Get Off SSRI Drugs
and Overcome Depression Naturally
by Jeffrey Dach MD
A Young Woman with Depression and PMS Gets Off SSRI Drugs,
and Reclaims Her Life, a Case Report
Two old Debbie came into my office on November 7, along with her Dad,
complaining of severe PMS, painful periods with irregular cycles for
which birth control pills had been tried and discontinued because of
Debbie is so depressed that she spends much of her
time alone in her room. She is on two different antidepressants, Zoloft
200 mg/day and Wellbutrin 300 mg/day prescribed by her psychiatrist.
She has been unable to sleep for many years without Ambien, a
prescription sleep drug. Her Fast Food Diet diet from McDonald's,
Wendy’s and Taco Bell, and lack of exercise has left her overweight. She
takes no nutritional supplements. Her physical exam shows dilated
pupils, dry skin, and brittle thin nails. Her reflexes, although
hyperactive, are delayed (230 msec).
labs showed a low Vitamin B-12 level of 304 (normal above 400), and an
extremely low Vitamin D level of 14 (deficiency is below 20). Her
thyroid labs were low with a TSH of 4.0 (normal less than 2.5), and a
free T3 of 270 (normal 230-420). (17). Her luteal phase progesterone level was low as well.
Dilated Pupils, a common finding on SSRI Drugs.
Deciding to Get OFF the SSRI's
explained to Debbie, that her insomnia, dilated pupils and hyperactive
reflexes were du e to the SSRI antidepressant drugs which are
over-stimulating her nervous system. When I suggested that she taper off
the SSRI drugs, she and her dad breathed a sigh of relief, and said
"that was the main reason they came to see me, to get off the drugs."
suggested that Debbie and her Dad go back to her psychiatrist and ask
the doctor to work with them in getting off the drugs by providing a
Psychiatrist and Patient
The Psychiatrist Drags His Feet
I learned that her psychiatrist was in general agreement, yet was
dragging his feet and refused to provide the tapering schedule for
Debbie to get off the SSRI drugs. After waiting a few weeks realizing we
were just wasting time, I finally went ahead and called into her
pharmacy the authorization to reduce her SSRI dosage in half every week
until the dosage was small enough to stop altogether. Tapering is
required because the SSRI drugs are chemically addictive and can produce
5-HTP for Sleep, acts as an Antidepressant
sleep during the SSRI tapering period, I recommended 5-HTP capsules
which increases serotonin naturally with no side effects.(20) She was encouraged to stop the prescription sleep drugs (Ambien).
I explained to Debbie that low Vitamin B-12, low Vitamin D and low thyroid function could all be possible causes of depression.
John R Lee MD, Pioneered Use of Progesterone
Natural Progesterone for PMS
PMS and painful periods were treated with natural progesterone
capsules, 50 mg twice a day for the last two weeks of her cycle (days
14-28). The night-time progesterone had the added benefit of helping her
Debbie was started on natural thyroid half grain daily,
high quality multivitamin, B12, vitamin D, and iodine supplementation,
stopped the fast food, and began going out more for daily activities.
December 3, Debbie had tapered down to Zoloft 50 mg per day and
Wellbutrin 100 mg per day. She says, "I am feeling good in general. I
have a lot of energy. I am out of my room more. I am basically in a good
mood, and sleeping about 4 hours a night."
By mid December, Debbie was off the SSRI drugs and off the sleeping pills.
A Dramatic Improvement
January 28, 2008, Dad calls in and says , "Debbie is doing so much
better. She has more energy and is sleeping well. The difference is
between Night and Day."
That same day, Debbie calls in and says,
"I feel a lot better. My energy is pretty good. I am back to work at my
mother-in-law’s business at the sales counter. I am sleeping good at
night 6 ½ to 7 hours. My mood is stable, pretty much happy. More normal
than before. I’m not snappy, and not in my room as much. I am getting
out and doing stuff."
Regarding her last menstrual cycle, Debbie
remarked "This time, no cramps, no PMS, no mood swings. The
progesterone capsules are definitely helping, I have never had a period
without pain before. It was awesome to have no pain. Now, I can do
normal stuff. Before, when I had my menstrual period, I would be in bed
for 7 days because of the pain.”
Adverse Side Effects of SSRI drugs
My previous newsletter
discussed adverse side effects of SSRI antidepressants, namely
akathesia, a form of agitation which drives people to commit suicide,
sexual dysfunction (impotence), tremor, involuntary body and facial
movements, tardive dyskinesia, and hyperactive reflexes indicating a
hyperactive nervous system. The SSRI induced loss of sexual function may
be irreversible even after discontinuation of the drug. (1)
many studies, SSRI efficacy was no better than placebo raising
questions about SSRI efficacy. It is astonishing that today, SSRI
antidepressants are the standard mainstream medical treatment for PMS
(Pre-Menstrual Syndrome). In addition, BCP's, birth control pills are
frequenty given as treatment for PMS, irregular periods, or any female
complaint for that matter (relating to cycles). Natural, bioidentical
Progesterone is a far better and more effective alternative for PMS. Broda Barnes found irregular cycles frequently responded to natural thyroid in spite of "normal" thyroid labs.
SSRI drugs for PMS - The Wrong Way
A Practice Which Should Be Abandoned
antidepressants may have some justifiable uses as a temporary treatment
in the severly depressed. However, the widespread usage of SSRI
antidepressants for PMS and Menopause should be abandoned.
on SSRI antidepressants for PMS, or menopausal symptoms should be
encouraged to taper off the SSRI drugs (under a physician’s
supervision). The correct diagnostic workup includes hormone levels,
thyroid panel, vitamin D and B12 levels. Treatment with natural
bio-identical progesterone, natural thyroid and vitamin supplementation
is more effective with fewer side effects than the current mainstream
use of SSRI antidepressants or BCP's (birth control pills).
A Successful Outcome
of Debbie Depressed illustrates a successful outcome treating
depression and PMS with progesterone, natural thyroid, vitamins D and
B12, and by modifying diet and lifestyle. It is very gratifying to see
Debbie make such a dramatic recovery after discontinuing the SSRI drugs.
References for Causes of Depression:
Low vitamin B12 levels are associated with depression. (2)(3)(4) (5)
Low Vitamin D levels are associated with depression.(6) (7) (8) (9)
Low thyroid function is also associated with depression. (10) (11) (12)
Lastly, bioidentical progesterone has been widely used as an effective treatment for PMS (Pre-Menstrual Syndrome). (13) (14) (18)(19)
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Jeffrey Dach MD
Jeffrey Dach, M.D. BLOG TrueMedMD disclaimer
(1) http://jeffreydach.com/2007/05/14/paxil-prozac-and-ssri-induced-suicide-by-jeffrey-dach-md.aspx Adverse side effects of SSRI drugs, Paxil, Prozac and SSRI Induced Suicide by Jeffrey Dach MD
Jeffrey Dach, M.D. BLOG TrueMedMD disclaimer
Low B12 and Depression
vitamin B12 level and good treatment outcome may be associated in major
depressive disorder Jukka Hintikka , Tommi Tolmunen , Antti Tanskanen
and Heimo Viinamäki Department of Psychiatry, Kuopio University
Hospital, Kuopio, Finland BMC Psychiatry 2003, 3:17 December 2003
B12 Deficiency and Depression in Physically Disabled Older Women:
Epidemiologic Evidence From the Women’s Health and Aging Study Brenda
W.J.H. Penninx, Ph.D., Jack M. Guralnik, M.D., Ph.D., Luigi Ferrucci,
M.D., Ph.D., Linda P. Fried, M.D., Ph.D., Robert H. Allen, M.D., and
Sally P. Stabler, M.D. Am J Psychiatry 157:715-721, May 2000
of depression: time to consider folic acid and vitamin B12, Journal of
Psychopharmacology, Vol. 19, No. 1, 59-65 (2005). Alec Coppen
B12, Folate, and Homocysteine in Depression: The Rotterdam Study, Am J
Psychiatry 159:2099-2101, December 2002. Henning Tiemeier, M.D., et al.
vitamin B12 deficiency, and to a lesser extent, folate deficiency were
all related to depressive disorders.”
Low Vitamin D and Depression
Major Depression and Vitamin D, By John J. Cannell, MD, The Vitamin D Council.
D vs broad spectrum phototherapy in the treatment of seasonal affective
disorder. J Nutr Health Aging. 1999;3(1):5-7. Gloth FM 3rd, Alam W,
Hollis B. Seasonal Affective Disorder (SAD) is prevalent when vitamin D
stores are typically low. Improvement in 25-OH D was significantly
associated with improvement in depression scale scores.
and Vitamin D Deficiency: Overlooked Vitamin D Deficiency and
Depression: Undetected is Untreated, Dr Charles Parker Blog.
MAJOR DEPRESSION AND VITAMIN D The Vitamin D, John J. Cannell, MD March 20, 2004 The Vitamin D Council
Low Thyroid and Depression
Stories on Depression that Went Away (and other mental health issues)
These are actual stories from real patients whose depression went away
using desiccated thyroid on the Stop the Thyroid Madness Blog.
thyroid replacement therapy be considered for patients with
treatment-refractory depression? J Psychiatry Neurosci. 2002 January;
27(1): 80. by
Russell T. Joffe
Is the thyroid still important in major depression? Russell T. Joffe, J Psychiatry Neurosci. 2006 November; 31(6): 367–368.
Progesterone for PMS:
PMS Treatment Clinic- the nation's leading PMS Clinic was established
in 1982 and began treatment of Premenstrual Syndrome with natural
progesterone therapy according to the method of PMS world authority
Katharina Dalton M.D. of London, England. (Sadly, Katharina Dalton
passed away on September 17, 2004 at the age of 87.) The Premenstrual
Syndrome Treatment Clinic uses bioidentical hormones exclusively in the
treatment of premenstrual syndrome and menopause. Since its inception,
35,000 patients from all over the United States and 28 countries have
been evaluated and treated.
with Katharina Dalton, MD Progesterone and Related Topics, Dr. Dalton
successfully treated PMS, pre-eclampsia, eclampsia and post-partum
depression with natural progesterone.
Thyroid for Irregular Menstrual Cycles
the Unsuspected Illness, by Broda Barnes MD, An observation by Dr.
Barnes is that low thyroid is associated with menstrual irregularties,
miscarriages and infertility. Barnes treated thousands of young women
with thyroid which restored cycle regularity and fertility. In his day,
the medical system resorted to the drastic measure of hysterectomy for
uncontrolled menstrual bleeding. Although today's use of birth control
pills to regulate the cycles is admittedly a far better alternative,
Barnes found that the simple administration of desiccated thyroid served
quite well. Again, Barnes noted that blood testing was usually normal
in these cases which respond to thyroid medication.
What is the Normal TSH Level?
Association of Clinical Endocrinologists, Until recently, physicians
accepted the normal TSH range of 0.5 to 5.0 mIU/L. The National Academy
of Clinical Biochemistry (NACB guidelines believes that a sustained TSH
level above 2.5 mIU/L might not be normal.
TSH Normal Range: Why is There Still Controversy? Insights from One of
the Nation's Leading Endocrinologists, Dr. Jeffrey Garber said in
practice, he doesn't hesitate to treat a patient who is in the 2.5 to
5.5 TSH range In late 2002, the National Academy of Clinical
Biochemistry (NACB issued new guidelines for TSH of 0.4 and 2.5. January
2003, the American Association of Clinical Endocrinologists (AACE),
issued their TSH range of 0.3 to 3.0. (Normal range for free T3 is
Progesterone for PMS
John R Lee MD web site, pioneered use of natural progesterone.
Dr. Phil Interviews Holly Anderson on Treating PMS with Natural Progesterone
5-HTP for Depression
Use of Neurotransmitter Precursors for Treatment of Depression by
Stephen Meyers, MS. ( Altern Med Rev 2000;5(1):64-71.)In a 1988 open
study of 25 patients, the therapeutic efficacy of 5-HTP was found to be
equal to traditional antidepressants.
Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted
the Food and Drug Administration Irving Kirsch, Brett J. Deacon, Tania
B. Huedo-Medina, Alan Scoboria, Thomas J. Moore, Blair T. Johnson. Compared with placebo, the new-generation antidepressants do not produce
clinically significant improvements in depression in patients who
initially have moderate or even very severe depression, but show
significant effects only in the most severely depressed patients.
D Deficiency Is Associated With Low Mood and Worse Cognitive
Performance in Older Adults. Consuelo H. Wilkins, M.D., Yvette I.
Sheline, M.D., Catherine M. Roe, Ph.D., Stanley J. Birge, M.D., and John
C. Morris, M.D. Am J Geriatr Psychiatry 14:1032-1040, December 2006
Jeffrey Dach MD
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Hollywood FL 33021
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