xPAP and discontinuing antidepressants (long)

A common theme with those who suffer from sleep apnea seems to be depression and taking antidepressants or other types of psychiatric medications.
Since I feel very strongly that my diagnosis of depression was 100% incorrect, I want to go off these medications now that I am finally getting proper treatment for my real problem: OSA.

So I'm wondering at what point after starting xPAP did people start tapering off their psych meds?

I'm supposed to be taking 120mg Cymbalta and 20mg Adderall. Since starting CPAP, I've split the dose of Cymbalta in half and just take one 60mg pill instead of two. I haven't noticed any difference at all with the lower dose, but the pills never helped much with my feelings of fatigue anyway. There have been days when I've forgotten to take the Cymbalta altogether and I still didn't notice a difference.
As for the Adderall, I just have the 20mg pills. On days I've forgotten to take it, it's the same thing, no difference. It never really helped much with my fatigue, it just kept me from falling asleep at my desk on the really bad days.

I guess I'm just looking for any kind of advice you all could give about the best way to get off these meds that seem really unnecessary now that my OSA seems to be getting under control.
James Skinner recommended a book to me called The Antidepressant Solution, which I've ordered, but since I'm impatient... any advice is welcome.

I thought of this topic because I was supposed to have an appointment with my psychiatrist today. I had to cancel it earlier this week because I had a work meeting come up at the same time. Since the meds never seemed to make any real difference, I figured, "Why even bother rescheduling?" Why waste a co-pay, an hour of my time, and the gas money to drive to his office when I already know what will happen:
I'll tell him that I want to go off the meds, because I don't think I ever had depression, and they never helped much anyway. He'll disagree, and tell me I should keep taking them. I'll give him a copy of my sleep study and say I have a gut feeling that all my problems are caused by OSA, since my primary complaint was fatigue; and that if he was having 30 apnea events per hour and never getting a decent night's sleep, it would occasionally mess his mood up too. But basically it would get me nowhere, because once some doctors decide on a diagnosis, nothing will change their mind. It would be a complete waste of my time and energy.
I had an appointment with him the day of my sleep study (which I mentioned) and I kept talking about how tired I was, and actually was crying because I just felt so physically and emotionally worn out. His response was to start talking about possibly switching me to an MAOI. Um, no! Everything I've heard about those is even worse than Cymbalta.
Obviously, he's turned out to be entirely useless and if I never set foot in his office again, it will still be too soon.

While I think there are some people under certain circumstances who can be helped by psychiatric meds, I'm not one of them.
I don't mind admitting that I'm really bitter about being treated like a lab rat for doctors to try different psych meds on, especially since I never complained about actually feeling depressed, it was always "I'm just so tired. I'd be in a better mood if I wasn't so tired all the time." But getting most doctors to actually listen to you once you've admitted to taking antidepressants is next to impossible.

Anyway, aside from just venting, my point is that I want to get off these drugs as safely and quickly as possible, and any advice is welcome. Thanks for reading this.

check with your doctor first, and as long as you don't have any bridges or 5-story buildings to jump off,

but I'd just stop taking them. I took Zyban for a year to stop smoking, it is exact same chemical makeup as Wellabutrin the antidepressant, it had all those cautions also so I checked with my doctor and he said: Just stop taking it. You mean I don't have to taper off? No, you are not going to jump off a building are you? I said no, then stop taking it.

Save some, if you stop taking it and start wiggin out, take a half tablet or something, but I think you'll do fine.

Take the money you save in co-pay and buy yourself a nice dinner or bottle of wine.

Thanks Snoredog! Nope, no bridges or tall buildings nearby, I should be fine...
Maybe I'll take the money I was going to spend on my copay today and do some "retail therapy" instead.

If I were you and you want to taper off I would do like you said, I would take 1/2 the normal dose for a week, then half that again for another week and by the third week if you still feel no problems, quit it all. Then be mindful of how you really feel and why , be honest with yourself. You will know if you are having a problem.
Good luck. I believe that the less we have to take the better off we are unless there is nothing else that helps. I am not anti medication but anti OVER medicating.

Yeah, it really bugs me that antidepressants are basically handed out like Halloween candy.
Sure, they probably do help SOME people, but in my case, trying a bunch of different drugs for my "depression" just delayed finding out what was really wrong with me and getting the correct treatment.
What makes me incredibly angry though, is wondering how many other people are out there (with OSA or some other conditions that have similar symptoms to depression), taking drug after drug that doesn't help them, but who are never correctly diagnosed.
It's just really sad.

Adderall. Hmm, the guys in the lab must have thought they developed the ultimate snake oil, so marketing gave it an appropriate name.

Most psychiatrists these days only prescribe medications. If he or she has not had in-depth conversations with you to determine the underly causes ( if it is depression at all) then prescribing all those medications is inappropropriate. And you can bet if you did jump off a building his or her response would be " well I told her to keep taking them".

Trust your friends and family. Tell them that you want to stop taking your antidepressants because you feel you don't need them anymore. Also tell them to let you know if you need to go back on them. They will help you if you let them.

Some of the SSRI's and SSRNI's can sometimes have withdrawal effects if they are taken long-term and are suddenly stopped. Usually the sypmtoms are no worse than feeling like you have a bad cold or mild case of the flu.

Also, if you have herpes zoster (shingles) or neuralgia of any type sudden cessation of SSRI/SSNRI can cause the conditions to flare up or worsen.

Othertimes they can be severe but that's very rare. If you notice your mood changing severely, ringing in your ears, odd physical senstations, then be sure to check with your MD immediately as you may need to taper off.

As far as the Adderall is concerned, if you have been taking it for an extended period, you may have severe withdrawals and this will need to be managed by your MD as well.

I too know the frustration of being chronically medicated for depression only to find out that OSA was the likely culprit all along.

Good luck!

Thanks for all the help and advice.
Yes, rooster: Adderall does seem to be an appropriate name. How does one extract oil from a snake, anyway?

For a little more background information, about 4-5 years ago, I was working full-time and also taking 9 credit hours/semester in a master's degree program. Yeah, not smart, but I thought I could do it all. After getting into the program, I found out that I actually didn't like it that much, but I didn't want to be a "grad-school dropout" and have wasted a year of my life and a few grand in tuition money...

Anyway, I noticed that I was feeling really tired and crappy all the time; it
didn't matter if I got 2 hours of sleep because I'd stayed awake most of the night doing homework, or if I basically slept for the entire weekend. My mom and my sister had just been diagnosed with hypothyroid, so I decided to make a doctor's appointment and get tested to see if I had it too.
Since the clinic across the street from my apartment was on my insurance, I just decided to call there, and they randomly assigned me to one of their GPs. We chatted about my health history and I told her I thought I had hypothyroid because my mom and sister did. She said she'd test me, then asked about work and school. I told her about it and said that yeah, it was stressful, but lots of people do both work and school full-time, and I was handling it just fine. She seemed skeptical, but ordered a bunch of blood tests and told me to come back in a few weeks.

All of the blood tests came back fine, so she said it seemed like I might be depressed, and wrote me a prescription for Prozac. She said it usually works within 4-6 weeks, and if I hadn't started feeling better by my 6 week follow up, she'd give me something else.
It didn't work, so next she tried Effexor. I took that at varying doses for awhile and it didn't help me feel less tired, so she added Wellbutrin to it. That didn't help either, so she switched me to Lexapro while keeping me on the Wellbutrin. None of that helped, so she gave up and referred me to a psychiatrist.
Before my appointment with the shrink, I had to fill out this huge stack of forms with lots of horrible questions about being abused, having drug and alcohol problems, etc. None of that applied to me, thank God. On the forms and during my first appointment, I emphasized how tired I was. He decided that I had "Atypical Depression" and switched me from Lexapro to Cymbalta. I kept complaining that I didn't really feel depressed, just tired, so he threw the Adderall into the mix. It didn't help, so he upped the dosage.
I complained that all the medications were too expensive and didn't seem to be helping, so he took me off the Wellbutrin and upped my dosage on the Cymbalta. There never seemed to be enough in-depth discussions to really determine whether I had depression or if it was something else. I even asked one time if the "depression" could be a symptom of something else, and he was like "Maybe," but implied that since I'd already had bloodwork done it was unlikely. Yeah, because blood tests are the only way to monitor someone's health...

Oh, and during all this time, I got fired from my job and quit school. That was probably all for the best, but it still pissed me off.
And to be fair, there probably was some situational depression from the job/school situation, but I also went to counseling, which helped alot more than any of the drugs. I doubt whatever depressive symptoms I might've had really warranted all the long-term, high dosages of so many medications...

So, the Cymbalta at 120mg + Adderall at 20mg is where I'd been at for a year when I finally got sick of it all and asked a different doctor outright for a sleep study. And now here I am.

I'll make an appointment with the same doctor who finally sent me for the sleep study and get her advice about tapering off the meds. And my family and friends know what I'm doing, so I'm sure they're already keeping an eye on me...

A bitter grad-school dropout,
Amanda

Amadalee,

I'm not a medial person nor do I take any of these drugs, but here is some information you may want to keep in the back of your mind...

Below is an exerpt from the prescibing information for Cymbalta:

"Discontinuation of Treatment with Cymbalta — Discontinuation symptoms have been systematically evaluated in patients taking duloxetine. Following abrupt discontinuation in placebo-controlled clinical trials, the following symptoms occurred at a rate greater than or equal to 1% and at a significantly higher rate in duloxetine-treated patients compared to those discontinuing from placebo: dizziness; nausea; headache; paresthesia; vomiting; irritability; nightmares; insomnia; diarrhea; anxiety; hyperhidrosis; and vertigo.

A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Subsequently, the physician may continue decreasing the dose but at a more gradual rate "

If it is like all the other SSRI drugs, it will take a while (3 -5 days) to clear from your system.

The Adderall can be brutal - it's just legal meth - you probably shouldn't go cold turkey on it

Good Luck,

RiverDave

amandalee wrote:What makes me incredibly angry though, is wondering how many other people are out there (with OSA or some other conditions that have similar symptoms to depression), taking drug after drug that doesn't help them, but who are never correctly diagnosed.
It's just really sad.

I'm guessing the number is high enough that we wouldn't really want to know it.

Susan M.

No doubt you've already found this Amandalee but anyway:

http://en.wikipedia.org/wiki/Adderall

The doc who sent you for the sleep study sounds like she's got her head screwed on right. The others

I've been on antidepressants for like 15 years... Wellbutrin. Everytime I try to get off it, I do well for a bit and then boom! big crash. I haven't tried getting off it since starting cpap but it is a plan when my treatment is stable and I feel genuinely rested.

Coming off Wellbutrin isn't as difficult as coming off an SSRI like Cymbalta. Some people who have been on that for years have lots of problem withdrawal symptoms. You've only been on it for a year so it should be less troublesome. But do be careful and taper off. My neice was on Effexor for 5 years and had a miserable several months getting off it. She had those "brain zaps" you hear about.

I think the safest thing is to ask your doctor to help you get off your meds so you have help with any withdrawal symptoms if they do come up. I wouldn't ask if you can come off, just ask for help getting off them. It is your life and your body. The doctor is working for you not the other way around. The doctor is not your parent either and cannot tell you what to do. If that doctor won't help you, find a new one! Best of luck and keep us posted how you are doing.

Im on Celexa and want to get off of it too since Cpap.Work with your doc. Thats what Im doing. She's open to it.

Kevin

Amadelee

After many years (25-30) of suffering from what the doctors called "DEPRESSION" and never finding any RELIEF, I decided to take my HEALTHCARE into my own hands.

I had tried every anti-depressent know, changed my diet, exercised and even gone to alternative doctors. Nothing worked.

A few weeks ago I saw an episode on Health Discovery about sleep apnea. The symptoms of this poor man was identical to mine. At this point I decided to take action.

Called a sleep lab and they said I would need an order from my primary doctor before I could be tested. I explained that my primary doctor would not give me an order to be tested but would rather prescribe pills for me to take.

At this point I decided to bypass my insurance and just pay for the study. I was able to see the sleep doctor and get a bed in the clinic that night. Two days later the sleep doctor called and said of the 6.5 hours I slept, I woke up an average of 18 time per hour and stopped breathing up to 15 seconds per occurance.

One week later I visited the clinic again and slept with a cpap machine. While it was a strange experience, I felt better the next day.

To make a long story short, I was able to obtain a prescription from the doctor and purchase an auto cpap with a-flex. I did not mess with insurance just purchase the best machine I could buy.

Tonight will be my forth night using the machine. It has been difficult to adjust to the mask, but I have managed.

What a difference the cpap machine has made. MY PROBLEM HAS BEEN DISCOVERED AND SOLVED. Not depression but rather sleep apnea.

Of course I stopped all medications. I now have the energy of a young kid (I am 44 years young).

Have said all this to say you need to TAKE YOUR HEALTH CARE INTO YOUR OWN HANDS. If you want to stop the medications, stop them. If sounds like they never helped you in the first place.

There is no one that has your health care in their best interest as you do. Take control and take action. If I had continued to listen to my primary doctor, I would still be tired, dragging and taking two or three naps per day.

Hunter1