Mimi79: Will I survive?

[Rhiannon]

Hi Mimi--

I just skimmed through your thread this morning, and a few things popped out for me.

 

I agree completely that you need to stay on your current dose of mirt until you are more stable.

 

I am concerned about your history and practice of taking Seroquel and Ativan intermittently. All of these psychiatric drugs are not just like aspirin, or a drink of wine. They don't just affect our system while they are in our bodies and then go away. They are very powerful chemicals that alter our nervous system's signaling. Then, it appears, our bodies react by trying to readjust things because they perceive this alteration as a life-or-death danger. So we are dealing not just with the drugs, but also with the changes our bodies are trying to make to neutralize them. When a person takes a drug intermittently, it's really like shaking your brain up in a blender, because it's UP DOWN UP DOWN UP DOWN and the brain reacting with constant attempts to adjust DOWN UP DOWN UP DOWN UP.  These are not minor adjustments, they involve trying to turn genes on and off, it's complicated and challenging.

 

This is why we emphasize staying on the same dose of the same drugs every day at the same time. Then your brain can do whatever it's going to do in reaction to the drugs, and it can stabilize, and once everything is settled down and stable you can taper slowly and your brain can adjust in a slow, regular way as you taper down.

 

Given your history of being on and off multiple drugs at multiple doses, your nervous system has been through a lot of this kind of confusion and chaos in the past, and you have never really had a chance to recover, it looks to me. I did the same thing in my past. 

 

I think really, honestly, rather than quitting Seroquel cold turkey, given how long you've been taking it skipping doses, you might be better off finding a lower dose to take of it every day at the same time, unless you are having a strong adverse reaction to it. If it were me, after taking it 2-3 times a week at 25 mg, I would try something like 5-10 mg every day at the same time every day. That and the mirtazapine 45 mg, take those consistently, every day at the same time, no changing doses or switching around.

 

The Ativan, you've only been taking it since January so you might do okay with just quitting that. You will probably have some withdrawal though, and if it's difficult, you may want to do something similar, find a small dose and take it regularly. But you will have to taper it eventually.

 

You can get better. It will take time. You can get a lot of support here. My very best wishes to you in your journey.

[Rhiannon]

Also: You will survive. But it's going to be a long journey. You won't feel better fast. You will need to be very patient with your healing process and give your body a lot of support in the form of stability with diet, exercise, all the lifestyle type factors, good self-care, and again, patience patience patience. This is a long healing journey. These drugs are not to be trifled with and unfortunately most of us have been under the care of doctors who don't understand them very well at all.

[Mimi79]

@Rhiannon Thank you so much. This is something I was thinking of, taking a low dose of seroquel everynight. But I’ve just read Dr Breggins’s book and now I’m so afraid to take any neuroleptic. I don’t want tardive dyskinesia!! 
But if it can help me to stabilize, maybe it worth a try. 
Patience is the thing I have problem with. I have two kids, a home and a job. And actually, it is very hard for me to achieve all my duty. 
The worst for me is the OCD thoughts. They make my life miserable. It’s new to me, I’ve never had that issue before. I feel like I don’t have the tools to cope with that. If I could get rid of that, it would be easier. 
Thank you very much for the advices. I feel less alone. 

[Mimi79]

@Rhiannon As I read your signature, I understand that we can see some improvement, even If we still are on medication. It give me some hope. I was thinking that I will have to wait till the end to feel better again. Now I understand that just lowering the dose can give some relief. 
Thank you again...

[Rosetta]

Hi, @Mimi79

 

You wrote on my thread and asked about OCD.  I don’t know what to say about it to be honest.  It was very intense for me.  I’m grateful that it is more or less gone.

 

I think your question was whether it will go away after you finish your taper?  Yes, I would bet on that.  It may go sooner after you get to a certain point.  That could be after stabilization or it could be after you reduce the med to a particular dose.  No one can say.

 

At this time, OCD is so mild and intermittent that it doesn’t affect my life too much.  I believe it was caused or intensified by Celexa.  I developed many odd characteristics while on Celexa.  There were advantages to having OCD, but many disadvantages.  The switch to Zoloft made it so much worse.  I would like to make that point.  Had I slowly tapered off of Celexa, I am quite sure it would have gone away.  Instead, the sudden withdrawal of Celexa and addition of Zoloft was quite awful.

 

Our brains compensate for these drugs in unexpected ways.  They compensate to the lack of the drug in other unexpected ways.  To withdraw one drug and add another is particularly dangerous, in my opinion.  All sorts of problems occur.  There is simply no way to know which symptoms are caused by withdrawal of the first drug, caused by the addition of the second, which are side effects, which could be natural in a virgin brain, etc.  Our own hormones that change throughout our lives complicate the equation, as well.  Doctors tend to ignore the effects of the drugs and diagnose new conditions as if those conditions would have arisen in a virgin brain.  The ignorance is astounding!

 

What's is done is done.  You can’t change the past.  Yes, you can stabilize while on medication.  I realized, after the fact, that I did that many times if I took my medication consistently for a while.  Please don’t quit in some vain hope that you will get better that way.  

 

I agree with Rhiannon that taking Seroquel as a sleeping pill “as needed” is a terrible, terrible idea.  Taking it every day - I don’t know.  Maybe you could throw that question out to get input from several moderators.  I’m not qualified to opine, but Rhiannon has a very good point.  Taking a small dose every day at the same time and never missing it is much better than “as needed.”

 

You may also want to consider whether you are addicted to Ativan.  Again, I don’t have an opinion, but after using it 2-3 times per week since January you are risking addiction.  When, exactly, did you start?  It’s half life is 12 hours,  and it takes almost 3 days for it to clear your body.  That means that taking it more than once every 4-5 days is risky — to me.  (It also is much, much stronger for a person in WD from other drugs.  It’s effect may be quite strong on you to a degree that would shock your doctor.)   Please ask someone here with more knowledge before you continue using it 3x per week.  

 

Quitting altogether is an option, too, but there may be problems with that.  The truth is that you probably won’t know for sure whether quitting makes anything worse.  This syndrome is so bizarre, and with 3 drugs in the mix attributing any worsening to a particular drug is very difficult.

 

What I feel is certain is that taking Seroquel intermittently will make your condition worse.  In which way, I can’t say. Likewise, a careful, slow taper of mirt is a must.

 

I’m really sorry you are struggling.  Hang in there.

 

💖Rosetta

[Mimi79]

Thank you Rosetta. 
So this is what I’m going to do. 
I stick to 45mg of Mirtazapine,

I’ll take 6.25mg Seroquel each night (1/4 pill) and I’ll stop the Ativan. 
Then I wait to stabilize. With Patience.

Do you think it’s ok?

[Mimi79]

I’ve started to use Ativan 0.5mg  around Jan 26 2020. I’ve been taking it 2-3 times a week (as I said). Do you think I need to taper it?  I would prefer not touching it anymore. 

[Rosetta]

If I were you, I would stop the Ativan and save the pills for future times when you might need it.  I would not take it more than once a week or once every 4 days.  You might try taking 0.25 or less when you do use it.  It is possible to get hooked on a benzo in only 2 weeks.  Keep track of your symptoms on paper and post them here.  Each day keep a symptom log with time you took each med

Example:

7:00 am 

 wake up time/symptoms at wake up AND what you remember of your symptoms through the night

10:00 am

Noon

2:00 pm

6:00

10:00 pm or bedtime

 

I don't have the knowledge to recommend what to do with Seroquel, but hopefully someone else will answer your question.

[Shep]

On 2/25/2020 at 11:24 AM, Mimi79 said:

The night I don’t use seroquel, I don’t have any sleep problems. I use it when I’m more stressful during the evening.

 

Mimi, I want to come back to this post from a few days ago. 

 

Earlier in your thread, you mentioned taking magnesium. Some people like to place some magnesium in water and shake it up and sip on it slowly. And you may also want to take nice relaxing Epsom salt bath in the evening, since Epsom salts contain magnesium and can be very calming to the nervous system. 

 

The problem with taking Seroquel is it can cause insomnia when it's time to taper off it. So you may be getting some relief with the periodic use now, but it can cause problems when it's time to taper. So if you're not already dependent on it, you may want to stop taking it, especially since you're able to sleep without it. 

 

Just some thoughts. You'll need to do what's right for you, but the fact that you're able to self-soothe and go to sleep without it means you may not be dependent on it yet and it might be a good time to add in a bit of evening magnesium or take an Epsom salt bath to help calm the nervous system and quiet those OCD thoughts. 

 

Please post your thoughts. 

 

On 2/19/2020 at 9:45 AM, Mimi79 said:

I didn't mention it, but I've been taking Omega-3, B and D vitamines, probiotics and magnesium glycinate for several years now. 

 

But yesterday, I did a blood test at my job (I work in an hospital) and my B12 is really hight above the normal range. Do I have to stop B vit?

 

I also wanted to touch base on this. Gridley gave you the post on the problems some people have with B vitamins. And some people also have problems with vitamin D, which they find stimulating (see Vitamin D3 (cholecalciferol or calcitriol).

 

What time(s) of the day are you taking your supplements?

 

Rosetta mentioned keeping a symptoms log in her post above, which is a great idea. Here is more on how to do this:

 

Keep daily notes of drug schedule and symptoms to track patterns and progress

 

Please posts these notes for a couple of days and we can better guide you in how to proceed. 

Edited February 29, 2020 by Shep
fixed typo

[Mimi79]

Thank you to all. So @Shep, if I understand you, I don’t need to take a small dose of Seroquel as Rhiannon told me to do? I just want to do the good things. No, I don’t have any problem with my sleep when I don’t take a Seroquel. I was using it the evening when I’m more stressful and when my ocd or anxiety are out of control. 

During the last week, I stopped my B complex and it didn’t calm me down. I’ve feel a little bit more depress as well, so I reinstated it yesterday. But I only take it once a day (morning) instead of twice. I cut my dosage of D vit too, as I was taking 3x 1000UI. Now I just take one 1000Ui each morning. 
 

Now I will stabilize on those regiment, hoping for the best. I have really bad anxiety during the day (a big part is caused by my brand new OCD) and for the moment, I don’t see any improvement.  Maybe some Ativan WD Symptoms are partially causing this anxiety. Who knows! 

 

I will give you a daily schedule in the next days...

 

Thank you.

[Mimi79]

@ShepAnd If I understand you, you ask me to post my OCD thoughts? I just want to be sure that I understand you well.

[Shep]

47 minutes ago, Mimi79 said:

Thank you to all. So @Shep, if I understand you, I don’t need to take a small dose of Seroquel as Rhiannon told me to do? I just want to do the good things. No, I don’t have any problem with my sleep when I don’t take a Seroquel. I was using it the evening when I’m more stressful and when my ocd or anxiety are out of control. 

 

At some point in the evening, your OCD symptoms are going away, which is how you're able to go to sleep. 

 

When do you notice these symptoms easing off? 

 

If you're able to cope without bringing in another drug, that would be best. 

 

48 minutes ago, Mimi79 said:

Maybe some Ativan WD Symptoms are partially causing this anxiety. Who knows! 

 

Yes, this could be true. A lot of the changes, including supplement changes, can create upticks in symptoms or cause new symptoms to start.  But as you continue to hold everything steady, this will even out. 

 

24 minutes ago, Mimi79 said:

@ShepAnd If I understand you, you ask me to post my OCD thoughts? I just want to be sure that I understand you well.

 

Just stating that you're having OCD thoughts is all that is needed. You may want to rate them on a scale of 1 - 10, with 10 being the worst. 

 

Have you ever tried mindfulness? Mindfulness can be a very powerful way of letting go of OCD thoughts. 

 

Mindfulness and Acceptance

 

Easing your way into meditation for a stressed-out nervous system

 

If you go on YouTube, you'll find thousands of guided meditations for relaxation that may be helpful. This is one I still use for relaxation in the evenings:

 

Guided Meditation Deep sleep | anxiety and insomnia relief | relaxation before bedtime video (21 minutes)

 

If the OCD is really strong, it may not be as effective and you may find that distractions such as playing video games, taking walks, looking for funny memes on the internet, watching a favorite TV show, etc. can be helpful in taking your mind off these thoughts. 

 

One of my favorite YouTube gurus Mooji says, "Your thoughts are just visitors and you are NOT a hotel. Don't let them in!"

 

So try not to engage with these thoughts. They are symptoms of neurotoxin poisoning and like having a very noisy annoying neighbor - something to ignore as best as you can. Once you turn them into background noise, you take away their power. 

 

If you can learn to do this during withdrawal, you'll have developed quite an amazing non-drug coping skill. 

 

As you post your daily notes, we'll be able to give you more targeted advice. 

 

[Rhiannon]

Hi Mimi and Shep--

 

As far as whether or not to CT the Seroquel--personally, like I said, if it were me I would probably try to taper it off, since you've been taking 50-75 mg of it a week for like ten months now and I suspect that is enough to cause a withdrawal reaction if you just CT it completely, and you are also planning to CT, at the same time,  the Ativan (which you have been taking for a much shorter period of time). For me, that's more of a withdrawal risk burden than I would be wanting take on, especially in an already-destabilized nervous system dealing with the aftermath of ups and downs on multiple drugs already.

 

So yes, if it were me in this situation, or like, my daughter or something, I would suggest to take a small amount, say 5 mg of Seroquel a day, at the same time every day, rather than CT off the 2-3 times a week use that's been ongoing since last May.

 

The Ativan, you've only been taking that a much shorter time and either a very fast taper or CT might be just fine with that, although you will probably have some WD with that too. Again, I am conservative about WD risks, I would probably do a quick taper if it were me, but other people might not.

 

My approach is generally to focus on stabilizing first, limiting withdrawal symptoms, depending on the person's situation and tolerance and urgency and other factors like age, history etc.  If there are not strong toxic drug reactions happening, I generally focus on stabilizing first, and then tapering once stable, in order to minimize the suffering and disruption caused by WD. It's always kind of a crapshoot though, as you know, because nobody wants to be taking these drugs any more than they have to. 

 

Of course Seroquel is a powerful drug and I completely understand if you want to get off it right away.

[Mimi79]

The reason my anxiety/ocd is lessening during the evening is because I calm myself down by listening funny tv shows or films on my coach. 
 

The kind of OCD I’ve developed during the last month is sensorimotor OCD. I’m focusing too much about some sensations in my body. It’s so weird!! 

 

So when I don’t move and I’m watching Tv or reading something, I’m able to forget a little bit those sensations and lessening my anxiety.

 

I am regularly doing mindfulness, but when I’m very stressful, It’s very hard. I try to continue despite this. 
 

I don’t know why, but some days, I don’t have any OCD.  And some days it’s awful. I don’t understand why. 

 

 

[Mimi79]

@Rhiannon You talk with such experience, I can only agree with you. Of course I’m afraid of the effect of Seroquel, but I think that a very small dose like 5mg is certainly not too much a danger. I will think about it.

I’ve stop CT Seroquel 25mg at multiple occasions during the last 10 years and I’ve never experienced any WD symptoms with this drug. Of course, I’m not as young as I was (I’m a old 40 😉 )! 
 

I have to say that I’m actually treating an UTI with antibiotic (Macrobid) and some natural traitements and maybe it is not helping for my anxiety. 
 

I’m off for the week at my job (spring break of my kids) so I’ll try to sleep and rest a lot and take care of myself. 
 

Thank you all, your help is priceless!!

 

 

[Rosetta]

Yes, I agree that quitting Seroquel and Ativan at the same time is risky.  Rhiannon is quite well respected here at SA, by the way.  It’s very good to have her advice.

 

The absolute safest option would be to taper Ativan, too.  The reason I feel quitting Ativan is a good option is because trying to dose a tiny amount is so difficult especially for someone with no experience.  I have never tried to weigh powder myself.  I would be concerned that I would get different doses each time.  Maybe I’m too concerned about that, Rhiannon?  I don’t think the manufacturer makes a 0.25 mg pill, unfortunately.

 

You need to buy a scale and weigh doses of Seroquel anyway.  Five (5)mg is easier to weigh.  Your Ativan pills are 0.5 mg probably?  Do they have a line down the middle (a score)? Based on your statement that you took it 2-3 times per week, I’m guessing that if you are dependent, you might be dependent on 0.25 mg or less.  However, you may not even know how much you have been taking or how often, but you could count your pills.  Is it possible you took it every day or every other day for the past 2 weeks?  Hopefully not as you were using Seroquel instead.

 

I’m very relieved to hear that you are not having trouble sleeping.  Distracting yourself from the OCD thoughts is a good strategy.  When is the last time you took Ativan?

 

As for the fact that you Ct’d Seroquel several times, people CT these drugs and have no complaints, but there is a theory that after a past CT the body reacts negatively to the next or the third or fourth.  So, having CT’d a drug in the past with no ill effect is a good reason to avoid CT now.  Being in poor shape due to WD symptoms is another good reason to avoid CT.

 

I hope your day is going well today,

Rosetta

[Mimi79]

Thank you Rosetta. 
My last 0.5mg Ativan was last Monday. 
I haven’t take any since. Today my anxiety is a bit better than yesterday, but my OCD is still there and making me miserable. 
Fortunately I usually have a good sleep. Even without Seroquel. 
I think I will still avoid Ativan the more I can and not tapering it. 
And take a low dose of Seroquel for a while (5mg). 
This afternoon I received my Gemini Scale from Amazon. It is so tiny!!! I will try it in the next days. 
Thank you again!

[Shep]

19 hours ago, Rhiannon said:

Hi Mimi and Shep--

 

As far as whether or not to CT the Seroquel--personally, like I said, if it were me I would probably try to taper it off, since you've been taking 50-75 mg of it a week for like ten months now and I suspect that is enough to cause a withdrawal reaction if you just CT it completely, and you are also planning to CT, at the same time,  the Ativan (which you have been taking for a much shorter period of time). For me, that's more of a withdrawal risk burden than I would be wanting take on, especially in an already-destabilized nervous system dealing with the aftermath of ups and downs on multiple drugs already.

 

Seroquel is the last drug I came off of and it's an unusual drug. At these small doses, it's not working as an antipsychotic (affecting dopamine), but as an antihistamine. Under 150 mg, it affects histamine receptors. This is why it's used off label in low doses as a sleep aid. Yes,  it is much safer at these low doses (as you mentioned in another post, Mimi). 

 

The half-life of Seroquel is only 6 hours, so after 42 hours, the drug is out of your system. So if you were taking the drug every other day, you may not be dependent on it because the previous dose would have washed out. So it really depends on how you were taking it.  

 

One of the most common withdrawal effects from low-dose Seroquel is insomnia, so since you're able to sleep, Mimi, you may want to consider this before reinstating. 

 

Just my two cents worth. 

 

19 hours ago, Mimi79 said:

The reason my anxiety/ocd is lessening during the evening is because I calm myself down by listening funny tv shows or films on my coach. 
 

The kind of OCD I’ve developed during the last month is sensorimotor OCD. I’m focusing too much about some sensations in my body. It’s so weird!! 

 

So when I don’t move and I’m watching Tv or reading something, I’m able to forget a little bit those sensations and lessening my anxiety.

 

I am regularly doing mindfulness, but when I’m very stressful, It’s very hard. I try to continue despite this. 
 

I don’t know why, but some days, I don’t have any OCD.  And some days it’s awful. I don’t understand why. 

 

 

Sounds like you're building some great distractions and coping skills. 

 

Do you have an iPod or a way of listening to some funny podcasts or other distractions during the day? 

 

18 hours ago, Mimi79 said:

I have to say that I’m actually treating an UTI with antibiotic (Macrobid) and some natural traitements and maybe it is not helping for my anxiety. 

 

Very true - all of these can definitely increase anxiety, even for someone not going through withdrawal.

 

What natural treatments are you using? When did you start taking them? 

[Mimi79]

For my UTI, of course I have an antibiotic (Macrobid).  I’m taking bearberry extract 3 times a day and D-mannose.

 

Now, what is stressing me the most is that I have a feeling that Macrobid doesn’t work for my UtI. I’m afraid I’ll have to take Cipro. But I will cross the bridge when I’ll reach the river. 

 

My OCD is still bad, even if I try to distract. It’s always in the background. I’m encouraging myself that this is neuro-emotion and it will fade away when I will stabilize or taper my AD. I really hope so!
 

 

[Mimi79]

I’m questioning, do you think I have to go see a psychologist for my OCD. I know this is probably a symptom of my Overwhelmed CNS, but do I have to work hard to get rid of it or it is useless?

[Rosetta]

No, you don’t “need” to see a psychologist.  If you could find one who understands what’s happening to you and could support you through this that would be lovely.  A dream come true.  Someone who would validate what you are experiencing would be helpful.  If you end up with one who makes you feel worse because she does not believe ADs can cause PAWS, gets annoyed with you for failing to improve, tries to get you to consider “therapeutic” doses of psychotropics, and encourages you to be diagnosed with bi polar because you have a windows/waves pattern of recovery occur in one day, then you are better off without one.  

 

I promise you OCD resolves as your brain adjusts to life in “protracted withdrawal syndrome,” dysautonomia, or PAWS -  whatever you want to call it.  It is going to drive you bonkers until it lessens, but it’s just like every other malfunction going on in your body right now.  It will intensify, then lessen, return and intensify, then lessen, etc.  It is maddening.  Absolutely maddening.  I was there.  Try to hang on. 

 

For me, and many others, symptoms are worse in the morning and lessen throughout the day.  I had times when they would ramp up again in the evening.  I had ocasional euphoria, mania, and paranoia.  (I shudder to think what kind of drug cocktail I would have ended up addicted to if I had continued to see a psychiatrist. )  What helped me was to recognize the pattern and tell myself, “You just have to get through the morning,” or “this will happen in the evening for a while and then stop.”  I would read books, watch shows, whatever to get through that harder part of the day.  Thank god you can sleep.  You will heal faster because of that, I think.

 

What’s important is to have people who understand why you keep coming back to the same ground over and over and “never get better” in a linear fashion.  Healing from this type of disruption to the brain is not linear.  It progresses as two steps forward, one and 7/8 back, two steps forward, 1 and 7/8 back, etc.  To other people it seems that you are malingering, attention seeking, paranoid, and are a person who will not do “the work” to get better.  It’s not your fault, but patients like us irritate that h*ll out of psychologists who know nothing about recovery from traumatic brain injuries, strokes, and PAWS.   The pattern of recovery is very similar for all three.

 

I hate to dissuade you from trying to find on the ground support because on the rare occasion that someone does find that miracle psychologist it can be very useful. I think you have to kiss a lot of frogs, though.  Somewhere on this site is a list of recommended psychiatrists and counselors.  If there is one in your area, maybe you will get lucky.

 

I’m thinking of you!  You are not alone and you are not crazy.  Your brain is trying to adjust, and as it does it is going to send out off-the-wall signals.  I know it is so very hard to endure.

 

💖Rosetta

[Mimi79]

Thank you so much Rosetta! 
I think I will copy your message and re-read it when I’m desperate.

In fact, I‘m actually seeing a psychologist since September because at this time I didn’t realize that my anxiety was caused by a too fast WD. I thought that « I » was the problem. 
She has helped me to learn some tools, she taught me ways to accept and manage my emotions and anxiety. Those tools will be useful for all my life. 
I’ve talk about my desire to WD and she is not against my choice. In fact, she doesn’t seem to know a lot about PAWS. So I don’t think she will be a great help, nor a nuisance. Positive side is that she is very open minded. We have a great relationship. And she knows I have GAD and only GAD. 

But If I feel not so great during all my WD, I don’t think I will continue to see her all along. It’s quite expensive! It cost me 110$ each week, so this is why I asked this question on my previous post.

 

Today, I had a good day. Ok, I cheated a little bit because I took an Ativan this morning (my first since last Monday). But I went at my parent’s sugar shack and I’ve walked in nature a lot. Full snow and full sun, it was beautiful! And a good family meal. I’ve even laughed at loud with my sister-in-law! I rarely laugh by this time. So I realize even it is not perfect, I can still have some good days.

 

So thank you again.

 

[Mimi79]

I’ve another question. How can I know that this is time for me to start my tapering? I know I have to stabilize, but what stabilization means exactly? Do I have to wait until I have no more anxiety? No more OCD? Until I feel great? This is something I’m not sure I’ve totally understand. 

 

I know it won’t be for now and that I need to wait some weeks again, but I’m wondering what will be the « signal » that I’m ready?

 

Thank you for answering.

[Rhiannon]

On 2/29/2020 at 1:43 PM, Rosetta said:

Yes, I agree that quitting Seroquel and Ativan at the same time is risky.  Rhiannon is quite well respected here at SA, by the way.  It’s very good to have her advice.

 

 

Aw, thank you Rosetta!

 

I do know a lot about the course of withdrawal in general, but it sounds like Shep has some very specific knowledge and first-hand experience with Seroquel, and I don't have either of those things with that particular drug.  Shep, if you think it's safe to come straight off the Seroquel in this case and at these dosages, I am going to defer to you on that. 

 

I do think that half-lives can be deceptive when it comes to withdrawal, at least with benzos for sure I've seen it, people can end up with nasty WD from what appears to be infrequent use. And half life is just half, there's still a lot left after that half is gone, and these drugs can have strong effects even at very small plasma levels as it turns out (as we all sooner or later find out the hard way).

 

Also, I think the science is really just not done about what kinds of lasting effects these drugs have downstream. Physiology is complicated, biochemistry is incredibly complex, everything feeds back onto everything else in ways that are poorly understood, and medical science has a rich history of arrogantly assuming we are at the pinnacle of modern knowledge only to find out we're completely wrong about something, OOPs, sorry about your Nana. 

 

Hence my tendency to vote on the side of caution, especially in complex cases.

 

[Mimi79]

I’ve another question. How can I know that this is time for me to start my tapering? I know I have to stabilize, but what stabilization means exactly? Do I have to wait until I have no more anxiety? No more OCD? Until I feel great? This is something I’m not sure I’ve totally understand. 

 

I know it won’t be for now and that I need to wait some weeks again, but I’m wondering what will be the « signal » that I’m ready?

 

Thank you for answering.

[Shep]

12 hours ago, Rhiannon said:

I do know a lot about the course of withdrawal in general, but it sounds like Shep has some very specific knowledge and first-hand experience with Seroquel, and I don't have either of those things with that particular drug.  Shep, if you think it's safe to come straight off the Seroquel in this case and at these dosages, I am going to defer to you on that. 

 

I do think that half-lives can be deceptive when it comes to withdrawal, at least with benzos for sure I've seen it, people can end up with nasty WD from what appears to be infrequent use. And half life is just half, there's still a lot left after that half is gone, and these drugs can have strong effects even at very small plasma levels as it turns out (as we all sooner or later find out the hard way).

 

Thanks, Rhiannon. You are very wise. Yes, half-lives can indeed be deceptive. 

 

Seroquel at this low dose is a lot like taking Benedryl, due to Seroquel's effects on histamine at that dose. So with periodic use, it doesn't carry as high a risk of stopping as some other drugs, especially those with delayed withdrawal. My main concerns with reinstating are (1) she may get insomnia when she tapers it, since that's one of the most common withdrawal symptoms and (2) there's a drug interaction between Seroquel and mirtazapine (Drug Interaction Checker - mirtazapine and seroquel). 

 

The low dose of a Seroquel reinstatement makes the interaction less problematic, but as the mirtazapine is decreased, since it's also a drug with a high affinity for histamine receptors at lower doses, taking both drugs at night may cause problems, including paradoxical reactions, later on in her withdrawal journey. 

 

 

On 3/2/2020 at 12:02 AM, Mimi79 said:

Today, I had a good day. Ok, I cheated a little bit because I took an Ativan this morning (my first since last Monday). But I went at my parent’s sugar shack and I’ve walked in nature a lot. Full snow and full sun, it was beautiful! And a good family meal. I’ve even laughed at loud with my sister-in-law! I rarely laugh by this time. So I realize even it is not perfect, I can still have some good days.

 

Due to Ativan's short half-life, you may be getting some rebound and interdose symptoms with your off-and-on use. You posted this earlier:

 

On 2/29/2020 at 2:56 PM, Mimi79 said:

I don’t know why, but some days, I don’t have any OCD.  And some days it’s awful. I don’t understand why. 

 

I'm wondering if some of this is because of the periodic use of Seroquel and Ativan creating rebound and interdose symptoms. 

 

You really need to decide if you wish to reinstate Seroquel and / or Ativan or not and then stick with your decision. It's unclear whether or not you are dependent on these drugs. Did you take Ativan because you wanted to go enjoy the day or because you were overwhelmed with symptoms? Please take some time to sit and think through this because you're risking becoming dependent on this drug, if you're not already. Please also note the concept of kindling. 

 

What is the kindling phenomenon that occurs with benzodiazepines?

 

The nervous system is something you need to nurture. Off and on dosing is traumatic to the nervous system. As JanCarol, another moderator, likes to say about periodic dosing, "You're playing basketball with your brain."

 

 

7 hours ago, Mimi79 said:

I’ve another question. How can I know that this is time for me to start my tapering? I know I have to stabilize, but what stabilization means exactly? Do I have to wait until I have no more anxiety? No more OCD? Until I feel great? This is something I’m not sure I’ve totally understand. 

 

You may find this post by Brassmonkey to be helpful. You want to get to a place of what he calls withdrawal normal:

 

Withdrawal Normal

 

How are you feeling overall? Is your sleep still good? 

 

 

[Mimi79]

Hi @Shep

I know using Ativan was not very wise. I had a family party and wanted to be sure that I would be able to have good times with my family. On day to day, I’m so anxious, I’m not able to enjoy my daily activities.

 

When my OCD Started a month ago, I was not using Ativan at all. This happened when I lowered my Mirtazapine. But maybe now Ativan plays a role in my OCD?

 

I’m still very anxious and my ocd makes my life a real battle, but fortunately, my sleep is still good. I am off work this week and I sleep until 9h00 am every day. I think I’m using my sleep as an escape...

 

I’m very afraid that my OCD could bring me in depression. Now, I try to stay positive, but what if I become so depress that I can’t handle it anymore? 
 

Thank you.

 

 

 

 

 

 

[Mimi79]

I read the WDnormal text. If I understand, WDnormal is when there is not big changes one day to another? 
But if I still have some anxiety/ocd, does it means I have to wait? 

[brassmonkey]

Hi Mimi-- what you describe, "not big changes one day to another", would be referring to stability and is an indicator that it could be time to make a reduction if you are tapering. While a person is tapering there are always going to be some symptoms. Waiting for them to completely go away between reductions doesn't work.  Every time a person does a reduction they will trigger some symptoms in response, it's just the way the body works. When those symptoms even out to a constant level it's an indicator that it may be time for another reduction.  It's part of what we refer to as "listening to our body".

 

WDnormal is a measure of healing. It's noticing improvements in the overall level of your symptoms over a long period of time. It is a moving baseline that helps a person keep track of how well they are doing.  Let's say last fall you were stable but still feeling pretty bad all the time, no big swings either direction, you just normally felt bad.  For that time that feeling would be your WDnormal. Now, six months later, you're still stable, but now you feel blah all the time.  That feeling blah is your new WDnormal and shows an improvement over feeling bad all the time. Six months from now you may be feeling "just all right".  That would show another improvement and would again raise the level of your WDnromal. It's a way of showing yourself that over the long run things are getting better.

[Mimi79]

Thank you, @brassmonkey.

I think I have now a better idea of what is WDnormal. 
I know I need to stabilize a little bit more before I start my tapering, but I am excited to begin and  to free myself from this drug. 
I was thinking that I needed to be free of anxiety (and ocd) before tapering. Now I understand that it is not necessarily true. Maybe I will have to taper even if I don’t feel good. It won’t be easy...


 

 

[Mimi79]

I wonder how can I know that I need to taper the Ativan? I was using it 2-3 times a week for a month. How will I know that this is Ativan WD symptoms?  
 

And I know that I’ve already ask a similar question, but I still struggle a lot with my OCD, and do I need to go see an OCD specialist to get rid of it or it is not necessary (because it is probably caused by WD)? I’m so afraid that I will stay with that OCD even after my WD...

 

Thanks.
 

[Shep]

You're asking good questions, Mimi. Let's take a look at when the OCD symptoms started.

 

On 2/18/2020 at 10:32 PM, Mimi79 said:

Worst of all, 4 weeks ago, I started to have OCD like obsessive thoughts and that’s very unusual to me, because I never had OCD before

 

Since the OCD started before you began taking Ativan, it's likely a symptom from the antidepressant. However, rebound and interdose withdrawal problems can be caused by periodic Ativan use, so that could have made it worse. 

 

You mention in your signature that you took Seroquel some nights for sleep, but now you don't need to take it for sleep. So you may be stabilizing. 

 

Please post your thoughts. 

[Mimi79]

13 hours ago, Shep said:

However, rebound and interdose withdrawal problems can be caused by periodic Ativan use, so that could have made it worse. 

How can I know this is rebound or interdose WD problems from Ativan? How does it looks like?

 

And still for my OCD, do I need to work with an ocd specialist or it will fade with stabilization?

I’m so afraid to stay like this forever!!

[Shep]

42 minutes ago, Mimi79 said:

And still for my OCD, do I need to work with an ocd specialist or it will fade with stabilization?

I’m so afraid to stay like this forever!!

 

Please re-read Rosetta's posts earlier in your thread. They will be very reassuring for you that this too shall pass. You may want to print them out and any other posts or information you find comforting. Part of your OCD is thinking this is permanent. So it's good to have more positive - and more realistic - information at the ready when you need reassurance that this is temporary. 

 

45 minutes ago, Mimi79 said:

How can I know this is rebound or interdose WD problems from Ativan? How does it looks like?

 

 

Questions:

 

• Are your symptoms worse than 4 weeks ago before you added in Seroquel and Ativan? 
• Are you able to go to work and / or take care of family? 
• Are you able to drive or take public transportation as needed? 
• Are you sleeping better now than you were 4 weeks ago? 

You may want to take a look at your symptoms before you started adding in Seroquel and Ativan and see if you're any worse now. You may be more tired, as struggling with these intense symptoms can be exhausting over time. But if the symptoms themselves aren't any worse than before adding in these drugs, then it may be more from the changes in mirtazapine (which is when the symptoms started) than from the Ativan. 

 

If you feel you need to be on Ativan, then you'll need to take it every day at the same times of the day and then taper off it later. 

 

Personally, I would be hesitant to do this unless the symptoms were severe and you could pinpoint to the Ativan being the cause, as opposed to needing to stabilize from the mirtazapine changes. 

 

Like I mentioned earlier, you're sleeping now, which is an improvement. 

 

[Mimi79]

I’ve always been sleeping well, despite all my symptoms. So I’ll screen to my symptoms to see if it is worse or not.

 

I has been 2 weeks since I stabilize my dose on mirtazapine. For now, I see that I have a little bit less anxiety. My overall mood is a little bit better to. But my OCD is still bad and I don’t see a lot of improvement. Maybe I need to stabilize more to see result. 
 

It’s official, I’ve stop my use of Seroquel. I don’t use it anymore. I try to not use my Ativan, but it is hard because it helps me with  my ocd. 
 

I can work and take care of my family, but it is very hard. 

[Shep]

15 hours ago, Mimi79 said:

I’ve always been sleeping well, despite all my symptoms. So I’ll screen to my symptoms to see if it is worse or not.

 

Thanks for this information. You may want to update your signature because you have "Seroquel 25mg on and off to help sleep, since may 2019, 2-3 times a week."  

 

When did your sleep improve? 

 

15 hours ago, Mimi79 said:

I has been 2 weeks since I stabilize my dose on mirtazapine. For now, I see that I have a little bit less anxiety. My overall mood is a little bit better to. But my OCD is still bad and I don’t see a lot of improvement. Maybe I need to stabilize more to see result. 

 

I'm glad you're seeing some improvements. Two weeks is early on, so holding and stabilizing sounds like a very good idea.