RobertZ: Protracted withdrawal with persistent myoclonus

[RobertZ]

Hi,

I've been on psychiatric medication since early March 2022. I've also been to a psych hospital twice after becoming suicidal due to severe insomnia and sleep-onset myoclonus, which started shortly after I was put on escitalopram and trazodone for depressed mood. Before being put on the meds, I was able to sleep without issues despite having low mood. No myoclonus, no twitching, my sleep was fine.

 

After a couple of weeks on the drugs, I became hyperaroused in the evening and started experiencing muscle jerks as I was about to fall asleep, which jolted me awake every time. I talked to my psychiatrist about these symptoms and he switched me to sertraline and mianserin. The side effects disappeared and something strange happened: I would sleep easily 12-13 hours a day, which is unusually long for me. However, in May 2022 this effect subsided and the myoclonus returned. I was unable to get proper asleep for about a week and started having suicidal thoughts, thinking that my life is ruined because the antidepressants messed my brain up beyond repair and I would never be able to sleep. This landed me in a psych ward, where they gave me trazodone, olanzapine and benzodiazepines at bedtime. I improved and was discharged within a few days.

 

I abruptly stopped the olanzapine they gave me in the psych ward, as my psychiatrist said it was unnecessary because I was not psychotic or schizophrenic (he didn't tell me to taper the olanzapine gradually!). He also refused to prescribe me benzodiazepines for sleep because they are addictive. I was put back on sertraline and quetiapine instead of the mianserin I had been taking before the hospital. The quetiapine worked well for my sleep initially but stopped working eventually as I developed tolerance. In August, I decided to stop all drugs, thinking they were causing my myoclonus and insomnia. Within days, I developed akathisia and severe insomnia. Feeling restless and on-edge 24/7 was the worst time of my life and I truly wanted to die. I ended up in the mental hospital for the second time. They fed me a bunch of antidepressants and antipsychotics, which were able to put me to sleep most of the time. I was discharged in November and immediately quit the antidepressants. I only kept taking the quetiapine 300 mg because it was able to help me sleep despite my myclonus.

 

Now I'm free from all antidepressants and I take only the quetiapine, benzodiazepines and Z-drugs for sleep. It was probably a bad idea to quit the antidepressants they gave me in the hospital cold turkey, but I didn't want them to do me more harm than they already did.

 

I'm trying to get off the quetiapine from 300 mg in 25 mg steps. I fear that my brain may have been damaged permanently by all the meds I've been taking. My myoclonus still persists and I am unable to get restorative sleep on the benzos and Z-drugs. I would welcome any and all advice on how to get rid of the drug-induced myoclonus. It really takes away so much sleep, energy and joy of life from me. 

Edited March 3, 2023 by manymoretodays
name to title only

[manymoretodays]

Hello and welcome RobertZ,

Many thanks for getting your medication history in your signature as well.  So helpful.

 

Good, good on that your experience with these psychotropics have been just within the past year.

Complicating your case is the many tried and then on and off again nature of this past year.  This does a number on our nervous systems.

 

Has the usage of benzo's and Z drugs gone on for more than 2 weeks?  Unfortunately that can also create a dependency that then requires tapering.

 

In your next reply just give a synopsis of how long you have been using benzo's and give us the name or names of those as well how long used, how often, and in what doses.   Same with your Zdrug.  None of these drugs are innocuous, easy on and off.  Unfortunate.

 

How psychiatric drugs remodel the brain

 

Please also get familiar with using a drug checker prior to using any more drugs, and also an interaction checker. 

Try the interaction checker at Drugs.com  Then copy and paste for us the results after you have reviewed them.  A link back to Drugs.com, or copy and paste the whole report in a reply post.  No downloads please.  After doing that with your 3 mentioned drugs, then you can go back and use the top box to learn more about each drug individually.  If Drugs.com is somehow non-accessible you can try and do the same at a site called Medscape.

 

We are a site dedicated to helping folks to taper, and with the hope that most will wish to get as low as possible with their doses, and/or ultimately off drugs of this nature.

I don't know if your new, out of the hospital doctor told you, but quetiapine, is also of the antipsychotic class of drugs.  It wasn't developed for primary use as a sleeping pill.

 

I also don't think you will find the relief of the myoclonus from another psychiatric or other medication of any kind.  Here's a topic on Hypnic/hypnagogic jerks when falling asleep.  Sounds promising too that perhaps it may let up once you have time and stabilization of your nervous system.

Hypnic/hypnagogic jerks when falling asleep

This ^ sounded a lot like the "myoclonus when falling asleep" that you mentioned.

By the way.....read the underlined topics, just click on the passage, and begin at post one in the topic. 

 

I know a year or just under that, is a long time when having this kind of sleep disruption but there is hope.  Hang on to hope.  And try the stretching and music, and maybe some Epsom salt soaks in a tub or to your feet, before retiring for the night.

 

How are you doing with the 25 mg drop in quetiapine? That's less than the 10% from 300 mg, and that is good in our world.

Why taper by 10% or less of my dosage?

 

When did you go to 275 mg of quetiapine?  Date or approximate date.

 

 

Next taper, will be then 10% off 275 mg or down to 247.5mg, and yes you can still go down by just 25 mg to 250 mg, thus keeping your taper in bounds.  Then from 250 mg to 225 mg is exact at 10%.  You can even get to 200 mg, dropping by 25 mg.

After that you may want to titrate your decreases much more carefully, to avoid going too fast.  And often around 200 mg you most definitely need to keep tapers to not greater than 10%.  The properties of the drug do change from affecting dopamine and those receptors to histamine around 150 mg.  And I expect you are feeling more than just the myoclonus now in the way of symptoms, so we don't want you to have to go through more WD.

 

Tips for tapering Seroquel(quetiapine)

 

The Windows and Waves Pattern of Stabilization

 

When we take medications, the CNS (central nervous system) responds by making changes over the months and sometimes years that 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 when it comes to giving the nervous system time to reset.

 

Other symptoms you may relate to can be found here:

Dr. Glenmullen's Withdrawal Symptom checklist

again first post and you'll have to download a PDF of the symptom list.....many that do occur when a nervous system has been destabilized by both drugs and WD's.  Let us know, what else you've experienced this year that match up with any of those.

 

Fill us in a bit more on your benzo and Zdrug usage.  Name of benzo, dose, how often?  Same with the Zdrug.  Thanks.  This will give us a better idea of how to guide you and support.

Other medications of note?  For your heart or anything else?

 

Welcome again.  So sorry for your past no fun year of sleep and likely worsening of down and low moods.

This is your Introduction topic now, and your place, your home base.  You've introduced yourself to the community and post here for most concerns, for now, while we get to know you better.

 

Best, Love, peace, healing, and growth,

moderator manymoretodays(mmt)

 

 

 

 

[RobertZ]

Hi, thanks for the reply and the many helpful links. It is great to have a place to share experiences with others.

 

The Z-drugs and benzos I've been using for sleep are zopiclone (7,5 mg), zolpidem (10 mg), diazepam (5 mg) and estazolam (2 mg). I've been taking just one tablet daily of either at a time since getting out of the hospital in November 2022, which I realize is a pretty long time. I have not upped the dosage as I do not seem to have developed a tolerance and  they still manage to put me to sleep. I know I may have become dependent on them though and they are not doing me any favours in the long run. I just see them as a lesser evil than getting no sleep at all because I'm jerking myself awake all night. I know I'll have to come off them eventually too. 

 

I started the quetiapine taper on 21 March and I'm doing fine so far, aside from feeling slightly on-edge. Initially I didn't want to go lower than 275 mg to be on the safe side. The reason for my decision to taper is that I started having finger and small muscle twitches all over the body (dyskinesia?), on top of feeling numb and demotivated during the day. I don't have any neurological disorder, CNS MRI, bloodwork are OK. I don't take any other pills long-term for any particular disease.

 

The drug interactions checker says quetiapine, benzos and Z-drugs are all CNS-depressants and warns of respiratory depression, sedation, etc. Sedation (especially at night) I can live with. Haven't had any heart or breathing problems.

https://www.drugs.com/interactions-check.php?drug_list=1979-0,2333-0&types[]=major&types[]=minor&types[]=moderate&types[]=food&types[]=therapeutic_duplication&professional=1

https://www.drugs.com/interactions-check.php?drug_list=862-0,1979-0

 

My psychiatrist recently prescribed me chlorprothixene 50 mg for sleep (!) and told me to reduce the quetiapine to 200 mg. I'm not sure if I should change the doctor at this point. Adding another antipsychotic to the quetiapine doesn't seem to be a good idea. DrugBank says "The risk or severity of adverse effects can be increased when Quetiapine is combined with Chlorprothixene." The last thing I want is to develop some gross movement disorder and keep sticking my tongue out at people until the end of my days. Now I see it was a mistake to treat quetiapine like a sleeping aid, but I was desparate for sleep and didn't know any better (my doctor should have though).

 

PS.

I realize I may have done damage to my nervous system by abruptly stopping/starting antidepressants and was wondering about reinstating sertraline (possibly along with mianserin) - the last SSRI I was on. But after so many months off of it, things could go either way and there is no guarantee the myoclonus will go away. I don't want to add more fuel to the fire by throwing in another drug that may or may not work.

 

Cheers

R.

[manymoretodays]

Hi RobertZ,

I'd sure avoid anymore serotonin inducing drugs from here on out.  Or antipsychotics.

I'd think if you can communicate well, if I were you, that I might change doctors now: especially if the initial prescribing doctor isn't going above and beyond, in helping with the adverse reaction that was caused with your first prescription, doing things like letting you know they are consulting with experts, and being very sympathetic with you rather than beginning to tell you this is mental illness or something.

 

I gandered a look at your original prescription of escitalopram and trazodone interactions:

Drug Interaction Report: escitalopram and trazodone

and I'm thinking that yes, that drug combination ^ caused serotonin syndrome(overload, toxicity)

That the myclonus hasn't improved, and you are just being treated with brakes........dumbing numbing and sleep meds and benzos.......I don't know, but there must be a better path forward.

 

Has your psychiatrist consulted with a toxicologist?  That would have likely been immediately helpful, back when you had the initial drug reaction, and may be helpful now.  Those 2 drugs should not be combined.  Your escitalopram levels and then subsequent free serotonin might have shot up way too high.  And as I am reviewing things on serotonoin syndrome, I'm seeing that a symptom like myoclonus is very important in diagnosis.

 

Serotonin Syndrome or Serotonin Toxicity

In my opinion(as a lay person) you should have been medically hospitalized a year ago, not thrown in to the mental ward.

 

With the z drugs and valium, sounds like dependency has set in if it has been nightly.  Why 4 drugs to choose from? 

 

With the Seroquel/quetiapine, first drop, it sounds like you've done okay.  I come up with April 18th as being 4 weeks from your first taper on the 21st of March, and so......if it was me I'd proceed down to 250 mg then. 

 

I'm feeling really sad and a bit flummoxed with your case, and so will ask another to look on in too.  I'll follow but I am just not sure what to tell you.  We can help you with a slower taper of your Seroquel/quetiapine than your doctor is informed on.

 

And best. Love, Peace, Healing, and Growth,

mmt 

 

 

Edited March 5, 2023 by manymoretodays
altered one part

[RobertZ]

17 hours ago, manymoretodays said:

I'd think if you can communicate well, if I were you, that I might change doctors now: especially if the initial prescribing doctor isn't going above and beyond, in helping with the adverse reaction that was caused with your first prescription (...)

I might do just that. All  my doc did was to dismiss the symptoms as transient, reduce the dose (didn't help) and eventually switch me to sertraline + mianserin, which worked for a while until the symptoms returned.

 

17 hours ago, manymoretodays said:

I gandered a look at your original prescription of escitalopram and trazodone interactions:

Drug Interaction Report: escitalopram and trazodone

and I'm thinking that yes, that drug combination ^ caused serotonin syndrome(overload, toxicity)

That the myclonus hasn't improved, and you are just being treated with brakes........dumbing numbing and sleep meds and benzos.......I don't know, but there must be a better path forward. 

 

Has your psychiatrist consulted with a toxicologist?  That would have likely been immediately helpful, back when you had the initial drug reaction, and may be helpful now.  Those 2 drugs should not be combined.  Your escitalopram levels and then subsequent free serotonin might have shot up way too high.  And as I am reviewing things on serotonoin syndrome, I'm seeing that a symptom like myoclonus is very important in diagnosis.

The description of the serotoning syndrome seems to fit what I was experiencing: profuse sweating (especially at night), shivering, agitation/anxiety, muscle jerking - I probably had some form of SS without being aware of it.

I find it strange that the myoclonus would continue for this long, even though I've been off the antidepressants for quite some time now. Could brain damage from serotonin toxicity be permanent? I'd immediately quit the sleep meds and quetiapine too, just not seeing a better option at the moment than to taper the quetiapine slowly and stay on the sleep meds to help with myoclonus/insomnia.

 

My psychiatrist didn't consult a toxicologist. I'll bring it up during my next appointment, but I'm sceptical.

17 hours ago, manymoretodays said:

Why 4 drugs to choose from?

 

I figured I could avoid dependency/tolerance by switching them up every night.

 

17 hours ago, manymoretodays said:

I come up with April 18th as being 4 weeks from your first taper on the 21st of March

 

I started the taper 21 Feb. My mistake, apologies.

 

17 hours ago, manymoretodays said:

I'm feeling really sad and a bit flummoxed with your case, and so will ask another to look on in too.  I'll follow but I am just not sure what to tell you.

You've already been more helpful than my doctor. God bless you.

 

 

[Altostrata]

Hello, @RobertZ

 

On 3/2/2023 at 11:21 AM, RobertZ said:

My myoclonus still persists and I am unable to get restorative sleep on the benzos and Z-drugs.

 

Please explain more about the myoclonus. When does it occur? How long does it last?

 

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

 

What other symptoms do you have that you believe are drug- or withdrawal-related?

 

On 3/2/2023 at 11:21 AM, RobertZ said:

I became hyperaroused in the evening and started experiencing muscle jerks as I was about to fall asleep, which jolted me awake every time.

 

Please see Strange sensations while falling asleep -- surges, zaps, jerks

 

Hypnic / hypnagogic jerks when falling asleep

Magnesium, nature's calcium channel blocker

 

Potassium and magnesium are good for muscle relaxation. Often the more common hypnic jerks and "restless legs" are due to inadequate magnesium in the diet and are relieved with magnesium supplementation.

 

[RobertZ]

Hi, @Altostrata

 

8 hours ago, Altostrata said:

Please explain more about the myoclonus. When does it occur? How long does it last?

It occurs most frequently in the evening when I'm in bed, transitioning from wakefulness to sleep, early in the morning when waking up (assuming I managed to fall asleep in the first place), and only rarely later in the day when I'm at rest. It is not action-induced. Some nights are better than others and I would only get a few jerks; other nights I would jerk awake 50+ times and not get any sleep at all -- thankfully those really bad nights are now rare. 

The myoclonus are brief (up to 0,5 s) non-rhytmic muscle contractions in my trunk, limbs or neck. My upper back muscles seem to be affected the most when lying down -- other than that, there does not seem to be a particular pattern to the location of the jerks, and they may occur anywhere in my body, from fingers and small muscles to large muscle groups like the upper legs or chest.

 

The trigger for my myoclonus seems to be connected with me trying to relax, wind down, go from alertness to sleep/rest.

 

9 hours ago, Altostrata said:

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

I take quetiapine 275 mg at 9 p.m. and one tablet of either the benzos or Z-drugs from my signature at their respective dose at 10:30 p.m., immediately before bedtime. I try to stick to fixed hours when I go to bed.

9 hours ago, Altostrata said:

What other symptoms do you have that you believe are drug- or withdrawal-related?

Feeling drowsy and demotivated, facial/jaw twitches (especially in the morning), becoming agitated later in the day, and a burning / shock-like sensation in my legs and feet in the evening. 

9 hours ago, Altostrata said:

Potassium and magnesium are good for muscle relaxation. Often the more common hypnic jerks and "restless legs" are due to inadequate magnesium in the diet and are relieved with magnesium supplementation.

 

I supplement Mg, K, Ca and omega-3 fish oil.

 

I'll definitely check out the links, thanks.

[Altostrata]

What we see here is when people have adverse reactions to psychiatric drugs and then go on and off drugs, switch them, skip doses, and experience withdrawal, their nervous systems can become sensitized to all psychoactive drugs and even foods, with outsized adverse reactions.

 

Could it be that your myoclonus was an adverse reaction to escitalopram and trazodone, and your subsequent drug switches added their own adverse effects? Since you had a fairly immediate adverse drug reaction and continued to take the combination of escitalopram and trazodone for a month, you may never have had the chance to naturally recover from the initial adverse drug reaction.

 

See Adverse reactions to an antidepressant within a few doses -- how long for recovery?

 

We have seen that drinking alcohol, taking antibiotics, or getting covid can also prolong or exacerbate adverse drug effects. Have any of these occurred since last March?

 

 

13 hours ago, RobertZ said:

I take quetiapine 275 mg at 9 p.m. and one tablet of either the benzos or Z-drugs from my signature at their respective dose at 10:30 p.m., immediately before bedtime. I try to stick to fixed hours when I go to bed.

 

You are rotating through 4 benzo-like drugs? Why are you doing this?

 

Why do you take quetiapine AND a benzo-like drug at the same time? Have you found any combination that addresses your sleep issues?

 

Most likely, you're taking too many brakes (sedatives, antipsychotics) at once and this is causing a paradoxical reaction -- keeping you awake rather than assisting sleep. Irregular dosing of the sedatives at night isn't helping.

 

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. This can help identify symptoms that are adverse effects from your drugs.

[RobertZ]

On 3/8/2023 at 5:15 AM, Altostrata said:

Could it be that your myoclonus was an adverse reaction to escitalopram and trazodone, and your subsequent drug switches added their own adverse effects? Since you had a fairly immediate adverse drug reaction and continued to take the combination of escitalopram and trazodone for a month, you may never have had the chance to naturally recover from the initial adverse drug reaction.

That may have been the case and there is not much I can do about it now. My hope is that I will improve over time and avoid further pitfalls.

On 3/8/2023 at 5:15 AM, Altostrata said:

We have seen that drinking alcohol, taking antibiotics, or getting covid can also prolong or exacerbate adverse drug effects. Have any of these occurred since last March?

 

I used to have a beer or two once a week until about last May/June. Then I quit all alcohol. I got covid in late 2021. No major illness since last March.

 

On 3/8/2023 at 5:15 AM, Altostrata said:

You are rotating through 4 benzo-like drugs? Why are you doing this?

 

Why do you take quetiapine AND a benzo-like drug at the same time? Have you found any combination that addresses your sleep issues?

Quetiapine alone stopped working for my sleep and I had some benzos and Zs lying around. They all still work most of the time at the minimum doses. I prefer them to the chlorprothixene 50 mg and pregabalin 2 x 150 mg  prescribed "for sleep" by my doctor  on top of quetiapine as I don't want another antipsychotic as a sleep aid now that I'm trying to taper quetiapine. I'll most likely change doctors as I'm not happy with the overmedication.

 

On 3/8/2023 at 5:15 AM, Altostrata said:

Most likely, you're taking too many brakes (sedatives, antipsychotics) at once and this is causing a paradoxical reaction -- keeping you awake rather than assisting sleep. Irregular dosing of the sedatives at night isn't helping.

 

I'm planning to get off the sleep drugs as well once I'm quetiapine-free. Or should I get off the benzos first? I take them at a relatively lower dose than quetiapine, so a taper off those would be quicker. Not quite sure about trying to get off two classes of drugs simultaneously. I take a sedative regularly at 10.30 p.m.

 

08/03/2023:

 

05.00 a.m. Woke up, feeling drowsy, not rested. Muscles twitching, facial numbness.

6.00 a.m. Ate breakfast, took omega-3 fish oil.

7.00 - 12.00 a.m. Did shopping and chores. Still feeling drowsy.

01.00 p.m. Ate lunch, took Mg, K & Ca supplements.

02.00 p.m. Feeling more awake. Electric/burning sensation across whole body.

03.00 p.m. Went for a walk.

06.00 p.m. Ate dinner.

09.00 p.m. Lying in bed, muscles twichting. Took quetiapine 275 mg

10.30 p.m. Burning feet/electric-like sensation in legs. Took zolpidem 10 mg.

11.30 p.m. Fell asleep.

09/03/2023:

02.30 a.m. Woke up, went back to sleep.

04.30 a.m. Woke up with muscles twichting.

[Altostrata]

9 hours ago, RobertZ said:

08/03/2023:

 

05.00 a.m. Woke up, feeling drowsy, not rested. Muscles twitching, facial numbness.

6.00 a.m. Ate breakfast, took omega-3 fish oil.

7.00 - 12.00 a.m. Did shopping and chores. Still feeling drowsy.

01.00 p.m. Ate lunch, took Mg, K & Ca supplements.

02.00 p.m. Feeling more awake. Electric/burning sensation across whole body.

03.00 p.m. Went for a walk.

06.00 p.m. Ate dinner.

09.00 p.m. Lying in bed, muscles twichting. Took quetiapine 275 mg

10.30 p.m. Burning feet/electric-like sensation in legs. Took zolpidem 10 mg.

11.30 p.m. Fell asleep.

09/03/2023:

02.30 a.m. Woke up, went back to sleep.

04.30 a.m. Woke up with muscles twichting.

 

Is the quetiapine immediate-release or extended-release?

 

On 3/2/2023 at 11:21 AM, RobertZ said:

The quetiapine worked well for my sleep initially but stopped working eventually as I developed tolerance.

 

But you were drinking at the same time, correct? In your signature, please add the dates you started each of zopiclone (7,5 mg), zolpidem (10 mg), diazepam (5 mg) and estazolam (2 mg) 

 

On 3/6/2023 at 2:45 AM, RobertZ said:

The description of the serotoning syndrome seems to fit what I was experiencing: profuse sweating (especially at night), shivering, agitation/anxiety, muscle jerking - I probably had some form of SS without being aware of it.

I find it strange that the myoclonus would continue for this long, even though I've been off the antidepressants for quite some time now.

 

Yes, you might have had serotonin syndrome from combining trazodone and escitalopram. This is a serious adverse drug reaction that may take months to resolve. Explained here 

 

[RobertZ]

7 hours ago, Altostrata said:

Is the quetiapine immediate-release or extended-release?

Immediate release.

 

7 hours ago, Altostrata said:

But you were drinking at the same time, correct? In your signature, please add the dates you started each of zopiclone (7,5 mg), zolpidem (10 mg), diazepam (5 mg) and estazolam (2 mg) 

Correct. Done.

[Altostrata]

So you've been taking one benzo-like drug or another every night since November 2022, and you still have insomnia?

 

How often do you take diazepam? Will your prescription be refilled indefinitely?

[RobertZ]

16 hours ago, Altostrata said:

So you've been taking one benzo-like drug or another every night since November 2022, and you still have insomnia?

With the benzos, I sleep 2-4 hours a night but do not feel well rested, so yes, you could say I still have insomnia, even though I technically "sleep". Without them, I'd barely sleep at all because I'd jolt awake the moment I am about to fall asleep.

 

The benzo stuff was not my first choice, though.

 

After I was discharged from the psychiatric hospital last November, I got myself admitted to a neurology ward about the myoclonus. CNS MRI, bloodwork, CSF were normal; EEG was abnormal (slowed). In retrospect, I think this might have been because of quetiapine -- antipsychotics can produce a slowing of activity during EEG. I got prescribed valproate extended-release  2 x 500 mg and pregabalin 2 x 150 mg for what I presume was suspected epilepsy, and which I took for 2 weeks. Neither helped with the myoclonus, so I switched over to benzos.

 

16 hours ago, Altostrata said:

How often do you take diazepam? 

Every other day or sometimes daily at bedtime.

17 hours ago, Altostrata said:

Will your prescription be refilled indefinitely?

I don't know. It sucks being on this stuff, but it sucks even more not being able to fall asleep, especially now that I'm trying to taper quetiapine.

[Altostrata]

It could be that your inconsistent benzo and z-drug dosing is causing some of your symptoms. You've been rotating the 4 drugs since November 2022.

 

Sometimes one benzo-like drug does not substitute for another, and the dosages might not be equivalent in strength. @Shep @Frogie can you check dosage equivalents for diazepam and estazolam?

 

It could be that you have intermittent withdrawal symptoms from skipping doses of any of those 4 drugs.

 

Benzos are muscle relaxants and should help relax your myoclonus, which actually sound like hypnic jerks, which we see quite often when people have protracted withdrawal syndrome.

 

Please review

On 3/6/2023 at 7:59 PM, Altostrata said:

Strange sensations while falling asleep -- surges, zaps, jerks

 

 

Hypnic / hypnagogic jerks when falling asleep

Magnesium, nature's calcium channel blocker

 

 

How much magnesium and potassium do you take per day? Calcium opposes the effect of magnesium, you might stop taking it.

 

Since you have a cupboard of benzos, if I were you, I might take a consistent amount every night, dosage TBD after consultation with @Frogie and @Shep, and drop the z-drugs. Hopefully, this will stabilize your sleep and stop the jerking.

[RobertZ]

Woke up today with stronger than usual muscle twitches all over body, including face and tongue. I'm nearing 3rd full week of my quetiapine taper (300->275 mg) and I think this could be my body's reaction to the lower dose. What worries me, however, is that the twitches seem to fit the description of TD.

 

I'm not sure whether it would be better to stick with the 10% per month rule or taper faster to stop the muscle twitching from getting worse or progressing into full-blown TD.

[Frogie]

19 hours ago, Altostrata said:

 

Sometimes one benzo-like drug does not substitute for another, and the dosages might not be equivalent in strength. @Shep @Frogie can you check dosage equivalents for diazepam and estazolam?

2 mg of Estazolam is equal to 20 mg of Diazepam.

[Altostrata]

2 hours ago, Frogie said:

2 mg of Estazolam is equal to 20 mg of Diazepam.

 

Thanks, @Frogie Since the half-life of estazolam is about half that of diazepam, could be we are seeing intermittent withdrawal from estazolam when the other drugs are taken, because they would all represent much lower dosage equivalents, particularly the z-drugs. 

 

@RobertZ my guess is that stabilizing on your benzo dose might be helpful. Suggest you put tapering quetiapine aside for now and take 2.5mg diazepam every night at the same time, but some hours earlier than the quetiapine. 

 

Since diazepam has a long half-life, a consistent dose of 2.5mg per night will build in effect over a couple of weeks. @Frogie does this sound okay?

 

Please let us know how you're doing.

[RobertZ]

54 minutes ago, Altostrata said:

Please let us know how you're doing

On top of the muscle twitching, I've been feeling extreme agitation today ON and OFF (more like panic attacks). Anxiety about getting permanent TD, too. I guess my quetiapine taper will have to wait until I stabilise. Thanks for asking and the great work you are all doing.

[Frogie]

1 hour ago, Altostrata said:

Since diazepam has a long half-life, a consistent dose of 2.5mg per night will build in effect over a couple of weeks. @Frogie does this sound okay?

I think that sounds like a really well thought plan. consistency and stabilization will help tremendously. And Diazepam has a half life of 20-50 hours, so I think it would work well.

[RobertZ]

15/03/2023

It seems I've become super-sensitive to caffeine. Within 20 minutes of drinking a cup of coffee, I got finger tremors and anxiety. Never had this reaction with coffee. Also, was doing some online research on quetiapine and came across this:

https://www.psychotropical.com/quetiapine-the-miracle-of-seroquel/

Seems like a fun and informative read, so I'll post it here.

 

[Altostrata]

It's not unusual for people suffering drug mishaps to become sensitized to caffeine. You might consider gradually reducing your caffeine intake.

[StillChill]

@RobertZ I too experience the same hypnic  jerks and myoclonic features. Super fearful I’m getting TD from Mirtazapine and the WD from Olanzapine that I was only off and on for a couple weeks. It’s terrible and the worst. Only sleeping 4-5 hours a night is not restorative. I’ve been very close to try some benzos, but I don’t think it will help in the long run, but what will… 

[RobertZ]

On 3/17/2023 at 1:48 AM, StillChill said:

Only sleeping 4-5 hours a night is not restorative. I’ve been very close to try some benzos, but I don’t think it will help in the long run, but what will… 

I can tell you from experience that benzo-aided sleep is not restorative either. I'd prefer 4 hrs of natural sleep over 8 hrs of benzo-sleep anytime. Avoid benzos if you can.

[StillChill]

23 minutes ago, RobertZ said:

I can tell you from experience that benzo-aided sleep is not restorative either. I'd prefer 4 hrs of natural sleep over 8 hrs of benzo-sleep anytime. Avoid benzos if you can.

Yeah, adding anything to the mix has proven over and over again to not benefit in the long term. But we all end up desperate on the short term. I also feel that the Mirtazapine takes away the restorative sleep also. 
 

My PDoc recently gave me a script for gabapentin, I haven’t and likely won’t take any. 

[RobertZ]

On 3/18/2023 at 9:13 PM, StillChill said:

My PDoc recently gave me a script for gabapentin, I haven’t and likely won’t take any.

I got a prescription for pregabalin, which is apparently similar to gabapentin. Not taking it since I don't want to "confuse" my nervous system with any more psych meds.

 

My muscle twitches got more intense a week after the recent reduction of quet. Seems the taper has unmasked some EPS I might have developed. I'm considering a cold turkey (= probably even more EPS) vs. continuing the taper (= risking TD due to long-term exposure). Not sure where to go from here atm.

[Altostrata]

4 hours ago, RobertZ said:

My muscle twitches got more intense a week after the recent reduction of quet.

 

This would not be surprising, as quetiapine acts on systems involved with movement. Could be all your quetiapine changes sensitized these systems.

 

Are you still rotating through your benzos? Did you do this?

 

On 3/12/2023 at 12:40 PM, Altostrata said:

....

@RobertZ my guess is that stabilizing on your benzo dose might be helpful. Suggest you put tapering quetiapine aside for now and take 2.5mg diazepam every night at the same time, but some hours earlier than the quetiapine. 

 

Since diazepam has a long half-life, a consistent dose of 2.5mg per night will build in effect over a couple of weeks. @Frogie does this sound okay?

 

Please let us know how you're doing.

 

[Mcat]

Fellow jerks sufferer here - I'm not looking forward to the very real prospect that they will intensify once I start tapering either, so I'm feeling this. Can I ask what TD means?

[RobertZ]

4 hours ago, Mcat said:

Can I ask what TD means?

Tardive dyskinesia -- a number of movement disorders you can get from taking antipsychotics that may be irreversible.

 

 

[RobertZ]

10 hours ago, Altostrata said:

Are you still rotating through your benzos?

I've settled on diazepam 2.5 mg just like you suggested and my sleep got better. Now the only variable is the quetiapine dose. Currently on 250 mg

[StillChill]

22 hours ago, RobertZ said:

 

My muscle twitches got more intense a week after the recent reduction of quet. Seems the taper has unmasked some EPS I might have developed. I'm considering a cold turkey (= probably even more EPS) vs. continuing the taper (= risking TD due to long-term exposure). Not sure where to go from here atm.

Can I ask what EPS means? 

[RobertZ]

1 hour ago, StillChill said:

Can I ask what EPS means?

Extrapyramidal symptoms = involuntary, uncontrollable movements.

[Altostrata]

9 hours ago, RobertZ said:

I've settled on diazepam 2.5 mg just like you suggested and my sleep got better. Now the only variable is the quetiapine dose. Currently on 250 mg

 

Well, that's good news. (FYI @Frogie @Shep) How long have you been consistently taking 2.5mg diazepam per day?

 

Since then, have there been any other changes in your symptom pattern?

 

What is your current drug schedule?

[RobertZ]

21 hours ago, Altostrata said:

Well, that's good news. (FYI @Frogie @Shep) How long have you been consistently taking 2.5mg diazepam per day?

 

Since then, have there been any other changes in your symptom pattern?

 

What is your current drug schedule?

I've been taking the diazepam for two weeks now. Some new symptoms - irritability, low mood, being overly sensitive to sounds and caffeine - appeared after the recent reduction 275 mg -> 250 mg quetiapine (18/03). Also, all my muscles would twitch like crazy on a bad day. On other days the twitches subside. I have tremors when I stand or flex any muscle even for a brief moment.

 

Would these movement problems improve or worsen if I stopped quet. abruptly? Getting permanent dyskinesias is the last thing I want. My current schedule is 2.5 mg diazepam + 250 mg quetiapine.

[Altostrata]

On 3/27/2023 at 9:02 AM, RobertZ said:

recent reduction 275 mg -> 250 mg quetiapine (18/03)

 

Excuse me, how did this happen while you were stabilizing on a new benzo schedule?

 

Changing 2 drugs at once brings confusion into your system pattern. We cannot tell where any unusual symptoms might have come from.

 

On 3/27/2023 at 9:02 AM, RobertZ said:

Would these movement problems improve or worsen if I stopped quet. abruptly?

 

Suggest you settle down from these 2 changes for a month before making another change. We also advise making MUCH SMALLER changes in quetiapine, or you risk potentially severe withdrawal symptoms, including dyskinesia. See Tips for tapering off quetiapine (Seroquel)

 

Your twitches pre-dated your taking any quetiapine, correct?

 

[RobertZ]

11 hours ago, Altostrata said:

Your twitches pre-dated your taking any quetiapine, correct?

Partially yes, the sleep-onset ones I had before taking quetiapine. However, after I was put on low-dose (75 mg) quetiapine, new twitches also appeared in my face, neck, feet and fingers -- I can definitely see a link to the antipsychotic here. My quet. dosage was then increased to 300 mg and these new movements subsided. Now, after the two reductions  (300 -> 275 -> 250 mg) they are back. I suspect the taper unmasked the quetiapine-induced movement disorder.

 

12 hours ago, Altostrata said:

Excuse me, how did this happen while you were stabilizing on a new benzo schedule?

 

Changing 2 drugs at once brings confusion into your system pattern. We cannot tell where any unusual symptoms might have come from.

 

I was feeling stable symptom-wise and decided it was the right time to make another cut. The symptoms (twitching in particular) never completely go away, even on a good day. This makes it difficult to figure out the right timing for the next cut.

[Altostrata]

4 hours ago, RobertZ said:

I suspect the taper unmasked the quetiapine-induced movement disorder.

 

I suspect the taper umasked a quetiapine withdrawal symptom, which also can be a movement disorder.

 

4 hours ago, RobertZ said:

I was feeling stable symptom-wise and decided it was the right time to make another cut. The symptoms (twitching in particular) never completely go away, even on a good day. This makes it difficult to figure out the right timing for the next cut.

 

You're welcome to devise your own taper schedule and method. If problems arise from it, I can't see how peer support will be able to help other than to say "sorry, you're causing your own problems".