success ☼ Undiagnosed1: Unsure of what to do next

[Undiagnosed1]

 

fully-functional-undiagnosed1

 

Hello all,

 

New to the site. A little about my situation, After being prescribed 300mg gabapentin twice a day + 900mg before bed, 15mg remeron before bed, and 100mg trazodone before bed for what's said to be anxiety disorder that appeared out of no where.

 

I visited a psychiatrist per the hospital. It took me two weeks to find one to see me, upon my visit she says that she wanted to get me off as much as possible as she thought the gabapentin should be all I needed. She stated that I should be able to stop the Trazodone and remeron right away with no issues. I questioned weather this was a good idea....

 

Anyways I decided that the trazodone had to go first because of the side effects I was having from it tapered from 100mg to 75 for two days then fifty for two days noticed a slight down feeling then 25 for 4 days "what a mistake" on the forth day I felt so bad racing thoughts of hurting myself, really bad depression "which I have never had" and more than an hour of servere anxiety if not for the gabapentin surely I would have been flailing around like a fish out of water.

 

I found this site that night after everything seem to calm down and decided to updose. I owned a mg scale and went back up to 37.5mg. First day was great present day not so good, pretty ok morning around 12pm started having stomach issues and some feeling down laid on the couch for several hours started to feel better so I went to the gym and did my daily 8 mile bike ride.

 

My problem is that I am supposed to return to work on the 30th or lose my job and insurance.I don't know if I updosed correctly or how to stabilize enough to return to work. I would appreciate any advice I can get at this point. So upset because this is the first time in my life I have had to take any meds daily, feeling so lost.

 

Edited January 19, 2019 by ChessieCat
added link

[scallywag]

Undiagnosed -- Welcome to Surviving Antidepressants (SA)

 

Reducing dosage as quickly as you have with trazodone has a high risk of triggering symptoms. It's beyond unfortunate, and should be a medical practice license-revoking offence in my opinion, to fail to advise patients to gradually make small reductions in dose of neuroactive medications. Doctors are "mis-undereducated" about the effects of these medications, largely because the pharmaceutical industry does the vast majority of the research and has little incentive to investigate the negative effects of their money-making products.

 

The symptoms you are having -- thoughts of self-harm, "depression," and heightened anxiety -- are likely caused by the dose reductions. You can read more about withdrawal symptoms at this link:

What is withdrawal syndrome.

 

Here are a few links that discuss how dose reductions can cause these symptoms, even though you're still taking the medicaitons:

One theory of anti-depressant withdrawal syndrome

How your brain responds to psychiatric drugs - aka "Brain remodeling"

 

When a someone is taking multiple medications, we ask that that you post an interactions report. Please include all drugs you are taking for ANY reason: prescription, over-the-counter, or street drugs. Follow the link below to get your report. Just select the text, copy it and paste it in a post here.

Drugs-dot-com Drugs Interactions Checker.

 

A request: Would you summarize your history in a signature -- drugs, doses, dates, and discontinuations & reinstatements, in the last 12-24 months particularly?

• Any drugs prior to 24 months ago can just be listed with start and stop years.
• Please use actual dates or approximate dates (mid-June, Late October) rather than relative time frames (last week, 3 months ago)
• Spell out months, e.g. "October" or "Oct."; 9/1/2016 can be interpreted as Jan. 9, 2016 or Sept. 1, 2016.
• Please leave out symptoms and diagnoses.
• A list is easier to understand than one or multiple paragraphs.
• You can find instructions in this topic: Please put your withdrawal history in signature
• If you are using a phone or mobile device, you need to switch to the "full" or desktop version of the site. Instructions are in Post 9 and Post 10

We suggest that people take a very conservative and cautious approach to tapering: reducing by no more than 10% per month to minimize the risk of withdrawal symptoms.

Why taper by 10% of my dosage?.

 

Topics relevant to your medications:

Tips for tapering off trazodone (Desyrel)

Tips for tapering off Remeron (mirtazapine)

Tips for tapering off Neurontin (gabapentin)

 

Lastly, please be conservative with exercising. Your CNS (central nervous system) has been destabilized by the dramatic reductions in trazodone. Vigourous exercise can make your symptoms worse. You may need to slack off considerably from what you used to do. Most of us find that gentle exercise -- walking, swimming, yoga, tai chi, etc. -- is the least disruptive to our well-being.

 

This is YOUR introduction topic -- the place for you to ask questions, record symptoms, share your progress, and connect with other members of the SA community.

 

I hope you'll find the information in the SA forums helpful for your situation. I'm sorry that you are in the position that you need the information, but am glad that you found us.

[Undiagnosed1]

Interactions between your selected drugs

 

Major trazodone  mirtazapine

Applies to: trazodone, Remeron (mirtazapine)

Using traZODone together with mirtazapine 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.

 

Moderate trazodone  carvedilol

Applies to: trazodone, Coreg (carvedilol)

Carvedilol and traZODone may have additive effects in lowering your blood pressure. You may experience headache, dizziness, lightheadedness, fainting, and/or changes in pulse or heart rate. These side effects are most likely to be seen at the beginning of treatment, following a dose increase, or when treatment is restarted after an interruption. Let your doctor know if you develop these symptoms and they do not go away after a few days or they become troublesome. Avoid driving or operating hazardous machinery until you know how the medications affect you, and use caution when getting up from a sitting or lying position. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

Moderate trazodone  gabapentin

Applies to: trazodone, gabapentin

Using traZODone together with gabapentin 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.

 

Moderate gabapentin  mirtazapine

Applies to: gabapentin, Remeron (mirtazapine)

Using gabapentin together with mirtazapine 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.

 

Moderate carvedilol  mirtazapine

Applies to: Coreg (carvedilol), Remeron (mirtazapine)

Carvedilol and mirtazapine may have additive effects in lowering your blood pressure. You may experience headache, dizziness, lightheadedness, fainting, and/or changes in pulse or heart rate. These side effects are most likely to be seen at the beginning of treatment, following a dose increase, or when treatment is restarted after an interruption. Let your doctor know if you develop these symptoms and they do not go away after a few days or they become troublesome. Avoid driving or operating hazardous machinery until you know how the medications affect you, and use caution when getting up from a sitting or lying position. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Edited January 17, 2017 by scallywag
highlight level of interaction

[Undiagnosed1]

As I know there is no for sure answers, but my question is even after such a short period of time will the taper take as long as mentioned?

And as far as my updose do you guys think it was enough? And could stabilization happen within a week or so? Feeling lost in this endeavor...

[scallywag]

Some people can taper easily and quickly off medications after briefly taking them. You say you had symptoms occur after you'd reduced from 100-75-50-25 over 8 days, a sign that the reductions were too much too fast. I'm not sure what to suggest and have asked other moderators to have a look at your question.

 

What were the side effects you were having that prompted you to start to taper trazodone?

 

Your symptoms and any pattern that occurs may be helpful to suggesting a next step. Please keep notes on paper of your symptoms and the times of your dose(s). This post has a useful format for a daily log:

Take notes of doses and symptoms.

 

Post each day's log here in your introduction as a new reply.

 

We'll get back to you soon with some ideas for a next step and an answer to your question about tapering more quickly.

[Undiagnosed1]

What prompted me to choose to taper trazodone first was that it stopped helping for sleep it made me a complete zombie

the day after had urine retention and my memory seems to be bad.

 

My fast taper was prompted by the doctor telling me I could stop both remeron and trazodone completely all at once.

I was very skeptical of her recommendation, so I chose to try the one causing me the most issues or so I assume.

 

She also performed a GeneSight psychotropic test which I had never heard of and stated that the reason for my side

effects of both were because my cyp1a2 and cyp2d6 had variation was found in genotype that may impact the response

to the medication which are receptors that both the medications used. I'm not educated about this stuff...

 

She wanted to put me on pristiq if I felt any depression and I refused any more medication until I could get off of some of the medications I was currently taking. She had no problem with this request.

 

I have been keeping notes since the day I was put on them in the hospital.

 

If my math is correct using the scale I have been taking around 37.5mg 0.214 this is my third day at this weight/mg

on 1/15/17 I felt great most all day.

 

On 1/16/17 I had a slight down feeling for a couple of hours also pretty zoned out,

GI issues around lunch time which calmed down after a couple of hours, still feeling zoned out decided to go to the gym

and do my 8 mile daily bike ride, after my workout I felt more myself the remainder of the night.

 

1/17/17 I felt pretty good thus far other than I started feeling pretty tired at about 1:00pm after eating my lunch at

2:30 I seem to have a little more energy.

 

As far as dosages and times

Gabapentin 300mg Coreg 12.5mg 9:30am

Gabapentin 300mg Coreg 12.5mg 3:30pm

Gabapentin 900mg Remeron 15mg Trazodone 37.5mg 10:15pm

Bed at 11:00pm

[nz11]

She wanted to put me on pristiq ...

So are you saying the doctor is using the genesight test to better guide her drug recommendations and as a result of the test it is suggested  pristiq is the drug for you? ..ie the test concludes pristiq better matches your genetic profile.

 

nz11

curious

[Undiagnosed1]

Only if I felt any depression. Which I only feel during the w/d.

 

Yesterday I felt good all day minus a little flat feeling in the afternoon which I attribute to the mirtazapine.

 

So far this morning I woke up with racing thoughts. I hate this up and down  

[Undiagnosed1]

Totally zoned out all day with absolutely no motivation. Someone please advise.....

[Undiagnosed1]

Woke up this morning feeling sedated and depressed

 

forced myself to get up went and washed car felt a bit better

 

forced myself to go shoot a game of pool at friends house

 

then it happened the trigger word was said "s " word

 

started my mind racing/ self harm thoughts caused bad anxiety which I'm still experiencing.

 

I hope these feeling and thought stop soon I need to stabilize   

Edited January 21, 2017 by ChessieCat
unitalicised font for easier reading

[scallywag]

Today is the 19th, 5 days after your increase to 37.5 mg. It can take at least another week to stabilize after a dose change, so the 26th.

How long to stabilize after reinstating or updosing.

 

Your symptoms may have settled by the time you need to return to work, and they may not.

 

When was the last time you spoke with your doctor? How helpful or supportive is your doctor? Would s/he support a longer time off work in writing?

[scallywag]

Hi Undiagnosed. A symptom log will probably be very helpful in best-guessing a next step for you. Would you keep posting your notes here in your intro topic in the format outlined in the post linked below?

Take notes of doses and symptoms.

[Altostrata]

Hello, Undiagnosed.

 

Yes, it is possible you will stabilize on your trazodone updose before the 30th. Stay as calm as possible and make sure to take your drugs on the same schedule each day. As scallywag mentioned, keeping daily notes on paper about your symptoms, when you take your drugs, and their dosages would be very helpful.

 

You are fairly dramatically overmedicated as it is. If I were you, I'd get untangled from your current drug cocktail before adding anything.

 

Why are you taking Coreg? Why mirtazapine and trazodone? Were they both added at the same time?

[Undiagnosed1]

Hello Alto,

 

First I'd like to thank you and Scallywag for your responses. I will try to keep this story as short as possible.

 

In August of 2015 I was given Bactrim for an infection after 5 doses I got Stevens Johnsons Syndrome.

It was horrible, 5 days in ICU and another 1 1/2 months to recover at home.

 

In July of 2016 I was bitten by a black widow caused severe muscle contractions which I now realize was a bad panic attack.

I had very wobbly legs for a week and the panic attack blew out an old hernia.

 

1st of August I had the hernia repaired and spent another 2 months at home.

 

During my recovery I got a sinus infection and that's when everything took off like a rocket ship.

Started having extreme anxiety and panic attacks.

 

My gp gave me Xanax which worked but as you know it's poison. Couldn't function at work, sleeping in my car etc. 

Took it for a little more than a week and had to stop. Went through 3 days or so of withdraws, which caused more anxiety.

 

Went back to my gp he prescribed Zoloft, It caused Ideations

 

Went back to my gp he prescribed Lexapro, It also caused Ideation

 

This was all within weeks of each other. I withdrew from all of that which was worse than Stevens Johnsons x5

 

After having anxiety and panic attacks with nothing for weeks, And not sleeping for days I went to the ER on December 23rd

They fed me .5 Ativan sent me home with .5 Ativan. I slept about 6 hours and awoke with bad anxiety and panic attacks.

 

I returned to the ER on the 24th and was told there was nothing they could do for me If I didn't want to hurt myself and released me.

 

On Christmas day I was determined they were going to help me or so I thought... So I went in and said I wanted to hurt myself

"not a true statement"  Wham! I was admitted to the ward.

 

The first drug I was given was Gabapentin 300mg twice a day "what a god send" But I was still not sleeping at all.

The second drug given was the mirtazapine 15mg. I slept that night and woke up like a bus hit me.

The next night I could not get to sleep was given .5 Ativan and slept through the night.

The third night he added 100mg Trazodone and 12.5 x 2 Coreg "my bp was 163/117 and I'm 35 yrs old.

I was knocked out

The following day he said well that's it and released me from the hospital....

I was told to find a cbt therapist and a psychiatrist.

 

I was unable to get in with a psychiatrist until the fifth of January

In the mean time the meds had stopped working for sleep.

 

When I saw the psychiatrist she recommended 900mg of gabapentin before bed would help me get to sleep "it did"

and was told to stop both the mirtazapine and trazodone cold turkey. I was very skeptical of this as I had already

read otherwise but wanting so badly to get off of these meds that I found out were ad's after the fact that I made the

choice to do a rapid taper one at a time. As follows 

 

1-6 75mg Trazodone

1-7 75mg Trazodone

1-8 50mg Trazodone

1-9 50mg Trazodone noticed racing thoughts and feeling a bit down

1-10 25mg Trazodone

1-11 25mg Trazodone

1-12 25mg Trazodone

1-13 25mg Trazodone That day it hit me like a ton of bricks. Severe anxiety Severe feeling of depression which I never had before.

1-14 updosed by weighing out a 50mg pill to 0.214 = 37.5mgs and the waves began.

 

I'm now 7 days into it and have a groggy mornings a feeling of depression from 1:00pm to about 3:00pm and then its up from there having really good nights. The symptoms during the days vary but my nights seem to be really good. I hope it continues to get better.

I'm sorry for the novel but I wanted to be as informative as possible.

 

My med times and dosages do not change and are as follows

 

300mg Gabapentin 12.5mg Coreg 9:30 am

300mg Gabapentin 12.5mg Coreg 3:30 pm

900mg Gabapentin 15mg Mirtazapine 37.5mg Trazodone 10:15 pm Bed at 11 pm

 

I also cycle 6 to 8 miles 5 days a week which seems to help me...mentally atleast

[scallywag]

The fact that your symptoms lighten after 3 pm is a great sign. What time do you take the trazodone?

[Undiagnosed1]

10:15pm

[scallywag]

Have you tried taking it earlier so that more of the groggy time occurs when you're sleeping?

[Undiagnosed1]

I have not as I was told to take at the same time...

[Undiagnosed1]

1-22

 

8:00am awoke felt great

9:00am gabapentin 300mg 12.5mg coreg

9:30am church very zoned out feeling through service

11:00am cleared up some

12:00pm very slight low feeling till 12:30pm

2:00pm started to feel better overall

3:30pm gabapentin 300mg 12.5 coreg

4:00pm felt great for the rest of the evening / went to gym etc

[scallywag]

If you wanted and it works for your schedule, you could try taking it an hour earlier for a week or so to see if that makes a difference. If it does shift your wake-up time out of grogginess, that's useful information and you could try edging the time you take it earlier by shifting it again by 30 minutes. If it makes no difference, either keep it at 9:15 or move back to 10:15 based on whatever works best in the evenings for you.

[Undiagnosed1]

1-23

 

8:00am awoke feeling good

9:30am 300mg gabapentin 12.5 Coreg

12:30 - 1:45 racing thoughts / feeling down / bad gi issues

3:30pm 300mg gabapentin 12.5 Coreg

felt good most all afternoon minus gi issues

10:15 900mg gabapentin 37.5mg trazodone 15mg remeron

[Undiagnosed1]

Thank you for the suggestion scallywag the grogginess seems to be letting up as I start to stabilize. I just wish I could level out

[Lama]

Hi,

 

I'm on trazadone and trying stabilize, it's hard.

Glad to hear your doing better.

[scallywag]

Good to read that you're noticing improvements. Stability is good.

[Undiagnosed1]

Thank you for stopping in lama.

 

Your right it is hard each day can seem so long and the mental symptoms can be disturbing at times if it was all physical symptoms I think I could handle it

fairly well. Its also hard not knowing what the next day brings but all we can do is stay strong.

 

I just can't wait till I stabilize for a while and I can start the journey to tapering off atleast one of these drugs at a time.

 

Scallywag Thank You for all the support you have given in my time of need.

 

Curious as to what Alto will have to say, How often does she stop in?

[Undiagnosed1]

Needing some help since my drop in trazodone I've been waking up to severe anxiety and panic which I'm reading are cortisol spikes. The anxiety last about four hours and has happened the past two days. Its very disturbing and I wonder how long this may last as its driving me mad. I have contemplated going to the hospital but I know that's not the best idea. My question is will this subside in a reasonable amount of time?

[Lama]

Yes they do. It's time that takes a while. I'm trying stabilize too. How long have you been taking this dose?

[Undiagnosed1]

Two weeks today

[Lama]

Yes just keeping taking it, it takes awhile 2 weeks is not much time . Give at least 2 more weeks. That's the normal time. See how you do. Wish you well soon. I'm on 6 week and still a little anexity here and there. The what if and fear.

[Undiagnosed1]

Ty got my fingers crossed its horrible

[Lama]

It's worst feeling in world. Just keep praying.

[scallywag]

Undiagnosed, In the topic about cortisol surges in the Symptoms forum, Waking with anxiety, managing cortisol spikes, members discuss their experience with this and what they've tried to cope with or reduce it. You may find a useful idea or two there.

[Undiagnosed1]

Thank you scallywag that thread is where I learned what was happening to me. I'm hoping it doesn't last like some were speaking of

as I noticed they spoke of when they went off all together.

 

I can summarize my last two days

 

6:30am awoke with really bad anxiety/panic racing thoughts

10:30am anxiety/panic and racing thoughts stopped

pretty foggy remainder of day till 5:00pm

went to the grocery store and etc with no problems

 

no dosage changes nor times

[Undiagnosed1]

Forgot to mention I installed the black out curtains in hopes that it helps

[Undiagnosed1]

I swear this stuff is making me depressed... I was never depressed before even during my extreme anxiety and panic attacks. I have bad fatigue and no motivation... Any suggestions would be greatly appreciated

[ChessieCat]

Hi,

 

Are you able to give a more detailed description of your symptoms?  Do they follow a pattern?