Mario77: Multiple medication mishaps

[Mario77]

@Frogie Frogie, I am in need of support. I have the worst day of my life. Are you there, my friend? I am shaky, with back pain and intrusive thoughts. How do I deal with these? I did not even start tapering anything...

[Frogie]

@Mario77

 

If you are feeling this way, you shouldn't taper at this point. 

 

It could be that the liquid mirtazapine is metabolizing pretty fast in your system. That is perfectly normal and may take a few days to clear up. It could be the going up and down on the Lexapro also. It takes about 4 days for medications to reach levels in your body.

 

You might split your clonazepam into 2 equal doses, and about 8-10 hours apart. But make sure you take it an hour after you take anything else.

 

Take a Epson salt bath. Sometimes they help. Or a hot shower.

 

"Change the channel" -- dealing with cognitive symptoms

[Mario77]

@Altostrata

Hi, here id my day

 

6AM woke up with anxiety

7 AM Got out of the bed, took propranolol 40 mg and amlodipine 10

8AM Breakfast and 0.75mg clonazepam 

9AM Escitalopram 15mg

10AM Sleepy ,brain fog

11AM Less brain fog

12 PM Lunch

1 PM Clonazepam 0.75mg, heavy eyelids

2 PM work situation generating back pain, stiffness, 

3PM agitation, restlessness, chills and shakes

5PM home, tired

6PM more calm

10PM will take 3rd clonazepam with 18.75 mirtazapine

 

[Mario77]

@Frogie

As you can see, I have days when in desperation I am taking 15 Lex, days when I am trying to stay at 12.5...About clonazepam, not sure I can make it through the day with only 2 dosing times (even if I keep the same total dose). My agitation and jitteriness is max around noon, when I try to take my third 0.75mg. Would it be better to take it twice, maybe 1 mg in the am and 1.25 in the evening? I am afraid of taking 1.25 in the evening, close to my mirtazapine...Or keep it 3 times a day 8AM, 12PM and 10PM? I really appreciate all the help. Any advice on managing my anxiety without meds?

 

[Frogie]

You can't go up and down on the Lexapro. That causes HUGE issues. You have to stay on the same dose all the time. You need to stay on 12.5. Your CNS is very sensitized. And you are adding fuel to the fire now.

 

You can take your clonazepam 3 times a day. Just make sure you space it out every 6 hours or so and at least an hour after anything else you take.

[Mario77]

OK, I'll try 12.5 mg from now on. But not sure what to do when I am not feeling well and I am blaming the lack of Lexapro.  I was very depressed on 12.5, that's why I raised it (beside the doctor and wife). But 15 is not making much of a difference, in my opinion. So, should I stay here, at 12.5 and suffer? Today I will be all liquid mirtazapine. Do you think is too early? I am taking 7.5 in pills now and the rest liquid for a week or so already. I'll keep the clonazepam one hour from the rest (even from mirtazapine in the evening?)

[Altostrata]

4 hours ago, Mario77 said:

My agitation and jitteriness is max around noon

 

This is probably an adverse drug reaction, possibly from the Lexapro. If I were you, I'd stop increasing your Lexapro to treat anxiety. It's NOT an anti-anxiety drug.

 

We often see that Lexaprom and other SSRIs INCREASE activation -- agitation, nervousness, anxiety, sleeplessness. Your doctor apparently believes differently. You could look up adverse effects of Lexapro on drugs.com. In fact, you should educate yourself about each of your drugs, doctors often will not give adequate information about them.

 

Also, settle on clonazepam twice a day or 3 times a day. If I were you, I'd divide up your total clonazepam dose (1.50mg) instead of adding 0.75mg as a third dose. It's very possible you're getting paradoxical reactions from clonazepam as well. Benzos make their own gravy in that if you take TOO MUCH, they will cause anxiety. That is a paradoxical reaction.

 

"Depression" is a common side effect of chronic benzo use, as well.

 

So if you continue to increase your drug dosages or otherwise fiddle with your drugs, you may be causing your now problems.

 

We cannot analyze your symptom pattern until you settle into a definite, consistent, day-to-day schedule. Please continue to post 24 hours at a time.

 

By the way, we see people in your situation ALL THE TIME. It's not unusual for doctors to go overboard in psychiatric drug prescription and misidentify adverse drug reactions for increased anxiety or other psychiatric problem.

[Mario77]

Thanks, @Altostrata. But how can I decrease all of a sudden my total clonazepam from 2.25 to 1.50mg? That's huge...I tried a few days to take only 0.5 at lunch. I will do Lex at 12.5mg and keep the liquid mirt where it is. @Frogie suggested to keep everything as it is for a month (at least regarding mirtazapine and Lexapro). I was able to skip the lunch benzo for a week; but that was 2 weeks ago or so. Since then I regularly take it (mostly 0.75, a few times 0.5). I'll keep posting my diary.

[Frogie]

@mario77

 

I think @Altostrata thought you were only taking 1.5 mg clonazepam  not 2.25 mg. Keep it the same, just making sure you are not taking it at the same time as any of the other medications. 

 

Please don't go up or down on the Lexapro. It is not an anti-anxiety medication. It is an anit-depressant you are just desensitizing your central nervous system doing this. It takes 4 days for the dose to reach a correct level in your system to begin with. You need to keep it at 12.5 mg.

 

Take ALL your medications at the same time EVERY DAY. Don't skip doses or take it at different times. That will help even it out in your body.

 

Thanks for keeping the notes coming.

[Mario77]

@Frogie So no clonazepam and mirtazapine at bedtime? Separate them by 1 hr?

[Frogie]

@Mario77

 

No take your mirtazapine (this is just an example) at 8 pm, then the clonazepam at 9 pm. 

[Mario77]

6AM woke up anxious

7AM Propranolol 40mg, Amlodipine 10 mg

8AM Clonazepam 0.75mg

9AM Escitalopram 12.5-slight increase in anxiety

10AM busy at work, not so anxious

12PM lunch, clonazepam 0.75 mg

1PM Stiff back, chest pain, ruminating thoughts

4PM a bit better

5PM nap 1/2 hr

 6 PM evening calm

7 PM dinner

9 PM clonazepam 0.75mg

10 PM mirtazapine 18.75 liquid only

 

[Frogie]

@Mario77

 

Your notes look like you aren't experiencing too much anxiety, which is a good sign.

 

Keep holding at that schedule and keep the notes coming.

 

 

[Mario77]

@FrogieToday I had huge akathisias in the am (feet moving in bed), after my propranolol and amlodipine  at 7:30. Took clonazepam 1 mg around 9:30. A bit better , but scared. Escitalopram 12.5 at 10. I am tired and disoriented , always cold

[Mario77]

@FrogieThen the notes are not good. I do have horrendous symptoms, more like agitation than worry. I just drink water and eliminate it. I just want to curl in a ball in bed

[Mario77]

@Frogie @AltostrataHelp...I took 15 lex today, I could not stand the akathisia. And 1.50 clonazepam so far...What do I do? Go to ER?

[Frogie]

@Mario77

 

The akathisia is caused my a desensitized central nervous system. From changing doses of the Lexapro I would suggest. You can't keep going up and down on doses.

 

If you go to the ER they will probably fill you full of other medications.

 

Have you tried Epson Salt baths? Hot showers? Weighted blankets sometimes help too.

 

 

I'm really sorry you are going through this.

 

 

[Altostrata]

You're now taking 0.75mg clonazepam 3 times a day -- increasing your daily total -- and your symptom pattern has gotten worse?

 

How long have you been taking 2.25mg clonazepam per day?

 

5 hours ago, Mario77 said:

Today I had huge akathisias in the am (feet moving in bed), after my propranolol and amlodipine  at 7:30. Took clonazepam 1 mg around 9:30.

 

I am confused. This was 1mg clonazepam in addition to your other 3 doses of 0.75mg?

 

This looks to me like a drug-drug interaction between propranolol and the excessive clonazepam you still had in your system from your doses the day before.

 

2 hours ago, Mario77 said:

Help...I took 15 lex today, I could not stand the akathisia. And 1.50 clonazepam so far...What do I do? Go to ER?

 

I have explained repeatedly that Lexapro is not an anti-anxiety drug, and that it may be generating symptoms of activation itself. And then you increased the dosage.

 

Mario, I am not sure you want to go off your drugs. You appear to be overusing clonazepam, causing other symptoms of activation. Stop making ad hoc changes in your drugs, you're causing your own symptoms. 

 

We need to see your daily notes.

[Mario77]

@Altostrata@FrogieI am on 3 x 0.75 clonazepam for 6-7 weeks (with the exception of one week were I was able to stay at 2 x 0.75mg. I was on 15 Lexapro for 2 weeks now maybe (with the exception of 2-3 day here and there where I could keep it at 12.5mg). Today the akathisia was horrendous, I could not take it anymore. I know stability and constancy is important, but I was VERY agitated and lost it. As such, I took 0.25 clonazepam extra (around noon) and 25 mg Lex around the same time. I am a  bit  better now. Took extra 40 propranolol around 3pm, hoping that it might help somehow. I am a mess. I will post a 24hr note later. 

Please do not give up on me...Please.

 

[Frogie]

@Mario77

 

Just going up and down on ALL the medications is going to do nothing but create more akathisia and create a very desensitized CNS. Your body can not handle it all of this.

 

You have to get it straightened out where you are only taking what you need to take and nothing more.

 

You've got to learn self care and stop relying on the medications to "make things better". It is only making things much worse.

[Mario77]

@FrogieOK, let's start today. Can I stabilize at 15 Lex or  should I try again to go back at 12.5?  Can you suggest a dosing schedule, starting around 7AM and including my meds? I would really appreciate that. 

[Frogie]

@Mario77

 

If I set up a schedule, you have to stick with it and learn some self care and not rely on these medications to make you better. They aren't, they make it worse, so you take more out of desperation.

 

If it was me I would take the 12.5 lexapro and stabilize on it. Not a drop more.

 

I'll work on a schedule and post it.

 

But this is all I can do for you. You have to want to help yourself.

[Frogie]

@Mario77

 

7 am - .75 mg clonazepam

 

9 am - 12.5 mg Lexapro

 

1 pm - .75 mg clonazepam

 

7 pm - .75 mg clonazepam

 

9 pm -  18.75 mg  Mirtazapine

 

Does that look ok to you, or does it need to be tweaked a little? 

[Mario77]

I am afraid it will mess up my sleep...Right now I take mirt and clonazepam right before lights out.

Do you think it will not affect my sleep? Maybe do 8PM clonazepam, 10PM mirt? 😶

[Mario77]

How about my propranolol and amlodipine, morning, around 8AM?

[Frogie]

@Mario77

 

7 am - 40 mg propranolol 

 

8 am -  .75 mg clonazepam

 

9 am - 12.5 mg Lexapro

 

10 am - 10 mg amlodipine 

 

2 pm - .75 mg clonazepam

 

8 pm - .75 mg clonazepam

 

10 pm -  18.75 mg  Mirtazapine

[Mario77]

Before, after, with food? Doesn't matter?

Starting tomorrow. What do you suggest as self-care, when I have bad symptoms?

 

Thanks, God bless you, @Frogie

[Frogie]

@Mario77

 

You can take it with meals, and a snack with afternoon doses.

 

"Change the channel" -- dealing with cognitive symptoms

 

Guided Meditations, Calming Videos, Sleep Hypnosis

 

Journalling - Therapeutic Writing & Health Benefits

 

You can take Epson salt baths, showers, just be mindful.

 

Keep posting notes. Need to see them.

[Mario77]

@FrogieJust asking, why is 12.5 better than 15, since I was on 15 for a while? And maybe doing better on 15. Thanks.

[Frogie]

If you want to stay on 15 mg then you have to stay on it and not move up and down. But like we have explained, it is not for anxiety, it is an antidepressant. And a very strong one at that. That's a high dosage also.

[Mario77]

@Frogie No offense, and just for  the sake of arguing...

How about those people whose anxiety improves after Lexapro? There are people out there taking 30mg or more. Not that I want to be one of them, but scouring the Net you can find testimonies like https://www.drugs.com/comments/escitalopram/lexapro-for-generalized-anxiety-disorder.html

 

[Frogie]

@Mario77

 

I'm not taking offense or arguing either. 

 

Please note that Lexapro is a very potent SSRI, 2 - 4 times stronger than other SSRIs. We go by a harm reduction method here, meaning we recommend tapering no faster than 10% a month off the previous month's dose (not the original dose prescribed). 

 

If you wish to keep increasing your dose of the Lexapro, you might want to listen to your dr at that point because I can't advise you on what to do.

[Mario77]

@Frogie All I want is to feel better. I was just curious, since some people are feeling better with AD, before deciding to taper. Maybe @Altostrata can chime in.

Obviously you and the website offer a great service with your advice.

My day yesterday was a bit chaotic:

7AM propranolol 40 and amlodipine 10

8 AM Clonazepam 0.75, ruminating in bed

9 AM lex 12.5 mg, akathisia

10 AM akathisia, agitation, 0.25 clonazepam

11 AM fidgety, akathisia

12 PM 0.75 Clonazepam and 2.5 lex

2PM a bit better, propranolol 40mg again

4PM better

6PM made it to a restaurant!

830 PM bed

1030 0.75 Clonazepam plus liquid mirtazapine

 

 

 

[Frogie]

@Mario77

 

Your notes are better. You still have akathisia, but hopefully staying on this schedule, you will straighten out and feel better soon. It takes about 4 days to register any symptoms.

 

Keep the notes coming.

 

Thanks!

[Mario77]

So far I'm on the schedule with my medication. So, in theory I should see a stabilization in 4-5 days...if I don't rock the boat?

 

 

 

 

 

 

 

 

[Frogie]

@Mario77

 

It takes 4-5 days for the medication to regulate in your bloodstream. With all the changes you have made up and down, you probably won't feel relief for a little while.

 

But you have to stick to the schedule so your body will get used to it and your CNS will settle down.

 

Unfortunately, you can't expect miracles with all of this.  Please don't rock the boat anymore🙂