Longstocking: Tired of feeling sluggish and sleepy, want to try tapering off of meds again

[Longstocking]

Hello everyone, 
I registered on this forum a while ago, and finally decided to introduce myself as I'm thinking about trying tapering from my meds again. I have read through the threads of tapering off lamotrigine and fluoxetine before but would like to hear other people's history with these meds and not just on tapering but also if you experience similar side effects(?) while on them. 

Here's my history of psychiatric medication (sorry that it's so long, I wanted to give all the important details) :

I'm in my thirties. I've been on psych meds for three years. I was first put on them after I got a serious burn-out/depressive episode. It was most likely caused by very stressful work conditions (I am a social worker), but I remember having similar but much milder episodes before that. My main psychiatric "symptoms" were always very physical : mostly crushing fatigue, low-key anxiety that feels like tension in my chest. Mentally it's usually a lack of interest in anything and hopelessness, sometimes light derealisation. 

I have been on several different drugs and drug combos in varying doses (fluoxetine, lamotrigine, venlafaxine, fluvoxamine, sertraline and occasionally several benzos to deal with acute anxiety) which never "worked" or "stopped working" after a while or seemed to make things worse. Since then I went through several episodes of doing "better" and then the return of the above-mentioned symptoms.

Until July 2022 when I was put on a combination of 20mg fluoxetine and 100mg lamotrigine, which seems to be the combo that seems to be "working". This is what I am taking now. My mood is pretty stable (although kind of flat). Anxiety is low or non-existant. I can function okay on it. 

However I feel "off" and I have a hard time telling if it's the meds, residual "symptoms" of depression or something else altogether. I experience morning grogginess, constant light somnolence during the day, fatigue, sluggishness, muscle weakness, feeling a little "out of it", almost a little drunk, difficulty concentrating, slight memory issues and a sort of flat feeling where I don't feel particularly happy not sad. Most of the time these symptoms are light and I can function more or less normally but I have some days or periods when they become more severe and everyday life becomes more difficult, especially at work. I used too exercise a lot, for example. I used to love climbing and running and now it's too hard and not exciting at all. 

When I mention these thing to my psychiatrist he always seems to be slightly skeptical and keeps saying that fluoxetine is a stimulating rather then sedating drug and that lamotrigine shouldn't be causing somnolence especially at such a small dose.

 

After doing well for several months on this combo, my psychiatrist agreed that I may taper off fluoxetine if I wanted to but insisted I stay on lamotrigine. He suggested I to do the usual alternating one pill and half a pill for a few weeks, then half a pill every day, and so on. I think I stopped fluoxetine over a period of a little over two months. I understand now that that was a very quick taper even for fluoxetine (I didn't know it then). However, I don't remember any serious withdrawal effects aside from maybe occasional slight dizziness. It seems that sleepiness and fatigue decreased at least at the beginning although didn't go away completely. After being completely off of fluoxetine for two weeks or so, I started having the depressive symptoms again which led me to believe that I really "needed" the drugs so return to my usual dose and felt better quickly but return to my usual slightly "sluggish" state.

Later, when I learned about psych meds withdrawal, I started to suspect that maybe it wasn't a relapse but rather withdrawal effects from a quick taper and decided to try tapering off again but much slower. This is where I learn about antidepressant withdrawal. My psychiatrist agreed to prescribe me fluoxetine solution which allowed me to taper in a more or less recommended 10% increments. I was taping very slowly over a period of many months. Again, I don't think I had many usual withdrawal symptoms aside from some light dizziness and occasional slight agitation. But then I started to get impatient and especially started to suspect that sleepiness and sluggishness was mostly due to lamotrigine. So I started to taper off of it, at the same time (which was stupid, I realize), and very quickly (stupid) because lamotrigine pills dissolved very badly in water and I felt like I couldn't get the right dose at all. So I want from 100mg to 75mg and the after several weeks to 50mg. Again, I don't think I had any symptoms that could be attributed to withdrawal. But when fluoxetine was close to 10mg and lamotrigine at 50mg I slowly started to feel the return of depressive symptoms, and particularly the crushing mental and physical fatigue. Everything became hard again and I barely could go to work. So after struggling for many weeks I decided to return to my previous dose of 20mg fluoxetine and 100mg lamotrigine. I started to feel better quickly. I returned to my usual sluggish state but at least I could get out of bed and go to work and be able to manage. I started to believe again I may need to take these drugs for the rest of my life. 

It's annoying to always be sleepy and sluggish and I still want to stop the meds. Not only because of the side effects that seem to be causing, but also become I am not sure they are "actually' helping. I don't know what to believe about the actual reasons of mental difficulties. My symptoms always feel very "physical" and I am unsure how they can be dealt with through therapy, for example. So this makes the biomedical theories sound plausible. But at the same time I've been living without meds in the past and there are so much evidence about their ineffectiveness. And I often wonder how much of its action is placebo effect in my case.

So I am planning to start tapering off fluoxetine again, by 10% increments and then eventually hopefully off lamotrigine (which seems to be the recommended way). But I'm afraid to not have enough patience again, or to being unsure what are symptoms symptoms, what are withdrawal symptoms and what is normal part of ageing or some other medical problems altogether. I would like to hear other people's experiences.

By the way, I take both fluoxetine and lamotrigine in the morning. I tried taking them at night or splitting the doses and it only made things worse : worsened sleep, intense and vivid dreams and increased grogginess and sleepiness. 

[Emonda]

Welcome @Longstocking

 

It looks like you've been on a bit of a journey and have since done some reading on this site.

 

Here are a few helpful links which you may have already seen:

 

Keep It Simple, Slow, and Stable - there are some good nuggets in here.

 

Never skip doses to taper - sadly your doctor recommended this...not recommended on this site.

 

15 hours ago, Longstocking said:

But I'm afraid to not have enough patience again,

 

Why taper by 10% of my dosage? - Just ensure the monthly reductions get smaller and smaller. It's 10% of the most recent dose, not the starting dose.

 

Time and patience. Rushing is not a short cut.

 

15 hours ago, Longstocking said:

unsure what are symptoms symptoms, what are withdrawal symptoms and what is normal part of ageing or some other medical problems altogether.

 

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF)  I find this really helpful to refer to often. It's good to be reminded that what I am experiencing are WD symptoms, not a relapse.

 

Given you are taking two drugs, you should read this: Taking multiple psych drugs? Which drug to taper first?

 

 

 

Windows and waves pattern of stabilization - you'll have good period and not so good periods. It seems to be part of the process.

 

We don't suggest many supplements, but two that many of us find helpful are magnesium and omega-3 fish oil. Here are the links for info about those. Add one at a time and start with a low dose to see how it affects you. 

Magnesium

 

Omega-3 fatty acids (fish oil)

 

Avoid alcohol. 

 

This is your own Introduction topic.  Each member has only ONE Introduction topic.  Your own Introduction topic is the best place to ask questions and the place to journal your progress.  This keeps your history in one place and means you do not have to repeat your story. 

 

Once again, welcome to S.A.

 

Emonda

[Longstocking]

Thank you for your reply. I did read though most of the threads you've linked, but it's still a good reminder.

 

I am aware of the 10% of the last, not initial dose rule. That's what I did during my previous fluoxetine taper. It's the lamotrigine that I reduced faster then that because of the difficulty of making a solution.

 

I do take magnesium and Omega-3 but sadly didn't notice any improvement.

 

Anyway, thanks for the advice.

[Longstocking]

On 3/18/2024 at 10:40 AM, Emonda said:

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF)  I find this really helpful to refer to often. It's good to be reminded that what I am experiencing are WD symptoms, not a relapse.

 

But that's the thing, from what I've read about differences of withdrawal symptoms vs. relapse, it makes it seem like the depressive symptoms I developed last time I tapered was a relapse, rather then withdrawal. It developed very gradually and I didn't experience any other common withdrawal symptoms. This makes it hard to stay motivated to keep tapering. It's sometimes hard not to go back to thinking that I simply need the medication to "treat" my brain problem.

 

As for the somnolence, I experience it when I am on full dose, so it can' really be the withdrawal symptom, but rather a side-effect of the drug.