Motodew: what to taper first

[Motodew]

What to taper first, but complicated...

 

Hello. I was on lorazepam for 23 years, starting at 2mg a day ending years later at 4 mg a day.  Unwisely went to a detox where they crossed me directly over to diazepam for just 5 days.  Also on amitriptyline 75mg and 25mg of Trazadone for sleep.  This near-cold turkey detox lasted 7 days of hell until reinstated on 20mg of valium.  This represents a 50% cut.  Stayed at this dose for a couple of months and now tapering the diazepam using the Ashton protocol.  I am at 13 mg down from 20mg. 

 

Severe insomnia is what started me on this path and is my achilles heel to this day.  What is going on now is that as diazepam was added and lorazepam taken away, the diazepam seems to be potentiating the side effects of the amitriptyline.   My before bed cocktail is currently 10mg diazepam, 50mg amitriptyline and 25m trazadone.  This usually gives me 5 or so hours of sedation, I would not consider it sleep.  Constantly exhausted all day, tremors, agitation, fatigue and weakness, urinary retention, cognitive issues. 

 

I understand the accelerator and brake model but what do you do when your AD, in this case amitriptyline, is a brake and your are also on a benzo, another brake?   I was assuming the benzo should go first but the way my body feels in the day I am convinced that the worst of the side effects are coming from the amitriptyline.  They have been there from the time I started taking it so I am pretty sure it is the greater problem.  But of course I have already started the benzo tapering.

 

The way I am thinking right now I would like to pause the diazepam taper and start reducing the amitriptyline instead.  Need advice if this makes any sense or if I should keep on with the benzo taper instead.  I assume tapering both would be a terrible idea. TIA for any information.

 

Edited November 8, 2022 by ChessieCat
added topic title

[manymoretodays]

Hey there Motodew and welcome,

Thanks for getting to your signature.  Awesome.  Ooooh though, what a history with so many different psychotropics.  I'm sorry.  How long ago was your visit to detox?  And that sounds rough.

I take it the amitriptyline and possibly Trazadone were started again there?

 

On 10/20/2022 at 10:14 AM, Motodew said:

My before bed cocktail is currently 10mg diazepam, 50mg amitriptyline and 25m trazadone.  This usually gives me 5 or so hours of sedation, I would not consider it sleep.  Constantly exhausted all day, tremors, agitation, fatigue and weakness, urinary retention, cognitive issues. 

 

Ooof, you are having a very tough time of it now.

We rarely recommend tapering two drugs at the same time.  It sounds like you may have looked around the site a bit already.

I think first I'll have you do an interaction check with all your current drugs included.

Please go to Drugs.com and use the interactions checker there.  Take a look, and then if you could link us to the results, or copy and paste them here.  Thank you.

 

I think you've seen this topic, I will put it here again for ease of reference:

Taking multiple psych drugs? Which drug to taper first?

 

And I think we might need to separate your drug timing out a bit first, in hopes of limiting interactions.  And you'll see when you look at the interactions check.

I would just begin, with moving your trazodone away from your valium and amitriptyline.  Move it by one hour, and then another hour, so that it is spaced apart from those two, by two hours.

 

When did you last taper your Valium?  You could go ahead and add that date right to your signature.  A short cut for edits and updates to your signature is here:

AccountSettings/update or edits

 

And you are hoping to taper off or down to the lowest dose possible someday of your drugs?  We are a site primarily focused on tapering, for those desiring that.  And would rather not do medication management, we're not qualified, we're not interested in that, and that should really truly be your prescribing doctors job.  So.  I do just want to make you aware of that.  We are staffed with volunteers, people or peers, who have tapered or who are in the process of it, and have decided that there must be a better way to manage our lives now......that what were given.

Anyway.

 

Okay, so more links to topics for you as I don't know what you've seen so far.  And do, consider this now as a time for us to get to know you, prior to making any suggests.  You've been patient, thank you.

 

Before you begin tapering-what you need to know(click on the underlined passages to get to the topic, scroll up to the first post if need be, and begin there)

 

We go with a harm reduction method of tapering, with each taper being just 10% or less of each previous dose.  This does go for the benzo's as well as AD's(antidepressants), as well as other psychotropic drugs.

*Why taper by 10% of my dosage?

 

*Tips for tapering off amitriptyline

*Tips for tapering off trazodone

both worth a good read through, to get more familiar with the drugs you are taking, as well as methods of getting doses needed for tapering when that time comes

 

We don't have a topic specific to benzo's, we do have a forum however that you will see from the Home Page, when you are signed in, and you are welcome to browse there.  It's not currently staffed for new members.  I'm guessing you might be familiar with some of the other specific benzo tapering places online.  Benzobuddies is one.  There may be FB groups as well.

I am glad you joined us here though.

 

What happens during tapering and WD(withdrawal):

*What's happening in your brain?

Brain Remodelling

What is withdrawal syndrome?

 

Dr.Glenmullen’s withdrawal symptom list.

 

The Windows and Waves Pattern of Stabilization

 

When we take medications, the CNS (central nervous system) responds by making changes over the months and years we take the drug(s). When the medication is discontinued, the CNS has to undo all the changes it made.  The CNS likes stability. Rebuilding the neurotransmitter production and reactivating the receptor and transporter cells takes time -- during that rebuilding process symptoms occur. And sleep is really important during withdrawal.  Insomnia is no small deal.  And I am glad you get the 5 hours you mentioned.  I know it's not ideal or you feel rested and great, but.....it's something.

 

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium and omega 3 (fish oil). Many people find these to be calming to the nervous system.  

 

Magnesium, nature's calcium channel blocker 

Omega-3 fatty acids (fish oil) 

 

This is your introduction/journal page where you have now introduced yourself to the community, you can ask questions here regarding your case and tapering, give updates, and just keep a record of your journey.  Try to communicate with us right here.  Thanks.  One introduction topic per member.

 

And best, Love, peace, healing, and growth,

manymoretodays(mmt)

[Motodew]

Thanks for the response.  There are absolutely drug interactions with all three.  Increased sedation, etc. but it is where I am now. 

 

I have read most of the information.  I was tapering valium at 10% every two weeks.  Then I decided to halt that and try to taper amitryptiline because I feel such side effects from it.   I went too fast and it did not go well.  I am back to my valium taper now at 12mg.  

 

Lots of symptoms but by 7 pm I start feeling normal again.  Every single night, so this indicates to me that the sedation/side effects from the morning have worn off. 

 

My main question was really whether the amitryptiline or benzo should be tapered first, but I guess now I am just continuing with the benzo. 

 

I am six months out of detox.  I actually brought the amitryptiline and trazadone with me.  Was on them during the near cold taper. 

 

I am having to maintain working full time which is really hard.  

 

Thanks for the info.