Tezzasaurus: Many ADs and aripiprazole

[Tezzasaurus]

HISTORY:

*1998-2010: Buspar, Prozac, Wellbutrin, Paxil, etc.
*2018: started sertraline/Zoloft
*2019: Went to ketamine clinic seeking ketamine, but was dx with bipolar II instead. Started Vraylar, Topomax, and Ropinirole. Continued sertraline.
*January 2020: Got pregnant. Was advised by psychiatrist to cold turkey Vraylar, Topomax, and Ropinirole and quickly taper sertraline. Began my sertraline taper but was having such intense w/d symptoms from the Vraylar, etc., I was a mess and I cold-turkeyed the sertraline, too.
*March 2020: Psychiatric hospitalization. Miscarried in hospital. Hospital docs determined bipolar II dx was a mistake. Started ECT but quit when pandemic started. Started escitalopram/Lexapro 20mg, and aripiprazole/Abilify 5mg as an adjunct.
*2021: Started bupropion/Wellbutrin 300mg to help with daytime sleepiness and fatigue. Continued escitalopram and aripiprazole. Increased bupropion to 450mg, then decreased back to 300mg for seizure safety for Transcranial Magnetic Stimulation therapy.
*Early 2022: Replaced escitalopram with venlafaxine/Effexor 150mg (cross-tapered over a few weeks).
*Summer 2022: Dx with sleep disorder (alpha wave intrusion). Started trazodone 50mg as a sleep aid.
*November 2022: Started phasing out aripiprazole by going down to 2mg from 5mg (p-doc's idea). Had symptoms, went back up to 5mg for the holidays.
*January 2023: Began tapering aripiprazole again, this time decreasing to 4mg for three weeks.

**********************************************

 

As you can see, I am on a big, hot, tangled mess of psychotropic drugs.

 

Since my diagnosis in summer 2022 with a sleep disorder, and treatment, I am doing better than ever (no depression symptoms for several months). And I'm on way too many drugs. My psychiatrist has agreed with me that it's appropriate to phase out at least one. We're starting with the Abilify/aripiprazole. P-doc wants to go fast; I want to go slow.

 

I checked the drug interaction website that is recommended here. It seems the Wellbutrin/bupropion has major interactions with everything else, so I believe that should go next. I would like one day to get down to nothing except trazodone, since it is treating my sleep problem.

 

Questions: How do you handle disagreements with your psychiatrist? I need to keep her on my side enough that she keeps prescribing my medication. Bonus if she will prescribe the smaller pills that make it easy to taper. What if I want to go slower than she wants to? What if she does not agree that I should get off a particular med?

 

My goal is to keep feeling good through the tapers.

 

Thanks in advance for any help you can provide,

Tezz

[getofflex]

Hello, and welcome to SA.  We are a volunteer-run community of people who have been or are getting off of psychiatric drugs.  I'm very glad you have found us.  We can help you get off of your drugs, but it will take time, patience, and perseverance.  But you can do it!  I can tell you now, it looks like your doctor is tapering you off way too fast.  Please read on, to see why I say this. 

 

You say you had symptoms from reducing the aripiprazole from 5 mg to 2 mg in November, and so you reinstated back to your original dose of 5 mg.  Did this reinstatement fully resolve your symptoms?  If not, what symptoms persisted after this reinstatement?  How did you feel after you dropped from 5 to 4 on Jan. 6?  How are you feeling now?  

 

Can you please copy this paragraph below of drug history into your signature box, and pare it down to where it is only drug names, dates, and dosages.  No explanations, diagnoses, symptoms, etc. - just a very brief, concise list of your drugs and their history.  Thank you.  

 

4 hours ago, Tezzasaurus said:

*1998-2010: Buspar, Prozac, Wellbutrin, Paxil, etc.
*2018: started sertraline/Zoloft
*2019: Went to ketamine clinic seeking ketamine, but was dx with bipolar II instead. Started Vraylar, Topomax, and Ropinirole. Continued sertraline.
*January 2020: Got pregnant. Was advised by psychiatrist to cold turkey Vraylar, Topomax, and Ropinirole and quickly taper sertraline. Began my sertraline taper but was having such intense w/d symptoms from the Vraylar, etc., I was a mess and I cold-turkeyed the sertraline, too.
*March 2020: Psychiatric hospitalization. Miscarried in hospital. Hospital docs determined bipolar II dx was a mistake. Started ECT but quit when pandemic started. Started escitalopram/Lexapro 20mg, and aripiprazole/Abilify 5mg as an adjunct.
*2021: Started bupropion/Wellbutrin 300mg to help with daytime sleepiness and fatigue. Continued escitalopram and aripiprazole. Increased bupropion to 450mg, then decreased back to 300mg for seizure safety for Transcranial Magnetic Stimulation therapy.
*Early 2022: Replaced escitalopram with venlafaxine/Effexor 150mg (cross-tapered over a few weeks).
*Summer 2022: Dx with sleep disorder (alpha wave intrusion). Started trazodone 50mg as a sleep aid.
*November 2022: Started phasing out aripiprazole by going down to 2mg from 5mg (p-doc's idea). Had symptoms, went back up to 5mg for the holidays.
*January 2023: Began tapering aripiprazole again, this time decreasing to 4mg for three weeks.

 

How to List Your Drug History in Your Signature

 

Here is some important information about how these drugs actually work.  This explains why we get symptoms from going off of these medications, and why it's so important to taper slowly and carefully, and be very cautious about changing our doses: 

 

How Psychiatric Drugs Remodel Your Brain

 

 

This helps you understand what withdrawal syndrome is: 

 

Video on Recovery from Psych Drugs

 

Windows and Waves Pattern of Stabilization

 

 

Tapering is best done extremely slowly, and we generally taper by 10% of the current dose no more than once every 4 weeks, so that the reduction becomes exponentially smaller.

 

 Why Taper by 10% of my Dosage  

 

Also, we generally suggest that people taper their most activating drugs first.  Is aripiprazole activating or sedating for you?  This link will explain about which drugs to taper first for those on multiple drugs.  You might want to taper bupropion or venlafaxine first.  

 

Taking Multiple Psych Drugs - Which to Taper First

 

Here is a link with checklists of common WD symptoms: 

 

Dr Joseph Glenmullen Withdrawal Symptom Checklists

 

 

Here are some techniques to cope with symptoms: 

 

Non Drug Ways to Cope with Withdrawal Symptoms

 

Stability is really important when we are tapering off psych meds.  Please read the link about stability:

 

Keep It Simple, Slow, and Stable

 

 

We don't suggest many supplements, but 2 that many of us find helpful are magnesium and omega-3 fish oil. Here are the links for info about those. It is suggested to add one at a time, and start with a low dose to see how it affects you. 

Magnesium

Omega 3 Fish Oil

 

Since you have made some large reductions and reinstatements in your aripiprazole recently, and reduced by 20% in early January, I would strongly suggest that you hold on your current drug regimen for a while, before doing any more tapering, and allow your nervous system a chance to adjust.  When you read my first link, how psych drugs remodel the brain, you will see why this is so important.  If you don't have time to read the other links, at least read this one soon.  Let us know how you are doing, and we will take it from there. 

[Tezzasaurus]

Thanks for your reply, Getofflex.

 

 

3 hours ago, getofflex said:

You say you had symptoms from reducing the aripiprazole from 5 mg to 2 mg in November, and so you reinstated back to your original dose of 5 mg.  Did this reinstatement fully resolve your symptoms?  If not, what symptoms persisted after this reinstatement?  How did you feel after you dropped from 5 to 4 on Jan. 6?  How are you feeling now? 

 

When I reduced aripiprazole from 5mg to 2mg in November, I had one day, about a week or two in, when I was irritable and irrational. I reinstated the next day, and everything went back to normal immediately. Later, I felt okay going from 5 to 4 on January 6th. I had a dip in mood and energy levels for a week or so in the middle of January, but now I feel much better.

 

4 hours ago, getofflex said:

Also, we generally suggest that people taper their most activating drugs first.  Is aripiprazole activating or sedating for you?  This link will explain about which drugs to taper first for those on multiple drugs.  You might want to taper bupropion or venlafaxine first. 

 

Aripiprazole is probably sedating for me. My psychiatrist and I chose it to go first (before I found this website) because it has the greatest risk of metabolic consequences (i.e. cardiovascular disease, diabetes).

 

4 hours ago, getofflex said:

We don't suggest many supplements, but 2 that many of us find helpful are magnesium and omega-3 fish oil. Here are the links for info about those. It is suggested to add one at a time, and start with a low dose to see how it affects you.

 

It just so happens that I am taking these supplements already. I am taking Magnesium 300mg at night, and I am taking omega-3 algae oil, which I understand to be equivalent to fish oil.

 

4 hours ago, getofflex said:

Since you have made some large reductions and reinstatements in your aripiprazole recently, and reduced by 20% in early January, I would strongly suggest that you hold on your current drug regimen for a while, before doing any more tapering, and allow your nervous system a chance to adjust.  When you read my first link, how psych drugs remodel the brain, you will see why this is so important.  If you don't have time to read the other links, at least read this one soon.  Let us know how you are doing, and we will take it from there. 

 

Thank you for all the resources. That first link was very interesting. Isn't this similar to brain injury? I did notice one link to a brain injury website on the post about non-drug ways to cope with withdrawal.

 

I consider myself well when I am functioning in my daily tasks, not sleeping too much, doing small self-care necessities (like brushing teeth), getting along with others, and laughing and telling jokes, perhaps singing while I work. Right now that is all happening.

 

In addition, I am currently doing aerobic exercise at least every other day. This helps my mood a lot.

 

I want to keep all of that in place; it's like a swaying tower I don't want to knock down.

 

I will consider holding at 4mg for a few more weeks, as you suggest . I am also interested in adding meditation/mindfulness.

 

Thanks again for your reply, Getofflex.

Sincerely, Tezz

 

 

[getofflex]

It sounds like you are doing very well, all things considered.  

 

Do you think you will continue to taper the aripiprazole, or taper one of your activating drugs?  It's up to you.  

 

I suggest that you plug in your drugs to the interactions checker, and see if there are any drug interactions between your drugs.  Let us know what you find out, please.

 

https://www.drugs.com/drug_interactions.html

 

14 hours ago, Tezzasaurus said:

I want to keep all of that in place; it's like a swaying tower I don't want to knock down.

This is a good analogy.  Doing a very slow harm reduction taper will help to ensure the tower doesn't fall down.  Once a nervous system gets destabilized, it can take months to years to recover.  

 

I will put in some links for how to taper the various drugs.  Please only taper one drug at a time.  Let us know what you decide to do. 

 

Tips for Tapering Abilify

 

Tips for Tapering Bupropion

 

Tips for Tapering Venlafaxine

 

 

 

 

[Tezzasaurus]

Hello, Getofflex,

 

After I used the drug interactions tool on drugs.com, I made this drawing to represent the results:

 

 

It sure looks like bupropion is a bigger culprit than aripiprazole. It has a major reaction with ALL THREE of the other ones.

 

I have an appointment with my psychiatrist. I'll do nothing until I meet with her, and then ask if I can switch to a combination of XL and IR tablets as described in the post on tapering Bupropion.

 

Thanks, Tezz

 

 

 

[getofflex]

Excellent work, Tezz.  It sounds like you are on the right track, and intend to start tapering Bupropion.  That's good, because it is a very activating drug.  

[littlebird]

18 hours ago, Tezzasaurus said:

After I used the drug interactions tool on drugs.com, I made this drawing to represent the results:

 

I like how you did that!! I'm going to try this with mine, this is a great way to visualize this. Glad you're here, welcome!

[Tezzasaurus]

Thanks, littlebird! I made it with MS Paint.

 

Thanks for the welcome,

Tezz

[Tezzasaurus]

UPDATE:

 

I was able to make a appointment with my psychiatrist this week (yesterday/Thursday). She was agreeable to the idea of pausing the aripiprazole taper, and beginning a bupropion taper. She also agreed to the idea of splitting the bupropion dose between XL and IR in order to taper (as the bupropion thread here in SA suggests).

 

However, she said that XL and IR aren't exactly equivalent. So for the first change, she is having me go from 300ml of XL to 150mg of XL +  only one 75mg of IR.

 

I agreed to that, and I started today.

 

I decided to take the 75ml pill at 4pm (a compromise between afternoon and evening). Around 5pm I noticed an upswelling of irritability. I was short with my kids and my mind was churning on why they kept leaving stuff on the floor.

 

I was wondering if anybody could suggest how I should proceed about the irritability. Should I change the time I take the IR tablet - and to what time? Or should I just proceed ahead and hope that the 5pm irritability fades away?

 

I know I'm not following exactly the SA bupropion protocol. But I am, at this point anyway, still trying to be agreeable and cooperative with my psychiatrist. I hope that's not a mistake.

 

Thanks for any help you lovely people can provide,

Tezz

 

 

[getofflex]

This sounds like a good plan.  It would help a lot if you could put a list of your current drugs with their doses in your signature, thank you. That way, it will automatically appear with every post, and this really helps the staff not have to wade through previous posts for information.  

13 hours ago, Tezzasaurus said:

I decided to take the 75ml pill at 4pm (a compromise between afternoon and evening). Around 5pm I noticed an upswelling of irritability. I was short with my kids and my mind was churning on why they kept leaving stuff on the floor.

 

I was wondering if anybody could suggest how I should proceed about the irritability. Should I change the time I take the IR tablet - and to what time? Or should I just proceed ahead and hope that the 5pm irritability fades away?

This has only happened once, so it may be a coincidence.  It may also be that the immediate release is activating your system.  I don't know that changing the time you take it would help.  I would suggest learning non drug ways to cope with the irritability.  I suspect your body needs time to get used to the change in the drugs.  This link discusses the intense emotions most of us go through during tapering and WD.  

 

Neuro Emotions

 

It may be time to have a family meeting with your kids, and partner (if you have one) and let them know what you are going through, and asking for them to be more helpful and cooperative.  Try and work on non drug ways to calm down your nervous system, such as meditation, gentle exercise, epsom salt baths, listening to calming music, spiritual practices, etc. Search the net for how to cope with irritability as a parent with children.  

 

Articles About Dealing with Stress and Anxiety

 

 

13 hours ago, Tezzasaurus said:

But I am, at this point anyway, still trying to be agreeable and cooperative with my psychiatrist. I hope that's not a mistake.

It depends upon the psychiatrist.  If I were you, I would have a discussion with him/her about this site, and what our tapering protocol is.  The vast majority of them taper their patients off way too fast, but yours may be an exception.  this link will help you in talking to your doctor: 

 

How to Talk to a Doctor About Tapering and Withdrawal

[Tezzasaurus]

Thanks for your thoughtful reply, getofflex. I will read all the threads you linked.

 

And I have updated my signature with current doses of all psychiatric meds.

 

Thanks again!

[j1290]

Hi @Tezzasaurus!

 

I regularly do a scan for fellow travellers tapering Bupropion, and came across your thread.  

 

I was on 450mg XL, and it took me a while to find a combo that I could taper off of.  I never got the mixture of XL and IR in a way that I felt stable on, but in retrospect that could have been due to any number of things or me just not understanding what I was doing.  

 

I switched to all IR and tapered from that, but I found it much harsher than the XL and got side effects galore like headaches and head pressure and whatnot.  It worked for me, but if you can find the way to make it work, the XL and IR should be more comfortable.   

 

I've found that the time I take the pills makes a difference, but when I'm getting WD from making a cut, it's really hard to narrow anything down very much in that area.   

 

I use the daily withdrawal checklist, and I've found the WD symptoms after a cut to be very predictable, and getting easier as I reduce more.   Regarding irritability, I've found it increased a ton when switching to the IR, and also it increases a lot the first 2 or 3 weeks after a cut.   I can totally relate to ruminating about things that don't warrant the energy.  I've gotten less of that as I have reduced.   I found that if I'm too irritable I'll take part of a blood pressure pill or something to take the edge off so I can get by.   I also know  day 7 and 8 of a cut are rough days so I make sure those are on a weekend when I'm away from work.  Every little bit helps.   

 

Enjoying your posts, please post often!

[littlebird]

11 hours ago, j1290 said:

Regarding irritability, I've found it increased a ton when switching to the IR, and also it increases a lot the first 2 or 3 weeks after a cut.   I can totally relate to ruminating about things that don't warrant the energy.  I've gotten less of that as I have reduced.

 

Dude, I needed to read this today and get some hope that things will get better. I’m irritable as all get out, and stuck in Rumination Station. It’s really good to hear  a reminder that I might have some relief to look forward to as time passes.

 

Wellbutrin tapering is a trip! Tezzasaurus, hope you’re doing all right with it. 

[Tezzasaurus]

Hello, @j1290, I was just reading through your signature - do I read correctly that you are using liquid bupropion? I am also using the daily symptoms checklist - it's been useful so far. Thanks for your post!

 

Thanks, also, @littlebird! I am doing alright! I hope you are, too!

[j1290]

3 minutes ago, Tezzasaurus said:

do I read correctly that you are using liquid bupropion? I

Hi @Tezzasaurus   I was using liquid bup that I made myself, but not right now.  When I get down to 75mg or so I expect I'll switch back to it.   Actually worked really well.  How do you like the daily WD checklist?  Think it helps?  I love that thing.  

[Tezzasaurus]

Update: My P-doc agreed that it's time for me to finally get off aripiprazole. Yay!

 

Her advice: just stop, or if you want, take a half tablet for a week then stop.

 

Hilarious.

 

The last time I cold-turkeyed an antipsychotic I ended up in the psychiatric unit of the hospital for 3 days while they reinstated me, and I had a miscarriage. (It all started a few weeks prior when my then-P-doc told me to cold-turkey all my psychiatric meds to protect the baby).

 

I won't be stopping the aripiprazole like that this time.

 

So I scoured all the pages on this forum dealing with liquid suspensions and got to work.

 

My protocol: One 2-mg tablet of aripiprazole dissolved in 10mL water for 40 minutes. Swirl, then add 10 mL mango-flavored Naked fruit juice (it's medium-thick). Refrigerate. First, I'll be spending two weeks shifting *up* to taking the full 2mg as a liquid (I've already started by taking 1/2 tablet and 1/2 of the liquid each day).

 

I'm tracking symptoms daily with the symptom tracker file found on this forum.

 

I'm so grateful for this website and all the people who post life-saving information and uplifting encouragement. THANK YOU!