Broadmargin: What to taper first? Lamictal / Klonopin / Zoloft

[broadmargin]

Hey!

 

I've been on one SSRI or another since i was 18.  I'm 37 now.  I've come off Zoloft, Paxil (twice), Klonopin (i know it's not an SSRI), and now Lexapro.

 

I was on Lexapro for about 4 years.  Most SSRIs that i have been on stop working after about 3-4 years.

Recently it was suggested that i might be on the bipolar spectrum.  I'm mostly hypomanic.  When i get depressed, I'm still hypomanic, so i have mixed states that result in severe anxiety.  Everything i have ever taken has been a result of anxiety. 

 

ANYWAY.  I wish i had come across this site earlier. 

I started having severe anxiety and panic late last year (November) while on 5mg of Lexapro ( i had dropped myself from 10mg to 5mg sometime in the last 4 years because i was sleeping all the time.  1.5 hour naps every afternoon, then another 9 hours at night).  So when my anxiety went up i upped my lexapro (with a doctor's consent) to 10mg (January).  Things were a little better, but not much.  I went to 15mg (February).  This was not good.  crawling in my skin, suicidal thoughts.  I lasted on 15mg for 3 weeks, then dropped to 10.  I had just begun seeing a new therapist at this time.  He advised that i get of Lexapro immediately.  So i "tapered off".  Since my base was around 5mg it was not hard to get back to 5mg (was good at 5mg by March).  Then i went from 5 to zero in about 3 weeks.  That sucked.  I dropped off completely on Tuesday April 12.  Exactly 2 weeks ago.

 

I've had to supplement with Klonopin to deal with some of the anxiety.  So i'll have to deal with coming off that again, but with a slow enough taper i know i can do it (the last time i came off Klonopin i spent 6 months tapering).

 

I was not aware that SSRIs required the same type of taper but i should have known.  My Paxil withdrawals were nightmarish.  Lexapro has been pretty bad as well.  The brain zaps seem to have stopped, but i still get dizzy every day.  My mood swings are FAST and they suck.  I had a great deal of anger and agitation when i first started tapering.  That seems to have cleared up.  My face gets tingly sometimes (usually my lips).  As far as anxiety and depression...  It comes and goes.  good days and bad days.  If i can stay motivated and busy, i tend to do quite a bit better.  The only thing is, i can't really relax.  I don't drink.  I kinda wish i did (not really)

 

Since i started coming off Lexapro, i started trying to take care of myself.

I started taking Omega 3, a probiotic, and Magnesium daily.

I started working out 3x a week.

I try to meditate once a day. (i've been doing this for a few years).

 

I'm here to soak up the information and maybe help if i can.

[Madeleine]

Sounds like your anxiety has been caused by too-fast tapers., ie you are experiencing withdrawal

[broadmargin]

That's possible, however i usually have to stop taking an SSRI because my anxiety becomes unmanageable while i am still on the original dosage.  I'm sure that the rapid taper doesn't help, but i'm not sure the withdrawal is the root of the anxiety. 

 

but anything is possible.  I could have come off my first SSRI too fast and started a chain reaction of withdrawal symptoms that i just assumed was my original anxiety.

[Rose9975]

Hi Broadmargin, Welcome to the site xx

[Petunia]

Hi Broadmargin, welcome to the site.

 

It sounds like you have a history of changes in drugs, dosages, and stopping without tapering. All this can be very disruptive to the nervous system and not recommended. My guess is that this has contributed to much of your ongoing symptoms and what you are experiencing now.

 

When stopping any psychiatric drug, we suggest reducing by no more than 10% of the current dose every 4 weeks, this reduces the risk of withdrawal symptoms arising. Please read through this which will explain why:

  

Why taper by 10% of my dosage?

 

Here is some information to help you determine if what you have been experiencing might be withdrawal: What is withdrawal syndrome?

 

Reinstatement of a small amount of the drug can often work well to alleviate withdrawal symptoms. According to medical knowledge, reinstatement is the only way to alleviate withdrawal. Reinstatement is best done immediately upon appearance of symptoms. The more time that passes, the less likely it is to work. Once you have stabilized on a low dose of the drug, then a slower, safer taper can be started. Here is some information about reinstatement to help you decide if its something you would like to try:  About reinstating and stabilizing to stop withdrawal symptoms

 

For some people, withdrawal syndrome can last a long time. I did a 3 month 'taper' off 5mg of lexapro at the end of 2010. After being on the drug for 6 years, and other antidepressants previously, I should have been tapering for at least a year, maybe longer. I still haven't recovered fully after 7 years, but by the time I found this site and realized my symptoms were withdrawal, it was too late for me to reinstate.

 

At only two weeks off, there is a good chance reinstatement would work for you. Then after you stabilize you could taper properly and hopefully avoid long term suffering. If I were you I would reinstate 2.5mg immediately and give yourself 4 days to see if it helps. Please read the reinstatement topic above for more information.

 

Here is how to taper lexapro properly:

 

Tips for tapering off Lexapro (escitalopram)

 

Because you have been taking Klonopin regularly, you will need to taper off that also, but for now, I suggest you remain stable on your current dose, you don't want to be in withdrawal from two drugs at the same time.

 

But when you are ready, we have a forum for help with benzo tapering here:Members-only benzo forum

 

 

You can use this thread as your ongoing journal to track progress, write about symptoms, ask questions and communicate with the community, add to it whenever you want. Its a good idea to bookmark it or follow it, so its easy to find again.

 

Please stay in touch and let us know what you decide.

 

Petunia.

[broadmargin]

Ok, so i'm currently on:

25mg Zoloft

75mg Lamictal

1mg Klonopin per day .5AM / .5PM

 

My plan is to taper the Lamictal first (as it seems to do nothing).  I was prescribed Lamictal because it was thought that i was bipolar.  After months of monitoring, it tuns out i'm not bipolar.  I'm just very anxious.  I've been on SSRIs for 20 years.  I was "given the pills without the skills".  So now i'm in CBT and applying what i am learning as much as i can.

 

So back to the matter at hand.

Drop Lamictal in 10% increments first (as it seems to be doing nothing).

 

I've read here that i should drop the antidepressant (taken for anxiety) before the Klonopin.  I would like to do this, but i really need to make sure i have my CBT habits in place before i ditch the SSRI.  They seem to be the only things that keep me on an even keel (and they only seem to do so at the smallest dose.  If i go any higher, my anxiety actually increases).

 

I'm just looking for some feedback.  I want to make sure this is the normal / recommended course of action.

[baroquep]

Hi broadmargin, 

 

I've merged your recent post with your original introduction thread in order to keep all of your information organized and in one place.  It is important to post all of your questions in your original introduction thread to keep your tapering history, dosages, recommendations up-to-date and in one place.  I've included a link to your intro thread and if you go to the top right-hand corner of your computer screen, you can press the "grey follow" button above the "reply to this topic" so you will be able to find it much easier.  Broadmargin's Intro Thread

 

It looks like you have made a few changes since your original post back in April, and I would ask that you update your signature with your current medication details.  Instructions:  Withdrawal History Signature

 

Can you answer a few questions so that we can have a clearer picture of what has been going on with you since April?  

• When did you start taking Zoloft?
• When did you start taking Lactimal?

Edited August 25, 2017 by baroquep

[broadmargin]

Thank you for merging the topics.

 

I had a really bad experience after coming off the lexapro.  I had a therapist (not a doctor) suggest that i was bipolar II and recommend Lamictal.  I went to see a Psychiatrist and told them i was bipolar II and should be taking Lamictal.  And for some insane reason, they prescribed it to me.  

 

And then everything starting to just kind of fall apart.  I was off the Lexapro, but i tapered too fast, so i was having mood swings.  I was tapering up on Lamictal and it was doing nothing whatsoever.  I was trying to make sure i didn't' increase my Klonopin dose, so my anxiety just sort of skyrocketed.

 

Eventually i had to find a whole new team to help me.

So i was put on

Lamictal - tapered up to 75mg.  Started May 1, 2017

Zoloft 25mg August 1, 2017

 

I've been on Klonopin at one dose or another for about a year now.  

 

It turns out that Zoloft causes Lamictal to metabolize slower, so the level builds in your blood stream.  I've been experiencing severe leg cramps and general muscle pain.  I've not been able to exercise because the recovery is untenable.  The pain in the days following the workout is unbelieveable.  I would like to get "stable."  I would like to get to a good place and then start cutting the Lamictal in 10% increments.  I would also like to eventually cut the zoloft, but it seems to be the glue that's holding me together at the moment.  

 

[baroquep]

Hi Broadmargin, thank you for providing the information requested, it's very helpful to see everything at a glance.  I am going to attach a link which will outline the protocol recommended by Surviving Antidepressants when deciding to taper off of multiple medications.  Before you make any further changes, it would be a good idea to familiarize yourself with the information so that you can make an informed decision.  

 

Taking Multiple Psych Drugs? Which Drug to Taper First?

 

As Petunia mentioned above, when stopping any psychiatric drug, SA suggests reducing by no more than 10% of the current dose every 4 weeks, this reduces the risk of withdrawal symptoms arising.  Because you have had a number of changes in a very short period of time, your central nervous system is likely very sensitized and you need to proceed carefully so as not to make things worse. 

 

Drug conflicts can make you sick, or make symptoms from any of the drugs you are taking worse. Studies show the more drugs you take every day -- your drug burden -- the more likely the combination has an adverse effect on your health. 

 

Doctors are supposed to be alert to them, but often they overlook the important step of checking for drug interactions. It's a good idea to enter all of your medications into the free Drug Interactions Checker here http://www.drugs.com/drug_interactions.html If any of your drugs are interacting, print out the report, discuss it with your doctor, and request that your drug burden be minimized for your overall health.  Could you please enter all of your medications/supplements that you are currently taking and then copy and paste into this thread? 

  

 

[broadmargin]

Hey!

 

I've been on one SSRI or another since i was 18.  I'm 37 now.  I've come off Zoloft, Paxil (twice), Klonopin (i know it's not an SSRI), and now Lexapro.

 

I was on Lexapro for about 4 years.  Most SSRIs that i have been on stop working after about 3-4 years.

Recently it was suggested that i might be on the bipolar spectrum.  I'm mostly hypomanic.  When i get depressed, I'm still hypomanic, so i have mixed states that result in severe anxiety.  Everything i have ever taken has been a result of anxiety. 

 

ANYWAY.  I wish i had come across this site earlier. 

I started having severe anxiety and panic late last year (November) while on 5mg of Lexapro ( i had dropped myself from 10mg to 5mg sometime in the last 4 years because i was sleeping all the time.  1.5 hour naps every afternoon, then another 9 hours at night).  So when my anxiety went up i upped my lexapro (with a doctor's consent) to 10mg (January).  Things were a little better, but not much.  I went to 15mg (February).  This was not good.  crawling in my skin, suicidal thoughts.  I lasted on 15mg for 3 weeks, then dropped to 10.  I had just begun seeing a new therapist at this time.  He advised that i get of Lexapro immediately.  So i "tapered off".  Since my base was around 5mg it was not hard to get back to 5mg (was good at 5mg by March).  Then i went from 5 to zero in about 3 weeks.  That sucked.  I dropped off completely on Tuesday April 12.  Exactly 2 weeks ago.

 

I've had to supplement with Klonopin to deal with some of the anxiety.  So i'll have to deal with coming off that again, but with a slow enough taper i know i can do it (the last time i came off Klonopin i spent 6 months tapering).

 

I was not aware that SSRIs required the same type of taper but i should have known.  My Paxil withdrawals were nightmarish.  Lexapro has been pretty bad as well.  The brain zaps seem to have stopped, but i still get dizzy every day.  My mood swings are FAST and they suck.  I had a great deal of anger and agitation when i first started tapering.  That seems to have cleared up.  My face gets tingly sometimes (usually my lips).  As far as anxiety and depression...  It comes and goes.  good days and bad days.  If i can stay motivated and busy, i tend to do quite a bit better.  The only thing is, i can't really relax.  I don't drink.  I kinda wish i did (not really)

 

Since i started coming off Lexapro, i started trying to take care of myself.

I started taking Omega 3, a probiotic, and Magnesium daily.

I started working out 3x a week.

I try to meditate once a day. (i've been doing this for a few years).

 

I'm here to soak up the information and maybe help if i can.

 

 

Edited August 30, 2017 by baroquep

[baroquep]

Hi broadmargin,.

 

Thanks for the info.  Just a few more questions:

 

Can you post what symptoms you were experiencing when you stopped Lexapro?

 

Do you feel that the addition of Lactimal and/or Zoloft has helped with your symptoms or made them worse?

 

What are your current symptoms besides anxiety?

 

It it would be a good idea to keep track of your daily symptom pattern and the link below will help you with the format to post back into your thread.

 

 

 

 

Edited August 30, 2017 by baroquep

[broadmargin]

Lexipro withdrawal was pretty standard SSRI withdrawal

• Brain Zaps
• Fatigue / Insomnia
• Increased Anxiety
• Increased Depression
• Dizzyness
• Mood Swings
• I don't believe i had any physical symptoms besides dizziness.

All the symptoms (other than increased anxiety and depression) were gone within 1 month of discontinuation. 

The mood swings started as a daily thing.  Up one day, down the next.  As time went on, they stretched out.  I would have two or three good days then two or three bad.  The bad days got less bad.  The good days got a bit more stable.  However, the overarching issue was that the stability (or the mean emotional state) was lower than i was able to handle at that time.

 

From my personal opinion, Lamictal has done nothing if not increase my anxiety.  I believe it has increased it because i have health anxiety, and the drug doesn't really make any sense to be taking.  I'm not bipolar (from 2nd, 3rd, and 4th opinions).  So it isn't really something i need to be taking, but i can't get off it until i'm stable.

 

Zoloft has helped.  My general state is better and my lows aren't so terrible.

 

I suffer pretty specifically from GAD.  I work myself into a state of anxiety and then i have to slow things down and get myself out of it.  Before dropping of Lexipro and starting Lamictal, i never had suicidal thoughts.  I believe (personally) that the lamictal played a role in these thoughts.  I don't know how exactly, but i've never been as low as i was on Lamictal.  And i've spent time off SSRIs.  I always end up in an anxious/panic state.  I stress myself out (i take on too much) and i hit a wall.

 

So hopefully i can get to a stable place with zoloft (though they want to try viibryd) and then get off the lamictal.  Removing the lamictal would ease my health anxiety.  And thats my only plan at the moment.  The next stage, i'm not sure.

 

Thank you for taking the time to read my posts and follow up.  It means a great deal.

[broadmargin]

Also, i just got the results of my Genesight testing.  I don't know if there is a discussion specifically about that type of gene testing.  I have the two short alleles on the Serotonin Transporter Gene ( SLC6A4 ).  So i am (theoretically) less tolerant of stress.  This also means that standard SSRIs may not work for me since the transporter is not good at transporting.  I'm still trying to figure out what it all means (if anything).

 

I'm pretty sure i can handle what life has to offer, i just have to work a little harder to manage the stress.

[ChessieCat]

Here is an SA topic:  genetic-testing-personalized-medicine-liver-enzymes-genotypes-genesightrx-genomind-etc

 

 

[Altostrata]

Hello, broadmargin. 

 

It sounds like you have a plan, to stabilize on Zoloft.

 

Are you here to get information about tapering Lamictal? Are you still taking Klonopin? Why?

 

Why does your doctor want you to take  Viibryd?

 

Personally, I don't put any stock in those genetic tests purporting to diagnose psychological conditions. Environmental factors, including drug reactions and interactions, are far more important.

[broadmargin]

I am here to get information on tapering lamictal.

The last time i tried to reduce dosage i ended up with some anger and increased muscle pain and cramping.  I wasn't sure if it was connected, but since reinstating my dose, those issues have gone away.  I initially reduced by 20%.  Next time i will reduce by 10%.  - something i learned here.

 

I was put on lamictal to manage mood swings, but it didn't do anything (mainly because my mood swings were panic attacks).  I'm not sure lamictal does anything at all if you aren't truly bipolar.  The only thing I've experienced since taking Lamictal is an agitated depression and suicidal thoughts.  There were other factors of course (coming off the Lexapro fast), but these usually result in my anxiety getting bumped back up, it's never manifested itself in the way it did with the Lamictal in play.

 

The klonopin is in place until the i'm stable on the zoloft.  I've tapered off klonopin in the past (slowly) and i know i can do it again.

 

The Lamictal is just causing me a lot of psychosomatic anxiety.  I don't want to be on it, i don't need to be on it, and when i have anxiety i question whether or not the Lamictal has something to do with it. 

 

My doctor suggested viibrid because the genesight test suggested viibryd.  So, i'm not really on board with that.  I'm not rying to open a whole new can of worms with the Viibryd.

 

 

[broadmargin]

OK, so i forgot i had a lot of equipment lying around that is pretty great for making liquid suspensions.

 

I'll be tapering Lamictal first.  75mg.  So first cut would be 7.5mg.  Which means i would take 50 mg in pill form and 17.5 mg in liquid form.

 

I'll be using one of these: https://www.amazon.com/Scilogex-86143101-MS-H280-Pro-Circular-Top-Magnetic/dp/B00AYGIFCA/ref=pd_sim_328_3?_encoding=UTF8&pd_rd_i=B00AYGIFCA&pd_rd_r=M8YKPF8RQZXD6AD091W6&pd_rd_w=kSwex&pd_rd_wg=AX6bi&psc=1&refRID=M8YKPF8RQZXD6AD091W6

 

It uses a small magnet (in a plastic capsule) to spin the liquid.  It can also heat the liquid as it spins it.  I don't know that heating is required (in fact i assume it would be a bad thing to do as the medicine could break down or change properties).  I also ordered some Ora-Plus just to see what the hype is all about.  

 

I'll start by dissolving 25mg pills into some an amount of liquid that is reasonable for ingesting 17.5mg.  I assume i can get it done in 10ml (though that is SUPER small).  So probably more like 50ml.  

 

I will report back with updates.

 

 

[broadmargin]

So i'm "stable" on Zoloft.  

Stable, in this case (and all other SSRI cases in my past), meaning that i have a dulled response to things.  I'm generally unmotivated and i don't care about much.

In this scenario it's a necessary evil.  I was hypersensitive to everything just a month ago.  

Sometimes i think "I'm not experiencing life as fully as possible.  I'm not feeling as happy as i would without the medication."  But the truth is, i was in hell for the last few months with the rapid withdrawal of Lexapro.  There was no Joy or Happiness that i'm suddenly not feeling.  I'm just sort of ... skimming along.

 

Anyway.  With everyone discussing the withdrawal effects of different medications, i thought i would mention the effects of going onto a medication.  It's a familiar feeling.  It's not a great feeling, but it's something i can work with.  

 

Now the fun starts /s

[broadmargin]

Attached is a study (of only 2 patients) concerning the interaction between Zoloft and Lamictal.  It's shown here that 25mg of Zoloft can increase the blood concentration of Lamictal by roughly 100% (in this particular patient).  The other patient also showed a strong interaction between the two. 

 

There is another study that i can't get the full text of that is more recent.  It states that the interaction is of no clinical significance, but i don't know how to parse the data from the results of the abstract.

https://www.ncbi.nlm.nih.gov/pubmed/22426846

Zoloft-Lamictal.pdf

[baroquep]

Hi Broadmargin, as the interaction between Zoloft and Lactimal isn't a major concern, I feel that as you reduce lactimal, you will also reduce your sensitivities to the effects caused by this combination.  If you still have concerns, I would suggest you talk with the prescribing Doctor for additional information rather than getting information from other sources, particularily as they may not apply specifically to you.  

[broadmargin]

Thanks for the reply.  I agree, it is probably of no major concern.  I just wanted to make sure i consolidated the info into a post here as it may or may not be relevant to my situation.

[broadmargin]

Been gone a while enjoying some stability.

Started tapering the Lamictal about a month ago.  I'm moving faster than advised until i can get some lower dose pills.  I believe I can order 5mg pills.

 

So far;

headaches (tension and behind the eyes)

fatigue

depression (it's not constant, but it comes and goes with the cuts).

 

[Hibari]

You can get 5mgs pills.  The ones I use are dispersalable but I just swallow them whole

 

I don't know if there are lower doses than that but it would be great if there was.

 

Wishing you the best during the next phase of your taper.

 

 

[broadmargin]

I’m in a window now after a bad wave last week.  Some family came into town and stayed with me for a week over thanksgiving.  It was difficult to maintain, and I think I kind of fell apart the following week (last week).  Now I’m just drinking as much water as possible and getting good sleep.

 

currently stopping all tapers until I get back from a trip out of the country for Christmas.  I only need one change at a time.  I’ll be back in my taper in January (ideally).

 

 

[Hibari]

I hear you.   I'm holding as well till some work projects and commitments drop off in mid December. 

 

Life still goes on so we have balance our cuts with that in order to maintain a sense of well being.

 

 

[broadmargin]

I have discontinued Lamictal.  I just wanted to come back and update the post in case anyone read it in the future. 

The cuts resulted in headaches and depression, but since i have come off the drug the depression has lessened GREATLY.

 

I'm happy i am off of it, and i don't feel as though i have any residual issues.  I was on a low dose for a short amount of time.

 

I'm currently cutting Klonopin.  Which is NO FUN. 

[mammaP]

Hi Broadmargin, thank you for updating. Could you update your signature for us please?  It would be good if you can hold off on the klonopin taper for a while to stabilise after finishing the lamictal taper. It will take some time for your brain to settle. A coupe of months at least.  Enjoy being less depressed and feeling better.  It would be good if you can post on the nbenzo forum for your klonopin taper, it is for members only and not visible to the general public. That is where the benzo experts hang out and will support you. Please take it slowly, I know you have quit before but each time you quit a drug it becomes harder the next time.   I am glad that you are feeling better.   

http://survivingantidepressants.org/forum/29-members-only-benzo-forum/

[broadmargin]

Thanks!  I have a post over there for the klonopin withdrawal and I have updated my signature!