Jshect major issues with Wellbutrin/Deplin and klonopin addiction

[Jshect]

So I need to really go into the visit with Dr. K and really be prepared.

 

Questions to ask him:

1. Will Trileptal increase the amount of time the Klonopin is in my system? How will it effect the other meds?

2. I'll tell him your theory on what's causing the PVCs and see if he has one.

3. I'll tell him I want to use your strategy of reducing the Wellbutrin by using 100 mg SR and 49 mg IR.

Alto, forgive me if you've already answered this, but have you known anyone to take a 100 mg SR pill in the AM and then cut a second SR pill in the PM and weigh it by .001 scale? 

4. Also, if he's too chicken-sh## to recommend a plan or sincerely has no clue what to do, would he be willing to have a consultation.

If you can think of any other questions to ask him let me know?

[Altostrata]

I would not count on Dr. Kane to know anything about the drugs in detail, their interactions, or how to taper any of them.

 

Dr. Sandson and his colleagues have looked more into the interactions. But it's a long shot that they'll know anything about tapering.

 

To be honest, you're taking so many drugs and it's such a weird combination, even an expert would only be able to guess what's causing the PVCs or any of your side effects.

 

Yes, people take a 100 mg Wellbutrin SR pill in the AM and then a second dose of SR later. That's how SR is supposed to be dosed, twice a day. Taking a smaller amount for the second dose is the way many people here have tapered Wellbutrin.

[Jshect]

I guess you prefer the second dose of Wellbutrin being IR because you can control the amount much more precisely. I am just extremely worried my heart's not going to react well to the IR, but maybe if I divided it into 3 equal doses or something. I take the SR at 11AM. See when the PVCs kick in and then take 1/3 of the IR every three hours until I've taken all of it. I don't know I'll figure something out.

 

The pharmacist said to get Trileptal from him in liquid form and then it would be easy enough to taper by a ml or so when I needed to.

 

So, I guess my plan is 100 mg SR in the morning 49 mg IR dissolved into liquid in the afternoon and evening. I'll see how badly the PVCs get and adjust the Trileptal and possibly Loxapine accordingly, as symptoms come, as Meimeiquest suggested. You guys don't have to worry because I've had long stretches of time with these PVCs nagging me and I've worn a halter monitor and the cardiologist said I am not in any danger. If the PVCs are bad there are ways of dealing with the anxiety: Walking, warm baths etc. I'm sure I'll be able to find more ways to relax until they're gone

 

Thanks for the help guys, I couldn't have even conceived of a starting plan without you guys. 

[Altostrata]

I have no idea about how any of these plans will work.

 

I would not purchase Trileptal liquid for tapering until you've got the Wellbutrin dosing worked out.

 

Or, taper Trileptal and leave Wellbutrin alone. Don't make changes in two drugs at once.

[Jshect]

Well, I'm just trying to be optimistic. I predict PVCs when I start taking IR, but taking 49 mg IR seems to be about as close as I can get trying to reduce the Wellbutrin as minimally as possible. It's either that, which you seem to think is the best method for reduction, or taking 100 SR AM, 49 SR PM, or taking 100 SR AM, 45 compounded formula which is between SR and IR. These seem to be my only options. I've been on this combination for 4 years, I can't wait around forever, I can ask Dr. Kane to contact Dr. Sandson's contact. I've still got 150 SR pills. I could alternate every other day. If after weeks of this and the PVCs won't go away I can always return to 150 SR and eventually the PVCs will go away, they always do.

Anyways, Dr. Kane is my doctor, so I will check in here on survivingantideprsants, but if I'm having a million PVCs I will also call his office and put some pressure on him to try to figure something out. For goodness sakes he's a medical doctor, he prescribed me these meds, I'm paying him, he should be sharing in some of this burden that I've placed on you, god bless you. Maybe, it'll motivate him to do some research, and talk to some people.  

  I mean, my goodness, the burden I've placed on you and meim, and myself, researching and researching this ad nauseam, some of this burden needs to be on my prescribing psychiatrist. Maybe it's the Wellbutrin irritability I'm feeling now, but I feel like much of this burden, if not all of it, should be on the psychiatrist who got me into this mess, and not on us, and up until now none of it has been on him. Maybe when the PVCs hit, if I start leaving messages with him it will motivate him to actually research this himself. Not only could he consult one of Sandson's experts, but he could also consult with a cardiologist. Why should I have to drive 6 hours and pay $300 to meet with a new psychiatrist? Why did I pay money to go to a cardiologist? Dr. Kane should be talking to the cardiologist, not me. What do I know about these medications that I could explain to a cardiologist?

Am I being irrational?

[Jshect]

He owns his own business, he employs another doctor, 2 nurse practitioners, I think he may even employ a counselor. He's making tons of money prescribing medications, I've been seeing him for 5 years, He put me on the Deplin (that's when some mania started, then the PVCs when I tried to quit), I feel like it's his professional and moral responsibility to at least consult with one of Sandson's psychiatrists and a cardiologist.

Like I said, am I being irrational here? should I go to his office with this attitude (toned down and tactful of course)? 

I just feel a little betrayed. Dr. K and I were friends in a way. He'd fill a prescription and then we'd talk music or technology for 3 or 4 minutes. Now he hardly says anything and I feel like he tries to downplay the precariousness of my situation. I'm curious to read my file, because when I switched to Dr. Alderfer I have a feeling it may not have mentioned that I'm having medication issues and PVCs. I almost feel guilty talking to doctor Kane about my situation because we were friends and I know he doesn't want to deal with it, but now I feel sort of angry. Maybe I should ask to read his file on me. If hasn't put in my file, that when I try to decrease the accelerators PVCs occur, and this chart follows me around to new psychiatrists this is only going to make things more difficult.

[Altostrata]

You are entirely within your rights as a patient to ask Dr. Kane to consult with one of these drug-drug interaction experts.

 

You are entirely with your rights to ask him to do anything. All he can do is refuse.

 

I've still got 150 SR pills. I could alternate every other day.

 

 

Given the short half-life of Wellbutrin SR and IR, if I were you I would keep daily dosages and dosing schedule consistent.

[Jshect]

I just want to thank you Alto for being there, I know my case is a pain in the rear. 

 

"Given the short half-life of Wellbutrin SR and IR, if I were you I would keep daily dosages and dosing schedule consistent."

You're 100% correct on that. I will.

[Jshect]

Alright, well I saw Dr. Kane today. I have thirty 100 mg SR Bupropion pills and I have thirty 75 mg IR. I work tomorrow so I'll start Friday.

My thoughts are as follows:

I'll take 100 mg SR at 11:00 AM. I'll dissolve the 75 mg pill into 7.5 ml of water (I believe you said it dissolves pretty rapidly). I'll take out 2.6 ml of the solution leaving 4.9 ml (49 mg) bupropion. I guess I could wait and see when my PVCs start to get unbearable and take 25 ml. Then when they inevitably get unbearable again take the other 24 ml. I can write down those times and then take them at those times everyday. The good news is I take so many sedatives at night I should still be able to get to sleep with PVCs, and once I'm asleep I stay asleep (the bad news is the sedatives temporarily increase the PVCs). I'm a sound sleeper. The other good thing is I am working all day shifts now so the 100 mg SR should get me through the work day with minimal PVCs.

 

So my Bupropion schedule may look something more or less like this:

11:00 AM -100 mg SR,  5:00 PM - 25 mg IR solution,  8:00 PM - 24 mg IR solution

Does that seem reasonable to you Alto or do you have any suggestions?

 

The challenge is going to be dealing with the PVC-induced anxiety. I know they're not harmful. I wore a halter monitor, they did some cardiac tests my heart is fine even when I'm having 6-10 PVCs a minute. My body still gets all of the oxygen-rich blood it needs even with the small PVC and with the larger heartbeat next. I've just somehow got to convince my subconscious to relax when it feels the PVC and the more intense second beat.

Maybe my body will find some sort of homeostasis with this new medication routine and the PVCs will go away. I know it is very, very important to stick to the three times I designate to take the Bupropion. 

[Altostrata]

....

 

So my Bupropion schedule may look something more or less like this:

11:00 AM -100 mg SR,  5:00 PM - 25 mg IR solution,  8:00 PM - 24 mg IR solution

Does that seem reasonable to you Alto or do you have any suggestions?

 

.....

 

This seems reasonable to me.

 

You may have a hard time dissolving a 75mg tablet in 7.5mL. I might use 15mL.

 

Then you would have 75mg in 15mL, 5mg in 1mL, or 1mg in 0.2mL.

 

There would be 49mg in 9.8mL.

 

To take 25mg, you would remove 5mL with the oral syringe and shoot it into your mouth.

 

To take 24mg, you would remove 4.8mL with the oral syringe and shoot it into your mouth.

 

Please consider meditative deep breathing to deal with the anxiety. It's very easy, all you have to do is breathe, the hard part is to keep reminding yourself to do it. See

Easing your way into meditation

 

Meditation can heal the brain which can heal the mind and body

 

Mindfulness, Meditation, and Prayer After Brain Injury

 

Pranayama Breathing for Anxiety and Depression

 

Meditation for a stressed-out nervous system

 

Good links for anxiety/worry

[Jshect]

I will taper it using the method you just described.

 

I will definitely look at all of those links.

 

The big problem with deep breathing and meditation is that I start to focus on my body and notice the PVCs even more. During normal general anxiety sitting and focusing on my breathing helps. The problem with the PVCs is deep breathing actually triggers PVCs. The cardiologist said that may be because when you take a deep breath it moves the heart which may trigger a PVC. With meditation (although I've never been any good at it) I become more aware of my body. I'll definitely read your links though. I'm sure there are Buddhist monks out there who could meditate in a way that makes them comfortable with the PVCs. Monks who could step outside their bodies and their PVCs, and shift there focus elsewhere, like on a mantra. There are a couple different companies (Indian, Eastern etc.) that offer meditation and yoga classes in my area. I could always email them and see if they could give me advice concerning meditation and PVCs specifically.  

 

So far the best ways I have found to deal with specifically PVC anxiety is walking, a warm bath, massage... all sort of pleasant distractions. It's my mind that's creating this anxiety by noticing the PVCs, so with walking for example, I sort of get lost in my thoughts and the anxiety reduces. Then when I sit down again, I start to notice them and the anxiety gradually creeps back.

 

Well, maybe I'll get lucky and the PVCs won't be that bad. Or maybe they'll die down after my body adjusts to my new regimen. Anyways, if after a couple weeks go by and I'm having 10 PVCs a minute I can always go back to 150 mg SR, eat healthy, and the PVCs will go away and I'll be back where I started. If that's the case then maybe I'll have to just pay $300 and drive 3 hours to Maryland to see Sandson's expert.

 

Well, wish me luck tomorrow. Thanks, Alto! 

[Jshect]

"Gradually, by just paying attention without reacting, we become aware of a stillness. Sounds, sensations, even emotions and thoughts just come and go. Free of judgment. Free of reaction..."

Yes, I guess if I were truly good at meditation, the sensations of the PVCs would come and go, and I could just be in the present without them bothering me. Just train my mind to be at peace with them.

[Altostrata]

Right, then don't focus on your breathing. Focus on leaves moving in the trees or something outside of yourself.

 

Good luck!

[Jshect]

Well so far so good. I took 100 mg SR at 12:20 today. Now it's 5:53 and I'm having no PVCs. So I really don't know when to take the IR. Do you think this may be a case where because some of the Bupropion metabolites have around 30 hour half-lives, it may take a few days for my body to really notice the reduction in dosage? This is great, so far, I was honestly expecting 6-10 PVCs/minute and so far not one. Well, I'll keep you updated.

[Altostrata]

Don't get too crazy. Stick to your plan until you can figure out what's what.

[Jshect]

12:20 PM: 100 mg SR

  7:30 PM:  25 mg IR

11:30 PM:  24 mg IR

 

I started to notice a couple of PVCs around 7:30 so I took the 25 mg solution and they went away. I was going to wait until I noticed them again and take the final 24 mg, but they did not return so I just went ahead and took the final dose at 11:30 PM. I'm feeling good and about to go to bed, so so far so good. I'll let you know how things go tomorrow. I'll try my best to take the same dosages at the same time tomorrow.

[Altostrata]

Yes, be very regular.

 

This may work, don't bring in confounding factors!

[Jshect]

Well, today went well. I had a couple PVCs this evening but it wasn't bad. It isn't unusual for me to have a few here and there almost randomly. Hopefully they won't gradually increase throughout the week. But, so far I can't complain, my body seems to be tolerating the switch from SR to IR alright. I definitely think spacing it out and taking it three times a day is key. 

I really can't believe the three years I've been seeing Dr K. and struggling with this med he never thought of spacing out the dosage like this. I never thought of it, but it seems like it should have been common sense to a practicing psychiatrist. 

I can't thank you enough Alto.

[Altostrata]

Good to hear it's going okay, Jshect.

 

Few psychiatrists know anything about how to taper the drugs.

 

You're welcome.

[Jshect]

Well, everything is going pretty well. When do you think I should drop another milligram on my Burpopion withdrawal?

I am having issues with Klonopin withdrawal. That is definitely going to be an issue that will not go away unless I deal with it somehow. I do think I am better off tapering the Bupropion first, even though it may seem like Klonopin would have been the obvious choice. Klonopin seems to keep my irritability and anger down which I get from the Bupropion. However, somehow I am going to have to deal with Klonopin withdrawal as I lower the Bupropion. (I already had dependency withdrawal while I was holding steady at 2 mg which I have been dealing with in various ways which I can elaborate on if you would like to know.) I really don't want to have to ask Dr. Kane to raise the Klonopin dosage though, and I don't know that he'd do it or that I'd even want to raise it.

However, I would like to keep moving on the Bupropion taper.

Thanks. 

[Altostrata]

If your heartrate remains steady, you might consider reducing by 1mg per week or so.

[Jshect]

Hi guys, I am back. I had to halt decreasing my medication while taking care of my sick mother. Now, I have the perfect opportunity to get off of the meds and I am doing so.

I've gone from 2 mg to 1.75 Klonopin on August 8th.

I've gone from (150 mg SR) to (100 SR, 41 mg IR) Wellbutrin.

I'm at 8.6 mg Loxapine.

 

I think I'm going to round robin taper those.

My one question is I forget how quickly I should taper the Klonopin. Dr. Kane says .25 every two weeks. What do you think?

[Altostrata]

Hi, jshect. Good to hear from you, I always wonder how you're doing.

 

Are you feeling better now that you've reduced some of your drugs?

 

Go here http://survivingantidepressants.org/index.php?/forum/29-members-only-benzo-tapering-discussion/to discuss benzo tapering.
 

[Skyler]

My one question is I forget how quickly I should taper the Klonopin. Dr. Kane says .25 every two weeks. What do you think?

 

10% or less a month, same as the other psychotropics.  I'm the benzo mod here, stop in when you get a chance.  Best to taper one drug at a time, and reduce the most activating drugs first.  Benzos are brakes, better to taper the 'accelerators' first, but first introduce yourself.

[Jshect]

Hi guys, I'm actually making progress. I haven't been on here in a while. It turns out the PVC's I got was due to some sort of imbalance in minerals (specifically Magnesium) from my medications. I started taking Magnesium supplements. I am completely off the Wellbutrin. Last time I was on this forum, I was on around 140 mg, and unable to lower due to bouts of PVC's. I started taking magnesium from food sources, and I quickly got down to around 10 mg. When I tried to go lower I started getting them again. I read that, in pill form, you only absorb about 10-20% of the magnesium, so I started taking bath salt/magnesium baths, upping the supplement from 1 to 2 or 3 Mg pills, and taking a mineral supplement that has other minerals as well, and now I am off the Wellbutrin. I am off the Oxcarbazepine as well. I'm currently tapering both the Loxapine and Klonopin.

I'm on

8.1 mg Loxapine

25 mg Trazodone

2.5 mg Bystolic

.75 mg Klonopin

 

I'm going to reduce the Klonopin by .25 every 3 weeks, so in around 9 weeks I should be off it. 

Thanks for all the support you guys gave me, and I will continue to update you. If you have any advise on the best method to get my minerals to prevent PVC's let me know. Oh, and an article I read said that most medications disrupt Mg levels, so everyone on here on psychiatric medications may want to be supplementing minerals.

Thanks

[Altostrata]

That is excellent news, Jshect, I'm very happy for you! How are you feeling?

 

We widely recommend fish oil and magnesium supplements, see
http://survivingantidepressants.org/index.php?/topic/36-king-of-supplements-omega-3-fatty-acids-fish-oil/
http://survivingantidepressants.org/index.php?/topic/1300-magnesium-natures-calcium-channel-blocker/

 

It's true, magnesium (and potassium, which is in green vegetables) help regulate heart function. Magnesium oil may be a good, convenient way for you to get more magnesium into you.

 

How did you find out you needed magnesium?

 

If I were you, I'd leave the Klonopin for last, and plan to taper it much more slowly.
 

[Jshect]

Now I'm at

 

.375 mg Klonopin

1 mg loxapine

25 mg bystolic

 

I'm almost off of the Loxapine. I realized that was also contributing to my pain and my heart palpitations so I began tapering that. Down to 1 mg from 8 and I'm getting some insomnia, nausea, and depression. The good thing is PVCs and pain are down. This is going to be a rough final stretch. 

[Kecanoe]

Hang in there.  You are doing amazing!

[Jshect]

What's next though? I went on this horrible journey called pharmaceutical medications for 12 years that had virtually no positive effects on me, and now I'm struggling just to return to step one again, problem unsolved.

[Petunia]

From the first page of your thread:

 

Most of my life I have had constant brain fog, mental and physical fatigue, depression, and anxiety. My mind would get fatigued very easily, which limited me to minimum wage jobs. I had problems with alertness and verbal communication (paradoxically) despite making good grades in school and having a high IQ. I have tried, which seems like, nearly every psychiatric med out there. 

 

 

This sounds like a dietary or nutritional issue or possibly a thyroid problem, here is a list of symptoms of hypothyroid symptoms in men:

• Feeling cold
• Tiring easily
• Dry skin and brittle nails
• Constipation
• Depression
• Trouble concentrating
• Sore muscles
• Weight gain
• Swelling of the thyroid gland, called a goiter

http://www.everydayhealth.com/thyroid-conditions/hypothyroidism-symptoms-in-men.aspx

 

You're doing great getting off the psyche drugs, now you will be able to discover the real cause of your issue and fix it properly. Do some research to find possible causes of your symptoms and then ask your doctor for tests.

[Altostrata]

jshect, is this all you're taking?
 

.375 mg Klonopin

1 mg loxapine

25 mg bystolic

 

 

 

You've been forging ahead. Good for you, you're in a much better position, health-wise. It might be time for a hold. Has there ever been a whole month you didn't make a drug change?

[Jshect]

Alright, now I'm down to three pills and I'm still having problems. 

I'm on:

.25 klonopin

 15 mg Deplin

 2.5 mg Bystolic

 

When I got off of the Welbutrin, I thought my pain would be over so I started working out again. I started getting a different, strange pain. Both hamstrings started killing, my calves still cramped up, and both of my lower lats started hurting. That's when I got off of the Loxapine. The lat pain went away. But my calves and hamstrings were still tight.

SO I went off of the Deplin. My pain disappeared along with my energy and I started getting tons of PVC's. This time the Magnesium didn't help, so I went back on it. The PVC's are still here (but less intense), but the hamstring and calf pain are back.

It's odd, I didn't think the Deplin had any dramatic side effects. I still think it might be due to my beta blocker (Bystolic.) I read that beta blockers can restrict blood vessels in my legs and cause pain. That's still odd the pain went away with the Deplin.

I have stopped at .25 Klonopin, because I was having insomnia, anxiety, depression, along with PVC's. I was feeling suicidal, but was afraid to go to the Emergency Room because they'd end up putting me on more meds.

My sister is somewhat helpful in this and in some ways she makes me miserable. She thinks all this crazy medication stuff is in my mind and she ridicules me when I talk about the medications, the pain, or the PVC's because she thinks I'm making it up.

My new psychiatrist agreed to let me stay put at .25 mg Klonopin, but she wants me to go on an SSRI because of my anxiety and depression.

What do you think my next move should be? I thought I might start tapering the Bystolic because that could be contributing to my leg pain, but one of the withdrawal symptoms of that med is PVC's which cause intense anxiety. I'm trapped. 

[Altostrata]

If I were you, I'd leave reductions in Klonopin for the very last.

 

You may wish to taper Deplin rather than quit it cold turkey. You still need to give your system time to accommodate to changes.

 

Deplin is a megadose of methylfolate. It may be that you do better with a little bit, some people need folate supplementation. There are many inexpensive methylfolate supplements available, such as http://www.iherb.com/Doctor-s-Best-Best-Folate-Fully-Active-Featuring-Quatrefolic-400-mcg-90-Veggie-Caps/38067

 

If working out hurts, do it less strenuously and build up intensity very gradually. Don't beat up your body.

 

If you don't like what your sister says, tell her to mind her own business.

 

I suggest working with your new psychiatrist to stabilize with .25mg Klonopin and discuss non-drug ways to deal with depression. See Non-drug techniques to cope with emotional symptoms

 

Are you still taking care of your parents? Do you still worry about being underemployed? Do you have a recent and very difficult history with a ridiculously complex drug regimen? You have good reason to be depressed and anxious.

 

The depression and anxiety might be withdrawal symptoms from all your drug changes. In addition, you may be experiencing inter-dose anxiety rebound from the Klonopin. Please discuss this in http://survivingantidepressants.org/index.php?/forum/29-members-only-benzo-tapering-discussion/
 

If you go to a doctor and ask for drugs to take away your symptoms, you will surely get them. Isn't this how you got caught up in that dangerous drug cocktail before?

[Jshect]

I didn't ask for them. I went to a new psychiatrist to help me get off most of my current meds. She insists I take an SSRI. I can't avoid my sister, because she handles the finances. She means well, but she can be brutal. 

[Altostrata]

Jshect, you'll have to find your inner rebel to simply say "No" -- firmly and politely -- to some suggestions from other adults. You can do that, it's allowed.

 

"Depression" can be a side effect of benzos. Taking an antidepressant to treat a side effect, whether it's withdrawal syndrome or an adverse effect of a drug, doesn't make any sense, except to perpetuate drug-taking.

 

I strongly suggest you tell the psychiatrist you want to deal with "depression and anxiety" with non-drug means and ask her if she has any suggestions.

 

If she insists you take a drug, you can say no. If she can't treat you unless you're on multiple drugs, she's not the right doctor for you.

 

Any doctor can write a prescription for a benzo. Do you have a good relationship with your GP? You might explain all the trouble you've been having with that ridiculous collection of drugs you were taking and that you are tapering off to minimize repercussions, but you'll have to take the benzo until you're stable enough to start reducing it.

 

In the meantime, please start a topic in http://survivingantidepressants.org/index.php?/forum/29-members-only-benzo-tapering-discussion/to discuss your benzo schedule. It could be that taking the benzo differently will reduce your "depression and anxiety."
 

[Jshect]

What is the deal with Deplin? That is the drug that pushed everything over the top for me. When I started taking it, it said there were no known side effects? That's obviously not true. It's feels like a stimulant. I have two of the four MTHFR mutations so I thought I was alright on the Deplin, but obviously I'm getting too much methylfolate (or whatever). What do you guys know about the safety of Deplin and excessive folate?