Medication Withdrawal: Managing Anxiety and Heart Symptoms

Drug withdrawal issues

Hello, Director Zhang.
Thank you for helping everyone with their concerns.
At the beginning of last year, I started experiencing ventricular premature contractions (VPCs) and missed heartbeats.
My cardiologist said it was nothing to worry about and might be due to autonomic nervous system dysregulation.
However, I became very concerned, which led to anxiety and eventually panic attacks.
I then consulted a psychiatrist and have been taking (Prozac 40mg + Xanax 0.5mg once daily before bed) for a year and a half.
I recently reduced the Xanax to half a pill, and I've been on this dosage for almost a month.
I have also started RTMS, and this is my fifth session targeting the right hemisphere.

Could you please tell me if there is a difference in effects between the left and right hemispheres? Which side is more suitable for treating anxiety and autonomic nervous system dysregulation? Over the past few days, I have felt that my parasympathetic nervous system is very active, and my body sometimes feels so relaxed that it doesn't feel like my own.
I don't feel uncomfortable, but it is a bit frightening.
I have also started to taper off Prozac; I have reduced it from 40mg to 30mg over the past two days.
However, isn't Prozac supposed to be a medication with a slow metabolism? Why do I feel changes on the first and second days? Sometimes I notice my heart rate is a bit faster, and my breathing feels a bit constricted, but these sensations are brief and tolerable.
Could this be withdrawal symptoms? If I can tolerate the symptoms, can I continue to taper off slowly? Or do you have any other suggestions? Thank you! Wishing you peace!

Nick, 20~29 year old female. Ask Date: 2021/09/11

Dr. Zhang Gengjia reply Psychiatry

Dear Sir/Madam,
From your letter, it is clear that you are experiencing discomfort and distress due to both ventricular premature contractions (VPC) and autonomic nervous system dysregulation.
1.
Facing an uncertain future, severe depression and anxiety disorders are common conditions in modern society.
These are chronic illnesses that require long-term treatment for recovery.
2.
Autonomic nervous system dysregulation is also a chronic condition characterized by episodes of exacerbation, remission, recovery, and relapse.
More than half of patients may experience a recurrence after remission.
Due to individual differences in physiology, it may take time to identify the appropriate medication.
Please be patient and cooperate with your physician, informing them of your physiological conditions.
3.
Regarding pharmacological treatment, each primary medication requires 4 to 6 weeks to assess its efficacy.
If you experience any discomfort after reducing medication, please note the duration and frequency of these symptoms.
4.
In addition to medication and psychotherapy, repetitive transcranial magnetic stimulation (rTMS) is a non-invasive, anesthesia-free, and highly safe treatment option that does not require hospitalization.
It can improve anxiety and depressive moods.
Patients with treatment-resistant depression or poor medication response often show significant improvement in their depressive and anxiety symptoms after rTMS treatment.
Please discuss any psychosomatic issues thoroughly with your physician during your follow-up visit, as some symptoms may be related to the original condition, while others could be withdrawal symptoms from medication.
Our clinic is open for consultations from Monday to Friday, both in the morning and afternoon.
I recommend considering a visit to allow your physician to personally assess your symptoms and collaboratively determine the best course of action for you.
Wishing you mental and physical well-being.
Sincerely,
Dr.
Chang Geng-Jia
Department of Psychiatry

Reply Date: 2021/09/11

More Info

Managing medication withdrawal, particularly from antidepressants like Prozac (Fluoxetine) and anxiolytics like Xanax (Alprazolam), can be a complex process, especially for individuals with underlying anxiety disorders and cardiac symptoms. Your experience with premature ventricular contractions (VPCs) and the subsequent anxiety and panic attacks is not uncommon. It’s important to approach this situation with care, as both the psychological and physiological aspects of your health are intertwined.

Firstly, regarding your question about the effects of right versus left transcranial magnetic stimulation (TMS), research indicates that the two hemispheres of the brain can have different roles in emotional regulation. The left hemisphere is often associated with positive emotions and approach behaviors, while the right hemisphere is linked to negative emotions and withdrawal behaviors. Therefore, targeting the right hemisphere may be beneficial for anxiety and depression, as it can help modulate the overactivity of the right hemisphere that is often seen in these conditions. However, the effectiveness can vary from person to person, and it’s essential to discuss your specific treatment plan with your healthcare provider.

As for your experience of feeling overly relaxed or "not like yourself," this can be a common sensation during the adjustment period of TMS or when reducing medication. The autonomic nervous system, which regulates bodily functions, can become imbalanced during these transitions, leading to sensations of increased parasympathetic activity (the "rest and digest" system). While this can feel unsettling, it is often temporary.
Regarding your medication reduction, it is crucial to understand that selective serotonin reuptake inhibitors (SSRIs) like Prozac can indeed have a long half-life, which means they stay in your system for an extended period. However, individual responses to tapering can vary significantly. Some people may experience withdrawal symptoms even with a gradual reduction, while others may not. The symptoms you describe—such as increased heart rate and a feeling of breathlessness—can indeed be withdrawal symptoms, especially if they occur shortly after reducing your dosage.
If you find these symptoms manageable, it may be reasonable to continue tapering your medication slowly. However, it is essential to do this under the guidance of your healthcare provider. They can help you develop a tapering schedule that minimizes withdrawal symptoms and ensures your safety.
In addition to medication management, consider incorporating lifestyle changes that can support your mental health and cardiovascular health. Regular physical activity, a balanced diet, adequate sleep, and mindfulness practices such as meditation or yoga can significantly improve anxiety symptoms and overall well-being.
Lastly, if you continue to experience significant anxiety or cardiac symptoms, or if the sensations become overwhelming, it is crucial to consult your healthcare provider. They may recommend adjusting your tapering schedule, exploring alternative treatments, or providing additional support through therapy or other interventions.

In summary, managing medication withdrawal requires a careful and individualized approach. Open communication with your healthcare provider is vital to ensure that you are supported throughout this process. Your health and well-being are paramount, and with the right strategies and support, you can navigate this challenging time effectively.

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