4raven: Doxepin - it's been forever

[4raven]

I'm not sure I'll ever be able to get off medication. I've been on it longer than I have been off. I was prescribed Doxepin (Sinequan, Silenor, Zonalon, Prudoxin) after the birth of my second child 32 years ago, for postpartum depression. The truth was I just couldn't sleep and it was debilitating. Doxepin was a miracle drug for me at the time, but I was never able to get off it. Every time I tried, I would feel like I had the flue - extremely achy, nausea, headache, insomnia. I always wound up going back on. I remember my doctor telling me it was withdrawal, and I was so upset because, when I was prescribed it I was told it was not habit forming. That's when I learned that their definition of an addictive substance was different than I thought. Addiction involves increased tolerance they said. You abuse the drug if you are addicted because you need more and more to get the same effect. I don't believe that. If you can't live without something, you're addicted to it. I've cut down the amount over time (I keep trying). I got down to 100 mg, but that's as far as I've been able to get.

 

I truly hate this drug and I wish I could get off it, but after so many years, and so many tries, I've given up. I'm hoping to gain some insight here. I do feel like a bit of a lost cause. Over time other drugs were added. Tranxene (clorazepate) for anxiety. That I take as needed. 3.75 mg, and Wellbutrin (Buproprion) to combat the side effects of Doxepin. I take 100 mg each morning. So for me it's downers in the evening and uppers during the day. My psychiatrist is due to retire soon. I wonder what will happen to me when he is gone.

 

Doxepin 100 mg nightly since 1987

Tranxzene as needed,  3.75 mg since 1994

Wellbutrin 100 mg in the morning since 2004

Edited August 16, 2020 by Gridley

[Gridley]

Welcome to SA, 4raven.

 

I sympathize.  I've been on another tricyclic antidepressant, Imipramine, since 1986.  In 2016, before I discovered this site, I tapered down from 75mg to 25mg, but I went too fast and, following the advice from this site  held at 25mg while I tapered Lexapro, which is more activating.  I do believe it's possible to get off these tricyclic drugs, and I will be tapering Imipramine very slowly after I finish my Lexapro taper and Ativan taper.

 

We recommend tapering by no more than 10% of your current dose every four weeks.

 

Why taper by 10% of my dosage?

 

Tapering faster than that puts you at risk of withdrawal(which most doctors don't believe exists).  Your brain has gotten used to functioning with the drug and when the drug is taken away too quickly, some very unpleasant symptoms can result.  This is likely what has happened to you in the past.  This link explains the situation, whether they call it addiction of dependency or whatever.

 

Brain Remodelling 

 

Here is some information on withdrawal.

 

What is withdrawal syndrome.

 

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

 

When we take psychiatric medications, the CNS (central nervous system) responds by making changes over the months and years we take the drug(s). When the medication is discontinued, the CNS has to undo all the changes it made. Rebuilding the neurotransmitter production and reactivating the receptor and transporter cells takes time -- during that rebuilding process symptoms occur.  

 

We recommend tapering only one drug at a time and tapering the more activating drug (which we call accelerators)  first, leaving the more sedating drug (which we call brakes) to act as a buffer to be tapered later.  Tricyclic antidepressants are brakes.  If the Wellbutrin has an activating (stimulating effect) on you, you might want to consider tapering it before the doxepin.

 

Taking multiple psych drugs? Which drug to taper first?

 

This link is specifically about tapering Wellbutrin.

 

Tips for tapering off buproprion (Wellbutrin, SR, XR, XL)

 

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium and omega 3 (fish oil). Many people find these to be calming to the nervous system. 

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

Add in one at a time and at a low dose in case you do experience problems.

 

This is your Introduction topic, where you can ask questions and connect with other members.  We're glad you found your way here.

 

 

 

 

 

 

 

 

 

 

[4raven]

Thank you so much Gridley, for all the information. I appreciate you taking the time to respond.  I am trying to process it all. 

[Erell]

Hello  4Raven, 

 

glad to ditto Gridley and welcoming you on SA

 

Could you complete your drug signature by clicking on this link : Account Settings – Create or Edit a signature.

 Include drugs, doses, dates, and discontinuations & reinstatements in the last 12-24 months. Also include supplements. This will help us give you the most accurate advice we can. 

Any drugs and supplements prior to 24 months ago can just be listed with start and stop years. 

 

I understand that you have given the info in you posts above but this will appear below every post you make, and allow the Mods to see your history at a glance.

If you have difficulty just inform me and I will  help.

 

16 hours ago, 4raven said:

I'm not sure I'll ever be able to get off medication. I've been on it longer than I have been off.

 

I understand your concern, however we have here testimonies of people who have taken psychdrugs for decades and manage to slowly taper.

Some people also find out they do better if they don't put the pressure of "getting off" on themselves, but rather focus on slowly reducing their drugs amount in order to reach a place where they can feel comfortable and don't suffer from too much side-effects.

 

 

16 hours ago, 4raven said:

Tranxene (clorazepate) for anxiety. That I take as needed. 3.75 mg

 

Our CNS like stability : unsteady doses can destabilise it and symptoms occur.

Question : Can you tell us more about your Tranxene use ? Do you take it every day ? How many ? ...

 

Question : Currently, are you suffering from side-effects, or symptoms ?

 

Gridley gave you some links to important topics : they are a lot of infos and it can be a lot to process, so please feel free to ask questions.

Again, welcome ☀️

 

 

[4raven]

Thank you so much Gridley, for all the information. I appreciate you taking the time to respond.  I am trying to process it all. 

My history:

Doxepin

1987/ October: 250 mg

1987/December: 200 mg 

1997 CT Doxepin to Zerzone severe withdrawal, back to

Doxepin 200 mg

2000 175 mg

2000 CT Doxepin to Celexa severe withdrawal, back to

Doxepin, 175 mg

2004 150 mg

2010 125 mg

2012 100 mg

2014 125 mg

2016 100 mg

2017 125 mg

2018 100 mg

 

1992 Tranxene 3.75 mg as needed for sleep. 

2000 7.5

 

Wellbutrin

2004 200 mg

2014 150 mg

2016 100 mg

 

About Tranxene use: I do not use this every day. I average 2 or 3 times per week. I use it if I wake early in the morning and can't get back to sleep. I will take two and go back to bed. I usually get three more hours of sleep doing this.

[Gridley]

24 minutes ago, 4raven said:

Tranxene

 

Please be careful with the Tranxene.  Physiological dependence to benzos can result from 2 to 4 weeks of regular use.  I know you don't use it regularly, but it's also possible to become dependent from intermittent use.  

 

Thanks for providing your drug history.  As you process the information, if you have any questions please don't hesitate to ask.

 

 

[Shep]

21 hours ago, 4raven said:

About Tranxene use: I do not use this every day. I average 2 or 3 times per week. I use it if I wake early in the morning and can't get back to sleep. I will take two and go back to bed. I usually get three more hours of sleep doing this.

 

Hi, 4raven.

 

I'm going to add onto Gridley's sage advice about dependency from intermittent use. 

 

Please note the half-life of Tranxene is 36-200 hours for its active metabolite (BENZODIAZEPINE EQUIVALENCE TABLE).

 

Even if you are a fast metabolizer and at the 36 hour rate, you would still have 25% of the drug in your system 3 days later. If you're a slow metabolizer (at the 200 hour rate), you would have 25% of the drug in your system 16 days later. Here's an online half-life calculator that allows you to quickly make these calculations:

 

Drug half-life calculator

 

So it's possible you may be dependent and some of your systems are from fluctuating doses and / or rebound anxiety. 

 

Please take some time to decide if you wish to continue taking this drug. If so, you'll want to pick the lowest effective dose to take every day at the same time and dose. Due to the long half-life, you'll only need to take it once a day. 

 

If you decide to stop, you may find these threads helpful:

 

Tips to help sleep: so many of us have that awful withdrawal insomnia

 

Non-drug techniques to cope with emotional symptoms

 

Are you currently taking any supplements or any other types of medications beside psychiatric drugs? If so, please list them and the dose. 

 

 

[4raven]

Thank you Shep, for the information. It's very likely I am addicted to Tranxene, with it's long half life. Probably why I feel I need to use it every 3 or 4 days. However, the thought of taking it every day in order to taper pains me because I've never taken it on a daily basis.  I think the longest I have ever gone without it was about eight days. I'll look into it.

[ChessieCat]

Even if a drug has a long half life it is generally better to take it on a daily basis because then the levels in the body are more consistent.

[Shep]

10 hours ago, ChessieCat said:

Even if a drug has a long half life it is generally better to take it on a daily basis because then the levels in the body are more consistent.

 

Very true! And with periodic benzo use, it masks withdrawal symptoms from tapering another drug, so it's hard to know when it's safe to decrease or when it's best to hold. If you're managing an uptick in symptoms by taking a benzo, you may be tempted to taper faster than your body is able to handle. 

 

Consistency is always the best policy for withdrawing from these drugs. 

 

11 hours ago, 4raven said:

It's very likely I am addicted to Tranxene, with it's long half life. Probably why I feel I need to use it every 3 or 4 days. However, the thought of taking it every day in order to taper pains me because I've never taken it on a daily basis.  I think the longest I have ever gone without it was about eight days. I'll look into it.

 

It's a difficult decision. But think of it this way - even though you haven't physically been taking a Tranxene pill every day, the drug has been in your system every day. If you are dependent, stopping it cold turkey could harm your nervous system. The goal is to strategically set up a plan that protects your nervous system, as well preserving sleep as much as possible throughout your tapers. Please note it's going to take several years to get off this cocktail safely. Keeping you as functional as possible is the long-term goal. 

 

If you decide to stay on Tranxene, you'll need to figure out when is the best time to do take it on a daily basis. Please note the drug interactions in this cocktail:

 

Drug Interactions - Tranxene, Doxepin, Wellbutrin

 

What type of Wellbutrin are you taking - is it immediate release, sustained release (SR), or extended (XR or XL)?

 

 

[4raven]

That drug interaction report was a real eye opener. I didn't know such a resource existed.  I've been taking this drug combo for a very, very, long time with really no ill effects. I have never taken Tranxene during the day.  Originally, the meds were prescribed to keep me functioning optimally during the day, and they have done just that. However, I am due to retire in November and have a strong desire to get off this stuff. I honestly didn't think it would be that hard, or dangerous. I certainly didn't think it would take three years. My psychiatrist has not been seeing patients since March, due to Covid. He is only available by phone. I only saw him every two or three months, for twenty minutes, anyway. I'm thinking he's not going to be available to supervise this taper. I guess it is up to me to do this on my own as most people here have. I am very lucky I found this site. I have to educate myself. Thank you so much.

[4raven]

Oh, sorry, the type of Wellbutrin is SR

[Erell]

Hello 4raven

 

16 hours ago, 4raven said:

However, the thought of taking it every day in order to taper pains me because I've never taken it on a daily basis. 

 

Utterly understand this as I've been in your shoes some years ago : always used my benzo as "rescue" dose, and was quite reluctant to take it everyday.

However, once I stabilised on a daily dose I felt better : I didn't know at that time but some of my anxiety was probably interdose withdrawal from inconsistent doses.

This stabilisation allowed me to start my taper.

 

4 hours ago, 4raven said:

I honestly didn't think it would be that hard, or dangerous. 

 

Keep in mind that a taper doesn't necessarily has to be horrendous.

A lot of us came on SA in crisis state without much knowledge : you came here before tapering, so if you decide one day to taper you'll have the knowledge to do it properly ☺

 

There a lot of infos on SA : take the time to read and feel free to ask questions here.

My computer isn't working these days so I can't paste you links : take a look at the "Tapering" section, it might give you a better understanding of the importance of a slow taper.

 

Take care ☀️

[4raven]

I have actually tapered myself over the years. When I was first prescribed Doxepin, my psychiatrist wanted me to reach 300 mg. His thinking was that the reason ADs don't work well is that people don't take them in high enough doses. This was 1987. I hit 300 mg and slept for 20 hours straight. I told him it was too much medication. He cut it to 250. I again told him it was too much - so groggy in the morning, dry mouth, constipation, sugar cravings, weight gain, etc. Over the years I kept weaning myself, without the doctor's blessings. I know it's 32 years later, but I have reached 100 mg of Doxepin. 

 

I did the same thing with Wellbutrin. Was first prescribed 200 mg. It was too much. I asked the doctor to cut that one down. Now I seem to be in a pickle because I am addicted. I think doctors thought you could stop the drugs cold turkey because they thought they were non habit forming, at least that was the bill of goods I was sold at the time. Maybe we're not addicts in the true sense of the word, but our bodies are physically dependent on these drugs, and it looks like getting completely off them is going to be tough. I am looking at the tapering section now.

 

Thank you for the info.

[Shep]

23 hours ago, 4raven said:

Oh, sorry, the type of Wellbutrin is SR

 

Thanks. I've added the "SR" to your signature. 

 

23 hours ago, 4raven said:

That drug interaction report was a real eye opener. I didn't know such a resource existed.  I've been taking this drug combo for a very, very, long time with really no ill effects.

 

The half-life of Wellbutrin SR is about 21 hours, so you may be getting some adverse effects as it bumps into the doxepin, since those two drugs have a major drug interaction. 

 

Many of us were able to handle these drug better in the beginning, but over the years as we got older, the drugs became more problematic. Since these drugs destabilize the nervous system, a hyper-active nervous system can become more sensitive, even to drugs and supplements that we've been on for a long time.

 

Are you currently taking any other medications or using any supplements? If so, please list them. We'll want to look for any more potential drug interactions. 

[4raven]

Most of the adverse effects appear to be seizures. This is scary. I'm wondering why I have never had any ill effects, even at much higher doses. I'm also wondering why the doctor would have prescribed these drugs to be taken together if the interaction was so dangerous.  I was planning to start by tapering the Wellbutrin. It's SR, so I can't cut the pill, or it becomes immediate release. Not sure how to proceed. There was a time when the pills were very expensive, so I decided (without telling the psychiatrist) to take a Wellbutrin every other day. Nothing noticeable happened. I did that for about eight months. When the doctor found out about it, he prescribed a lower dosage to be taken daily, again, there was no noticeable difference on my part.  I'm still reading. There's so much to this.

[Gridley]

@4raven

 

The following link about halfway down gives some ideas about tapering Wellbutrin SR.

 

Tips for tapering off buproprion (Wellbutrin, SR, XR, XL)

[Shep]

13 hours ago, 4raven said:

 I was planning to start by tapering the Wellbutrin.

 

The first step is to figure out the Tranxene. Please don't start tapering the Wellbutrin until you've decided to either stop taking the periodic benzo or go on it consistently every day. 

[4raven]

If I start with the Tranxzene, I have to average out how much I actually take on a daily basis. I am prescribed 60, 3.75 mg tabs monthly, but I don't get it filled monthly. I guess I could take one 3.75 mg tab every night and see what happens. Or, I could cut it out completely and see what happens. I don't want to risk having a seizure though. I need to do some more reading. This is a bit overwhelming. 

[Erell]

35 minutes ago, 4raven said:

 This is a bit overwhelming. 

And this is a lot of infos.

 

Please, take your time to read and digest the infos, there's no rush.

But I also wanna say : don't overdo the reading, meaning don't read too much others stories if it triggers you.

Psychdrugs taper are not necessarily horror stories. 

For example, my benzo taper was sometimes bumpy but I never experienced extreme symptoms, was able to be functionnal (even graduate !).

 

The main thing and advice n°1 is to taper very slowly. 

By doing so, we offer our CNS the time to do his repair work along the road.

[Sarita]

Hello, thank you for sharing your story. Was just wondering how high on Doxepin where you at before you got down to 100 and how did you taper? I’m sorry , I just read your signature. My prayers are with you. Hang in there and know you are in my prayers!

[4raven]

Hi Sarita,

 

Sorry for the delay in responding. I moved to the Midwest from the East Coast in November, and have just picked up this forum again.  I was initially put on 300 mg of Doxepin, which was a ridiculous amount, in 1987. That psychiatrist felt antidepressants didn't work because people were not prescribed them in high enough doses. I was a zombie and told him it was too much. He reduced it to 250 mg fairly quickly (1988). From there, over the years, I steadily decreased the dose on my own. It was over such a long period of time, that I hardly remember when I decreased exactly. I know I went down to 200mg and stayed there for a very long time, probably from 1990 - 2000. That psychiatrist died and I was recommended to another in 2001. At that time I was at 200mg. During my time with this doctor, I lowered my dose steadily. I know I was at 150mg for many years, probably from 2001 - 2015. I bounced from 150mg, 125mg, 100mg between 2015 and 2020. I have been at 100mg now for about a year. I'm holding here while I try to reduce and eventually get off Tranxene, which is a benzodiazepine. 

[ikam]

On 8/16/2020 at 9:29 PM, 4raven said:

I'm not sure I'll ever be able to get off medication. I've been on it longer than I have been off.

Hi, just to add this is how I often feel. I was prescribed doxepin first in 1983, I have been on different tricyclic and other AD and then back to doxepin. 

I have managed to tapper to 50mg.

This is strange, as I sleep better on a lower dose, I also get up more refreshed. But during the day I feel extremely tired...

I have not figured out how to cut the capsules, so I can decrease 10% at a time. 

Sometimes I feel that I will never he able to stop doxepin completely...