summitbound: Which should I taper first, lithium, Effexor, or mirtazipine?

[summitbound]

Moderator note: Link to benzo forum thread: summitbound: Poly-drugged: Thinking about tapering an AD w/ benzo

 

Hello, I'm brand new to this site.  I've been so busy learning about benzo tapering (and suffering!) on benzobuddies.org that I have yet to tackle getting off any of my antidepressants.  I've already been tapering the benzo for over a year.  I know that the general rule is to taper off your benzos first, and then work on your antidepressants.  That said, I probably have a year or more left on my benzo taper and I hate being poly drugged with three antidepressants.   I'd like to safely chip away at at least one of them.  I think the mirtazipine is really helping with my sleep during bezno withdrawal, so I don't think I want to touch it.   It seems like the low hanging fruit would be the lithium, since it seems I'm on a less than theraputic dose at 675 mg.  Thoughts?

 

So far, I have been "blessed" during my benzo taper in that I have not suffered from depression, severe anxiety, or panic. So I do want to tread carefully.  Thanks so much!  

Edited May 7, 2018 by Shep
added username to title and link to benzo thread

[SkyBlue]

9 minutes ago, summitbound said:

Hello, I'm brand new to this site.  I've been so busy learning about benzo tapering (and suffering!) on benzobuddies.org that I have yet to tackle getting off any of my antidepressants.  I've already been tapering the benzo for over a year.  I know that the general rule is to taper off your benzos first, and then work on your antidepressants.  That said, I probably have a year or more left on my benzo taper and I hate being poly drugged with three antidepressants.   I'd like to safely chip away at at least one of them.  

 

So far, I have been "blessed" during my benzo taper in that I have not suffered from depression, severe anxiety, or panic. So I do want to tread carefully.  Thanks so much!  

 

Hi Summitbound (great name!) and welcome to SA. 

 

I'm so glad that so far you haven't had severe emotional symptoms and are treading carefully. That bodes very well for your journey. 

 

There is a ton of great information on this site. 

A few places to check out first are:

 

Taking multiple psych drugs? Which drug to taper first?
If you're not having an adverse reaction from the other medications, taper the most activating drug first. 

Preparing to taper
Taking care of yourself so you are prepared to taper.

 

Taper more than one drug at a time?
This is recommended only if you know your withdrawal symptom pattern and know how to control your taper with various tapering techniques.
 

Again, welcome! 

 

[SkyBlue]

Also, please create a "signature" that will tell us about your current dosages, etc. It will accompany all of your posts on the site and be a quick reference for where you're currently at in your taper.

 Please put your drug and withdrawal history in your signature 
 

Thank you!

[summitbound]

Ok, thanks. Signature updated. 

[manymoretodays]

Hi and welcome from me too summitbound,

 

Yay and thanks for updating the signature.  A few more details will help us all help you as well:

 

A request: Would you summarize your history in a signature - ALL drugs, doses, dates, and discontinuations & reinstatements, in the last 12-24 months particularly?

• Please leave out symptoms and diagnoses.
• A list is easier to understand than one or multiple paragraphs. 

• Any drugs prior to 24 months ago can just be listed with start and stop years.
• Please use actual dates or approximate dates (mid-June, Late October) rather than relative time frames (last week, 3 months ago)
• Spell out months, e.g. "October" or "Oct."; 9/1/2016 can be interpreted as Jan. 9, 2016 or Sept. 1, 2016.

 

On 4/28/2018 at 2:44 PM, summitbound said:

I know that the general rule is to taper off your benzos first, and then work on your antidepressants. 

 

Not necessarily.  Here's the link again to tapering multiple psych drugs:

http://survivingantidepressants.org/topic/2207-taking-multiple-psych-drugs-which-drug-to-taper-first/

 

Try and read........ especially the first post.  "Brakes and accelerators".   Our general rule is to taper off the "accelerators" first unless..........you'll see.

 

Also, if you can please put all your current medications into the drug interaction checker at drugs.com, and then copy and paste the results here on your introduction/journal page that would be great.  Sorry as I am unable to post the link.  That should really help you/us decide which way to go now. 

 

We generally recommend tapering  one medication at a time......again ........unless.  It looks like SkyBlue gave you a link on tapering more than one ^ as well.

 

Okay......all for now from me.

 

Love, peace, healing/inrecovery, and growth,

mmt

 

 

Edited May 1, 2018 by manymoretodays
spacing, spelling, elaboration after a reread

[summitbound]

Thanks for all the good information.  I read the above links.  I guess I'm not clear one whether Effexor, mirtazipine, or lithium are "accelerators" or "brakes."  None of them are SSRIs, which are clearly accelerators.  I've read that Effexor, an SNRI, can be activating (an accelerator?) at higher does, and sedating (a brake?) at lower doses.  Mirtazapine sure helps with my sleep, so I'm assuming it is a brake?  And I have no idea where lithium falls.  Is there a list of specific medications and whether they are accelerators or brakes?  Which ones "touch" GABAa receptors negatively? (sorry for my benzo brain fog...).

[manymoretodays]

Hi summitbound,

I am going with most definitely Effexor as an accelerator.  Lithium as a brake?  Is it sedating for you?  Your Valium is also a brake.

With the mirtazipine.........hmmm.........going to go with it being a brake as well, as it helps you sleep.

 

I don't think we have a list.  Go down in that link as well and read what Rhiannon has to say.  As a general rule we do not recommend tapering multiple drugs at once unless there is a problem identified with any one of your drugs.

 

I can't really answer/I don't know which ones touch GABAa receptors.  You could do a search........pose the question followed by survivingantidepressants.org in your main browser.

 

To find your other recent posts or your way back here once you sign in just click Activity> My Activity Streams

 

Oh and please go to:  https://www.drugs.com/drug_interactions.html

Put all your medications in there.  Then copy and paste the results back here in your introduction/journal.  That should help decide where to get you started tapering as well. 

 

L, P, H/IR, and growth,

mmt

 

You are welcome to start another brief introduction on our Benzo forum and do some reading there as well:  http://survivingantidepressants.org/forum/29-members-only-benzo-forum/

Use the link or go back to Forums> Support> members only benzo forum

Okay......over and out. 

 

 

 

Edited May 4, 2018 by manymoretodays
got the link!! :-)

[summitbound]

Thanks so much, everyone!  I did plug in my meds to the interaction site.  Lots of potential for seratonin syndrome.

[manymoretodays]

Hi summitbound,

No luck copying and pasting with the interactions?  I shall give it a whirl.  Your current medications are Valium, EffexorXR, mirtazipine, and Lithium........correct? 

Interactions between your drugs

Major

lithium venlafaxine

Applies to: lithium, Effexor XR (venlafaxine)

Talk to your doctor before using lithium together with venlafaxine. Combining these medications 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 while taking the medications. 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.

 

Major

venlafaxine mirtazapine

Applies to: Effexor XR (venlafaxine), mirtazapine

Using venlafaxine 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 seek immediate medical attention if you experience these symptoms while taking the medications. 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. 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.

 

Moderate

diazepam venlafaxine

Applies to: Valium (diazepam), Effexor XR (venlafaxine)

Using diazePAM together with venlafaxine 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.

 

Moderate

lithium mirtazapine

Applies to: lithium, mirtazapine

Using lithium 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.

 

Moderate

diazepam mirtazapine

Applies to: Valium (diazepam), mirtazapine

Using diazePAM 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.

 

Minor

lithium diazepam

Applies to: lithium, Valium (diazepam)

Consumer information for this minor interaction is not currently available. Some minor drug interactions may not be clinically relevant in all patients. Minor drug interactions do not usually cause harm or require a change in therapy. However, your healthcare provider can determine if adjustments to your medications are needed.

 

I did see that you started a thread in the Benzo area as well.  As you will be tapering one of your non-benzo's next it is best to post right here on your main thread.  I did want you to have access to some of the pinned topics there and information.  

So........in addition to the interactions I copied for you I'll add the link again that Shep gave you in your Benzo post as well........so we have it here to access.

http://survivingantidepressants.org/topic/11689-about-going-off-mirtazapine-plus-venlafaxine-effexor-aka-california-rocket-fuel/

 

Edited May 7, 2018 by manymoretodays
grammar, clarity

[manymoretodays]

And okay second post for the morning.  Really, really crucially important now is that you do some daily logs for us.  First on paper and then share here on your main thread.   That helps us clarify which medication may need a taper or change next.  In the meantime.......try to just HOLD steady with your medication.

 

http://survivingantidepressants.org/topic/1008-before-you-begin-tapering-what-you-need-to-know/

 

This is a good example of what we would like to see in your drug and symptoms journal: 

(I just copied over the last post in that link for you)

 

A symptom pattern that occurs regularly over several days could mean the symptoms are from withdrawal, other adverse effects of drugs, or something else you do on a daily schedule.

 

In the course of discussion in your Introductions forum topic, you may be asked to keep notes on paper of your daily symptom pattern, including when you take your drugs, their dosages, and any symptoms.

 

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

A symptom pattern that occurs regularly over several days could mean the symptoms are from withdrawal, other adverse effects of drugs, or something else you do on a daily schedule.

 

And as Shep advised, please include any supplements as well as your sleep patterns.

 

Okie dokie.  Have a great day.

Love, peace, healing, and growth,

mmt

 

 

 

 

 

Edited May 7, 2018 by manymoretodays

[summitbound]

O.K., I'll start my daily log of medicines and symptoms today.  How many days worth of data should I record before I post the results here?

[Shep]

You may want to go ahead and post your first day or two so the mods can make sure you're putting in all of the needed information. That's easier than finding out you're missing information later on. 

[summitbound]

I'm still recording my daily logs which I'll post in a few days, but I thought in the meantime I'd provide this in case its helpful.  This is a comprehensive list of my current symptoms which I provided recently to my primary care physician and my psychiatrist.  My primary care doctor finally, after five years, believes my symptoms are due to my medications (particularly benzo tolerance and withdrawal).  My prescribing psychiatrist flatly denies that these symptoms are due to my psych drugs, and said he thinks I have chronic fatigue syndrome or fibromyalgia.

 

1.      Continued cognitive impairment (daily)

2.       Flu-like severe fatigue, but this has fortunately improved some over the last year.  Now seems to come in waves.  Feel moderate fatigue everyday.

3.      Head pressure (most days), occasionally turning into a headache

4.      Tinnitus (most days)

5.      Muffled ear drum (as if water in my ear) (once a week or so)

6.      Arthritic feeling hands (daily)

7.      Whole body muscle soreness - as if I did a hard workout the day before (daily, most profound in the AM)

8.      Muscle twitching, especially in legs, occasionally left side of head, stomach muscles, and back (daily)

9.      Muscle jerks, mostly in legs (daily)

10.   Word finding problems and stuttering (occasional)

11.   Joint soreness, especially ankles, knees and fingers (daily)

12.   Soreness on the bottom of my feet, especially heels (most days)

13.    Sensitivity to loud noises and chaotic situations (daily)

14.     Irritability and occasionally rage (more common in evenings)

15.    Depersonalization (occasional)

16.     Brain fog, poor memory, inability to perform math, difficulty organizing my day (daily)

17.   Tremor in my hands (daily, most noticeable in AM)

18.   Slow resting heart rate (50’s), then fast heart rate (100) for no apparent reason (monitor occasionally with my Fit Bit).

19.   Food having a metallic taste (only a couple times)

20.   My overnight home pulse ox readings show very high variability in my heart rate, much more erratic that measurements I took a couple years ago.

21.   Chest pain (occasional)

22.   Looping, racing negative thoughts (occasional, more common in early AM or late in the evening)

23.   Burning sensation on my face, arms, right leg.  Tingling / burning sensation on my tongue.  Sometimes feels like pins and needles.  Visibly flushed face. (all occasional)

24.   Went from having no dreams two years ago to now very vivid dreams every night and even during naps. (nightly).  Occasional nightmare.

25.   Cold torso sensation, kind of like the feeling prior to doing something frightening or prior to a panic attack.  (frequent, can last for several hours)

26.   Perceived muscle weakness, but no evidence of true weakness

27.   Inner trembling or quivering (occasional)

28.   Sewing machine, shakey leg (occasional)

29.   “Neuropathy” pain in my right ankle – similar pain migrates to my left ankle as well.  Sometimes bad enough I limp from the pain. (occasional now)

30.   Exercise intolerance

31.   Lightheadedness (very occasional)

32.   Very little appetite now.  Have to remind myself to eat.

33.   Scatterbrained, as if I have ADHD.  Difficulty focusing. (daily)

34.   Feeling that I only have so much energy, and I have to pick wisely how I use it.  If I exert myself too hard, I pay for it with exhaustion.

35.   Constipated most of the time, alternating with occasional diarrhea

36.   Hair texture on head and eyebrows seems stiff. Hair sometimes seems greasy or flat. 

37.   The hair on my forehead and my eyebrow hair feels annoying, as if my skin is hypersensitive to the movement follicles.

38.   Very dry, chalky looking skin especially on my hands and legs.

39.   Sleep quantity is generally good.  Fall asleep quickly around 10:30 pm, wake up around 7:00 am.  Occasionally wake up around 4-5:00 am and can't fall back asleep.  Wake up once in the night to use the restroom, but fall back asleep quickly.

40.   Sleep quality is poor.  Sleep feels unrefreshing, but I can never sleep in.  Napping is hit and miss.  Sometimes I’m exhausted but can’t nap, other times I sleep for 3 hours (only try to nap once or twice a week).  Been using my prescribed oral appliance for my mild sleep apnea.

41.   Struggling to work 20 hours a week now due primarily to cognitive impairment and cognitive fatigue.

42.   Now on 9.0 mg of valium daily, which I split into three doses.  I notice an increase in above symptoms as I approach the 5 hour mark.  I have missed a dose a couple of times, and noticed a significant increase in symptoms for the next 24 hours.

43.   Symptoms come in waves or clusters.  I have a few relatively good days, lots of bad days, and some in between.  But never, ever feel “well”. 

44.   I've had a few "windows" of calmness, like a calm I've never felt before.  They haven't lasted more than half a day.

45.   I've had NO significant increase in depression or anxiety, other than anxiety caused by not being able to perform well and work and feeling sick.  The cold torso, pre-panic attack sensation is disconcerting.

[manymoretodays]

Hi summitbound,

 

Yes, that is helpful.  Nice descriptive terms too! 

We have a print out list which a Dr. Glenmullen  made(he also has written books about W/D). 

From here on out......if you can print out the form........then do a daily checklist for yourself(as well as once in awhile sharing improvements or changes with us) it may help you see progress and changes over time.  http://survivingantidepressants.org/topic/2390-dr-joseph-glenmullens-withdrawal-symptom-checklist/

 

The first post has the printable form.

 

3 hours ago, summitbound said:

My primary care doctor finally, after five years, believes my symptoms are due to my medications (particularly benzo tolerance and withdrawal).  My prescribing psychiatrist flatly denies that these symptoms are due to my psych drugs, and said he thinks I have chronic fatigue syndrome or fibromyalgia.

 

I'm not at all surprised on your shrinks denial.  Same old story........seen many times over.  Nice that your GP is somewhat on board though.  Often we can only educate and hope they will see....... and then want to get involved in learning more.  They just don't have any decent practice guidelines, as yet(I'm hopeful), to go by....... and often HAVE to play it safe to keep their positions safe.

 

Very good summit.  Thank you.

 

Love, peace, healing, and growth,

mmt

 

[manymoretodays]

And a couple more links that may help your further understanding:

http://survivingantidepressants.org/topic/82-the-windows-and-waves-pattern-of-stabilization/

http://survivingantidepressants.org/topic/1160-how-psychiatric-drugs-remodel-your-brain/

 

Hopefully you are beginning to navigate the site somewhat yourself now as well.  Feel free to discuss things or offer support to other members.  You can search for those introductions that have some similarities to your medication adventures..... by the tags too.  Your tags are right below your user name and title.  Just type in the search box in the right hand corner and others tagged with your medications will come up in the introduction section.  Or just read and comment.  Or explore. 

 

Best,

mmt

[Shep]

11 hours ago, summitbound said:

My primary care doctor finally, after five years, believes my symptoms are due to my medications (particularly benzo tolerance and withdrawal).  My prescribing psychiatrist flatly denies that these symptoms are due to my psych drugs, and said he thinks I have chronic fatigue syndrome or fibromyalgia.

 

It's good to be skeptical of these types of labels.  There's a great website called Beyond Meds, written by someone who spent decades on many psych drugs and was able to come off all of them. She's written about the link between psych drugs and chronic fatigue.

 

Protracted psych drug withdrawal syndrome, chronic illness, CFS, Fibromyalgia: it’s autonomic nervous system dysfunction

 

It comes down to what these drugs have done to our nervous system. Another great article that explains a lot:

 

One theory of antidepressant withdrawal syndrome

 

It's important to protect your nervous system. There are many non-drug ways of doing so and they will help you are on your journey to be drug free:

 

Non-drug techniques to cope with emotional symptoms

 

Many people find supplements to cause problems during withdrawal. The only two that SA recommends are fish oil and magnesium, as these tend to be calming to the nervous system. However, because some people do have reactions, we recommend only trying one and a time and at a very low dose to start. Here is more information:

 

King of supplements: Omega-3 fatty acids (fish oil)

 

Magnesium, nature's calcium channel blocker

 

I'm glad you have a primary care doctor that is on the right side of history with this. Unfortunately, psychiatry - the field that caused this epidemic - has a long way to go. Perhaps these threads will help you navigate your way through conversations with your psychiatrist: 

 

How do you talk to a doctor about tapering and withdrawal?

 

What should I expect from my doctor about withdrawal symptoms?

 

Withdrawal dialogues & encouragement

 

[summitbound]

Hello all -

 

I am feeling very paralyzed.  I began recording a daily symptom log, but I think the my list of symptoms I posted above paints a more accurate picture of what I am experiencing.   

 

I reached out to a notable psychiatrist who is known for assisting with psychiatric drug tapering (don't know if I'm allowed to list his name here).   I had a phone appointment with him. 

 

He recommended holding at the 9.0 milligrams of Valium, tapering off the lithium first, then the Effexor, and only then resuming my Valium taper.   He said in his experience some people actually have to have some benzos to help with the Effexor withdrawal. That said, I shared the same list of symptoms I posted above, and he felt that the list was most indicative of benzodiazepine withdrawal. 

 

The Effexor / mirtazipine combination I'm on did lift me out of a bad depressive state when I was put on them a year and a half ago (although I think my depression might have been the result of being ripped off of Parnate too quickly).   I do think the Effexor / mirtazipine combo may have kept a solid "floor" under me despite experiencing the many losses and symptoms associated with the benzo withdrawal (which could make anyone depressed). 

 

All of my health problems began 5 years ago when I went from the 3.0 mg of Xanax I had been on for years down to 2.0 mg of Xanax because I was doing "well" and thought it might be a good idea to reduce the Xanax.  I really do feel my symptoms are classic for benzo withdrawal, and for that reason I am inclined to get that poison out of my system FIRST.   

 

I've also consulted with a nurse practitioner who helps people taper, and she feels coming off Effexor is much easier than benzos.  She does not have a strong opinion as to which to taper first.  The intensity of my current symptoms is severe.  With the almost 2 month hold I've been doing with the Valium, the only symptoms that have improved some is my cognitive functioning and muscle twitching.  I don't know if I could stand holding at 9.0 mg of Valium, with all my symptoms, while I spend a year tapering off the lithium and Effexor.  My biggest fear is that I'll make a wrong decision, and end up with a horrible symptom like akathisia, persistent terror, or agoraphobia.  So, ironically, while I am confused  and feel stuck by the differing opinions I've received, I appreciate hearing any strong opinions and guidance  you (the SA community) might be able to provide. 

 

I know there might not be one "right" way to go about this, but I don't want to break a cardinal rule that I'm not aware of and end up with akathisia, etc.  I have to start chipping away at one of the drugs again to move forward again.  Thanks so much.

Edited June 6, 2018 by SkyBlue
added para breaks

[SkyBlue]

15 minutes ago, summitbound said:

 

I reached out to a notable psychiatrist who is known for assisting with psychiatric drug tapering (don't know if I'm allowed to list his name here).   

 

I've also consulted with a nurse practitioner who helps people taper, and she feels coming off Effexor is much easier than benzos.  

 

(...) while I spend a year tapering off the lithium and Effexor.  

 

I know there might not be one "right" way to go about this, 

 

Hello Summit,

 

A few things stand out to me from your post. 

 

I've never heard the word "easy" used in the same sentence with "Effexor." I'm not trying to scare you. But I am hoping that she doesn't mean "faster" when she says it's "easier" to come off Effexor.

 

At what rate is the doctor wanting to taper you off the Effexor and lithium? If it's a one-year period, I'm concerned that he's recommending much faster than 10% of your current dosage per month.

 

Yes, you definitely can mention the doctor's name here (if you want), and if he is on-board with a well-informed, 10%/month maximum taper, we would love if you would be willing to list him in the Recommended Doctors thread. 

 

Have you seen the thread here on this forum about "Which drug to taper first?" 

 

There is generally a "right" way to do this, and that's one drug at a time, maximum of 10%. There are exceptions, of course, and I know you have a number of drug interactions going on, including the potential for serotonin syndrome.

 

 

 

[summitbound]

He recommended reducing the 675 mg of lithium by 112.5 mg every month.  So 6 months to get off it.  He said I should regroup with him then to tackle the Effexor.   He said he has patients count Effexor beads.

[summitbound]

Thanks so much for the responses.   I am 95% certain that the majority of my symptoms are due to benzo withdrawal, so getting the benzo poisons out of my system is my #1 priority.  I just finished a 2 month hold at 9.0 mg of valium.  During the two months my symptoms improved substantially, although I was still sick.  I have to make forward progress, so a week ago I started tapering again at a rate of only 2% per month.  All of my above symptoms dramatically increased again, with the addition of more non-situational fear/anxiety.  To revisit my original question:   Could my Effexor, lithium, or mirtazipine be acting in such a way that it is making my benzo withdrawal even harder?  Is there any literature, or personal experiences, that would support tapering off of one of those drugs first (or even concurrently) so I can make it through benzo tapering and withdrawal?.  Thanks so much.

[manymoretodays]

Hi summitbound,

Good to see you back.

5 hours ago, summitbound said:

Thanks so much for the responses.   I am 95% certain that the majority of my symptoms are due to benzo withdrawal, so getting the benzo poisons out of my system is my #1 priority.  I just finished a 2 month hold at 9.0 mg of valium.  During the two months my symptoms improved substantially, although I was still sick.  I have to make forward progress, so a week ago I started tapering again at a rate of only 2% per month.  All of my above symptoms dramatically increased again, with the addition of more non-situational fear/anxiety.  To revisit my original question:   Could my Effexor, lithium, or mirtazipine be acting in such a way that it is making my benzo withdrawal even harder?  Is there any literature, or personal experiences, that would support tapering off of one of those drugs first (or even concurrently) so I can make it through benzo tapering and withdrawal?.  Thanks so much.

 

summit, I think if you are referring to the symptoms that you listed above in this thread........many of those could also be due to adverse reactions from your other medications, and the combination of medications that you are presently on, as well as due to your tapering again with the benzo.  We are going to need you to do a drug and symptoms journal for us(the link is in my 2nd post below).

 

On 6/6/2018 at 3:02 PM, summitbound said:

I reached out to a notable psychiatrist who is known for assisting with psychiatric drug tapering (don't know if I'm allowed to list his name here).   I had a phone appointment with him. 

 

He recommended holding at the 9.0 milligrams of Valium, tapering off the lithium first, then the Effexor, and only then resuming my Valium taper.   He said in his experience some people actually have to have some benzos to help with the Effexor withdrawal. That said, I shared the same list of symptoms I posted above, and he felt that the list was most indicative of benzodiazepine withdrawal. 

 

And I think this notable doctor was getting close to what we would have you consider.  His tapering protocols might be a bit variable to what we would recommend.  On  holding with the Benzo tapering now I think he is totally in line with what we would have you consider.  I think continuing with your benzo taper now........ will make your Effexor or Mirtazepine or even Lithium taper that much harder.

 

I'm going to copy over Shep's response to you as well.   May 7th...........from your thread over in the benzo section.

_________________________________________________________________________________________________________________________________________________________

Hi, summitbound.

 

Welcome to the benzo side of SA.

 

On 5/6/2018 at 5:34 PM, summitbound said:

I've been so busy learning about benzo tapering (and suffering!) on benzobuddies.org that I have yet to tackle getting off any of my antidepressants.  I've already been tapering the benzo for over a year.  I know that the general rule is to taper off your benzos first, and then work on your antidepressants.

 

Please stop tapering the benzo until we can set up a taper strategy - removing a benzo when you are on multiple antidepressants can be very dangerous. The concept of tapering the benzo first is a BenzoBuddies concept that is based on the Ashton Manual from the 1980s. We know a lot more about tapering benzos now, especially when the benzo is in a cocktail of other drugs. Please see:

 

Ashton and beyond in benzo tapering

 

BenzoBuddies is great for getting social support but their tapering information is potentially very dangerous. 

 

On 5/6/2018 at 5:34 PM, summitbound said:

I've also wondered about the Effexor, as I've read it can be "activating."   The drug interactions site shows that any combo of mirtazipine-lithium-Effexor runs the risk of seratonin syndrome.  Wondering if some of the withdrawal symptoms I've been attributing to benzo withdrawal might be attributable to the antidepressant combo.

 

Yes, you are right about this. Effexor can be "activating". And when it's combined with mirtazapine, it's called California Rocket Fuel. Please see:

 

About going off mirtazapine plus venlafaxine (Effexor) aka "California rocket fuel"

 

Again, please stop tapering the benzo until we can help you set up a safe taper strategy. 

 

The best way to set up a taper strategy is to record your symptoms and your drugs in this journal format:

 

Drug and symptoms journal format

 

Please also include:

• any supplements you are taking
• how much sleep you get each night

By doing this, you'll be able to track how you feel before and after each dose and determine which drugs are "brakes" and which are "accelerators". The most important thing is to preserve your sleep. 

 

Please post your journal and any questions you have here in your thread. 

_________________________________________________________________________________________________________________________________________________________

Edited July 7, 2018 by manymoretodays

[manymoretodays]

I'm hoping you will consider holding now on further benzo tapering.

As Shep mentioned in the post I copied over here.............what we need:

 

The best way to set up a taper strategy is to record your symptoms and your drugs in this journal format:

 

Drug and symptoms journal format

 

Please also include:

• any supplements you are taking
• how much sleep you get each night

By doing this, you'll be able to track how you feel before and after each dose and determine which drugs are "brakes" and which are "accelerators". The most important thing is to preserve your sleep. 

 

Soooo.......work on the drug and symptom journal and post here...........with the times, medications and doses, and symptoms(you'll see when you open that link what we need).

Review the information in your drug interactions report posted above, as well as the links on California Rocket Fuel, and Taking multiple psych drugs.

 

Love, peace, healing, and growth,

mmt

Edited July 7, 2018 by manymoretodays

[summitbound]

Hello All  -  Sorry it took so long for me to respond.  I started my symptom journal today, and I'll post it in a week.  I've reviewed the above links.  Thanks!

[summitbound]

Hello All -  It's been quite a while since my original post, so I hope folks will still see this post.  I've been so overwhelmed just trying to survive with my symptoms, managing my two small children, and trying to hang on to my (now) part-time job by my fingernails that even doing something as important as this is hard.  Thank you so much to anyone who can review this.   Please let me know if I need to elaborate on any of the descriptions.  Also, when I did my 2 month hold on 9.0 mg of dry Valium, I was dosing 3.5 mg when I woke up, 3.5 mg in early afternoon, and 2 mg in the evening.  I starting liquid tapering the evening dose at a rate of 2% per month for about 2 weeks (see above).  Then I learned that if you change to liquid tapering, you should do equal doses at equal intervals (every 8 hours), and when you convert from dry to all liquid doses you should hold for 2-4 weeks to let your body adjust.  So, starting on 7/10 I went to all liquid and have been holding at 8.87 mg per day, thus the 3 x 2.96 mg doses show below.  Also, on 7/21 I cut my lithium dose from 562.5 to 450 mg.  I was having to cut 1 1/4 tablets, which I thought was pretty inaccurate, so I cut down to one 450 mg tablet that I now cut in half.  I was also just desperate to make some sort of progress.  I did notice some extra anxiety, but I wouldn't say it added any new symptoms that were substantially more severe than those listed below.  Again, thank you so, so much.  I'm really suffering.

 

SUMMITBOUND DRUG AND SYMPTOM JOURNAL

Friday 8/3

7:45 AM  Woke up

8:00 AM  Tinnitus, whole body muscle soreness, brain fog, jitteriness, pain in both ankles and wrists, head pressure, soreness on sides of stomach muscles, lots of low back pain, pain in finger joints, leg muscle twitches, irritability.

8:15 AM  Took Effexor ER 187.5, lithium 225, diazepam 2.96

2:25 PM  All of the symptoms as this morning, except increasing head pressure.  More scatter brained. 

2:30 PM  Took diazepam 2.96

8:00 PM.  All of the AM symptoms plus burning skin on my face and forearms.  Loud tinnitus. 

9:00 PM.  Occasional mild muscle jerks in lower legs

9:20 PM   Took mirtazipine 30, lithium 225, diazepam 2.96

9:45 PM  Fell asleep

[Forgot to record meal times for Friday]

 

Saturday 8/4

6:45 AM  Woke up

7:00 AM  Effexor ER 187.5, lithium 225, diazepam 2.96

9:30 AM.  Really bad whole body muscle and joint pain. Especially Lower back. Tinnitus, head pressure, irritability, noise, light, and touch sensitivity. Brain fog.  Muscle twitches in my legs.  

12:45 PM. Muscle tension in my arms and shoulders.  Inner trembling.  Left ankle joint and foot pain to the point of almost limping. 

2:00 PM  . Bloated belly, lots of twitching/spasms in my lower legs. 

2:30 PM diazepam 2.96

4:30 PM.   All the 9:30AM symptoms are at 1/2 the intensity they were then, except head pressure and tinnitus are the same.  Intrusive thoughts. Very little appetite.  

9:30 PM  Took mirtazipine 30, lithium 225, diazepam 2.96

10:00 PM  Fell asleep

[Forgot to record meal times for Saturday]

 

Sunday 8/5

6:00 AM  Woke up. Vivid dreams last night

6:15 am. Mild head pressure and tinnitus. Pain in ankles and feet.  Lower leg twitches.  Also a few mild twitches in left bicept, lower thighs, and lower back. 

6:30 AM  Effexor ER 187.5, lithium 225, diazepam 2.96

8:00. Am - Breakfast

8:30 AM Intrusive, looping rage full thoughts

9:00 AM.  Cold to my core fearful sensation (feel like you’re about to do something frightening, or just before a panic attack).

12:35. Pm. Irritable, head pressure. 

1:00. Pm.  Skin burning on arms and face, mild chest pain, fatigue, loud tinnitus. 

1:15 pm. Muscle twitches on the sides of my stomach. 

1:30 pm. - lunch

1:45 pm.  Constipated

2:00 PM  Took diazepam 2.96

6:00 pm - dinner

9:00 pm Noise sensitivity, tinnitus, muscle aches

9:45 PM  Took mirtazipine 30, lithium 225, diazepam 2.96

10:15. Pm. Went to sleep

 

Monday  8/6

7:00 AM  Woke up

7:15 AM. Moderate whole body muscle pain, fairly bad feet pain and lower back.  Mild head pressure and tinnitus. Very little appetite.

7:30 AM  Took Effexor ER 187.5, lithium 225, diazepam 2.96
8:00 AM. Breakfast

10:00 AM.  Mild head pressure and tinnitus. Physical fatigue and muscle weakness.  Muscle twitches in left thigh. 

11:00. AM. Near vision seems better compared to yesterday.  Moderate cognitive impairment today. 

12:00 PM. Lunch

12:30  PM Trying to work.  Very scatterbrained, unable to focus. 

2:00  PM  Very bad brain fog.  Very spaced out.

2:30 PM  Tookdiazepam 2.96

7:15. Dinner

8:00 pm. Tons of head pressure.  Very irritable. Racing, looping, negative intrusive thoughts. Burning face. Tinnitus.  Stomach muscle twitches. Occasion heart palipatations. 

8:30 PM  Took mirtazipine 30, lithium 225, 

9:00 PM. Felt agitated and rageful

9:30 pm. Took diazepam 2.96

10:00 pm  Fell asleep

 

Tuesday 8/7

5:30 AM.  Woke up agitated with rageful, looping thoughts.  Replaying anger from a disagreement with my wife the night before. Lots of head pressure. Twitching in my legs. 

6:45 AM  Took Effexor ER 187.5, lithium 225, diazepam 2.96

9:15 AM  Looping, rageful thoughts. Feel outside of my body, almost out of my mind.  Like an anger switch was flipped and I can’t turn it off.  Derealization / depersonalization. Didn’t go into work. 

9:45 AM - Breakfast 

1:15 PM - Lunch

2:00 PM  Took diazepam 2.96

2:30 pm - Cognitive impairement, spaciness. 
6:00 PM dinner

8:30 PM Lots of head pressure, sore joints, weak muscles, tinnitus. Cold core fearful sensation.  Chest pain. 

9:00 PM. Burning skin on arms. 

9:45. PM. Pain in both ankles and left knee pain. Lower leg twitches. Mild head pressure, tinnitus. 

10:00 PM  Took mirtazipine 30, lithium 225, diazepam 2.96

10:45 pm  Feel asleep

 

Wednesday 8/8

6:45 AM  Woke up

7:15 AM.  Ankle and foot pain. Mild head pressure. Sore forearms.  Lower back pain. Left knee pain

7:30 AM  Took Effexor ER 187.5, lithium 225, diazepam 2.96

9:00 AM - Breakfast

12:00 PM.  Bad cognitive impairment, awkward gait, spacyness, knee pain, burning skin on arms, mild tinnitus, mild head pressure, diarrhea. Some cold core fearful sensation. 

1:15 pm. Lunch

1:30 pm.  Hand tremor. 

2:30 PM  Took diazepam 2.96

6:30 pm - Dinner

8:30 pm. Very bad head pressure, tinnitus, looping negative thoughts, burning skin on chest, cognitive impairment, sore forearms, thighs, biceps, shoulders, ankles, knees and feet.  Occasional strong / skipped heartbeats. 

9:45 PM  Took mirtazipine 30, lithium 225, diazepam 2.96

10:30 PM  Fell asleep

 

Thursday 8/9

7:30 AM  Woke up

8:00 AM  Effexor ER 187.5, lithium 225, diazepam 2.96

9:30 Am Breakfast 

9:45 AM Virtually no muscle or joint soreness this morning. Mild head pressure, no tinnitus.  Feel very angry, like I’m looking for a fight. 

11:30 AM. Tinge of cold core sensation. Tinge of depression. Slight knee soreness. 

1:00 pm.  Spaciness, agitated, as if I’m somewhat “out of my mind” scatterbrained.  Very little appetite.  Very little head pressure.

1:15 PM Took diazepam 2.96 

1:30 pm lunch

3:45 pm.  3 beer drunk sensation (feels as if I was drunk on three beers), depersonalization, very bad. Hard to function. Can’t think. 

5:30 pm dinner

7:00 pm.  Diarrhea, tinnitus, head pressure. 

7:30 pm - cold core

10:00 pm. - diarrhea, mild head pressure, cold core, more clear headed.  No muscle or joint soreness. Hand tremor. 

10:15 PM  mirtazipine 30, lithium 225, diazepam 2.96

10:30  PM Fell asleep

 

Friday 8/10

6:45 am Woke up

7:00. Am  Head pressure, knee pain, tinnitus, lower back pain

7:15 diazepam 2.96

8:00 AM  Took Effexor ER 187.5, lithium 225, 

8:15 am - noise sensitivity, looping angry thoughts

9:30 am - Breakfast 

9:45 am - Some anxiety, fear

12:00 pm - agitated, anxious, cold core, a little depressed, cognitive impairment, pressure in ears

12:30 PM diazepam 2.96

1:30 pm. Whole body muscle soreness.  Knees sore.  Burning skin on face. Tinnitus. 

1:45 pm - Lunch

2:00 pm.  Heartburn sensation in chest, like breathing off alcohol

4:15 pm.  Moderate cold core.

6:30. Pm - dinner

7:00 pm - A mild cognitive window for a few hours. I was able to read a magazine article.  Muscle soreness, head pressure. Tinnitus. 

8:15 pm.  Burning sensation in chest as if I drank a shot of hard alcohol. 

10:00 PM  Took mirtazipine 30, lithium 225, diazepam 2.96

11:00 pm  Feel asleep

 

[manymoretodays]

13 hours ago, summitbound said:

Also, when I did my 2 month hold on 9.0 mg of dry Valium, I was dosing 3.5 mg when I woke up, 3.5 mg in early afternoon, and 2 mg in the evening.  I starting liquid tapering the evening dose at a rate of 2% per month for about 2 weeks (see above).  Then I learned that if you change to liquid tapering, you should do equal doses at equal intervals (every 8 hours), and when you convert from dry to all liquid doses you should hold for 2-4 weeks to let your body adjust.  So, starting on 7/10 I went to all liquid and have been holding at 8.87 mg per day, thus the 3 x 2.96 mg doses show below.  Also, on 7/21 I cut my lithium dose from 562.5 to 450 mg.  I was having to cut 1 1/4 tablets, which I thought was pretty inaccurate, so I cut down to one 450 mg tablet that I now cut in half.  I was also just desperate to make some sort of progress.  I did notice some extra anxiety, but I wouldn't say it added any new symptoms that were substantially more severe than those listed below.  Again, thank you so, so much.  I'm really suffering.

 

Looks good Summit and thank you.  I'm amazed.......working and small children while on this kind of "cocktail".  Are you finding any non-drug strategies to help you cope?

I'm just going to parse some of the above out a bit, and then ask for some more experienced input as to further direction, tapering strategy.  Try to just HOLD on further changes in the meantime.  I'm hoping we can get to work on reducing the Effexor next.........

 

From the above quoted narrative(will summarize):

July 10 Valium 8.87 mg/day  Holding

July 21 Lithium taper 562.5 mg to 450 mg

 

If you get a chance, in the meantime,  could you update your signature with the above.

And woah!!!!  You......are.......a........trooper!!! 

 

Love, peace, healing, and growth,

mmt

 

 

Edited August 13, 2018 by manymoretodays

[summitbound]

MMT - Yes, your summary is correct.  Updated my signature.  I am seeing a therapist who is working with me on meditation, breathing, mindfulness, yoga, and other non-med anxiety coping skills.  I've tried accupuncture, but unfortunately I didn't notice much benefit.  Thanks again!

[manymoretodays]

Just a couple more questions and requests for you summit.  And I'm glad you've got some ground support going with coping skills.

And thanks for updating your signature.  Just add the date to your current Valium dose.  The date you got to and began HOLDING at the 8.87mg.

The same with the Lithium and date of that taper.

 

Did you decide to taper Lithium now?  As you know.......we generally just have you taper just one medication at a time.  It looks like you did a 20% drop on July 21st.  I don't know if you've seen this yet but here's what we've got collected on Lithium tapering:  Tips for tapering off lithium

 

Are you working with the Dr. that you mentioned previously now?  Or benzo buddies?

I don't want you to get overwhelmed with "too many cooks" so to speak or too much variance in advice.

.......and awaiting more expertise to chime in, I'm  just trying to get some of this a bit more organized in advance of that....... 

 

Okie dokie,

Love, peace, healing, and growth,

mmt

 

Edited August 13, 2018 by manymoretodays

[Altostrata]

Hello, summitbound.

 

I know you are very distrustful of the Valium, for good reason. However, it's not the most dangerous drug you're taking.

 

Our emphasis is different from benzobuddies. We want to keep your nervous system stable while you go off drugs. We don't focus on the benzo. Please hold on tapering the benzo while we unravel your symptom pattern.

 

Please put ALL your drugs in the Drug Interactions Checker https://www.drugs.com/drug_interactions.php

and copy and paste the results in this topic.

 

Are you getting regular blood tests for the lithium? Why was lithium added?

[summitbound]

Lithium answer - Yes, I'm aware of the rule to taper one medication at a time.  Since I had been holding at between 8.87 and 9 mg of Valium for three months, I wanted to make progress on at least one other drug.  Splitting the lithium into 1/4's seemed like it was resulting in uneven pill splits, so I thought I'd get rid of the inaccurate 1/4 tablet and cut to 450 mg (one whole lithium tablet).  That way I'd at least be getting an accurate dose over a 24 hour period.  I knew that cutting to 450 mg would be a 20% jump (exceeding the 10% rule), but I thought I'd take the chance.  Thanks for the "Tips for tapering lithium" link, I'll read it.

 

Dr. answer - My psychiatrist of 12 years is still my prescribing psychiatrist.  However, I no longer trust him and am no longer using him for taper advice.  Just for refills.  The notable psychiatrist I mentioned above blogs for Mad in America.  He's in California, I'm in Colorado.  I just did one phone consultation with him to get his perspective.  He recommended chipping away at the lithium as low hanging fruit.  I was only planning on checking in with him every six months or so to get perspective.  He said in my situation, there is no easy tapering answer and to just take his opinion as an opinion.  He said he actually refers to the good people here at SA for ideas.  So, the only real cook in the kitchen is me.     Thus, my need for help.

 

I feel that most of my symptoms are due to reaching benzo tolerance 5 years ago, and then suffering withdrawals during my extremely slow benzo taper.  I think this is the case because I had most the 45 symptoms listed in my May 9 post while I was still on the Parnate.  When I was ripped off the Parnate, and my psychiatrist threw me Remeron / Effexor combo,  virtually all my symptoms stayed the same.  The only things that seemed to change once switched to the Remeron / Effexor combo were: 1) I became more emotionally blunted (almost unable to cry even at my sister's funeral -- not like me), and 2) My insomnia went away and I was able to sleep better, possibly due to the Remeron.  SO, I'm strongly leaning towards continuing my Valium taper and holding on the lithium, Effexor, and Remeron until I'm completely off the Valium.  That could take 10 months.

 

What I really need help with from folks here at SA is coming up with a comprehensive, wisely informed taper strategy (realizing there are no guarantees).   I want to tackle tapering the drug that is causing the most symptoms first (which I'm pretty sure is the benzo).  BUT, I don't want to make some sort of critical mistake (due to my lack of knowledge) and be thrown into something horrific like akathisia.  It's consumed much of my energy just to learn about benzo withdrawal and proper tapering, so I haven't even started digging into learning about the pitfalls of the other three drugs.  I do know that both benzo withdrawal and Effexor withdrawal can cause akathesia.  Fortunately, during my benzo taper I have NOT experienced much depression or severe anxiety, even despite the hell and losses I've been through the last 3 years.   Perhaps the Remeron / Effexor combo is artificially lifting my mood enough that I've avoided depressive benzo withdrawal symptoms thus far?  I do know what severe depression feels like -- I can't imagine going through all of the hell I'm going through now and having depression thrown in.  Also, I realize that tapering four drugs, one at a time, at 10% per month will take me 40 months!!!!!  So that's a lot of time holding on other drugs while I taper one.  I want to reduce my exposure to the most harmful drugs first.  And, if the dose of one of the drugs like Effexor is too high and could be making my benzo withdrawal symptoms even more severe, and it would be wise to taper it down partially, that would be great to know.

 

So I hope I'm making sense!!  Thanks again for your help.

 

 

 

[summitbound]

Hi Altostrata -  Yes, I have gotten blood tests for the lithium and the doctor said they were low, not at harmful levels for my organs. It was below the "theraputic" range.  The psychiatrist added the lithium to help with depression, not for any sort of mania.  I believe the results of the Drug Interaction Checker for all my drugs is posted above.

[summitbound]

Also wanted to add.... Every time I've come off a hold on my Valium, and started tapering at a rate of even 2% per month, all of my above symptoms have spiked.  Within 24 hours of my first 2% pull, they spike.   Holding on the Valium. does not make me feel well.  I am still very, very sick.  It just calms down the intensity of the above symptoms.   It would be hard to imagine trying to hold at my current dose of Valium for say the next year, as sick as I am now (if the Valium is indeed the cause).

[Altostrata]

I would be suspicious of any psychiatrist prescribing a 4-drug cocktail for anything.

 

I don't know how I missed the drug interactions report. Well, you can see the combination of 3 of the 4 drugs you're taking is rather risky. The reason they have these interactions is because they block each other's liver metabolism. This can damage your liver.

 

5 minutes ago, summitbound said:

When I was ripped off the Parnate, and my psychiatrist threw me Remeron / Effexor combo,  virtually all my symptoms stayed the same.  The only things that seemed to change once switched to the Remeron / Effexor combo were: 1) I became more emotionally blunted (almost unable to cry even at my sister's funeral -- not like me), and 2) My insomnia went away and I was able to sleep better, possibly due to the Remeron.  SO, I'm strongly leaning towards continuing my Valium taper and holding on the lithium, Effexor, and Remeron until I'm completely off the Valium. 

 

I am not following your reasoning leading to reducing Valium. If you're taking 4 drugs, how can you attribute any particular symptom to Valium? What I see in your daily symptom pattern is adverse reactions to drug combinations.

 

1 minute ago, summitbound said:

Also wanted to add.... Every time I've come off a hold on my Valium, and started tapering at a rate of even 2% per month, all of my above symptoms have spiked.  Within 24 hours of my first 2% pull, they spike.   Holding on the Valium. does not make me feel well.  I am still very, very sick.  It just calms down the intensity of the above symptoms.  

 

Calming down the intensity of the symptoms is the benefit of taking Valium!

 

You're saying when you reduce the Valium, you get worse -- how on earth do you get to a conclusion that the Valium needs to go??

 

As you say only your sleep improved on the Remeron / Effexor, my attention goes to the Effexor. If it's not doing anything for you, and it has a potentially dangerous interaction with the other drugs, why continue to take it?

 

My inclination would be to hold on tapering lithium, Valium, and Remeron while tapering Effexor. This may preserve your sleep while you go off a drug that tends to be stimulating.

 

The other 3 drugs are brakes, more or less. Just dropping one drug from the cocktail can change the dynamic considerably.

 

If you become dopey while you taper Effexor, I would then reduce lithium, then go back to tapering Effexor.

 

Yes, it is going to take you a long time to get free of all 4 drugs. You can thank your psychiatrist for that.

 

Yes, Dr. Shipko considers us the leaders in tapering and withdrawal.

[summitbound]

So, this is my logic regarding #1.  My first symptoms started 5 years ago when I was Parnate, lithium (1,350 mg), and Xanax.   I believe I hit tolerance with the Xanax.  I began tapering the Xanax three years ago, and my symptoms immediately increased in intensity and number significantly.  When I was converted over to Effexor / Remeron, and still tapering the Xanax, my symptoms remained consistently the same.   I'm assuming Parnate and Effexor / Remeron have different mechanisms of action, different impacts on the brain and liver?  Wouldn't I have noticed a change in symptoms if the Parnate vs. Effexor / Remeron combo were the cause of my symptoms?   Symptoms have remained the same, Xanax taper has remained the same, MAOI / antidepressants have not.  Also note, I'm on 450 mg of lithium now (much less than the 1,350 mg when this all started).  Wouldn't that have helped my symptoms some?

 

Here's my logic on #2.  Every benzo withdrawal site and Facebook group I've been to (and Ashton)  describes the same pattern when tapering.  The greater the percent you try to cut per month, the more symptomatic you'll be.  The goal is 10% per month.  Some people can only tolerate 5%.  And the really unfortunate can only tolerate 2%.  The rate of taper is driven by how much suffering you can tolerate.  People hold when they can't tolerate the intensity of the symptoms anymore.  But they don't feel well while holding either.  It's a band aid to help you catch your breath, and then you dig in and start tapering again.  The only way out is through, they say.  And this holds true for folks that were ONLY prescribed a benzo.  So it would be expected that as soon as I stop holding, and start tapering the Valium, my symptoms would get worse (that said, I know my situation is complicated with three other drugs involved).  I cannot stress enough how dramatically worse everything gets within 24 hours of a 2% cut.  It's as if your body is extremely angry that you just took some of the benzo it needs away.

 

I know that benzos are considered "safe" biologically.  But there are lots of suicides, all the time, from people trying to taper just a benzo. (I know that happens with AD's too)  The symptoms and withdrawal depression get that bad.  I don't think I could live a year in the state I'm in right now.  I'm about to loose my job, my marriage is extremely strained, I can't take care of my kids, and I go through the day trying to cope, feeling like I've had three glasses of wine mixed with 3 cups of coffee. (I can't think, but amazingly, somehow, I can write).   If Effexor is the cause, I'll definitely taper the Effexor first.  If I'm doing irreversible damage to my liver, I'll taper that drug.  If benzos are the cause, I'll continue tapering the Valium.  But I do feel like this is a life or death decision.

 

 

 

 

 

[summitbound]

I'm sorry, I just re-read what I wrote.  I don't mean to be argumentative.  I'm just feeling desperate.

[Altostrata]

7 minutes ago, summitbound said:

I believe I hit tolerance with the Xanax.  I began tapering the Xanax three years ago, and my symptoms immediately increased in intensity and number significantly.

 

Our rule is: If tapering increases symptoms, stop tapering. You are adding benzo withdrawal symptoms to your situation.

 

Some benzo groups will tell you to keep tapering no matter what. We don't advise that.

 

Whatever information benzo sites offer, they address people taking benzos only. You cannot apply the same assumptions to a 4-drug cocktail. Your 4 drugs INTERACT. The interactions produce or exacerbate your other symptoms. Removing any of the 4 ingredients will change the interactions of the other 3 drugs and your symptom pattern in unpredictable ways -- which we hope will be an improvement.

 

In addition, you have a long, complex drug history with many drug changes. There is no way to tell where symptoms are coming from. You think you hit benzo tolerance but your symptoms may have been due to a change in lithium or Parnate or, God knows, something else your dumb psychiatrist bounced off your brain.

 

We need to simplify your drug burden. It makes zero sense to remove the benzo and add benzo withdrawal to the mix. You might be able to get off Effexor easier, which can change the balance of the other 3 drugs.

 

We won't know what this does until you reduce Effexor.

 

Please note that since you're taking 4 drugs, reviewing and analyzing your drug intake and symptom pattern is very time-consuming. You've requested advice here and we've done our best. If you still want to taper the benzo, good luck.

[Meimeiquest]

You might have to divide the Valium into multiple daily doses to keep it even.