lxjuice: tries to come off quetiapine

[lxjuice]

I have some history with coming off psych meds:

 

sertraline 50mg/day for 8 weeks, CT, no withdrawal

prazosin 3mg/night for 2 years, taper of 0.5mg/2 weeks, mild rebound insomnia. This one's really easy to come off. It's not a dirty psych med, it only hits 1 receptor.

trazodone 50mg/night for 1 year, rapid taper to ~20mgish with no w/d and then slow taper of 10% every 2 weeks. Mild rebound insomnia for maybe a week from 20mg.

mirtazapine 15mg/night for 3 months, rapid taper to 7.5, 3.75mg then nothing. Occasional anxiety attacks, no insomnia but I was taking it with quetiapine and they share a lot of receptors (looking at you H1).

 

quetiapine 200mg/night for 6 months - trying to come off this now and having a horrible time. I dropped 200->150mg quickly in 25mg jumps over the space of a month and only had mild rebound insomnia. I got cocky and dropped another 25mg, and only had mild insomnia the first night but the second I had almost no sleep and extreme daytime hyperarousal. I reinstated at 150mg/night but it didn't help, possibly because of delayed w/d from the other drops. It's been 5 days back at 150mg and only last night did my sleep get slightly better. Hopefully it continues. I definitely needed it when I started taking it but at the same time I wish I never did...

 

I hate how my usual methods of getting out of extreme anxiety (breathing etc) just don't seem to be working to reduce it, only to help cope. Really hammers in that the withdrawal is more neurological than psychological.

[SkyBlue]

3 hours ago, lxjuice said:

I hate how my usual methods of getting out of extreme anxiety (breathing etc) just don't seem to be working to reduce it, only to help cope. Really hammers in that the withdrawal is more neurological than psychological.

 

Hi Lx and welcome to SA.

 

Thanks for creating a drug signature. 

Can you please add the dates when you reduced, updosed, etc. on the quetiapine? 

 

Reinstatement can be tricky. It's possible that you reinstated at too high a dose. It's possible also that stopping the mirtazapine earlier this year has sensitized your nervous system. There is hope -- the dose just might need to be adjusted. Have you read the thread on reinstatement (first page especially)? https://www.survivingantidepressants.org/topic/7562-about-reinstating-and-stabilizing-to-reduce-withdrawal-symptoms/

 

 

Also, here is a thread with drug-specific info:  https://www.survivingantidepressants.org/topic/1707-tips-for-tapering-off-seroquel-quetiapine/

 

I'm sorry you are going through extreme withdrawal. So many of us can definitely relate to the fact that our usual methods aren't always helpful during withdrawal. As you said, it's definitely neurological--in fact, there is a term here on SA: "neuro-emotions," for those intense emotions that are caused by our neurological responses during withdrawal. 

 

Please let us know when you've read the first page on reinstatement and what the start/change/updose dates are. 

 

 

[lxjuice]

1 hour ago, SkyBlue said:

 

snip

 

January 200mg

March (start) 150mg

March (mid) 100mg

March (mid, only a few days later) 200mg

May (start) 175mg

May (mid) 150mg

3rd June 125mg

5th June 150mg

6th June 200mg (no difference)

7th 150mg 

 

Reinstating to 150mg didn't make the w/d any better or worse. I'm not sure where to go with it, even having read the main reinstatement post.

 

Edit: having read more of this site, I've just realised that I might have had withdrawal syndrome from sertraline without even realizing it!! My anxiety got worse for no reason 3 months after stopping sertraline, before which it was getting better, and then it slowly improved over the next several months. I also had a really odd episode of extreme muscle and fascia pain, flu-like symptoms that lasted for 3 days about a year after dropping sertraline which I always found really strange... and delayed withdrawal is the only thing that could explain it. Damn.

[Altostrata]

Welcome, lx.

 

Well, you do your pharmacokinetics research. However, the number of receptors a drug is said to effect does not predict withdrawal symptoms, as all your other hormonal systems and internal feedback web adapt to the presence of the drug and may generate symptoms upon its absence.

 

Going on and off psychiatric drugs tends to sensitive your nervous system. It could be when you went off prazosin, your nervous system had not experienced as many drug-induced stresses as it has now. You can now assume your nervous system is sensitized to drug changes. Please take care going off any psychiatric drug.

 

7 hours ago, lxjuice said:

It's been 5 days back at 150mg and only last night did my sleep get slightly better.

 

Yes, it takes about 4-7 days for a drug change to fully register. After that, your nervous system still has to settle down from the uproar. Please take your drugs on a very regular daily schedule and let us know how you're doing.

 

[lxjuice]

I took the usual 150mg at the usual 10pm last night and it kicked in a lot quicker than it normally does (40mins vs 1.5-2hrs) and I got hit with a huuuuuge wave of anxiety. It happened again once I got in bed but passed. It's disconcerting seeing that quetiapine's alpha blockade is working since I can see my veins dilate, but it's still giving me adrenaline rushes.

 

I have a feeling it's related to food. I've kind of had this vague notion built up from my general experience taking it but I think food consumption speeds up Q absorption. I had dinner at 8pm last night, normally it's 6-7pm. I'll have to try sticking to a consistent dinner time and see how it affects it.

[lxjuice]

Last night I finished dinner after 7pm and dosed at 10pm. I still had an adrenaline rush about 45mins after taking it but it was milder and went off quicker. Finishing fatty foods at 7pm and dosing at 10pm never caused me any problems before, maybe I've sensitized? I'm thinking of dropping to 143.75mg for tonight which is slightly less than a 5% drop?

 

I also found this:

 

The bioavailability of quetiapine is marginally affected by administration with food, with Cmax and AUC values increased by 25% and 15%, respectively.

 

25%!!! Seems eating it with fatty food straight before increases the peak effect by 25%!! And they call this "marginal". Even if I wasn't in withdrawal, what the hell FDA... then again I shouldn't be surprised, it's the same FDA that allows doses to have something like +/-10% variation on what it says on the label.

[Carmie]

Hi lxjuice, 

 

Im tapering of quetiapine too. Our bodies are so all over the place when tapering. Like what’s happening to you now, one minute eating something is fine and later it effects your medication. It’s so weird, and the thing is nearly everyone one here has a problem with something they eat or a supplement.

 

Speaking of supplements, please be careful what you take, as it too interferes with the withdrawals. What’s recommended on this site is magnesium and fish oil, but even then everyone is different and you have to start slowly and don’t take both at once. Some people can’t tolerate these either but others have had great success with it. 

 

Everything is trial and error and everyone reacts differently to things, so in the end only you can decide what works for you. 

 

I didn’t know that the bioavailability of quetiapine is affected by food, I’ll have to do some research on that. An increase of 25% percent? That seems astronomical! 

 

Sending hugs🤗

[lxjuice]

Woah, 300mg to 7.5?! Well done!

I take magnesium, fish oil and vitamin D and ashwagandha. So far I haven't found any of these to affect anything, except ashwagandha for morning anxiety. When I take it, I'm OK in the morning and the anxiety waves start to build up towards the evening and ironically, peak 40mins after taking Q.

 

Here's something else. I'm pretty sure quetiapine above 100mg actually causes insomnia in me. Those few days I was on 100mg a few months ago were the best sleep I had since I started on it and after raising to 200mg, I never got back there again. Plus since the w/d started I can feel it activating me somewhat after I dose. Even 3.5hrs after fatty food. This kind of thing must be quite common here. Still waiting to see if anyone thinks I could try to drop to 143.75mg because of increased sensitivity, otherwise I'll keep taking 150mg.

[Carmie]

6 hours ago, lxjuice said:

Woah, 300mg to 7.5?! Well done!

I take magnesium, fish oil and vitamin D and ashwagandha. So far I haven't found any of these to affect anything, except ashwagandha for morning anxiety. When I take it, I'm OK in the morning and the anxiety waves start to build up towards the evening and ironically, peak 40mins after taking Q.

 

Here's something else. I'm pretty sure quetiapine above 100mg actually causes insomnia in me. Those few days I was on 100mg a few months ago were the best sleep I had since I started on it and after raising to 200mg, I never got back there again. Plus since the w/d started I can feel it activating me somewhat after I dose. Even 3.5hrs after fatty food. This kind of thing must be quite common here. Still waiting to see if anyone thinks I could try to drop to 143.75mg because of increased sensitivity, otherwise I'll keep taking 150mg.

 

Hi lxjuice, 

 

Yes, I managed to get down to 7.5mg from 300mg but it took many years and lots of withdrawals. I remember at one stage I couldn’t leave my flat for about three months. I knew nothing much about tapering but I tapered nevertheless. 

 

Even though I’m on a much lower dose now it will take me even longer to get off this than the tapering I’ve  done before as the amounts to taper get so tiny. I’m really sensitive to even small amounts of tapering and I can’t taper at 10%, it’s way too high. I used to taper at that when I was tapering off higher doses. Before I knew about the 10% tapering I was tapering even higher with not so great consequences. 

 

It sounds like you have to stop eating the fatty food close to your dose of Quetiapine. 

 

Im sure the mods will be around soon to help you with your tapering.They are very caring, but extremely busy and most of them are still going through withdrawals themselves so are struggling. 

 

Sending hugs🤗

 

 

[Carmie]

Hi lxjuice, 

 

How are you doing?💚

[lxjuice]

On 1/26/2019 at 1:06 AM, Carmie said:

Hi lxjuice, 

 

How are you doing?💚

 

I'm good. I'm holding at 150mg for now since it's not a great time in my life to try to come off it, but I have had no wd or rebound symptoms since August. I've also made fair progress in therapy, and I read a study which said fear extinction ability predicts how hard coming off antipsychotics is. I'll be back probably at the end of the summer when I start tapering down again, this time in much smaller amounts and with less anxiety & avoidance hanging around my life it should be much easier.

[ChessieCat]

Just adding some additional information which you might find helpful now and/or in the future.  The first post is about tapering.  The second post is coping techniques.

 

Here's some additional information which might help you to understand what is happening:

 

Recovery isn't linear it happens in a Windows and Waves Pattern

 

Withdrawal Normal Description

When we take a psychiatric drug, we are adding chemical/s to the brain.  The brain then has to change to adapt to getting the chemical/s.  It might have to change something to do with A and then once that change has been made it affects B so another change has to be made and so on down the line.  It is a chain reaction, a domino effect.

 

The same thing happens when we take the drug away.  That's why it's possible to experience such a vast array of withdrawal symptoms, and they can change, and be of different intensity.

 

are-we-there-yet-how-long-is-withdrawal-going-to-take

 

These explain it really well:

 

Video:  Healing From Antidepressants - Patterns of Recovery

 

 

On 8/31/2011 at 5:28 AM, Rhiannon said:

When we stop taking the drug, we have a brain that has designed itself so that it works in the presence of the drug; now it can't work properly without the drug because it's designed itself so that the drug is part of its chemistry and structure. It's like a plant that has grown on a trellis; you can't just yank out the trellis and expect the plant to be okay. When the drug is removed, the remodeling process has to take place in reverse. SO--it's not a matter of just getting the drug out of your system and moving on. If it were that simple, none of us would be here. It's a matter of, as I describe it, having to grow a new brain. I believe this growing-a-new-brain happens throughout the taper process if the taper is slow enough. (If it's too fast, then there's not a lot of time for actually rebalancing things, and basically the brain is just pedaling fast trying to keep us alive.) It also continues to happen, probably for longer than the symptoms actually last, throughout the time of recovery after we are completely off the drug, which is why recovery takes so long.

 

AND

 

On 12/4/2015 at 2:41 AM, apace41 said:

Basically- you have a building where the MAJOR steel structures are trying to be rebuilt at different times - ALL while people are coming and going in the building and attempting to work.

It would be like if the World Trade Center Towers hadn't completely fallen - but had crumbled inside in different places.. Imagine if you were trying to rebuild the tower - WHILE people were coming and going and trying to work in the building!  You'd have to set up a temporary elevator - but when you needed to fix part of that area, you'd have to tear down that elevator and set up a temporary elevator somewhere else. And so on. You'd have to build, work around, then tear down, then build again, then work around, then build... ALL while people are coming and going, ALL while the furniture is being replaced, ALL while the walls are getting repainted... ALL while life is going on INSIDE the building. No doubt it would be chaotic. That is EXACTLY what is happening with windows and waves.  The windows are where the body has "got it right" for a day or so - but then the building shifts and the brain works on something else - and it's chaos again while another temporary pathway is set up to reroute function until repairs are made.  

 

[ChessieCat]

We strongly encourage members to learn and use non drug coping techniques to help get through tough times, both in their life in general and when tapering, as there will be times of discomfort as we reduce the drug.

 

Understanding what is happening helps us to not get caught up with the second fear, or fear of the fear.  This happens when we experience sensations in our body and because we don't understand them we are scared of them and then start to panic.

 

This document has a diagram of the body explaining what happens in the body when we become anxious:

 

https://www.getselfhelp.co.uk/docs/AnxietySelfHelp.pdf

 

Anxiety Stuff - all kinds of stuff about anxiety attacks and things that help ...

 

Audio FEMALE VOICE:  First Aid for Panic (4 minutes)

 

Audio MALE VOICE:  First Aid for Panic (4 minutes)

 

Non-drug techniques to cope

 

dealing-with-emotional-spirals

 

Dr Claire Weekes suffered from anxiety and learned and taught ways of coping.  There are videos available on YouTube.

 

Claire Weekes' Method of Recovering from a Sensitized Nervous System

 

Audio:  How to Recover from Anxiety - Dr Claire Weekes

 

CBT Course:  An Introductory Self-Help Course in Cognitive Behaviour Therapy

 

Resources:  Centre for Clinical Interventions (PDF modules that you can work through, eg:  Depression, Distress Intolerance, Health Anxiety, Low Self-Esteem, Panic Attacks, Perfectionism, Procrastination, Social Anxiety, Worrying)

 

On 4/28/2017 at 4:03 AM, brassmonkey said:

 

AAF: Acknowledge, Accept, Float.  It's what you have to do when nothing else works, and can be a very powerful tool in coping with anxiety.  The neuroemotional anxiety many of us feel during WD is directly caused by the drugs and their chemical reactions in the brain.  Making it so there is nothing we can do about them.  They won't respond to other drugs, relaxation techniques and the like.  They do, however, react very well to being ignored.  That's the concept behind AAF.  Acknowledge, get to know the feeling involved, explore them.  Accept, These feelings are a part of you and they aren't going anywhere fast. Float, let the feeling float off as you get on with your life as best as you can.  It's a well documented fact that the more you feed in to anxiety the worse it gets.  What starts as generalized neuroemotinal anxiety can be easily blown into a full fledged panic attack just by thinking about it.

 

I often liken it to an unwanted house guest.  At first you talk to them, have conversations, communicate with them.  After a while you figure out that they aren't leaving and there is nothing you can do to get rid of them.  So you go on about your day, working around them until they get bored and leave.

 

It can take some practice, but AAF really does work.  I hope you give it a try.

 

 

[Carmie]

On 1/30/2019 at 7:08 AM, lxjuice said:

 

I'm good. I'm holding at 150mg for now since it's not a great time in my life to try to come off it, but I have had no wd or rebound symptoms since August. I've also made fair progress in therapy, and I read a study which said fear extinction ability predicts how hard coming off antipsychotics is. I'll be back probably at the end of the summer when I start tapering down again, this time in much smaller amounts and with less anxiety & avoidance hanging around my life it should be much easier.

 

Glad to hear all is going well lxjuice, 

 

Sounds like you’ve got a good plan in deciding to taper down in smaller amounts when you taper again. It’s best never to taper more than 10% a month. I can’t do that much now, I’m tapering just over 3% at the moment. 

 

Wishing you all the best with your tapering 💚

[lxjuice]

I've decided to start tapering again but leisurely because I'm not getting any severe side effects that need me to come off it quickly.

I am only on quetiapine 150mg per night and the plan is to taper by a a quarter of a 25mg tablet dosed volumetrically, anything from every week to every month until I reach 100mg at which point I will re-evaluate whether I should start dropping smaller.

The first day on 143.75mg was fine, I was more alert and my sleep is somewhat worse, about 2 points down on a 1-10 scale. I had quite a severe panic attack about half an hour after taking it at night suggesting it might unfortunately be going paradoxical, but it passed in mins with deep breathing and I got to sleep/woke up fine.

I will probably not post every single day and instead summarize my progress and symptoms whenever I drop the dose.

 

Also the 25mg tablets I have, generic made by Teva, dissolve readily in water. Just split it to bypass the film coating, drop them in 20ml water and give it half an hour.

[lxjuice]

Also does anyone have any insight into these anxiety attacks, reading the rest of my thread again I remember the one I had last night feels like the ones I had before. It's not just anxiety but it's very electrified and forceful like I've seen in posts by other people. My subjective feeling is that it's different to any anxiety attack or panic attack I've had while not in withdrawal.

[Gridley]

51 minutes ago, lxjuice said:

It's not just anxiety but it's very electrified and forceful like I've seen in posts by other people. My subjective feeling is that it's different to any anxiety attack or panic attack I've had while not in withdrawal.

 

Withdrawal symptoms, such as anxiety or depression, can be much more intense than the experience of these feelings  before withdrawal.

[lxjuice]

It's been a week, I would say the withdrawal settled by Sunday although I'm still getting some mild itching. No anxiety attacks after the first one at bedtime or otherwise. Next drop to 137.5mg scheduled for Monday since I'm quite busy this weekend.

 

I would say the withdrawal was literally about a quarter as bad as when I dropped by 25mg last year, except it also went away much quicker. Way more than 4x quicker... days vs months.

[lxjuice]

I've decided to microtaper by 0.5ml per day with a solution of 25mg/20ml. So far so good on 125mg + 11.5ml whatever that is in mg. Rather than being somewhat hypomanic for a few days and crashing like the first drop to 15ml, I feel like I'm just constantly a bit amped up and more hyperaroused in the evenings which is easier because it's less up and down. Short half life sucks.

[brassmonkey]

"So far so good on 125mg + 11.5ml whatever that is in mg."

 

139.375mgai

 

The liquid you are using 25mgai/20mL has an AIC (Active Ingredient Concentration) of 1.25mgai/mL.  Multiply that by the 11.5mL tha you are taking and you get 11.5 X 1.25 = 14.375.  Add that to the 125mgai (in tablets I assume) and you get 139.375mgai for your dose.

[lxjuice]

The withdrawal photosensitivity is really bothering me. A sunny day is only a bit too bright but more to the point makes my eyes feel itchy and raw which I recognize from last time I tried to taper too. I will hold until it stops and then see about decreasing by 0.33ml/day. Well, 1ml every 3 days anyway since my syringes have graduations of 0.2ml and can't measure 0.33ml out accurately. And as fate would have it, 0.33ml/day would put me at 60 days for a 25mg pill which is roughly the suggested 10%.

[lxjuice]

Resumed tapering at 0.4ml/day at some point. Now at 137.5mg. Still going almost completely uneventfully if anyone's following.

[lxjuice]

The itching is very annoying. I am currently on 131.something mg. I held for a while with zero symptoms and resumed at 0.2ml/day and it immediately returned and it's my only symptom. Benzo or pregabalin stops it. Has anyone tried antihistamines for it and which drug were you tapering?

[lxjuice]

I've decided to time my tapering for when the lockdown eases up. I wasn't getting many mental symptoms before but it's been much worse since the lockdown and now I've stabilized but still slipping because of the lockdown in general. I'm on an awkward dose of about 130mg so I will taper very slowly, like 0.2ml twice a week, until 125mg and then I don't have to make liquid. Then we'll see. But it looks like I'm going to stop at 125mg, again.

[lxjuice]

So it's 3 years on since I settled on 125mg and in the last 4 months or so I've gone from 125mg to 100mg in these drops in order: 3.125mg, 3.125mg, 6.25mg, 12.5 mg.

 

What's strange is that starting from 125mg this time, smaller drops like 1-3.125mg would give me REALLY severe insomnia and leave basically incapacitated for 4 days. Higher drops (6.25mg and 12.5mg) aren't as much of a problem, with less insomnia and more emotional upheaval and anxiety (more avoidance behaviours rather than hyperarousal). I also noticed this during the process of getting from 150mg to 125mg but it was a bit different, smaller drops gave me insomnia and hyperarousal and bigger drops gave me a lot of energy and none or mild insomnia (6-8 hours sleep, depending). Still the point is that after a certain level, the bigger drops were more comfortable than the smaller ones. I dropped 200mg to 150mg at once a few months after I started taking it all those years back, and that was completely painless, it just stopped suppressing my thoughts as much. At least for me, 125-150mg was a really hard range to drop, maybe because of significant changes in receptor binding in this range. It can't just be my underlying issues changing as the 200mg to 150mg drop wasn't far away from the peak of my symptoms but these must definitely play a part with somewhat bigger drops being much easier overall than tiny drops, and this being consistent over several years. Can't pin it down on any one thing.

 

I won't be posting regularly but will throw an update in every now and then.