Antidepressants not as effective as research suggests

thank you for your article,
My patients have a very hard time coming off antidepressants once  they have been taking them for a while, they obviously have some sort of effect on the patient’s mood. What do you suggest for those patients that  wish to get off their meds but cannot? Have they become somehow addicted to the placebo?
Justin

Editor’s Note: As always, I strongly suggest that tapering of psychiatric meds be done under the supervision of a qualified, experienced psychiatrist or doctor. However, as AA points out, such a practitioner is not always available and many GPs do not have the necessary experience to guide a patient through this. I’ve decided to publish this comment for this reason. Please make every effort to find a doctor before trying this on your own.

Hi Justin,

This is a copy of a comment I made on the Furious Seasons Blog regarding tapering psych meds.  As an aside, I am not a medical professional.  However, I and many people in similar situations have found psychiatrists clueless about how to taper.  

In my opinion, Chris’ advice about not doing things on your own is normally right on target.   But following your psychiatrist’s advice in tapering might be deadly as most of them do it way too fast.

Anyway, here is the post.

“For those of you not familiar with my story, started tapering off of a 4 psych med cocktail in 2006. I am down to 1 med and expect to be off at the end of this year or in 2010.

With the exception of one med (Wellbutrin XL) which I essentially cold turkeyed, I have tapered the other meds at pretty much at 10% of current dose every 3 to 6 weeks. With Effexor and other drugs with a shorter half life, you may have to taper even more slowly. By the way, I wouldn’t recommend a cold turkey but I did an experiment with Wellbutrin XL using supplements to get off it quickly as my insurance coverage was running out. Fortunately, it worked.

Tapering slowly doesn’t mean that you won’t have withdrawal symptoms that can be incapacitating. But by tapering slowly, I have been able to have some semblance of a life which I doubt I would have had following tapering schedules that most medical professionals would force you into.

How to taper slowly:

For meds that can be crushed (check with pharmacist), buy a .001g scale on Ebay that runs between $15.00 and $30.00. Then go to a place like Vitacost and buy empty gelatin capsules. You also need a pill crusher.
Crush the pill you want to made the reduction from such as a 10mg pill. Put in capsule and weigh it. Take 90% of dose and that the new amount you need to take. Put excess in storage capsule that most pill crushers have to be used for a future measurement.
By the way, with these scales, you might want settle for a range such as .193 to .195 grams as it is hard to hit the right number exactly and it doesn’t seem to make a difference. Also, weigh it twice to make sure it is accurate.
For drugs like SSRIS, if you are at 10mg or under, using the liquid form is a great option as you can use a syringe to measure the amount. Here is a thread on the Paxil Progress Boards that might be helpful:
http://www.paxilprogress.org/forums/showthread.php?t=36443
Personally, I would be a klutz at this:)) but this option has worked well for people.
Another option is to use a compound pharmacist. They will make the doses you can’t get at your local CVS pharmacy. The downside is that not all insurance companies allow you to do this and you may have to pay up front and get reimbursement later. I did this with Wellbutrin XL by the way and it worked great. Here is a link to find a local one:
http://www.findings.net/sucompounding.html
For people on a drug like Pristiq or Effexor, normally, I am totally against doing this for various reasons but switching to Prozac might be the best option since it is an easier drug to taper logistically. Also, the long half life vs. the short half life of Effexor might make it easier to taper.
If that doesn’t work, using a compound pharmacy if it is financially feasible might work the best because of the difficulties in being able to customize the dose by yourself.”