Terrible withdrawals from antipsychotic

[Evie81]

I'm bipolar and prescribed a combination of an anticonvulsant with well-known antidepressant properties and a second generation antipsychotic. I know I'm not supposed to mention names here so I'm hoping this is allowed.

I recently had a slight manic episode and, of course, the antipsychotic was pushed heavily again. I have no problem with this med other than it causes weight gain and massive withdrawal symptoms. In the past I quit this med because of these reasons but 'when all you have is a hammer, everything looks like a nail' to a psychiatrist, so round again you go.

I've now, unwittingly, missed two doses of the antipsychotic and I'm feeling like a junkie looking for a fix. So dizzy, nauseous, feelings of 'unrealness', difficulty focussing my gaze, motion sickness. The feeling can probably be best described as just stepping out of the fairground centrifuge, when your brain adjusts to its new reality of not being spun around and you're best off closing your eyes or you might vomit, but this 24 hours a day.

This is just 2 doses! I've spoken to my pdoc about this in the past as one of my objections for going back onto this med but it seems these claims are not being taken very seriously. He shrugged it off saying it was very unusual and it was only a small dose. Well, the dose is as large as I allowed it to be (he pushed for much higher and I told him he as joking) and these accounts of withdrawal are found all over the internet, so I know it is not that unusual . Either way, large dose or not, the effects are just the same.

Having these symptoms again makes me wonder if I should even be on this stuff. I recall the days when they said that benzos were not addictive. Oh oops, those were addictive. Wait, have some of these Z-class sleeping pills. Oh wait, those were addictive too. Now, here, have some second generation antipsychotics... only a matter of time you reckon.

Do any of you experience withdrawals even at small doses and how did you approach this with your pdoc?

[Nurse_Jenn]

Hi Evie81,

Thanks for posting on the forum. I am glad you are reaching out for some support for the symptoms you are describing when reducing your medications. Side effects from reducing or ceasing your medication is something many people are frustrated by. I am sorry that you are going through this experience. I am also sorry that your treating doctor has not taken your concerns as seriously as they are sounding in your message. (I don't know what 'pdoc' means but I assume psychiatrist?)

In any case, there are a few steps you might want to consider in terms of your medication management. Sometimes it is helpful to record side effects or withdrawal symptoms in a journal or calendar each day. This way if you are speaking with your treating doctor, you can show them exactly what is happening to you over time. Another recommendation might be to get a second opinion on your care. If your treating doctor is not open to other options in terms of medication management, then you might consider this.

Another suggestion is to seek the support of a GP and express your concerns of withdrawal and seek some advise. They can perform a physical examination and make sure that you are travelling okay physically and may be able to work with you on what other people you might invite into your care circle such as a psychologist.

If you are uncomfortable talking with your treating doctor about a different approach, if you have someone you trust, you could request that they attend your appointment along with you. Making care decisions can sometimes be difficult on your own.

I encourage you to only cease taking medication under the specific supervision of a doctor especially if you are experiencing side effects from missing doses. You are definitely not alone in your experience of withdrawal symptoms coming off medication. There are many forum posts that address the frustration of taking medication and finding the right balance. I encourage you to revisit the conversation with your treating doctor until you feel you have the right balance.

If you ever need immediate support you can always reach out to 1300 22 4636 on the Beyond Blue support line. If you ever need any immediate support in relation to your symptoms, always get checked by a health professional.

Wishing you the best possible outcome,

Nurse Jenn

[Haether]

Hi Evie,

firstly, I'm surprised your post got through, as there is only one anticonvulsant with well-known antidepressant properties. My suggestion would be to look at alternative ways to manage mania, so you don't take the antipsychotics in the first place. There's medication and therapy strategies that diminish the need for antipsychotics. The anticonvulsant-with-well-known-antidepressant-qualities is known as a pretty ineffective antimanic, but there is an anticonvulsant(s) with well-known antimanic activity, so you could discuss using that as rescue medication when you get manic symptoms, instead of an antipsychotic. They can be taken together, so you could discuss whether that's appropriate for you with your psychiatrist. Another option would be to take the anticonvulsant with antimanic properties (or another antimanic mood stabiliser) long term as a preventive, in combination with the antidepressant anticonvulsant, rather than only using the antimanic anticonvulsant as a rescue med. That way you are less likely to get breakthrough manic symptoms. This is something your psychiatrist can advise you on.

Another option would be to try a different antipsychotic, I've literally tried a dozen antipsychotics, in order to find one with the best side effect profile. You may find you don't get withdrawals with other antipsychotics.

I would think your experience is very atypical. Something can be all over the internet, but still pretty rare. Doesn't make it any more pleasant though. Rare adverse effects certainly happen.

It's highly unlikely antipsychotics are addictive. If something is addictive, people develop tolerance to it, so need ever-increasing higher doses for the same effect, and you also see drug-seeking behaviour as people crave the drug. There's very little evidence for that with antipsychotics. I've taken antipsychotics off and on for nearly ten years, currently off, and never had any problems with ceasing cold turkey, no withdrawals, no tolerance, no craving. And I don't think I'm unusual. It's understandable to be concerned about addiction, but for virtually everyone that's irrelevant when it comes to antipsychotics. Even people who abuse them don't describe being addicted to them.

There's heaps of medication options out there, and heaps of ways to minimise use, unfortunately I went way over the word limit describing them. I reckon the staff get an unlimited word limit cos I'm sure their posts are heaps longer than mine!

[monkey_magic]

Hi Evie81,

When my dose was significantly lowered I experienced horrible side effects. There are times I also feel my body craving the drug.

In my experience it is so typical of psychiatrists to dismiss what we say as well. I have a good doctor that believes me but my psychiatrist doesn't and doesn't really care for that matter.

I find pharmacists good to talk to about the drugs.

You definitely aren't alone and I wish u well on finding a good balance to stay well.

MM