(Dr. Shipko's 6th visit to Power Surge) Mary: Before I introduce our guest tonight, Power Surge Founder and Host, Dearest, asked me to express her regrets at having to miss only her third guest chat in eight years. She asked if I would sit in in her place, so I'll be your host tonight. It is my pleasure to welcome back to Power Surge, DR. STUART SHIPKO, Director of The Panic Disorder Institute. Dr. Shipko is a Psychiatrist and Neurologist whose practice focuses on panic disorder, stress-related medical conditions, stress and trauma related disorders, psychiatric injury, psychosomatic medicine and general psychiatry. Welcome back, Dr. Shipko. Let me begin by asking you Dr. S., if could you kindly explain exactly what SSRI's are and how serotonin works naturally in our bodies without SSRI's? Dr. Stuart Shipko: We should mention that the topic for tonight is SSRI withdrawal and side effects. SSRI's, Paxil, Prozac, Zoloft, Celexa and Luvox (and sort of Effexor) are the SSRIs. They increase serotonin at the level of the synapse, But no mechanism of action has been fully determined for them. Serotonin does a lot of things, but tonight I want to focus on the drugs. Withdrawal. SSRI withdrawal is emerging as a very significant problem. The exact incidence of people having withdrawal when trying to stop a SSRI has never been documented. One study cites withdrawal symptoms in Luvox 86% of the time and with Paxil 50% of the time. In my experience the phenomenon of dependency and withdrawal is relatively common. Although SSRI withdrawal has been well documented in the literature it is almost never taken into consideration in the prescribing practices of these drugs (Paxil, Zoloft, Celexa, Prozac, Luvox). Despite the fact that about 1/3 of family physicians and 2/3 of psychiatrists state that they are aware of withdrawal, patients are hardly ever warned of this when they are prescribed and when it occurs it is rarely identified. It is as if theyre meaning doctors. Drug dependence has two major components: tolerance and withdrawal. It is well known that tolerance to the SSRIs is common, or "poop out" over time. As they become ineffective the dose is usually increased to maintain some effect. Literature cites that SSRI's poop out about 1/3 of the time. Most physicians will increase the dosage as effect is lost and few physicians will consider the possibility that tolerance is occurring and decide to discontinue the drug. Many people are no longer getting any effect from their SSRI even at the highest dosages. Frequently they continue to take it because when they try to stop it they develop withdrawal symptoms. When stopping a SSRI, the higher the dose and the longer the duration of use, and the shorter the half-life of the drug, the more severe the withdrawal reaction is going to be. Despite descriptions of withdrawal syndromes GlaxoSmithKline, manufacturer of Paxil, which has a short half-life and the pronounced withdrawal, provides doctors with a brochure that says "no association has been made between Paxil and addiction." This is misleading. It would almost seem as if the manufacturer is going out of their way to be deceptive about the addiction issue. A lawsuit is in progress that contends that GlaxoSmithKline knew about withdrawal and deliberately hid it from the public. I wanted to get some foundation for the discussion. Well, I could go on, but I will take questions now. Mary: Thanks, Dr Shipko :) Scarlett: Just wondering if there were ever a good reason to use these SSRIs? Dr. Stuart Shipko: Yes, they have their place in psychiatry, but they are being overprescribed and inappropriately prescribed. Wildflowers: I was given Paxil a few months ago in a plastic bag from my doctor - 10 mgs. per day for a week. Then to up to 20 mgs. Stayed on 10 mgs. for 13 days. Tried one 20 mg. and was very sick. Was sick for the whole time on Paxil. Quit cold turkey. It took one week to feel somewhat normal. I was then given a benzodiazapine a few weeks later to take as needed. It works for me. I feel fortunate to have gotten off Paxil as soon as I did -- very scary on and off. Dr. Stuart Shipko: All too common. The most frequent form of prescription is to give a bag of samples to a patient with little instructions and no warning on side effects. Glad you are off Paxil. Theresa343: I have been on Zoloft for about 10 years. I have tried to come off 3 times and 3 times the depression comes back. It is worse. I have even considered suicide. How does one come down from an SSRI? I had a surgical menopause 12 years ago. and started Zoloft at 25 mg and now take 100 mg a day. I also take 1 mg of Ativan PRN. Please help. Dr. Stuart Shipko: Some patients are going into withdrawal while still taking the drug if its effect has worn off and the dosage is not increased. Physicians tend to either add in a second drug or to try to change to yet another SSRI. One reason why SSRI drugs are continued is that when they are stopped the patient becomes quite sick, emotionally and physically, and no real "antidote" is available except to restart the SSRI. Zoloft, in particular seems to have severe, tearful depression as a major withdrawal effect. There is no antidote and I am working on this now -- thinking that perhaps boosting nutrition will help. Tapering slowly is not always enough. It can take 3 or 4 months for the severe depression to pass. Noah: I had the same experience as Wildflower but with Zoloft 12.5 - 3 weeks, was 'high', shaking, drove weird, felt like detox then serzone, severe allergic reaction. Now on Remeron 8 months. Today given EFFEXOR. I am chicken to take it. Dr. Stuart Shipko: Shouldn't you be afraid to take it? Noah: : ) yep Dr. Stuart Shipko: There is your answer, Noah. Gypsynmo: I have been on Zoloft for about 3 months, don't see where it's doing me any good. Will I go through withdrawal if I stop it now? I have Lupus also. Dr. Stuart Shipko: Gypsy: The shorter the duration and the lower the dose, the less likely you will be to have withdrawal. Not everyone does. Shauna: What type of withdrawal symptoms are common on drugs like Paxil? I am on Prozac once a week pill for treatment of depression and anxiety related to Cushing's Syndrome. Is withdrawal different when on the once a week prescription? Thanks. Dr. Stuart Shipko: Shouldn't Cushing's Syndrome be treated with adrenal tumor removal? Well, anyway, The withdrawal symptoms from the various SSRIs are similar and discreet SSRI withdrawal syndromes have not really been described. The major categories of withdrawal are: 1) vertigo, tinnitus and dizziness 2) electric shock like sensations of the head, neck, and shoulders (zaps) 3) nausea and vomiting 4) flu like symptoms 5) nightmares and insomnia 6) irritability 7) new onset of a severe depressive syndrome characterized by v by Power Surge. All Rights Reserved.