concerned: Zyprexa withdrawal

[concerned]

Hello Everyone! 

 

My psychiatrist provided me Zyprexa (20 mg) to divide and use PRN when "manic."  I took one 10 mg dose, then a series of 5 mg doses over three to four weeks.  Since my first dose, I have continued to experience brain fog, memory loss, and depersonalization.  My family intervened and (fortunately) the total exposure was 55 mg (maybe less). My average daily dose was around 2 mg over the nearly the month I took it.

 

The last 5 mg dose was on June 6th, 2022, this was when the tinnitus began but has seemed to improve some (though still present).

 

[Withdraw Begin] Tuesday (June 14, 2022): I was lethargic and vomited after eating a meal, while experiencing loose stools. Slept all day after taking a Zofran. The timing of this makes sense, as this marks (nearly) four elimination half-lives of Zyprexa. 

 

Wednesday (June 15): Napped all day and my family went out to eat. I was very removed from the conversation, feeling trapped in my mind. After nearly 20 minutes, I just remembered that I went to the grocery store and package store. My anxiety began to manifest and only slept four hours that night with 10 mg melatonin. 

 

Thursday (June 16): I cannot remember this day at all (which was yesterday). I faintly remember being an anxious wreck having to pace. I entirely forgot that I went on a car ride with my mom. I woke my mom up in distress around 2:30 am to help talk me down (I thought this happened yesterday). I have no idea if I slept last night or not, if I did it was very light. 

 

Friday (June 17): I don't remember this morning. I think I sat anxious for hours until my mom gave me 30 mg of CBD. This seemed to help for several hours, allowing me to go outside and do some yard work to sweat. This, combined with the CBD, made me feel like I had improved some. This feeling has somewhat wore off three hours later. I am concerned with getting sleep tonight. I am feeling very hopeless.

 

I reached out to my past psychiatrist which assured me nothing I'm going through is likely permanent, though I wasn't able to give him nearly enough detail. My current psychiatrist still has not returned my call. 

 

I have several questions (well, reassurances... I understand no one can tell the future):

 

(1) Has anyone else experienced this severe of memory loss and recovered (preferably within six months)?

(2) Based on my history (low total dose, short length of treatment, current symptoms), are my withdraw symptoms normal? 

(3) Would going back on a low dose of Zyprexa improve my recovery? I went off of the drug for the same issues I have now and would be skeptical to consume more.

(4) My cognitive issues are seemingly worse without the medication in my body, is this normal?

 

I began magnesium, fish oil, and stress B-complex today. I believe my brain will benefit from not staggering these. I intend on sweeting everyday.

 

Fortunately, I have a very supportive family and do not have to worry about anything other than recovering (I'm 25 years old).

 

I feel like in the past year, I have been robbed of my intelligence and personality. I was supposed to return to college in two months, but that is likely out of the picture. I am hopeful for beginning this spring in six months.

 

I have read so many horror stories from Zyprexa causing lasting damage. 

 

Thank you all for your support! 

 

 

[concerned]

Reinstating Zyprexa after Withdraw

 

Hello everyone!

 

I've been on various psychiatric medications over the past 18 months and believe I have kindled my brain.

 

When I began Zyprexa, I started having memory problems and cognitive issues.  My exposure to the drug lasted over a month, consisting of 5 mg doses PRN (cumulative dose = 55 mg).  I last took Zyprexa on June 6th, 2022 and began experiencing withdraw symptoms on Tuesday, June 14th (I had no idea what was happening at first). I believe it was the on and off dosing that triggered this event. My memory is so poor that I can't remember what happened earlier in the day, let alone yesterday.

 

I remember puking once, with GI issues the first day.  Since, I have crippling anxiety, severe insomnia (haven't slept in three days), and hopelessness. 

 

After reading this forum, I took my first reinstatement dose (approximately 2.5 mg) on Friday, June 17th.  This was four days after withdraw symptoms began and eleven days after my last dose (around four elimination half-lives).  I'm not sure if I'm feeling better, but I am certainly not feeling worse.  

 

How should I adjust my reinstatement dose? When will I start benefiting from reinstatement? 

 

Will my memory improve? I am entirely dependent on my family right now and cannot take care of myself (25 years old).

 

I'm just trying to find some hope. 

 

I worry my physician will not know what to do.

 

Thank you very much!

(I made a post last night and understand it needs approval, but I cannot find it on my profile history)

 

 

Edited June 18, 2022 by ChessieCat
added Intro topic title before merging with intro topic

[Altostrata]

Welcome, @concerned

 

I see you have a number of drug switches in the last several months. For what reason were all these drugs prescribed?

 

How did you feel in March-May, after you had gone off lithium ER, Seroquel ER, Wellbutrin ER, and guanfacine ER and before you took Zyprexa? 

 

It is quite unusual for Zyprexa to be prescribed PRN. Did you take it every day May 14 to June 6?

 

What is your sleep pattern now?

 

[concerned]

For what reason were all these drugs prescribed?

 

For bipolar disorder, which was recently changed to GAD, MAD, and PTSD. I should have never been on many of these medications.

 

How did you feel in March-May, after you had gone off lithium ER, Seroquel ER, Wellbutrin ER, and guanfacine ER and before you took Zyprexa?

 

I apologize for any misunderstanding: 

 

I began lithium ER (1200 mg) and Seroquel ER (300 mg) in March 2021. I am still on lithium ER, but withdrew from Seroquel ER in late April 2022. This occurred over one week, at the direction of my physician. 

 

Lamotrigine ER (50 mg) was initiated late-January 2022. Two days before my acute withdraw symptoms occurred (June 12th), I discontinued this medication without taper, again, at the direction of my physician. 

 

Wellbutrin ER (300 mg) and Guanfacine ER (6 mg) were added March 2022, and still remain on those medications. This was for hypersomnia and ADHD, respectively.

 

I have been having some memory issues since this spring (2022), but was able to pass my fourth semester of medical school. They became much worse when I began the Zyprexa mid-May. 

 

Zyprexa was prescribed PRN as a “fire extinguisher” meant to quell manic symptoms and insomnia. I first took Zyprexa mid-May 2022 at 10 mg, to “test how I would respond.” From that point on, I took nine 5 mg doses over the next three-to-four weeks. Maybe less, as I was using a pill cutter to quarter 20 mg tablets. During this period I began experiencing noticeable memory issues and I “wasn’t myself” to family. That is when I chose to discontinue the PRN dosing. The last 5 mg Zyprexa dose was on June 6th. Nearly four half lives later, I began having acute withdraw symptoms. This included not sleeping for four days, extreme anxiety and panic, severe short term memory loss, lacked emotions other than despair. After reinstating Zyprexa (2.5 mg) two days ago (so only two doses so far), everything has improved some, except for: memory issues, constipation (haven’t went in five days), libido is shot (although I was able to finish this morning, purely to see if that was broke as well). Oh and I have some tinnitus that began this morning. This also occurred the day before my last dose of Zyprexa, I took it because I thought they were hallucinations.

 

So I believe I have been withdrawing for several weeks, off and on, and just recently had acute symptoms when my plasma levels dropped low enough.

 

I slept probably 12 hours last night, but it felt weird. There were some streaks of light when I would close my eyes. I’m happy that I’m sleeping though.

 

Two questions:

 

(1) Should I lower my reinstatement dose, to make tapering one day easier? 

 

(2) If other symptoms are improving, should memory, constipation, and libido follow?

 

Thank you very much!

[Altostrata]

What times o'clock do you take your drugs, with their dosages?

 

23 hours ago, concerned said:

Zyprexa was prescribed PRN as a “fire extinguisher” meant to quell manic symptoms and insomnia.

 

You went off 300mg Seroquel ER over a week in late April. When did these "manic symptoms and insomnia" appear, when previously in March you had "hypersomnia and ADHD"?

 

You started taking 2.5mg Zyprexa daily on June 18? If I were you, I might reduce this to 1mg, that should reduce the adverse effects.

[concerned]

Morning (upon waking ~10:00 AM):

- fish oil ( >1000 mg DHA & EPA)

- magnesium (140 mg)

- Metamucil (1 tsp.)

 

Night (before bed ~12:00 PM):

- Zyprexa (1.25 mg) [BP1]

- lithium ER (1200 mg) [BP1]

- Wellbutrin XR (300 mg) [Hypersomnia]

- baclofen (30 mg) [Sleep Consolidation]

- Intuniv (6 mg) [ADHD & PTSD]

- fish oil ( >1000 mg DHA & EPA)

- magnesium (140 mg)

- Metamucil (1 tsp.)

 

Now that my memory has improved some: 

 

January 2022, I discontinued Seroquel, no taper, for one month. This was due to persistent sexual side-effects (which abated upon reinstatement). During this time I was dysthymic, slept constantly, and began to have memory issues. Due to this, I reinstated. All associated symptoms improved to a meaningful degree, though still were a burden. I attributed these symptoms as side-effects of the drug, rather than withdraw effects. Due to these persistent symptoms, my physician agreed to tapering off of Seroquel, over one week, late April 2022. My hypersomnia and dysthymia became non-issues, though the memory issues remained the same. It was not until the introduction of Zyprexa that things became worse.

 

There were no mania or insomnia symptoms when Zyprexa (10 mg) was initially introduced around mid-May 2022. This initial administration was to prove if I tolerated the medication, so if mania or insomnia arose, I would be prepared. Now this is where things get very fuzzy, as I cannot remember much after mid-May 2022: Several days after the first dose of Zyprexa (10 mg) I began experiencing insomnia, so I administered Zyprexa (5 mg) again, at the direction of my physician. This continued on a PRN basis until the first week of June 2022 (when I discontinued due to my family’s concern). I believe I would take a dose, insomnia would improve for a day or two, then back to square one… another dose, and the process continued. I took a total of 55 mg over a three or four week time time period. During this same time period, and up until reinstatement, I was an entirely different person. 
 

The hypersomnia has been an off and on feature since high school (2012), so nothing new there. The ADHD was actually not the primary reason why I was started on Intuniv (6 mg), it was for my PTSD. Both the Wellbutrin XR (300 mg) and Intuniv were very positive additions. They will be the last to go when tapering begins.

 

I reduced my Zyprexa dose to 1.25 mg. I will report back on this adjustment.
 

Today was better than yesterday (third day of reinstatement). My family says that I am more like myself, since before I CT’ed Seroquel in January 2022. So that’s awesome. My emotions are coming back. I can laugh, cry, and get fired up some. Too much going on at once gets on my nerves more than it used to. My anxiety and insomnia are pretty much resolved. Tinnitus has not been noticeable, except around sleep.

 

Libido still isn’t there. I’m having weird sensations (like icy hot) on the back of my hands, forearms, shins, and genitals. It comes and goes, and hasn’t been painful or incredibly distracting. It does seem to be getting slightly worse day by day.

 

Now, the most concerning: my memory and cognition. I have some difficulty recalling things in the past, prior to mid-May 2022. Everything after that is a blur. I have difficulty remembering what happened this morning, let alone the day before. For example, I was just surprised to see posts that I had made earlier in this thread. My short term memory has very slightly improved, at least compared to the acute withdraw period of four days. My concentration is not terrible, but I have difficulty staying engaged in conversations.

 

I have a few questions:

(1) I believe I am beginning the stabilization phase, which will likely take at least a year. During this period, should symptoms, such as memory, improve? Or is that confined to other areas, such as emotion?

(2) What can I actively be doing to improve my memory and cognition? I am going to begin using the Elevate app and start working through Khan Academy math videos, from the very beginning. Starting a journal, where I record everything that happens may help (at least allowing me to review lost memories).

(3) Is it typical for someone to permanently regress from their initial reinstatement response (well, without having some drug hypersensitivity reaction)?

I have poured over the forum the past several days and unfortunately do not retain tons of information. I have been taking screen shots and keeping tabs to have some record of critical material. 
 

I am incredibly blessed to be out of acute withdraw and am optimistic about the future. I understand this will take time and I’m ready to put in the work.
 

Thank you for helping so many lives. Had I not stumbled across your forum, I may have been stuck in that hell forever. 

[concerned]

The reinstatement adjustment (down to 1.25 mg) seems to have not worsened anything. Should I go for the liquid method and go even lower? 
 

I apologize for all the questions that either cannot be answered or that I could find elsewhere on the forum. I would be interested for some direction concerning question (2) on the previous post. If not, I completely understand. 
 

Thank you again!

[Altostrata]

13 hours ago, concerned said:

Night (before bed ~12:00 PM):

- Zyprexa (1.25 mg) [BP1]

- lithium ER (1200 mg) [BP1]

- Wellbutrin XR (300 mg) [Hypersomnia]

- baclofen (30 mg) [Sleep Consolidation]

- Intuniv (6 mg) [ADHD & PTSD]

- fish oil ( >1000 mg DHA & EPA)

- magnesium (140 mg)

- Metamucil (1 tsp.)

 

Why are you taking all these drugs at the same time at night? Please add the date you started baclofen with dosages to your signature.

 

Please put ALL your drugs in this Interactions Checker and post the report or a link to it in this topic.

 

13 hours ago, concerned said:

There were no mania or insomnia symptoms when Zyprexa (10 mg) was initially introduced around mid-May 2022. This initial administration was to prove if I tolerated the medication, so if mania or insomnia arose, I would be prepared.

 

So you were never "manic"? This seems like an odd decision, to expose you to the effects of a highly risky drug just in case.

 

13 hours ago, concerned said:

Several days after the first dose of Zyprexa (10 mg) I began experiencing insomnia, so I administered Zyprexa (5 mg) again, at the direction of my physician. This continued on a PRN basis until the first week of June 2022 (when I discontinued due to my family’s concern). I believe I would take a dose, insomnia would improve for a day or two, then back to square one

 

We view psychiatric psychotropics generally as "brakes" and "accelerators". When you take too much in brakes, your nervous system rebels against being pressed down, with symptoms of activation and insomnia. This is a paradoxical reaction.

 

You probably did better with 5mg Zyprexa because 10mg was TOO MUCH for your nervous system, particularly given the other drugs you were taking. 1.25 mg might be fine.

 

You are taking these brakes:  Zyprexa (1.25 mg), lithium ER (1200 mg), baclofen (30 mg). Your accelerators: Wellbutrin XR (300 mg), guanfacine

 

Prescribing brakes and accelerators together, especially to be taken at the same time of day, is very stupid. When sleep or anxiety is an issue, prescribing accelerators at all is surpassingly dumb.

 

Given your drug cocktail, it isn't surprising you have low libido, memory, and cognition issues.

 

On 6/19/2022 at 3:00 PM, concerned said:

For bipolar disorder, which was recently changed to GAD, MAD, and PTSD. I should have never been on many of these medications.

 

The ephemerality of your diagnoses, with the stupidity of your drug cocktail and unrecognized drug adverse effects, makes me suspect your doctors don't know what they're doing and none of these diagnoses are correct.

 

From what drug do you think you have withdrawal? From your account, it appears to me you also had an adverse reaction to excessive Seroquel.

 

What is it you want to do with this cocktail? Your current psychiatrist thinks you're on the wrong bunch of drugs? What changes has this doctor proposed? Are you a minor, do you have control over your treatment?

 

 

 

 

[concerned]

Quote

7 hours ago, Altostrata said:

Why are you taking all these drugs at the same time at night?

That's what I was told to do. If you have any suggestions as to changing this, please let me know.

 

Quote

7 hours ago, Altostrata said:

Please put ALL your drugs in this Interactions Checker and post the report or a link to it in this topic.

Major (reduces seizure threshold) = Wellbutrin w/ Lithium (or) Zyprexa (or) Seroquel

 

Moderate:

 

- Intuniv + Balcofen = additive effects in lowering your blood pressure

- Intuniv + Seroquel = additive effects in lowering your blood pressure

- Intuniv + Zyprexa = additive effects in lowering your blood pressure

- Intuniv + Wellbutrin = may add to the side effects of Wellbutrin

 

- Balcofen + Lamictal = increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating

- Balcofen + Lithium = increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating

- Balcofen + Zyprexa = increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating

- Balcofen + Seroquel = increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating

- Lithium + Lamictal = increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating

- Lithium + Zyprexa = increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating

- Lithium + Seroquel = increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening, although it is a rare side effect

 

- Seroquel + Zyprexa = increase side effects such as drowsiness, blurred vision, dry mouth, heat intolerance, flushing, decreased sweating, difficulty urinating, abdominal cramping, constipation, irregular heartbeat, confusion, and memory problems

 

I believe I am withdrawing from Zyprexa, Lamictal, and Seroquel. 

 

The Zyprexa (1.25 mg) reinstatement (four days ago) has come with tremendous improvement in my mood and emotions. 

 

I am beginning to recall last week: My physician had me discontinue (CT) Lamictal (50 mg) last Monday (June 13, 2022). I have what feels like icy-hot gradually covering my body. I attribute this to the Lamictal withdraw.

 

Concerning Seroquel, here's a review of my history with this compound: Beginning in March of 2021, my psychiatrist titrated me up to 300 mg of Seroquel ER. This dose was held until January 2022, where I cold-turkey'ed the medication due to libido issues. This period lasted only one month, due to dysthymia, extreme hypersomnia, and confusion. Upon reinstating, I noticed a slight memory issue (maybe because I was awake to notice), but was able to complete my studies. Upon the direction of my physician, I tapered down from 300 mg of Seroquel via 50 mg reductions every day until April 25, 2022 (this was 57 days ago). My memory issues became somewhat more pronounced and I worried that I may not be able to return to school this fall. Zyprexa certainly sealed my fate.

 

I've tempered my expectations: Would it be possible to reinstitute Seroquel and Lamictal? I have no idea how to run the cost-benefit analysis for this.

 

Thank you very much for your insight. 

[concerned]

Quote

10 hours ago, Altostrata said:

What is it you want to do with this cocktail?

(1) Reinstate Lamictal, only if this would do more help than harm. I assume reinstating Seroquel would not help in my case?

(2) Stabilize and hold for at least six months before hyperbolic tapering (what, I don't know yet... one step at a time).

 

Quote

10 hours ago, Altostrata said:

Your current psychiatrist thinks you're on the wrong bunch of drugs? What changes has this doctor proposed? Are you a minor, do you have control over your treatment?

I think I'm on the wrong drugs and convinced my psychiatrist to start taking me off of them, but not before they tried pushing alternative medications. During one of our early spring appointments, they enlightened me to the fact that: "Those that love the science of medicine, are not good clinicians, that's why I practice the art of medicine." That was my queue to stop taking things at face value. Of note: They bragged, when putting me on Zyprexa, that they have been a national representative for the drug since its inception, 1996. The drug is older than me. 

 

I have known that my psychiatrist is self-serving, self-interested, and finds offense to my input. On Monday, when we spoke, they vehemently denied my acute withdraw symptoms and threatened that if I continue reading "bullsh*t on the internet" they will drop me as a patient. They pressed me to start pulling medications aggressively, but I convinced them that I think it is in my best interest to not make any changes. Fortunately, they wrote me a script for Zyprexa (2.5 mg) after I insisted that reinstatement saved my life. At the end of the conversation, they laughed and reminded me that I had only just completed my second year of medical school.

 

I will have to play ball in order to keep getting refills until I find someone else. I'm calling three different practices to increase the probability of finding someone that will actually listen to me. Until then, I have someone that offered to write me what I need until I find a permanent arrangement (though, I have two months of refills).

 

I am 25 years old and have control over my treatment. I am staying with my mom and twin brother. They have been selfless and understanding through this ordeal. 

 

I watched one of your interviews tonight, it made me very emotional. 

 

Is there any way I can contribute to SA?

[Faure]

46 minutes ago, concerned said:

 

Is there any way I can contribute to SA?

Hello, I’m sorry to read how medicated you are at only age 25. With Alto’s support I hope you will be able to safely reduce your medication load and live a full life. There are more resources coming available, books and films. If you are in the right state of mind to have a look:

 

Medicating Normal, film

Joanna Moncrieff, psychiatrist

Royal College of Psychiatrists, UK leaflet about ADWD
 

There is a donate button at the top of most pages, not always visible, but it is at the moment; it takes you to PayPal ☺️

[Altostrata]

Thanks for the offer of donation.

 

If you have recent changes in several drugs, we can't tell which drug is causing withdrawal effects. It may not make sense to reinstate all the drugs.

 

13 hours ago, concerned said:

They bragged, when putting me on Zyprexa, that they have been a national representative for the drug since its inception, 1996. The drug is older than me. 

 

This is not a good sign.

 

You can see there are potential drug-drug interactions in your cocktail. Do you have any of those symptoms? How's your blood pressure?

 

It's obvious you have the adverse cognitive effects. 

 

On 6/20/2022 at 10:29 PM, concerned said:

Morning (upon waking ~10:00 AM):

- fish oil ( >1000 mg DHA & EPA)

- magnesium (140 mg)

- Metamucil (1 tsp.)

 

Night (before bed ~12:00 PM):

- Zyprexa (1.25 mg) [BP1]

- lithium ER (1200 mg) [BP1]

- Wellbutrin XR (300 mg) [Hypersomnia]

- baclofen (30 mg) [Sleep Consolidation]

- Intuniv (6 mg) [ADHD & PTSD]

- fish oil ( >1000 mg DHA & EPA)

- magnesium (140 mg)

- Metamucil (1 tsp.)

 

Per brakes and accelerators discussion, you are taking a bunch of drugs at night for "sleep consolidation". It doesn't make any sense to have accelerators in the batch to act overnight. If I were you, I'd move 300mg Wellbutrin XR earlier by 2 hours each day until you are taking it in the morning. After that, I'd move Intuniv earlier by by 2 hours each day until you are taking it at noon. 

 

We also want to separate drugs to observe effects of each drug, if we can, and reduce confounding. 

 

After you change your drug schedule and let it settle for a week, I would start tapering baclofen. It's the last one in and, with all those brakes onboard, you may be able to go off it relatively quickly. We don't have a topic specifically about tapering it. 

 

Baclofen comes in a prescription liquid. It probably would be easiest to start with 20mg tablet and 10mg in liquid per day, taper from the liquid. We recommend 10% exponential decreases at each step.

Why taper by 10% of my dosage?

 

 

Combining tablets or capsules with liquid to taper

Using an oral syringe and other tapering techniques

How to make a liquid from tablets or capsules
 
Pharmacy liquids to make suspensions

 

Questions and answers about liquid medications

 

[ChessieCat]

17 hours ago, concerned said:

Is there any way I can contribute to SA?

 

See:

 

Donations gratefully accepted

[ChessieCat]

26 minutes ago, Altostrata said:

If I were you, I'd move 300mg Wellbutrin XR earlier by 2 hours each day until you are taking it in the morning. After that, I'd move Intuniv earlier by by 2 hours each day until you are taking it at noon. 

 

Please note that Alto said to change the Wellbutrin time then AFTER THAT change the Intuniv time.

 

It is important to only make one change at a time.

 

the-rule-of-3kis-keep-it-simple-keep-it-slow-keep-it-stable

 

[concerned]

On 6/22/2022 at 6:53 PM, Altostrata said:

You can see there are potential drug-drug interactions in your cocktail. Do you have any of those symptoms? How's your blood pressure?

 

My blood pressure has been normal at my monthly appointments, beginning with the introduction of Intuniv in March 2022. 

 

On 6/22/2022 at 6:53 PM, Altostrata said:

If I were you, I'd move 300mg Wellbutrin XR earlier by 2 hours each day until you are taking it in the morning.

 

I will start working on that tomorrow. 

 

On 6/22/2022 at 6:53 PM, Altostrata said:

After you change your drug schedule and let it settle for a week, I would start tapering baclofen. It's the last one in and, with all those brakes onboard, you may be able to go off it relatively quickly. We don't have a topic specifically about tapering it.

 

Thought experiment: If I began taking my medications on the same day, one year ago, would baclofen be any more challenging to taper than the others? 

 

I am trying to determine whether I should taper baclofen, shortening my decade(s) long marathon, or lithium, to attenuate cognitive impairment. With classes resuming in two months, I believe shedding some of the lithium may increase my performance. 

 

If I were to proceed with the lithium taper, my target reduction dose would be 300 mg (nominal). Fortunately, Lithium Oral Solution, USP is on backorder indefinitely, so I will be enjoying lithium-laced snack packs for the foreseeable future. I've attached my draft schedule. 

 

I will be posting a one week post-reinstatement review soon. 

 

Thank you all very much! 
 

[concerned]

On 6/26/2022 at 12:25 AM, concerned said:

If I were to proceed with the lithium taper, my target reduction dose would be 300 mg (nominal).

 

On second thought, when I taper lithium, I will drive it to discontinuation.

[concerned]

My chief complaints post-reinstatement are tinnitus and a less than painful burning sensation on my skin that migrates.

 

After investigating ototoxic drugs, I will be eliminating Wellbutrin XL first. Hearing loss is permanent, and lithium-induced cognitive impairment may not be.  I am very concerned about this and believe a rapid taper would be appropriate. As unfortunate as this may be, we have a deep bench of brakes.

 

I believe the burning skin sensation is due to my Lamictal XR (50 mg) cold turkey on June 13th, 2022. All of my other symptoms have gotten better with the reinstatement of Zyprexa (1.25 mg), while the burning skin has had more waves than windows as time goes along (no other symptom has this pattern). Though, I very well may be wrong. 

 

I apologize for the back and forth. I am still trying to make sense of all of this. Thank you all so very much!

[Altostrata]

On 6/25/2022 at 9:25 PM, concerned said:

Thought experiment: If I began taking my medications on the same day, one year ago, would baclofen be any more challenging to taper than the others?

 

It probably would be as challenging to taper as any other. The only advantage in tapering it now is that you started it less than 3 months ago and may not be fully adapted to it yet, thus perhaps making it easier to go off. Also, you are taking 2 other brakes at the same time and may not notice its absence at all.

 

Tapering off Wellbutrin also makes sense. Tinnitus is a common adverse effect, though it might be caused by any of the other drugs or their interactions as well. 

 

As you've been taking Wellbutrin in your nighttime sleep cocktail, it's unlikely it has had any benefit at all. If sleep is a concern, I would move it earlier before beginning to taper it. 

[concerned]

I've been breaking 2.5 mg Zyprexa pills in half for the past month. Would a liquid suspension provide me more stability? 

 

With a 10% margin of error, it seems that my dose should fluctuate between 1.0 to 1.5 mg daily. I'm not sure if this really matters, as I will always take 2.5 mg every two days, with an average of 1.25 mg daily. The elimination half-life for oral Zyprexa is around 30 hours. 

 

If it would possibly help, I'm game.

 

Thank you all very much!

[ChessieCat]

Post #1 of this topic explains the various ways to get non standard doses:

 

tips-for-tapering-off-zyprexa-olanzapine

 

If you change form of a drug it is better to do a cross over:

 

cross-over-changing-form-eg-tablet-to-liquid-of-drug-or-changing-brand-of-same-drug

 

 

Edited July 14, 2022 by ChessieCat

[Altostrata]

17 hours ago, concerned said:

I'm not sure if this really matters, as I will always take 2.5 mg every two days, with an average of 1.25 mg daily.

 

It does matter. We advise NOT to skip doses, that is destabilizing. You should take 1.25mg every day.

Tips for tapering off olanzapine (Zyprexa)
 

[concerned]

I’m sorry for the misunderstanding, I never skip doses. I have been splitting the 2.5 mg Zyprexa tablets in two, then taking one half every night. 

 

I was wondering if a liquid suspension would provide me more stability, relative to imperfect splitting of a small unscored pill (introducing daily variability). 

I’m just trying to optimize what I can.

 

Thank you again.

(I was referring to my two-day average in the quote above.)

[Altostrata]

Hello, @concerned how are you doing?

[concerned]

Thank you for reaching out. Relative to my acute withdrawal, I am doing well. 

 

I still have issues with long-term memory, such that by nightfall, I have trouble recalling the major plot points of my day. Over the past month, my constant panic and autonomic symptoms have abated. This relief is likely due to several things: (1) I have reduced Wellbutrin from 300 to 100 mg (SR), and (2) the introduction of propranolol (5 mg TID + 10 mg PRN). I will further reduce my Wellbutrin dose in several days, hold for two weeks, then jump off. My gastroenterologist wrote me a prescription laxative to take daily. Instead, I have been using it on a PRN basis to allow my system a better chance at achieving homeostasis while maintaining enough regularity to mitigate another bout of SIBO. I recently discovered that Intuniv (guanfacine) is often used as a negative control in gut motility studies, representing an intervention promoting constipation. In response to this, I have reduced my dose by 25%, which I believe has provided some benefit. Last but not least, I abruptly discontinued lithium carbonate (1200 mg) four weeks ago due to a reduction in renal function. I have not experienced any deleterious effects. In fact, my processing speed has improved, along with my apathy.  

 

I have taken a leave of absence from medical school due to my recent experience. To keep my brain moving, I have enrolled part-time to finish my graduate studies in biomedical engineering. If, for some reason, I cannot return to medical school within two years, this will allow me to continue building my future. Fortunately, I have past exposure to my current course content, so I am not "forced" to learn anything new. Classes have helped increase my confidence and acclimatization back into the world. It is frustrating that, at the moment, I crave companionship (well, back scratches, really), but I need to wait until I am back to baseline. 

 

Concerning supplements, I have been on a high dose of fish oil (2,000 mg DHA, TID), magnesium (225 mg elemental, TID), immediate-and-extended-release melatonin (3 mg, QHS), along with subcutaneous somatropin (4.0 IU, QHS). I intend on introducing an antioxidant (fisetin, a flavonoid), whey protein isolate, and high polyphenol EVOO soon. As far as self-care goes, I hike deep into the woods to fishing holes, spend quality time with family and friends, and constantly work outside in the yard. 

 

Since I hit my target dose of growth hormone two weeks ago, my sleep has significantly improved. I wake up refreshed, no longer experiencing sleep inertia. Please note that I am following a protocol designed by a TBI specialist in Spain. The target dose is physiological, as it places me in the 95th percentile of males my age (+2 STDEVs). I have been monitoring my blood glucose without event. I will run it for three months, then one month off, until I have completed my taper. My next major intervention may be intranasal insulin, but I am months away from fully understanding its implications in my unique context.  

 

On a side note, I spoke with Dr. Stuart Shipko several hours ago. This phone call was very encouraging and provided me with well-needed validation. 

 

I have yet to find a more receptive psychiatrist, though I feel like I am getting close. My tentative plan is to begin tapering Zyprexa in January, approximately six months post-reinstatement. Assuming my memory impairment has not improved by then, should I wait to start tapering? 

 

Thank you again for this resource. It has been a blessing. 

 

I am looking forward to writing my success story in a few years.

[concerned]

For reference, I sent this message to moderator on August 10th, 2022 (nearly one month ago):

 

Quote

Hello Alto --

 

Have you come across anyone that has experienced kidney damage from withdrawal? 

 

My eGFR has dropped 40% in the past two months.  I suspect that an unrelenting, excessive sympathetic tone has critically reduced renal perfusion via vasoconstriction.  I have discontinued lithium (CT), but fear that this will only provide a marginal, though, important deacceleration.  I do not want to post this because honestly, I'm terrified and do not want to potentially trigger anyone else.  Once I know more, I will do a write-up on my introduction.

 

My other symptoms:

 

[GEN] low-grade fever, fatigue, malaise

[NEU] headache

[COG] anterograde amnesia (vivid recall limited to hours), word-finding difficulty, disorientation, etc. (executive function preserved, guanfacine)

[PSY] anxiety punctuated by panic attacks, delayed sleep phase, poor sleep quality, emotional liability

 

[GI] constipation (requiring maximum dose prescription), stool smelling strongly of ammonia (occasionally, breath), abdominal pain [consult tomorrow]

[URO] stage 3 kidney disease, sexual dysfunction [consult TBA]

[HEENT] astigmatism (attributed to dry-eyes), tinnitus, dry mouth (may be causative to first cavity)

[CVD] palpitations (during panic attacks)

 

The weeks of impressive improvement that followed reinstatement made me question the "Surviving" in "Surviving Antidepressants." 

 

I get it now.

 

For anyone that may read through my introduction, things can improve drastically in a matter of weeks. I was suffering greatly.

 

My renal function will be assessed in two months, hopefully things have improved. This is the main source of my health anxiety, and rightfully so. 

[Altostrata]

16 hours ago, concerned said:

(1) I have reduced Wellbutrin from 300 to 100 mg (SR)

 

How did you reduce Wellbutrin to 100mg? Did you feel any unusual symptoms after doing this? When was the last time you made a dosage change of any of your drugs?

[concerned]

27 minutes ago, Altostrata said:

How did you reduce Wellbutrin to 100mg? Did you feel any unusual symptoms after doing this? When was the last time you made a dosage change of any of your drugs?

 

I reduced my Wellbutrin dose 200 mg, from 300 (XL) to 100 mg (SR), on August 13, 2022. I made such a large cut for several reasons: (1) Wellbutrin dosing must be adjusted when there exists [renal impairment], (2) I had just removed a major brake, lithium carbonate, and feared my panic, palpitations, insomnia, etc. was going to be amplified. This was one of those scenarios I chose to expedite due to adverse reactions. Also note, I have been dividing my 100 mg (SR) dose into two doses, upon waking and mid-afternoon. 

 

My taper length, not dosing schedule, somewhat follows your experience of reducing 50 mg per week, where I made a larger reduction and held it for four weeks. In several days, I intend further to reduce my dose to 50 mg for one week, then 25 mg for my last week before jumping off. 

 

I didn't experience any unusual symptoms but rather immediate relief. Since making these medication changes nearly one month ago, many of my symptoms have continued to improve. 

 

I have updated my signature concerning medication changes. 

[concerned]

Although, I may extend my last taper dose of 25 mg to two weeks, rather than one week. 

[Altostrata]

16 minutes ago, concerned said:

I didn't experience any unusual symptoms but rather immediate relief. Since making these medication changes nearly one month ago, many of my symptoms have continued to improve. 

 

Did you have adverse effects from Wellbutrin from when you started it in March?

 

17 minutes ago, concerned said:

I intend further to reduce my dose to 50 mg for one week, then 25 mg for my last week before jumping off. 

 

Do you mean 25mg Wellbutrin twice a day, then 12.5mg twice a day?

[concerned]

42 minutes ago, Altostrata said:

Did you have adverse effects from Wellbutrin from when you started it in March?

 

Yes, I did experience side-effects when I started Wellbutrin, much like the one's I had before lowering my dose four weeks ago.

 

42 minutes ago, Altostrata said:

Do you mean 25mg Wellbutrin twice a day, then 12.5mg twice a day?

 

For the past four weeks I have been taking 50 mg twice per day.

This upcoming week I will be taking 25 mg twice per day.

Then the following week(s), I will be taking 12.5 mg twice per day. 

 

17 hours ago, concerned said:

My tentative plan is to begin tapering Zyprexa in January, approximately six months post-reinstatement. Assuming my memory impairment has not improved by then, should I wait to start tapering? 

 

Would you offer your opinion on this? Let's say memory impairment is my only residual symptom.

 

Thank you for your help.

[Altostrata]

It's too bad you stayed on Wellbutrin despite those adverse effects.

 

3 hours ago, concerned said:

For the past four weeks I have been taking 50 mg twice per day.

This upcoming week I will be taking 25 mg twice per day.

Then the following week(s), I will be taking 12.5 mg twice per day. 

 

I would put at least 2 weeks between the reductions to 25mg and 12.5mg twice a day, to make sure you don't get withdrawal symptoms. If possible, I'd add another reduction, to 6.25mg twice a day.

 

January seems reasonable to start tapering Zyprexa.

[concerned]

2 hours ago, Altostrata said:

It's too bad you stayed on Wellbutrin despite those adverse effects.

 

The side-effects “went away” after a few weeks, then were amplified following my acute withdrawal.
 

2 hours ago, Altostrata said:

I would put at least 2 weeks between the reductions to 25mg and 12.5mg twice a day, to make sure you don't get withdrawal symptoms. If possible, I'd add another reduction, to 6.25mg twice a day.

 

That sounds like a better plan. 
 

Thank you again for your help. I will stop back in once I finish the Wellbutrin taper in a month or so.

[concerned]

I started metformin [500 mg ER, BID] as prophylaxis to [olanzapine-induced metabolic dysfunction] on September 10, 2022. Metformin must be adjusted when there exists [renal impairment]. Also, it is suggested that individuals [temporarily discontinue] the medication when they are sick.  These adjustments prevent metformin's toxic accumulation, which can lead to lactic acidosis. Although I'm currently on a low dose of olanzapine, my exposure will be two years or more due to tapering. Interestingly, [melatonin] has shown similar efficacy in this setting. 

[Altostrata]

Are you getting regular kidney function tests?

[concerned]

The metformin was from my GP.

 

My psychiatrist said it is routine to retest renal function three months from an abnormal draw. Which, if you believe lithium was the primary cause of renal dysfunction, that’s rational (assuming discontinuation). But the steep reduction in function, in an athletic 25-year-old, with only 15 months of exposure, my differential would have more depth. It’s unfortunate that the majority of physicians stop reading after residency. 

I will be retesting function in a few weeks from an independent lab. 

Note: This is the quack that threatened to drop me, and pull my refills, if I kept reading “bull****” online. I’d like to see how well he dances. 

[Altostrata]

You've just reduced from 100 Wellbutrin SR to 50mg SR? You'll still have to take this in split doses. Please let us know how you're doing.