Rabe: how to taper and adjust Viibryd while on Clonazepam

[Shep]

On 7/31/2018 at 10:13 PM, brassmonkey said:

We have a saying "when in doubt, hold". I'll have to get with Shep to figure out what is going on before I can recommend anything.

 

I agree 100%, Brass. Holding is what I mentioned over on Rabe's benzo thread after she posted that her latest compounded batch of Klonopin could have as much as a 3% variance. 

 

3% is a major difference to someone with a destabilized nervous system. 

 

9 hours ago, Rosetta said:

Your doctor is not going to allow you to hold the Viibryd?

 

7 hours ago, Rabe said:

I doubt it...

 

Rabe, any doctor can prescribe Viibryd. Most doctors are thrilled to see patients take an antidepressant, especially while they are dealing with a benzo, as doctors misguidedly think that antidepressants "work". 

 

Here is the provider directory off of the Mad in America website:

 

Mad in America - Provider Directory

 

You can look up providers in your area. If there isn't anyone who is able to prescribe drugs (such as a therapist), you may want to reach out to them to see if they know of any local medical doctors that can and may be aware of withdrawal syndrome. 

 

Also, you may want to show your doctor this article from the New York Times:

 

New York Times - Many People Taking Antidepressants Discover They Cannot Quit

 

And these articles from the trade journal of psychiatry, Psychiatric Times:

 

Psychiatric Times - Online Communities for Drug Withdrawal: What Can We Learn?

 

Psychiatric Times - Antidepressant Withdrawal, Online Data, and a Bottom Line

 

If these articles don't work, I would see if it's possible to change doctors. 

[Rabe]

@brassmonkey  @Shep I want to thank you for your thoughts and help.  I have some questions.  9mg capsules run out nest Tues.

 

If I hold and get another week of the capsules...they could have a variance as well?  So each time I get things compounded there could be a variance or there could not I guess...correct?  I have not seemed to have an issue with the .1mg capsules...although who knows.  I can say that when took the evening Clonazepam .1mg capsules I felt drugged.  I haven't felt that so much with the .7mg but I never seem to know what the result of taking any of the medications or their doses is going to be since this last taper and capsule change.  

The two drugs share the liver enzyme so dropping the Viibryd is always going to affect the Clonazepam as well?...it seems to have both when starting and tapering.  So then do you drop the CLonazepam instead?  Any thoughts on that?  Every single morning I have a headache...Im guessing thats the Clonazepam.  I have reacted to it a number of times adversely while tapering at home and here and it's doubling cause of my psoriasis that has improved as it is decreased...as has the depression (when not tapering anything!)  Tapering the Viibryd may help the rev I get hours after taking it and may help the electrolytes...dont know.  

I dont really want to do this myself because I was such a mess when cutting tablets that I couldnt think and Id forget if Id taken them etc etc. But if the dose would be more stable than idk.  If so I get a scale and tablets I guess.

Essentially I feel overwhelmed.  Just asking for your best thoughts about a next move because I really only have today Fri, Mon and Tues..

Thank you again!

Becky

 

[Rabe]

I feel like I need to get off them and a 1.25% taper would be a place to start...but not another .5 right now.  Yesterday was the first day I felt pretty good going on 6 weeks 

[Rabe]

can you get closer than 3% by crushing and weighing yourself?

[Rosetta]

I'm wondering if the variance was less of a problem in the 0.1 mg pills because there was 6 times less drug in the capsule.  Therefore, if 4 or 5 capsules had a little more drug in them then the other 4-5 had a little less and overall you got just about 9 mg.. The 0.7 mg capsules might have a more problematic variance from one to the other as 3% of 0.7 is a lot more drug than 3% of 0.1.  Can you go back to the 0.1 mg pills? (It's also possible that the pharmacy messed up the 0.7 mg pills.). I know it's more expensive to get all 0.1 mg pills, but there's less risk perhaps.  

[Rabe]

That makes sense Rosetta...thank you.   Just took the .2 at 6 and the Clonazepam is just making me feel so sick.  I feel so defeated right now.  Thank you for those thoughts...I going to call the pharmacy tomorrow.  How are you?

[Rosetta]

I'm ok today, Rabe.  Thank you, Sweetie.  I'm hoping you can get this all under control.  -R

[wantrelief]

2 hours ago, Rabe said:

Just took the .2 at 6 and the Clonazepam is just making me feel so sick.  I feel so defeated right now

I am so sorry you are feeling this way, Rabe.  I am thinking about you. 💗

[Rabe]

@Rosetta and @wantrelief I wanted to say thank you for your kind thoughts and support...means so so much to me! 💜

[Rabe]

@brassmonkey I think the doctor might go along with the slide if he says no to the hold.  

 

Would it be 1.25% per week? That would be the 5% he was wanting, right?  Do we do the % on the dose at the time?  SO first on the 9.0 and then the 8.?

Not thinking well with math, sorry.  I want to be able to present this correctly to him today as I will need to get these capsules by Monday.  Thank you so much for your help with this.  

 

[brassmonkey]

If you are currently taking 9mg then a 5% Brassmonkey Slide would go like this:

 

Week one   8.775mg

Week two   8.555mg

Week three 8.336mg

Week four   8.127mg

Week five    8.127mg

Week six     8.127mg

[Rabe]

Thank you so much...is it going down by 1.25% @brassmonkey?  When I did that I got 8.88 something...but Im a tad lost in all this...sorry. 

I finally called the doctors office after no answer to texts and he is on vacation again... till mid August... so the only rx is the one for the .5 drop next week.  guess I do that, pray for the best and then take the slide to him when I see him end August.  It just has felt nice to have a slightly more balanced system the past 2 days.

No hold, no slide.....😳Oh well...I did talk to the pharmacist who was wayyy more knowledgable than the doctor.  She said they have many people who taper far slower than I because of their sensitivities...thats why they're there.  She also said as we get lower now it would be better to do percent rather than a repeated mg drop, as you know.  THEY are willing to do whatever is best for me...hmmmm...why cant doctors do that?

She verified what @Rosetta said about the  .1mg capsules as opposed to the single  .2 and .7 capsules...the variance would probably be less when taking more than one capsule as opposed to one because there will be different amounts of filler and med though they try hard for that not to be.  She also said big pharmaceutical companies are allowed and can have up to a 10% variance in their medicines!

In any case thank you...not looking forward to next week...its like dropping both meds and is so upending...but is what is until next drop.  She did say this would be similar to the past two drops..think .05? difference.  That care!     

[Rosetta]

You should ask the pharmacist to give you the name of doctors who prescribe slow tapers!!

[Rabe]

I didnt think about that @Rosetta Do you think they would do that?  I could call Monday.

[Rosetta]

Can you go there and talk to her again face to face?  That would be better, but yes, I think she would.  Don't you think she is shaking her head that you are tapering when you don't want to?  

 

I really think you should get a scale Rabe.  You get capsules, right?  You could have had the option of measuring these doses out of the capsules in the right amount while your doctor is off enjoying his vacation.  

 

I'm just so mad at your therapist.  You are not a GD drug addict who is whining about WD.  If that's her attitude, then maybe you don't need her.  Find someone else.  You deserve compassion and appropriate care.  You are doing a very brave thing, and you deserve all the support you need.  Just like everyone on this board you have been victimized by the pharmaceutical companies and the doctors and yet you are taking matters into your own hands and fixing yourself instead of expecting to stay on benzos forever.  Your therapist should live just one month like we do, and she would be begging for an appropriate solution to this epidemic of iatrogenic harm.  It makes me so unbelievably angry!!

[Rabe]

Trust me, if I could do something other than the taper I would...I am less than enthused....and kind of upset, but feels familiar.  

 

Thank you for your thoughts and support, Rosetta.  I am so so grateful!  This is the same therapist that told me I need to get my voice back...but I guess that continues to be only if you can say what others want to hear and be how others want you to be.  I think it was because I texted the doctor about not being able to taper further at this time.  It was definitely uncalled for and I think not professional, but perhaps she had a bad day...idk.  I did think lots today that I would just wish for them to walk a bit in my shoes so that they could better understand.  How can the pharmacist be empathetic and the doctor and therapist not?  The only thing is that I seem to be an anomaly to them...like I cant really be this way...

[Rosetta]

I think pharmacists see a lot of things that make them pause.  For instance, they see people come in to their workplaces in a panic because they lost their medicine or let their prescription run out.  They see people change over time from taking these medicines.  They see the differences in prescribing practices between doctors, too.  Who knows what they learn from all they see.  They aren't in the echo chamber of one doctor's office.  I'll bet most of them are very mistrustful of medicines these days.

[Rabe]

Very insightful...I was thinking of regular pharmacies...but I think the compounders see and hear even more...?

[Rosetta]

Rabe, I know you will be ok.  It may be a bit bumpy, but you have learned how to ride it out.  We are all here for you.  Let us support you, ok?  Don't isolate.  Come and ask for pep talks.  One day you'll be free of this BS.

[Waterfall]

Hey Rabe, 

I just wanted you to know that I'm thinking of you. 

I hope the next little while isn't too rocky. 

 

[Rabe]

Thanks you @Rosetta and @Waterfall I just continue to react to the clonazepam..especially the .2 afternoon dose.  Taper will just make that worse...sorry if I isolate.  Just too much sometimes.  Love you guys and hope you had a good night and day!! 💜

[FarmGirlWorks]

On 8/3/2018 at 7:50 PM, Rabe said:

 I did think lots today that I would just wish for them to walk a bit in my shoes so that they could better understand

Hear, hear @Rabe: if only they could, their tune would be soooooo different. You ‘re being courageous, just know that. 

[Rosetta]

Remember that you are not alone.  We are always thinking of you.  

[Waterfall]

I second that.  Always thinking of you, Rabe. Never alone.  

Hugs. 💜

[Rabe]

@Waterfall @FarmGirlWorks@Rosetta I wanted to say thank you for your thoughts.  I called the pharmacy this morning and told them what was going on and that the doctor is out of town and would they send 8 days of the same viibryd dose and they will.  She is wonderful.  At first I felt bad that I am not doing as the doctor and therapist want....felt stupid and felt like fear had taken hold as therapist said...but then was able to drive and see my daughter and grand daughter, had a lovely day, ate a bit and as day went on I thought nope...just advocating for myself.  If they want to discuss fear Im more than willing to because this entire journey is certainly one of courage and strength amidst fear and uncertainty.  Its counter productive to taper and have my system jolted to the point that my GI system comes undone and I start reacting to food and medications I am on...even Tums!  UGH!  

So, and going to go to my PCP and talk to her about all this and see what she recommends.  And will be telling the therapist Wed that Im not tapering anymore right now and the dr as well when he returns.  If they want to let me go as a result thats ok...I will have to work something else out.  Realize this surge of grit may not last..ut feels good for now.

Thank you all again...going to rest and try to heal my gut.  Any suggestions would be appreciated.  This is a familiar cycle for me over the years after childbirth, after surgery, after lost of stress...just had to sit it out and let my body heal..it knows how to....didnt need and dont need anymore meds.

Just pray to start being able to take the ones Im on without issues again soon!!

Love to all!💜

[wantrelief]

Good for you, Rabe!

 

16 minutes ago, Rabe said:

If they want to discuss fear Im more than willing to because this entire journey is certainly one of courage and strength amidst fear and uncertainty

So very true.  

 

You should be so proud of yourself!  💗

 

 

[Rabe]

@wantrelief Thank you so much for cheering me on...really means a lot!!  Take care!!💜

[Hazel]

Hi Rabe,

wanted to thank you for stopping by on my thread to offer support.  I see you are going through a hard time right now as well and wanted to offer you my support.  I hope things start to improve for you very soon and know I am here for you!

Hazel

[Waterfall]

You go girl.  

You're stronger than they think.  

Maybe stronger than you think too.  

Hugs Rabe.  💜

 

[Rabe]

@brassmonkey 

If you are currently taking 9mg then a 5% Brassmonkey Slide would go like this:

 

Week one   8.775mg

Week two   8.555mg

Week three 8.336mg

Week four   8.127mg

Week five    8.127mg

Week six     8.127mg

 

Could I ask you to explain what the % is and how its working?  The pharmacist made up a week of the 9.0, bless her.  I would like to take this to my doctor when he returns next week but think it would be helpful if Im understanding it and can explain it well.  I really was good at math at one time...not able to wrap my head around numbers like I used to these days.  Thank you!

[Rabe]

My other question is I was reading about the tapering and how you know you are stable...feeling the same kind of ickiness each day...I can say I dont have that.  Just seems more the waves and windows described here ... 

[Rosetta]

Hi Rabe,. Thinking of you!!!

[brassmonkey]

Hi Rabe--  for percentages it goes like this; each week you reduce the previous weeks dose by 1.25%.  This is done four times which gives a total reduction of 5% over the course of four weeks.  Then there is a hold period of two weeks to let everything settle into place and the symptoms to return to baseline.

 

Previous dose is 9mg

Week one reduce    9mg         by 1.25% to  8.775mg

Week two reduce    8.775mg by 1.25% to  8.555mg

Week three reduce 8.555mg by 1.25% to  8.336mg

Week four  reduce  8.366mg by 1.25% to  8.127mg

Week five hold at    8.127mg

Week six hold at     8.127mg

 

This gives a total reduction of 5% over a span of 6 weeks. The next series of reductions start to taper off of the 8.127mg

 

Week one reduce 8.127 by 1.25% to 7.923mg

and continue with the same pattern used above.

 

This method can be used with either dry cutting and weighing with scales or using a liquid solution.

 

Hope that helps.

Brassmonkey

[Rabe]

It does brassmonkey...thank you so much!  Do you have any thoughts on if continuing with compounding is ok through this?  Or not?

 

Other is do you have any thoughts on whether it is ok to start tapering again while getting such changes on days and during days...I am going to hold another 8 days.  Seems everytime I start tapering things upend and dont want to settle down much.  Maybe that is just how it is going to be?

 

Thank you again for your help.  I will print that out and hopefully he will take a good look at it...if I have to go down slower then I will...would like to be able to enjoy my grandchildren now and then rather than try to win the taper race the doctor would like to see.  

 

THANKS AGAIN!! 

[Rabe]

@brassmonkey Sorry..forgot to put this in the above...dah!!!

[Rabe]

@Rosetta...thank you so much Rosetta!!!  Hope your night goes well!!💜