SSRI Withdrawal: It's Not Just About Tapering | The Neuroscience Behind the Struggle

[@giorgiobalestrieri2235]

It's insane that we have to inform ourself by the internet while being gaslighted by doctors

[@violet_fluid]

So insane!!!!

[@potatochalbro]

And they will tell us in our face "that's impossible". This happened to me in 2024.

[@matthewarnspiger632]

Yeah, its pretty fuckin crazy that the first paper examining the SSRI withdrawal syndrome was in the literature a decade ago, despite these medications being prescribed for 40 years.

[@A_random_nerd_with_braces]

Very good video. You are much more knowledgeable about this than many doctors, including psychiatrists. Having been through horrific withdrawal myself I have found a) these drugs are way over-prescribed and b) most doctors lack even the most basic knowledge when it comes to tapering off and the results can be absolutely devastating for patients. I found much more knowledgeable help through support groups online, run by people who have survived withdrawal syndrome and know first hand how horrendous this can be - and can give great advice. Many thousands if us have been let down so badly by doctors that we no longer trust them and would never go anywhere near the medical system for support because they screwed us up so badly in the first place. It’s pretty tragic to be honest.

[@PsychiatrySimplified]

Yes it unfortunate. Hoping that education changes this

[@PauL-xc6pl]

We can do this, my loves! You're not alone.

[@John1963-l1i]

Thank you! This video is absolutely brilliant! After watching it three times, let me try to try to summarize: The neurological effects of SSRI tapering are broad (as evidenced by wide-ranging withdrawal symptoms) and contribute substantially to allostatic load. Allostatic load must be carefully managed to encourage homeostasis discourage the risk of disfunction and cascading withdrawal. Individuals differ in their capacity to tolerate allostatic load. Hyperbolic tapering is essential, as it helps control the extent of the neurological effects (and therefore the extent of the allostatic load and withdrawal symptoms), but it must be carefully tailored to each individual. Careful hyperbolic tapering may be augmented through certain pharmacological interventions that can help mitigate the neurological effects of tapering (especially sleep issues) and therefore reduce the risk of a negative spiral or cascade. Apart from this, we should presumably incorporate positive and constructive lifestyle changes that may help reduce allostatic load or increase the offsetting rewards. When we’ve done all we can, we should be patient , relax as much as possible, and let our miraculous bodies get on with the healing process. 🙂 Does that sound about right?

[@PsychiatrySimplified]

Thanks for the effort you put into viewing the video. I’ll refine / add some aspects. Imagine one if habitually used to carrying a load of 15 kg daily for years . Their ‘body’ and ‘brain’ is used to this ( homeostatic paradigm) - this load is unlikely to lead to effects that are surprising or unpleasant. Now suddenly one day the individual decides to move from 15 to 30 kg without any other intervention. This will constitute an allostatic load - and will begin to disrupt the homeostasis. Here the individual has options - either increase weight gradually and examine how well one is able to get to 30 kg and after how long . There will be fluctuations . ( tapering is the opposite)) Alternatively one can decide to exercise and strengthen using other strategies while simultaneously gradually increasing load. Or one keeps pushing to get to 30 kg in the shortest time possible ( a greater risk of injury etc - ie disruption of homeostasis) If we apply the same principles to withdrawal we can see the effects are highly individual as you say - differs in their capacity to tolerate allostatic load. In the above case - injury maybe a shoulder tear but it may also in some lead to exacerbation of say arthritic pain - which is essentially allostatic load leading to not just one effect but more than one. Same with withdrawal and allostatic load. Hope that adds to your summary. Thanks

[@John1963-l1i]

@ That’s very helpful. Thanks! One more thought about the weight analogy with respect to withdrawal in particular. If I understand correctly, a sudden cessation of medication could be like suddenly adding 30 lbs of allostatic load (or 50, or 150, depending on the individual, factors such as the type of medication, the length of time on the medication, etc.). This sudden addition of weight could overwhelm an individual’s capacity to manage the change through natural allostatic processes and result in injury to the CNS (i.e., severe, acute withdrawal and potentially protracted withdrawal). Hence, it may be best to start with conservative additions to the allostatic load and adjust with experience. Of course, to complicate matters substantially, the “weight” adjustments have to follow the downward trajectory of a hyperbolic curve… In my own case, I had been using Paroxetine for more than 20 years. My doctor had me follow a linear taper starting at 25 mgs and reducing 5 mgs every 3 weeks. At 5 mgs I crashed and went through 10 days of severe, acute withdrawal and another 8 weeks of slow re-stabilization. Using the weight analogy, and understanding the hyperbolic nature of SERT occupancy, this linear taper would have been like adding 2 lbs, then 5, then 20, then 50, and…voila, my CNS couldn’t handle the load, and it “broke”. Through trial and error, I now suspect that I can manage a taper of roughly 4.5% of the previous dose every 2.5 - 3 weeks. Based on where I’m at now, the remainder of the taper will take me into mid-2027 or beyond. Perhaps my CNS will gradually “strengthen” throughout the process in a way that would permit increases in the tapering rate, but I won’t push my luck too far. Better to be safe than sorry. One last thing. Your connection of withdrawal and pain management opened a new door for me. I’m making arrangements to meet with a therapist that specializes in pain management and stress. I’m hoping that she can help me develop a plan and skills to help me work constructively through the remainder of the tapering process. Linking withdrawal management to pain management was a REALLY helpful insight. Until now, I had no idea where I could turn for practical support. This new avenue is a very encouraging development for me. MUCH appreciated!

[@naomimara3340]

Which pharmaceutical intervention?

[@John1963-l1i]

@ Toward the end of the video, Sunil mentions several medications that can be used to treat withdrawal symptoms. The particular medication would depend on the particular symptom. As a rough pain analogy, if you have a bad headache at bedtime, it may be helpful to take a Tylenol. You don’t want to take Tylenol all the time, but a Tylenol in this situation may help you get a good sleep and thus minimize the impact of the headache on your overall allostatic load and save you some grief. In the case of withdrawal, if you’ve recently made a taper and you’re feeling excessively anxious at bedtime (for example), it may be helpful to take a benzodiazepine to help settle your nervous system and get a good sleep. Personally, I would only use a medication like that on a very short-term basis, like using Tylenol to treat a bad headache. I wouldn’t want to replace reliance on one medication (Paroxetine) with reliance on another (a benzodiazepine). That would make no sense to me.

[@LostLevelMusic]

I have the rebound anxiety now. Also horrible anhedonia... I don't feel any positive emotions. I've been off SSRIs for 11 months. It's kind of like a living hell, feels like being trapped in a void. I just hope I heal and get better. Good video.

[@PsychiatrySimplified]

Hope you can speak to someone about the issues you are having . Thanks for the feedback

[@Snowflake1374]

Going through same hell 12 months off SSRI. No positive emotions. Depression-like. Also horrible neurological dysregulation. Severe brain pain and pressure.

[@Dr.M.Shafiq]

Does clonazepam use 1.0mg for 3 month and tapering for 2 month cause withdrawl symptoms. Rebound Anxiety, tachycardia, hyperthermia 100°F fever,vibration in hand body,Insomnia, decreased appetite are withdrawl symptoms?

[@frusia123]

Please look into herbal remedies, they can be very effective, if you can find a certified manufacturer who sells exactly what's written on the bottle. There are not that many studies on herbs, because those remedies can't be patented so the big pharma doesn't see much investment returns in them. But some studies have been done, for example on lavender oil which was found to have an effect not inferior to benzodiazepines, with minimal side effects. St John's wort works similarly to antidepressants, this is well proven, although it can interact with many meds, so if you're taking anything, it might be worth looking into other herbs of similar properties such as lemon balm. And I cannot stress that enough, don't get tempted by cheap products, or even expensive supplements that have not been certified by external institutions. But if you find a good manufacturer, this is so worth trying.

[@7inchdestroyer959]

how are you now

[@Protracted-Withdrawal]

Great video. Another important aspect is protracted withdrawal, which can last for many months and often even years after discontinuation of SSRI/SNRI. This is due to an autonomic dysregulation. Unfortunately, the etiology of both acute and protracted withdrawal is not yet fully understood.

[@PsychiatrySimplified]

Thanks for the feedback 🙏🏻

[@amitabh15]

Protracted withdrawal is a functional neurological disorder. Which essentially begins from hyperarousal and over excitation of amygdala. So this explains somewhat. I had serotonin syndrome and then cold Turkeyed that led to protracted withdrawls/fnd. Now I don’t know how to get better. Any recommendations?

[@PsychiatrySimplified]

Has an assessment been carried out - psychiatry or neuropsychiatry?

[@amitabh15]

@@PsychiatrySimplified yes it has. I was diagnosed with ptsd and FND at neurology clinic. Along with that I received a couple of other labels such as visual snow syndrome and fibromyalgia. They couldn’t offer any advice, other than EMDR and John sarno’s books.

[@amitabh15]

fndaustralia.com.au/resources/FND-Learning-guide-for-nurses.pdf

[@JayNayMay]

Got off Zoloft 50mg after 14 years over 2 months ago still having withdraws

[@PsychiatrySimplified]

Please discuss the phenomenon with the doctor so they can treat it. For example if someone has had high Bp and previously they had headaches and then they treat the Bp and headaches cease. Then when they withdraw the medication and stop it - the return of the Bp elevation which can happen may present as other symptoms besides headchaes as well - chest pain, exertional breathlessness, migraine, blurred vision etc. we go to the doctor and express the symptoms - based on the expression , they will investigate and treat . The answer may not be just an anti hypertensive. It could be something else depending on the symptoms

[@G.Fahsko]

Wonderful work - thanks for sharing. Helps a lot!

[@PsychiatrySimplified]

@@G.Fahsko 🙏🏻

[@staceyseymour9297]

I found this to be quite informative. However, I was disappointed that the bottom line was that more medications might be helpful. I started an SSRI over twenty years ago and although it may have been helpful early on, I continued to struggle emotionally. Several years ago I was prescribed an antipsychotic as an adjunct treatment for depression. When I quickly tapered off of it, because it made me feel agitated, I began having panic attacks. A doctor then prescribed me a benzodiazepine for the panic attacks. As I continued to struggle I sought help at a outpatient psychiatric facility. The psychiatrist there told me that I was medication-resistant and had me do ECT (shock therapy) and TMS (transcranial magnetic stimulation). After all that, and still struggling, I decided that maybe being on too many meds was the problem. After rapidly tapering three of five meds, I had akathisia and was begging for death. I wish I had known to do a slow, hyperbolic taper. I tried stopping the meds the way that psychiatrists had always told me to stop them and I am suffering immensely. Adding more medications just means that you will eventually have to try to get off of them. It's a vicious cycle.

[@PsychiatrySimplified]

Sorry to hear. The bottom line of the video wasn’t more medications. It was the nature of allostatic load and how for some even hyperbolic taper isn’t sufficient. Many then get caught in a cycle of reduction for years - while allostatic load increases - this process eventually for some ca. result in an illness state - for some that means medication interventions. Reduction of medication and the complete cessation are two very different outcomes which vary between individuals and are also dependent on the severity and nature of the condition the medications were initially started for.

[@Commendo2024]

I went from 40 mg to 2.5 within almost a year. I haven’t had trouble sleeping yet! (Knock on wood). I also quit smoking (lots of) weed about a year and a half ago. The sleep disturbances were unreal. Weed also reduces REM. The nightmares were out of this world. I could smell them and taste them. They were vivid and disgusting. And I could remember them very well. I started having vivid dreams a few weeks ago, but nothing like when I quit weed. (Hopefully it won’t be as bad.) Wish me luck! Bless You all! Note: I have been feeling highly depressed and numb. Weird because I was prescribed those medicines for Anxiety in the first place. I’m a recovered alcoholic and was prescribed this drug(SSRI) when I developed ‘Agoraphobia’. I believe what caused my agoraphobia was when I was brought along to an after hour nightclub and decided to take pills (extacy and speed) along with my friends. That trip lasted 72 hours without sleep. I had a huge panic attack(first one ever) when I came back from there. I developed agoraphobia a little after. I was 18 and am now 38. I wish I can let go of that drug(SSRI). I am now 100% sober and don’t even drink coffee anymore. The only drugs I take are SSRI(almost off of it) and Vyvanse(which I also plan on stopping). Wish me luck. Please. Bless You all! Edit: I also have epilepsy from quitting alcohol cold turkey. 23:50 now I’m scared.

[@PsychiatrySimplified]

Thank you for sharing. Wish you well. Please consider reduction under medical supervision in view of your history.

[@amitabh15]

On another note. Neuro programs now although teach some old curriculum speaking of serotonin for activating frontal cortexes in depression, but these programs also add a disclaimer that the monoamine hypothesis is now being abandoned. They don’t know how SSRI work. It’s not possible that benzo withdrawal, SSRI withdrawal, post concussion syndrome, long covid, fibromyalgia, visual snow syndrome, hallucinationogenic persistent perceptual disorder present in a similar fashion, yet only one is connected to serotonin. I agree with high activity in limbic system. I’m not sure if it can be easily hypothesized as a separate disorder. Ultimately, all these disorders have been hypothesized based on the basis of biological monoamine hypothesis. Yet, it’s none of it is that simple. A highly alert fear center of the brain from injury, infection, abnormal psychological experience can produce thousands of symptoms via various sensory, auditory, vestibular, perceptual, visual cortexes. Anyhow, I quite enjoy watching your videos. I think they provide great value with possibilities for treatments. Clonidine is recorded in anecdotal experiences for being utilized in akathisia, HPPD, ptsd and several similar conditions. Maybe there is a noradrenaline connection after all. But that would mean that one size fits all. As you know nearly everyone responds differently.

[@indigobunting2431]

I have all those symptoms, all the time, after stopping meds. Their utter uselessness for menopause is well known among my friends.

[@PsychiatrySimplified]

Sorry to hear

[@critter4004]

And yet, doctors continue to prescribe them all the time! 😠 😡

[@ndestors]

Well… that would change a 25y user AD and a 1y user in withdrawl Symptoms ? The long term users are struggles and need years to heal !

[@Qwerty-nm6qi]

Thank you for validating and explaining the reality of withdrawal. The extreme agitation you mention is akathisia. Antipsychotics are the number 1 cause of akathisia so not sure why you’d give that to someone already suffering from it.

[@PsychiatrySimplified]

No akathisia and agitation are different phenomenologically and in their history. Labels create a lot of confusion. Hence the phenomenology I.the specific assessment of the experience matters in treatment. Akathisia is not agitation. Both are very treatable and require different approaches

[@Qwerty-nm6qi]

@@PsychiatrySimplified ok! Then would love you to make a video about Akathisia , it doesn’t seem treatable to me (i have it)

[@mazymonroe8749]

​@Qwerty-nm6qi I wonder what the treatment for it is? Something you have to pay to find out maybe?

[@jerryholdcroft4607]

Day 20 of my dose reduction, there are important changes, so I didn't hide this post in the replies as usual. I have found a clarity of thought I haven't felt for a long time!, I feel clear headed and alert to my surroundings. I am out of my comfortable 'cocoon' of indifference and lethargy which had become something of a crazy 'Catch 22' situation, I wanted to recover but didn't have the energy or compulsion to do so, I was just happy to drift along in life unaffected by anything. My emotions have not been tested yet (I live a boring life!) and yes I am worried about any unexpected stress or anxiety and how well I will be able to cope with that. This is a significant change for me and I'm pleasantly surprised at such a positive development. 🙂

[@PsychiatrySimplified]

Thanks for sharing and am pleased for you

[@Vancouver_1986]

You can make your own thread to document your body's withdrawal (jumping off a cliff or % reductions) and how you ended up on a Psychotropic Pharmaceutical(s), documenting your frustration at uninformed GP's/Psychi's, Therapists, etc. Just everything, really. It's incredibly important for as many people as possible to specifically show iatrogenic injuries while on these Pharamceuticals and the Withdrawal (NOT relapse) from them. Maybe that will help people stop losing money, jobs, etc.

[@dazersbev]

Mu​ltiple class actions should be enacted globally, and the masses of people who's lives have been destroyed by these medications should be compensated. Consequence to the billion dollarised pharmaceutical companies should be so massive. People then need to come together, everybody, and put a stop to the corrupted and ineffective practice of drug manufacturing for profit, and the lobbying and bribery of government by big pharma to push through patented unsafe compounds. To be told something is safe in pregnancy, only to find out years later it is not, and it potentially caused the death of your unborn child, is unacceptable. To be told something is safe and will help you, and then be given it for 15 years, only to find out it is a damaging, disruptive, dependence-building drug causing a myriad of almost irreprable negative consequences directly and indirectly, this is unacceptable. History will only repeat over and over unless change is made. Look at the semaglutides, the unseen, untalked about damage, the profiteering. This should not be accepted. The sick society will eventually crumble, the healthy one will prosper. Pharma and government along with private need to work together, for the benefit of everyone as a whole, not just lining the pockets of a ceo and board members. There are no doubt numerous drugs and compounds with a high therapeutic index, which could be prescribed and benefit millions, but won't be put through trial due to lack of patentability and profitability. Synthesis of these drugs may also be simple, sometimes structurally similar to certain vitamins. This is what needs to be looked at, along with holistic perspective. The best solutions are not always the most complicated ones, but the simplest ones sitting right in front of you. Maybe not trust some guy to give you just another drug for your ssri withdrawal symptom. Maybe take another look at your dose protocol, diet, sleep, exercise, supportive activities and relationships, maybe then dig a bit deeper and look at compounds like agmatine, emoxypine, bromantane, nsi-189, colouracetam and others. It's time to take back our lives and our futures people. 👊

[@3manifold]

I have told my doctor that i experienced this, i got anxiety over the feeling of physical scratches, even those give me anxiety, and doctor keep adding up trifluoperazine dose i dont understand

[@PsychiatrySimplified]

Difficult to know the rationale but please have a discussion asking about the rationale.

[@3manifold]

​@@PsychiatrySimplified btw god bless you, you responded to all the comment😊

[@lifeAfterSSRIs]

I was able to quit sertraline with zero withdrawals thanks to exercising and drastically reducing sugar consumption. I had tried to quit sertraline at least 7 times over the course of 13 years, and had horrible withdrawals every time. When i finally succeeded, I was on my diet and exercise regimen and simply ran out of my medication because of procrastination. The withdrawals were completely gone. It was an unexpected result. I've been off the medication for four years now.

[@PsychiatrySimplified]

Thanks for sharing! Interesting. So the diet and excercise is what you attribute helped you?

[@lifeAfterSSRIs]

​@@PsychiatrySimplified Absolutely. I've had a sweet tooth my whole life and had never been into exercise. Those were the two variables that changed.

[@georgebordeaa]

@@lifeAfterSSRIsI have always been on a diet being a bodybuilder but WD hit me hard anyway. I am 23 months in protracted.

[@lifeAfterSSRIs]

@@georgebordeaa I'm really sorry to hear that man.

[@lifeAfterSSRIs]

@@georgebordeaa What really seems to do the trick for me is cutting out sweets and doing cardio. Cardio does something for me that weights just can't. But that is just my own experience.

[@azalia423]

I've noticed that many, many people using hyperbolic tapering get stuck.

[@PsychiatrySimplified]

True . Also the reason for doing this video

[@alexschrijnemaekers8067]

Wonderful as always! Cheers from Brazil, Dr. Rege!

[@PsychiatrySimplified]

Obrigado 🙏🏻

[@petergriffin680]

I still experience streaks of light out of the corners of my eyes on occasion. I never had this before treatment. It’s not painful but it definitely spooks me at times, but when I try to move my eyes to look at the lightning bolt-like lights I see, they disappear.

[@violet_fluid]

Me too! Omg, I was so scared. Plus I got floaters in my eyes.

[@lam7402]

I’m suffering over 8 years and it’s horrific , I’m afraid to move sometimes

[@PsychiatrySimplified]

@@lam7402 please see a doctor for a full evaluation. I’m sorry to hear

[@cboyer191]

Those withdrawal symptoms are the exact same withdrawal symptoms I had with Gabapentin. I was first prescribed Gabapentin in 1997 at 13yrs old after blowing out my knee and took it continuously until after recovering from my 7th surgery on that knee 6yrs ago at age 34. I'd been on the highest dose my doctor could legally prescribe for 2yrs prior to the last surgery. I hated the way it made me feel....icky is the only way I can describe how Gabapentin made me feel and it wasn't really helping anymore so without talking to my doctor or doing any research I just stopped taking it. I don't recommend quitting that way. I had the exact same withdrawal symptoms as the ones in this video...FOR A WHOLE MONTH. On the plus side(I guess?) after going through that it made the 7 days of absolute Hell of withdrawals from quitting heroin cold turkey seem like a cake walk(in retrospect, not at the time lol)

[@PerisK4]

Did you used to do heroin? Im curious about the comparison of withdrawal symptoms

[@raulleitao8865]

Excellent video. I am suffering from withdrawl symptoms from desvenlafaxine even being switched to prozac to mitigate the symptoms. My Dr don't believe me. What can I do? I am terribly lost. I give all my money to find a solution. Hugs from Spain. Please I need help.

[@PsychiatrySimplified]

Its difficult to provide advice as its an individualised approach. 1. Focus on sleep 2. In second part of video i discuss medications such as mood stabilizers or clonidine, prazosin etc which can be used depending on the symptoms one has 3. Discuss the above with the doctor - as it is important to differentiate between when withdrawal symptoms are becoming worse and may be overlapping with hyperarousal and agitation

[@jimwillmott6050]

Thanks!

[@PsychiatrySimplified]

Thanks for your generosity! Appreciate it 🙏🏼

[@safaasgari3115]

I'm dying every day. I was on many drugs for my OCD and then they misdiagnosed me with bipolar put me on many other drugs my life is over. It's been nine months. I am off my meds, but it's like nightmare😢 Akhatisia,anhedonia, cognitive impairment, insomnia, DPDR, racing thoughts, and severe mood swings،Hyper sensitive nervous system. Hyper salivation,horrofic nightmare.looping intrusive thoughts ,weird flash back from old memories and negitive feeling I never had them before starting medication. I'm getting worse every day. I can't take it anymore 😢😢 I really want to live, but I can't take it anymore. I am so close to suside everyday. Could you please help me? Most of my physical symptoms are gone, but mental ones are so severe and are changing every hour. I am afraid the reinstate can make things worse . To your knowledge what can I do?

[@PsychiatrySimplified]

Im sorry to hear. Please see a psychiatrist or a doctor to assess and treat the symptoms. The Hyperarousal or agitation is distressing and seeing a doctor / psychiatrist to discuss the severith may help. Pls seek medical advice

[@safaasgari3115]

@PsychiatrySimplified I did in the past, and they misdiagnosed me with bipolar disorder and put me on more meds that detoriate my situation. Also, I made tolerance poopout whodrawal medications made me like a robot and bl9cked my positive emotions.

[@sewwandi141]

kzbin.info/www/bejne/jmeQqmyhoZV4sNEfeature=shared

[@danielfreeman5222]

Hello my friend, Don't give up suicide doesn't fix anything. You were created for a purpose. These feelings are from the medication. Don't allow yourself to fuel the symptoms. It is hard but you can overcome. Believe in Jesus get a Bible and read what he wrote about you.

[@bambi3338]

It's terrible!! From my experience, doctors don't know or don't want to know about the horrors of withdrawal and invent more disorders, refer people to more doctors and then more medications and the nightmare continues!!

[@amitabh15]

Could you make a video on non medication based treatments for this condition?

[@PsychiatrySimplified]

No medication aspects I’ve touched on - sleep being the most crucial. One can try exercise, meditation , mindfulness or emotional regulation .

[@safaasgari3115]

Thanks. Your video is so complete in this field. Could you please prepare another video about the psychological aspect of whidrawal like racing thoughts. Looping intrusive thoughts more severe than my OCD, flasback thoughts, and derealization. Why is your brain reacting to every thought and catastrophizing

[@PsychiatrySimplified]

I’ve just released a video on overthinking. kzbin.info/www/bejne/Z3OwaXdtgJ13jrssi=v5SlSdKZcyisiTMe

[@OguChukwunyere-mt3qy]

thanks for your explanation, could have a column to discuss protracted withdrawals in psychiatry ? thanks

[@PsychiatrySimplified]

Protracted withdrawal is a label. The video covers protracted withdrawal in terms of the mechanism. It’s ultimately the symptoms that guide treatment. The video covers The steps needed to address the changes that occur after discontinuing SSRIs or if tapering is difficult. So applicable for all changes

[@Pedro73114]

Are there any supplementation strategies that can help alleviate SSRI tapering symptoms?

[@PsychiatrySimplified]

Now that have been specifically evidence based or recommended. However one may consider Zn, Mg B6 which helps in production of serotonin and melatonin. B6 in high doses can be neurotoxic so one has to be cautious. Other spectators to help sleep can make a difference

[@sashatodhunter7060]

Is it true the risks of withdrawal effects from some SSRIs/SSNRIS can be higher than from Buprenorphine?

[@PsychiatrySimplified]

Yes they can due to individual differences. A direct comparison is very difficult to know ofcourse

[@joannalee2572]

Great video ! I have to keep watching it to understand how to help my son . He tried Zoloft had very bad side effects, he can’t talk normal, only repeating words and very bad ocd. Can NAC help or other supplements? I just want him to be back to normal that he can talk normal . Thank you

[@Snowflake1374]

It's for real. 1 year off SSRI. Long term use. Severe WD, it’s like nothing normal, hard to describe in words. Inhumane. Symptoms like brain pain sensations, pressing, burning, electricity, vibrations, chemical terror. Pulsating along the spine and muscle pains. Can only walk shorter distances. Rapid taper almost c/t. Feels like brain injury. Neurological injury. Can we heal? Thanks for important information!

[@PsychiatrySimplified]

@@Snowflake1374 sorry to hear. this is treatable . Please discuss this with your doctor

[@Snowflake1374]

@@PsychiatrySimplified How? I tried reinstating too late got worse. As far as I know, protracted WD is not treatable, no fix exept going thrugh it = Hell.

[@PsychiatrySimplified]

@@Snowflake1374 please have a listen to the video again. Labels like protracted withdrawal dont need to a management plan. Reinstating in context of anxiety and agitation worsens the situation. Often it’s not pure withdrawal anymore - likely a combination of hyperarousal and agitation which needs to be treated accordingly. If anything provide the doctor will all symptoms so they can address them with a significant focus on sleep. Ps not advice

[@Snowflake1374]

Not treatable, no cure. I have talked to Dr’s. They said nothing helps (exept reinstatement if you’re too far out) and it can takes years. Tried reinstate, too late, got worse. Once you crash and is neurological dysregulated/injured. Only time can hopefully heal. In my case also iatrogenic injury. You can also call it neurotoxic injury or temporary brain injury.

[@Snowflake1374]

Not treatable. I have talked to Dr’s. Once you’ve crashed and it is neurological dysregulated/injury then Only TIME can hopefully heal which can take years. In my case iatrogenic injury as well.

[@PsychiatrySimplified]

A breeze ? Did you listen to the patient presentation later ?

[@sarahar616]

I did. I too have experienced these symptoms in the past however Cymbalta is on a different level of pure hell. Thankyou for sharing your knowledge on antidepressants ☺️🙏☮️

[@christopherhearn4600]

I'm hoping I can ask my GP to watch your video, I've been on maximum dose venlafaxine and Pregabalin and also tramadol, I live with severe withdrawal symptoms even though I'm taking the medication and so he wants to take me off all meds I have to say I'm petrified 😪 have a wonderful weekend and thank you so much for your videos 🫂

[@DiamondEyez456]

I fought with my psychiatrist to taper extremely slowly off Effexor..in a titration type of way. I already deal with fibromyalgia, and the fact that my GP who originally had me on the how to take care of my thyroid for at least eight years … so they were very bad things that happen. I know it’s been very scary… so that’s why I fought with my psychiatrist to allow me to taper and how I needed it, which was the smartest thing to do versus telling me to stop at 37.5 mg and then just giving me Prozac..😵‍💫😑

[@DiamondEyez456]

I fought with my psychiatrist to taper extremely slowly off Effexor..in a titration type of way. I already deal with fibromyalgia, and the fact that my GP who originally had me on the how to take care of my thyroid for at least eight years … so they were very bad things that happen. I know it’s been very scary… so that’s why I fought with my psychiatrist to allow me to taper and how I needed it, which was the smartest thing to do versus telling me to stop at 37.5 mg and then just giving me Prozac..😵‍💫😑 FYI, so many women are just tossed antidepressants when really they should be on hormone replacement therapy. It’s disgusting how many GPs will just toss antidepressants at women going through hormonal changes and really so many women have benefited from going on hormone replacement therapy and what they actually needed because that’s what was going on within their body. .. hormone changes. With the right hormone as you can equally get your dopamigetic and serogenic properties plus the added benefit of heart saving health ( unlike antidepressants that could actually put more strain on the heart), less joint pain, etc etc etc. Where is the antidepressant could just not do anything at all regarding so many different organs and systems in the body and just add more frustration for the things it’s not taken care of.

[@Mnichols374]

Im off now 14 months and its been hell how long does this take ? This is brutal the head pain and being out of my mind is so so bad what can I do? And the anxiety and terror is horrific.doctor took me off in a month after 16 years on zoloft at 100mg this is hell.

[@PsychiatrySimplified]

Please seek medical advice. If the symptoms haven’t resolved please seek medical input. I’ve covered why in the video

[@Mnichols374]

​@@PsychiatrySimplifiedi heard this can last a long time for the brain to find homeostasis again. This is like a brain injury.

[@jimwillmott6050]

Considering that SSRI withdrawal enhances noradrenaline, wouldn’t withdrawal from tapering an SNRI be worse since serotonin levels will drop while noradrenaline reuptake is inhibited at the same time as low serotonin increases noradrenaline?

[@PsychiatrySimplified]

@@jimwillmott6050 not necessarily. Venlafaxine as an SNRI has amongst the most prominent withdrawals as its SERT affinity is high. An SSRI after stopping or SNRI leads to a rebound NA increase via LC rebound. An SNRI such as duloxetine or desvenlafaxine has a SERT:NAT ratio of 10:1. After ceasing the SNRI the noradrenergic levels drop via the NAT activity being ‘restarted’.

[@jimwillmott6050]

Well what you described concerning increased noradrenaline explains my current withdrawal symptoms from a slow taper of duloxatine to 16.5mg (taken 1X/day 8:00AM). My anxiety is unbearable on awakening in a sweat. BP is elevated along with GI distress. Seems serotonin is too low relative to noradrenaline.

[@PsychiatrySimplified]

@@jimwillmott6050 sorry to hear. Was it prescribed for anxiety? With sweats yes it does sound like a noradrenergic rebound. Ultimately its the symptoms that we should focus on as the response to discontinuation is very heterogenous- in this case ensuring that sleep, Hyperarousal is addressed becomes important.

[@jimwillmott6050]

I’ve taken many different psychotropic drugs for 22 years for depression. More recently adderall, duloxatine and trazadone. I tapered off adderall and limit caffeine. Over 17 months I followed hyperbolic tapering for duloxatine from 60 to 16.5 mg. Trazadone from 100 to 15mg. My symptoms are almost exactly those of the young lady you showed in video except sleep has been good. Thanks for your concern and interest.

[@PsychiatrySimplified]

The description I've highlighted is the progression towards agitation - its likely not agitation as sleep is good -have a look at the video on anxiety vs Hyperarousal vs agitation

[@TinaMcinnes-k7l]

I am coming off of paroxerine. I take 1/8 every second day in the morning, 1/8 at night. It use to be 1/8 every morning. Its 5 week later and all the symptoms you describe i have. Im also on 12.5mg of quetiapine at night. So i sleep good. But those symptoms are aweful. Ill try asking my doctor if i can send your info to him. Any suggestions Thanks

[@PsychiatrySimplified]

Hope things get better for you

[@annien6913]

Does this information also apply to withdrawal from mirtazapine and bupropion?

[@PsychiatrySimplified]

The principles of allostatic load and homeostasis apply to all situations where we are making pharmacological changes. Mirtazapine has prominent antihistaminergic activity hence historic rebound can occur as opposed to Serotonergic rebound. Having said that Mirtazapine also has anti anxiety effects via serotonin antagonism so removal of that can lead to a rebound. Bupropion is activating via NA and DA potentiation with nicotinic receptor antagonism - so activating agents when removed tend not to have a rebound - but a deficit . Hope that makes sense. So bupropion does not typically have a rebound withdrawal like SSRIs do

[@stonecoldkramer567]

Do you know the cause of Brain Zaps during SSRI/SNRI withdrawal? They're quite worry some at times.

[@cookcookkkkk]

They dont. Theyre clowns within the medical profession.

[@naomimara3340]

He covered it all in video. You can't expect him to answer 100% of questions. It's already extremely rare and kind that he is responding to so many.

[@amitabh15]

So how can this be treated? The biggest mysteries of all?

[@PsychiatrySimplified]

I've covered the principles of treatment in the second half of the video

[@jerryholdcroft4607]

Day 6 of my dose reduction and I'm feeling slightly light headed and fuzzy headed at the same time, my general mood has lifted slightly, there is some slight nausea but not drastic, I did wonder if the thought (even subconsciously), of dose reduction, which I have associated with the chance of an improved lifestyle, if there is some sort of placebo effect in play?. I intend to include the sugar reduction and exercise regime (afarp) in my plan based on what others have said, watch this space!

[@PsychiatrySimplified]

Good luck

[@jerryholdcroft4607]

Day 9 of dose reduction, I'm not sure alternating 50mg and 100mg is proper tapered withdrawal but it was recommended by my GP who asked me to contact him after 2 weeks, I still have light headedness and slight nausea, a touch of irritability on occasions. Sleep is still good although I'm waking very early, there does not appear to be much difference in emotions or libido yet (still blunt) but I'm assuming its down to the long term conditioning of 100mg over 14 years. It's actually, on the whole, quite promising at the moment, as I half expected neural fireworks and psychotic crashes, but I still have a fairly boring life (which is actually a good thing in these circumstances!)

[@jerryholdcroft4607]

Day 15 of dose reduction and I'm having some notable changes. The irritability is still there much of the time and often this leads to angry thoughts, which do seem to be overreactive and not driven by any significant emotional response, these instances also can lead to increase in headaches. One worrying development is the bouts of despair I feel, which seem to be increasing, I first thought it might be the depression returning but the feeling is not deep and is usually a momentary thing, as my well established philosophical reasoning (SSRI disassociation) resolves the issue (anxiety and poor mood). Sleep is being disturbed by waking very early and not being able to simply drift back into it as most people do, I have to lie awake and wait for self meditation to work or if that fails simply get up and have a nap later in the day.

[@SunshineLaundromatonVine]

​@@jerryholdcroft4607 any update

[@critter4004]

I feel like if ANY person considering taking antidepressants would watch this video first... they'd have second thoughts. Should be required!!!

[@PsychiatrySimplified]

As a caveat - there are a range of antidepressants - which differ in the propensity of withdrawal with some having a minimal withdrawal propensity.

[@kalaiselviramaiah3854]

Thank you for your time explaining pls do continue especially methods on tapering benzo and clozapine tks

[@roslynross-u5g]

I've been cold Turkey off luvox which I was on for 17 years, my doctor told me to stop taking them, I'm going through horrible withdrawal, is there anything I can do to help these symtoms, ive been off them for 4 weeks, how much longer is this going to take😢

[@PsychiatrySimplified]

Gradual tapering is recommended. Cannot provide advice but the recommendation is to gradual taper and not stop immediately

[@roslynross-u5g]

@@PsychiatrySimplified I've been off them all for over 4 weeks now , so I'm guessing it's a bit late for a slow taper.

[@ivanjakus6421]

Any advice when quiting luvoxamine, i am on 4th day. This is hell! Ty ony any advice

[@PsychiatrySimplified]

Please listen to the latter half of the video - the patient experience and management . The trajectory of discontinuation that is not resulting in significant allostatic load should be a downward trajectory. If it’s not improving or getting worse- look at the key aspects to look at - sleep, arousal, agitation etc. one may need to address that to ease the process . Otherwise this distress acts as a load worsening the cascade

[@ivanjakus6421]

​@@PsychiatrySimplifiedcan you somehow simplify what did you mean with this, i am croatian, even when I translate can not understand what you mean to say. Hoppefully not to treat simptoms with other drug? Much love from Croatia

[@PsychiatrySimplified]

Does this help ? Ako doživljavate prestanak uzimanja SSRI-a, obratite pozornost na drugu polovicu videa u kojoj raspravljamo o iskustvima pacijenata i kako upravljati simptomima. Idealno bi bilo da proces povlačenja s vremenom postane lakši. Ako se vaši simptomi ne popravljaju ili se pogoršavaju, usredotočite se na ključne čimbenike poput spavanja, uznemirenosti i tjeskobe. Rješavanje ovih problema može olakšati proces odvikavanja, inače bi stres mogao pogoršati stvari.

[@ivanjakus6421]

@@PsychiatrySimplified omg, you are the best! Can I make up somehow? Here doctors are brutal, they blame patience for everything, never mentioned side efects, so thanks from bottom of my heart. If you ever go to Croatia, you have to stay in me! Lovr

[@PsychiatrySimplified]

No problem! Hope you feel better soon

[@Kieran-og1ev]

Interesting video, refreshing to hear something different about withdrawal after years of reading the same advice. I wonder if you can make a video about withdrawal from amitriptyline/elavil/TCAs in general? I know there is a lot of crossover but as you mention in this video, the anticholinergic aspect of some medications add another level of complexity to withdrawal. A video on regaining homeostasis after withdrawing would also be helpful. Thanks for the attention to a topic which sorely needs it!

[@PsychiatrySimplified]

Thanks for the feedback. The rrgaining homeostasis principles I've covered in the latter half of the video. The cholinergic rebound would have different symptoms (overlaping) which have similar principles in management.

[@jellyfish1093]

Very good explanation. Can you explain why some experience tinnitus when going through withdrawal? Thank you

[@PsychiatrySimplified]

Tinnitus is a common symptom that can occur as part of hyperarousal / salience network activation. This can occur usually because the because the executive control network is unable to inhibit the default mode network hence resulting in self-referential symptoms part of which can be tinnitus. The salience Network activation which manifests as hyperarousal can result in a heightening of internal signals for example - sensitivity to sounds, visual disturbances or symptoms such as tinnitus. We become more acutely aware of internal signals ( which are normally kept inhibited ) when the default mode network is dysregulated. this dysregulation occurs due to a combination of salience Network activation and executive control network struggling to inhibit the DMN and SN.

[@jellyfish1093]

@@PsychiatrySimplified thank you so much for explaining this

[@stevie_89]

Thank you for this very informative video. I was prescribed an anti-emetic (compazine - an anti psychotic) during my SSRI discontinuation for the severe dizziness, and got severe akathisia which persists two years later. I am wondering if you can give more detail on why you have recommended D2 blocker anti psychotics to address agitation, as the opposite happened for me. Could you address the akathisia risk with these medications? Clonidine has been recommended to me but I'm too terrified to try anything now. Would love to know your thoughts, thank you.

[@PsychiatrySimplified]

Prochlorperazine is a D2 antagonist - ones to reduce agitation are low dose D2-5HT2A antagonists with antihistaminergic effects - such as quetiapine , olanzapine mainly. Severe akathisia may be part of the agitation- the motor agitation. Issue is akathisia has a very specific definition and if it’s persisted after AP has ceased this is unlikely to be akathisia by the definition of a AP induced SE . In these situations it becomes crucial to address symptoms based on phenomenology and not labels. There is no one size fits all here and it’s very individualised

[@stevie_89]

@@PsychiatrySimplified thank you for taking the time to reply. 🙏 I am in Australia and have been unable to find a psychiatrist or neurologist who knows about this and can help me. I am one of the cases who have cascaded and I'm unable to taper. Can you recommend anyone who would see me in Aus? There are a community of akathisia sufferers who have not been able to resolve their symptoms after drug cessation, while less common Seroquel and Olanzapine have caused akathisia for some, along with Abilify, Latuda, benzo and SSRI withdrawal. More drugs seem to make most of us worse. It's a dire situation and any attention to it is much needed. 🙏

[@stevie_89]

I have emailed your clinic although I am not sure if you are still consulting . Thanks .

[@stevie_89]

You have said this is highly individualised but most psychiatrists have absolutely zero idea about this and so certainly cannot tailor an individual plan, and you don't take patients or have a list of recommended psychiatrists. Where do we go with this valuable information? Chat gpt has given me more information than any psychiatrist ever has been able to give on my situation. There are some dopaminergic properties to Clonidine that make it a risky option if your akathisia is caused by dopamine depletion and there is no doctor to clarify this with because they don't understand this level of detail.

[@joelrivardguitar]

I have a variant of tardive akathisia (inner agitation with depression) from Venlaflaxine. I tapered 5 years ago and it started after I tapered. Clonidine is useless for me. It's nice to have for nights you can't sleep or something like that. No meds, exercise, meditation, good diet, anything, helps long term except a benzo. Exercise helps while I'm training but the effect doesn't last. Lorazepam completely stops the agitation/depression and anxiety. I just take it in the evening and suffer a bit during the day. Being active during the day helps minimize it but it's completely impossible at night to sit and focus on a task mentally without some help. So search up Dr Stewart Shipko, he has 9 articles on Mad in America. All about this topic and his experience treating people who feel they have some sort of long term condition after tapering SSRI. So it's an informed position based on experience. He gained a reputation as a specialist in this so people sought him out. I find he is exactly correct on every single aspect. It's like he was reading my mind. I was on a waiting list for a psych after my doc had me try Buspirone and Clonadine and then was like "see ya" after that didn't work. I told her only Ativan helped but she wasn't interested. At the time I was only taking it every 2-3 days because I had to ration it. I knew it worked because I had some from an old script for flight anxiety. Then had to do what I had to do to get it. There is no other option. Thankfully my psych had a sense of ethical responsibility to not let people suffer.

[@richwoodcutterbro8581]

Could it be that adding bupropion to sertraline before I reduced sertraline and then stopped eases my withdrawal then, given that bupropion should activate noradrenaline?

[@PsychiatrySimplified]

Difficult to say. Noradrenergic potentiation plays a part in withdrawal so adding bupropion in the context of noradrenergic withdrawal may worsen things but also noradrenergic and dopaminergic potentiation allows one to control the emotional heightening.

[@richwoodcutterbro8581]

@@PsychiatrySimplified yes i see, i guess timing may be crucial here. My dreams have been incredibly vivid as you suggest in the video. Not nightmares but real enough to wake me several times int he night.

[@ansnfbsknanssshshbsnsndnd5438]

I can't get of 10mg Celexa even tho it's such a low dose. :/

[@PsychiatrySimplified]

@@ansnfbsknanssshshbsnsndnd5438 it is the drop at the lowest doses where the withdrawal symptoms are more prominent as the cursive is hyperbolic . So drops are more prominent as the lower doses go to even lower

[@johnhendel7357]

I got that feeling for no reason. Live with it everyday and night for years.

[@amitabh15]

Are you aware of anyone who’s fully recovered from withdrawals using this method? Curious. Protracted withdrawal syndrome is FND. But if there’s a way to rescue it, then why not. After all FND itself is fully reversible.

[@PsychiatrySimplified]

Which method? There isn't one method - its applying basic principles of treatment. And yes, individuals improve and can be treated better. In many cases, what is being considered withdrawal can be agitation - and treatment of agitation is effective.

[@haramsabandoz1847]

So which rebound is more likely on paroxetine withdrawal? noradrenaline or acetylcysteine ? Or is all about receptor 5-ht1a ?

[@PsychiatrySimplified]

Paroxetine as I mentioned in the video also has anticholinergic effects so cholinergic rebound occurs along serotonergic aspects

[@haramsabandoz1847]

Ok but what should i do doctor ,please help me 😢

[@ethanlubell4774]

Also I disagree regarding clondiine. Yes onboarding the SSRI can increase agitation initially but that’s short term. Long term it reduces it. That’s why clonodine is just making the symptoms while the SSRI reduces them long term

[@PsychiatrySimplified]

Thanks for your comment. I’m not sure what you mean by disagree? With which part? SSRIs do not treat agitation and can worsen it. They treat the anxiety paradigm. Big difference. That’s why in treating depression guidelines clearly say - caution with SSRI or ADs as can increase agitation. Pls see the video on anxiety vs hyperarousal vs agitation. 3 different constructs. Every single person’s withdrawal experience is unique. Did you see the common neurobiology of NE rebound. It’s the symptoms that tell us the expression of the underlying dysfunction and clonidine targets the most prominent one of sleep dysfunction , REM rebound. It’s not about agreeing or disagreeing - it’s what is infront of us and what we need to target. Not every single person can substitute an SSRI and reach the state they desire during withdrawal. I’ve seen the sever end of the spectrum when the cascade continues to worsen.

[@MichaelONeill-s6u]

Thanks for sharing this Dr Rege do you think the same principles apply with mirtazapine I have been tapering for 3 years from 45 mg to 9 mg and the withdrawal have been consistent I was prescribed it for anxiety but it only made it worse listening to your video makes a lot of sense to me years of stress and pain

[@PsychiatrySimplified]

Yes it does - except that mirtazapine has hiataminergic rebound and serotonergic via reversal of the 5HT2A antagonism.

[@MichaelONeill-s6u]

@@PsychiatrySimplified Thanks for your reply any advice please

[@amitabh15]

Which out of the medications you recommended works on noradrenaline pathway reduction? My GP asked, I showed him the video, he asked if I could message you to clarify.

[@PsychiatrySimplified]

I would recommend focusing on the symptoms. If nightmares, sleep disorientates. Vivid dreams , unrefreshed sleep - prazosin or clonidine Note benzodiazepines also do this but come with their own issues If agitation is present - this is the severe psychomotor restlessness - then low dose AP may be needed. Please also see video on anxiety vs hyperarousal vs agitation Moreover please note the entire symptomatology needs to be addressed - I.e if depression is present then simply addressing sleep won’t resolve situation. Ps not advice

[@amitabh15]

@@PsychiatrySimplified okay, what would one do for comorbid depression with SI’s?

[@boburuncle41]

I got put on 300mg per day of Effexor after detoxing from prescribed Oxy for back pain. I have given up any hope of getting off Effexor through the medical system. Im 61 and the trauma of coming off medications in a medical setting with Doctors explaining that its(detoxing) like "the flue symptoms" more than once is beyond any excuse of medical ignorance. I always thought doctors should experience coming off of meds as part of their schooling. It would clear up a lot of the problems with the pharmaceutical industry. I remember the compounding pharmacist could not understand how I could be so effected by with drawls. I dont believe these patient issues have anything to do with science but more to do with money. I dont buy into the system not taking responsibility and pleading scientific ignorance on the topic of depression and anxiety. Im looking into theraputic Ketamine or Mushrooms. That science has been around forever but yet, we get told "its dangerous" while choking down meds for our whole lives in western culture. Oh but, "they have been clinically trialled so are safe" Yeah, right

[@jerryholdcroft4607]

My GP has advised me to drop to 50mg Sertraline per day from the 75 mg (100/50mg) for a week then start taking 60mg Duloxetine which is an SNRI, I presume to kick start my reaction deficit?

[@jerryholdcroft4607]

After week of 50mg dose, I am now suffering from some insomnia, I can't switch off and my head is buzzing all the time. I have flu like symptoms and headaches. I'm feeling increasingly depressed which is causing bad moods and a low outlook on life. I do hope changing to 60mg Duloxetine in a few days is going to make a positive difference!

[@ryanpellico6083]

Would this be problematic for mirtazapine abrupt discontinuation via 5ht2c or the alpha 2 antagonism or are they both problematic

[@Medsyria1]

Dr is there a difference between MDD and PDD in management?

[@PsychiatrySimplified]

Sorry whats PDD? Persistent delusional disorder? Or...

[@Medsyria1]

@@PsychiatrySimplified Dysthymia

[@PsychiatrySimplified]

Yes dysthymia - often tends to have underlying psychological aspects - this requires an understanding of childhood experiences for a formulation. MDD itself is heterogenous and has various presentations

[@WileCoyoteMoncure-Smith]

I know I have missed a dose or lost a bottle when these sensations begin to come on.

[@PsychiatrySimplified]

Yes for many that is the case

[@chrishobson6844]

Hey, Dr. Sanil, have you ever considered making a video about Viloxazine (Qelbree)? It seems to have an interesting mechanism of action, but there are not many videos about it.

[@PsychiatrySimplified]

I’ll add to the list. Thanks for the suggestion

[@3manifold]

So it's different to person to person?also will this resolve in short term? What about protracted wd?

[@PsychiatrySimplified]

I’ve covered that in the video - it’s the symptoms that should be discussed with the doctor . Ultimately it’s not about labels but how to address the symptomatology and distress.

[@annaskinner7187]

Excellent video, very informative and high quality! I had that "toxic" effect from increasing Mirtazapine dose after a gradual decrease. My supportive therapy is Pregabalin 150mg.

[@PsychiatrySimplified]

Thanks for the feedback. 🙏🏼

[@bambi3338]

From my experience, doctors don't know or don't want to know about the horrors of withdrawal and invent more disorders, refer to more doctors, then more medications and the nightmare continues!! All these drugs are Russian roulette.

[@9mm11a1]

This remind me of meth withdrawal

[@PsychiatrySimplified]

Yes principles are similar. Methamphetamine also has significant serotonin potentiation and hence can have a similar effect after stopping in addition to the NA and DA aspects

[@josephdavis8094]

Size more. Famuly

[@ethanlubell4774]

This is why people like mark horowitz are wrong. Hyperbolic tapering can be dangerous for some. The people who successfully come off their meds are because they do the underlying work while on meds and know how to keep calm during withdrawal symptoms. The withdrawal itself doesn’t dramatically increase allostatic load it’s our reaction to it that does

[@PsychiatrySimplified]

Yes it is correct - but the reaction to it however is embedded in our fear responses which may have multiple other etiologial underpinnings - personality styles, trauma , medical conditions etc

[@GuovannaLee]

These are only a few symptoms you've mentioned

[@PsychiatrySimplified]

The expression of symptoms is heterogenous. There can be multiple expressions within the FINISH domains. Also it’s not for us to decide how the amygdala rebound expresses itself. The symptom expression in a video or in. Textbook will never be exhaustive

[@rosmarbal]

Mark is a psych registrar. Still training with limited real world experience. Makes a lot of claims that in practice don't compute/work.

[@ethanlubell4774]

@@rosmarbal Yes he spreads alot of bad information online in my opnion. His maudsley deprescribing book has bad info in it. The rate at whcih he recomends comming off these meds is so unnecessary and can cause alot more harm