Jshect major issues with Wellbutrin/Deplin and klonopin addiction

[Meimeiquest]

I don't have answers, but we did a lot of "talking" about this on the thread The Importance of Methylation and B Vitamins. Why don't you read that, top to bottom, and then post your questions. In that thread, I talk about juicing to detox a chemical taste in my mouth. It took a couple of months, but it did work. I think nutrition is really important in recovery, and obviously in whatever your underlying issues are.

[Jshect]

I did read it. My focus is not that great. These threads get hard to follow because it seems like it's 15 people talking about their 15 individual and different symptoms and I get kind of lost. I'll try reading it again.

[Jshect]

Maybe, I'll retain more if I break the thread up and read 1/3 of it at a time, instead of trying to read and follow the whole thing at once. 

[Meimeiquest]

I did read it. My focus is not that great. These threads get hard to follow because it seems like it's 15 people talking about their 15 individual and different symptoms and I get kind of lost. I'll try reading it again.

It is

[Altostrata]

If you read comments on mthfr.net, you'll see many, many people have adverse effects from B vitamins no matter what they try. Quite a few people here, including me, are sensitive to B vitamins.

 

Raw green leafy veggies contain folate and other B vitamins; B12 is found only in meat, fish, dairy, and eggs.

 

I'm not an enthusiastic eater of raw greens (I'm MTHFR heterozygous in two alleles just like you) but I recommend a daily green smoothie of fresh raw greens, water, plus a half an apple for taste. It is quite energizing, drink it early in the day.

 

We have partial capacity to process B vitamins, might as well put it to use.

[Jshect]

If you read comments on mthfr.net, you'll see many, many people have adverse effects from B vitamins no matter what they try. Quite a few people here, including me, are sensitive to B vitamins.

 

Raw green leafy veggies contain folate and other B vitamins; B12 is found only in meat, fish, dairy, and eggs.

 

I'm not an enthusiastic eater of raw greens (I'm MTHFR heterozygous in two alleles just like you) but I recommend a daily green smoothie of fresh raw greens, water, plus a half an apple for taste. It is quite energizing, drink it early in the day.

 

We have partial capacity to process B vitamins, might as well put it to use.

I'm relieved to hear it's not just me. I will look into your green smoothie of raw greens. It's just strange how b12 makes me feel smarter and happier and like s*** at the same time. The problem is that I eat a lot of meat and I still have a b12 deficiency. I'm going to have a more advanced methylation test done. I'll reread the b vitamins and methylation article more slowly. Oh, I wish I could hire my own personal 24/7 Harvard doctor.

[Altostrata]

LOL! Harvard doctors....the worst psychiatric research comes out of Harvard.

[Jshect]

If you read comments on mthfr.net, you'll see many, many people have adverse effects from B vitamins no matter what they try. Quite a few people here, including me, are sensitive to B vitamins.

 

Raw green leafy veggies contain folate and other B vitamins; B12 is found only in meat, fish, dairy, and eggs.

 

I'm not an enthusiastic eater of raw greens (I'm MTHFR heterozygous in two alleles just like you) but I recommend a daily green smoothie of fresh raw greens, water, plus a half an apple for taste. It is quite energizing, drink it early in the day.

 

We have partial capacity to process B vitamins, might as well put it to use.

Yes, I pretty much eat a spinach salad everyday now, and that's high b2, so maybe I can make up for my b2 deficiency that way. I've looked up the foods with the highest b12: shell fish (clams) 100g 98.9μg (1648% DV); Oysters (408%); Beef liver (83.1μg (1386% DV); Fish (Mackerel):19.0μg (317% DV); Smoked Salmon (257%), Herring (186%), Tuna (154%), Canned Sardines (126%) and Trout (106%).

 

If I could find some clams that are low in mercury and I ate 100g a day, that would be close to 700ug a week. Would that be enough to make up for my b12 deficiency. 700 ug/week is a lot less than 1000 ug/ day when you use the supplement, but if I can't tolerate the supplement that's may be my only option.

[Jshect]

Well, I'm off to Martin's to get some clams. I know I can tell a noticeable difference in my mood when I eat Salmon and that could be because you get 300% DV of B12, so I'll eat about 2000% DV of B12 worth of clams tonight and let you know how I feel! I've never had clams before. I hope they're good.

[Altostrata]

Sounds like you're feeling pretty good, going off to a clamfest!

 

We absorb only a tiny bit of the 1000mcg in a B12 tablet or shot. We need only a few mcg per day, see http://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/

 

Any excess is stored in your liver for a rainy day.

[Jshect]

I hate how all of these sites that list B12, have fortified cereal high on the list, as if that is a good way to get your vitamins. They pulverize the flour, strip the nutrients, then add inferior, synthetic vitamins made in science labs. I know, technically, or statistically, they rate high on % B12, but I think it misleads people into thinking they're getting something healthy when they're not.

[Jshect]

 

So loxapine is a prime suspect. However, reducing it first would give oxcarbazepine more room to speed up CYP3A4, which may cause 1) faster metabolism of trazodone into mCPP and reduced effectiveness (if any) of trazodone; 2) faster metabolism and reduced effectiveness (if any) of clonazepam.

 

 

I wonder if the 10% reduction in Loxapine is causing faster meabolism and reduced effectiveness of clonazepam, as you stated. I've been getting some rather wicked Klonopin withdrawal symptoms lately. The symptoms vary depending on what stage in the taper or withdrawal I'm in. The initial withdrawal symptoms suck.  I get an upset stomach when I eat, I almost feel like I have a fever, I get anxiety, and I can't think straight. Should I up my Klonopin dosage from .625 to .7 by creating a liquid solution? I can't bear going through Klonopin withdrawal while tapering off of all of my other meds. Curse the day I was prescribed Klonopin. It's one of those "too good to be true meds."

 

Thanks

[Altostrata]

How do you know those symptoms are from Klonopin? When did they start?

 

What is your symptom pattern now?

[Jshect]

I've gotten to know my Klonopin withdrawal symptoms pretty well. I started to read a link someone posted about Klonopin withdrawal and staying put at a certain dosage, but I didn't finish it. I will read it tonight. This actually isn't new. I've been at .625 for some while now. The withdrawal symptoms come and go. .625 mg is 1 1/4 Klonopin pills. I have a feeling if I cut the quarter smaller some days that could possibly cause withdrawal. I know the symptoms very well, as I went from 1.5 pills to 1.25 pills. It was hell. When I eat and have an upset stomach, feel like I have a fever, feel uncomfortable, get anxiety (while not having PVCs) I know it's Klonopin. I feel like I have a fever, but when I take my temperature I don't. I'm going to take a little extra Klonopin, because I really do not feel like going through these awful withdrawal symptoms again. One of the strange symptoms is positive. At times I'm actually more articulate and intelligent. I'm also calmer and more relaxed at times, which is good when I'm feeling irritable from Wellbutrin. I usually get this a after withdrawing for a couple of days. Yesterday, I was just completely fatigued and could barely move. Those are my initial Klonopin symptoms. Anyway, I know it's Klonopin withdrawal. After tapering for a few weeks the symptoms get worse again, so basically when I taper from 1.5 to 1.25 the symptoms go from bad, to OK, to terrible, until I stabilize.

What do you suggest I do Alto? I should probably start crushing the pills and creating a liquid solution to make sure I am getting the exact amount each night.

[Jshect]

How do you know those symptoms are from Klonopin? When did they start?

 

What is your symptom pattern now?

As I said, the symptoms come and go, but most recently the symptoms started yesterday and were extreme fatigue, upset stomach, difficulty thinking clearly, feeling uncomfortable, anxiety. Today, they are fever, upset stomach, calmer, more polite, more articulate but still uncomfortable. The extreme fatigue is gone. After a couple of weeks of this the good articulation will give way to disorientation. I have a really hard time at work when I become disoriented. 

[Altostrata]

Yes, you should do what you need to do to keep your Klonopin dosing consistent. Also be sure to take it on a regular schedule.

 

With the drugs you're taking, it's a wonder you're still upright. My guess is you're a fast metabolizer via one or more liver enzyme.

 

How are the PVCs? Are you ready to make another reduction? Did you see the doctor you thought might be helpful?

[Jshect]

Besides the Klonopin withdrawal, I think I have stabilized as far as the 10% Loxapine reduction is concerned, and I'm ready to begin to taper another medication by 10%. I think you wanted me to taper the Trazodone next by 10%. After that you said to taper Oxcarbazepine. If I taper the Trazodone by 10% and start having many PVCs, I may immediately start tapering the Oxcarbazepine. There are few things worse in life that I've experienced than having 10 PVCs a minute. The anxiety is so excruciating, that I can't even think straight or relax for even 20 seconds. I think it's ruining my teeth too. The anxiety is so extreme, that my mouth becomes very dry, and my teeth start to hurt. How all of this is going to effect my Klonopin levels, I think only Alto may know.

[Jshect]

Yes, you should do what you need to do to keep your Klonopin dosing consistent. Also be sure to take it on a regular schedule.

 

With the drugs you're taking, it's a wonder you're still upright. My guess is you're a fast metabolizer via one or more liver enzyme.

 

How are the PVCs? Are you ready to make another reduction? Did you see the doctor you thought might be helpful?

Actually, since we reduced one of the "brakes" my PVCs have been a lot better. Plus, I'm eating a lot of foods high in B12 and there's a possibility that may boost the "accelerators" a little, though I can't say for certain, because there's so many factors. 

[Altostrata]

Pretty funny. I'm only guessing. This guy may have a better guess
 

Neil Sandson in Baltimore, MD is one of the top experts on CYP conflicts http://www.healthgrades.com/physician/dr-neil-sandson-y64ns/appointment

jshect, your psychiatrist might want to confer with him.

 

 

Since you're familiar with it, how about reducing the loxapine another 10%?

 

You might also get a bite guard for your teeth. Many of us (including me) have had to do this to cope with the withdrawal tension.

[Jshect]

I know you may like this idea, but I kind of like the energy I have and the reduced PVCs I'm having caused by lowering one of the "brakes." I don't want to lower one of the "accelerators" and lose the energy and bring back the PVCs. What if we reduced the Trazodone (accelerator) and Oxcarbazepine (brakes) both by 10% at the same time so I can stay one step ahead of the "brakes."

[Jshect]

Pretty funny. I'm only guessing. This guy may have a better guess

 

Neil Sandson in Baltimore, MD is one of the top experts on CYP conflicts http://www.healthgrades.com/physician/dr-neil-sandson-y64ns/appointment

jshect, your psychiatrist might want to confer with him.

 

 

Since you're familiar with it, how about reducing the loxapine another 10%?

 

You might also get a bite guard for your teeth. Many of us (including me) have had to do this to cope with the withdrawal tension.

Yes, I would be up for lowering the Loxapine by another 10%. If I start to get too high from the "accelerators", I could than reduce the Trazadone, or Wellbutrin. I am very, very sensitive to taking anything other than Wellbutrin SR, so I talked to a local compounding pharmacy, and they said they could make reduced doses of Wellbutrin SR, so I could cut by 10% at some point and take a 135 mg SR capsule instead of 150 mg SR, whenever we start reducing that.

The loxapine withdrawal, while slightly irritating and noticeable, was not that bad. The biggest pain in the rear are the klonopin withdrawal, and anything that triggers PVCs. Of course the irritiability, agitation, and ESPECIALLY the pain caused by the Wellbutrin is also irritating.

[Altostrata]

I would leave the Klonopin for last.

 

How about the daytime irritability, has that increased, decreased, or stayed the same?

 

My guess is lowering the loxapine will enable the Wellbutrin to be metabolized faster, which should reduce its effect in the daytime.

[Jshect]

Yes, I'm ready to make another move, and I will let you decide what we cut, but I would like to keep the "accelerators" ahead of the "brakes" if possible. If you want me to cut the loxapine by 10% I can do that. That's convenient because the Loxapine is in a capsule so it's very easy to reduce. However, If I start having some kind of agitated mania from the "accelerators", I may have to also cut one of the accelerators by 10%(Deplin, Wellbutrin, Trazadone). I will call that psychiatrist you mentioned and see if I could do a phone consultation. I believe I see my psychiatrist in a week, so he could prescribe a compounded 135 mg SR Wellbutrin pill, unless you think we should cut the Trazadone first.

[Jshect]

I would leave the Klonopin for last.

 

How about the daytime irritability, has that increased, decreased, or stayed the same?

 

My guess is lowering the loxapine will enable the Wellbutrin to be metabolized faster, which should reduce its effect in the daytime.

 

Sorry, I'm typing posts while your replying and not seeing your reply. My irritability hasn't really been that bad. A couple of times it was bad, but overall it hasn't been that bad. I'm seeing an Eastern Practitioner, and he does acupuncture, sacreal cranial manipulation, and I'm honestly telling you what he does really works. Plus I think the B12 puts me in a more positive mood. Like I was saying, if we lower the Loxapine by another 10% and I start getting an agitated mania, we could immediately try lowering the "accelerators" by 10%. What do you think?

Thanks a lot, Alto!!

By the way does anyone know an affordable care act insurance that has a good prescription med plan. They just raised my monthly premium to $356 a month! 

[Altostrata]

Your psychiatrist would consult with Neil Sandson, probably on the phone.

 

My guess is it's the mCPP from the trazodone that caused the agitation. Lowering loxapine might aid in speeding the processing of that, too.

 

Reducing the Deplin in a pinch probably would have the least risk of withdrawal symptoms.

[Jshect]

Sorry, I was typing when you replied, my reply to two posts ago, is my second post.

[Jshect]

I don't know anything about liver enzymes, but I'm positive at least some of the irritability is coming from the Wellbutrin. It even lists agitation, irritability, and anger as common symptoms. It may be both medication acting synergistically. The Deplin would probably not be a good medication to reduce first, because the full effects of a small reduction may not be noticed for 4-6 weeks. That's how long my psychiatrist said it takes to change the Deplin levels in your blood. I know this because when I first tried reducing the Wellbutrin, I noticed the change immediately. The agitation, pain, and energy immediately left, and the PVCs immediately began. I tried raising the Oxcarbazepine. The exact same thing happened, immediately. When I lowered the Deplin, it took like a month for the agitation, pain, and energy to leave, and the PVCs to kick in. The Deplin has kind of a delayed reaction when you reduce or increase it. Plus, even while taking 15mg Deplin, my Folate levels were still only borderline, so I was probably really deficient in Folate before Deplin. Probably best to lower either the Wellbutrin or Trazadone, since the effects will be more immediate and we'll know what we're dealing with.

[Altostrata]

I'm worried about lowering Wellbutrin, because you had such a bad time with it before and it may be all that's keeping you awake during the day. But I don't think Wellbutrin is the worst offender. I suspect it's the mCPP from the trazodone. It's a vicious chemical.

 

Since you've been on trazodone the longest -- I assume it helps you sleep? -- I am wary of reducing it.

 

The oxcarbazepine is an inducer of an enzyme that breaks down trazodone and Wellbutrin, so I wouldn't reduce that yet.

 

The nebivolol may be helping suppress the PVCs and it's not interfering with much, except when you're off the other brakes, it might be too much of a brake.

 

Everything is blocking the metabolism of everything else, so my guess is if you lower one thing, the others will shift around and be processed faster, which reduces their effect. (I'm most worried about variations in the clonazepam level, but you'll have to cope with that. Reducing it at this point could cause a lot of problems.)

 

If I were you, I'd make another cut in the loxapine at this point, because you're familiar with what happens. Cutting any of the others is a leap into the unknown. Wait and see if you have bad "accelerator" symptoms, then make a decision accordingly.

[Jshect]

Yes, that's probably my best bet. The first 10% reduction wasn't that bad, so why not try another 10%. Like I said, I see my old psychiatrist in a week and he may be able to help us out. He was an associate professor of psychiatry at UVA in the past, so when I present this info to him, he may be able to add some valuable insight. Of course, he is one of the one's who got me into this mess, but he is a very nice guy. I think he panicked when i told him I was having a million heart palpitations and immediately wanted to dump me onto a cardiologist, but I think he will listen when I show him your posts Alto, so hopefully he will cooperate. I mean, you have been right so far, I cut the "brakes" by 10% and my PVCs left. That means we're on the right track, I guess. So, sometime within the next couple of days I will cut loxapine by another 10%. Of course I could wait a week and talk to my Pdoc, but I'm running out of patience, and want to get moving. Maybe, I could try to cut by only 5% until i see him in a week. What do you think Alto, 5%, 10%, or wait to talk to my psychiatrist?

 

Thanks, Alto.

[Jshect]

Also, if the Klonopin withdrawal symptoms persist would you recommend me upping the dosage a little. I don't know that I could handle going through Multiple withdrawals from Klonopin and other drugs at the same time.

 

By the way, I once stopped oxcarbazepine and Loxapine, cold turkey for a few weeks and I didn't suffer any terrible withdrawal symptoms. I was only on Wellbutrin and not Deplin then, and definitely had mania, but come to think of it, it wasn't the completely agitated mania I got while taking Deplin and Trazodone on a regular basis so you may be right about Trazodone and agitation. Immediately after using trazodone, it seems like a calming, sedating med, so I don't usually associate it with agitation, but maybe in the long-term, it does cause agitation. 

[Jshect]

I'll have to google mCPP and agitation.

[Jshect]

One more thing, It could be the Wellbutrin and Trazodone causing the agitation, but I think it's definitely the Wellbutrin causing my pain. I'm more concerned about the pain, than the agitation. I'll piss people off and they'll get over it, but the pain is miserable. I've played pickup basketball for 20 years, and I haven't played in over a year because of the pain. The only problem though, is that when I reduce the Wellbutrin the pain may decrease, but so will my energy. Oh, brother!!!!!!!!!!!!!!!!< banging my head against the wall.>      We'll just have to pick our poison. 

[Altostrata]

It sounds like the pain started when you added the Wellbutrin. This indicates trazodone and mCPP are the culprits. All of the drugs blocking or using cyp2D6 are contributing to this. Loxapine is one of them.

 

Is the pain worst in the daytime or night?

 

Read this about trazodone and mCPP http://survivingantidepressants.org/index.php?/topic/2883-tips-for-tapering-off-trazodone-desyrel/

 

Uh oh, this is the psychiatrist who prescribed 5 random drugs for you? This guy doesn't know anything. Scary, but a good psychiatrist is very, very hard to find.

 

Neil Sandson, the drug conflicts expert, might have some ideas which drug to taper first but isn't likely to know anything about tapering.

[Altostrata]

The challenge is -- this is like a game of pickup sticks. Which stick to pull out and not disturb the pile? I definitely do not want any increase in cardiac symptoms.

[Meimeiquest]

I hesitate to say this because it may have nothing to do with you, but tapering the Wellbutrin seemed to unstop my liver. I on't have time to explain all the things that happened, and I don't know if you would have any kind of the same reaction. I am a 2D6 ultra metabolizer, and that taper was rough.

[Rhiannon]

As far as the insurance thing, does your state have an exchange? If not, check with the federal one. I think it's healthcare dot gov. They can also refer you to local people you can talk to.

 

We wouldn't know here what is available in your area because it varies from state to state depending on the exchanges and whether or not that state accepted the free Medicaid or turned it down.

 

And you need to check and see if you qualify for a subsidy and how much. I think you can find that out on the exchanges too.

 

They're not allowed to deny you or discriminate based on your pre-existing conditions any more. I'd definitely look into it.