Anxiety attack

Starting a new prescription is easy. If your doctor tells the pharmacist to write on the label, “take once a day with food,” you know exactly what to do. Most people can manage such a simple instruction without a second thought. Except for cortisone-type drugs, the chances are good that your doctor will not mention how to stop medications. Corticosteroids like prednisone or prednisolone are frequently tapered gradually over a couple of weeks. That is common practice.

The Natural Homeostatic Balance Is Delicate:

Discontinuing a drug can be much harder than starting. That’s because many pharmaceuticals rearrange the body’s natural biochemical balance and nerve function. Many health professionals are surprised to learn that the body may respond to such a challenge by adaptation. When such medicines are stopped suddenly, an unpleasant withdrawal reaction may occur.

The Benzo Boondoggle:

When benzodiazepines were first introduced in this country by Hoffman-La Roche in 1960 it was love at first sight. Chlordiazepoxide (Librium) became a runaway best seller. A few years later, its kissing cousin, diazepam (Valium), took the top spot. These drugs were perceived as almost perfect anti-anxiety agents (“anxiolytics”). Psychiatrists believed they had few, if any, side effects. For the most part, health professionals did not worry about withdrawal as a problem.

With the “success” of Librium and Valium, other drug companies hopped on the bandwagon. Here is a list of subsequent benzodiazepines:

  • Alprazolam (Xanax)
  • Chlordiazepoxide (Librium)
  • Clonazepam (Klonopin)
  • Clorazepate (Tranxene)
  • Diazepam (Valium)
  • Estazolam (ProSom)
  • Flurazepam (Dalmane)
  • Halazepam (Paxipam)
  • Lorazepam (Ativan)
  • Midazolam (Versed)
  • Oxazepam (Serax)
  • Temezepam (Restoril)
  • Triazolam (Halcion)

What are Benzodiazepines Prescribed For:

Benzos were prescribed for everything from nervousness, grief and irritability to insomnia, panic and muscle spasms. Addiction specialists also prescribed benzos to people dealing with withdrawal symptoms from stopping alcohol or narcotics.

Drug Company Bonanzas:

Pharmaceutical manufacturers spend billions trying to convince physicians to prescribe their latest products. There is little incentive to teach health professionals how to deprescribe a drug.

The FDA hasn’t been of much help either. It has not required drug companies to develop strategies to help patients stop taking a prescription.

If anything, the FDA has enabled drug companies to downplay the problem. Instead of requiring the words “withdrawal symptoms,” which sounds scary, the FDA may allow the term “discontinuation syndrome.” That sounds less worrisome. And guidelines for phasing off a medicine are frequently ambiguous.

Trying to Stop Medications Can Be Hard:

Pharmaceutical manufacturers have had very little incentive to investigate drug dependence. The almost perfect medicine, from a marketing perspective, would be one that seems safe but is hard to stop.

Patients who tried to stop benzodiazepines like alprazolam, diazepam or lorazepam often reported symptoms such as anxiety or insomnia. If they complained, many health professionals thought the original symptoms were just coming back. The solution: more benzos! A physician once told us that a patient was experiencing a “Xanax deficiency.”

Benzodiazepine Stories:

Some people think that it is OK to stay on a benzodiazepine indefinitely. Here is a story of why that could be problematic, especially for an older person.

Mary and her mother:

“When my mother was in her late 80’s, her general practitioner prescribed lorazepam for anxiety. Over the next few years, she became increasingly confused and agitated to the point where she told neighbors that my father had kidnapped her and was holding her hostage. She stopped recognizing my brother. She lost the ability to do even simple tasks. She had numerous panic attacks. She thought there were two of my father, one living upstairs and one living downstairs.

“When my brother and I finally got her to a geriatric psychiatrist at the University of Chicago, he diagnosed her with Alzheimer’s disease. He also changed her anxiety medication. Within a month, she was back to her pre-lorazepam clarity and was amazed at what we told her had been going on with her for the past several years. She passed away at 97 with complete mental clarity.”

Benzos can increase the risk of confusion (Neuroepidemiology, online, Dec. 24, 2016). Perhaps even worse, such drugs can make people unsteady. That can lead to falls (Maturitas, July, 2017).

Peggy in Florida had a hard time discontinuing Klonopin:

“I took Klonopin for 20 years for insomnia. I started to taper off slowly and this took over two years. Despite this effort, I went into severe withdrawal with physical symptoms: burning, stinging, heat, spasms, nerve pain, intense spaciness, dizziness, memory problems, nausea, loose bowels, weight loss, and others.

“I am slowly recovering from this terrible ordeal. I take no prescriptions. I have a very supportive doctor. A genetics test revealed that I am especially susceptible to benzodiazepines, which may account for my long withdrawal.”

SSRI-type Antidepressant Medications:

It may also be hard to stop medications like SSRIs (selective serotonin reuptake inhibitors). They include drugs like paroxetine and sertraline.

The official prescribing information for sertraline (Zoloft) states:

“Adverse reactions after discontinuation of serotonergic antidepressants, particularly after abrupt discontinuation, include nausea, sweating, dysphoric mood, irritability, agitation, dizziness, sensory disturbances (e.g., paresthesia, such as electric shock sensations), tremor, anxiety, confusion, headache, lethargy, emotional lability, insomnia, hypomania, tinnitus, and seizures. A gradual reduction in dosage rather than abrupt cessation is recommended whenever possible.”

Gradual Reduction in Dosage?

What precisely does “a gradual reduction in dosage” mean? Is that over a week, a month or six months? Without more detailed instructions, physicians and patients have to come up with their own regimens.

One woman wrote:

“It is three weeks since I took my last sertraline pill. I’ve experienced dizziness, headaches, nausea due to vertigo, night sweats, hopelessness, brain zaps and numbness throughout my whole body.”

Another reader said:

“I’ve been taking sertraline for 25 years. As a nurse I know about gradual withdrawal. I decreased down from 200 mg to 12.5 mg over four months. I finally got through the physical symptoms but am now experiencing stress, anxiety and rage.

“It has me yelling at the automated lady on customer service recordings and crying in the bathroom at work. These symptoms are totally uncharacteristic of me. I wonder if I’ll ever be myself again.”

Stopping Proton Pump Inhibitors Also Challenging:

When most people think about “withdrawal symptoms” or “discontinuation syndrome” they imagine sedatives, sleeping pills or antidepressant medications. Very few consider heartburn medicine.

Stopping acid-suppressing drugs may cause rebound hyperacidity. Here is what happened to one patient:

“I was prescribed omeprazole during chemotherapy which lasted 5 months. I am now finished with chemo and am in the process of weaning off omeprazole. I was never advised on how to stop taking the drug. I just quit. That was the worst thing I could have done. Heartburn symptoms blasted full force.”

Patients need detailed instructions before stopping acid-suppressing drugs such as esomeprazole or lansoprazole.

Trouble Stopping Other Medications:

Antihistamines like cetirizine may cause unbearable itching if stopped suddenly. Here is a link to this unexpected complication.

Many antidepressants, including citalopram, desvenlafaxine and duloxetine can trigger a discontinuation syndrome. Read more at this link.

So can many sedatives and sleeping pills. Zolpidem (Ambien) may not be that easy to stop. Here’s a link.

Even a supposedly non-addicting pain reliever like tramadol can cause some people challenges:

FDA, Drug Companies & Doctors Must Figure This Out!

Doctors should alert patients that stopping certain drugs suddenly can be disastrous. And the FDA must require drug companies to better define a “gradual reduction in dosage” to diminish withdrawal symptoms.

It is time for health professionals to figure out how to advise patients to stop medications safely. That means research. It may not be lucrative, but before a drug company can advertise how wonderful their new drug is perhaps they should be required to learn if it needs to be tapered. More important, they should have to supply physicians, pharmacists and patients with detailed information on how to discontinue their pricey products.

Please share your own experience in the comment section below and vote on the value of this article at the top of the page.

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  1. Marita M., LCPC
    Chicago
    Reply

    As a psychotherapist I occasionally encounter clients who suddenly decide to wean off their medications without medical supervision or have been told by their psychiatrists that “it doesn’t matter” how they titrate. Unfortunately, such lack of consideration can leave individuals to suffer unnecessarily with extreme emotions, uncontrollable crying spells, and sleeplessness. It is a great disservice and irresponsible for pharmaceutical companies and MDs to minimize potential side effects of anti-depressant/anti-anxiety medication withdrawal.

    It’s optimal that when such medications are needed, (and research has proven) such medication treatment is most effective when used in collaboration with psychotherapy or counseling. I find that clients/patients are better served when psychiatrists collaborate with psychotherapists/counselors who have consistent observation of the individual’s behavior compared the infrequent visits (once every 3, to 6, to 12 months) the same individual has with their psychiatrist.

  2. Joan
    Reply

    Trying to get off a clonidine patch of only 1mg. (for high blood pressure). Been on about 6 weeks. All the dr’s. I have talked to say there is nothing to it, just take it off, but I can’t. I get spikes in blood pressure a day or so later. I am trying to block with tape small portions of the patch. A little every few days and even that has not been easy. It is a hard drug to get off of. Problems are usually with larger doses and with the pills, but I am having trouble with the patch.

  3. Joan
    Reply

    I think some Drs just don’t care. All they see is the bottom line….MONEY. My primary Dr sent me to an RA guy to see if it would help my rheumatoid arthritis. I had been in the hospital after a fall, and they did a lot of tests. I thought I just had arthritis but at 77 years old what could they really do? It wasn’t a bad case of RA but it affected some fingers and my knees and ankles. One ankle turned at a right angle all the way. I could walk but with 2 canes or a walker. So I gave the RA guy a chance. He was so nice. He said, “I will make you feel better.” He prescribed a med with a long name beginning with H. It had been $4 a month but the FDA was “testing” it, and I paid $120 a month. I took it for 6 months, and it didn’t help at all so the RA dr gave me prednisone. Only 5 mg a day. BUT I took it for 6 months. In addition, he said I should take some kind of med for my bones. It was a shot called Prolia. That cost $186 every 6 months. Fine if it helped. All of a sudden I got MOON FACE from the prednisone. I called him and he couldn’t see me because he was too busy. By this time I was feeling rotten and having all kinds of things happen to my body. So I called him again, and he didn’t want to speak to me his very nice nurse whispered to me. She knew him. I insisted on talking to him and he did me a favor and spoke to me. I told him what was going on and he said…rudely…stop taking the prednisone. I said …should I taper off. He said no because it was a low dose. I stopped cold turkey and got so sick.

    I went to my primary Dr. And told him what happened. He said he would have told me to taper off because I had been taking it for 6 months. I really should have gone right away to my primary Dr. I was sick for a year and every now and then still get MOON FACE. It doesn’t hurt but I look like a chipmunk. I called the RA dr and cancelled all future appointments. He was so mad he called me back. He said I was helping you!!! On my next visit to my primary I asked if he had recommended this Dr. He said no but he had asked the hospital to send in a rhematoid Dr. I told him that this Dr had made me so ill. He said, “I know.” What could he say? No more prednisone for me but now I know that if I’m taking any med for a long time I will ask my primary doctor before I stop taking it .

  4. Jacquelyn McClellan
    FL
    Reply

    In Dec 2016 Alprazolam was no longer effective and I decided to stop. I knew I would have withdrawal issues and asked doctor for Effexor to take while tapering. Had nightmares, suicidal thoughts daily, colon issues, loss of appetite, and hair loss. Stopped Effexor in May 2017 and there and finally feel human again. Still have anxiety and some depression, but will have to weather the storms.

  5. Patty
    Reply

    You are providing such valuable information. Educating and saving lives. Every human being should be reading this information. Best defense is prevention. It is sad that people’s lives are ruined by misinformation, deception and negligence by RX Drug Co., Doctors, FDA and an unhealthy healthcare system.

  6. John C
    New York (NY)
    Reply

    Hi my name is John I was abruptly cut off from my Klonopin and Cymbalta. I actually had a house fire and had nowhere to live I had been staying in my car for 2 months until it got very cold I live in Upstate New York I had to move rather abruptly due to the extreme weather conditions and failed to make it into my nurse practitioner for a drug test she immediately caught me off of both medicines at once leaving me with not only a feeling of animosity but Extreme physical symptoms that caused my pain doctor to also cut me off of a very strong prescription of much-needed pain medicine as a result of a serious back surgery in which I have 6 screws and a cage in my back

    when I went in to see my pain doctor it was about a week and a half of not having my Cymbalta and Klonopin I was on absolutely nothing except the regular dose of my pain medicine which my appointment was in the morning so I’d only taken one pill of 4 milligram Dilaudid however because of my condition which I became very disoriented and very unclear even as to where I was he thought I had taken something other than prescribed which I had not I understand how my pain doctor could see the change in my personality however that was a result of me not having my Cymbalta and Klonopin I have been on Cymbalta for over 14 years and Klonopin for about 5 I’m not 100% sure if I was able to take any legal action which by the way I would not do because I believe that there is too much suing in this country today however not to get off track I was very disappointed with my nurse practitioner for immediately cutting me off of my medicine

    not only is it very very dangerous it was a very hard time in my life when I needed this medicine the most because my house had burned down thank God my original general practitioner God bless her soul took me back and immediately put me back on the medication and within a week or week and a half I was back on track

    I’m not quite sure what my point is however I hope no one ever has to go through this as it is very dangerous and very concerning because I will not lie I have become dependent on these particular drugs I do not abuse drugs I take them regularly, religiously and believe it has improved the quality of my life so please for any doctors who may glance at this or people who are prescribed a similar medication Please be aware that stopping this medication abruptly can be extremely dangerous and very very unpleasant to put it mildly thank you for your time and thank you for reading this sincerely John

  7. busy fingers
    BC
    Reply

    If drugs are absolutely necessary then the drug manufacturer needs to know howto successfully stop these drugs should the patient want to or need to get off them. This information should also be given to the patients Dr who prescribed the drugs so that he or she can advise the patient accordingly and safely. I know some people who will just stop taking presriptions with hazardas consequesis due to frustration with Drs advice. or lack of it.

  8. Mary Jane
    NYC
    Reply

    Drug dependence (legal or illegal) has reached epidemic proportions in this country. Doctors won’t help, so we patients are best served by taking charge of our own health. Unfortunately for all of us, too many people are making money off of drugs (legal and illegal).

  9. mary m.
    indiana
    Reply

    how well I know the story. my sister took Xanax for sleeping each night for several years.. last year I warned her abt taking them and also her RN daughter warned her but she continued until she fell, had short term memory loss and went from one hosp to the next when she died dec 2016 at 84 yrs old.

    I know Xanax pretty well as I use it to fly back and forth to Europe. I dislike flying and it is a big help. my doctor knows this is the only time I use it.period. it is a short term drug. very addictive. used way too much by seniors for everything.

  10. KSargent
    SpartanburgSC
    Reply

    I have attempted 3 times to taper off of Effexor ER. I take 225mg daily and my M.D. decreased me 75mg per week and then 37.5mg for a week then 37.5mg every other day for 2 weeks. I still had horrible withdrawal effects. I had the brain zap, nausea and vomiting, dizziness, unbalanced walking into walls, insomnia, blurred vision, ringing in my ears and a roaring in my head, uncontrollable crying, nerve pain all over my body, tingling and numbness in my hands and feet. This went on for 2 weeks after I was completely off the drug. I couldn’t take it anymore so I went back on Effexor ER gradually starting with 75mg the first week and adding 75mg weekly until I was back to the original 225mg. By the time I was back to 225mg all withdrawal symptoms were gone. I guess I’m stuck on Effexor ER for life.

  11. Rose
    Florida
    Reply

    I was on Lyrics for 2 years before I developed serious side effects. I began to have a sensation of burning heat on the soles of my feet but they were cool to the touch. I went to a pain doctor who played around with increasing my dosage which only made things worse. I finally decided that I would have to get off the drug. What a nightmare! To make a long story short, I had to get my family physician to prescribe varying doses of the drug so I could gradually taper myself off.

    It took a year to accomplish as I kept battling a side effect that made me feel like I wanted to jump out of my skin along with severe apprehensiveness. Close to suicidal. I had to do this all on my own; figure it all out on my own. I will never again take drugs that screw around with my brain.

  12. Kathy
    Reply

    Please purchase Dr Peter Breggin MD ” Psychiatric Drug Withdrawal” A Guide 4 Prescribers, Therapists,Patients & their Families. Also Gwen OLSEN’S “Confessions of an Rx Drug Pusher”. Both these books have saved my life. Dr’s or Psychiatrists will never reduce your medication, but they’re always quick 2 add more 2 your already cocktail.

    They won’t withdraw your meds due to liability. If they reduced your meds & u suicided they’re liable, so it’s easier 4 them 2 say keep taking your meds just incase you have a relapse. There is only a handful of good honest & sincere Psychiatrists out there.

    I have absolutely no faith left in certain psychiatrists, u want 2 get well, get yourself a good honest Psychologist & be honest w/yourself, no holding back secrets. Keep away from those MHInstitutions & their SHRINKS & that revolving door.

  13. Anne
    Georgia
    Reply

    Add Gabapentin to the list of drugs that are hard to reduce and leave.

  14. Ann Blake-Tracy, Executive Director, International Coalition for Drug Awareness
    USA
    Reply

    Thank you so much for this much needed article and your extremely valuable work which I have long highly recommended!

    After spending the past 25 years helping patients withdraw safely from antidepressants & benzos (since they are so often prescribed together) I have grown very weary of hearing patients being told to talk to their doctors about how to withdraw from these drugs because I have not found one yet who knows how to do that safely!

    I mistakenly assumed that surely physicians had learned something about gradual withdrawing after dealing with steroid and benzo withdrawal for decades. What I have witnessed patients suffer as a result has been beyond belief!

    When invited to be a guest on Coast to Coast radio (with 20 Million listeners at the time) soon after the 1999 Columbine massacre, I knew people needed to know how to come off antidepressants safely if they were about to learn that antidepressants were the catalysts behind not only this high profile killing, but many others. So I hurried to produce an hour and a half long CD on how these drugs work and how we had learned that withdrawal had to be very gradual in order to avoid a manic psychosis in a rapid withdrawal.

    And then as we approached the 2004 FDA hearings on suicide and antidepressants, especially among youth, I gathered material for the FDA to help them understand my great fear of the expected warning of suicide causing many to be dropped off their antidepressants too rapidly. My fear was the rapid withdrawal could trigger a rash of suicides and possibly homicides from the abrupt withdrawal effects upon blood sugar and sleep, and therefore, sanity/consciousness.

    Thankfully the FDA did issue a strong warning at that time on abrupt withdrawal but sadly I have RARELY heard of a physician passing that warning on to a patient in the over a decade since.

    PS: In my experience after 25 years on Zoloft a 4 mo. withdrawal would not be considered “gradual” but far too rapid. A gradual withdrawal after 25 years would be more like 5 years of weaning. The body and brain need time to readjust after so many, many years on.

  15. Kim
    Reading, Pa
    Reply

    I had been on clonazapam for 8 years and it gave me hallucinations and more problems. I tried to commit suicide several times while on it. I was told by my psychiatrist that she was going to take me off of it and it would take a week. I was also in a homeless shelter at the time. It was a nightmare!

    I had hot flashes, spasms of my arms and legs, my legs were literally jumping up! I had an addiction to clonazapam. I had headaches/migraines, extreme dizziness/vertigo and within 6 months lost 23 pounds. It was the worst time in my life! It was bad enough being homeless, then to top it off I was having major issues from withdrawal.

  16. Yusuf (JP) Saleeby, MD
    NC and SC
    Reply

    Functional Medicine physicians are the biggest exception… we are goal oriented at reducing polypharmacy and help patients get off medications they really don’t need.

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