Christian: Reinstatement Question

[downtongirl]

Glad you are having some improvements.

[Christian]

 

 

The only positive is that I'm down to one Ambien pill a night. Any advice? If I can get this sleep thing at least to a point I can get 4-5 hours a night with least amount of drugs that probably would be best. Hopefully a 50 MG of Seroquel with nothing else can get me there until I get through these hard times.

You've managed to reduce your Ambien by 50% which is good, but that's a big dose drop. You might consider tapering the rest of the Ambien with smaller drops. The way I've done this in the past is, once I'm sleeping reasonably well, make a small dose cut (e.g. chip off about one-eighth of the pill), hold there for a few days until sleep stabilises on the new dose, then repeat. Very similar to our slow tapering method for SSRIs only I did it quicker as I hadn't been on the z-drug for long. (See my thread about it here: http://survivingantidepressants.org/index.php?/topic/7862-reasonable-use-of-z-drugs-for-sleep/).

 

Seroquel is a nasty drug, but if you are sleeping on it better than the Ambien, it might be a way for you to get off the Ambien, then you will need to taper off the Seroquel as you really don't want to be on that long-term.

 

Switching to another med is always a gamble. Some people manage to switch okay, for others it is a disaster as they end up in w/d and the new drug doesn't cover it. Paxil is chemically completely different to Lexapro, so it is impossible to predict how that switch might go. Celexa (citalopram) is very similar to Lexapro (escitalopram), but some people have found it less stimulating, and I've seen a couple of people do this switch okay, so that may be a reasonable option for you if you feel like you need to switch. There's no guarantee, but at least with them being almost the same, it's kind of a lower risk switch.

 

You need to make your changes just one at a time. I'd probably do the Ambien taper first, while holding the Lexapro and Seroquel where they are currently. The reason for this is that the Ambien could be giving you rebound anxiety. For the same reason avoid taking benzos.

[Christian]

I was given Seroquel in an attempt to get me to sleep through the night. It has worked better than Ambien in that regard. Ambien does the trick if you want to fall asleep right away. I don't want to be on either of these. Is there a better alternative of the sleep meds? Lunesta ? Trazodone? I know not benzo's. I know meds aren't recommended here but I only have been taking Seroquel 3-4 days so can still quit no problem.

[Christian]

I read Silenor and Ramelteon are both not addictive. Seroquel puts people to sleep but it causes symptoms plus the WD factor. I'm considering calling another psychiatrist and throwing this Seroquel away as soon as I get a better alternative.

[AliG]

No . We don't recommend drugs , at all . It's sometimes necessary to go through a period of insomnia , rather than keep relying on drugs. They don't give you deep R.E.M. sleep anyway. It's just drugged sleep . Check out :

http://survivingantidepressants.org/index.php?/topic/555-tips-to-help-sleep-so-many-of-us-have-withdrawal-insomnia/

There are many non- drug ways of dealing with insomnia. It's just a matter of figuring out what works for you. It may take some time , but you will get there in the end . It might take some time, though . It's not easy.

Ali

[downtongirl]

AIG....at what point do you say the insomnia has gotten to a point to where it is unhealthy?  The reason I ask is if someone has gone several days or longer with out any sleep and they have tried non prescription methods but it is not working then what do they do?  The body can go on little sleep for a while but what about if you aren't getting any sleep?  

[Altostrata]

Christian, this is a site for going off psychiatric drugs. We are not in a position to recommend any drugs to solve your sleep problem which, by the way, seems to be due to drug use and overuse.

 

downton, sleep problems are extremely common in withdrawal syndrome. We have many, many people who have gone through long, rocky periods with little sleep. As with other withdrawal symptoms, this gradually improves as the nervous system heals.

 

I'm going to have to ask you both to stop seeking drug solutions for your problems on this site. It's not what this site is for, a lot of people here have been injured by drugs, and we do not recommend them except for the purpose of bridging to go off. If you want a solution in a pill, you'll have to go elsewhere.

 

ALL psychiatric drugs incur physiological dependency over time, they ALL can be difficult to go off. There is no free lunch.

[Christian]

Completely understood Alto and it won't happen again!

[downtongirl]

Gotcha Alto!  I guess I am just trying to determine when is the line in the sand drawn for me....when do I stop trying to drive or go to school, etc.  I know that is a personal decision I was just looking for what other people felt were there limitations.  With regards to your comment about all psychiatric drugs insure physiological dependency over time do you feel this holds true for some of the amino acids or supplements that affect gaba or serotonin for example?  Do you feel there is evidence to say that any of these could incur dependence and withdrawal with them?

[Altostrata]

People have had trouble with the serotonergic amino acids, such as SAM-e and 5-HTP, both with side effects and withdrawal.

 

Please see our Symptoms and Self-care forum  http://survivingantidepressants.org/index.php?/forum/8-symptoms-and-self-care/for information about specific supplements.
 

[SquirrellyGirl]

Gotcha Alto!  I guess I am just trying to determine when is the line in the sand drawn for me....when do I stop trying to drive or go to school, etc.  I know that is a personal decision I was just looking for what other people felt were there limitations.  With regards to your comment about all psychiatric drugs insure physiological dependency over time do you feel this holds true for some of the amino acids or supplements that affect gaba or serotonin for example?  Do you feel there is evidence to say that any of these could incur dependence and withdrawal with them?

Alto answered this, but I've thought a lot about it and being that my background/education is in biologoy, I have a lot of curiosity about this stuff.  I'm reading Robert Whitaker's Anatomy of an Epidemic, and he lays out the history of these drugs.  Along with that he documents the treasure hunt that researchers conducted to find the disease process for depression and schizophrenia, the hypotheses being that low serotonin causes depression and high dopamine causes schizophrenia.  They never could prove these imbalances!

 

You may have heard that 1/3 of people with depression have low serotonin.  What was fascinating to me to learn is that when they came up with these figures, 1/3 of the control groups (normal people) ALSO had low serotonin! Likewise, about 1/3 of normal people and 1/3 of depressed people had HIGH serotonin!  The same types of numbers came out for dopamine when comparing normal and schizophrenic patients!

 

So, you can't even say that low serotonin caused the depression in those patients!  So, where does that leave us with serotonergic supplements?  We're still chasing the imbalance theory with those, and it is a myth!

 

Whitaker also discusses how research learned what happens to our nervous system with these drugs.  With SSRIs, the blocking of serotonin receptors causes an increase of serotonin in the gap between neurons.  The idea being that increased levels make us happy.  Since the body likes homeostasis, likes the way things were set up before the drugs, it pushes back in two ways:  

 

1)  post-synaptic receptor numbers are increased in an effort to mop up that extra serotonin

2)  pre-synaptic production of serotonin decreases since there is already too much of it around

 

I think there may be another part I'm forgetting, perhaps an increase in enzymes that degrade and dispose of some of the serotonin.  Normally it gets recycled through re-uptake.

 

So, if you pump extra serotonin into the system via these supplements, has it been proven that this leads to an increase in the neuron gap?  And if so, that would cause  1 and 2 to occur, and that means dependency when the supplements are taken regularly and withdrawal when they are discontinued.

 

I probably got a lot of things wrong here but I am looking to get better educated on this stuff since I find it all very interesting.

 

BTW, I took tryptophan or 5-htp and Sam-E while in protracted withdrawal from Effexor, and none of it did any good to stop the tide.  Years before tryptophan was pulled off the market, I took it at bedtime to help with sleep, which it did, but I think increased serotonin can make us sleepy, plus tryptophan is a precursor of melatonin.  Of course, you never want to take any of these when on ADs.

 

I also think Sam-E contributed to some of the anxiety I was having in WD!

 

Christian, sorry to hijack your thread!  I hope you are having a good day!

 

SG

[Christian]

No problem, Squirrly Girl. My thread is for everyone to enjoy!

[Altostrata]

It's always a good day when SquirrellyGirl stops by.

[Christian]

No . We don't recommend drugs , at all . It's sometimes necessary to go through a period of insomnia , rather than keep relying on drugs. They don't give you deep R.E.M. sleep anyway. It's just drugged sleep . Check out :

http://survivingantidepressants.org/index.php?/topic/555-tips-to-help-sleep-so-many-of-us-have-withdrawal-insomnia/

There are many non- drug ways of dealing with insomnia. It's just a matter of figuring out what works for you. It may take some time , but you will get there in the end . It might take some time, though . It's not easy.

Ali

[Christian]

Ali,

Thank you for aking how I am BTW. I hope you are doing well as well!

[ladybug99]

Hi Christian. Did you send me a PM? I'm having trouble downloading it. I tried sending a a PM on return, but having trouble with that as well. Ugh!

[SquirrellyGirl]

It's always a good day when SquirrellyGirl stops by.

That's so sweet!  Gave me a Joy Point for the evening!

 

I hope everyone had a nice weekend!

SG

[Christian]

Yes I did.

[SquirrellyGirl]

No problem, Squirrly Girl. My thread is for everyone to enjoy!

Don't worry, your humor was not lost on me LOL!

 

SG

[ladybug99]

Christian, please try sending a PM again. I'm hoping it will go through.

[Christian]

I just did

[Songbird]

I read Silenor and Ramelteon are both not addictive. Seroquel puts people to sleep but it causes symptoms plus the WD factor. I'm considering calling another psychiatrist and throwing this Seroquel away as soon as I get a better alternative.

 

I would like to correct this. Silenor(doxepin) is a tricyclic anti-depressant.  Rozerem (ramelteon) messes with the melatonin system.  I've seen people (on another forum) have trouble withdrawing from both of these meds.  People are always looking for a "better alternative" in the pharmaceutical realm, but so far there is no magic pill that works perfectly with no side effects or withdrawal problems.

 

There are some better alternatives (actually not alternatives because you can add them in to your existing regime) that you can add in to help your sleep, such as relaxation exercises and sleep CDs.  I wasn't a believer in relaxation exercises until I crashed and they (plus a sleep CD) helped me to finally sleep when I hadn't for a week.  The more you do them, the more the relaxation response kicks in, so even if they don't appear to do much initially, over a week of two or daily exercises, the benefits accumulate.  The sleep CD works like this as well, as your brain becomes more and more used to hearing it and falling asleep, so it kind of trains your brain.

[Christian]

Hello friends,

I would like to update my current situation based on some symptom changes in the last few days. I have been back on 5 MG of Lexapro for 26 days. These symptoms are my current symptoms and drug patterns.  

 

Anxiety-constant (less intense) 
Social interaction fear-constant- (less intense) 
Headache-primarily in the evenings, especially around 7 PM on  
Internal restlessness-constant- not as intense
Obsession with my health-not as intense but still bad 
Dizziness-a little better

Head pressure- constant- I have felt this since I increased my Lexapro to 10MG on 12/1 during that one week attempt and quit abrubtly.    
GI Issues- a few hours a day, no biggie
Insomnia- constant, though Seroquel helps 
Poor Concentration- constant- can read but conversations and TV are challenging and uncomfortable- less intense but still bad-hard to work-very concerning
Tiredness/Fatigue- insomnia related I'm sure. 
No appetite-this has improved 

Sleep pattern- bedtime 10-10:30. Fall asleep at 11-1130 pm. Wake up at 2-230 am. Take a 1/2 Ambien (6MG) and fall asleep at 3:30am. Wake back up at 5-6 am.

 

Waking pattern-Once up at 6 AM very tired and the hangover feeling from the pills. This lasts until 11 AM-Noon.  

Meds 
Lexapro-5 MGS/ 2.5 MG AM and 2.5 MG at bedtime 
Ambien-6 MGS/dose when I wake up at 2:30 AM

Seroquel- 50MG at bedtime ( I cant sleep on 25 MG) 
Melatonin- 5 MGS bedtime dose 

Supplements-
Multi vitamin-morning
Magnesium- night 
Ashwaganda-night
Fish oil- breakfast and lunch

Seriphos- after dinner and bed time
Itosinol-15 g daily 

 

 

On a personal note my employer is wanting to promote me into another group. I am in sales and will be expected to travel much more. I know this is going to be a concern in my current state. I am praying I can just improve maybe just a little more (especially in the concentration dept). Working from home vs seeing clients in person is quite different. I am open to feedback. I hope others are doing well.     

[Petunia]

Hi Christian,

I merged the topic you started in tapering in with your intro thread here. It had been locked anyway, so you weren't going to get any more replies and I thought having all your information here in one place was best. Then I read through your entire thread and now I'm tired and somewhat confused

 

But I do have a few thoughts and some questions.

 

Did you ever have any problems with sleep prior to 2002 before you started taking Lexapro?

 

 

My Dr told me to quit Lexapro in June which I did cold turkey...... I had dizziness for a month but that's it. I tried it back up on my own in September but quit after a week cause of the symptoms.

 

If you only had dizziness for a month, but then felt fine (I assume) why did you start taking it again in September?

 

What were the symptoms that caused you to quit again after a week?

 

When you reinstated on 1/1/16 and were taking 5mg in the morning, you wrote that your sleep was horrible, which is understandable because you were in withdrawal and had only just reinstated, but I'm wondering if the pattern of horribleness changed when you started taking your dose or part dose at night?

 

After reading your thread, I'm getting a picture that suggests lexapro was always a little too activating for you, even though it may have helped in some ways, it may have been effecting the quality of your sleep for a long time, along with other side effects.

 

Unfortunately its all become very complicated now with all the stopping and starting and the addition of other drugs. Its impossible to know what symptoms are being caused by what. But its clear you had a delayed withdrawal reaction after stopping lexapro after being on it for 15 years. That's what happened to me I was on SSRIs for 13 years, tapered over 2 months and stopped. I had a few weeks of the expected withdrawal symptoms and then felt mostly ok for about 3 months, then I started experiencing a lot of new symptoms including sleep problems, anxiety and sensory issues... it was lexapro withdrawal stage 2.

 

Your update suggests you are stabilizing and starting to feel a little better and that's great, I think you are on the right track now with keeping everything the same, but I can't help but wonder if you were taking your full dose of lexapro in the morning, it might possibly reduce your routine middle of the night waking.

 

It seems like you routinely wake up 4 hours after you have taken your bedtime dose and this reminds me of my pattern when I first started taking SSRIs. I was told to take it at night. I would take it at bedtime, go to sleep, then wake up 4 hours later and lie awake for an hour with my mind racing. So I changed to taking it in the morning and it solved that problem.

 

I'm not suggesting that if you took your full dose in the morning it would fix your sleep completely, withdrawal messes up our sleep cycle regardless, but it might possibly reduce the tendency to wake up in the middle of the night. If you could stop waking up, you could avoid having to take that 2:30 dose of Ambien and you might not feel so drugged all morning.

 

I just had another thought. Some people with middle of the night waking take natural substances to help get back to sleep, these are less likely to cause daytime grogginess. Some things that work for some people are another dose of magnesium, taurine, inositol, glycine and Valerian. I'm thinking that even if you don't move your lexapro dose to the morning, you could try a supplement to get you back to sleep rather than the Ambien.

 

Melatonin, if it works is good for getting you to sleep, but it doesn't keep people asleep, perhaps another small dose of that at 2:30. But I've heard that some people feel groggy the next day if they take that too late, so maybe not that.

 

A few other thoughts...

 

The B group vitamins in multi-vitamins can be activating, they may be contributing to daytime anxiety and night time sleep problems, I'm in protracted withdrawal and find that some of the B vitamins in these mixed supplements increase my symptoms, a lot of people in withdrawal can't tolerate some of the B vitamins.

 

When do you take your 15g of inositol? I suggest you take it at night if you aren't already.... its a calming supplement and can cause drowsiness in some people.

 

And one last question, has anyone advised you to give up caffeine? If you are still drinking beverages which contain this, you may get a little more symptom relief if you give it up. But if you do, taper off over a few days because it has its own short but somewhat painful withdrawal syndrome, mainly headaches.

 

Hoping for more improvement for you so you can accept the promotion, keep up the good routine, you're doing well.

[Christian]

Petunia,

 

Thanks for the response. I appreciate it. I will address your points below.... 

 

Why I started back up in September and late November for failed one week reinstatement attempts?

I never thought of withdrawals. But I may have been in them as I was getting a little anxiety, along with dizziness (which I didnt know was WD). I quit the attempts due to it making me a little dizzy and lightheaded. Also, the anxiety increased while taking Lexapro which I heard these symptoms are standard start up effects.

 

When did my insomnia start?

 

My insomnia started after I was off Lexapro for 3 weeks after the one week failed reinstatement. So did the sever anxiety, fear and concentration issues. Headaches and dizziness were constant since I increased my dose to from 5 MG to 10 MG in early December for two days prior to quitting.  

 

Moving my current Lexapro reinstatement dose to the AM?

 

I started out with a morning dose but still wasn't sleeping.

 

Caffeine and Vitamin B?

 

I quit coffee and caffeine a month ago and Vitamin B complex a week ago. I take 500 MG of magnesium a day. I will take 10 MG of the 15 daily intake of itosinol in the evening, I will look into taurine, glycine and Valerian. 

 

I agree I am in state 2 WD which stinks. Did the anxiety and sleep ever improve for you Petunia? I actually slept most of last night with getting up a few times but falling back to sleep.  Yes it took 50 MG of Seroquel but no Ambien was needed. Lastly, How about cognitive issues? Did you struggle with that during WD?  

[Christian]

Petunia,

 

Thanks for the response. I appreciate it. I will address your points below.... 

 

Why I started back up in September and late November for failed one week reinstatement attempts?

I never thought of withdrawals. But I may have been in them as I was getting a little anxiety, along with dizziness (which I didnt know was WD). I quit the attempts due to it making me a little dizzy and lightheaded. Also, the anxiety increased while taking Lexapro which I heard these symptoms are standard start up effects.

 

When did my insomnia start?

 

My insomnia started after I was off Lexapro for 3 weeks after the one week failed reinstatement. So did the sever anxiety, fear and concentration issues. Headaches and dizziness were constant since I increased my dose to from 5 MG to 10 MG in early December for two days prior to quitting.  

 

Moving my current Lexapro reinstatement dose to the AM?

 

I started out with a morning dose but still wasn't sleeping.

 

Caffeine and Vitamin B?

 

I quit coffee and caffeine a month ago and Vitamin B complex a week ago. I take 500 MG of magnesium a day. I will take 10 MG of the 15 daily intake of itosinol in the evening, I will look into taurine, glycine and Valerian. 

 

I agree I am in state 2 WD which stinks. Did the anxiety and sleep ever improve for you Petunia? I actually slept most of last night with getting up a few times but falling back to sleep.  Yes it took 50 MG of Seroquel but no Ambien was needed. Lastly, How about cognitive issues? Did you struggle with that during WD?  

I would also like to add that I dont know if I am improving based on my reinstatement or am just coping with it better. .  

[Altostrata]

Christian, what is your pattern of daily drug intake and symptoms now?

[Christian]

Hi Alto. Im not sure if you saw it but I posted it last night including the times of drugs, doses and symptoms. It's more detailed than I have described in the past. Also last night I was able to get through the night (getting up frequently) without an Ambien.

[Altostrata]

I apologize, Christian, I see it now.

 

5mg melatonin is a large dose, it might be working against you, especially since you're taking so much Seroquel.

 

How often have you taken Ambien in the last week?

[Christian]

I have had no more than 1/2 an Ambien since last Thursday? Btw, I take a daily Multi vitamin that has magnesium in the AM plus a 300 mg magnesium pill before bed. I've seen people mention another form of magnesium but the name escapes me. Is the pill good enough to or do I need the other type of magnesium that might be a powder or liquid ?

[Altostrata]

Read http://survivingantidepressants.org/index.php?/topic/1300-magnesium-natures-calcium-channel-blocker/
 

[SquirrellyGirl]

I have had no more than 1/2 an Ambien since last Thursday? Btw, I take a daily Multi vitamin that has magnesium in the AM plus a 300 mg magnesium pill before bed. I've seen people mention another form of magnesium but the name escapes me. Is the pill good enough to or do I need the other type of magnesium that might be a powder or liquid ?

Which version of mag are you taking, Christian?

 

Each product provides a different amount of elemental magnesium depending on what it is bonded to.  I'm using the glycinate version, which has low Mg but is highly bioavailable.  I think 800 mg provides 100% of the RDA of Mg.  800 sound like a lot, but there's little Mg in it so it requires that much to reach the RDA.  I probably am taking 1000 mg split AM/PM.

 

The chelated versions are more bioavailable and less likely to cause laxative effects.  Alto gave you the thread on Mag.

 

I hope your day is better than yesterday 

 

SG

[Christian]

Thanks, Squirrely Girl. Last 3 days havent been as bad as prior weeks. The anxiety is at a slightly lower level. Today I feel a little more rested cause I slept 6-7 hours plus not as many sleeping pills. I hope it builds. I wish this cloud in my brain would go away so I can focus properly. I have work to do!    

[Christian]

 

I have had no more than 1/2 an Ambien since last Thursday? Btw, I take a daily Multi vitamin that has magnesium in the AM plus a 300 mg magnesium pill before bed. I've seen people mention another form of magnesium but the name escapes me. Is the pill good enough to or do I need the other type of magnesium that might be a powder or liquid ?

Which version of mag are you taking, Christian?

 

Each product provides a different amount of elemental magnesium depending on what it is bonded to.  I'm using the glycinate version, which has low Mg but is highly bioavailable.  I think 800 mg provides 100% of the RDA of Mg.  800 sound like a lot, but there's little Mg in it so it requires that much to reach the RDA.  I probably am taking 1000 mg split AM/PM.

 

The chelated versions are more bioavailable and less likely to cause laxative effects.  Alto gave you the thread on Mag.

 

I hope your day is better than yesterday 

 

SG

 

This is what I take. 

[Christian]

this is what I take...plus 225 MG in my multi vitamin

 

[Altostrata]

Please be consistent with your Ambien intake. At this point, taking it inconsistently could be adding to sleep problems.