Jony: Cipralex, Victan, Mirtazapine, Nozinan

[Jony]

@Gridley

 

I have read carefully and it all makes sense. 

 

But I forgot to mention, the idea was to leave what I started to take later. My theory is that if it was with escitalopram and ethyl loflazepate I managed to stabilize (mirtazapine and clonazepam came later to help me sleep better) then it would be these ones I should keep. 

 

Once I take two antidepressants how about starting reduce mirtazapine? Comparing escitalopram to mirtazapine this last one is a "brake" or at least is less "accelerator". Still, since I take 15 mg by now (so I have that "margin" of 80%... ) maybe if I reduce it to, let's say, 10 mg I would be able to feel less drowsy when wake up. 

 

What do you say? 

 

[Gridley]

38 minutes ago, Jony said:

What do you say? 

It's a little complicated.   

 

First, though you were stable on the escitalopram and ethyl before, the fact that you added two new drugs changed the situation.  There's no guarantee you will return to the same stability once you're off the mirtazapine.  Your brain and central nervous system are different now than before you added the new drugs.  

 

One reason why we taper the accelerators like escitalopram first is that the brakes can ask as a buffer against withdrawal.

If you taper the mirtazapine first, you may run into the old sleep problems, and sleep is very important in withdrawal.

 

Before I found SA, I tapered a brake, Imipramine, first, leaving the accelerator, escitalopram for later.  About halfway into my taper, I began experiencing some very unpleasant and constant symptoms of anxiety, because I had taken away much of the protection the brake was giving me.  I had to updose the Imipramine and, after receiving the advice from SA to stop tapering Imipramine and start tapering Escitalopram, I finally stabilized and the anxiety receded.

 

Please consider these points.  It's your decision.  However, if you choose to taper the mirtazapine first, dropping from 15mg to 10mg is much too fast.  It's a 30% drop, much faster than we recommend no more than the 10%.we recommend (link in my previous post) and putting you at risk of withdrawal symptoms. If you do decide to taper the mirtazapine first, you should decrease by only 10%, which would be 1.5mg, giving you a new dose of 13.5, where you would hold for four weeks.  The following link is specifically about tapering mirtazapine, including how to get the small non-standard doses you'll need for your taper.  See especially the section, "reduce by splitting tablets" and the link about using a digital scale.  Many members use the AWS Gemini-20 scale, available on Amazon (I hope) in Portugal.  The GEMINI-20 Scale

 

Tips for tapering off Remeron (mirtazapine)

 

 

 

 

[Jony]

Of course I wouldn't go straight from 15 to 10 mg. 10 mg would be the goal following the 10% reduction rule. 

 

1 hour ago, Gridley said:

First, though you were stable on the escitalopram and ethyl before, the fact that you added two new drugs changed the situation.  There's no guarantee you will return to the same stability once you're off the mirtazapine.  Your brain and central nervous system are different now than before you added the new drugs.  

 

It's a good point that I forgot. You may be right. In fact sleep is a very important part of the whole thing and mirtazapine works on it. 

 

Therefore it should be better to continue the escitalopram taper. 

[Gridley]

9 minutes ago, Jony said:

Therefore it should be better to continue the escitalopram taper. 

That is my suggestion.  

[Jony]

1 hour ago, Gridley said:

That is my suggestion.  

 

And I take your advice. I'll stay on 5 mg for now. As soon as I feel more confident I'll continue tapering escitalopram. 

[Jony]

Hard times around here. In four days, two panic attacks. 

It is relatively normal for me to feel anxious but I can handle it. What is more complicated are this panic attacks and how deal with it.

 

It all starts with a strange feeling in my head, as if I was slightly out of my mind, blurry vision and dizziness. Then I start to feel my legs trembling and I can barely stand on my feet. The heart rate goes up, blood pressure rise, feel my throat tight, cold sweats, hot flashes (like waves of heat) and all that stuff. 

 

A few days ago I ended up at hospital. ECG, blood analysis, X-rays etc..and nothing was found. 

 

Today, about five hours ago, the same scary thing. I tried to stay calm and think rationally about what I was felling but it's a hard thing to do. 

 

I lay down on my bed, took a half pill of ethyl loflazepate (I had already taken 2 mg by morning as usual) and eventually everything went to normal. By normal I mean, I don't feel all those symptoms right now but it seems like I'm always about to have another crisis. I feel my head "empty", some burning/tight on my chest, pounding heart... 

 

The last time I changed the dosage of my meds was several months ago. And until last Tuesday everything was fine. 

Another thing that could be interesting, the "peak" of this anxiety, wich leads to the PAs is around 5 pm, six or seven hours after I take both escitalopram an ethyl loflazepate. It could be a coincidence, but who knows... 

 

Could this be a delayed reaction to lowering the dosage? Do you have any suggestions? 

 

Thaks a lot for your attention. 

 

P. S. - I haven't had a PA in about 15 years. 

 

 

 

 

 

 

[Gridley]

28 minutes ago, Jony said:

 

Could this be a delayed reaction to lowering the dosage?

 

In an earlier post, you said you were:

"dropping about 10% per month until reach 8mg. After that I always kept the same dose reduction, 1mg each time."

 

That's the problem with dropping by 1mg each time at the lower doses--you're tapering by more than 10%, and it's increasingly more than 10% the lower you go.  If you drop 1mg from 5mg it's a 20% drop.

 

So, yes, it could be a delayed reaction.  For that reason I would hold where you are now and let the situation stabilize before continuing the escitalopram taper.  Let your body and your symptoms tell you when it's time.   When you do, do it by 10% of current dose, not 1 mg per drop.

 

Here's a link that may be helpful:

 

Audio:  First Aid for Panic (4 minutes)

 

 

[Jony]

1 hour ago, Gridley said:

 

In an earlier post, you said you were:

"dropping about 10% per month until reach 8mg. After that I always kept the same dose reduction, 1mg each time."

 

That's the problem with dropping by 1mg each time at the lower doses--you're tapering by more than 10%, and it's increasingly more than 10% the lower you go.  If you drop 1mg from 5mg it's a 20% drop.

 

So, yes, it could be a delayed reaction.  For that reason I would hold where you are now and let the situation stabilize before continuing the escitalopram taper.  Let your body and your symptoms tell you when it's time.   When you do, do it by 10% of current dose, not 1 mg per drop.

 

Here's a link that may be helpful:

 

Audio:  First Aid for Panic (4 minutes)

 

 

 

Thanks @Gridley. I just have downloaded that audio. I'll stay on 5 mg for now, as I said. I won't reinstate the benzo neither . I have to cope with this in a natural way. 

 

 

[Jony]

Well, this drop from 6 to 5 mg was a thoug one. The other ones (from 9 to 8, 8 to 7 and 7 to 6) were easier, by far. I've been tempted to reinstate 6 mg but as long as I can handle it I won't to. 

 

It was actually a ~17% dose reduction . Since I was on 6 mg for a long time (almost a year maybe) I just thought I could try to push it. Not a good idea as you know, and I also should have known too... Having taken this drug for so many years must be considered as well. 

 

Last night to cope with symptoms I took 0.6 mg clonazepam instead the usual 0.5 mg. Hope it was only once. 

 

Anxiety, nausea, dizziness, numbness and headache are the most frequent ones. Also, sometimes when that anxiety and dizziness and nausea attacks I think I'm going crazy. It really looks like madness is going to take over me. 

 

Who the hell invented this poison? 

[Jony]

It has been hard to cope with. No problems to sleep as I said before but the anxiety increases throughout the day especially in the afternoons when it reaches its peak. Dizziness, nausea, tightening and burn chest, in the first place, then numbness and hot flashes but this ones are just...uncomfortables. 

 

What should I do? Reinstate escitalopram to 6 mg or updosing the benzo? (this last one was an "idea" from my doc, whom I talked today...) 

@Gridley

 

[Gridley]

10 hours ago, Jony said:

Reinstate escitalopram to 6 mg or updosing the benzo? (this last one was an "idea" from my doc, whom I talked today...) 

If the symptoms are intolerable, you could updose escitalopram to 6.  I wouldn't updose the benzo. You'll soon become dependent on the benzo updose and, when you do, you won't be getting anything out of of it and will have further to taper.  

 

As I said earlier,

"That's the problem with dropping by 1mg each time at the lower doses--you're tapering by more than 10%, and it's increasingly more than 10% the lower you go.  If you drop 1mg from 5mg it's a 20% drop."  As you said, dropping to 5 was a 17% drop.

 

I would stabilize on 6 and then continue with 10% drops, not 1 mg drops.

 

[Jony]

On 2/6/2020 at 12:23 PM, Gridley said:

If the symptoms are intolerable, you could updose escitalopram to 6.  I wouldn't updose the benzo. You'll soon become dependent on the benzo updose and, when you do, you won't be getting anything out of of it and will have further to taper.  

 

As I said earlier,

"That's the problem with dropping by 1mg each time at the lower doses--you're tapering by more than 10%, and it's increasingly more than 10% the lower you go.  If you drop 1mg from 5mg it's a 20% drop."  As you said, dropping to 5 was a 17% drop.

 

I would stabilize on 6 and then continue with 10% drops, not 1 mg drops.

 

 

I did that. Thanks a lot @Gridley.

 

You guys, do a great job here. 

[Jony]

I reinstated to 6 mg Thursday. 

 

Yesterday no problems at all. Felt great all day long. Moreover I haven't felt that way in a long time. 

 

Today that anxiety, nausea, dizziness and racing heart came again. Not like a few days ago, but still quite annoying. 

 

How long should I wait until consider updose? @Gridley

 

[Gridley]

2 minutes ago, Jony said:

 

How long should I wait until consider updose? @Gridley

 

That's great that the updose to 6 is working so well.  You are now 3 days in, and it's not uncommon for benefits to be felt at this point.    It'll take around 6 or 7 days more for the updose to reach full state in your blood.  Let's see how you feel then.  6 may be just the right dose for you and there may be no need to go higher.  Remember, we are not looking for perfect with an updose/reinstatement; we are looking for good.  

[Jony]

9 minutes ago, Gridley said:

 

That's great that the updose to 6 is working so well.  You are now 3 days in, and it's not uncommon for benefits to be felt at this point.    It'll take around 6 or 7 days more for the updose to reach full state in your blood.  Let's see how you feel then.  6 may be just the right dose for you and there may be no need to go higher.  Remember, we are not looking for perfect with an updose/reinstatement; we are looking for good.  

 

Thank you for your kindness and attention @Gridley. I'll wait as calmly as possible. 

 

[Jony]

Since yesterday anxiety improves a little bit, not so much. However, I cannot concentrate and think properly. It is frustrating to be reading something and having to go back to the beginning of the sentence to remember what I had just read. 

 

One thing I forgot to mention before, I've been sleeping less 2 hours than usual. However, I don't feel tired when I wake up whatsoever. Just wake up earlier than before. 

 

So the question is : since I was on 5 mg for a short period can it be a a sort of WD symptom? 

 

I mean I'm was on 6 mg for less than 2 weeks... 

 

 

 

[Gridley]

5 minutes ago, Jony said:

 

So the question is : since I was on 5 mg for a short period can it be a a sort of WD symptom? 

Likely so.  Sleep disturbance is one of the most common WD symptoms.  

[Jony]

19 minutes ago, Gridley said:

Likely so.  Sleep disturbance is one of the most common WD symptoms.  

 

And those cognitive symptoms? Any guess? 

[Gridley]

1 hour ago, Jony said:

 

And those cognitive symptoms? Any guess? 

Cognitive difficulties, know as "cog fog," is another very common WD symptom.  See #19 in this withdrawal symptom checklist:

 

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

[Jony]

25 minutes ago, Gridley said:

Cognitive difficulties, know as "cog fog," is another very common WD symptom.  See #19 in this withdrawal symptom checklist:

 

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

 

So the only thing I can do is wait...

[Gridley]

7 minutes ago, Jony said:

So the only thing I can do is wait.

Yes.  It still may take some weeks or months for your nervous system to settle down. You probably will continue to have waves and windows, but symptoms won't be as intense. 

 

One thing you can do:  two supplements that we recommend are magnesium (glycinate is a good form) and omega 3 (fish oil). Many people find these to be calming to the nervous system. 

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

Add in one at a time and at a low dose in case you do experience problems.

 

 

 

[Jony]

Today I messed up with dosage. I took 7 mg instead 6 mg, my mistake counting the drops...

 

Should I continue next morning on 6 mg as if it never happened? @Gridley

[Gridley]

13 hours ago, Jony said:

 

Should I continue next morning on 6 mg as if it never happened?

 

Yes.  This happens quite often.  There may be a minor reaction but it will straighten itself out.

[Jony]

This morning I had to make the decision to stay on 7 mg or go back to the normal 6 mg dose. As I didn't know what to do, I kept the 7 mg. Perhaps it would had been a better option to keep the 6 mg. 

 

But in the meantime I was thinking about it and I noticed something else. 

 

Since I was on 5 mg just a few days, it is unlikely that the reduction from 6 mg to 5mg, just 2 or 3 days, caused all that trouble. Maybe the 6 mg was getting to "short" for me. In fact I've been more nervous for a few months now. 

 

So, shouldn't the reinstament really be to 7 mg and not to 6 mg? @Gridley

 

On the other hand, since I've been on 6 mg for a several months, maybe the updosing to 7 mg will means a new adaptation of my CNS. 

 

What should I do? What would be the best option in your opinion, in order to stabilize as soon as possible? 

 

[Gridley]

29 minutes ago, Jony said:

What would be the best option in your opinion, in order to stabilize as soon as possible? 

So that I'm clear about the time frame of your dosages, please list for me 

1. the date you dropped from 6 to 5 and how long you were on 5

2. the date you updosed from 5 to 6

3. how long you were on 6 before making a mistake and taking 7

4.How were you feeling during the time you were on 6?

5. You said you were feeling nervous fora few months now.  At what dose were you during these few months?

 

That information will help me figure it out.

[Jony]

11 minutes ago, Gridley said:

So that I'm clear about the time frame of your dosages, please list for me 

1. the date you dropped from 6 to 5 and how long you were on 5

2. the date you updosed from 5 to 6

3. how long you were on 6 before making a mistake and taking 7

4.How were you feeling during the time you were on 6?

5. You said you were feeling nervous fora few months now.  At what dose were you during these few months?

 

That information will help me figure it out.

 

1- Dropped from 6 to 5 in the Feb.27. Was on 5 mg for two days. (This also coincided with some days when I forgot to take both Escitalopram and victan. So, I forgot for a few days (maybe three) and then I started at 5 mg. It is not uncommon to me forget and I never had any major problems.) Ended up at hospital with PA at Jan.29.

 

2- Updose from 5mg to 6 mg Feb.5/6 don't remember. 

 

3- I've been on 6mg during 4/5 days. I only took 7 mg yesterday and today. 

 

4- You mean, after I had been on 5 mg? If so, I felt almost same way than before, when I went to hospital. If you are talking about the whole time I was on 6mg, it was about 6 months, I guess. 

 

5- At 6 mg. 

 

@Gridley

 

Let me know if you doubts are cleared up. Many thanks. 

 

 

[Gridley]

11 minutes ago, Jony said:

. I only took 7 mg yesterday and today. 

 

 

I would go back to 6 and hold there for 7 to 10 days.  We need to establish a baseline before deciding whether or not to updose to 7.  

 

It's very important to take the dose every day.  Make a real effort to do this--maybe with little reminder notes or a pill container for a week's worth of pills.

 

Please keep us updated on how you're doing.  Keep daily notes on paper on how you're feeling.