Get Off SSRI Drugs
and Overcome Depression Naturally
by Jeffrey Dach MD
__________________________________________
A Young Woman with Depression and PMS Gets Off SSRI Drugs,
and Reclaims Her Life, a Case Report
Thirty Two 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.
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).
  
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 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, 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 severly 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)
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Jeffrey Dach MD
4700 Sheridan Suite T
Hollywood FL 33021
954 983-1443
www.jeffreydach.com
www.drdach.com
www.naturalmedicine101.com
www.truemedmd.com
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
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This article may be copied on the internet provided a link and credit is given.
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My daughter received an injection of Depo Provera for birth control and she experienced severe psychological problems.
She did not have a period for 6 mos. and has never been the same. Is there anything that can reverse the effects of this terrible form of birth control ?
I would not be surprised if the very public problems of Britney Spears is related to this form of birth control.
How can young women be warned to avoid this? Please help.
Maria
________________________________________________
Dear Maria,
Thanks for making your comment and for bringing attention to the adverse side effects of Depo-Provera, a synthetic, chemically altered version of progesterone. Your warning about this will serve others who will have the knowledge to avoid the side effects.
warmest regards,
Jeffrey Dach MD
www.drdach.com
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My question "Is there anything that will reverse the effects of this?" was not
answered. Can you please address this? Is there research literature I can access? I know there is a class action lawsuit pending in Canada, but that will not help my daughter. She is my greatest concern.
Thank you for your kind attention.
Maria Sanchez
________________________________________________________
Dear Maria,
I would start from Square One, and do a complete diagnostic evaluation, looking for hormonal imbalance. My approach would be to do an 11 sample salivary hormone analysis of estradiol and progesterone, and a 4 sample cortisol salivary test. In addition I would evaluate thryoid function with TSH, Free T3, Free T4. I would also check vitamin B12 and Vitamin D levels which can cause depression if low.
A nutritional supplement program would include high fiber diet, DIM to increase homonal metabolism, and 5-HTP which is known a natural antidepressant.
warmest regards,
Jeffrey Dach MD
www.drdach.com
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I just read your article on the use of SSRIs. My husband was given a series of SSRI drug "cocktails" and after a year of this, he developed a tremor in his left hand, and he has since been diagnosed with Parkinsons.
I am convinced that over prescribing of SSRI drugs triggered the problem and I was pleased to see that you believe they are dangerous and can lead to tremors, etc.
We live in Southern California. Can you recommend a doctor that abides by your reasoning?
My husband is taking Requip, and he's had his dose increased to accommodate his increasing symptoms. He has mentioned his SSRI history to his neurologist who doesn't believe there is a connection.
I'd feel more comfortable if he was seeing someone who at least accepts the possibility that there could be a connection.
DS from California
_________________________________
Dear DS from California,
Here are a few links to articles discussing yor question.
(1) SSRI-Induced Parkinsonism May Be an Early Sign of Future Parkinson's Disease
(2) May 01, 2001 Vol. 18 No. 5
Movement Disturbances Associated With SSRIs Raphael J. Leo, M.D.
(3) J Clin Psychiatry. 1996 Oct;57(10):449-54.
Movement disorders associated with the serotonin selective reuptake inhibitors.Leo RJ.
Department of Psychiatry, School of Medicine, State University of New York at Buffalo 14215, USA.
BACKGROUND: To review the case reports and case series of movement disorders ascribed to the use of serotonin selective reuptake inhibitors (SSRIs). METHOD: Reports of SSRI-induced extrapyramidal symptoms (EPS) in the literature were located using a MEDLINE search and review of bibliographies. RESULTS: Among the 71 cases of SSRI-induced EPS reported in the literature, the most common side effect was akathisia (45.1%), followed by dystonia (28.2%), parkinsonism (14.1%), and tardive dyskinesia-like states (11.3%). Among patients with Parkinson's disease treated with SSRIs, there were 16 cases of worsening parkinsonism.
(4) Prescrire Int. 2001 Aug;10(54):118-9.
Extrapyramidal effects of SSRI antidepressants.[No authors listed]
(1) About a hundred detailed reports of extrapyramidal adverse effects linked to a "selective" serotonin reuptake inhibitor (SSRI) antidepressant have been published.
(2) The effects include acute dystonia, akathisia, and onset or aggravation of parkinsonism. Late-onset dyskinesias are rare.
(3) All SSRIs have been implicated.
(4) The annual incidence is unclear. It has been estimated at about 1-2 cases per 1 000 patients.
(5) In patients with Parkinson's disease, SSRIs are an alternative to tricyclic antidepressants but can worsen the disease itself.
To find a doctor in your area, use the FIND A DOCTOR link for ACAM and A4M on the sidebar to the left.
warmest regards,
Jeffrey Dach MD
www.drdach.com
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I am currently on Effexor and Ativan for panic and anxiety, which is working nicely, but I was worried about the effects of these drugs on my brain.
I came across information regarding Lithium Orotate in helping with brain damage from these meds. and also helping in other areas too. I have started to take 10 mg. 2x/day. I have felt a little different for the past few days, and even my husband notices that I have been irritable, but that actually passed last night. I don't feel anxious or depressed or anything.
Just wanted to know if you thought this dosage was appropriate. Dr. Wright seems to encourage taking the Lithium Orotate along with SSRI's. What is your take on this?
Please advise.
Thank you,
Wendy from CT
______________________________________
Dear Wendy,
A new report by Irving Kirsh just revealed a startling revelation about SSRI antidepresants. In most cases of depression, the drugs are no better than placebo, yet have troubling adverse side effects.
Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted
to the Food and Drug Administration by Irving Kirsch, Brett J. Deacon, Tania B. Huedo-Medina, Alan Scoboria, Thomas J. Moore, Blair T. Johnson, PLoS Medicine Feb 2008.
"Conclusions:
Drug–placebo differences in antidepressant efficacy increase as a function of baseline
severity, but are relatively small even for severely depressed patients. The relationship between initial severity and antidepressant efficacy is attributable to decreased responsiveness to placebo among very severely depressed patients, rather than to increased responsiveness to medication.
These findings suggest that, 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.
The findings also show that the effect for these patients seems to be due to decreased responsiveness to placebo, rather than increased responsiveness to medication.
Given these results, the researchers conclude that there is little reason to prescribe new-generation antidepressant medications to any but the most severely depressed patients unless alternative treatments have been ineffective.
In addition, the finding that extremely depressed patients are less responsive to placebo than less severely depressed patients but have similar responses to antidepressants is a potentially important insight into how patients with depression respond to antidepressants and placebos that should be investigated further."
In other words, in their opinion, the SSRI drugs seem to work, but placebos also work about as well.
The adverse side effects of SSRI drugs are listed in my previous article:
Paxil,Prozac and SSRI Induced Suicide
Jeffrey Dach MD
warmest regards,
Jeffrey Dach MD
www.drdach.com
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I salute this! There is nothing more efficient than overcoming depression in a natural way. Most of us know what kind of effects antidepressants can have.
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