Medication Changes: Fast or Slow?

I’m wondering: if you take psychotropic medications (e.g. antidepressants, mood stabilizers), and you undergo a medication change, over what timeframe does your doctor/psychiatrist effect the change? 

When I first came into contact with psychiatry, some years ago, the medication changes I experienced took place over weeks. This avoided the worst of the side effects (which can be pretty bad, believe me!). These days, the trend is for rapid medication changes – at least in the city where I live – as rapidly as the body can tolerate, usually over periods of days rather than weeks. I went through a fairly large number of changes like this last year, and it was pretty awful. 

So, I’m just wondering: do doctors and/or psychiatrists do things differently in different parts of the world? I’d be really interested to hear.

For the sake of comparison, I live in a large capital city in Australia. 

29 Comments

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29 responses to “Medication Changes: Fast or Slow?

  1. malrich2

    same in New Zealand chop and change with no regard for you

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    • Thanks! Got a friend going through hell right now, and I did it enough times last year to really question the practice. I guess they’re following the “rip the bandaid off” philosophy. Do you know about trends in other parts of the world?

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      • malrich2

        stop all the pills and go for TMS seams to be helping never ever have ECT but google Dr ozz TMS for more

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      • Yes, I wouldn’t go down the ECT path myself, but I don’t hear much about TMS in the city where I live. I looked into it a few months ago. Have heard some good stuff about the treatment, though the ECT-promoters say it’s all BS. Anyway unfortunately it doesn’t seem to be an option here … is it widely accepted/available in NZ?

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      • malrich2

        no not here our government dose not care and thinks ECT is safe and works well dumb pricks

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  2. My other half went through several medication changes last year and his psychiatrist did it over a period of about 3 weeks. Not sure if that is usual or not.
    I’m off my meds now – cold turkey. With all the hoo-ha leading up to Christmas, my routine was thrown out and before I knew it, it was post-Christmas and I remembered I hadn’t taken my meds in a week or so. So I continued in that vein. Three weeks on and I am great. I’ve been having a couple of issues and thought they might be related to withdrawal but it is unusual for symptoms to show up weeks later. Been diagnosed with compressed vertebrae and a fractured vertebrae as well so that seems to be the cause. (thank goodness).

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    • Three weeks would be considered “long”, I think, by most psychiatrists I’ve come in contact with over here recently – except for certain classes of medications, such as long-term diazepam. I am so pleased for you that things have been great the last three weeks! Not so pleased about your variously injured vertebrae though 😦 Poor thing.

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  3. im in nsw.
    my doc introduces slowly.
    increases established meds more promptly and for me makes any reductions very very slowly.
    but then im on effexor and cutting down on it is no easy task.

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    • Yeah – my psych took me off effexor in just 4 days back in July – that was a bitch!!!!! He also took me off mirtazepine at the same time. I wasn’t myself for weeks – personality change 😦 I remember just screeching obscenities at a nurse one day, which is really *not* *me* at all. Now, having cycled through a few other meds, guess what? I’m back on the effexor/mirtazepine mix. *sigh* all that suffering, just to end up back when you started! Do you mind me asking which country you live in?

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      • Australia too. in nsw.
        Christ coming off effexor in 4 days is dangerous!
        you ever considered seeing another doctor?

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      • Yes it was pretty hairy … he did put me in hospital for the duration; and yes, I am getting a second opinion from a senior (i.e. professorial) psychiatrist sometime early this year. Actually, I consider my “primary” psych carer to be my psychotherapist, who’s actually a psychiatrist who practices as a psychodynamic psychotherapists. Unfortunately he doesn’t do medications, but he is very, very good on the other front – and I believe that long-term, getting my thinking sorted is just as important as getting the meds right.
        Thanks for understanding just how hellish those four days were! I was in hospital for three weeks afterwards, recovering. Then the bloody new medication didn’t work, nor did the one after that …

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      • Im glad you were in appropriate care.
        Im sorry you have had such a hard time .

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      • Ah, well – such is life! 🙂 I lived through it, luckily, so now it has become just another story which helps shape who I am. I’ve got one friend who tells me in this very upbeat, motivational manner that 2014 is going to be my year. I appreciate the sentiment, even though I am dubious about their authority to make such a statement! lol

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      • Trust your friend. Maybe this is your year. Last year was an amazing year for me when I least expected it.

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      • Thanks! ❤ Well, actually, "friend" is a bit misleading – he's the personal trainer I've started seeing twice a week to kickstart my fitness after my annus horribilis. I've gone from being someone who ran half marathons to not being able to jog 20 minutes 🙂 He said that to me during our first session in the new year, which was three days ago, as I was drawing in ragged breaths and holding up my fingers about an inch apart – our code for "just a little bit longer to recover, please!" So I guess he does have a certain mandate to call this my year – as he's got a certain amount of power to bully / cajole / coach me back into physical fitness.

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      • good for you. keep it up. its funny how much physical well being cant help our mental health.
        part of the reason my 2013 was so good was my passion for long walks. It boosted my mood 200%.

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      • I feel a post about exercise and mood coming on … after I’ve been to the gym later today!

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      • looking forward to reading it

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  4. eddieredvine

    My GP changed my anxiety medication recently… I came off the Citalopram by trailing off rather than cold turkey. Then a week medication free and then started the Venlafaxine. These didn’t effect me for around 6 weeks and we have been steadily increasing them till an effective dose is achieved. I’m in Scotland in the UK 🙂 Eddie x

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  5. My evil cat just stepped on my tablet, erasing my response, so here we go again!
    My first med was Effexor and I hated it! Too many bad side effects. Over the next few months I quickly cycled through a lot of other meds before finally settling on Wellbutrin and Pristiq (Effexor’s younger cousin). Most transitions were over a few weeks, one a week, and another immediate when the higher dose had me breaking out in rashes.
    But my most recent change was 3-4 months! It was super slow, mostly because you can’t really taper off Pristiq. So I started with the one lower dose of Pristiq and a low dose of Prozac. A little more Prozac, then off Pristiq completely, and finally a little more Prozac again because I was exhausted once the Pristiq (my med of 3 years) was gone. Very slow, but relatively painless with checkins every three weeks to monitor the effects.
    I think the difference was quick trials to find something that helps and transitioning from a longtime med that sort of worked into something new.
    (Canada)

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  6. I’m in South East North Carolina, USA. My Psych Doc here is very good with meds. He knew exactly how long I should take going on or off different meds. For the most part it has been about 2 weeks to go on or come off. I had several docs in California that were quite a bit less in tune with how long to give me. Twice taking me off one and putting me on another is the space of 6 days. Those days were hell.

    As far as ECT goes, it was more common in California than it is around here. In California, it was possible to have ECT on an outpatient basis. Here you have to be inpatient in a Psychiatric hospital to have ECT treatment. I am trying to avoid having treatment as I do not want to go in patient again. Besides, there’s just something comforting about coming home after a treatment, and curling up in your own bed for a few hours.

    I should also say, no matter how I have portrayed ECT (memory loss etc.) I am thankful for having had treatment. It pulled me free from a hole that I didn’t think it would ever get out of. I would not hesitate having treatments again if I were in that situation.

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    • Good on you, Gavin. Just goes to show how having a doctor that’s in tune with what’s going on for you is absolutely necessary to healing – well, in my opinion it is, anyway! Thanks also for your comments on ECT. Have a good day today!

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  7. I live in British Columbia, Canada. I have had 2 different experiences with medical changes. The first was fast, within days (boy did that ever suck) and the second was a bit slower, over weeks. Which still had the negative effects. I like it faster, like removing a band-aid. Get it over with!

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