CollinS19: Anxiety has come back after an updose?

[CollinS19]

I had a depressed episode in 2013 and since then have been on 200mg of Lamictal, 15mg of Remeron, and 0.5mg of Risperdal, all once at night. I have autism.

 

In January 2023, I forgot to take my Remeron for four days and that caused an episode of anxiety. I wanted to feel better quickly, so I started taking two 15mg tablets instead of one.

 

I since learned that it doesn't work that way. However, I kept with the 30mg because I'm nervous there could be a problem if I go back to the usual dose. A few years ago tried taking 0.25mg of Risperdal (half my usual dose) to see if I could tolerate it but I couldn't.

 

All year, I have still had some anxiety, but it has usually been at a level I can tolerate. Still, it is out of the ordinary for me to still have anxiety this long.

 

Yesterday, the anxiety got to an unfamilar high level, and I am wondering where it is coming from. I feel as if I am off my medication.

 

I have read a few places that say changing your recommended dose can cause problems. I'm considering slowly going back to 15mg, but there is always the worry that it could cause problems.

 

I have other suspicions. I read that alcohol can cause interactions with my meds, and I have been drinking alcohol occasionally since 2015. I have never felt a direct impact from using alcohol with my meds, so I always figured it is okay.

 

My other minor suspicion is marijuana. I have tried marijuana a few times in my life and I have always had a strong anxiety reaction to it. In January this year, a couple weeks before I accidentally stopped taking my Remeron, I tried a 10mg THC edible and had another anxiety reaction for a couple days. Can it cause long term problems?

 

Looking for advice. 

Edited August 18, 2023 by manymoretodays
name to topic title

[Altostrata]

Welcome, @CollinS19

 

Skipping doses of psychiatric drugs can cause withdrawal symptoms. Anxiety is a common withdrawal symptom. You should take your drugs on a consistent schedule every day.

 

It appears you doubled your Remeron dose, and your doctor filled your prescription at this increased dose. It is possible that it is causing an adverse reaction.

 

On 8/17/2023 at 12:00 PM, CollinS19 said:

I read that alcohol can cause interactions with my meds, and I have been drinking alcohol occasionally since 2015. I have never felt a direct impact from using alcohol with my meds, so I always figured it is okay.

 

Have you discussed your concerns with your doctor?

 

We offer peer support for going off drugs. Do you want to go off your drugs?

 

To help us out, follow these instructions Please summarize your drug and withdrawal history in your signature You may need to use a computer to do this.

[CollinS19]

The doctor did not prescribe the updose. I did it on my own, thinking I would get better quicker after accidentally going off it. I did start feeling better after a week, and at some point I decided to switch back to 15mg because I didn't want the weight gain, side effects, etc.. So I went back to 15mg and I think had another bought of anxiety a week later. So I decided to commit to 30mg.

 

However I didn't feel much of any side effects except for a little anxiety that never went away. Then on Aug 16, the anxiety went super high.

 

In the past, a sudden big wave of anxiety has always been attributed to me forgetting to take my meds or taking too little of them (typically a week prior) to which I start taking the meds accordingly and feel better within a couple weeks. My current situation is difficult because the problem MAY be that I'm taking too much, and I'm feeling the effects many months later.

 

The anxiety has made it hard to function, eat and sleep. My family doctor gave me 50mg hydroxyzine on Aug 17 and took it 4 times a day through Aug 19 but it didn't do anything.

 

Went to the ER on Aug 19 looking for quick relief, and they told me to stop the hydroxyzine and gave me 1mg Ativan to take up to three times a day. I took an Ativan at 5pm Aug 19 and 12am Aug 21.

 

The Ativan helps calm the anxiety, and helps me sleep and eat, but it wears off within a couple days. I like that I feel better, but it complicates things because it's another thing I'm throwing into the cocktail and I don't want get addicted to it. Luckily they only gave me 10 of them.

 

The ativan was meant to help me get to today where I'm seeing a psychiatrist. But I'm nervous what he will say because I don't want to add another medication if that's what he suggests.

 

I'm not someone who is looking to go off meds anytime soon because I've never had much trouble with them. I'm just looking for advice around ADs because this is a new situation for me.

 

 

I posted my situation on reddit and people told me that mirtazapine can cause more anxiety at higher doses. They suggested I taper back to 15mg. So on Aug 19, I started taking 1.75 tablets or 26.25mg.

 

I know you here suggest the 10% rule, but I wonder how that is achieved. Do you use a pill cutter? Because I can't even cut the tablets into fourths that evenly.

[CollinS19]

Saw a new psychiatrist today and he suggested 5mg of lexapro, not to take ativan for more than a week, and that I should be fine going straight from 30mg to 15mg. He thought I might not need Lamictal or Risperdal.

[CollinS19]

I want to try tapering slowly but I don't know how to handle the anxiety at the rate I would move.

[Altostrata]

10 hours ago, CollinS19 said:

In the past, a sudden big wave of anxiety has always been attributed to me forgetting to take my meds or taking too little of them (typically a week prior) to which I start taking the meds accordingly and feel better within a couple weeks.

 

This is a good way to destabilize your nervous system. Very possibly, all your drug-related symptoms arise from inconsistent dosing.

 

We provide peer support for tapering or withdrawal syndrome. We don't provide monitoring for drug adverse effects during maintenance drug treatment, that's your doctor's job.

 

4 hours ago, CollinS19 said:

I want to try tapering slowly but I don't know how to handle the anxiety at the rate I would move.

 

Is this something you want to do now?

 

 

[CollinS19]

My idea was to taper slowly back to 15mg and I started a few days ago, but it's difficult at the rate I'm going. You say I should trust what my doctor says and take 15mg?

 

You mean everytime I go off meds and then back on again in a short span (which has happened 3-4 times), that it throws off my nervous system? And what does that mean? That I need to reevaluate my doses every time? Because I feel like I've never had an issue by sticking with the same doses I've been on since 2013.

 

I hope i don't sound aggressive, I'm just desperate for answers.

[Altostrata]

11 hours ago, CollinS19 said:

I know you here suggest the 10% rule, but I wonder how that is achieved. Do you use a pill cutter? Because I can't even cut the tablets into fourths that evenly.

 

See Tips for tapering off mirtazapine (Remeron)

 

 

5 minutes ago, CollinS19 said:

My idea was to taper slowly back to 15mg and I started a few days ago, but it's difficult at the rate I'm going. You say I should trust what my doctor says and take 15mg?

 

Taper what drug?

 

Exactly what drugs are you taking now, at what times o'clock and dosages?

 

5 minutes ago, CollinS19 said:

You mean everytime I go off meds and then back on again in a short span (which has happened 3-4 times), that it throws off my nervous system? And what does that mean?

 

That is correct. Every time you make a drug change, your nervous system has to adapt. Adaptation takes weeks or months, not days. Multiple changes  on top of changes can disrupt the functioning of your nervous system, causing odd and uncomfortable, sometimes disabling, symptoms.

 

If you look around in the Introductions topics, you'll see many people who have experienced this.

 

It's possible none of your doctors are aware of this.

[CollinS19]

I believe everything i am taking is correctly written in my signature. I take everything between 9pm and 11pm.

 

The drug im talking about tapering from 30mg to 15mg is remeron because 15mg is what I've always taken until Jan 2023. And in my case, deviating from usual doses has caused problems, but going back to the same doses seems to fix it within a couple weeks or sometimes a couple months.

 

Are you saying my psychiatrist is wrong? He said he once had people go from 45mg remeron to 0mg with no problems, but that anecdote didn't help because I have done that and had problems.

[Altostrata]

What drugs are you currently taking, at what times o'clock and dosages? Are you taking Lamicta? Are you taking Risperdal?

 

16 hours ago, CollinS19 said:

Are you saying my psychiatrist is wrong?

 

This site exists because people find their doctors don't know what they're talking about. If you prefer to follow your doctor's direction, it's your decision.

 

If you want to taper Remeron, see Tips for tapering off mirtazapine (Remeron)

 

 

 

[CollinS19]

I take everything between 9pm-11pm

Lamictal 200mg

Risperdal 0.5mg

Mirtazapine 26.25mg = 1 3/4 tablets

Vitamin D3 2000 iu

Melatonin 10mg

[Altostrata]

On 8/22/2023 at 12:41 PM, CollinS19 said:

Saw a new psychiatrist today and he suggested 5mg of lexapro, not to take ativan for more than a week, and that I should be fine going straight from 30mg to 15mg. He thought I might not need Lamictal or Risperdal.

 

If you want to follow your new doctor's advise and change up your drugs, please take any problems or questions arising from the drug changes to your doctor.

 

It is important to take your drugs on the same schedule each day. But it doesn't make sense to take all those drugs together, that could be causing some of your problems, as well as the inconsistent dosing. For your information, you may wish to put ALL your current drugs in this Interactions Checker and review interactions with your doctor.

 

If all you want to do is taper mirtazapine, I suggest you take your drugs consistently for 2 weeks so you can understand your baseline symptom pattern, and then follow Tips for tapering off mirtazapine (Remeron)  to taper mirtazapine more gradually than your doctor recommends.

[CollinS19]

2 hours ago, Altostrata said:

it doesn't make sense to take all those drugs together

Why? I've had no issues

[Altostrata]

Many of your unpleasant symptoms may be due to your taking your drugs inconsistently, switching drugs, or adverse reactions causing by taking them together at the same time. It could be that drugs were added to address adverse effects from other drugs -- this is called a prescription cascade.

 

But if you're happy with the results and prefer to follow your doctor's direction, please take any consequent problems to your doctor.

 

If you want to taper mirtazapine, follow Tips for tapering off mirtazapine (Remeron)  The instructions are easy enough to follow. I don't think you need any further help from the staff here. Good luck. 

[CollinS19]

I decided to try not taking the ativan this week and started feeling like myself again by Friday. Then as I drove home from vacation, the anxiety quickly came back and I had to take another ativan. So that's three in one week. I know I need to stop taking it at some point which worries me. The panic attack yesterday in the car was pretty bad and I dont know what to do in those situations.

 

I need to fix my medication problem quickly. If the solution is to go back from 30mg Remeron to usual 15mg, I would switch right away if I knew there wouldn't be problems, but I won't know unless I try, so I'm going slow. But I worry I'm going too slow. I once tried going half dose of my Risperdal and that caused some problems but they weren't as bad it could be. Thats why I worry about going down a dose to fix the problem. I've been taking 1 3/4 tablets of Remeron for a week now and I don't know if it's working yet.

 

I'm opening to the idea of taking lexapro, but if I need a month to find out if it works, that's still a long way away. The Ativan really helps.

[CollinS19]

On 8/24/2023 at 9:07 PM, Altostrata said:

 

I still would like some assistance. I posted an update.

[FireflyFyte]

Hi Collin,

 

As Alto stated, we are a site dedicated to helping people taper off medication. We can not assist with inquiries about trying new medication, these questions should be directed towards your prescribing doctor.

 

We recommend dropping no more than 10% of the previous dose per month, going from 30mg to 15mg would be a 50% drop and much higher than we recommend. You can read more about tapering at 10% of the previous dose per month at Why taper by 10% of my dosage?

 

Thanks,

 

Firefly

[Altostrata]

@CollinS19 we do not help with drug regimen maintenance problems, that's what doctors get paid for. If you are having problems with your cocktail, please talk to your doctor.