54fiftyfour: trazodone WD

[54fiftyfour]

Yesterday evening I had a strong attack of depression and fatigue. It is lasting this morning too, despite the fact I slept eight hours.

 

I'm still in my bed and am not able to do anything. I'm really desperate, also for the sufference of my family and the possibility to lose my job.

 

Clonazepam dosage: 0,18 mg. in the morning and 0,5 at night.

[54fiftyfour]

Shep,

 

I don't perceive any significant difference after the reduction of 3% (0,18 mg. in the morning). Symptoms can change between and during day, as usual. Today, for example, anhedonia is  strong, anxiety and depression are lower. Sleep, however, is clearly going better and I''m focusing on this important result. I'm still clearly under the effect of trazodone WD. Sofar I decided to mantain 0,5 mg. at night, following your advice. Please, let me know what you think, if you can.

[Shep]

1 hour ago, 54fiftyfour said:

Shep,

 

I don't perceive any significant difference after the reduction of 3% (0,18 mg. in the morning). Symptoms can change between and during day, as usual. Today, for example, anhedonia is  strong, anxiety and depression are lower. Sleep, however, is clearly going better and I''m focusing on this important result. I'm still clearly under the effect of trazodone WD. Sofar I decided to mantain 0,5 mg. at night, following your advice. Please, let me know what you think, if you can.

 

I would hold for awhile and see if the improved sleep brings a stronger baseline. If you feel that the symptoms of anhedonia is a side effect of the daytime benzo dose, you may want to slowly move that dose to add to your nighttime dose. It's best to move the morning dose slowly, one hour per day. So if you take it at 8 am, for example, tomorrow take it at 9 am. The next day take it at 10 am and so on until you have it moved to nighttime. However, if you feel that you would go into interdose withdrawal, you may not want to do that. Some people are fine with only taking clonazepam once a day and others report that it helps to take it twice a day. 

 

Are you still on vacation? If you've been having different foods than usual while on vacation, staying up later than usual, or being in more stimulating situations such as being around a lot of people, some of your symptoms may be from that. The fact that your sleep is improving is a great sign of resiliency. 

[54fiftyfour]

On 7/20/2022 at 12:54 PM, Shep said:

At this point, you have four choices:

 

1. Stop the benzo cold turkey. This will likely cause your nervous system to crash, so not a good idea. While tolerance, side effects, paradoxical effects, and adverse reactions are bad, you have to weigh that against pulling the vine off the trellis too quickly (to use an analogy in the "How Psychiatric Drugs Remodel the Brain" thread linked earlier in this post). For more on cold turkey, please see - Cold Turkey and Too-Fast Tapers
2. Stay on the benzo forever.  This would likely cause more problems than coming off, especially in the long run. 
3. Add back in a small amount of mirtazapine. This is an option, but you would have to stay on your current dose of benzo long enough to establish some sort of baseline because of the ripple effect of the waves from earlier periodic benzo dosing. It looks like you may already be stabilizing by getting some sleep last night. We've been pushing the benzo advice more in your case because it's the first step to seeing if a reinstatement of the previous drug is even needed or if it may make things worse for you. 
4. Taper the benzo at 10%. This is a good compromise to mitigate withdrawal symptoms while still getting off the drug. You would only do this if you don't reinstate the mirtazapine. If you reinstate the mirtazapine, you would need to stabilize first and then determine which drug is helping the most with sleep. The drug that helps the most with sleep is the drug you would taper last, as preserving sleep is key. 

 

Thank you, Shep.

 

Symptoms of anhedonia are certainly amplified by clonazepam, expecially in the morning.

 

On July, 20, when my sleep was worse then now, you presented me this four hypothesis. I would exclude the first three and slowly try the fourth. As I explained, clonazepam is not a good drug for me. I can't perceive all this benefits that it should "theoretically" give. Besides it worsen my sexual problems, causing an additional strong stress. My psychiatrist also told me that, over time, it will stop producing hypno-inducing effects. This is not so motivating to follow the second hypotesis.

 

Now I'm reducing only the morning dose of 10% a month (3% of total dose). Instead of adding it in the night, could it be a good compromise to mitigate trazodone WD symptoms while still continuing to get off clonazepam (at least morning dosage) and waiting to verify if the improved sleep brings a stronger baseline?  

 

 

 

 

 

[Shep]

2 hours ago, 54fiftyfour said:

Now I'm reducing only the morning dose of 10% a month (3% of total dose). Instead of adding it in the night, could it be a good compromise to mitigate trazodone WD symptoms while still continuing to get off clonazepam (at least morning dosage) and waiting to verify if the improved sleep brings a stronger baseline?  

 

Reducing by 3% of the total dose is very reasonable. Let us know how you're doing over the coming weeks. Hopefully the improved sleep will lead to a stronger baseline. While the hypnotic and sleep-inducing effects can decline over time, the goal is to get off the drug without causing withdrawal symptoms that are worse than any loss of effectiveness. It's a delicate balance and your symptoms will be your teacher, guiding you when it's safe to continue tapering and when it's best to hold and let your nervous system rest for awhile. 

[54fiftyfour]

2 hours ago, Shep said:

Reducing by 3% of the total dose is very reasonable

 

It is very reasonable at the present time, as trazodone WD symptoms, also today, are always strong. I hope that something will improve, becouse reduction of 3% a month requires six years and more to be completed. Frankly, it seems too much. If things don't get worse, I would like to speed the reduction a bit. 

 

2 hours ago, Shep said:

Hopefully the improved sleep will lead to a stronger baseline.

 

It occurs to me that, in 2009, paroxetine WD symptoms didn't stop me from sleeping during night, but days were really terrible. Based on your experience, is there a correlation between good sleep and symptoms relief?

[54fiftyfour]

22 hours ago, Shep said:

 

Reducing by 3% of the total dose is very reasonable. Let us know how you're doing over the coming weeks. Hopefully the improved sleep will lead to a stronger baseline. While the hypnotic and sleep-inducing effects can decline over time, the goal is to get off the drug without causing withdrawal symptoms that are worse than any loss of effectiveness. It's a delicate balance and your symptoms will be your teacher, guiding you when it's safe to continue tapering and when it's best to hold and let your nervous system rest for awhile. 

 

Shep,

 

I could think that, probably, clonazepam has already lost its effectiveness. To be honest, I did never perceive great result from it, but now it seems that the dosages are nomore sufficient and I developed a certain grade of  tolerance or abstinence. Sometime I think that clonazepam is causing more problems than trazodone WD symptoms. 

 

Yesterday and today I remained in a constant state of underlying and paralizing anxiety with slight headhache. It's like I should need more drug to get it away, but I don't want to do that. What could the right behaviour be, if this symptoms enhance? To resist and wait?

[Shep]

Please work on non-drug skills. 

 

Non-drug techniques to cope with emotional symptoms

 

Find some healthy distractions to focus on. That will help pass the time during your hold. 

[54fiftyfour]

Reading a post of Brassmonkey about mgai and mgpw (I confess that I was not able to understand much), I had a doubt.

 

To reduce the dose of clonazepam (Rivotril - 1 ml = 2,5 mg; 1 drop = 0,1 mg) from 0,2 mg. to 0,18 mg. (-10%), I fill with water a graduated cylinder of 100 ml. up to 50 ml. Then I add two drops (0,2 mg.), mix well and take off 5 ml, drinking what remains (45 ml.).

 

Is it correct?

[Shep]

On 8/30/2022 at 7:26 AM, 54fiftyfour said:

To reduce the dose of clonazepam (Rivotril - 1 ml = 2,5 mg; 1 drop = 0,1 mg) from 0,2 mg. to 0,18 mg. (-10%), I fill with water a graduated cylinder of 100 ml. up to 50 ml. Then I add two drops (0,2 mg.), mix well and take off 5 ml, drinking what remains (45 ml.).

 

Is it correct?

 

Adding 2 drops (0.2 mg) into 50 mL of water means you have .004 mg per mL. If you drink 45 mL, then you are taking 0.18 mg. This is correct. This is a 10% reduction of 0.2 mg. 

 

You can double check this by the fact that 45 mL is a 10% reduction from 50 mL. 

 

How are you feeling? How is your sleep? 

[54fiftyfour]

Thank you again, Shep.

 

Sleep varies from 4.30 to 7 hours. For now I'm not complaining, if I think about four months ago (2 or 3 hours). Nomore motor agitation before and during sunrise onwards.

 

Monday with very low anxiety, so much that I went out to eat with a friend. Yesterday and today I feel agitation and derealization again.

 

Various fibromyalgia pains and loss of 14 kilograms in four months.  

 

Mood is a mess: despair, resignation and strong depression with crying fits. Total anhedonia.

 

During 15 days at 0,18 mg. in the morning, I felt a little less numb and grogginess after taking the dose. The rest of symptoms remained unchanged, but they can have different intensity from day to day and along the same day.

 

In this two weeks I'm trying to reduce the morning dose to 0,17 mg., while keeping the night one at 0,5 mg. The total would be -4,3% in a month, tapering gradually from 0.7 to 0,67. Sounds potentially dangerous?

[54fiftyfour]

Today (Thursday) is like on Monday: very low anxiety and agitation. Hope that this "truce" lasts, at least until tonight... 

[Shep]

22 hours ago, 54fiftyfour said:

In this two weeks I'm trying to reduce the morning dose to 0,17 mg., while keeping the night one at 0,5 mg. The total would be -4,3% in a month, tapering gradually from 0.7 to 0,67. Sounds potentially dangerous?

 

You're currently taking 0.18 mg in the morning and 0.5 mg at night. This is a total of 0.68 mg. 

 

Reducing the morning dose to 0.17 mg would be a reduction of 0.01 mg, which is a 1.5% reduction of your current total daily dose and would bring you down to 0.67 mg in total. 

 

You mention tapering from 0.7. If you were to make this reduction within a month of when you were last at 0.7 mg, then that would be a total of 0.7 mg - 0.67 mg, which is a 4.3% reduction. Again, you are correct in your math. I don't think this is potentially dangerous, however, if you feel you need to hold longer and give yourself time to stabilize more, than please do so. It's best to err on the side of caution. 

 

Your symptoms will be your guides and teachers along the way. It sounds like you're learning to pay attention to them and that's great. 

 

Please update your signature with your recent reduction. A direct link is here:

 

 Account Settings – Create or Edit a signature.

 

 

[54fiftyfour]

During this week I will monitor my symptoms, in particular anxiety and agitation. Let's see how it goes on. If they remain stable or improve, I would like, next week (6-12 september), to try reducing further 0,01 mg. in the morning and 0,025 at 23.00. The night dosage is too strong for me: it makes me wake up with headhache and increases general depression. The total reduction from August 15 would be weekly gradual and almost 10% in a month. I hope not to crash.

[54fiftyfour]

Anyway, my decision will depend by the symptoms. May be the night reduction could be too high (from 0,5 to 0,475 mg.). I could perhaps think to lower it or to compensate the nocturnal -5% without reducing the morning dosage. We will see.

[54fiftyfour]

Sorry, just a curiosity. I visited benzobuddies website and was really amazed, when I read that, albeit indicatively, it recommends a 10% stepwise dose reduction every 7-14 days, not every month. Is their suggestion reliable and based on concrete experience? Not too fast?

 

http://www.benzobuddies.org/forum/index.php?PHPSESSID=c53bqtle23ugfvb45t8qcvfl44&topic=9522.0

[ChessieCat]

1 hour ago, 54fiftyfour said:

I visited benzobuddies website and was really amazed, when I read that, albeit indicatively, it recommends a 10% stepwise dose reduction every 7-14 days, not every month.

 

SA's suggested tapering protocol for any psychiatric drug is no more than 10% with a hold of at least 4 weeks.

 

And to listen to your body/symptoms and not to reduce again unless stable. or at WDnormal.

[Shep]

13 hours ago, 54fiftyfour said:

Sorry, just a curiosity. I visited benzobuddies website and was really amazed, when I read that, albeit indicatively, it recommends a 10% stepwise dose reduction every 7-14 days, not every month. Is their suggestion reliable and based on concrete experience? Not too fast?

 

http://www.benzobuddies.org/forum/index.php?PHPSESSID=c53bqtle23ugfvb45t8qcvfl44&topic=9522.0

 

Benzo Buddies is a social site and not considered very reliable when it comes to tapering advice. It's based on the out-dated 1980s model of benzo tapering from the Ashton Manual, not the harm-reduction approach SA uses. The owner of that site is rarely active and isn't doing any research to update their tapering protocol based on the latest research. 

 

[54fiftyfour]

Since few days ago I began to feel some negative effects of gradual reduction of clonazepam. During night, anxiety rises in the solar plexus and cervical area with some cardiac palpitations, disturbing sleep. It's not overwhelming sofar, but just alarming and lasting during day. I perceive it's something new, not related to trazodone WD. Last night I had unusual chills and continuous awakenings. Consider that sleep was lately good, now it is a little worsening.

 

From August 8 (about a month ago), I gradually reduced the morning dosage from 0,2 to 0,17 mg. (-15%) and, from september 1, I tapered the night dosage from 0,5 to 0,48 mg. (-4%). The total daily reduction was -7,1% (from 0,7 to 0,65 mg.).

 

Clonazepam is terrible for me. It increases my depression and suicidal thoughts a lot, makes me speak badly and wheeze, keeps me fatigued and with muscle aches. This is the reason of my desperate attempt to taper at least a little bit. 

 

I know, however, that WD sympoms could be even worse. What should I do now? First thing, to stop tapering, I suppose, and hope the symptoms  subside. Or could it be necessary to restore the "old" daily dosage?

 

Guys, I'm really exhausted. 

 

 

[54fiftyfour]

Anxiety is becoming extreme in the afternoon. These are not my obsessive thoughts, but a form of abstinence. Any advice?

 

 

[Shep]

 

23 hours ago, 54fiftyfour said:

I know, however, that WD sympoms could be even worse. What should I do now? First thing, to stop tapering, I suppose, and hope the symptoms  subside. Or could it be necessary to restore the "old" daily dosage?

 

You could go back to where you were on August 30 or maybe a bit less then that because your nervous system may already be adjusting to that lowered dose. Or you could hold until you stabilize and then do a micro-taper going forward (5% or less a month). 

 

Please use English in your signature. 

 

[54fiftyfour]

An update from my last post (September, 5).

 

After a few days of extreme anxiety, my situation seemed to stabilize and, in the following days, I reduced the night dose of 0,01 again, mantaining a good sleep (up to eight hours).

 

Summarizing the tapering over a month:

 

Starting situation (July, 12 - August, 14): 0,2 morning and 0,5 night - Total/day: 0,7 mg.

 

Outcome of gradual reduction of next month (August, 15 - September, 11): 0,16 morning (-20%) and 0,47 night (-6%) - Total/day: 0,63 mg. (-10%).

 

At this point I kept 0,47 night dose for three more days with good sleep. From September, 15 to now I reduced only the night dose of 0,01 mg (0,46 mg., -2,1%), but I quickly begun to feel bad changes:

- sleep is worse (lighter, less hours and more interruption);

- headhache during night and in the morning;

- shiver and anxiety from six/seven o'clok, before taking the morning dose (0,16 mg.).

 

At this point I blocked the tapering process, but I don't know if it's correct just waiting that my body stabilizes, or the situation can get worse and I should increase the dose. If I remain stable, the daily reduction will remain -1,6% (from 0,63 to 0,62 mg.) untill the end of the second month (October, 9).

 

During day, I can have some anxiety attack, but my main symptom is strong depression and anhedonia.

 

[54fiftyfour]

I read very carefully Shep's post on "hypersensitivity and firing".

 

My medical history is full of  assumptions and deactivations of psycho-active drugs (including finasteride) with cold turkey and adverse reactions.

 

I must deal with both AD and benzo withdrawal symptoms and I reasonably presume I don't have the necessary serotonin metabolism to mediate the neurotransmission between GABA and glutammate.

 

Clonazepam, in the long term, reduces GABA receptors and can modify the genic expression of neurons. No guarantee that this changes, once they happen, are restorable as before.

 

My hypersensitivity is at the limit and the risks of firing are very, very high. I moght also have already developed a certain form of clonazepam tolerance and, in this case, I would not know what to do.

 

With these premises, my tapering process promises very long, difficult and frustrating. I don't want to be pessimistic, but only realistic.

 

Certainly there have been some degrees of improvement from the acute phase of trazodone WD. That must be said, but my sufference is (and will be) still very high.

[54fiftyfour]

Shep, can you kindly post some reply? I really need to know what you think. Thank you.  

[Shep]

 

26 minutes ago, 54fiftyfour said:

I moght also have already developed a certain form of clonazepam tolerance and, in this case, I would not know what to do.

 

I don't think that's the case here. You wrote:

 

1 hour ago, 54fiftyfour said:

An update from my last post (September, 5).

 

After a few days of extreme anxiety, my situation seemed to stabilize and, in the following days, I reduced the night dose of 0,01 again, mantaining a good sleep (up to eight hours).

 

 

You had stabilized and only started having problems after you made another reduction. This means you're tapering too fast for your nervous system to handle.

 

I would go into a very long hold and see if you can get back to a stronger baseline before tapering again. You may even want to updose a slight amount. It's safe to updose a benzo within 2 - 4 weeks of a reduction. 

 

And then do a micro-taper of 5% or less a month. That 10% reduction was likely just too much for your nervous system to handle. 

 

 

On 9/6/2022 at 6:22 AM, Shep said:

Please use English in your signature. 

 

We really need to have your signature in English. A direct link is here:

 

Account Settings – Create or Edit a signature

[54fiftyfour]

And regarding my post on "hypersensitivity and firing"? Don't you think it is realistic?

[Shep]

6 minutes ago, 54fiftyfour said:

And regarding my post on "hypersensitivity and firing"? Don't you think it is realistic?

 

Sorry, 54, I don't know what you mean by "firing." 

 

Most people who come to this site are in various forms of hypersensitivity. The best advice we can give is to stop tapering and hold until you reach a stronger baseline before tapering again. 

 

The fact that you had stabilized and were sleeping well is a very good sign of resilience. And that happened recently, even after all of the other changes in the past. There's no reason you can't get that baseline again by holding. Continuing to taper past your nervous system's ability to handle this will only lead to more hypersensitivity and kindling. 

[54fiftyfour]

On 9/30/2022 at 1:25 PM, Shep said:

Sorry, 54, I don't know what you mean by "firing." 

 

Sorry, Shep. I mean "kindling" by "firing". The meaning of the post is a great concern for the consequences of my past medical history (too many hotchpotchs) and for the fact that now I'm in trouble again with a mix of prolonged trazodone WD symptoms and clonazepam effects in the short (depression, dysarthria, impotence, etc.) and long term (reduction of GABA receptors and modification of neuron's genic expression). I've been taking Rivotril from four months already and who knows how long I'll have still to take it for not going to abstinence. If what you wrote in the aforementioned post is true, my tapering process will probably involve a lot of suffering becouse of too many assumptions and deactivations of psycho-active drugs (including finasteride) with cold turkey and adverse reactions.

 

I will follow your advice to stop tapering and hold until I reach a stronger baseline before tapering again. I really think I have no other choice. I hope to be able to resist this daily torment.

[Shep]

11 hours ago, 54fiftyfour said:

Sorry, Shep. I mean "kindling" by "firing". The meaning of the post is a great concern for the consequences of my past medical history 

 

Even with your past medical history, you still reported this:

 

On 9/30/2022 at 5:56 AM, 54fiftyfour said:

After a few days of extreme anxiety, my situation seemed to stabilize and, in the following days, I reduced the night dose of 0,01 again, mantaining a good sleep (up to eight hours).

 

This is a sign of resiliency, 54. 

 

You are looking at the worst possible outcome and assuming that's where you're heading. This happens to a lot of us during withdrawal. It may help to remember that withdrawal effects the fear center of the brain, which can make things seem dark, strange, and scary, and we tend to focus on them because we're wired to be on the lookout for danger for our own survival. Due to withdrawal, the fear center of your brain has gone on high alert and it's searching for anything in your memory center to match up to that level of fear. This can cause you to catastrophize and go into spiral thinking. Please see:

 

Dealing With Emotional Spirals

 

"Change the channel" -- dealing with cognitive symptoms

 

 

[54fiftyfour]

Over the months, the autoimmune symptoms worsened. I have subcutaneous pain all over the place, particularly under the ribs and down my back. I also lost 15 kilos in a few months. Is it normal during PAWS? Please, tell me. And what can I do to mitigate them? Taking vitamin D? I don't drink anymore coffee and alcool, avoid gluten and eat fruit and vegetables every day...

 

Clonazepam is destroying me. Every night I take it, I start to feel severe pain in the liver and pancreas area and lose momentarily sleep. I'll have to do some test now. Also, as I already said, Rivotril severely accentuates my depression, causing me to think suicidal especially in the morning. I suspect it aggravates the autoimmune symptoms, too. They are more intense after I take it. Believe me, I can't take this drug for years. It's devastating for my mind and body. Maybe it is not for everyone, but for me I'm sure it is, it's not my hypochondria. Is it possible that nothing can be done to get out of this nightmare?

 

This week I will go to the doctor who, in Italy, administers flumazenil in very low doses to treat benzodiazepine addiction. I'm aware it can be very dangerous for us and I will not take any initiative, but I'm curious to know what he thinks about my situation. One thing is certain: I'll never be able to go on for years with that drug on. It will kill me before I finish to taper it.

[54fiftyfour]

And then, if I have to re-examine everything, clonazepam was never really effective when the symptoms of trazodone WD (anxiety, agitation, insomnia, akathisia, etc.) became acute. It has only been helping me to sleep for a couple of months becouse that sympotms are a little less intense, but the price of this drug is very high. 

[54fiftyfour]

Be patentato, there is another point: I also noticed, in the recent weeks, that the morning dose, often, increases not only depression, but also anxiety levels. It happens after taking it while I'm working and I don't understand why.  

[Shep]

On 10/9/2022 at 10:14 AM, 54fiftyfour said:

This week I will go to the doctor who, in Italy, administers flumazenil in very low doses to treat benzodiazepine addiction.

 

If you haven't already seen this over on Benzo Buddies, you may want to have a read. 

 

FLUMAZENIL AND BENZO WITHDRAWAL

 

This is not something we would recommend because it's too risky -  flumazenil competitively binds to GABA receptors, dislodging the benzodiazepine.  Please be careful with this type of treatment. 

[54fiftyfour]

What do you think about vitamin D supplementation? If yes, how much? I have alteady taken it in the past with good results, but was not so sick as now...

[ChessieCat]

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

 

vitamin-d3-cholecalciferol-or-calcitriol

 

[54fiftyfour]

Yesterday I went to the doctor who administers flumazenil to reduce the dipendence from benzos. He didn't propose it in my case, as I expected and thought.

 

On the contrary, he proposed me to assume NAC - N-acetylcysteyne to reduce the glutammate activity and calm the SNC. In your opinion, could it be useful or dangerous?

 

Sincerely I'm worried from the dosages he proposed (600 mg. 3×day), but may be a very little dose could help. Is there someone who tried it with success?