Remeron88: greetings - need some help

[Remeron88]

Yes, I had some minor insomnia, panicked, and went back on a full dose of Zoloft and added Remeron.

 

The last worsening of my tinnitus on 6/27/2020 (hearing tones over almost every song now) hasn't lessened or improved.

[Altostrata]

What drug or supplement change did you make in June prior to June 27? Did you drink alcohol, take antibiotics, etc.?

[Remeron88]

No, I didn't change or take anything.  I just had my once a week dessert, which was choc ice cream and sauce on Saturday the 27th and then my tinnitus worsened.  I wasn't limiting carbs in meals prior to the 27th either.

[Altostrata]

Between June 1 and June 27, did you make any changes in drugs or supplements, drink alcohol, take antibiotics, etc.? Did you like to listen to loud music?

[Remeron88]

I didn't.  I do however listen to somewhat loud music (70-75 db) for 3-6 hours 3-5 times a week.

[Altostrata]

Please consult Dr. Google about tinnitus. Yours might have very little to do psychiatric drugs.

 

Also check whether the supplements you're taking are good for tinnitus, NAC and lysine particularly.

 

We don't provide general medical advice and can't help you with tinnitus from loud music.

[Remeron88]

What makes you say that it has little to do with drugs?  I don't think this is from loud music, 75 db is not in the damaging category and this started way before I was listening to music.  Why else would I be so sensitive to sugar, alcohol, etc. if my nervous system was not sensitized in some way by the drugs?  Please explain @Altostrata.  Thanks.

[Altostrata]

The tinnitus could be from either, or either could be exacerbating it. You will need to pursue both avenues of self-care.

 

You might also see if it's connected to diabetes. Not everything is related to drugs.

 

It would be a good idea for you to avoid anything that seems to make the tinnitus worse. If you continue to drink alcohol, we can't help you here.

[Remeron88]

My last alcoholic drink was 7/27/19 and I don't plan to ever drink again, same with caffeine and tobacco.  I am actually losing weight since going low carb and I aim to get to 180-190 lbs from 210 originally.  I also eat one meal a day.  As for the loudish music, I suppose I can turn it down some and take my NAC, which is protective, before listening and perhaps add another antioxidant.

 

But the question remains of how to actually improve the tinnitus.  If you or another mod know which med to reduce and how much to give me a shot, I would greatly appreciate it.  Thank you so much.

[Altostrata]

Not sure what you're looking for here. We help people taper off drugs. If that doesn't help the tinnitus, we're not miracle workers who can cure everything.

 

As explained before, you are still taking a significant amount of risperidone, mirtazapine, and sertraline. Any of those or in combination may cause or exacerbate tinnitus.

 

Or you may have tinnitus from exposure unrelated to drugs. Many people have tinnitus from listening to music over headphones -- you could look it up. I have had tinnitus for decades from an ear infection.

 

What we can help you with is reducing your drug burden. We cannot cure tinnitus.

[admike]

@Remeron88 I do have tinnitus as well- developed by venlafaxine cold turkey and going back on it couple days later. I can tell you, it's very likely linked to your medications in your case as well, there are lot of similar reports https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3357564/ for instance. These studies show that tinnitus  can be caused by administering antidepressants, but even cured by it. Serotonine is important player with tinnitus, but other chemicals and brain processes act too. Altostrata is right, there is no wonder treatment or supplement. It is too difficult system which we can't simply control in other ways than stupidly wearing noise making devices in your ears:( But I can tell you this: the less you focus on tinnitus, the less it bothers you- try to use psychology instead of psychiatry, it requires some work but at least it won't do any more damage.

[Remeron88]

Thank you @admike.  It seems like going off and back on a SSRI is the likely cause, which means I need to keep reducing the Zoloft.  The Remeron is probably not helping either.

[Remeron88]

@Altostrata I've used Neosporin on small cuts multiple times in the past couple months.  Could the neomycin in it somehow absorb into my system and cause ototoxicity?  I've read that it doesn't really absorb too much.

[ChessieCat]

 

From https://www.drugs.com/monograph/neosporin-topical.html

 

Quote

 

Neosporin Pharmacokinetics

Absorption

Bioavailability

Topical: Not absorbed to any appreciable extent from intact skin.¹⁴¹ Readily absorbed through denuded or abraded areas of skin or skin that has lost the keratin layer (i.e., wounds, burns, ulcers).^a

 

[Altostrata]

2 hours ago, Remeron88 said:

@Altostrata I've used Neosporin on small cuts multiple times in the past couple months.  Could the neomycin in it somehow absorb into my system and cause ototoxicity?  I've read that it doesn't really absorb too much.

 

You need to read up on tinnitus and figure this out for yourself. I'm not going to do this research for you, period.

[Remeron88]

Since sugar can make my tinnitus worse, do I have to cut out all carbs?  Is it safe to eat minimal carbs and the occasional pizza?

[Altostrata]

Join an online group about tinnitus, please, and figure out the best regimen for yourself.

[Remeron88]

I have a question about ototoxicity.  My wooziness is still present here and there and it's been 3.5 months since my last reduction of the Zoloft.  Could this symptom be from continuing use instead of withdrawal?  Do the drugs cause ongoing 'damage' via ototoxicity the longer you're on them or is dizziness/vertigo more of a w/d effect or sudden side effect?

[ChessieCat]

4 hours ago, Remeron88 said:

Could this symptom be from continuing use instead of withdrawal? 

 

This has already be answered:

 

On 8/20/2020 at 8:32 AM, Altostrata said:

As explained before, you are still taking a significant amount of risperidone, mirtazapine, and sertraline. Any of those or in combination may cause or exacerbate tinnitus.

 

[Remeron88]

I was talking about my wooziness, not the tinnitus.

[ChessieCat]

My apologies.

[Remeron88]

My wooziness has worsened considerably in the past week.  I can't really describe how I feel, it's like lightheadedness meets a 'sloshed' feeling.  This is all most likely withdrawal effects from reducing the Zoloft, right?  Or is it ongoing damage from taking my cocktail?  I need to know so I can hold or reduce accordingly.

 

If it is w/d, and this is from a sudden decrease in serotonin, would taking a serotonergic supplement like magnesium help?

 

I hope you can answer my questions this time.

[ChessieCat]

26 minutes ago, Remeron88 said:

decrease in serotonin

 

SA doesn't "deal" with brain chemicals.  We deal with symptoms.

 

Magnesium is one of two supplements which SA recommends.  The other being Omega 3 fish oil.

 

However, SA's recommendation of magnesium is to provide calming not to increase the serotonin.

 

33 minutes ago, Remeron88 said:

If it is w/d, and this is from a sudden decrease in serotonin, would taking a serotonergic supplement like magnesium help?

 

When tapering it is best to reduce your drug slowly enough so that you keep withdrawal symptoms to a minimum.  Trying to "tweak" your serotonin because you have reduced a drug is only going to confuse the brain and could make things worse.  Even if it didn't, and you increased your serotonin by taking something else, you are still going to have to get off that "something else" too.

 

As part of the reduction process different chemicals in the brain are going to be reduced (because with the drug you are adding chemicals), because that is obviously part of the process of getting off a drug.  The idea is to "sneak" it away slowly enough so that the brain doesn't have to make big changes in one go.

 

I suggest you check out these, especially the one on medication spellbinding:

 

Video:  Simple Truths About Psychiatry - Series of 10 by Dr Peter Breggin

 

[ChessieCat]

  And a reminder:

 

On 6/29/2020 at 12:04 PM, Altostrata said:

You would like advice and I want information. I don't get paid for this. Don't make it difficult for me. Daily symptom notes before further discussion.

 

You have never been forthcoming with daily symptom notes.

 

51 minutes ago, Remeron88 said:

This is all most likely withdrawal effects from reducing the Zoloft, right?  Or is it ongoing damage from taking my cocktail?

 

Without the daily symptoms notes it is difficult to assess whether your symptoms are from the drug combination, and possibly the time/s you take your drugs, or from withdrawal:

 

If you would like assistance to try and work out what is causing your issues you will need to provide the daily symptom notes as requested 2 months ago.

 

From what-will-get-you-warned-or-banned 

 

On 6/16/2011 at 4:45 AM, Altostrata said:

 

Being uncooperative, specifically, not keeping notes and reporting your symptom pattern when requested to do so.

Keeping daily notes of your symptoms, when you take your drugs, and their dosages is quite simple. In many situations, particularly when you're taking multiple drugs, we need this information to tell if a drug is causing an adverse reaction or if an adjustment is working.

 

If, after requested, you avoid doing this, we can't help you. If you persist in withholding this essential information, you may receive more than one warning point, up to being banned from the site (4 warning points).

 

 

 

 

Edited August 31, 2020 by ChessieCat

[Remeron88]

Ok, here's when I take my drugs, give or take an hour.  My dosages are in my signature.

 

Remeron, Risperdal: 1 am

Zoloft: 12 pm

 

Yesterday/Today: I noticed wooziness get somewhat worse after taking my nightly doses.  I woke up in the middle of the night to blow my nose and when I blew out I felt on the verge of vertigo, like something in my head was being tweaked.

Today I stayed in bed until 1:30 pm.  I got up and took my Zoloft, and the wooziness was more or less constant, and persisted during my afternoon walk at 4 pm.  The wooziness has never been this constant.  I then ate dinner (bunch of chicken nuggets) and the wooziness improved.  Still a little better as I write this now at 7:20 pm.

 

Could my low carb diet be causing hypoglycemia contributing to the wooziness, which would explain why eating dinner helped?

 

Thank you.

 

[ChessieCat]

39 minutes ago, Remeron88 said:

My dosages are in my signature.

 

We are all volunteers.  SA is a very busy website with lots of members needing mod assistance.  We are not going to waste our time trying to find the information.

 

Please post your notes as per these instructions and this example.

 

The time of day, dosage, and severity of symptoms are essential information. Include

 

- Time and dosage for all drugs taken throughout the day, psychiatric and non-psychiatric.

- Following each dose, note any symptoms. If you are having a reaction to the drug, it may take hours for a symptom to show up -- that's why we ask you to keep notes all day long.

- If you're not taking any drugs, your symptoms throughout the day.

- Your sleep pattern. Since so many drugs disturb sleep, if you find you're waking in the middle of the night, it could be from a drug you took earlier in the evening. If you're not taking any drugs, there may be ways you can improve your sleep.

And so forth. A diary, in chronological order, looking something like this:
 

Example:

DATE:

 

6 a.m. Woke with anxiety
8 a.m. Took 2.5mg Lexapro
10 a.m. Stomach is upset
10:30 a.m. Ate breakfast
11:35 a.m. Got a headache, lasted one hour
12:35 p.m. Ate lunch
4 p.m. Feel a bit better
5 p.m. Took 2.5mg Lexapro
6 p.m. Ate dinner
9:20 p.m. Headache
10:00 p.m. Took 50mg Seroquel
10:20 p.m. Feeling dizzy
10:30 p.m. Fell asleep
2:30 a.m. Woke, took 3mg Ambien (NOT "took 1/2 tablet Ambien")
2:45 a.m. Fell asleep
4:30 a.m. Woke but got back to sleep

[ChessieCat]

Please post also post a 24 hour period in one go so it is easier to compare the different days.  Thank you.

[Shep]

On 8/19/2020 at 6:27 PM, Remeron88 said:

I also eat one meal a day. 

 

8 hours ago, Remeron88 said:

I then ate dinner (bunch of chicken nuggets) and the wooziness improved.  Still a little better as I write this now at 7:20 pm.

 

Could my low carb diet be causing hypoglycemia contributing to the wooziness, which would explain why eating dinner helped?

 

Please research low blood sugar. You may want to go on a hypoglycemia diet, which means eating small meals and snacks (high protein, low carbs, and low sugar) throughout the day. 

 

A low carb diet is actually good for hypoglycemia. The trick is in keeping your blood sugar steady by eating nutritious meals and snacks throughout the day. So only eating once a day is likely causing or exasperating some of your symptoms. 

 

Here is some information and dietary tips than may help:

 

Hypoglycemia (low blood sugar) diet

 

Suggested meal plan - hypoglycemia (low blood sugar) diet

 

 

[ChessieCat]

12 hours ago, Shep said:

So only eating once a day is likely causing or exasperating some of your symptoms. 

 

Good pick up Shep!

 

From https://www.newhealthadvisor.org/symptoms-of-not-eating-enough.html

 

Symptoms of Not Eating Enough:

 

1. You Have Low Energy

5. You Experience Quick Mood Shifts

8. You Cannot Sleep Comfortably

9. You Feel Depressed

12. You Experience Headaches

 

and

 

This webpage has a diagram showing where and how the body can be affected:

https://www.healthline.com/health/low-blood-sugar-effects-on-body#1

 

[Remeron88]

Date: 9/1/2020

 

12:15 am: take 3 mg Risperidone, 22.5 mg Remeron - notice no change in wooziness, which is improved since earlier that day.

1 am: sleep

9 am: wake up, eat 3 protein bars, go back to bed

12:30 pm: wake up, take 150 mg Zoloft, have protein bar and hard boiled egg

12:30 - 4 pm: wooziness is constant yet better than yesterday, mostly there when walking around.

4 - 6 pm: went golfing, don't notice wooziness at all.

6:30 pm: eat dinner steak and potato with spinach

6:30 - 8:30 wooziness better than earlier

8:20: eat protein bar

8:30 pm: wooziness better

10:30 pm: wooziness present at rest

12:50 eat protein bar

1 am: wooziness gone

1:15 am: take 3 mg Risperidone, 22.5 mg Remeron, go to sleep

 

My protein bars are Costco low carb/sugar: https://www.costco.com/kirkland-signature-protein-bars-cookie-dough-and-chocolate-brownie-20-count,-2-pack.product.100655710.html

 

Brief history of wooziness: The wooziness/imbalance first started 1/22/2020 and lasted about 6 weeks.  It came back 7/2 in response to exercise and then on 7/18 became more or less constant until 7/29 (when it cleared up).  Now its back since 8/27 but more intense and constant.

 

There may be a psychosomatic component to this.  My focus seems to shift from the tinnitus to the wooziness.  A week ago I reached some peace with my tinnitus and immediately the wooziness came back.

 

I know it may seem that eating helps, but the wooziness fluctuates and is more or less random.  Thank you @Shep and @ChessieCat.

[Shep]

5 hours ago, Remeron88 said:

My protein bars are Costco low carb/sugar: https://www.costco.com/kirkland-signature-protein-bars-cookie-dough-and-chocolate-brownie-20-count,-2-pack.product.100655710.html

 

Most protein bars, including this one, are processed. In moderation, they may be okay, but you ate 6 yesterday. I would eat real, home cooked food as much as possible. Many of us have problems with processed food during withdrawal. 

 

 

5 hours ago, Remeron88 said:

1 am: sleep

9 am: wake up, eat 3 protein bars, go back to bed

12:30 pm: wake up,

 

Is this a regular pattern? Do you feel you're overly sedated? 

 

5 hours ago, Remeron88 said:

There may be a psychosomatic component to this.  My focus seems to shift from the tinnitus to the wooziness.  A week ago I reached some peace with my tinnitus and immediately the wooziness came back.

 

This is insightful, Remeron. Try the change the channel technique to see if you can redirect your focus from symptoms to activities that keep your mind busy with more productive thoughts. 

 

Please keep posting your daily notes. 

[Remeron88]

9/2/2020

 

1:15 am: take 3 mg Risperidone, 22.5 mg Remeron, sleep

10 am: wake up, eat 3 protein bars, notice wooziness is ok

11 am: sleep

12:45 pm: wake up, take 150 mg Zoloft, have slice of cheese and hard boiled egg

12:30 - 4 pm: wooziness is worse than yesterday around this time

4 - 5 pm: went golfing, felt the wooziness

6:00 pm: eat dinner (burrito)

6:30 - 8:30 nap

8:30 - wooziness almost gone

11:30 -wooziness pretty much gone

1:15 am: take 3 mg Risperidone, 22.5 mg Remeron, go to sleep

 

For the last 2 days, it only gets bad after i take my Zoloft and then dies down as the day goes on.  But today was worse than yesterday, I felt it during golf.  I'm running out of time, I need advice on whether this is from reducing or taking the meds before this balloons into full blown dizziness/vertigo.  Thanks.

[Shep]

8 hours ago, Remeron88 said:

For the last 2 days, it only gets bad after i take my Zoloft and then dies down as the day goes on.  But today was worse than yesterday, I felt it during golf.  I'm running out of time, I need advice on whether this is from reducing or taking the meds before this balloons into full blown dizziness/vertigo.  Thanks.

 

You've been at 150 mg Zoloft since May 11, 2020 (per your signature), so it could be a side effect. 

 

You also posted this back in September 2019, which also speaks to a side effect: 

 

On 9/21/2019 at 11:23 PM, Remeron88 said:

Today I've been woozy, slightly dizzy and disoriented, and have loss of balance.  Why is this happening after years of staying on the same doses?  Is it temporary or a sign of things to come?

 

You are massively polydrugged, sleeping around 11 hours a day, and trying to fix your symptoms with a ton of supplements. 

 

You likely are going to have these symptoms as side effects and as withdrawal effects. So they may get worse when you make a reduction. You'll need to work with non-drug coping skills and acceptance. 

 

Please include your supplements in your daily drug and symptoms notes. 

[Remeron88]

@Shep Thank you.  In your opinion, is this a continuation of ototoxic 'damage' from taking the Zoloft, such that continuing at this dose will eventually result in dizziness/vertigo?  I was more inclined to believe it is a discontinuation effect, and the explanation being depletion of serotonin in the VCN (Alto posted this https://pubmed.ncbi.nlm.nih.gov/20144124/ in a thread about vertigo as an explanation).  If it is the former I have to keep reducing, but if it is the latter I have to wait it out.  I'm not sure which to do and I am scared of getting dizziness/vertigo eventually.  Please help me reach a decision.

[Shep]

I don't know, Remeron. You're on 3 drugs that can cause dizziness and I'm not familiar with all of your supplements, which may also be causing problems. 

 

You'll need to decide if you wish to come off these drugs or not. Some of the symptoms that are side effects may get ramped up when you taper, but you'll have to manage them. Since you've been holding since May, you may want to make a small decrease of 3 - 5% and see how you do. 

[Remeron88]

The wooziness is getting worse, fast.  I need answers.  I don't care if you have to guess, just please give me your opinion on what the cause of this is.  Please, no more "I don't know".  I need all the mods help on this @Shep, @ChessieCat, @Altostrata.  I am having anxiety attacks over this, and can't just sit here suffering without any knowledge.