Going off Lexapro, then going back on

[troubledwater]

(I could have put this in GQ and asked for studies/trials, but am interested in experiences/anecdotes as well. )

I take Lexapro, and my doctor is discouraging me from going off of it, not because I am failing to cope with my life, but because she says that if I went off of it, and then went back on at a later time, it might not work anymore.

There are millions of sites dealing with:
1) antidepressants that don't work for certain individuals
2) antidepressants that do work for some people but stop working after a while
3)
4) unpleasant side effects from taking antidepressants
5) unpleasant side effects from discontinuing antidepressants

What I haven't seen is anyone talking about the effect my doctor describes. Has anyone heard of this/experienced this?

[BigT]

It's a well-known phenomenon with benzodiazepines, but I've never heard of it with SSRIs. I do not know what it's called.

I do know that SSRIs can "poop out," which means they stop being effective if used for too long. The technical term is tachyphylaxis.

[Lynn Bodoni]

unpleasant side effects from discontinuing antidepressants

This is very, very real. Discontinuing antidepressants is extremely unpleasant, in my experience.

[lavenderviolet]

Can't provide any cite, but I have heard from other doctors that if you go off psych meds and then go on them again that you won't necessarily have the same response, though I think most doctors would at least try the med that worked for you before.

I think one reason that you probably can't find any cites for this is because most of the time once a med that is found works for the person they try to keep the person on it. Unfortunately, there is research showing that after three episodes of depression that someone's risk of having another episode is about 90%, so in many situations it is recommended for the person to stay on an antidepressant for maintenance.

Why do you want to go off it? If you're experiencing side effects, or having trouble affording it, those would be good reasons to ask your doctor about switching to something else.

[BigT]

Oh, forgot something: I also know that withdrawal will be more difficult the more times you go off and back on (especially in a medium length of time) --this applies to all medicines that produce any form of dependency. It's called the rebound withdrawal.

[troubledwater]

Originally Posted by lavenderviolet

Can't provide any cite, but I have heard from other doctors that if you go off psych meds and then go on them again that you won't necessarily have the same response, though I think most doctors would at least try the med that worked for you before.

I think one reason that you probably can't find any cites for this is because most of the time once a med that is found works for the person they try to keep the person on it. Unfortunately, there is research showing that after three episodes of depression that someone's risk of having another episode is about 90%, so in many situations it is recommended for the person to stay on an antidepressant for maintenance.

Why do you want to go off it? If you're experiencing side effects, or having trouble affording it, those would be good reasons to ask your doctor about switching to something else.

Thanks, lavenderviolet, for letting me know my doc is not the only one saying this.

Why do I want to go off it? (warning-long story) Well, in short, I feel fine. Yes, I have a genetic predisposition to depression. I especially do not deal well with loss - my first two bad episodes were due to relationships gone wrong. Six years ago, when I concluded I should probably get back on a/d I had a LOT of major stress. My unemployed and shiftless brother was living with me and goddamn, he NEVER left the house. My only escape was spending time with a bf, except I had let myself be bullied into being in the relationship, and did not actually want to spend time with him. Meanwhile, my mother was fighting cancer, and I was doing long distance caregiving because my father couldn't do it alone. I had financial stress because of course time away from work to care for my mother was unpaid.

Since then, I have gotten my brother out of the house and he now lives in another state. I ended the relationship. My mother died, and my father died just four months later. It was really rough, and boy was I glad to already be on a/d, but I got through it, because people do get through it.

Obviously, I have some doormat issues here, but my parents' mortality reminds me that life is finite, and helps me not put up with crap from my brother, and to stay out of unhealthy relationships. (The guy that did not work out as a bf has turned out to be a good platonic friend!) Physically, I am ridiculously healthy. I've improved my eating habits and exercise regularly. I've held on to my job throughout the downturn and have paid off my mortgage. Instead of looking around and concluding that "everyone" is better/happier/whatever than me, I look around and think I am pretty damned lucky. I truly do not believe I need to be on a/d right now or in the immediate future. The only reason to stay on them is because I MIGHT have another major episode and in that case the Lexapro MIGHT not work. I'm trying to figure out my odds here.

[troubledwater]

Originally Posted by BigT

Oh, forgot something: I also know that withdrawal will be more difficult the more times you go off and back on (especially in a medium length of time) --this applies to all medicines that produce any form of dependency. It's called the rebound withdrawal.

Good to know. I had no issues I can recall going off Zoloft and later Prozac, but I know that Lexapro has a shorter half-life that results in a much different withdrawal scenario than some of the other SSRIs.

Went off Zoloft because it worked a little too well - I didn't worry about much of anything (like, maybe I should start working on my thesis one of these days?) Went of Zoloft because the dr (not the one I have now) increased the dosage with the idea of reducing my social anxiety, and I got very manic and agitated and went off it altogether.

Between Zoloft and Prozac, and then Prozac and Lexapro, I went a couple of years without any meds at all. This is my preferred scenario, to take them only when I need them, and now I think I may possibly never need them again, but there are no guarantees.