HoosierKara: Vraylar (cariprazine) Cold Turkey

[HoosierKara]

Hello!

 

I was on the antipsychotic Vraylar (cariprazine) 1.5mg/day for 4 months early this year, off-label because I’m suffering from anxiety and depression due to menopause and my psych nurse practitioner said it would enhance the efficacy of my 10mg Lexapro.

 

My insurance denied coverage for the Vraylar in May of this year ($1600/month without insurance) and my NP said I could go off of it cold-turkey because it has a long half-life and was essentially “self-tapering”.  I went off abruptly on May 15, 2023.

 

On May 24, 2023 the bottom dropped out of my life.  Debilitating anxiety, nausea, paresthesia, obsessive/racing thoughts, constant suicidal ideation.  I could barely leave the bed.

 

Over the last month the symptoms have eased but only slightly; I am no longer suicidal but the anxiety and nausea plagues me all day and my brain can’t think of much else than my pain and how I can stop it.

 

I couldn’t find much online about Vraylar withdrawal, which led me to this site.  It’s been 5 weeks of a nightmare; do you think this could still be from the abrupt cessation of the Vraylar?  I was only on it for 4 months and I feel like my entire life has changed.  Does cold-turkey withdrawal ever get better?

 

Thank you so much for any help you might have.

[Altostrata]

Welcome, @HoosierKara

 

We don't get many inquiries regarding cariprazine, an atypical antipsychotic, fortunately. It seems your prescriber likes to experiment with new drugs.

 

Have you told your prescriber about your bad results? Those do look like withdrawal symptoms. 

 

Generally, withdrawal symptoms from psychiatric drugs very slowly go away over months. It's a good sign you're seeing improvement.

 

If the symptoms are intolerable or are getting worse, you may wish to consider low-dose reinstatement, such as 0.25mg Vraylar, to start. 

 

Often when people have recently come off, reinstatement of a small amount of the drug can help. You'd stabilize for some months and taper later by tiny amounts.The liquid form of the drug is the most convenient way to accomplish this. According to US NIH DailyMed, the ingredients in the capsule are not time-release, they can probably be made into a suspension with water or a compounding pharmacy can make a liquid by prescription.

 

See 

How to make a liquid from tablets or capsules

Using an oral syringe and other tapering techniques

Pharmacy liquids to make suspensions

 

What is withdrawal syndrome? 
 
About reinstating and stabilizing to reduce withdrawal symptoms 
 
The Windows and Waves Pattern of Stabilization

[HoosierKara]

My symptoms have gotten worse the past two days: more extreme anxiety, nausea, dizziness, near-constant hot flashes, no appetite.  I’m spending most of my time lying down.  It’s been 6 weeks since stopping Vraylar; do these seem like withdrawal symptoms still?  Would they get worse after getting slightly better?

 

Thanks again for your perspective!

[Altostrata]

Yes, those are classic withdrawal symptoms. What we see here is that they can last a lot longer than a few weeks, they can last for many months or years.

 

If your withdrawal symptoms have gotten worse, it's likely to be a very long time before they get better. Please consider low-dose reinstatement as explained above.

[HoosierKara]

I’m considering reinstatement, but it’s been over six weeks and I’m afraid it wouldn’t work.  I only took the blasted drug for four months; are there any success stories regarding cold-turkey quitting?  I would hate to think I invested six weeks of hell just to go back on the drug that harmed me.

 

Edited to add: I’m not even sure my prescriber would go for reinstatement as my insurance denied coverage for Vraylar and my prescriber thinks that it’s just a resurgence of my original illness.  But my original anxiety has never been this intense.  Has anyone healed from a cold-turkey without reinstating?

[Altostrata]

You might look around in the Introductions forum. Intro topics where people quit cold turkey are tagged "cold turkey".

 

It can take many months to recover.

[HoosierKara]

@Altostrata, thank you so much for taking the time to respond.  I really appreciate your time and expertise.

 

I’ve been experiencing mini-windows each night when my symptoms almost completely go away.  Then the next morning the symptoms are back.  Does anybody else experience this?  Is this something that happens in withdrawal, or is it more of a menopause thing?

 

Thanks again for any insight anyone can provide!

[Altostrata]

About what time o'clock are these windows? How long do they last? Is there anything you do or take regularly in the earlier part of the day that might cause these effects? What times o'clock do you take your drugs, with their dosages?

[HoosierKara]

Usually the windows open around 8 pm, sometimes earlier (July 12 it opened around 4:30 pm).  I’ve had these windows every night consistently since my WD ordeal began on May 24.  The windows last until I go to sleep, or until about 8 am when I wake up with anxiety.

 

Since June 23 I’ve been taking my pills and supplements at night (around 7 pm).  I take the three meds at the dosages listed in my signature (Lexapro, Wellbutrin and Buspirone) along with 420mg magnesium glycinate, a multivitamin for age 50+, 1000mg fish oil, vitamin D3, and Ashwaghanda.

[Altostrata]

You take Lexapro, Wellbutrin and Buspirone together at the same time at night? Why do you do that?

 

 

Please put ALL your current drugs in the Drug Interactions Checker https://www.drugs.com/drug_interactions.php

and copy and paste the results or a link to them in this topic.

[HoosierKara]

Okay, I tapered off the buspirone and Wellbutrin because @Altostrata’s response made me see that I was being over-medicated and I wanted to stop before the hole got too big.

 

Now I’m tapering off the Lexapro I’ve been on since November 2022 (see signature).  It’s a nightmare that is only getting worse.  Extreme anxiety and depression, intrusive thoughts, SI, brain fog, unsteady on feet, crying every day, now I can’t sleep.  At all.  My CNS has been on five-alarm high-alert for nearly a week.

 

Am I tapering too fast?  I want to never ever take this poison again, but will the withdrawal get better if I go slower?  I just need some help and reassurance.  My psych NP had a two-week taper plan ready for me back when I started in July so of course she’s no help.  My husband is pushing for a Prozac bridge but I’m terrified.

 

Can someone please just talk to me?  I’m so scared.

[Altostrata]

2 hours ago, HoosierKara said:

Am I tapering too fast?

 

Yes. If you have withdrawal symptoms, stop tapering, allow your system to stabilize before tapering again.

 

You've already gone off 2 drugs and your system may need a long vacation from drug changes. Don't push it too far. See 

Why taper by 10% of my dosage?

The Windows and Waves Pattern of Stabilization 

 

[HoosierKara]

Hi…I got the message that Alto is stepping back; is anyone else seeing these threads?  I have so many questions and I feel so alone.

 

 Thanks to anyone who sees this!

[FireflyFyte]

1 hour ago, HoosierKara said:

Hi…I got the message that Alto is stepping back; is anyone else seeing these threads?  I have so many questions and I feel so alone.

 

Yes, there are several moderators still reading threads.

[KenA]

@HoosierKara We still do have a team of moderators and mentors available to help with any questions you may have. We are a team of volunteers helping others in the best way that we can, so there may be a slight delay at times in getting a response. We did create a new cover page for the website that has the most commonly asked questions and answers and is a wealth of knowledge to help you get started. If you have any other questions, please don't hesitate to ask

 

KenA

[HoosierKara]

Thank you so much @FireflyFyte and @KenA!  And bless you @Altostrata for the immeasurable amount of work you’ve done for all of us.

 

I haven’t tapered down since 11/29/23 when I did an 11.11% bump down on my liquid Lexapro, and while I do have some windows, I’m *still* overcome with anxiety.  Not many physical symptoms, but the three horsemen: anxiety, depression and insomnia, are driving me to dark places.  Is this normal??  I’m still so scared.

 

i have an appointment with my psych NP on the 16th where I’m going to ask about the Prozac bridge.  Does anybody think that’s a good idea?  I tried to find a definitive thread about it but the link I found didn’t go anywhere.

 

Thank you all again for your patience and expertise.

[KenA]

@HoosierKara Not sure if you have seen this topic on the Prozac bridge or not.

 

 

 

[KenA]

46 minutes ago, HoosierKara said:

but the three horsemen: anxiety, depression and insomnia, are driving me to dark places.  Is this normal??

I had all three of these for quite a long time. They eventually faded away as I healed. Sadly they are pretty normal for WD.