tapererer: Possible "kindling" issue

[tapererer]

Yesterday was my best day in a long time; I’m feeling some hope. But I woke today with anxiety again, and not quite sure what it’s from. But I’ll carry on trying not trying to fuel it and see how the day goes…

 

5/28

 

3:30 am awoke. Restless, unable to return to sleep.

4:00 am some sleep. Anxiety level 2

5:00 am awake. Anxiety level 2.

6:00 am Took Wellbutrin XL 150m

7:00 am Anxiety level 3

8:30 am Took Ativan .5mg Anxiety level 3

11:30 Anxiety level 2

12:pm TMS Anxiety level 2

1:00pm Anxiety level 2

3:00 Anxiety level 2

4:00pm Took Wellbutrin 75mg Anxiety level 2

5:00 Anxiety level 2

7:00 pm Anxiety level 1

8:30 pm Took Ativan .5mg Anxiety level 0

10:00 pm bed. Anxiety level 0

[tapererer]

I also wanted to mention that I met with my psychiatrist yesterday. He was happy with my progress and had a few recommendations:

 

1. Bump up the afternoon Wellbutrin to 150 (2x75 immediate release). He says this would give me the therapeutic dose, from which I could stabilize and the start a new taper.

 

and/or

 

2. At some point I can begin a 4-week taper of Ativan.

 

or

 

3. Stay the course and discuss again in 3 weeks. 
 

I picked #3, so will keep posting and following the advice I get here…

[tapererer]

5/29

 

3:30 am awoke. Restless, unable to return to sleep.

4:00 am some sleep. Anxiety level 2

5:00 am awake. Anxiety level 2.

6:00 am Took Wellbutrin XL 150m

7:00 am Anxiety level 3.5

7:30 exercised 25 mins.

8:30 am Took Ativan .5mg Anxiety level 3

10:00 Anxiety level 2.5

1:00 Anxiety level 2

3:00 Anxiety level 3

4:00pm Anxiety level 2. Took Wellbutrin 75mg

5:30 Anxiety level 1.5

7:00 pm Anxiety level 1.5

8:30 pm Took Ativan .5mg Anxiety level 1

10:00 pm bed. Anxiety level 1

[tapererer]

And woke again this morning with inexplicable anxiety, which still has been the one constant for most of this ordeal. Pushing on…

[tapererer]

Discouragement hit hard yesterday and I fell into a depression I’m still climbing out of. Will post more later.

[Nanda]

Have strength, everything will be fine.  I also stopped my duloxetine very quickly and 4 days later I started taking it again, but it didn't seem to have any effect, on the contrary it gave me more anxiety.  My doctor gave me 0.5 xanax 3x a day I continued to feel a lot of anxiety, that's when he switched to a benzo with a longer half life.  He passed me the clonazepam: in the first week: 4 drops in the morning, 4 drops after lunch and 8 drops you like at bedtime.  And from the second week onwards, reduce 2 drops from the total of 16. That is, the first week 16 drops, second 14 drops, third 12 drops and so on, until zero in the sixth week.  According to him, it would be a good time for me to get out of the acute anxiety crisis caused by the rapid withdrawal of the medication and also the time for duloxetine to start working again.  After that I will spend some time stabilized at 30mg and then I will start to taper again.  I found a good plan and after I started with the clonazepan, the anxiety almost stopped (I am on the third day).  Talk to your doctor to try another approach to get you out of the acute crisis and then you will adapt the dose of the antidepressant.

[tapererer]

2 hours ago, Nanda said:

Have strength, everything will be fine.

Thank you so much for the encouragement, @Nanda, and I’m glad things seem to working out for you.

 

I had a better day today, and am looking for continued improvement this week. This weekend’s depression was a setback, but I know that’s how it can be.

 

Thanks again!

[tapererer]

Woke again with anxiety this morning. I’m thinking of making some changes to see what might help:

 

1. Increase my afternoon Wellbutrin to 150, for a total of 300/day. Perhaps this will even out the blood levels over 24 hours and help with the mornings.

 

2. Change my Ativan schedule to 3 AM and 3 PM, which might decondition me from going into anxiety in the mornings.

 

@Altostrata, thoughts?

 

Thank you….

[Altostrata]

If you want to go off drugs, increasing Wellbutrin is going in the wrong direction. Why do you think more is better?

 

We need to see what your baseline symptom pattern might be, with a consistent drug schedule. If you keep changing your drugs, we won't be able to figure this out.

[tapererer]

6/1

3:30 am awoke. Restless, unable to return to sleep.

4:00 am some sleep Anxiety level 2

5:00 am awake. Anxiety level 2.

6:00 am Took Wellbutrin XL 150m

7:00 am Anxiety level  3.5

8:00 am Anxiety level 4

8:30 am Took Ativan .5mg Anxiety level 4

11:00 am Anxiety level 2

12:00 Anxiety level 2

TMS

1:00 Anxiety level 2

3:00 Anxiety level 3

4:00pm Anxiety level 2. Took Wellbutrin 75mg

6:00 pm Anxiety level 2.5

7:30 Anxiety level 3

8:30 pm Took Ativan .5mg Anxiety level 2

9:30 pm bed. Anxiety level 1

 

7 hours ago, Altostrata said:

If you want to go off drugs, increasing Wellbutrin is going in the wrong direction. Why do you think more is better?

 

Thanks. I do want to go off drugs, but I also really want to wake up in the morning without anxiety, and I'm not sure what's going to help that. This anxiety does have a big effect on the rest of my day, and I was thinking that more Wellbutrin might help that in the short term so I can stabilize my life a bit before attempting another taper (much like @Nanda described above).

 

Some good news though is that this morning, while I did wake at 3:30, I didn't have much if any anxiety. I'll continue on the current drug schedule then for now and see if things continue to improve.

 

Do you have an idea of how long it might take to determine the baseline, given I don't make any changes?

 

Thanks again...

 

 

 

[tapererer]

6/2

 

3:30 am awoke. Restless, unable to return to sleep. Anxiety level 0

5:00 am awake. Anxiety level .5

6:00 am Took Wellbutrin XL 150m

7:00 am Anxiety level  2

8:00 am Anxiety level 4

8:30 am Took Ativan .5mg Anxiety level 4

10:00 am Anxiety level 1.5

11:00 am Anxiety level 2

12:00 Anxiety level 2

TMS

1:30 Anxiety level 3

4:00pm Anxiety level 2.5. Took Wellbutrin 75mg

6:00 pm Anxiety level 2.5

7:30 Anxiety level 3

8:30 pm Took Ativan .5mg Anxiety level 1

10:30 pm bed. Anxiety level .5

[tapererer]

6/3

 

3:30 am awoke. Restless, unable to return to sleep. Anxiety level 0

4:00 some sleep

5:00 am awake. Anxiety level 2

6:00 am Took Wellbutrin XL 150m

7:00 am Anxiety level  2

8:00 am Anxiety level 2.5

8:30 am Took Ativan .5mg Anxiety level 2.5

10:00 am Anxiety level 2

12:00 Anxiety level 2

2:00 Anxiety level 3

4:00pm Anxiety level 3. Took Wellbutrin 75mg

6:30 pm Anxiety level 2.5

7:30 Anxiety level 1

8:30 pm Took Ativan .5mg Anxiety level 1

10:00 pm bed. Anxiety level .5

[tapererer]

6/4

 

3:30 am awoke. Restless, unable to return to sleep. Anxiety level 0

5:00 am some sleep. Anxiety level 1.5

6:00 am Took Wellbutrin XL 150m

7:30 am Anxiety level  2.5

8:00 am Anxiety level 3.5

8:30 am Took Ativan .5mg Anxiety level 2.5

10:00 am Anxiety level 2.5

12:00 Anxiety level 2

TMS

2:00 Anxiety level 3

3:00 Anxiety level 2 (depression level 3 much of the day)

4:00pm Anxiety level 2. Took Wellbutrin 75mg

7:00 Anxiety level 2.5

8:30 pm Took Ativan .5mg Anxiety level 1

10:00 pm bed. Anxiety level .5

[tapererer]

6/5

 

3:30 am awoke. Restless, unable to return to sleep. Anxiety level 0

5:00 am some sleep. Anxiety level 2

6:00 am Took Wellbutrin XL 150m

7:30 am Anxiety level  2

8:00 am Anxiety level 2.5

8:30 am Took Ativan .5mg Anxiety level 2.5

10:00 am Anxiety level 2

11:00 am Anxiety level 1.5

12:00 Anxiety level 2

2:00 Anxiety level 3

3:00 Anxiety level 2 (depression level 3 much of the day)

4:00pm Anxiety level 2. Took Wellbutrin 75mg

7:00 Anxiety level 2.5

8:30 pm Took Ativan .5mg Anxiety level 1

10:30 pm bed. Anxiety level .5

 

@Altostrata, I’m not sure how much improvement I’m feeling day to day now. My med dosing has been stable for a couple of weeks, and my depression is getting worse. This is affecting my life more and more, I’m feeling frustrated, and I need to find some stability. I haven’t increased the Wellbutrin to 300 yet, but really want to try that, and then tackle tapering down the road.
 

Also, could my continued Ativan use be causing problems now? Is there a plan for tapering the Ativan? 
 

Thank you…

[Altostrata]

It appears your Wellbutrin doses are causing anxiety. Anxiety is a well-known adverse effect of Wellbutrin.

 

You also may be over-using Ativan, which is masking the reaction from Wellbutrin.

 

Are you taking immediate-release Wellbutrin in the evening? Please clarify the type.

[tapererer]

6/7

 

3:30 am awoke. Restless, unable to return to sleep. Anxiety level 0

5:00 am some sleep. Anxiety level 0

6:00 am Took Wellbutrin XL 150m Anxiety level 0

7:00 am Anxiety level  1

8:00 am Anxiety level 2

8:30 am Took Ativan .5mg Anxiety level 2.5

10:30 am Anxiety level 2.5

12:00 Anxiety level 2

TMS

2:00 Anxiety level 2

3:00 Anxiety level 2

4:00pm Anxiety level 2. Took Wellbutrin 75mg

7:00 Anxiety level 2

8:30 pm Took Ativan .5mg Anxiety level 1

10:00 pm bed. Anxiety level .5

 

I take 150 XL in the morning and 75 immediate-release in the afternoon.

 

Things do seem to be improving though. I was on Wellbutrin for many years without the anxiety issues, so perhaps this side-effect is beginning to diminish slowly. 

 

I would though like to reduce my Ativan usage...what would be a good first step?

 

Thanks....

[tapererer]

6/8

 

4:30 am awoke. unable to return to sleep. Anxiety level 0

5:00 Anxiety level 1

6:00 am Took Wellbutrin XL 150m Anxiety level 1

7:00 am Anxiety level  1

8:00 am Anxiety level 2

8:30 am Took Ativan .5mg Anxiety level 2.5

10:30 am Anxiety level 2.5

12:00 Anxiety level 2.5

2:00 Anxiety level 2

3:00 Anxiety level 1.5

4:00pm Anxiety level 1. Took Wellbutrin 75mg

6:30 Anxiety level 3

7:00 Anxiety level 2

8:30 pm Took Ativan .5mg Anxiety level 1

10:00 pm bed. Anxiety level .5

[tapererer]

And for what it's worth, here's a plot of my daily average anxiety level, which is showing a general downward trend:

 

https://imgur.com/a/wq35p82

[tapererer]

6/9

 

1:30 AM Woken for work emergency. Anxiety level 1

3:00 AM Work complete. Anxiety level 3

5:30 am awoke. Anxiety level 4

6:00 am Took Wellbutrin XL 150m Anxiety level 4

7:00 am Anxiety level  3

8:00 am Anxiety level 2.5

8:30 am Took Ativan .5mg Anxiety level 2.5

10:30 am Anxiety level 3

12:00 Anxiety level 2.5 TMS

2:00 Anxiety level 3.5

4:00pm Anxiety level 3. Took Wellbutrin 75mg

6:00 Anxiety level 2

7:00 Anxiety level 1.5

8:30 pm Took Ativan .5mg Anxiety level 1

10:00 pm bed. Anxiety level .5

[tapererer]

6/10

 

5:00 am awoke.Anxiety level 0

6:00 am Took Wellbutrin XL 150m Anxiety level .5

7:30 am Anxiety level  1

8:00 am Anxiety level 2

8:30 am Took Ativan .5mg Anxiety level 2

10:30 am Anxiety level 2

1:00 Anxiety level 1.5

2:00 Anxiety level 1

3:00 Anxiety level 1

4:00pm Anxiety level .5. Took Wellbutrin 75mg

6:00 Anxiety level 1

7:00 Anxiety level 1.5

8:30 pm Took Ativan .5mg Anxiety level 1

10:00 pm bed. Anxiety level 0

[tapererer]

6/11

 

5:00 am awoke.Anxiety level 0

6:00 am Took Wellbutrin XL 150m Anxiety level .5

7:00 am Anxiety level  1.5

8:30 am Took Ativan .5mg Anxiety level 2

10:30 am Anxiety level 1

12:00 Anxiety level 1.5 TMS

2:00 Anxiety level 1.5

3:00 Anxiety level 3

4:00pm Anxiety level 2.5. Took Wellbutrin 75mg

5:00 Anxiety level 2.5

6:00 Anxiety level 2.5

8:00 Anxiety level 3

8:30 pm Took Ativan .5mg Anxiety level 4

10:00 pm bed. Anxiety level 2.5

[tapererer]

6/12

 

4:30 am awoke.Anxiety level 0

6:00 am Took Wellbutrin XL 150m Anxiety level 1.5

7:00 am Anxiety level  1.5

8:30 am Took Ativan .5mg Anxiety level 2

10:30 am Anxiety level 1.5

12:00 Anxiety level 2

1:00 Anxiety level 2.5

2:30 Anxiety level 3

3:00 Anxiety level 3

4:00pm Anxiety level 2.5. Took Wellbutrin 75mg

5:00 Anxiety level 2.5

6:00 Anxiety level 3.5

8:00 Anxiety level 2.5

8:30 pm Took Ativan .5mg Anxiety level 3

10:00 pm bed. Anxiety level 1.5

[tapererer]

6/13

 

3:30 am awoke. Restless. Anxiety level 0

4:00 am Anxiety level 1

5:00 am Anxiety level 2

6:00 am Took Wellbutrin XL 150m Anxiety level 1.5

7:00 am Anxiety level  1.5

7:30 am Anxiety level 4

Yoga

8:00 am Anxiety level 2.5

8:30 am Took Ativan .5mg Anxiety level 2

10:30 am Anxiety level 1.5

1:00 Anxiety level 1.5

4:00pm Anxiety level 1.5. Took Wellbutrin 75mg

6:30 Anxiety level 1.5

8:30 pm Took Ativan .5mg Anxiety level 2

10:00 pm bed. Anxiety level 1.5

Depressed most of the day (depression level 5)

[tapererer]

On 6/8/2021 at 10:59 AM, Altostrata said:

It appears your Wellbutrin doses are causing anxiety. Anxiety is a well-known adverse effect of Wellbutrin.

 

@Altostrata I'm at 150mg XL in the morning and 75 immediate release in the afternoon of Wellbutrin. What do you think would be the best way to reduce this a bit to see if it helps the anxiety? Maybe first reverse the doses (75 AM/150 AM) and see if the AM anxiety decreases? Or cut down the PM to 50?

 

Thanks!

[Altostrata]

If I were you, I'd reduce the evening Wellbutrin. You've been taking it since June 1? You might cut it in half.

 

Also, as mentioned before, you may be overusing Ativan. "Depression" is an adverse effect of benzos, as well as potential paradoxical reaction when you take too much (keeps you from sleeping, make you anxious, etc).

 

It appears you have been following the principle of increasing drugs to crush symptoms, but gotten the opposite effect. Often less is more effective than more.

[tapererer]

24 minutes ago, Altostrata said:

If I were you, I'd reduce the evening Wellbutrin. You've been taking it since June 1? You might cut it in half.

 

Thanks, I'll do that.

 

24 minutes ago, Altostrata said:

Also, as mentioned before, you may be overusing Ativan.

Yes, and I've been looking for a schedule to taper that. Should I consult @Frogiefor that?

 

Thanks again...!

[tapererer]

11 minutes ago, tapererer said:

Also, as mentioned before, you may be overusing Ativan.

And for what it's worth, my psychiatrist recommend a go down by .25 mg every 10 days. Too fast?

 

 

[tapererer]

1 hour ago, Altostrata said:

If I were you, I'd reduce the evening Wellbutrin. You've been taking it since June 1?

Oh, and sorry, @Altostrata, I've been on this current dose since April, 23.

 

Here's my reinstatement schedule:

 

https://imgur.com/a/jDbG05d

 

Thanks!

[Altostrata]

Do not change more than one drug at a time.

 

Suggest you start tapering the evening Wellbutrin by 10% of your total daily dose, which is 22.5mg. It will take about 4 days for this change to take full effect. Please let us know how you're doing.

 

It would be good for your psychiatrist's education to know that the Ativan may be addressing the adverse stimulating effects of Wellbutrin and was unnecessary, as you could have stayed at a lesser dose of Wellbutrin at any time.

[tapererer]

1 minute ago, Altostrata said:

Suggest you start tapering the evening Wellbutrin by 10% of your total daily dose, which is 22.5mg. It will take about 4 days for this change to take full effect. Please let us know how you're doing.

Thanks so much...will do!

[tapererer]

2 minutes ago, tapererer said:

Suggest you start tapering the evening Wellbutrin by 10% of your total daily dose, which is 22.5mg

That would make daily total of 202.5. So 150 in the morning, and I have 25mg caps I had made. I can take two of those PM for a total of 200mg...close enough?

[Altostrata]

I don't know. Maybe. How sensitive are you to reductions in Wellbutrin?

[tapererer]

Just now, Altostrata said:

don't know. Maybe. How sensitive are you to reductions in Wellbutrin?

I would say from this current episode, that yes, I'm pretty sensitive. Maybe I'll cut a 75 in half for now?

[Altostrata]

You want to decrease by 37.5mg instead of 22.5mg or 25mg?

[tapererer]

6 minutes ago, tapererer said:

Maybe I'll cut a 75 in half for now?

Doh! That's not right...

 

Ok, I'll figure out something closer with splitting the 75s. It's dose time and I need to run to an appointment. So I'll do the 2 x 25 tonight, and work it closer tomorrow...

 

Thanks!

[tapererer]

Actually, now I look at my original tapering schedule, I see that I made a “successful” drop from 250 to 200 mg in October 2020. I say successful because I felt no withdrawal issues from tapering until February, about 4 months later, after I’d tapered all the way off.

 

Given that data, I’m feeling better about the 225 to 200 mg drop I’m staring today. Does that sound reasonable?