Courageous: inconsistent Trazodone

[Courageous]

Hi,

 

I'm feeling both shock and gratitude for having discovered your website and beginning to education myself about what's happening to me.

 

I began to wake up in the middle of the night ("the morning cortisol spike"), every night, in November 2018.  I don't know why this started happening but my guess is that it was a result of progress in my meditation practice that started to give me access to PTSD.  It felt like I had opened a door to trauma and I tried everything I could to close the door again (because I didn't want the sleep disruption) but to no avail.  Shortly after that I started a new job and it was hell trying to get through the workday with inadequate sleep every day.

 

In January 2019 I saw a sleep expert and told him that I intended to see a doctor to get a sleeping pill.  He told me that patients take sleeping pills only once every 3 days to avoid habituation but that at least they get a night of good sleep every few days that way, and that the pill currently in vogue is probably Trazodone.

 

The next day I saw a doctor.  He spent a lot of time warning me away from Ambien, and for that I am grateful, but when I mentioned Trazodone (from my conversation with the sleep expert) he prescribed 50 mg for me.  I asked him about the 3 day rule and he had never heard of it—he said he thought people took the pill daily.  I think I remember him telling me it was non-addictive.

 

I started taking Trazodone 2x/week and it helped with my sleep.  A week later, with the doctor's permission, I increased the dose to 100 mg.

 

Things were generally manageable for the next month or so until I started taking Trazodone more frequently, here and there, like the night before an important meeting at work.  I figured this was OK because the pill bottle read, "Take 1 tablet by mouth at bedtime as needed for insomnia."  I also experimented with different dosages, increasing my dose if I was overtired or reducing it (by 25%) if I had slept well lately.  I started having suicidal thoughts and two nights in which I was unable to sleep at all, which has never happened to me before.  Now I can't fall asleep without the Trazodone and it had been easy for me to fall asleep before I started taking it.

 

On 2019 May 3 I started doing research on the Internet, found this website, and realized that I had become addicted to Trazodone and that I had been giving myself inconsistent dosages and frequencies.  As an attempt to stabilize I started taking 100 mg every night.  This gave me good sleep for two nights and then last night I was able to sleep for only 2 hours.

 

I'm shocked that I wasn't warned about how dangerous this drug is and wish I'd never taken it.

 

Please advise me:  I understand the importance of tapering 10% but I don't know where I should start because my dosage hasn't been consistent.  I took a guess 3 days ago and chose 100 mg.  That seemed to work for two nights but last night was hell.  Should I continue to take 100 mg every night and hope for stability, or what would be best?

 

Thank you,

Courageous

 

P. S.  I am also grateful for my meditation practice because without it I think I'd be going insane and spiraling into depression right now.

 

[Gridley]

Hello, Courageous, and welcome to SA.  Thank you for completing your drug signature.  I'm sorry your doctor was so uninformed.

 

How have you been feeling since you started taking the consistent dose of Trazodone a few days ago?  Are you having any side effects?

If I understand you correctly, 100mg is the most common dose you've been taking since you started.  If so, that's probably the place to start on your taper.   As you've read, we recommend tapering no faster than 10% of current dose every four weeks.  Some have to go more slowly.

How stable are you feeling?  It's best to be as stable as possible before beginning a taper.

 

Preparing to taper

 

Why taper by 10% of my dosage?

 

This link explains the importance of a slow taper.

 

Brain Remodelling 

 

As an alternative, a micro-taper is the gentlest way to come off these drugs. 

 

Micro-taper instead of 10% or 5% decreases

 

The Brassmonkey Slide is a way of making micro-taper reductions weekly, as opposed to a larger reduction once a month. 

 

The Brassmonkey Slide Method of Micro-tapering

 

There is generally going to be an increase in  symptoms every time you taper.  Using the Brassmonkey Slide Method that increase should be minimal with the symptoms returning to baseline before the next taper.

 

This link is specifically about tapering Trazodone.

 

Tips for tapering off trazodone (Desyrel)

 

This is your introduction topic -- the place for you to ask questions, record symptoms, share your progress, and connect with other members of the SA community.  I hope you’ll find the information in the SA forums helpful for your situation.  I'm sorry that you are in the position that you need the information, but I am glad that you found us.  

 

[Courageous]

Hi Gridley, thanks for the welcome.  Over the past few months my dosages have been between 50 and 100 mg and not every night.  I chose 100 mg with which to start being consistent every night because it's on the high end of the range.  The first two days since I started being consistent were good, then last night I was able to sleep for only 2 hours.

 

Should I keep taking 100 mg every night in order to stabilize, or lower it?  What can I expect to happen?

 

Thanks for your attention and thoughts.

 

[laydefish]

Hi Courageous! I know what your going thru & I wanted to tell you that you came to the right place & know that your loaded with the right information, your going to be just fine. Hang in there & stay Strong!

[Courageous]

Thank you for the encouragement, laydefish!

 

I'm feeling "stable" now on 100 mg/night but in retrospect wish I'd tried a lower dose for consistency.

 

I started tapering by 10% on Friday and so far things are OK.

 

I wonder if I will be able to taper more quickly than monthly because I've been on Trazodone for only 5 months, and during much of that time for only 2x/week?

 

[ChessieCat]

2 hours ago, Courageous said:

I've been on Trazodone for 4 months and most of that was only 2x/week.

 

I just started tapering 10% from my (now) nightly 100 mg.

 

Because I haven't been on it very long I'm intending to try tapering 10% every week for 6 months, which will get me down to 5 mg before jumping off.  I know that everyone reacts differently but does this sound ballpark reasonable?

 

From Post #1 of Tips for Tapering off Trazodone:

 

Please note that this is 10% of the current dose followed by a 4 week hold.

 

On 7/20/2012 at 12:40 PM, Altostrata said:

Reduce trazodone by 10% per month to start
The 10% rule holds for trazodone, just like other antidepressants: Reduce by 10% per month, calculated on the last dosage. (The amount of the reduction gets progressively smaller.)

See Why taper by 10% of my dosage?

 

[Courageous]

Quote

Please note that this is 10% of the current dose followed by a 4 week hold.

 

Yes, thank you for the correction.

 

Based on previous medical experience I take patient communities such as this one very seriously and I appreciate your guidance.  I just read your website; thank you for publishing it!

 

I came up with the idea of a 1 week hold after following the above 10% link and reading this from Your Drug May Be Your Problem: How And Why To Stop Taking Psychiatric Medications by Peter R. Breggin and David Cohen:

 

Quote

Seven to ten days is a reasonable length for each step if the duration of drug use has not exceeded one year.

 

My doctor originally suggested 2 weeks (I know, I know...) but after I showed her the NYT article she said "this may be a 3 month project".  I'm trying to figure out where I fit into the different recommendations.

 

Do you suggest that it's important for me to begin with a 4 week hold and then assess whether I can taper more quickly?  Or are you suggesting that I should stick to 1 month cycles for the whole taper, even though I haven't been on Trazodone for very long?

 

I appreciate your thoughts,

Courageous

 

 

[Gridley]

2 hours ago, ChessieCat said:

5 mg before jumping off.  I know that everyone reacts differently but does this sound ballpark reasonable?

 

5mg is very high for jumping off.  This link provides some guidance:

 

When to end the taper and jump to zero?

[Courageous]

On 5/12/2019 at 7:51 PM, Gridley said:

 

5mg is very high for jumping off.  This link provides some guidance:

 

When to end the taper and jump to zero?

 

Oh gosh, thanks for pointing that out!

 

There's a lot of information to take in while I've been struggling with fear and insomnia.  I appreciate your patient guidance.

 

[Courageous]

I want to publicly own that I've been wrestling with denial since I discovered this website.  I normally consider myself a "rational" person but it's been very challenging to be in acceptance about what I've been learning here, even as events in my life have been unfolding pretty much in accordance with it.

 

 

 

[Courageous]

Dear moderators, thank you for the time and attention you've given me.

 

I'm currently in withdrawal pain and feeling humbled and more acceptance of the situation I'm in.

 

If you're willing I would like some more guidance, specifically two questions:

 

I tapered too fast 6 days ago and immediately reinstated back to my last stable does of 75 mg but I'm still experiencing pain from the withdrawal.  My sleep has improved.  Should I wait it out or try increasing my dose?

 

I've tapered too fast twice now and wonder what my next steps should be.  Should I hold at a constant does for 2 months before trying a taper again?  Given my history, should I hold even longer?

 

Thank you for your wisdom and patience with me.

 

[ChessieCat]

Please simplify your drug signature and make it easier for us.  We don't need the extra details, just the dates and doses so we can see the information we need at a glance and not have to read back through your posts.  I suggest that you copy and paste the current drug signature into a post and then use the preferred format:

 

Keep it simple.  NO diagnoses or symptoms please - thank you.

• details for last 2 years - dates, ALL drugs, doses
• summary for older than 2 years - just years and drug/s

Account Settings – Edit a signature

[ChessieCat]

9 hours ago, Courageous said:

I tapered too fast 6 days ago and immediately reinstated back to my last stable does of 75 mg

 

If you make a reduction and find that it is too much of a decrease you don't necessarily go back to the previous dose.  You can make an updose.  I found when I reduced too much that even a small increase helped to take the edge off my symptoms and brought them to a bearable level.  You might find that you need to hold for longer before making the next reduction.

 

9 hours ago, Courageous said:

I'm still experiencing pain from the withdrawal.  My sleep has improved.  Should I wait it out or try increasing my dose?

 

You might have increased too much.  When I went from 75mg to 67.5mg I got unbearable ear pain about 2 days later but I only updosed to 70mg and the ear went a few hours afterwards.

 

Because it's only been 6 days you might be able to go to 70mg.

[Courageous]

44 minutes ago, ChessieCat said:

Please simplify your drug signature and make it easier for us.  We don't need the extra details, just the dates and doses so we can see the information we need at a glance and not have to read back through your posts.  I suggest that you copy and paste the current drug signature into a post and then use the preferred format

 

Thank you, this is the post saved with the extra details:

• 2019-01-16 Prescribed 50 mg of Trazodone, which I started taking about 2x/week.
• 01-23 Increased dose to 100 mg.  Sometimes I took it 3x/week and I experimented with lowering the dose to minimize hangover effect.
• 05-03 After learning that I was experiencing Trazodone withdrawal I started taking 100 mg/night for consistency.
• 05-10 Reduced dosage: 90 mg/night
• 05-16 Starting tapering by 2.5 mg/night.
• 05-31 (50 mg) Didn’t sleep and went back up to 65 mg/night.
• 06-07 Withdrawal symptoms were interfering with my sleep and job so I went back up to 75 mg/night.
• 06-13 Started to feel better than I had in a long time, like the withdrawal symptoms had lifted.
• 06-15 Started hyberbolic taper of 10% to 67.5 mg
• 06-17 Couldn’t sleep, withdrawal came back, increased dose back to 75 mg.
• 06-20 Started feeling pain inside my arms.
• 06-23 The pain is getting worse and I'm taking 200 mg magnesium every 2 hours for it.

[Courageous]

56 minutes ago, ChessieCat said:

If you make a reduction and find that it is too much of a decrease you don't necessarily go back to the previous dose.  You can make an updose.  I found when I reduced too much that even a small increase helped to take the edge off my symptoms and brought them to a bearable level.  You might find that you need to hold for longer before making the next reduction.

 

 

You might have increased too much.  When I went from 75mg to 67.5mg I got unbearable ear pain about 2 days later but I only updosed to 70mg and the ear went a few hours afterwards.

 

Because it's only been 6 days you might be able to go to 70mg.

 

Thank you.  I think I've screwed up because the pain in my arms is getting worse and scaring me.

 

I may not have made it clear that I was stable for only two days, after too fast of a taper, at 75 mg before going down to 67.5 mg.

 

Do you think maybe the pain was caused by increasing too much?  I don't know if I should hold at 75 mg, increase to 80 mg, or go down to 70 mg.

 

Edited June 24, 2019 by Courageous

[ChessieCat]

15 minutes ago, Courageous said:

• 06-15 Started hyberbolic taper of 10% to 67.5 mg
• 06-17 Couldn’t sleep, withdrawal came back, increased dose back to 75 mg.
• 06-20 Started feeling pain inside my arms.

 

It's difficult to know if it's from the reduction to 67.5mg done on 15 June or the increase to 75mg done on 17 June.

 

AND / OR

 

It might be the fast taper and/or changing doses catching up with you.

 

It takes about 4 days for a dose to get to full level in the blood and a bit longer for it to register in the brain.

 

You have made a lot of changes up and down in a very short period of time.  Your brain likes consistency.  Keep it Simple, Slow and Stable

 

You need to choose a dose and stick to it for a while until you, hopefully, stabilise.  Please read this:  Stability.   It is up to you to decide which dose you take.  If it was me I would not be increasing.  I'd either be sticking at 75mg or reducing to 70mg.

 

Q:  Are you taking any other drug/s, supplement/s, etc?

 

Please keep daily symptom notes on paper and post them here in your topic.

 

Example:

 

6 a.m. Woke with anxiety
8 a.m. Took 2.5mg Lexapro
10 a.m. Stomach is upset
10:30 a.m. Ate breakfast
11:35 a.m. Got a headache, lasted one hour
12:35 p.m. Ate lunch
4 p.m. Feel a bit better
5 p.m. Took 2.5mg Lexapro
6 p.m. Ate dinner
9:20 p.m. Headache
10:00 p.m. Took 50mg Seroquel
10:20 p.m. Feeling dizzy
10:30 p.m. Fell asleep
2:30 a.m. Woke, took 3mg Ambien (NOT "took 1/2 tablet Ambien")
2:45 a.m. Fell asleep
4:30 a.m. Woke but got back to sleep

[Courageous]

Bless you for replying so quickly!  The pain is increasing but I'm going to hold at 75 mg at your advice and will post my daily symptoms later.

[ChessieCat]

6 hours ago, ChessieCat said:

Q:  Are you taking any other drug/s, supplement/s, etc?

 

[Courageous]

11 hours ago, ChessieCat said:

Q:  Are you taking any other drug/s, supplement/s, etc?

 

I've been taking 200 mg of magnesium glycinate about every 2 hours for the withdrawal symptoms (mostly pain now).

 

I took an ibuprofen last night for the first time for the pain to help me sleep.

 

I also took a Lactium last night to help me get back to sleep.  I usually don't take this and don't know if it actually helps.

 

I've been taking fish oil irregularly but will start being more methodical about it.

 

I'm not taking any other drugs or supplements.

 

[Altostrata]

Welcome, Courageous.

 

On 6/7/2019 at 6:32 PM, Courageous said:

I want to publicly own that I've been wrestling with denial since I discovered this website.  I normally consider myself a "rational" person but it's been very challenging to be in acceptance about what I've been learning here, even as events in my life have been unfolding pretty much in accordance with it.

 

 

 

 

What an interesting remark! What have you learned here that you are working to accept?

 

On 6/23/2019 at 5:38 PM, Courageous said:

 

Thank you, this is the post saved with the extra details:

• 2019-01-16 Prescribed 50 mg of Trazodone, which I started taking about 2x/week.
• 01-23 Increased dose to 100 mg.  Sometimes I took it 3x/week and I experimented with lowering the dose to minimize hangover effect.
• 05-03 After learning that I was experiencing Trazodone withdrawal I started taking 100 mg/night for consistency.
• 05-10 Reduced dosage: 90 mg/night
• 05-16 Starting tapering by 2.5 mg/night.
• 05-31 (50 mg) Didn’t sleep and went back up to 65 mg/night.
• 06-07 Withdrawal symptoms were interfering with my sleep and job so I went back up to 75 mg/night.
• 06-13 Started to feel better than I had in a long time, like the withdrawal symptoms had lifted.
• 06-15 Started hyberbolic taper of 10% to 67.5 mg
• 06-17 Couldn’t sleep, withdrawal came back, increased dose back to 75 mg.
• 06-20 Started feeling pain inside my arms.
• 06-23 The pain is getting worse and I'm taking 200 mg magnesium every 2 hours for it.

 

Thanks for this summary.

 

What we see here -- something that doctors know absolutely nothing about -- is that going on and off psychiatric drugs and having adverse reactions and withdrawal symptoms makes the nervous system hypersensitive to psychoactive drugs and sometimes supplements and even foods.

 

Trazodone has a nasty metabolite that is active in the daytime. This is explained in Tips for tapering off trazodone (Desyrel)

 

It's very possible the pain is an adverse reaction to this metabolite. If I were you, I'd go back to 67.5mg and see if it decreases. You may experience a few sleepless nights while your nervous system accommodates.