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taper

Using amino acids for anxiety and depression: does the right dose ever change or need a tweak?

October 19, 2018 By Trudy Scott 8 Comments

If you are using targeted individual amino acids for anxiety and/or depression and doing well on them, you’ll likely get to the point when you’re asking questions like how to discontinue them and does the right dose ever change or need a tweak, especially after some stressful life events. Amy posted this question in the comments section of the blog on using tyrosine to create a sense of calm energy (paraphrased and formatting for ease of reading)

Trudy you are a God send! I stumbled upon your work after following Julia Ross. I have depression and anxiety. I’m currently taking:

1000 mg tyrosine 2x daily

500 mg glutamine morning, 1000mg mid-morning and afternoon

500mg DPA (Endorphigen) 3 x daily (previously I was using DLPA but your recommended DPA was so much better and less stimulating)

50 mg 5-HTP afternoon and

1500mg tryptophan at night

I used the amino acids to treat what used to be referred to as “atypical” depression: loss of motivation, tiredness, lethargic, intense carb craving, feelings of guilt and hopelessness. I would become paralyzed with depression, barely able to get through the days. When I was younger I treated these episodes with antidepressants but as I got older could no longer tolerate the side effects. I’m also still on birth control pills at the age of 46 and believe I may be in perimenopause but can’t stop the pills for medical reasons.

Tyrosine gave me my energy back, glutamine cut the carb cravings. DPA and True Calm work wonders for my anxiety.

I watch my sugar intake and always consume lots of animal protein. I’m so grateful for this solution.

After trialing this seems to be the right combo. I always get confused when is it time to discontinue supplements? Do you stop or slowly reduce or taper?

Does the “right” dose ever change? I’ve been on this combo about 2 months. I’ve felt great but some anxiety/panic creeping back up …. wondering if supplements need a tweak or is this just the result of some stressful life events. Advice appreciated!

I was really pleased to hear the wonderful results she was having and glad that she had trialed the amino acids to find the correct amount for her unique needs and situation. I don’t see this happening often enough and it really is the most effective way to get results. It’s what I do with all my clients – methodical, step-by-step trialing of each amino acid, one at a time and carefully documenting results (both good and bad) in order to find the optimal dose of each one.

When and how to discontinue the amino acids?

To answer her question about when and how to discontinue this is my feedback:

Once you are feeling back to your old self with no more anxiety, panic attacks or depression, you may choose to stop everything at once, but I prefer to slowly lower the amount of one amino acid at a time and add back if your symptoms come back. They don’t need to be “tapered” but doing it this way it helps with preventing your original anxiety and depression symptoms going back to really bad in one big swoop and having to start all over again.

I will add that I have had feedback from someone saying when she stopped tryptophan abruptly she felt the same withdrawal effects as when she weaned off meds but based on my experience this is very rare.

After posting her question Amy made some adjustments – taking less of all of them. As I mentioned above I find it better to lower the amount of one amino acid at a time – kind of reverse of the trialing method you use when starting the amino acids. Also, since she mentioned she felt anxiety/panic creeping back up, I would have expected her to increase some of the calming amino acids.

Does the right dose ever change or need a tweak?

And to answer Amy’s other question: does the right dose ever change or need a tweak?

Yes, the “right dose” can change based on stressful life events especially if you have pyroluria – stressful life events can cause you to dump more zinc and vitamin B6 affecting serotonin and GABA production and increasing the social anxiety.

Amy does mention that she’s on the birth control pill and this depletes zinc and vitamin B6 and hence serotonin) and has an impact on the microbiome – so this may well be playing a role in the need to tweak doses.

There are many other factors that could lead to the need to adjust the amino acids (or other supplement protocols):

  • hormonal changes like PMS, perimenopause or menopause
  • something contributing to leaky gut like adding back gluten or accidental exposure to gluten
  • antibiotics (affecting the microbiome and serotonin/GABA levels)
  • artificial sweeteners (because of their effect on the microbiome and hormones)
  • starting on other medications (since many cause nutritional depletions)
  • adding in a new food like collagen/gelatin (for some people collagen and gelatin may lower serotonin levels)
  • running a marathon (it likely depletes zinc and may ramp up cortisol)
  • a formulation changing completely without you knowing (one example is Seriphos – used to lower high cortisol – where the core ingredient changed completely and the labeling stayed the same)
  • a product changing from using gelatin to cellulose capsules (this may be problematic if you have SIBO)
  • you move into a new home and get mold exposure
  • you get a new dog or cat and start using Frontline Plus for fleas (fipronil, the active ingredient, targets GABA receptors and recent research points to increased anxiety, aggressive behavior, memory problems)
  • you have started using a sauna (depletion of zinc and other minerals, as well as stirring up toxins)
  • your need for serotonin support increases as you head into winter-time (some low serotonin folks are more susceptible to the winter blues)
  • a recent course of fluoroquinolone antibiotics (impacts on magnesium and GABA levels and the mitochondria)
  • you may no longer need them

This is not a complete list of reasons that could impact you but this will give you an idea of what to start to think about.

Hopefully this shows how important it is to monitor how you’re doing and adjust as needed (either up or down) and think about what is changing in your life.

If you’d like to read about the amino acids products Amy uses – the same ones I recommend and use with clients – you can find them listed on my supplements blog.

We appreciate Amy for allowing me to share her results and posting these questions which are a great learning opportunity for you.  She shared this with me:

I hope my “story” is helpful. Keep doing this important work! I work in the behavior health field. My colleagues think this is radical thinking and continue to only support the medical model. I’ve done a lot of my own research and trial and error. I wish there were more-open minded clinicians.

Hopefully with success stories like this, all the nutritional psychiatry research and behavioral health practitioners like Amy who have experienced it first hand and/or with clients/patients and family, we’ll change how mental health care is approached.

Do success stories like this lead you to be more open-minded about anxiety nutrition solutions? Have they worked for you?

And have you found the ideal dose of amino acids and then needed to adjust them up or down based on any of the above? How methodical were you in doing your adjustments?

Filed Under: Amino Acids, Anxiety, Anxiety and panic, Tryptophan Tagged With: adjust, anxiety, depression, discontinue, DPA, microbiome, right dose, stress, taper, tryptophan, tweak, tyrosine

How do I taper tryptophan without withdrawal symptoms: a tight band around my head, brain zaps and agitated free-floating anxiety?

September 21, 2018 By Trudy Scott 12 Comments

I have not had any clients experience the need to taper or slowly wean their tryptophan dose or report tapering side-effects similar to those they experienced when tapering off an antidepressant. However, I recently had someone ask this question on the blog (and then had someone else ask a similar question) so I’m sharing these questions and my responses in the hope of gleaning some additional information (and educating you if this applies to you). I never say never and am always learning. I’m also very interested to know how common this is and what some of the underlying factors could be.

Here is the question that was asked by Lara (we’ll call her Lara) and slightly paraphrased for clarity:

I’ve been taking 1500 mg of tryptophan for 3 months, and it has helped a lot with sleep and depression. I dropped to 1000 mg about a week ago then 500mg just to see how I’d do without it. I didn’t think it was numbing my feelings, but I am experiencing a return of feeling good.

I’ve been on antidepressants before and I am feeling the same withdrawal effects as when I weaned off meds. This is exactly why I chose to not go back to pharmaceuticals. It was difficult to wean off. How do I taper tryptophan without experiencing withdrawal symptoms? Thank you for your valuable knowledge.

These are the kinds of questions I’d ask a client in this situation:

  • Was the 1500mg helping and which low serotonin symptoms were eased?
  • How did this change when you reduced to 1000mg and then reduced to 500mg? i.e. did the low serotonin symptoms come back?
  • Which antidepressant are you comparing these affects to? And how long ago did you wean off the antidepressant?
  • Which brand of tryptophan you are using? (I find Lidtke is the best quality)

Keep in mind that we always want to be sure it’s not a one-off situation. In order to be sure someone is observing mild adverse effects from a supplement I’ll often have my client stop it and then add it back to make sure. And sometimes more than once.

In this instance repeating the process may be a good idea i.e. going back to 1000mg and then 1500mg and then reducing again, carefully documenting in a food mood supplement log.

It turns out that Lara was using the Lidtke tryptophan and she was seeing wonderful benefits for her low serotonin symptoms with none of the typical SSRI side-effects:

the 1500mg before bed with a small carb helped me get to sleep and stay asleep. It also helped with anxiety and depression during day. I tend to be a worrier, have social anxiety, and get stuck with negative thoughts about myself and others. And have very little interest in life.

I was on Zoloft from 2005 – 2009. Got off of that and did Lexapro for only 6 months in 2012. The Zoloft was life changing for me but I did not like the side effects and being on an antidepressant for the rest of my life.

The tryptophan is superior to these SSRIs [selective serotonin reuptake inhibitors] – no sexual side effects, no weight gain, or anhedonia [inability to feel pleasure in normally pleasurable activities].

She describes how she reduced the tryptophan and how her withdrawal symptoms were similar to those she experienced when tapering off her SSRIs in the past:

The withdrawal effects were felt when dropping from 1500mg to 1000mg, to 500mg, then zero over 2 days and they lasted about 3 days. By the 4th day I was no longer feeling bad.

The symptoms are hard to explain – it felt like a tight band around my head, also brain zaps (this is a common SSRI withdrawal symptom many describe feeling in their head).

The worst of it was a deep agitated free-floating anxiety like you’re walking along the edge of a cliff and there’s a physical pain in your gut. Fortunately, it was only present from waking up till around 2pm.

These are questions I’d ask or wonder about

As I mentioned in the introduction, I have not had any clients experience the need to taper or slowly wean their tryptophan dose or report tapering side-effects similar to those they experienced when tapering off an antidepressant. But if this is an issue some individuals experience I’d like to know about it

I’d also like to know how long the tapering side-effects of tryptophan last and how severe the symptoms are. In Lara’s case the symptoms were pretty severe but fortunately they only lasted 3 days which is very much shorter than SSRI tapers.

There could be confounding factors and here are additional questions I’d ask or wonder about if a client experienced similar adverse tapering effects. These are questions you could ask yourself if you have experienced this when stopping tryptophan abruptly:

  • Could the prior use of SSRI prescriptions be a factor? (but I have worked with many clients with prior use of SSRIs and not have tryptophan tapering issues)
  • What else has changed in terms of stress, diet, hidden gluten exposure, or even the something like a recent introduction of collagen (which may deplete serotonin levels in susceptible folks)?
  • Are there hormonal changes that could affect serotonin levels – like in a woman with PMS or perimenopausal or menopausal symptoms? (again, I’ve worked with many women of all ages and haven’t observed this to be an issue)
  • If you are prone to the winter blues and reduced winter serotonin, could stopping the tryptophan in the winter play a role? (I have had clients have SSRI tapering issues in winter because of being prone to the winter blues and choose to work with their doctors on their SSRI taper in the spring and summer for this reason)
  • Could this also be an issue with summer blues in hot states like Arizona?
  • Could any of these play a role: a recent medical procedure, a course of antibiotics (especially fluoroquinolones) or antifungals, poor gut health, a new infection, decreased immunity or increased inflammation?
  • Could low levels of these nutrients play a role: vitamin B6, ferritin, magnesium and zinc?
  • Would using high doses of vitamin C during the “taper” help reduce some of the symptoms? (this works well as an antidote when you take tryptophan and don’t need it and want to negate some of the negative effects, so may help in this situation)

Stopped tryptophan and felt very angry and down

The other question I had about tryptophan weaning is this one from someone who shared that she had suggested tryptophan for a friend. This friend was

experiencing a lot of ruminating and anxiety. She responded beautifully and felt great. About a year later, she tried to stop taking it, and said she felt very angry and down. Is there a weaning process for the tryptophan?

This could possibly be related to the above and you could pose similar questions but based on on what I see with clients I feel this is more of a matter of stopping the tryptophan too soon while she still had low serotonin – especially if the ruminating and anxiety came back. Feeling angry and down are classic signs of low serotonin.

The questions asked were specifically about tryptophan but they could also possibly apply to some individuals who stop 5-HTP abruptly.

I’d love to hear if you’ve experienced anything like this with either tryptophan or 5-HTP and if yes please share your answers to some of the above questions.

Right now, I’m afraid I don’t have an answer for you on how to taper tryptophan without these withdrawal symptoms: a tight band around the head, brain zaps and agitated free-floating anxiety. Right now, I’m not sure how big an issue this is. If it is common, I’m hoping some of the feedback I receive may provide some answers.

Filed Under: Tryptophan Tagged With: 5-HTP, agitated, angry, antidepressant, anxiety, anxious, brain zaps, down, symptoms, taper, tryptophan, withdrawal

How do I taper from my antidepressant with tryptophan and can I safely use the other amino acids?

November 18, 2016 By Trudy Scott 55 Comments

antidepressant-tapering

Today’s article is based on a question I am seeing more and more on the blog: How do I taper from my antidepressant with tryptophan and can I safely use the other amino acids?

I find my clients do better when tapering off an antidepressant (which is often prescribed for anxiety and panic attacks) when their nutritional status is solid. Incorporating diet changes and adding amino acids and other nutrients first can result in a more successful taper with less side-effects. This would mean starting with the basics – eating real whole food, incorporating quality animal protein, eating to balance blood sugar, and removing gluten, caffeine and sugar.

If needed and based on testing results, it’s important to address any other nutritional deficiencies such as low iron, low vitamin D, low stomach acid, low total cholesterol, low B12 (and whatever else is an issue), plus support the adrenals/sex hormones/thyroid if needed and addressing gut health like leaky gut and dysbiosis.

Adding a good copper free multivitamin and often the addition of zinc and vitamin B6, evening primrose oil and possibly fish oil – the latter based on each person’s unique needs.

With antidepressants such as selective serotonin-reuptake inhibitors (SSRIs), I have my clients work with their prescribing doctor and get the approval to add tryptophan (or 5-HTP) 6 hours apart from the SSRI. If they are taking the medication at night they get the approval from their doctor to switch it to the morning, and will take tryptophan (or 5-HTP) at least 6 hours later, mid-afternoon and evening.

If they decide to do both the medication and tryptophan (or 5-HTP), they get a protocol for the SSRI taper for the future. This is important. If you are in too big a rush to start right away, it often causes more issues. It’s also important to make sure you get a very slow taper protocol from your doctor. Some antidepressants are harder to taper (Paxil is notoriously difficult) and they all should be tapered really slowly.

The plan is to start to taper the SSRI once you have been using the tryptophan (or 5-HTP) for at least 4 to 8 weeks and are seeing real benefits by using it. This translates to much much less or none of the following symptoms: anxiety, depression, insomnia, rumination, worry, negative-self-talk, perfectionism, afternoon and evening carbohydrate cravings, PMS, rage or anger.

For some of my clients it’s 3 months before they feel they are ready to taper. This may be because of feedback they have provided based on prior taper attempts and how they are feeling this time. It may also be based on what else is going on in their lives like a stressful work situation. It may also be based on the time of the year: winter is generally not a good time to taper and definitely not if you suffer from increased depression or anxiety in winter.  

The tryptophan (or 5-HTP) is adjusted up as needed while continuing to taper the SSRI.  

The doctor is always kept informed and monitors for the possibility of serotonin syndrome. I learned about the potential concerns about serotonin syndrome when using tryptophan or 5-HTP with an SSRI from Julia Ross, author of The Mood Cure, and so I continue to caution my clients about this.

When I interviewed Dr. Peter Bongiorno in season 4 of the Anxiety Summit (Serotonin and anxiety: tryptophan, 5-HTP, serotonin syndrome and medication tapers), he shared that he is not concerned about serotonin syndrome being an issue with tryptophan or 5-HTP dosed with an SSRI, even if taken at the same time. He cited research that found the combination of tryptophan and SSRI did not result in serotonin syndrome in any of the participants.      

Dr. Bongiorno also uses the same approach to address the basics:

the most important thing is that we really establish all the basics and that they’re in the healthiest place possible.  Because if those aren’t there, if a patient just gets off the medication and we haven’t really done anything to change the underlying reasons why they got to the place where they had the mood issue, in most cases they’re going to go back there again.

Some people need amino acid support in more than just the low serotonin area so we review the amino acid questionnaire and consider trials of GABA and other amino acids too. All this only applies for SSRIs and tryptophan or 5-HTP. The other amino acids can safely be used with SSRIs, and it’s not uncommon to also have low GABA, low endorphins, low catecholamines and low blood sugar and need them all, but it’s still best to discuss them with the prescribing doctor.

We also review all the amino acid precautions.

Some people choose to work with their doctor to taper the SSRI and then add the tryptophan (or 5-HTP) once they have quit the medication. I have found that this makes it much harder to do and more side-effects are seen. With the amino acids you start to get some relief right away and have hope on the first day! They also make it so much easier to quit the sugar, gluten and caffeine without having to use will-power.

In summary, these are my recommendations for doing an SSRI taper with amino acids:

  • doctor’s approval to taper the SSRI and use amino acids
  • address diet and nutritional deficiencies first – before starting to taper
  • work with someone knowledgeable in amino acid use
  • OR educate yourself by
    • reading my book The Antianxiety Food Solution , Julia’s book The Mood Cure and Dr. Kelly Brogan’s new book A Mind of Your Own
    • listening to the Anxiety Summit interviews [on sale just after Thanksgiving]

                   (please don’t simply read one or two blogs and jump in to this)

  • use the amino acids from day one to start addressing low levels of all the brain chemicals
  • use the tryptophan or 5-HTP at least 6 hours away from the SSRI

I would like to add that Dr. Brogan shares that coffee enemas help her patients who are doing medication tapers and this is something I plan to start implementing going forward.

Have you used a similar SSRI taper protocol? And how did it work for you? What would you have done differently? And what advice would you give someone contemplating an SSRI taper?

Have you found that coffee enemas have helped?

Filed Under: Antidepressants Tagged With: 5-HTP, amino acids, antidepressant, anxiety, depression, serotonin, SSRI, taper, tryptophan

Medication tapering and withdrawal: an interview with Dr. Kelly Brogan

April 8, 2016 By Trudy Scott 71 Comments

mind-of-your-own-meme

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.

=================================================================

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.

=================================================================

We cover much more than the medication taper and withdrawal and you can listen to the entire interview here:

https://s3-us-west-2.amazonaws.com/axmisc/kelly-brogan-mind-of-your-own-interview-spr16.mp3

 

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)!

mind-of-your-own-meme2

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.

mind-of-your-own-meme3

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.

Filed Under: Antidepressants, benzodiazapines, Books, Depression, Drugs, Events Tagged With: a mind of your own, antianxiety, antidepressant, anxiety, benzodiazepine, depressed, interview, Kelly Brogan, medication, SSRI, taper, withdrawal

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