Chaos9211: Clomipramine Taper

[Chaos9211]

3 hours ago, Ryder said:

I have seen your post above about planning your taper. Maybe one drug at a time to start the first few weeks so you will know which drug is affecting you with what symptoms

Hi Ryder, 

 

Yes you are right as it varies with each individual, the best approach is to trial with one drug at a time. 

 

Hope your taper is going alright

[Chaos9211]

13 hours ago, LotusRising said:

I guess it depends on what symptoms you think you can tolerate.

Thanks Lotus for your patience and helping me out on this, I guess this is the key point.

 

So far the lithium taper has the lowest withdrawal profile (mood disturbance wise), My plan is to proceed with Lithium taper and bring it to 400 mg in steps and then hold to see what precipitates. This will probably give another 6 to 8 weeks for clomipramine to be held at 50mg and if any delayed waves await they can settle down.

During the Lithium taper steps if I am feeling high energy or excited state, I will hold the taper at that dosage and revert back to clompiramine taper.

 

As of this morning I have reduced the lithium dosage by 100 mg bringing the net per day to 600mg. The tablets are a pain to cut, and divisions smaller than 1/4th are not accurate. I understand this is higher than 10%, and for further reductions down the line I may have to get a digital scale to accurately shave off tablets. Unfortunately due to  lithium shortage and a general shortage of the base chemical in my location, there is no other brand or even different dosage in the same brand. 

 

I have updated the signature to reflect the changes

 

[LotusRising]

It sounds like you have thought everything through, so this sounds like a good plan. Yes, planning for a scale in the future is likely a good idea.

 

Please keep us updated.

[Chaos9211]

Hi all, 

 

Mini-update sort of, Lithium is definitely a "brake" for me. Agitation is higher, am louder and easier to offend. I miss out on what people say during conversation, its like I have a mind of my own which is just ever so slightly racing ahead jumping from one thing to another. Still functional and probably only noticeable to me and my close family only.  Can be due to aggregate effect of less sleep overall, but i suspect it is the reduction of lithium action and corresponding increase of clomipramine action since the brake is reduced.

 

Nocturnal panic attacks / Hypnic jerks are similar to prior to Lithium dose reduction. Not intense but still enough to disturb  sleep till 3 ~ 4 AM (sometimes 6~7 AM)

 

Will hold it at present values share more notes. May benefit someone else doing a lithium + AD combo taper.

 

Fingers crossed if I am still reasonably functional by 15th March, I will revert back to 10% clompiramine taper.

[Chaos9211]

Hi All,

 

Had a major setback, around 8th march, I had not slept for two consecutive nights, that combined with probably Lithium reduction from 800 mg to 600 mg, resulted in a manic episode. crying / shouting / crying ad nauseum. mood was highly volatile and it took me good dose of SOS Klonopin to calm down enough and get some sleep. next 3 to 4 days were volatile but phase started to recede as I had to revert lithium to 800 mg by first day of manic episode (9th march maybe)

 

a week was spent in remorse that I may never be able to get off these meds etc. Just yesterday I again started to have some clarity of thought that Lithium was always a brake, so I should probably focus on Clomipramine taper once I stablize a bit. I was never this hyped up when original I started titrating clomipramine up from 25 mg to 50 and then to 75mg (circa 2021). So atleast silver lining is that 50 mg clomipramine without lithium is definitely too much for me in my present circumstances.

 

Take away, Lithium can be as notorius as any other psychotropic medication taper with caution.

 

Night time hypnic jerks / panic attacks still ongoing. sleep is still a mess and probably not helping me recover from all this. Will hold till end of March atleast to see where I am at. Then if it is bearable I might drop Clomipramine by 10%

 

Will update signature soon.....

 

 

[Ryder]

Since you have mentioned that you would like to come off Clomipromine first, that might help a little with your digestion. 
 

Ryder. 

[Chaos9211]

mate I am at my wits end now, the pdoc is suggesting I try pregabalin for sleep. I dont know how long I can hold this off. I may have to do something eventually as I cannot function with such low sleep.

[Ryder]

You made a reduction on Lithium one month ago, is that correct ? 

[Chaos9211]

13 minutes ago, Ryder said:

You made a reduction on Lithium one month ago, is that correct ? 

21/2 100 mg, no change for 8 or 9 days, then 100 mg more. Hypo state came around 9th march

[Chaos9211]

May have been a combo of 

Fast taper + 2 consecutive sleepless nights.

 

But one thing is clear even after 100 mg reduction i could feel energy building up, irritibility etc

 

So clomipramine it is before anything else for me now.

[Ryder]

"21/2 100 mg, no change for 8 or 9 days, then 100 mg more."

 

Yeah that's way too fast man. 

[Chaos9211]

Hi all, 

Thought will provide an update. Due to the hypo state that precipitated around 9th March, I lost some legitimacy in controlling my medications, I was advised to atleast try pregabalin for improving sleep. I titrated it up from 50mg with to a final of 125mg. It did improve the sleep hypnic jerks marginally at 50mg and then at 125 mg there is a marked difference

 

Since Valium sort of acts on same system and it was not doing anything for me due to tolerance, I used this opportunity to drop valium to 2.5mg from 5 mg in steps. So far things are under control, no uncontrolled anxiety or rebound insomnia as such. 

 

Lastly, on a positive note, due to sleep improvement I was able to drop 10% clomipramine, (thus staying on my 4 weekly schedule) yes!

 

So I don't know, i have added two more meds, which sort of support me in sleep but have been able to reduce the clomipramine and benzo. I guess with my situation (post hypo) I shall take that as a win for now.

 

Clomipramine taper effects for myself are quite predictable so far, 4 ~ 5 day of dose reduction joint and muscle aches all over. This stays for a couple of days, combined with low energy and low mood. Day 8 ~ 9, body aches settle, mood is still dodgy, rumination / anxiety. This is where external support to help change the channel, having some constructive thing to do and overall a low stress environment really helps.  Around Day 15ish, things become tolerable overall with occasional hiccups. If given 2 more weeks the symptom pattern is fairly tolerable. 

 

Will hold the current meds till 15th April, after that I am thinking of slow tapering the Lamotrigine to 50mg and then do the next clomipramine reduction. Reason being that lamotrigine was added to help with hypnic jerks, it didnt give much effect there but definitely helped with day time anxiety  / derealization. Now that I have pregabalin sort of narrowed down for sleep improvement, I guess I can minimize these other drugs as much as possible. 

Also Clomipramine reduction has definitely reduced my overall energy so maybe that is also providing some added benefit in the hypnic jerks reduction.

[Chaos9211]

Update, Still holding on clompiramine as have low energy overall for last 4 or 5 days, depressive thoughts as well. Energy and low mood starts picking up towards midday / afternoon. Intrusive images have increased from 1 a day to 20 a day over the course of last 3 or so weeks.

 

Will give it more time to see if these symptoms settle only then will taper further. 

 

Also have dropped Valium from 2.5mg to 2.0 mg from 13th April. Holding that as well till the symptoms subside.

 

It is scary as the intrusive images are similar to what I had before I was put on clomipramine to being with. 

 

Hypnic jerks are still relatively under control, I do wake up few times everynight but instead of painful muscle tightness it is more like restlessness.