Show 1389: Getting Off the Medication Treadmill

This week, Joe and Terry Graedon welcome your questions and stories about difficulties in stopping medicines, whether prescription or OTC. Dr. Richard Friedman, an expert on drugs to treat anxiety and mood disorders, describes the symptoms of discontinuing such an agent too suddenly. Have you had trouble getting off the medication treadmill? You can ask your questions about how to stop a medicine and share your experience at 888-472-3366 between 7 and 8 am EDT. Or email us: radio@peoplespharmacy.com

Getting Off the Medication Treadmill:

There are a number of questions we should ask as soon as we receive any prescription. What is the drug supposed to do? When do we take it? What side effects might we experience? One question we should always ask–but often don’t–is when should we stop taking it, and how.

You might be surprised how many medications could be hard to stop. You’ve probably heard that benzodiazepines used to treat anxiety or insomnia can cause unpleasant symptoms if a person stops taking one too abruptly. How suddenly is too suddenly? That seems to vary from person to person. However, while a few people have no trouble stopping cold turkey, some people need to taper the dose gradually over weeks or months.

Discontinuing Antidepressants:

People who begin to feel anxious when they stop an anti-anxiety medicine may naturally conclude that their original complaint has returned. Those who experience symptoms upon stopping an antidepressant don’t always believe that, though. That’s because symptoms of an antidepressant discontinuation syndrome tend to be more physical than psychological. People tell us they sweat, feel nauseated and dizzy, experience “brain zaps” somewhat like electric shocks or have a sensation they describe as “head-in-a-blender.” None of these were part of the original complaint of depression.

Some who have suffered from discontinuation syndrome found that decreasing the dose in tiny increments very gradually makes the symptoms tolerable. Neither the manufacturers nor the FDA have provided guidance for prescribers or patients on how to get off the medication treadmill with minimal trouble.

OTC Discontinuation Problems:

You might not be surprised that some powerful prescription products can be very tricky to stop without serious symptoms. But over-the-counter drugs are a different situation. People generally don’t think of them as triggering problems, but we have heard from hundreds of people who wind up using certain OTC products for years because they can’t figure out how to get off them.

Nasal Spray:

One of the classic examples is decongestant nasal spray. These work really well to clear a stuffy nose. However, using one for more than a few days can lead to rebound congestion upon stopping. For many people, being unable to breathe through the nose is so intolerable that they keep using the nasal spray for months or years. Some describe themselves as being “addicted to Afrin” although really the problem is not addiction but getting off the medication treadmill.

Proton Pump Inhibitors:

People take acid-suppressing drugs like omeprazole (PrilosecOTC) and esomeprazole (Nexium 24HR) to treat frequent heartburn. The label warns, however, not to use it for more than 14 days at a time. People who take such drugs for many weeks, not just two, often find that rebound hyperacidity results in heartburn worse than ever if they stop the drug suddenly. How can you get off PPIs?

Antihistamines:

Another example of OTC medications that can be difficult to quit are the antihistamines cetirizine (Zyrtec) and levocetirizine (Xyzal). Lots of people take them for a few weeks in the spring or fall when their allergies are bothering them and stop without problems. Others, especially those who have taken them for a longer time, experience intolerable itching if they stop suddenly. This itching can last up to six weeks or so, and many listeners find it so horrible that they go back on the drug.

This Week's Guest:

Richard Friedman, MD, is a Professor of Clinical Psychiatry and the Director of the Psychopharmacology Clinic at Weill Cornell Medicine.
Dr. Friedman’s specialties include anxiety and mood disorders, psychopharmacology and refractory depression. His website is https://weillcornell.org/richardfriedman

[caption id="attachment_131110" align="alignnone" width="768"] Dr. Richard Friedman, Weill Cornell Medical Center[/caption]