Tag Archive: psychiatric treatment


“I forgot to take my medication for a few days and I thought I was going crazy…I thought I had the flu- given the headaches, diarrhea, nausea, vomiting, chills, dizziness and fatigue.  I have had insomnia, agitation, difficulty concentrating, vivid dreams, feeling like I just not myself, irritability and even suicidal thoughts. What the heck is going on?!?”

SSRI discontinuation Syndrome (or SSRI Withdrawal syndrome) is a condition that can occur following the interruption, dose reduction, or discontinuation of Selective Serotonin Re-uptake Inhibitors (SSRIs) or Serotonin-Norepinephrine (SNRIs) antidepressant medications. The symptoms often begin between 24 hours to 10 days after reduction in dosage or complete discontinuation, depending on the elimination half-life of the drug and the patient’s metabolism. While some of the prescribing labels of some SSRIs note the possibility of “intolerable” discontinuation reactions they are not commonly discussed and are sometimes mistaken by patients and physicians as worsening of psychiatric symptoms, or worse, dismissed as being imagined.  Unfortunately, some patients have extreme difficulty discontinuing use of SSRI drugs.  Discontinuation Syndrome tends to occur more frequently with antidepressants having a shorter half-life (Luvox, Paxil, Effexor, Cymbalta) than with longer-acting (Prozac).  The exact mechanism of SSRI Discontinuation Syndrome is unknown and is likely due to a variety of factors.

Symptoms that can occur in this discontinuation syndrome can include:

  • Dizziness
  • Vertigo
  • Lightheadedness
  • Difficulty walking
  • Nausea/vomiting
  • Fatigue
  • Headaches
  • Insomnia
  • Shock-like sensations “Brain Zaps”
  • Paraesthesia (skin crawling, burning or prickling)
  • Visual disturbances
  • Diarrhea
  • Muscle pain
  • Chills
  • Agitation
  • Irritability
  • Impaired concentration
  • Vivid dreams
  • Depersonalization – sense of unreality and loss of self
  • Suicidal thoughts

These symptoms last anywhere from one to seven weeks and vary in intensity from mild-moderate to extremely distressing for some individuals.  Studies now indicate that 35-78% of individuals who are on SSRIs or SNRIs for five weeks or longer, who then abruptly stop these medications or decrease their dose too dramatically, will develop one of more of these discontinuation symptoms.

To avoid these symptoms: Do not stop your antidepressant abruptly.  Take your medication regularly: in some of the shorter half-life medications, symptoms may occur in sensitive individuals who are a few hours late in taking their medications.  Talk with your provider about what to do if you miss one or more dose of your medication.  If you are experiencing any of these symptoms, discuss them with your provider as soon as possible.  SSRIs and SNRIs can be useful tools in the treatment of depression and anxiety; however, they must be adjusted and titrated with care and caution.  These discontinuation symptoms can frequently be minimized or avoided with proper planning and judicious titration and should not be taken as an absolute reason not to try such medications if deemed appropriate.

Advertisements

May is Mental Health Month. Established by Congress in 1949, this designation was made to help illustrate the importance of mental health issues to the overall health and well-being of American citizens.  While mental health care has changed dramatically since 1949, one thing still remains: the perceived stigma regarding mental health conditions.

Despite the availability of relatively safe and efficacious treatments for these disorders, many individuals fail to seek treatment for their mental health conditions.  Inadequate treatment of mental health conditions remain a significant public health concern: costing millions of dollars in lost productivity, absenteeism, and health care costs.   Existing barriers to receiving adequate mental health treatment include the availability of appropriately trained mental health providers, affordable treatment options, and perceived stigma.  Perceived stigma is the belief that people will devalue and discriminate against individuals who use mental health services and/or have a mental illness.

Perceived stigma can cause a variety of problems for individuals experiencing mental health conditions, including:

  • a delay or failure to seek appropriate treatment
  • premature discontinuation of treatment
  • rejection or ridicule by family and friends
  • discrimination at work, school, or church
  • inadequate health insurance coverage of mental health conditions
  • feelings of anger, frustration, shame, or low self-esteem
  • encountering harassment or violence

Mental illness was commonly thought of as a personal character weakness; we now know that mental health disorders have a biological basis and can be treated like any other medical condition.  Yet as recently as 2008, an APA survey revealed that more than 50% of Americans saw stigma and potential negative perceptions as barriers that would prevent them from seeking treatment.  While an estimated 75 millions Americans experience a mental health disorder in any given year, only one in four will receive treatment. Current lifetime prevalence rates for any mental disorder (including substance abuse) indicate that 57.4 percent of all Americans will personally experience mental illness at some time in their life.

Historically, the traditional medical model has separated mental and physical health; only recently is science “catching up” and revealing the multitude of “mind and body” connections.  We now know that our physical health is directly impacted by our emotional health; and that suffering from a mental condition can be a devastating and debilitating as any physical condition can be.

Despite the progress that has been made in correcting and removing many of the misconceptions surrounding mental health conditions, we still have a long way to go to defeat many of the biases, fears, and misinformation that people continue to have about mental health and the subsequent stigma these attitudes can create. By talking about mental health, we can raise awareness and dispel the stereotypes that exist about individuals with mental health conditions.

What can you do to fight the stigma?

  • Seek treatment– If you suffer from a mental health condition, don’t let fear keep you from getting relief by seeking appropriate diagnosis and treatment.  Safe and effective treatments are available.
  • Don’t define yourself by your disorder–  You are not “Depressed”, you are a person with depression.
  • Utilize available resources– seek out support and assistance groups such as Celebrate Recovery and NAMI. If you can not afford your medications, inquire about patient assistance programs.
  • Speak out and speak up– Your story may encourage someone else to seek the treatment they have needed but didn’t have the courage to ask for.
  • Don’t allow your mental health condition to cause you to feel shame or self-doubt– Mental health conditions are real medical conditions; they are not character-weaknesses or punishments.  By coming to terms with your own illness, you show others that their judgements are based on a lack of understanding rather than reality.  If you are having problems with negative self-esteem or shame, seek appropriate counseling to come to terms with these feelings.

5 Misconceptions About Therapy

I was inspired by Therese Borchard’s post today, “9 Rules for Survivng Therapy” to include some common misconceptions that I have encountered regarding therapy.

  1. Therapy is good for everyone:  Although Socrates said, “The unexamined life is not worth living”, it doesn’t follow that every person is ready to go through therapy at any given time.  Issues with psychological or internal resistance can be uncomfortable at best, and requires that the individual be stable and secure enough in one’s ego to tolerate such conflict.
  2. All therapy is the same:  There are many different types and styles of therapy (psychoanalysis, psychodynamic, Gestalt, Interpersonal, Cognitive Behavioral, Supportive). Most therapist practice a few different types of therapy, but generally have one therapeutic approach that is their primary focus. Not all therapists and therapies may be the right fit for all patients.
  3. My therapist is my friend:  This is a difficult one for many people. The therapeutic relationship is by nature supportive, non-judgement, and personal.  While the therapeutic relationship may feel “friendly” it is a one-sided relationship (whereas friendships are inherently two-sided).  Excepting certain revelations for specific therapeutic intent, the therapist doesn’t reveal much to the patient. This allows for therapeutic process of “transference” to occur (where the patient projects their own ideas and feelings about other people onto the therapist).
  4. Therapy should feel good:  Another common misconception is that therapy should leave the patient “feeling good” after each session, much the way a visit to a “spa” would feel.  The reality is that, while most individuals eventually feel better, therapy is hard work.  Most people will feel worse, perhaps disheartened, as issues are brought up and discussed; but eventually may feel relief as issues are resolved.
  5. Therapy should be easy:  While therapy may seem simple, it is very hard work and can emotionally draining.  It takes a great deal of courage for any person to face their “demons” and come to terms with the things in their life that may be keeping them “stuck”.