Grizzly: About to begin tapering

[Grizzly]

I have been inspired by a friend who is a user of this site to research how best to taper off several anti-depressants, including: Trazodone, Buproprion, Prestiq and Amitryptiline. 

 

I currently take 50 mg of Trazodone before bed. I also take the Amitryptiline before bed. My psychiatrist has suggested I can stop the Trazodone because the Amitryptiline should have enough of a sedative effect to get me to sleep. But when I've tried to stop the Trazodone altogether, I've not been able to sleep. So, I'm thinking about cutting the 50 mg and taking 25 mg.

I'm also considering reducing the Buproprion 200 mg. Unfortunately, it is extended release. I don't think my psychiatrist would be willing to prescribe a lesser dose but it's possible. I have considered just taking the 200 mg. pill every other day, which I suspect might be viewed as reckless. 

The Prestiq seems especially complicated. I don't plan to address it anytime soon. 

And I'd like to drop the Amitryptiline dose because, being an older anti-depressant, it leaves me with a dry mouth and the potential for sexual dysfunction. 

 

I am open to any and all advice about how to proceed.

I don't know exactly how this forum works and am open to feedback about that too.

Grizzly

[KarenB]

Welcome Grizzly - so glad you followed your friend's suggestion; knowledge is power! 

 

Alternating doses is actually a very bad way to reduce your amount.  They say it's like playing ping-pong with your brain - ouch!  Your Central Nervous System can get really destabilised, and that makes any future tapering more difficult.  We recommend a gentle taper, reducing one drug at a time, and by no more than 10% of your current dose each month.  This allows your brain time to adjust as you go, and lessens any withdrawal.

 

You could start with this thread:  http://survivingantidepressants.org/index.php?/topic/2207-taking-multiple-psych-drugs-which-drug-to-taper-first/ and then discuss your thoughts here. 

 

Many people find Fish oil and Magnesium useful during withdrawal.   

 

Keeping things simple is your best bet:  Keep it Simple; Keep it Slow; Keep it Stable

 

Would you be able to fill out a signature – all drugs/dates/dosages etc - so we can see your situation easily whenever you post, and help you more accurately?  Thanks.

 

Have a read of those and then you can come back to this thread to discuss things further.  This can be your journal to record your tapering and healing progress, and to ask questions.  You can also google 'SurvivingAntidepressants .......' filling in whatever topic you like if there are specific things you want to read up on. 

 

Welcome to SA,

Karen

[Grizzly]

I would welcome advice about which drug or drugs I should start with for tapering. 

I'm on: 

Buproprion HCL SR, 200 mg. pill once a day

Prestiq  ER  100 mg. once a day

Trazodone 50 mg. tablet before bed

Amitriptyline 100 mg. before bed

 

I was thinking about starting with Buproprion and/or Trazodone because they seem like the low-hanging fruit, though I might be all wrong about that. 

I gather the Prestiq taper will be complicated and likely require the cooperation of my psychiatrist. 

I'd like to get off Amitriptyline because of the side effects. 

 

Thank you for any advice you can offer. 

[Grizzly]

I'm not sure I know what I'm doing yet to utilize this site.

By introduction, I am wanting to start tapering off of four antidepressants: Buproprion HCL SR 200 mg. once a day; Prestiq ER 100 mg. tablet; Trazodone, 50 mg. at night; Amitriptyline, 100 mg. tablet before bed.

 

I'd welcome advice about which drug to choose first to taper and any related advice. 

[savinggrace]

You know, Grizzly, I responded to you a couple nights ago but noticed your post seems to be on Woof's thread? I was hoping the error would be caught and fixed. If no moderator comes along soon, there is a report button on the bottom right of the screen. You can notify them of your problem. Hopefully is will get straightened out soon, and you will get the advice you are seeking.

 

All I am able to do is welcome you, and assure you that you are in the right place. Best of luck.

 

Grace

[scallywag]

Hi Grizzly, welcome to SA!
 
You've come to a site with lots of information, knowledge and wisdom.   I see you've found the thread discussing your exact situation, multiple psych drugs to taper.
 
It will help the moderators answer your questions and otherwise assist you if you put your withdrawal history in your signature.  Please put your withdrawal history in signature

 

Often the decision of which drug to taper first is driven by the drug interactions. Have you checked your drugs in an interactions checker yet? Drugs.com Drug Interactions checker

 

I've just done the 4 drugs you've listed: (link has details of possible interaction effects)

A summary of interactions

• Major interactions
  1. amitriptyline <> buproprion
  2. amitriptyline <> trazodone
  3. buproprion <> trazodone
  4. amitriptyline <> Pristiq (desvenlafaxine)
• Multiple drugs in same category
  1. four antidepressants, maximum recommended for this category = 1
  2. four psychotherapeutics, maximum recommended for this category = 3
  3. four CNS drugs, maximum recommended for this category = 4

A moderator will see your post soon and will probably have a few questions for you. Stay tuned.

[SquirrellyGirl]

Hello Grizzly - welcome to SA!

 

Scallywag got you going with lots of info.  I am going to bring your situation up for review, but I know it would be helpful if you could answer more questions.

 

1.  What was the order that you were put on these meds and the reason for each addition?  Side effects, sleep issues, etc.

2.  What times specifically are you taking your meds.

3.  Are you having any notable side effects?

4.  Are you taking any other meds, OTC or Rx?

5.  How is your sleep?

 

If you could fill in your signature block, it would be very helpful; it appears below all your posts. 

 

This is your intro thread.  You can find it more easily by bookmarking it.  This is where you can document your journey, ask questions about your particular situation, give updates, etc.  By clicking Follow above, you will be notified anytime someone responds in your thread.

 

We generally recommend tapering one med at a time.  It may be possible to go a little bit faster in the beginning with the first ones since the other's may provide a buffer, but I can't guarantee that - everyone is different!  

 

We recommend a 10% taper:  Why taper by 10% of my dosage?

 

This may be helpful, too:  Preparing to taper

 

It is important to keep track of your experience daily on paper, noting the dates of dosage changes, when any symptoms come up, sleep patterns, when symptoms go away, etc.  This will help in knowing what to expect with future cuts.  In the beginning, I would recommend doing one drop per four weeks.  There's a bit of wiggle room once you know how you are handling cuts; you might be able to cut every three weeks, or maybe it would have to be five or six.  It just depends on your system.  The main thing is to listen to your body and let it guide you, rather than the calendar.  People get into too much trouble when they cut despite having symptoms, for instance, just because it was the "Plan."

 

You can surf around SA and spend time reading up on helpful tips in the Symptoms and self-care forum.  

 

Most of us find  Magnesium and Omega-3 Fish Oil useful while tapering.

 

So, give those links a read and come back with questions!

 

SG

[Grizzly]

Thank you for the warm welcome, SavingGrace, Scallywag and SquirrelyGirl,

I was referred to the site by cabinhope, who also encouraged me to read Anatomy of An Epidemic. The more I've read the angrier I've become about how psychiatry has failed my loved ones and failed me. 

I lost both my father (in his 70s) and my sister (in her 60s) to suicide. Both had been compliant and pliable patients. Both had ECT. My sister had tardive dyskinesia. 

I work as a newspaper reporter and find Anatomy of An Epidemic to be credible, well-researched and written. 

 

I'll try to answer the questions posed by SquirrelyGirl.

Current meds are: Buproprion HCL SR, 200 mg once a day; Prestiq ER 100 mg once a day; Trazodone, 50 mg before bed; Amitriptyline, 100 mg before bed.

[] Trazodone was added to Prozac back in 2000 for sleep. Buproprion was prescribed in about 2009. Prestiq a few years ago and Amitriptyline. 

[] Trazodone and Amitriptyline before bed. Others in the morning.

[] Major side effects seem attributable to Amitriptyline, including dry mouth and some sexual effects. 

[] Also take Liothyronine, 5 mcg twice a day. 

[] I have been experiencing early morning awakening for several months but attribute that more to life changes than to depression. I fall asleep after taking Trazodone and Amitriptyline.

 

I filled out my signature block but don't know whether it will appear in this post.. 

I have not experienced a clinical depression in more than three years. 

 

My current plan is to start tapering the Trazodone. And then the Buproprion. I gather a taper from Prestiq can be difficult. I'd like to taper off the Amitriptyline because of its side effects. My mouth is dry all the time. 

 

Thank you. 

[JanCarol]

We could do this for you, but it's better if you do it yourself.

 

Please put all of your drugs into the drug interactions checker:  http://www.drugs.com/drug_interactions.html

 

and be prepared to be amazed at what has been done to you.  

 

Also, it is an awesome tool for picking the most troublesome med to start on.

 

There are special challenges for each of your drugs.

 

I wait to hear your interactions.  Again - what was the order these drugs were prescribed?    Which is the newest prescription, what is the one you've been on longest?  This tells us how the drugs have restructured your brain, and helps us to figure out which Jenga blocks we can start removing while trying to maintain the best stability.

 

Welcome to SA!

[Grizzly]

Of the drugs I'm now on, the order of being prescribed.

Trazodone, around 2000

Buproprion, around 2008

Prestiq, around 2012

Amitriptyline, around 2014

 

Other drugs have been added and dropped during the period from 2000 to 2014 (Lamictal, Effexor, Prozac, Abiliify, Lithium).

 

I have decided to start tapering with the Trazodone, I've cut each 50 mg tablet into quarters and, starting last night, took three of the quarter sections. Fitful sleeping but not bad. I started with the Trazodone because my psychiatrist though the Amitriptyline alone had enough sedation to help me sleep. 

 

Interactions

• 1. amitriptyline <> buproprion
  2. amitriptyline <> trazodone
  3. buproprion <> trazodone
  4. amitriptyline <> Pristiq (desvenlafaxine)
• Multiple drugs in same category
  1. four antidepressants, maximum recommended for this category = 1
  2. four psychotherapeutics, maximum recommended for this category = 3
  3. four CNS drugs, maximum recommended for this category = 4

[scallywag]

Hey Grizzly, I think JanCarol was suggesting that you enter all your drugs into the interaction checker at drugs.com, then copy+paste the results here. The report lists what specific issues may result from an interaction between 2 drugs. It can be a quite an eye-opener.

[Grizzly]

Of the drugs I'm now on, the order of being prescribed.

Trazodone, around 2000

Buproprion, around 2008

Prestiq, around 2012

Amitriptyline, around 2014

 

Looks like I'm vulnerable to serotonin syndrome, something my psychiatrist has mentioned. 

Print   Close

 

 

 

 

Drug Interaction Report

Drug interactions for the following 4 drug(s):

Drug List: My+Drug+List amitriptyline bupropion desvenlafaxine trazodone Interactions between your selected drugs

Major amitriptyline bupropion

Applies to: amitriptyline, bupropion

Talk to your doctor before using buPROPion together with amitriptyline. 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 amitriptyline, 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.

Major amitriptyline trazodone

Applies to: amitriptyline, trazodone

Using amitriptyline together with traZODone can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should seek immediate medical attention if you experience these symptoms while taking the medications. 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. 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.

Major bupropion trazodone

Applies to: bupropion, trazodone

Talk to your doctor before using buPROPion together with traZODone. 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 traZODone, 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.

Major amitriptyline desvenlafaxine

Applies to: amitriptyline, desvenlafaxine

Using amitriptyline together with desvenlafaxine can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should seek immediate medical attention if you experience these symptoms while taking the medications. 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. 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.

Major bupropion desvenlafaxine

Applies to: bupropion, desvenlafaxine

BuPROPion may rarely cause seizures, and combining it with other medications that can also cause seizures such as desvenlafaxine 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.

Major trazodone desvenlafaxine

Applies to: trazodone, desvenlafaxine

Using traZODone together with desvenlafaxine can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should seek immediate medical attention if you experience these symptoms while taking the medications. 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. 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.

No other interactions were found between your selected drugs.
Note: this does not necessarily mean no interactions exist. ALWAYS consult with your doctor or pharmacist.

Other drugs and diseases that your selected drugs interact with

• amitriptyline interacts with more than 500 other drugs and more than 20 diseases.
• bupropion interacts with more than 300 other drugs and 8 diseases.
• desvenlafaxine interacts with more than 400 other drugs and 8 diseases.
• trazodone interacts with more than 500 other drugs and 8 diseases.

Interactions between your selected drugs and food

Moderate bupropion food

Applies to: bupropion

Using buPROPion with alcohol may increase the risk of uncommon side effects such as seizures, hallucinations, delusions, paranoia, mood and behavioral changes, depression, suicidal thoughts, anxiety, and panic attacks. On the other hand, sudden withdrawal from alcohol following regular or chronic use can also increase your risk of seizures during treatment with buPROPion. If you are prone to frequent or excessive alcohol use, talk to your doctor before starting buPROPion. In general, you should avoid or limit the use of alcohol while being treated with buPROPion. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects 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.

Moderate trazodone food

Applies to: trazodone

Alcohol can increase the nervous system side effects of traZODone such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with traZODone. Do not use more than the recommended dose of traZODone, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

Moderate desvenlafaxine food

Applies to: desvenlafaxine

Alcohol can increase the nervous system side effects of desvenlafaxine such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with desvenlafaxine. Do not use more than the recommended dose of desvenlafaxine, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

Therapeutic duplication warnings

Therapeutic duplication is the use of more than one medicine from the same drug category or therapeutic class to treat the same condition. This can be intentional in cases where drugs with similar actions are used together for demonstrated therapeutic benefit. It can also be unintentional in cases where a patient has been treated by more than one doctor, or had prescriptions filled at more than one pharmacy, and can have potentially adverse consequences.

Duplication Antidepressants

Therapeutic duplication

The recommended maximum number of medicines in the 'antidepressants' category to be taken concurrently is usually one. Your list includes four medicines belonging to the 'antidepressants' category:

• amitriptyline
• bupropion
• desvenlafaxine
• trazodone

Note: The benefits of taking this combination of medicines may outweigh any risks associated with therapeutic duplication. This information does not take the place of talking to your doctor. Always check with your healthcare provider to determine if any adjustments to your medications are needed.

Duplication Psychotherapeutic agents

Therapeutic duplication

The recommended maximum number of medicines in the 'psychotherapeutic agents' category to be taken concurrently is usually three. Your list includes four medicines belonging to the 'psychotherapeutic agents' category:

• amitriptyline
• bupropion
• desvenlafaxine
• trazodone

Note: The benefits of taking this combination of medicines may outweigh any risks associated with therapeutic duplication. This information does not take the place of talking to your doctor. Always check with your healthcare provider to determine if any adjustments to your medications are needed.

Duplication CNS drugs

Therapeutic duplication

The recommended maximum number of medicines in the 'CNS drugs' category to be taken concurrently is usually three. Your list includes four medicines belonging to the 'CNS drugs' category:

• amitriptyline
• bupropion
• desvenlafaxine
• trazodone

Note: The benefits of taking this combination of medicines may outweigh any risks associated with therapeutic duplication. This information does not take the place of talking to your doctor. Always check with your healthcare provider to determine if any adjustments to your medications are needed.

Drug Interaction Classification

The classifications below are a guideline only. The relevance of a particular drug interaction to a specific patient is difficult to determine using this tool alone given the large number of variables that may apply.

Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.

Do not stop taking any medications without consulting your healthcare provider.

Disclaimer: Every effort has been made to ensure that the information provided by Multum is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. Multum's information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill, knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective, or appropriate for any given patient. Multum Information Services, Inc. does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. Copyright 2000-2016 Multum Information Services, Inc. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse, or pharmacist.

[Grizzly]

Hey Grizzly, I think JanCarol was suggesting that you enter all your drugs into the interaction checker at drugs.com, then copy+paste the results here. The report lists what specific issues may result from an interaction between 2 drugs. It can be a quite an eye-opener.

I did that. Is there anything else I should do at this point? I'm trying to get oriented on the site. Thank you.

[SquirrellyGirl]

Hi Grizzly, 

 

I'm waiting on other mods to advise you, but what stands out to me is the risk of seizures between buproprion and the other drugs.  Otherwise, my understanding is that it is generally preferred to taper the ADs before the benzo so that the benzo can temper the anxiety and insomnia from coming off the ADs.  I have put out a notice to the more experienced mods to assess your situation and come up with a plan :-)

 

SG

[Grizzly]

Hi Grizzly, 

 

I'm waiting on other mods to advise you, but what stands out to me is the risk of seizures between buproprion and the other drugs.  Otherwise, my understanding is that it is generally preferred to taper the ADs before the benzo so that the benzo can temper the anxiety and insomnia from coming off the ADs.  I have put out a notice to the more experienced mods to assess your situation and come up with a plan :-)

 

SG

Ok. I didn't think there was a benzo on that list. Which one is that? 

[SquirrellyGirl]

Oops, my apologies - for some reason I always think of trazadone as a benzo, but you are right, it is not!

 

SG

[JanCarol]

Wow, thanks for doing that Griz.  Wow.  All drugs are equally major with each other.  Wow.

 

Please HOLD on all tapers until we confer on this!  I know you've dropped 25% Trazadone.  Please note this in your signature, including the date you dropped it.  Please keep record of symptoms from the drop - it may take a month (or more) before you know the significance of this drop.

 

This is a very important test you've set up.  This is how Dr. Kelly Brogan does it - she drops by 25% and then watches to see how the symptoms fall.  HOWEVER, we are NOT doctors, we do NOT have a clinic or a practice or the ability to help if things go horribly wrong, so we NEVER recommend that much of a drop for someone who has been on for as long as yourself.  But you've done it - we may as well see how it goes.  If it starts to get rough after 4 days, you might consider up-dosing to your former dose, and considering a 10% taper.  As Squirrelly said:  Why taper by 10% of my dosage?

 

 

Please read the threads that we give you before you do anything else!  You are in a precarious position, and need to treat these drugs with respect, because they are like that nice little doggie wagging its tail at you until you reach down your hand and realize that really, it's a wolf and about to take your arm off.

 

Your name, Grizzly.  Do you have any experience with them?  I have only experienced Eastern Black Bear, and I know that the best way to avoid conflict is to hold still and sneak.  That's what a taper is - sneaking away from the bear.  If you drop your lunch and run - the bear will chase you (and come back for the lunch).  Keep calm, and plan on going v-e-r-y s-l-o-w-l-y, because once that withdrawal bear is on you, there's not much you can do.  And we don't have a clinic - to "put you back together" again.

 

The other thread which you should read is this:  Preparing to Taper

 

and I also like this article:  Psych Central 6 Ways to Prepare for Antidepressant Withdrawal

 

and this video explains the process very well  Healing from Antidepressants - Patterns of Recovery (by Toxic Antidepressants):  

 

At some point you will likely need to make liquids to taper off safely, because the drug companies do not give the small dosages required to come off the drugs:  http://survivingantidepressants.org/index.php?/topic/3068-pharmaceutical-liquids-to-make-suspensions/

 

Please, hold at your current dosages.  Alto should be along soon with her recommendations.  Please use this time to read some of these threads (I know, this is a big site, it can be quite overwhelming, but that's what we mods are for - to help you find what you need) - and learn about what to expect as you come off of these drugs.

 

And please, as you have questions, ask them here, and we'll try and get to you as soon as possible (we are all volunteers).

 

I hope you see the sun today!

[Grizzly]

JanCarol,

Well, I say "wow" back. Thank you for reviewing my situation so thoroughly and offering your thoughts and recommendations. This is a remarkable site. I suppose being of service to others who are tapering is part of what sustains recovery. I'm grateful. 

 

As for grizzlies...I lived in Montana for 10 years. Saw many grizzlies from a safe distance. Had one close encounter. And, yes, the advice is to stay calm and slowly back away. 

 

I will hold on any additional changes, review the threads you recommend and revise my signature.

Thank you again. 

 

A friend passed along this quote from Kubler-Ross. Perhaps it is salient for many people on this site: 

 

"The most beautiful people we have known are those who have known defeat, known suffering, known struggle, known loss, and have found their way out of the depths.  These persons have an appreciation, a sensitivity, and an understanding of life that fills them with compassion, gentleness, and a deep loving concern.  Beautiful people do not just happen."     Elisabeth Kubler-Ross

[scallywag]

Grizzly, I had a look at your drug interactions.  There are six possible interactions:

- amitryptilene with each of

   1. bupropion

   2. trazodone

   3. desvenlafaxine

 

- bupropion with each of

   4. trazodone

   5. desvenlafaxine

 

- trazodone with

   6. desvenlafaxine

 

The initial check for interactions shows a major interactions for combinations 1, 2, 3, 4, 5.  I was suspicious about #6 and ran a check for only trazodone and desvenlafaxine and found that their interaction is considered "major".

 

 

Interactions between your selected drugs: trazodone desvenlafaxine

Major

 

Applies to: trazodone, desvenlafaxine

 

Using trazodone together with desvenlafaxine can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should seek immediate medical attention if you experience these symptoms while taking the medications. 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. 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.

 

Wow -- your p-doc has subscribed 4 drugs for which 100% of the 2-way combinations yield major interactions. Maybe s/he has some 'splainin to do?

[Grizzly]

I have always liked and admired my psychiatrist, who managed to get through medical school even though he is blind. He is regarded as a regional expert on psychopharmacology. That said, after reading Anatomy of An Epidemic, I have wondered how much he is aware of the damage anti-depressants do. I meet with him next week and will see how willing he will be to be an ally in the tapering.

[SquirrellyGirl]

Fascinating about your doc!  I think these guys can be brilliant at playing with the chemistry set, but still haven't gotten caught up on the fact that they are throwing drugs at an unknown - no disease process that causes our "afflictions."  And they seem to have a real disconnect about what is actually happening to the nervous system while on these drugs, the changes that necessitate slow tapering, that cause withdrawal, often profound, for patients trying to come off.  They've turned therapy over to the psychologists and therapists, so all they really do have to offer patients is drugs.  What's to happen when the writing is finally on the wall to the point that everyone realizes these drugs should not be used for commonplace reactions to life situations!  What will they do with themselves? 

 

Anyway, glad you are here, Grizz!

 

SG

[Grizzly]

Fascinating about your doc!  I think these guys can be brilliant at playing with the chemistry set, but still haven't gotten caught up on the fact that they are throwing drugs at an unknown - no disease process that causes our "afflictions."  And they seem to have a real disconnect about what is actually happening to the nervous system while on these drugs, the changes that necessitate slow tapering, that cause withdrawal, often profound, for patients trying to come off.  They've turned therapy over to the psychologists and therapists, so all they really do have to offer patients is drugs.  What's to happen when the writing is finally on the wall to the point that everyone realizes these drugs should not be used for commonplace reactions to life situations!  What will they do with themselves? 

 

Anyway, glad you are here, Grizz!

 

SG

Thank you. I am too.

[rapunzel2]

I'm so sorry about your father and sister I lost my mom to suicide. you can read about my story here http://survivingantidepressants.org/index.php?/topic/4865-rapunzel2-a-mess-with-drugs/

 

I also recommend Peter Breggin's book "Medication Madness" https://www.amazon.com/Medication-Madness-Psychiatrist-Mood-Altering-Medications-ebook/dp/B008S0JVPE?ie=UTF8&keywords=medication%20madness&qid=1423427387&ref_=sr_1_1&sr=8-1

 

This book really opened my eyes about why my mother died and what had happened to me. 

[Grizzly]

Thank you. I'm sorry about your mother. I'll read your story and check out Breggin's book. 

[Grizzly]

I'm still getting oriented to the site. I'm not sure whether I should report side effects from tapering in a post like this or in my signature. I hope somebody will let me know. 

I'm continuing the 25 percent taper of the Trazodone at night. I've not noticed, after the first night, that my sleep is affected by the taper. But today, for the first time, I felt some stuff that felt like side effects - sort of a fluttery feeling in my brain and some anxiety in my chest. Neither was terribly bothersome but it alerted me that there may be more to come. 

Thank you. 

[Altostrata]

Welcome, Grizzly.

 

Please report withdrawal symptoms or any other effects of your drug cocktail in this topic.

 

Your psychiatrist prescribed 4 antidepressants and then casually observed you might be at risk of serotonin syndrome? He may be admirable in many ways, but a religious faith in the more, the better when it comes to antidepressants is not one of them.

 

The good news is you are probably a fast metabolizer, which is why you haven't had terrible side effects from this combo before. The bad news is that you are very much overdrugged.

 

Why was the amitriptyline added?

 

Have you been having any odd symptoms during the day?

[Grizzly]

Thank you, Altostrata. I believe the amitriptyline was added about three years ago, I believe. It's interesting...he's been pushing me to stop the Trazodone, saying the amitriptyline should provide enough of a sedative effect for me to sleep. I think he's been pushing that because he is afraid of the serotonin syndrome. But he NEVER suggested tapering the Trazodone. He just suggested I stop. I tried that one night several months ago and after a few hours of not sleeping I went ahead and took it. 

The only daytime symptoms are the ones I described, the fluttery feeling in my brain and some anxiety in my chest.

 

Thank you for your insights and concern. 

[JanCarol]

OK Grizzly - it's been over 4 days since your big 25% drop in Traz.  

 

Have you noticed good changes?  Bad ones?

 

I know you noted some fluttery feelings and slight changes in sleep - these things that I know from years of "med changes," (which I always thought was the cruellest part of psychiatry - the getting used to new drugs, being ripped off of old ones, transition times).

 

To help you objectify your symptoms, here is a list:  

http://survivingantidepressants.org/index.php?/topic/2390-dr-joseph-glenmullens-withdrawal-symptom-checklist/

 

and a topic about rating your symptoms daily to track your progress:

http://survivingantidepressants.org/index.php?/topic/1779-rate-symptoms-daily-to-track-patterns-and-progress/

 

We don't need to see the detail of every up and down - but over time you will start to recognize patterns.  "This week my sleep is worse, but my head space is clearer, and I can actually finish the crossword" or "hopeless at solitaire this week, but felt physically energized"  It's going to change a lot as you taper.

 

Recovery comes in Waves and Windows - the drill of 3 steps forward, 4 steps backward, then 2 steps forward and only 1 step backward - windows are when you see the sky, feel hope, and feel "like yourself" again (whatever that is - those of us who have been drugged a long time often wonder "what is Self"?) but the waves often come crashing down on the windows, and the survival of them is dependant upon the knowledge:  THERE WILL BE ANOTHER WINDOW.  Once you start having windows, the waves - as gruesome as they are - have less power.

 

It's good to post the good symptoms, too - so that you can come back to your thread and read - look - a month ago I had a great day, played a little guitar, took a walk in the woods, and kissed my grandchild.  And remember - the wave wasn't always there - it won't always be there.  It is transient.  Cyclical.  Each wave is coming like an "UNDER CONSTRUCTION" sign, you lose access to parts of yourself while your brain is trying to repair the damages from the drugs.  Recognize the waves, "It is only a symptom, only a wave," and like clouds in the sky, let them go.  They will go.

 

I love your Kubler-Ross quote.  Yes.  and Yes.  That's the second time I've seen it this week - someone is trying to get a message through to me that I may be too hard on myself, that these awful things in our lives - are what makes us who we are today.

 

SO - surviving the waves, and coming off the drugs - it becomes vital to replace the drugs with some other form of coping with emotions and mental symptoms.  I'm going to suggest you wait until the symptoms come, and let us know and we can send you to where you need.  Sometimes, surfing around people's stories, reading about horrible symptoms, can be activating.   So instead, let's emphasize the Non Drug Techniques for Coping with Emotional Symptoms (where you will find lots of tools to put in your toolkit!)

 

The first symptom you mention is that flutter in the chest, a bit of anxiety.  There's an Australian expert, from the 60's and 70's who was practically prophetic in her view of what she called "Nervous disorder" (before the words "anxiety" and "panic" came to be "diagnoses.")  She describes with great clarity ways to deal with and view these body feelings, and how to live through them, not be so reactive to them.

 

Her name is Claire Weekes, and there are several links about her on site - maybe you could start with this one:

Dr. Claire Weekes - Recovering from a Sensitized Nervous System

 

Additionally I've been seeing some great studies about Mindfulness and Acceptance and how the regular daily practice of mindfulness actually re-circuits the brain to be less reactive to those "fight or flight" feelings.  It does require regular, daily practice.

 

If you get in a pinch, here is a little 4 minute MP3 to help "talk you down:"  First Aid for Panic

 

We can do this Griz, let's see how this first drop goes, keep reporting, and we'll keep sending you info.  Plan on holding your doses at least a month before we continue.

 

(yeah, the closest I've been to Grizzly was in Yellowstone - about 10 metres from the car.....but I also knew how a smaller, black bear can open a car like a tin can - and I was sorely afraid!)

[Grizzly]

JanCarol,

I am grateful for your referrals and thoughts and kindness. I will review these links. As it happens, I am participating in a mindfulness meditation small group class in which I enrolled before starting down this path. And I do find it helpful. I've been listening primarily to guided meditations by Jack Kornfield, including one titled The Temple of Healing. 

Yellowstone is one of my favorite places, especially before or after the main tourism season. 

 

Thank you,

Grizzly 

[Cabinhope]

So glad you are here Grizzly

[Altostrata]

Grizzly, how are you feeling?

[Grizzly]

Thank you very much for checking in. I'm doing OK. Some anxiety. Some emotional vulnerability. But nothing intolerable. I am grateful for this site and grateful to cabinhope, who got me here. I witnessed much of the nightmare she experienced and now, in hindsight, see the appalling ways psychiatry failed her. I think psychiatrists and therapists who aren't wiling to read Anatomy of An Epidemic are guilty of malpractice.

. 

[Altostrata]

Have these symptoms changed since you reduced trazodone?

[Grizzly]

Well, these symptoms emerged after I reduced the trazodone. But they're tolerable so far. 

[JanCarol]

Ah!  Kornfield!  Good source for relief and being present with feelings.

 

I think psychiatrists and therapists who aren't wiling to read Anatomy of An Epidemic are guilty of malpractice.

 

My psychiatrist read "Anatomy" at my request, but dismissed it as "meta-data" and "inflammatory journalism."  Sigh.  And she's actually supported my taper sort of.  I gave her a choice - I said I could do it with her, or do it without her, which did she prefer, and she stayed on board.  Others aren't so lucky.

 

My therapist, on the other hand, read it, and then went to hear him speak when he came to town.  She's fully on board, now, and bemoans the state of affairs when people "flip" to bipolar due to overdrugging.

 

How ya feeling today?  It's been over a week - still mild symptoms?

[Grizzly]

Thank you for checking in. Yes, still mild.

I have an appointment tomorrow morning with my psychiatrist. I will ask him to become an ally in this and seek his advice about how to proceed and see what he says...though I'd not necessarily adopt his strategy.. 

He is likely to actively discourage me from coming off any of the meds. But I plan to be assertive. 

 

Afterward,I'll post a summary of that appointment and see whether anyone has related feedback.

 

Thank you again,

Duncan