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Nikki74: Lexapro mirtazapine diazepam akathisia

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Nikki74

If I can't handle the Diazepam cut, can I updose safely? 

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Nikki74

Severe depression really is taking over. I know you can't help with this. My psych wanted me to start Zoloft or try Mirtazipine at a higher dose again.

 

I feel stuck as I know any med will throw my cns more and could make akasthesia worse. 

 

All morning I have had suicidal ideation, as I have often. 

 

I have read your guidelines and know this is not something you can help with.

 

I just don't know what to do with this severe depression. 

 

My GP is supportive of trying to get me stable with what I'm on and tapering in the future.

 

the darkness is very heavy though. 

 

Nikki 

Edited by Nikki74
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Shep
23 hours ago, Nikki74 said:

8.15am Mirtazipine 15mg (seems to stop the early morning agitation and gives me some sleep)

 

12.30 2mg Diazepam 

 

17.30 2mg Diazepam 

 

Midnight 5mg lexapro and 1.5mg diazepam

 

(last night was my first night taking the 1.5mg at the time and I'm only 3 days into the set times for diazepam and lexapro as previously was taking lexapro in early hours if I managed to fall to sleep naturally for a bit without taking anything, plus maybe 2mg diazepam).

 

4 hours ago, Nikki74 said:

If I can't handle the Diazepam cut, can I updose safely? 

 

Hi, Nikki.

 

Thanks for your update and for listing the timing of your drugs.

 

Two thoughts:

 

1.  Regarding your question of updosing - this usually only works if you were stable on a previously higher dose. Please see this article for more information:

 

Notes on Updosing - benzos

 

Right now, you haven't allowed your nervous system to get used to anything. Again, it takes at least 4 days for your nervous system to register a change and a week or longer to begin to stabilize. 

 

2. Your sleeping pattern is working against you. Because you are getting the bulk of your sleep after taking mirtazapine, by taking it in the morning, you are working against higher levels of cortisol and against your adrenals. Please note this from Alto:

 

On 4/6/2011 at 9:26 PM, Altostrata said:

Your adrenals also run on a sleep schedule of approximately 10 p.m. to dawn. They tend to reactivate if you stay up later, which may keep you from sleeping. If you can, get to bed by 10 p.m. and retrain your sleep cycle.

 

Here is some additional information on sleep:

 

Tips to help sleep - so many of us have that awful withdrawal insomnia

 

Instead of updosing the diazepam, what do you think of moving the mirtazapine to the evening and working on getting your sleep cycle to a 10 pm - 6 am rhythm? 

 

Let me know your thoughts and we can work on getting you a schedule to move it, as it's best to only move a drug by one hour a day, as that's the gentlest on the nervous system. 

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Nikki74
44 minutes ago, Shep said:

 

 

Hi, Nikki.

 

Thanks for your update and for listing the timing of your drugs.

 

Two thoughts:

 

1.  Regarding your question of updosing - this usually only works if you were stable on a previously higher dose. Please see this article for more information:

 

Notes on Updosing - benzos

 

Right now, you haven't allowed your nervous system to get used to anything. Again, it takes at least 4 days for your nervous system to register a change and a week or longer to begin to stabilize. 

 

2. Your sleeping pattern is working against you. Because you are getting the bulk of your sleep after taking mirtazapine, by taking it in the morning, you are working against higher levels of cortisol and against your adrenals. Please note this from Alto:

 

 

Here is some additional information on sleep:

 

Tips to help sleep - so many of us have that awful withdrawal insomnia

 

Instead of updosing the diazepam, what do you think of moving the mirtazapine to the evening and working on getting your sleep cycle to a 10 pm - 6 am rhythm? 

 

Let me know your thoughts and we can work on getting you a schedule to move it, as it's best to only move a drug by one hour a day, as that's the gentlest on the nervous system. 

Thanks Shep.

 

thinking about the Mirtazipine change. This morning (and is the case some mornings) I only got an hour's sleep on it and woke up so very depressed. I was taking it at night I think up til 13th September, always had taken it at night, then my GP advised me to change it to the morning as I was so agitated and restless in the day. 

 

From 7th Sept to 13th Sept I had changed the lexapro to the morning after my psych told me to, my GP then reversed it again as I'd always taken it at night all the years I was on it!

 

so confusing.

 

i know when I was taking the Mirt at night after all the changes I went through in July, it only ever gave me a couple of hours' sleep.

 

anyway, a bit of explanation for you.

 

i tend to look forward to taking it in the morning as I'm so revved up it gives me a break.

 

so if I do change it, it'd mean taking it an hour later each day til it's 10pm? I am concerned about practicalities of this as I need to be able to care for my son and do dinner etc in the eves.

 

I'd need to get my teenage son in bed earlier than normal as I normally get him to bed 10.30/11 then spend an hour winding down before taking lexapro and diazepam at midnight knowing I won't get much sleep anyway.

 

Hmm. It would be good to take the mirt at night but nervous about change...

Edited by Nikki74
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Shep
23 hours ago, Nikki74 said:

i tend to look forward to taking it in the morning as I'm so revved up it gives me a break.

 

so if I do change it, it'd mean taking it an hour later each day til it's 10pm? I am concerned about practicalities of this as I need to be able to care for my son and do dinner etc in the eves.

 

I'd need to get my teenage son in bed earlier than normal as I normally get him to bed 10.30/11 then spend an hour winding down before taking lexapro and diazepam at midnight knowing I won't get much sleep anyway.

 

Hmm. It would be good to take the mirt at night but nervous about change...

 

Hi, Nikki.

 

I asked the other mods and Alto about this and there really is no easy answer to getting your drugs moved around in a way that will help you, as opposed to hinder you.

 

By taking the most sedating drug (i.e. the drug that, as you wrote "gives me a break") to the evening, you are likely going to sleep better. So if this is something you wish to do, there are two methods:

 

1.  Move the mirtazapine 1 hour a day until it's taken at night. So you'd take it at 9 am tomorrow, 10 am the next day, 11 am the day after that, etc. until you have it at whatever hour at night you wish to take it. The advantage to this is that it slowly gives your nervous system time to acclimate to the change in mirtazapine dosing. The drawback is it will take 12 days to move it to 8 pm and you'll be crossing paths with your other drugs which could cause some paradoxical reactions.

 

OR

 

2.  Abruptly switch the Lexapro and the mirtazapine so that you are dosing the Lexapro in the morning and the mirtazapine in the evening. 

 

Please let us know what you think. Unfortunately, with this kind of drug cocktail in reverse position and with your recent changes being so frequent and abrupt, you're in a very precarious position. It's likely going to be unpleasant for awhile.

 

But the goal is get you in a position where you are sleeping more and then able to handle the morning panic and dread. The mornings are so bad due to the elevated cortisol, but there are ways of using non-drug coping skills and distracting to get you through it. As you are able to sleep more, you'll be stronger and more able to handle the mornings. 

 

Let us know what you think and how you'd like to proceed. 

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Nikki74

Ok thanks I'll let you know.

 

my akasthesia is much worse. 4 days into diazepam cut now. Nothing helps, Zero sleep in 24 hours. Even Mirtazipine didn't work today. 

 

Desperate! 

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Shep

Hi, Nikki.

 

How much were you sleeping when you were taking zopiclone? 

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Nikki74
4 hours ago, Shep said:

Hi, Nikki.

 

How much were you sleeping when you were taking zopiclone? 

 

4 hours ago, Shep said:

Hi, Nikki.

 

How much were you sleeping when you were taking zopiclone? 

Initially on 3.75mg I slept about 7 hours. Within a month or less that stopped working so it was upped to 7.5mg which worked for 7 hours. Then that stopped working so well after a couple of weeks and became maybe 4 hours.

 

Ps I had a terrible reaction to it eventually, the metallic taste got stronger as the day went on and I'd dry retch, my tongue was white and swollen and started to blister and bleed, and my teeth became painful when eating sugar. I still have the neuralgia in my teeth. Awful drug! 

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32 minutes ago, Nikki74 said:

Initially on 3.75mg I slept about 7 hours. Within a month or less that stopped working so it was upped to 7.5mg which worked for 7 hours. Then that stopped working so well after a couple of weeks and became maybe 4 hours.

 

Ps I had a terrible reaction to it eventually, the metallic taste got stronger as the day went on and I'd dry retch, my tongue was white and swollen and started to blister and bleed, and my teeth became painful when eating sugar. I still have the neuralgia in my teeth. Awful drug! 

 

Thank you, Nikki, this is helpful information. I was thinking that you're going through zopiclone withdrawal and really having a hard time, so was considering asking if you thought reinstating might help, but after reading this, that's probably a bad idea.

 

My only thought is that you may be so dependent on the recent increased diazepam that your reduction is causing problems. 

 

You could wait a few days to see if things settle down, as 4 days is still early. Or you could updose the diazepam back to where you last were stable.  Due to all of the recent changes, that may be difficult to pinpoint, but I'd like to hear your thoughts on this. 

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21 minutes ago, Shep said:

 

Thank you, Nikki, this is helpful information. I was thinking that you're going through zopiclone withdrawal and really having a hard time, so was considering asking if you thought reinstating might help, but after reading this, that's probably a bad idea.

 

My only thought is that you may be so dependent on the recent increased diazepam that your reduction is causing problems. 

 

You could wait a few days to see if things settle down, as 4 days is still early. Or you could updose the diazepam back to where you last were stable.  Due to all of the recent changes, that may be difficult to pinpoint, but I'd like to hear your thoughts on this. 

I'm thinking I might updose to 6 or 7mg diazepam.

 

i don't know if this is relevant but when I started to taper off the pregabalin which I did way too fast over one week, I was getting restless legs. Then I tapered the lexapro 15mg over three weeks and was starting to get panic attacks but thought I'd be ok to stop it so I did. The week following I had this extra energy but what I now think was restlessness and then woke up exactly a week after stopping the lexapro (and I was left with only being on 15mg Mirtazipine) with the most horrific anxiety and what I think now was akasthisia. GP doubled my mirt at that point to 30mg and all hell broke loose.  I'd sleep but with nightmares and wake with terrible restless legs and churning stomach. I'd be unable to stop all day til the evening. I was put on the Zopiclone because I was worn out from the nightmares. At the same time I lowered the mirt back to 15 and reinstated lexapro at 10mg. I noticed the churning and restlessness first thing in the morning stopped while I was on the zop. And it's come back since coming off the zop. And I've been fire fighting bad nights since and with noticeably more akasthisia too. So I do think the zop did something but also caused a bad reaction and lost its effect for long sleep quite quickly. 

 

just wish I could pinpoint what caused the akasthisia! My GP feels maybe it was the pregabalin but I'm not so sure. He prescribed me beta blockers to try for the akasthisia and sleep. Any thoughts on that? 

 

i was going to attempt the direct swap of Mirtazipine to the night tonight and lexipro to the morning. Too much? 

 

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Shep
4 minutes ago, Nikki74 said:

just wish I could pinpoint what caused the akasthisia! My GP feels maybe it was the pregabalin but I'm not so sure. He prescribed me beta blockers to try for the akasthisia and sleep. Any thoughts on that? 

 

I would be hesitant to add another drug, such as a beta blocker or any other drug, into your current cocktail. Adding another sedating drug into your cocktail with two other sedating drugs can likely cause a paradoxical reaction. The more you dampen down the nervous system, the more it hyper-reacts. And this is especially true for people whose nervous system is already destabilized. 

 

9 minutes ago, Nikki74 said:

i was going to attempt the direct swap of Mirtazipine to the night tonight and lexipro to the morning. Too much? 

 

As I mentioned in an earlier post here, this is definitely an option. Please note that this is very abrupt and may trigger additional symptoms, so please use as much self care as possible and let us know how you're doing. 

 

 

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Nikki74
4 minutes ago, Shep said:

 

I would be hesitant to add another drug, such as a beta blocker or any other drug, into your current cocktail. Adding another sedating drug into your cocktail with two other sedating drugs can likely cause a paradoxical reaction. The more you dampen down the nervous system, the more it hyper-reacts. And this is especially true for people whose nervous system is already destabilized. 

 

 

As I mentioned in an earlier post here, this is definitely an option. Please note that this is very abrupt and may trigger additional symptoms, so please use as much self care as possible and let us know how you're doing. 

 

 

Ok I understand re beta blocker. Out of interest, do you think the diazepam and Mirtazipine might be causing problems against each other as they're sedating? 

 

Hmm I'll think on the swap a bit more! It'd be good to get them swappped round.

 

im slightly dilerious after so little sleep and grasping at straws and not thinking clearly.

 

 

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Shep
1 hour ago, Nikki74 said:

Out of interest, do you think the diazepam and Mirtazipine might be causing problems against each other as they're sedating? 

 

Yes, this could definitely be a possibility. That was one reason for advocating for the abrupt switch in mirtazapine and Lexapro as opposed to creeping the mirtazapine up slowly an hour a day where it would be in close proximity to the diazepam doses for a number of days before moving to the evening. 

 

 

 

On 10/2/2017 at 8:59 AM, Nikki74 said:

8.15am Mirtazipine 15mg (seems to stop the early morning agitation and gives me some sleep)

 

12.30 2mg Diazepam 

 

17.30 2mg Diazepam 

 

Midnight 5mg lexapro and 1.5mg diazepam

 

Above is your current schedule. In order to lessen the likelihood of a paradoxical mirtazapine / diazepam reaction, you may want to take the mirtazapine earlier in the evening, away from your last scheduled diazepam. For example:

 

     8:15 am Lexapro

 

     12:30  2 mg diazepam

 

     17.30  2 mg diazepam

 

     20.30  15 mg mirtazapine

 

     Midnight - 1.5 mg diazepam

 

 

Let me know what you think. I do hope you can eventually move to an earlier bedtime, but for now, this kind of schedule may help. 

Edited by Shep

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UnfoldingSky

Nikki, just popping it to say hello and see how you are doing. 

 

 

 

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Nikki74
11 minutes ago, UnfoldingSky said:

Nikki, just popping it to say hello and see how you are doing. 

 

 

 

Hi US

 

Thank you. Well I'm having what I'd call a lull in symptoms this morning... a window? Perhaps a false window as I've just made a change and took my Mirtazipine last night and slept! Not solid but I had the most restful night I've had in months. I received my weighted blanket yesterday and slept with that on me too. 

 

Ive actually been able to feel half human this morning and am doing some journaling.

 

but like I say, I've just swapped Mirtazipine to night and this morning took lexapro instead of last night so I am kind of expecting the change to catch up with me soon...

 

Akasthisia pretty much nil so far today...

 

im wondering if because I had a double dose of 15mg Mirtazipine yesterday (my usual a.m. time then bedtime) it's given me a bit of temporary calm.

 

sorry, lots of detail there! 

 

How are you? 

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UnfoldingSky

Hey no problem!  I'm thrilled for you and hoping it's not a false window and that the improvement will continue!  How did you find the blanket? I hope it was reasonably comfortable?

 

I'm doing okay, nothing much happening here thanks for asking though!

 

 

 

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Nikki74
12 hours ago, Shep said:

 

Yes, this could definitely be a possibility. That was one reason for advocating for the abrupt switch in mirtazapine and Lexapro as opposed to creeping the mirtazapine up slowly an hour a day where it would be in close proximity to the diazepam doses for a number of days before moving to the evening. 

 

 

 

 

Above is your current schedule. In order to lessen the likelihood of a paradoxical mirtazapine / diazepam reaction, you may want to take the mirtazapine earlier in the evening, away from your last scheduled diazepam. For example:

 

     8:15 am Lexapro

 

     12:30  2 mg diazepam

 

     17.30  2 mg diazepam

 

     20.30  15 mg mirtazapine

 

     Midnight - 1.5 mg diazepam

 

 

Let me know what you think. I do hope you can eventually move to an earlier bedtime, but for now, this kind of schedule may help. 

Ok so I've done the swap... and waiting for the fall out! 

 

I actually had a good and restful sleep, broken but restful.

 

I've lost my diazepam routine. Don't be annoyed :/

 

I upped to 6mg yesterday.

 

Here is what I did yesterday:

 

4.30 diazepam 2mg in desperation as akasthisia was so bad and had had zero sleep but it had little effect.

 

8.15am 15mg Mirtazipine did not bring me sleep

 

10.30 2mg diazepam dozed for half an hour

 

14.30 2mg Diazepam 

 

23.30 15mg Mirtazipine slept til 7am, broken but not akasthisia 

 

8.15am today 5mg escitalopram 

Zero Akasthisia until about 10.30 

 

Spiritual journaling, able to concentrate on tv and self care for first time in weeks.

 

11am 2mg diazepam 

 

i know this has now completely changed the routine again :/ Sorry. Just trying to work out how to get my stable diazepam dose through this swap and the undoubted fall-out to come. 

 

I wish I could continue to have the sleep and the start to the day I've had last night/ today. But probably slept due to double Mortaz dose yday? i.e. The 8.15am and 23.30?

 

on the diazepam, I really find it hard to take it if I just don't feel the need to. Like today, to get my doses in and avoid taking it close to Mirtazipine at bedtime (I decided to take it at bedtime as the sleepiness normally starts quite soon after taking it) I'll need to squeeze em in before say 6pm. But after taking my first dose today I'm already feeling that horrid disconnection from the world outside my head.that drunk/ distant feeling and can't imagine taking the rest of my doses over the next 6 hours (it's nearly midday).

 

And as my mirt/lexapro swap evolves and maybe creates problems before settling (hopefully!) how do I keep my diazepam dosing constant? 

 

I woke up feeling clear on things and quite clear headed but the fog is descending.

 

Sorry this is confusing. 

Edited by Nikki74

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37 minutes ago, UnfoldingSky said:

Hey no problem!  I'm thrilled for you and hoping it's not a false window and that the improvement will continue!  How did you find the blanket? I hope it was reasonably comfortable?

 

I'm doing okay, nothing much happening here thanks for asking though!

 

 

 

Thanks. I love the blanket. It could do with being a bit heavier but I ordered their max weight. If I double it over it's great.

 

glad all ok with you.

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Nikki74
13 hours ago, Shep said:

 

Yes, this could definitely be a possibility. That was one reason for advocating for the abrupt switch in mirtazapine and Lexapro as opposed to creeping the mirtazapine up slowly an hour a day where it would be in close proximity to the diazepam doses for a number of days before moving to the evening. 

 

 

 

 

Above is your current schedule. In order to lessen the likelihood of a paradoxical mirtazapine / diazepam reaction, you may want to take the mirtazapine earlier in the evening, away from your last scheduled diazepam. For example:

 

     8:15 am Lexapro

 

     12:30  2 mg diazepam

 

     17.30  2 mg diazepam

 

     20.30  15 mg mirtazapine

 

     Midnight - 1.5 mg diazepam

 

 

Let me know what you think. I do hope you can eventually move to an earlier bedtime, but for now, this kind of schedule may help. 

Ok so I've done the swap... and waiting for the fall out! 

 

I actually had a good and restful sleep, broken but restful.

 

i have a confession to make. I took a 40mg propranolol at 16.30 day before yesterday. I didn't think to mention it as it was a one off but after what you said about sedating meds I've been thinking... It made me dozy all evening. That night I took my 1.5mg diazepam and 5mg escitalopram and had that awwwful night with severe akasthisia. I ended up taking 2mg diazepam at 4.30am to little effect then took the 15mg Mirtazipine at 8.15am and for the first time it didn't get me to sleep. I took another 2mg Diaz at 10.30am and dozed for half an hour. Then took another 2mg Diaz at 14.30. 

 

Dont be angry :/ 

 

im just wondering if the propranolol caused my bad night rather than being 4 days into my diazepam drop to 5.5mg.

 

So I took 6mg diazepam yesterday and not in my routine. Then:

 

23.30 15mg Mirtazipine slept til 7am, broken but not akasthisia 

 

8.15am today 5mg escitalopram 

Zero Akasthisia until about 10.30 

 

Spiritual journaling, able to concentrate on tv and self care for first time in weeks.

 

11am 2mg diazepam 

 

i know this has now completely changed the routine again :/ Sorry. Just trying to work out how to get my stable diazepam dose through this swap and the undoubted fall-out to come. And to work out if the single propranolol dose threw things or my diazepam drop.

 

I wish I could continue to have the sleep and the start to the day I've had last night/ today. But probably slept due to double Mortaz dose yday? i.e. The 8.15am and 23.30?

 

on the diazepam, I really find it hard to take it if I just don't feel the need to. Like today, to get my doses in and avoid taking it close to Mirtazipine at bedtime (I decided to take it at bedtime as the sleepiness normally starts quite soon after taking it) I'll need to squeeze em in before say 6pm. But after taking my first dose today I'm already feeling that horrid disconnection from the world outside my head.that drunk/ distant feeling and can't imagine taking the rest of my doses over the next 6 hours (it's nearly midday).

 

And as my mirt/lexapro swap evolves and maybe creates problems before settling (hopefully!) how do I keep my diazepam dosing constant? 

 

I woke up feeling clear on things and quite clear headed but the fog is descending.

 

Sorry this is confusing. 

 

It's just over an hour after taking 2mg diazepam at 11am and I'm feeling the akasthisia sensations and not relaxed.

 

 

Edited by Nikki74

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Shep
12 minutes ago, Nikki74 said:

i have a confession to make. I took a 40mg propranolol at 16.30 day before yesterday. I didn't think to mention it as it was a one off but after what you said about sedating meds I've been thinking... It made me dozy all evening. That night I took my 1.5mg diazepam and 5mg escitalopram and had that awwwful night with severe akasthisia. I ended up taking 2mg diazepam at 4.30am to little effect then took the 15mg Mirtazipine at 8.15am and for the first time it didn't get me to sleep. I took another 2mg Diaz at 10.30am and dozed for half an hour. Then took another 2mg Diaz at 14.30. 

 

Dont be angry :/ 

 

im just wondering if the propranolol caused my bad night rather than being 4 days into my diazepam drop to 5.5mg.

 

So I took 6mg diazepam yesterday and not in my routine. Then:

 

23.30 15mg Mirtazipine slept til 7am, broken but not akasthisia 

 

 

Nikki, I'm not angry, but I'm getting concerned that you may not be a good candidate for coming off your drugs on an on-line forum environment. What you're attempting to do - what we all are attempting to do - is difficult and there's not a lot of support in the medical community for this. It requires a lot on your part to be able to manage your taper and your symptoms safely and predictably. 

 

Please see:

 

Before you begin tapering - what you need to know

 

Please pay careful attention to this post:

 

 

We give you tapering advice on the information you provide us and that comes with more risks if you are not telling us important information about using other drugs and / or making other changes. 

 

 

1 hour ago, Nikki74 said:

I actually had a good and restful sleep, broken but restful.

 

I've lost my diazepam routine. Don't be annoyed :/

 

I upped to 6mg yesterday.

 

Again, another reason to wonder if you are going to be a good candidate for doing this in an online environment. 

 

Please do not make more than one change at a time. Changing the timing of your mirtazapine also changed the level in your bloodstream. Add to that an additional diazepam dose. And prior to that, a sizable dose of propranolol. 

 

I'm glad to hear you had a "good and restful sleep"; however, right now, you have no idea if it came from any of the multiple changes made within the past couple of days. 

 

I get a very strong vibe that you want desperately off these drugs, that you're dealing with severe fatigue and sleep deprivation, and you have a child to take care of. But please, going forward, let's stick to one drug change at a time.

 

You can do this, but keeping it simple and working on non-drug coping skills (and the weighted blanket is brilliant, by the way), you'll have a much easier journey. 

 

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Nikki74
34 minutes ago, Shep said:

 

Nikki, I'm not angry, but I'm getting concerned that you may not be a good candidate for coming off your drugs on an on-line forum environment. What you're attempting to do - what we all are attempting to do - is difficult and there's not a lot of support in the medical community for this. It requires a lot on your part to be able to manage your taper and your symptoms safely and predictably. 

 

Please see:

 

Before you begin tapering - what you need to know

 

Please pay careful attention to this post:

 

 

We give you tapering advice on the information you provide us and that comes with more risks if you are not telling us important information about using other drugs and / or making other changes. 

 

 

 

Again, another reason to wonder if you are going to be a good candidate for doing this in an online environment. 

 

Please do not make more than one change at a time. Changing the timing of your mirtazapine also changed the level in your bloodstream. Add to that an additional diazepam dose. And prior to that, a sizable dose of propranolol. 

 

I'm glad to hear you had a "good and restful sleep"; however, right now, you have no idea if it came from any of the multiple changes made within the past couple of days. 

 

I get a very strong vibe that you want desperately off these drugs, that you're dealing with severe fatigue and sleep deprivation, and you have a child to take care of. But please, going forward, let's stick to one drug change at a time.

 

You can do this, but keeping it simple and working on non-drug coping skills (and the weighted blanket is brilliant, by the way), you'll have a much easier journey. 

 

Ok.

 

how shall I proceed with my dosing times of diazepam?

 

I understand what you say.

 

I regret making so many changes in a small space and hope I've not set myself up for worse to come in coming days... ?

 

i have read the links about before tapering etc. 

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Shep

It's okay. It's a learning process. I'm glad you are ready to set up a formal dosing schedule and stick to it.

 

Do you want to leave the diazepam at 6 mg or go back to 5.5 mg? 

 

I would pick a diazepam dose and then stick with it. It may be uncomfortable for awhile as your nervous system adjusts, but I'm hoping the evening mirtazapine dosing will help, along with letting your nervous system settle into a routine. My only advice is to separate the mirtazapine and the diazepam so there's less chance for a paradoxical reaction, as I posted here

 

And then keep doing the non-drug coping skills that you've listed. Those are really key and it looks like you have a good assortment of journaling, coloring, using a weighted blanked, etc. All of this matters. ;)

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Nikki74
1 minute ago, Shep said:

It's okay. It's a learning process. I'm glad you are ready to set up a formal dosing schedule and stick to it.

 

Do you want to leave the diazepam at 6 mg or go back to 5.5 mg? 

 

I would pick a diazepam dose and then stick with it. It may be uncomfortable for awhile as your nervous system adjusts, but I'm hoping the evening mirtazapine dosing will help, along with letting your nervous system settle into a routine. My only advice is to separate the mirtazapine and the diazepam so there's less chance for a paradoxical reaction, as I posted here

 

And then keep doing the non-drug coping skills that you've listed. Those are really key and it looks like you have a good assortment of journaling, coloring, using a weighted blanked, etc. All of this matters. ;)

Ok thank you.

 

I'll think on the diazepam and respond a bit later.

 

i really don't know yet... I've never been that stable on it, just felt better when I was only taking max 4mg a day but that was during taking Zopiclone which dampened down some stuff too. So I'll try to get my addled brain round it and get back to you a little later if that's ok?

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Shep
1 minute ago, Nikki74 said:

Ok thank you.

 

I'll think on the diazepam and respond a bit later.

 

i really don't know yet... I've never been that stable on it, just felt better when I was only taking max 4mg a day but that was during taking Zopiclone which dampened down some stuff too. So I'll try to get my addled brain round it and get back to you a little later if that's ok?

 

Of course. I'm glad you're going to take some time to think about it and come up with a plan. 

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Nikki74

Do you think by effectively taking 30mg Mirtazipine yesterday albeit in split doses, ill have caused a kindling effect that now I'll get even more withdrawals from? 🙁

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Nikki74
3 hours ago, Shep said:

 

Of course. I'm glad you're going to take some time to think about it and come up with a plan. 

Still trying to work it out. I've drawn up an overview of the last three months and all the changes to try to glean what's caused what etc!! 

 

Id like to be able to just be on 5.5mg really but concerned about my recent changes with mirt/lex swap and my silly beta blocker moment two days ago.

 

ive had the best day today I've had in weeks. Clearer head, able to read and write and hold a conversation. Minimal discomfort with akasthisia symptoms. I mean it's not been 'normal' but tolerable! But who knows why that is. 

 

One question for today: I've taken 4mg diazepam so far and it's 17.30. I don't feel I want to take any more today but clearly I must in order to keep dosage up. I'm feeling quite wired as it is (I'm sure the diazepam does this as much as help as well). What time should I take the rest of today's dose? 

 

And of course, how much? 

 

So far since Sunday my diazepam had been thus:

 

sun 5.5mg

mon 5.5 mg

tue 5.5 mg

wed 5.5mg

thur 6mg

fri (today) so far 4mg

 

Second question, what dose timetable would you now recommend for my diazepam based on 5.5mg?

 

Thank you Shep.

 

 

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Nikki74

Ps I've re read the 'your ability to self manage'. It's true I'm up against it regarding my existing health condition (CFS) plus sleep deprivation, being on my own (no adult support in the home) and in a right mess due to all the changes I've been told to make my GP and psychiatrist since June!

 

I guess what I'd like is to try to stabilise first. Which I know is what you're trying to get me to. That's my first goal. 

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Nikki74

Really kicking myself for making the rapid mirt/lex swap! Argh, it was desperation and I'm gonna pay for it aren't I?! 😕 

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baroquep

Hi Nikki, I'm a little concerned for you ... why did you discontinue mirtazapine to start taking lexapro?  I thought you were taking both?  what drugs are you now currently taking?  could I ask you to update your withdrawal history signature when you make a change to your medication so it is easier for moderators to understand what is going on?  

 

Account Settings – Create or Edit a signature

 

I'm about to head off to bed and likely won't see your answer until tomorrow but wanted to attach a few links so that you could get a bit more information on the recommendations made here.

Stabilizing - What Does That Mean?
Keep it Simple, Slow and Stable
Slowness of slow tapers

Before you begin tapering what you need to know

 

 

Edited by baroquep

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Nikki74
8 hours ago, baroquep said:

Hi Nikki, I'm a little concerned for you ... why did you discontinue mirtazapine to start taking lexapro?  I thought you were taking both?  what drugs are you now currently taking?  could I ask you to update your withdrawal history signature when you make a change to your medication so it is easier for moderators to understand what is going on?  

 

Account Settings – Create or Edit a signature

 

I'm about to head off to bed and likely won't see your answer until tomorrow but wanted to attach a few links so that you could get a bit more information on the recommendations made here.

Stabilizing - What Does That Mean?
Keep it Simple, Slow and Stable
Slowness of slow tapers

Before you begin tapering what you need to know

 

 

Hi, I've not discontinued, I've swapped the timings. So same dose.

 

i was on 5mg lex at night and 15mg mirt in the morning. I've done an exact swap so mirt at night and lex in the morning.

 

im getting dry retching today. Haven't had this since was on Zopiclone. 

 

 

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Nikki74
9 hours ago, baroquep said:

Hi Nikki, I'm a little concerned for you ... why did you discontinue mirtazapine to start taking lexapro?  I thought you were taking both?  what drugs are you now currently taking?  could I ask you to update your withdrawal history signature when you make a change to your medication so it is easier for moderators to understand what is going on?  

 

Account Settings – Create or Edit a signature

 

I'm about to head off to bed and likely won't see your answer until tomorrow but wanted to attach a few links so that you could get a bit more information on the recommendations made here.

Stabilizing - What Does That Mean?
Keep it Simple, Slow and Stable
Slowness of slow tapers

Before you begin tapering what you need to know

 

 

Hi, I've not discontinued, I've swapped the timings. So same dose.

 

i was on 5mg lex at night and 15mg mirt in the morning. I've done an exact swap so mirt at night and lex in the morning.

 

im getting dry retching today. 

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Nikki74

I'm going to try to update my signature on my laptop as can't do it on my phone. 

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baroquep

Hi Nikki, not sure why you switched the timing of your meds ... did your doctor advise you to do this?  From what I understand when we move the timing of our doses, it needs to be done gradually and carefully.  When we take these drugs, our brain adapts to getting a certain dosage at a certain time of the day and I'm not surprised that you are having difficulty.  

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Nikki74
5 minutes ago, baroquep said:

Hi Nikki, not sure why you switched the timing of your meds ... did your doctor advise you to do this?  From what I understand when we move the timing of our doses, it needs to be done gradually and carefully.  When we take these drugs, our brain adapts to getting a certain dosage at a certain time of the day and I'm not surprised that you are having difficulty.  

Hi Baro, Shep suggested it and said I could either do gradual or straight swap and explained the benefits of gradual and risk of straight swap. I rather stupidly decided to do a straight swap. 

 

Can't work out if I have akathisia or whether all of this is withdrawal and chaos from the last few months. Today 'akathisia' is full on, or whatever it is. I appreciate this is probably because of my timing swap but also we'd been working on reducing my diazepam to 5.5mg a day and am wondering if it's this as well.  I know, Shep explained I should only do one change at a time. I just wasn't thinking clearly and got carried away with changes. I'm feeling regretful, foolish and distressed. I know there's nothing you can do. I hope you will still support me.

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baroquep

of course I will still support you and glad to hear that you are working closing with Shep, you are in very good hands. just  when I saw you did a straight switch, became concerned. has it only been one day since you swapped?

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Nikki74
3 minutes ago, baroquep said:

of course I will still support you and glad to hear that you are working closing with Shep, you are in very good hands. just  when I saw you did a straight switch, became concerned. has it only been one day since you swapped?

Yes, well I took mirtaz at night on Thursday (so have done two nights of that) and took lex in the morning for the first time yesterday, so it's my second day today. Though of course I had a double dose of mirtaz on Thursday as had had it in the morning too.  I have the best sleep and morning I've had in months Thurs/ Fri morning. Bit of a false window I think...

 

Thanks

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