annatino: I need help because I messed myself up

[Shep]

On 11/3/2022 at 11:32 AM, annatino said:

I am having brain fog a lot

 

Is the brain fog getting better or worse as you taper? 

[annatino]

3 minutes ago, Shep said:

 

Is the brain fog getting better or worse as you taper? 

I am having brain fog sometimes. I am feeling spaced out, forget words, sometimes I pause while I am talking to someone because I cannot find the right words.

I get tinnitus, body aches, burning eyes, blurred vision, nerve tooth sensitivity, avoiding to go out.

Many of these symptoms are on and off, especially two weeks before my period starts.
 

Regardless, we don’t know which one is worst then another, being in three different meds, it’s hard to pin point which one is giving me the symptoms.

 

I believe these are happening because the side effects of all.

 

Mirtazepine is notorious in triggering histamine.

I want this one out of my body so bad, and unfortunately it is the one that will take me longer to taper because the weight of the pill is 135 mg right now.

[Shep]

2 minutes ago, annatino said:

I believe these are happening because the side effects of all.

 

 

Are these symptoms getting better or worse as you taper? If they're getting worse, than they're not side effects - they're withdrawal symptoms. 

 

If your symptoms are getting worse, I would stop tapering. Continuing to push through these kinds of symptoms can damage your nervous system. This can be a lot worse than side effects. 

 

[annatino]

7 minutes ago, Shep said:

 

Are these symptoms getting better or worse as you taper? If they're getting worse, than they're not side effects - they're withdrawal symptoms. 

 

If your symptoms are getting worse, I would stop tapering. Continuing to push through these kinds of symptoms can damage your nervous system. This can be a lot worse than side effects. 

 

But these pills are making me lazy Shep.

I am not motivated at all, and I cannot stay like this another few years. 
I need to tapper all at the same time, or else it will take me 5-6 years one by one and cannot stay this way anymore.

 

Honestly I don’t know care if I am going through minimal withdrawals. I will put up with it as long as I don’t have insomnia, anxiety, akatisia...all the unbearable ones that I had four months ago when I came here and you  helped me stabilize. 

[Altostrata]

On 8/8/2022 at 3:58 AM, Shep said:

There is a number of drug interactions with your drug cocktail:

 

Drug interaction report - sertraline, Ativan, mirtazapine

 

@annatino did you read your drug interaction report?

 

The Ativan you're taking is enough alone to make you feel sluggish, drowsy, and unmotivated. It appears you've been taking a benzo fairly steadily for a couple of years.

 

Please keep daily notes of times o’clock you take your drugs, their dosages, and your symptoms throughout the day. We need to know how you feel before and after taking each drug, and your symptoms in between. Post 24 hours of notes at a time in this topic, in a simple list format with time o’clock on the left and notation (symptom or drug and dosage) on the right. This can show if your symptoms are adverse effects from one of your drugs.

 

1 hour ago, annatino said:

Honestly I don’t know care if I am going through minimal withdrawals. I will put up with it as long as I don’t have insomnia, anxiety, akatisia...all the unbearable ones that I had four months ago when I came here and you  helped me stabilize. 

 

We're trying to make sure your withdrawal symptoms don't become worse. You can taper any way you want, but we have no magic to fix it if you get bad withdrawal symptoms.

 

 

[annatino]

21 minutes ago, Altostrata said:

 

@annatino did you read your drug interaction report?

 

The Ativan you're taking is enough alone to make you feel sluggish, drowsy, and unmotivated. It appears you've been taking a benzo fairly steadily for a couple of years.

 

Please keep daily notes of times o’clock you take your drugs, their dosages, and your symptoms throughout the day. We need to know how you feel before and after taking each drug, and your symptoms in between. Post 24 hours of notes at a time in this topic, in a simple list format with time o’clock on the left and notation (symptom or drug and dosage) on the right. This can show if your symptoms are adverse effects from one of your drugs.

 

 

We're trying to make sure your withdrawal symptoms don't become worse. You can taper any way you want, but we have no magic to fix it if you get bad withdrawal symptoms.

 

 

Thank you for replying to my message.

 

I am doing ok with minimal side effects.

The Ativan was only once in a while up until July when I was told to take it every day because I was hit with withdrawals from taking it only once every 3-5 days. 
 

I take my meds at the same time every day since July and couple months ago I started reducing.

 

I am taking Sertraline at 12 pm ( currently at 28 mg - decreasing 2.5% a week from current weight of the capsule powder)

 

Ativan 0.30 mg cut in two pieces and taken at 9 am and 2 pm

 

Mirtazepine 13.5mg - at 10:30 pm 

 

 

[Altostrata]

If you want to do it your way, it saves us work. Good luck!

[annatino]

11 hours ago, Altostrata said:

If you want to do it your way, it saves us work. Good luck!

Hey Alto,

It’s not about doing it my way. 

I am going at minimum 10% a month, I am not rushing it whatsoever.

 

Not sure why you would assume I don’t want your help?

[annatino]

8:30am took 0.15mg Ativan

12pm - took Sertraline 

1:20pm - took 0.15mg Ativan 

2pm - started to get tinnitus 

Now I am confused which drug is making my tinnitus hiss into my ears. 

Ativan or Sertraline? 

Took Ativan at 8:30am and did not have tinnitus.

[Altostrata]

More likely the sertraline is causing tinnitus. Does this happen every day?

 

Need to see what happens before and after you take mirtazapine as well.

 

Please continue to post daily notes, 24 hours (a day and night) at a time.

[annatino]

It does happen every day around 2-3pm.

Now recently I feel like a electric sensitive nerve mild pain to my front tooth. This happened before when I was taking Ativan on and off.

 

I will continue posting it.

 

[annatino]

@Shep

Hi Shep. I just thought to pop in and say hi! 
I am doing great. 
I am on 25mg Sertraline, 10mg Mirtazepine and 0.15mg Ativan.

In January 2023 I will be off Ativan.

Every time I cut Mirtazepine, I feel horrible for few days. That drug is really hard to come off.

I will take my time to come off slowly, and I know it will take me few good years but that’s ok. 
 

Happy Holidays to you and the rest of the moderators.

 

I will come back sometime with a positive update. 
 

XXX

[Shep]

 

Quote

 

2022 November - Sertraline 29mg, Mirtazepine 13.5mg, Ativan 0.30mg

2022 December- Sertraline 25mg,

Mirtazepine 10mg, Ativan 0.15mg

 

 

@annatino I just looked at your signature - you've reduced sertraline by 14% (29 mg down to 25 mg), mirtazapine by 26% (13.5 mg down to 10 mg), and Ativan by 50% (0.30 mg down to 0.15 mg), all within a timeframe of just one month. 

 

7 hours ago, annatino said:

I will take my time to come off slowly, and I know it will take me few good years but that’s ok. 

 

I'm confused by this, considering considering how quickly you're tapering. 

 

I'm very glad to read you're doing well but feel the need to caution you against going too fast, too soon. 

 

As you get to the lower doses, you may want to slow down. Please see:

 

Why taper? SERT transporter occupancy studies show importance of gradual change in plasma concentration

 

The lower doses contain a disproportionate concentrate of the drug. This is why many people find the lower doses to be especially difficult to taper.

[annatino]

4 hours ago, Shep said:

I'm confused by this, considering considering how quickly you're tapering. 

 

I'm very glad to read you're doing well but feel the need to caution you against going too fast, too soon. 

 

As you get to the lower doses, you may want to slow down. Please see:

Oh no, no! 
I reduced since October. 

I do 10% a month.

It’s the Ativan that I went a bit faster as I feel better on the lowest dose.

 

[Altostrata]

20 hours ago, annatino said:

I am on 25mg Sertraline, 10mg Mirtazepine and 0.15mg Ativan.

In January 2023 I will be off Ativan.

 

Suggest you stay at this Ativan dosage and reduce mirtazapine instead. The Ativan may reduce the withdrawal from mirtazapine, maintaining your sleep.

[Shep]

20 hours ago, annatino said:

Oh no, no! 
I reduced since October. 

I do 10% a month.

It’s the Ativan that I went a bit faster as I feel better on the lowest dose.

 

Please correct your signature to reflect this. I'm very glad to read you're only doing 10% a month.

 

[annatino]

@Shep

Hi Shep,

 

I am back to update my situation.

At the moment I am on Sertraline 25mg, Mirtazepine 9mg.

 

I tried getting off 0.11mg Ativan this Monday and ever since I was bed ridden. Had yesterday morning better but by evening everything went down hill 

Tight chest and anxiety, tinnitus, hissing and new pulsing/pounding sounds, pins and needles in feet, pain on my left hip. 

Felt depressed and scared.

 

I was not able to work the two days part time job this week. 
 

My sleep was perfect 8-10 hrs but this morning I woke up at 6 am and was very frightened.

 

I decided go take 0.11mg pill and after 1.5 hr I was starting to feel better. 
 

I cannot split this crumb in two doses. 
 

Should I increase to 0.15mg and cut into two doses? 
it’s been few weeks to a month since I went down from 0.15mg and begging of January I took 7.500 IU Vitamin D3 for three days and everything started to appear. Feeling low and having intrusive thoughts. 
 

I want to make sure I will be ok if I go back to 0.15mg and split that into two again. At 8 am and 2 pm. I don’t want to kindle myself.

 

 

[annatino]

@Shep

Hi Shep,

 

I am back to update my situation.

At the moment I am on Sertraline 25mg, Mirtazepine 9mg.

 

I tried getting off 0.11mg Ativan this Monday and ever since I was bed ridden. Had yesterday morning better but by evening everything went down hill 

Tight chest and anxiety, tinnitus, hissing and new pulsing/pounding sounds, pins and needles in feet, pain on my left hip. 

Felt depressed and scared.

 

I was not able to work the two days part time job this week. 
 

My sleep was perfect 8-10 hrs but this morning I woke up at 6 am and was very frightened.

 

I decided go take 0.11mg pill and after 1.5 hr I was starting to feel better. 
 

I cannot split this crumb in two doses. 
 

Should I increase to 0.15mg and cut into two doses? 
it’s been few weeks to a month since I went down from 0.15mg and begging of January I took 7.500 IU Vitamin D3 for three days and everything started to appear. Feeling low and having intrusive thoughts. 
 

I want to make sure I will be ok if I go back to 0.15mg and split that into two again. At 8 am and 2 pm. I don’t want to kindle myself.

 

 

[annatino]

Is anyone reading my update?

 

I am taking 0.11mg Ati again after three days of torture. 

I do feel ok after that although I don’t take it twice a day because the dose is very small to split and it’s almost impossible to do it.

There are some withdrawals but they are bearable like hissing and vibrating in my ear. 

 

I am currently cutting the Mirtazepine to 9mg and next month will go to 8mg and after that I will split the pill in half on the score line, and will stay on it while I get off Sertraline, the activating one

 

 0.11mg Ati at the same time then on the end I will taper the remaining 7.5mg  Mirtazepine.

It will take a long time but I want to be safe.

[Shep]

8 hours ago, annatino said:

Is anyone reading my update?

 

Please note we have a very small volunteer staff in various timezones and many of us have other responsibilities such as jobs and families. 

 

8 hours ago, annatino said:

I do feel ok after that although I don’t take it twice a day because the dose is very small to split and it’s almost impossible to do it.

 

How are you measuring your dose - are you using a scale? Once you get to the point where it's impossible to measure out the smallest of doses, it's okay to split it out by eyeballing it. You may want to take a slightly larger amount at night for sleep, if it's still helping with sleep, and move the smaller amount for during the day to help with interdose withdrawal, if that's still an issue. 

 

8 hours ago, annatino said:

I am currently cutting the Mirtazepine to 9mg and next month will go to 8mg and after that I will split the pill in half on the score line, and will stay on it while I get off Sertraline, the activating one

 

If your sleep is good on what you're currently taking, I would target the sertraline first and leave the mirtazapine for last. It's possible some of your daytime symptoms are related to sertraline side effects as opposed to benzo interdose withdrawal, since benzos tend to mask the side effects of the SSRI. Now that you have less benzo in your system, some of your daytime symptoms may be the SSRI. 

[annatino]

2 hours ago, Shep said:

How are you measuring your dose - are you using a scale?

Hi Shep and thank you for answer back to me. 
I am using a scale an weight 0.5mg tablet and split it in 3-4 times, making ready for the next days. Basically one pill 0.5mg will last me 3-4 days depends if the rest becomes powder and not using that. I am at 0.11mg for couple weeks and making the mistake to stop it for three days. 
went back on 0.11mg but I think that 0.15mg work d just perfect to me and was easy to split it in two doses one at 8-9am and the other at 2pm. I take the Sertraline at 12pm.

 

Just wanted to confirm with you if it’s ok to go back to 0.15mg. 
I was on 0.11mg for around couple weeks. I don’t think I will risk kindling.

I am recovering for past days back on the 0.11mg and feeling better. I was at the bottom again for three days and was very scary to find myself back to that level. 
 

[Shep]

8 hours ago, annatino said:

Just wanted to confirm with you if it’s ok to go back to 0.15mg. 
I was on 0.11mg for around couple weeks. I don’t think I will risk kindling.

I am recovering for past days back on the 0.11mg and feeling better.

 

This is really confusing - if you're back on 0.11 mg and feeling better, why would you want to increase to 0.15 mg? 

[annatino]

I actually took 0.11mg in the morning and a small bit 0.04mg in afternoon.

 

At 0.11mg for ost weeks I didn’t feel too well. So when I was at higher weight like 0.15mg, I was doing good.

[Shep]

Thanks for clarifying that, @annatino. Glad things are stabilizing. You may want to go into a long hold and see if you can build a solid baseline before continuing to taper. 

 

 

 

[annatino]

6 minutes ago, Shep said:

Thanks for clarifying that

Thank you Shep. 

I decided to stay on 0.12mg Ativan a day- split in two pieces and take at the same time. 
 

The only thing that I am stuck with is hissing in the years and vibrant sound in my head that goes for 5 seconds and stop for 10 seconds and repeats, all day.

 

What do you mean about long hold before reducing? How long should I wait until cutting Mirtazepine to 8mg. I have one more week on 9mg, and I was gonna move to 8mg; so I guess I won’t do it for another few more weeks?

I want to get to 7.5mg half a pill then stay on it until getting off the Sertraline. I believe the Sertraline is giving me symptoms right after I take the pill at 12pm and really makes me feel uneasy.

[Shep]

16 hours ago, annatino said:

What do you mean about long hold before reducing? How long should I wait until cutting Mirtazepine to 8mg. I have one more week on 9mg, and I was gonna move to 8mg; so I guess I won’t do it for another few more weeks?

 

That's right - I would hold for a few more weeks. I based this on your update in these two posts from just 3 days ago: 

 

On 1/26/2023 at 10:41 PM, annatino said:

I tried getting off 0.11mg Ativan this Monday and ever since I was bed ridden. Had yesterday morning better but by evening everything went down hill 

Tight chest and anxiety, tinnitus, hissing and new pulsing/pounding sounds, pins and needles in feet, pain on my left hip. 

Felt depressed and scared.

 

I was not able to work the two days part time job this week. 

 

On 1/26/2023 at 10:50 PM, annatino said:

I am taking 0.11mg Ati again after three days of torture. 

I do feel ok after that although I don’t take it twice a day because the dose is very small to split and it’s almost impossible to do it.

There are some withdrawals but they are bearable like hissing and vibrating in my ear.

 

When you destabilize to the point of being in, as you say, "three days of torture," it's best to hold and give your nervous system a rest. That level of severity of symptoms is letting you know you are very dependent on this drug. 

 

16 hours ago, annatino said:

I want to get to 7.5mg half a pill then stay on it until getting off the Sertraline. I believe the Sertraline is giving me symptoms right after I take the pill at 12pm and really makes me feel uneasy.

 

That's fine, but if you rush reducing the mirtazapine too soon, you won't know if you're having withdrawal symptoms from that drug or if you're having more Ativan withdrawal symptoms. Remember, withdrawal comes in windows and waves. And your symptoms were several for several days and that just happened a few days ago. 

 

 

[annatino]

2 hours ago, Shep said:

very dependent on this drug. 

Hi Shep

 

How will I be able to come off of it this drug If I will stay on it more years?

This morning I woke up again with adrenaline surge this hours after I took half of the 0.11mg Ativan which I rarely do get the fear feeling upon waking.

I am afraid that 0.11mg is not enough?

 

Also I am afraid that 9mg Mirtazepine it’s not cut/shaved with precision from 15mg pill. 
I don’t like how I feel and I am not ready to work my part time job. I only go two days a week and it’s been already 10 days since I try stabilizing.

[Shep]

4 hours ago, annatino said:

How will I be able to come off of it this drug If I will stay on it more years?

 

Slowly, just like with all psychiatric drugs. The goal is not to get off the drugs fast, but to be as functional and to feel as well as possible throughout the entire journey. 

 

23 hours ago, annatino said:

I decided to stay on 0.12mg Ativan a day- split in two pieces and take at the same time. 

 

4 hours ago, annatino said:

This morning I woke up again with adrenaline surge this hours after I took half of the 0.11mg Ativan which I rarely do get the fear feeling upon waking.

I am afraid that 0.11mg is not enough?

 

I am having a very hard time following how much Ativan you are taking. Your dosages have been all over the place. 

 

Please pick a dose and stick to it for several weeks. A lot of your instability is likely coming from all of the changes. 

 

On 11/4/2022 at 8:08 PM, annatino said:

I am doing ok with minimal side effects.

 

You were doing much better back in November. This was before you started reducing the Ativan, going from .30 mg in November down to as low as .11 mg this month, as well as reducing the mirtazapine. 

 

I would stop tapering all of your drugs until you stabilize again. 

[annatino]

3 hours ago, Shep said:

I am having a very hard time following how much Ativan you are taking. Your dosages have been all over the place. 

Shep,

 

0.11mg  or 0.12mg to me it’s basically almost the same because the scale it’s very sensitive and varied. It is very hard to get the weight with precision because the tiny crumbs/powder impossible to weigh exactly the same number.

[annatino]

3 hours ago, Shep said:

Slowly, just like with all psychiatric drugs.

I will do it slowly, it is just very hard to get lower then 0.10mg and dividing that by two. I am used to take it twice a day and the lower I get, the more hard time I have separating this into two.

I don’t know it taking it once a day would be a good idea because the inter dose withdrawals of the short half life of the Ativan.

 

 

[Shep]

Are you able to get prescription liquid Ativan? That's the easiest way to get those really low doses. Or you can make your own liquid. 

[annatino]

I am afraid to try to liquid. Even when I tried 1/3 water and rest pill, I had very bad withdrawals.

 

Is switching to Valium 0.75mg bad idea? I am just asking for curiosity, I am not keen to change the meds, but heard some people did better on Valium because the long half-life.

[Shep]

On 8/22/2022 at 9:14 PM, annatino said:

I wanted to ask your opinion if I should switch to 3.5mg Clorazepat, an older type benzodiazepine, that helped some people switch from short half life benzodiazepine like Ativan or Xanax. Clonazepam I would never touch that devil again and Diazepam it’s possible to make me tired.

 

On 8/23/2022 at 8:18 AM, Shep said:

I wouldn't continue to switch drugs. You risk kindling:

 

Benzo Kindling

 

Also, a crossover to another drug involves removing the first drug. The new drug may or may not cover the withdrawal from the old drug, so you may no longer sleep all night and have 12-hour windows like you're having now. 

 

If all you need is a longer half-life, dividing the Ativan and taking it more than once a day will solve that problem. Ativan's half-life is 10 - 20 hours, and since you're having 12 hours of feeling normal and sleeping all night, it sounds like you may be at the best you can be. As you continue to hold, you may find even more stability. 

 

@annatino The above is from our earlier conversation regarding Valium (diazepam) from earlier in your thread. 

 

You were incredibly stable back in August. In looking at your signature, here are your drug changes:

 

Quote

 

22 August -Sert 35mg -Mirt15mg - Ati 0.5mg >’22 November - Sert 29mg, Mirt13.5mg, Ati 0.3mg >

‘22 December- Sert25mg,

Mirt 10mg, Ati 0.15mg > ‘23 January - Sert25mg, Mirt9mg, Ati 0.11mg 

 

 

There are way too many changes and way too fast. It looks like you did a lot of large reductions from November to December 2022.

 

From November to December, you reduced sertraline from 29 mg to 25 mg, a 14% reduction in one month.

 

From November to December, you reduced the mirtazapine from 13.5 mg to 10 mg, which is a 26% reduction in one month. 

 

And Ativan went from .3 mg to .15 mg from November to December. This is a 50% reduction. 

 

Please re-read your thread. We recommend only tapering one drug at a time for no more than 10% off the prior month's dose. We recommend coming off the SSRI first so the sedating AD and the benzo can aid with sleep. See this post -  Taking multiple psych drugs? Which drug to taper first?

 

If you feel like you're worse off now then you were before November, it's likely because of the way you're tapering. Let us know if you'd like guidance on how to come off these drugs. But please only do so if you're interested in following our harm reduction method. You really are making this harder than it needs to be.

 

[annatino]

2 hours ago, Shep said:

mirtazapine from 13.5 mg to 10 mg

I think there is a mistake. I will remake my signature. The Mirtazepine I reduced 1mg a month since September. I am at 9mg now.

 

2 hours ago, Shep said:

Let us know if you'd like guidance on how to come off these drugs.

I do want your guidance and thank you so much for helping the ones in despair. I it wasn’t for you, I would not be alive probably or maybe I would be in 5 meds at the highest dose 😰

 

I am sorry if I am confusing you, I was a bit rushing with the Ativan because I was afraid of hitting tolerance. I would happily stay on that 0.5mg a day like I was in summer but I really was scared that this dose is a bit to high and did not want to take daily that much. 
It seems even 0.15mg was doing great to me. I guess there is no high or low dose in benzodiazepines because it’s seems like a fraction is working compare to the people that take way much more then I do.

 

I will come back and let you know when I feel the same as I did in summer. Alit happened, my dad passed, I cannot keep a job full time and am hit with perimenopause and withdrawals at the same time. 
I am blessed that God keeps me strong to go over this trials. 
 

God bless Shep. 🌹🌹🌹
 

[Shep]

Thanks, @annatino. Yes, do come back after you've stabilized and are ready to continue to taper. Don't worry about hitting tolerance with Ativan. Many people stay on the same dose of a benzo for years, even decades. Tolerance doesn't happen that quickly. You have plenty of time. 

[annatino]

Thank you Shep.

I emailed a compounding pharmacy and asked for liquid Ativan 0.11mg.

I am waiting for them to answer. 

Still in pretty awful condition after that crash. It’s been two weeks and I am mostly in bed, and push myself to make dinner. Went couple times to do groceries. I am not well enough to work. I am lucky that I have flexible part time job and my son has full time job until he starts school in September. 
I need to recover at 100% because he needs to go to school and I need to work full time. 
 

Do you think that 11mg Ativan is too low dose? What could cause me to feel like this? I understand that I sped up taper the Ativan?