Withdrawal syndrome vs adrenal fatigue

The beginning of this post is written by Alto Strata, she runs the withdrawal group Surviving Antidepressants where this article first appeared.

She has also written other informative articles that appear on Beyond Meds:

●  Neuropsychiatry: Same baloney, different sandwich 

●  Protracted withdrawal from SSRIs and SNRIs antidepressants 

●  GABA/Glutamate cycle in withdrawal from psychotropics– SSRIs, benzos, and Lamictal.

There is a second half to this post that includes a story as example of what Alto is talking about in the first half. The second half is written by me, Monica.

I’d like to add one caveat before reading the article by Alto Strata. She does elude to this in the article but I want to make it clear. There are times when adrenal fatigue is likely an issue for some people some of the time during the course of a withdrawal journey. But it’s also very clear  that more often it really is the opposite. For me early on I did respond to supplements that helped support the adrenals and perhaps at that time I truly had adrenal fatigue. Later I became gravely hypersensitive to such things and now they are plain dangerous. Our bodies may need different things at different times. And it’s true that very often and probably most often our adrenals are  producing too much cortisol rather than too little. That is part of what appears to be the iatrogenic autonomic nervous system dysfunction caused by the psych med use and subsequent withdrawal. 

**updated note: some years out, adrenal fatigue has reasserted itself but needs to be treated very gently

Update 2016: It’s become clear to me that whenever it’s possible that it’s helpful for folks who’ve not begun withdrawal and have the time to consider a carefully thought out plan to attempt to bring greater well-being to your body before starting the withdrawal. That means learning how to profoundly nourish your body/mind and spirit prior to beginning a withdrawal. For suggestions on how to go about doing that check the drop-down menus on this blog for ideas. Anything that helps you learn how to live well can be part of your plan. That plan will look different for everyone as we learn to follow our hearts and find our own unique paths in the world. Things to begin considering are diet, exercise and movement, meditation/contemplation etc. Paying attention to all these things as you do them helps too. The body will start letting us know what it needs as we learn to pay attention.

Adrenal fatigue and psychiatric drug withdrawal — by Alto Strata

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In many ways, withdrawal syndrome is the opposite of adrenal fatigue.

In withdrawal syndrome, the theory is that the brain is sending erratic “fight or flight” signals to the adrenals and the adrenals are obediently responding with adrenaline and cortisol, as they are designed to do.

The normal diurnal cortisol cycle may be exaggerated, as we see when people wake up with panic or anxiety due to the morning cortisol spike. However, there may be waves or surges of cortisol on and off throughout the day, felt as waves of what we call neuro-anxiety, neuro-melancholy, or neuro-panic (they seem to be coming from the body instead of the emotions), as well as other symptoms of autonomic upset such as palpitations, dizziness, and brain zaps or tingling.

A 4-times a day saliva test for cortisol will not reliably pick up these odd surges, and if it does, the results will be nonsensical, as they may capture a spike. The 24-hour urine test may show an *average* higher level of cortisol — it’s capturing all the urinary cortisol throughout the period.

But — nobody knows what to do with these results, absent a tumor. Unless you want to rule out a tumor or can afford to do the 24-hour cortisol test out of sheer curiosity, it’s not worth it to do it. (For 24 hours, you have to pee into a bucket every single time you pee.)

Because people with withdrawal syndrome often suffer a harsh insomnia, frequent nighttime waking, or early waking with the morning cortisol increase, they may feel fatigued from lack of sleep. But stimulating the adrenals would be exactly the wrong thing to do in this situation. Their faithful output of cortisol surges is causing the problem, you don’t want to encourage them.

The adrenals control many essential functions in the body. Unless you really know what you’re doing and you absolutely have to do it, you don’t want to directly interfere with their operations in any way.

As opposed to adrenal fatigue, elevated cortisol in withdrawal syndrome keeps you going even though you’re dead tired. People also report a surprising low incidence of colds and flu.

While most people seem to get the “alerting” kind of withdrawal symptoms, a minority seem to become exhausted and sleep a lot. (I’ve never seen this become prolonged. It might be a protective way for the body to heal itself.)

It is possible one might have had chronic fatigue syndrome or an adrenal or endocrine problem *before* withdrawal, and withdrawal syndrome exacerbates it. I guess it is possible that although they are tough little organs, after a very long time, one’s adrenals might poop out from the stress of withdrawal. (Among medical doctors, adrenal fatigue is highly debatable.)

However, adrenal fatigue does not seem to be central to withdrawal syndrome. Please do not experiment with stimulating your adrenals. Don’t take adrenal tonics or licorice. Like the rest of your system, with calm and stability, they will return to normal functioning.

If you believe you have adrenal fatigue, there are sites that specialize in discussing and supporting it. You may wish to visit them to see if the symptom patterns people report are a better match for your symptoms than withdrawal syndrome.

Since we believe any kind of chemical or herbal messing with the adrenals is not good for most cases of withdrawal syndrome, we won’t have much information on them here.

If you have non-invasive ways of calming the adrenals, reducing cortisol, and calming the nervous system, please feel free to post them in this forum.  To visit the forum click here: Surviving Antidepressants.org

When I read the above piece by AltoStrata I thought of an incident with a doctor I had a couple of years ago. Alternative doctors and integrative doctors often want to diagnose psychiatric drug withdrawal as adrenal fatigue. This can be quite dangerous and we need to know how to protect ourselves. I thought I’d repost an edited version below. It was first posted a couple of years ago. Dealing with doctors is an artform we need to develop so it helps to see what happens with others. 

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A story of a doctor behaving badly

— By  Monica Cassani

April 2009

I’ve been going to an Integrative Doctor’s office off and on in my town since 2005. They’ve been pretty clueless about how to help me but I keep going back because it’s the only place I can get certain sorts of unusual blood work done that standard traditional docs won’t do. This time I went to them to get a blood test that would test my detoxification enzymes. Specific enzymes that detox environmental toxins, pharmaceuticals etc. I had consulted with one of my friend’s colleagues in San Francisco and he recommended a bunch of tests including a test for heavy metal toxicity and once again an adrenal gland test which I already know is low from the last time I took it.

Adrenal functioning tends to get even worse over the course of a benzo withdrawal so it makes sense to look at them again.

From the very beginning these docs at this practice have wanted me to take Cortisol, a natural steroid, to pump up my adrenals. Way early on, before I knew what I was doing,  I looked at the side effect profile and said NO–it was a gut feeling. Since then I’ve studied my circumstance in depth and consulted with numerous people all over the country and I now have tons of anecdotal evidence that taking Cortisol in my condition is downright dangerous. I’ve been telling them this for about 3 years now. (now I know that it could even be life-threatening for me)

So when I was talking to this guy a couple of weeks ago I got excited because it sounded like we had a plan for moving forward. We agreed too, that I would once again look at my adrenal function.

At this point I said to the doc, “Dr. J—you need to promise me you will never bring up Cortisol again. I won’t take it, it’s dangerous for me and I don’t appreciate your not respecting that in the past.” He said very lightly and clearly, “No problem, there are other natural things you can do.”

I felt relieved. He had promised me he wouldn’t bring it up again because every doc in that practice has been trying to force it on me and they get sort of hostile and controlling about it.

Anyway. He called a week later after their staff meeting. God knows what happened in the staff meeting, but low and behold he started telling me I NEEDED to take the Cortisol!!!

I said to him, “Dr. J you promised me you wouldn’t do this.” I was mildly agitated in tone. He said, “Well, if you want to feel better right away you need to take it.”

I said, “Dr. J, it’s not realistic for me that I would feel better right away.”

He said, “Well when I was sick like you I needed to take Cortisol just to be able to go to work everyday.”

I said, (getting a bit agitated) “Dr. J, I don’t believe you’ve been sick like me.”

He said, “No, really when I was sick like you I needed to take it.”

I finally lost it and raised my voice and said, “Dr. J, you have never been sick like me! I’ve been on neurotoxins for 20 years!”

He promptly said, “I’m not taking your abuse.” And he hung up.

Just in case you wonder. I KNOW he has NEVER been on psych meds because he doesn’t know anything about them. So I know he cannot compare whatever illness he had to mine.

In any case I wrote the following letter to him which he will receive tomorrow.

Dear Dr. J,

You can call it abuse if you like that I got angry at you after telling you explicitly numerous times that I will not take Cortisol or you can look at yourself and see why you are hell bent on telling me what I should do when I’ve told you I won’t do it.

Your experience is NOT like mine. I was on neurotoxins at astronomical doses for 20 years.

I’m sure you’ve suffered too and I don’t question that, but you cannot compare our experiences.

I am very very sick today. I’m in horrible physical pain. I’m shaking and weak.

I got mad at you. It may not have been the best behavior in the world but I felt once again ignored and dismissed. My experience spit on.

I simply ask that you respect my decisions. I’ve done excessive amounts of research about my condition and know many other people who suffer with it. You do not. I’m begging you to trust me because I need help but if I have to pretend to do what you suggest when I know it’s dangerous for me just to get along with you then we can’t work together.

I am housebound. I’ve needed home care. I need help. No one knows what to do with me but I need someone who has ideas and I have listened to yours and agreed on the tests you suggested…I need you to listen to me too. We have to be partners. I won’t be a submissive patient.

If you don’t want to deal with that, fine. But if you respect me, I’ll respect you…but if you push things on me I don’t want then, no, I won’t stand for it and I didn’t.

that is what got me here in the first place—trusting doctors implicitly.

I won’t do it again.

Gianna

So, once again, I have no doctor. Every doctor who practices medicine in a way I will consider still feels a need to control what I do with my body. Just like a typical psychiatrist. It’s infuriating.

The two docs who treat me with the greatest respect are, oddly enough, my traditional psychiatrist who allows me to dictate how I need to slowly and safely withdraw. He profoundly respects me even if he doesn’t actually know how to help guide me.

And my general practitioner too, who practices ordinary medicine has helped me get home care, given me a diagnosis of iatrogenesis  and has believed all my symptoms and never called me crazy or even given a hint that he doubts me, but again has no tools in his toolbox to help me.

So both of them really don’t know how to help me. They simply TRUST me.

Instead the docs with the specialty knowledge have such huge egos they think they know how to fix me when in point of fact they’ve never even worked with anyone like me. And they will admit it. They know no one whose been on the psych meds  like me. So why do they pretend to know how to treat me with such great confidence?? Their egos are astounding. And I’ve been harmed or received really bad advice now over and over again by numerous “alternative, integrative, orthomolecular” doctors now.

The thing is if I find one willing to partner with me and trust me like my regular doctors we might actually be able to put our heads together and accomplish something. But these guys aren’t willing to trust me. (I’ve found that doctor now, 2 1/2 years later…he actually understands the issue and has seen it before!)

Just to make something clear—I do not assume all doctors are like this, but it does seem like most of them are. I do not have issues with my traditional docs, psychiatrist and general practitioner nor my neuro-psychologist. I’ve known all these people for years. The only people I have problems with are the ones who think they know the answers to my problems when they don’t. Because no one does and unless someone is willing to be frank about that I’m not willing to work with them. I’ve talked to the foremost experts in the country on psychotropic drug detox and the people who know the most admit they know nothing.