TheLandofNod: Chronic insomnia is driving me insane. Reinstate or stay the course?

[TheLandofNod]

Greetings SA community,

 

 

This is my first post here, but I've been browsing for quite a while now trying to figure out where my symptoms (particularly insomnia) are coming from. Just a quick caveat, my narrative is kind of all over the place right now because I'm going through some pretty severe brain fog.

 

Venlafaxine ER 187.5 mg daily (morning)
Bupropion XL 300 mg daily (morning)
Risperidone 2 mg nightly (bedtime)

 

So I very unwisely cold turkey'd off all three of these since March 14th of this year and am now on my 4th month off. Getting off these three drugs (esp. cold turkey for the Effexor) was worse than the 9th circle of Hell. Needless to say, it was an immeasurable amount of anxiety, anguish, and despair beyond my fathomable imagination. That is all I have to say about the acute withdrawal phase. Just wish I didn't have to learn the hard way.

 

Since March (and during the acute withdrawal process), I have been experiencing chronic insomnia (daily) and terrible mood swings/depression. What's weird to me is that I was only on them for 6 weeks, and before that I had a month long gap of getting off  all my meds before 'relapsing'-- and before that month long gap I was on pretty much of every psychotropic drug you can imagine for 7 years in order to deal with what could've been momentary/situational depression that was instead prolonged into an agonizing boom and bust of cycling and sampling through a plethora of pharmaceuticals and morphing it into the monster of protracted depression/anxiety to very unnatural levels.

 

For the last 4 months, I haven't been able to sleep more than 2-3 hours a night, sometimes I'll be up all night as well or wake up every 30 minutes to an hour. If I'm lucky I'll get maybe 5 fitful, fragmented hours of sleep. I never crash at all, I just feel 'amped' all the time. It seems like no matter what I do my brain just does not turn off. Like whenever I lay down, I feel completely wired no matter how tired I get. And then during the wees hours of the morning, my cortisol level would spike to astronomical levels to the point where my heart feels like it's about to burst right out of my chest and I'm nearly vomiting from the stress. I'm fairly certain at this point that this bout of chronic insomnia (and other symptoms) is from CT'ing off the Effexor (Venlafaxine) because this is the first time in my life that I have ever experienced this.

 

And now, because of persistent insomnia I feel like a shadow of my former self. I can't work, I can't smile/laugh, I can't enjoy anything or experience pleasure (anhedonia/dysphoria), been feeling isolated/alone from my family/friends because it's so difficult to explain what I'm going through, and I feel like I can barely function throughout the day (like eat or even shower). Been hospitalized countless times on top of that. I feel like it's ripped my soul inside out.

 

Subsequently during the 4 month period, I've been prescribed Remeron, Seroquel, Ambien, Vistaril and for some reason Depakote (probably because my psychiatrist thought I was going through bipolar mania) to deal with insomnia and what they considered to be "rebound depression." Either I was hypersensitive to unbearable side effects or they didn't work at all. At the end of the day, I'd still wake up in the middle of the night as fitful as a cold chihuahua, my heart nearly bursting out of my chest from panic attacks. While my psychiatrist insists it is "rebound depression," my PCP/GP insists that the insomnia is primary and not secondary (from medication or medical issues). I really don't know who or what to believe especially in the midst of confusion/frustration from sleep deprivation. Anyways at the moment I am not taking any medications and have already had a physical done (including getting my thyroid checked) and my PCP/GP couldn't find anything wrong with my body. I've recently begun to self-implement CBT-I and SRT as well in order to address this. Although I think it would help if I saw a sleep specialist or a psychotherapist specializing in insomnia. 

 

So this kinda goes back to my original point, is reinstatement even worth doing 4 months out or am I better off just staying the course of staying clean? The reservations I have with reinstatement is that I don't want to prolong anymore unnecessary exposure/risks to a drug (even at ultra low doses because I'm duly convinced that this drug ruined my life) that I wouldn't touch with a 10 foot stick at this point and have to 'reset' my brain's recovery from the protracted withdrawal syndrome of insomnia. Also, considering that based on what I've read on this site about reinstating; I'm pretty sure I already missed the window of opportunity for reinstatement (given that it's been 4 months) and that the risks of adverse/hypersensitive reactions and symptoms prolonging outweigh the benefits of symptom management and reduction in the context of cold turkey withdrawal.

 

My question is will the insomnia last forever unless I reinstate Effexor? I'm absolutely terrified that I have to live with this for the rest of my life.

 

Also, any links/tips to dealing with insomnia (although chances are I probably already read about it) is appreciated as well.

 

In the meantime, I'm trying my best not to fixate/obsess over my symptoms and live life the best I can with where I'm at now and stay positive despite the doom and gloom I constantly feel all day. It's hard, but it's not impossible to keep hope alive even during the abyss.

 

 

Thanks for reading this,

TheLandofNod

[SkyBlue]

21 hours ago, TheLandofNod said:

 

So I very unwisely cold turkey'd off all three of these since March 14th of this year and am now on my 4th month off. 

 

So this kinda goes back to my original point, is reinstatement even worth doing 4 months out or am I better off just staying the course of staying clean? 

 

My question is will the insomnia last forever unless I reinstate Effexor? I'm absolutely terrified that I have to live with this for the rest of my life.

 

Also, any links/tips to dealing with insomnia (although chances are I probably already read about it) is appreciated as well.

 

In the meantime, I'm trying my best not to fixate/obsess over my symptoms and live life the best I can with where I'm at now and stay positive despite the doom and gloom I constantly feel all day. It's hard, but it's not impossible to keep hope alive even during the abyss.

 

Hello, Nod, and welcome to SA. 

 

Your terrible insomnia is directly related to acute withdrawal. 

Please help us out by creating a drug history signature here: https://www.survivingantidepressants.org/topic/12364-please-put-your-withdrawal-history-in-your-signature/

 

It sounds like you are somewhat familiar with reinstatement. Here is a thread on that subject; as you can see, reinstatement comes with possible risks and possible benefits. https://www.survivingantidepressants.org/topic/7562-about-reinstating-and-stabilizing-to-reduce-withdrawal-symptoms/ It's a really individual decision and pretty much the only universal "rule" is to reinstate only a tiny, tiny amount--much less than your last dose.

 

Here is a thread on insomnia. Other info can be found by searching the site -- you might want to browse topics in the Self-Care section of the forum.

https://www.survivingantidepressants.org/topic/53-tips-to-help-sleep-so-many-of-us-have-that-awful-withdrawal-insomnia/

 

No, you will *not* have to live with this for the rest of your life, not at all.

 

I'm sorry for what you're going through. I want to congratulate you for living the best you can with where you are now. This is a great attitude that can only help your recovery. 

 

[TheLandofNod]

I updated my drug signature, it's not very thorough right now I know but I will update it.

 

Alright, I can't stand this anymore. I'm going insane and can barely function (if at all) because of chronic insomnia. Even though it's been 4 months since I had my last cold turkey dosage; I know it's risky but I think I have no choice but to reinstate. 

 

So if I originally took 187.5 mg of Effexor XR, then how many beads should I start off with for Effexor XR reinstatement after 4 months? I know it's risky 'm a little confused because each capsule has a different amount. Like one capsule I counted 37 big beads and 4 small beads, another capsule I counted 36 big beads, and 0 small beads, and last capsule I counted 38 big beads and 1 small bead. 

 

I heard taking 10 beads is the "standard" for Venlafaxine reinstatement but how do you know that's the standard if I'm not even seeing a standard amount of beads per capsule?

 

Other questions I have is how long am I supposed to be on 10 beads (or whatever is the starting amount) before tapering down to zero?

 

Before I reinstate, my first goal right now is to get off Trazodone. I've only been on it for 4 days (took 50 mg for the first two days, and 100 mg for the last two days). Is it safe to just cold turkey off now because I've only been on it for less than a week.

 

Thank you.

[Poulesportive]

Land of Nod, while you're waiting to hear from the moderators regarding the meds (I am waaaay out of my league with regard to your med tapering/reinstatement questions), just wanted to say that I have had very bad insomnia too after 20+ years of SSRIs and many a failed, too-fast taper trying to get off of them. My body is now hyper-sensitized to just about everything, and two things have really helped me with insomnia and just generally not feeling like crap: taking a Magnesium supplement and ditching gluten/making diet changes. 

 

Dr. Kelly Brogan, a holistic psychiatrist who supports tapering (who I found out about on SA), has lots of free info on her website that I think is worth a read, including how to cope while coming off meds https://kellybroganmd.com/stop-madness-coming-psych-meds/ and here she is on magnesium: https://kellybroganmd.com/magnesium-most-important-female-supplement/.  I take either 200 mg of magnesium glycinate a day or if I'm feeling amped and like I"m not going to sleep, then 400 mg. It's been recommended that I take more, but with 400 mg I sleep really well, so that's the max I've taken.

 

I wish I could help with your med Qs but it's all I can do to manage a 10% drop in my Cymbalta dose. Good luck to you!!

[PoetJester]

Hey LandofNod  (  i googled the name, didn't realize it was a Robert Louis Stevenson poem.  Kidnapped had been a favorite novel of mine, back when i could sleep and thereby read novels)

 

Anyways, i don't have a lot to say over here, i am half dead myself from the effects of insomnia but i did want to say "hi" and thanks for the username choice which led me on to the poem and your introduction, as well.  i have called myself "Haggard the Horrible" on some facebook posts, after the famous Dik Browne cartoon "Hagar the Horrible", due to the effects of this sleep deprivation on my face.  \\

 

i did try trazadone for 3 or 4 days as well about 8 months or so into my wd from zoloft and zyprexa and was ok withdrawing from it.  i basically just went back to my fragmented depressed sleep and feeling exhausted.  joy.  joy.    .  i had had some upper body weakness from the trazadone and it really wasnt giving me much for sleep anyways.  

 

sorry, for the silly post.  hope you see some improvement on the sleep front soon.

 

Poetjester 

 

 

[mammaP]

On 7/3/2018 at 12:34 AM, TheLandofNod said:

What's weird to me is that I was only on them for 6 weeks, and before that I had a month long gap of getting off  all my meds before 'relapsing'-- and before that month long gap I was on pretty much of every psychotropic drug you can imagine for 7 years 

Hi Landofnod, the above sentence speaks volumes, 

 

On 7/3/2018 at 12:34 AM, TheLandofNod said:

Subsequently during the 4 month period, I've been prescribed Remeron, Seroquel, Ambien, Vistaril and for some reason Depakote

 

On 7/3/2018 at 12:34 AM, TheLandofNod said:

 Been hospitalized countless times on top of that. I feel like it's ripped my soul inside out.

 

You have been polydrugged for 7 years with every drug imaginable.  What were the ones you quit before venlafaxine, buproprion and risperidone? 

Did you take any of them for a longer period? I am sorry, I know it isn't easy but it is extremely important that we have you full history,  and detailed for  the last 12 months.  Your nervous system is very unstable from all the drugs and my heart goes out to you. Depending on what you quit before being prescribed effexor you may be able to reinstate another less difficult one to help with withdrawal. 

 

We have some great topics on insomnia. It has been my biggest problem too. 

Scroll down the first post to find links to sleep topics.

https://www.survivingantidepressants.org/topic/604-important-topics-about-symptoms-including-sleep-problems/

 

[Gridley]

LandofNod,

 

I have a tip on insomnia that has worked for me, allowing me to get 7-8 hours of broken but decent sleep per night.  Insomnia has been one of my biggest WD problems, but about ten days ago it worsened.  It so happened that I saw a link on SA (which I don't have, sorry) about the connection between the large leg muscles and the brain.  The upshot was that it's a two-way communication, not just brain-to-leg muscles but leg muscles-to-brain and that exercising the major leg muscles had a positive effect in the brain (that is a very poor synopsis, sorry).

 

I can't do strenuous exercise (too activating) but, with nothing to lose, I started doing a few minutes of  exercises of the large leg muscles, mostly my quads.  I have a machine that allows me to do leg presses, but squats would work too.  The first night after doing the exercises my sleep was markedly improved, and I went from 4-5 hours sleep to around 8.  So every afternoon now I do my exercises and every night my sleep has remained improved.  Not a cure, by any means, but definitely better sleep.  You might want to give it a try. 

[TheLandofNod]

Hi all, thank you for all your responses.

 

So I know it's not black-and-white because of the sheer complexities and idiosyncrasies of individual physiology and neuropharmacology, but I do have a rather peculiar question about drug reinstatement that's been lingering in my mind since I first discovered this site.

And my question is:

 

What exactly is the purpose of reinstatement? 

 

Is it to enhance/shorten the healing process, and perhaps prevent what might otherwise be permanent withdrawal symptoms? 

or

Is it to make your symptoms alleviated or at least bearable while you undergo a healing process that is either-way not affected by reinstatement?

 

If it is the first case, then I would without hesitation go for reinstatement even though it's been 4 months since my last dosage of Effexor XR.

If it is the second case, then I am going to rule out reinstatement and stay the course on staying clean even if I am still dealing with insomnia.

 

In the meantime, I am currently getting off Trazodone. Tonight will be my final dose of 50 mg (I've only been on it for 5 days so far) and hopefully the last time I will take psychotropic drugs.  I know I am not alone, but I am utterly sick and tired of being sick and tired of this whole ordeal that has stolen so much from me and want to finally want to find a solution for it ASAP (although I acknowledge that the healing process is not overnight).

 

I have sincerely reached a point beyond desperation and sometimes beyond reason to address this, as others here can attest to as well. Lately, I've been feeling a lot of frantic despair because I simply can't decide on what to do.

[Gridley]

It is the latter, to alleviate withdrawal symptoms so they are bearable.  This is what I generally write about the purpose of reinstatement:

 

"Reinstatement of a very small dose of the original drug is the only known way to help alleviate withdrawal syndrome.  The only other alternative is to try and wait out the symptoms and manage as best you can until your central nervous system returns to homeostasis.  Unfortunately no one can give you an exact timeline as to when you will start feeling better and while some do recover relatively easily, for others it can take many months or longer."

[Altostrata]

Welcome, Landof.

 

You have a fairly typical case of withdrawal insomnia. In fact, getting 2-3 hours is not the worst it can be.

 

You have a choice: To try reinstating a very small amount of a drug or see if you can improve your sleep by non-drug means and stress reduction.

 

You must assume that going on and off drugs and experienced severe withdrawal and other adverse reactions has made your nervous system hypersensitive. You will need to be careful with drugs and supplements, and avoid stress to let it settle down.

 

Reinstating is tricky because you've been on so many drugs for such a long time, it's impossible to tell what might work. If you have Effexor on hand, taking 10 beads out of the capsule (or even fewer) might be a way to see if it will have a beneficial effect.

 

If poor sleep is your major withdrawal problem, you will want to build it up with non-drug techniques. See

 

Tips to help sleep -- so many of us have that awful withdrawal insomnia

 

Waking with panic or anxiety -- managing cortisol spikes

 

What is the sleep cycle?

 

Melatonin for sleep: Many people find it helpful

 

TV or computer use in evening can disrupt sleep: Bright light signals the brain that it's daytime

 

As Poulesportive mentioned, magnesium can help. Many people do better with fish oil and magnesium supplements, see
http://survivingantidepressants.org/index.php?/topic/36-king-of-supplements-omega-3-fatty-acids-fish-oil/

http://survivingantidepressants.org/topic/15483-magnesium-natures-calcium-channel-blocker/

 

A lot of people find them helpful. Try a little bit of one at a time to see how it affects you.

 

To restore sleep, it is absolutely essential to limit light stimulation before bedtime and to get off the computer early in the evening.

 

Please let us know how you're doing.

 

 

[TheLandofNod]

I've updated my sig. 

 

True, it could be worse -- way worse. I'm already taking magnesium supplements and also have implemented an extremely strict regimen of sleep hygiene/restriction (although it is admittingly still a work in progress).

 

Thank you for your post, Altostrata. You're right, given the factors that I've dabbled in so many different drugs (in my desperate attempts to alleviate, at times, absolutely unbearable symptoms and subsequently exacerbating them), that my nervous system is probably in complete disarray right now, and the risks over benefits being too high; I've decided that I am going to cancel reinstatement and stay the course.

 

Now, my last question arose from this Quora post: https://www.quora.com/Can-permanent-damage-arise-from-abruptly-discontinuing-an-SSRI-or-will-I-just-experience-temporary-withdrawal-symptoms

 

I know you answered this question in a different rendition as well, Gridley. When you stated that reinstatement is simply for symptom alleviation and not to enhance/shorten the healing process.

 

But what's your take on this, Altostrata? Or anyone else reading this?

 

Can you get permanent damage (like to the brain/neurological, cardiovascular, gastrointestinal, endocrine, etc. whatever) from abruptly discontinuing (i.e. going cold turkey) a SSRI or SNRI that would otherwise have been prevented if you tapered off properly?

 

I'm seriously starting to get panic attacks over this. Getting really worried. Okay, deep breaths. 4-7-8.

[TheLandofNod]

The worst part about the recovery process from antidepressant protracted withdrawal is just how lonely it can get. There is no literally no one else in my life that I can talk to about these symptoms. I think I either come off as some crazy hypochondriac or someone with obsessive compulsive tendencies (actually I was diagnosed with OCD, although I don't necessarily identify with it). 

 

In the meantime, I'm applying for jobs and looking for housing because I am currently on the verge of homelessness. It's extremely frustrating and a real uphill battle because I feel a complete lack of momentum from simultaneously dealing with withdrawal symptoms.  It's hard for loved one or really anyone in my life (especially doctors) to understand the private, personalized Hell in a hand-basket that withdrawal can be, especially for drugs that are nominally legal. 

 

People look at me and think "Well, you look fine to me." No, I'm not fine at all. I'm far from it. Actually, my life is a constant living nightmare like every second right now and the only yearning wish I have at this point out of everything else in my life is knowing how long this would last. This is the eternal question that bounces around my head (and bypassing my prefrontal cortex, which feels practically dissolved in its current state) that can never be answered and is always followed up by the agonizingly predictable but for-the-lack-of-better-words response: "It depends."

 

But what can I say, I have to muscle through this, right? There is no alternative unless I want to panic and grasp at straws again: whether it is getting back on medication to alleviate symptoms or drive my own head in a tailspin to try to "figure it out." At times, I have to completely disassociate myself from my own body because the pain and the sheer mindf**k is just too much to deal with; like my brain is on the verge of short-circuiting or shutting down from all the anxiety and stress. But again, the worst part is the loneliness. 

 

I know there's plenty of links I can go to for this matter, but how do you guys personally have overcome or dealt with the waves of hopelessness or despair (like contemplating and imagining the worst case scenario 24/7) during this often Byzantine process of healing?

[FarmGirlWorks]

You are right that it can be isolating to feel like crazy death inside and look normal on the outside. A friend the other day was updating me about a mutual acquaintance who was diagnosed as bipolar a month ago and is now on meds (don't know which ones). My friend was appalled and surprised by how people had ditched this person and were even talking about her behind her back. I told her that as someone going thru this for friggin' 15 months now, yes! people leave you because it is scary, boring, and socially not accepted. What is ironic is that this friend is one of the people who I see as someone who disappeared when I got sick.

 

I'm sorry you're going thru all that you are right now with WD on top of it. As far as tips, my yoga teacher said after a suicide last year of a local boy rockstar, "Poor Chris. He just forgot to wait one day to see if it would change." Sometimes just hanging on to the next minute was all I could do. However, the suicidal ideation (SI) -- while not completely gone -- has decreased greatly from earlier months of this. And making myself go out occasionally has helped. I can't always but when I can, I do.

 

Yes, it is annoying to hear "it depends" and "time is the best healer" but that seems to be very true. Best of luck and hang in there.

[TheLandofNod]

On 7/14/2018 at 12:03 PM, Altostrata said:

Reinstating is tricky because you've been on so many drugs for such a long time, it's impossible to tell what might work. If you have Effexor on hand, taking 10 beads out of the capsule (or even fewer) might be a way to see if it will have a beneficial effect.

I have been off Trazodone since 7/15 (yesterday). Should I wait or is it safe to reinstate Effexor now at 10 beads every morning? Also, is it 10 beads out of any capsule whether it is a 37.5, 75, or 150 mg?

 

And how long should I be on 10 beads before tapering down to 0?

 

Thanks. 

[Altostrata]

How about starting with 5 beads? Any Effexor capsule will do -- but always take beads from a consistent dosage capsule from the same manufacturer.

 

We need to see how you do before determining how long you might be taking a bit of Effexor.