Curious, what does Ashton say about depression in w/d?

[[Sw...]]

I'm at about 2.5 months free.  Doing well for the most part.  Lately my worst symptoms have been fear and depression.  Have been under some stress lately with my child sick but he is starting to feel better and so am I.  The depression comes in bouts.  Mornings are the worst.  I really have to keep myself distracted.  I am not thinking about taking AD but I was just thinking that maybe it would have been a good idea in the beginning.  Unfortunately my dad went through this along time ago, after just 2 weeks of taking Ativan.  He ended up going to a pdoc.  My dad was having such a hard time getting off the Ativan that the pdoc prescribed Effexor in the morning and Remeron at night for him.    His w/d after that was very steady, no ups and downs, just a zombie really, but no shaking, fears, anxiety, etc...  It was a quick ramp up and then ramp down.  3 months total.  He did well after that.  Thankfully he didn't have any problem tapering off the ADs.  I know I'm just second guessing my decisions here but I am really curious what Ashton says about using ADs during w/d.  I seem to recall she said to take them if having bad bouts of depression?

[[ti...]]

Hi Sweetpepper,

 

This is what prof Ashtons states, hope this helps.

 

Antidepressants are the most important adjuvant drugs to consider in withdrawal. As mentioned before, depression can be a real problem in withdrawal and can sometimes be severe enough to pose a risk of suicide, though this is unusual with slow tapering. Like any other depression, the depression in withdrawal responds to antidepressant drugs and is probably caused by the same chemical changes in the brain. Both the "old fashioned" tricyclic antidepressants (doxepin [sinequan], amitriptyline [Elavil]) and the selective serotonin reuptake inhibitors (SSRIs; fluoxetine [Prozac], paroxetine [Paxil]) can be effective and an antidepressant drug may be indicated if depression is severe. There is a school of thought, mainly amongst ex-tranquilliser users, that is opposed to the taking of any other drugs during withdrawal. But suicides have occurred in several reported clinical trials of benzodiazepine withdrawal. If depression is severe during benzodiazepine withdrawal as in any other situation, it seems foolhardy to leave it untreated.

 

 

[[Be...]]

This also is in the Ashton Manual about depression:

 

"Depression, aggression, obsessions. Depressive symptoms are common both during long-term benzodiazepine use and in withdrawal. It is not surprising that some patients feel depressed considering the amalgam of other psychological and physical symptoms that may assail them. Sometimes the depression becomes severe enough to qualify as a "major depressive disorder", to use the psychiatric term. This disorder includes the risk of suicide and may require treatment with psychotherapy and/or antidepressant drugs.

 

Severe depression may result from biochemical changes in the brain induced by benzodiazepines. Benzodiazepines are known to decrease the activity of serotonin and norepinephrine (noradrenaline), neurotransmitters believed to be closely involved in depression. Antidepressant drugs including the selective serotonin reuptake inhibitors (SSRIs such as Prozac) are thought to act by increasing the activity of such neurotransmitters.

 

Depression in withdrawal may become protracted (see section on protracted symptoms) and if it does not lift within a few weeks and is unresponsive to simple reassurance and encouragement, it is worth seeking a medical opinion and possibly taking an antidepressant drug (see section on adjuvant medication). Depression in withdrawal responds to antidepressant drugs in the same way as depressive disorders where benzodiazepines are not involved. If, as in many cases, an antidepressant drug is already being taken along with the benzodiazepine, it is important to continue the antidepressant until after benzodiazepine withdrawal is complete. Withdrawal from the antidepressant can be considered separately at a later stage (See Chapter II, Schedule 13)."

 

 

[[Fr...]]

Beeper, Thank you for quoting Dr Ashton on depression in benzo WD! It's encouraging to me.

Frannie 

 

[[Sw...]]

Severe depression may result from biochemical changes in the brain induced by benzodiazepines. Benzodiazepines are known to decrease the activity of serotonin and norepinephrine (noradrenaline), neurotransmitters believed to be closely involved in depression.

Thanks for the quotes.  They are helpful.  It is somehow reassuring to know that benzo w/d causes physical changes in the parts of the brain that cause depression.  I swear deep down I am happy but on the surface it can sometimes bring on a gloomy, "whats the point" kind of attitude.  So not like me!  I often wonder how benzos affect female hormones.  We hear so much now about how hormone imbalance causes anxiety and depression.  Estrogen Dominance,  Low Progesterone, Low DHEA, etc...  Its enough to make your head spin.  Its a slippery slope, isn't it. 

If depression is severe during benzodiazepine withdrawal as in any other situation, it seems foolhardy to leave it untreated.

  I do see her point.  I had considered AD in the beginning because I had heard they helped anxiety and I was suffering bad anxiety and insomnia.  But then I learned AD may worsen insomnia and anxiety for the first couple of weeks so I said, no way! 

[[dr...]]

This is one area where I have a bit of a bone to pick with Heather Ashton.  She emphasizes the benefits of adjuvant antidepressant therapy.  Yes, there is no doubt that there can be significant benefits for some who are going through benzodiazepine withdrawal.  However, she does not seem to cover all the bases when looking at the problems some experience as a result of the added antidepressant.  Some of these problems include additional side effects, possible ramping up of withdrawal symptoms, and potential problems with SSRI withdrawals, euphemistically called "discontinuation syndrome" by the pharmaceutical industry.

 

If severe depression happens, obviously it has to be treated and an antidepressant may be the only option.  However, I think there are lots of people like myself, who are scared of the potential withdrawals at the outset of a benzo taper.  I more or less added Lexapro (SSRI) as a preemptive measure to try and mitigate the withdrawals.  I had no idea that it would create more problems than it would help.  In my opinion, the addition of an antidepressant as an adjuvant cannot automatically be assumed to be a helpful measure.  More caution is warranted before adding an antidepressant.

 

best,

 

Draftsman

[[Sw...]]

Interesting points Draftsman.    What are your Lexapro symptoms?  From what I hear the ADs are hit or miss and it takes a while to find the right one.  I'm glad to see that Prof. Ashton only recommends AD in the case of severe depression.  It saddens me that so many doctors are quick to prescribe ADs and Benzos.  Hopefully the word gets out and the Doctors wake up and take note.  I was just reading the other day that one of the first lines of treatment for women with bothersome menopausal symptoms is Zoloft.  Really, there has to be a better way by now! 

[[dr...]]

Hi SweetPepper:

 

My main Lexapro side effects include additional sweating (common with SSRIs), neck stiffness, urinary retention, and body aches.  Although such symptoms are associated with benzo withdrawal, I have noticed substantial changes with these particular symptoms as my Lexapro dosage has changed.  A higher dosage results in more symptoms, and a lower dosage reduces them.  I didn't realize Ashton only recommended an antidepressant in cases of severe depression.  That's good to hear.  Of course it's fine to try a medication to see if it works.  But it's bad news if you have to experience withdrawals coming off of it, a story all of us here already know too much about.  I got painted into a corner with the Lexapro by having side effects on one side of the dosage (5 mg.) and withdrawal symtoms on the other end (when I cut from 5 mg. to 2.5).

 

best,

 

Draftsman

[[re...]]

years ago i found sertraline ssri to be helpful for 2 years then simply tapered it no problem.

now i'm just off the benzo boat but seeing a pdoc on monday, and may even request , if he thinks its appropriate after benzo clonazepam w/d, a small dose of something in this line.