Scientific expertise blended with out-of-the-box thinking for new practical ideas you can use to help yourself on your journey to vibrant health, by Chris Masterjohn, PhD.
I was on Cymbalta, 60mgs 1xper day for 20 years. I was prescribed it for pain and initially I think it worked to take away about 50% of the pain I was experiencing. But that came at a price. It also took away my libido. It took away any pleasurable sexual sensation and that affected my marriage so much so, that after 40 years, it ended. I am 73 and this has been the worst thing to happen to me especially at my age and with my disabilities. I am now completely alone with no help from anyone, no social life and really no friends close by. When you become a 3rd wheel society completely blows you off. It's a hard reality and a cruel one too. I decided to get off the drug since I don't think it was helping anymore and with all we have learned about pharmaceuticals, I decided to get off everything, so I started being weaned off the Cymbalta under a doctor's care. We went from 60 mgs to 40. No problem. Then we went from 40 to 20, still no problem. The problems started when we went 20mgs every other day. I was horribly dizzy, nauseous and unable to function. I lost 20 lbs because I was unable to eat anything, unable to get off the sofa, to walk the dog, to do household chores. It was just awful. I'm finally off now, and the symptoms for the most part are now gone but I got very angry over the fact that a pharmaceutical drug could control my life to the point that it did. It takes over your emotions, your physical responses and I don't even know what else but I do feel that even my personality was affected. How could I have allowed this to rule me for 20 years!? My advice is to never start a drug that you don't know everything there is to know about it. I didn't understand the ramifications of taking a drug like this and now I'm paying for it big time.
Trying to get off of this drug has been one of the worst experiences ever. I’m so sorry you had to go through that. Cymbalta has also destroyed my libido. I have emotional lability issues, weight gain, high blood pressure, and most recently eye pain and blurred vision. So happy you were able to push through and get off of it. Those withdrawals are no joke.
Thank you for this piece. I do have to say CBT has been next to useless for someone whos hyper self aware (with anxiety). Somatic therapy and Brainspotting have been life changers.
Maybe this explains why Wim Hof breathwork works so well. I found that i could sometimes produce an incredible morning MDMA state by doing Wim Hof until i fell asleep..
People report great benefits using cerebrolysin, palmitoylethanolamide (etc), nebulized DMSO, and various peptides for SSRI damage.
And let's not forget probably the most popular remedy, which is psychedelics. I've known tons of people who microdosed certain psychedelics to eliminate SSRI withdrawal. Certain shroom strains work a lot better than others. The Psilouette pheno of shakti shrooms has exceptionally high levels of norbaeocystin and seems ideal. Super pure lsd also works tho harder to find. Vaping 10mg dmt now and then works. If the patient is already off their psych meds they can use the best psychedelic recipe ever, which is also cheap and nearly legal in most jurisdictions: https://open.substack.com/pub/ibogaqueen/p/raw-acv-with-aya-loveyhuasca-or-5
WHM would most likely not be long enough in the hypoxia cycle. We’ve not seen any adaptability to hypoxic conditions through this mechanism of hypoxia, which is akin to breath hold (apnea) hypoxia. One requires longer periods of Intermittent Hypoxia exposure to elucidate the longer-term adaptive responses of hypoxia and/or altitude.
I think you are probably right, but it is complicated because there are different timescales of adaptations, some microseconds, others hours, and others days.
How much, if at all, do you think the mechanisms you've described in this series also apply to protracted withdrawal states caused by benzodiazepines? I've had akathisia and other extrapyramidal symptoms for ten years since a Clonazepam withdrawal, and while I feel much better now than in the early years, I would not be opposed to finding something that could get rid of the remaining pain.
For what it's worth, hyperbaric oxygen therapy about 8 times/month seemed to accelerate my healing in the past year.
Would this also apply to SNRI’s? How does norepinephrine affect mitochondrial function? I am about to start a slow hyperbolic taper off of Cymbalta. I’ve been on it for 11 years. I’ve been on various psych meds 20 years. I’m trying to get as much information as possible.
And how do we address that one? I have 3 to worry about as I came off Diazapam and Venlafaxine. 😔 But unfortunately have just gone back on Venlafaxine again.
I think mitochondrial dysfunction from withdrawal is a good theory. Another plausible theory is that SSRI/Finasteride/accutane hurt the gut microbiome while being ingested and when ingestion stops an opportunistic bacteria/funghi takes over and causes massive dysbiosis/sibo. I’m considering this theory because some people recover with a fecal matter transplant. Interested in your thoughts on this theory Chris! I’m yo-yoing back and forth between gut and brain to fix this issue
Excellently put together. I agree and believe that most, if not all, diseases and maladies are due to aberrations in the electron transport chain within cytochromes inside the mitochondria. IR and NIR light can accelerate the energy reactions in the ETC. I try to expose myself to as much sunlight as possible without burning, in conjunction with earthing, especially when exercising. The hypoxia angle is interesting. Would the Buteyko method of breathing help in some way to achieve the hypoxic response? Regards, Mike Cleaves.
First and foremost, Dr.s know NOTHING about withdrawing from SSRI’S …. second, if you are even thinking you might be getting off of SSRI’S SAFELY in under one year, you are dreaming. Thirdly, until you have your diet consisting largely of protein, (no junk food, sugars, processed garbage) it will be almost impossible to heal.
There was just a study but a minute ago where the overall conclusion was that withdrawal wasn't as bad as was feared. Did you address this here or in this series and I missed it. It was a recent study...seems like one that should be mentioned and addressed. SSRIs are only a passing interest of mine but I happen to have hard about it because of a writer I follow DeBoer covered it a month ago https://freddiedeboer.substack.com/p/nobody-wants-to-hear-good-news-about
I don’t have access to that paper, and have no interest in chasing it down, but the substack article written about it has no value at all as it doesn’t address the single most relevant factor, which is how long the trials were. Literally nothing else matters much, as the incidence and severity of withdrawal symptoms is a direct function of time spent on the SSRI, which means thus trials are of little utility because the ones addressing incidence of withdrawal are short.
So if you want to catch my attention on this, find me the table summarizing the studies from that paper and show me how long the people were on SSRIs prior to discontinuing.
Got you covered. Found the details in supplement 1 eAppendix 2. 51 trials included in this table (not all were used in subsequent analyses).
*Biggest problem is the follow-up period*: 39/51 included studies only observed patients for up to 2 weeks for any symptom changes (several one week or less). Only 4 looked at 12 weeks or beyond (12, 28, 36, and 52 weeks).
*Next biggest problem was treatment duration*: 35/51 included studies only studied patients taking the drug of interest up to 12 weeks (several less than that). An additional 7 studied patients at 16 weeks (3) or 24 weeks (4).
Third biggest problem was conflict of interests - the COI statement was several lines long. I did not confirm if every author reported COI, but absolutely true that several did, and several had multiple COIs.
There were 3 studies that had both a treatment duration beyond 24 weeks, and a follow-up period beyond 2 weeks:
1) Rapaport et al 2002 (pay-walled) - zoloft in anxiety, 52 weeks of treatment, 28 weeks of follow-up, abrupt discontinuation, the withdrawal group did worse. From the abstract, number need to harm (NNH) roughly 9-10. (https://onlinelibrary.wiley.com/doi/10.1111/j.1600-0447.2001.00263.x)
2) Clauw et al 2013 (free) - milnacipran (SNRI) in fibromyalgia. variable treatment period (70% >156 weeks). 12 week follow-up. Withdrawal group had worse pain, and worse adverse events. Again NNH about 9-10. https://pmc.ncbi.nlm.nih.gov/articles/PMC3978750/
3) Lewis et al 2021 (paywalled) - mix of drugs, primary care setting, >36 weeks treatment (70% included treated >156 weeks), one year follow-up. lumped worsening symptoms and "withdrawal" symptoms together. 39% in continuation group, 56% in withdrawal group. NNH ~6. https://pubmed.ncbi.nlm.nih.gov/34587384/
There was another study Feiger et al 1999 that treated for 16 weeks with nefazodone (older atypical; I've never seen this used) followed for 36 weeks. 18.3% "relapse" rate in the withdrawal group vs 1.8% in the continuation group. NNH ~6 again. Didn't include it because no one uses this drug anymore, and it's withdrawn from several countries' formularies due to liver toxicity risk (apparently still available in US, though, again, *no one* uses it). https://pubmed.ncbi.nlm.nih.gov/10221638/
Seems pretty clear to me that the trials that had sufficient treatment duration and sufficient follow-up show that withdrawal is a real and common phenomenon, and this is with the clinical data "stacked" against looking for it.
Some experts claim that high-dose melatonin can provide all kinds of benefits. For example, Prof. Russell Reiter of U of Texas is considered perhaps the top expert in the world on melatonin, and he takes something like 80 mg per night long term (he is 86 years old and still working). However, I have also read that high-dose melatonin "suppresses" the sex drive (causes ED?). Is there any truth to that?
For certain mental health issues, like OCD, though, I've heard that getting off of SSRI's is just not effective--that the symptoms usually come back. Any thoughts on that?
Chris you MuST talk to Brooke Seim or angie peacock or Dr. Joef...all on youtube...helping real ppl taper...we can't exercise or talk supplements we are too sensitive and sick ...very sick. Im in protracted withdrawal from ritalin...concerta....never met anyone trying to figure out withdrawal before like you have. Appreciate your efforts
Yes, April. I've just come off Diazapam myself so am in the same boat. My nervous system is very sensitive and trying to heal. I would love to know how we could embrace it also.
I was on Cymbalta, 60mgs 1xper day for 20 years. I was prescribed it for pain and initially I think it worked to take away about 50% of the pain I was experiencing. But that came at a price. It also took away my libido. It took away any pleasurable sexual sensation and that affected my marriage so much so, that after 40 years, it ended. I am 73 and this has been the worst thing to happen to me especially at my age and with my disabilities. I am now completely alone with no help from anyone, no social life and really no friends close by. When you become a 3rd wheel society completely blows you off. It's a hard reality and a cruel one too. I decided to get off the drug since I don't think it was helping anymore and with all we have learned about pharmaceuticals, I decided to get off everything, so I started being weaned off the Cymbalta under a doctor's care. We went from 60 mgs to 40. No problem. Then we went from 40 to 20, still no problem. The problems started when we went 20mgs every other day. I was horribly dizzy, nauseous and unable to function. I lost 20 lbs because I was unable to eat anything, unable to get off the sofa, to walk the dog, to do household chores. It was just awful. I'm finally off now, and the symptoms for the most part are now gone but I got very angry over the fact that a pharmaceutical drug could control my life to the point that it did. It takes over your emotions, your physical responses and I don't even know what else but I do feel that even my personality was affected. How could I have allowed this to rule me for 20 years!? My advice is to never start a drug that you don't know everything there is to know about it. I didn't understand the ramifications of taking a drug like this and now I'm paying for it big time.
Trying to get off of this drug has been one of the worst experiences ever. I’m so sorry you had to go through that. Cymbalta has also destroyed my libido. I have emotional lability issues, weight gain, high blood pressure, and most recently eye pain and blurred vision. So happy you were able to push through and get off of it. Those withdrawals are no joke.
Thank you for this piece. I do have to say CBT has been next to useless for someone whos hyper self aware (with anxiety). Somatic therapy and Brainspotting have been life changers.
(Withdrawing from Sertraline, down to 18mg, following Maudsley guidelines after a severe withdrawal episode going down from 19mg to 15mg)
Maybe this explains why Wim Hof breathwork works so well. I found that i could sometimes produce an incredible morning MDMA state by doing Wim Hof until i fell asleep..
People report great benefits using cerebrolysin, palmitoylethanolamide (etc), nebulized DMSO, and various peptides for SSRI damage.
And let's not forget probably the most popular remedy, which is psychedelics. I've known tons of people who microdosed certain psychedelics to eliminate SSRI withdrawal. Certain shroom strains work a lot better than others. The Psilouette pheno of shakti shrooms has exceptionally high levels of norbaeocystin and seems ideal. Super pure lsd also works tho harder to find. Vaping 10mg dmt now and then works. If the patient is already off their psych meds they can use the best psychedelic recipe ever, which is also cheap and nearly legal in most jurisdictions: https://open.substack.com/pub/ibogaqueen/p/raw-acv-with-aya-loveyhuasca-or-5
WHM would most likely not be long enough in the hypoxia cycle. We’ve not seen any adaptability to hypoxic conditions through this mechanism of hypoxia, which is akin to breath hold (apnea) hypoxia. One requires longer periods of Intermittent Hypoxia exposure to elucidate the longer-term adaptive responses of hypoxia and/or altitude.
I think you are probably right, but it is complicated because there are different timescales of adaptations, some microseconds, others hours, and others days.
How much, if at all, do you think the mechanisms you've described in this series also apply to protracted withdrawal states caused by benzodiazepines? I've had akathisia and other extrapyramidal symptoms for ten years since a Clonazepam withdrawal, and while I feel much better now than in the early years, I would not be opposed to finding something that could get rid of the remaining pain.
For what it's worth, hyperbaric oxygen therapy about 8 times/month seemed to accelerate my healing in the past year.
Antibiotics can also affect mitochondria, lymecycline I think alters protein synthesis.
Could any of your ideas ring true for antibiotics because for acne lymecyline can be prescribed for months or a year.
In some worms these antibiotics it seemed to increase lifespan, I know we are not worms but interesting none the less.
Would this also apply to SNRI’s? How does norepinephrine affect mitochondrial function? I am about to start a slow hyperbolic taper off of Cymbalta. I’ve been on it for 11 years. I’ve been on various psych meds 20 years. I’m trying to get as much information as possible.
Principles are similar but you just have an extra dopamine issue to worry about.
And how do we address that one? I have 3 to worry about as I came off Diazapam and Venlafaxine. 😔 But unfortunately have just gone back on Venlafaxine again.
Would addressing the mitochondrial piece address the dopamine piece that arises when considering PSSD specifically ?
It certainly could, since you can't make or regulate dopamine properly without good mitochondrial function.
I think mitochondrial dysfunction from withdrawal is a good theory. Another plausible theory is that SSRI/Finasteride/accutane hurt the gut microbiome while being ingested and when ingestion stops an opportunistic bacteria/funghi takes over and causes massive dysbiosis/sibo. I’m considering this theory because some people recover with a fecal matter transplant. Interested in your thoughts on this theory Chris! I’m yo-yoing back and forth between gut and brain to fix this issue
Excellently put together. I agree and believe that most, if not all, diseases and maladies are due to aberrations in the electron transport chain within cytochromes inside the mitochondria. IR and NIR light can accelerate the energy reactions in the ETC. I try to expose myself to as much sunlight as possible without burning, in conjunction with earthing, especially when exercising. The hypoxia angle is interesting. Would the Buteyko method of breathing help in some way to achieve the hypoxic response? Regards, Mike Cleaves.
How would you address the dopamine issue?
Hopefully his next series
First and foremost, Dr.s know NOTHING about withdrawing from SSRI’S …. second, if you are even thinking you might be getting off of SSRI’S SAFELY in under one year, you are dreaming. Thirdly, until you have your diet consisting largely of protein, (no junk food, sugars, processed garbage) it will be almost impossible to heal.
There was just a study but a minute ago where the overall conclusion was that withdrawal wasn't as bad as was feared. Did you address this here or in this series and I missed it. It was a recent study...seems like one that should be mentioned and addressed. SSRIs are only a passing interest of mine but I happen to have hard about it because of a writer I follow DeBoer covered it a month ago https://freddiedeboer.substack.com/p/nobody-wants-to-hear-good-news-about
I don’t have access to that paper, and have no interest in chasing it down, but the substack article written about it has no value at all as it doesn’t address the single most relevant factor, which is how long the trials were. Literally nothing else matters much, as the incidence and severity of withdrawal symptoms is a direct function of time spent on the SSRI, which means thus trials are of little utility because the ones addressing incidence of withdrawal are short.
So if you want to catch my attention on this, find me the table summarizing the studies from that paper and show me how long the people were on SSRIs prior to discontinuing.
Got you covered. Found the details in supplement 1 eAppendix 2. 51 trials included in this table (not all were used in subsequent analyses).
*Biggest problem is the follow-up period*: 39/51 included studies only observed patients for up to 2 weeks for any symptom changes (several one week or less). Only 4 looked at 12 weeks or beyond (12, 28, 36, and 52 weeks).
*Next biggest problem was treatment duration*: 35/51 included studies only studied patients taking the drug of interest up to 12 weeks (several less than that). An additional 7 studied patients at 16 weeks (3) or 24 weeks (4).
Third biggest problem was conflict of interests - the COI statement was several lines long. I did not confirm if every author reported COI, but absolutely true that several did, and several had multiple COIs.
There were 3 studies that had both a treatment duration beyond 24 weeks, and a follow-up period beyond 2 weeks:
1) Rapaport et al 2002 (pay-walled) - zoloft in anxiety, 52 weeks of treatment, 28 weeks of follow-up, abrupt discontinuation, the withdrawal group did worse. From the abstract, number need to harm (NNH) roughly 9-10. (https://onlinelibrary.wiley.com/doi/10.1111/j.1600-0447.2001.00263.x)
2) Clauw et al 2013 (free) - milnacipran (SNRI) in fibromyalgia. variable treatment period (70% >156 weeks). 12 week follow-up. Withdrawal group had worse pain, and worse adverse events. Again NNH about 9-10. https://pmc.ncbi.nlm.nih.gov/articles/PMC3978750/
3) Lewis et al 2021 (paywalled) - mix of drugs, primary care setting, >36 weeks treatment (70% included treated >156 weeks), one year follow-up. lumped worsening symptoms and "withdrawal" symptoms together. 39% in continuation group, 56% in withdrawal group. NNH ~6. https://pubmed.ncbi.nlm.nih.gov/34587384/
There was another study Feiger et al 1999 that treated for 16 weeks with nefazodone (older atypical; I've never seen this used) followed for 36 weeks. 18.3% "relapse" rate in the withdrawal group vs 1.8% in the continuation group. NNH ~6 again. Didn't include it because no one uses this drug anymore, and it's withdrawn from several countries' formularies due to liver toxicity risk (apparently still available in US, though, again, *no one* uses it). https://pubmed.ncbi.nlm.nih.gov/10221638/
Seems pretty clear to me that the trials that had sufficient treatment duration and sufficient follow-up show that withdrawal is a real and common phenomenon, and this is with the clinical data "stacked" against looking for it.
Do people heal from this if they don’t apply what you say to do? Can the body heal over time
Some experts claim that high-dose melatonin can provide all kinds of benefits. For example, Prof. Russell Reiter of U of Texas is considered perhaps the top expert in the world on melatonin, and he takes something like 80 mg per night long term (he is 86 years old and still working). However, I have also read that high-dose melatonin "suppresses" the sex drive (causes ED?). Is there any truth to that?
For certain mental health issues, like OCD, though, I've heard that getting off of SSRI's is just not effective--that the symptoms usually come back. Any thoughts on that?
Why wouldn't they? They never did anything to try to fix the OCD.
Chris you MuST talk to Brooke Seim or angie peacock or Dr. Joef...all on youtube...helping real ppl taper...we can't exercise or talk supplements we are too sensitive and sick ...very sick. Im in protracted withdrawal from ritalin...concerta....never met anyone trying to figure out withdrawal before like you have. Appreciate your efforts
Yes, April. I've just come off Diazapam myself so am in the same boat. My nervous system is very sensitive and trying to heal. I would love to know how we could embrace it also.
I came off ritialn. Went to a family reunion and to fight back tears and dissociation
You might want to contact t others like Geraldine Burns who worked with Heather Ashton and is a pioneer in the field
Chris what about Infared light ? Can that help
The article has a whole section on it.