beckm: Which drug to taper first?

[beckm]

Hello,

I have had issues with all types of benzos and went through a rapid detox at 2 different facilities. I was put on Seroquel 100 mg and Gabapentin 600 mg to help me with horrible insomnia. It just made the insomnia worse, and caused me terrible anxiety. I went back on Klonopin 1.5 mg added to the other 2 meds so I could sleep. My memory is starting to fail, and I have trouble getting my words out. I want off all these meds but not sure which to start first. I have no side effects from Seroquel other than mild akathesia, so no diabetes or other issues. It does make me very irritable.

Edited July 31 by Emonda
Name to title

[Catwoman73]

Hi @beckm, and welcome to SA!  We are a community of volunteers providing peer support in the tapering of psychiatric medications, and their associated withdrawal syndromes. 

 

Thank you so much for completing your drug signature.  I'm so very sorry for all you have been through- we certainly don't recommend rapidly stopping any psychiatric medications, nor do we recommend using other psychiatric medications to treat the withdrawal symptoms of psych meds.  It looks like you've fallen victim to both of these things, and this has likely destabilized your nervous system in a big way!

 

I want to clarify before advising you- are you still taking all of these drugs- adderall, klonapin, Seroquel, and gabapentin?  Wow, that is a LOT.  It would be hard to say what med is causing what issues, because they all have moderate interactions with one another.  How long ago were your two rapid detox stays?  You could very well still be in protracted withdrawal from those rapid stops, explaining some of the symptoms you have been experiencing.  But you've come to the right place- we're happy to help you out.

 

When you are taking more than one psychiatric drug, order of tapering is important.  It's best to taper the more stimulating drugs first, as the more calming drugs can help mitigate the withdrawal symptoms of the more stimulating ones.  Read more about choosing which drug to taper first here:

 

Taking multiple psych drugs? Which drug to taper first?

 

Whichever drug you end up choosing, we recommend tapering by no more than 10% of your current dose, no more often than every 4 weeks.  This is known as a hyperbolic taper, and is designed to minimize withdrawal symptoms as you proceed.  Faster tapering or cold turkey stops can certainly lead to protracted withdrawal, as I described above.  Read more about hyperbolic tapering here:

 

Why taper by 10% of my dosage?

 

This is important because, once you've been on these drugs for more than just a few short weeks, your body starts to make many changes to adapt to the presence of the drugs.  These changes are both biochemical and genetic- yes, these drugs do change how our genes are expressed.  Read more about how these drugs change your brain here:

 

How Psychiatric Drugs Remodel Your Brain

 What is happening in your brain?

 

Tapering hyperbolically does help minimize withdrawal symptoms, but it will not likely eliminate them altogether.  I would strongly recommend starting a symptom journal, so you can track what is happening as you proceed.  You can use this list of typical withdrawal symptoms as a template:

 

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

 

As you taper, you will notice that you have good days/weeks and bad days/weeks.  This is a very normal experience- we refer to it as the windows and waves pattern of stabilization.  Keeping a journal can help you identify your windows and waves.  

 

Windows and waves pattern of stabilization

 

There are a few things you can do to take care of yourself as you taper.  Eat a healthy, whole foods diet, stay adequately hydrated, get some gentle exercise, and keep stress to a minimum.  Avoid all neurologically active substances, like caffeine, nicotine, alcohol and recreational drugs.  And avoid taking any further psychiatric drugs to manage withdrawal symptoms.  Adding anything to your current cocktail could make things significantly worse, and will also create a situation where you have yet another drug to taper, thereby prolonging your tapering/withdrawal journey.  

 

You have already had issues with insomnia due to withdrawal, and likely will again.  Here are a few links to our recommended coping strategies for insomnia.  Do be careful when adding any new supplements, even the ones recommended here- it is quite common for those of us in withdrawal to become hypersensitive to medications, supplements, and even foods while tapering.  Always start with a very low dose to see how you fare, and titrate upwards slowly. 

 

Tips to help sleep: so many of us have that awful withdrawal insomnia

 Path to Better Sleep FREE online for everyone from the US Veterans Administration

 Magnesium, nature's calcium channel blocker 

 Melatonin for sleep

 Music for self-care: calms hyperalertness, anxiety, aids relaxation and sleep

 

The mental game while tapering is really tough, so it's a good idea to create a habit of some non-drug methods of coping with cognitive/emotional symptoms.  Mindfulness and meditation are the cornerstones of my ability to cope- I would highly recommend you start practicing both right away, as it takes some time to really get the hang of it, and experience the full benefits.

 

Non-drug techniques to cope with emotional symptoms

 Easing your way into meditation for a stressed-out nervous system

Ways to cope with daily anxiety

"Change the channel" - dealing with cognitive symptoms

Dealing With Emotional Spirals

 

In summary- you will have to decide which med to start tapering, depending on which you feel is the most activating for you.  Do check out the link I provided to help you make that decision.  Taper by no more than 10% of your current dose, no more often than every four weeks.  We can help you with doing the math on your dosages, and how to best create the oddball dosages that are required for hyperbolic tapering.  Start a symptom journal so you can identify your windows and waves, and possibly things that trigger waves for you.  Take good care of yourself in general, and practice some non-drug coping mechanisms, so that you are prepared to deal with symptoms as they pop up.  Most of all, I want to say congratulations on your decision to move forward with tapering!  There's a whole new you waiting on the other side!  Don't lose hope, and know that as we taper, we are always healing, even on the days when it doesn't feel like it!  Your brain and body is highly resilient- you will heal, your cognition will improve.  It just takes some hard work, time and patience. 

 

This is your introduction topic- each member gets one intro topic.  Please post updates, questions and concerns on this thread.  But don't hesitate to explore the rest of the forum- there's tons of good information here!  And it's always a good idea to engage with other members by commenting on their threads- after all, we are a community of like-minded people!  It's nice to know that there are people out there who understand, and are going to cheer you on as you go through your tapering journey!❤️‍🩹

[beckm]

Thanks for your super helpful welcome, Catwoman73. I will be checking out all that great information for sure! To answer your question about how long ago were the 2 detox stays, the first was in 2014 and the second 2015. I was taking Xanax and Ambien at that time, and having interdose withdrawals that made life pretty miserable. I was able to survive on just Seroquel 100 mg and Gabapentin 600mg, both to help with insomnia. It hardly helped at all, and sometimes I had horrible panic attacks. I tried breathing techniques, which sometimes took the edge off temporarily, and I went to therapy, which did nothing. After the first detox, I relapsed within 2 weeks, and after the second detox, I relapsed within 2 months. I found a psychiatrist who was willing to give me Klonopin instead of Xanax, and that was extremely helpful for the interdose withdrawals. I still continued the Seroquel and Gabapentin, and the combination of the 3 drugs helped me sleep a good 5-6 hrs a night. Still, I was always tired and unmotivated, so I gave in and found another Dr to put me back on Adderall. I’ve now been on all 4 of those meds since 2015. I can for sure stop the Adderall, though the cravings hang around for awhile, but I will obviously need help with the other 3 drugs. I am so motivated to do this the right way, no matter how long it takes. I am 62 and still work part time, but my moods are all over the place.

[Catwoman73]

Are you thinking of starting with the Seroquel?  If you feel that it's causing you mild akathisia, that might be a good place to start.  Here is our thread specifically on tapering Seroquel for your review- it's important to familiarize yourself with this info before starting.

 

Tips for tapering off Seroquel/Quetiapine

 

Basically, you need to know if you are taking the extended release or immediate release formulation before proceeding.  I would absolutely follow the no more than 10% of the current dose no more often than every four weeks advice, and given your history, I would consider starting with a 5% drop first, just to see how you fare.  You can always return to 10% if things are going smoothly.  If you are on the extended release, you may wish to switch to the immediate release so that you can create your own liquid formulation at home.  Immediate release tablets are available in 25mg, 50mg and 100mg.  In order to make that first 5% or 10% drop, you could take a 50mg tablet, half of a 50mg tablet, and then use the other half of the 50mg tablet to create your own suspension.  Dissolve that 25mg in 20mL of water (you can buy syringes on amazon).  Once dissolved, add 5mL of maple syrup (the real stuff) or ora-plus (also available on amazon).  This will help the particles distribute more evenly in the solution, since it is thicker.  That will give you a solution of 1mg/mL.  Be sure to stir/shake the solution really well before taking it.

 

So you would start by taking the following:

A 50mg tablet

A 25mg tablet

For a 5% drop: 20mL of the above solution, discard the remainder.

For a 10% drop: 15mL of the above solution, discard the remainder.

 

If you currently have a bunch of 100mg immediate release tablets, you could use those up first.  You could split the tablet into quarters- take 3/4 of a tablet in tablet form, then create a solution as above with the final quarter.  

 

If you have a cooperative physician, you can also get a liquid compounded by a pharmacist with a prescription.  However if your doctor is like most, he/she likely does not believe that tapering this way is necessary, so you would have a lot of explaining to do!  If you have the energy for the fight, I say go for it... personally, I had to fire my doctor lol.  I needed much more support than he was able to give me, and I needed to work with someone who believes me.  

 

Always remember, decrease slowly, keep yourself as stable as possible as you go.  You will have good and bad days- be sure to work on those non-drug coping mechanisms.  If you ever make a drop and have terrible effects, go right back to your previously tolerated dose, allow time to stabilize, and then try dropping by a smaller amount.  When it comes to tapering, the tortoise always wins.  This is absolutely NOT a race.  

 

For your reference, here is specific info on tapering gabapentin as well:

 

Tips for tapering off Gabapentin

 

Your Klonopin will likely be the last drug to taper from for you, as it will help mitigate some of the withdrawal symptoms from the other.  We can cross that bridge down the road, but basically, it's the same type of thing... slow and steady is the way!

 

[beckm]

Thank you so much for that tapering schedule and advice. My Dr seems to think I should taper off the Klonopin first because it does the most damage to the brain. Ugh… so many different opinions! I’ve already started the gabapentin taper, so at least one poison is on its way out!! I’ll keep everyone posted on the rest!