biggarf- Starting with a trintillex taper

[biggarf]

Hello everyone, I hope you are all doing well. Im a 21 year old neuropsychology (yes ironic) student in ontario. I was diagnosed with ADHD and an assortment of developmental and learning disabilities at 11 (we knew I had problems much earlier but the waitlist was very long) and MDD at 13, with an assortment of other psychiatric diagnoses that no longer fit. I had incredibly severe MDD which led as far as auditory hallucinations of my negative thoughts, catatonia, and i wept for most hours of the day, including at school or in public. I had a relatively stable childhood, with a mom who has depression, and both my parents are together and loved me very much, so my depression was very out of contex. I often switched meds and had doses changed due to side effects or lack of efficacy, and had very few medications that worked. the first time I was tapered in 2019 I had very severe withdrawal and required inpatient care, and I wasnt tapered onto another medication. I am currently in a very good place mentally and have been stable for the past 2 years after rTMS stimulation, and changing my diet and exercise routine, along with regular sunshine. I have a large personal support group in my life and feel that I want to know what life is like without these meds, and am able to make these changes and still be supported. My history is as follows:
 

2015: Sertraline (150 mg) and Adderall XR (30 mg) (1 hospitalization took place)
2016-2017: tapered off sertraline and replaced with Wellbutrin (300 mg), tapered off Adderall and replaced with Vyvanse (70 mg) Lorazepam (1mg for sleep) (1 suicide attempt and 2 hospitalizations took place)
2018: put back on Sertraline (200 mg) due to hallucinations, Vyvanse (70 mg) continued, Abilify 10mg was added. ( 1 very serious suicide attempt and 2 hospitalizations took place)
2019: Sertraline tapered into Latudia (40 mg), Abilify was tapered off, Vyvance was tapered into Concerta (72mg) (1 hospitalization took place)
2020: Latuida tapered into duoloxetine (60 mg), Strattera (40 mg) added, Concerta (72 mg)
2021-2023 Duoloxetine tapered into Trintillex (10mg), Strattera (40mg) Concerta (72 mg)

 

I am extremely into learning about how diet and lifestyle influences psychiatric illness. I eat a meat rich diet with whole carbs and plenty of fruits and vegetables, and avoid seed oils. I take ashwhaganda, and creatine, both help a lot with depression, as well as L-carnitine supplements. I hope to do research in the future on the effects of diet and mental health, and how underlying inflammatory markers and nutrients influence neurotransmitter production. I plan to begin tapering my trintillex next week from 10mg to 9mg, after meeting with a new psychiatrist and will update you on my journey

[Onmyway]

Welcome @biggarf

Seems like you have read the relevant information here and are going to follow the no more than 10% of your previous dose reduction. 

 

We are happy to help and learn of your journey until now and from now on. Please let us know if you have any questions. Have you also considered Brassmonkey's method? Given your history of lots of medication changes an even gentler approach may be helpful.  What do you think?

 

OMW

[biggarf]

Thank you, I looked into the brass monkey method, and it looks like a viable option, however eyeballing my pill cutting has been difficult and I think i would end up with the same result with the pill cutting because im slivering it off every day.

[Onmyway]

Hi @biggarf, 

you should not be eyeballing at this point - you should find a way to measure precisely your dosage - that is very important. 

Here are some ways in which you can get the right dosage. Keeping things stable is very important at this point. 

 

[biggarf]

Thank you @Onmyway, I will be looking into getting a milligram scale. In the meantime, I saw a psychiatrist after a very long wait and he suggested I focus on lowering my Concerta, as he was shocked that I was prescribed 72mg as a child, which is a dose he wont even prescribe to fully grown adults. Since Concerta has an extremely short half life of 3.5 hours, he told me I should be fine to decrease it to 59mg right away and difficult to cut. I put the trintillex taper on hold for now and am focusing on decreasing my stimulants first since they cause me to pick at my skin for long periods of time and I have tachycardia. I will update later

[Onmyway]

Hi @biggarfthat makes sense. I don't know proper doses of stimulants and such but once you lower them some of the other symptoms may get better as well. There are some very irresponsible doctors around so I am glad you got someone who is more careful. We see people prescribed dangerous (as in you can drop dead from that dangerous) doses of medicines. 

OMW

[biggarf]

So today was my first day of a decreased dose of concerta. I dont believe I have had any physical side effects, however, I have been extremely down about my body image, and constantly find myself checking my body consistently and hating what I see. This is usually normal for me to check every time im in front of a mirror, but its been constant and im feeling quite distressed. Im not entirely sure if its because of the medication since I am prone to not liking my physical appearance, but its a lot more intense then usual

[Onmyway]

Hi @biggarf, 

have you looked into internal family systems therapy - it's supposed to be good with eating disorders which is often triggered by not liking one's body. Preoccupation with something is common in withdrawal so I am suspecting that it might be helpful. 

 

This is an explanation of what IFS is if you wanted to have a look - it may or may not be the right thing - but doesn't hurt to check it out. 

 

https://cls.unc.edu/wp-content/uploads/sites/3019/2020/03/Handouts-for-IFS.pdf

 

OMW

Edited July 26, 2023 by Onmyway

[biggarf]

Thank you @Onmyway, I had a look at it and its the same type of therapy I used to do with my therapist regarding unhelpful defense mechanisms. I will keep this in mind, since it wouldnt be good to fall into an ED while im tapering my meds.

[biggarf]

im on day 4 of my decreased concerta dose and have been so incredible unproductive. No desire to achieve anything and work is piling up. I havent lifted weights and I have no drive to see my friends, eat, or do anything really and I hate it. I want to cry right now this ******* sucks

[Onmyway]

@biggarf, 

you may want to try other ways in which to motivate yourself. Remember that you don't always need motivation to get things done - sometimes you just have to do them (motivation=feeling like you want to). Heck, most of the things that I need to do I don't want to do at all but I do them despite not feeling like it. In withdrawal 'acting as if' is often helpful to get you going. Your feelings should not determine whether you eat or exercise. Feelings are not as important as we think they are.

This is a good article that says what I mean slightly more eloquently. 

https://ambitioncandy.com/productivity/how-to-get-things-done/

 

OMW

[biggarf]

Hey guys, I hope everyone is doing well. I have been on my decreased concerta dose for a little while and I think the withdrawal is just about done, I am planning on starting to taper my trintillex once this dose is stabilized :)

[Onmyway]

Hi @biggarf

this sounds good. Do you know how to measure the right dose of Trintellix? Are you following the 10% every 4 weeks or Brassmonkey's Slide method?
OMW