GeminiTaurus Taper off Zyban

[GeminiTaurus]

Hi:  I discovered this wonderful website in late January 2015 and developed a taper plan.

 

I am currently on:  Citalopram (down to 8.6ml of a a dissolved 20mg tablet), Zyban (a divided dose of 300mg taken in the morning and around 6pm), Risperidone (2mg in the evening), Lamotrigine (200mg taken in the evening).  So two anti-depressants, an anti-psychotic and a mood stabliser (I was diagnosed with bipolar disorder in late 2011).

 

I started a taper of citalopram in February this year.  I have been dissolving a 20mg tablet in 20ml of water and using a syringe to give myself the dose according to my taper plan of 10% a month.  I am down to 8.6ml and haven't been having withdrawal symptoms which is great.  If I do feel low and fatigued and down on myself, I remind myself that life wasn't sweetness and light even at the higher dose.

 

My plan is to taper off the anti-depressants which will reduce the need for the anti-psychotic - and will taper that also eventually, leaving myself just on the mood stabiliser.  I have decided to taper the Zyban at the same time as the citalopram to speed this up.  It looks like a long-term plan which could take me around 3 years to achieve - which is daunting.  

 

I don't like being on medications (particularly the anti-psychotic as it has a known cardiovascular side-effect) and hope to manage the bipolar primarily through self-care (exercise, sleep, social contact, and eliminating stress).  I have a small number of side-effects currently - e.g. I feel much less intelligent than before the diagnosis - but am not sure whether it is the condition or the medications that have created that.

 

During my last mania in 2014 I cold-turkeyed off the anti-depressants and I consider this is why I went into a very deep depression with lots of anxiety immediately after the mania.  I had been told that mania and depression are "yoked" in that a mania is followed by a depression - so it took me a while to come to the conclusion that it was probably the abrupt stopping of the anti-depressants that triggered the depression.  I have been stable and reasonably content for the past year.

 

I have read through the wellbutrin tapering page and have calculated some taper options (see attached spreadsheet).  In my country it is not possible to obtain the immediate release version of the drug so I will need to break up the slow release version.  I am considering either dissolving or crushing and weighing.  To help in my decision, I would appreciate information on how stable the solution would be (i.e. could I dissolve my daily total and use throughout the day?) and how stable the crushed tablets would be if put into capsules (i.e. could I prepare enough for the week in advance?)  Also, does the taper plan make sense?

 

Thanks for the advice!

 

zyban taper.xlsx

[Altostrata]

Welcome, GeminiTaurus.

 

As you probably know, Zyban is the same as buproprion, or Wellbutrin. Are you taking it for smoking cessation? How long have you been taking it?

 

We do not recommend tapering two drugs at once. If you run into problems, you won't know which is causing them. This can become a mess to untangle.

 

If you're feeling sluggish, reducing buproprion, which generally is stimulating, will make that worse. You're also taking two "brakes," risperdone and lamotrigine.

 

Please put ALL the drugs you take in the Drug Interactions Checker http://www.drugs.com/drug_interactions.html and copy and paste the results in this topic.

 

You probably will not be able to make a liquid of the slow-release buproprion, it has binders in it that might make it gluey. You might experiment with one tablet and see. It will keep as long as a liquid made with the immediate-release type.

[GeminiTaurus]

Hi Altostrata:  Thanks for replying.  I have made comments in red below.

As you probably know, Zyban is the same as buproprion, or Wellbutrin. Are you taking it for smoking cessation? How long have you been taking it?

Yes, I discovered that they are the same.  No, I'm not taking it for smoking cessation - that's just the way the drug comes in New Zealand.  I'm not sure of the date I started taking it.  It was prescribed as an add-on to Citalopram when I had a persistent depression.  It would be at least 3 years - including a brief stint of cold turkey, but back on within a month of discontinuing.

We do not recommend tapering two drugs at once. If you run into problems, you won't know which is causing them. This can become a mess to untangle.  Okay, thanks for the advice.  That's going to make for a long taper period!

 

If you're feeling sluggish, reducing buproprion, which generally is stimulating, will make that worse. You're also taking two "brakes," risperdone and lamotrigine.  Yes I do feel sluggish, I don't fancy feeling more so!  Because I get psychotic when I am manic I believe I need to be on the brakes while I'm still on the anti-depressants as the AD's can trigger mania.  Do you have a view on that?

 

Please put ALL the drugs you take in the Drug Interactions Checker http://www.drugs.com...eractions.html and copy and paste the results in this topic.  See below.  Looks like i'm lucky not to have seizures.

 

You probably will not be able to make a liquid of the slow-release buproprion, it has binders in it that might make it gluey. You might experiment with one tablet and see. It will keep as long as a liquid made with the immediate-release type.

Do you know how long the IR liquid will keep its potency for?

Thanks very much.

 

Thanks for the suggestion to go to the drug interaction site.  This is what it said:

 

Interactions between your selected drugs

Major bupropion  risperidone

Applies to: Zyban (bupropion), risperidone

Talk to your doctor before using buPROPion together with risperiDONE. Combining these medications may increase the risk of seizures, which may occur rarely with either medication. In addition, buPROPion can increase the blood levels of risperiDONE, which may increase other side effects. You may be more likely to experience seizures with these medications if you are elderly, undergoing alcohol or drug withdrawal, have a history of seizures, or have a condition affecting the central nervous system such as a brain tumor or head trauma. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. You should avoid or limit the use of alcohol during treatment. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Major bupropion  citalopram

Applies to: Zyban (bupropion), citalopram

Talk to your doctor before using buPROPion together with citalopram. Combining these medications may increase the risk of seizures, which may occur rarely with either medication. In addition, buPROPion can increase the blood levels of citalopram, which may increase other side effects. You may be more likely to experience seizures with these medications if you are elderly, undergoing alcohol or drug withdrawal, have a history of seizures, or have a condition affecting the central nervous system such as a brain tumor or head trauma. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. You should avoid or limit the use of alcohol during treatment. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Major risperidone  citalopram

Applies to: risperidone, citalopram

Using citalopram together with risperiDONE can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening, although it is a relatively rare side effect. You may be more susceptible if you have a heart condition called congenital long QT syndrome, other cardiac diseases, conduction abnormalities, or electrolyte disturbances (for example, magnesium or potassium loss due to severe or prolonged diarrhea or vomiting). Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or heart palpitations during treatment with these medications, whether together or alone. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate risperidone  lamotrigine

Applies to: risperidone, lamotrigine

Using risperiDONE together with lamoTRIgine can increase your blood levels of risperiDONE. This can cause side effects such as excessive drowsiness, dizziness, increase in heart rate, seizures, and tremors. Talk with your doctor before using these medications together, and report any side effects promptly. You may need a dose adjustment or special tests to safely take both medications. Avoid driving until you know how these medications will affect you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

[Altostrata]

There is a lot of controversy about whether antidepressants "trigger" mania or whether they might cause adverse effects in just about anyone.

 

Still, you are taking two "brakes." Doesn't that seem like a lot? Why two? And why at those dosages?

 

You can see for yourself that the combination of risperidone and lamotrigine might be responsible for your sluggishness.

 

Has your symptom pattern changed as you've reduced citalopram?

 

The Wellbutrin tapering topic contains information about the liquid.

[Fresh]

Hi GeminiTaurus , welcome to the site.

 

Could you give us your drug history by filling out you signature - this comes up each time you post.

  

Without knowing anything about your history , you might begin to consider that you don't , in fact , have

a bipolar disorder , and this diagnosis was based on the presentation of withdrawal symptoms.

Something to consider.  Many of us have started out being diagnosed as "depressed" , then got upgrades

to "bipolar" when the hypo-manic symptoms set in.

 

It would be great to know a little more about what led to you starting meds in the first instance , and

how things progressed from there.

 

Best wishes ,  Fresh

[JanCarol]

Hey GeminiTaurus - I'm one of those too (I'm a Taurus with like 6 planets and rising in Gemini!)!

 

AND I've been diagnosed as "bipolar," as well.

 

Please, here is how to do your signature:  How to complete your Signature or Complete your Signature from Phone or Tablet

 

Your response to Alto:

Yes I do feel sluggish, I don't fancy feeling more so!  Because I get psychotic when I am manic I believe I need to be on the brakes while I'm still on the anti-depressants as the AD's can trigger mania.  Do you have a view on that?

 

As someone who has deep terror of ever being caught in a mania again (my manias were not grand:  they were anxious, paranoid, horrible places) - I hear where you are coming from.

 

You're winding down the citalopram.  You've done it at a nice, steady 10%.  And it's been smooth.  Well done you!

 

That's going to make for a long taper period!

 

Throw away your calendar.  As you see from your interactions, you are on a complex cocktail.  

 

I hear you about the brakes, and leaving them on to prevent mania.  If you go slowly enough, you can do it.  I've been coming off lithium - famous for "breakthrough mania worse than prior to the drug" and so far, no manic!  But it's taken 2 years so far (just the lithium), and I'm not off it yet.  There is a chance I will stay on a tiny amount of it for years, just to ensure my stability.  That's my current plan.

 

Alto is right (she usually is) about the one-drug-at-a-time plan.  Please see:  Polydrugs? Taper off the Antidepressant First! to see what others say about coming off of complex cocktails.

 

I have a little experience in complex cocktails.  Without having your signature, your lamictal should cushion your tapers somewhat.  

 

After the Citalopram, hold for about 3 months.  Then consider tapering the resperidone.  If you start to "wind up" (it will help greatly to have the social support you speak of - a good friend to say, "hey, you know - you're wired!").  If it goes too far, and you have to reinstate some resperidone, you will have decreased your load. 

 

Hold again.  (Holds are important, they help your brain heal:  see:  Rhi's description of healing the brain)

 

Then try to decrease the buproprion.  

 

If you want, you can alternate tapers between these two.  Just not at the same time.  Make sure, when you have symptoms that you know what your symptoms are from - was it this one or that one?  Keep the variables simple:  3 KIS's Keep It Simple, Slow, Stable

 

Again, the lamotrigine could protect your tapers somewhat.  Leave it for last.  

 

After you've been doing this - slowly, carefully - after about 6 months you'll start to notice your faculties returning.  If you do it slowly, carefully, with good support - you may have withdrawal effects and symptoms - but you are in control of your taper.  If it gets to be too much, just hold.  (there's that "hold" again!)  Try to prevent it from getting to be too much, by going slowly and carefully.  Pay attention to your body, and your life circumstances (moving house or changing job is not a good time for tapering!), and you will come out of this.

 

You may still have symptoms of your original illness.  Personally, I'm a little too loud, a little too spastic, and sometimes I wonder if I offend the people around me.  It doesn't help that I'm in a foreign country (a Yank in Aussie land) and Aussies are too polite to tell me when I'm outta line.  Sometimes I take on too much, or get uptight or anxious - but after bringing my drugs wayyy down (I'm on a tiny crumb of lithium now) I'm more "me," and my little fits seem more like a "normal human" and less like a "maniac."  My husband tells me I'm more flexible, more accessible, and more available and open.  All the feedback from friends is fantastic.

 

So while the taper may take years - your recovery will be forever, anyway - and you'll start reaping the benefits long before you finish your taper.

 

Without knowing your signature / drug history, it is usually a good idea to take up Magnesium and Omega-3 fish oil.  Magnesium is depleted by these drugs, and fish oil helps smooth your nervous system.  But again - one variable at a time.  I'd start with the fish oil, and gradually build up to 3-5000 iu per day.   After you've been on that about a month, start adding in the Magnesium.  Read the link to see about types and also to read - people in withdrawal can react to the darndest things.

 

There are other vitamins and minerals that can be depleted by these drugs:  Vit D, B vitamins, Zinc come to mind.  BUT - be very careful with supplements, because they can be activating - and if manic is the thing you are concerned about, then "activating" is something you don't want.

 

Lastly, here are our resources for Non Drug Techniques for Coping with Emotional Symptoms  - you seem to already have some ideas, but it's a good place to look and see what resonates with you, what helps you, and prepare your self-support.

 

Welcome to SA!

[GeminiTaurus]

Thank you for your welcome Alto, Fresh and JanCarol.  I have now added my signature which should give more context and answers to some of the questions.

 

I haven't figured out how you do those nifty quote inserts - advice on how to do that?  In the meantime I will provide my responses below the question in red.

 

Alto said:Still, you are taking two "brakes." Doesn't that seem like a lot? Why two? And why at those dosages?

The risperidone was added when the lamotrigine wasn't strong enough to hold mania at bay.  Apparently lamotrigine is more effective as an anti-depressant than anti-mania.  I just didn't want to go on to lithium.  Actually, tried lithium but had a toxic reaction.  I'm not sure about why the lamotrigine dosage is as it is, that was what was prescribed.  The risperidone dosage has been lowered from about 6mg immediately post-mania.

 

Has your symptom pattern changed as you've reduced citalopram?

No.

 

Fresh said:  Without knowing anything about your history , you might begin to consider that you don't , in fact , have

a bipolar disorder , and this diagnosis was based on the presentation of withdrawal symptoms.

My first presentation was with a mania and I hadn't previously been on an anti-depressant so I don't think it was a withdrawal symptom.  I have heard that people get triggered into mania while on anti-depressants if they are actually bipolar.

 

JanCarol: Thanks for the link to the signature article.  Signature now completed.  Also, thanks for all your other words of wisdom.  It is great to know that you're successfully managing your bipolar symptoms while reducing your meds - and it is also good to be able to relate to your bipolarness.  I have been fortunate that my manias were grand events, yours sound horrid.  It's a bit of a curse though as I really enjoyed my manias - and the only reason I want to not have one again is that they are always followed by a depression (but that could be medication-related) and because I've read that they create a type of lesion in the brain and I need all the brain cells I've got!  As a matter of interest, did you have any sense of a reduction in intelligence after starting on meds?  I'm not sure if it's the bipolar or the meds that have done it for me.

After the Citalopram, hold for about 3 months.  Then consider tapering the resperidone. 

Good suggestion.  As a matter of interest, why would you taper the risperidone before tapering the zyban?

 

Thanks.

[JanCarol]

Hey GeminiTaurus!

 

How are you feeling?  

 

At the bottom of each post is a button that says "quote" (I don't know what it looks like on a phone) - but I just select the text I want to quote and press the "speech bubble" symbol on my reply box (where it says font and stuff, just below and to the right of the emoji button).  That's 2 different ways to quote.  The first one has less control than the second, but is easier to use.  If you do, please trim, edit out the stuff that you aren't answering to.  (geez, it's good I'm not in tech support - clear as mud, right?)

 

I have no idea what SA looks like from a phone, but one of our members (CymbaltaWithdrawal, tech wizard extraordinaire) made a nifty video to help:

https://www.youtube.com/watch?v=IVZNLZXpa9w

 

also, there's a short thread about reading from a phone:  http://survivingantidepressants.org/index.php?/topic/2285-reading-this-site-on-a-phone-youll-miss-a-lot/

 

 I have been fortunate that my manias were grand events, yours sound horrid.  It's a bit of a curse though as I really enjoyed my manias - and the only reason I want to not have one again is that they are always followed by a depression (but that could be medication-related) and because I've read that they create a type of lesion in the brain and I need all the brain cells I've got!  As a matter of interest, did you have any sense of a reduction in intelligence after starting on meds?  I'm not sure if it's the bipolar or the meds that have done it for me.

 

Yes, I've read about those people - the ones who enjoy their mania.  I imagine it's a creative, amazing time when the whole world is at your feet.  You're right - I've not had that one.

 

As far as the "lesions" and "brain damage" from bipolar - I don't buy it.  Researchers and doctors get so excited when they find the bio-medical cause for something - but - finding a never-medicated bipolar brain would be rare.  I believe, yes, that extreme states of emotion and mind can change the brain, and there may be some losses in there.  But I don't believe that's limited to "bipolar."

 

I have an ex-boyfriend who went into psychology.  30 years later, we met again on Facebook and exchanged photos.  He said:  you went on the drugs, didn't you?  I asked why he thought that.  He said, "It's something about the eyes.  I can always tell when someone went on the drugs."  What I'd love to do is exchange photos in another 20 years, to see if that quality is still there.

 

Yes, I've lost intelligence points, but I've gained emotional intelligence.  As for the intelligence points I lost - was it the trauma? recreational drugs? more trauma? pain? the mania?  anxiety?  months and months of depressions? psych drugs? more trauma? complete discombobulation at the hands of a narcissist? total loss of my faith?  the years and years of depressions?  There's no way to parse it out and say that I lost my complex maths with the recreational drugs, but didn't lose the linguistic flexibility until the psych drugs, and lost the verbal and social intelligence until the mania.....no.  I'm a package, and I've got what I've got.

 

What's more important is how to deal with it from here on out.  Have you "met" Will Hall?  He's got some great ideas about Mad Pride and what he calls "Mental Diversity."  (I would add Emotional Diversity to that, too)

 

Here's a sample:

 

And oh!  You know there is a tribe of Kiwis on here?  Meet them here:

http://survivingantidepressants.org/index.php?/topic/7803-new-zealand-members-please-check-in-here/