Bullitt1968: one-time method for reducing and discontinuing psychotropic drugs

[Altostrata]

Yes, I understand that you've been through a lot and are suffering with your current drug regimen. However, we cannot wave a magic wand and fix your situation, you have to make changes in your drugs.

 

We can't address swapping out diazepam for a probably excessive dose of lorazepam, especially when other drugs may be contributing to your symptom pattern. We go by symptom pattern here, and yours is confounded by multiple drugs that you refuse to change, not your doctors. We can't help you under these circumstances.

[Bullitt1968]

@Altostrata

 

I have been reducing the promethazine from 100 mg to 90 mg for 14 days.

 

What concerns me: Psychological factors don't play a role at all? You only follow the drug regimen. I have a great fear of losing my father, who is now 83. At that age I lost my beloved grandfather to Alzheimer's and I live here with my parents and notice how my father is also deteriorating mentally. We live in a very close symbiosis, when I suffer, my parents suffer too and I feel guilty.

For me, the question is why this is not taken into account, you can't ignore these factors. You say I have a depression caused by medication. That may be true, I think that also, but all the things I've been experiencing for years and the fear of loss alone are reason enough for a severe depression.

For Example: Even when I'm on all my medication, if there's a trigger, like my dad getting sick, I can have a panic attack.
 

I don't understand why that doesn't play a role. So there could be wrong perceptions or not?

[Bullitt1968]

I have been reducing the promethazine from 100 mg to 90 mg for 14 days. What concerns me: Psychological factors don't play a role at all? You only follow the drug regimen. I have a great fear of losing my father, who is now 83. At that age I lost my beloved grandfather to Alzheimer's and I live here with my parents and notice how my father is also deteriorating mentally. We live in a very close symbiosis, when I suffer, my parents suffer too and I feel guilty. For me, the question is why this is not taken into account, you can't ignore these factors. You say I have a depression caused by medication. That may be true, but all the things I've been experiencing for years and the fear of loss alone are reason enough for a severe depression. Even when I'm on all my medication, if there's a trigger, like my dad getting sick, I can have a panic attack.

I don't understand why that doesn't play a role. 

 

[Altostrata]

If you want to discuss drug reduction, please supply your daily symptom notes.

 

We address tapering, we don't provide psychotherapy, and we can't cure your depression, if that's what you have. You are free to continue on your drugs to treat your depression. Please let us know when you are willing to reduce your drugs.

[Bullitt1968]

@Altostrata

 

As I said, I started reducing 14 days ago promethazine, I am ready to reduce otherwise I don't think I would have done it. I have to wait now surley 4 2 weeks until next reduction. I do not want do reduce more than one drug . After I reduced promethazine maybe to 50 mg , I will take a pause and than try reduce pregabalin.
 

If I do this now, should I include psychological factors in the daily drug regime or not? 

I asked a very simple question and received no answer. As I said, I started reducing 14 days ago, I am ready to reduce otherwise I don't think I would have done it.

That is a simple question but a important question for withdrawal and you do not want to ask this question, Therefore, I have to assume that psychological factors are really not taken into account and then I would like an explanation why. In my opinion, this is not possible. Thoughts can trigger feelings and bodily sensations. 

 

[Altostrata]

If you're not feeling any ill effect from promethazine reduction, you probably can taper it faster.

 

Whether and how you address your psychological issues is up to you. We advise on deprescribing. You have described a symptom pattern that seems likely due to adverse drug effects. Among adverse effects from high doses of benzos is "depression". Up to you if you want to wait for this to go away before reducing the drugs that appear to be causing other fairly serious adverse effects. 

 

I'm not going to argue with you about your depression. We do deprescribing here, we don't cure depression.

[Bullitt1968]

@Altostrata

I understand. Unfortunately, I can't reduce the benzodiazepines now as they prevent most of the psychological withdrawal symptoms of the failed Prozac withdrawal last year. My psychiatrist and Dr. Horowitz have advised me against this and recommended that I try dosing down with the promethazine and pregabalin first. The benzos should be reduced at the end. I can't do a benzodiazepine withdrawal on top of a long-term withdrawal from Prozac with long-lasting strong withdrawal symptoms, because that would make the symptoms even worse. Without the increase in benzos, I would not have survived the crash last year! And with strong Benzo withdrawal symptoms by reducing them now I will not survive this! That is fact, I forgot sometimes a dosage of the benzos and than I have these strong symptoms like Akathisialiked symptoms with strong Compulsively imposing suicidal thoughts and feelings,
I cannot risk this and hope, there will be now strong suicide thoughts and feelings even if I know that it is from withdrawal, the risk, that I commit suicide is to high. I hope, that is understandable.

Reducing the promethazine more quickly, I'm afraid of a discontinuation psychosis.

 

[Bullitt1968]

@Altostrata

 

Dear Altostrata, thank you very much for your patience and support. I'm sorry, in German forums and weaning groups the psychological factors play a role. After thinking about it a bit, I think it's better the way you do it, otherwise it's too complex and complicated. I will suggest this in the forum where I am.

I will now start with the drug regime regarding the reduction of promethazine.

Best regards

Markus

[Altostrata]

I also agree that gabapentin tapering should be next. After that, rescheduling the benzo to avoid the adverse effects you're probably mistaking as withdrawal.

[Bullitt1968]

@Altostrata

 

Dear Altostrata,

I am currently dealing with the legal side. Is there a binding living will for psychiatry? I am afraid that if I have to go to a psychiatric ward because of acute self-endangerment and then tell them about physical dependence on antidepressants, they will declare me insane and carry out a benzodiazepine withdrawal against my will.

I have a history of this, I have experienced something similar before when I was voluntarily admitted to the ward from the psychiatric day clinic because I was very afraid that I might harm myself and I told the senior doctor on the ward that I had been given lorazepam as a requirement in the day clinic and had now been given it there every day for more than two weeks and that there was therefore already a physical dependence and that the lorazepam could not simply be left out because that could lead to a bad cold withdrawal. What did the senior doctor do? Right: took the Lorazepam away from me and I was in cold turkey for 3 days, this led to a trauma, 3 days and 3 nights full of panic and fear with strong psychological and physical withdrawal symptoms, in the 3 days I asked more than 10 times to check the medication, to call the day clinic and to have it confirmed that I was physically dependent and that the Lorazepam had to be restarted immediately. Nothing happened. For three days and nights, I was told by different nurses "You have to endure this!"

I don't want to experience that again! Jurisdiction in the USA is certainly different than in Germany. I would be interested to know how you regulate this, what you recommend. We have such a decree, but it is so complex that not even a lawyer can understand it and it is not legally binding.

 

[Altostrata]

Sorry, I'll consult only on tapering. Please do not tag me for other reasons.