Konstantine: Anhedonia, insomnia, and stomach issues after 3 week taper from rexulti and lamictal

[Konstantine]

Hello, 

I have been browsing this forum for about a week and decided to join now that registration is open. 
 

My journey began in 2018 when I was so depressed that I was committed to an in patient stay at a mental hospital for 2 weeks. During that stay I was put on lexapro and buspar at amounts I can’t recall now. I recovered enough to restart my life on the medication which I couldn’t really tell if it helped. What worked the most during my in patient stay was the group therapy and positive affirmations I received. During my 2nd week I had a breakthrough and felt positivity for the first time since having my breakdown. 
 

I was set up with a psychiatrist and therapist who both stopped taking my insurance about 6 mos in but followed their recommendations to new psych ang therapy where I had mixed results. I stayed with them for 3 years until I felt they weren’t helping much. During that time I was switched from lexapro to effexor because I was sweating profusely from the former. 
 

I felt disillusioned by the experience and while I kept taking my Effexor I didn’t see a regular psychiatrist or therapist for about 6 mos until my primary physician urged me to find another. 
 

When I finally did last year I started with a new psychiatrist who took me off Effexor and put me on abilify which I felt nothing from. Eventually about 6 mos ago I was switched to rexulti at 1 mg. I stayed on the buspar the whole time until it was replaced with lamictal/lamotrigine a few months later at 25 mg. 

I started seeing my current psychiatrist around this time in March ‘24. I like him but I don’t get much out of our sessions because I have issues I can’t talk through. 
 

Please pardon if these dates and times aren’t adding up. I don’t remember it all that well but through it all my depression was mostly constant waning or gaining at times. 
 

Until April ‘24 when my depression became too much to bear and I entered a day program for a week and a half.  Beforehand I was deeply depressed and would come home from work despondent after thinking negatively all day where I would sleep. Eat dinner and then go back to bed. I was having strong suicidal ideation. 
During that stay my psychiatrist upped my dosage of rexulti from 1mg to 3 and over a few weeks my lamictal went from 25 mg to 100mg. I didn’t get much from the day program but it was enough to pry me from the extra sleep and ideation. 

 

I switched to a psychiatrist that worked within my therapist’s practice because I naively believed they would work together. This never happened and I immediately regretted switching because I found this psychiatrist dismissive and short with me. She kept me on the same medication and dosages. 

May ‘24 to June I was feeling restlessness bordering on akasthasia where my restlessness was so strong I couldn’t sit still. It was very hard to deal with and by early July I had enough of not feeling like myself and asked to go off my meds for which I was directed to do a 4 week taper off both the 3mg and 100 mg lamictal. It was a very imperfect tapering where I was directed to get a pill cutter which I used to try and get 1.5 mg of rexulti, 1 mg which I had from the previous prescription and then 0.5 which I comically was prescribed accidentally by my previous psychiatrist. My current psychiatrist said this was fine. Lamictal was much easier to taper over 4 weeks because I had been using the 25 mg pill I had originally been prescribed and went down from 75 to 50 and then 25 in the last week. The restlessness was soon joined by what I learned in my day program were symptoms of anhedonia which slowly got stronger and stronger. 
 

I had been off meds entirely for 3 weeks when the insomnia began. I could no longer nap. Had trouble falling asleep and would wake up at midnight and couldn’t fall back asleep. I told my psychiatrist and she prescribed 100 mg of trazodone which help me get to sleep but isn’t always great at keeping me asleep. I go to bed out of boredom at 9pm and if I’m lucky enough to sleep through I wake up at 4am a full two hours before I need to be up for work. 
Last week I started taking otc Calm powder with magnesium, melatonin, and L-theanine. When I have a few bad nights in a row I take otc unisom as well. I’m still waking up too early but I’m sleeping through the night which has helped my stress levels at work and overall made me feel better because I’m at least rested. 
I’ve read through a bit of the insomnia thread and I know the unisom and trazodone won’t be popular here but I am really struggling. I use a cpap at night already and have a sleep specialist appointment next week but I have my doubts they can help. 
 

I’ve had gastrointestinal issues my whole life and of course that’s part of this too. I’m having diarrhea daily and my diet isn’t too bad I don’t think. 

I’m really struggling about what to do next. My friend loves his psychiatrist and says she’s very receptive and a good listener with a background as a nurse practitioner. She has really helped him and he’s doing well. 
I read through the “what to tell your doctor” thread and I plan to discuss all of this with her but it’s so much I’m anxious about presenting arguments to her that I got from the internet. I’m torn on how to approach this. 
 

Did I taper too fast? I read the withdraw vs. relapse and I do agree that I hadn’t started feeling this specific way of anhedonia, emptiness, and biggest of all not knowing what to do with myself. I never had many hobbies but now I can’t find enjoyment in anything I do. It’s not totally hopeless I still engage well with my family and find my wife and child to be the one distraction (sh*tty way to put it) that keeps me going. I’ve had heavier depression but nothing like this before with no direction, lack of motivation, and inability to feel pleasure outside of love for my family. I’m scared I’m going to be like this forever as I’ve read on this forum that withdrawal can last years. I’m just really scared. 
 

I hope this wasn’t too confusing of a first post. Thank you for letting me join. 

[LotusRising]

Hi @Konstantine

 

Welcome to SA,

 

You've had a lot of drug changes and I expect this has disrupted the balance in your nervous system. Your taper was also very fast from the rexulti and lamictal, so your body has not had time to catch up with all the changes.

 

The restlessness started after you were prescribed rexulti and lamictal?  How long had you been off effexor and buspar, prior to starting these?