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Dr. Mark
Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5220
Experience:  Dr. Mark is a PhD in psychology in private practice
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I have been on lexapro for about 6 months, then just changed

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I have been on lexapro for about 6 months, then just changed to Prozac for 8 days. Kwan to stop takin medicine as inolingeneed it. Can you please tell me how I should go abou his. Thank ou
Submitted: 5 years ago.
Category: Mental Health
Expert:  Dr. Mark replied 5 years ago.

Hi! You know, to give you the best answer, I think I should ask you a few questions first that will help define the problem and the situation.


What is the problem that the medication is prescribed for?

Is the Prozac helping yet? Why did you switch from Lexapro?

Have you discussed with your prescribing physician your desire to get off medications completely? What was his/her response?

Are you getting any psychotherapy? If so, what type? How long and how is it helping?

Any extra information that will help, feel free to share.


Dr. Mark

Customer: replied 5 years ago.
The drug is fir depression
The Prozac hasn't made any difference than the lexapro
Have not discussed with my physician

I ave had a problem for two years that has been resolved and I feel much much better

I feel like I don't need the medicine anymore
Expert:  Dr. Mark replied 5 years ago.

Thank you for the added information. It helps a lot. I believe I can now be of help with this issue.



First, let me say I can imagine how much now that you are feeling better you don't want to be taking medications. Many professionals would not support this, but many would. I am of the belief that for depression that came along later in life (not chronic throughout one's life), if the situation improves, it can be done successfully IF the person takes the proper precautions. So that's what I'm going to focus on. I also want you to know that at the end of the posting I'll paste in for you a technique you can use to help you when you are feeling low or have anxiety. When you are feeling depressed and in a dark hole, this is something you can use to help yourself with some relief and you can use it over and over.


To completely get off meds in a safe and proper way, then, you need to focus on four things. The four things: having the doctor supervise the tapering off of the meds, diet, exercise, psychotherapy.

Tapering off: you've been on meds for a while now and just stopping is NOT the proper way to do this. You may very likely experience withdrawal symptoms from stopping the meds. The proper way to get off these medications is to taper off. So this needs to be done with your doctor. The doctor also needs to be on your side if you find after a while without the meds that you do indeed need to still be taking them. So have the doctor supervise the tapering off process. The doctor may be more receptive to this if you discuss your commitment to replacing the meds with the program below.

Diet: cut out coffee, sugar, white flour. That may be tough. But you will see results as some of the newer research shows. Also, you need to take Omega 3 fatty acids. Either in fish oil or capsules. You need because you have depression a clinical dose, about 3,000 mg a day. Discuss this with your doctor. The research is conclusive on this. So that's diet. Oh, and lean meats only. No fast food restaurants, no fatty foods.


Exercise: 5 days a week moderate exercise, to include 3 days of strength training as you get more used to it. Pretty amazing isn't it? I told you it would require work, but what you put in to it you will get out of it. Your doctor will verify the research results showing the benefit.


Psychotherapy: this requires to have you reorient your thinking about yourself and depression and meds. Medications only treat the symptoms of depression and that it is important to treat your depression as a HUMAN symptom.

So this would need you to reorient your view of what's happening to you so that your emotions, which ARE after all, what is being talked about here with depression are treated with human respect and value and given a chance to help you grow and gain as a human being. This would mean changing your focus from the medications being your main "work" on your depression to your exploring your emotional reactions of being in such a depressed dark place as being your MAIN work and the meds and remedies as being the boost you need to help you not be so panicked and anxious and in a dark hole so that you CAN work on what's going on inside. Do you see this reorientation? We have emotions because they are part of how we grow and learn and become more fulfilled. But if we keep medicating them and trying to get them just to go away without ever exploring what's going on, we NEVER get that chance to get anything from them. So in your situation where you are feeling good, you would want the psychotherapy to focus on what happened and monitoring your current emotional state and gaining skills.

If your doctor isn't able to refer to anyone, here is the web address for Psychology Today's therapist directory. You can sort by zip codes and when you see someone who seems like they might be helpful (they show you a photo of the therapist!) look at the listing and see if they list CBT therapy in their orientations and depression as one of the areas they work with.

http://therapists.psychologytoday.com/rms/

If you want someone who isn't as structured as a pure CBT therapist, consider seeing if the therapist also lists humanistic and/or psychodynamic therapy in their orientation. The idea here isn't that these types of therapy are magic. It's that you may want to find a therapist who will form a strong therapeutic alliance with you and will help you look at the sources of your emotions.

I wish you the very best!

Now for the technique: here are instructions on a therapeutic protocol called Progressive Muscle Relaxation (PMR). It's really quite easy to do almost anywhere. My patients, when I teach them PMR at first are amazed how simple it is and that it is a psychological protocol. It was first used in the 1920s! Since then, of course, it has been refined and many studies have been done showing its effectiveness. I want you to practice the PMR at least 5-6 times before an attack or feeling acute anxiety. Why? Because when you're in the throes of anxiety, you will only remember to do something you are very familiar with it. So practicing 5-6 times is really a minimum.


I want to stress the importance of breathing as well. Part of the physiology of what is happening to you when the anxiety of depression is present is that your breathing is getting shallower. This reduces the oxygen in your blood to your brain. That increases the anxiety and depression, which strengthens the emotion and you are in a vicious cycle! Not good. So breathing is the primary tool. I have found in my practice that learning breathing techniques can be helpful. But some of my patients are not interested in learning more than one thing at the beginning, so I have found that just reminding you to BREATHE deeply at the same time you are doing PMR is almost as good. If you are willing to take a yoga class and learn breathing techniques, that's the best. But, breathing deeply with your PMR will help.


So, we're ready for learning PMR. I want you to print my instructions below my signature and have a copy in each of the rooms of your home where you may be when you have an attack. And again, you need to practice this easy technique at least 5-6 times as soon as you can. It needs to become as natural to you as breathing. Ah, remember breathing?


INSTRUCTIONS:

  1. After finding a quiet place and several free minutes to practice progressive muscle relaxation, sit or lie down and make yourself comfortable.
  2. Begin by tensing all the muscles in your face. Make a tight grimace, close your eyes as tightly as possible, clench your teeth, even move your ears up if you can. Hold this for the count of eight as you inhale.
  3. Now exhale and relax completely. Let your face go completely lax, as though you were sleeping. Feel the tension seep from your facial muscles, and enjoy the feeling.
  4. Next, completely tense your neck and shoulders, again inhaling and counting to eight. Then exhale and relax.
  5. Continue down your body, repeating the procedure with the following muscle groups:
    • chest
    • abdomen
    • entire right arm
    • right forearm and hand (making a fist)
    • right hand
    • entire left arm
    • left forearm and hand (again, making a fist)
    • left hand
    • buttocks
    • entire right leg
    • lower right leg and foot
    • right foot
    • entire left leg
    • lower left leg and foot
    • left foot
  6. for the shortened version, which includes just four main muscle groups:
    • face
    • neck, shoulders and arms
    • abdomen and chest
    • buttocks, legs and feet

Quickly focusing on each group one after the other, with practice you can relax your body like ‘liquid relaxation’ poured on your head and it flowed down and completely covered you. You can use progressive muscle relaxation to quickly de-stress any time.

What You Need:

  • A comfortable place.
  • Some privacy.
  • A few minutes.

Again:

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