Cabinhope: Willing to begin

[JanCarol]

Hey g'day Hope!

 

Because of the rash, I dropped from 125 to 100 on Lamictal last Wednesday. 

 

 

1.  More than a 10% drop.  Please don't do this again!  And too soon, too!  I thought you said you were gonna hold it for awhile?

2.  This precedes any other tapers.  No more tapers for at least a month.  

3. Please put tapers and dates in your sig, so that a mod can understand what you are doing without reading paragraphs of history.

4.  Constantly changing your meds is a symptom of Neuro-emotion.  You have something uncomfortable, so you change your meds.  This can cascade into a nasty spiral.  Please stop doing it.

 

If you want to see how dangerous the lamictal is to taper too fast, read:   https://beyondmeds.com/2007/12/20/lamictal-withdrawal-from-hell/   (yes, that's our SA: GiaK - encouraging that she is so well now - but please pay attention to the danger, too!)

 

Maybe you will be fine, most people are - but do you want to take the chance that severe autonomic dysregulation and complete dysfunction happens to you?  I didn't think so.  It's just too risky, please play it safe. 

 

 

I've just been reading about Rhiannon....tapered multiple drugs incrementally, simultaneously.

Thoughts? 

I just spoke with my compounding pharmacy. He believes he can help me with the Pristiq taper. So I guess I'll begin that in a few weeks. Anybody else want to weigh in on this at all??????? 

 

That is good news about the compounding pharmacy. 

 

Do not start a taper before 1 month from your Lamictal drop.  (again, updated signature = critical!)

 

Rhiannon is extraordinary.  Are you prepared to fight every day for your doses?  Are you prepared to weigh, measure and taper 5 different drugs (some liquid, some powder?)?  She had to do it that way, because of the way the drugs were intertwined in her system.  You may do this someday - but for now - start simple, and see if you can get off a more simple way.

 

For you I would recommend getting the Pristiq down.  Then, as you come off the Paxil, you may need to adjust other drugs.  But alternate.  Do 3 tapers of one drug, rest an extra month, and try a few tapers of another.  Rhi's method is very exacting and challenging - I only recommend it for the most dedicated sufferers.  BUT ALL OF THIS is LATER!  Much later!  Please consider the Pristiq first, and leave all the complicated stuff for later!

 

I was doing some drugs (ecstasy, mushrooms, lsd) and drinking a great deal and just generally not taking care of my 24 year old self in any sort of adult way. I remember a doctor tried Serzone, then Prozac.

 

Yeh, I was lucky - I learned early on (at a similar age to you) that drugs and drugs don't mix.  I believe that the psychedelics sensitized me and made me more susceptible to depression and eventually a few full-blown manias.  Then, the psych drugs - well - drove it home.

 

It's good that you're seeing the history - that your eyes are opening.  Doidge and Whitaker are a great start.  Take your hold time to educate yourself - it will help sooooooo much.

 

But please mind your tapers carefully, and keep us appraised in signature.  All the good information in the world cannot protect you from withdrawal symptoms if you choose to careen down the cliff against wiser advice.

[Cabinhope]

I'll put it in my signature. I only made that one change, I haven't changed anything else. And I do plan to wait at least a month before starting Pristiq. Promise. The ONLY reason I eliminated 25 instead of 12.5 Lamictal was because I was worried about the rash.

 

Believe me, I am not anticipating any sort of hasty process. At all. One thing at a time. I'm willing to dedicate years to this...I am not being cavalier in the least. What I went through was so traumatizing, it's a miracle I am even finding the willingness to consider this process. Steady as she goes.....

[Altostrata]

....

 

Sparing all the details, I landed on the following drugs:

Remeron 15mg

Paxil 20mg

Lamictal 125mg

Pristiq 100mg

Lithium 600mg

Klonopin .5mg

Trazodone 50mg

 

....

 

You must be a fast metabolizer via liver enzymes to be able to function under all of those drugs. This is the danger with fast metabolizers: They get overloaded with drugs.

 

Sorry if I missed this info: Which drug was added last, and what for?

 

We look at these drugs as "brakes" and "accelerators." Lamictal, Lithium, and Klonopin are brakes. Remeron and trazodone, often prescribed for sleep, are sort-of brakes. Paxil can be a brake or accelerator. Pristiq is an accelerator.

 

Generally, we suggest tapering the accelerators and then the brakes, because the brakes can reduce some of the more trying withdrawal symptoms, such as sleeplessness.

 

Lamictal is a pretty good brake and probably did NOT cause your rash, as you were taking it for a long time at a stable dose and did not have a rash from it earlier. My guess is your rash was caused by interaction of your drugs plus some other ingredient added recently, or maybe the tick bite.

 

What leaps out at me is the trazodone. Trazodone is a big troublemaker, it has horrible interactions hours later with the other drugs you take during the day. See Tips for tapering off trazodone (Desyrel)

 

Was the trazodone added for sleep?

 

If I were you, I'd tackle the trazodone first, this will help reduce the load on your liver, rather than Pristiq, which will be more difficult. You can get practice with tapering the trazodone first.

 

Lamotrigine is not metabolized in the liver in a way that would interact with the other drugs.

 

What times of day do you take each of your drugs? Why do you drink so much coffee, do you feel dopey without it?

[Cabinhope]

The Trazodone was added for sleep 4 years ago in the spring after Lexapro was added TO Paxil while Paxil was tapered to zero over 2 months. I came OFF the Lexapro, highest possible dose, after being on it for 4 months. This is what wrecked me. So, yes, Trazodone was added for sleep as I was waking verrrrry early with panic. Prior to that I had never had any issues with sleep.

 

In descending order from most recent to older are:

Lithium

Lamictal/Pristiq (concurrently)

Klonopin

Remeron

Trazodone

Paxil

 

All of that happened, minus the Paxil, within a 6 month period of time. This doesn't include all the quick drops of various things. Nightmare.

[Cabinhope]

And..

I take the Pristiq in the morning along with my 2 thyroid meds.

I take the Paxil at 5pm.

I take the Klonopin, Trazodone, Remeron, Lamictal and Lithium right before bed.

The Lithium was added at the very end because I was just so activated and hyper strung out and crying constantly after adding in all the new stuff. I was a mess. The Lithium stopped the tears and allowed me to scrape myself together.

I drink coffee in the morning to get going. I'm totally doped up if I don't. And even then I am in a fog quite a lot of the time.

 

Thank you for your input, sincerely, it means a great deal to me.

I'll redirect my focus to the Trazodone. This is such a huge step for me. This idea seems far less daunting.

Hope

[Cabinhope]

One more thing...the Remeron was added just before the Lamictal/Pristiq partly in an attempt to help me put on weight as I lost 20 lbs during and after the Paxil/Lexapro fiasco. It was very activating and agitating. Just like all AD's have always been for me at first.

[JanCarol]

Hey Hope - 

 

Alto has spoken - she is the wisest of us.  I'm glad I asked her!  I should have asked her sooner, and am sorry - I apologize to you for any conflicting information I may have given.

 

I bow out of my Pristiq suggestion (though you've done some research, maybe it will go next!) and go with her greater wisdom that the Trazadone has lots of nasty little fingers everywhere, and we need to gently, gently remove the trazadone next.

 

Clear as mud?  I'm sorry for the confusion, my suggestions are fine, but Alto's are better!

 

* * * * *

 

I did think of you as today I had coffee (I often have tea)

 

There is a thing called "bulletproof coffee."  The idea is great, but I don't recommend drinking a full pot of bulletproof.  I reckon you are drinking it to keep from being over sedated.  Or because you like it, and have always started the day with coffee.  (ahhh, the Goddess Caffeina!)

 

Bulletproof coffee calls for 1-2 Tablespoons of grass fed butter and MCT oil per cup of coffee, blended in a blender.  The benefits are : 1.  it's ketogenic, and it "slows down" the caffeine, and 2. instead of getting sharp spikes in caffeine, you get a gentle curve of stimulation and withdrawal.

 

BUT - I've studied a bit of nutrition, and I reckon the 4T's of fat per cup of coffee is wayyy too much!  Especially if you are drinking a whole pot!  Plus MCT oil is only part of the benefits of coconut oil - and I prefer to get 100% of the benefits of coconut oil.

 

So I make a modified bulletproof coffee (and I don't use the blender, because I'm lazy and don't want to clean the blender every day).

 

So I make a cuppa coffee, and melt 1 teaspoon of grass fed butter* and 1 teaspoon of coconut oil.  You could even do less - just a little fat to slow down the caffeine.  I add coconut milk to taste (I cannot have milk anymore, but grass fed butter seems to be okay)

 

This will slow down your coffee, and maybe provide you with a mood stabilizing benefit - and maybe, just maybe - you can painlessly decrease your coffee intake!  That's how it worked for me, I went to having 3 cups per day, to maybe 1 cup per day (today is a lucky day!)

 

*Kerrygold, or even Aldi Organic butter is fine.  Here is an article which doesn't mention the Aldi Organic:  http://www.foodrenegade.com/where-find-butter-from-grassfed-cows/

 

I hope you see the sun today!

[Cabinhope]

Ok, then. Trazodone it is. Question...invest in a scale or let the compound man work his wonders? I have not inquired about cost for compounding, but am willing to bear the cost. I could easily achieve a clean 25 by cutting...but getting up to 45 for that first taper and subsequent tapers....I've read the thread. Scales pretty accurate? Where to find the correct one?

 

As for coffee, until my 20's I coudln't even touch caffeine. My body just naturally couldn't handle it, too activating. And during long periods of non smoking I naturally consume far less as I tend to use them together. In anticipation of upcoming changes I think it might be wise to either stop smoking again or switch to decaf. Thoughts? And I do put coconut oil in my coffee, never knew about butter!

 

Heartfelt thanks. Truly. I have a psychiatrist on my hands who believes I stopped the Lamictal cold turkey. I'm worried about 2 things. 1) When he finds out I have not he might drop me for non-compliance.

2) I worry that he might say, 'I do not endorse you getting off of any drugs.' I'm an independent thinker, but I just don't want to hear any negativity about this process nor discouragement. It will plant doubt. And I don't need that. He came into the picture well after everything had been added, changed, dropped. He doesn't know the hell. So, yeah, this guy.

 

Best case would be to have my functional med doc take over at this point. Her main focus is tick borne illness, but I guess she can do this.

[Fresh]

Compounding is a bit confusing working out what to order , and you need several quotes because some places

charge astronomical amounts.

 

The easiest way to get started is with a digital jewellers' scale from ebay , that weighs to 0.000.

They cost around $30. That will be fine while you work out if compounding is necessary longer term.

[Cabinhope]

http://www.ebay.com/itm/Etekcity-500G-Digital-Pocket-Kitchen-Scale-Stainless-Steel-Backlit-Display-0-00-/172105238319?hash=item281245872f:g:tiAAAOSwuAVWxKpm

 

So, this...

[Altostrata]

You can make a liquid yourself, or you can have trazodone compounded into a liquid. That would be a lot easier than weighing fragments. Make the transition with part tablet and part liquid for your dose.

 

Please read Tips for tapering off trazodone (Desyrel)

[Cabinhope]

I see my psychiatrist this morning to inform him of my decision to begin to peel away these medications. I'm 2 weeks into a drop in Lamictal, intending to hold there and redirect my focus to Trazodone. The transformation in my beliefs about these drugs over the past two weeks is nothing short of a miracle....along with my change in thinking about what has happened to me.

 

I worry, just a bit, about his reaction. But I realize it is MY choice. And while I have some fear, I feel under-girded by this new found sense of taking steps toward liberation.

 

I have been researching, doing a lot of Internet reading. I'm discouraged by stories I read about people who have had to quit work, who lose their homes, etc. I'm seeking reassurance that this is not a foregone conclusion, an eventuality. If I move cautiously and slowly enough does this absolutely have to be a disabling process??? I've been through hell from coming off of things too quickly, medically advised, before and I do NOT intend to go through hell again. Caution and warnings aside, and understanding that things could be uncomfortable sometimes, do I have to assume that this process will cause me to lose traction?

 

For all of the stories of success I can zero in on the stories of hell. I tend to read the one negative review on Amazon books first for example. Chime in you guys! Cheerleaders needed!

Hope

[AussieShell]

Hi Hope,

 

I understand your trepidation with telling your psychiatrist. It is possible he may be understanding or may not. Hopefully he is supportive but if he isn't, you just need to be assertive and pleasant enough to keep him writing whatever prescriptions you need to get through this. It is your body and your decision. Unfortunately they are not given the most helpful information on how to withdraw from these medications. So I would take anything he says that contradicts the very slow taper process with a grain of salt. The most unwell I have ever been was from too fast tapers and rapid med changes. Of course there are no guarantees that the process will be without incident for you - it is such as individual thing. Some people (like me) are very sensitive to any changes. I think anecdotally, the fact you are tolerating so many meds is possibly a good sign for you! But I would absolutely take all the good advice the very experienced people here have given you regarding tapering. Being on so many meds is complicated, there is no way to completely predict what is impacting what and how. But was is the alternative? Continuing on the meds indefinitely? I think you have made a great and brave choice to try to rid yourself of them considering what you have endured. You can do this Hope - I believe in you. Good luck at your appointment.

[AliG]

Hope. You can do this. Stay strong and tell your Doctor what you want to do , with your tapering. If you don't feel comfortable with that , then just get the script, and tell him whatever ...   I think there are members here,  whose doctors think they are on full dose. It's that old saying of , " what they don't know  won't hurt them ".

 

What should I expect from my doctor about withdrawal symptoms?

 

How do you talk to a doctor about tapering and withdrawal?

 

This does not have to be a disabling process, at all .

 

Ali

[Cabinhope]

That meeting could not have gone better. He was totally supportive and even discussed down-regulation and why it's so difficult to get away from many of these drugs. He agreed with Trazodone first. He did not place any doubt in my mind or try to dissuade me in any way. Really grateful for this new beginning.

[Cabinhope]

Ok, so this week marks one month since shaving off some Lamictal. Per Alto's suggestion I am going to switch over to Trazodone and begin that titration. I feel good and strong and optimistic.

 

Thoughts....I am reading Anatomy of an Epidemic and wow is it compelling, mind changing, game changing, exposing, etc. Very well done and well researched. It's amazing the sham. Causes me to rethink everything I've been through, seeing with new lenses. I am still in the section covering dopamine receptors as they relate to schizophrenia and how the neuroleptics, according to studies, caused things to be so much worse. The author presents evidence that would suggest that the dopamine receptors can be permanently altered because of the upset caused by antipsychotics. Permanently altered. Sigh. I have not gotten to the 'antidepressant' section of the book, but I'm afraid I'll find the same news....that because of length of use my receptors have permanently down regulated.

 

Thoughts on this? Anyway, I step down Trazodone Wednesday night. Here we go!

[AliG]

Hope.  The fact that you are feeling optimistic and strong , in the lead up to your taper should make all the difference for you . A positive attitude is so important to this process.

The book is illuminating and it's great that you are reading it. Knowledge is power.  Try not to worry too much about possible long term outcomes. Everyone is different, in their recovery  and it's nice if you can keep that positivity flowing. This factor alone can have a bearing on how you heal. The mind is very powerful in this sense.

I hope it goes well .

Ali

[Cabinhope]

So I'm about 6 weeks into my Trazodone taper.

I went from 50 to 37.5 for three weeks. I am on my third week of 25.

The results have been thus....about a week to 1.5 weeks into a drop I have anger and edginess. It ultimately smooths out.

Otherwise, eating and sleeping well.

I have had a very short cycle with marked increase in premensteual emotionality and crying.

Creativity and productivity very good, better than in a long time.

Next week I will asses whether to continue to hold at 25 or move forward.

Thanks for feedback.

Hope

[Cabinhope]

Lots of crying last night and negative thinking. Not sure if it's hormones or the Trazodone drop 2 weeks ago from 37.5 to 25.

My friend, and longtime partner, Grizzly joined last week and people have been so attentive to him. Thanks for that.

I wonder if new people's processes hold more merit and get more attention?

I need input, too.

Thanks.

[AliG]

I'm not sure if that's fair , Hope. Looking back you have always received responses within a few days. You haven't posted for a while. We try to do the best that we can. You have to remember we are all volunteers who are also going through withdrawal ourselves.

 

Is there a reason for the huge drop ?  That's not recommended. A 10 % drop would be 33.75 I think . For sure, hormones could be involved as well which can complicate things further. I have that issue and it's not an easy puzzle to solve . 

I'm pleased that your friend has had some help .  Sometimes new people in distress can occupy some time, but that's ok .

Ali

[Cabinhope]

You're right. I apologize. Just been a hard string of days.

The reason I dropped from 37.5 to 25 is because that first drop seemed to go without incident really. And in the back of my mind I've thought of Trazodone as so benign. I guess it's not. Should I go back to 37.5? And do the liquid taper from there?

And the hormones. Ugh. What have you done to address hormone fluctuations, pms, etc?

Again, I'm sorry. I am deeply grateful for the help and input I've gotten so far. I can post more often, just hadn't wanted to clog the lines with unnecessary musings.

So, yes, this is hard. I'm not used to the crying.

[Cabinhope]

Ummmm, anyone?

[scallywag]

The reason I dropped from 37.5 to 25 is because that first drop seemed to go without incident really. And in the back of my mind I've thought of Trazodone as so benign. I guess it's not.

 

Should I go back to 37.5? And do the liquid taper from there?

 

And the hormones. Ugh. What have you done to address hormone fluctuations, pms, etc?

 

... So, yes, this is hard. I'm not used to the crying.

 

Judging from your posts, I'm guessing that monthly cycles haven't affected you this way before.  Is this correct?  When I started tapering earlier this year, I experienced some changes in my cycle. Could be dose changes, could be menopause or perimenopause; I don't know. You may find helpful information and ideas about PMS and hormone fluctuations in PMS and menstrual cycle issues with withdrawal.

 

Summarizing in bullet points your taper, from previous posts:

- mid-April, you cut Lamictal from 125 to 100 mg (20%) because of a rash

- around May 4 you cut Trazodone from 50 mg to 37.5mg (25%)

- around May 25 you cut Trazodone from 37.5 to 25 mg (33%)

- you're now coming toward the end of your 3rd week at 25

 

Symptoms and well-being:

-  7-10 days after a cut you experience anger and edginess that smooths out

- eating and sleeping well

- increased creativity and productivity

- changes in your menstrual cycle

- symptoms: crying and negative thinking

 

It may well be that 2 aggressive cuts within 6 weeks is more than your CNS can handle. You effectively cut 50% of original dose in 3 weeks: Day 1--50 mg to 37.5; Day 21--37.5 mg to 25.

 

I think you've made a lot of changes with your doses and it may have been a medium-core boot camp for your CNS. There's no war on, consider giving your hard-working lean mean CNS machine some R&R.

 

My best guess is that the lowest risk is to stay where you are until the crying and negative thinking diminish. I'll ask other moderators to weigh in.  Make notes of your symptoms and when they occur. Enjoy the improvements you're seeing and hold tight for more info.

[Cabinhope]

Thank you so much. You summarized perfectly.

I intend to stay put. This cycle just really has knocked me down way more than usual. Saturday was the last day of the last cycle. I was stressed beyond measure, edgy, sinking, wanting to withdraw. Sunday, first day of new cycle...out of sorts, long crying jags, atypical. Today, migraine, out of it and down but not despairing and crying like yesterday.

I'll read the hormone link. Thank you for that.

And thank you for taking the time to reply.

[scallywag]

Glad to hear that you'll hold steady for a while. And that's good news about your sadness and despair easing. Keep hanging on!

[Cabinhope]

Mercy! This is definitely CNS stuff. This morning high, high adrenaline. I feel like I've had 3 pots of coffee. It's intense.

I dropped from 37.5 to 25 Trazodone on June 30. Damn.

Is it too late to go back to 37.5 and hold? Then go more slowly as you all have stridently suggested.....

Stupid me.

Someone please tell me it's not to late to get out of the woods.

I'm so unclear about how to do the liquid. I've read through the thread. I'll read it again.

Ugh. Cortisol high I can feel it. High, high alert.

[scallywag]

Cabinhope, you haven't discontinued Traz, so reinstating to a higher dose shouldn't be a problem.

 

Rather than making another big change to 37.5, what do you think about a gentler step of 25% (~28 mg) or 50% (~31 mg) of the difference between 25 & 37.5? If the symptoms improve, you'd have good evidence that your symptoms are from Traz w/d and could fine tune from there. Please read the reinstatement thread:
About reinstating and stabilizing to reduce withdrawal symptoms

[Cabinhope]

OK, I am happy to do as you suggest but I'm still confused about how to achieve these percentages. Do I need to visit my compounder or can I do this myself? I need someone to walk me through this as I'm having a hard time wrapping my brain around exactly what to do. I have read the thread. It seems I can liquefy the pills myself....but what then? I'm totally in the dark.

Help.

[scallywag]

What form of Traz do you have on hand and what are the doses?

 

Just a reminder about 2 threads that will be helpful for you:

Tips for tapering off trazodone (Desyrel)

Making a liquid from a tablet or capsules

[Cabinhope]

I have 50 mg tablets, scored in the middle.

I have read the Trazodone taper thread but not the liquid suspension thread.

[Cabinhope]

So, go back to 3/4 of a 50mg tablet or cut that quarter in half? I am dry cutting.

Trust me, I intend to go so much slower. Can't believe I thought it was ok to do as I've done. Maybe that's why others aren't commenting as well.

The liquid suspension thing seems so obtuse for some reason. I really need to study it. For now, can I just get a digital scale off eBay?

Today was the first day I've had this high alert thing happening. Yes, the pms and start of new cycle were profoundly harder this month, but today I was just soooo jacked up, very intense.

Anyway, I guess I'll take a 25mg half and split a quarter to get to the neighborhood of 37.5. Tonight. And for awhile.

[scallywag]

If you've decided on 37.5 mg, then 3/4 of a 50 mg tablet will do the job! Get settled on that for several weeks.  While you're getting stable, start to figure out the liquid. 

 

Quick & dirty version: Put the tab in a container that has markings for 50 ml.  Put in water to reach the 50 ml mark.  Let the tablet dissolve, cover the container and shake if necessary.  You then have a liquid that is 1 mg per ml.  To take your dose you use an oral syringe with markings that allow you to measure 1 ml of liquid. You may be able to eyeball 0.5 ml "in between" measurements.  As your dose decreases, you use a higher volume of water, say 100 ml to get a solution that is 0.5 mg per ml.

[Cabinhope]

Woops, meant to type 31.25. That would be half of a 50mg tablet (25mg that I've been taking for the past 2 weeks) plus half of a quarter tablet (1/2 of a quarter portion or 6.25). So I'd be adding back in that 6.25mg, not 12.5. My error.

You had originally suggested this.

Sound good? And yes, stay put for awhile. And decide whether to do scale or liquid. I've read about both. Do you have a preference?

Thanks again.

[Cabinhope]

And if I do liquid, where does one find the sort of container with 50ml markings? I guess the syringe comes from a regular drug store?

[JanCarol]

Hey Hope - 

sorry I missed your precipitous drop!

I've made a ton of notes, which I will get to later tonight.

 

It's awesome that you've reached a place of understanding why we hold so long.  It may feel like "the hard way," but believe me, Pristiq or Paxil wouldn't be very forgiving of a 50% drop in such a short period of time!

 

I have hope that you will stabilise in a month to six weeks.

 

I see you are learning about liquids.

 

I found it hard to wrap my head around, too - but when I started moving from dry cutting (1/4s and 1/2s of tablets, I had 2 diff size tablets) to weighing, I thought to myself that the liquid taper people had it much better!

 

Anyhow, just a quick note to let you know I'm glad you survived.  I may say more about that later.

 

And a reminder:  when you move to liquid, even as part of your dose (let's say you take 1/2 tablet, and the rest of your dose as liquid) - be sure to try the liquid for a month before reducing your dose.  This gets you good at the liquid, and you will find out how sensitive you will be to changes.

 

Thanks Scallywag for looking in when I must have been looking at my feet or something!

 

So on a good night, you might get an overwhelmingly long post from me because I never know when I'll be back.  Hopefully, it gives you some food for thought when you want to go back and review.  Also, I'm not just writing to you (so please don't take it personally) but for the 90% of members on SA who never post a single word, they just follow from the wings and shadows, and hopefully learn from your experience and mine.

 

I hope you see the sun today, I'll talk to you again soon.

[AliG]

Hope . You can order a graduated cylinder from Amazon.  The syringe from the chemist .  Have a read through this link :  

 

http://survivingantidepressants.org/index.php?/topic/2693-how-to-make-a-liquid-from-tablets-or-capsules/

 

Ali