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Looking after ourselves

Lise07
Senior Contributor

Discontinuation Syndrome

Hello Everyone,

 

I'm new to these forums (although I've lurked a bit) but finally decided to write something because of the situation below:

 

My psychologist has suggested that I might try going without my medication since I've been doing pretty well lately, and so I consulted a doctor about a taper plan. Without divulging specifics (as I see it's against the forum rules) I have been taking a rather strong dose of SNRIs for the past few years.

 

I've been weaning myself of them over the past month or two, and as of yesterday I've stopped taking them completely. That's the good news I guess. 

 

The bad news is I feel awful. The physical symptoms aren't great but I can deal with them. The psychological ones are intense. I feel like a little ball of rage and sadness (oscillating between the two and occasionally both at once) and it's taking everything in my power to stop myself yelling at everyone and everything, hurting myself, or bursting into frustrated tears in public. On top of that my girlfriend's parents are visiting from overseas and their prescence is triggering a lot of my contamination obsessions, and makes me feel like my home is no longer a safe retreat.

 

Does anyone have any tips for dealing with the side-effects, particularly anger? I've tried distraction (video games), exercise, punching pillows, and singing. I'm not typically an outwardly angry person and I'm afraid I'd feel very ashamed if I did have a public outburst.

9 REPLIES 9

Re: Discontinuation Syndrome

Hi @Lise07, welcome to the forum.

I'm not a mental health professional, nor an expert, but have had personal experience of being treated for mental illness for about 30 years. This has involved many first hand experiences with different medications, as well as the symptoms of changing from one to another, or discontinuing altogether.

It seems to me that what you are describing might possibly be, as you suspect, side effects of discontinuing your medication. In that case, the symptoms may ease as your body becomes more accustomed to being without the meds. One to two months seems a reasonably long amount of time to have been tapering down though, so it may be a bit unusual that you are still experiencing significant side effects of this process. For me, the effects of discontinuation have usually passed more quickly than what you have described.

On the other hand, it seems possible that what you are experiencing is a return of the actual symptoms of your mental ill health, which may stick around, or even get worse, as they are no longer being treated or managed by medication. I wonder who prescribed the meds for you in the first place, and whether you have discussed with them this current decision to wean off. It would seem wise to do that, if possible.

My experience suggests that a psychologist may not necessarily be the best person to be advising you to cease taking medication. In my experience, it is a psychiatrist, or at least a trusted GP, who will have the best advice on medications, as they specialise more in medical treatment of mental illness.

It sounds like the GP you saw was not your regular GP? Or maybe you don't have a regular GP. If not, I'd suggest it might be helpful to develop an ongoing relation with one who has a good understanding of mental health issues. It's been so very valuable to me that my GP knows and understands my mental health issues over time, and is thus better able to consider all that might be involved, and better advise me.

Just because you were doing well on your meds doesn't necessarily mean that your medication should be discontinued. In many instances a relapse may occur if medication is ceased. The fact that you were doing well may be partly due to you taking the medication in the first place, so that ceasing it may be causing a return of original symptoms.

So, it seems to me that what you are experiencing could be either an effect of discontinuation, or an actual flare up of mental illness symptoms, due to it no longer being treated with medication.

In my case, decisions about medications for my condition are made only in consultation with my psychiatrist. A psychiatrist is the medical expert on medications. In my experience, a psychologist will be an expert in 'talk therapy', but not so much on questions of medication.

Just to emphasise again that I am no expert, except in my own personal experience. I hope what I have written may be of some use to you. I'd probably be seeing a medical doctor again about what you are going through, and, depending on what your mental health diagnosis is, perhaps preferably a psychiatrist.

Re: Discontinuation Syndrome

Thanks for your reply @Mazarita. I should have been a bit clearer in my initial post - when I said "doctor" I meant "psychiatrist". The difficulty is neither my current psychologist nor psychiatrist were around when I started taking medication since I was living overseas at the time. I've only moved back to Australia in the last year and a half, and have been in my current location for even less time. Your suggestion is a good one, but I can't think of how to implement it in my case.

 

While she hasn't said so directly, it's clear to me that my current psychologist is somewhat anti-medication. Well, more accurately she views therapy as more effective and medication as a somewhat temporary aide. I've also recently realised I have a tendency to sugar-coat things in our sessions, probably because I KNOW what I SHOULD be doing and I'm a perfectionist with a fear of criticism 😄 

 

I did a fair bit of reading about discontinuation, and while it can be tricky to distinguish between these symptoms and a recurrence of the original problem, the difference seems to be the timeframe in which symptoms occur. Unfortunately I think the only way to know what's what is to wait.

 

My girlfriend suggested I call someone today (after I went for a spontaneous nighttime walk around the block in my pyjamas to get away from the house), so I might contact the psychiatrist to check whether what I'm feeling is normal or something to be concerned about.

Re: Discontinuation Syndrome

@Lise07, good to know you have already thought through some of these issues. Sounds like contacting the psychiatrist might be a good idea. I remember those times when I used to just take off in the middle of the night, driving nowhere in my fluffy slippers. Smiley Tongue

Wondering if you were given a diagnosis when first prescribed the medication, and what your current psychiatrist thinks of that now, and of you withdrawing from the meds.

Wishing you well, whatever steps you choose to take with all this now. 

Re: Discontinuation Syndrome

I first noticed symptoms when I was 10 years old (I am now in my late 20s) but battled keeping them contained for years, with a considerable degree of success (I actually out myself through ERP when I was about 13). It was only a few years ago after a friend pointed out that it seemed like something was off that I finally swallowed my pride and went to see someone. However, in classic me style I did all the research first then rocked up to my first psychologist session saying "I think I have OCD and depression". No one really challenged me on it since so as a result I've never been 'independently diagnosed' by a mental health professional. 

 

I've become a while lot better at talking about my issues over the past few years but I've realised I still have a real habit of 'sanitising' them, since I'm still really ashamed and want to look like I'm in control. The person I've been most honest with was a German psychiatrist who had a really deadpan manner. I wasn't afraid of saying "yes" when he asked if I was suicidal, because I didn't fear his expression changing or him being too worried about me!

 

This post turned into way more word-vomit than I'd intended. How can I actually express all my feelings without my other feelings (fear of judgement) clamming them up? I think I need a robot doctor...

Re: Discontinuation Syndrome

Hello @Lise07Do you think it is just too fast a reduction ... I have generally tapered a lot slower than over a month, more like a few months on each level of dosage ...

Re: Discontinuation Syndrome

Update: I've made an appointment to see my psychiatrist tomorrow 🙂

Re: Discontinuation Syndrome

@Lise07. Anger,  irritation,  frustration,  rage - these are all symptoms I have when in full blown depression.  So I wonder if,  rather than a withdrawal side effect,  your irritation might be due to depression and anxiety increasing. 

Just a suggestion,  as we are all different. 

Re: Discontinuation Syndrome

@utopia after speaking with the psychiatrist on Friday I realised a lot of the frustration is triggered (directly and indirectly) by not being able to act on my compulsions - either because there are other people around or because I know I shouldn't. I then get frustrated and angry at myself for even having these feelings in the first place because they seem so ridiculous. All these feelings have been repressed/denied for so long though that it's not always an obvious link.

 

So yes, it's probably just my baseline rather than a medication side-effect. However, we decided that to survive Christmas witwith the family AND in-laws I could probably use some pharmaceutical help 😄

Re: Discontinuation Syndrome

@Lise07. I'm glad you won't be going solo for Christmas.  It is a hard time of the year to deal with,  even when on medication .

So pleased to hear about your v8sit with your psychiatrist. Sounds like some good progress was made. 

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