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neroli: Is this benzo withdrawal, or other drugs interacting

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neroli

I am preparing to taper Escitalopram using the 10% reduction method.  I am on 10mg per day and there is no liquid form available in this country.  Cutting the pills is impossible to get the reductions small enough, so I am going to do a water titration, spreading the cut over a month.  The first month (30 days) would be a cut of !mg, titrated at around 0.03mg increments in water per day.  Some questions that I have not been able to work out:

 

1) If I titrate down as I've suggested above, it will take me 30 days to take off 1mg.  Do I then need to hold for a month?

2) I am making a spreadsheet to keep track of the reductions - how much to toss each day.  The first titration will be easy to calculate - let's say I am using 200ml water - I can populate the spreadsheet with formulae that will give me incremental reductions of 0.03mg a day.  When it comes to the next cut (10% of 9mg = 0.9mg, again reduction over  30 days) I will still be dissolving a 10mg tablet in the 200ml of water (because I can't cut 0.1mg off the pill) and I cannot work out what formulae to use in the spreadsheet.  My only idea has been to somehow make a formula in the cells that deducts that last amount of liquid from the initial taper down to 9mg, then take the further incremental dose reductions of 0.9mg divided by 30 days from that.  It will be the same issue when I make the next 10% reduction from 8.1mg down to 7.29mg, Any ideas/experience of how this can be done?

3) How do I find out if reducing the escitalopram will affect the blood plasma levels/potency (or whatever happens) of the Nortriptyline and Diazepam I'm also taking?

 

Thanks for any advice.

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neroli
5 hours ago, Altostrata said:

I'll move this to your Intro topic so as not to take this topic off-track with details about your own particular tapering.

Thank you, Altostrata, I'll take a look at the links - wondered where my post had gone!

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neroli

Anyone, I'm really scared that my nervous system/other body systems have been permanently damaged and that I will never get better.  I am still finding my legs are like lead and I am fatigued easily, getting shakes a lot too.  The physio is working me through a programme of light exercise to treat the functional neurological disorder that has been diagnosed and, although she treats people with CFS mainly, is confident that with a graded programme I will come right.  To her it's all a matter of re-trainng the brain to send the right signals I really appreciate this woman sh'e good).  My worry is that it's nothing to do with brain signals but that I've been well and truly whacked by the drugs and they've caused permanent damage.

 

This part in my signature is what I mean about being whacked:

 

April 2013 - July 2014 Dr changes meds through Sertraline, Venlafaxine, Fluoxetine, Mirtazapine (physical and mental mess by this point).

July 2014 - CT Mirtazapine
July 2014-February 2016 Medication free, long term w/d syndrome
February 2016 Fluoxetine - dreadful, taper off over a few weeks
July 2016 - mid January 2017  Medication free, long term w/d syndrome, physical breakdown

 

I've improved from last year - being propped up by benzos, nortriptyline and Escitalopram (although this last one didn't seem to do much beneficial, that's why I was put on Nortrip. as well).  I'm tapering the benzo but in a few weeks will hold that taper and start trying to get off the Escitalopram, hoping that that will ease up the fatigue and lead legs (Citalopram caused me fatigue and weakness when I was on that - not to the degree that I have now but it was there, that's why I"m hoping getting off the escitalopram will improve leg weakness and fatigue)

 

I know no one can tell me whether I will get well - but has anyone been in a similar messed up state and come out of it to better wellness?

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neroli

@Rosetta

 

Thought I reply to you in my intro thread so the benzo thread doesn't go off topic.

 

You said "I can do many more things and go out more easily." which sounds so good, having those glimpses of the light help so much to keep going on.  I hope for you that you get many more of those and soon.

 

As you know, I had a good day on Wednesday, so good that when I got home in the evening, I had enough energy to potter about a bit.  I thought I'd cracked it - yes! I've got stabilised on the benzos and I can crack on with the Escitalopram taper - my mind worked overtime thinking I'd dive in with a 1mg reduction in a week or so.  I was feeling invincible.

 

But, then I thought I'd missed a dose of Diaz on Wednesday, so I took a dose that night, outside my usual time.  Today - crash.  My sleep wasn't so good last night - only dozing from 2.00am on (which doesn't help at all) and my muscles have felt like they are on the verge of cramp, I've had an anxiety attack this afternoon and been on edge all day.  So, perhaps the messed up dosing yesterday gave me a jolt.  I've managed to do some work and have been for a short walk.  Now in bed with such tired legs I have no idea what they will be like tomorrow.

 

Shep has informed me that changing the times of doses can cause wobbles.  So whether I did miss a dose, or took an extra one at night I guess I need to be extra vigilant about dosing.  AND scale down the big plans to cut Esci. fast and furious - bring it back down to cautious cuts.

 

Well, I hope you had a good day and the anxiety passed - it really is extremely testing.  Good on you for keeping on keeping on.

 

Here's my fingers crossed for a better sleep tonight .....and more windows for you.

 

Best of wishes

 

Neroli

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Rosetta

Yes, it's difficult to have a good day and then have a rough day the next.  It feels so discouraging.  However, the fact that you had a good day is very encouraging!  That means you are progressing.  Super!  

 

The consistent dosing is so very, very important it seems.  (It's one reason I think it's criminal to prescribe these drugs in the first place.).  EI'm sorry you made a mistake.  Using a pill box is a good thing -- one with the days of the week on it.  That way if you think you missed a pill, but you look in the pill box and it's gone then you know you took it.  You simply have to refill it every Sunday or the system doesn't work.  

 

I did have a good day after I left the house.  I went out and that always makes me feel better.  It's hard to remember because if I feel bad I was to hide and isolate.  Then, I start to feel worse, not better.  

 

It was really nice to "see" you, Neroli.

 

-Rosetta

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neroli

Thanks, Rosetta, for your kind words.  And I'm glad you had a good day.

 

I had a good one today as well.  Surprisingly.  But very nice.

 

I've got my pill bottles sorted now, have marked the caps more distinctly and the extra bottle I take with a spare dose in in case I collapse and have to stay in hospital or at a friend's now has the pills wrapped in tin foil.  That way, I will definitely know that I've gone into the wrong bottle!

 

So, another day of hope.  onwards to tomorrow....

 

Good to catch up,

 

Neroli

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neroli

I've been working with Shep over in the benzo forum.  I'd got down to 12mg Diaz. as you can see in my signature and was having a rough time. I decided to up dose to 12.25mg to see if that would stabilise me.  It's three weeks since I up dosed and it's been a mixed bag, not totally great and I'm not sure if I've stabilised.  I've been talking about starting to taper off the Escitalopram for a while - it didn't do much to help when I had the physical breakdown beginning of last year after protracted hard core symptoms while off meds, so I want to get it out of my system.  I've also got lead legs and I don't know whether the Esci. is exacerbating this (when I was on Citalopram years ago, I notice there was fatigue and some weakness while I was on it - except I didn't recognise it was that until I had gone through a lot of meds. and the long-term WD stuff and had started to read more about what a-ds can do).  

 

But actually, how can anyone know what is playing into the lead legs when I'm on three drugs which all have weakness and fatigue as side-effects?  There's no clear answer on that and maybe the legs will take a long time to resolve (I hope they do).

 

So, let's go to the basic level of why I want to start tapering the Esci.  1) It didn't do much good, yet I'm carrying it as a drug burden now, 2) advice on this site is to taper the a-ds before the benzo.

 

My last post to Shep included: "My plan was to start the Escitalopram taper at the beginning of July (one week away).  I've gone up and down thinking about whether to start with a 10% cut, do a 0.25% Brass Monkey-style taper, down to being super-cautious and cutting only 0.1% until I see how it goes and if I can up the cuts.  Now I'm wondering if I can handle even a small cut, given that even "stabilising" at the current dose of benzo is still a roller coaster.  Or maybe it's always going to be that way whether I remain at current dosages or start cutting."

 

He suggested I come over to my intro. thread and see if any moderators have ideas or suggestions.

 

I've attached my symptom diary from early June after I up dosed.

 

I'd appreciate any thoughts.  Many thanks.

 

Neroli

SymptomDiaryJune2018.xlsx

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Rosetta

Bump

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Rabe

I sure hear you on wanting a drug out of your system! From my own experience neroli, I;d get better stabilized before you start tapering another med...  

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neroli
4 hours ago, Rosetta said:

Bump

Hi Rosetta How do I bump - or have you bumped it by posting your bump message?

 

thanks for your support.  hope better days happening for you.

 

Neroli

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neroli
3 hours ago, Rabe said:

I sure hear you on wanting a drug out of your system! From my own experience neroli, I;d get better stabilized before you start tapering another med...

Thank you,  Rabe.  I'm finding it very confusing - there are conflicting reports from people on the Diazepam hold - have seen it reported that Diazepam can cause depression and "turn on you" re. anxiety.  I'm doing what I can to research and listen to my body.  thanks for your input.

 

Wishing you the best, you've been on quite a rough road yourself by the looks of your signature.

 

Neroli

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Rabe

Yes its been an interesting journey for sure.

Had no idea what these benzodiazepines were all about ..... but have quickly learned.

I find for myself that I get depressed, especially when tapering, but in between doses as well...and the anxiety also comes and goes but I dealt with it before the drug as well.  

You have really tapered a lot in short time....

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Rosetta

Hi.  Yes, I bumped it.  Keeping it on the first two pages of posts makes it more likely you will get an answer.  

 

I think I would hold a while longer if I were you, too.  It was only June 14 that you had an anxiety attack and you may have missed a dose just before that.  I hope a Mod will have a chance to look at your symptom diary that you attached a couple of posts up.

 

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neroli
11 hours ago, Rabe said:

You have really tapered a lot in short time....

Hi Rabe

 

You think so?  I thought I was going really slowly and was getting down on myself for not being able to go faster.  Shep has been good at holding me from that taper a bit.  Think I'm getting the depression while tapering and holding as well, and the anxiety.  I didn't have anything like this bad before all this.  So angry sometimes - so very sad sometimes.  

 

All the best

 

Neroli

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neroli
4 hours ago, Rosetta said:

Hi.  Yes, I bumped it.  Keeping it on the first two pages of posts makes it more likely you will get an answer.  

 

I think I would hold a while longer if I were you, too.  It was only June 14 that you had an anxiety attack and you may have missed a dose just before that.  I hope a Mod will have a chance to look at your symptom diary that you attached a couple of posts up.

Thank you, Rosetta.  Useful to know these techniques - I will bump it tomorrow again.

 

Yes, maybe the hold is the best for now.  The time seems like ages on a hold (impatience).  But then when I see it has only been three weeks etc. I realise it's not that long.

 

thank you for dropping by and helping me.  That's so kind of you.

 

Very best to you

 

Neroli

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Rosetta

Neroli,

 

You are welcome.  I understand about feeling down and frustrated with oneself that the anxiety and depression continue.  We have been taught all our lives that anxiety and depression are under our control -- if we would only do the "right" thing these feelings would go away.  Now, we are in a position in which it's not easily fixed by diet or exercise or being social -- it's literally a brain chemical dysfunction created by the drugs that were supposed to fix an imaginary brain chemical dysfunction!! It boggles the mind, doesn't it?! 

 

The fact is that going slower with a taper is always the right thing to do.  It seems the wisdom is to get our tasks done as quickly as possible is ubiquitous.  So, we transfer that wisdom to this problem and it backfires.  Feeling that we aren't progressing makes us want to do something to speed the process, and for taperers the obvious "something" is step up the taper.  That is the opposite of what is necessary to quell the symptoms.  You will, in fact, increase the disruption to your life and increase your distress.

 

I, too, feel the need to do something to speed this process.  I get discouraged and upset with myself that I'm not progressing past this yo-yo stage.  Isn't there something I can do? More magnesium, more walking, meditate more, meditate a different way?  I can't shake the feeling that something terrible will happen if I don't get well quickly, but, of course, that's ridiculous.  Doesn't it sound illogical?  Things happen no matter what is happening otherwise.  It's all random.  I think it's the consistent anxiety that, quite naturally, is telling me to do something differently -- that's what anxiety is designed to do, right?  Our bodies were not designed to make sense of illogical, chemically induced anxiety.  

 

So, time for self compassion.  Time to treat yourself like a frightened child.  Be kind, be understanding, and let the child know this feeling will pass.  Someone said on my thread "Let yourself be in a mess."  Good idea.  We wouldn't demand that the child " just get over it," and we can't demand that of ourselves.  It simply won't work.  It will instead make things worse.

 

Well, that was as much for me as it was for you, Neroli.  I hope you can find self compassion, and I hope your symptoms quiet down soon.

 

Peace, Rosetta

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neroli

@rosetta

 

Thank you - great words, Rosetta.  Would like to write more in response but am just going out to work.  Hope you r day is good - will catch up with you again later.

 

Neroli xx

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neroli

Bump

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neroli

Hello Rosetta

 

Yes, getting off as speedily as possible is my goal.  It is made even more urgent by the continual lead legs I've had for nearly a year and a half now.  It doesn't seem to get better and it has seemed to get worse to me.  I'm still managing to get into work but it's harder, my walks at the weekend have shortened.  I realise the potential benefit in holding and am doing that to see if I stabilise.

 

I've been reading the Inner Compass, the Withdrawal Project, Laura Delano's site, and now I'm in the thick of trying to work out what interactions could affect withdrawal from the three drugs I'm on and any potential risks from over-activating one of the drugs by reducing another of the drugs.  I'm nowhere near getting to groups with it but it seems to involve the CYP enzymes which affect metabolism of the drugs.  I'm on the point of asking my doc. if I can be referred to a pharmacologist or endocrinologist because it sure seems complex and will take a lot of reading and making notes.

 

So, I hope your day went well.  I managed a better day at work today.

 

Wishing us both wellness

 

Neroli

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Shep

Hi, Neroli.

 

I've asked the AD mods to check in with you after they have a chance to go over your most recent drug and symptoms journal. 

 

Your best bet may be to hold and see if you can stabilize more before making any other reductions, but it will be good to have a second pair of eyes, especially from the AD experts, and offer you their advice. 

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Gridley

Neroli,

 

I'm in a similar situation, with the Lexapro and a benzo. I've been tapering the Lexapeo using the Brassmonkey 2 1/2% method with general success.  I do have symptoms (mostly

anxiety and insomnia, plus anhedonia and apathy and (like you) fatigue.  In a year and a half I've gotten down from 20mg to my current 6.4.  I've had to hold longer than the usual two weeks on a few occasions.

 

She has advised you well, and I too think it's a good idea to work on the AD now.  Before I came into SA, I tapered my Imipramine first (tricyclics are a brake, like benzos) and got into some severe anxiety problems.  These have abated greatly since I started getting lower on the Lexapro.

 

Given your history and what you've written, I'd suggest you go with some version of the Brassmonkey taper.  The regular 10% method might be too much of a jolt for you.  Here are some possible variations:  If you want to be cautious, you could start with 1% per week instead of 2 1/2% and see how that feels.  You could also hold longer than the standard two weeks.  I've found holds help me a lot, though I have to battle the attitude that I want to be done.

 

I'm happy to help you any way I can.

 

Best,

Gridley

 

 

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neroli
7 hours ago, Shep said:

I've asked the AD mods to check in with you after they have a chance to go over your most recent drug and symptoms journal. 

Thank you, Shep.  Supportive of you to ask the mods Mods to have a look.  Am holding until I've got more information and suggestions from the mods.

 

Best wishes

 

Neroli

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neroli
5 hours ago, Gridley said:

I'm happy to help you any way I can.

Gridley

 

Thank you so much for coming in to tell me of your experience.  That's very helpful and I appreciate your support.  Especially the info. about tricyclics being a brake like the benzo.  It sounds like you found the right way to come off.  Did you do any research on drug interactions/enzymes and metabolism, or was the info. from SA enough to make your decision to taper the Lexapro first?

 

Wishing you well

 

Neroli

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Gridley

The information from SA was convincing to me.  I didn't do any further research.  I later read on SA that Lexapro was a very activating SSRI (perhaps one of the most activating) and that corroborated my decision.

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Altostrata

Hello, neroli.

 

You're taking nortriptyline and diazepam at the same time at night? Did nortriptyline ever make you sleepy? What is your sleep pattern?

 

When you wake up, how do you generally feel? How do you generally feel after taking Lexapro?

 

11 hours ago, neroli said:

I'm in the thick of trying to work out what interactions could affect withdrawal from the three drugs I'm on and any potential risks from over-activating one of the drugs by reducing another of the drugs.  I'm nowhere near getting to groups with it but it seems to involve the CYP enzymes which affect metabolism of the drugs.

 

Don't worry about this, the information about the CYP enzymes is incorporated into the Drug Interactions report you got from drugs.com back in January.

 

When a bunch of drugs are interacting, it's very difficult to figure out which is causing the problem. Could be all of them, they're an ecology to themselves. Liver enzymes might not even be involved (but often are).

 

We try to go by symptom pattern to isolate the worst offender.

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neroli

 

Hello Altostrata

 

Thank you for your message.

22 minutes ago, Altostrata said:

You're taking nortriptyline and diazepam at the same time at night? Did nortriptyline ever make you sleepy? What is your sleep pattern?

I take my last dose of Diazepam at 3.00pm.  90mg of Nortriptyline at 8.45pm.  I don't notice that it makes me sleepy, possibly because I settle down to sleep at 9.00pm.  Generally what happens is that I "black out" into sleep around about 20 minutes later (there is no sensation of drifting off like my "normal" experience used to be).  From then, until about 1, 2 or 3 am I am asleep and wake to go to the toilet.  I don't always go back into a deep sleep - especially if I wake at 3am.  Then it can be more of a doze, and around 4 I will put on guided meditations to help me doze until 5.45am when I get up to shower.  When I first went on Nortriptyline I had a sense that it made me feel tired the next day but now I can't discern whether it's the drugs or a disturbed night's sleep.  Back last year, it wasn't until I got up to 90mg Nortrip. that I started to sleep without the aid of Zopiclone and night-time doses of Lorazepam.

 

31 minutes ago, Altostrata said:

When you wake up, how do you generally feel? How do you generally feel after taking Lexapro?

I generally have anxiousness by 5.45am when I get up, I cannot lie in and enjoy the warmth of the bed or anything like that.  I am shaky, woozy, sometimes very tired and my legs are like lead (but the legs thing goes on all the time).  I don't notice any particular difference at taking the Lexapro.

 

35 minutes ago, Altostrata said:

Don't worry about this, the information about the CYP enzymes is incorporated into the Drug Interactions report you got from drugs.com back in January.

That's good to know - I thought I was going to have to research like mad!

 

Thank you for your support

 

Neroli

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neroli
43 minutes ago, Gridley said:

The information from SA was convincing to me.

Thank you, Gridley.

 

Altostrata has also given me some help in this regard.

 

Best wishes

 

Neroli

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Altostrata

My guess is the shakiness is from the diazepam, but a trial taper of the Lexapro might reveal otherwise. Since it doesn't seem to be doing anything, I'd work on getting Lexapro out of the picture.

 

As you make drug changes, your daily symptom pattern will be very important. Please let us know how you're doing.

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neroli
17 minutes ago, Altostrata said:

Since it doesn't seem to be doing anything, I'd work on getting Lexapro out of the picture.

Yes, thanks, Altostrata.  That was my thinking, (also that the shakes could be from inter-dose Diazepam withdrawal, it can take a while for the shakes to go after my morning dose of Diaz.)).  I will continue to keep my symptom diary and update as I make any changes.

 

Am holding for the moment to see if I get more stabilised from what could have been a too rapid taper of Diazepam and some wobbles from that.  Then I'll go in cautiously on the Lexapro.

 

Best wishes

 

Neroli

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Altostrata

Yes, interdose withdrawal.

 

Please let us know how you're doing.

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neroli
On 6/28/2018 at 1:33 AM, Gridley said:

I've been tapering the Lexapeo using the Brassmonkey 2 1/2% method

Gridley - have you been dissolving the Lexapro in water to make your cuts?  I've just read that the brand I've got is film coated and that crushing or dissolving the tablets can cause stomach upsets, or that the drug is coated so it is broken down in the small intestine.  My doc. and pharmacist have told me there is no liquid formulation available in this country, so I'm wondering how I make the small cuts with a tablet that is just about impossible to pill-cut below a half (I'm on 10mg).

 

Just in case you have any info./thoughts.

 

Many thanks

 

Neroli

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Gridley
Posted (edited)

Neroli,

 

They make it so hard for us.  I don't dissolve in water.   I've been using the Gemini-20 scale (available at least in the U.S. on Amazon) to weigh my cuts and put the cut tablet in a gelatin capsule.  My Lexapro isn't coated, and I've never has any stomach upsets.

 

I'm going to ask the other moderators if they have any ideas.

Edited by Gridley

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Altostrata

neroli, look on your package of Lexapro. Does it say "extended release" or some such?

 

It's unlikely your Lexapro has an extended-release coating, none of them do. Your doctor and pharmacist don't know anything about titrating this drug and were too lazy to look up the formulation of the tablet.

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neroli
11 hours ago, Gridley said:

I'm going to ask the other moderators if they have any ideas.

Thank you so much, Gridley and Altostrata  I did check the package (no info. there), so I googled the brand and as far as I know, the coating is not enteric (which I think is more likely to be used to avoid stomach upset or to delay digestion until the small intestine), it called it a film coating which could just for "cosmetic" effect.  I have tried dissolving the tablet in water and it does make a suspension, so the coating is not water-resistant.  There was no information saying it was extended release.

 

Thank you for your help.

 

Neroli

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neroli

Posting my latest symptom spreadsheet.  Overall nothing feels much better and maybe worse in terms of fatigue and an added symptom of nausea creeping in. SymptomDiaryJune2018.xlsx.  Been dealing with most of this stuff for over a year, legs, I think have become stiffer - though still manage to do some walks and get myself into work.  Bloomin' hard.  I know there are people in worse situations and I try to keep in mind what I am able to do.  Hope fades sometimes.

 

Wanted to start Escitalopram taper next week.  

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