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  1. I have been on Zoloft for over 40 years. I have been on Vicodin and Xanax for almost that long but have recently rapidly discontinued these two drugs over the course of 2 months. After one month of severe W/D sxs, I crossed over to Valium 30mgs. After stabilizing for a month, I began slowly tapering the Valium from 15mg, which is going well. I feel that the Zoloft has completely stopped working for me a long time ago and that it is now only preventing W/D sxs. I am at the maximum dose and I think that I would feel better at a much lower dose or completely off of it. I read here on SA that it is a good idea to taper off of your AD first and then taper your benzo. I am now considering holding my taper of the Valium and beginning the taper of my Zoloft, keeping the Trazadone for sleep. I realize that this process will take a long time, especially with me being at the maximum dose of Zoloft. I really want to taper off of the Valium at some point due to the possibility of future dementia issues. I am 65 years old and am wondering if it is even worth the trouble to start this process knowing that possibly the next 10 years, or more, of my life could be a living hell. I would like any and all thoughts on my predicament and if you think that I should begin this journey, which should I begin with and how to go about doing it. I know that slow, slow, slow is the key with any taper. Thank you for reading my story, Leon
  2. I require urgent help please. Over the past 18 months I have had several medication changes due to going off 150mg Effexor cold turkey in July 2017. I didn't know how to do it any other way at the time and I told no-one what I was doing, not even my doctor. it just wasn't working any more. I had been off Effexor for about 3 months and thought I had got through the worst of it although still had some withdrawal affects going on but I was functioning okay and sleeping. I thought I'd call my doctor and let him know what I did and that is where I went wrong. He told me to reinstate Effexor immediately at 75mg from memory, which I did because I felt like I had done something terribly wrong. Upon reinstatement my whole body went into shock and I couldn't move. It was shocking. My doctor told me to go into hospital and that he'd help fix it. By the time I left hospital I think I was on the minimum effective dose of Zoloft. After leaving hospital I found that the Zoloft was overstimulating and I didn't sleep for a week. I had to take 25mg of seroquel for sleep. Zoloft wasn't the right antidepressant for me. Without tapering off Zoloft, my doctor would try me on several different antidepressants over the next 6 weeks, including prozac, mirtazapine, brintalex, valdoxen, lexapro. I had adverse side affects to all of these medications and can't remember what dose he started me on. I believe now that my brain/body couldn't tolerate medication anymore. I needed to go back to hospital and I needed to find another doctor. I found another doctor and I think in February 2018 from memory, and I apologise that my memory is very vague due to my recent round of ECT. I think I started taking 20mg of Prozac, which did have it's challenges. I underwent a round of ECT, in April 2018 and left hosptial feeling better on 20mg of Prozac and Olanzapine - I can't remember this dose - maybe 5mg because 10mg was too much and I couldn't function on that amount. I agreed to take the Olanzapine only for 3 months to get myself back to work an back to life. When my doctor took me off the olanzapine I think she did it too quickly and the withdrawal was intense. It was so intense that I tried to commit suicide. Next step, back to hospital when my doctor suggested that I should go back onto Effexor as it had worked for me in the past. I was desperate, I didn't feel comfortable about it, but she's the doctor and knows best right? The current situation is that I came off Effexor 150mg (the original dose was 225mg), under the guidance of my psychiatrist in November 2018. She tapered me off the medication over 2 weeks. The reason I needed to come off Effexor was due to the fact that I just wasn't able to function whilst taking it, I actually felt worse. The hell that followed was horrendous and I did try and reinstate a low dose of Effexor although it just made matters worse. She had be do a course of TMS treatment and then my doctor suggested ECT . I agreed because I thought it was supposed to help with the withdrawal, although in hindsight I think she was trying to treat depression, when I told her I wasn't depressed and that I was experiencing was withdrawal. The ECT was a really bad idea. After the 9th ECT treatment I felt as though I was losing my mind, I felt like my brain was on fire. This sensation lasted quite a number of days and the only thing that helped was 5mg of valium as a PRN, which I took for about 6 days. I am now in such a state. I don't know where to turn. I can't sleep and I can't turn to my doctor for help because she has totally screwed me over. Please help me, I am so desperate. I am currently taking the following vitamins and supplements. Fish Oil 2000mg 4 x day N-acetylcysteine 1000mg 2 x per day Vitamin D 1 x day Vitamin C 1 x day Nux Vomica IM (when nauseous) Magnesium amino acid chalate - 1 scoop 2 x per day Naturopath remedies - Wellbeing mix 3 x day, soothing drops 3 x day, sleep support 2 x per day, Sleep and Rejuva Sleep Forte 4 x day, compounded melatonin 5mg for sleep.
  3. How it all started. November 2017 I was prescribed .5 mg of Klonopin to be taken once daily I do not have any pre existing anxiety or health issues. The "medicine" was given to me to help with some stress induced insomnia. Since then the stress that caused the insomnia has long been resolved. I was told this medication was a low dose, and it was perfectly safe, and could be taken nightly for up to 3 months without having any problems with dependency or addiction. Even though i told the doctor 11 years prior i had a bad withdrawel from Ativan that was prescribed to me after my mothers death. He said klonopin is much safer and easier to come off of. Also i took increasing doses of Ativan for close to a year... so of course it was hard to withdraw from... I took the Klonopin .5mg exactly as prescribed for about 10 to 12 days, and then for a week after I took half the dose .25 mg. Then i quit... Apparently I'm very sensitive to these types of medications and not biochemically compatible with them, because what happened over the next 8 days, I describe as increasing anxiety, insomnia, and irrational fear, that got to the point (8 days out) of having absolutely zero sleep the night before and feeling completely detaches from reality. Now i wish i would have realized what was happening and stuck it out, because I'd probably be 100% recovered by now. However, I ( like so many of us ) went running back to the doctor for help. I made an emergency appointment with my doc. He prescribed me a very high dose of Gabapentin and told me that its a great new medication used for benzo and alchohol withdrawels. He promised me that this drug was completely safe and not addictive at all as he did with the Klonopin. but he convinced me of it by telling me it wasn't a controlled substance. It worked great for about a week, but then all of those strange withdrawal symptoms from the Klonopin started coming back, and I required more of the Gabapentin to control those symptoms... My doctor actually said I could pick up the 3600 mg of it a day if need it without any worry of withdrawal. I had a massive bottle of 300mg pills and another massive bottle of 100mg pills to "fill in" I got to the point where I was taking 300 mg in the morning, 300 mg in the afternoon, and 1200 mg at night. But something just didn't feel right, I wasn't myself, I felt like I had suddenly lost 10 or 15 IQ points, the world seemed dull and so did my emotions. So the doctor pulled me off the gabapentin and put me back on the klonopin and once stable I would do a very slow taper, i was desperate to feel normal again so i agreed... I was pulled from the gabapentin after being on it for only 9 days... but with no taper and put back on the klonopin. Only this time it was not really working... I am well aware of Heather Ashton, slow tappering, micro tappering, and the effects benzos have on our gaba receptors... i personaly think Ashton is to highly regarded... I think the cross over to valium is a bad idea and does not work out for a lot of people... i respect the work she did, and her research, but that information is out dated and had needed to be continued and expanded upon. I do not agree all benzos effect the brain the same way the only difference is half life... My doctor thought going on valium would be my best option because of the long half life.... but there was no transition, it was just simply stop the Klonopin 1 day and start on 8mg diazapam the next... valiums main chemical of action breaks down in just 4 hours, while the rest of it just builds up in our systems... so the relief factor is short, while the rest of the chemicals just build up. Where I am at now I am currently taking 3 mg of Valium in the morning and 3 mg of Valium at night as well as 300 mg of Gabapentin in the morning and 300 mg at night ( yes im back on the gaba... mainly because the lack of sleep that started after my 2nd valium cut was just killing me) . This process is drawn out for the better part of a year now, and I'm still not medication free, and I'm still suffering insomnia, anxiety, and a sense of detachment. What I'm really wondering is if anyone has been on this combination of medications, and how they approached the taper. It doesn't matter which one I cut, I feel the effects of both in very much the same way with the same type of symptoms. Should I be tapering say half a milligram of Valium every two weeks, and 100 mg of Gabapentin every 2 weeks? Or tackle one at a time??? I apologize as this intro has turn into a book, I'm just very desperate for answers from people who have been through this I'm not seeking medical advice just personal experiences. My doctor and my pharmacist both say that what I'm experiencing is impossible given my dosage. But i know better. Just last year I was a highly functioning, healthy , strong, muscular, independent hard-working man, that ate a very healthy diet. After taking the Klonopin for just 17 days, the aftermath has been the loss of my job, i've had to move in with my sister for the time being. And all any doctor wants to do is give me more drugs or up my doses. I know the reality is this is a side effect kind of withdrawal from the medication so I refuse to do that. I have had a ton of blood work, and other neurological tests that are all perfectly normal I currently take both ionic and threonate magnesium in the middle of the day. I dont know if it helps ot not... i still eat healthy and walk at least 3 miles a day. SYMPTOMS I have lost 10 pounds of muscle, i have diahrea everyday I have benign faciculation dissorter My hands are shakey I have a massive panic attack in the middle of the night that wakes me up After the panic attqck at night I spend the rest of my hours in stage 2 of sleep ( where i feel like im not sleeping but i actually am) during this time i have a constant stream of thoughts, songs stuck in my head, and thins that make literaly no sense at all... I sleep between 2 and 6 hours per night. I have daytime anxiety mainly in the afternoon. Thank you, and best wishes to all of you.
  4. I have been on meds since I was around 18, I am now 33, I have been tapering off all my meds for the last year now, I have managed to get off venlafaxine xr 75mg which I tapered off for around 4 - 6 months, and quetiapine 50mg over the last 12 months, I was on 200mg at one point and also tapered off diazapam 10mg, and also propranolol 10mg, I have been off all meds now for nearly 3 months and have been fine, I have been at the gym most days and eating healthy, I was starting to look good again and becoming myself again, I have not been human while on meds for the last lots of years, I was finally starting to enjoy life and then the last few weeks my sleep has been getting very fractured and I have been waking up very early with extreme brain fog, it feels like my head is going to explode sometimes, now the last 2 nights I have not slept at all and feel like death, I even took 2 melatonin tablets and they did nothing, what on earth is going on? I am worried I have done some serious damage to my brain, I am too worried to go and get checked at the doctors as I could not handle news that I have some brain disease, I have read that meds can cause effects many months after, can anyone give any advice/peace of mind?
  5. ADMIN NOTE: Read this entire topic before attempting a switch to fluoxetine. Be sure to read details and cautions below . Consult a knowledgeable medical practitioner before changing medications. Also see Tips for tapering off fluoxetine (Prozac) Switching or bridging with another related drug, usually of a longer half-life, is a medically recognized way to get off psychiatric drugs, particularly if you find tapering your original drug to be intolerable. Many people with failed tapers from venlafaxine (Effexor), desvenlafaxine (Pristiq), paroxetine (Paxil), and duloxetine (Cymbalta) find they need to bridge in order to go off the drug. For many doctors, a switch to Prozac to go off a different antidepressant is routine. Because of the risks of switching drugs -- see below -- we recommend attempting a very gradual direct taper from your drug, with bridging with a different drug only a last resort. There are a lot of unknowns in bridging. Fluoxetine (Prozac) has the longest half-life of any of the modern antidepressants. Because it takes more than a week for a dose to be metabolized completely, a careful taper off fluoxetine is easier for many people -- see information about Tapering off Prozac. And, at least fluoxetine comes in a liquid. (Do not assume fluoxetine is "self-tapering"! We have many people here with Prozac withdrawal syndrome. While going off fluoxetine usually has less risk, one might still develop withdrawal symptoms going off fluoxetine. No bridging strategy is risk-free.) Citalopram (Celexa )and its sibling escilatopram (Lexapro) have half-lives of about 35 hours, a relatively long half-life among SSRIs, and are other candidates for a bridging strategy. They also come in a liquid form. You must find a knowledgeable doctor to help you to with a bridging strategy. The cross-taper method discussed below is probably the safest way to make a change in drugs. You might wish to print this post out to discuss it with your doctor. For most people the switch goes smoothly but for some it doesn't. The drawbacks of switching to another drug to get off the first drug, described below, apply to ALL bridging strategies for ALL drugs, including benzodiazepines (where people often want to bridge with diazepam per the Ashton method). Risks of bridging A bridging strategy has the following drawbacks for a minority of those who try it: Dropping the first antidepressant in the switch may cause withdrawal symptoms even though you're taking a bridge drug. Adverse reaction to the bridge drug, such as Prozac. Serotonin toxicity or adverse effects of a drug combination. If withdrawal symptoms are already underway, switching to a bridge drug may not help. A cross-taper requires a number of careful steps. Difficulty tapering off the bridge drug. All of the bridge drugs can be difficult to taper themselves. So, like anything else, a drug switch is not guaranteed to work. When to switch or bridge "The devil you know is better than the devil you don't know". A direct taper from the drug to which your nervous system is accustomed carries less risk than a switch to a new drug. You may have a bad reaction to the substitute drug, or the substitution may not work to forestall withdrawal symptoms. The risk of a switch is justified if you find a taper from the original drug is simply too difficult. Usually people will do a switch when they find reducing the original antidepressant by even a small amount -- 10% or even 5% -- causes intolerable withdrawal symptoms. (I have heard doctors say they don't even try tapering off paroxetine (Paxil) or venlafaxine (Effexor ), they switch to Prozac at the beginning of the tapering process.) If you are having intolerable withdrawal or adverse effects from an antidepressant, it may be worth risking the worst case, which is that a switch to a bridge drug doesn't help and you have withdrawal syndrome anyway. If you're thinking of switching simply as a matter of convenience, you need to weigh the risks against the amount of convenience you would gain. Generally, switching for convenience is a bad idea. CAUTION: A switch to a bridge drug is not guaranteed to work. It's safer to slow down a taper than count on a switch. A switch really should be used only when a taper becomes unbearable or there are other serious adverse effects from the medication. You must work with a doctor who is familiar with bridging, in case you develop severe symptoms. Overview of cross-tapering method For drug switches, many doctors prefer cross-tapering, where a low dose of one drug is added and gradually increased while the first drug is reduced. For a period, both drugs are taken at the same time. Here is a graphic representation of cross-tapering: If you are making a switch to Prozac, the second antidepressant is fluoxetine (Prozac). Given fluoxetine's long half-life, it may take a couple of weeks to reach full effect. The effect of the amount you add at each stage of the cross-taper will build throughout the process. As it is possible to overshoot Prozac dosage, it's best to be very conservative about increasing fluoxetine throughout the cross-taper, you could end up with serotonin toxicity from too much fluoxetine (see below). Also see this discussion about cross-tapering with Prozac: Serotonin toxicity and serotonin syndrome You run the risk of serotonin toxicity if you are taking too much serotonergic. Most antidepressants (and some other drugs, such as triptans and MDMA) are serotonergics. Serotonergic effects of antidepressants are added when you take more than one of them, particularly if you add an SSRI (such as Prozac, Celexa, or Lexapro) to an SNRI (such as desvenlafaxine (Pristiq), duloxetine (Cymbalta), venlafaxine (Effexor), venlafaxine XR (Effexor XR), milnacipran (Savella), and levomilnacipran (Fetzima)). (Other types of antidepressants should not be combined with tricyclics or MAOIs.) Symptoms of too much serotonergic can be: Nervousness, anxiety, akathisia, sleeplessness, fast heartbeat. Symptoms of serotonin toxicity can be these plus disorientation, sweating, and others. Serotonin syndrome is even more serious. See Serotonin Syndrome or Serotonin Toxicity Reduction of the drug dose should resolve serotonin toxicity. Note that if you cross-taper, you will be taking 2 drugs at once for part of the time. Because of the potential of serotonin toxicity by overdosing SSRIs as well as in combination with SNRIs, it's safest to err on the lower side of a Prozac dose "equivalent" -- such as 5mg -- to your original drug. This is why doctors familiar with the Prozac switch will cross-taper by adding an initial LOW DOSE of Prozac to an SNRI. Start low, the effect of fluoxetine will increase over several weeks. Another concern: Escilatopram (Lexapro) is several times stronger, milligram for milligram, than the other SSRIs. If you add 10mg escilatopram to the high dose of 60mg duloxetine (Cymbalta), for example, you run the risk of serotonergic toxicity -- 10mg escilatopram is equal to approximately 20mg-30mg duloxetine. How much fluoxetine (Prozac) to substitute for my drug? Since fluoxetine's half-life is so much longer than those of other antdepressants, its effect is a little different. It's not a stronger antidepressant, but the effect of each dose lasts much longer. This may be the reason a lower dose of fluoxetine often seems to adequately substitute for other antidepressants. For an idea of equivalent doses of your medication to fluoxetine (Prozac) read this post (January 7, 2018) in this topic. It compares fluoxetine 40mg/day (a fairly high dose of Prozac) to other antidepressants. Source of that data: https://www.ncbi.nlm.nih.gov/pubmed/25911132 If you have tapered to a lower dose of an antidepressant, an even lower dose of Prozac may be more tolerable. If you are about half-way down, you might want to try 10mg Prozac. If you have decreased further, you may wish to try 5mg Prozac. If you have substituted fluoxetine for your drug and after two weeks, you feel you have withdrawal symptoms, you may wish to gradually the fluoxetine dosage. After each change in fluoxetine, wait at least 2 weeks to see the effect before deciding on another increase. More is not better for nervous systems sensitized by withdrawal. EXAMPLES OF THE PROZAC SWITCH Below is information I've gathered from doctors about how to do the Prozac switch. You will see there is no standard protocol. Healy 2009 method for the Prozac switch From Healy 2009 Halting SSRIs withdrawal guidelines: Phelps-Kelly 2010 method for Prozac switch From Clinicians share information about slow tapering (2010) Jim Phelps, one of the authors of the above, posted in 2005 in some detail about the so-called "Prozac bridging" strategy. He said it is described in Joseph Glenmullen's book, Prozac Backlash, maybe in the chapter titled of "Held Hostage." The technique Dr. Phelps described in this post skips doses and finishes with alternating dosages, which we do not recommend for people who are sensitive to withdrawal symptoms. Given that fluoxetine liquid is available, this is completely unnecessary. Foster 2012 method for Prozac switch Dr. Mark Foster, a GP whose mission is to get people safely off psychiatric drugs includes this in a presentation he gives to doctors. http://www.gobhi.org/spring_conference_powerpoints/safewithdrawal_of_psychotropics%5Bautosaved%5D.ppt. His method involves overlapping Prozac with the other antidepressant -- cross-tapering. Prey 2012 method for Prozac switch Another knowledgeable doctor (whom I trust) explained his technique to me (this is the technique I personally would prefer if I had to do it, it seems much gentler) For a "normal" dose of Effexor (150mg per day or more) or Paxil (20mg) or Cymbalta (20mg), he would switch to 10mg Prozac with a week of overlap. In other words, take both medications for a week and then drop the Effexor. Lower doses of Effexor or other antidepressant require lower doses of Prozac as a "bridge." The lower dose of Prozac reduces the risk of excessive serotonergic stimulation (serotonin toxicity) from the combination of the two antidepressants during the overlap period. Do not stay on the combination of the first antidepressant and Prozac for more than 2 weeks, or you run the risk of your nervous system accommodating to the combination and having difficulty tapering off both antidepressants. Later, taper off Prozac. He acknowledged Prozac can have its withdrawal problems, but given Prozac's long half-life, gradual tapering should be easier than tapering off Effexor. Smoothing out a transition to fluoxetine Even with a cross-taper, your system might feel a jolt after you finally drop the initial antidepressant, particularly if it is an SNRI, such as Effexor, Pristiq, or Cymbalta, or other drug that is not an SSRI like fluoxetine. (Other SSRIs include Paxil, Zoloft, Luvox, Celexa, Lexapro). If you go through a rough patch after the transition, patients find they can take a tiny chip of the original drug (or a bead or two, if it's a capsule containing beads) for a week or two to smooth out the transition. Eventually, you'd take a chip as needed only when you feel a wave of withdrawal from the original drug, and then finally leave the original drug entirely behind. (A gelatin capsule might make a tablet fragment easier to get down, but it is not necessary if you can wash it down with a good swallow of water. The gelatin capsule quickly dissolves in your stomach.) Here's an example. There is no shame in doing this. Whatever works, works.
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