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.

  

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[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.

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[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.

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[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