MirtHurt: Too fast Mirtazapine taper, when might I stabilise after reinstating?

[MirtHurt]

This has been a truly horrific evening. My wife is beyond distraught at what these drugs have done to me. I'm starting to dread each new day, as I don't seem to be moving towards stability. I will try anything to just give me a bearable existence again, so I can function and do my job, take my daughter to the park. That's all I want but I feel utterly hopeless.

[MirtHurt]

Just to finish off today's entry, as I don't seem to be able to edit it, I had a little relief after my sobbing episode but tonight I've had bad head pressure and tinnitus.

[Shep]

Hi, Mirt.

 

Thanks for writing out your symptoms report.

 

I noticed that you wrote "first meal of the day" at 19:00 on Saturday and 18:00 on Sunday. I think you may be dealing with low blood sugar and it's increasing your anxiety earlier in the day and then you're reporting feeling better after eating. 

 

Take this part of your report for Saturday, for example:

 

 

1900 first meal of day

1940 head pressure lessened

2200 essentially symptomless
 

 

 

Is this a common pattern for you regarding meals? 

 

The reason I'm asking is a lot of people report issues with fluctuating blood sugar during withdrawal, including people who never had issues prior to this. It's best to eat small, nutritious meal throughout the day. The low blood sugar diet is a good one during withdrawal. That means protein and little to no sugar and only complex carbohydrates. 

 

Some of the symptoms of low blood sugar are anxiety, irritability, headaches, dizziness, and many other of the same symptoms as withdrawal. 

 

And taking these drugs on an empty stomach may also be causing problems. 

 

Try improving your diet over the next couple of days and see if that improves your overall functioning. 

[MirtHurt]

My eating pattern has only really got bad over the past week or two, because I'm just getting very very down and distressed at seeing no improvement. And staying in bed far too long.

I'll try to improve the diet, but I suspect it is not a big factor in this. I'll mention this to my wife, she's the food shopper and chef when I'm this ill. She knows all about this sort of stuff.

Do you think there are any changes to when I take the drugs I should consider?

I'm really getting into a very bad place mentally, with no sign of improvement more than 7 weeks after reinstating. I am so drained from feeling ill all the time. I feel utterly desperate. I have so much to lose if I can't stabilise. More than I could bear. I'm trying to stay calm. But each week that grinds on without improvement makes it harder.

[MirtHurt]

I'm pleased to report today was a lot better then yday.

0745 50mg Quetiapine, 4mg Diazepam, back to sleep

0845 25mg Quetiapine

1000 up and out of bed. Mid level anxiety.

1115 saw therapist.

1230 150mg Ibersartan, lunch, anxiety lessened.

1500 had to get letter for welfare payments appeal (theyre trying to cut my money off)

1600 anxiety down, slight depression

1800 dinner

1830 cinema with friend.

2030 back home. Some tinnitus, tiny bit of anxiety but v bearable.

 

2220 25mg amit and 45 Mirt

 

Noticeably very little head pressure and dizziness today.

[Altostrata]

The worst symptom is really this incessant dizziness / head swimminess / DP...and just being more 'on alert' than I was before. I guess that IS anxiety...

 

^ This is only to be expected, given the way you're taking 5 neurological "brakes" plus a statin. You've gotten yourself in a pickle trying to smother benzo withdrawal symptoms.

 

You are taking 4mg diazepam once a day, in the morning. The "anxiety" you feel a few hours later may be a paradoxical reaction to this dose. It is possible a paradoxical reaction might be caused by the diazepam overlapping the Seroquel dose. 

 

Taking the Seroquel when you wake up at a normal waking hour and then going back to sleep is a very eccentric dosing pattern. The morning Seroquel is probably where you might start tapering. You don't need the Seroquel to sleep, it could be contributing to adverse effects later in the day, and it's a drug that has a high risk of sugar metabolism dysregulation.

 

Suggest you minimize sugar.

[MirtHurt]

But should I change the time when I take the Seroquel?

I realise it's eccentric, but it's a hangover from the benzo hell.

 

Maybe I should start taking the Diazepam at night?

Btw I have only been taking the Diaz and Seroquel together for about 3 weeks (I changed to the morning when I updosed). Before that I took it lunchtime ish.

And I was getting the same anxiety before I started taking it in the morning (that is, after the aborted Mirt taper). So I assume we can discount the paradoxical reaction.

 

Dizziness and head pressure have been notable by their absence the last couple of days. Anxiety also down. Not gone, but significantly down.

 

I don't think I can consider tapering anything until I am stabilised properly.

 

Oh and I haven't taken the statin for over a month. I only started taking it again in Jan after abandoning it for most of 2016 (when I was so ill and hopeless I just didn't care). In Jan I started to try to look after myself again. But when the Mirt WD hit after the aborted taper, I read on another group that the statin might be making it worse. I'm completely unconvinced on the efficacy of the statin, anyway. For the time being I'm staying off it.

[Petunia]

Hi MirtHurt,

I've been away from the site for a while, so haven't been involved in your case, but I just read through your thread and have a few thoughts, which I don't really want to share, because its probably not what you will want to hear. But I've been involved in the withdrawal community for about 4 years, have read hundreds, if not thousands of stories, just like yours and have a fairly good idea of how things turn out in given situations, when circumstances follow particular courses.
 
So I'm just going to give you my opinion, based on that.
 
You have been a victim of medical incompetence. None of this is your fault, but as a result, your life, as you knew it has been taken away.  This happens more often than we generally hear about, to many, many innocent people. We all have the, 'it will never happen to me' belief, until it happens to us.

 

It sounds to me like you are still in a process of trying to come to terms with what has happened to you. I see you cycling between confusion, shock, denial and bargaining, not wanting to let go of something which has been taken from you...... your health, identity, self-image, ability to support your family, your sense of control in life and the basic security of being able to manage your own emotions and behavior.... and so much more.
 
When you are able to accept what has happened, and let yourself off the hook, so to speak, I think you will start to feel some relief. You are still a husband and a parent, and your family needs you. I'm going to say that again because I think its important. You are a husband and a father, most likely a son and a friend and many other important roles which you still play in the lives of other people. Your family needs you to keep living so you can remain a part of their lives. This is your new job right now. Much more important than your previous work, which you might go back to one day. But for now, your career is in Life Maintenance and Personal Recovery.
 
Start working on acceptance. This unfortunate thing which has happened, is something which has been done to you, you didn't deserve it, but it happened. As someone else put it, you are in a pickle, but not of your own making, but you are the only person who can get yourself out of it.
 
You will get yourself out of this pickle, it wont be easy and it will take time, but you will do it, if not for yourself, then for your wife and especially for your daughter. You might not be able take her to the park right now, but you will teach her how to ride a bike, help her with homework and tell those embarrassing dad stories when she brings friends home from school.
 
But you need to get well first. This will probably be the hardest thing you ever do, but you will succeed by moving forward, one step at a time. One step after the next, keep walking forward towards health and drug freedom.
 
The drugs you are currently taking are not helping you. They are harming you. You need to come off them. If you are going to regain your health and previous lifestyle, you need to start lowering your drug load. Its these drugs which have caused your current illness. The drugs you are still taking are delaying your recovery and continuing the harm which has been done. But you need to stop them slowly and carefully, so as not to make your situation even worse.
 
There is a possibility, that while you are still taking all these drugs, with their multiple interactions, that you wont be able to stabilize any more than you already are. Once the nervous system becomes sensitized by any withdrawal, previously tolerated medications might now cause paradoxical reactions and an increased rate of deteriorating health. How long are you willing to wait?
 
If I were you, I would start here:
 

The morning Seroquel is probably where you might start tapering. You don't need the Seroquel to sleep, it could be contributing to adverse effects later in the day, and it's a drug that has a high risk of sugar metabolism dysregulation.
 
Suggest you minimize sugar.

Think of this as your 'wake up call'...you only get one.

 

Wake up MirtHurt!   Its time to get up and moving towards reclaiming your health and life.

 

 

[MirtHurt]

But I really have seen some distinct improvement this week though.

[MirtHurt]

I realise that getting off the drugs will have to be broached at some point, but I do believe I can get more stable before that happens. In the meantime I'm very keen to hear other suggestions regarding how to best do that - timing of drugs, diet etc.

[MirtHurt]

anyway, on with the diary - yesterday was again a much more bearable day - and thus far today is also.

 

wednesday 5th april

 

0745 waking: 4mg diaz 50mg quetiapine, sleep

 

0900 25 mg quetiapine

 

1000 up and of bed. anxiety noticeably lower than usual.

 

1300 lunch ibersartan, no anxiety

 

1800 dinner

 

2000 visited friend, tinnitus only symptom

 

2330 45mg mirt, 25 mg amitrip

 

0100 asleep

[Shep]

I realise that getting off the drugs will have to be broached at some point, but I do believe I can get more stable before that happens. In the meantime I'm very keen to hear other suggestions regarding how to best do that - timing of drugs, diet etc.

 

Hi, Mirt.

 

Are you feeling better now that you're eating more than once a day? 

 

If so, you may want to add in breakfast and see if that helps. Low blood sugar is one of the easier symptoms to deal with and it can make all of the difference in the world if it gets rid of symptoms. 

[Altostrata]

Sorry, I've given you my best guess. Any one of the 6 drugs you're taking could cause a person to feel groggy or light-headed. The benzo alone can have severe side effects, including paradoxical or rebound anxiety; the combinations can cause all kinds of problems.

 

Personally -- and I'm not a doctor -- I don't believe you can "balance" taking all 6 together. As far as "balancing" goes, your guess is as good as anyone else's. Suggest if you experiment, you change only one thing at a time and keep notes so you can tell what does what.

 

As this is a site for going off drugs, I'm not sure if we can help you with "balancing," we're about minimizing the drug burden.

[JanCarol]

Hey Mirthurt - 

 

checking in on your cognitive (this is from March so you may have shifted from then)

 

 

and the conclusion I reached is that this is definitely the only job for me. Without that job, I can't *be* well. 

 

There's a series of cognitive distortions.  https://psychcentral.com/lib/15-common-cognitive-distortions/

 

"Only" is one of them.  As soon as you restrict your wellness to Only This, it's bound to be taken away from you as a test.  It's kind of black and white, and kind of global.  (Caveat:  I am not a CBT expert and only speak from my personal experience.)

 

At least in my experience, when I attach to "This is IT!" The universe has a way of making sure that it's not The One.

 

I've never had a job that I felt that awesome about - I've had a series of jobs that I was good at and could do well.  

 

But i have been in relationships where I was sure this was the "only" thing for me.  And this "Only" thing was not true.  There were Others.

 

I'm just concerned because as you attach to this as the "Only" solution, you are blocking other potential solutions.

 

Believe me, it is exciting and amazing when someone expresses a passion for their work, and I"m pulling for you to get this dream situation.  I hope that it will be everything you ever wanted.

 

Might it help then to take the Q at night instead? 

 

 

Since you are having daytime dizziness - I would suggest yes.   Keep notes on paper of when you take your doses, and when you have your symptoms.  Read the links that Shep gave you about the individual drugs, half lives, and interactions.

 

Do not move the dose all at once.  This will be tricky.  For Seroquel, it might be better if you moved it backwards.  If you are taking it at 9 am now, set an alarm to move it back to 7 am for few days, then 5 am.  And then on back.

 

My main concern (I still have more reading to do) is that your amitryptaline and mirtazapine are at the same time at night.  They have a major interaction, so you might want to separate them out.

 

Additionally, the Seroquel interacts moderately with amitryptaline and mirtazapine.  The docs have given you a pretty impossible combination to take safely!

 

I see that Scallywag is thinking the same thing as me - that - maybe these shouldn't be a big bang of cocktail before bed, even though you are taking them to sleep - you say your sleep is fine.  But Seroquel has 7-12 hour long half-life.  Taking it to get an "extra hour sleep" is counter productive, as you're getting most of its effects during the daytime.  I would venture to say that the way you are taking Seroquel is responsible for your non-productive days.

 

If you go to shift work, this could get problematic, as taking drugs before sleeping on a swing shift could mess with the half-lives of the drug.  We generally recommend (and pretty strongly too) doses at the same time in every 24 hour cycle.

 

 

Another question if I may: are 'diet' sodas problematic? Or can they be for some people anyway. I know they're laced with all sorts of chemicals... 

 

 

The main problem is aspartame, but even some of the stevia blends are a problem.  

 

Aspartame seems to be linked with more brain tumours.  It crosses the blood brain barrier.  https://nutritionfacts.org/2016/09/01/side-effects-of-aspartame-on-the-brain/

 

Additionally ALL artificial sweeteners send a message to the brain that "we're getting calories" and so increases insulin production which contributes greatly to insulin resistance and metabolic disorder.

 

Sugar is pretty hard on the system too, but at least the body knows how to run on sugar.  The solution for me is use real food (sugar) - just less of it.  I don't buy bottled drinks - not only do the plastics contribute to the Great Pacific Garbage Patch, but there's nothing in that manufactured beverage that will help me.  Instead, I make my own drinks at home, from mineral or filtered waters - a splash of juice in a glass of water, or a tea (often herbal!) sweetened with juice, or even sugar or honey.

 

Okay, I'm turning the page now, to see what you're doing (drum roll please) but I'll push post.

If I've commented on something which is resolved just ignore me, or laugh at me, or squeeze my clown nose until it squeaks.

[JanCarol]

Okay, I've been through it all - including Petunia's excellent post - which I believe cuts to the heart of the matter, and Alto's reminder that you are on 6 conflicting drugs which cannot really be balanced.

 

I'm going to address moving the seroquel to nighttime before you taper it.  I believe that most of your daytime symptoms are from this neuroleptic drug.  You are still in the "low dose" category - it's not hitting D2 receptors much at that level, but it can dope you out via histamine receptors.  Seroquel can hit up to 7 different receptors, depending on you and your dose.

 

If you take the schedule I put in the last post, updated here:

 

1.  ONLY TAKE 1 dose of 75 mg seroquel per day.  Stop splitting the dose.

2.  Gradually, over a number of days, move the seroquel back to nighttime.  8 am, 6 am, 4 am, 2 am, midnight.

3.  DO NOT take the Seroquel with your amitriptaline and mirtazapine.  Once the Seroquel is shifted back to within an hour of the other ones, I want you to split them by an hour too.

 

So that - you take mirt at 8 pm

amitryptaline at 9 pm

Seroquel at 10 pm.

 

From there, you can stabilise for 3-6 months and get safe to taper.

 

 A possible long term plan would be Seroquel first - get it down to 25 mg.  Then mirtazapine - get it down to 7.5 mg.  Then taper off of amitryptaline entirely.  Then see how you feel on the lower doses.  This is a long term plan - it will take at least 2 years to get this far, especially if you are slowed down by symptoms.  The goal is, as always, a symptom free taper.  However, you are already suffering drug interactions and side effects, so this could be more dramatic for you.

 

I suspect that as you get the Seroquel down to a more manageable amount, your brain will come back online and you (and your wife & daughter) will see more of the man you know and love.

 

What has happened regarding your dream job?