Saphris (Asenapine) is a drug that was approved by the FDA in 2007 for the treatment of schizophrenia and the manic phases of bipolar disorder. It functions by acting primarily on 5-HT2A serotonergic receptors and D2 dopaminergic receptors as an antagonist. It also elicits effects on a variety of other serotonergic receptors (5HT2B, 5HT2C, 5HT6, 5HT7), dopaminergic receptors (D3 and D4), and noradrenergic receptors (Alpha-1A and Alpha-2).
Its action on 5-HT2A and D2 receptors is thought to improve various positive symptoms of schizophrenia, while its action on noradrenergic receptors is thought to minimize both negative symptoms and cognitive symptoms of schizophrenia. The complex pharmacological effects of Saphris have been promoted as essentially targeting all potential problematic symptoms of schizophrenia. Despite its marketing as a utopian new-age atypical antipsychotic, not everyone who uses it will find it effective for management of symptoms.
In fact, certain individuals may find that Saphris makes them feel worse or triggers unwanted side effects (e.g. extrapyramidal symptoms). Others may find that Saphris is effective for a short-duration, but that its efficacy dwindles over the long-term. Should you find Saphris to be ineffective and/or problematic, your doctor may encourage you to discontinue. Discontinuation often leads to an array of (potentially debilitating) withdrawal symptoms.
Factors that influence Saphris withdrawal
There are many factors that may influence the severity and number of withdrawal symptoms that you experience. In addition, many of these factors may dictate how long your withdrawal symptoms last following complete cessation of Saphris. These factors include: the time span over which you’ve taken Saphris, your dosage, how quickly you tapered, and other individual factors (e.g. daily habits, other medications, etc.).
Typically, the longer you’ve taken Saphris, the more debilitating the withdrawal symptoms. Over a short-term, your neurophysiology isn’t fully adapted to the influence of Saphris, making it easier to discontinue without as severe of discontinuation repercussions. However, over a long-term, the drug alters your brain functioning (neurochemistry) and alters various physiological biomarkers.
Those who have been taking Saphris since its initial inception in 2007 are likely going to have a much tougher time discontinuing than individuals who have only taken it for a short-term (e.g. months). In addition, many people build up a tolerance to the effects of the drug over a long-term, leading their psychiatrist to increase the dosage, giving Saphris more control over your neurophysiology. Those who have been taking it for a longer-term usually face more substantial neurophysiological backlash when they attempt to quit.
Dosage (5 mg to 10 mg)
The standard dosage for Saphris is 5 mg or 10 mg administered sublingually twice per day. This means that most people are taking either 10 mg total per day or 20 mg total per day. In general, those who are on high doses of the drug are going to have a tougher time discontinuing than those taking lower doses or the minimal effective dose. It should be noted that some of the dose-related impact on withdrawal may be associated with your bodyweight and size.
For example, if you are a small statured person that is a light weight and short, yet you’re taking 20 mg per day, the drug may be of greater potency for you than someone who is twice the size of you taking the same dose. The greater the dosage you’ve been taking, the more your neurophysiology will have adapted to accommodate the drug. Individuals taking supratherapeutic doses (e.g. exceeding 20 mg) will likely have the most difficult time discontinuing – especially if they are small-statured.
Cold turkey vs. Tapering
The speed by which you taper down your Saphris may also have a significant impact on your withdrawal symptoms. Those who go “cold turkey” are likely to have more debilitating, longer-lasting symptoms than those who conduct a gradual taper. When you quit cold turkey, especially after a long-term of daily usage, your body doesn’t know how to react.
It may expect the drug, and without it, your entire nervous system doesn’t know how to react. Cold turkey discontinuation may serve as a shock to your CNS, causing a more protracted withdrawal than had you tapered. As a general rule of thumb, it is recommended to taper at a rate of 10% per month for any psychiatric medication; this can be adjusted based on whether you think it’s too fast or too slow.
Conducting a gradual taper off of Saphris allows your nervous system to gradually recalibrate itself. Think of tapering as slowly guiding your nervous system in the right direction, and think of cold turkey as expecting it to adapt without any guidance. Most professionals acknowledge that cold turkey discontinuation is often significantly more debilitating.
Individual variation is perhaps the most important factor of withdrawal. Two people could take Saphris for the same duration and at the same dosage, yet one may recover significantly quicker than the other and/or have less debilitating withdrawals. Individual variation can include things like: other medications you’re taking, genetics, social support, baseline neurophysiology, and daily habits.
Someone who is taking another psychiatric medication and/or quickly transitions to another drug may not notice many withdrawal symptoms due to the fact that the new medication may serve as a buffer. In addition, someone taking certain supplements may find that the supplements alleviate various symptoms. Furthermore, some of the discontinuation effects can be chalked up to specific genetics and baseline neurophysiological functioning.
Daily habits such as how much sleep you get per night, your stress level, dietary intake, exercise, and whether you keep yourself busy can all play a role in withdrawal. Someone who engages in stress management (e.g. meditation), gets some daily exercise, works during the day, and gets enough sleep will likely have an easier time with Saphris withdrawal compared to someone who makes no effort to optimize their daily habits.
Saphris Withdrawal Symptoms: List of Possibilities
Although Saphris may be a newer medication (approved in 2007), it is important to avoid assuming that newer equates to an easier withdrawal. Discontinuation from Saphris may trigger withdrawal symptoms as severe as any antipsychotic on the market. Below is a list of symptoms that you may experience during Saphris withdrawal.
- Agitation: Many people become severely agitated when they discontinue Saphris. This agitation is often characterized by an internal sense of nervousness or anxiety, and may lead to restlessness. It is unclear as to why this symptom emerges, but may be due to fluctuations in neurotransmission of serotonin and/or dopamine.
- Anger: If you feel as if you’re ready to rage or have uncontrollable bouts of anger, it’s likely a result of withdrawal. Anger is a common symptom that emerges upon discontinuation of many antipsychotics. This is due to the fact that your brain isn’t able to effectively modulate various neurotransmitters like serotonin.
- Anxiety: Another very common withdrawal symptom that may emerge is that of anxiety. For some people, the anxiety experienced during Saphris withdrawal may be the most severe they’ve ever experienced in their entire life. It is important to know that this symptom will gradually improve over time, assuming you proactively take steps to minimize it. Some people may become so overwhelmed by withdrawal anxiety that they experience panic attacks and/or constant sensations of fight-or-flight.
- Brain fog: Certain individuals may find that when they stop taking Saphris, they are unable to think clearly. It’s almost as if their brain is full of fog and their prefrontal cortex is no longer working properly. If you’re experiencing brain fog, it is important to know that it should improve with time. Since your brain is no longer getting the noradrenergic effects of Saphris to enhance certain aspects of cognition, it may take awhile to recover back to a baseline.
- Cognitive impairment: In many cases, cognitive function becomes impaired when a person stops taking Saphris. Impaired cognitive function is often due to the fact that the brain is no longer receiving an artificial modulation of select neurotransmitters via a pharmaceutical pill. The brain and nervous system are attempting to recalibrate homeostatic functioning, but neurotransmission is still in disarray – causing cognitive deficits.
- Concentration problems: Many people report that they have a difficult time concentrating at school and/or on the job as a result of Saphris discontinuation. The concentration difficulties may be similar to those experienced by individuals with ADHD (or even worse). It may take awhile before concentration returns back to normal, so do your best to function and realize that it should improve over the long-term.
- Confusion: A combination of concentration problems, cognitive impairment, and severe brain fog all may be so severe, that a person ends up confused. This confusion may result in memory deficits and difficulty functioning in everyday life. Assuming you didn’t experience overwhelming confusion prior to the medication usage, it should subside in time.
- Depersonalization: A relatively common symptom to experience when you stop taking Saphris is depersonalization or feeling as if you are no longer connected to your body – you may feel as if you are observing yourself from a third person. Depersonalization can be highly unpleasant and is generally caused by neurotransmitter imbalances, but can also be exacerbated by anxiety. It is highly unpleasant, but tends to improve gradually as your brain learns to function without the drug.
- Depression: As a result of the numerous neurotransmitters impacted by Saphris, it is no wonder that some people experience severe depression when they discontinue. Even among people that weren’t depressed prior to using this drug, depression could be a byproduct of withdrawal. It is important to realize that withdrawal-induced depression should gradually subside in time.
- Diarrhea: An adverse reaction that some people experience when they withdraw from Saphris is diarrhea. If you are unable to hold down any food and have incessant “disaster pants” – you may want to consider taking some over-the-counter Imodium or working with your doctor. Diarrhea and other gastrointestinal distress should correct themselves over time.
- Dizziness: Those that quit cold turkey or conduct fast tapers are likely to feel dizzy. You may experience extreme dizziness, almost similar to that which you’d experience when drinking too much alcohol or getting off of an amusement park ride. The dizziness may make you second guess your ability to drive a vehicle and/or heavy machinery.
- Fatigue: If you notice that you’ve become lethargic, drowsy, and that your energy level has plummeted after quitting Saphris, you are not alone. Many people feel extremely fatigued during withdrawal. In part, the fatigue is due to imbalances in neurotransmitters as the brain is readjusting itself, but also related to the taxing physiological consequences of withdrawal.
- Fever: Some users of Saphris notice that when they quit taking it, they develop a low grade fever and feel chilled. High fevers haven’t been reported and are less likely. Low grade fevers are most likely to occur among individuals who taper too quickly and/or decide to quit cold turkey. Fevers are thought to be triggered as a result of the physiology still expecting the drug, but no longer getting it.
- Flu-like symptoms: Many people describe their withdrawal from Saphris as being akin to influenza. This is due to the fact that they may have a headache, fever, dizziness, nausea, and may end up vomiting. They may also sweat profusely and experience body aches – all of which are similar to the flu.
- Headaches: A very common withdrawal symptom is that of headaches. Headaches may be mild or severe (such as migraines). If you experience headaches, make sure that you’re staying properly hydrated, minimizing stress, eating enough, and getting plenty of rest. In most cases, headaches should lessen in severity within a few weeks.
- Insomnia: If you can’t fall asleep at night, or stay asleep at night after you’ve discontinued Saphris, you are not alone. Insomnia is considered one of the most commonly experienced withdrawal symptoms. You may be able to ameliorate insomnia with the usage of certain supplements, stress reduction techniques, and daily exercise.
- Irritability: Some people become increasingly irritable when they discontinue antipsychotics like Saphris. If you notice an increase in irritability in the early stages of withdrawal, understand that it should gradually improve over time. Getting plenty of exercise, eating healthy, and reducing stress (e.g. via meditation) may significantly attenuate irritability stemming from withdrawal.
- Mood swings: A person may experience non-bipolar mood swings following discontinuation. In other words, their mood may be subject to constant, seemingly uncontrollable fluctuation. If you notice that you feel anxious one minute, then depressed the next, then hopeful – you’re probably experiencing the wrath of withdrawal-induced mood swings. Realize that mood should be less subject to fluctuation the longer you’ve been off the medication.
- Muscle aches: Another physical response associated with discontinuation is that of muscle aches. You may notice that your joints are sore, your muscles are stiff, and that you cramp up easily. Some people may feel as if they are achy in random places throughout the body as well.
- Nausea: It is common for people to become nauseous when they first quit Saphris. Nausea is a very common discontinuation effect, and tends to subside within a couple weeks. Should you experience severe nausea, it could lead to vomiting. Certain individuals may want to conduct a more gradual taper if the nausea is too debilitating.
- Palpitations: Sometimes it may feel as if your heart is beating especially loudly, irregularly, and/or rapidly. These are considered a physiological response to discontinuation, but may be exacerbated by anxiety and the fight-or-flight response. Should you notice palpitations, try not to panic and instead focus on engaging in relaxation.
- Restlessness: Some people may feel excessively restless when they stop taking this antipsychotic. The restlessness may be triggered by agitation, inner emotional turmoil, and increases in anxiety. If you feel restless, you may want to get up and go for a long walk or attempt to ameliorate it by using a relaxation technique.
- Sleep problems: It may be difficult to get a full night’s sleep when you quit Saphris. This is due to the fact withdrawal can cause heightened anxiety, racing thoughts, and insomnia. Your circadian rhythm may be out of whack, and your neurotransmitter levels are imbalanced. It takes time for the sleep cycle to correct itself after you’ve discontinued a potent psychiatric drug. Do your best to get sufficient sleep each night.
- Suicidal thoughts: Should you experience an increase in suicidal thoughts or feel as if you want to die, seek immediate professional help. Understand that many people become increasingly suicidal when discontinuing this medication due to the fact that their neurotransmission is now more imbalanced than in the past. Assuming you were not suicidal prior to starting the medication, suicidal thoughts caused by withdrawal should subside but may be highly unpleasant and difficult to bear.
- Sweating: You may wake up in the middle of the night covered in a puddle of sweat. In addition, you may find that your body is sweating profusely throughout the day. Sweating is a very common reaction to Saphris discontinuation, especially if you quit cold turkey. It may be a natural detoxification mechanism by the body, but may also be a physical withdrawal symptom associated with physiological dependence on the drug.
- Tremors: It is possible to experience tremors and body shakes while taking Saphris, but you may also experience them when you discontinue. If you notice that your body shakes uncontrollably and you cannot control your limbs, realize that it’s a natural physiological response to no longer receiving the drug. Tremors are more likely to occur among individuals that titrate downwards too quickly.
- Vomiting: Some people feel so sick when they quit Saphris that they end up vomiting. The vomiting is usually preceded by nausea, and tends to only occur in extreme cases of withdrawal. Those who quit the drug cold turkey from high doses may be more likely to vomit. Should you experience vomiting, it shouldn’t be long-lasting.
- Weight changes: For some people, Saphris causes weight gain (a modest amount). When discontinuing the drug, most people will end up losing the weight that they gained. If you lost weight while taking Saphris, you may end up gaining weight. Understand that weight fluctuations upon discontinuation may be directly related to your appetite and activity level.
Note: Understand that the number and severity of symptoms you experience is subject to significant individual variation.
How long do Saphris withdrawal symptoms last?
Everyone wants to know how long Saphris withdrawal symptoms will last. It is important to realize that there is no specific exact universal withdrawal timeline that can be followed by everyone. For one person, noticeable symptomatic improvement may be experienced within several weeks of their last dosage.
For another individual, withdrawal symptoms may last for months after discontinuation. As was mentioned above, the length of withdrawal is often dictated by various factors including: duration of usage, dosage, tapering speed, genetics, and lifestyle choices. Should withdrawal prove to be protracted, working with your doctor and a psychotherapist may provide significant benefit.
As a general rule of thumb for long-term users, expect Saphris withdrawal symptoms to persist for at least 90 days. Three months time may sound harsh, but consider all the neurophysiological changes that you’ve endured from consistent (daily) administration of a drug over a long-period of time. For some people, most of the withdrawal symptoms will be cleared up within several months, while for others they may last much longer.
It is important to focus on things that you can personally do to expedite your recovery. While you may not be able to modify your genetics, you can make sure you’re eating healthy, getting proper sleep, working with a psychotherapist, minimizing stress, and taking any other supplements (or drugs) that provide significant benefit. A tool I’ve found invaluably helpful is keeping a daily journal – this allows you to easily track improvement over time.
Understand that withdrawal is not easy for most people and that you shouldn’t expect improvement overnight. Take things one day at a time, or even one hour at a time – focusing on something you can do right now (in the present moment) to improve your situation. As days continue to pass, your symptoms should gradually subside.
Have you experienced Saphris withdrawal?
If you’ve been through Saphris withdrawal (or are currently withdrawing), feel free to share your experience in the comments section below. Discuss how long you had been taking Saphris, the dosage you were taking, as well as your most debilitating withdrawal symptoms. Mention how long your withdrawal symptoms lasted and whether you’ve found anything helpful for mitigating certain symptoms.