Rico: Zyprexa tapering

[Shep]

 

Moving the Zyprexa has helped compared to before. However, this is what's happening:

 

When I take the Zyprexa, I feel mentally agitated, zoned out, and slow. Zyprexa never used to do this to me. I have gone blue in the face trying to tell others around me that Zyprexa is not working the way it used to in the past. I remember the day that I took the first 10mg tablet of Zyprexa after not having taken it for a while, and I felt an immense pressure in my head - especially the frontal lobe, and I couldn't even close my eyes to sleep. I could barely talk and it was a horrible experience.

 

Now, when I take the 2.5, the same thing is happening but on a smaller scale. And now that I have moved it earlier than the other two meds, the effect is very noticeable.

 

 

 

From your description, especially the part that I bolded, it's clear the Zyprexa should be the first drug to go, especially considering it's dangerous side effect profile. It could also be that by moving the dose earlier in the day, your brain may be registering it as increase. This will even out, but due to the fact that you're starting a taper while you're destabilized, it's best to go slow and practice lots of non-drug coping skills to get your CNS as nurtured as possible. 

 

Here are the links to get you started:

 

 

Why taper by 10% of my dosage?

 

 

Tips for Tapering off Zyprexa Olanzapine

 

Do you have the information you need to use a scale or to make a liquid?  Let us know if you need more information, and we'll guide you through the process.

 

Please keep updating exactly the way you have been (time of day, drug name & dose, your symptoms). This is extremely helpful and you're doing it perfectly. 

[Rico]

I can't sleep. I have pain in the left side of my face and head and my left arm is tingling.

[Shep]

Rico, please read over the links I just posted.

 

Do you have the information you need to start your Zyprexa taper? 

[Rico]

Thanks Shep.

 

I am really struggling due to the lack of sleep.

I just woke up and can't get back to sleep. I don't know what's happening. I am very anxious or mind racing - I don't know.

 

Yesterday

5:00 pm - took Zyprexa tablet 2.5mg

6.00 pm - 8:30 - attended 12 step program for mental health - difficult to concentrate and take in information. My memory is really bad too.

 

9:00pm - took lithium 900 and Epilim 1000 and magnesium 150mg

 

10:30 - couldn't sleep, felt pain in the left side of my face and left arm tingling. Brain just wouldn't switch off.

 

11:30 - took 2 panadols to help with the pain

 

Somehow fell asleep

 

4:30 am - woke up feeling brain tremor, highly anxious and desperate for sleep.

 

This lack of sleep and poor sleep is making me more anxious and agitated. Wht can I do please???

[vjekob]

Guys, I feel like I'm stepping out of line here since I've no experience
with this mix of drugs and I'm not a doctor but I'd really like to help

 

Rico - as I know how my daughter felt with a too high dose of Olanzapine.

I would start the Olanzapine taper very very slowly eg. 1% every 2-3 days
and holding at a dose for a couple of days if things get worse (wiithdrawl) until the situation stabilizes.
it could possibly be that some tapering could make a big improvement.

 

The other thing is that I give my daughter Olanzapine late at night eg 11pm
specifically as it then wears out while she sleeps - not sure what
effect reversing the order you have now would have - if that makes any sense.

Edited October 26, 2016 by scallywag
white space

[Rico]

I didn't sleep well last night - only 4 hours.

 

I woke up with severe anxiety, mind racing and really tired and wanting fro sleep but I can't.

 

I popped a 5mg Valium at 7am to get some relief.

 

I slept for a couple of hours, had a scary dream, and now woken up in he same state as this morning.

 

I am really panicking now. I don't want to get worse because I don't want to end up in a public hospital.

 

Vjekob - thanks for your help. Zyprexa doesn't sedate me like it used to in the past. I had a bad reaction with it this time round.

[Shep]

Rico, popping Valium for relief is unlikely to help. Please re-read this post, as there's a major interaction between Valium and Zyprexa.

 

Many of us go through nights without much (if any) sleep during this process. It's important that you be in a place mentality where you can manage your taper. 

 

Learning to get through this process is difficult, and we all struggle with it at times, but it's important to catch your thoughts before they go to the dark places. Thoughts such as "I only slept for 4 hours, so I know I'll end up in a public hospital" can be replaced with "I only slept 4 hours, but I can lie quietly or watch TV or play a computer game to pass the time." 

 

I think you're struggling more with catastrophic thoughts than with lack of sleep right now. This is a great thread for learning how to shut down those dark thoughts quickly and move onto something that will calm your CNS:

 

"Change the channel" -- dealing with cognitive symptoms

 

In time, these kinds of non-drug coping skills become habit. I have a list of movies on NetFlix I want to watch, so I save them for my insomnia nights so I have something to do. And I actually look forward to finally getting to see those movies.

 

Some people play video games, listen to music, meditate, or if nothing else, pace until they can settle down. 

 

It's important to have your toolbox full of non-drug coping skills available. 

 

Please read this post about starting your Zyprexa taper and let us know if you have any questions. 

[Rico]

Thanks Shep. I don't know what to say.

 

When I got home last night from my group meeting, I was sort of ok. I took my meds and spoke to my girlfriend and then tried to go to sleep.

 

I found it difficult to get to sleep. Not just thoughts - I had pain in the left side of my face and I was very agitated. I tried listening to relaxation music, but it was too hard. My mind would not switch off and was tormenting me. I really feel that the current medication is making things worse, especially after taking the Epilim and Lithium. Last year I experienced insomnia from Epilllim and Lithium (without Zyprexa) but the doctor didn't believe me. Many years ago, Epilim and Lithium would be sedating.

 

When I woke up early this morning, my brain was on fire and it's very scary, I tried to go back to sleep but couldn't, I was desperate for some relief so that's why I took a Valium tablet (5mg).

 

Should I move the Zyprexa back to the same time as the other meds?

 

I don't want to go insane.

[Rico]

Just want to say thank you to everyone who has been supporting me. I am trying very hard to hang in.

[Rico]

Hi

 

I believe the Epilim is causing insomnia, this happened last year. I took the Epilim 1000 today at 6:00pm and will take the other two medication s (Zyprexa and lithium) at 8:00pm.

 

Going forward I am thinking of taking the Epilim in te morning and the other medications at night.

 

I experienced insomnia last year from Epilim, and some research has revealed that Epilim can cause this.

 

Also, after taking it today at 6:00pm, I felt my mind go blank and it was like I had no thoughts.

 

Any thought?

[Shep]

Rico, we really need you to be very consistent with how you take your drugs. I know you're struggling right now, and I do know how these drugs can affect judgment and thinking.

 

I came off all of my drugs either cold turkey or rapid taper until I got down to a very small dose of Seroquel, so I do understand how hard it is to taper. But my withdrawal has been very severe with rebound psychosis and dp/dr, so I can only caution you on not making the same kinds of mistakes I made.

 

I would stick to taking the Zyprexa at the earlier timeframe and start tapering it (and continue taking your other two drugs at bedtime). From everything you've written in this thread so far, the Zyprexa seems to have the most side effects and be causing the most problems. Please re-read your posts. 

 

Also, if you haven't read this thread yet, please do so. It's about how these types of changes can destabilize your CNS. Even changing the timing of your dose can have an effect. This is why we need you to be as consistent as possible.

 

Limbic Kindling -- Hardwiring the brain for hypersensitivity

 

Let us know if you have any questions about tapering Zyprexa. 

[Rico]

Hi Shep, thank you for your help and patience. Just to clarify, I haven't started any tapering yet if any drugs. I am just trying to find some stability before I do that.

 

I was previously taking Zyprexa eadlier @5pm like you suggested, but I then found myself too zoned out to do anything.

 

When I take the Epilim and Lithium medication at 8:00pm, sleep is difficult.

 

I had a suspicion that Epilim is causing insomnia. It definitely causes depression. I suspected that this is the reason why I lay in bed in an agitated depressive state. I did some research online, and others experiences sleep issues because of Epilim.

 

Here is what happened last night and today. I would be very interested in your thoughts (or anyone else's).

 

6:00 pm - took Epilim 1000mg: felt slow, mind black, then very depressed.

 

I burst out of the house in anger and frustration and just walked and walked. I normally don't do any exercise, but I walked to the oval up the road, did half a lap and walked back home.

 

I came home and had a shower, and was very angry and frustrasfed with my current situation, side effects, etc.

 

I later talked to my girlfriend about how I felt.

 

I also noticed that I felt better after the brief exercise - which seemed to release some emotions.

 

8:00pm - took Zyprexa 2.5 and Lithium

 

10:00pm - went to sleep

 

Other than getting up in the middle of the night to drink water, I slept right through.

 

This has been the best sleep I have had for weeks.

 

Can I attribute this to having the Epilim earlier?

 

I have read the some people take their Epilim in the mornings to avoid sleep problems.

 

What are your thoughts?

[Shep]

Hi, Rico.

 

Sleep issues can be a problem with all psych drugs, so you'll find these kinds of reports and articles if you go looking for them.

 

Which drug do you want to taper first? From your earlier posts, it sounded like the Zyprexa was causing more problems than the others.

 

I was previously taking Zyprexa eadlier @5pm like you suggested, but I then found myself too zoned out to do anything.

 

That's a problem with antipsychotics, but being zoned out is not going to hurt you (unless you try to drive). It's annoying, but as you come off the drug, it will become less troublesome.

 

This has been the best sleep I have had for weeks. 

Can I attribute this to having the Epilim earlier?

 

That's hard to say. It could have been the exercise. If you're able, perhaps take a 30 minute walk in the afternoon or evening every day and see if you get some relief. That's a really healthy non-drug coping skill, and as you found out, it's great for anger, anxiety, and stress relief.   

 

[Rico]

Hi Shep,

 

Yes, i do want to taper off the Zyprexa first, but I also want to be off Epilim as soon as possible because of the depression that it is causing.

 

Is it possible to taper these two medications together?

 

Given the suspected sleep disturbance by Epilim, should I take it in the mornings?

 

Sorry, I am a little lost again ????

[Rico]

Tapering question / dilema

 

Firstly, I want to thank everyone for their advice and support on this site, it has helped tremendously.

 

I have been on Zyprexa 2.5mg, Epilim 1000, Lithium 900 for approximately 3 months.

 

I initially wanted to get off zyprexa first, and the suggestion to take the zyprexa earlier did help, although I discovered that taking the Epilim earlier helped more with sleep.

 

I am currently taking the Epilim 1000mg at 5:00pm with food and the other two meds at 8:00pm. I have also found a bit of walking helps too.

 

Unfortunately though, an hour after I take the Epilim 1000mg, I sink into a deep depression and I sort of shut down.

 

I understand from this site that you should only taper on medication at a time. The medication I would like to get off first is the zyprexa. However, using the 10% method, this is going to take a fair bit of time.

 

I was discussing with my partner, the possibility of coming off Epilim first, which is not as strong as zyprexa, and maybe I can come off it a bit quicker.

 

Our concern about coming off the Epilim after the zyprexa is that my liver function is not good. My current reading is 42 points above the high range in the blood test.

 

So, since I have not been on Epilim for that long, would it be possible to do a faster taper of the Epilim?

 

Here is my update for yesterday / today:

 

6:00pm - took Epilim (Depakote) 1000mg

 

7:00pm - got depressed, angry, frustrated...went for a walk.

 

8:00pm - took zyprexa 2.5, lithium 900mg +150mg magnesium. Talked out my issues with my partner.

 

11:00pm - fell asleep. Slept quite well (first time in ages) but did wake up to drink

 

8:00 am - woke up fairly ok, but a bit stressed about all this medication stuff and what to do etc (I have been used to doing whatever the pdoc says for many years)

 

2:30 - saw my psychologist, who gave me a good tip: set an hour a day to worry about your stuff, rather than spend all day worrying about things.

 

3:00-5:00- generally in much better mood

 

5:00pm - took Epilim 1000mg

 

6:00pm - plummeted into depression again, and started discussing the above tapering issue with my partner and family.

 

I am generally quite disappointed at how I have been treated by psychiatry. The information on this site has been more helpful than any information i have had from my pdoc - especially regarding moving the medications apart. I now have to rebuild my life again, but can't help feeling ripped off. It is quite sad that there are millions of people out there who are taking medications to combat side effects and being unnecessarily medicated.

 

Today is the first time I have felt better in a long time, and I thank the wonderful people in this forum who have encouraged me, held my hand, and offered me hope. I am also very lucky to have a supportive partner who has been there for me every step of the way.

 

Thank you

Rico

[Altostrata]

Rico, I think I asked you before: Do you get regular tests for kidney function? Lithium can damage kidneys.
 
It is likely that going on and off drugs has made your nervous system hypersensitive to all psychiatric drugs. Even though your dosages are the same or lower than before, you are overdrugged on all 3 drugs and feel exaggerated effects from them.
 
We had suggested taking the least sedating drug earlier in the day. I gather taking the Epilim earlier, rather than Zypreza, is a better schedule for you.

 

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.
 
Both Zyprexa and Epilim can cause liver damage. The two drugs interact destructively:
 
http://wiki.psychiatrienet.nl/index.php/Combining-Olanzapine-Valproic_acid
 

Combining-Olanzapine-Valproic acid

Adding valproic acid to olanzapine.
General information

• Olanzapine is principally metabolized by CYP1A2 and CYP2D6.
• Valproic acid is principally metabolized by CYP2C9, CYP2C19, CYP2A6 and UDP-glucuronosyltransferases. Valproic acid is an inhibitor of the enzymes CYP2C9, epoxide-hydroxylase and UDP-glucuronosyltransferases.
• This combination of drugs may have possible synergistic effects. However, this combination will also have additive side effects. Dose adaptation will be recommended for this combination.

Start valproic acid

• Start valproic acid according to the general dosing advice. Monitoring of the liver function every 3 to 4 months during the first year of treatment with either olanzapine or valproic acid is recommended.^%5B1%5D

Cave

• Concurrent use of olanzapine and valproic acid may potentiate the risk of hepatotoxicity.^%5B1%5D

 

https://www.ncbi.nlm.nih.gov/pubmed/22972535
Ther Drug Monit. 2012 Oct;34(5):512-7. doi: 10.1097/FTD.0b013e3182693d2a.
Valproic Acid significantly lowers serum concentrations of olanzapine-an interaction effect comparable with smoking.
Haslemo T¹, Olsen K, Lunde H, Molden E.

Abstract

BACKGROUND:
Preliminary reports have indicated that valproic acid (VPA) reduces serum concentrations of olanzapine (OLZ). The aim of this study was to investigate the impact of VPA and other antiepileptic drugs (AEDs) on serum concentrations of OLZ and 3 of its major metabolites in a large-scale material of therapeutic drug monitoring samples.

METHODS:
OLZ-treated patients were stratified into subgroups according to coadministration of various AEDs, that is, lamotrigine (LTG; 110 patients/153 samples), VPA (92/166), LTG + VPA (7/12), carbamazepine (CBZ) (8/8), oxcarbazepine (2/3), gabapentin (3/4), levetiracetam (2/3), and topiramate (2/2). A control group treated with OLZ without AEDs was also included (205/247). Dose-adjusted serum concentrations (C:D ratios) of OLZ and its major metabolites (N-desmethyl, N-oxide, and 10-N-glucuronide) were compared between AED subgroups and controls, using linear mixed model analyses with age, gender, and cigarette smoking as covariates.

RESULTS:
Significantly lower OLZ C:D ratios were found in patients comedicated with VPA (-32%, P < 0.001), VPA + LTG (-31%, P < 0.01), and CBZ (-50%, P < 0.001), compared with controls. The 10-N-glucuronide concentration was significantly lower in patients comedicated with VPA (-26%, P < 0.001), whereas CBZ significantly lowered N-desmethyl (-42%, P = 0.001) and N-oxide (-52%, P < 0.001) metabolite concentrations. C:D ratios of OLZ and metabolites were not significantly affected by comedication with LTG or any of the other AEDs. All covariates were significant determinants of OLZ C:D ratio, that is, age 60 years or above +35% (P < 0.001), female gender +11% (P < 0.01) and smoking -32% (P < 0.001).

CONCLUSIONS:
Concurrent use of VPA significantly decreases serum concentrations of OLZ to an extent comparable with smoking. The mechanism behind the interaction could not be derived from the results of this study.

 

 

The red flags in liver function indicate that going off either or both Epilim and olanzapine seem like a good idea. As you are clearly having adverse effects from olanzapine, if your sleep is tolerable with this current schedule, if I were you, I might reduce olanzapine by 10% and see what happens.

 

Depending on the results, you may wish to alternate reducing olanzapine and Epilim.

 

Please stay on your current schedule for at least 4 days before reducing olanzapine or making any further changes.

 

You cannot expect to go through any of this without some discomfort, so get your coping toolbox ready.

[Rico]

Hi Alto...I don't get regular tests, but the last test I had about a month ago showed only issues with my liver function. I did have tests in hospital also, but I can't remember the results. I will go this week to my GP and request blood tests, especially for liver and kidney function. I'll post the results when I get them.

 

Here is the result from the drug interaction checker:

 

Interactions between your selected drugs

Moderate

lithium divalproex sodium

Applies to: Lithium Carbonate ER (lithium), Depakote (divalproex sodium)

 

Using lithium together with divalproex sodium may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. 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. Talk to your doctor if you have any questions or concerns. 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

lithium olanzapine

Applies to: Lithium Carbonate ER (lithium), Zyprexa (olanzapine)

 

Using lithium together with OLANZapine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. 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. Rarely, a syndrome consisting of weakness, lethargy, fever, tremors, confusion, abnormal muscle movements, and increased white blood cells and other lab values has also been reported during combined use of these medications. Talk to your doctor if you have any questions or concerns. 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

divalproex sodium olanzapine

Applies to: Depakote (divalproex sodium), Zyprexa (olanzapine)

 

Using divalproex sodium together with OLANZapine can increase the risk of liver problems. Talk with your doctor before using these medications together. This can cause fever, rash, loss of appetite, nausea, vomiting, fatigue, right upper abdomianal pain, dark urine, and yellowish skin. If you take both medications together, tell your doctor if you have any of these symptoms. You may need a dose adjustment or special test if you take both medications. 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

 

----

 

Can you please tell me more about alternating the tapering of zyprexa and epilim?

 

Thanks

Rico

[Altostrata]

There's not much to tell. You reduce on by 10%, see what happens over a month. If it went smoothly, you reduce the other drug by 10%, wait a month, etc.

 

This is helpful when two drugs compete, such as Epilim keeping you awake while Zyprexa puts you to sleep. If you reduce Zyprexa too much, the Epilim might keep you awake.

[Rico]

Thanks Alto. Does this mean that I can't reduce the Epilim until the Zyprexa is gone?

[ChessieCat]

No, you alternate the drugs you taper.

 

"You reduce one by 10%, see what happens over a month.

 

If it went smoothly, you reduce the other drug by 10%, wait a month, etc."

[Rico]

Thanks Alto and ChessieCat for the help and information.

 

I will stick to the current schedule for at least 4 days before any tapering...it will take a while to get the liquid form of zyprexa anyway.

 

I woke up today quite depressed and out of it and have been in a daze all day. I have been "in my head" all day and feeling down but sometimes I am not even aware of what the thoughts actually are if that makes sense. I drift off very easily and my concentration is really poor. I am quite emotionally numb too and have to admit that I wish there was a quicker way to get off these medications. I have a fear that I have been permanently damaged because when I sit there lost in thought - or just lost - I worry that something has gone terribly wrong with me. I am just not living in the present at all. This year has been very traumatic, confusing and stressful. My memory is not very good either so it's hard to process what on earth happened.

 

Thanks for the help.

[Shep]

I have a fear that I have been permanently damaged because when I sit there lost in thought - or just lost - I worry that something has gone terribly wrong with me. I am just not living in the present at all. This year has been very traumatic, confusing and stressful. My memory is not very good either so it's hard to process what on earth happened. 

 

Best advice I can pass on from having been where you are:

 

1. Don't judge your future by where you are now. What you're feeling is not permanent, but the process of coming off and recovering is lengthy. When those dark thoughts show up, pick some Non-drug Techniques to cope with emotional symptoms, learn to handle Neuro-emotions, and when nothing else works, learn to  "Change the channel" -- dealing with cognitive symptoms. Write down which activities and coping skills you enjoy and take some time to explore them. They will come in handy during withdrawal and they will serve you well into the future when you're off drugs. 

 

2. Write down your taper schedule, listing your drugs, the dose you need to take, the time of day or evening to take each dose. Set an alarm on your clock, cell phone, or watch so you don't miss any doses (this is common when you have memory problems).

 

3. Keep symptom notes either here on the forum or on paper, using this format: Keep notes on paper about your drug dosages and daily symptom pattern, just like you've been doing.

 

 

That's it. Eventually, you'll settle into a routine. Thoughts will come into your head again and again making you second guess yourself. This is normal, and a major reason to learn the non-drug coping skills. 

 

Most of us are profoundly changed for the better by this experience, and that's a powerful motivator to keep going. 

[Shep]

I will stick to the current schedule for at least 4 days before any tapering...it will take a while to get the liquid form of zyprexa anyway.

 

 

 

This will involve a compound pharmacy. If this is too expensive or if your doctor won't write a prescription,  you can make your own liquid suspension:

 

 

 

 

Using a liquid to taper: Pharmacy compounding
At a very low dose of olanzapine, if you are sensitive to dosage reductions, you may wish to request a prescription for a liquid from a compounding pharmacy. This will enable tapering by a fraction of a milligram.

A pharmacy compounding formula using crushed tablets is here http://www.pharminfotech.co.nz/manual/Formulation/mixtures/olanzapine.html
(It notes olanzapine is "practically insoluble in water.")
 
You will need a prescription written for the custom compounded liquid. The only drawback is this can be quite expensive.
 
Using a liquid to taper: Make your own liquid
However, like other drugs that are not particularly soluble, you can make a suspension as our member Rhi describes below http://survivingantidepressants.org/index.php?/topic/3743-tips-for-tapering-off-zyprexa-olanzapin/?p=45153
 
According to http://www.pharminfotech.co.nz/manual/Formulation/mixtures/olanzapine.html

Olanzapine (as crushed Zyprexa^® tablets) is stable for up to 6 hours at room temperature and up to 48 hours refrigerated in water and the following beverages; orange juice, apple juice, cola and milk.

 
Also see http://survivingantidepressants.org/index.php?/topic/2693-how-to-make-a-liquid-from-tablets-or-capsules/
 
If you want to experiment with dissolving the tablet further:
 
https://www.caymanchem.com/pdfs/11937.pdf

 

Olanzapine is sparingly soluble in aqueous buffers. For maximum solubility in aqueous buffers, olanzapine should first
be dissolved in DMSO and then diluted with the aqueous buffer of choice. Olanzapine has a solubility of approximately
0.5 mg/ml in a 1:1 solution of DMSO:PBS (pH 7.2) using this method. We do not recommend storing the aqueous
solution for more than one day.

http://www.perrigo.com/files/rx/pdfs/pds173-ORA-Plus.pdf

 

ORA-Plus is an aqueous-based vehicle consisting of a synergistic blend of suspending agents that have a high degree of colloidal
activity. The suspending agents form a structured, gel-like matrix which suspends particles and allow for little settling. ORA-Plus
is buffered to a slightly acidic pH to help reduce degradation of medicinal agents through oxidation. An anti-foam agent is incorporated in
ORA-Plus to allow for vigorous shaking with minimal foam.

 

 

 

 

[Rico]

Thank Shep.

 

I woke up this morning feeling like **** from the Zyprexa. It's a familiar feeling because I have been on/off this drug for many years. All last year I struggled with it whilst trying to hold down a job and the depressive, groggy, cognitively impaired state was a daily battle. Nearly each day last year when I had a job was a struggle. I was suicidal nearly everyday going to work. It was awful. I pushed and pushed myself. I was on exactly the same medications that I am on now. I saw my pdic every week, and one stage couldn't handle the depression (my prof kept telling me I am not depressed) and went to see another quack who tried out antidepressants on me and then did a CT off one of them (Dotheipine) where I experienced the worst withdrawal ever. I ended up back on Zyprexa after a stint in Seroquel - which I cannot metabolise at all and it made me very sick.

 

My Endocronologist told me that I need to get off Zyprexa because I was diagnosed with secondary hypogonadism and that I needed to lose weight. I managed to then get off the Zyprexa by tapering 25% every two weeks. That taper actually worked and I started to feel better and my testosterone levels started to rise again and I wasn actually functional at work again. Unfortunately, I then thought to myself if I can get off Zyprexa, I can get off the Epilim and lithium. And this is whenever the problems really started which caused me to end up in hospital.

 

Fast forward now, I am back on the same combination as last year and this time it is not even working in the same way as last year (as described in previous posts).

 

I totally understand the 10% tapering method. It makes a lot of sense but the thought of staying on this drug for such a long time makes me very depressed.

 

I am very overweight, my hormones are stuffed, I am having bowel issues, and I feel like **** everyday and cognitively impaired. I am very angry that my doctor put me back on this. I remember the night when I first took the 10mg tablet and felt like my frontal lobe was going to explode and I couldn't talk or even sleep. Zyprexa never did that before.

 

If Zyprexa is making me this sick, doesn't it make sense to try and get off it quicker?

 

Please don't think that I am ignoring the good advice that I have had on this forum but this particular drug is a nightmare for me.

[ChessieCat]

I can understand you wanting to get off the Zyprexa quickly but you are going to need to be patient and take one step at a time.

 

Instead of trying to think too far ahead, I suggest you concentrate on your first taper of Zyprexa.  You may find that you start to feel some improvement.  It may not be much but together with keeping notes you could also Rate Symptoms Daily to Check Patterns and Progress so that you might be able to see from your recording an improvement that you might not have noticed.  Don't forget to log your quality and amount of sleep.  Report back here about how the Zyprexa reduction is going and then the mods can offer suggestions based on that.  Once you have stabilised then you can think about Step 2.

 

You are on the right track but you will need to take one day at a time and be consistent with your dosing.  Shep's post above is excellent, especially about how to keep track of your drugs and doses.

 

Learn to accept what is happening here and now, and don't compare it to the past.  These topics might help:  Acceptance and Acceptance and Mindfulness

[Rico]

Thanks ChessieCat. I will be patient this time and listen to those around me. I will get the compounding formula from the pharmacy sometime this week and will just do a 10% reduction and report back on progress.

[Rico]

Acceptance

I find acceptance hard at the moment. From the day I was given a diagnosis and medication at the age of 18, I never accepted having a "mental illness". A stressful breakdown due to university led me to be on antipsychotics (first one was Risperdal). I hated the drug, and I was extremely cognitively impaired.

 

My will to fight though, was strong. I started reading simple books, doing simple maths, and also found my spirituality too. I worked very hard to get better. I had all sorts of drugs thrown at me. I even refused to accept disability payments and got a job selling vaccum cleaners door-to-door. I got sacked within two weeks because I crashed the car (sleeping at the wheel because of Risperidone sedation).

 

My goal was to return to university, and I achieved that. I was on a daily dose of 5mg Zyprexa, 2000 Epilim and 1350 Lithium. Although I slept for 12-14 hours daily and became pretty overweight, I managed to get a distinction average and finish most of the degree. I fought all the way, every day. I hid my inner struggle from everyone around me. I was always withdrawn internally and quite depressed. Anedhonia is the best term to describe me.

 

Despite this, I pushed through. I built a successful career in IT and had relationships and my hobbies have always been fast cars and motorbikes. I always struggled with taking Zyprexa - I couldn't function in the morning at work and thinking was a struggle. I would regularly have 2 red bulls and chocolate in the morning just I wake up.

 

In 2007, during a hospitalisation, they took me off Zyprexa and I was just on Epilim and Lithium. For the next 5 years, I was finally able to function. I progressed well in my career and was pretty "normal". The dose of Epilim and Lithium were even small too - neither was in a therapeutic range.

 

Unfortunately, I became distressed because of a relationship issue in early 2012. I went to see my psychiatrist about it - up until then, I was barely seeing him. Also, up until then, I had just accepted that I was bipolar and that any negative behaviour in my life was just a symptom of my illness.

 

How ridiculous this sounds now. When I went to see my psychiatrist, he told me the medications are not working for me anymore and this is why I am having issues. He then picked up a brown box where he pulled out a sample packet of Saphris. He had just received them from the pharmaceutical company and he told me that if I take this wafer I Saphris, I would not need Epilim or Lithium. I was the first of his patients to try this drug, so his information was purely from the pharmaceutical company.

 

I had no idea those days about the dangers of antipsychotics (Saphris is an antipsychotic) or the bullsh*t that I was been fed by this doctor (since the age of 18). In fact, I was excited that I would have only one tablet to take and all my problems would be solved. This doctor by the way, also discouraged me from seeking therapy with a psychologist because I had a biological condition and that psychologists were "superficial and useless".

 

He also told me that I can stop the Epilim and Lithium CT after I start the Saphris. Within 4 days of taking Saphris, I became extremely ill. I wondered the streets day and night in a dazed, confused and traumatised state. I endes up two weeks later taking myself to the emergency department asking for help. I was hospitalised and lost my job an apartment. This was in 2012 and was indeed the turning point in my life thanks to this "doctor".

 

Each time I ring this topic with him, he just says "Saphris didn't work for you". Makes me angry. In 2013, I was hospitalised and discharged on a small dose of lithium. I had also secured a high paying job with an investment bank that I was going to start within a few weeks. When I went to see my doctor he said "lithium won't hold you, you need more". He prescribed 10mg of Zyprexa, 2000 Epilim and 1350 Lithium. I was completely zonked out and when I started the new job I could barely function.

 

It's at this time also that I met my lovely girlfriend who is still by my side today. When I told my pdoc that I couldn't function at work and was sleeping in the car at lunch, he tapered the Zyprexa over - week! I was in hospital again within a matter of weeks. To this day, he reckons that this tapering has worked for other patients. bullsh*t.

 

After a year in this role struggling to be well and completely unaware of withdrawal symptoms etc, I lost the job. I then gave up. I CT of all meds and just gave up. I went to the beach and just sat there in intense mental pain from the withdrawal and couldn't care less. A week or two later, I called the ambulance myself because the anxiety was too much. When they found out I had "stopped my medication" in the hospital, they put me on a treatment order using Invega Sustenna - pure hell. After seeing how bad I was on it, they stopped after two injections.

 

Unfortunately, they were LAI's with a median half life of 49 days. I went through hell for months because of this drug. But I kept fighting. I got another job last year taking the same meds I am on now. I soon developed tinnitus and experiencing very unusual neurological symptoms. I remember my first day at work just staring at the high rise apartments in the distance fantasising about suicide. If it was not for my girlfriend, the most beautiful girl in the world, I honestly would not be here. The rest of that year was trying to get off Zyprexa. After a few failed attempts, I managed to get off it.

 

Earlier this year though, everything fell apart when I got off the Epilim and lithium too, too quickly. Five hospitalisation later, overweight, depressed and dysfunctional, I am writing this. I am overwhelmed when I think about what the hell happened to my life. I blame myself for it but still angry with my doctor who has been most unhelpful. I have left out a lot of detail here because so much happened this year that is so difficult to comprehend.

And this is why I find acceptance difficult. I feel I am at fault and at the same time a victim. I am also worn out and tired of all this. It's been going on for way too long. It's not so much that I don't have the patience for tapering, it's that I am tired. My will is weak. I also have to file for bankruptcy, and I am pretty isolated during the week. And of course, I am scared. I don't want next year to be a repeat of this year. I simply couldn't do it. And lastly, I love my girlfriend so much and want to marry her, and I just don't feel adequate enough as a person.

Sorry if this post was too long, but thank you for reading it.

Edited October 30, 2016 by Shep
added paragraph breaks for legibility

[Shep]

Hi, Rico.

 

Thank you for sharing your story. I added paragraph breaks to make it easier for everyone to read. 

 

Your story is quite powerful, and you've overcome a great deal. 

 

The fact that you went to college and built an IT career while taking these very powerful mind altering drugs says how strong and how smart you are. I also made it through college while on massive amounts of drugs, and it was a struggle each and every day with memory problems and severe fatigue. 

 

There's an analogy that I like to share:  when you are on these massive drug cocktails, it's like having weights on your ankles and wrists. You carry this weight with you, 24 hours a day, seven days a week. It's a struggle far and above what everyone around you has to deal with.

 

But as you shed these drugs, you shed these weights. And as you slowly get off these drugs and enter the recovery phase, you continue to shed more and more of the weight, more and more of the burden. 

 

Until one day, you are healed enough to realize exactly how much weight you've had to shoulder all of these years. And you realize exactly how strong you are now. So even though it's hell right now, you are building up mental and physical strength.

 

So I don't think any of this is a waste or reason to beat yourself up over. 

 

Keep moving forward, Rico. We'll be with you all the way. 

[Rico]

Thanks Shep for the encouragement and support.

I have settled down a lot, but generally feel slow and feel like I am "mentally disabled". My concentration is not the best and I am very annoyed with the side effects I experience from the drugs - especially my memory.

Here's what's been happening:

Yesterday:

8:00am woke up at girlfriend's place depressed.

5:00pm - took Epilim 1000mg

6:00pm - became very depressed - as always happens after taking the Epilim. It's not a melancholy type depression - I feel like my whole nervous system is shutting down and I just feel awful.

8:00pm - took the lithium 900mg and Zyprexa 2.5mg

8:30 - went for a walk. I noticed that my brain just felt like jelly. Complete apathy and just zoned out.

10.00pm - went to sleep. Sleep was ok, but i noticed that during the night I feel dehydrated and toxic.

Today:

Lay in bed feeling depressed and my thoughts were disorganised.

12:30pm - got out of bed to have breakfast.

------

I am planning to start a taper of the Zyprexa once the solution comes through sometime this week.

However, something has to be done about the Epilim. The depression is very bad once I take it.

I was thinking of dividing the dose over the morning and night. And also thinking, I may as well divide the lithium over morning and night too.

I would really like to reduce it, but I know that others here have recommended one medication at time. Which does concern me because I don't want to be in Epilim for a long time just because I am tapering Zyprexa.

For now, what do you think of this as a plan:

Morning: 500mg Epilim, 450mg Lithkum

Afternoon: 500mg Epilim, 450mg Lithium

Night: Zyprexa 2.5 and begin tapering

Thanks
 

Edited October 31, 2016 by Shep
removed real name

[JanCarol]

Hey Rico - 

 

You said:

 At one stage earlier this year, I was discharged from a hospital on lithium alone (1500mg) and I felt good. I then thought I didn't need it and stopped it abruptly. I have been to hospital several times this year and it pains me to say that I have learnt the hard way. 

 

This is why we insist upon the 10% of previous dose taper, no more often than once a month.

 

Going off the drugs you are on too quickly - the Epilim can cause rebound seizures, the Zyprexa, rebound psychosis, and the Lithium, rebound mania, if they are Cold Turkey'd (CT'd) or tapered too quickly.

 

 I have smoked a lot of cigarettes today, and I was thinking maybe the nicotine is making me buzz too much. I was also thinking is this an akasthisa symptom of Zyprexa?

 

Yes, any nervous, restless activity can be caused by akathisia, but cigarettes are special in that they ameliorate some of the effects of the Zyprexa.  There are a lot of people who smoke just to balance out their neuroleptics.  The cigarette gives a little, instant "hit" that smooths some of the uncomfortable feelings of Zyprexa.  The problem is, it is very short acting - and incredibly addictive.

 

But worry about that one later.  If it feels cruels to smoke, then quit.  If it feels cruel not to smoke, then smoke.  At some point, as you get healthier, the balance will tip towards you wanting to choose healthier things.

 

Have these drugs permanently damaged me? Is there any way I can get off them faster?

 

The damage will improve, as you come down in dose.

 

Trying to hurry the process can cause more damage, and then the process actually takes longer (and may involve crises and hospital visits and more drug cocktails!).  That's why we go slowly.

 

Why taper by 10% of my dosage?

 

See:

The slowness of slow tapers 

 

I wish I had a social drumming group to go to!!!!

 

 Do I need to check in to a private hospital? 

 

A private hospital is not going to have any more recognition of withdrawal and side effects than a public one.  Fact is, a friend of mine (here in Oz) got drugged to the gills by a private hospital, and then when she went flying into a public emergency room from a toxic reaction, they recognized right away that she had akathisia.  She was stunned that they recognized it (but I suspect it is still quite rare here in Oz to respond this way).

 

If you are in danger of harming yourself or others, then perhaps you should consider hospital.  But know that you are likely to get fast switches (quit one drug, start a new one), too-fast tapers, cold turkeys, and new drugs when you go to a hospital complaining of symptoms.

 

Studies show that if you have "mental illness" on your chart, doctors are more likely to discount what you are telling them.  This becomes really difficult when there is an actual, physical illness - and the doctors put it down as part of the "mental illness."

 

I totally understand the 10% tapering method. It makes a lot of sense but the thought of staying on this drug for such a long time makes me very depressed. 

 

The good news is, you don't have to wait until you are totally off the drugs to start feeling better.

 

As your drug load reduces, you will find that your condition improves, even when you are having waves of symptoms.  It does get better, but you need to be patient, gentle, and easy, easy easy with yourself, in order to heal.

 

The goal is to sneak away from the drug, like you were sneaking away from a predator - like a lion or a bear.  The big cats, in particular, pounce on anything that moves, so you want to do this very quietly, in stillness, moving only one tiny step at a time so that you get away before the predator / drug notices!

 

 i noticed that during the night I feel dehydrated and toxic.

 

Please make an effort to stay hydrated.  Dehydration is a condition under which the lithium can become toxic.  All it takes is - too many red bulls and not enough water and your kidneys won't be able to handle it.  Try and switch out some of your red bull for electrolytes, or add himalayan pink salt to your diet to keep your micro-minerals up.  Your kidneys will thank you.

 

You have been on lithium for over 5 years now, and it is likely to be the last one to taper.  You need to take care of yourself through this process because you are walking a tightrope between these drugs (and with all those weights on your wrists and ankles - that was a good image, Shep!), and taking care of yourself will be essential on the path to get off of them safely.

 

I was thinking of dividing the dose over the morning and night. And also thinking, I may as well divide the lithium over morning and night too.

 

This will make your tapering more complicated, later.  Then you will need to taper 2 doses daily, and possibly set up liquid or cut tablets for 2-3 drugs at 4-6 doses per day.  If you can avoid doing splitting your doses, it will make your tapering schedule much easier.

 

If you are looking for a schedule, consider:  lithium in am, The more agitating brake (zyprexa?) in the afternoon, and the more sedating brake (epilim?) in the evening. 

 

It does get better, but it will take time, patience, diligence, and self care.

 

I hope you see the sun today.

[Rico]

Thanks JanCarol, I think moving the lithium to AM is a good idea.

 

I had a horrible sleep last night and woke up very depressed and tired. I feel quite sick.

 

Yesterday

 

5:00pm - took the Epilim 1000, headache, feeling slow, a bit depressed

 

8:00pm - took the lithium 900mg and Zyprexa 2.5

 

Started feeling zoned out, pressure in eyes and discomfort in front of my brain. I know this is from the Zyprexa

 

10:30pm - went to sleep in a confused state, found it difficult to close my eyes because of the pressure I felt behind them.

 

Somehow "fell asleep" but woke up very depressed and tired like I hadn't had any sleep at all.

 

Today

 

10:30 - took the lithium 900mg

 

I am getting really sick of the Zyprexa and what it is doing to me. It never used to do this to me before. It used to be sedating and that's it. I feel now that it is causing a lot of damage.

 

I tried taking it in the afternoon before, and fhe Epilim later, but that didn't work because the zones out feeling at 5:00 pm was unbearable and the Epilim kept me awake.

 

I am really frustrated and sick of being this toxic. I have thoughts that going to a private hospital will solve this problem and I will come away feeling better and on less medication, but I know deep down that this is unlikely.

 

This is so hard. I am barely functioning today. I am planning to start the Zyprexa taper later this week when the liquid formula comes through.

 

To be honest, I don't feel like a 10% reduction is going to make any difference. Given that the Zyprexa is screening me around like this, shouldn't I taper off it faster? I feel like I am poisoning my brain everytime I take it now.

 

Thoughts anyone??

[JanCarol]

Yes, a 10% reduction will make a difference, but you must be patient!

 

Here's my "wolf or bear" post, that I alluded to earlier:

 

Think of the Zyprexa as a wolf or a bear.

 

When you are in the wild and you encounter one of these things, the FIRST thing you must do is: KEEP CALM.  (yeah, I know, the meme and all, but it's true)  The next thing you do is DON'T MOVE!

 

If it is a total standoff and you want to get away, you CANNOT run.  It's you and the bear.  If you run, the bear and wolf have a hard-wired instinct to chase, and you will lose.

 

The goal in a standoff with a bear is to sneak.

 

That's what a taper is.  Sneaking away from the wolf.  You've seen a cat stalk - it waits until the prey is not looking, then moves a bit (maybe 10%?)  then it waits.  And waits.  And waits.  Holding will save your life, when you are in a standoff with a bear.  And olanzapine and Epilim are a bear and a wolf respectively!

 

Before, you dropped your berries and ran away (CT), and the bear caught up to you.  Didn't work. 

 

The goal is to sneak the drug out of your system sooooooo slowly that your brain hardly notices it's gone.  And doesn't chuck a wobbly like before.

 

Please read the The slowness of slow tapers  to see what others have said.  It's actually faster to go slow, because you don't go into crisis.

 

I hope you see the sun today.

[Rico]

Today

 

9:30 - woke up extremely depressed

 

10:30 - took lithium 900mg

 

Felt slow and depressed all day. My memory is very bad and I am very weak.

 

4:00pm - totally crashed, felt like my brain was having a fit inside my head, severely depressed.

 

5::00pm - ordered the liquid form of Zyprexa which will come on Thursday

 

5:30-7:00 - slept on the couch as I was mentally exhausted. My mind wouldn't switch off, but I just lay there and sort of slept.

 

I am really scared. I fear that even the lithium is causing problems. I feel so depressed and disabled. I don't want to go to hospital. I feel so fragile, depressed, and mentally exhausted. I can barely function. I just want to be well.

 

I honestly feels like there's something horribly wrong with my brain. All the drugs are making me sick and I am not moving forward at all.

 

I'll take the Zyprexa soon and just sleep because I am mentally exhausted.

 

Does anyone have a clue as to what is going on please?

[Altostrata]

Rico, you seem to change when you take your drugs and their dosages quite frequently.

 

Every time you do this, your system has to adapt to it. This can take a minimum of 4 days to many weeks.

 

We're not miracle workers. If you choose to improvise and then feel worse, we're not going to be able to tell you what's going on.

 

We keep on telling you to keep dosing steady so you can get a better idea of what does what. You don't seem to want to do this.

 

I think you have the general idea of tapering, though you don't like it. All of this is up to you, really. We can't wave our magic wands and get you off the drugs. You're going to have to figure this out yourself.

 

If you want to take your drugs on yet another schedule, that's your decision. If you want to use the liquid to reduce Zyprexa, that's your decision. You've introduced so many variables, we cannot predict what will happen or how that taper will go.

[Rico]

Alto, I am quite confused now.

 

I haven't reduced any doses of the drugs. I am just feeling so sick from all of them and trying to find a way to not feel as sick.

 

Taking the Zyprexa earlier didn't work for me because I felt worse after 5pm.

 

Taking the Epilim earlier helped a little, but I would get very depressed after taking it.

 

Following the suggesting of another member, i took the lithium in the morning, and the Epilim in the afternoon and Zyprexa at night (that was yesterday).

 

I figured it would make sense to divide the doses of Epilim and Lithium so that I would not feel like crap at 5pm and leave the Zyprexa at 8pm.

 

What should I do??? I haven't started tapering any drug, I have only moved around the Epilim and Lithium because of the effect they have one me.

 

I am really lost now. Please bare with me.

[ChessieCat]

Hi Rico,

 

It looks like you forgot to state when you took your Lithium in Post #106.