The RxISK website has been undergoing major renovation. There is still a great deal of work going on behind the scenes to look at new ideas and better ways to make available the best tools and information about prescription drug side effects.
The old site had a Symptoms on Stopping Zone – a Withdrawal Zone. Withdrawal is an important feature of RxISK, so we are hoping to bring back a new version of this.
Dependence on and withdrawal from treatments happens with many more drugs than just the classic drugs of abuse like the opiates or benzodiazepines. It can happen with pretty well all psychotropic drugs and with many drugs whose actions on the brain are downplayed. But it can also happen with drugs that have little or no effect on the brain and one of our hopes is to bring into the light withdrawal syndromes that have been hiding in the shadows for too long.
The new zone will include a free-standing tool – RxISK’s Withdrawal Algorithm. This is a set of structured questions that provide you with a score to help you work out if your problems are likely to be linked to withdrawal from your medication or not. Only RxISK has an algorithm like this. This same algorithm features in the RxISK Report, but we want it to be available to use outside of the report as well.
We want to bring together everything relating to withdrawal, all in one place – medication guides, guides on dependence, tapering information, etc.
A few months ago, we introduced a new tool called Search by Side Effect. Some of you might have wondered what it’s for and how best to use it. The usual way of searching for side effect information on RxISK is to look up all of the adverse effects reported on individual drugs. This is done using Drugs A-Z.
But Search by Side Effect works the opposite way. It lets you input the name of a side effect, and brings up a list of drugs that have had this side effect reported to the FDA and Health Canada.
This means you can look up all the drugs that are associated with a problem like parosmia (strange smells) or dysgeusia (strange tastes) or hallucinations, jitteriness or other problems, some of which are classically linked to withdrawal and some not.
It enables you to go in and research the range of other drugs that may be producing the problem you are having. You might find for instance that antidepressants other than the one you are on cause the parosmia that you are experiencing. This makes it much more likely your drug is causing this problem whatever anyone else says – or has caused this problem even after the drug has left your body.
The question of withdrawal has not featured to the extent it should in medical practice to date because the debate has been dominated by classic symptoms on classic drugs. It is almost certainly the case that there are many other problems happening on many other drugs not usually thought of as causing dependence. The people to whom these problems are happening are likely to be labelled as neurotic, or showing illness behaviour or having supra-tentorial features, if they mention or make too much of any symptoms they are having – because everyone knows “this” (osteoporosis drug, gut drug, heart drug, antidepressant) is not a drug of abuse.
The time has come to rewrite the clinical picture of dependence and withdrawal and recast the debate about what can go wrong when we stop treatments and why this happens.
Some of us at RxISK have been working on the inside of these issues for years. One hunch we have that might explain what is happening in complex withdrawal is that many drugs, when used in the longer run, can give rise to a peripheral neuropathy. This would be expected to lead to symptoms such as strange smells, tastes or sensations, along with food intolerance and stress sensitivity. Effects like these can sometimes start on treatment but usually show most clearly as legacy effects – effects than endure after treatment stops.
The Complex Withdrawal website is not where it was. It hasn’t disappeared – it has moved to the main RxISK website and has become a Complex Withdrawal section.
It can be found in the Tools menu. Again, we want people to find the information and tools that they need without having to look in separate locations or on separate websites.
We’ve also created a page for Post-SSRI Sexual Dysfunction (PSSD), which you can also find in the Tools menu.
The phenomena of PSSD and complex withdrawal bring out clinical features that are commonly neglected. No one knows what causes PSSD or complex withdrawal. We offer some ideas. The ideas are speculative, but PSSD and complex withdrawal syndromes are fact.
As always, we value your feedback and ideas. If there is anything you would like to see, or anything that you think could be improved, please let us know.