TCM in the Treatment of SSRI withdrawal syndrome
The following report describes the treatment of a 19 year old female who had previously experienced SSRI withdrawal symptoms, but experienced no symptoms with Traditional Chinese Medicine therapies.
Selective Serotonin Reuptake Inhibitors (SSRIs) are a class of antidepressant drugs that help to increase serotonin, a chemical responsible for communication between nerves in the brain. Representative drugs include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa), estialapram (Lexapro) and fluvoxamine (Luvox) (WebMD)
SSRI withdrawal syndrome also referred to SSRI Discontinuation syndrome has been shown to affect individuals who abruptly discontinue SSRIís. Common SSRI withdrawal effects including: lightheadedness, dizziness, vertigo, gait instability, headaches, fatigue, insomnia, bizarre dreams, confusion, poor concentration and memory, gastrointestinal distress, electric shock sensations, anxiety, paresthesia and irritability (Skaehill and Welch 1997).
The case involved a 19 year old female who had been on Paroxetine 20 mg at bedtime for panic disorders for 3 years. Six months previous to treatment the patient who was 4 months pregnant at the time, had attempted to remove herself from paroxetine by reducing the dosage to 10mg/day, and then discontinued any paroxetine after 1 week. The patient reported she had suffered from symptoms of nausea, loss of appetite, anxiety, irritability, disassociation, and electric shock sensations. Patient reported she was unable to sleep for any extended period of time. She also reported diarrhea for several days then constipation for several days intermittently and continued to remain on 20mg of paroxetine for the remainder of her pregnancy.
Patient began treatment approximately 1 month after delivery of her child. At the initial treatment, the patient exhibited signs of mild anxiety, irritability, and nausea. Tongue: red body with a yellow coating. Pulse: wiry.
Liver Qi stagnation invading the Stomach with Liver Fire flaring upwards.
Purge Liver Fire and Tonify Stomach Qi. The patients symptoms were treated the same as a one would treat drug addiction and withdrawal.
The patient received treatments once a week for a period of 6 weeks. A combination of acupuncture, auricular therapy, and herbal therapy was used to reduce the occurrence of previously reported side effects. The patient took the last dosage paroxetine (20 mg) and then began treatment the following day.
The protocol established by the National Acupuncture Detoxification Association (NADA) for drug withdrawal was used for the initial visit. The points used were:
Weekly acupuncture treatments were given for 6 weeks to alleviate anxiety and to move Qi and Blood. points used were : Hegu (LI4),Taichong (LV3) and Yintang (HN3).
Figure 1. NADA protocol ear chart.
The patient received one treatment of this protocol through the insertion of needles for 45 minutes, and then replacement of the needles with ear seeds which remained in the ear for 3 days.
The patient was placed on a commercial formulation of Chai Hu Long Gu Mu Li Wan (Bupleurum Dragonbone Oystershell Teapills). This formulation has been shown to treat the symptoms commonly associated with drug withdrawal (Maclean and Taylor 2003 p372).
The recommended dosage is 8 pills 3 times a day. The patient was initially placed on 12 pills 3 times per day for 2 weeks. After 2 weeks the dosage was reduced to 8 pills three times per day. The patient was then reduced at a rate of two pills per administration on a weekly basis. At the end of 6 weeks administration, the formula was discontinued. The formula was discontinued as the ultimate goal was for the patient to be able to operate without the assistance of herbal or other medications.
Weeks 1-2 12 pills 3 times per day
Week 3 8 pills three times per day
Week 4 6 pills Three Times per day
Week 5 4 pills Three Times per day
Week 6 2 pills Three Times per day
Table 1. Dosage table.
The patient reported only slight anxiety and nausea during the first 2 days of treatment and no further symptoms beyond that. The patient received counseling sessions to help deal with the underlying root issues which caused the anxiety. The patient has not needed any continued care for the treatment of panic disorders. The patient has been symptom free for over 2 years at the time of writing.
The reasoning for the higher dosage was that the formula would be more effective in treating drug withdrawal symptoms. One company (plum flower) produces a higher dosage formula specifically for usage in treatment of drug withdrawal symptoms. The higher dosage of Chai Hu Long Gu Mu Li Wan (Bupleurum Dragonbone Oystershell Teapills) in conjunction with the combination of other therapies, resulted in the elimination of symptoms. SSRI withdrawal has been shown to have a number of serious side effects.
Maclean, W. & Taylor, K. 2003. The Clinical Manual of Chinese Herbal Patent Medicines, 2nd Edition. Sydney: Pangolin Press.
Skaehill, P. & Welch, E. [Clinical Reviews: SSRI Withdrawal Syndrome]. [online]. Date last updated: October 1997. Available from: http://www.ascp.com/public/pubs/tcp/1997/oct/ssri.html [Accessed 28th March 2006].
WebMD. [Clinical depression Information and Terms]. [online]. Date last updated: unknown. Available from: http://webcenter.health.webmd.netscape.com/content/article/45/1663_51211 [Accessed 28th March 2006].