3 ms·

Didn't read the underlying paper, and definitely not a medical expert, but I do wonder how they define "withdrawal?" Is there a standard definition? If you sta

by bradhe 8y ago

Didn't read the underlying paper, and definitely not a medical expert, but I do wonder how they define "withdrawal?" Is there a standard definition? If you start taking a drug that modifies how your body works, isn't it logically obvious that if you STOP taking that drug, your body will revert to it's previous state and that state change will likely be negative, therefor you're withdrawaling?

theoh 8y ago
No, this is about withdrawal symptoms. When you stop taking certain pharmaceuticals, you may experience withdrawal symptoms that aren't just a return to how you felt before you started. In the case of antidepressants these symptoms sometimes include dizzyness and nausea. Withdrawal symptoms come into play in the case of addictions as well. It can be dangerous to suddenly stop taking an addictive substance. You may have heard the phrase "cold turkey": that refers to withdrawal symptoms. https://en.m.wikipedia.org/wiki/Cold_turkey https://en.m.wikipedia.org/wiki/Cold_turkey The body is not a state machine with trivial logical properties!
dbt00 8y ago
Your second paragraph is incorrect. Withdrawal is not an orderly transition to a previous physical state, it's the presence of previously unseen symptoms, typically due to biochemical adaptations to the presence of the foreign substance. For example, if you drink a lot, some normal neural pathways are repressed by the regular presence of alcohol and your body compensates by increasing the affected neurotransmitters (GABA in this case). As a result, when you stop drinking, you have a corresponding oversupply of GABA, causing the physical symptoms of Delirium Tremens. I was on Lexapro for 3 years. When I tapered off according to the standard protocol (already in place to avoid withdrawal issues), I experienced debilitating vertigo symptoms and had to change my process from a 2 week reduction to a 3 month process. It was intense.
- schrodinger 8y ago
  >your body compensates by increasing the affected neurotransmitters (GABA >you have a corresponding oversupply of GABA Isn't it the other way around? I had thought that alcohol was a GABA agonist, so your body adapts to produce less of it. Then when you stop, you're _undersupplied_ which produces the DTs.
  - incidentnormal 8y ago
    Yeah correct, alcohol is technically a positive allosteric modulator of the GABA-A receptors, which means it potentiates the effects of GABA in those receptors. Over time, the receptors downregulate to compensate for being over-stimulated. Upon withdrawal from alcohol, the GABA-A receptors are unable to respond strongly enough to the GABA which exists, so in effect you're undersupplied and that contributes to the DTs. Alcohol is actually a very messy drug that acts on a huge range of receptors but the effect on the GABAergic system is probably the most significant.
rob-olmos 8y ago
SSRI withdrawal can present new symptoms not existing before, such as the feeling of "brain zaps" and body temperature increases, so a friend has described.
- stevehawk 8y ago
  The brain zaps are no joke. I was on the lowest dose of lexapro for a year.. as in my 'taper off' schedule was to just start alternating what days I took it and eventually spread it out because I couldn't even step down in dosage size I was on such a low dose. Static electricity in the brain is a weird and painful experience. That said, it wouldn't stop me from going back on it if I had to.
  - aaaaaaaaaab 8y ago
    The on/off taper is the dumbest idea ever, but some psychiatrists don’t know this. It basically puts you on a constant serotonin rollercoaster, thus the awful brain zaps and other side effects. Lowering the dose one-sixth at a time every four weeks is the right approach. It gives your neurons time to get accustomed to the lowered serotonin levels by slowly increasing the number of available receptors.
    - jschwartzi 8y ago
      This is one of the reasons that Paroxetine comes in both liquid and pill form. The pills are for maintenance and the liquid is for tapering off.

by bradhe 8y ago

theoh 8y ago

No, this is about withdrawal symptoms. When you stop taking certain pharmaceuticals, you may experience withdrawal symptoms that aren't just a return to how you felt before you started. In the case of antidepressants these symptoms sometimes include dizzyness and nausea. Withdrawal symptoms come into play in the case of addictions as well. It can be dangerous to suddenly stop taking an addictive substance. You may have heard the phrase "cold turkey": that refers to withdrawal symptoms. https://en.m.wikipedia.org/wiki/Cold_turkey https://en.m.wikipedia.org/wiki/Cold_turkey The body is not a state machine with trivial logical properties!

dbt00 8y ago

Your second paragraph is incorrect. Withdrawal is not an orderly transition to a previous physical state, it's the presence of previously unseen symptoms, typically due to biochemical adaptations to the presence of the foreign substance. For example, if you drink a lot, some normal neural pathways are repressed by the regular presence of alcohol and your body compensates by increasing the affected neurotransmitters (GABA in this case). As a result, when you stop drinking, you have a corresponding oversupply of GABA, causing the physical symptoms of Delirium Tremens. I was on Lexapro for 3 years. When I tapered off according to the standard protocol (already in place to avoid withdrawal issues), I experienced debilitating vertigo symptoms and had to change my process from a 2 week reduction to a 3 month process. It was intense.

schrodinger 8y ago
>your body compensates by increasing the affected neurotransmitters (GABA >you have a corresponding oversupply of GABA Isn't it the other way around? I had thought that alcohol was a GABA agonist, so your body adapts to produce less of it. Then when you stop, you're _undersupplied_ which produces the DTs.
- incidentnormal 8y ago
  Yeah correct, alcohol is technically a positive allosteric modulator of the GABA-A receptors, which means it potentiates the effects of GABA in those receptors. Over time, the receptors downregulate to compensate for being over-stimulated. Upon withdrawal from alcohol, the GABA-A receptors are unable to respond strongly enough to the GABA which exists, so in effect you're undersupplied and that contributes to the DTs. Alcohol is actually a very messy drug that acts on a huge range of receptors but the effect on the GABAergic system is probably the most significant.

rob-olmos 8y ago

SSRI withdrawal can present new symptoms not existing before, such as the feeling of "brain zaps" and body temperature increases, so a friend has described.

stevehawk 8y ago
The brain zaps are no joke. I was on the lowest dose of lexapro for a year.. as in my 'taper off' schedule was to just start alternating what days I took it and eventually spread it out because I couldn't even step down in dosage size I was on such a low dose. Static electricity in the brain is a weird and painful experience. That said, it wouldn't stop me from going back on it if I had to.
- aaaaaaaaaab 8y ago
  The on/off taper is the dumbest idea ever, but some psychiatrists don’t know this. It basically puts you on a constant serotonin rollercoaster, thus the awful brain zaps and other side effects. Lowering the dose one-sixth at a time every four weeks is the right approach. It gives your neurons time to get accustomed to the lowered serotonin levels by slowly increasing the number of available receptors.
  - jschwartzi 8y ago
    This is one of the reasons that Paroxetine comes in both liquid and pill form. The pills are for maintenance and the liquid is for tapering off.