RxISK Stories – Azathioprine Withdrawal

August, 31, 2012 | 4 Comments


  1. Great post!
    Thanks for sharing and thank you for your work Dr. Healy.
    I took a look at the SSRIs withdrawal protocol that was updated. It is better but I just wanted more emphases in the part about those who had to go back to the drug because of physical addiction.

    I was on Effexos 225 mg and it took me 19 months to withdraw. I was in hell during this period.

    What I didn’t know is that, at least for me, is that the last doses are the worse to withdraw. When I was tapering the last 37,5 mg I should have stay months on this dose till my body adjusted.
    I’m sure that if I had done that I would have succeed or even staying on these dose would be great.

    I got had some of my functions back at these dose and was fine.

    It was only at the end of the process that I had to cope with the brain zaps but all the other withdrawal symptoms I had.

    But I tapered till the end till 0 mg.

    It was when the problems started. For three months I felt terrible emotionally and physically.

    Some symptoms I cannot even describe with words. I remember having a king of “despair” or “anxiety” or “deeply don’t know the word” that was something unbearable.

    I felt cold and hot at the same time; woke up in the night and had to change my clothes and sheets because they were all wet of sweat… it was hell…

    Tried to kill myself twice; was violent and so on.

    I could do nothing…

    Long story short: I went back to Effexor at 150 mg dose.

    Am I going to take it for life? It seems so. They took the tablet out of the market and it is difficult to withdraw the capsule.

    I have to live…

    I have already written about suicidal ideation but I’m still learning. I was suicidal for some months last year and this year and I thought it was real suicidal ideation.
    Now I can see it was not. I know the difference real suicidal ideation and drug-induced. But I’m still learning about the drug-induced.

    Now I’m great and those feelings are gone. It is only when they are gone that I can analyse them and make the differentiation.
    I have to write more about it because I don’t want people taking their lives because of that.

    I don’t condemn suicide and understand but taking your life because of these drugs is not fair. And it’s happening!
    Nobody cares.
    I do and would love to raise awareness about it.

    Ruminations about killing yourself can also be drug-induced and it is not the same of the real wanting to die.

    When you are tapering you know that the suicidal ideation is because of the drug, you can identify it but it is so strong that you say to yourself: “It is withdrawal, I was fine half an hour ago, I have to call someone.”
    The strange thing is that you don’t. You don’t call anyone and even thou you say to yourself “it is withdrawal call someone” you don’t.

    I wrote about it at my blog justAna.
    Now I have to write about these new feeling I just understood.

    Please, don’t take your life because of these drugs. Please!

  2. Ana:

    People who find themselves stuck on a medication can, I think, learn something from the benzodiazepine withdrawal community. First, the “tapers” designed by doctors (other than one Dr. Ashton, who ran a benzo withdrawal clinic in the UK before mandatory retirement) seem worse than useless. Second, learn about using a compounding pharmacy, if that is an option for you. Many people do not know that with the help of a prescribing doctor you can get a medication in just about any dose you request (I’m talking small doses here) and any form you request (liquid, capsule, patch, etc).

    By getting ever smaller doses from a compounding pharmacy, it may be possible to taper successfully.

    Consider ativan/lorazepam, for example. Many people become unwittingly dependent on it[*]. The smallest commercial dose of lorazepam is 0.5 mg. It is extraordinarily difficult for a physically dependent person to taper off of ativan by cutting up 0.5mg pills (a minimum of four doses per day is typically needed in order to minimize interdose withdrawal during a taper). Withdrawal symptoms are horrendous, complex, random, and varied; doctors almost always attribute them to something wrong with the patient rather than as iatrogenic (caused by the pills). A relative of mine had to use a compounding pharmacy to make capsules as small as 0.05mg, in order to taper off of ativan over a period of many months.

    My inner cynic wonders if the commercially available doses are kept so high on purpose: what better way to insure a continued revenue stream?

    The benzo withdrawal community has a lot of advantages over people who have trouble with other drugs. The benzos have been around for a long time, are prescribed for a large variety of reasons, and the percentage of patients who experience a withdrawal syndrome seem quite high; so even though most doctors are clueless (even the ones who know better than to prescribe benzos long term themselves don’t have the first clue how to humanely help victims of long-term prescription by other doctors) there is a good sized community of fellow travelers on the Internet. That is an invaluable resource both in terms of practical knowledge and in terms of validation for the benzo victim.

    The patients Dr. Healy writes about on azathioprine and clopidogrel have none of these advantages. And yet of all the things I’ve witnessed in my many decades on earth, the hardest thing I’ve ever see a person do is get rid of the poison called ativan. I’ve watched people die of cancer, and even though the outcome is death the experience itself wasn’t nearly as hard on the patient. A significant number of benzo withdrawers fail: someone very firmly committed to doing it can generally, with the right help and knowledge, succeed. But often one or more of commitment, knowledge, and help are missing; and some kill themselves before they heal from the withdrawal syndrome.

    [*] I think the whole language of “addiction” and “physical dependence” presents an additional social barrier, protecting the revenue streams of the drug companies, because they imply that the problem is with the patient not the drug. This is grossly unfair and stigmatizes the victim: it is at least as bad as blaming the rape victim for being raped because of how she dresses, which our society does not put up with for a minute. But we don’t just put up with this stigmatizing “addiction” nonsense as applied to patients who never took a drug off-prescription in their life: we go right along with it, assuming there must be something especially wrong or weak-willed about that person. Our medical system categorizes iatrogenic victims as either addicts or mentally ill. So in addition to poisoning them, we as a society kick them while they are in their sickbeds feeling suicidal.

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