successful withdrawal still can be achieved if the clinician has a good store of experience to rely on.
Lacking an overarching method for guiding withdrawal is often the main reason why people’s attempts at antidepressant withdrawal fail. Because of this, I would recommend antidepressant withdrawal only with the aid of someone who’s had a good track record in helping others through withdrawal. Many people who were not aware of this precautionary measure before starting out have ended up with serious debilitating anxiety and depression, some needing hospitalization or antipsychotic medication. These patients may have been told, by well-meaning, but ignorant, psychiatrists, to lower the medication dosages “slowly.” Without true healing, such an approach is often a quick way to a hardy relapse into depression and anxiety.
Having said that, however, it is generally important to withdraw slowly (occasionally, energy healing allows a rapid reduction to be appropriate). Compounding pharmacies are often necessary to help create liquid suspensions of medications that allow for gradual dosage reductions that are much smaller than available dosage forms. Typically, the time for lowering the medication is when the “functional dosage”—the way the medication dosage supports mental function– is being experienced as being slightly higher than needed. This state of being on a higher dosage than is functionally needed is usually accompanied by early and mild side effects from the medication, i.e. increased vivid dreams, increased gastric activity, or apathy. Lowering the medication at such a point will lead to a normalization of function, rather than a state of deficiency. The faster the healing process, the faster the pace of antidepressant withdrawal. With effective use of kinesiology, the need for side effects to help determine the time for lowering the medication can be eliminated.
B. Underlying Illness & Medication Dependency
Even the most successful medication withdrawal, however, will only treat half the problem: medication dependency. Quite often, the forgotten half of withdrawal is the underlying illness. Only treatment that simultaneously heals both the underlying illness that led to depression and anxiety, as well as medication dependency, will lead to stable mental health after cessation of medications. The underlying problems must have been quite severe in order to have a person agree to take antidepressants. Therefore, even with successful medication withdrawal, one may be left with that same severe state of mental illness, plus the intervening years of progressive worsening of unhealed underlying causes. In short, just tweaking a few neurotransmitters will not accomplish the job.
When addressing psychological traumas and negative mental habits that led to the initial symptoms of depression and anxiety, it is imperative that patients heal their psychological issues at the subconscious level. To do so, they first need to gain insight into what those issues were, and then to apply energy medicine techniques to help with healing. Emotional Freedom Technique, EFT(www.EFTuniverse.com), and other acupressure techniques are a quick and effective way to heal traumas. At a minimum, the healing of traumas requires letting go of them through forgiveness at the subconscious level.
To heal the underlying physiological imbalances which led to the initial symptoms, a general blend of supportive nutritional supplements is used. Diet may need to be cleared of foods that cause hypersensitivity reactions. General nutritional areas that often need to be supported through orthomolecular means are: vitamins, minerals, essential fatty acids, amino acids, antioxidants, gastrointestinal support, and detoxification. The higher the absorbability of the supplement, the less one will need of it to get the job done. So, absorption is the key to choosing high quality nutritional supplements, rather than dosage. If common, underlying infections such as Epstein Barr Virus, Staph or Strep, H. Pylori, viral hepatitis, Lyme or its co-infections are discovered to be undermining one’s health, they need to be treated.
To address medication dependency, the first thing to do is: know your medication.
C. Antidepressant Psychopharmacology & Biochemical Support
It is important to know how the medication helps and how it hurts the person, when trying to withdraw from it. Open up a PDR or look online to really know the medication’s psychopharmacology and its unique functions in the body. When withdrawing from a medication, everything that the medication suppresses will become elevated, and everything that it elevates will become suppressed—unless you do something to prevent that condition beforehand.
To prevent the imbalance that will ensue upon lowering an antidepressant medication, one must anticipate what will happen when the medication is lowered. There are different types of antidepressants. The most commonly used ones are SSRIs (Selective Serotonin Reuptake Inhibitors such as Prozac, Zoloft, Celexa, Paxil, and Lexapro) and SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors such as Effexor and Cymbalta). Tricyclics are seldom used nowadays. For those that elevate specific neurotransmitters, it is helpful to use supplements that help the body to create these neurotransmitters more easily before one attempts to lower these medications–not after. If the medication is first lowered and the person has low levels of the corresponding neurotransmitters, adding supplements after a taper has already taken place may not allow for normal levels to be restored quickly enough, and withdrawal will ensue upon lowering the medication. There are websites devoted to the nutritional support of creating neurotransmitters. I have used TravaCor (Neuroscience), Norival (Ecological Formulas/ Cardiovascular Research), Taurine (500 mg capsules), and GABA homeopathic oral drops (Deseret Biologicals), GABA (500 mg capsules), or GABA rice (germinated brown rice) to support neurotransmitter production. Generally, if I were to use Norival, it would be to help those coming off of an SNRI, and only after I have made sure that the patient had enough serotonin and GABA to remain calm, when I start adding a potentially stimulatory amino acid.
Beyond neurotransmitter support, there is a need for immune and hormone system support. For, antidepressants have an effect on hormones and the immune system. All medications are like two sided coins. They have a beneficial side and a toxic side. Antidepressant medications are beneficial, because they have, among their many side effects, some side effects that help lessen depression and anxiety. They are toxic, because they have been patented by a pharmaceutical company, which means they are unique molecules that are no longer a food item that the body will recognize. If the body does not recognize it as food, it is a foreign object, a toxin, and therefore, must be eliminated—both through detoxification pathways and through the immune system. (This is why, if a person’s body is already overwhelmed by too many foreign objects, i.e. toxins, the toxic side of medications will be poorly managed, and more uncomfortable and harmful side effects will ensue upon taking the medication. If a person has a robust and healthy detoxification system, then the toxic aspects of a medication will not even be noticed by the patient taking the medication.)
As medication levels get lower, its beneficial and helpful side effects shrink, but its allergenic effects–stress for the body–does not diminish proportionally. Compare this to what we know about vaccines. Vaccines contain small amounts of the stimulating particles, antigens that produce a powerful response in the form of an immune cascade. In a similar way, even a small amount of medication can cause a strong immune response—not the kind that causes hives, but like the kind that occurs with a kidney transplant. As withdrawal progresses, the imbalance between benefits and the immune reaction (stressor) will make the withdrawal gradually more difficult, unless you anticipate it and treat it. I have found that Opsin II (Professional and Complementary Health Formulas) and/or quercetin (Quercetin 300 by Allergyresearch) may be helpful in reducing the histamine response generated by medications, allowing for an easier withdrawal process.
With regard to hormonal support, I differ from other orthomolecular physicians in that I prefer to use pineal gland support, rather than thyroid or adrenal support. My clinical experience has shown that pineal gland (Deseret Biologicals) eases withdrawal significantly. Patients tend to have better sleep, appetite, and lower stress levels when given this hormonal support.
Conclusion
At this point, you may have read more than you ever wished to know about antidepressant withdrawal, or you may feel cheated from knowing all that you need to know to do it on your own. You may also have the distinct impression that it may not be safe for you to attempt to do this on your own. And you’re probably right. It is unfortunate that antidepressant withdrawal can’t be made any simpler than this. It would be wonderful if people could merrily take themselves off these medications safely and with little trouble. But that is generally not the case. By reading this article, you have the advantage of knowing more than I ever did, when I began my journey as a holistic psychiatrist. Through ten years of psychiatric training, the only useful piece of advice I remember receiving from my mentors when medication withdrawal was discussed was to “do it slowly.” Three words on a topic that meant everything to my patients. And these three words may still be all that current traditional psychiatrists know about antidepressant withdrawal, unless they have searched for solutions beyond the medical field. May these three pages help you with success in your journey for freedom and happiness.
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