Cabinhope: Willing to begin

[Cabinhope]

There must be some cosmic shuttle between LA and western Montana.  I love both.  And there's a $50 Allegiant flight between the two.

 

I've been back a lot.  I last lived there in '94 finishing up the very marketable degree of Liberal Studies with a minor in Native American studies.  I'm skipping this fall and last fall but have been for many consecutive falls prior.  Every time I'm in Missoula I feel at once solidly at home and in place.  There's something really healing and grounding about being in a place so wild that nature could take you out in a second.  And not being at the top of the food chain while in the wilderness, something about that puts my own petty worries to rest and quells tedious fears.  Pretty magic. You get this I'm sure.

 

Bozeman was a very much still a cow town in the early '90's and yes, is now a sea of yoga mats bouncing down Main St on the backs of perfectly outfitted newcomers.  Thankfully, Missoula is hemmed in on all sides by mountains making the sprawl impossible.  It will remain forever small and hippie and liberal in perpetuity (Arian Nations and related separatists aside).

 

So yes, a lot to consider.  I guess what is cool to me is how something as innocuous as a conversation with a stranger could adjust my perception fairly radically so that I now consider myself free to pursue a new path when just a few weeks ago I felt locked into a certain path here in Virginia.  

 

 

[Cabinhope]

OK, so it’s been awhile.  I am successfully whittling down the mirtazapine, 4mgs to go.

Because it is such a POWERFUL histamine blocker I have this mushroom cloud of histamine activity every time I drop 1/2 mg which is how I’m doing it.  So this has led me to read about histamines again as I have before.  It makes a lot of sense.

 

I was an irritable, sneezing, ill tempered little girl always itchy eyes and runny nose.  I had allergy shots then and again about 10 years ago.  I am learning that cortisol ramps up to counter histamine.  I am also now learning about the connection between estrogen and histamines, that each complements and boosts the other....and I’m 46 now.  Every ovulation and every cycle the estrogen bump kicks off migraines, also histamine related.  I am puffy and inflamed all over really.  My face is puffy, and I’m miserably constipated.  All histamine things.

 

It sounds like the liver metabolizes histamine.  Sooooo, with my drug load it’s possible there’s some sluggishness there.  Who knows?  How would I know?  Is it safe to clear the liver at all with a short trial of milk thistle tincture?  I have no idea.  And what should I be eating?  It sounds like allll the GAPS stuff and bone broths and ferments are high in histamine.  So, I’m looking for input here.  Any molecular biology buffs?  Alto, do you know about best practice for how to approach histamine intolerance?

 

Lots of dots connecting but what to do with all of it...? 

[Cabinhope]

Input please!  Seems like the last couple of times I posted I didn’t hear back from anyone.  I’m trying to avoid enlisting the help of a new psychiatrist for input.  Mine quit, along with 8 others last year, the local hospital in favor of fancier jobs elsewhere.

 

I have continued to feel better and better.  Major life changes, shifting toward the better, as I have carefully reduced.  I enter a 2 year RN program in 2 weeks.  I am working with addicts in our local hospital as a Peer Recovery Specialist, specifically those with endocarditis from needle use, dirty needles/dirty drugs.  In short, my life continues to open up as I continue to slowly ‘come to’.

 

So, read updated signature above.  I am SLOW in tapering.  I’m touching base because lately I’ve just been foggy, sleepy, out of it. I need to be sharper for school.  I did take a slough of science prerequisites over this past year so the brain is there.  But it still feels like it’s in bed under lots of cozy quilts.  So last night I shaved some Lithium off thinking it could be a bit of LIthium haze.

 

Just want input please.  Need to be more alert and less absent minded.  In all feeling super great and happy and productive.

[Cabinhope]

Please weigh in someone.

I quartered my 300mg Lithium tablet 4 nights ago, 25% instead of 10 I know.  Feeling low.  Terrible headaches, restless sleep, trouble organizing myself.  Even so it has been ‘ok’.  Received news yesterday that boyfriend (13 yr partner) is moving back to Montana so of course that figures in.  How much I don’t know.  How to know the difference between transient, adjusting mood and normal reactions to life change on the cusp of starting school full time?  I’m 47, not 27.  In any case I need help with liquid on this one.  For the record, have not been exercising.  Have been eating a lot of sugar.

 

I take a 300 mg tablet.  I want to add back in 1/8th of the pill, 37.5.

Do I do a 1:1 ratio and work with a larger volume of liquid than I am used to?  Or concentrate it to be working with 300mg/150ml? GIve it another few days wtih exercise before adding back?  I am stuck here.  Please someone help me figure it out.

Hope

[Cabinhope]

Anybody?

[JanCarol]

Hey Cabin - I'm a s-l-o-w one - I think I need help figuring out what's going on....

 

You were tapering Mirtazapine Jan-July?  And that's down to 1 mg.

Then you dropped Lithium from 300 to 225 mg on the 12th, and by the 4th day were very unhappy with the big drop?  4 days is a fair shake. 

 

Fair enough - sometimes lithium can go faster - but that dose is on the low side.  25% drop from 900 mg is sure to be less harsh than 25% drop from 300.

 

But it's been longer, now - if you are exercising, and feeling better, perhaps you can do it without an updose.

 

So -- if you want to go back up by half of that.  That sounds fine.

This is a liquid taper?  (i may have to call in other mods for the liquid stuff)  Oh yes.  You are asking - really liquid questions.  My experience is - dissolve tablet in 100 ml water, discard the % you don't want to take.  That makes the maths easy for me.  100ml of water discard 13 ml.  (12.5%)  

 

If you want to do 150 ml, you would discard 19 ml (18.75 ml)  this is (300mg-37.5)/2

 

Do I understand, or do we need other, more liquid-y mods?

 

On 8/16/2018 at 9:49 PM, Cabinhope said:

 How to know the difference between transient, adjusting mood and normal reactions to life change on the cusp of starting school full time?  

 

Yeah, that's a hard one.  Now that I'm 2 years out - I think it's back to "normal emotions" for me.  But that's 2 years off all psych drugs - you've got a lot of stuff going on - 3 antidepressants, a benzo, lamictal and lithium.  That would make anyone volatile!

 

And to be honest, I still head for the sugar sometimes, too. Some people, as they come off their drugs, lose the attraction - but some of us got drugged for blood sugar spikes to begin with.  In other words, instead of saying, "you have a broken brain," they should've said, "let's check your blood sugar!"  (I have a few of those that might've prevented a lot of trouble for me:  methylation, blood sugar, and thyroid).

 

Don't beat yourself up - let's make the best of it as possible.  You're doing great, just keep it slow, steady, stable!  (hard to do when your life is in an uproar - but life is chaos, and I think we're meant to experience that!)

 

And see the sun today!

Edited August 18, 2018 by JanCarol

[Cabinhope]

Oh JanCarol, so great to hear from you!

Yes, correct, mirtazapine taper still happening.  Down to less than 1mg.

 

Was on as much as 450 Lithium at the beginning 5 years ago.  Took an ambitious 150mg drop to 300 last summer with nothing big to report.  So I felt safe knocking out 25% last week, its been 7 days now.  Since writing I decided no need for the updose.  It transitioned from the initial 'alternate planet' and low mood feelings into really incredibly aching body and brain.  Flu like aching and migraines, incredible.  I have been lucky enough to be able to get into a deep, cold mountain swimming hole in a very pristine, clean creek 3 times this week.  The frigid water has been amazing for the aches and for the vagus nerve.  But I do think next time, whenever that is, I'll be more conservative.  I feel, still, like I've been hit by a semi.  I know it has something to do with sodium channels and nerves signaling and such.  So, in short, no updose.  Staying at 225mg lithium for now.

 

THANK YOU for responding.  If you will scroll back in my thread a little you'll see that at some point someone suggested, with accompanying drug interaction chart, Lithium might be the next best thing to let go, hence this action.  Where I am with all of this now is my goal is to bring down overall load as much as possible.  I am fine with slow rate and totally grasp that.  I just don't know which drug next, if there should be anything done in tandem, etc.  Should I knock a couple more out individually or bring the rest down together?  I have no idea what to do.  I suppose my intuition is to knock down the pristiq, but has anyone determined a decent way to do that yet?  Gratefully, it is my only controlled release drug.

 

What do you think?

Hope

[Altostrata]

Hi, Cabinhope. You've come such a long way! Good for you, starting the nursing program. You have a lot to offer.

 

Looking back over your topic, I saw you decided to taper lithium because of its effect on your thyroid. This makes sense to me.

 

While I have reservations about tapering more than one drug at a time, you seem to have it in hand, you're level-headed when you run into snarls.

 

What times of day do you take your drugs, and their dosages? It looks like mirtazapine is about to be jettisoned, which is good because it contributes to that traffic jam in your liver. Paxil, Pristiq,  and Klonopin also participate. Lamotrigine and lithium are metabolized elsewhere.

 

If I were you, I would not taper the Lamictal or Klonopin any further, keep that on board while you go off Paxil after lithium. Reducing Paxil should help clear up the fogginess.

 

Are you working with a doctor who will write prescriptions for you? Unless you can find a psychiatrist who at the very least understands drug-drug interactions -- it's unlikely you'll find any who know about tapering -- there's no reason to have one on your payroll. The drug cocktail your past psychiatrists have prescribed for you is dangerous, you're lucky your liver has handled it as well as it has.

[Cabinhope]

Alto!  Thanks for this encouragement.  Really means a lot.  I am doing my best that's for sure.

 

Hashimoto's was discovered a few years after starting Paxil over 20 years ago so I doubt if the Lithium was doing much to it at this point, but still.

 

I have never tapered any klonopin except for 5 years ago in the midst of the fiasco one psychiatrist had me c/t the same amount I'm on now, .25.  I was a wreck.  It was reinstated at .25, and I haven't touched it since. 

 

The Lamictal, ok, I was going to shoot for 75 because it seems like a tidy #, but I will defer to you.  Will leave alone.

 

So you think to continue on Lithium with the goal of eliminating?  I was wondering about staying on some minor amount, say 50, as though a tonic.  But again I defer.

 

The SNRI and SSRI scare me to death.  Because of what happened 5, going on 6, years ago.  At that time I tapered Paxil, while simultaneously adding more and more lexapro, over 6 months.  That's how I got where I did.  I c/t'd the lexapro trying to reinstate the Paxil at that 6 month point and the rest is history.  

 

As for nursing, yes, the ultimate goal is Psych NP.  I want to work with this opioid epidemic and have already begun doing so as a Peer Recovery Specialist in our local hospital system.  Still sorting out how I feel about suboxone.  Upon graduating in 2 years, at 49, I plan to do some reservation work.  That population has been eviscerated by trauma and subsequent addiction and psych drug treatment.  Suicide is pandemic.  The idea is to be a principled practitioner who has shared experience of psych drug trauma who explores every avenue EXCEPT psych drugs.  I think I can pull it off.  Gut health, diet, endocrine.....SO MUCH to square away first before ever, ever considering psych drugs.  I wouldn't be here were it not for having to drag my own ass through hell.

 

So the plan?  Jettison mirtazapine, check.  Continue down and off of Lithium?  To be followed ever so carefully by Paxil?

 

MUCH GRATITUDE y'all.

Hope

[Cabinhope]

And, yes, I have someone to prescribe.

[ChessieCat]

3 hours ago, Cabinhope said:

As for nursing, yes, the ultimate goal is Psych NP.  I want to work with this opioid epidemic and have already begun doing so as a Peer Recovery Specialist in our local hospital system.  Still sorting out how I feel about suboxone.  Upon graduating in 2 years, at 49, I plan to do some reservation work.  That population has been eviscerated by trauma and subsequent addiction and psych drug treatment.  Suicide is pandemic.  The idea is to be a principled practitioner who has shared experience of psych drug trauma who explores every avenue EXCEPT psych drugs.  I think I can pull it off.  Gut health, diet, endocrine.....SO MUCH to square away first before ever, ever considering psych drugs.  I wouldn't be here were it not for having to drag my own ass through hell.

 

Wow!!!  This is just fantastic to hear.

[Cabinhope]

Hi, just checking in.

I’m halfway through a verrry immersive RN program.  Wow.  Amazing my brain can take it!

I just updated my signature.  I have gone very slowly so not a ton to report.  Have taken little bits of things off here and there.

Still on:

Paxil 20, Pristiq 100, Klonopin .25, Lithium 225, Lamictal 50

 

What to do next?????

Alto, I read through that last post of yours.  You suggest nixing Lithium next?  Please share thoughts.  My thought has been to keep a hair of it on board, like 75 perhaps, as I face menopause soon I guess.  I’m 48.  Still regular cycles until last month I had a 31 day cycle.....a change from 27 days cycles my entire life.  My mood tanks, edgy and down, around ovulation and again end of cycle.  I’m afraid of what will happen when estrogen really begins to leave me as I know it has great interplay with serotonin. The director of the women’s reproductive mood disorders center at John’s Hopkins once told me her favorite for women, both postpartum and transitioning through menopause, is Lithium.  After all of my total and complete breakdown in trust of doctors, that sticks in my head. 

 

Anyone else, thoughts?  Stay on this path of kicking Lithium to the curb, then (gulp) Paxil?

 

Nursing school is hard.  My brain...I notice comprehension is different than it used to be for me.  I’m less sharp, concentration is ok, but cognition in general feels like my brain is wading through wet cement.  Still want to pursue Psych NP.  I have a lot on the ball, and I love my life....it’s so much, SO much better, more real, than it was 6 years ago when I found myself on higher doses of 7 drugs.  I am also now a Registered Peer Recovery Specialist employed by our local hospital system.  The main thrust of launching this program was/is to address the opioid addiction as we are positioned in its center.  But in this role I also visit the inpatient psych unit at the hospital and lead groups twice weekly.  It is heartbreaking to witness so many people finding themselves inpatient for drug side effects, so many who believe that they are ‘treatment resistant’, and to witness the new drugs coming onboard including ketamine.  Lord.  I also see quite a bit of schizophrenia which I’m not sure how to reconcile how I feel about psych drugs in the face of obvious brain malfunction.

 

Anyway, there’s my novella for the time being.  Life is really full and beautiful.  I do feel still like I’m wrapped in cotton batting a little.  I think it’s the Lithium.  Cheers, carry on.

 

Hope

[ChessieCat]

8 hours ago, Cabinhope said:

I think that tapering Pristiq will be in my future.  It’s ever-present on my mind, and I have been so afraid based on my previous experiences.  I have not known how to tackle a sustained release drug.  I had spoken once with the compounding pharmacist in my town, and he was willing to take on the duty of compounding it with a slow release additive.  I’m sure he will still be willing when the time comes.  Still, I haven’t known anyone, until reading your posts, to do this.

 

I've been tapering Pristiq using compounded tablets with slow release formula.  In Australia Pristiq is only available in 50mg and 100mg, so I used 50mg plus capsules, but once I got below 50mg I have been taking only capsules.  Once I got to 10mg I started splitting my dose so that I take a small amount at night time to reduce the interdose withdrawal.  Andie is also in Australia.

 

I am now down to 3.25mg

 

My tapering program

My Intro (goes to my tapering graph)

[Cabinhope]

Neat, how’d you do that graph?  I could put one together too I suppose as I’ve kept scratch notes on my period charts regarding tapers of different things.  This is also very inspiring.  So I think here in America we also have 25’s.  Did you or Andie do a bigger jump up front?  Or 10% from the start?

[Altostrata]

Cabinhope, that drug cocktail might make anyone's brain feel like wet cement. You know that taking those two antidepressants together is a terrible idea. If you feel lithium is helpful for you, perhaps you should address that later.

 

You may want to taper Paxil first because it comes in a liquid. Chessie is our expert at tapering Pristiq.

 

I hope your liver and kidney function are being monitored appropriately.

[Andie]

37 minutes ago, Cabinhope said:

Did you or Andie do a bigger jump up front?  Or 10% from the start?

 

I started coming down 10 percent from the start and would definitely recommend this. 

 

My doctor originally tried to taper me off very quickly . I tried this about 3 times and each time was a disaster.  With Pristiq slow and steady is definitely key. 

 

If it were me, I would tackle the Paroxetine first as it’s available in liquid form and will be much easier to work with it. 

[Cabinhope]

Ok, Paxil next then.  Glad to have mastered liquid, but seems like you guys are advocating pharmaceutical liquid.  How does it come?

Alto, nope, no one is checking my liver or kidney function.  Which tests specifically would be ordered so that I can specifically request them?  Doctors are worthless.  I have not been lucky yet to have found a great one.

BUN I suppose for kidney?  What for liver?

[ChessieCat]

Here's the Tips for tapering off Paxil (paroxetine)

 

2 hours ago, Cabinhope said:

Did you or Andie do a bigger jump up front?  Or 10% from the start?

 

I tried to go from 100mg to 50mg Pristiq, experienced withdrawal symptoms and found SA, then updosed to 75mg.  I was suffering mild serotonin syndrome and needed to reduce quickly.  However I did do 2 longer holds, one at 50mg for 3 months and another at 20mg for 7 weeks.                           

[Andie]

It’s so much easier to taper small doses using a liquid, you can measure out minuscule amounts. It is even better if you can get a proprietary formulation so you know it’s been tested for stability etc.

 

I don’t know much about antidepressants in liquid form as here in Australia as we don’t have access to them,  but I wish we did! 

 

Can you mention to your Doctor that you haven’t had your liver or kidney function tested? Your Doctor should know the specific lab work required. 

 

 

 

 

[Cabinhope]

Ok, thanks you guys.

I’ll get liver and kidneys tested.

I’ll go about getting a scrip for liquid paxil.

Alto, you mentioned taking the SSRI and the SNRI together as being a ‘terrible idea’.  Intuitively this makes sense but could you, or anyone, elaborate on this from a biochemical perspective?  What’s going on in my brain with these two drugs on board at the same time?

Also, full disclosure, I’m not totally off the mirtazapine.  I feel like I should be, and the amount is so small now, .25 mg, that I have felt like it’s basically gone.  But it’s not.  I don’t have it in my signature.  I just dropped a few nights ago from .25 to .2, and true to what y’all say, it’s more noticeable at smaller doses.  I have some very strong tension and dread, BUT I also just ovulated.  Woah is me.  Should I just rip the bandaid off at this point?  I hate these ******* drugs.

So obviously I have to deal with this little bit of mirtazapine before anything else.

[Gridley]

17 minutes ago, Cabinhope said:

Should I just rip the bandaid off at this point?

 

Cabinhope, this link might be of help in deciding when to drop to zero. 0.2mg might be a little high, especially given the reaction you had going from 0.25 to 0.2.

When to end the taper and jump to zero?

[Cabinhope]

Yep, pretty discouraging to react to this tiny drop here at what I have thought of as the end to this drug.  I have had disturbances before with mirtazapine drops, usually migraines which I never had before starting this cocktail 6 years ago.  I did have one of those yesterday.  Usually things resolve within a week or so.  

 

Incidentally, I would like to hear ladies who have been through menopause talk about that in the context of coming down on drugs.

 

And another aside, I took a DNA test through a company called Genesight that looks at the function of the CPY2D6 enzyme to determine how I metabolize drugs.  Might be helpful, might not.  Anyone have experience with this test?  It is complete, but have not had a doc interpret for me.  The results were sent to the doc who ordered it.  Do I need a clinician to interpret or can I ask for the results to do it on my own?

 

Thanks, as always.