gdsequoia: quadriceps cramps and eye accommodation problems - paroxetine, Abilify

[gdsequoia]

I've got a question.

My tapering is primarily motivated by the side effects I get from my meds:

- cervical dystonia (caused by my long neuroleptic history)
- dry eyes (started when I switched from tolperisone to baclofen)
- muscle pains (mostly WD-related)
- constipation

 

None of these were improving when I was tapering Lexapro (accelerator). And the constipation was getting worse (Lexapro helps me get bowel movements).

When I was tapering Abilify (brake), the dystonia and constipation were improving (rapidly).

 

In light of that info, I think I have 2 options:
1. Microtaper the Abilify (e.g. by 1 or 2 percent a month). Any faster, and my muscle pains will permanently worsen again.
2. Do nothing, as tapering Lexapro makes things worse for me.

 

Option 1 is somewhat dangerous as Abilify is a brake. But since it'd be a microtaper, maybe the danger would be low?

 

(I cannot taper the baclofen or biperiden, as they work wonders for my dystonia, and I'm already on a low dose of them. I've tapered them to the minimal effective dose.)

 

What do you think?

[ChessieCat]

Any reduction, however small, would reduce your drug load.  If you cannot get off the drug completely the goal is to use the lowest effective dose.

[gdsequoia]

Yes, @ChessieCat, my question is, which drug should I taper (and how fast), given the above info?

 

I ask because the usual SA.org recommendation is to taper the accelerator, whereas I'm thinking about tapering one of the brakes.

[ChessieCat]

SA provides guidelines for a harm reduction approach.  It isn't set in stone that you have to do it the way SA suggests, just like SA recommends tapering only one drug at a time, some members have managed to taper multiple drugs because they have been attuned to their body/symptoms and been very careful and possibly also tolerated medium withdrawal symptoms rather than remain on their drug cocktail and suffering side effects.

 

So, it's up to you.

[gdsequoia]

I have painful, irritated, dryish eyes. Altho the ophtalmologist said there's nothing wrong with my eyes - not even dryness. I can barely use electronic screens at home. I'm typing this outside in the cold.

 

Thinking abt trying a combo-for-eyes supplement. It contains lutein, zeaxantin, vitamins A/C/E/B2, omega 3, zinc, copper, selenium.

 

Also working on logging my daily eye-symptom pattern. So far, it seems that my eyes get much better when I take my dose of Abilify+Biperiden. Will experiment to see which of the two is the WD-culprit.

[gdsequoia]

Does the abovementioned supplement sound good to you guys? Or should I focus more on the logging?

[ChessieCat]

When trying anything new it is generally suggested to take them individually and not as a complex.  It is also better to start with a small dose to see how you react.  And it is important to only make one change at a time:

 

the-rule-of-3kis-keep-it-simple-keep-it-slow-keep-it-stable

 

You could try searching SA for the individual ingredients.  Use a search engine and add site:survivingantidepressants.org to the search term.

[gdsequoia]

Thanks, Ches.

[gdsequoia]

I wonder why there has been so little research (controlled, double-blind studies) on PAWS. Leading to psychiatrists (including mine) not taking it seriously. Do you guys know?

[ChessieCat]

psychology-today-protracted-withdrawal-syndrome-after-antidepressant-use

 

There are 2  references at the bottom of the article.  The second one has a large amount of input from Altostrata (from information gathered from SA).  SA topic here (Alto has made a comment in the last post):

 

hengartner-2020-protracted-withdrawal-syndrome-after-stopping-antidepressants-a-descriptive-quantitative-analysis-of-consumer-narratives-from-a-large-internet-forum

 

[gdsequoia]

I take 400mg magnesium lysinate/glycinate chelate for muscle pain. It works well but is often absent in pharmacies.

 

What other forms of magnesium are worth trying for muscle pain?

 

I know about citrate but it can't be taken long term (it is an osmotic laxative so it can cause electrolyte disbalance).

[gdsequoia]

I find it very hard to taper Abilify. Is there a way to "bridge" it by switching to another AP?

 

I have read that bridging is an option for ADs, but what about Abilify?

[ChessieCat]

From your drug signature it appears that you are taking:

 

Abilify, Paxil, tolperison, biperiden

 

It may be side effects of one, two or more of these drugs and/or drug interaction of any combination of these drugs.

 

tolperisone is not available in the USA so an interaction check cannot be done.

 

 

Abilify & Paxil from https://www.drugs.com/interactions-check.php?drug_list=1800-1156,233-109:

 

Quote

PARoxetine may increase the blood levels and effects of ARIPiprazole. This can make you more likely to develop side effects such as drowsiness, seizure, Parkinson-like symptoms, abnormal muscle movements, and low blood pressure. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. Contact your doctor if you experience agitation, aggression, confusion, convulsions, muscle spasm, or movements that you can't stop or control such as lip smacking, chewing, puckering, frowning or scowling, tongue thrusting, teeth clenching, jaw twitching, blinking, eye rolling, shaking or jerking of arms and legs, tremor, jitteriness, restlessness, pacing, and foot tapping. Also be alert to symptoms of low blood pressure such as dizziness, lightheadedness, fainting, and/or increased pulse or heart rate.

 

 

tolperisone - http://www.druginfosys.com/drug.aspx?drugcode=1078#SideEffects

 

biperiden - https://www.rxlist.com/akineton-side-effects-drug-center.htm

 

From the above webpage:  Akineton (biperiden hydrochloride) Tablet is an anticholinergic antiparkinson agent used to treat the stiffness, tremors, spasms, and poor muscle control of Parkinson's disease. Akineton is also used to treat and prevent these same muscular conditions when they are caused by drugs such as chlorpromazine, fluphenazine, perphenazine, and others.

 

Quote

 

Common side effects of Akineton include:

• dry mouth/nose/throat,
• blurred vision,
• drowsiness,
• euphoria or disorientation,
• urinary retention,
• dizziness when standing up,
• constipation,
• nausea,
• vomiting,
• agitation,
• disturbed behavior,
• decreased sweating,
• difficult or painful urination,
• involuntary movements,
• slow heart rate, and
• a reduction in rapid eye movement (REM) sleep

 

 

 

 

 

 

 

 

[gdsequoia]

Thanks, @ChessieCat!
I am not taking Paxil currently - my current AD is Lexapro. Should I remove Paxil from my signature? I last took Paxil 12 months ago.

Also I am not sure if you are replying to my latest post, or to the one before that.

[ChessieCat]

We need to see your drug history.

 

Please add the dates you were on Paxil.

 

I suggest that you Bold and Colour Currently Lexapro so that it is obvious what you are taking currently.

 

35 minutes ago, gdsequoia said:

Also I am not sure if you are replying to my latest post, or to the one before that.

 

I was responding to your post about changing from Abilify.  It may not be that you are having difficulties tapering Abilify.  It may be something else causing the issues because you are taking other things as well.

 

On 3/11/2021 at 10:51 PM, gdsequoia said:

 

What other forms of magnesium are worth trying for muscle pain?

 

Check out the magnesium topic and/or do some research on the internet.

 

[gdsequoia]

@ChessieCat

Ok, I tried to add the requested Paxil information to my sig, while keeping the sig short.

 

I used to have a more comprehensive sig - you kept a backup of it in your post here.

 

13 minutes ago, ChessieCat said:

It may not be that you are having difficulties tapering Abilify.

It's pretty much that, because the problems (eye pain, muscle pain) worsen when I reduce Abilify too fast, and get better when I reinstate it.

 

And by "too fast" I mean "faster than 1.5% per fortnight".

 

27 minutes ago, ChessieCat said:

Check out the magnesium topic and/or do some research on the internet.

Ok, thanks.

[gdsequoia]

Excuse me, English is my second language, so I have a question:

 

Is "reinstatement" the same as "updosing"?

 

And also, from the micro-taper thread:

 

Quote

As with any tapering schedule, if withdrawal symptoms appear, slow your tapering or hold on the current dosage until the nervous system stabilizes.

Does this mean I should never updose when microtapering?

[ChessieCat]

Reinstatement is when a person has stopped a drug completely and then starts taking it again.

 

Updose is when a person is still taking the drug but increases the amount of the dose.

 

A lot of the information in Post #1 of this topic relates to both reinstatement and updosing:

 

About reinstating and stabilizing to reduce withdrawal symptoms

[gdsequoia]

Thanks, @ChessieCat.

 

I'm interested in the following quote:

Quote

Reinstatement is best done immediately upon appearance of withdrawal symptoms.

Does that apply in the "updosing" case as well?

 

For example, my latest abilify reduction worsened my eye problems significantly. But they are bearable. Should I updose or not?

 

TIA!

[ChessieCat]

The question I ask myself if bad withdrawal symptoms happen after a reduction is:

 

If this continues would I be able to put up with it?

 

If my answer is no, then I do a tiny increase, but not back to the previous dose.

 

If my answer is yes, then I do not updose but stay on that dose and I hold for longer and listen to my symptoms and not reduce again until back to withdrawal normal.

 

Stability

WDnormal

[gdsequoia]

An update from me.

 

My Abilify microtaper is not going well. I was doing a 1,7% decrease, biweekly. But every time I actually do the 1,7% decrease, my myalgia worsens, so I updose back.

 

I'm starting the brassmonkey slide method, using this tool: http://www.taperoff.co/

 

My chosen parameters are:

0.63% "decrease per week"

2 "weeks to hold"

 

But first I'm gonna wait 30 days to stabilize.

 

Btw, it seems my tardive dystonia has lessened after my latest Abilify decrease.

[gdsequoia]

On 4/19/2021 at 12:17 PM, ChessieCat said:

The question I ask myself if bad withdrawal symptoms happen after a reduction is:

 

If this continues would I be able to put up with it?

 

If my answer is no, then I do a tiny increase, but not back to the previous dose.

 

If my answer is yes, then I do not updose but stay on that dose and I hold for longer and listen to my symptoms and not reduce again until back to withdrawal normal.

Hi Ches,

I wanted to thank you again for this. I have found it to be a very practical and simple piece of advice.

 

All the best.

 

[gdsequoia]

Hi. An update from me.

I am currently tapering biperiden (not Abilify any longer). It's a non-psychiatric medication, so it's technically off-topic for this forum, but I want to share my experience, since some other members may find it useful. Biperiden is frequently prescribed along with antipsychotics.

 

As you can see in my signature, here's my progress with biperiden so far:

Quote

Biperiden: 2.7mg 1Jun20; 2.6mg 26May21; 2.5mg 31May21; 2.38mg 18Jun21; 2.11mg 4Jul21

That's faster than the "10% per month" rule, but I have decided that it's the right rate for me. (it's still slower than what the biperiden leaflet recommends, and it's not a psychiatric medication).

 

So far, the only WD symptom I've gotten (from that taper) is mildly increased sweating. My main two problems (eye pain/dryness and muscle pain) have been slowly getting less strong during these 6 weeks. Cervical dystonia (which was the reason I'm taking biperiden at all) has not worsened.

 

I believe biperiden is not the right med for my dystonia to begin with. I think it never did help with my dystonia. (unlike the tolperisone).

 

All the best, and thanks to the entire SA crew for providing an absolutely lifesaving resource.

[Manny78]

How are you tapering biperiden? I will have to taper it too. 

[gdsequoia]

14 hours ago, Manny78 said:

How are you tapering biperiden? I will have to taper it too. 

Hi Manny,

You can see my schedule (so far) in my previous post. As you can see, I have been attempting to reduce by about 11-12%  per month. I rely on my intuition to see when to reduce and how much to reduce.

 

I am gradually speeding up my biperiden taper, to see how much speed my body can take. I plan to reduce by about 6% weekly.

 

I've stopped tapering abilify (right before I started tapering biperiden).

 

It seems I can tolerate biperiden reductions much better than I can tolerate abilify reductions.

 

Hope this helps.

[gdsequoia]

Update:

 

I am still tapering the nonpsychiatric, anticholinergic drug biperiden.

 

Constipation has worsened. I think I will hold the current biperiden dose until this resolves.

 

My interpretation:

It's cholinergic rebound syndrome (CRS), because biperiden blocks muscarinic acetylcholine receptors. CRS includes signs of dysautonomia as part of its peripheral component. [1]

 

Dysautonomia includes constipation. [2]

 

It has been reported that withdrawal symptoms of cholinergic rebound may reach their peak within 2 weeks after abrupt discontinuation of anticholinergics. [3]

 

[1] https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-019-2055-1

[2] https://my.clevelandclinic.org/health/diseases/6004-dysautonomia

[3] https://onlinelibrary.wiley.com/doi/full/10.1111/pcn.12088

[gdsequoia]

Two years ago I took 150mg pregabalin (Lyrica) for 4 days, then coldturkeyed it and since then, my eyes hurt.
3 days ago I worked too much on the PC and now I'm in an eye crysis; i can barely use a PC.

Should I try reinstating the pregabalin (in a super low dose)?

TIA guys!

[gdsequoia]

Since the latest biperiden taper step, I have developed slowly-worsening "restless legs" syndrome. Will updose to 2.15mg I guess.

[gdsequoia]

Question to all:

 

I have some sharp lower back pain (because of weak back musculature because I can't do proper exercises because I have chronic muscle spasticity because of Abilify WD). My neurologist suggests I take diclopram for 5 days.

 

Diclopram is a combo of a NSAID and omeprazole. Omeprazole raises Lexapro blood levels a lot, and I take Lexapro. Then when I stop the omeprazole, my Lexapro levels will go down again, worsening my Lexapro WD.

 

If I don't take the omeprazole, I'm at risk of GI problems because of interaction between the NSAID and Lexapro.

 

Please advise.

[Altostrata]

Did you ask your neurologist for alternatives that don't include omeprazole? Maybe a topical, to put on your skin?

[gdsequoia]

On 12/18/2021 at 3:42 AM, Altostrata said:

Did you ask your neurologist for alternatives that don't include omeprazole? Maybe a topical, to put on your skin?

Yes, he said I could just take the NSAID without the omeprazole, and that it would be somewhat riskier to do so.

 

For now, I don't want to risk it, though. I bought a lumbar support pillow instead. Which works quite well so far, for me. Also topicals do work to a good extent, in my experience.

 

Thanks for replying.

[Altostrata]

The concern is that oral diclofenac sodium will cause gut injury.

[gdsequoia]

Yep. That's the risk he was talking about.

[gdsequoia]

So, an update from me. (I've updated my sig too)

Until April 2021 I tapered Abilify in a stupid manner (didn't wait for a return to WDnormal before doing each step, etc). Every step of that tapering made my primary WD symptom (muscle pain/tightness) worse.

Since then, no matter how much I wait, I never get a return to WDnormal. In other words, the "wave" doesn't pass - I don't get "windows". In fact, my WD symptom permanently worsens every time I do any kind of moderately straining activity, such as "walking at a normal pace" or "doing 2 pushups" or "looking at a computer screen for an hour". Muscle relaxants (chelated magnesium, vitamin D3, baclofen and tizanidine) do help a lot, but eventually they become insufficient as my WD symptom progresses.

 

A neurologist has diagnosed me with "tardive dystonia" wrt this WD symptom. Not sure if he really read my drug/symptom history very carefully, so take this diagnosis with a grain of salt; I'm just throwing it out here.

 

I'm aware that this is all my fault. Still, if anyone has ideas for me (other than "wait some more"), I'm all ears!