AliciaJM: not sure what step to take next

[AliciaJM]

After a covid infection this past spring, I started to experience sleep disturbances and some anxiety and depression. I was initially put on lorazepam to help with sleep on a short-term basis (July 1-5, 2022) and have used it off and on since then as a sleep aid, only getting a couple of hours of sleep when used. I have not used it in a few weeks now and would like to avoid to using it again as I was feeling desperate/psychologically attached to it when I couldn't sleep. I was prescribed trazadone for sleep help and zoloft for my low mood. With the new medicines, I started to feel more anxiety more intensely than I ever had before. It was worse on the medication than it was before I started. Once my zoloft dose was increased to 50 mg, I started feeling more depressed and having suicidal ideation that was more persistent than what I ever experienced before (now it seems that suicidal ideation is more the norm...). After starting to see a psychiatrist, I was taken off the zoloft (because of the suicidal ideation concerns) and the trazadone (which didn't seem to make a huge difference with sleep). I am currently taking Lexapro (2.5 mg in late September and then 5 mg since October 7, 2022, both of which seemed to initiate more suicidal thinking) and Mirtazapine as a sleep medicine (7.5 mg since September 28, 2022). My psychiatrist does not think that I am getting enough sleep with the Mirtazapine (I get about 4-5 hours a night that does not feel restorative) and was concerned about the morning low mood/somnolence/depression/moroseness I was experiencing with the mirtazapine introduction. He would like me to discontinue mirtazapine over a few days and start taking Ambien for sleep on a temporary basis (2-3 weeks) to "buy time" while the antidepressant may begin working. There is no plan for what happens after that point yet. A naturopath has suggested hydroxyzine instead of switching to Ambien to see if that helps with sleep (and with possible long covid-related high histamine levels). I've also been doing CBT-I for the past few months with little payoff from that.

I am here because I am concerned about the Ambien idea and want to learn more about what I might be getting into, but don't know what else to do at this point (over 4 months of insufficient sleep and 3.5 years before that of fractured sleep because of co-sleeping with my toddler). I don't feel that I am in a stable place at all and am fearful of discontinuing these medications altogether at this point. I have also read now on this site that Lexapro is a very strong antidepressant. I thought that I wasn't taking very much, but it seems that I am. I'm concerned about the increase in my suicidal thinking since starting and increasing the Lexapro. And, also wonder if it's negatively impacting my sleep. 

 

I meet with my psychiatrist in a couple of days and wonder about asking to switch to a different SSRI or reducing my dose back to 2.5. I feel so trapped by this situation and now scared because I've inadvertently gotten started on a strong SSRI that may be making my suicidality worse. 

 

I realize that this isn't really a withdrawal question, but a different kind of question... a where do I go from here post... 

 

Edited October 11, 2022 by ChessieCat
added spacing and removed grey background

[Altostrata]

Welcome, @AliciaJM

 

Not everyone gets along well with psychiatric drugs. It appears you have had one adverse reaction after another, such as:

 

On 10/11/2022 at 12:14 PM, AliciaJM said:

With the new medicines, I started to feel more anxiety more intensely than I ever had before. It was worse on the medication than it was before I started. Once my zoloft dose was increased to 50 mg, I started feeling more depressed and having suicidal ideation that was more persistent than what I ever experienced before

 

Suicidal thinking is a known adverse effect of antidepressants. Obviously, if an antidepressant is causing this, it's not a good drug for you. Antidepressants might simply not fit with your nervous system.

 

As is the usual practice, your doctor has prescribed what's known as a drug cascade, with drugs added to mask adverse effects of other drugs. The Ambien is one such element in the cascade. This is a sign of a bad psychiatrist. Admittedly, it's very hard to find a good one.

 

Many of your symptoms are probably from your current cocktail as well as going on and off prior drugs. If you wish, we can suggest ways to unravel this. As this is a peer support site for going off drugs, we cannot suggest ways to improve your drug cocktail if you want to continue it.

 

To help us out, follow these instructions Please summarize your drug and withdrawal history in your signature You may need to use a computer to do this. 

 

[AliciaJM]

Thank you, @Altostrata for your reply.

 

I've updated my medicine history in my signature. Hopefully that is helpful to see.

 

I admire the courage of people here as they taper off of their medications. 

 

I am curious to know what you would recommend from this point. At the same time, I am feeling so unstable and so so very exhausted that I am finding it hard to think or feel that I could have the energy or courage right now to unravel this whole process. I have had months (and years) before then of sleep deprivation and my desire for more sleep is very, very strong. So, I have to admit, the temptation is there to continue on the drug cocktail just to get some sleep. Not that I want all of this in my life anymore and the pharmaceutical options for further sleep help seem intense. Additionally, when I mention to other providers that the psychiatrist is suggesting Ambien (or other sleep drug) they defer to his recommendation. But, they all know how damn tired I am. 

 

My husband has suspected that I don't have a great psychiatrist. And, I'm sure that a good one is hard to find. I will say that he has been responsive when I've mentioned feeling less well on a higher dose. He suggested reducing my lexapro dose to 2.5 again, which I did today (not in a slow taper, though, obviously). I also expressed concern about the Ambien and the psychiatrist suggested doxepin as an alternative. 

 

This is all such a new and disconcerting (to say the least) situation. I am finding that I am not present in my life, either because I am consumed with worry about the medicines and/or I am so tired/anxious/depressed. 

 

The long covid piece makes this situation extra tricky. I didn't have a normal baseline before all of this began. I had covid and then didn't get better and subsequently became more anxious and depressed with disturbed sleep. If I could go back in time, I certainly would, and I would stop myself from starting these kinds of medications. I can only go forward now, though...

 

Sorry that I am not more sure of what I want to do from here. I feel as though I need some sleep and then I can tackle this situation better (the irony I guess is that at this point to get more sleep means to try more medication). 

 

 

 

[Doctorsrcrap]

Hiya. 

I can't give you any advice but just wanted to give you some encouragement. 

You are not alone in this and with help from people on this site you are going to be fine. 

In my opinion stay far away from physciatrist as the only thing they know is medication and in my honest opinion they do more harm than good. 

Listen to the good advice from people like alto and you are going yo be ok xx

[Altostrata]

To figure out what's going on, 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.

[AliciaJM]

I am really feeling so stuck here and that makes me have more intense suicidal feelings/thoughts. I am afraid to stay on the medicine in case it's not helpful (may be making things worse) and afraid to come off the medicine in case it could be helping me and that what I am experiencing is as yet untreated anxiety and depression (plus sleep trouble). Like, I am thinking of coming off of the medications too soon... like I haven't given them a chance to work yet. Does that make sense? And, I get to feeling so desperate that I think of going to the ER for voluntary admission thinking that they might be able to help me. The psychiatrist does want me to discontinue the mirtazapine and is proposing a quick tapering schedule, which I know you wouldn't recommend.

 

Here are some recent notes (the first couple of days I did not put the exact times).

10/15/22:

8 a.m.: 2.5 mg lexapro with breakfast (and many supplements)

Very tired/low all morning

Brain fog in the morning and early afternoon

Very anxious in the morning

Stomach pains/ache in the late afternoon and evening

Background of suicidal ideation most of the day

Lack of pleasure/interest in activities all day, slightly less anxiety in the afternoon

Headache in the evening

Waves of anxiety in the evening with chills/burning sensations

Constipation all day

11 p.m. Took 7.5 mirtazapine, 300 mg mag glycinate, Iso-phos

Bed at 11:45. Slept until around 2:30, moved to couch, read, tried to get back to sleep. back to sleep around 5 until 7. 

 

10/16/22:

Very low feeling upon awakening, not feeling like myself

8:00 a.m. 2.5 lexapro with breakfast

Nursed with my toddler in the morning, much rumination and suicidal ideation-- see no way out of this situation

Anxious, depressed, spoke with people outside of church, feeling very upset and scared

Dull persistent hopelessness

Nausea/upset stomach

Anxiety off/on 

Anxiety when thinking the medication might be making things worse

Dull headaches/off feeling

11 p.m. Took 7.5 mg mirtazapine, 300 mg mag glycinate, Iso-phos (100 mg)

No notes for 10/17/22

 

Dozed between 5 and 7:30: Waking up with anxiety, suicidal ideation
8 a.m. Ate breakfast and took 2.5mg Lexapro
9 a.m. Very anxious, depressed, feeling paralyzed by uncertainty about what to do with medications, some stomach upset (like burning, nervous stomach). Feeling trapped. 

[Altostrata]

Do you get nausea or stomach upset at the same time every day? Are there any times in the day that you feel better?

 

Be sure to take Lexapro with food in the morning. What supplements are you taking then?

 

Please continue to post daily notes 24 hours at a time.