☼ IHateSaphris: Saphris (Asenapine) Withdrawal - progress and plans

[IHateSaphris]

I have just started trying to get off Saphris. All these forums and blogs are terrifying me. Especially the story of "acetyl".

It was prescribed to me after wellbutrin alone wasn't fixing my depression. I am not bipolar or schizophrenic. I think it was an overly aggressive choice and i wish i had researched it before taking it.
I was taking  20mg daily along with 10mg lexapro and 450mg wellbutrin.  It put me in a zombielike state. I used to be a high performing software developer, at the top of my field, well respected and capable of great things. After Saphris I was unable to think clearly and lost my ability to design software, ending my career as a software developer. I may as well have been asked to perform Brain surgery so complete was the loss of ability. On top of that my current insurance doesnt cover it and i can no longer afford it. I previously tried going off it when i was only taking 10mg. I went too fast and started to experience anxiety pretty bad before going back on it and eventually ended up going up to 20mg.
This time i am going much slower. I tapered from 20 to 10 for two weeks and then to 5mg  for the last three weeks. Going to 10 went relatively smoothly. Going to 5 has brought on some anxiety that comes and goes. The worst withdrawal symptom so far has been the sexual dysfunction and this is where things make no sense. Each time i increased the saphris dose (5 to 10 and then 10 to 20) i experienced a decrease in sexual function. I expected things to improve when i reduced my dose but the exact opposite happened. With each decrease in dose my sexual ability is still declining. I am married one year and am not ready for my sex life to go away. I hope this will return once my brain recovers.
Anyway now that i am at 5mg i am stopping my taper and waiting for the anxiety to subside. It has actually been better the last two days. Not as intense. Also while i am at 5mg i am going to taper off the wellbutrin since that can cause anxiety, before i continue my saphris taper. I will continue the lexapro.
I expect this last 5mg to be the hard part and plan to go very very slowly. At each reduction my plan is to wait until symptoms subside before going on to the next reduction. I plan to hoard saphris over the next 6 months so that i have a multi year supply. My latest rx is for 60 10mg tablets per month expecting that i would be taking 2tablets or 20mg per day. Since i am currently only taking 1/4 of that this makes my rx good for enough for two years. When i reduce even farther it will last even longer (4 years at 2.5mg). Since my insurance will not cover it i will have to pay out of pocket but i think it will be worth it to have a chance to get off this drug successfully.
I am seeing a new psychiatrist and he didnt know about saphris withdrawal. To his credit he went right out and researched it. Unfortunately he was unable to find any scholarly or official documentation of saphris withdrawal. The only thing available is anecdotal reports on forums and blogs like these. At least he said i could taper the saphris at whatever rate i feel comfortable.
I will report in as the taper continues. Hopefully i can be successful and serve as hope for others. I was unable to find any record of successful withdrawal from saphris

[Altostrata]

Welcome, IHateSaphris.
 
You were right to stop tapering Saphris and let your nervous system rest before going on to the next step.
 
In the meantime, 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.
 
What is your current symptom pattern? How's your sleep? What time of day do you take each of your drugs?
 
Please read

Taking multiple psych drugs? Which drug to taper first?

Why taper? Paper demonstrates importance of gradual change in plasma concentration
 
Why taper by 10% of my dosage?

 

I am sorry you are experiencing sexual dysfunction from drug changes. This is a very common adverse effect of psychiatric drugs, including Lexapro, as well as a withdrawal symptom.

 

The relationship of any symptom to the drugs is not linear. Rather, you need to think of the nervous system as the living, self-regulating web that it is. When one element is changed, others change, too, and one result can be that the complex orchestration of sexual behavior (or other autonomic processes) can be thrown out of harmony.

 

Your psychiatrist sounds better than most, in that he will work with you on tapering.

[IHateSaphris]

Right now my current symptoms are minimal. I have extremely low-grade anxiety and have had two good days without significant feelings of tension in my chest. But I do know the hard part is coming, once I dip below 5mg. Since Saphris is an orally disintegrating tab, I can't adjust the dose by mixing in water and you can only be so accurate with cutting tablets. My dr. said the next move is to alternate 5mg one day and 2.5 the next, but I don't want to give my brain those ups and downs. So I will try to cut the tabs to get 3.75mg as my next step. It's more than 10%, but I don't see any other way. I am going to just take long rests in between steps for my brain to stabilize. I have a 3 year plan, more if the current pdoc will prescribe Saphris for me for the taper.

 

My sleep is good right now. I had a week or two of waking up at 4am after I went to 5mg, but that has resolved itself and I am sleeping through the night again. I take this as a positive sign, along with the reduction in anxiety, that my nervous system is adapting to removal of the Saphris successfully.

 

I take all of my drugs in the morning except for simvastatin (which apparently works best while you sleep) and Saphris, both of which I take at night before bed.

 

For the record, I have been on other psych drugs before:

Zoloft, started and stopped with no problem.

Paxil made me very uncomfortable within the first few days and I discontinued immediately with no ill effects.

Lexapro - I've been on it before and stopped with no problems but I plan to stay on it now as it very clearly helps my depression and anxiety, it was like a light switch when I started taking it again, like a blanket lifted off my brain. The only thing I don't like is the sexual side effects, but at 10mg it's low enough that, before the saphris effect, I had perfectly acceptable sexual function. It's the saphris that really killed me in bed. 

Effexor XR - Stopped with no problems

Clomipramine - Made me uncomfortable within the first few days, stopped immediately with no problems

Abilify - Made me unconfortable within the first few days, stopped immediately with no problems.

[IHateSaphris]

Interactions between your selected drugs

Major bupropion  escitalopram

Applies to: Wellbutrin (bupropion), Lexapro (escitalopram)

Talk to your doctor before using buPROPion together with escitalopram. 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 escitalopram, 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  asenapine

Applies to: Wellbutrin (bupropion), Saphris (asenapine)

BuPROPion may rarely cause seizures, and combining it with other medications that can also cause seizures such as asenapine may increase that risk. The interaction may be more likely 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. Talk to your doctor if you have any questions or concerns. 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 while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications 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

Major escitalopram  asenapine

Applies to: Lexapro (escitalopram), Saphris (asenapine)

Using escitalopram together with asenapine 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 bupropion  lisinopril

Applies to: Wellbutrin (bupropion), lisinopril

Lisinopril and buPROPion may have additive effects in lowering your blood pressure. You may experience headache, dizziness, lightheadedness, fainting, and/or changes in pulse or heart rate. These side effects are most likely to be seen at the beginning of treatment, following a dose increase, or when treatment is restarted after an interruption. Let your doctor know if you develop these symptoms and they do not go away after a few days or they become troublesome. Avoid driving or operating hazardous machinery until you know how the medications affect you, and use caution when getting up from a sitting or lying position. 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 lisinopril  asenapine

Applies to: lisinopril, Saphris (asenapine)

Asenapine and lisinopril may have additive effects in lowering your blood pressure. You may experience headache, dizziness, lightheadedness, fainting, and/or changes in pulse or heart rate. These side effects are most likely to be seen at the beginning of treatment, following a dose increase, or when treatment is restarted after an interruption. Let your doctor know if you develop these symptoms and they do not go away after a few days or they become troublesome. Avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you, and use caution when getting up from a sitting or lying position. 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

[IHateSaphris]

Also willing to entertain any better ideas for tapering something like Saphris. The orally disintegrating tablet makes it very hard. I can't dissolve it and then drink it, it doesn't work like that. Also cutting the tabs is only so accurate and I am sure will vary the actual dosage by up to 1mg day to day.

[Altostrata]

When do you feel this low-grade anxiety? Is it better or worse at any time of day?

 

Please keep daily notes on paper about your symptoms, when you take your drugs, and their dosages.

 

If I were you, I stick with cutting the Saphris tab in half, to 5mg, for a good while.

 

Why was buproprion added? You can see it interacts with several drugs.

 

At some point, did you have trouble sleeping on one of your drug cocktails?

[IHateSaphris]

The low grade anxiety comes and goes. Often for no obvious reason. Sometimes just while watching tv at night when im relaxing with my wife.

Bupropion was actually what i started on. Only when that wasnt cutting it did she add saphris. Then when i was still depressed she added lexapro.bthats when things got better.

I had serious trouble sleeping before the lexapro was added but i was so depressed its not surprising. The only other sleep trouble was just recently with the cut in saphris but as i said that has resolved. I slept straight through for 8 hours last night.

[Altostrata]

Please keep notes on  paper regarding your daily symptom pattern.

 

Given the above, you might cut Wellbutrin rather than Saphris, as it might have caused the sleep problems.

 

See Tips for tapering off Wellbutrin, SR, XR, XL (buproprion)

[IHateSaphris]

I am currently cutting the wellbutrin while i hold on the saphris. Wellbutrin wasnt the cause of the sleep problems. I was on that for nearly a year before my depression worstened. Serotonin being out of whack can cause sleep problems. Since the lexapro fixed everything i can only guess this is the case. The only thing about discontinuing the wellbutrin is that it does help me. My depression is caused by more than just a serotonin deficiency. There's a dopamine and/or norepinephrine component too.

 

Also i will be holding off any more moves with the saphris until the wellbutrin taper is done.

[IHateSaphris]

Anxiety kicked in a little last night and a very slight amount today. I feel like it's just hiding there waiting to jump on me as soon as i cut my dose any farther.

[JanCarol]

Hey IHS - 

 

I reckon it's criminal that the doctor put you on so many drugs with MAJOR interactions!  Did it give you pause to find out that ALL of your drugs are on the MAJOR interactions list?  It shocked me to read that list, and I've been looking at lists like this for awhile!

 

So I reckon, it's not just the saphris - it's the saphris on top of the wellbutrin on top of the lexapro!  (and possibly on top of the statin, too, see below)

 

It's also definitely criminal that the drug companies don't give us the dosages we need to come off the drugs, so we need to make due with what we can.  I'm sorry you are having trouble splitting your saphris, and wonder, as your dosages get lower, if it might help you to get a scale:  http://survivingantidepressants.org/index.php?/topic/1596-using-a-digital-scale-to-measure-doses/ or make a liquid:  How to Make a Liquid from Tablets or Capsule

 

Now as for statins.  They are sneaky drugs, and gradually rob your brain of fats and cholesterol and can not only contribute greatly to cognitive fog, they can cause severe memory disorders:

Statins - Lipitor and others

 

This website is by Duane Graveline, MD, a former astronaut, who didn't realize that his statins were causing his severe memory disorder. http://https://www.spacedoc.com  Look on his site for "side effects" and you will see memory, cognitive, mood, muscle weakness - all manner of side effects that you may be blaming on the saphris alone.

 

You might look here to see what others have said about Non-Psych Drugs Causing Psych Symptoms.

 

I was on lipitor and crestor and ezetimbe for 15 years - my cholesterol was still bad on the drugs.  And I still am concerned and work on my cholesterol off the drugs.  My cholesterol is still bad - but was that 5% improvement worth the flat, dead brain that I believe the statins caused?  Cholesterol is an essential part of feeding our hormonal system, as well as our brains.  Cholesterol keeps our arteries from going limp.  It serves a function in our bodies, and I'm not sure that eliminating or lowering cholesterol is a good, across the board practice.  Most people over 50 are on cholesterol lowering drugs - this sounds like a sound business plan to me, not a medical practice at all.  

 

Again, I wouldn't dream of telling you to go off your statins, but please do a little research and see what you think about all of these drugs - the lexapro, the wellbutrin, the saphris, the statins - educate yourself to take charge of your health.  The rest of your life will thank you.

 

If Alto thinks that the wellbutrin may be the most stimulating one - then maybe it's time to hold on the 5 mg saphris, and look at tapering Wellbutrin.  Wait for a month of the 5 mg (June 8?) Saphris before considering your next taper.  If your month on 5 mg is okay, then it's probably safe to taper again.  

 

Safe prescribing practice indicates that a person only be on ONE drug from a class - and this/these doctor/s put you on three!  And did they expect that to work for you?  Apparently they did.  It only took the side effects from the last one - to throw you into a state which caused you to question the prescription.

 

I'm glad you have a doctor who is willing to help you.  May it ever be so. 

 

I hope you see the sun today!

[simack]

Hi I hate saphris, (I couldn't agree more with your username!). I'm 14 months into saphris withdrawal now myself, I can't offer you much help unfortunately, other than to listen to alto and the other mods for tapering advice. I ran into the same trouble when trying to taper down from the last 5mg of saphris. I started cutting the wafers in half for two weeks then just stopped, much too fast of a taper and all hell broke loose, (I hadn't found this site by then)

I went panicking back to my psychiatrist and was switched over to zyprexa. This didn't stabilize me, but took the edge off slightly and let me get more that an hour's sleep at night. Now 14 months on I'm still not stable, and have been holding for three months now hoping things calm down a bit before tapering again.

So yeah, I'd hold the saphris for now and take things very slowly, I wish I had have found this site before I went off to fast..

[DMV64]

Hello!

I am soon to begin a Saphris taper. Is it true I cannot dissolve the sublingual tablet in water and just drink a portion? Won't the tablet still dissolve in water? Any suggestions welcome!

-D

[IHateSaphris]

I know. I disappeared.

 

I got free.

 

Got my life back.

 

The process sucked hard, but I'm in full remission and i have my faculties.

 

[IHateSaphris]

On 9/14/2017 at 10:13 AM, DMV64 said:

Hello!

I am soon to begin a Saphris taper. Is it true I cannot dissolve the sublingual tablet in water and just drink a portion? Won't the tablet still dissolve in water? Any suggestions welcome!

-D

Quick answer: no you cannot drink a sublingual drug, it won't work. See my DM.

[DMV64]

 I am so excited to read your message! It is very hopeful. And I'm really glad that there is a way to taper this!

[Altostrata]

IhateSaphris, how are you doing now?

 

This calls for our cheerful "here comes the sun" symbol ☼ to be added to the title of your Intro topic, to show you're recovering.

 

Please continue to let us know how you're doing. I hope you will add your story to our Recovery Success Stories eventually!

[DMV64]

On 5/29/2016 at 9:23 PM, IHateSaphris said:

I have just started trying to get off Saphris. All these forums and blogs are terrifying me. Especially the story of "acetyl".

It was prescribed to me after wellbutrin alone wasn't fixing my depression. I am not bipolar or schizophrenic. I think it was an overly aggressive choice and i wish i had researched it before taking it.
I was taking  20mg daily along with 10mg lexapro and 450mg wellbutrin.  It put me in a zombielike state. I used to be a high performing software developer, at the top of my field, well respected and capable of great things. After Saphris I was unable to think clearly and lost my ability to design software, ending my career as a software developer. I may as well have been asked to perform Brain surgery so complete was the loss of ability. On top of that my current insurance doesnt cover it and i can no longer afford it. I previously tried going off it when i was only taking 10mg. I went too fast and started to experience anxiety pretty bad before going back on it and eventually ended up going up to 20mg.
This time i am going much slower. I tapered from 20 to 10 for two weeks and then to 5mg  for the last three weeks. Going to 10 went relatively smoothly. Going to 5 has brought on some anxiety that comes and goes. The worst withdrawal symptom so far has been the sexual dysfunction and this is where things make no sense. Each time i increased the saphris dose (5 to 10 nd then 10 to 20) i experienced a decrease in sexual function. I expected things to improve when i reduced my dose but the exact opposite happened. With each decrease in dose my sexual ability is still declining. I am married one year and am not ready for my sex life to go away. I hope this will return once my brain recovers.
Anyway now that i am at 5mg i am stopping my taper and waiting for the anxiety to subside. It has actually been better the last two days. Not as intense. Also while i am at 5mg i am going to taper off the wellbutrin since that can cause anxiety, before i continue my saphris taper. I will continue the lexapro.
I expect this last 5mg to be the hard part and plan to go very very slowly. At each reduction my plan is to wait until symptoms subside before going on to the next reduction. I plan to hoard saphris over the next 6 months so that i have a multi year supply. My latest rx is for 60 10mg tablets per month expecting that i would be taking 2tablets or 20mg per day. Since i am currently only taking 1/4 of that this makes my rx good for enough for two years. When i reduce even farther it will last even longer (4 years at 2.5mg). Since my insurance will not cover it i will have to pay out of pocket but i think it will be worth it to have a chance to get off this drug successfully.
I am seeing a new psychiatrist and he didnt know about saphris withdrawal. To his credit he went right out and researched it. Unfortunately he was unable to find any scholarly or official documentation of saphris withdrawal. The only thing available is anecdotal reports on forums and blogs like these. At least he said i could taper the saphris at whatever rate i feel comfortable.
I will report in as the taper continues. Hopefully i can be successful and serve as hope for others. I was unable to find any record of successful withdrawal from saphris

Sorry that I seem to have pasted all of this I’m working from my phone here. I am also tapering Saphris . I’m down to 1.2 mg and I’m using the Gemini 20 scale. Or use the tweezer to break it into bits and weigh the pieces. It took a while to get used to but now I pretty much have it down

[Altostrata]

PS SurvivingAntidepressants.org Web site volunteer help wanted!

[Hello20]

@IHateSaphris

I totally agree with your name. Anyway I'm looking at tapering Saphris soon too. Can I ask how you tapered the tablet and how long did it take you to taper off it?

I just went through withdrawals from Lexapro and that was terrible.

[Hello20]

@DMV64

Hi, just wondering how you went with your taper of Saphris and any tips for getting off it?

[Hello20]

@simack

hi simack, can I ask how you are doing now and some other questions about coming off saphris?