I recently had the absolute pleasure of interviewing Dr. Kelly Brogan, holistic women’s health psychiatrist and author of the new bestseller, A Mind of Your Own. I’ve had the section on medication tapering and withdrawal effects transcribed because it’s so valuable.
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Kelly: Now much of my practice is devoted to psychiatric medications tapers. Guess what? I didn’t learn that in my training. There wasn’t a single hour of education on this subject. I have learned how to do this from patients, and really from patients globally who are educating each other and frankly educating physicians about how to engage in a safe and responsible psychiatric medication tapers……
…when you try to taper off a medication after long-term exposure, either because you’re no longer deriving that initial benefit from it, or because something has changes about your life circumstance and you want to try a different kind of healthcare maybe, they you might learn that these are some of the most habit forming medications, I would say habit forming substances, on the planet.
I wouldn’t believe this if I haven’t seen it with my very own eyes, but this is what actually compelled me to put down my prescription pad for good. After I read that book, I began to take patients, or at least offer them the opportunity to taper them off of medication. Even when we did it responsibly, I was essentially running an outpatient rehab. I mean from neurologic symptoms to psychiatric symptoms, physical symptoms, autoimmune diseases flaring, patients developing impulsive behavior and even violence. It was beyond description.
Then I began to see that actually a lot of patients around the world are talking about this. They’re talking about withdrawal from anti-depressant specifically, but of course other medications as well. Their doctors are totally ill-equipped to help them because we don’t learn about how to do this in our training. We actually in fact dismiss patients when they talk about these being addictive medications. Of course, now finally Fava is a group of researchers who have finally begun to publish the reality of this withdrawal syndrome, and how disabling it can be.
Since I have 4 grounded lifestyle interventions, and actually begun with nutrition such that I don’t even begin a medication taper until about 2 months into lifestyle change, everything is different now in my practice. I feel that once you can optimize your physiology, you really put yourself in a much, much better position to safely and strategically taper. Wow. Isn’t that something you would want to know before taking your first prescription? I certainly never told any patients that it could be like a horror show and you might never be able come off of a psychiatric medication if you’re taking it for longer than a year or so. I never informed patients of that.
A lot of what I discuss and describe in this book is in service of presenting people with a full picture of what the science has to say before they make a decision. I think we really wish that there was a magic pill. We really wish there was a safe effective quick fix. Unfortunately, what is available is really anything but that.
Trudy: Yeah. We want that quick fix. I’ve got a few follow on questions, because this is a lot of good information here. The fact that you see all these problems when people are coming off the meds, is there a time frame, or is that really dependent on each person?
Kelly: It’s very, very dependent on each person. That ends up being the take home that we are talking about. What I like to call end of one medicine. We’re talking about the fact that our levels of biochemical individuality have ever been more relevant than when we’re exploring how we interact with chemicals in our environment, in our pharmaceuticals. We really need to understand that every single person is an individual.
When I taper patients off of meds, I normally do what’s called a test dose decrease, which often is around 20% to 25% of the dose. We come down by that. Again, this is after we’ve done the initial months at least of fairly strict dietary compliance working with relaxation response, doing 20 minutes or more of movement, working on sleep. All of this has to happen first. Then we begin, and so we start with a test dose. If we see in about 2 to 4 weeks that test dose is completely well-tolerated, meaning you don’t even notice the difference, then we probably can work in bigger increments. That’s actually a godsend. These tapers, when we’re working in 10% and less doses, could take literally years.
You want to begin to learn about what your body is capable of bouncing back from. We begin with 25%. If that’s not a pretty picture, then we’ll just scale it back to about 10% of the initial dose, and work with that 10% increment at about every 2 to 4 weeks, sometimes unfortunately slower. The increment and then the speed are 2 variables that we have to learn for each patient.
I don’t know what I would do without a compounding pharmacy. While many of these medications are available in liquid form, and some of them, like Effexor for example, have beads inside a capsule, to be able to tailor and personalize the dosage to each individual patient is wonderful and that I have that option through compounding pharmacy. I work with one in Massachusetts named Johnson Compounding, and they’ve just been a wonderful support over the years to my patients.
Trudy: Wonderful. Very slow and then obviously very individualized. Now I’m very familiar with the effects of benzodiazepines and the slow taper process that’s needed for someone on the anti-anxiety benzodiazepine medication. Would you say that SSRIs can have comparable effects in some people, or are they not as bad as the benzodiazepines?
Kelly: That’s a great question. What we’ve observed in psychiatry is that there’s really been a transition from using benzodiazepine as sort of like a spot treatment to transitioning into using anti-depressants long-term. When I was in my training, the typical gold standard protocol would be to start somebody on both benzodiazepine and anti-depressant, and then taper them off to benzodiazepine and leave on the anti-depressant with the thinking being that benzodiazepine are acknowledged for their habit forming properties and anti-depressants are totally safe.
What we are learning is in fact, that group that Fava runs, with the papers that they’re putting out, they are essentially equating the anti-depressant withdrawal phenomenon to benzodiazepines. In my clinical experience, I would actually argue that SSRIs are worse with long-term exposure. A lot of people at this point, given that it’s been decades since Prozac, have been on these medications for more than 10 years. We’re really talking about a level of habituation that could be challenging to undo. It’s not that I haven’t. I struggled a lot with Klonopin for example. It’s not that I haven’t encountered challenges with benzodiazepines.
A patient in my practice I’m taking off of Lexapro a thousandth of a milligram a month. I’ve never heard of something like that. Heroin, crack, cocaine, oxycontin: show me something that would ever require that. It’s unbelievable. I think it’s at least comparable I would say, and that’s what the literature is beginning to demonstrate, is that there are actually comparable phenomenon, but we really never ever talked about anti-depressants in this way, so it really is a game changing perspective.
Trudy: The fact that you say people are not told that this could be a possibility, and the fact that you’re talking about this and writing about it I think is so important, because people need to know. They would choose not to do this if they did know. I see there is this MA bill going through [correction: being proposed – you can read more here]. It’s about benzodiazepines and people needing to consent to the fact that it’s going to possibly cause them issues. It sounds like we need to do the same with these anti-depressants.
Kelly: Absolutely, 100%.
Trudy: Now, I’ve heard that certain SSRIs are worse than others. I’ve heard that Paxil can be really bad. Have you seen a difference between different medications?
Kelly: Basically we look at half-life of these medications, and we extrapolate from there. Assuming that Prozac would be the easiest, and there are medications like Paxil and Effexor that are more challenging. In my experience, there are 2 ways of discontinuation – the field likes to call it discontinuations issues. The first is acute. It’s within 72 hours of a dose change where you can get brain zaps and headache, and gastrointestinal distress, you feel agitated. The Paxils of the world are much more likely to cause those more immediate withdrawal symptoms.
What I have found is unfortunately there’s no free lunch. There isn’t a medication that actually is effortless to come off for everyone, so that even when you’re on Prozac, for example, for a long period of time, even though it has this long half-life, it should be easy to come off of, in my experience, it can often be challenging as well. These other medications often manifest as second waves. What I have found is almost uncanny – after about 2 months, it’s almost always 6 to 8 weeks after the final dose or after a major dose change. It’s like the other shoe can drop.
You have those immediate withdrawal symptoms, and then about 2 months later, you can begin to have what has historically been categorized as a relapse. This is when your doctor will tell you, “You see, you should have never even tried to go off your medication. You need it for life. Now you know.” That’s what we’re taught to say. In fact, it’s actually a protracted withdrawal phenomenon. Again, this has now been documented that this can occur for unfortunately, I don’t want to scare anyone, it can occur for months and months and even years after the final dose. That being said, there is a medication that spares you from that arm of this problem.
Even I went for years tapering patients off of Wellbutrin and thinking, “Well, this is the easy one. I can even come down by 50% of the dose, and it’s not a problem.” Right now, I have in my practice, a patient who has been completely destabilized coming down by 25 milligrams of Wellbutrin. Again, it’s a very individualized process, and I don’t think that there are any obvious choices in terms of medications that are easier come off of after long-term exposure.
Trudy: Thank you for sharing that. It’s scary, but the good thing is that there are solutions. People on these medications must do the slow taper and make all the changes that you’ve talked about. I’m glad that you mentioned, “Don’t rush into this, make all the food changes.” We’re going to talk about some of the things that you recommend in a second, but get yourself in a better place to start making these changes. If you’re listening to this and you’re thinking, “Oh my gosh. This is terrible.” Don’t go and rush out and just stop. You simply don’t want to stop cold turkey. You want to be working with someone. Then obviously read the book and get resources so you can be in a good place when you’re starting to make these changes.
Kelly: Absolutely. That’s all incredibly important. Yes. Please don’t ever consider just stopping your medication.
Trudy: Absolutely. I have one final question on the medication aspect. You’ve got a small section in the book where you talk about using amino acids are helping people taper, and as you know, my community is very into using the amino acids. I find them very helpful for helping people with mood and anxiety issues. Can you talk a little bit about how you use the aminos and how beneficial you find them when someone is doing this taper?
Kelly: Yes. Absolutely. I am quite certain that there are many, many, many roads to physiologic and psycho spiritual resiliency. I, in no way, intend to position myself as having the answer by any means. I am very much trying to create a space for all of those who are passionate about natural healing, including yourself and our colleagues, because I think that just about everything in the natural health arena offers you the potential for very high yield, very low-risk healthcare.
I certainly don’t consider myself an expert in amino acids and don’t have a fraction of the knowledge that you have about this arena. That being said, I do use them for tapers specifically. If I use supplements I wait after a month of dietary change before introducing any supplements, mostly because I want to, I don’t know, send patients the message of what a single intervention, in terms of lifestyle, what a dietary intervention can do in terms of moving the needle of their health. I often don’t want to cloud the picture with other interventions like even supplements or even detox.
After that period, if it is necessary, I’ll often lead with some of the supplements that I talk about, whether it’s probiotic or glandulars, I use a lot based on my work with the only mentor I’ve ever had, Dr. Nicholas Gonzales. I learned a lot about using glandulars, using specific minerals, using fatty acids, that sort of thing. Well, we’re working with SSRIs. I tend to use tryptophan more often than 5-HTP. I do use tryptophan even in the 3 to 6 gram range before dinner and before bed. I would say that it’s helpful often, not in every case, with a lot of the insomnia specifically. It’s about the worst thing that can happen in the setting of a taper. It’s the kind of insomnia that’s induced by psychiatric medication taper.
I have several tricks up my sleeve, and that’s certainly one of them. Through my own self-education, and again, you may have a more sophisticated perspective on this that when you use 5-HTP or tryptophan for the longest period of time, meaning over a couple of weeks, so you want to balance it out with tyrosine or DL-phenylalanine. If we are using it for a period of time, I might incorporate that. I have found that when I work with Wellbutrin tapers, it’s extremely helpful. Tyrosine and actually an herb called mucuna support dopamine.
Then all of my patients who are tapering – I have them on a blend of amino acids.
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We cover much more than the medication taper and withdrawal and you can listen to the entire interview here:
A Mind of Your Own: The Truth about Depression and How Women Can Heal Their Bodies to Reclaim Their Lives is superb, brave, bold, science-based (which I love!) and offers holistic solutions for depression (and anxiety). Get the book from Amazon or better yet, get a copy from your local book store (ask them to get it if they don’t carry it)!
It launched March 16th and there is a grass-roots effort to share this book widely because of the mainstream media blackout. Join the grassroots effort and help share this valuable message!
Take a picture with the book and post on social media with #amindofyourown and you can have an impact. You’ll also automatically show up in “hall of fame” on the tagboard.
You can go and get the first chapter of the book if you’re on the fence (get it here: http://kellybroganmd.com/amindofyourown/?ref=35). After reading the first chapter, I know you’ll want to get the book and join the grass roots effort.
If you already have the book lets us know in the comments what you think.
Feel free to post questions on the blog and please do share your SSRI or benzodiazepine taper and withdrawal story so we can all be better informed.
PS. Both Kelly Brogan and myself will be presenting at the Mindd Conference in Sydney in May. We’ll also be presenting at IMMH/Integrative Medicine for Mental Health Conference in September in Washington DC. Come along to those events, and you can hear Kelly Brogan speak live, and you can hear me speak live as well.
Hi Trudy,
A couple of weeks ago you had send out an email commenting that unless 3,000 books are sold in physical bookstores by Mar 21, it wouldn’t make it to the NY Times best seller list. I was wondering if she got the 3,000 books sold. I would have bought one at the bookstore, but I had already bought it online.
I do hope she got the 3,000 as this information needs to get out there. Enough of this persecution of persons with integrity that are doing the right thing to expose the lies & to truly help others.
Thanks,
Alice
Hi Alice
How kind of you to ask. I’m sure Kelly will be touched! I don’t have details about the 3,000 but I do know she did make it to the NY Times bestseller list of 4/3/16 http://www.nytimes.com/best-sellers-books/2016-04-03/advice-how-to-and-miscellaneous/list.html and the USA Today bestseller list http://www.usatoday.com/life/books/best-selling/search/author/kelly%20brogan/
Thanks for the support and I’m so glad you got a copy – keep spreading the word!
Hi Trudy!
I’ve heard Kelly speak of her success using the Fisher Wallace Simulator for depression. It is also reported to be excellent for insomnia. What are your thoughts on the use of this device for either condition? I have read many wonderful recommendations for this device. Thanks for any input you may have.
Thanks,
Lacey
Hi Lacey
The Fisher Wallace Stimulator (often known as a CES device) is FDA-Cleared to treat depression, anxiety, insomnia and chronic pain.
I have had clients use a similar CES device in the past and didn’t find that many people noticed a big enough difference so I stopped recommending it. This was when I worked in Julia Ross’ clinic and the first year I started my own practice.
I find that the targeted individual amino acids like tryptophan, GABA and DPA are so much more effective for immediate relief of depression, anxiety, insomnia and chronic pain symptoms. Our approaches differ in this respect – I have my clients use amino acids from day 1 (together with dietary changes), while Kelly has her patients make only dietary changes for the first month and will then use amino acids in the 2nd or 3rd month to support the medication taper/withdrawal.
Kelly writes about it on page 236 of the book and has her patients that do use it, use it for 3 weeks and then as needed. She mentions she likes this device for providing immediate relief.
Thanks for asking the question. It may be something I’d reconsider for folks who can’t take the aminos or other supps because they are super-sensitive. This is the case with some people doing a benzodiazepine taper. And now, as we’ve heard from Kelly, this could also apply to people doing a SSRI or SNRI taper too.
I’m posting a link to Fisher Wallace Stimulator site for others who may be interested http://www.fisherwallace.com/ You’ll find the supporting research under “Cranial Electrotherapy Stimulation.”
In regards to my previous comment it should be the Fisher Wallace Stimulator, NOT Simulator. Sorry for the error.
Thanks!
Lacey
I wish I’d had Kelly Brogan’s book years ago when I got off Paxil after finding myself becoming suicidal. The pharmacist told me the symptoms I experienced were not really happening and that I should try another antidepressant – scary thought at that point! I weaned off by cutting tablets down until I was on grains a day. Still had to cold turkey at one point which was physically incredibly difficult and uncomfortable. Apparently the symptoms are well known now but I also resorted to the Internet for information at that time. I had withdrawal symptoms for over a year. Thank you, Kelly, for speaking out. Your work will save lives.
Karen
You poor thing – I am sorry you had to do that alone with no support.
And yes, she is my hero for speaking out like this and her work is and will continue to save lives!
Hello,
I am trying to taper off of Xanax and I feel that My Psychiatrist does not know what he is doing. I am having a hard time dealing with the Xanax withdrawal and the gabapentin he put me on to “help” ease the withdrawal symptoms. The Gaba is causing so many nasty side effects ie. nausea, weight gain, agitation, depressed mood, sleep and stomach problems.
Can you please recommend a Psychiatrist in the Orland Park Il. area who can help me?
Thanks
Eileen
Eileen
I’m sorry to hear you’re not getting the support you need and are not doing well. I don’t know someone to refer you to but I would check with Dr William Walsh http://www.walshinstitute.org/ as he is in that area. I also encourage joining http://www.benzobuddies.org and they may have a referral for you. Be aware that they do not advocate supplements during a taper while I find them to be beneficial for most people, plus making all the dietary changes before considering a medication taper.
I am not a fan of gabapentin as it has it’s own set of issues, some of which are similar to benzodiazepines.
Dear Trudy,
You been extremely helpful to me and You lighted that bulb in my head….as a mom of a 15 years old son. He developed OCD and was put on 200 mg of Zoloft. I knew nothing about antidepressants at that time , and I was desperate seeing him like that and I agreed to med. Then I listened to the Mental Wellness Summit and I hear you talking. I changed his diet, supplement him, and I asked the doctor to taper. I use Lidtke L-tryptophan, and I give him Inositol. We are down now to 100 mg, and he seems to be doing good. Of course I do worry every day about it, but you and Dr Kelly Brogan are God sent and so thankful to you, because you give me hope and faith.
Ildiko
Thanks so much for sharing! this made my day and I have tears in my eyes! I am so glad to hear he is doing well. It’s ok to worry a bit and just continue to go slow and support him nutritionally. And do read Kelly’s book – she is wonderful with the awareness she is bringing and goes into antidepressants in more depth than our interview.
If you’re worrying more than a bit them consider some serotonin and may be adrenal support for yourself.
Hello Trudy,
I have been using Tryptophan, GABA and 5-HTP since September of 2015, when I went off of Lexapro. I probably tapered off of the Lexapro too quickly and am still having issues with a depressed/negative mood with varying degrees of anxiety. I do not want to go back on antidepressant/antianxiety medication. I noticed that Kelly mentioned only using amino acids for a few weeks while tapering. How long is it safe to take the aminos?
Margaret
I’m sorry to hear this. It’s had to know but if we were working together I’d look at product quality (these are what I use https://www.everywomanover29.com/blog/amino-acids-pyroluria-supplements/), how much you are taking and increase based on trials (https://www.everywomanover29.com/blog/how-to-do-an-amino-acid-trial-for-anxiety/) and go through the list of all possible causes (https://www.everywomanover29.com/blog/60-nutritional-biochemical-causes-of-anxiety/)
I feel it’s safe to take them as long as you need them. Kelly likes to have her patients start them after making dietary changes for 1-2 months so they know what impact the diet had. She finds them helpful during the taper to mitigate side-effects. If you tapered too quickly you may be feeling some of the residual effects of the medication. Did you read her book and the section on meds?
May I ask how long you were on Lexapro? And if you were recently or are currently on a benzodiazepine?
Hello Trudy,
Yes, I had been on Zoloft & Clonopin in 2009-2011. I started Clonopin again in 2013- took it for 16 months then transitioned to Lexapro which I took for 15 months and stopped in Sept. 2015. I was also placed on low dose hormone replacement therapy which I took for 12 months. The Clonopin & SSRIs helped get me out of the dark, anxious pit I was in. Not sure if the HRT helped or not. Unfortunately I am experiencing early morning awakening with severe morning anxiety (that usually improves later in the day). Also have a depressed/negative/agitated mood.
I have made significant dietary changes and read most of Kelly’s book. Im taking Lidtke L-Tryptophan 1000mg 3Xday, 5-HTP 100mg 2Xday, PharmaGABA 100-200mg in the am and Theanine Serene at bedtime. Also taking multivitamin, fish oil, B Complex, B6-200mg, D3-4000mg and Zinc-30mg. I am wondering if I should try Inositol or Lactium since I am still having a lot of anxiety. Finally got my doctor to order the cortisol saliva test.
Wonderful interview, thank you Trudy and Kelly! 🙂
Trudy and Kelly, my husband is a psychiatrist, and since we have both read Kelly’s book,he is ready to change the way he treats patients. It’s been really eye opening, and we keep telling others about both of you. Thanks so much for all you do!
Lorraine
This is wonderful news! Thanks for coming and sharing here! I’ll make sure Kelly hears this too. Feel free to share your husband’s info here if he is ok with that. We love integrative psychiatrists!
If he needs additional learning resources let us know. I’m actually in the process of gathering a list of programs/courses/certifications both in nutritional mental health and in integrative/holistic health and will be sharing via a blog soon.
Could you post the link to your list of training for integrative psych and functional med-based nutrition?
Trudy, I have been reading Kelly’s book. I’ve been on Prozac over 30 years. About 10 years ago, the doc upped it from 20 mg to 40 mg. after your summit and several other web summits, I saw that I could make healthy changes. I have gradually titrates down to 10 mg of Prozac over about a year, but have hit a bad place. I’ve lost drive, motivation, passion; pain and depression have increased, including migraines. I’ve increased fish oil, Curcumin, and just ordered Lidtke tryptophan. I will continue to read Kelly’s book. I read your blogs. Thanks for any other advice you can give.
Appreciate you,
Betsy
Betsy
I’m sorry to hear this. You may need to find a doctor who can help you lower your dose even more slowly. Kelly does use amino acids during a taper to mitigate side-effects. I like to get people on the amino acids as soon as they start dietary changes but wither way, adding in tryptophan now may help. Be sure to work with your prescribing doctor.
Thank you Trudy and Kelly,
Finally, people who are recognizing the damage done by these pharmaceuticals, and acknowledging that their effect on more systems than the brain – gut, endocrine, etc.
I am a member of an online information support website called http://www.survivingantidepressants.org, where we have helped people taper off psych drugs for years, now, using a 10% (or less) per month (or more) Harm Reduction plan.
SA is sparing with supplements on the website (we are not medical professionals, just caring peers), but I’m always happy to learn more, and see that I already use some of the aminos discussed here.
Thank you again – I’ve already bought Kelly’s book, now I’m off to get yours, Trudy!
JanCarol
I’m really glad to learn about this online support website. Getting peer support is so valuable! And yes, there is more and more awareness and Kelly’s book is a great resource that will hopefully bring even more awareness.
You say “SA is sparing with supplements on the website (we are not medical professionals, just caring peers)” I found this thread http://survivingantidepressants.org/index.php?/topic/606-important-topics-about-tests-supplements-treatments-diet/ and am sharing it here as a reference to SAs position on supplements (for other readers of this blog).
I have found that nutritional support from food and nutrients – especially individual amino acids like tryptophan, 5-HTP, tyrosine – are very valuable during any medication taper. I like to use amino acids from day 1 (with the prescribing doctor’s approval).
Kelly has a similar approach – solid nutritional support for a few months before mediation taper. She prefers to use amino acid support only during the taper i.e. after the first few months of dietary changes.
We both agree that there is no one size fits all when it comes to supplements and dosages. And I agree that doing one thing at a time is best, plus using single nutrients rather than combos.
I’d love to hear which amino acids you use and how they have helped you?
Do you happen to know if the SA community has been polled to find out which amino acids and other nutrients have helped them? I see some comments from individuals saying they have seen benefits.
Thank you Trudy for allowing me to post my event here.
For any of your followers who are in the UK Sally Pacholok co author of Could it be B12? is one of four expert speakers at a conference to take place at Loughborough University in June of this year. http://www.b12deficiency.info/conference-2016/
The day costs just £62.00 and includes lunch, refreshments and CPD certificate. It is open to all.
Sally and the other speakers will cover B12 and folate deficiency, methylation chronic fatigue, autism, thyroid disease and the impact on both mental and physical health.
For any followers who have not been tested for B12 deficiency despite suffering from depression (very often one of the first presenting symptoms) then please see this page for more help. http://www.b12deficiency.info/what-to-do-next/
Best wishes Tracey
Tracey
Thanks for sharing here and for hosting this fabulous looking event. I’m a big fan of Sally’s work and heard her present in California a few years ago. I wish I was closer – I’d come for sure! I’ve shared on my FB page and twitter for my UK followers and will include in my ezine.
B12 deficiency is something Kelly Brogan often discusses in relation to depression and anxiety – and how many people with low B12 are put on meds when they really just need to address the low B12.
Really kind of you Trudy thank you!
Yes that is the experience of many of those who write to me, offered copious anti depressants in place of B12 injections. The problem we have in the UK is the ludicrous restriction for many B12 deficient patients to just 4 injections per year. Sally Pacholok’s amazing work in raising awareness has helped millions of people, I am very proud to work with her!
Tracey
Wow…UK is the ludicrous restriction for many B12 deficient patients to just 4 injections per year!
Glad to help share the knowledge!
Hi Trudy, my son has been on 20mg dosage of prozac for about 8 mos. He was doing well but I wanted to see if we could get him off of it. I am working with the doc to taper at 10mg plus 850mg l tryptophan divided for about 2 weeks now. He has been showing some symptoms of depression and also one episode of mood swings from giggly to depression over a couple of hours. He felt something wasn’t right. I contacted the doc he felt these were symptoms of too much serotonin and suggested stopping the l tryptophan and keeping the 10mg of prozac. I am questioning that. To me it seems like he is not getting enough serotonin. Do you have suggestions as to symptoms of too much serotonin? Should we up the prozac or L tryptophan?
Tracy
My apologies that I missed this comment – I do hope you found a solution for your son. It’s challenging because the taper can cause symptoms of depression and so can too much tryptophan
Trudy
Thank you for your response. I did find a happy balance by just lowering the tryptophan and keeping the prozac at 10 mg. Thanks again!
Tracy
Wonderful. I have found that by addressing overall health, diet, adrenals, gut etc, many people can lower the med as they increase the tryptophan
Dear Trudy, my brain has been dependent on Paxil for about 20 years. It is my goal to be able to live without this drug. I have made many attempts at withdrawal, from going cold turkey to slowly weaning over many months, but it has never worked for me. I end up being unable to function at all and going back on. I am terrified of what long-term use may do to my brain. The good thing is that I take 10 mgs now and am “okay” at that dose, (not great, but can function) but for many years I took 40 mgs. I’ve been to many doctors over the past 20 years and all they say is that obviously, since I am not successful at weaning, I must take it forever because my brain needs it. I am in Kentucky. My doctor is an “addiction specialist” so I thought he would know what to do to help me, but all he told me to do is start taking a pill every other day and then gradually go longer between pills. That info is just wrong! Does anyone know of a doctor in KY (or southern IN or northern TN)? I may have to attempt this again on my own. I have just received Dr.Brogan’s and Dr.Bongiorno’s books, as well as the Lidtke tryptophan. Is there anything else I need to buy? I have heard that folate must be optimized before working with neurotransmitters. Is this true, and if so, which folate would you recommend?
Donna
My apologies that I missed this comment – I do hope you have found a supportive practitioner to work with. There is often more than one underlying cause so as well as the effects of the medication taper, your practitioner will likely look at and help you address all of these (here are the 60+ I consider https://www.everywomanover29.com/blog/60-nutritional-biochemical-causes-of-anxiety/
Hi Trudy. Do you know what “blend of amino acids” Dr. Kelly Brogan uses for tapers? Thank you!
Chris
I believe it’s a blend from Douglas labs
I’ve tapered off the benzos, xanax and clonazepam which I took at different times. It took 4-6 months to taper off those. There would be rebound anxiety at the one week mark after a reduction, and if I got through that ok without increasing the dose, then I would stabilize. I would reduce again when I felt ready to tackle more anxiety and panic attacks. My doctor had a patient who was even more sensitive and it took 5 years to taper off a benzo.
Now I’m 3-1/2 years into what will hopefully be a 5 year taper from 150mg of Zoloft. I’ve been on Zoloft since 2001. I’m using the Paxil Progress taper (unfortunately that forum is now closed, but it’s very similar to the Surviving Antidepressants taper.) I’m reducing by 10% of the previous dose every 8 weeks. I may get minor withdrawal symptoms, such as a cold sweat, around 4-6 weeks. Then I add a few more weeks for insurance. So far so good.
Initially, I did the taper that my doctor gave me and it was done within a month or two, which I now know is the same as going cold turkey. I had some symptoms at the 8 week mark, but then thought I was fine. UNTIL…8 months later. Then all hell broke loose. I had a horrendous withdrawal syndrome, horrible 24-7 akathisia being the worst symptom, but basically every symptom you can get except for brain zaps.
Eventually I was able to very gradually reinstate the Zoloft and also do tons of calming supplements as well as Relora to lower sky high cortisol (caused by the withdrawal – literally off the chart 5 times higher than normal.) That stopped the withdrawal syndrome. It took 10 months – I call it my “lost year”. After I felt stabilized, I did a clonazepam taper (which I had to take due to the withdrawal syndrome), then when I felt stable from that, I started on my current Zoloft taper.
The taper described in the article, which reduces by 10% of the original dose every 2-4 weeks, is going to be way too much for some people. Note that I am reducing by 10% of the previous dose – a much different thing. This makes your reduction smaller and smaller each time which accommodates how the brain works with these drugs.
The Surviving Antidepressants taper and harm reduction plan looks like a good way to do it to me.
Caledonia
Each person’s taper is going to look very different and must be tailored. And you’re right – really really slow is the best.
Hi Trudy,
I have been on Paxil 25 mg CR for about 15 years. I am also in Cymbalta 90 mg. that was increased from 60 mg last November due to stress brought in from divorce.
I am under intense stress from divorce proceedings but an interesting in knowing what problems being on these drugs is for me. I will lose my insurance with divorce do I am concerned about withdrawal symptoms if I can not get an insurance to cover the medications.
I have major depression and an anxiety disorder. Psychiatrist prescribed clinipapran for anxiety but my pharmacist warned me to try not to take it because of it’s addictive nature. I have not been taking that. What would you recommend got tapering Paxil and Cymbslta?
If you don’t have drug insurance, you may qualify for your drug company’s “patient assistance” program. The income limits are not as small as you might think. I was able to get mine for free for several years. Just google the name of your drug and “patient assistance program”.
Linda
I’m sorry to hear this. I can’t give specific advice via the blog but can share that I have my clients do the amino acid questionnaire, review the precautions and do a trial https://www.everywomanover29.com/blog/anxiety-amino-acids-overview/
You will need to find an integrative doctor like Dr. Brogan to help you with the medication taper. Unfortunately Paxil can be problematic for some people (as Dr. Brogan shared) and can take longer to taper.
I agree with your pharmacist on the benzodiazepines and I encourage you to search the blog for more information on these meds so you can be informed.
Hi,
I love this interview. I love that the truth is coming out. I have been taking 100mg of Zoloft daily for 15 years, after it was prescribed to me by 2 separate therapists after a bad breakup with a boyfriend. I said no the first time, but the second doctor was one I respected. I figured they saw something in me I couldn’t see for myself. In 2008, I was trying to become pregnant. I was advised to stay on the meds during a pregnancy, as my then psychiatrist told me the depression would be worse for the baby than the meds. My son was born with a heart defect and needed open heart surgery at 3 months. I few years back I got a new psychiatrist who was never open to my lowering my dose. I begged her, promising I would be getting therapy at the same time. A couple of years ago I had come down from 100mg. to 50 mg. without any major side effects. I wanted to come down more. My psychiatrist was still against me lowering my dose any amount for any reason, and she definitely never discussed a taper with me. I’ve had similar experiences with other psychiatrists I’ve seen. For these reasons, I have had(until now) a complete lack of trust in the industry. Nine months ago I fired my doctor and stopped taking Zoloft completely, and began taking 5HTP. I had no symptoms for about 2 months, and then I began to unravel. Looking back I should have found a decent psychiatrist to help me with a taper, but at the time I had no faith in psychiatrists. I should have done more research, but I didn’t.:( So for the last 7-8 months I’ve been battling depression, anxiety, insomnia(the type that wakes me early morning with anxiety and self depreciating thoughts), and high level irritability and impatience(my poor kids!). The insomnia and depression feed each other. I’ve always been someone who needs at least 8 hours sleep a night, starting at around 10pm. I truly believe that if I could deal with even just the insomnia, my coping skills would be able to help me manage the rest. I have tried 5htp, calms forte, melatonin, chamomile, valerian, gabatrol(which includes phenyl gaba, L Theanine, taurine, glycine,and L tyrosine. I’ve also tried homeopathy, Epsom salt baths, running and yoga. I eat no gluten, dairy, corn, soy, almost zero sugar or caffeine. The best I get is that I still wake up between 1-5 am, but with less agitated thoughts. Still, for the sake of my health and my kids, I need to sleep!
On a positive note, I’m so happy to have found this community of people all over the world who are bringing this nightmare to life. I am so impressed by and grateful for the growing number of doctors and scientists who are willing to take the risk of debunking what the pharmaceutical companies have turned into a multi-billion dollar industry. I have learned not to blindly follow the “experts”, but that this stuff shouldn’t be taken lightly or haphazardly the way I’ve done it. There are real experts out there!
So with all of that said, I need to find someone to help me with this issue. Do I go back on a low dose and do a real taper? Do I just wait it out? Any suggestions or referrals are greatly appreciated.
I very gradually reinstated Zoloft after being off for about 10 months. I was very sensitive and had to go in baby steps. (I was assisted by a psychiatric nurse practitioner.) Based on my research about these drugs, this is not unusual. I also was doing supplements similar to what you describe. It took both methods to calm down my akathisia.
I checked my adrenals with a 24 hour/4 point cortisol saliva test because I was so overstimulated. I found out my cortisol was off the charts, five times higher than normal. I’ve since found out that withdrawal can overstimulate your adrenals, so it’s possible this is the cause of your insomnia and other symptoms. Relora was instrumental in calming them down. Seriphos would also do the same thing. It took 3 months of Relora plus reinstatement to get everything to fully calm down.
They say after a certain point, it’s better not to try and reinstate. Off the top of my head, that would be after about a year off. So based on my experience and what I’ve heard, I think you could still try to reinstate the drug, as long as you don’t wait too long.
Note, that same practitioner said I was experiencing anxiety from not being on the drug and that I would have to take it for life and that she didn’t believe in withdrawal symptoms happening six months after discontinuing the drug. All wrong stuff she had been taught by the drug company. But she was helpful for reinstatement for someone who had been sensitized. So if you run into a person like this (highly likely), just take the help in reinstating, and ignore the rest. Then do a proper taper when you feel stabilized.
Caledonia
Thanks for sharing and offering your perspectives. I’m glad you were able to find some relief by addressing high cortisol.
I agree, withdrawal symptoms can certainly extend beyond 6 months and it’s different for each person.
I’d love to hear your resource that recommends to NOT reinstate the med once you’ve been off it a year? and any resources for reinstating in general so I can learn what folks are being told/are reading?
I got the info from reading in the Paxil Progress forum, which unfortunately is now defunct. Unfortunately it doesn’t seem to be very well archived on the Internet Archive Wayback Machine, so I can’t point you to a particular link on there.
Other than that, I suggest searching or making a post and asking on the Surviving Antidepressants forum. I found a page at Surviving Antidepressants which says to reinstate as soon as you start having withdrawal symptoms. http://survivingantidepressants.org/index.php?/topic/7562-about-reinstating-and-stabilizing-to-reduce-withdrawal-symptoms/
It looks like there is really no hard and fast rule, because everyone reacts differently, but in general, the sooner the better. It sounds like weeks and months is better than years. (I started reinstating about 2 months after the really horrible symptoms started. I had relatively mild symptoms at 6-8 weeks, then felt perfectly fine, then about 6 months after that the akathisia etc. started.)
Caledonia
Thanks for sharing this. It’s useful for me to learn what is being recommended on forums such as these. I do have some concerns about some of the support groups/forums that say no to some of the nutritional support that we know helps so many individuals with SSRI withdrawal (here is one example about 5-HTP http://survivingantidepressants.org/index.php?/topic/12657-taking-5htp-as-well-as-b-vitamins/
Please see my comment I posted for Kirsten, about getting set up for withdrawal with nutritional support BEFORE starting.
Are you currently back on the zoloft?
Hi Kirsten
Thank you for sharing and sorry to hear what you have been through and the lack of support around your desire to safely get off your meds. I do hope your son is doing well now.
I have no experience with having clients go back on a low dose of an SSRI (especially 9 months after quitting) and then tapering more slowly although I have heard of similar approaches with benzodiazepine tapers.
Each person is different. Some can taper more quickly and do fine, others have a really hard time. It’s always challenging to know if the symptoms you describe are due to the SSRI discontinuation or have other root causes (as mentioned below) or are a combination of both.
I can’t offer you specific advice via the blog but if we were working together I’d start by looking for these possible root causes for the insomnia, anxiety and depression and would focus on low serotonin (I use tryptophan and GABA with great success – doing a trial and increasing until the optimal amount is found), high cortisol (tested via saliva test), hormone balancing (with high cortisol, progesterone is often low) and eliminate ALL caffeine.
Kirsten
I’m adding to this because I’d like to clarify the way I work with clients who are wanting to quit SSRI medications. We work on optimizing their health, gut, sleep, adrenals, stress etc via diet and supplements first. With the doctor’s approval amino acids are typically added – tryptophan or 5-HTP (6 hours from SSRI), GABA, glutamine etc. Once they are doing well, they work with their doctor on the SSRI taper, adjusting amino acids up, if needed, as they go down on the medication. And then they continue with nutritional support once they have stopped the SSRI.
All this mitigates the side-effects of a taper – which is why I’ve not had a client with the need to reinstate their meds. We also saw results like this when I worked in Julia Ross’ clinic.
I don’t agree with the forums on no supplements or nutritional support either. Some of them can be very helpful. Your plan sounds pretty good to me. I have done similar supplements at various times while on Zoloft with no issues and would do them again if needed.
Hi Trudy,
Hoping you can help clear something up for me. Can antidepressant withdrawal cause an overactive HPA axis?
When I was on opioids and Cymbalta my cortisol levels were flatlined (via 4 point salivary cortisol testing). However I had another test done after tapering off of Cymbalta (and off all other medications) and both my total and free cortisol levels are through the roof, especially in the morning (via DUTCH test). Ironically I am still tired all the time even with high cortisol.
Thank you!
Chris
The best would be to repeat the same salivary test to keep as many variables the same – especially since you are still tired.
I know you and Dr. Brogan have different opinions regarding amino acids and neurotransimttor defeciencies regarding depression, etc.
I wondered if, in your opinion, sometimes people need massive amounts of amino acids.
I have been using Dr. Hinz’s protocol, and am taking 7.5 grams of tyrosine powder three times a day, as well as about another 6000 mg in capsule form. I
I have been on antidepressants for over 25 years, and started to wean off them. I have reduced my Zoloft from 150 mg to 15 mg, which is way below therapeutic dose. But I have had so many awful side effects of withdrawal. Aside from depression I also have obsessions and a bit of Tourette’s. So I think my brain is really screwed up.
I still have some symptoms, but am feeling much better. However, not 100%.
Many thanks
S.J.
SJ
I’ve not ever had anyone use more than 3000mg of tyrosine and typically 2000mg is considered a high amount. With depression and obsessions and Tourette’s I’d also think low serotonin.
This is the way I work with clients who are wanting to quit SSRI medications: we work on optimizing their health, gut, sleep, adrenals, stress etc via diet (no gluten, no caffeine, no sugar, eating for blood sugar control) and supplements first. With the doctor’s approval amino acids are typically added – tryptophan or 5-HTP (6 hours from SSRI), GABA, glutamine etc. Once they are doing well, they work with their doctor on the SSRI taper, adjusting amino acids up, if needed, as they go down on the medication. And then they continue with nutritional support once they have stopped the SSRI.
All this mitigates the side-effects of a taper.
All the foundations (food, gut, gluten etc) are covered in great detail in my book “The Antianxiety Food Solution.” Of course there is a whole chapter on the amino acids too.
Hi Trudy,
I have been on anti depressant medications for the last 15 years, specifically Effexor, for the last 4. I met with a local natural medicine doctor and am beginning to taper off. He has me getting Vitamin D & B shots weekly, along with Omega 3, Vitamin D, Iodine and multi vitamin supplements. I am a bit scared to be weening so quickly, but he said it is not a problem, that I might have slight symptoms, but that the shots will really help. I also gave up dairy, almost all wheat, red meats and have been eating a lot of vegetables and a ton of water. I’m still scared, though. I have Gaba in my purse at all times, just in case. He took a bunch of blood tests to check my adrenals, thyroid, etc. And a hair mapping test. Should I suggest that I don’t want to start weening until after I get those results?
Thank you for your time!
-Michelle
Michelle
I would always suggest going super super slow. I’ve had much success with addressing all root causes of the anxiety first (for a good few months) and then starting the taper. So real whole food, blood sugar control, no caffeine, no gluten (this must be 100%), no sugar, addressing gut health and using amino acids like GABA and tryptophan, addressing any deficiencies like low zinc, low B6, low iron etc.
I am a proponent of red meat but it must be grass-fed – such a fabulous source of iron, zinc, amino acids and omega-3s
My husband is a disabled Marine with chronic pain, a traumatic brain injury who was told npby the VA to stop diazepam and has taken himself off of ambien. It has been 4 months and it was not a gradual withdrawal. Would it be better for him to go back on the diazepam and then begin a very slow withdrawal or to stay like he is, with no sleep in four months? And where can he find someone in MN to get the shot in the neck that helps with PTSD and withdrawal?
Kim
Sorry to hear this about your husband. Some people do better going back on the benzos and doing a slow taper bu T would consider this first: have him do the amino acid questionnaire and trials of tryptophan and/or GABA (more here https://www.everywomanover29.com/blog/anxiety-amino-acids-overview/).
Essential oils may help too (https://www.everywomanover29.com/blog/bergamot-diazepam-reducing-anxiety/)
I’m not sure what the shot in the neck is?
My daughter, 22 yrs., was prescribed Bupropion in July for anxiety. She didn’t think it was helping so she called the PA. The PA increased her dose from 150 to 300. After a few weeks she called back saying she didn’t think it was helping. The PA increased it to 450 over the phone. She told my daughter to take the 300 and then cut another one in half. We never wanted her to take anything but she is 22 and we let her decide. We were not comfortable with increasing it so much and never seeing her. Almost 4weeks ago she had a seizure and was taken to the ER by ambulance. This should have never happened. She has tapered off the drug and has not had anything in 12 days. She has had horrible withdrawals. She has always been very happy, upbeat, and positive. Now she is deor seed and suffering from side effects.
My question is can she safely take any supplements for anxiety? Right now she is taking magnesium and B complex.
Thank you for your help.
Susan
I am sorry to hear this. Seizures are listed as one of the rare side effects of this medication and there are case reports like this one in the published literature: Extended-Release Bupropion–Induced Grand Mal Seizures http://jaoa.org/article.aspx?articleid=2093332. Would you mind sharing if she was on immediate-release, sustained-release or extended-release?
If I was working with her I would have her start with a trial of GABA assuming she scores high on the low GABA questionnaire (https://www.everywomanover29.com/blog/how-to-do-an-amino-acid-trial-for-anxiety/) and go from there, looking at serotinin support next.
It goes without saying that this would be addressed too: diet changes to eat real whole food, eating for blood sugar control, quality protein at breakfast, organic food, no sugar and no caffeine, looking at the adrenals, no gluten and watching the nut-flours (high copper effects) etc.
I am so sorry. I thought I had included what she was taking NFC. It was the extended release. Everything we have read indicates that this drug is for depression and to quit smoking. She has never been depressed but with these withdrawals she has now become depressed. We are sick about what this has done.
I will ask her to fill out the questionnaire.
Thank you so much.
Susan
Thanks for sharing it was the extended release. I’m afraid I don’t know what NFC is?
I also said above “Seizures are listed as one of the rare side effects of this medication” – this is per the medication sites.
I’d like to add to this. I’ve done some more digging and see that a generic version of this taken off the market in 2012 due to higher doses causing an increase in seizures http://www.nejm.org/doi/full/10.1056/NEJMp1212969
Haha! NFC?! A slip of the finger at 3:45 AM. I think it was supposed to have been 450 XL.
Thank you so much for all of your help.
Hello Trudy,
I ran across your site and this posted interview via Google search. I’m hoping you can provide me your advice or forward me to your mirror site; everymanover29.com )
I’m very interested in the topic of this article as I have been taking Wellbutrin SR for eighteen years and would like to do whatever necessary to taper off it. The reasons are two-fold. First, I’ve been working outside the USA and have found it increasingly difficult to get WB-SR in my country. The last two years I had to fly to a nearby country, get local prescriptions and try to buy a year’s supply to make the trip worthwhile. The second reason is that I’m finding the necessary dosage creeping up over time. Until about eight years ago I took one 150mg/day. Then due to stress of the job in the Middle East and political uprising in the country, increased to 2-150mg per day. Now having lived outside the USA most of the last 15 years I think I’m suffering a bit of burnout from the accumulated background stress of living in ‘2nd world’ countries’. I’m headed back to the USA, Cleveland, OH, in a couple months and would like to begin a tapering withdrawal and general tune-up on my health.
Could you recommend, or give me a way to locate , a doctor in the Cleveland area that you feel is qualified to monitor my tapering off process? From previous experience finding a highly qualified doctor who has a comprehensive outlook on health is like finding a needle in a haystack. I would prefer to have the oversight of a qualified doctor who is in synch with the use of aminos + diet + misc. + skilled tapering experience with WB-SR. There’s a growing amount of information posted on the internet concerning the use of Tryptopan, Tyrosine, and 5-HTP to phase off anti-depressants, but it’s probably not ideal to patch together the ‘best’ advice and conduct my own withdrawal regimen.
Your advice will be appreciated.
Thanks,
David
David
I’m afraid I don’t have a recommendation for a doctor who can guide you. This is the approach I use with my clients http://www.everywomanover29.com/blog/taper-from-antidepressant-tryptophan-amino-acids/ and I find a well-educated client is often able to get the support they need from their prescribing doctor with all this in place, even if the doctor is not familiar with the use of amino acids.
This is something I do when working with clients tapering and do work long distance. I have a waiting list right now https://www.everywomanover29.com/services.html
I like your sense of humor: everymanover29.com! I’m glad you weren’t put off by the website name. I help everyone and have plans to change it to anxietynutritionsolutions.com
Hi Trudy,
Does it have to be a specific type of doctor you see to work with on the amino acids and tapering?
I am on Paxil and see a psychiatrist for it. Should I work with him?
Candice
The following doctors may be able to help – functional medicine doctor, integrative doctor, naturopath etc. Not all doctors are familiar with how to use the amino acids and my clients/folks in my community will share a copy of my book with their doctor once they have read it and understand what they hope to achieve. Unfortunately not all doctors are familiar with the safest approaches for doing medication tapers.
Thank you for the response!
I’m about to begin a taper off of venlafaxine which I have been taking for the past 15+ years. I’ve tried to quit before but always crashed, so had to get back on a maintenance dose of 150 mg. I’m interested to hear if you have used iodine or NAC in addition to amino acids. From my reading, it appears that many people suffer from iodine deficiencies & that iodine is required for dopamine synthesis. Glutathione is important for overall health & NAC is a glutathione building block. Also do you do any testing to determine levels of choline or serine? Do you know anyone who is using lecithin during a taper? I’m trying to maximize my intake of nutrients that may have contributed to my depression in the first place.
When I miss a dose of Effexor I have vivid dreams but on the Effexor I don’t have any dreams that I remember. This is one of my motivations for getting off the Effexor. Have you ever seen this in your patients?
Thank you for your very important work. You are making a difference!
Pam
I don’t use iodine or NAC or lecithin with everyone – it’s a case by case basis depending on each person’s needs. One thing I do with everyone is make sure they have the foundations in place – real whole food, quality animal protein, good digestion, good microbiome, no caffeine, no sugar, no gluten (and sometimes no grains), adrenal support etc. My book “The Antianxiety Food Solution” (on amazon here http://amzn.to/2kptFWm) covers it all plus there is an entire chapter on the amino acids.
I am having a horrible time finding a knowledgeable practitioner to work with. I am in the SW Virginia area and doctors here don’t believe in SSRI withdrawals. At least, I haven’t found them. Not sure how to go about it. I’ve been on Prozac 10 mg/day for 19 years and tried to come off 3 separate times. I do really well tapering, although I can see how I would do well to go slower, as 3 weeks after discontinuing the drug, I crash and have to go back on it.
Has anyone ever tapered down to a low, subtherapeutic, tolerable dose and stayed there for say, 2 or 3 years and then tried to discontinue? I just wonder if a few years time would be enough to sufficiently heal the brain enough to prevent withdrawals upon discontinuation. I say this because I am now not having so much trouble with depression as I am staying on the drug just to prevent withdrawals – that is, I can’t stop taking it!
Hello,
I was on lexapro for 10 years at 2.5 mg. When I started taking the drug initially I developed cold sores and then Bell’s palsy on the right side of my face coincidentally at the exact same time I started the lexapro. I started the drug for anxiety and panic attacks. 5 years ago I tried to get off the drug and developed horrible withdrawal symptoms so I had to reinstate at 2.5mg. Now fast forward 5 years and I am 29 years old and wanted to get pregnant. So my psych told me to stop cold turkey due to the dose was too small and it was a merely a placebo. I consider myself a smart person and have a masters but starting the drug and stopping it abruptly was the dumbest thing I’ve ever done.
5 months off lexapro I had surgery. After surgery I got even more sick so I tried to reinstate to stabilize. The lexapro made me so sick I ended up in the psych ward where they gave me more drugs and I just became sicker and sicker so I had to abruptly stop everything. Now I am in pure hell. But I am afraid I have a neurological as well. Hence why I mentioned the Bell’s palsy. The right side of my body is in extreme pain, numb most of the time and feels heavy. The right side of my face and he muscles on the right side of my body keeps twitching.
I am desperate for suggestions.
Hi Laura,
That sounds horrendous for you. I’m so sorry. This is probably obvious (when I got off Zoloft cold turkey, I was overwhelmed and nothing seemed obvious), but it sounds like you need a practitioner who understand this stuff on a holistic level the way Dr Brogan does. When I got off my meds, I finally realized how little most doctors know about the long term side effects of mood-altering medications. I felt like I was losing my mind. Things have improved drastically, but we are all different. I think a good doctor is one who realizes that we don’t all handle these drugs the same way, and finding this out is an important part of interviewing a practitioner. It seems to me that your body is very out of balance on probably many levels. It would be useful to boost your health in all ways associated with lifestyle choices(clean diet, exercise, mindfulness exercises), and certainly find a doctor who understands your situation. If they don’t know the answers, they must be willing to work with you to find the answers rather than just using a “one size fits all” model. If it were me, I would go to a highly acclaimed psychiatrist and/or alternative doctor because they are more likely to consider your whole self and deep healing, rather than just putting a band aid on the problem.
I really feel for you. I know the fear of thinking these things will go on forever and not seeing a light at the end of the tunnel. Hang in there. It gets better.
Hi Trudy,
I am in Australia. Do you know of anyone here that has some experience with tapering using amino acid therapy? I have not been able to find anyone and am having to try to navigate myself though tapering of 20mg Aropax (Paxil) which I have been taking for 18 years. I have managed to taper down to 3mg slowly over the last 12 months without any amino acid support but am now really struggling and am needing help with getting of this last 3mgs. If you don’t know of anyone in Australia, would you be able to help me long distance via email or skype? I have read quite a lot about using amino acids but am feeling a bit confused and overwhelmed by it all as I have read conflicting advice and ideas about what is best practice. If you could be of any help to me I would be extremely grateful. Thanks. Martine
Martine
I’m afraid I don’t have a referral. Best is to read this blog and work with and discuss with your prescribing doctor as there is the risk of serotonin syndrome with SSRIs and tryptophan https://www.everywomanover29.com/blog/taper-from-antidepressant-tryptophan-amino-acids/
If this is not possible I’ve had client’s work with a knowledgeable pharmacist (with the doctor’s monitoring) or find a new doctor or share my book with him.
If you are new to the amino acids (and other anxiety nutrition solutions like gluten/sugar/caffeine removal, blood sugar control, gut health, pyroluria etc) my book “The Antianxiety Food Solution” is a great place to start. More here https://www.everywomanover29.com/blog/the-antianxiety-food-solution-by-trudy-scott/
We do also discuss this on the Anxiety Summit 5: Gut-Brain Axis, Nov 8-14, 2021. Look for “SSRI Impact on the Microbiome and Safe SSRI Tapering” with Dr. Achina P. Stein, DO, DFAPA, ABIHM, IFMCP. Register here https://anxietysummit5.byhealthmeans.com/?idev_id=739
Thanks Trudy. I appreciate all your advice. I started following the Dr Martin Hinz protocol a weeks ago but just taking 2/3 of the recommended dosage to see if that helps with tapering off the last 3mg of my Paxil. It does seem to have helped with my mood, brain fog, alertness and motivation but my sleep could be better. This protocol uses L Tyrosine and 5 HTP morning and night with other supporting supplements. What are your thoughts on the Dr Hinz protocol and would I be better taking Mucuna and L Tryptophan instead? Also, if you think Mucuna and L Tryptophan are the way to go, what daily dosages would you recommend? Any help in this regard would be greatly appreciated.
Martine
I don’t use this protocol because there is no one-size fits all. When sleep is not great we reduce or avoid tyrosine and may increase tryptophan or 5-HTP.
Thanks for your reply Trudy. Yes, after thinking about it further (and after trialling the Hinz protocol for a few weeks), I agree, no one size can possibly fit all. Subsequently, I have now stopped strictly following the protocol and started experimenting with each individual supplement as you recommend. Sleep is a bit of an issue for me so I have started trialling Mucuna instead of tyrosine and I am not sure about my cortisol levels but suspect them to be high (as I have mod to severe stress levels) so have also moved to experimenting with tryptophan instead off 5HTP. Only trouble is I am not sure how much to take of each and when to take it. I am experiencing mild to moderate anxiety and depression (up and down and sometimes experience even more severe depressive feelings) as well as not great quality sleep most nights. So trying to work out on my own a program to follow along with trying to taper off my last 3mg of Paxil/day is very challenging. Any suggestions would be gratefully appreciated.
Martine
I spell out the timing and dosing in my book in the amino acids chapter. I also only do one trial at a time and when someone has anxiety and sleep issues I start with tryptophan and when the ideal dose of that one is found, we then trial GABA and find the the ideal dose, and only then consider dopamine support with tyrosine.
Thanks Trudy. I will purchase your book to help work out dosing. Just one more question… Do you also use other supporting supplements/cofactors as part of your amino acid therapy such as: Vitamin C, vitamin B6, and calcium citrate (to assist with synthesis of serotonin and/or dopamine), L-cysteine or NAC (to compensate for L-tyrosine-induced depletion of sulfur amino acids), Folate (for synthesis of sulfur amino acids) and Selenium (in response to the ability of cysteine to concentrate methylmercury in the central nervous system)?
Martine
Yes on an as-needed basis