Cipralex Withdrawal Question

[freespiritgirl]

Hi there,

I have panic disorder and have been on 10 mg of Cipralex for about 4 months. It helped to calm my mind but it didn't take away all the panic symptoms.  I have been using other techniques to cope with those.  I was starting to feel better so I decided to decrease my medication to 5 mg.  I felt fine for the first few days but about the 3rd or 4th day I began to feel a constant nervous feeling in my stomach and I started to have panicky feelings again.  

From your experience, do you think that my symptoms were my original symptoms or withdrawal symptoms?  How can I tell the difference? I read that if you go back on the previous dose and the symptoms go away, it is withdrawal.  I've gone back on the previous dose and the feelings are going away.  

Also, is going from 10 mg to 5 mg to quick of a reduction?

My last question - does medication actually help heal or does it simply cover up the symptoms?

If someone could provide some insight based on their experience, I would be greatful.

Thank you.

[freespiritgirl]

I went back to the previous dose about 5 days ago an I have been having alot of anxiety (physical symptoms, thoughts racing, 2 panic attacks), which i had before i started the medication (prior to the reduction this was all stablized). I also have headaches and nausea which i didn't have before I started on the medicine so its hard to tell if I have withdrawal, original symptoms or both. Hopefully it will as stabilize in the next week or so. I will definitely lower super slower next time...lesson learned.

Thanks for the great info!

[Paxiled]

This is just a theory of mine, but if you only got a small benefit you probably weren't metabolizing the drug all that well.  That makes it much easier to come off of.  The better one metabolizes a drug the better it works, but it also means more side effects and it's harder to come off of.  Remember that all the ssris except Prozac leave the body very quickly, in a matter of hours, and some people suffer withdrawal just by missing the time of their next dose by a short period of time.  A drug has to get past the liver's defenses to get into the brain, and that's one reason why some drugs work for us and some don't.  Some psychiatrists who act more like doctors will even test the liver metabolites before prescribing a drug to make sure the patient can metabolize it.  It's very complicated to get any medication, which the body generally sees as a foreign intruder and something toxic, to where it needs to go, as the body is well adapted to food and plants and substances found in them but not so much to newer drugs not derived from natural sources.  That's one reason it takes so long to get a drug to market.

[Paxiled]

Yes, you do, but you don't want to exacerbate it by suffering withdrawal.  This is a really difficult area and I don't know if you're suffering withdrawal or not, but my own view is that it's best to be real careful because withdrawal can in some of the worst cases cause new problems and can last a very long time.  So if you think it's withdrawal it never hurts to go back on the last dose at which you felt fine and go slower and see what happens.  Eventually you get to the same place.  

[freespiritgirl]

Yes 10 mg of Cipralex isnt that high of a dose for me. Prior to this experience, I had been on Celexa for two years and when I got off of it I was fine for a few months but then I was even worse than when I started on it. This made me conclude that medication alone would not help me recover from Panic. Everyone i know or read about who have recovered from panic used therapy to change they way they think about fear or used a combination of therapy and medication so that is what I am trying to do now.  I'm using the medication only take the edge off the panic. Here is an interesting study that illustrates this: http://www.scientificamerican.com/article/prozac-extinguishes-anxiety-rejuvenating-brain/

The reason i lowered my meds because yes I was starting to feel better but I know it simply alleviates symptoms it doesnt help you recover. In order to recover, you have to feel some of the symptoms and face and accept them and let your body heal itself.  

[birdie0907]

"I got a small benefit from Celexa within the first week, so I am guessing it probably left my system as quickly. "
This should have included the below.
I am guessing that small amounts necessary to cause an effect left my system as quickly.

[birdie0907]

I get your point that if withdrawal effects occur quicker than system shortages, the drop down test could be useful, if you had some way to know your system had the minimum necessary to stave off the anxiety effects. However I am thinking there is no way to know if you have the minimum amount. I got a small benefit from Celexa within the first week, so I am guessing it probably left my system as quickly.
Regarding your last 2 sentences, freespiritgirl lowered her dosage although she states that 10 mg wasn't enough to deal with all the panic symptoms. Not that I am criticizing her in any way for doing so.

[Paxiled]

There are many writings on going off these medications, including some good books.  Those who are concerned about withdrawals, and most doctors and psychiatrists haven't been historically, have developed protocols for tapering off these drugs.  Much of this came out in 1996 when the difficulty of stopping ssris first came out as a kind of accident.  A BBC reporter learned that people were having a terrible time stopping Paxil, and the BBC did a report on it.  What followed shocked them, when thousands of messages came in thanking them for finally telling them what their doctors and psychiatrists weren't telling them they were going through.  A psychiatrist in England named Healey (I think that's the right spelling) was one of the first to come out and say that this was an issue psychiatrists were talking about among themselves but not to their patients, and he was the one who was assigned the task to do the discovery during the subsequent lawsuit against GlaxoSmithKline, the manufacturer of Paxil, and found the company knew about this problem before the drug came to market but failed to report this to the FDA (or anyone else).  They immediately settled the case, and from that came the black box warning about withdrawal (officially called discontinuation syndrome because it sounds less threatening) that is on the information included now with antidepressants and benzos.  From this came a lot of suggested protocols for properly tapering off these drugs, including the suggestion that if someone is trying to discontinue the drug or lower the dosage and they find a sudden increase in their problem, particularly if it's a new problem they didn't have before but including a sudden increase in problems they did have before, it was likely withdrawal symptoms.  This was based on the belief that someone lowers their dose or tapers off most often because they're feeling like that don't need it anymore and that a recurrence of the problem would take more time to show itself whereas withdrawal would occur quickly.  Which isn't to say it couldn't be the case that the problem was still there and, as you say, the dose came down too low, but one would wonder if you knew you still had a problem why you would be altering your dosage.  Again, this is usually done by people who feel they don't need the medication anymore and are trying to come off of it.

[birdie0907]

I just noticed you say you have panic disorder which I presume has been diagnosed by a professional. I imagine that makes a lot of my comments void, however I still think my first paragraph is valid.

[birdie0907]

I don't understand the theory. "if you go back on the previous dose and the symptoms go away, it is withdrawal.  I've gone back on the previous dose and the feelings are going away."                 Years ago when on a different med, I was doing fine at 30 but tried cutting my dose to 20 and the problems started so I returned to 30 and the problems went away. To me, that meant I needed the higher dose. I stayed stable on the higher dose for 6 more months then went off meds.
I am also wondering if you are on a high enough dose when you say Cipralex didn't take away all of your symptoms. I am not an expert and can't diagnose you and am not trying to, but I would discuss this with doc if you stay on Cipralex for a while. My reasoning was when I was on meds doc said I needed a break from the anx and dep so I could remember what it was like to be happy again - I am wondering if you are getting enough break from the anx. You say you have other methods to combat some of the panic symptoms so perhaps 10 is ok though - I am just throwing ideas out there.
Countering that thought that the dose might need to be even higher are recent studies suggesting people should avoid SSRI dep drugs, so it is really hard for the poor patient to figure what to do. Here is a link. http://www.medhelp.org/user_journals/show/1007063/1--Article-on-2013-study-of-anti-depression-drugs

[freespiritgirl]

Hi Paxiled,

Thanks, that really helps :-) my doctor advised that I could go down to 5mg (a 50% reduction), but clearly he doesn't know what he's talking about and doesn't realize everyone is different so it might be best to go down as slow as possible. I read online that a 10% reduction every few weeks is best so next time I'll try that. I don't feel confident enough to reduce after that terrible experience...

Thanks again!

[Paxiled]

Just covers up the symptoms.  Since we don't know the physiological cause of anxiety or depression yet there's no medication that can cure it.  The only known cure for some is learning to think differently.  This drug just artificially changes the way the body deals with serotonin.  As to the withdrawal question, yes that' what it sounds like given your smart decision to see what happened if you went back to the original dose.  You're going to need a slower taper down it looks like.