Peter23: Tardive dysphoria after going off sertraline

[Altostrata]

On 10/10/2023 at 10:18 AM, Peter23 said:

9:00am Pregabalin 200mgs and 6mgs Diazepam ( My anxiety is very acute first thing in the morning ).

15::00 Pregabalin 200mg.

16:00 Diazepam 4mgs.

21:00 Pregabalin 200mgs

12:00 Olanzapine 7.5mgs: Zopiclone 7.5mgs:

Agomelatine 25mg .

 

@Peter23, you are taking a batch of drugs that would stop a horse. You can get a drug interactions report for these 5 drugs, including agomelatine, here https://go.drugbank.com/drug-interaction-checker#results

 

Needless to say, they're all interacting with each other, diazepam and olanzapine producing a major drug-drug interaction, all producing excessive sedation.

 

I don't believe withdrawal symptoms would be visible through the effects of the "brakes" you're taking all day long.

 

Most likely, all of the symptoms you feel, including "depression", "anhedonia", "anxiety" etc. are adverse drug effects. If I were you, I'd stop asking psychiatrists for the solution to your condition -- if they don't perceive it's deprescribing your irresponsible cocktail, and want to add drugs instead, it's not worth talking to them.

 

The zopiclone in particular seems highly superfluous. It's possible it's causing rebound anxiety in the morning. If I were you, I'd go off it first. Half-life is only 5 hours so a rapid taper might do.

 

After that, the pregabalin, also highly superfluous, but that should be tapered gradually.

[Peter23]

Do you think reinstatement of a very low dose of the last SSRI (Sertraline) I was on would reverse my protracted antidepressant withdrawal symptoms? Or have I been off it now too long to have any useful effect? My last dose was in February 2021. 

[manymoretodays]

Hey.  I'm not real worried about your protracted WD syndrome. It may not be your biggest problem right now.  Symptoms of WD and drug adversities can be similar. And I don't think you'd benefit.  When you read the reinstatement topic you'll see.  The biggest benefit with reinstatement is seen, when done immediately after symptoms arise.  I think you'd benefit more from less right now.  Less drugs.  What did you think about going off the zopiclone in the way Alto described?                           I think it's time, Peter23......to begin to end your relationship with these types of drugs.  23 years now.  It'll take awhile, but it will pay off eventually.  I mean it has for me and many others.  L, p, h, g  mmt

Edited October 18, 2023 by manymoretodays
More

[manymoretodays]

Would you do a interactions report Peter23?  Use the drug bank link Alto gave us above, so you can add the agomelatine.  Then copy the link to results or copy a paste them in a reply box.  Also....share your thoughts once seeing your drug interactions.  Thanks.

[Peter23]

Thanks Manymoredays for your reply. I agree with you about the negative effects of the drug interactions after looking at them as you suggested. Unfortunately the drug bank link doesn't accept Agomelatine. 

I am very keen to come off the cocktail of drugs I have ended up on following my two admissions to hospital. I'm not sure how to copy and paste the results of the drug interactions. 

You have suggested coming off the zopiclone first and I completely understand the rationale for doing so. However I know this is a very potent drug which I think is equivalent to about 10mg of diazepam. I have tried taking half a tablet but suffered rebound insomnia along with severe anxiety and panic. I was thinking about asking my primary physician if she would prescribe the liquid formulation of zopiclone which has a concentration of 7.5mg/ 5ml. I could then taper down by 1ml every 4 weeks. I know this could take some time but is much safer and more successful than a rapid dose reduction. Please let me know what your thoughts on this are. 

[Peter23]

I should have said reducing the zopiclone liquid formulation 7.5m/5ml by 1 ml every two weeks not every 4 weeks. 

[Peter23]

Sorry the drug interactions bank did accept Agomelatine. I was using the wrong drug interactions bank at first. 

I can clearly see that the over zealous prescribing of my previous psychiatrist has created more problems for me than my protracted antidepressant withdrawal. I am really shocked at the way all these drugs are interacting. I really regret agreeing to go into hospital for ECT last year. That is when my problems started to multiply. I was prescribed the zopiclone when in hospital for ECT in October last year. 

On my second admission in January of this year I was told by my psychiatrist that I was in hospital for a "drug holiday " as she called it. I was meant to be coming off some of the drug cocktail I was on but ended up on more medication. I deeply regret starting zopiclone and agomelatine as I can now clearly see that they have made my situation much worse. It's no wonder I feel so bad!! I am extremely anxious about starting to come off these drugs and think I will need the support of an addiction counselor. I intend to discuss this with my primary physician. 

[manymoretodays]

Sounds okay Peter23.  So that would be 1.5 mg of zopiclone in every 1 ml.  And yah, I like every 2 weeks better than 4 weeks.  This is a FT, and Peter23........entertain the thought that it may go smoothly or okay.

 

Plan ahead, for if you wake up with panic.......what will be your first non-drug go to?  Audio's, guided meditations, music, etc?  What things might help?  And know that one day or night does not make a pattern.  In other words things might settle on night 2.....or 3.  Or it may go fine.

 

And, please see:

Tips for tapering off Z drugs for sleep

 

With your other drugs on board, this might go really well.

Don't go into with negative predictions.

 

For study purposes, and reference, here's the link to pregabalin tapering too:

Tips for tapering pregababalin(Lyrica)

 

Do another set of NOTES, if/when asking any questions too, around your medications.  That always help show us more clearly what is what.  You did those well!  A+  They are not only for us, but for you too- they should prove helpful.

 

L, P, H, and G,

mmt

[manymoretodays]

Can you link us to a copy of it?  The interactions.  And we both were typing at once I think.  Double posted.

Don't get mired in regrets or guilt.  Stay in the now.  You won't regret that.

💜

Edited October 18, 2023 by manymoretodays

[Peter23]

Thanks Manymoredays. I'm not sure how to send you a link to the drug interactions Tried to copy and paste it but it didn't work. 

I am planning on making an appointment with my primary physician to discuss tapering off the Zopiclone. I'm hoping to be referred to the Drug & Alcohol services to get some counselling on addiction. Thank you for your advice and support. 

[manymoretodays]

That's okay.  I'll try later. 

Meantime......Digest all the new information Peter23.  And try not to delay too long on beginning to lower your drug burden.

 

Keep in mind too, when getting counseling from Drug and Alcohol Services that you may get treated like an "addict" and I don't think you started out asking for these drugs or even trying them "recreationally".  You just went with the flow of modern mainstream psychiatry.  Developed dependencies.

So don't let them rush you off anything, as that can be harmful.

 

Your counseling might be good though.......as long as they focus on helping you gain confidence in yourself and your ability to self manage, and teach you some non-drug coping practical things.

 

You have a bonafide illness I think, overmedication and underrecognition of drug effects.  Sometimes too fast tapers previously too I imagine.

 

Okay.  I imagine your partner knows whats what too, that you are ill now........and will cut you some slack on chores if needed.  I hope so.  Take care.

 

L, P, H, and G,

mmt

[manymoretodays]

Ahh, why wait.  Here we go I hope.

Your 5 drugs and drug interactions:

https://go.drugbank.com/drug-interaction-checker#results

 

Hmmm, working on, it went back to the main checker without your drugs.

Edited October 19, 2023 by manymoretodays

[manymoretodays]

Testing.

https://go.drugbank.com/drug-interaction-checker#results

Interactions Found

Diazepam

 

Olanzapine

Severity

 

major

Description

The risk or severity of adverse effects can be increased when Diazepam is combined with Olanzapine.

Extended Description

Concomitant use of intramuscular olanzapine with parenteral benzodiazepines is associated with increased risk and incidences of adverse events, including hypotension, bradycardia, excessive sedation, cardiorespiratory depression, and/or even death 3,4,1,2. In post-marketing reporting, at least 160 case reports demonstrated rare but temporal associations of treatment with intramuscular olanzapine with cases of respiratory depression, hypotension or bradycardia, or even death mostly in patients who concomitantly received benzodiazepines, and/or other antipsychotic medicinal products or who were treated in excess of olanzapine recommended daily doses 4. Concomitant use of intramuscular olanzapine and benzodiazepines (oral, intravenous, or intramuscular) with or without other antipsychotic agents was noted in 24 out of 29 fatal events 1. The presence of underlying comorbidities and use of polypharmacy, however, makes it difficult establishing a causal relationship between treatment and event in these case studies. Although the official prescribing information does not specifically discuss the use of orally administrated olanzapine, a responsibility exists to consider the genuine potential for additive pharmacologic effects with orally administered agents too.

References

Marder SR, Sorsaburu S, Dunayevich E, Karagianis JL, Dawe IC, Falk DM, Dellva MA, Carlson JL, Cavazzoni PA, Baker RW: Case reports of postmarketing adverse event experiences with olanzapine intramuscular treatment in patients with agitation. J Clin Psychiatry. 2010 Apr;71(4):433-41. doi: 10.4088/JCP.08m04411gry. Epub 2010 Feb 9. [Article]

AN UNEXPECTED REACTION TO TREATMENT WITH BENZODIAZEPINES AND OLANZAPINE IN A WOMAN WITH A MANIC CONDITION [Link]

Olanzapine FDA Label [File]

Olanzapine EMA Label [File]

Diazepam

 

Agomelatine

Severity

 

moderate

Description

The risk or severity of CNS depression can be increased when Diazepam is combined with Agomelatine.

Extended Description

Central nervous system (CNS) depressants can cause sedation, falls, respiratory depression, coma, and death.2,3 The potential interaction between a CNS depressant and another CNS depressant drug due to synergistic effects is well documented in the literature,3,1,4,5 although the risk and severity of CNS depression vary from each drug. The subject and affected drugs are both CNS depressants that, when co-administered, may result in a more profound CNS depression. As the risk and severity of CNS depression resulting from the combined use of CNS depressants vary from each agent, each interaction between CNS depressants should be considered individually.

References

Mayer JM: Mechanisms of drug interactions with alcohol. Adv Alcohol Subst Abuse. 1984 Summer;3(4):7-19. doi: 10.1300/J251v03n04_02. [Article]

Zlott DA, Byrne M: Mechanisms by which pharmacologic agents may contribute to fatigue. PM R. 2010 May;2(5):451-5. doi: 10.1016/j.pmrj.2010.04.018. [Article]

Borodovsky JT, Krauss MJ, Chi T, Bierut LJ, Grucza RA: Trends in Prescribed Central Nervous System Depressant Medications Among Adults Who Regularly Consume Alcohol: United States 1999 to 2014. Alcohol Clin Exp Res. 2019 Jul;43(7):1510-1518. doi: 10.1111/acer.14081. Epub 2019 May 28. [Article]

Lee C, Wanson A, Frangou S, Chong D, Halpape K: Opioid toxicity due to CNS depressant polypharmacy: A case report. Ment Health Clin. 2021 Mar 31;11(2):70-74. doi: 10.9740/mhc.2021.03.070. eCollection 2021 Mar. [Article]

Bounds CG, Nelson VL: Benzodiazepines. . [Article]

Pregabalin

 

Eszopiclone

Severity

 

moderate

Description

The therapeutic efficacy of Eszopiclone can be increased when used in combination with Pregabalin.

Extended Description

Pregabalin may potentiate the effects of central nervous system depressants due to additive effects. In post-marketing experience, there are reports of respiratory failure and coma in patients taking pregabalin alone or in combination with other CNS depressants.

References

Lyrica [Link]

Pfizer information for health professionals [Link]

FDA label [File]

Olanzapine

 

Agomelatine

Severity

 

moderate

Description

The risk or severity of CNS depression can be increased when Olanzapine is combined with Agomelatine.

Extended Description

Central nervous system (CNS) depressants can cause sedation, falls, respiratory depression, coma, and death.2,3 The potential interaction between a CNS depressant and another CNS depressant drug due to synergistic effects is well documented in the literature,3,1,4,5 although the risk and severity of CNS depression vary from each drug. The subject and affected drugs are both CNS depressants that, when co-administered, may result in a more profound CNS depression. As the risk and severity of CNS depression resulting from the combined use of CNS depressants vary from each agent, each interaction between CNS depressants should be considered individually.

References

Mayer JM: Mechanisms of drug interactions with alcohol. Adv Alcohol Subst Abuse. 1984 Summer;3(4):7-19. doi: 10.1300/J251v03n04_02. [Article]

Zlott DA, Byrne M: Mechanisms by which pharmacologic agents may contribute to fatigue. PM R. 2010 May;2(5):451-5. doi: 10.1016/j.pmrj.2010.04.018. [Article]

Borodovsky JT, Krauss MJ, Chi T, Bierut LJ, Grucza RA: Trends in Prescribed Central Nervous System Depressant Medications Among Adults Who Regularly Consume Alcohol: United States 1999 to 2014. Alcohol Clin Exp Res. 2019 Jul;43(7):1510-1518. doi: 10.1111/acer.14081. Epub 2019 May 28. [Article]

Lee C, Wanson A, Frangou S, Chong D, Halpape K: Opioid toxicity due to CNS depressant polypharmacy: A case report. Ment Health Clin. 2021 Mar 31;11(2):70-74. doi: 10.9740/mhc.2021.03.070. eCollection 2021 Mar. [Article]

Bounds CG, Nelson VL: Benzodiazepines. . [Article]

Pregabalin

 

Agomelatine

Severity

 

moderate

Description

The therapeutic efficacy of Agomelatine can be increased when used in combination with Pregabalin.

Extended Description

Pregabalin may potentiate the effects of central nervous system depressants due to additive effects. In post-marketing experience, there are reports of respiratory failure and coma in patients taking pregabalin alone or in combination with other CNS depressants.

References

Lyrica [Link]

Pfizer information for health professionals [Link]

FDA label [File]

Agomelatine

 

Eszopiclone

Severity

 

moderate

Description

The risk or severity of CNS depression can be increased when Agomelatine is combined with Eszopiclone.

Extended Description

Due to additive effects, CNS depressants and eszopiclone may lead to increased sedation, mental status changes, coma, and a decline in respiratory function associated with central nervous system depression. Eszopiclone overdose in combination with other CNS depressants has been associated with death.

References

McCrae CS, Ross A, Stripling A, Dautovich ND: Eszopiclone for late-life insomnia. Clin Interv Aging. 2007;2(3):313-26. [Article]

Gunja N: The clinical and forensic toxicology of Z-drugs. J Med Toxicol. 2013 Jun;9(2):155-62. doi: 10.1007/s13181-013-0292-0. [Article]

FDA Approved Drug Products: Lunesta (eszopiclone) oral tablets [Link]

MSDS, Eszopiclone [Link]

Pregabalin

 

Diazepam

Severity

 

moderate

Description

The therapeutic efficacy of Diazepam can be increased when used in combination with Pregabalin.

Extended Description

Pregabalin may potentiate the effects of central nervous system depressants due to additive effects. In post-marketing experience, there are reports of respiratory failure and coma in patients taking pregabalin alone or in combination with other CNS depressants.

References

Lyrica [Link]

Pfizer information for health professionals [Link]

FDA label [File]

Diazepam

 

Eszopiclone

Severity

 

moderate

Description

The risk or severity of CNS depression can be increased when Diazepam is combined with Eszopiclone.

Extended Description

Due to additive effects, CNS depressants and eszopiclone may lead to increased sedation, mental status changes, coma, and a decline in respiratory function associated with central nervous system depression. Eszopiclone overdose in combination with other CNS depressants has been associated with death.

References

McCrae CS, Ross A, Stripling A, Dautovich ND: Eszopiclone for late-life insomnia. Clin Interv Aging. 2007;2(3):313-26. [Article]

Gunja N: The clinical and forensic toxicology of Z-drugs. J Med Toxicol. 2013 Jun;9(2):155-62. doi: 10.1007/s13181-013-0292-0. [Article]

FDA Approved Drug Products: Lunesta (eszopiclone) oral tablets [Link]

MSDS, Eszopiclone [Link]

Olanzapine

 

Eszopiclone

Severity

 

moderate

Description

The risk or severity of CNS depression can be increased when Olanzapine is combined with Eszopiclone.

Extended Description

Due to additive effects, CNS depressants and eszopiclone may lead to increased sedation, mental status changes, coma, and a decline in respiratory function associated with central nervous system depression. Eszopiclone overdose in combination with other CNS depressants has been associated with death.

References

McCrae CS, Ross A, Stripling A, Dautovich ND: Eszopiclone for late-life insomnia. Clin Interv Aging. 2007;2(3):313-26. [Article]

Gunja N: The clinical and forensic toxicology of Z-drugs. J Med Toxicol. 2013 Jun;9(2):155-62. doi: 10.1007/s13181-013-0292-0. [Article]

FDA Approved Drug Products: Lunesta (eszopiclone) oral tablets [Link]

MSDS, Eszopiclone [Link]

Pregabalin

 

Olanzapine

Severity

 

moderate

Description

The therapeutic efficacy of Olanzapine can be increased when used in combination with Pregabalin.

Extended Description

Pregabalin may potentiate the effects of central nervous system depressants due to additive effects. In post-marketing experience, there are reports of respiratory failure and coma in patients taking pregabalin alone or in combination with other CNS depressants.

References

Lyrica [Link]

Pfizer information for health professionals [Link]

FDA label [File]

 

Edited October 19, 2023 by manymoretodays

[manymoretodays]

Sorry, still a bit of a messy format, but got it above copied and captured here, for reference.

 

Hope it's a good day Peter23. 

 

L, P, H, and G,

mmt

[Peter23]

Thanks so much for copying the drug interactions for me Manymoredays. I am going to ask for an appointment with my primary physician next week to discuss tapering off the Zopiclone. It is a good time for me to begin reducing the dose as all of the external stressors are now off me.

I didn't explain before but my older brother died earlier this month and my daughter got married last week. So it has been quite a stressful time recently. 

[Peter23]

Still feeling overwhelmed by the thought of coming off so many psychotropic drugs. The way I'm feeling at the moment is a fate worse than death. I have no quality of life and all I have to look forward to is more withdrawals from the 5 drugs I have to come off over a period of months or years. Don't know if I have enough fight left in me after 5 years of withdrawal. 

[Peter23]

I'm desperate to start reducing the psychiatric drugs I'm on but also frightened that my doctor will want to reduce them too quickly. I feel mentally paralyzed by the thought of  more withdrawals on top of my protracted antidepressant withdrawals. I keep putting off making an appointment with my primary care physician to discuss reducing the Zopiclone in case she wants to reduce the dose too fast. I just feel stuck in this awful place. 

[Peter23]

Having daily serious suicidal thoughts. They terrify me. Don't want to tell my psychiatrist in case I'm taken back into hospital and given more drugs. Don't want to tell my partner and frighten him. As I said in my previous post I feel trapped on all the psychotropic drugs I'm on especially, since my last hospital admission. Have so many regrets about agreeing to go on Zopiclone and Agomelatine while in hospital. Was'nt able to think straight while in a psychiatric ward. Also still hadn't become aware of protracted antidepressant withdrawal as opposed to " Tardive dysphoria ". Finding it very difficult to see a drug free future.

[Peter23]

Started reducing diazepam by 10% for the next 4 weeks (1mg). No withdrawal symptoms noted so far. 

[wantrelief]

Hello Peter,

 

I have read your thread and wanted to say that am so very sorry for everything you've been through and for what you are enduring.

 

2 hours ago, Peter23 said:

Started reducing diazepam by 10% for the next 4 weeks (1mg). No withdrawal symptoms noted so far. 

I am relieved to hear you haven't had any withdrawal symptoms and will be hoping that continues going forward.

 

Wishing you all the best,

WR

[LotusRising]

16 hours ago, Peter23 said:

Started reducing diazepam by 10% for the next 4 weeks (1mg). No withdrawal symptoms noted so far

Good to hear @Peter23, what day did you make the initial reduction?

[Peter23]

I made the initial dose reduction on the 25th December. 

[Peter23]

Thank you so much for your kind words of support Wantrelief. Sorry it has taken me so long to reply. I missed your post. Thank you also for taking the time to read my thread. It is unfortunate that I didn't become fully aware of protracted antidepressant withdrawal until after I was admitted to a psychiatric ward. That whole experience multiplied my problems a hundred fold. 

[Peter23]

Started reducing Agomelatine by 10% of my dose of 25mg. Feel like I really need to get off this awful drug.

[Peter23]

Have now reduced my diazepam dose to 8mg. Not experiencing any withdrawal symptoms so far. I know I have a long way to go but it feels good to know that I am at least on the right path of breaking my dependence on psychotropic drugs. 

[Peter23]

I would like to thank all the monitors on this site for their unwavering support and all those who have sent me messages of support. 

[FireflyFyte]

On 2/1/2024 at 2:38 PM, Peter23 said:

Have now reduced my diazepam dose to 8mg. Not experiencing any withdrawal symptoms so far. I know I have a long way to go but it feels good to know that I am at least on the right path of breaking my dependence on psychotropic drugs. 

 

Glad to hear that your taper is going well.

[Comfyquilt]

@Peter23 way to go on your taper! Very inspiring ✨

[Peter23]

Thanks Comfyquilt for your work of encouragement. Hope things are going well for you. Best wishes 

[Peter23]

Unfortunately I had to go back up to 9mg diazepam due to massive increase in anxiety and obsessive thoughts. Maybe have to reduce at a slower rate. Feeling really disheartened at the moment at my slow progress towards tapering and coming off all the other medications I have been prescribed due to misdiagnosis. Thinking maybe I should start tapering the zopiclone first rather than the diazepam. Just afraid to discuss coming of this drug with my doctor in case he suggests too fast a taper. I know that zopiclone comes in liquid formulation if the pharmacy can locate the manufacturer. If I could be prescribed the liquid which comes in the concentration of 7.5mg/5ml I could taper by 1.5ml every two weeks. This would allow me to be completely off it in about 2 months. Think I am experiencing severe morning anxiety due to the zopiclone which has a very short half life of 5 hours. Guess I'm just very frightened about withdrawal symptoms on top of protracted antidepressant withdrawal symptoms. Really just need to bite the bullet and make an appointment with my primary physician to discuss the options. 

[LotusRising]

Hi @Peter23,

 

I just had a quick read through your last few posts. It looks like you made a reduction to your diazepam and then two weeks later also reduced your agomelatine. Is that correct? 

 

It may be easier to just pick one drug and go from there.

 

When do you take the diazepam? Does is help you sleep?

[Peter23]

Hi LotusRising I'm not currently reducing the Agomelatine. I take 5mg diazepam in the morning and 4mg in the evening. Just so afraid of all the potential withdrawal symptoms I face in trying to come off so many longterm psychiatric drugs. I'm already struggling on a daily basis so just can't help worrying about coming off so many drugs. 

[Peter23]

Is it better to ask your psychiatrist to prescribe the liquid formulation of a drug rather than your primary physician?