Get Off SSRI Drugs and Overcome Depression Naturally
This is a case report on a young woman who managed to get off SSRI Drugs, and reclaim her life. Thirty Two year old Debbie came into my office on November 7, along with her Dad, complaining of severe PMS, painful periods with irregular cycles for which birth control pills had been tried and discontinued because of side effects.
Above Left Image: Migrant Mother, Florence Thomas Courtesy of Wikimedia
Debbie is so depressed that she spends much of her time alone in her room. She is on two different antidepressants, Zoloft 200 mg/day and Wellbutrin 300 mg/day prescribed by her psychiatrist. She has been unable to sleep for many years without Ambien, a prescription sleep drug. Her Fast Food Diet diet from McDonald's, Wendy’s and Taco Bell, and lack of exercise has left her overweight. She takes no nutritional supplements. Her physical exam shows dilated pupils, dry skin, and brittle thin nails. Her reflexes, although hyperactive, are delayed (230 msec).
Debbie's Laboratory Studies
Debbie’s labs showed a low Vitamin B-12 level of 304 (normal above 400), and an extremely low Vitamin D level of 14 (deficiency is below 20). Her thyroid labs were low with a TSH of 4.0 (normal less than 2.5), and a free T3 of 270 (normal 230-420). (17). Her luteal phase progesterone level was low as well.
Dilated Pupils, a common finding on SSRI Drugs.
Deciding to Get OFF the SSRI's
I explained to Debbie, that her insomnia, dilated pupils and hyperactive reflexes were du e to the SSRI antidepressant drugs which are over-stimulating her nervous system. When I suggested that she taper off the SSRI drugs, she and her dad breathed a sigh of relief, and said "that was the main reason they came to see me, to get off the drugs."
I suggested that Debbie and her Dad go back to her psychiatrist and ask the doctor to work with them in getting off the drugs by providing a tapering schedule.
Psychiatrist and Patient
The Psychiatrist Drags His Feet
Later, I learned that her psychiatrist was in general agreement, yet was dragging his feet and refused to provide the tapering schedule for Debbie to get off the SSRI drugs. After waiting a few weeks realizing we were just wasting time, I finally went ahead and called into her pharmacy the authorization to reduce her SSRI dosage in half every week until the dosage was small enough to stop altogether. Tapering is required because the SSRI drugs are chemically addictive and can produce withdrawal effects.
5-HTP
5-HTP for Sleep, acts as an Antidepressant
For sleep during the SSRI tapering period, I recommended 5-HTP capsules which increases serotonin naturally with no side effects.(20) She was encouraged to stop the prescription sleep drugs (Ambien).
I explained to Debbie that low Vitamin B-12, low Vitamin D and low thyroid function could all be possible causes of depression.
John R Lee MD
John R Lee MD, Pioneered Use of Progesterone
Natural Progesterone for PMS
The PMS and painful periods were treated with natural progesterone capsules, 50 mg twice a day for the last two weeks of her cycle (days 14-28). The night-time progesterone had the added benefit of helping her sleep.
Debbie was started on natural thyroid half grain daily, high quality multivitamin, B12, vitamin D, and iodine supplementation, stopped the fast food, and began going out more for daily activities.
By December 3, Debbie had tapered down to Zoloft 50 mg per day and Wellbutrin 100 mg per day. She says, "I am feeling good in general. I have a lot of energy. I am out of my room more. I am basically in a good mood, and sleeping about 4 hours a night."
By mid December, Debbie was off the SSRI drugs and off the sleeping pills.
A Dramatic Improvement
By January 28, 2008, Dad calls in and says , "Debbie is doing so much better. She has more energy and is sleeping well. The difference is between Night and Day."
That same day, Debbie calls in and says, "I feel a lot better. My energy is pretty good. I am back to work at my mother-in-law’s business at the sales counter. I am sleeping good at night 6 ½ to 7 hours. My mood is stable, pretty much happy. More normal than before. I’m not snappy, and not in my room as much. I am getting out and doing stuff."
Regarding her last menstrual cycle, Debbie remarked "This time, no cramps, no PMS, no mood swings. The progesterone capsules are definitely helping, I have never had a period without pain before. It was awesome to have no pain. Now, I can do normal stuff. Before, when I had my menstrual period, I would be in bed for 7 days because of the pain.”
Adverse Side Effects of SSRI drugs
My previous newsletter discussed adverse side effects of SSRI antidepressants, namely akathesia, a form of agitation which drives people to commit suicide, sexual dysfunction (impotence), tremor, involuntary body and facial movements, tardive dyskinesia, and hyperactive reflexes indicating a hyperactive nervous system. The SSRI induced loss of sexual function may be irreversible even after discontinuation of the drug. (1)
In many studies, SSRI efficacy was no better than placebo raising questions about SSRI efficacy. It is astonishing that today, SSRI antidepressants are the standard mainstream medical treatment for PMS (Pre-Menstrual Syndrome). In addition, BCP's, birth control pills are frequenty given as treatment for PMS, irregular periods, or any female complaint for that matter (relating to cycles). Natural, bioidentical Progesterone is a far better and more effective alternative for PMS. Broda Barnes found irregular cycles frequently responded to natural thyroid in spite of "normal" thyroid labs.
SSRI drugs for PMS - The Wrong Way - A Practice Which Should Be Abandoned
SSRI antidepressants may have some justifiable uses as a temporary treatment in the severely depressed. However, the widespread usage of SSRI antidepressants for PMS and Menopause should be abandoned.
Women on SSRI antidepressants for PMS, or menopausal symptoms should be encouraged to taper off the SSRI drugs (under a physician’s supervision). The correct diagnostic workup includes hormone levels, thyroid panel, vitamin D and B12 levels. Treatment with natural bio-identical progesterone, natural thyroid and vitamin supplementation is more effective with fewer side effects than the current mainstream use of SSRI antidepressants or BCP's (birth control pills).
A Successful Outcome
The case of Debbie Depressed illustrates a successful outcome treating depression and PMS with progesterone, natural thyroid, vitamins D and B12, and by modifying diet and lifestyle. It is very gratifying to see Debbie make such a dramatic recovery after discontinuing the SSRI drugs.
References for Causes of Depression:
Low vitamin B12 levels are associated with depression. (2)(3)(4) (5)
Low Vitamin D levels are associated with depression.(6) (7) (8) (9)
Low thyroid function is also associated with depression. (10) (11) (12)
Lastly, bioidentical progesterone has been widely used as an effective treatment for PMS (Pre-Menstrual Syndrome). (13) (14) (18)(19)
Jeffrey Dach MD
4700 Sheridan Suite T
Hollywood FL 33021
954 983-1443
Jeffrey Dach, M.D. BLOG TrueMedMD disclaimer
References
(1) http://jeffreydach.com/2007/05/14/paxil-prozac-and-ssri-induced-suicide-by-jeffrey-dach-md.aspx Adverse side effects of SSRI drugs, Paxil, Prozac and SSRI Induced Suicide by Jeffrey Dach MD
Low B12 and Depression
(2) http://www.biomedcentral.com/1471-244X/3/17
High vitamin B12 level and good treatment outcome may be associated in major depressive disorder Jukka Hintikka , Tommi Tolmunen , Antti Tanskanen and Heimo Viinamäki Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland BMC Psychiatry 2003, 3:17 December 2003
(3) http://ajp.psychiatryonline.org/cgi/content/abstract/157/5/715
Vitamin B12 Deficiency and Depression in Physically Disabled Older Women: Epidemiologic Evidence From the Women’s Health and Aging Study Brenda W.J.H. Penninx, Ph.D., Jack M. Guralnik, M.D., Ph.D., Luigi Ferrucci, M.D., Ph.D., Linda P. Fried, M.D., Ph.D., Robert H. Allen, M.D., and Sally P. Stabler, M.D. Am J Psychiatry 157:715-721, May 2000
(4) http://jop.sagepub.com/cgi/content/abstract/19/1/59
Treatment of depression: time to consider folic acid and vitamin B12, Journal of Psychopharmacology, Vol. 19, No. 1, 59-65 (2005). Alec Coppen
(5) http://ajp.psychiatryonline.org/cgi/content/abstract/159/12/2099
Vitamin B12, Folate, and Homocysteine in Depression: The Rotterdam Study, Am J Psychiatry 159:2099-2101, December 2002. Henning Tiemeier, M.D., et al.
“Hyperhomocysteinemia, vitamin B12 deficiency, and to a lesser extent, folate deficiency were all related to depressive disorders.”
Low Vitamin D and Depression
(6) http://www.oasisadvancedwellness.com/learning/depression-vitamin-d.html
Major Depression and Vitamin D, By John J. Cannell, MD, The Vitamin D Council.
(7) http://www.ncbi.nlm.nih.gov/pubmed/10888476
Vitamin D vs broad spectrum phototherapy in the treatment of seasonal affective disorder. J Nutr Health Aging. 1999;3(1):5-7. Gloth FM 3rd, Alam W, Hollis B. Seasonal Affective Disorder (SAD) is prevalent when vitamin D stores are typically low. Improvement in 25-OH D was significantly associated with improvement in depression scale scores.
(8) http://www.corepsychblog.com/2007/02/depression_and__1.html
Depression and Vitamin D Deficiency: Overlooked Vitamin D Deficiency and Depression: Undetected is Untreated, Dr Charles Parker Blog.
(9) http://www.corepsychblog.com/files/Depression.D3.pdf
MAJOR DEPRESSION AND VITAMIN D The Vitamin D, John J. Cannell, MD March 20, 2004 The Vitamin D Council
Low Thyroid and Depression
(10) http://www.stopthethyroidmadness.com/thyroid-depression-mental-health/inspiring-stories/
Inspiring Stories on Depression that Went Away (and other mental health issues) These are actual stories from real patients whose depression went away using desiccated thyroid on the Stop the Thyroid Madness Blog.
(11) http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=149799
Should thyroid replacement therapy be considered for patients with treatment-refractory depression? J Psychiatry Neurosci. 2002 January; 27(1): 80. by
Russell T. Joffe
(12) http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1635797
Is the thyroid still important in major depression? Russell T. Joffe, J Psychiatry Neurosci. 2006 November; 31(6): 367–368.
Progesterone for PMS:
(13) http://www.pmstreatmentclinic.com/index.html
The PMS Treatment Clinic- the nation's leading PMS Clinic was established in 1982 and began treatment of Premenstrual Syndrome with natural progesterone therapy according to the method of PMS world authority Katharina Dalton M.D. of London, England. (Sadly, Katharina Dalton passed away on September 17, 2004 at the age of 87.) The Premenstrual Syndrome Treatment Clinic uses bioidentical hormones exclusively in the treatment of premenstrual syndrome and menopause. Since its inception, 35,000 patients from all over the United States and 28 countries have been evaluated and treated.
(14) http://www.natural-progesterone-advisory-network.com/PDFs/dalton.pdf
Interview with Katharina Dalton, MD Progesterone and Related Topics, Dr. Dalton successfully treated PMS, pre-eclampsia, eclampsia and post-partum depression with natural progesterone.
Thyroid for Irregular Menstrual Cycles
(15) http://www.amazon.com/review/RVRC3UKH8XQ22/ref=cm_cr_rdp_perm
Hypothyroidism the Unsuspected Illness, by Broda Barnes MD, An observation by Dr. Barnes is that low thyroid is associated with menstrual irregularties, miscarriages and infertility. Barnes treated thousands of young women with thyroid which restored cycle regularity and fertility. In his day, the medical system resorted to the drastic measure of hysterectomy for uncontrolled menstrual bleeding. Although today's use of birth control pills to regulate the cycles is admittedly a far better alternative, Barnes found that the simple administration of desiccated thyroid served quite well. Again, Barnes noted that blood testing was usually normal in these cases which respond to thyroid medication.
What is the Normal TSH Level?
(16) http://www.aace.com/public/awareness/tam/2003/explanation.php
American Association of Clinical Endocrinologists, Until recently, physicians accepted the normal TSH range of 0.5 to 5.0 mIU/L. The National Academy of Clinical Biochemistry (NACB guidelines believes that a sustained TSH level above 2.5 mIU/L might not be normal.
(17) http://thyroid.about.com/od/gettestedanddiagnosed/a/garbertsh.htm
The TSH Normal Range: Why is There Still Controversy? Insights from One of the Nation's Leading Endocrinologists, Dr. Jeffrey Garber said in practice, he doesn't hesitate to treat a patient who is in the 2.5 to 5.5 TSH range In late 2002, the National Academy of Clinical Biochemistry (NACB issued new guidelines for TSH of 0.4 and 2.5. January 2003, the American Association of Clinical Endocrinologists (AACE), issued their TSH range of 0.3 to 3.0. (Normal range for free T3 is 230-420).
Progesterone for PMS
(18) http://www.johnleemd.com/
John R Lee MD web site, pioneered use of natural progesterone.
(19) http://www.johnleemd.com/store/drphil_anderson.html
Dr. Phil Interviews Holly Anderson on Treating PMS with Natural Progesterone
5-HTP for Depression
(20) http://www.thorne.com/altmedrev/.fulltext/5/1/64.pdf
5-HTP, Use of Neurotransmitter Precursors for Treatment of Depression by Stephen Meyers, MS. ( Altern Med Rev 2000;5(1):64-71.)In a 1988 open study of 25 patients, the therapeutic efficacy of 5-HTP was found to be equal to traditional antidepressants.
(21) http://medicine.plosjournals.org/archive/1549-1676/5/2/pdf/10.1371_journal.pmed.0050045-L.pdf
Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted
to the Food and Drug Administration Irving Kirsch, Brett J. Deacon, Tania B. Huedo-Medina, Alan Scoboria, Thomas J. Moore, Blair T. Johnson. Compared with placebo, the new-generation antidepressants do not produce clinically significant improvements in depression in patients who initially have moderate or even very severe depression, but show significant effects only in the most severely depressed patients.
Vitamin D
(22) http://ajgponline.org/cgi/content/abstract/14/12/1032
Vitamin D Deficiency Is Associated With Low Mood and Worse Cognitive Performance in Older Adults. Consuelo H. Wilkins, M.D., Yvette I. Sheline, M.D., Catherine M. Roe, Ph.D., Stanley J. Birge, M.D., and John C. Morris, M.D. Am J Geriatr Psychiatry 14:1032-1040, December 2006
Jeffrey Dach MD
4700 Sheridan Suite T
Hollywood FL 33021
954 983-1443
Jeffrey Dach, M.D. BLOG TrueMedMD disclaimer
(c) 2007-2008 all rights reserved jeffrey dach md
Disclaimer click here: http://www.drdach.com/wst_page20.html
The reader is advised to discuss the comments on these pages with his/her personal physicians and to only act upon the advice of his/her personal physician Also note that concerning an answer which appears as an electronically posted question, I am NOT creating a physician -- patient relationship. Although identities will remain confidential as much as possible, as I can not control the media, I can not take responsibility for any breaches of confidentiality that may occur Finally, the material produced by myself may be reproduced for personal use, provided that appropriate credit is given.
Link to this article: http://jeffreydach.com/2008/02/04/get-off-ssri-drugs-and-overcome-depression-naturally-by-jeffrey-dach-md.aspx
(c) 2008 all rights reserved Jeffrey Dach MD.
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Comments
BTW, it might be a placebo effect but I feel an initial improvement from the vitamin D supplementation. Also, I exercised yesterday which felt good, too.
Thanks for another interesting and thought-provoking article.
I have always been a "high-strung" person with low grade anxiety as a constant state of my existence. When my husband became disabled from a neurological condition, at age 43, I agreed to take the anti-depressants that I refused to take all the rest of my life. I do get relief from them.
I am one of the people that could not ween themselves off Paxil, no matter what I tried. I went into such severe anxiety, that I knew it had to do with the drug itself, not my life or my temperment. It was definitely bio-chemical in nature as no matter how small a dose I took, that horrible feeling went away immediately -- very scary.
Although my doctor didn't want to do it, I took half a Paxil for two days, and then went onto 50 mg of Zoloft. Don't know why that is a drama for physicians to do, but I was fine with the transition. I have not tried to get off Zoloft.
After four years, I am now coming off birth control that I still took at age 50 to regulate my cycle. OMG, this has not been a pleasant month -- I am having serious brain fog and mood swings. (My poor husband has received the brunt of it.) Not sure if peri-menopause, menopause (tests say no) or just plain crazies, but I need to give it time to get out of my system.
So, in summary, I am one of the people you are talking about -- someone that has used SSRI and birth control to temper the effects of menopause and stress. I live close enough in Florida to drive to have an appointment with you. I think that after a month off the BC, I will call. I have no doubt that I have viatmin deficiencies but at least I don't eat too much fast food -- yuck, that poor woman! Glad she is doing well now.
Thank you for posting it -- could not have been more timely than if I knew you existed and ask you to help me. Happy New Year!!
I wrote a diary here at OS about my difficulties in taking and then weaning off an SSRI. I gained eighty pounds across eighteen months and the p-doc still refused to accept that his drug was the cause. I've already posted it for the author in a prior diary, but this is so on-topic that I felt it merited a repost. Apologies if that's considered inappropriate here:
http://open.salon.com/content.php?cid=67663
And thanks for the discussion. I experienced many of the withdrawals commonly reported, including confusion, some minor cramping, and the so-called 'shock' sensations when I'd turn my head. The did fade across a few months though, and I feel none of them now. The p-doc idiotically recommended that I cold-turkey the SSRI. If your p-doc says the same, don't listen to him. Determine the half-life of whatever drug you're taking and work out a reasonable weaning period. It took me three months to wean off of 20mg/day of Lexapro.
Do it SLOWLY.
And expect some discomfort.
Further, given Dr. Dach's comment on the nature of patients' selection of doctors, I now believe that I'm wrong about the conflict of interest issue. I'm sorry for having raised this as well.
This was all very bad form on my part, and I wish I hadn't diminished myself in this way.
Have they made me gain weight- yup. Have they made me completely lose my sex drive- yup. Have they given me back some sense of peace and allowed me to give to others and interact with the rest of the world- yup.
I don't take them because they are a fad, I take them because they have completely changed the quality of my life.
Depression is a combination of things, but raising the available serotonin through SSRIs has been clinically proven to work for many people. Example: me. Are you implying that they, that I am just drug addict with denial?
here are some other drugs that contribute to Serotonin syndrome
:) I'll take my chances though, this med has meant a new life for me, and I'm happy for the chance to really live.
So your specialty is Radiology?
Kudos to you for writing about this and the other issues. Many mainstream doctors are either ill informed about the methods/ described above or they dismiss such ideas out of hand because it threatens their beliefs. Medicine should never be a belief, it should always be a constant and open minded exploration of the facts.
I do understand that there is skepticism for MD's who venture out of the realm of conventional and conservative medicine, because just as there are bad conventional MD's there are also bad alternative M.D.s. ( and they tend to get perhaps a bit too much publicity)
I have experienced horrid "alternative" medicine ; my mother had a physician that enabled her to pursue non-existent health concerns when in fact she had a brain tumor. Because of wasted time, te tumor became to large to remove easily and she suffered badly after the operation.
However, I have only seen the most ethical of content From Dr Dach, and I am always impressed by the abundance of references and citations.
thx doc. more, lots more...