SSRI withdrawal…

After being diagnosed with POTS, the first medication I was prescribed was a selective serotonin reuptake inhibitor (SSRI).  SSRIs are antidepressants but are often prescribed for off-label uses as well, such as for the treatment of dysautonomia.  Serotonin is a neurotransmitter used by the brain to control autonomic functions of the body, including heart rate, blood pressure and intestinal motility.  Doctors speculate that production and regulation of serotonin is faulty in those of us with autonomic dysfunction (i.e. dysautonomia).  Thus, SSRIs are commonly prescribed to individuals with POTS to aid in serotonin regulation.

However, I was very hesitant to start taking antidepressants. Depression, sometimes even severe depression, runs in my family. I am very fortunate that I have never exhibited any signs of depression.  Yet, I worried that taking a medication that altered my brain chemsitry could cause depression symptoms. For those of you that have never taken an antidepressant, the pill bottle handed over by your pharmacy also contains a sheet of paper that is referred to as a “black box warning.”  A black box warning is the most serious type of warning of serious side effects.  The warning for SSRIs cautions that they may cause suicidal thoughts or actions in minors that take the drug.

I was on the SSRI for dysautonomia for over two years, but could never really tell if it was helping. It did, however, cause me to gain weight, made me excessively tired, and caused sleep disturbances, including insane dreams and the occasional inability to tell the difference between dreaming and reality.  Additionally, SSRIs are known to cause birth defects.  The BF and I are not looking to have a baby anytime soon (sorry mom and dad – and the BF’s mom and dad), but my doctor recommended stopping medication at least 6 months before conceiving, and in my own personal circumstances, I’d like to extend that to at least a year.

Because stopping SSRIs can cause withdrawals, patients are instructed to taper off the drug.  However, I was already taking the smallest pill they make – 10mg – and cutting it in half. It doesn’t get much smaller than that, so I opted to just stop altogether.  A typical dose for the SSRI I was on for someone who takes it for on-label use (i.e. depression) is 60 mg. Since I was

only taking about 8% of the normal dose, and only 20% experience withdrawal symptoms, I didn’t expect to have any problems.

I guess I’m one of the lucky ones.

It has been three weeks – a rough three weeks.  The withdrawal symptoms are not easy to handle. I have wondered many times over the past few weeks whether I made a huge mistake stopping the medication.  On numerous occasions I almost broke down and took another dose, but decided that I would rather just push through.

Some of the symptoms of SSRI withdrawal include:

• Anxiety
• Depression and mood swings
• Light-headedness
• Dizziness and balance problems
• Electric shock sensations
• Fatigue
• Flu-like symptoms
• Headache
• Loss of coordination
• Muscle spasms
• Nausea
• Nightmares
• Tremors
• Trouble sleeping

Sounds a lot like the symptom list for POTS, huh??

I have found the electric shock sensations to be the worst symptom.  It feels like someone took a defibrillator to my brain and tried to resuscitate it.  It’s also similar to when you are on a rollercoaster and your stomach drops – except it’s my brain that is dropping. The first few times it happened it was incredibly scary. Now, it’s just very frustrating.

The nausea, dizziness and balance problems have increased – I am almost constantly uncertain whether I am moving, or whether the ground is moving and I am standing still. Or what is real. I have also awaken nightly with a huge adrenaline rush and a pounding heart, like in a panic, and a few daytime instances of extreme anxiety. It can be quite disturbing, especially because I have never been an anxious person.

From what I have read, SSRI withdrawal usually lasts about three weeks, so I hope I am near the end. Ironically I have found that exercise, which often exacerbates my POTS symptoms, to be extremely helpful in dealing with the SSRI withdrawal. In fact, if I go a day without working out, my withdrawal symptoms are extreme the next day. I will discuss exercise more in my next post.

So, what’s the best way to cease taking SSRIs?

• Consult with your doctor. Never stop taking an SSRI without your doctor’s approval and guidance.
• Taper off the medication. Slowly decrease your dosage, or take every other day.  It may take many months to completely stop, but it should help with the symptoms.
• Consider another SSRI in the meantime. Many doctors will prescribe another SSRI, temporarily, to help with the withdrawal symptoms. Again, discuss this with your doctor.
• Tryptophan and omega 3 acid.  Some patients have found starting tryptophan and Omega 3’s (e.g. fish oil, flaxseed) right before discontinuing the SSRI to be helpful. Ask your doctor if this is safe for you.
• Get out. Whether it’s the vitamin D or whether it’s just psychological, soaking up sunlight and getting a little exercise has helped some with the withdrawal symptoms.

Have you ever experienced withdrawal symptoms when stopping a medication? What did you find that helped?

“Hallucinations are bad enough. But after a while you learn to cope with things like seeing your dead grandmother crawling up your leg with a knife in her teeth. Most acid fanciers can handle this sort of thing.” – Hunter S. Thompson

Smell ya later.
– Linds

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