stellarpower: Introduction

[stellarpower]

Hi everyone,

 

I'm new here and I'm putting an intro in here as requested :)

 

I have a long history of mental health problems that could probably fill a book, so I'll try and summarise!!

 

I first started having problems aged 11 and during that time was hospitalised and also got a diagnosis of Asperger's. The hospital didn't provide me with any real therapy and I left feeling better only because things had stabilised in an environment where essentially all stressors were removed.

 

During my teenage years I was seen by CAMHS and was on and off loferpramine, citalopram, flouxetine and risperidone as far as I can mind; none made a huge difference but I was rarely above the starting dose.

 

In 2013/14 things got worse again and I had bad depression and was back to self-harming, more so than before. I was tried on mirtazepine but didn't do much and so then was put on trazodone as my antidepressant, as I wasn't sleeping very much at all, and given risperidone again. The NHS wouldn't give me any treatment other than a 6-12 week MCBT course which I knew wasn't right for me and which took over a year to get. I then searched for private therapy and underwent schema with bits of compassion for over two years.

 

I've just finished my first year of studies at the University of Edinburgh, things were looking better this time last year and during last autumn, and I agreed with my GP to decrease the trazodone as whilst it makes me sleep, the tiredness really affects me. So I went from 300mg to 250mg over Christmas, based on the logic that 50mg is the smallest clinically significant dose, and is the smallest tablet available. Also the Christmas holidays should have been quieter, so this was seen as a good time to make a start.

 

Well, it went horribly. I was badly depressed. Crying in the cinema lobby before seeing episode eight was a personal highlight, and the bottle of wine I got helped get me through the disappointment of a terrible plot not worthy of the Star Wars name. I try to stick these things out as I think if you put your dose back up straight away, you've gone through all that for nothing, but it eventually was inevitable that I needed to return it to normal. I stabilised a bit but the semester that followed dipped gradually and consistently until I was taken to hospital in the back of an ambulance. After that things worked themselves up until exams and I got through those and had a good start to the summer. In them meantime my referral to psychiatry went through this time, and just before coming home for the summer, we agreed to try the risperidone this time as my psychiatrist thought I probably didn't need it that much. I don't have psychosis, I take it for mood stabilisation.

 

He wanted me to reduce from 3 to 2 but I said I wanted to start with 2.5. This started well and the psych gave me the impression that as I didn't have an appointment for a few months , I was to reduce as I saw fit and try it and see what works. So when I visited family and stayed longer than expected I had to ration both the antipsychotics and the antidepressants and as I seemed to be doing okay thought I might as well keep at this lower dosage. I kept pushing it a bit and I was on 225 of the trazodone and about 1.5 of the risperidone, several days I was up all night so didn't take my dosage and then when things got harder I took half a milligram of risperidone to try and help. I ken I shouldn't have but my emotions go up and down and as I was unmonitored when things were going well it seemed a good idea and I thought I could cope. I'm tired of the side effects of these and would like to be running under my own steam if I can.

 

Well, things started to destabilise quite quickly and my mood fluctuations increased and I was back to self-harming at an increasing rate. I got through to the psychiatrist who managed to ring me even though officially appointments have to be in person, and we agreed to go back to 300/2.5, but it continued to get worse. This time last week I went to the GP, reluctantly as I have a bad experience with the NHS and mental health in this part of the country. Luckily the GP I saw was much more sympathetic and gave me an emergency referral to Acute Mental Health who saw me on Saturday and said they would do nothing. This was upsetting but yesterday I had a follow-up with the psychiatrist and after 11 years in the NHS they've agreed to recommend long-term therapy and I should be getting some DBT!

 

And that's pretty much it. I'm still on 300/2.5 and much more stable right now than earlier but still not in the best place and quite vulnerable. I'm gonna see what happens with the DBT and then see where I go from there medication-wise.

 

Thanks in advance for any comments!

[mammaP]

Hi Stellarpower, welcome to SA.  That is quiote a journey through the psychiatric system.  How long have you been on 300/2.5 now?  We ask all our members to fill in their signature with their drug and taper history. We need drugs and doses, when started and stopped. A brief summary for previous years but more detailed for the last 12 months. This gives us a good picture of all the changes and the best way forward for you. Every time a drug or dose is changed it rocks the nervous system, and when there are many changes in a short time it takes longer to recover. For now the best thing you can do is nothing. That might sound odd coming from a site that heps people to come off the drugs but you need to be stable before you start to taper off them. 

 

On 7/24/2018 at 12:44 PM, stellarpower said:

So when I visited family and stayed longer than expected I had to ration both the antipsychotics and the antidepressants and as I seemed to be doing okay thought I might as well keep at this lower dosage. I kept pushing it a bit and I was on 225 of the trazodone and about 1.5 of the risperidone, several days I was up all night so didn't take my dosage and then when things got harder I took half a milligram of risperidone to try and help. I ken I shouldn't have but my emotions go up and down and as I was unmonitored when things were going well it seemed a good idea and I thought I could cope. I'm tired of the side effects of these and would like to be running under my own steam if I can.

 

I know that you want to be off the drugs but this kind of irregular dosing is what made you sick.  We have all had to discover this the hard way, the nervous system is not made of rubber and is easily destabilised. It is good that you are feeling more stable now, and great that you are going to get the DBT terapy, I hope it helps you.   When you have been stable for about 3 months you can then think about tapering.  You will probably experience windows and waves while your brain and nervous system are settling down, don't be scared, this is a normal part of healing. Don't be tempted to reduce because that can throw you into withdrawal and you need to be good and stable. Stable does not mean perfect, it means at base level, where you are functioning. 

 

When you are ready to start tapering, we recommend tapering no more than 10% of the CURRENT dose with at least 4 weeks between cuts. This allows your brain to adjust to the lower dose and is more likely to succeed. Taper faster and you end up back on the full dose right back at aquare one and feeling bad. 

 

Here are some links for you. 

Why taper. This is scientific and explains the need to taper slowly

https://www.survivingantidepressants.org/index.php?/topic/6036-why-taper-paper-demonstrates-importance-of-gradual-change-in-plasma-concentration/

 

Tapering multiple drugs, which one first.

https://www.survivingantidepressants.org/index.php?/topic/2207-taking-multiple-psych-drugs-taper-the-antidepressant-first/

 

Tapering trazodone

https://www.survivingantidepressants.org/index.php?/topic/2883-tips-for-tapering-off-trazodone/

 

Tapering risperidone

 

https://www.survivingantidepressants.org/index.php?/topic/1716-tips-for-tapering-off-risperdal-risperidone/

 

There are some interactions with the drugs, and especially with some food and alcohol,. so will need to be careful to avoid things that will interact.  

https://www.drugs.com/interactions-check.php?drug_list=2019-1305,2228-0  

 

 

 

 

[stellarpower]

Hi mammaP, thanks for the reply.

 

I've been on 300/2.5 for about two weeks I reckon. Looking to wait at least a month and a half before I even consider any more reductions, I've still been struggling recently. However at that point I'll look at the 3-month mark you recommend for actual changes. I'll probably ask my GP if I can go onto liquid so it's easier to reduce the dose by a smaller amount as I don't fancy crushing up the tablets in a pestle and mortar etc. if I can avoid it. I'm quite surprised that the health system doesn't seem to be aware of the advice I'm hearing here, the doctors and psychiatrists I've seen just seem to recommend cutting by the smallest convenient amount which is at times significantly more than 10%.

 

I'm interested by the tapering graphs, so if the serotonin reuptake inhibtion is modelled by a graph of the form x/(x+c), then an exponential decay as suggested mathematically just about counteracts the curve given the right constants, but I'm intrigued as to why I've reacted badly on two occasions to cutting by 17% when I should be much less sensitive to a change given that I'm currently on a high dose. I think the change in trazodone over Christmas from 300 to 250 for only about two weeks induced a depression that lasted four months, and yet that should be less significant than a change from 50mg to say 25mg should I have reached that level. Have I interpreted the information correctly?

 

Thanks