Do Antiperspirants Cause Breast Cancer?

This morning someone flicked an article about the connection between antiperspirants and breast cancer onto my Facebook page, along with this illustration. 

I stopped using antiperspirants some years ago (except for those occasional social events where sweaty armpits would be likely, and definitely not considered a social asset), after my mother’s lymph nodes were removed as part of her breast cancer treatment. It just didn’t seem to me a natural, sensible thing to go clogging up the pores that Mother Nature so carefully provided for my body. So my natural response to this little Facebook post was to click the thumbs up and hit “share”. And then I thought this would be a good topic for a post here.

Now, I don’t post stuff on this blog—unless it’s about personal experience--without doing a bit of research on the subject first. That’s my science training coming to the forefront. So I set out to discover (as much as one can in a couple of hours): Can antiperspirants cause breast cancer? And this is what I found out.

The short answer is: we don’t have any proof that antiperspirants cause breast cancer. But, on the other hand, we don’t have any proof that they don’t either. The truth is, there isn’t enough research into this question to give us a definitive answer.  Here’s what we DO know:

The lymph nodes located in the tender area under the arms are connected to the breast tissue, and in the case of breast cancer are often surgically removed along with breast tissue. Lymph nodes, which as you can see in the diagram on the left, occur all over the body and operate as part of the body’s immune system, filtering, trapping, and destroying bacteria, viruses, and other pathogens, including cancers. Cleansed fluid from the lymph nodes is then released into the blood stream. But the lymph glands are not sweat glands, they are not directly linked to the skin surface, and they probably are not directly affected by antiperspirants. Sweat glands, on the other hand, are.

Most antiperspirants contain aluminium, which blocks the body’s sweat glands where it is applied. Sweat is a salty liquid excreted by the eccrine glands in response to stress (which can be physical, like exercise or heat, or psychological). It has little or no odour[i], but develops a smell with the presence of bacteria, or sexual pheromones[ii].  

Blocked sweat glands do not cease producing sweat, they simply are unable to expel that fluid to the skin’s surface—as they are designed to do--because the duct has been blocked. Besides causing the disruption of a natural bodily process, the aluminium in antiperspirants is a concern for another reason.

Aluminium is a toxic metal that has been linked to cancers, including breast cancer[iii]. One recent study shows changes in human mammary cells indicative of tumour and pre-tumour stages caused by exposure to aluminium chloride[iv], and another recent study showed elevated levels of aluminium in the nipple duct fluid of breast cancer patients compared with that extracted from healthy women[v]. Earlier studies noted the disproportionate number of breast tumours occurring in the upper outer quadrant of the breast, closest to the underarm area where antiperspirants are applied, and where the concentration of aluminium is highest[vi]. None of this research is adequate for “proof” that the aluminium in antiperspirants causes breast cancer, but there does appear to be a correlation. And obviously, breast cancer can be caused by other things as well.

Among those “other things” are parabens, a group of man-made preservatives commonly used in antiperspirants, deodorants, shampoos, and other skin and body products. Parabens can mimic estrogens in the body. Although the female body naturally produces estrogens during the reproductive years, high life-time levels of estrogens are correlated with an increased of risk of breast cancer[vii]. In one recent study where they collected and examined malignant breast tissue following mastectomies, 99% of the samples revealed the presence of parabens[viii]. Not all of the women in that study had used antiperspirants (although they may have used other products containing parabens), but of those who did, the greatest concentration of parabens was found in tissue samples taken from the outer, upper quadrant of the breast.  This doesn’t mean that the parabens caused the women to develop breast cancers, it just suggests there is a correlation. In spite of these concerns, there have been no modern toxicology studies examining the safety of parabens.

Back to the underarm lymph nodes:  It seems unlikely that the substances in your antiperspirant actively affect your lymph glands. Lymph glands deal to infections and undesirable biological organisms like bacteria, but they don’t clean out toxic metals or play with artificial hormone mimics. It seems likely that cancers that develop in the breast area migrate TO the underarm lymph glands from the breast rather than the other way around, and that the lymph glands are trying to mitigate the cancer cells. Nevertheless, research DOES suggest that using antiperspirants containing aluminium and/or parabens may increase your risk of developing breast cancer because of their effect on sweat glands and through skin absorption.

For another good summary of these issues, see Dr Mercola’s article on parabens, aluminium, and the breast cancer link. For the “official” story, the American Cancer Society reports “no link between breast cancer risk and antiperspirant use”. You can read their debunking of this “myth” here.

Meanwhile, I’ll continue to use soap and water and forgo spraying or smearing chemical concoctions under my arms.

---

[i] That’s what the literature says. I DO think the foods you eat play a part. I know some foods, like garlic and curry, make me smell a little pongier than usual the day after I’ve eaten them. Just my personal observation.

[ii] http://dermnetnz.org/treatments/antiperspirants.html

[iii] http://www.infowars.com/new-study-reveals-how-aluminium-promotes-cancer-growth/

[iv] Sappino, A.-P., Buser, R., Lesne, L., Gimelli, S., Béna, F., Belin, D. and Mandriota, S. J. (2012), Aluminium chloride promotes anchorage-independent growth in human mammary epithelial cells. J. Appl. Toxicol., 32: 233–243. doi: 10.1002/jat.1793 http://onlinelibrary.wiley.com/doi/10.1002/jat.1793/abstract;jsessionid=82FFF75E0138F8E3F80056B9EA064379.d03t03?deniedAccessCustomisedMessage=&userIsAuthenticated=false

[v] Mannello, F, Tonti, GA, Medda, V,Simone, P, Darbre, PD. (2011), Analysis of aluminium content and iron homeostasis in nipple aspirate fluids from healthy women and breast cancer-affected patients. J. Appl. Toxicol., 31:262-269. http://www.ncbi.nlm.nih.gov/pubmed/21337589

[vi] http://www.ncbi.nlm.nih.gov/pubmed/16045991

[vii] http://www.cancercompass.com/learn/cancer-information/breast-cancer/causes/estrogen-and-breast-cancer#connection

[viii] http://onlinelibrary.wiley.com/doi/10.1002/jat.1786/abstract?deniedAccessCustomisedMessage=&userIsAuthenticated=false

Weed Control in Wild(ish) Places

“All around us we see the bridges of life collapsing, those capillaries which create all organic life. This dreadful disintegration has been caused by the mindless and mechanical work of man, who has wretched the living soul from the Earth’s blood.”

--Vickor Schauberger

It bothers me that New Zealand’s Department of Conservation (DOC) and the Greater Wellington Regional Council (GWRC) seem so hell-bent on eradicating—by whatever means--some 300 or so plants that they have identified as “noxious weeds” from wild and semi-wild areas. Cutting, rooting out, spraying with herbicides and ring-barking are all recommended methods. The majority of these plants they define as “weeds” have simply expanded beyond people’s gardens into wilder areas. (See the weedbusting booklet put out by the GWRC,  DOC's list of invasive weeds, and common weeds in New Zealand.)

Cathedral Bells growing over pine tree debris.

For some of us, the border between “tended garden” and “wilder areas” is fuzzy. I recently moved to a quarter-acre hillside section that backs onto a gorgeous tract of native bush. My neighbours’ properties do the same. At one point not long ago, but before we moved in, a sizeable area out back—on our property and adjacent properties—was covered in pines, and these had been cut down and harvested for firewood maybe a year or two ago. Now that area is a steep and sunny—and potentially unstable—slope.  I’ve been watching with some delight over the summer as new plants of many varieties have sprung up to colonize the area, creating a new and interesting ecosystem.  I know as well that the roots of each plant help to stabilize a steep landscape. It has been fun seeing what naturally appears, how Mother Nature heals the scar and regenerates life. I’ve planted a couple of trees as well, on our side of the property line.

Blue morning glory
(photo from Common Weeds of New Zealand)

Many of the plants that have come up clearly fall under DOC’s and WRC’s list of “noxious weeds”: blue and white morning glory, cathedral bells, blackberries, banana passionfruit, arum lilies, broom, foxglove, clematis, agapanthas, a variety of grasses, thistles. The latest “infestation” is a 5-foot-high “sea” of weedy/flowery “things”—I have no idea what they are—that the bees  love.

A couple of weeks ago, two fluorescent-clad fellows appeared on my doorstep asking if they could use our property to access this regenerating area as part of their annual weed-control program.  I don’t remember now if they were from DOC or WRC. I confessed to not being all that happy about seeing the new plants destroyed as they help stabilize the slope and create an emerging ecosystem. Plus, I garden without chemicals, and I didn’t want to see the back of my lot sprayed with herbicide. So I declined to give them access.

A few days ago, I spotted the two fluorescent-coated men again, this time coming down the slope from a neighbour’s property up the hill. They’d hacked through the brambles and vines with cutters and saws, and sprayed great swathes of greenery, although they did not come down onto our property. The wind was blowing from that direction, and I overheard one chap remark to the other about the number of bees the area was supporting, and I thought—but can’t be sure—he was questioning the sense of spraying flowering plants that were being tended by the bees. I didn’t hear the response; they carried on with their task. Now, a few days later, I look out the bedroom window at a hillside that used to be verdant green and covered in flowers, and I see big brown patches of dead vegetation in the sunny, open area of the slope, and the trees along the verges are covered in hanging clumps of dying, browning vines.

It makes me both angry and sad to see Mother Nature’s attempt to heal a slash in the landscape thwarted by the poison and cutters of so-called "conservationists".  I recognize that in New Zealand, the word “conservation” seems to refer to wanting to create some imaginary, unchanging, unchallenged pre-European utopian landscape. Those who work in “conservation” here are really more operating as “gardeners”—picking and choosing, pruning and poisoning to create what they deem is “best” for our naturally wild and wildish spaces.  Any plant that is an "import" to these isolated islands is suspect, and creepy, crawly, sprawly, viney plants seem to be particularly demonized. I am sure their intentions are good, but I think these "conservationists" are playing God in a most foul way. I trust Mother Nature knows what she's doing, and knows how to heal the land when it has been altered. She could glory in the diversity we have brought into her playground. Why do we insist on making it so hard for her?

See my previous post on this topic Conservation: What’s in a Word?

Fluoride in Your Water?

The issue of water fluoridation comes up from time to time, and I’ve been figuring for a while that I should know more about this issue, so I did a little digging. Here’s what I’ve found:

In New Zealand, a little over 60% of our country’s drinking water has fluoride added to it[i]. Here in the Wellington Region where I live, only Petone and the suburb of Korokoro have fluoride-free water.  According to the Greater Wellington Regional Council, fluoride is added to the rest of the region’s drinking water to bring it up to a level between 0.7 and 1.0 parts per million (ppm), at a cost of $195,000 annually[ii]. The 0.7-1.0 ppm figure is based on the Ministry of Health’s recommendation,[iii] a level they consider optimum for dental health. In the U.S., the recommended level is 0.7 ppm[iv].

Fluoride is an industrial chemical. The most common form to be added to drinking water is Fluorosilicic acid[v], a liquid by-product of the fertilizer industry. In Wellington they use sodium fluorosilicate[vi] which, being a powder, is easier to ship. Fluoride occurs naturally in some water supplies, especially in volcanic and hydrothermal areas[vii].  

Fluoride was first added to a municipal water supply in 1945 when Grand Rapids, Michigan (USA) became the first city in the world to have artificially fluoridated water. This followed an earlier dental discovery that teeth discoloured by unusually high natural levels of fluoride in some local water sources were also unusually resistant to decay. Further research suggested that if fluoride was added to pure water, and levels were maximized at around 1.0 ppm, the tooth staining (flurosis) caused by the fluoride would be minimal and white (rather than brown), and teeth might be more decay-resistant[viii]. By 1960, many cities in the U.S. had introduced fluoridated water.

Other than its [assumed] advantage for dental health—more on that shortly—fluoride is not advocated for any other health benefit. In fact, concern has been raised in recent years about the health RISKS of excess fluoride consumption. The US EPA (Environmental Protection Agency) sets a maximum safety level of 4 ppm[ix], which is twice what their senior scientist recommended (see the documentary Fluoridegate). The World Health Organisation (WHO) recommends a maximum of 1.5 ppm[x]. 

Excessive consumption—and it is cumulative in the body over time—can lead to an increased likelihood of bone fractures and bone pain, and in children can caused pitted teeth and cosmetic tooth damage[xi]. Although there have been attempts to establish whether or not drinking fluoridated water increases the risk of cancer, examination of population records has proven inconclusive. Rats, however, showed increased risk of bone and liver cancers when given only fluoridated water to drink (see Fluoridegate). Fluoride, when combined with aluminium, may be a risk factor in the development of Alzheimer's (see here); aluminium is sometimes added to drinking water at the same time as fluoride, or can leech out of cookware. And in a recent meta analysis of several studies, fluoride exposure was linked to lowered intelligence levels in children[xii].

One concern is that we get fluoride from other sources besides our tap water, and we cannot  as individuals easily monitor the amount of fluoride we are consuming. Most of us brush with fluoride toothpaste, and if you read the back of the toothpaste tube it will say in bold print something like: Do not swallow. Rinse well after brushing. Fluoride is, after all, poisonous. But how much lingers and gets swallowed with your saliva? Many mouthwashes also have fluoride. So do many soft drinks, sports drinks, wines, and juices. Tea leaves concentrate any fluoride that was in the soil, and if you make tea with fluoridated water you’re getting a double dose. Some pesticides that may have been used while your food was growing contain fluoride. Some drugs are fluorinated. If your water is fluoridated, and you drink more of it in the summer when it’s hot, you’re getting more fluoride than you might do if the weather is cooler and you drink less. So it’s hard to measure. One caution: if you are using infant formula, be sure to NOT use fluoridated tap water to mix baby’s formula as the amount of fluoride your baby is likely to consume will exceed safe levels[xiii].

Lastly, I’d like to come back to the central issue: does fluoridated water actually decrease tooth decay? If it does, then countries with a high percentage of water fluoridation should have lower levels of tooth decay than countries that don't put fluoride in their water. Yet of the top seven countries[xiv] with the lowest tooth decay rates, only England fluoridates some of its water (around 11%) according to the WHO. Meanwhile, New Zealand is one of just 11 countries worldwide where over half the population drinks fluoridated water. The other “50%+ fluoridated” countries are the U.S., Australia, Chile, Brunei, Guyana, Hong Kong, Malaysia, Singapore, Israel, and Ireland[xv]. In Europe, where tooth decay rates are low, only 3% of the population drink fluoridated water[xvii].  Surprisingly, the WHO has recorded a general drop in decay levels over time in all countries completely irrespective of water fluoridation.

Which begs the question...if fluoride is a toxic chemical, and fluoridation doesn’t make any difference to rates of tooth decay, but it does cause dental fluorosis; it may increase the risk of developing bone damage, cancer, and Alzheimer's; it appears to impair children’s intelligence; AND it costs the taxpayers money to add it to our water...why in the world are we letting this stuff be put in our water supply?

---

[i] http://www.fluoridealert.org/issues/caries/who-data/

[ii] http://www.gw.govt.nz/fluoride-2/

[iii] Ibid.

[iv] http://www.hhs.gov/news/press/2011pres/01/20110107a.html

[v] http://en.wikipedia.org/wiki/Water_fluoridation

[vi] http://www.gw.govt.nz/fluoride-2/

[vii] http://en.wikipedia.org/wiki/Water_fluoridation

[viii] http://www.nidcr.nih.gov/oralhealth/topics/fluoride/thestoryoffluoridation.htm

[ix] http://water.epa.gov/drink/contaminants/basicinformation/fluoride.cfm

[x] http://www.who.int/water_sanitation_health/publications/fluoride_drinking_water_full.pdf

[xi] http://water.epa.gov/drink/contaminants/basicinformation/fluoride.cfm

[xii] http://www.ncbi.nlm.nih.gov/pubmed/18695947

[xiii] http://www.health.govt.nz/our-work/preventative-health-wellness/fluoridation/fluoride-and-health/infant-formula-and-fluoridated-water

[xiv] These countries are Denmark, Germany, England, Netherlands, Switzerland, Belgium, and Sweden. http://www.fluoridealert.org/issues/caries/who-data/

[xv] http://www.fluoridealert.org/content/bfs-2012/

[xvi] Ibid.

[xvii] Ibid.

1080 Update

It’s been a little while since I’ve done a post on 1080, and I thought I’d share a few titbits that I’ve come across recently.

kokako

The latest issue (March/April 2013) of Organic NZ has an excellent article, “Beyond 1080,” by Rebecca Reider which unfortunately is not available online for free (although the whole magazine is, for a fee). Reider highlights the Urewera National Park story where possums are being controlled primarily by trapping, and to a lesser extent through use of poison bait stations rather than aerial 1080 drops, and she writes, “The proof of success is in the resurgence of birds: in one area of the park, in the mid 1990s there were eight kokako pairs, teetering on local extinction; now there are over 100 pairs.” She also notes the project provides some local employment. With possum fur fetching over $100/kilo, plenty of fit rural folks keen to run trap lines, and unemployment a significant issue for many, it is unfortunate that DoC (Department of Conservation) persists in their mantra that there is no affordable alternative to aerial 1080 drops. The article is a worthwhile read. (Actually, the whole magazine is a worthwhile read...I subscribe...)

Rebecca Reider’s beautiful and impassioned plea for the cessation of aerial 1080 in the Golden Bay area (north end of the South Island) delivered last June to Environmental Commissioner Jan Wright is mentioned in a previous post, but worth sharing again here:

And speaking of birds, with much fur flying over Gareth Morgan's anti-cat campaign, a letter to the editor in the DomPost the other day mentioned the disappointing lack of birds the author had noticed on a recent walk in Rimutaka Forest Park near Wellington. I couldn’t help penning a brief reply, which was published in the paper a few days later, asking if the lack of birds might possibly be linked to the aerial 1080 drop there a few months ago. (See my previous posts Planned 1080 Aerial Drop in Wellington’s Back Yard and 1080 Drop Near Wellington August Update.) It seems unlikely to me to be the result of a cat problem in the Rimutakas.

While looking up something else the other day, I stumbled across a wonderful article by Emily Davidow on Wellington water that compared the clarity, aroma, taste and flavour of water from a variety of Wellington sites. First place was awarded to a private Waikanae spring, with Lower Hutt tap water rating second. Water from the Buick Street bore in Petone—often touted as the finest water in the region—came 4^th out of their 12 samples in a taste test. Carteron’s tap water rated last: “Nasty” with a “Janola nose”.   The description made me chuckle. The author went on to give a big plug for getting the fluoride out of our water.

The 1080 connection to this water story came in a comment left by the author at the bottom of the post talking about taking a guided walk through the Wainuiomata water catchment area and learning about the 1080 drops there. “I was surprised to learn how much 1080 is aerial dropped over the entire catchment area, contaminating the water supply and entire ecosystem.” Click into Emily Davidow's article—if you live locally, it’s a delightful read—and scroll down to the comments to catch the rest of what she has to say about 1080.

I’ll end this post with a new Graf Boys video published about three months ago on 1080 drops being done by Waikato Regional Council. 

10 Tips for Making Antidepressant Withdrawal Easier

This is my third in a series of articles on this site about antidepressant withdrawal. Do seek medical advice before discontinuing your antidepressant, and unless you are on a very low dose, don’t simply quit taking it. Beyond that, here are some pointers to make the withdrawal experience easier.

     1) Don’t decide to discontinue your antidepressant if you are going through a particularly stressful period in your life. Antidepressant withdrawal can be a major stressor itself, and withdrawal symptoms seem to be more extreme if you are stressed to begin with.  And don’t enter into a stressful situation if you are in the middle of withdrawal. Just don’t go there.[i]

     2) Anticipate and assume it will go well, but be prepared in case it doesn’t. Studies suggest at least 20% of people have no problem getting off their antidepressant. Most people go through several days with mild to moderate symptoms when decreasing their dose. Physically you might feel a bit achy, dizzy, have a headache, and/or feel a bit nauseous. Emotionally you’re likely to be anxious and snappy—think PMT. You are also likely to feel tired. A few folks have a much rougher time. See my last post, and Dr Glenmullen’s checklist for a more complete list of possible withdrawal symptoms.

3) Get yourself a support team. Let your spouse/parents/kids, close friends, and possibly co-workers/colleagues know that you’re altering a medication and that you might not be quite yourself during the time it takes for your body to adjust. If you’re not going to get support for coming off the meds from someone, figure out how you want to deal with that issue before you start the withdrawal. Some folks believe that having withdrawal symptoms means you need to take your antidepressant.  It doesn’t. (That’s the same logic as saying smokers who have trouble getting off cigarettes need to smoke.)

      4) Even if you feel grotty, get out and get some exercise every day. Go for a walk, or a swim, or a bike ride, or a run. Take the dog for a walk. Shoot some baskets. Throw some snowballs at a tree. Get some fresh air and work your blood cells and heart and muscles a little bit. You will feel better for it. Promise.

      5)  Eat light and healthy. Increase your intake of vegetables and fruits to increase antioxidant levels. Don’t add a bunch of vitamins or supplements, though. Some folks have reported reactions to supplements during withdrawal. And listen to your body. If certain foods don’t agree with you, don’t eat them.

     6) Drink plenty of water. It not only hydrates your body, but also helps flush your system. I haven’t read anywhere about tea or coffee so can’t comment on whether they help or not. (If you have some experience with this, your feedback would be appreciated!) I’d say if you are a regular coffee drinker, going off coffee might give you coffee withdrawals (yup, they’re real) and that wouldn’t be good. Green tea provides antioxidants so that is probably a good choice. Follow your instincts here.

     7)  Avoid recreational drugs and alcohol during withdrawal. You probably won’t feel like drinking or doping during withdrawal anyway, but some people seek anything that might help calm them down if they get feeling agitated during withdrawal. If your emotions are bubbling, the last thing you need is something else to jerk your emotions around, and substances that loosen inhibitions can be seriously bad news if you’re a bit volatile or vulnerable to begin with. I know one ordinarily quiet and gentle person who, after several drinks during withdrawal, took off after his step-daughter’s boyfriend with a 2x4—the young man had enough good sense to run!

      8) Take up meditation, or at least learn the “Freezeframe” technique that comes from the Heart Math folks. Both are outstanding for keeping calm and lowering stress levels. Use them daily, more than once a day if you can.

      9) Laugh. Every day. Even if you have to pretend to laugh, laugh, and after a while it won’t be so “pretend”. Watch a funny movie or read a funny book. Take up laughter yoga. Laughter is good for your heart, your immune system, your blood flow, your blood sugar levels... Really, it has no downsides at all. And regular bouts of laughter WILL make AD withdrawal easier.

     10) Count your blessings. Be grateful, and be aware of being grateful. Do this every day, several times a day. When you appreciate the small, positive things in your life, you bring your attention to those things, and that helps your immune system, and helps your body to heal. Even if it’s hard to think of something positive, make the effort. Be grateful for a sunset. For the warmth and flavour in a cup of tea. For kind words from your spouse, a “well done” from your supervisor, a few hours of uninterrupted and peaceful sleep, for not feeling as dizzy today as you felt yesterday.  Really FEEL that gratitude. Don’t kneecap your gratitude by adding a codicil like “It’s about time!” or “I’m glad to feel better today than I did yesterday but I’m still sick and tired of being sick and tired.” Just focus on the good stuff.

If you haven’t read my other two posts on antidepressant withdrawal, check them out:

Antidepressant Withdrawal looks at what withdrawal effects may occur when you stop taking your antidepressant and why they occur.

How Long Does it Take to Get off Antidepressants gives tapering advice.

For more information on psychiatric drugs and alternative ways to understand and resolve a variety of mental health issues, see my new book Reframing Mental Illness.

  

---

[i] Frank Streicher did. He shares his story about what happened on his website: “after about 4 days off the stuff and at the height of withdrawal, I put myself in the worst possible position. I reffed a high school basketball game between two of the best teams in the city. I was partnered with the worst ref in the league, and the game went into double-OT. Packed gym, people screaming, coaches yelling. Big mistake. The things that people say that normally roll off you, hit you like daggers when you're in withdrawal. The losing coach (who I'm surprised is allowed to work with kids) wouldn't let it go and kept at us long after the final buzzer. I'm a big enough guy to have ripped this coach in two. It took every ounce of determination I had to turn and walk away from that guy. I'm not a tough guy, but had I turned on him, I'm sure I would have killed him. I was that frayed. I went home and trashed my bedroom. I laugh at it now because it was my only opportunity to act like a 70s rock star with a valid excuse. I had to go back on the drugs before I hurt someone.” Frank’s website, quitpaxil.org, is a useful resource. Paxil (Seroxat, paroxetine) is one of the harder antidepressants to get off.

How long does it take to get off antidepressants?

The short and flippant answer to this question is “how long is a piece of string”. But seriously...

If you’ve read my previous post about antidepressant withdrawal, you’ll know that experts all recommend a slow taper off antidepressants to mitigate unpleasant withdrawal symptoms. So, how slow is slow?

In his book TheAntidepressant Solution, Dr Joseph Glenmullen suggests initiating your withdrawal by dropping down to the next lower pill size and monitoring the symptoms of your reaction to the decrease, which tend to peak 5-10 days following the drop[i]. He recommends using a checklist to monitor symptoms and severity, which is available here. This is also a good list to check out if you just want to know what kinds of symptoms are likely with withdrawal, but don’t be too horrified—most people only experience a few of these.

Once you’ve made a drop, don’t initiate the next drop until you feel comfortably stabilized, usually 2-4 weeks later.  If you are taking more than one drug, don’t withdraw from more than one drug at a time.

So if you are taking 10 mg of Prozac (fluoxetine) or Paxil/Seroxat (paroxetine), you’d drop to 0 mg straight away. If you’re taking 40 mg of Prozac or Paxil/Seroxat, you’d drop to 20, then 10, then 0, thus three withdrawal periods. If you’re taking 150 mg of Welllbutrin, you’d drop to 75, and later to 0. As a general rule, Prozac—which lingers in the body longer—is easier to get off than Paxil or most other “short life” antidepressants. If you’ve been on a drug for only a few days, you probably don’t need to taper off it.

 IF the withdrawal reaction you experience from a drop is severe (i.e., seriously debilitating or dangerous[ii]), Glenmullen recommends resumption of the drug at the former dose and in a few weeks, commencing a slower taper. This means using a pill cutter (or a very sharp paring knife or razor blade) to trim your tablets or obtaining your antidepressant in a liquid form from your pharmacist which you can then titrate.

At www.paxilprogress.org  you’ll find a great internet support community where folks can ask questions, read up on the latest theories about AD withdrawal, and get support from others with antidepressant withdrawal experience. There, they recommend dropping your antidepressant more slowly, by 10% of your previous dose every 3-6 weeks. The PaxilProgress folks also believe withdrawal symptoms get more severe as you approach 0 mg.

I think it makes sense to try Glenmullen’s faster version first and, if you run into problems, you’ll know to slow down and decrease by smaller increments.  As noted in my previous article, at least 20% of users do NOT have any significant problems getting off their antidepressant.

My next blog entry offers 10 tips for making withdrawal easier.

For more information on psychiatric drugs and alternative ways to understand and resolve a variety of mental "illness" issues, see my new book Reframing Mental Illness.

---

[i] I am summarizing whole chapters of this book with this statement. Glenmullen incorporates several tables suggested how each particular drug and dose can best be stepped down, and lots of helpful information if you are having trouble. I recommend reading the book, especially if you experience difficulties getting off your drug(s).

[ii] That is, you are unable to function normally for a period of time (we’re talking more than just feeling like you’ve got the flu, which is common) and/or you experience suicidal or homicidal thoughts or hallucinations.

Antidepressant Withdrawal

Given I wrote a master’s thesis on this topic[i], it’s probably surprising that it’s taken a while for me to write a webpage article about antidepressant withdrawal. Or perhaps not so surprising, since this is a very big topic for a rather brief web page.

Firstly—and this is really important—if you are thinking about discontinuing your antidepressant medication, DO NOT do it cold turkey. That is, don’t just suddenly stop taking your medication. Nasty things can happen, and every doctor, every psychiatrist, every pharmacist, even the pharmaceutical manufacturers will tell you this. If you decrease your dose slowly, those nasty things are less likely to be overwhelming, and if you are fortunate, you might hardly even notice you’ve altered your meds. See my next post for guidelines on tapering your antidepressant.

Here’s why antidepressant drug withdrawal can be a problem. Neurotransmitters are the chemical molecules that allow your cells to communicate with each other. When you take antidepressants, you disrupt the natural function of your cells and how they use neurotransmitters to communicate. Most antidepressants target the specific neurotransmitters serotonin, norepinephrine (noradrenalin), and/or dopamine. The most popular antidepressants, SSRIs (Selective Serotonin Reuptake Inhibitors) such as Prozac (fluoxetine), Paxil (peroxetine), and Celexa (citalopram), target serotonin.

Nerve cells in your brain and body communicate by releasing these neurotransmitters into the tiny gap between cells where they can be taken in by the adjacent cell. Any extra neurotransmitters not taken up by the receiving cell are reabsorbed into the releasing cell. When you take an SSRI antidepressant, it blocks the releasing cell’s reuptake of unused neurotransmitter, leaving the excess serotonin in the gap between cells. This brief animation shows how they work.

Pharmaceutical companies have pushed the idea that serotonin is a “brain” chemical, but in actuality, only about 10% of the serotonin in your body is in your brain; the rest of your body’s serotonin—which is also a hormone--is in your digestive tract and blood where it helps to regulate your digestion and ensure cardio-vascular health (heart and blood).

It’s not clear how your body compensates for the drug’s action, but some researchers think the extra serotonin (or other neurotransmitter) in the gap means cells come to produce less serotonin over time; others suggest the drug-blocked reuptake receptors may decay from disuse; and still others suggest that cells may grow more reuptake receptors to help mop up the excess serotonin in the gap created by the drug. Whatever the case, when you remove that drug from your system after you’ve been taking it for a while, your system tries to revert back to its normal function, but the process of cell communication—not to mention digestion and blood/cardiac function--has now been physically altered by the drug. So your cells have to go through the whole compensation thing all over again.

Estimates suggest that 20-80% of people withdrawing from antidepressants will experience problems[ii] that may last a few days, weeks or months and can, in extreme cases, last years or result in resumption of the drug as the only viable way to alleviate long-term withdrawal symptoms. Some of the side effects of antidepressant withdrawal mimic symptoms of depression or anxiety. Others, like extreme fatigue, brain zaps[iii], bizarre and disturbing dreams, dizziness, hypomanic behaviour, and digestive upsets[iv] may be unexpected[v]. 

One of the most common responses to antidepressant withdrawal is increased volatility of emotions for a while: what used to make you somewhat irritable may suddenly cause you to erupt with anger, a moderately sad movie may reduce you to tears, and a pleasant activity may rocket you to euphoria. This will pass, usually in a few days, but it’s helpful for you, your family, and perhaps your co-workers to be aware that this is a drug withdrawal reaction and not “you”.

One reason why abrupt discontinuation is a concern is the small but significant risk of increased suicidality that may come with this increased emotional volatility, an increased risk that also occurs with initiation of the drug[vi]. This is also a good reason to consult your doctor before embarking on a discontinuation process. Doctors routinely monitor when you go on the drugs, but won’t know you are discontinuing them unless you tell them.

You should also tell the people you are living with (i.e., family) that you are decreasing your dose, and ask them for their support, even if your withdrawal symptoms are relatively mild. It helps if those around you can “cut you some slack” during what might be a somewhat challenging time.

Lastly, if you’ve decided to discontinue your AD, pick a time when stress levels are low. Don’t decide to discontinue your drug if you are feeling plagued by work stress, in the middle of a messy divorce, or selling your house—it won’t help!

In my next post on this topic, I share some guidelines for determining how fast you can comfortably discontinue your antidepressant.  You might also want to read my posts/articles on related topics:

Psychiatric Med Use Continues to Rise

The Serotonin Story

Where Did Prozac (Fluoxetine) Come From?

60 Minutes: Unhappy Pills

Anxiety and Depression 

For more information on psychiatric drugs and alternative ways to understand and resolve a variety of mental "illness" issues, see my new book Reframing Mental Illness.

---

[i] Collateral Damage: A Mixed Methods Study to Investigate the Use and Withdrawal of Antidepressants Within a Naturalistic Population. http://researcharchive.vuw.ac.nz/handle/10063/1501

[ii] http://www.psychologytoday.com/blog/side-effects/201107/antidepressant-withdrawal-syndrome

[iii] Brief, sharp, electrical-like sensations in the head

[iv] Very few people get ALL of these. Thank goodness!

[v] Details can be found in my thesis, but for a quicker and easier to read summary, here’s an excellent article by Christopher Lane from Psychology Today: http://www.psychologytoday.com/blog/side-effects/201107/antidepressant-withdrawal-syndrome

[vi] http://www.ncbi.nlm.nih.gov/pubmed/19758520 or, for a more dramatic summary: http://rense.com/general29/ei.htm