marconyc: introduction

[marconyc]

Hi. I'm new here. Here are the basics of my story.

 

I had been on 150mg of Zoloft for 17 years for dysthymia and generalized anxiety disorder. I decided to taper off, with the blessing of my pdoc. My depression and anxiety returned, and I had to not only increase the Zoloft to 200mg but add 1mg of Abilify (plus Konopin as needed). It's been a year and a half since the episode began and a year since starting Abilify. I'm feeling quite a bit better--I hardly ever take the Klonopin, and my pdoc said I can try doing without the Abilify. I just went 16 days at only 0.5mg of Abilify, but I'm feeling anxious and depressed again and bumped back up to 1mg. I'm so frustrated with the whole situation. I'm working hard to recover: I'm in weekly therapy, I run just about every day (3-6 miles), and I meditate almost daily. 

 

I don't want to come off the Zoloft, just the Abilify. Maybe I won't be able to, in which case I need to come to terms with that. 

 

Any comments or questions would be greatly appreciated.

[mammaP]

Hi marconyc, welcome to SA. You can taper safely from abilify but as with most drugs it needs to be slow. Most doctors do not realise that when a patient becomes ill while tapering fast that is is actually withdrawal. They believe it is the mental illness and the drugs are needed for life. Tapering slowly allows the brain to adjust to the lower doses gradually and is much more comfortable. As the dose lower the side effects become less troublesome.  When you tapered the zoloft it would have been too fast for your brain to adjust and caused withdrawal.  When that happens people often become worse on reinstating and end up on higher doses plus other drugs, that is what happened to you. When someone suffers withdrawal after tapering too fast we recommend very low doses for reinstatement and have great success with them.  This is then much less to taper later.  

Can you tell us about the klonopin? K has a very long half life and can cause dependency very quickly. Taking it just once a week means that there is always some in the blood and causes withdrawal in between doses. This can be misinterpreted as anxiety and another klonopin settles it down. 

 

We ask all our members to fill in their signature with their drugs and tapering history. This helps us to help you.  *Signature instructions

 

Here is our topic on tapering abilify

*Tapering abilify

If you decide to taper zoloft, I can assure you that it is possible to do it safely. 

*Tapering zoloft

Maybe you have been told you will need zoloft for life because of a chemical imbalance, and it was your illness returning when you tapered it previously. 

That is a myth that was created by the drug companies when it became apparent that people could not stop the drug. It also helped them to sell their drugs. 

It has now been proven untrue

*Chemical imbalance myth

 

 

[marconyc]

Thank you for the reply, mammaP. I actually tapered the Zoloft very slowly--over the course of 2 years, in fact. And then, when I reinstated, I also did it very slowly. I'm sure I suffered withdrawal, but I also think my illness recurred, because it was chronic many years before I started antidepressants. I'm not saying that my depression and anxiety are purely genetic or caused by a chemical imbalance, but I do believe that a combination of genetic predisposition and adverse childhood experiences wired me for these problems, and that I may need antidepressants for life. I don't like it--at all--but it's better than suffering through every day. 

 

I hadn't taken any Klonopin for at least 3 weeks when I started to feel increased anxiety and depression over the past few days, so I don't think that's a factor. 

 

I'm going to try tapering the Abilify much more slowly, as you suggest. While I'm resigned to being on Zoloft for life, I would very much like to discontinue the Abilify.

 

Again, thank you for the thoughtful and helpful response.

[manymoretodays]

On 8/8/2018 at 12:26 PM, marconyc said:

I'm so frustrated with the whole situation. I'm working hard to recover: I'm in weekly therapy, I run just about every day (3-6 miles), and I meditate almost daily. 

 

11 hours ago, marconyc said:

I'm not saying that my depression and anxiety are purely genetic or caused by a chemical imbalance, but I do believe that a combination of genetic predisposition and adverse childhood experiences wired me for these problems, and that I may need antidepressants for life. I don't like it--at all--but it's better than suffering through every day.  

 

I hadn't taken any Klonopin for at least 3 weeks when I started to feel increased anxiety and depression over the past few days, so I don't think that's a factor. 

 

Welcome from me too marco,

Unfortunately sometimes just staying on the antidepressants is a set up for further depressive episodes.  Yet the choice is yours to be made.  I encourage you to look around the site a bit more while you are studying up on Abilify tapering.   Educate a bit.  Weigh and balance your old beliefs with some new ones......just to seek some truth for yourself.    One of my biggest gripes lately is that none of us were ever told of the dependencies created by these drugs, and given the full facts as to how completely ineffective they often are(they are truly not much better than placebos).   Oh.......how I wish I had been given a placebo some 30 years ago.  Many of the drugs have side effects, that are the same as the conditions that they were given to treat......or worse.........what a gamble!!!!  And we are not always told of this.

 

Some of that more recent anxiety and depression could certainly be due to the Klonopin usage........even 3 weeks out from your last dose.  As well as the more recent changes in your Abilify........and most certainly due to the changes in Zoloft as well.  The brain and nervous system really can take some time to re adapt, especially after 17 years of being artificially messed with.

 

When did you jump back on Zoloft after your 2 year taper?  When did you come off of it?  When was the dosage increased from 150 mg to 200 mg?

(you can just summarize when you do your signature,  the signature is really helpful for us.......so we can see a summary of your history at a glance)

Adverse childhood experiences can often be overcome.......at least that's my belief system now.  The medications can often cause some subtle genetic variations too........as far as to how we process and metabolize some of these psychoactive medications.  You seem to have some belief that Zoloft is fixing some genetic predisposition.........maybe I'm reading that wrong........I'd just encourage you to read here and elsewhere, as so often times........the medications taken ARE the main problem after awhile.

 

I'll just leave you with one or two further links:  What is withdrawal syndrome?

There's a whole index of information in the first post.  Try and read through at least the first couple of posts there.

This one is great too:  neuroplasticity

(and I'll try and find the video that is missing from that thread ASAP) 

And it does sound like you have some great non drug coping practices in place as well.   Check out our symptoms and self care section as well.  Hopefully you can find some new coping skills or just add to some of the discussions we have going.

 

This is your main introduction/journal page.....a place for you to ask questions about your own situation, post updates, and to generally introduce yourself to the rest of our fine community.  Mutual support is encouraged here as well......between members, including mods, and administration.  So feel free to visit others threads and comment as well.

 

Again.......welcome aboard.

Love, peace, healing, and growth,

mmt

Edited August 9, 2018 by manymoretodays
change to bold statement, and elaboration

[marconyc]

Thank you, manymoretodays. I'll complete my signature, but here's more information on the Zoloft taper: I tapered from 150mg to 50mg over the course of approximately 2 years. After being on 50mg for a few months, I was hit with a massive resurgence of my anxiety and depression. No brain zaps, but I experienced an intense agitation and dysphoria that I don't remember from previous episodes of depression and which I attributed to withdrawal. The anxiety was so bad that I would dry heave regularly. I lost about 15 lbs in a few months. My psychiatrist prescribed Klonopin, which I had taken many years ago and was able to discontinue without any problem whatsoever.

 

When it became clear to me that I was entering a deep depression, he increased the Zoloft from 50mg to 75mg for a few weeks, then from 75 to 100 for a few weeks, then from 100 to 150 for a month or so, then up to 200. I felt desperate. I wasn't suicidal, but the depression and anxiety were brutal. Five months after the episode began, my 44-year-old brother was diagnosed with stomach cancer, and my depression worsened. I could barely get out of bed. That's when my psychiatrist prescribed 1mg of Abilify. During the whole time, I continued working at a high-pressure job, which was extremely difficult. I should add that just prior to the start of the episode, my wife and I had a failed IVF attempt after trying to start a family for 5 years. And I had been doing the work of two people at my job for more than a year. So there's no doubt that I was dealing with multiple stressors. Still, the reduction in medication clearly had a massive impact on my mental health.

 

I had tried to taper the Zoloft responsibly because I have seen evidence that these drugs can make depression worse over time and because I had been doing so well for so long. I underestimated how much they had affected my nervous system, and perhaps I underestimated how serious my depression and anxiety are. As I said, I do think there may be some genetic component to my illness, as my father had dysthymia and OCD, my mother has anxiety, my mother's sister has depression, and my brother has depression and anxiety. I find Allen Schore's explanation of how psychological problems develop to be very persuasive; he believes that the quality of attachment in the first 2 years or so of life profoundly shapes the right hemisphere of the brain, and that while good attachment can override a genetic predisposition to illness, poor attachment can lay the groundwork for psychopathology. Schore also believes that the brain remains plastic enough to heal as an adult, but that it can be very difficult to do so. 

 

Thank you again for the thoughtful response and the links. 

[marconyc]

After 2 weeks at 0.75 mg of Abilify, I started to feel anxious and depressed again, including feelings of depersonalization (DP) and derealization (DR). I find DP/DR to be particularly disturbing. I bumped back up to 1mg of Abilify. I attributed my symptoms to the dose reduction, but in therapy, I realized that I was holding back some intense feelings of anger and grief. Expressing those feelings helped reduce the symptoms, but I’m still feeling the “ripple effect” of the DP/DR in the form of philosophical obsessions about the nature of the self. In spite of that, I’m going to try reducing the damn Abilify again. I so badly want to feel like myself again. It’s like my nervous system has to relearn how to react to stress again after years of progress in therapy. Sometimes I want to scream, sometimes I want to cry. And sometimes I want to publicly call out my psychiatrist for being criminally ignorant of how these drugs work and the dangers of withdrawal. 

[manymoretodays]

Hi Marco,

What form of aripiprazole are you using? 

Is it the liquid?

You might have decreased by a bit too much are my thoughts.......10% of 1 mg would be 0.1 mg

So you might consider that once you are feeling stabilized again, decreasing  your dose to 0.9 mg, or doing even less than a 10% taper.

 

Why taper by 10%

 

I just thought I would share with you the following information on liquid aripiprazole(Abilify is the brand name) as well.  It is one of the drugs that has a long half life, which results in any changes to the dose taking longer to register physiologically.  Something to keep in mind.

 

We usually deal with drugs that have half-lives of around 24 hours or less. For a psychiatric drug, aripiprazole has an unusually long half-life, plus it has an active metabolite with a long half-life. According to https://en.wikipedia.org/wiki/Aripiprazole
 

Quote

 

Aripiprazole displays linear kinetics and has an elimination half-life of approximately 75 hours. Steady-state plasma concentrations are achieved in about 14 days. C_max (maximum plasma concentration) is achieved 3–5 hours after oral dosing. Bioavailability of the oral tablets is about 90% and the drug undergoes extensive hepatic metabolization (dehydrogenation, hydroxylation, and N-dealkylation), principally by the enzymes CYP2D6 and CYP3A4. Its only known active metabolite is dehydro-aripiprazole, which typically accumulates to approximately 40% of the aripiprazole concentration. The parenteral drug is excreted only in traces, and its metabolites, active or not, are excreted via feces and urine.^[50] When dosed daily, brain concentrations of aripiprazole will increase for a period of 10–14 days, before reaching stable constant levels.^{[citation needed]}

 

 

 

 

 

When changing from tablet to liquid form, you may begin to feel a difference beginning as early as 4 days, however research shows for certain drugs (unless your symptoms ramp up right away, then you will want to back off,  the full effect takes 7-10 days for the Blood Serum Concentration to become Steady State in the blood.  You may not wish to change or increase your dose for at least 2 weeks, to allow your CNS to fully recognize the change for drugs like this one with a long half life, (the time it takes you body to metabolize half of the dose)."

 

The drug concentration peaks in just a few hours after you take it then starts to drop off as it moves toward the half life.  Because of the long half life and the overlap between doses the  concentration rises until it reaches a plateau which is Steady State.

Any dose change needs to reach Steady State.

 

The liquid form of aripiprazole has a Blood Serum Concentration approximately 20% higher than the tablets.  " The single-dose pharmacokinetics of aripiprazole were linear and dose proportional between the doses of 5-30 mg"

(source: https://www.accessdata.fda.gov/drugsatfda_docs/label/2006/021729lbl.pdf )

So when crossing over and changing your formulation from tablet to liquid, you might consider a decrease in dosage to reflect this.   I would suggest asking the pharmacist about this as well.

 

The abilify tapering link is in the post from mammaP a few posts back.

 

I saw another one of your posts today as well, regarding your success with psychotherapy.  To search to see if we have discussions going around different topics you can just type in your main browser survivingantidepressants.org followed by the topic you are wondering about.  I just put in therapy and 2 topics came up:

https://www.survivingantidepressants.org/topic/18528-should-i-engage-in-therapy-during-withdrawal/

https://www.survivingantidepressants.org/topic/1101-cognitive-behavior-therapy-cbt-for-anxiety-depression-and-withdrawal-symptoms

 

I do a bit of talk type therapy myself from time to time, usually more focused on coping skills than content and find that works for me well.

Go ahead and express away some of those feelings.......there are all kinds of safe ways of expression.

And a few more links to some of our must look at topics:

neuroemotions

The windows and waves pattern of stabilization

 

Love, peace, healing, and growth,

mmt

 

 

 

 

 

Edited September 8, 2018 by manymoretodays
clarity

[marconyc]

16 hours ago, manymoretodays said:

Hi Marco,

What form of aripiprazole are you using? 

Is it the liquid?

You might have decreased by a bit too much are my thoughts.......10% of 1 mg would be 0.1 mg

So you might consider that once you are feeling stabilized again, decreasing  your dose to 0.9 mg, or doing even less than a 10% taper.

 

Why taper by 10%

 

I just thought I would share with you the following information on liquid aripiprazole(Abilify is the brand name) as well.  It is one of the drugs that has a long half life, which results in any changes to the dose taking longer to register physiologically.  Something to keep in mind.

 

We usually deal with drugs that have half-lives of around 24 hours or less. For a psychiatric drug, aripiprazole has an unusually long half-life, plus it has an active metabolite with a long half-life. According to https://en.wikipedia.org/wiki/Aripiprazole
 

 

When changing from tablet to liquid form, you may begin to feel a difference beginning as early as 4 days, however research shows for certain drugs (unless your symptoms ramp up right away, then you will want to back off,  the full effect takes 7-10 days for the Blood Serum Concentration to become Steady State in the blood.  You may not wish to change or increase your dose for at least 2 weeks, to allow your CNS to fully recognize the change for drugs like this one with a long half life, (the time it takes you body to metabolize half of the dose)."

 

The drug concentration peaks in just a few hours after you take it then starts to drop off as it moves toward the half life.  Because of the long half life and the overlap between doses the  concentration rises until it reaches a plateau which is Steady State.

Any dose change needs to reach Steady State.

 

The liquid form of aripiprazole has a Blood Serum Concentration approximately 20% higher than the tablets.  " The single-dose pharmacokinetics of aripiprazole were linear and dose proportional between the doses of 5-30 mg"

(source: https://www.accessdata.fda.gov/drugsatfda_docs/label/2006/021729lbl.pdf )

So when crossing over and changing your formulation from tablet to liquid, you might consider a decrease in dosage to reflect this.   I would suggest asking the pharmacist about this as well.

 

The abilify tapering link is in the post from mammaP a few posts back.

 

I saw another one of your posts today as well, regarding your success with psychotherapy.  To search to see if we have discussions going around different topics you can just type in your main browser survivingantidepressants.org followed by the topic you are wondering about.  I just put in therapy and 2 topics came up:

https://www.survivingantidepressants.org/topic/18528-should-i-engage-in-therapy-during-withdrawal/

https://www.survivingantidepressants.org/topic/1101-cognitive-behavior-therapy-cbt-for-anxiety-depression-and-withdrawal-symptoms

 

I do a bit of talk type therapy myself from time to time, usually more focused on coping skills than content and find that works for me well.

Go ahead and express away some of those feelings.......there are all kinds of safe ways of expression.

And a few more links to some of our must look at topics:

neuroemotions

The windows and waves pattern of stabilization

 

Love, peace, healing, and growth,

mmt

 

 

 

 

 

Thank you very much, MMT. I am using the tablet form of the generic right now. It’s difficult to shave off 10% precisely, but I can do it roughly. I’ll try doing that and see how it goes. The information you provided on the half-life is also really helpful.

 

Regarding therapy, I find that sometimes symptoms that seem purely physiological will resolve after a powerful session. Interestingly, I saw a new pdoc recently for a second opinion on my meds, and he said he thinks what I’m going through is more psychodynamic than biochemical. I was surprised by that coming from a doc who focuses on medication management. I also know that withdrawal is a major factor, but it was encouraging to hear someone affirm the benefits of talk therapy.

[manymoretodays]

22 hours ago, marconyc said:

I also know that withdrawal is a major factor, but it was encouraging to hear someone affirm the benefits of talk therapy.

 

Yes......that's good.  I'm hearing that old refrain again.......as far as treatments goes around here(where I am living).......of meds AND therapy work best.  They used to say that one could not benefit from therapy unless, or until on medication(s).

 

These guys aren't going to be giving up their prescription pads anytime soon.

 

I'm glad the therapy is powerfully helping.  That's great!

 

Have you considered using a digital scale to measure your dosage of aripiprazole?

 

Oh.....and so sorry for all the hardships of late, for you and the wife.  Wishing you all the best to come.

 

Love, peace, healing, and growth,

mmt

 

[marconyc]

No, they aren’t giving up their pads anytime soon. Not only that, many of them refuse to even acknowledge that withdrawal is real. It’s infuriating. Thankfully there are some MDs out there, like Stuart Shipko (he blogs at Mad in America) who are listening to patients. 

 

I appreciate the kind words of support. It’s been a brutal year and a half. In addition to dealing with infertility, my brother was diagnosed with stomach cancer last year. He’s doing okay, but the recurrence rates are high. And my job continues to be a major stressor, as we’re still understaffed. All this while coping with withdrawal. I wish I had been able to avoid reinstating, but I need to keep my job and didn’t think I could function without meds. Even with the meds, though, I can still tell that I’m in withdrawal from the two years I tapered. These drugs really screw up your nervous system over time.

 

I haven’t thought about using a digital scale. Thanks for the suggestion. I’m still trying to decide whether I should continuing trying to taper the Abilify right now or if I should give myself some time at 1mg and then try tapering again later.

 

I had my first soccer game of the fall season today. But because of the stress intolerance caused by withdrawal, even excitement manifests as anxiety. I had nightmares last night and was nauseous before the game. It was good to play, but I’m upset that something I love, like a soccer game, can cause so much anxiety. 

[marconyc]

@manymoretodays I have a question. Is it possible that I'm still experiencing/recovering from SSRI withdrawal, even though I reinstated sertraline 20 months ago (and at a higher dose!) and added aripiprazole? Because it certainly feels that way to me. I'm feeling closer to normal but still not myself. The fact that I've seen continuous improvement over time is the only reason I've stuck with this new sertraline/aripiprazole regimen. I'm trying to at least celebrate the fact that I'm pretty much free of the clonazepam.

 

I'm going backpacking for a week with two close friends starting tomorrow. Last year I wasn't up to it, but the other guys couldn't go either so I didn't have to back out. Anyway, although I'm in a better place now than I was last year at this time, I'm still really anxious about the trip. Not for any particular reason, really, just because I'll be away from home, etc. As I said in an earlier post, sometimes even excitement manifests as anxiety because my nervous system is so sensitive right now. Not only that, sometimes the anxiety almost feels like depression--it's a sense of dread and doom. I just cried like a little boy who is scared to go to school even though I'm in my 40s. 

[manymoretodays]

5 minutes ago, marconyc said:

@manymoretodays I have a question. Is it possible that I'm still experiencing/recovering from SSRI withdrawal, even though I reinstated sertraline 20 months ago (and at a higher dose!) and added aripiprazole? Because it certainly feels that way to me. I'm feeling closer to normal but still not myself. The fact that I've seen continuous improvement over time is the only reason I've stuck with this new sertraline/aripiprazole regimen. I'm trying to at least celebrate the fact that I'm pretty much free of the clonazepam.

 

What are you doing with the clonazepam dosing now?  Boy howdy.......that could have something to do with your W/D symptoms!

As you may have seen, reading around the site.........we generally will have folks carefully taper off the benzo's last.  The reason being is that they can provide a cushion sometimes for subsequent W/D from AD's. 

You are still feeling undecided on eventually tapering your sertraline now, correct?

 

And yes, it could be that your CNS is still working hard, on finding stability/healing-recovery....... post-previous changes in the sertraline.  Brain remodeling

Kind of a reverse W/D??  I don't know though marco, for sure.

 

22 hours ago, marconyc said:

 

I had my first soccer game of the fall season today. But because of the stress intolerance caused by withdrawal, even excitement manifests as anxiety. I had nightmares last night and was nauseous before the game. It was good to play, but I’m upset that something I love, like a soccer game, can cause so much anxiety. 

 

Good on the soccer.  I know what you mean though.  Exercise......do more.....do less......do nothing?

 

L, P, H, and G,

mmt

[marconyc]

@manymoretodays Thanks. My gut tells me that I'm still experiencing withdrawal and that reinstating the sertraline and adding the aripiprazole is only doing so much to get me back to normal. Maybe I would have been better off in the long run not reinstating, I don't know. I do know that I was barely able to function and that I couldn't afford to lose my job. I felt desperate.

 

I don't think I became hypersensitive to the sertraline--it seems more like it's just not working as well since I tapered off. Not sure what you mean by "reverse W/D." I was only asking whether it's possible to be in W/D even after you reinstate because the drugs aren't working as well as they used to. That's what I suspect my situation is right now. 

 

In answer to your question, I don't think I'm interested in tapering off the sertraline, at least not for a while. I'm not at all happy about being on an SSRI, but this experience of withdrawal (or withdrawal/recurrence) has been harrowing, and I just don't know that I can go through it again. I realize that I'm also taking a risk by staying ON the meds, though. What a crappy situation. I do very much want to come off the aripiprazole, and I don't want to have to use the benzos. Speaking of which, my use of clonazepam has been irregular and PRN. I haven't had any for several weeks. At the most, I might take 0.5mg on a particularly stressful day, but in the past 6 months, I haven't used it for more than 3 or 4 days at a time. 

 

Exercise has been essential to me. I run 3-6 miles every other day, and either bike or play soccer or do Bikram on the other days. I don't think I could have made it through this without it.

 

 

[manymoretodays]

Hi again, 

Yes.......Reverse withdrawal= not a very good term. 

And I expect some brain remodeling is going on as well.  Look at it as your brain, well whole CNS trying to achieve stability.  So.....yes, you could say it's along the lines of W/D symptoms.

Perhaps some tolerance as well.

 

If you'd like, you could start an introduction in our Benzo forum as well  Benzo tapering and recovery

I'm wondering how you might do with a small regular dose of the clonazepam right now?  And I think it might be good to get some more input on it.  You came off it once before in 2002 I see.  Then back on it in January 2017.  Your signature is very helpful......thanks.  I'm still learning a lot at this point too, so bear with me.

 

And that's okay as far as your not wanting to rock the boat any further right now.  It's good in fact.  I think it would be tougher to be making too many changes too fast......as far as symptoms go.

So you are on the right track Marco!

 

I hope that is a bit clearer and helps.

 

L, P, H, and G,

mmt

[marconyc]

Thanks so much @manymoretodays. I really appreciate your responsiveness and encouragement. Most people just don't understand what this is like, and talking to people who have been through it is a godsend.

 

I've thought about using the clonazepam a bit more. My long-standing pdoc has told me not to worry about using it, but I recently went for a second opinion, and this other pdoc said he really doesn't like benzos. On the other hand, the first pdoc has encouraged me to try coming off the aripiprazole, whereas the second pdoc is telling me not to worry about that drug. It's so frustrating. 

 

Re your question about more input on the benzos: when I was first diagnosed with depression/anxiety, I was taking 0.5mg of clonazepam 3x/day. I took that for a couple of years and didn't have any trouble coming off of it because the episode of depression had resolved. I attributed my feeling better to the sertraline and talk therapy. When I was walloped with symptoms in early 2017, my pdoc prescribed 0.5mg of clonazepam 2x/day. I took it regularly until I started the aripiprazole and then began using it PRN. I did notice, though, that reducing the clonazepam wasn't easy this time around. In fact, I experienced both an increase in anxiety and even, I think, some depression when I came off it this time. Is that the kind of information you are looking for?

 

Thank you again.

[marconyc]

@manymoretodays As you know, I've been struggling to reduce aripiprazole. I'm on 1mg/day. Sometimes I think I should keep pushing to taper it, and other times I think I should give myself another 6 months at 1mg and then try again. On the one hand, I think it might helpful to just stay at 1mg for a while to see if I get back to baseline. Also, staying at 1mg would make it easier for me to know if changes in my mood are due to stressors or stuff coming up in therapy instead of dose changes. On the other hand, I'm afraid that if I give myself another 6 months or more at 1mg, it's going to be all that much harder to discontinue. In your experience, how much does the length of time someone is on a medication impact whether they can discontinue? If I stay on the aripiprazole at 1mg for another 6 months, am I making it impossible to ever come off of it? My pdoc says no, but I'm not sure how much I trust him on this point.

[manymoretodays]

Hi marco,

 

You are most likely backpacking at this point.

It CAN be frustrating with the pdocs.......they don't seem to understand why some of us do not want the dependencies(and addictive nature of some of these drugs).  Some of them actually really believe that these drugs ARE the answer for all that plagues us on a personal and even societal level.  Ugh.......keep learning marco and empowering yourself.  You are doing great thus far.

22 hours ago, marconyc said:

Re your question about more input on the benzos: when I was first diagnosed with depression/anxiety, I was taking 0.5mg of clonazepam 3x/day. I took that for a couple of years and didn't have any trouble coming off of it because the episode of depression had resolved. I attributed my feeling better to the sertraline and talk therapy. When I was walloped with symptoms in early 2017, my pdoc prescribed 0.5mg of clonazepam 2x/day. I took it regularly until I started the aripiprazole and then began using it PRN. I did notice, though, that reducing the clonazepam wasn't easy this time around. In fact, I experienced both an increase in anxiety and even, I think, some depression when I came off it this time. Is that the kind of information you are looking for?

 

Yes, you are doing a great job giving information.  Thank you.  It's good to keep it organized, when presenting it here......that way other mods and administration can access it more quickly and chime on in when needed.  Sometimes members will also have some great nuggets to share from their own experiences too.  Not to mention the great support and comradeship. 

14 hours ago, marconyc said:

@manymoretodays As you know, I've been struggling to reduce aripiprazole. I'm on 1mg/day. Sometimes I think I should keep pushing to taper it, and other times I think I should give myself another 6 months at 1mg and then try again. On the one hand, I think it might helpful to just stay at 1mg for a while to see if I get back to baseline. Also, staying at 1mg would make it easier for me to know if changes in my mood are due to stressors or stuff coming up in therapy instead of dose changes. On the other hand, I'm afraid that if I give myself another 6 months or more at 1mg, it's going to be all that much harder to discontinue. In your experience, how much does the length of time someone is on a medication impact whether they can discontinue? If I stay on the aripiprazole at 1mg for another 6 months, am I making it impossible to ever come off of it? My pdoc says no, but I'm not sure how much I trust him on this point.

 

I think that a bit of a hold on the ariprazole, until you feel that sense of W/D normal is a good idea.  You may feel ready to taper again sooner than 6 months.

Part of the problem may have been that you tapered too fast. You essentially did a 50% reduction, in less than a months time.

I think that the time that you have been on a medication may have an impact on your W/D, although I don't have a source to quote on this.  The other concern is the side effect or even adverse reaction profiles of some of these medications is not great when used long term.  So......I think that, for you, working on the ariprazole taper is a good idea.  So often, these medications cause more problems long term than they are worth.  Not to mention.......well I'm going to........that they sometimes can make the original condition, that one sought treatment for even more enhanced.

 

Would you do a drug interactions checker for yourself and us, when you get back.  https://www.drugs.com/drug_interactions.php

Include all your drugs and medications.  Then please copy and paste the results here on your introduction. 

 

Meantime, happy trails.  Getting out in nature can be so very helpful in healing.  More on that here:  https://beyondmeds.com/tag/forest-bathing/

Just don't overdo.

 

Love, peace, healing, and growth,

mmt

 

 

Edited September 11, 2018 by manymoretodays
space and comma

[marconyc]

Thank you @manymoretodays. I'm leaving for the trip in a few hours. Here are the drug interactions, per your request.

Interactions between your drugs

Moderate

clonazePAM  sertraline

Applies to: clonazepam, sertraline

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

Switch to professional interaction data

Moderate

clonazePAM  ARIPiprazole

Applies to: clonazepam, aripiprazole

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

Switch to professional interaction data

Moderate

sertraline  ARIPiprazole

Applies to: sertraline, aripiprazole

Sertraline may increase the blood levels of ARIPiprazole. This can increase the risk and/or severity of side effects such as drowsiness, seizure, Parkinson-like symptoms, abnormal muscle movements, and low blood pressure. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. Contact your doctor if you experience agitation, aggression, confusion, convulsions, muscle spasm, or movements that you can't stop or control such as lip smacking, chewing, puckering, frowning or scowling, tongue thrusting, teeth clenching, jaw twitching, blinking, eye rolling, shaking or jerking of arms and legs, tremor, jitteriness, restlessness, pacing, and foot tapping. Also be alert to symptoms of low blood pressure such as dizziness, lightheadedness, fainting, and/or increased pulse or heart rate. Avoid driving or operating hazardous machinery until you know how these medications affect you, and use caution when getting up from a sitting or lying position, especially at the beginning of treatment or after an increase in dose of ARIPiprazole. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

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

[marconyc]

Hi everyone--Just wanted to give an update. I successfully tapered the Abilify from 1mg/day to 0.75 mg/day and held there for a month. For the past 3 weeks I've been taking 0.50 mg/day. I realize that's more than a 10% reduction, but it's difficult to split the pills, and I'd rather not have to create a liquid if possible. Anyway, I was feeling pretty good at 0.50, but the past few days I've been feeling more anxious and depressed again. I think it might be due to the fact that my wife and I are about to do another round of IVF at the end of this week. I usually run 4-5 miles a day to help manage my mood and stress, but I pulled a muscle in my calf and haven't been able to go, and it's so damn cold here in NYC that I'm reluctant to go for a bike ride. (I don't belong to a gym--too expensive.) Anyway, I'm feeling crummy and wish I wasn't going through this. My wife is supportive, but she's freaked out about the IVF, so I don't want to burden her too much. I wish I had someone in my family I could talk to, but my father passed away, my mother is a nervous wreck about everything, and my brother isn't a talker. Thankfully I have a good therapist. Still, this whole experience has been rough: two years of not feeling like myself. I am improving, but it's been painfully slow and I'm still not back to normal even though I'm on a higher dose of Zoloft than I used to be and added Abilify. Wish it were easier.

[Gridley]

It's important not to taper too fast.  This is especially so at the lower doses.  You may want to hold for a while to let your system catch up to the drop from 0.75 to 0.50.

 

If you don't want to make a liquid, you could weigh your dosage with the AWS Gemini-20 scale available on Amazon.

[marconyc]

Thanks, Gridley. It's tempting to rush it at the lower doses. During my Zoloft taper a few years ago, I went really slowly at the higher doses and clearly went too quickly at the lower ones. I went from 150 to 100 without any problems, and even went from 100 to 75 without much trouble, but when I went from 75 to 50, I was hit with a massive wave of symptoms that resulted in reinstatement of the Zoloft at 200mg plus Abilify 1mg and Klonopin PRN. 

[ChessieCat]

Hi marconyc,

 

Many members find that the lower their dose gets the slower they need to go, by reducing less or holding for longer. 

 

Why taper paper: dose-occupancy curves

When to end the taper and jump to zero?

 

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

Edited January 14, 2019 by ChessieCat

[marconyc]

Thank you, ChessieCat. Much appreciated.

[marconyc]

On 1/14/2019 at 1:25 PM, ChessieCat said:

Hi marconyc,

 

Many members find that the lower their dose gets the slower they need to go, by reducing less or holding for longer. 

 

Why taper paper: dose-occupancy curves

When to end the taper and jump to zero?

 

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

 

ChessieCat,

 

These links are really good. Thank you. Two days ago, I reduced the Abilify from 0.50 mg (which I had stayed at for almost 4 weeks) to roughly 0.4. I'm feeling a bit more symptomatic right now, but I think it might be due to the fact that my wife and I are trying another round of IVF tomorrow and not because of the decrease. We have been trying for more than 5 years to start a family. One of the major stressors that contributed to my increase in depression and anxiety at the end of 2016 was a failed IVF. 

 

My immediate goal is to safely taper off of the Abilify. I'm more concerned about that than the Zoloft because of the more serious side effect profile of Abilify. (As for the Klonopin, I haven't taken any in many months.) But if I'm able to discontinue the Abilify, I'm unsure about trying to taper the Zoloft again. I went from 150 to 50mg over the course of about a year and a half, which seemed plenty slow, but the withdrawal was severe, and 2 years later, I'm still recovering, even after the reinstatement! I never want to go through that again. Of course, I would rather be off of Zoloft, in part because I worry about poop-out and increased chronicity. I also realize that the chemical imbalance theory of depression, at least the simplistic form in which it was sold to patients, is bunk. But I worry that because of a combination of genetics and upbringing, I can't survive without these damn drugs. 

[ChessieCat]

One step at a time.  You don't need to worry about the Zoloft for the moment.  And you can always go very slowly when the time comes.  Any reduction in the drug will be beneficial.

[marconyc]

1 minute ago, ChessieCat said:

One step at a time.  You don't need to worry about the Zoloft for the moment.  And you can always go very slowly when the time comes.  Any reduction in the drug will be beneficial.

So you think that even reducing the Zoloft as much as possible is worth it, even if I can't totally come off?

 

By the way, I have such feelings of frustration and anger about what I've been through. I have mixed feelings about my shrink: on the one hand, he helped me in the way he knew how, and the drug did work for a long time. But he never told me that the drug would be a life sentence and that coming off would be hell. He didn't properly advise me on how to taper, nor did he say to me, "Before you consider tapering, please be aware of what you might have to go through, and be aware that if you reinstate, the drug might not work anymore." Maybe I wouldn't have tried to taper. Maybe I would have gone even more slowly. But I would have liked to have been told what I was in for, both when I started the drug and when I decided to taper. It's unconscionable that psychiatrists are so uninformed about this stuff. It's been 2 effing years of not feeling like myself, of being so anxious I dry heaved, of feeling so depressed that I wanted to die, of being woken up from terrifying nightmares, of dizziness and harrowing episodes of depersonalization. I'm improving, but it's been extremely slow going. I hope that other people are spared some of this suffering thanks to sites like SA and the few psychiatrists out there who are sensitive to what their patients are going through. Sorry for the rant, it's just that sometimes I want to smash something. 

[ChessieCat]

29 minutes ago, marconyc said:

So you think that even reducing the Zoloft as much as possible is worth it, even if I can't totally come off?

 

Yes simply because it reduces the drug burden.  I came to SA because I was trying to reduce my dose from 100mg to 50mg because I was suffering from mild serotonin syndrome and I was getting very bad withdrawal symptoms.  After updosing to 75mg I decided that I was going to get to 50mg and see what happened.  I've ended up continuing to taper and I'm now down to 4.75mg.  It's taken me 3 y 3 m to get to this dose and it will take about 2 more years to be off completely.

 

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

What should I expect from my doctor about withdrawal symptoms?

 

33 minutes ago, marconyc said:

have mixed feelings about my shrink

 

This is not unusual.  Unless you want to see him for counselling, you can get a prescription for a regular doctor.

 

34 minutes ago, marconyc said:

But he never told me that the drug would be a life sentence and that coming off would be hell. He didn't properly advise me on how to taper, nor did he say to me, "Before you consider tapering, please be aware of what you might have to go through, and be aware that if you reinstate, the drug might not work anymore." Maybe I wouldn't have tried to taper. Maybe I would have gone even more slowly. But I would have liked to have been told what I was in for, both when I started the drug and when I decided to taper. It's unconscionable that psychiatrists are so uninformed about this stuff.

 

Not many medical professionals understand about tapering and withdrawal.  That is why this site exists.  The doctors get their information from the pharmaceutical companies $$$.  As an example, Pristiq was created just before the Effexor patent came to an end so Pfizer would have a patented drug.  Pristiq is desvenlafaxine, Effexor is venlafaxine which converts to desvenlafaxine.

 

Gwen Olsen was a drug representative for 15 years.  These are eye opening.

 

We are trained to misinform (6 minutes)

 

Manipulating Doctors (10 minutes)

 

Interview:  Confessions of an Rx Drug Pusher (51 minutes Gwen Olsen - ex pharmaceutical representative)

 

 

Two very good books to read are Your Drug May Be Your Problem by Dr Peter Breggin and Anatomy of an Epidemic by Robert Whitaker.

 

 

Kirsch et al went through Freedom of Information to get unpublished clinical trial results.

 

Video:  Irving Kirsch:  Emperor's New Drugs:  Antidepressants and the Placebo Effect (1 hour 20 minutes)

 

Approval Criteria Used by the FDA

 

Antidepressants and the Placebo Effect by Irving Kirsch (link to full article)

Abstract:

Antidepressants are supposed to work by fixing a chemical imbalance, specifically, a lack of serotonin in the brain.  Indeed, their supposed effectiveness is the primary evidence for the chemical imbalance theory.  But analyses of the published data and the unpublished data that were hidden by drug companies reveals that most (if not all) of the benefits are due to the placebo effect.  Some antidepressants increase serotonin levels, some decrease it, and some have no effect at all on serotonin.  Nevertheless, they all show the same therapeutic benefit.  Even the small statistical difference between antidepressants and placebos may be an enhanced placebo effect, due to the fact that most patients and doctors in clinical trials successfully break blind.  The serotonin theory is as close as any theory in the history of science to having been proved wrong.  Instead of curing depression, popular antidepressants may induce a biological vulnerability making people more likely to become depressed in the future.

Excerpt:

How Did These Drugs Get Approved?
....
The FDA requires two adequately conducted clinical trials showing a significant difference between drug and placebo.  But there is a loophole:  there is no limit to the number of trials that can be conducted in search of these two significant trials.  Trials showing negative results simply do not count.  Furthermore, the clinical significance of the findings is not considered.  All that matters is that the results are statistically significant.
....
(NB:  emphasis in abstract and excerpt are mine)

[marconyc]

Thank you, ChessieCat. This is all really helpful information, and it's inspiring to hear that you were only trying to reduce your AD dose but have been able to taper beyond what you first aimed for. 

[marconyc]

Today is one of those days where I feel worried that I'll never be the person I was before withdrawal. I guess I'm in a wave. My main symptoms are depersonalization (DP), hyperawareness of consciousness, and obsessive thoughts about the nature of the self. I get less freaked out by these symptoms than I used to, but they're still really unsettling to me. It's been about 10 days since my last cut from 0.50mg of Abilify per day to 0.40. I haven't had much in the way of withdrawal yet, until today. I'm not even sure what I'm feeling is due to the medication change because my job continues to be such a major source of stress. Sometimes I think environmental stressors are having more effect on me than the medication changes. I have a high-pressure job at a small marketing agency. We're seriously understaffed and the clients are incredibly demanding. Ever since I took over as the head editor 2 years ago, my stress has been through the roof. It just so happened that the job stress coincided with reaching a low level of Zoloft and with another failed round of IVF (my wife and I have been trying for more than 5 years now to start a family) and with my brother being diagnosed with stomach cancer. 

 

Over the weekend I felt some depression and anxiety, but now I'm feeling DP, and it's worse than the depression and anxiety. It's like another layer of suffering on top of the depression and anxiety. In a way, the DP itself isn't as bad as the anxious reaction it causes in me, which is this hyperawareness of consciousness and obsessing over how I think, what the "self" is, etc. I think my brain is trying to protect me from the stress of my life right now. I find that the DP hits after an extended period of sustained stress. I seriously hate my job and my boss but I'm the main breadwinner and I don't think I have the strength right now to start another gig. I'm pissed at myself for starting these meds, and I'm pissed at myself for stopping them, and I'm worried that I'll never feel normal again. 

 

Plus my calf is still torn so I can't run and I don't know if I want to brave the cold and go for a bike ride. 

[marconyc]

Today is my 15th day at 0.4 mg of Abilify. I just got back from a work trip and didn’t experience too much in the way of symptoms, which is good because traveling for work has triggered anxiety and depression symptoms ever since I tapered off Zoloft a few years ago. Another good sign is that the depersonalization I was feeling before the trip went away, probably because it was due to anxiety about traveling. But today I’m feeling crummy again. I think it’s because my wife’s pregnancy test is tomorrow and I know that if it doesn’t work, we are going to let go of trying to start a family. But I also cried really hard just now because my father passed away years ago and even though we had a very difficult relationship, I wish he were here for this. Right before his dementia got bad he told me he hoped I would become a father someday. I’m trying to allow these feelings to express themselves without trying to control them but it’s tough for me.  I think that’s one of the main reasons I’ve struggled with anxiety and depression. 

 

I realize this this is a forum for getting off psych drugs and not a general anxiety or depression support forum but I felt the need to get this stuff off my chest.

[marconyc]

Just found out that the IVF didn't work. My wife and I are devastated. Trying to get through the work day while crying my eyes out in the bathroom. I'm feeling so anxious and depressed right now that I just want to forget about tapering the Abilify. I wish I'd never tried tapering off the Zoloft in the first place. I went from being a happy, optimistic person to having panic attacks and wanting to die. It's been more than 2 years now of trying to recover and I still don't feel back to normal in spite of reinstating at a higher dose than I used to take and adding Abilify. 

[wantrelief]

Hi Marco,

 

I've been meaning to write on your thread for awhile as I relate to your story, specifically tapering ADs and having stress send a taper into a tailspin....I've had this happen more times than I can count, unfortunately, and now am in quite a pickle.  Anyway, I really wanted to reach out now to tell you how very sorry I am that the IVF didn't work.  I can't imagine having to be at work whilst dealing with your emotions around all of this.  My heart goes out to both you and your wife.  

 

[marconyc]

Thank you @wantrelief. I really appreciate it. I'm trying to keep it together but it isn't easy. All I want to do is sleep. I have no appetite. And I have a very stressful job. I am going to try increasing the Abilify from 0.4 back up to 0.5 mg/day and see if that helps. I also just took a very small amount of Klonipin (0.125mg). 

[marconyc]

@ChessieCat My wife and I just found out that another round of IVF didn’t work. I feel really anxious and depressed. All I want to do is sleep. I have no appetite and can’t stop crying. I am thinking of increasing the dose of Abilify. I hate to interrupt the progress I’ve made in reducing from 1mg to 0.4mg, but I need to be able to work. What are your thoughts on increasing? How much would you recommend? Also, what are your thoughts on using a bit of Klonopin?

[Altostrata]

I am sorry about the disappointment over IVF. Dealing with unhappy events is particularly difficult when you're also recovering from adverse drug reactions.

 

If you are sleeping, why do you want to take Klonopin or more Abilify? Either will make you more dopey.

 

If I were you, I would not think of psychiatric drugs as an easy way out of the distressing parts of your life. You're going to get into even more trouble.

 

See

 

The Windows and Waves Pattern of Stabilization

 

Withdrawal dialogues & encouragement

 

Neuro-emotions

 

Non-drug techniques to cope with emotional symptoms

 

Deep emotional pain and crying spells, spontaneous weeping

 

Dealing With Emotional Spirals

Easing your way into meditation for a stressed-out nervous system

[marconyc]

@Altostrata I meditate daily, exercise daily, write in my journal daily, and go to therapy weekly, so I’m trying my best to use nondrug approaches. I’m just having a very hard time functioning right now. It’s hard to get out of bed in the morning, hard to eat, hard to do my job.

 

The Abilify has actually been energizing for me overall. I believe there is a difference in its effect between lower and higher doses, with the higher doses being sedating. I’ve only ever been on 1mg at the most. The reason I’m considering using the Klonopin is that in spite of the sleepiness, I’m getting very anxious at work. I haven’t had any panic attacks, but I’ve felt close a few times.

 

I am feeling a little better today than yesterday, though, so I’ll try to hold out a bit longer. If I didn’t have a high-pressure job, it would be easier to ride out these waves.