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Distinguishing: Drug Withdrawal Symptoms vs. Mental Illness Returning

Many people going through withdrawal from various psychotropic drugs like antidepressants often have a difficult time distinguishing “withdrawal symptoms” from “returning mental illness.” It is generally difficult to distinguish withdrawal from the original illness due to the fact that there is generally some overlap. Withdrawal is capable of producing a variety of symptoms including severe depression and anxiety.

On the other hand, you may have suffered from a mental illness like depression and/or anxiety and notice that the original symptoms reemerge upon discontinuation from the medication. So are you experiencing a hellacious withdrawal? Or is your mental illness rearing its ugly head again? In most cases, you are likely experiencing a combination of both – making for an extremely uncomfortable experience.

Drug Withdrawal Symptoms vs. Mental Illness Returning

Below is an attempt to help you consciously distinguish what you may experience during withdrawal from a psychotropic drug (e.g. an antidepressant) vs. your original mental illness returning.

Drug withdrawal symptoms

The withdrawal symptoms are based upon drug-induced neurochemistry and physiological changes. When withdrawing from a medication, your neurotransmitter levels are not the same as they were pre-drug, neither is your brain functioning. This is why it’s often common for antidepressants to actually create a chemical imbalance that wasn’t previously there and then have a person developing new pyschiatric problems that emerged after a medication withrawal.

Often you’ll see individuals taking antidepressants for conditions other than depression (e.g. Cymbalta for neuropathic pain) and during withdrawal, they become incredibly depressed despite not having any depression prior to using the medication. This is a clear indicator that the psychiatric drugs can cause depression, anxiety, etc. during withdrawal among individuals who may have had perfect mental health prior to taking them.

  • Chemical withdrawal: Withdrawal from any psychotropic drug whether it be an antidepressant, antipsychotic, etc. is withdrawal from a chemical. It can be especially severe if you had established a degree of tolerance.
  • Drug dependence: Most people that use psychotropic drugs for an extended period of time can become dependent upon them for functioning. Strip the person of the drug, and an array of unwanted symptoms will appear.
  • New symptoms: Withdrawal is known for causing new psychiatric symptoms to appear. In other words, if you didn’t have mood swings prior to using a drug, you may have them during withdrawal. If you were taking an antidepressant for insomnia, you may now also experience depression and anxiety.
  • Objective differences: There will be some clear objective differences that could be measured comparing your withdrawal experience to your initial mental illness. Even if we could show you the data, you may still be so mentally fogged in withdrawal that you forgot specifically what you were like before you took the medication.
  • Perceptual differences: If your original mental illness was depression, you will likely perceive it differently. Even if you still call it depression, it may be more severe or may have changed in form or what you experience. In other words, the withdrawals chemical basis for depression can be differentiated by your perception.
  • Subjectivity: Some individuals will be able to subjectively distinguish their condition pre-drug from that which they experience during withdrawal. Many of these differences can be tracked via journaling and getting a better understanding of your emotion, cognition, focus, etc.

Recommendations

Below are a couple recommendations that can help you get a better understanding of withdrawal vs. resurgence of your underlying mental illness.  Both involve tracking specific things about yourself over time and then comparing them with your current state of functioning.

  • Journaling: This is a way for you to track your awareness over time. While it is imperfect in that you cannot expect reading a journal to replicate your physiological functioning while you read it, it does provide some information regarding how you were functioning at the time. For anyone that is meticulous about keeping a daily journal, perhaps reflecting on your emotional states pre-drug, during treatment, and post treatment will help give you a better idea of withdrawal.
  • Quantified self: You can collect and track some individualized biomarkers by utilizing some of the apps and tools on quantified self. This may help you collect some objective data about your functioning during withdrawal that may have differed from your pre-medicated functioning.

Returning mental illness (symptoms)

The symptoms of your mental illness are those that are firmly rooted in your homeostatic functioning. In other words, you’ve had the specific illness over the course of your life and it wasn’t necessarily triggered by an event or stress. The original symptoms for your mental illness were likely covered up or “masked” by the effects of the drugs. When you stop taking them, the mask is no longer there, resulting in a resurgence of sympmtoms.

  • Genetically-based: For most people, their mental illness will have some sort of genetic component, meaning it is not triggered by withdrawal from a drug.
  • Life-long: Since you have likely suffered from your mental illness prior to using medication, take the time to reflect on your pre-drug functioning. You will likely be able to distinguish it from your current state of functioning in some ways via reflection.
  • Organic: The symptoms resulting from your mental illness are considered organic in that they are not caused or triggered by an external factor. They are likely rooted in your genetic code.
  • Physiological homeostasis: Those who have chronic mental illnesses generally exhibit their symptoms while in homeostasis. Experiencing a mental illness in physiological homeostasis is much different than experiencing it while simultaneously dealing with a psychotropic drug withdrawal.

Overlap: “Compounding Effect”

There is a third aspect that needs to be addressed known as the “compounding effect.” This is a period of time where you are experiencing a chemical depression from medication withdrawal, accompanied by your original depression from your underlying illness and you feel significantly more debilitated (and crazy) than pre-drug.

Chemical depression: The depression resulting from withdrawal is based on withdrawal from a particular chemical. Since you are no longer ingesting that particular chemical, your nervous system is attempting to function without it. Unfortunately your neurotransmitters may now be lower than they were pre-drug, resulting in withdrawals until levels reach homeostasis.

Organic depression: The increase in neurotransmitters from your antidepressant may have covered up the organic depression that is rooted in your genetics. However the organic depression is no longer being masked by the artificial increase in neurotransmitters like serotonin. During withdrawal, most people generally experience a resurgence of their original, organic depression.

Compounding effect: The effects of the depression resulting from neurotransmitter deficiency (i.e. the chemical depression) combines with a resurgence of the organic depression, to create a compounding effect. This leads to a person actually feeling significantly more depressed than they originally were because it has become compounded.

Note: I chose to use depression as an example, but the same principle applies to things like anxiety, insomnia, etc.

How do you know when withdrawal symptoms have ended?

The way you can tell if your “withdrawal symptoms” have ended is by comparing your pre-drug state of functioning to your current state of functioning. Assuming you were genetically predisposed to a condition like depression, it will likely rear its ugly head during withdrawal. However, during withdrawal, the depression may be significantly more intense due to the fact that your brain needs to make repairs and readapt to homeostatic functioning.

If you feel worse and/or have seemingly developed some other ailment (that you never had before) such as poor concentration, mood swings, and/or anxiety, you are experiencing the withdrawal. Assuming you are providing your body with proper nutrition, sleep, and sufficient exercise, you should eventually recover to your homeostatic state of functioning. Eventually you should feel the same (if not better) than when you first took your medication.

When all withdrawal symptoms (that you didn’t have pre-drug) disappear, you can safely assume that you’ve returned to homeostasis. If you feel different than before you took the drug (e.g. you feel depersonalized), understand that this depersonalization is associated with withdrawal and you are not yet recovered. For many individuals it can be tricky to sort this out because being medicated for a long period of time makes it difficult to recall our functioning non-medicated.

Muddying the waters

It can become more difficult for some to distinguish withdrawal from their original condition if they are getting inadequate nutrition, sleep, exercise, are stressed, and/or aren’t staying busy. Just know that if you organically had a condition like bipolar disorder, you are still going to have it. However, if during your withdrawal you seem to develop a condition that you previously didn’t have before, it’s safe to say that the new symptom is resulting from withdrawal.

  • Drugs: Using other drugs such as switching to another psychotropic medication, using illicit drugs, and or continuing treatment with an existing medication will make it impossible to distinguish withdrawal from your original illness. Especially if you are playing “antidepressant roulette” with your psychiatrist.
  • Environment: If you live in a stressful environment, this could contribute to new symptoms simply resulting from stress. Do your best to cultivate a peaceful environment that allows you to heal and recognize when you’ve finished withdrawal.
  • Health conditions: If you have developed a new health condition, this may cause more anxiety and other symptoms. Many health problems can directly impact your mental health and therefore make it more difficult to determine withdrawal vs. original illness vs. new health problem.
  • Stress: If you are under significant stress from environmental factors, the stress will influence your nervous system and create an array of additional symptoms. This can further confuse people, especially considering the fact that they are often hypersensitive to stress during discontinuation.
  • Supplements: Taking supplements during withdrawal isn’t a bad idea if you have a strategic protocol and know what you’re doing. However, aimlessly taking supplements has potential to make symptoms worse and further muddy the waters of withdrawal vs. original condition.
  • Toxicity: Anything in your environment that you’d consider toxic such as harmful chemicals can influence your recovery and create new psychological symptoms. Obviously do your best to avoid anything that could be harmful to your brain.
  • Unhealthy foods: Eating a poor diet can make your mental health worse. For example, if you are eating a diet high in refined carbohydrates with high artificial sweeteners and aren’t getting proper staples such as vegetables and fruits, your mental health will suffer. Dietary and nutritional inadequacies can cause an array of mental health problems, making it more difficult to know whether you are still experiencing withdrawal.

Caveat #1: Those that are taking worse care of themselves during withdrawal may end up experiencing protracted withdrawal symptoms and have a longer recovery. Additionally it may seem as if a new condition is developed, when in reality, if you are taking worse care of yourself than you were prior to taking the medication, other factors may be influencing your physiological functioning.

Caveat #2: This second caveat is in regards to individuals who went on a psychotropic treatment for a condition that is not considered a mental illness. For example, someone may have used an antidepressant to help them sleep better at night (insomnia) or to cope with work-related stress. Among these individuals, not only will withdrawal symptoms eventually subside, but many actually feel much better than they did pre-drug because they began taking better care of themselves to promote recovery during withdrawal. This also applies to someone with situational depression who decided to medicate themselves; most of these individuals are capable of making a full recovery.

Are withdrawal symptoms from antidepressants real?

Many would argue and have argued that withdrawal symptoms from psychotropic medications are complete hogwash. Roughly a decade ago, psychiatrists (including my own) insisted that none of the medications carried any withdrawal symptoms, my family doctor held this same belief. I suffered and had a nervous breakdown after quitting Paxil cold turkey that I will never forget.

I experienced an array of symptoms that I never had before such as dizziness, headaches, sensitivity of sound and sight, visual changes, and brain zaps. This inevitably lead to me getting an MRI with the belief that I had a brain tumor or something seriously wrong. The MRI revealed that I didn’t have any such tumor, but still didn’t explain what I was experiencing.

When I finally got engaged in a forum online at the time (RxList threads), I realized that this was normal to experience when discontinuing Paxil. Fortunately this was advice that I received from people that had already been through the hell of withdrawal. I knew that withdrawal was significantly different than what I felt prior to taking the medication, but my psychiatrist made the assumption that my condition was organically worsening; this couldn’t have been more untrue.

I was put through the ringer of antidepressant medications via a process I now refer to as “antidepressant roulette.” This created many chemical alterations that took approximately 1 year to recover from, and 2 years to fully recover from; quite a prolonged ordeal. Fortunately I now am able to realize how powerful psychotropic medications can be, and how to properly use antidepressants. I also realized that it takes a significant period of time for the nervous system and neurotransmission in the brain to return to homeostatic functioning – this is the withdrawal period.

And several years after my experience, an array of data was released suggesting “antidepressant discontinuation syndrome.” For some reason they label it with a more technical term, likely due to the fact that these are pharmaceutical drugs rather than illicit drugs. Some have argued that this is strictly for financial reasons, to confuse consumers and promote a misleading guise that somehow withdrawal from a psychotropic pharmaceutical is significantly less severe than other drugs – hence calling it a “syndrome” rather than withdrawal.

Scientifically distinguishing pre-drug vs. medicated vs. withdrawal biomarkers

If there was a study I could propose to a university or team of researchers, it would be to collect measurements of pre-treatment biomarkers and compared them with those experienced during treatment, as well as during withdrawal. My hypothesis is that it will take a significant period of time (e.g. withdrawal period) for the person to readjust to their pre-treatment (likely homeostatic) functioning.

Proposed study: Comparing Biomarker Differences

This study would actually best be suited for individuals with no mental illness or those that aren’t currently involved in treatment. Gather biological data of each person such as with an EEG (brain waves), MRI (brain activation), PET (brain activity), hormone levels (blood test), nutrient/vitamin levels (blood test), sleep quality, neurotransmitter levels (blood test), etc. Once these measurements are taken, simply administer a therapeutic dosage of an antidepressant.

After they’ve been taking the medication for 4-6 weeks, gather the same set of biological data and note changes. Upon discontinuation of the medication, we could set up multiple protocols such as a prolonged taper, a short taper, and a cold turkey group. Then we could give participants a survey regarding mood and withdrawal symptoms, this survey could be given weekly.

Next after a week or two of withdrawal, gather the same biological data that we collected earlier. Compare this data to the person pre-medication vs. during treatment. I hypothesize that this will be different based on the fact that the person is now going through “withdrawal” from their psychiatric drug. Then at a later date (a month or so), do a fourth biological data test to determine changes and to determine to which the person has returned to homeostasis.

Scientific basis behind withdrawal symptoms

I believe a study like this would reveal to the non-believers that there is a scientific basis behind withdrawal; people aren’t making it up. Additionally this would be important because as I mentioned in my personal experience, psychiatrists often mistake medication withdrawals for a worsening case of a mental illness. They have no data that suggests that the person is going through withdrawal, so they medicate more aggressively, often leaving a patient more compromised and subject to further psychotropic debilitation.

A specific example of this was when I told my psychiatrist I felt as if I had no emotion. He interpreted this as blunted affect, leading him to conclude that I had premorbid schizophrenia, and needed an antipsychotic medication added to my drug regimen. When in fact, this all resulted from the Cymbalta withdrawal. Others are often misdiagnosed with Bipolar 2 disorder when they have changes in mood during withdrawal or after being medicated.

Note: I have written more extensively on the thought of tracking various biomarkers in the article “How To Improve Psychiatric Treatment Outcomes with Variable Tracking.”

Do you have difficulty distinguishing withdrawal symptoms from mental illness?

If you have a difficult time distinguishing drug withdrawal from your mental illness, feel free to share in the comments section. What makes it so tough to compare what you experience during withdrawal from what you experienced before taking your medication? In many cases it takes awhile for the dust (physiology) to settle (reset itself), so withdrawal symptoms can be expected along with returning symptoms of your mental illness.

Obviously if you don’t think you can handle what you are experiencing upon discontinuation, seek professional help. In the meantime, you may want to consider keeping a journal of your mood and specifics in regards to how you are feeling. You may also want to schedule regular appointments with a psychotherapist to see if talking about your experience helps.

Once you have functioned unmedicated for a substantial period of time (e.g. a year or two), you will be able to truly realize the difference between withdrawal symptoms and your underlying mental illness. While there is certainly overlap in some of the withdrawal symptoms and mental illness symptoms (e.g. depression), upon reflection, most will realize that the depression experienced upon discontinuation differs in that it is resulting from a chemical withdrawal, whereas the original was organic.

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{ 10 comments… add one }
  • Zoe clements January 10, 2015, 10:30 am

    I am on a slow tapering off from Prozac, after two years usage, and at the beginning I had withdrawal symptoms, so I agreed with my doctor to go even slower, (going to take me over a year to come off)… My questions are: Do we continually have withdrawal until we come to the end of tapering even if it is much lower and subtle?

    Also can withdrawal cause heightened feelings that seem real, as in strong infatuation are there any links in this? I understand dopamine plays its part in infatuation, does this go out of synch when tapering off? Hope I have made sense, apologies if not. I am not sure what’s real and what’s not, many thanks for a reply.

    • GLOOM January 10, 2015, 1:28 pm

      Yes Zoe, the point of conducting a gradual taper is to prevent highly intense symptoms from emerging all at once. Those conducting a taper are still going to have withdrawal symptoms, but the symptoms are generally less severe and more easily managed by patients. You are giving your brain and nervous system more time to readjust to reductions in dosing, which results in a smoother withdrawal for most people.

      Withdrawal can cause many things such as derealization and an altered sense of perception. It can certainly lead some people to experiencing more powerful emotions. The exact neurochemistry changes undergone by each person during withdrawal are poorly understood. However, if you are experiencing something during discontinuation (e.g. infatuation) that you haven’t previously experienced, there’s a strong possibility that its stemming from withdrawal. Best of luck.

  • James Brannick January 21, 2015, 12:30 am

    An extremely well written and invaluable article. They say knowledge is power and the more knowledge we have surrounding withdrawal from a medication the better. I was on 20mg citalopram daily for around 18 months and then I halved the dose to 10mg for a month then nothing. I am almost 10 days into not taking citalopram and to be honest the experience has been nothing short of hell and torment. I experienced extreme waves of anxiety and low mood coupled with irritability and aggression over the smallest of things.

    The so called “brain zaps” are very regular as well as flu-like symptoms aches and pains. The weeks ahead will hopefully improve my mental state as it is a scary experience to say the least. I am doing everything in my power to fully recover from the cessation of citalopram. I have a very good diet and try to walk as often as possible as well as trying to maintain a sleep pattern. I even have a cup of jasmine tea and a banana in front of me right now in an effort to alleviate the horrendous symptoms I am going through. I guess it takes time…

  • Pat kennett January 21, 2015, 5:32 pm

    An excellent eloquent article…thank you. It is 3 months since I took my last Citalopram tablet. I still get terrible anxiety and irritability. I tapered slowly over a year, so I never expected to have these symptoms for so long. I originally took them following delayed reaction to my mother’s death. Hindsight is a wonderful thing…no way did I need drugs, but I was too blind to see that at the time. Do you think my symptoms will eventually go…yes I know, you don’t have a crystal ball!

  • Joan Munro February 18, 2015, 6:05 pm

    Gloom, I am so sorry that you have gone through so much pain and suffering. I want to say thank you for sharing your experiences. Your articles have reassured me time and again that I am not going completely insane while I deal with symptoms of withdrawal from antidepressants. Thank you. -Joan

  • Dawn September 7, 2015, 11:26 pm

    Hi, I have been taking an SSRI off and on for about 15 years. I stopped taking a 20 mg daily dose of Celexa, cold turkey, a month ago after being on it for more than 9 years. Of course it was terrible and I should never have done it that way. However, knowing that the withdrawal was actually withdrawal and not a relapse this time around I was able to stick with it. Most of the physical effects are now gone including brain zaps.

    But, today I decided to start taking 5 mg again daily for a while. I can not handle the chemical depression, anxiety, irritability and crying spells. More importantly, I can’t stand what it must be doing to my 9-year-old daughter. I can’t be what I should be to her. But, I was done! I had gotten through the worst part, or so I thought, and I know once I stop it again the brain zaps and fogginess will return no matter how small I get the dose down.

    I am assuming at that time the chemical anxiety and depression will still be there but perhaps at a level that I can deal with. Do you think I am assuming the right thing? I just don’t want to be disappointed if it is just as bad, say, 6 months from now when I try completely clearing my system again.

  • John December 20, 2015, 7:35 pm

    I was on Paxil 25 CR in the beginning of 2015, went through extreme withdrawal. Then went down to 20, then a few weeks after went down to 10. Now I’m off completely and I don’t even know what I am saying sometimes. I am hearing things and seeing things and my left side is numb. Please tell me these effects aren’t going to be forever.

  • IANMAC April 4, 2016, 3:57 am

    I am still withdrawing as I write this. So yes it is true! I have also experienced the nervous breakdown and quitting cold turkey withdrawal from citalopram. Not fun. Now I am trying to get off Escitalopram slowly. Still not fun. I am afraid of getting depressed again (organically) but can’t take the detached feeling from the meds. It’s been 30 years on drugs, hope I can make it!

  • KSmith October 23, 2016, 1:58 am

    I did everything wrong in relation to my ssri; discontinued first week per doctor due to horrible effects…no issues; then another doctor put me on the same med (b/c I’d had success with it in the past)…kept pushing me higher and higher to the dosage she wanted me at; all the while, nauseated, brain fog…unreality…Went to psych pa who lowered the ssri to 10mg from 40 and added Buspar…felt somewhat better…then the symptoms started back up; crying erratically, depersonalized…he told me to stop it for a week to see how I felt; never returned to him so basically went CT off again…I am stuck in depersonalized hell (one month off)…question would be; should I just endure and push forward, hoping for a return to my normal state or have him adjust the med? I think you referred to it as the roulette of meds….don’t want to continue to damage my CNS.

  • Nancy November 10, 2016, 9:29 pm

    I’ve been off and on SSRIs for about 12 years stating at the age of 15. Started taking meds due to panic attacks. I’ve been off meds for 3 years and I feel numb. I don’t find things as enjoyable and I don’t feel like getting out and socializing. Will I ever feel “normal”? Or is this normal? Been on meds for so long I don’t know what normal is. Thanks.

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