[sunrise]

I was talking to a family member today who is taking an anti-depressant and two different mood stabilizers. This combination is working well for her. She wonders why she has to keep seeing her pdoc every 6 weeks since everything is fine. I urged her to keep seeing her the pdoc, as her reaction to the drugs could change, and her life events could change, making her more or less mentally well, so her need for meds might change too.

She had never considered this, thinking that once she found a good combination of drugs, she could just stay on them for life. Her therapist (not her pdoc) is recommending she tail off the drugs and see how she is actually doing "under there." It made me wonder how often people scale back their meds use to do a "self check" and see where they're at in their need for meds. If one keeps taking a lot of meds and never tries to lessen or go without, how will they know if they have improved or not? It seems like the meds could actually mask wellness.

Anyway, we were talking about this somewhat philosophical point today. How often do people go off meds (or lessen them) to do a self check for continued medication necessity? Is this something pdocs recommend from time to time?

hey. i don't take any medication. that being said i've surely taken a lot of medication in my time. there was a time when i would have done ANYTHING at all if there was even the slightest chance that it would help. now... i need to think. it is important to me that i not be sedated or otherwise affected and i guess i've got to wondering how much medications help me except for sedating me somewhat through a crisis.

i've heard that stabilisation for two years without remission is a good rule of thumb before attempting to reduce / cease medication. that is for depression at any rate. i'm really not at all sure that anti-depressants are shown to be effective to PREVENT remission, though they are certainly prescribed as such.

it is really very hard to assess how much medication helps one particular individual. one can't do a randomised double blind control trial on oneself. if one is taking meds and one gets worse then maybe one needs to stick with it a bit longer or maybe one needs to increase the dosage or maybe one needs to change to a different med or maybe... one is better off (or at least not worse off) without medications altogether (maybe even better off given the side effects and who knows what the long term side effects are going to be).

it is reccomended that reduction from medication be gradual. most medications have withdrawal syndromes associated with their cesation. this can be gotten around by tapering the medication down very slowly indeed. it might be that one experiences 'rebound effects' (a withdrawal syndrome basically) which, surprise surprise, typically consists in the problematic symptoms becoming more problematic than they ever were before. a lot of people give up giving up about then, thinking that this shows them what life would be like for them without meds. like any drug it takes your body some time to adjust without them, however. sometimes the million dollar question can be: are you strong enough to cope with worse feelings than you have had before while your body is withdrawing?

of course some other people don't really experience much in the way of withdrawal.

i suppose... i was never convinced that i functioned better on medication as opposed to off medication. so... i don't take it. hard to say...

[SecretGarden]

My doc took me off to start another med but I was without for several weeks. Then my life went downhill. Be careful.

[sunrise]

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alexandra_k said:
it is reccomended that reduction from medication be gradual. most medications have withdrawal syndromes associated with their cesation. this can be gotten around by tapering the medication down very slowly indeed. it might be that one experiences 'rebound effects' (a withdrawal syndrome basically) which, surprise surprise, typically consists in the problematic symptoms becoming more problematic than they ever were before. a lot of people give up giving up about then, thinking that this shows them what life would be like for them without meds. like any drug it takes your body some time to adjust without them, however. sometimes the million dollar question can be: are you strong enough to cope with worse feelings than you have had before while your body is withdrawing?

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alex, I think this is a very good point. I think a lot of people stop a med and feel worse right away due to withdrawal rather than actually being off the med. I think it is important to work through that withdrawal phase so you can see what being off the med is truly like without the challenging withdrawal symptoms. It takes longer than a few weeks for many meds. And yes, you are right, you must be strong enough to go through this and handle it.

SG, you have a good caution. I think it is helpful, even essential, to have the full advice and support of a doctor and therapist when scaling back or terminating one's psychoactive meds.

Paxil... made a huge difference in my life.. I think 6 years now.. it made the anxiety.. the OCD.. that part of my life.. sooo much better..

However, I am in a totally different spot than I was.. my life circumstances are so much different, I have learned new coping skills for the OCD.. and anxiety.. I do not have the on-call, a child at home, a stressful job...

And I am ready to try a taper down and going off MAYBE.. we shall see..but my life is totally different now..

[seeker1950]

My doctor was not happy that I had reduced my Paxil by half, from 40 mg. to 20 mg. over the past three months, but it's working fine for me right now, and he prescribed the 20 mg for the next three months. He wasn't optimistic about my going off the med completely, mentioning my OCD tendency to think obsessively, even if I'm no longer depressed. I'll just have to monitor that if I reduce the medication further, but I sure would like to go off it completely. I know that with Paxil, it's a slow and long process to wean off it, which I feel I'm doing.
I really think his negative response had a lot to do with the doctor ego. I also realize, though, that had HE recommended reducing the amount I take daily, and had I then experienced anxiety, I would have been right back there with him stating my anxiety symptoms and going back to the original high dose. By doing this on my own, I've weathered the initial anxiety (for about one week at the start) and been fine thereafter.
Patty

[ryandginger]

I've been on paxil And ativin for a little over a month now. Depression, PTSD .. Anxiety ..
I'm not a good candidate for pills... sooo addictive... specially to downers .. never cared for the jitters caused by the oher ..
So - I cut my paxil in half after the first 2 weeks .. and am in trouble with the Ativin already .. sigh.. as I type this I think I should just delete it, but then I know as soon as I click send, I'm on the right track ..
I have to fight the withdrawals, but am thinking that I do need something for sure, on my own I'm a mess! There are natural things like st.johnswort and . ..
Anyway .. I'm calling my doctor in the morning... I've found myself thinking of drinking = after 14 years sober!! .. I know its the pills ..
I'm sorry if this is inappropriate - if it is = Please let me know and I will edit .. but I think I needed to read what you've all said to see my own truth .. This has helped me .. thank you. And I do apologize if i've been in anyway inappropriate in posting this.
Jazmine

[DePressMe]

I think some people can go off meds after awhile. I am not sure I am one of those people. I have tried to go off my meds numerous times and each time I got depressed and/or suicidal and/or psychotic. I think it just depends on the person.

it can take a month or two for people to get through the rebound effects (withdrawal effects, basically).

see... when you are taking psych meds your neurology starts to change because your brain starts working hard, doing what it can, to return to its prior state. it starts countering the effects of the medication, basically. medication produces more serotonin? then the receptors that pick up the serotonin start to die off so that your brain isn't (from its point of view) being flooded with more than it needs). then you stop the medication and your brain is dealing with less serotonin (what the doctors thought the initial problem is) and now with new de-sensitised / dead receptors. hence you experience... worse symptoms than you ever experienced before.

one might worry that the medication has perminantly damaged your brain by killing those receptors. nah. brains are pretty plastic and so if you lay off the meds for a a month or two then the receptors start growing back / becoming more sensitised to the serotonin that is available. you gradually start to come right.

the million dollar question is: can you get through that hard time? might take a month or two.

strangely enough... there are people who ask the same question about people when they are having a major episode of mental illness. because... symptoms tend to remit in a couple months (aside from the more 'persistent' things that aren't so well managed with meds at any rate - such as dysthymia).

[sunrise]

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And I am ready to try a taper down and going off MAYBE.. we shall see..but my life is totally different now..

</div></font></blockquote><font class="post">freewill, that is wonderful your life is better now. I wish you success in taking a "peek" and seeing if you can do without the meds now. Good luck!

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I really think his negative response had a lot to do with the doctor ego. I also realize, though, that had HE recommended reducing the amount I take daily, and had I then experienced anxiety, I would have been right back there with him stating my anxiety symptoms and going back to the original high dose. By doing this on my own, I've weathered the initial anxiety (for about one week at the start) and been fine thereafter.

</div></font></blockquote><font class="post">That's interesting, seeker. I wonder how long the pdocs give a person when they taper or go off meds to see if that is a good solution for them? It seems that because of withdrawal, a fair trial would need to be at least a few months. If a person experiences withdrawl for a few weeks and pdoc responds by upping the meds again, it seems like that showed nothing--the person's biochemistry didn't have a time to adjust. (Of course, if a person is suicidal, they would need to make changes right away!) It's also interesting to be taking an anti-depressant for OCD but not needing the anti-depressant effect. My doctor (who does not have a big ego, thankfully) was kind of similar--she prescribed Lexapro for anxiety, not depression. It made me really nervous to think of taking an AD when I wasn't depressed, so I ended up not getting the prescription filled (it was way too expensive, anyway!). I'd rather have something just for anxiety if that is the problem.

DePressMe, I agree, yes, it depends on the person, and some people do best on meds for the longterm and cannot go off without really negative consequences. I am glad you have found a solution that works for you and keeps you safe.