Jony: Cipralex, Victan, Mirtazapine, Nozinan

[Altostrata]

BY JONY

  On 12/21/2017 at 8:59 AM, manymoretodays said:

Yes......it might be difficult, at best, as it's a "controlled substance", at least here in the States.  Tell them......GP or shrink that you are attempting to get onto the lowest possible effective dosage.........sometimes that works, but use discretion.........as it's also possible they will just say......."oh, just go off of it......you'll be fine".  When we know that sometimes......that can be difficult if not harmful.

 

I will do this if necessary...let's see...

 

First I'll try the approach that @Shep gaves me on benzo thread. Dropping off 25% of Clonazepam every few days...as I have a few pills (2 mg), it migth be enough.

 

 

  On 12/21/2017 at 8:59 AM, manymoretodays said:

Excuse me too.  I forgot to mention dosages in the example/sample that I gave above.  Do note your medication/drug dosages, on a daily basis in your main journal/introduction here. 

 

Copy that.

 

Today my night meds will be: Mirtazapine 15 mg, Levomepromazine 3.125 mg and Clonazepam 1.5 mg. 

 

Morning I took Escitalopram 9 mg and Ethyl Loflazepate 2 mg.

 

During afternoon I felt quite anxious but then that feeling was gone.

 

Tomorrow I will describe you how I feel and keep the dosages up to date.

 

Best,

 

Jony

[Altostrata]

BY JONY

 

Here´s what I found out at drugs.com.

 

It seems that Ethyl Loflazepate isn´t listed. I tried all known generic and brand names and didn´t show up there. So I check it out the following drugs: Levomepromazine, Mirtazapine, Escitalopram and Clonazepam. The dosage is the one in my signature.

 

Levomepromazine is also called Methotrimeprazine.

Interactions between your selected drugs

Major

methotrimeprazine  escitalopram

Applies to: methotrimeprazine, escitalopram

Using escitalopram together with methotrimeprazine can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening, although it is a relatively rare side effect. You may be more susceptible if you have a heart condition called congenital long QT syndrome, other cardiac diseases, conduction abnormalities, or electrolyte disturbances (for example, magnesium or potassium loss due to severe or prolonged diarrhea or vomiting). Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or heart palpitations during treatment with these medications, whether together or alone. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Major

mirtazapine  escitalopram

Applies to: mirtazapine, escitalopram

Using escitalopram together with mirtazapine can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should contact your doctor immediately if you experience these symptoms during treatment. In addition, combining these medications can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening, although it is a relatively rare side effect. You may be more susceptible if you have a heart condition called congenital long QT syndrome, other cardiac diseases, conduction abnormalities, or electrolyte disturbances (for example, magnesium or potassium loss due to severe or prolonged diarrhea or vomiting). Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or heart palpitations during treatment with these medications, whether together or alone. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

clonazepam  methotrimeprazine

Applies to: clonazepam, methotrimeprazine

Using clonazePAM together with methotrimeprazine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

clonazepam  mirtazapine

Applies to: clonazepam, mirtazapine

Using clonazePAM together with mirtazapine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

methotrimeprazine  mirtazapine

Applies to: methotrimeprazine, mirtazapine

Methotrimeprazine may increase the blood levels of mirtazapine in some patients. This can increase the risk and/or severity of side effects such as dizziness, drowsiness, restlessness, confusion, difficulty concentrating, impairment in thinking and judgment, dry mouth, constipation, low blood pressure, and heart rhythm abnormalities. Talk to your doctor if you have any questions or concerns. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring to safely use both medications. You should avoid or limit the use of alcohol during treatment. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

clonazepam  escitalopram

Applies to: clonazepam, escitalopram

Using clonazePAM together with escitalopram may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

No other interactions were found between your selected drugs.
Note: this does not necessarily mean no interactions exist. Always consult with your doctor or pharmacist.

Other drug and disease interactions

• clonazepam interacts with more than 400 other drugs and 10 diseases.
• escitalopram interacts with more than 500 other drugs and 9 diseases.
• methotrimeprazine interacts with more than 500 other drugs and 1 diseases.
• mirtazapine interacts with more than 500 other drugs and more than 10 diseases.

Drug and food interactions

Moderate

mirtazapine  food

Applies to: mirtazapine

Alcohol can increase the nervous system side effects of mirtazapine such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with mirtazapine. Do not use more than the recommended dose of mirtazapine, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

Switch to professional interaction data

Moderate

escitalopram  food

Applies to: escitalopram

Alcohol can increase the nervous system side effects of escitalopram such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with escitalopram. Do not use more than the recommended dose of escitalopram, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

Switch to professional interaction data

Therapeutic duplication warnings

Therapeutic duplication is the use of more than one medicine from the same drug category or therapeutic class to treat the same condition. This can be intentional in cases where drugs with similar actions are used together for demonstrated therapeutic benefit. It can also be unintentional in cases where a patient has been treated by more than one doctor, or had prescriptions filled at more than one pharmacy, and can have potentially adverse consequences.

Duplication

Central Nervous System (CNS) Drugs

Therapeutic duplication

The recommended maximum number of medicines in the 'Central Nervous System (CNS) Drugs' category to be taken concurrently is usually three. Your list includes four medicines belonging to the 'Central Nervous System (CNS) Drugs' category:

• clonazepam
• escitalopram
• methotrimeprazine
• mirtazapine

Note: The benefits of taking this combination of medicines may outweigh any risks associated with therapeutic duplication. This information does not take the place of talking to your doctor. Always check with your healthcare provider to determine if any adjustments to your medications are needed.

Duplication

Antidepressants

Therapeutic duplication

The recommended maximum number of medicines in the 'antidepressants' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'antidepressants' category:

• escitalopram
• mirtazapine

Note: The benefits of taking this combination of medicines may outweigh any risks associated with therapeutic duplication. This information does not take the place of talking to your doctor. Always check with your healthcare provider to determine if any adjustments to your medications are needed.

 

[Altostrata]

BY JONY

 

Main symptoms:

- muscle aches

- lack of concentration

- sensitivity to light, especially at night when driving a car, for example

- visual sensitivity (eg looking at pointed objects...it's weird, I know...)

- intrusive thoughts that lead to tics (a kind of obsessive compulsive disorder...)

- nightmares and vivid dreams (always just before wake up, never during night)

- congitive symptoms (eg difficulty in finding words to describe something, even in my native language...) (?may be related to lack of concentration?)

- memory problems (eg forget where I left my keys 5 min ago, but worse, have more difficulty to learn or memorize something than I used to) ( ?again, may be related to lack of concentration?)

 

[Altostrata]

BY SKEETER

Jony,

That is a heck of a report.  Have you had any issues with your heart feeling like it is fluttering in your chest, or chest pain?  If you have recently had to find out if they think you have an emergency any isues, you must take this info from drugs.com to the doctor/ER right away (if you are having new issues), or make an appointment for soon, if it comes and goes and this is normal for you, but for chest pain, or new fluttering or odd feelings in the chest, please go to the ER so they can do an ECG! This is my biggest concern. if you have a pre-existing cardiac condition, please see your doc ASAP, as they may want to do an ECG anyways

 

As for the serotonin syndrome, I have been there, felt generally unwell (malaise), had auditory and visual hallucinations, tremors in my arms and legs, etc, and was hospitalized.  Confusion  (severe) was a major symptom for me.  Watch out for any high fever (higher than a normal fever you get with the flu), as SS can cause life threatening hyperthermia (too much heat), in which the brain is very sensitive to, but generally you will have other symptoms as well.  I think you are smart to be only on 15mg of mirtazapine instead of 30.  I was on 3 different SSRI/SNRI drugs, and a bout of dehydration is what caused me to need the ER visit, at which point they admitted me, so drink plenty of fluids,  You have been on escitalopram and mirtazapine for a long time now, and are taking less Lexapro, and went back to a lower dose on the other AD.  If you have not had a reaction by now, you may not have any, you may want to ask your doc about this at your next appointment, but having been on them so long, there may be no issue, but I am no doctor.  All I can say for me, something was very wrong when I had my issues, I could not walk straight, and could not see well either.  If you are not sure, you probably can call a nurse line, but if you are aware enough to do that on your own, hopefully that means yo are functioning pretty well. Play it by ear, but just be cautious.

 

You are taking such a small amount of the levomepromazine that I doubt 1/8th of a pill will cause an issue, but read my first paragraph regarding this on this post, as this is not the only drug that causes this issue.

 

The other warnings are either on drugs you have been on a while, or are currently decreasing,  one of the main issues is impairment of concentration or confusion.  if you are having severe or even moderate issues with this, you should see your doc to see what he says, IMHO. You may want someone else to drive you, if this is the case.

 

How are you doing on 1/8th pill of the levomepromazine? Are you feeling better during the day yet?

 

Ethyl loflazepate is a benzodiazepine, so one of the issues it would warn you is probably a therapy duplication issue, it would also warn of confusion, probably dizziness, issues like that.  If you are having a hard time thinking to the point where you cannot make sense, you may want to go to the hospital.  I remember you saying it was hard to get an appointment because of the holidays.  Please utilize urgent care or the ER if you need to. but generally any side effects would have shown up by now due to taking both benzo's. I know you have been having insomnia, and I would expect you to sleep more if you were having an issue with the dose being too high, not insomnia.  Just pay attention to how you are feeling, and write it in your journal, and here if you like. You are also currently decreasing the other benzo (clonazepam), and obviously your doc was aware you were on a second benzo when he/she prescribed it, so just keep an eye on things, and do not take more than the bottles say, okay?

 

So, how is the 1/8th pill of levomepromazine feel compared to 1/4th of a tablet.  How do you feel on this dose?

 

I will head over to the benzo thread to see how you are doing over there.

 

The symptoms you are describing right now sound like normal withdrawal symptoms for antidepressant, or benzodiazepine withdrawal. I also felt every single one of those when I was lowering the benzo dose.

 

Here is some information on withdrawal symptoms:

Now Thursday at 0935am (bottom of page one, MMT wrote to you about journaling.  it is important to do, get a notebook, so you can keep all of your notes in the same place, and write when you took your drugs, how you felt and what time you felt any particular symptoms, you are looking for any trends, it also helps you see what days you changed doses, and how you felt after, and how long you felt that way.  Below is a link to our journaling thread,  The very first entry also has a link to follow, but the entire thread is good to read.  If you feel ill after meals, make sure to write down what you ate, etc.

I may not be able to type on line for a couple of days, but I can read, so please keep updating here and/or on the benzo side. Any discussion about the clonazepam dose, you will want to discuss under the benzo thread.  You can update your dose on your signature with each change, and we can see it here, on your intro thread as well.

 

** I am very interested to hear how you are doing on the 1/8th of a pill of the levomepromiazine.  Do you find the lower dose more tolerable?  Please let us know before you stop taking this drug on this thread, if you do not mind.

 

Thank you for being so kind and forthcoming with information!  Hopefully you will feel better soon now that you are not changing a whole bunch of things at once. After you are finished making changes with the benzo, you will return here, and hopefully we can get you to hold and not make any changes until you are feeling better. It is NOT true that you do not feel better, until you stop taking the drug, I am proof of that.  There are many stories of people here who felt better after holding, read mine if you like.  I am still on a benzo, just a much smaller dose than before.  Your brain may tell you to rush and get this over with, but the people that do that invariably end up feeling so much worse than they ever thought was humanly possible.  I ended up there for 4 months, and could not do anything for myself, it was very scary, and I do not want to see you in that position, so please do not try to rush off of any of these drugs, as they can have a nasty bite, and the symptoms do not just go away after a couple of days, for the large majority of people, I was one of them.  Took me 18 months to recover from one mistake.

 

I hope you begin to feel better soon!

Skeeter

[Altostrata]

BY JONY

 

@Skeeter

 

Many thanks for so much information. The symptoms table is very useful to describe them more clearly. I will use it.

 

Fortunately I do not experience something wrong due the combination Levomepromazine - Escitalopram - Mirtazapine, concerning heart conditions. I hope it stays that way.

 

Regardless that, it´s important to reduce this "mix" and dosage.

 

  On 12/22/2017 at 10:57 PM, Skeeter said:

So, how is the 1/8th pill of levomepromazine feel compared to 1/4th of a tablet.  How do you feel on this dose?

 

  On 12/22/2017 at 10:57 PM, Skeeter said:

** I am very interested to hear how you are doing on the 1/8th of a pill of the levomepromiazine.  Do you find the lower dose more tolerable?  Please let us know before you stop taking this drug on this thread, if you do not mind.

 

I'm feel fine with 1/8 pill. As I said before, since I started to drop off Levomepromazine soon I noticed two things : drowsiness and lack of libido improved a lot (they were the main side effects I felt). I will take today the very last 1/8 pill of Levomepromazine.

 

I will keep Escitalopram 9 mg for a while, slow and steady, and Ethyl Loflazepate 2 mg as always. As well Mirtazapine 15 mg.

 

Clonazepam I'm tapering off as I was told on benzo thread. 25% every few days...I think I was going too fast, and I felt more anxious for that, for sure.

 

Best,

 

Merry Xmas,

 

Jony

[Altostrata]

BY MANYMORETODAYS

 

Hi Jony,

 

  On 12/23/2017 at 3:48 AM, Jony said:

I'm feel fine with 1/8 pill. As I said before, since I started to drop off Levomepromazine soon I noticed two things : drowsiness and lack of libido improved a lot (they were the main side effects I felt). I will take today the very last 1/8 pill of Levomepromazine.

 

 

You might want to consider just HOLDING as well.  Or at least staying with the 1/8 pill of Levomepromazine for a bit longer. 

 

Love, peace, healing/in recovery, and growth.....

 

mmt

[Altostrata]

BY JONY

 

  On 12/25/2017 at 10:01 AM, manymoretodays said:

Hi Jony,

 

 

You might want to consider just HOLDING as well.  Or at least staying with the 1/8 pill of Levomepromazine for a bit longer. 

 

Love, peace, healing/in recovery, and growth.....

 

mmt

 

I dropped off at all...

 

It's one less to disturb me...

[Altostrata]

BY JONY

 

When I look at Dr. Joseph Glenmullen´s withdrawal symptom checklist what I see is a bunch of symptoms I already have. Even before I tried to taper any drug. Perhaps due to drugs tolerance we experience those symptoms, but also because their own side effects.( side or main effects, who knows..?)

 

I refer specifically to Confusion and Memory problems, like confusion or cognitive difficulties and memory problems or forgetfulness.

 

That´s why I'm trying to taper off quickly, as quickly as possible, all of them. 

[Altostrata]

BY MANYMORETODAYS

 

  On 12/26/2017 at 5:05 AM, Jony said:

That´s why I'm trying to taper off quickly, as quickly as possible, all of them.

 

I think Shep addressed this pretty well in the Benzo forum with you, and gave you some links to study and read.  As well as many questions to answer over there.

 

And I agree.......the confusion and memory problems could be due to too rapid of a tapering/C/T..........or from the drug itself.........I mean you/I have no way of knowing.

 

I just know that when I went off some of the antipsychotics or atypical antipsychotics/neuroleptics/whatever you want to call them(referring to your Levomepromazine) too fast.......I usually ended up in some difficulty for awhile.   So I'm still a fan of you doing at least a week of the Levomepromazine at the 1/8 dose, rather than just a day, at each decrease.......as it appears you may have done.  Sometimes the first couple of days off one of our meds/drugs can feel so great and freeing and then..........the reality of W/D symptoms may hit.   Yet, also.......listen, listen to your inner voice and body, etc........ 

 

Try and just go easy Jony.

 

Best, love, peace, healing/inrecovery, and growth,

mmt

[Altostrata]

BY JONY

 

  On 12/26/2017 at 9:26 AM, manymoretodays said:

So I'm still a fan of you doing at least a week of the Levomepromazine at the 1/8 dose, rather than just a day, at each decrease.......as it appears you may have done.  Sometimes the first couple of days off one of our meds/drugs can feel so great and freeing and then..........the reality of W/D symptoms may hit.   Yet, also.......listen, listen to your inner voice and body, etc.......

 

I did not drop off Levomepromazine that way...

 

 First, I reduced 50% (to 12.5 mg). Five days later I reduced more 50% (to 6.25 mg). I stayed on 6.25 for seven days. Finally I took 3.125 for four days...

[Altostrata]

BY JONY

 

  On 12/26/2017 at 9:26 AM, manymoretodays said:

I think Shep addressed this pretty well in the Benzo forum with you, and gave you some links to study and read.  As well as many questions to answer over there.

 

And I agree.......the confusion and memory problems could be due to too rapid of a tapering/C/T..........or from the drug itself.........I mean you/I have no way of knowing

 

I already realized that Clonazepam's taper will be more tricky. What a powerful drug they made...

[Altostrata]

BY JONY

 

  On 1/20/2018 at 4:40 AM, manymoretodays said:

That being said.  Please consider waiting a full 4-6 weeks before decreasing your escitalopram by 10% of your present 9 mg. dose.  And hold with the rest of your medications in the meantime.  I do know how confusing it can feel and be.  Yet, I really do think it will be better for your brain/body/spirit ultimate healing and recovery if you can hold steady now

 

That´s what I'm going to do, holding...

 

Meanwhile, yesterday I've done another cut on Clonazepam. From 1.7 to 1.6 mg. And it works...It was a huge reduction on these days...

 

Now I will hold until the next cut on Escitalopram...

[Altostrata]

BY MANYMORETODAYS

 

Good on the signature Jony. 

Please consider what we are saying.........which was advising you to stay put on your Clonazepam, saving it for last to taper.

 

You don't know for sure that the memory and cognitive problems are due to Clonazepam..........I mean they could be due to all the other juggling you have been doing in the last couple of weeks......the Xanax, the escitalopram, or even the levomepromazine.  It takes time for the trellis/neurosystem to readapt.  

 

Heres a couple links for you to peruse:

 

http://survivingantidepressants.org/topic/1024-why-taper-by-10-of-my-dosage/

 

http://survivingantidepressants.org/topic/6036-why-taper-paper-demonstrates-importance-of-gradual-ch

 

 

[Altostrata]

BY JONY

  On 1/20/2018 at 12:46 PM, manymoretodays said:

Good on the signature Jony. 

Please consider what we are saying.........which was advising you to stay put on your Clonazepam, saving it for last to taper.

 

For sure...

 

  On 1/20/2018 at 12:46 PM, manymoretodays said:

You don't know for sure that the memory and cognitive problems are due to Clonazepam..........I mean they could be due to all the other juggling you have been doing in the last couple of weeks......the Xanax, the escitalopram, or even the levomepromazine.  It takes time for the trellis/neurosystem to readapt

 

It can be from Clonazepam or not, right...In fact I dropped off Levomepromazine a few weeks ago and then started to taper Escitalopram...but my guess Is that Clonazepam...

 

However, I'm going to hold...and work on Escitalopram first before any change over Clonazepam.

 

And, of course, I let you know how I feel while holding...

[Jony]

Thanks @Altostrata for pick the pieces and rebuilt my Intro.

 

Here's another one, posted last week I guess...

 

"There's only one symptom bothering me, I forgot to mention...

 

Late in the afternoon, about 6:00-7:00 p.m. I start to feel anxious, but nothing I can´t handle with some techniques. I take the meds, both Mirtazapine and Clonazepam, at 8:30 p.m.

 

It seems that in this range (6-8:30 p.m) the effect of Clonazepam taken the night before combined with Ethyl Loflazepate taken by morning vanish..."

 

 

Just to update...I keep all doses same, as it is on my signature.

 

That anxiety I mentioned earlier was gone, at least on a daily basis and following a pattern. Now it comes and goes every once in a while...

 

I also have to say that there are days (or periods of a day) when I feel pretty much fine and some others more boring, so to speak. With those intrusive thoughts and brain fogginess. However, in the overall this last ones are less frequent. Let´s say, 70-80% of time feeling better and 20-30% with that brain fogginess.

 

I think I should hold the 9 mg of Escitalopram for a few more days...

 

Best,

 

Jony

 

 

[manymoretodays]

Oh my yes.  It's back!!!  Hi Jony.  Thank you Altostrata.

That sounds like a good report too, Jony.    And about 3 and 1/2 weeks since your last taper of escitalopram.  Interesting that your "anxiety" hits in the evening as you describe.  How have your mornings been?

 

Love, peace, healing, and growth,

mmt

Edited January 27, 2018 by manymoretodays

[manymoretodays]

Hi again Jony,  And I found this from Tuesday.  23 January.  It looks like you HAD started a new thread.......   Thanks. 

 

"I´ve been noticed one thing, first I didn´t pay attention but now I thought it could be interesting: in the morning I feel more depressed, with all regrets I have, all intrusive thoughts, stuff like that... Later in the day I start to feel better, despite becoming a little bit more anxious since about 5 p.m until I take Clonazepam at night (as discussed on my benzo thread). Let´s say, my best time in day is in the range 1 p.m - 5 p.m. and the mornings always are more complicated. When I just awake all seems to be hard...

 

Is there any explanation for this? "

 

I always attributed the tough mornings, in myself, to the cortisol reaction.  And here are a couple topics on that:

 

 

http://survivingantidepressants.org/topic/33-waking-with-panic-or-anxiety-managing-cortisol-spikes/

 

http://survivingantidepressants.org/topic/1147-high-cortisol-and-ssris/

 

Hugs Jony.  Glad your original introduction/journal is back!

 

Edited January 27, 2018 by manymoretodays

[Altostrata]

Thanks, Jony. It may take some time for your nervous system to settle down.

 

I merged your Intro topics. Please bookmark or follow this one.

[Jony]

4 hours ago, manymoretodays said:

That sounds like a good report too, Jony.    And about 3 and 1/2 weeks since your last taper of escitalopram.  Interesting that your "anxiety" hits in the evening as you describe.  How have your mornings been?

 

That 20-30% of time are mostly in the early morning...and it seems that there are an explanation to this, like you said:

 

4 hours ago, manymoretodays said:

I always attributed the tough mornings, in myself, to the cortisol reaction.  And here are a couple topics on that:

 

I have a trick to deal with it. After I wake up if I get out of bed and go do anything that feeling partially diseapears. If I stay on the bed and take a nap, like more 30/45 min of sleep then I feel that whole things. So sooner I start to do something more I feel better.

 

And it makes sense, regarding your theory of cortisol levels. If we spend energy doing something, we spend energy and our focus turn to other things more productives. Like the "Change the chanel" technique. Therefore, as Cortisol are the stress hormone we simply no need more and more of it...as well those levels decreasing over the day.

 

What do you think about my theory? 

[Altostrata]

"Change the channel" is always a good approach.

 

You might find mornings easier if you darken your bedroom with blackout shades and curtains, and wear a sleeping mask to reduce stimulation from early morning light.

 

 

[Jony]

On 28/01/2018 at 4:07 AM, Altostrata said:

"Change the channel" is always a good approach.

 

You might find mornings easier if you darken your bedroom with blackout shades and curtains, and wear a sleeping mask to reduce stimulation from early morning light.

 

 

 

I'll try that today...usually I leave the window a little open. Thanks

[Jony]

Today I complete four weeks since the last reduction on Escitalopram. From 10 to 9 mg. Straighforward, after a first attempt in wich I have to reinstate.

 

Meanwhile, I also reduced Clonazepam, from 2 to 1.6 mg, however with some "rescue" doses along the way. At first I had some days, perhaps 3 or 4, when I took about 4.5 mg of Clonazepam but over time I managed to stabilize. For now, I will not make any changes on this drug I guess...

 

So, next step will be another cut on Escitalopram. I don´t know when, yet...

 

 

 

 

 

 

 

 

[Jony]

Last 3 days I felt sleepy after the lunch, not only sleepy but also lethargic...can it be a WD symptom from Escitalopram? I had to take a nap yesterday and today I slept about 3 hours during the afternoon. A smooth sleep, actually neither awake nor sleeping, it is a quite strange, as if I had taken some beers or so...

 

Or is more likely to be due to the combo mirtazapine+clonazepam at night? In this case it is strange, because I never felt so sleepy and lethargic before...

 

I've found the correct term: numbness!

[manymoretodays]

Hi Jony,

Sorry so long for a response to your post.  I was vacationing for a bit.   I think it's more likely due to the mirtazapine and clonazepam combination.  Or just the usual effect of the mirtazapine even.  I didn't find mirtazapine to be very activating at all.......It's not an SSRI.  Then again, it is possible that the decrease in escitalopram has affected you this way as well.  It's possible.

On 1/31/2018 at 1:54 PM, Jony said:

A smooth sleep, actually neither awake nor sleeping, it is a quite strange, as if I had taken some beers or so..

 

Any strange dreams?  Or just kind of hypnotic?

 

Can you do a little bit of journaling again.  That's always helpful

And now 6 and 1/2 weeks out from your last escitalopram decrease.  And holding steady with your other medications?

It might be time Jony......for another 10% decrease from your 9mg. dose.

 

How is everything else going?

 

Love, peace, healing/inrecovery, and growth,

manymoretodays

 

 

Edited February 18, 2018 by manymoretodays

[Jony]

On 18/02/2018 at 5:10 AM, manymoretodays said:

Hi Jony,

Sorry so long for a response to your post.  I was vacationing for a bit.   I think it's more likely due to the mirtazapine and clonazepam combination.  Or just the usual effect of the mirtazapine even.  I didn't find mirtazapine to be very activating at all.......It's not an SSRI.  Then again, it is possible that the decrease in escitalopram has affected you this way as well.  It's possible.

 

Any strange dreams?  Or just kind of hypnotic?

 

Can you do a little bit of journaling again.  That's always helpful

And now 6 and 1/2 weeks out from your last escitalopram decrease.  And holding steady with your other medications?

It might be time Jony......for another 10% decrease from your 9mg. dose.

 

How is everything else going?

 

Love, peace, healing/inrecovery, and growth,

manymoretodays

 

 

 

Hi, @manymoretodays, actually I reduced escitalopram yet. From 9mg to 8mg.

I know that by-the-book it would be from 9 to 8.1, but I decided drop a little bit more.

 

Also, I reduced clonazepam to 1.5mg.

Both changes was made a week ago. When I have a break I will update my signature and describe how I feel...

[manymoretodays]

Thanks Jony,

 

That will be ever so helpful.  Not only the signature but if you can take some notes on the day to day and then share with us.  Try to describe any symptoms the best you can.

I'll include here, preferred format for doing that:

 

 

What we need to see for every individual day over several days is:

- Time and dosage for drugs taken in morning
- Time and description of any symptoms in the morning
 
- Time and dosage for drugs taken in afternoon
- Time and description of any symptoms in the afternoon
 
- Time and dosage for drugs taken in evening
- Time and description of any symptoms in the evening
 
- Time and dosage for drugs taken in middle of the night
- Time and description of any symptoms in the middle of the night (such as waking)
 
And so forth. A diary, in chronological order, such as:
 
6 a.m. Woke and vomited
8 a.m. Took 2.5mg Lexapro
10 a.m. Had diarrhea
10:30 a.m. Ate breakfast
11:35 a.m. Got a headache, lasted one hour
12:35 p.m. Ate lunch
4 p.m. Stomachache
5 p.m. Took 2.5mg Lexapro
6 p.m. Ate dinner
9:20 p.m. Headache
10:00 p.m. Took 50mg Seroquel
10:20 p.m. Headache got worse
10:30 p.m. Fell asleep
2:30 a.m. Woke, took 3mg Ambien (NOT "took 1/2 tablet Ambien")
2:45 a.m. Fell asleep
4:30 a.m. Woke with headache

 

An appointments diary is perfect for this and can be bought at stationery stores. 

They have a page for each day with times for appointments which can be filled in with doses, symptoms etc as shown by Alto.

 

Okay and best, as always......Love, peace, healing/inrecovery, and growth,

mmt

 

Edited February 19, 2018 by manymoretodays

[Jony]

On 18/02/2018 at 5:10 AM, manymoretodays said:

Hi Jony,

Sorry so long for a response to your post.  I was vacationing for a bit.   I think it's more likely due to the mirtazapine and clonazepam combination.  Or just the usual effect of the mirtazapine even.  I didn't find mirtazapine to be very activating at all.......It's not an SSRI.  Then again, it is possible that the decrease in escitalopram has affected you this way as well.  It's possible.

 

Any strange dreams?  Or just kind of hypnotic?

 

Can you do a little bit of journaling again.  That's always helpful

And now 6 and 1/2 weeks out from your last escitalopram decrease.  And holding steady with your other medications?

It might be time Jony......for another 10% decrease from your 9mg. dose.

 

How is everything else going?

 

Love, peace, healing/inrecovery, and growth,

manymoretodays

 

 

 

Hi,

 

Since last cut on Escitalopram, from 9 to 8 mg, I feel pretty fine. Just one thing bothering me, I guess I mentioned that before, when I wake up there is a period I dream, quite strange to explain.

 

Actually I'm not sleeping nor awake...

 

And that´s all...so far, so good....

[manymoretodays]

Hi Jony,

 

Yes, you described that feeling above.  The not asleep and not awake.  And that it occurs in the afternoon as well.

 

I'm not seeing any posting on your benzo thread recently.  Could you do that?  As it may well be that what you describe in your above post IS due to your clonazepam, or even the clonazepam decrease along with the escitalopram.  I'll say that again one other way in case you are not understanding.  It may be that by decreasing both escitalopram and clonazepam at the SAME TIME you are just making it MORE difficult for your brain to adjust.  Also please give a good try to doing the "diary" that I copied for you above.  2 posts up.  One or two days please.

 

And how are you feeling cognitively other than those weird times before getting out of bed or in the afternoon?

 

Here is a link to tapering escitalopram as well.  How are you decreasing your dose at present?

http://survivingantidepressants.org/topic/406-tips-for-tapering-off-lexapro-escitalopram/

 

Thanks Jony for all your feedback that you can provide.

 

Love, peace, healing/inrecovery, and growth,

mmt

Edited February 26, 2018 by manymoretodays

[Altostrata]

Hi, Jony.

 

We need to know when you get symptoms, when you take your drugs, and their dosages. Please keep daily notes on paper.

 

What time of day are you taking your drugs now?

 

Given that many people have sleep difficulties after reducing their drugs, sleepiness might not be a bad thing. It could be your body wanting to rest and repair.

[Skeeter]

Jony,

I have been gone for a bit, have just returned, am wondering how you are doing?

 

I hope you are well!

Skeeter

[Jony]

Hi @Altostrata @Skeeter @manymoretodays

 

It's been a while since my last time here.Time goes by... 

 

I forgot my password and also the email I registered. Can you recover my old account? Also tell me where to find my benzo thread. It was a hard work to find my thread. I even mistakenly asked a "competing" forum. Of course they didn't found my thread...

 

Yes, I am Jony®️ and I have updates to do. 👍

[manymoretodays]

Hi Jony!  Good to see you.  @Jony2

 

Is this it?  Your previous thread?  Just check it over to be certain.

 

And then here is your benzo thread too, I believe:  https://www.survivingantidepressants.org/topic/16559-jony-clonazepam-taper-off-fast/

 

And then could you do a new signature for us too?  Go to :  Account settings: signature

( Jony, hold off on this for now, until we hear from Shep, likely tomorrow)

Here is your old one:

Morning

Escitalopram 10 mg from 2005 to present

Dec 10.17 reduced to 9 mg; reinstated 10 mg; Jan 2.18 9 mg; Fev 12.18 8 mg

Ethyl Loflazepate 2 mg from 2005 to present

 

Night

Mirtazapine 15 mg from 2015 to present (November reinforcement 30mg) Dec 8.17 15 mg

Levomepromazine 25 mg started November 2017

8/12/2017 12.5 mg; 13/12/17 6.25 mg; 20/12/2017 3.125 mg; 23/12/2017 last 3.125 mg

Clonazepam 2 mg started Nov. 2017 (occasionally) ; last week 2 mg; Dec 19.17 1 mg; Dec 21.17 1.5 mg ; Dec 22.17 2 mg; Jan 2.2018 1.9 mg; Jan 7.2018 3mg; Jan 8.18 2mg; Jan 16.18 1.8 mg; Jan 17.18 1.5 mg ; Jan 18.18 1.7 mg; Jan 19.18 1.6 mg; Fev 12.18 1.5 mg

Xanax XR 1 mg in subtitution of Ethyl Loflazepate 2mg (occasionally)

 

Then don't forget to hit the SAVE button when you are done.

 

And yes, please update for us.  Thanks.  Welcome back.

 

L, P, H, and G,

mmt

 

***and checking Jony, as far as if we can recover old account and get you a new password.  So.....hold tight until tomorrow, okay?

 

 

Edited January 30, 2020 by manymoretodays
**** at end, left note for administration

[Jony]

10 hours ago, manymoretodays said:

Hi Jony!  Good to see you.  @Jony2

 

Is this it?  Your previous thread?  Just check it over to be certain.

 

And then here is your benzo thread too, I believe:  https://www.survivingantidepressants.org/topic/16559-jony-clonazepam-taper-off-fast/

 

And then could you do a new signature for us too?  Go to :  Account settings: signature

( Jony, hold off on this for now, until we hear from Shep, likely tomorrow)

Here is your old one:

Morning

Escitalopram 10 mg from 2005 to present

Dec 10.17 reduced to 9 mg; reinstated 10 mg; Jan 2.18 9 mg; Fev 12.18 8 mg

Ethyl Loflazepate 2 mg from 2005 to present

 

Night

Mirtazapine 15 mg from 2015 to present (November reinforcement 30mg) Dec 8.17 15 mg

Levomepromazine 25 mg started November 2017

8/12/2017 12.5 mg; 13/12/17 6.25 mg; 20/12/2017 3.125 mg; 23/12/2017 last 3.125 mg

Clonazepam 2 mg started Nov. 2017 (occasionally) ; last week 2 mg; Dec 19.17 1 mg; Dec 21.17 1.5 mg ; Dec 22.17 2 mg; Jan 2.2018 1.9 mg; Jan 7.2018 3mg; Jan 8.18 2mg; Jan 16.18 1.8 mg; Jan 17.18 1.5 mg ; Jan 18.18 1.7 mg; Jan 19.18 1.6 mg; Fev 12.18 1.5 mg

Xanax XR 1 mg in subtitution of Ethyl Loflazepate 2mg (occasionally)

 

Then don't forget to hit the SAVE button when you are done.

 

And yes, please update for us.  Thanks.  Welcome back.

 

L, P, H, and G,

mmt

 

***and checking Jony, as far as if we can recover old account and get you a new password.  So.....hold tight until tomorrow, okay?

 

 

 

Yes, this is my previous thread as well the benzo thread you found. 

 

So I'll wait to see if I can continue with the old account. 

 

Thanks again. 

 

 

[Shep]

3 hours ago, Jony said:

Yes, this is my previous thread as well the benzo thread you found. 

 

So I'll wait to see if I can continue with the old account. 

 

Jony, I've merged your two accounts - Jony was merged into Jony2 and then I changed the Jony2 screen name to Jony. This means you can continue to use your new email address and password, but still have your original Jony name. 

 

You're good to go now. 

[Jony]

Thank you very much @Shep.

 

First of all greetings to everyone. 

Second, sorry my English. Since I don't use it often it is possible that there are some grammatical errors. With practice I will express myself better, I hope. 

 

Well, let's go to the most important things. As I said before I was tapering both Escitalopram and Clonazepam back in 2018. To do that I asked my doctor to prescribe drops instead pills. 

 

Concerning Escitalopram, firstly I took a more conservative approach as I described in my signature, dropping about 10% per month until reach 8mg. After that I always kept the same dose reduction, 1mg each time. But instead of setting a deadline... I just let my mood decide. 

 

Whenever I was in a good mood for a while I dropped another 1mg. And that's how I got to the current 5mg. 

 

Regarding clonazepam I did it the same way, well.. slightly different. Let me explain. Since benzos allow for quicker adjustments (by their own mechanism of action comparing with AD) I increased and reduced the dose as needed. 

 

However, I wasn't constantly changing the dose but rather reinforcing it slightly, so I felt less "confident". Of course I don't want to make this look easy, after all it took a year and a half or so. 

 

In fact, reducing the initial dose to half (now I talk about escitalopram) may even be the easiest part. The explanation can be found on this paper I guess. 

 

As far as clonazepam is concerned, the fact that I kept ethyl loflazepate must also have helped a lot. 

 

So, what's the challenge now? Well, for now I'm on: escitalopram 5 mg, ethyl loflazepate 2 mg, mirtazapine 15 mg and clonazepam 0.5 mg. Since I'm a little bit anxious due to professional stuff (more than I have felt lately ) , but I need to be one hundred percent and taking this mix doesn't fit on the 100% concept (depending on mirtazapine and clonazepam to fall asleep for instance...) which drug should I consider tapering next? 

[Gridley]

33 minutes ago, Jony said:

which drug I should consider tapering next? 

 

We recommend tapering the more activating drug first, leaving the more sedating drug(s) to act as a buffer to be tapered later.

 

Taking multiple psych drugs? Which drug to taper first?

 

The escitalopram is the most activating of your drugs, so that would be the one to taper next.  We recommend tapering only one drug at a time.  Otherwise, if there are problems, you won't know the cause.

 

Dropping 1mg a months sounds like a nice slow taper, and if you were on a much higher dose it would work well.  5mg is well into the most sensitive part of the taper. Something like 85% of the drugs effectiveness happens in the first 10 mg, so making even a small change can have a big effect symptom wise. Decreasing by a straight 1mg also accelerates the amount that you  would be decreasing each time making it rougher and rougher with each drop. Decreasing by a percentage however decelerates the amount of each drop and makes things gentler on your system. We recommend tapering by no more than 10% of current dose every four weeks. Some have to taper at a lower percentage.

 

Why taper by 10% of my dosage?

 

The Brassmonkey Slide is a way of making micro-taper reductions weekly, as opposed to a larger reduction once a month. I used this method for my Lexapro/escitalopram taper.

 

The Brassmonkey Slide Method of Micro-tapering

 

This link is specifically about tapering escitalopram.

 

Tips for tapering off Lexapro (escitalopram)

 

You should know that there's a major drug interaction between escitalopram and mirtazapine, another reason to taper off the escitalopram.

Interactions between your drugs

Major

 

Using escitalopram together with mirtazapine can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should contact your doctor immediately if you experience these symptoms during treatment. In addition, combining these medications can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening, although it is a relatively rare side effect. You may be more susceptible if you have a heart condition called congenital long QT syndrome, other cardiac diseases, conduction abnormalities, or electrolyte disturbances (for example, magnesium or potassium loss due to severe or prolonged diarrhea or vomiting).