catalunya: Welp, here I am! A Luvox and Lyrica mess!

[Altostrata]

You may wish to calmly make your request for a prescription rather than discuss your symptoms. It is unlikely GPs would have any more knowledge of withdrawal syndrome than psychiatrists, who know very little.

[catalunya]

i will, alto. i don't want to discuss my symptoms other than to say that i'm absolutely fine (i'm not) just to ensure that i am receiving prescriptions for the drugs that i am taking without any physician questioning the efficacy of the cocktail and wanting to add yet another drug or change everything entirely which will lead to hospitalization. i had a physician once want to remove lyrica cold turkey and replace it with an atypical antipsychotic (risperidone) for the treatment of generalized anxiety disorder and panic disorder. i wound up in urgent care who referred me to the ER to see the on-call psychiatrist just to get a script. 

 

my main fear is that i'll run into a physician who will decide to not prescribe my medication -- lyrica in particular, as in the states it's not fda-approved for the treatment of anxiety-spectrum disorders, although it certainly is indicated and approved to treat generalized anxiety disorder by the european medicines agency (ema). i have run into a number of psychiatrists over the years in the US, though, who have had no idea what lyrica even is or that it's used in the treatment of anxiety disorders and naturally given their lack of knowledge, they were hesitant to prescribe the drug. 

 

open enrollment is coming up and i do want to change insurance providers but i feel as though i can't because i fear that my alternative (anthem blue cross) will deny lyrica coverage and the drug is prohibitively expensive. my current insurance provider (kaiser permanente) isn't great at all -- i lack access to top physicians lest i pay out of pocket to see a specialist (and i have in the past), although they, after my last and only voluntary hospitalization (i've never been involuntarily hospitalized), listed lyrica as a medically necessary non-formulary exception and so the drug is covered despite various doctors still being unwilling to prescribe it here and there. 

[peggy]

Hi catalunya,

 

I have read your thread and your story about trying to get off echoes mine - although i have only been on one drug. I too tapered too fast (3 times - slow learner) and ran into trouble on low doses.  My symptoms were pretty much debilitating too and I had a business to run that was giving me quite a bit of stress. In hindsight, if I could have extricated myself from the stress and just concentrated on ME, I might have been able to ride it out.  What i did though, was to pretend that i was indispensable and pushed on and on until I broke.  Because when i broke I had to pay someone else to step in - and they managed fine.

 

You are very wise to take charge of your health - is it possible you can take some leave at the moment or work reduced hours to help your nervous system to recover? I know it is very hard when you are financially independent, but if you continue until you crash (which you may not) what will you do then?

[catalunya]

hi peggy,

 

i'm so sorry to hear of all that you've been through because i know exactly how it feels and it's horrendous. 

 

how are you doing currently? i see that you are following a much slower taper and your doses have been decreasing proportionate to the amount you are taking, i.e., the lower the dose the smaller the cut. anyhow, i hope that you are in a much better position than you have been in the past on your current taper. what were you originally prescribed effexor for if you don't mind me asking?

 

fortunately, i work in educational administration and so i have the summer off (i return the 12th of august) -- i would have had to take a leave of absence otherwise and that's what i have had to do  during prior failed tapers. excellent advice to anyone in this sort of situation, though; if you are at your breaking point and still working, it would be wise to take a break from work if at any way possible. 

 

thank you for taking the time to reach out to me! be well!

[peggy]

thanks catalunya - i am doing very well at the moment - although i have been in this spot a few times before - taking 10% cuts. last time i got down to 14mg.  However I had some difficulties with bead size and discovered that i could have been dosing between 11 and 19mg.  Once I get to 20mg I will probably sit for a while longer and consolidate. My general work and family life is a lot less pressured at the moment and should be so for the next 6 months or so.

[catalunya]

i'm crossing my fingers for you, peggy! anyhow, i'm very glad to hear that you are doing well at a slower tapering rate and that you are in a stable, supportive environment. 

 

i very much hope that my taper isn't failing completely given that i'm terribly unstable and having to updose considerably -- likely even more so that i have done thus far, although i very much doubt that i will have to increase all the way back to my original doses or even half of my original doses. hopefully not. 

[Gh0st]

Hoping the taper is going well, Catalunya

[catalunya]

catalunya: If not experiencing withdrawal, safe to reduce after ~two weeks?

 

hi all,

 

my diagnoses and prescriptions are listed in my signature below. anyhow, over the past year and a half to two years, i've worked really hard to reduce pregabalin from a whopping 900mg/day to 50mg/day where i have remained because it was too agonising to continue, clonazepam from 4mg/day to 2mg/day where i stopped because it was of clinical usefulness, and escitalopram from 25mg/day to 15mg/day.

 

i've tapered and discontinued several medications in the past that aren't listed here. of those mentioned above, pregabalin has by far been the most difficult, clonazepam was unpleasant but not hellish, and to my surprise, escitalopram hasn't been terrible, although i have had terrible experiences CTing or nearly CTing SSRIs/SNRIs in the past.

 

anyhow, now that i've been on 15mg/day for about a week or so and with only minimal discomfort after decreasing from 17.5mg/day, my psychiatrist wants me to remain on 15mg/day for a month's time. because my symptoms are very mild, and because she is erring on the side of caution, is it necessary to wait the entire month before reducing another 2.5mg/day to 12.5mg/day, i.e., can i reduce when i feel as though i am ready, say two or three weeks, and not wait the entire month if i don't need to? the side effects of the drug are killing me, so i'd rather do this as quickly but as safely as possible to avoid possible relapse given that i do have quite severe anxiety disorders.

 

note: the goal currently isn't to remove escitalopram completely, but rather to decrease it as much as possible such that i still retain therapeutic benefits with minimised/acceptable side effects.

 

anyone have input? thank you!

 

Edited July 17, 2022 by ChessieCat
added Intro topic title before merging with intro topic

[ChessieCat]

Hi catalunya and welcome back to SA,

 

You don't say how long you have been on escitalopram.  It can take as little as 4 weeks for the brain to become dependent on a psychiatric drug.

 

Please add all drugs names, dates and doses to your drug signature so we can see your drug history at a glance.  Currently there are no dates at all and you joined back in 2015 and haven't posted in 6 years so we have no idea what you have stopped, started, reduced, changed etc.

 

dx: panic disorder, generalised anxiety disorder, mood disorder with major depressive features

 

rx: 2mg/day clonazepam, 50mg/day pregabalin, 50mg/hydroxyzine, 100mg/day lamotrigine, 15mg/day escitalopram

 

 

You can give a summary for any drugs you took more than 2 years ago but we need details for anything in the last 2 years.

 

Please list is as:

 

Drug name:  date, dose; date, dose;

Drug name:  date, dose; date, dose;

 

 

Escitalopram is a very strong drug compared to nearly every other antidepressant.

 

If you have only been on it for a short period of time, eg up to 2-3 months, then you might be able to do a fast taper off it.  However, if it is longer than that

 

SA's taper rate is to reduce by no more than 10% of the current dose and then hold on the dose for at least 4 weeks to allow the brain to adapt to not getting as much of the drug.

 

Just because you are not currently noticing withdrawal symptoms does not mean that the brain isn't busy still adapting to the reduction.  It takes about 4 days for a dose to get to a steady level in the blood and a bit longer for it to register in the brain.  This is why the suggested hold period is 4 weeks; to ensure that the brain has done what it needs to do.

 

If you try to taper too quickly it will most likely catch up with you down the track.  I have seen this happen with SA members.   And the effect of going on/off drugs and up/down in doses has a cumulative effect on your nervous system.  There are members of SA who have done the same thing multiple times with no issues and then the next time they do it their nervous system becomes unstable.  And it takes some of them many months to recover, and some of them never get back to how they were before they become unstable.  Some have had to leave work, some have had their relationship breakdown and some have had to move in with family/friends.

 

I would urge you to be cautious.  The aim of tapering is to keep withdrawal symptoms to a minimum so that you can live your life as normally as possible.

 

I have been a moderator here for 7 years and I have seen members try to speed up their taper and in the end it has taken them longer than if they had done a nice steady taper.  Some have ended up adding another drug, which then needs to be tapered, and some have switched to a different drug which doesn't always work; withdrawal symptoms from first drug and/or side effects/adverse effects from the second drug.

 

Edited July 17, 2022 by ChessieCat

[ChessieCat]

26 minutes ago, catalunya said:

anyhow, now that i've been on 15mg/day for about a week or so and with only minimal discomfort after decreasing from 17.5mg/day, my psychiatrist wants me to remain on 15mg/day for a month's time. because my symptoms are very mild, and because she is erring on the side of caution, is it necessary to wait the entire month before reducing another 2.5mg/day to 12.5mg/day,

 

This is very unusual.  Medical professionals generally taper people off their drugs too quickly.

 

It sounds like she is doing a 10% every 4 week taper HOWEVER, from the doses you have provided above she is doing a linear taper, not a hyperbolic taper.

 

The difference is that she is reducing by 2.5mg each time.  Whereas for a hyperbolic taper the new dose is calculated on the dose you were on before.  If you are currently taking 15mg, then the next reduction would be to 13mg, not 12.5mg.

Please check out Post #1 of this topic and check out the video which explains is quite simply:

 

Why taper paper: dose-occupancy curves

 

Post #1 of this topic explains how to get non standard doses:

 

Tips for tapering off escitalopram (Lexapro)

[ChessieCat]

33 minutes ago, catalunya said:

the side effects of the drug are killing me

 

Q:  Is it side effects or withdrawal symptoms?

 

If it is side effects then generally reduce as the dose gets lower.  Going too fast and ended up bringing on withdrawal symptoms would most likely make you feel even worse and you also might not be able to tell the difference between side effects and withdrawal symptoms.

 

Dr Joseph Glenmullen's WD Symptoms Checklist

 

 

 

[catalunya]

thank you all for responding!

 

okay, so i didn't  realise that i had another post here from six or seven years ago. i relapsed and was placed on everything again and had to start from scratch on the pregabalin withdrawal much more slowly, then i was placed on a ton of atypical antipsychotics which were horrible for  me - at  least the ssri is therapeutically useful. i was also placed on memantine at one point and then zolpidem and mirtazapine - i tapered off all by myself because they were harming more than helping. i apologise in that i don't remember which dosages were taken or for what period of time - the whole time period was a blur because the aaps really interfered with memory. the current cocktail that i am on is helping more than harming save for the ssri which has intolerable sides.

 

9 hours ago, ChessieCat said:

Q:  Is it side effects or withdrawal symptoms?

they are indeed the side effects. i was referencing the sexual and emotional side effects of the ssri being the catalyst to wishing to lower the medication such that there is a compromise between control of the disorders and decreased side effect intensity.

 

my current symptoms attributable to the decrease of escitalopram are rather mild at this point and consist of some mild headaches and a mild increase in anxiety. these, along with nightmares, were much more prevalent in the five days or so after making the last decrease, but have subsided considerably.

 

10 hours ago, ChessieCat said:

If you have only been on it for a short period of time, eg up to 2-3 months, then you might be able to do a fast taper off it.  However, if it is longer than that

 

it has been far longer than 2-3 months. i've only for brief periods of time been without an ssri/snri during my life which were disastrous because i do have very severe underlying conditions that respond well enough to ssris/snris, albeit only partially and thus the other medications. i was placed on paroxetine at the age of around 14 and it worked wonderfully, allowing me to live my life with very little in the way of side effects for a good ten years before relapsing. i'm in my mid-thirties now and for the past ten years have struggled to maintain stability after that relapse and a number of failed medication trials. i was recently rediagnosed with some other mood disorder that places me on the very mild side of the bipolar spectrum on top of the anxiety disorders that plague me and began taking lamotrigine with the intent per my psychiatrist of lowering escitalopram as it may be causing a dysphoric mixed state fueling the anxiety disorders in its presentation to some extent.  the goal that my psychiatrist and i have decided upon is to reduce to the point with the intention/goal that i've listed above. i have been taking escitalopram for approximately three years, with duloxetine prior to that and fluvoxamine prior to that with the order of ssris/snris prior becoming fuzzy only knowing for certain that i did well on paroxetine for about 15 or so years before it wasn't enough and i relapsed.

 

10 hours ago, ChessieCat said:

And it takes some of them many months to recover, and some of them never get back to how they were before they become unstable.  Some have had to leave work, some have had their relationship breakdown and some have had to move in with family/friends.

 

this is exactly what has happened to me in the past. in fact, it happened to me when attempting to taper pregabalin, although i was microtapering and i thought at the time that i was doing what i was supposed to be doing. i wasn't and i relapsed, lost my career, and moved in with family. it took me a good year to recover and was placed on different medications some of which i discontinued rather recently: mirtazapine and zolpidem. this was around the same time that i discontinued antipsychotics because they interfered with cognition to such a great extent that my daily life was impaired - low dosages even. cognitive impairment wasn't the only trouble, either. the class caused for a slew of intolerable, insufferable side effects.  it was truly a nightmare of a drug class for me to take.

 

the  reduction of the medications listed in the post that i wrote yesterday all occurred within the past year and half to two years.

 

10 hours ago, ChessieCat said:

SA's taper rate is to reduce by no more than 10% of the current dose and then hold on the dose for at least 4 weeks to allow the brain to adapt to not getting as much of the drug.

 

gotcha. i'll wait an entire month, reevaluate and then make changes as i see fit. the biggest problem is trying to identify withdrawal effects from the return of the presentation of symptoms of the illnesses being treated. it's quite difficult when some withdrawal effects, namely increased anxiety, panic attacks, agoraphobia, racing thoughts, etc., are identical to what i was placed on the drug for.

 

this especially worrisome for me because i start a phd program in september and trying to change medications while waiting for stability during the start of an important and rigorous academic program is by far from ideal.

[catalunya]

10 hours ago, ChessieCat said:

You can give a summary for any drugs you took more than 2 years ago but we need details for anything in the last 2 years.

 

oh, i forgot to add this. the only drugs that i've been on during the last two years are those in my signature. hydroxyzine was added within the past six months, and lamotrigine was added within the past three months. the others were all being taken or reduced. nightmare of a taper of pregabalin from 900mg/day to 50mg/day where i could not taper further even with pfizer's liquid solution. the reduction of clonazepam from 4mg/day to 2mg/day which was easier than expected. the elimination of zolpidem from 15mg/night to 0mg which wasn't difficult at all. the only drug being reduced right now is escitalopram.

[miomio]

Hi, 

Can i ask if ur mood disorder Was part of ur life before the meds? Or "only" the panic attacks and anxiety? 

[catalunya]

7 minutes ago, miomio said:

Hi, 

Can i ask if ur mood disorder Was part of ur life before the meds? Or "only" the panic attacks and anxiety? 

 

i was rediagnosed with a mood disorder nos with depressive symptoms recently after having major depressive disorder eliminated and replaced. the introduction of lamotrigine has been beneficial and with very few if any side effects. my current psychiatrist has been very careful with only touching one drug at any  given time to try to discern what is doing what. i do believe that the bipolar spectrum disorder diagnosis is accurate, although i've never experienced full-blown mania or even hypomania in the stereotypical sense. her hypothesis is that a dysphoric mixed state is leading to irritability, anxiety, and depression and all of those have lessened with lamotrigine on board.

 

anxiety has increased after beginning lowering escitalopram, which was expected, although  at present i'm not in significant distress. anxiety picks up here and there but it's not constant coming and going in waves. i haven't lost basic functioning and can go about my life as usual at this point.

[Altostrata]

Hello, @catalunya 

12 hours ago, catalunya said:

the biggest problem is trying to identify withdrawal effects from the return of the presentation of symptoms of the illnesses being treated. it's quite difficult when some withdrawal effects, namely increased anxiety, panic attacks, agoraphobia, racing thoughts, etc., are identical to what i was placed on the drug for.

 

Yes, this would be a problem if you are a conventional psychiatrist who thinks that drugs are holding back symptoms like a dam holds back a flood. Any symptoms would be seen as the original problem leaking through. This is a sign of a psychiatrist who does not quite understand withdrawal symptoms.

 

Withdrawal symptoms occur after reduction or removal of a drug. "Relapse" does not suddenly snap back. Very likely most of your drugs, which you think you're taking for "therapeutic" reasons, were added to address withdrawal symptoms or adverse effects of your many drug changes, clonazepam, pregabalin, hydroxyzine, and lamotrigine being prime suspects.

 

As you might recall, we advise a 10% exponential taper per month to minimize the risk of withdrawal symptoms, whether to lower dosage or to go off completely. We advise against tapering while you have withdrawal symptoms. We advise tapering only one drug at a time. 

 

These topics pertain to your drugs:

 

Tips for tapering off pregabalin (Lyrica)
 
Tips for tapering off lamotrigine (Lamictal)

Tips for tapering off escitalopram (Lexapro)

We don't have topics for tapering clonazepam or hydroxyzine. The tapering principles are the same as the others.

 

As you have a psychiatrist supervising your drug dosing adjustments, I don't think we can help you taper. Your doctor has her own ideas about tapering. She may want you to taper faster than our guidelines. She may be adding drugs while we're talking about reducing drugs. We don't treat bipolar or dysphoric mixed state or any mood disorder and cannot determine the "therapeutic" quantity of any element of your drug cocktail.

 

You may wish to look at the above information topics and discuss tapering techniques with your psychiatrist.

[catalunya]

@Altostrata, with limited respect to you, mental illness is indeed real and necessitates treatment in those for whom it is warranted. while there is unquestionably a crisis with the over-prescription of psychotropics, some of us do need them to function as productive members of society.

 

my post made yesterday, merged with the post made years ago, was not in an attempt to rid myself of psychotropics completely as i'd surely be dead if i were to and believe me, i've tried on both accounts, but rather to minimise the side effects of the ssri.

 

while this may not be a med-positive board, it is imperative that you respect those who do suffer from legitimate psychiatric problems before jumping to conclusions and dismissing all medications as unnecessary and harmful for all who take them.

[Altostrata]

You have our advice about tapering. We cannot assist you in treating your mental illness, that's what you pay your psychiatrist for. Good luck to you!

[catalunya]

1 minute ago, Altostrata said:

You have our advice about tapering. We cannot assist you in treating your mental illness, that's what you pay your psychiatrist for. Good luck to you!

 

i certainly didn't ask for any advice in treating mental illness.

 

 

[Altostrata]

We're not going to provide unpaid backup for your well-paid psychiatrist.

[catalunya]

close the thread. i won't be returning to this site.