TJo: Withdrawal from klonopin and remeron. Tough it out or go back up in dose?

[TJo]

I need advice! I have been on remeron and klonopin for 4 months. I am trying to come off due to side effects from both. I am also taking lamictal and holding on to that for now. I tapered off klonopin 4 days ago and have also been tapering off remeron from 26 down to 7.5 in about a week on the advice from an integrative psychiatrist. All was well until yesterday when my anxiety returned hard. I'm trying to wait it out for a few more days. I'm wondering if I should wait it out a few more days or go back to the dose of remeron I was more comfortable at. I really don't want to but I can't do this for more than a few days.

[TJo]

I've had bad anxiety at a lower dose of remeron for about 24 hours. Should I go back up or tough it out? I'm guessing I should go back. I was at 26 for about 2 months and then dropped by quarters over the last week. Im getting off because it hasn't worked in the 4 months I've been on it. Too fast? I was advised to go at this rate by an integrative psychiatrist. I also stopped klonopin 4 days ago. Could it be that?

[TJo]

I wanted to add that I skipped down from 18 to 7.5 to avoid the most sedating doses of remeron. I'm not sure how to get through the sedation that starts around 15mg when going down slowly. Advice? I really want to see if this anxiety lets up in a few days before reinstating. Advice would be so helpful.

[Jemima]

Please add to your drug history the amounts of the drugs you've been taking from the beginning onward and how often you took them, the starting and (where relevant) stopping dates and the tapering history of each.  This will help us give you better advice.  Because you've recently gone off Klonopin and made a major cut in your Remeron dose, it's difficult to tell what's causing the withdrawal symptoms.  Getting off a benzo like Klonopin so quickly often causes withdrawal symptoms, but then so does a big cut in an antihistamine antidepressant such as Remeron.

 

Welcome to the forum, TJo.  You'll find lots of solid information and friendly support here.

 

 

[TJo]

Thank you for the kind reply. 

My only previous use of meds was prozac for 6 months in 2000 for depression. At that point I had no anxiety symptoms and it was easy on easy off.

 

November 2012, I was hit with huge anxiety that started with the use of reglan in the ER for a migraine. I then went to my regular dr out of fear and tried prozac and lexapro in a matter of 3 weeks and couldn't manage wither of them even at a very low dose, it was too activating. I then went off the lexapro and tried natural remedies until January. In January, I was advised by a psychiatrist to try taking xanax 3 times a day for 10 days and tapering off to stop my anxiety. It was fine while on the xanax but then I came off of it and wound up in the hospital from exhaustion and anxiety. There I was put on remeron and assigned a new dr. The new dr prescribed the remeron, klonopin and lamictal.

 

I've been on remeron and klonopin for 4 months. 

I started remeron at 7.5 and tapered up to 30 over 3 weeks. I felt intensely depressed ( more than before I started it) and sedated until I was up to 30. I went from 7.5 to 15 to 30. I came down on remeron to 22.5 after a week of feeling too stimulated. I stayed at 22.5 with some ups and downs to 30 and 26 trying to find the right dose. We settled on 26 and I've been there for 2 and a half months. On June 18th, after seeing a new dr. in support of my tapering off,  I started dropping remeron by 3.75 every 3 days. I got down to around 18 and felt sedated on the third day. With the advice this dr I decided to jump over 15 and the 11 dose to avoid sedation and went to 7.5. I've been at 7.5 for two days. My sedation has been strong for the last two days. I didn't sleep last night and my anxiety has been awful today. I don't know how best to get through the low dose sedation while tapering. Anything lower than 22 seems to knock me out. I'm not sure how long I could last doing small cuts in that fog.

 

I started lamictal right after starting the 30mg dose of remeron, had been on remeron for a little over 2 weeks. I tapered up to 100 lamictal over 4 weeks and that's where I still am. (I was feeling ok but the doctor thought it would make the remeron work better. I really think the remeron dose at 15 caused a lot of problems and once that changed the lamictal wasn't really needed.)

 

I started the klonopin 2 weeks into starting the remeron. I started at .5 twice a day. Over time I felt too sedated and dropped the dose down by .125 a day down to .125 twice a day with just a nice lift in my mood and energy after each cut. I was at that dose, .125 2 times a day, for a month. I didn't know you had to taper from there too, so I tried to cut out one dose on 6/9 for a few days. My anxiety shot up this time. So on 6/11, I went back to taking .125 once a day and added .0625 back in the afternoons. I did this for 5 days and felt better. On 6/16 I went down to .0625 twice a day for 4 days. On 6/20 I went down to .03125 for 3 days and then off. I've been off for 4 days and really felt great at each cut and when I went off with a tiny bit of anxiety on the 1st day off. Last night I had terrible anxiety that lasted all through the night and all day today.

 

So, do I see if this passes, because isn't some of this going to happen no matter how I go off? Or do I go back on remeron, at what dose? Or do I go back on klonopin at what dose? Or back on both? The dr I'm currently working with suggested going back on the klonopin until things settle down. Thoughts?

[TJo]

I followed the advice of my dr and went back on klonopin at .0625. It has helped quell my anxiety. With that and lots of melatonin I slept pretty well last night. Today I feel ok but sad. I'm not sure if that's from the klonopin or from the whole lengthy journey. I'm still tapering off the remeron. I went down to 3.75 last night and plan to take it for the last time tonight. And the beat goes on.

[Rhiannon]

It sounds to me like you're going dangerously fast with all your tapers. I'm glad you've reinstated on a low dose of klonopin and I agree with your doc on that. You still have a lot of withdrawal yet to come from that, but staying on that low dose should help keep it from being as bad as it can get.  Personally I think you should stay on a low dose of remeron too, and wait for at least two months before cutting anything else.

 

When people taper too fast, lots of time the symptoms don't really kick in at first, and then by the time things get really bad they've cut too much, and reinstatement is always tricky and doesn't always work.  Please, please be careful.

[TJo]

Hi Rhi, 

Thanks for your advice. I really don't know what to do anymore. There are a lot of different ideas of what I should do. I'm just swirling in it. I will try to get in for an appointment with the doctor I'm working with now. I really like and respect him, but he seems to think I can (should) get off these medications quickly and that's certainly what I want, but may not be best. The problem is I didn't feel great before the medications, on the medications and don't fell good getting off of them either. It's all a mixed bag of yuck. For now, I'm happy to hang on to the low dose of klonopin and I'll think about staying at the 3.75 remeron. Tonight was going to be my first without it. 

My good news is that I finally found a good therapist to work with, I like the doctor I'm working with, the melatonin is helping me get good sleep and I've found you guys. I'll keep keeping on and updating as things keep unfolding. Thank you for your advice, it means a lot to me.

 

Terri

[TJo]

Rhi? What dose of klonopin would you recommend I go back to? I don't want to go higher than I need to but I'm still pretty uncomfortable.

[Rhiannon]

Mixed bag of yuck, indeed. I may have to steal that expression.

 

If I'm reading correctly, you were at 0.125 mg twice a day on June 9th, right?And you held there for a month? And now you're on a fourth of that amount daily? I think if it were me I'd probably titrate up by 0.0625 a day, holding each step for a few days, up to either 0.125 twice a day or 0.125 once a day and 0.0625 once a day. (if it were me, or one of my kids, I'd go with the 0.125 twice daily.)

 

I'm not thinking it will make your symptoms go away or prevent future withdrawals, but I think if you could stabilize somewhere around there it might help stave off the worst of the withdrawal. Klonopin withdrawal can really be a bear.

 

I'd also hold on the Remeron. If it were me I'd probably go back up to at least the 7.5 and hold there for a couple of weeks and see how that goes. (if it were me or one of my kids actually I'd probably go higher, up to 10 or so, since from what you describe it sounds like it's sedating for you, and that might be helpful right now.)

 

It's up to you, though. None of this is science, just "best guess", and everyone's mileage varies.

 

Most important is to stop cutting stuff now! What you're feeling now is the beginning of withdrawal. You will be doing yourself NO favors if you keep cutting. Going up and down rapidly on doses is also dangerous. Best to make small changes incrementally.

 

Overall I'd guess you'll get the best results by small reinstatements and then just hanging on and riding out the withdrawal until you stabilize, and then tapering slowly.

 

I guess I should add I'm not a doctor and this isn't medical advice.

[TJo]

Thanks, Rhi. I'm done cutting for now and I feel good about that instead of discouraged. I'm coming to understand that I was put on these current meds most likely due to Xanax withdrawal. I was on it for a month and then abruptly stopped. So now I want to do this the right way. I'm going up to .0625 twice a day and will see from there. I've been at half of that twice a day for a few days. If it's not feeling right, I'll keep going up before coming down. My husband and I are going on a date to the pharmacy tomorrow. I plan to wear my fancy shoes. Thanks so much for your help! Amazed by the generosity I've found here.

[Rhiannon]

Smiling at the image of you at the pharmacy in your fancy shoes...:-)

[TJo]

I'm having a super sad moment. Things are ok then they are not ok, then they are ok... repeat. I know this is part of the deal. I really want it to end and no one can tell me if/when it will end. I'm back to the doctor on Tuesday to get a better tapering schedule and some support. Do people get better? Please tell me they do.

[tezza]

Hi T Jo,

 

Welcome! Yes, people do get better. Sometimes it takes some time to stabilize after many changes but people do get better.

 

Hang in there...you've come to a good place for support and advice.

[TJo]

Rhi? Tezza? Jemima? I'm not sure I've gone back up enough. I'm trying to do the right thing here without going up higher than is in my best interest. I'm doing ok with some big-awful rough patches each day. Is that in the range of normal? If I stay at this dose will the symptoms diminish over time, get worse? I've been slowly tapering up according to Rhi's advice. I could go up again tomorrow and still not be as high as Rhi's recommended dose. I'm at .0625 in the AM and .03125 in the PM. Tomorrow I could go up to .0625 in AM and PM. But should I? Will it be better in the end? Tonight I had to walk away from my family at dinner time because my anxiety was so great. My 5 year old is trying to understand and I'm trying not to freak out in front of him. Help please ?

[tezza]

Bless your heart, TJo. I know this is awful, having a small child and being in WD. If I were you, I'd go on up slowly like Rhi suggested. It won't be an instant fix, keep that in mind.

 

There are no instant fixes for WD. If there were, we'd all be "fixed". It will probably take time to get through this and feel better. The fact that you feel ok for part of the day is a good sign.

[TJo]

You guys are stellar human beings. I really think something about this experience will be channeled into my work when I'm healthy. It's such an unknown darkness that needs to be brought into the light. Ok. I'm tapering up as advised. My new question is should I switch to diazepam to taper off or get a compounding pharmacy to cut the klonopin into gradually smaller doses? So many of the tapering charts (Ashton, etc.) work from a diazepam switch model. Thanks for weighing in.

 

Tjo

[Narcissus]

TJo, everything you're describing sounds normal by our standards.  I won't weigh in about the klonopin because I really have no idea.  Yes, people do recover!  Check out the recovery section, I peruse it myself whenever things get bad:http://survivingantidepressants.org/index.php?/forum/28-recovery-success-stories/

[TJo]

I am struggling with very dark and constant depression. I am off remeron since July and tapering from klonopin and lamictal. I am ok except for overwhelming, unrelenting depression. I have small children, I have to work. What should I do to help myself? My very awesome doctor has had me try 5htp and tyrosine with a bit of luck. I started Sam-e on Saturday at his request and I think I feel worse. Is that possible? If the Sam-E doesn't work he wants me on Wellbutrin and this guy is seriously anti-drug, like he writes books about not using drugs to treat depression and anxiety. But I need help and he can see I'm at a breaking point. Feed back is welcome.

 

Thanks.

[Meimeiquest]

Do you have any sense of reason or meaning behind it that therapy might help? I really feel for you!

[TJo]

Hi Silver Star, 

I've been in therapy every week for the last 7 months. So, I've been working that angle. My dear doctor said to me the other day that this depression is biological/genetic and unlike most depression he sees which is a result of poor life/stress management. He also said that I will feel better, he just doesn't know when.  So, drugs or no drugs? I kind of feel like I don't have a choice or something. I need out.

[Meimeiquest]

Have you had any genetic testing, like for vitamin-processing enzymes? Have you looked into gut health? I'm just brainstorming...

[TJo]

My primary doctor has suggested doing a urine test that looks at metabolites and I'm doing a saliva test to check on cortisol, dhea, testosterone, estrogen and progesterone. These two (primary doctor and psychiatrist) are more than happy to think outside the box. But it's expensive testing. We're waiting to hear back on the saliva test this week before doing the urine test. But, I'm up for anything at this point.

[Meimeiquest]

Call me Debbie Downer, but .i think metabolite testing is for taking drugs. I have been told saliva testing is a flash of a moment in time with some hormones, when you need a "video" of the day, which is a 24-hr urine test, because levels fluctuate, especially stress hormones. And cortisol is known to be one of the huge problems of withdrawal. But I hope it is helpful for you. It's just whena dr. Says it's genetic, what gene does he mean? I say that as third generation in my family with mental problems....

[Rhiannon]

My primary doctor has suggested doing a urine test that looks at metabolites and I'm doing a saliva test to check on cortisol, dhea, testosterone, estrogen and progesterone. These two (primary doctor and psychiatrist) are more than happy to think outside the box. But it's expensive testing. We're waiting to hear back on the saliva test this week before doing the urine test. But, I'm up for anything at this point.

 

I always encourage people to get a thorough medical checkup. But given your history, you are cutting way too much way too fast in my opinion, and you are going to feel like you feel now as long as you keep doing that, and at this point even for a while after you stop.  And it can get worse.

 

I do not recommend starting or continuing a taper when one is already destabilized and symptomatic, unless there's a problem with toxicity or severe or dangerous side effects.  You didn't hold long enough to stabilize.

 

Klonopin withdrawal is tricky and nasty. I would not play with that stuff.  I would totally stabilize however long that takes and then begin a slow careful taper.

 

Are you checking out benzo boards? There's a lot more on benzo withdrawal on those. Unfortunately there's not really one I can strongly recommend right now, but it's worth taking a look I think.

 

Them's my thoughts.

[Altostrata]

Hello, TJo.

 

Many people with withdrawal symptoms also have problems with 5htp and Sam-e. They are serotonergics and can be activating -- causing agitation, anxiety, or insomnia. Wellbutrin would be just as bad. Your system is trying to regain balance. These supplements or additional drugs can interfere with that.

 

Since they do more or less the same thing, I am wondering about your psychiatist's judgment in prescribing 5htp and Sam-e together and having you start them simultaneously. Even with supplements, it's best to try one thing at a time, at a low dose, to see how it affects you. If it's an adverse effect, you can back away more easily.

 

Tapering Lamictal while making other changes -- another huge mistake. We don't know where your symptoms are coming from.

 

Symptoms that might be mistaken for "depression" can be side effects of benzos.

 

Your "depression" being genetic? That's something doctors reflexively tell everyone prescribed psychiatric drugs, particularly if they have an adverse reaction. It's meaningless.

 

Your doctor may be kind and well-meaning but, sadly, not very knowledgeable.  What your system needs is stability, not the kitchen sink of supplements and drugs.

 

It sounds to me like you might have 1) withdrawal symptoms from Klonopin and Remeron 2) possibly "depression" from benzos 3) possible withdrawal symptoms from Lamictal 4) adverse reaction to SAM-e and 5-htp

 

Where are you with the Lamictal?

[TJo]

GoldStar and Altostrata,

I am taking 37.5 lamictal. My doctor started me slowly on 5htp in June and I increased gradually. He only added the Sam-e four days ago. The thing about me and the whole taper thing is I WAS NEVER STABLE. I was not stable before the meds. I was not stable on the meds. I am not stable now. It has been 10 months of craziness. I started with symptoms very much like the ones I have now and was put on medications to help stabilize those symptoms. The drugs I was put on didn't work. The remeron I was on helped me to sleep and get through part of a very hard year. Now I'm off that and working to get off the other two. But I am a barely functioning depressed person.  Stabilizing hasn't happened for me since this whole thing started. I mean, how would I stabilize? Is the idea to stop cutting and not add anything new? I know that this depression is in part related to the klonopin. I wasn't nearly this depressed until I got on the klonopin, but that's just it. Since being on the klonopin I've been way more depressed and feel like that's not gonna change until I'm off. I'm really interested in your input. I feel stuck and I have a lot of doubts about everything right now.

[Meimeiquest]

I see you had a reaction to Reglan. How exactly did you feel before you started the psych drugs? I know Reglan can cause real problems.

[TJo]

I felt like I couldn't quite wake up and had lots of anxiety. I am not anxious now, but I've continued to have a feeling like I just can't wake up. What do you know about Raglan? It's been almost a year since it was administered and it caused problems right away. It's what led me down a string of medications and up to this point. Is it permanently damaging? After one dose administered at the ER for a migraine?

[Meimeiquest]

I have just given Reglan in pediatrics, and not for years. I believe it works on dopamine and acetyl choline receptors in the gut. I am almost sure that it crosses into the brain because we were to look for nonspecific, subtle neuro changes like agitation or flattening, if I even remember right.

 

Huge maybe....it set you up for these problems and the added-on drugs have sustained the problems?

 

I really, really feel for you going through this as a working mom!

[Rhiannon]

 Is the idea to stop cutting and not add anything new?

 

Generally unless there is an urgent reason to cut (like a toxic reaction) or an urgent reason to add something (like extreme instability with serious suicidality, or dangerous autonomic symptoms): yes. That's the idea.

 

As long as you keep perturbing your CNS with medication changes, I think you will continue to experience the kinds of symptoms you have been experiencing.  At this point stopping will not help quickly either but it's what I would do, stop and wait as long as it takes, which could be many months.

[tgirl]

Hello Tjo,

How are you doing now?

Hope all is well.

[tgirl]

Hello Tjo,

How are you doing now?

Hope all is well.