marconyc: introduction

[marconyc]

@manymoretodays @Gridley @RichT Hope you're all doing well. I've been at 0.18mgai of aripiprazole since July 24 and I'm feeling WD normal. My wife and I just visited some friends in Portland, OR, and even looked at houses for sale. We're thinking of moving out of NYC once the baby comes. In addition, I interviewed for a job at a different company. My current job/company has been a major source of stress in my life. In fact, I would say that it was the biggest non-drug factor in the onset of this latest episode of depression that coincided with tapering off of sertraline. 

 

So, I believe I'm ready for another cut of the aripiprazole. What do you all think?

 

Thank you.

[manymoretodays]

Yay!  So you've had a couple weeks at WDnormal now.

 

I'm good with it, if you are.  One thought........you might do a less than 10% reduction this time.  What do you think?  I'm just thinking, maybe it would be even smoother that way.

 

I'm so glad things have stabilized and are going well, maronyc.

 

L, P, H, and G,

mmt

[Gridley]

3 hours ago, marconyc said:

 

So, I believe I'm ready for another cut of the aripiprazole. What do you all think?

Since you've been stable at WDnormal and things are looking up on a couple of fronts, it looks good to me for a cut.  I agree with MMT that less than 10% might be advisable now that you're getting so low.

[marconyc]

19 minutes ago, Gridley said:

Since you've been stable at WDnormal and things are looking up on a couple of fronts, it looks good to me for a cut.  I agree with MMT that less than 10% might be advisable now that you're getting so low.

Thank you, @manymoretodays and @Gridley

 

I'll brush off my calculator and try figuring out a cut of less than 10%. More soon.

[marconyc]

47 minutes ago, marconyc said:

Thank you, @manymoretodays and @Gridley

 

I'll brush off my calculator and try figuring out a cut of less than 10%. More soon.

@manymoretodays @Gridley

 

A 10% reduction from my current dose of aripiprazole would be the following:

 

.18mgai x 0.9 = .162mgai

.08 x .9 = .072

 

I could try weighing out .075, but I'm not sure the Gemini is that sensitive. Any suggestions?

[Gridley]

44 minutes ago, marconyc said:

@manymoretodays @Gridley

 

A 10% reduction from my current dose of aripiprazole would be the following:

 

.18mgai x 0.9 = .162mgai

.08 x .9 = .072

 

I could try weighing out .075, but I'm not sure the Gemini is that sensitive. Any suggestions?

 

I haven't gotten that low with my Gemini yet.  Brassmonkey says the scale is accurate to 4mgpw but no lower.  How much in pw is .075 of your ariprazole?

[marconyc]

34 minutes ago, Gridley said:

 

I haven't gotten that low with my Gemini yet.  Brassmonkey says the scale is accurate to 4mgpw but no lower.  How much in pw is .075 of your ariprazole?

.08 x .075 = .006

 

Do you mean I should try reducing by .006, which would bring me to .074mgpw? I can try that.

[Gridley]

29 minutes ago, marconyc said:

 

Do you mean I should try reducing by .006, which would bring me to .074mgpw? I can try that.

 

I am terrible at math and don't want to give you bad advice.  

 

I'm afraid my competence here is limited to telling you to see what, say, 6% of your current dose of 0.18mgai is in pw and if it's above 4mgpw, you can use the scale to make a 6% drop from your current dose.

 

 

[marconyc]

3 minutes ago, Gridley said:

 

I am terrible at math and don't want to give you bad advice.  

 

I'm afraid my competence here is limited to telling you to see what, say, 6% of your current dose of 0.18mgai is in pw and if it's above 4mgpw, you can use the scale to make a 6% drop from your current dose.

 

 

Thanks @Gridley I'll play around with the numbers and see if I can come up with a dose that the Gemini will be able to capture.

[marconyc]

1 minute ago, marconyc said:

Thanks @Gridley I'll play around with the numbers and see if I can come up with a dose that the Gemini will be able to capture.

 

If the Gemini is accurate to 4mgpw, then I suppose the best way to reduce at this point is from .08 to .076mgpw.

[Gridley]

11 minutes ago, marconyc said:

 

If the Gemini is accurate to 4mgpw, then I suppose the best way to reduce at this point is from .08 to .076mgpw.

 

That's a 5% drop, which is fine.

 

However,  I must be missing something but I don't understand how you can measure on the scale such a tiny drop, which is far less than the 4mg pill weight(pw) minimum that the scale can handle.

 

Are the dosages in your signature active ingredient(ai) or pill weight (pw)?  pw (because of the filler) is always much larger than ai, often at a 10:1 ratio.  I'm at 1.7mgai which weighs 18mgpw.  

 

I don't want to confuse you.  What you're doing seems to be working fine in terms of calculating your percentages.  

[marconyc]

1 hour ago, Gridley said:

 

That's a 5% drop, which is fine.

 

However,  I must be missing something but I don't understand how you can measure on the scale such a tiny drop, which is far less than the 4mg pill weight(pw) minimum that the scale can handle.

 

Are the dosages in your signature active ingredient(ai) or pill weight (pw)?  pw (because of the filler) is always much larger than ai, often at a 10:1 ratio.  I'm at 1.7mgai which weighs 18mgpw.  

 

I don't want to confuse you.  What you're doing seems to be working fine in terms of calculating your percentages.  

Yeah, I think you're right, @Gridley

 

I'll do the best I can given the limitations of the scale. I'll try weighing a reduced dose tomorrow or the following day.

[marconyc]

@Gridley @manymoretodays The dosages in my signature are active ingredient: my current dose is 0.18mgai of aripiprazole, which is .08mgpw. It seems like I'm able to measure out .09mgpw, .08mgpw, .07mgpw, etc, but nothing smaller than that. In other words, it doesn't seem like I can measure out .074 mgpw. So I don't know how I can decrease by less than 10% at this point. 

[manymoretodays]

Hmmm.  Yes, tres' difficult.

Can you do the "eyeball method" between the .08 mgpw and .07 mgpw once measured and then fill enough capsules, with a consistent amount marconyc?  For the whole 4-6 weeks ahead.

 

That would give you .075 mgpw by "eyeball method"

Then the active ingredient would be at 0.168 mgai

 

.075 mgpw :  0.168 mgai

 

That would be a 7% decrease from your present 0.18 mgai dose.

 

And I'll cognate/perculate on this a bit more too, as I'm going about my day today.

I'm just going to put a flag here to brassmonkey too,  @brassmonkey ,who is traveling and adventuring again I believe, but may be checking on in from time to time.  Gridley may have some ideas as well.

 

L, P, H, and G,

mmt 
 

[marconyc]

27 minutes ago, manymoretodays said:

Hmmm.  Yes, tres' difficult.

Can you do the "eyeball method" between the .08 mgpw and .07 mgpw once measured and then fill enough capsules, with a consistent amount marconyc?  For the whole 4-6 weeks ahead.

 

That would give you .075 mgpw by "eyeball method"

Then the active ingredient would be at 0.168 mgai

 

.075 mgpw :  0.168 mgai

 

That would be a 7% decrease from your present 0.18 mgai dose.

 

And I'll cognate/perculate on this a bit more too, as I'm going about my day today.

I'm just going to put a flag here to brassmonkey too,  @brassmonkey ,who is traveling and adventuring again I believe, but may be checking on in from time to time.  Gridley may have some ideas as well.

 

L, P, H, and G,

mmt 
 

@manymoretodays The aripiprazole comes in tablets, not capsules, but yes, I can try eyeballing a dose between .08mgpw and .07mgpw. Also, for some doses, the scale will actually toggle back and forth between two measurements for a while before settling on one. If I can find a dose that toggles back and forth between .08 and .07, that might be a good indication that I'm somewhere in between. I think I'll have to accept that from here on out, it's not going to be an exact measurement. 

[marconyc]

@manymoretodays @Gridley Sorry for all the confusion. First of all, the aripiprazole dosages in my signature are active ingredient, not per weight. Second, I must have made a mistake in how I've been writing the dosages per weight. When I started tapering, I did figure out that 2mg of active ingredient of aripiprazole shows as .090 on my scale, which I believe is 90mgpw (I moved the decimal point three places to the right). The dose I am now on shows up on the scale as .008, which should be 8mgpw, NOT .08mgpw, which is how I referred to it above. That's where I think the confusion lies here. 

The scale is able to show decrements of up to 1mg but nothing smaller, so that's why I can use the scale to reduce from 10mgpw to 9mgpw to 8mgpw to 7mgpw but not in between. And Gridley may be right that while I'm able to measure decrements of as little as 1mg, for some reason the scale can only read down to 4mg at the lowest. I don't know why that would be--I would think it should be able to read down to 1mg, but it seems to only be able to go down to 4mg. 

So, as ManyMoreTodays said, I'm going to have to eyeball it from here on out, and may have to stop altogether when I hit 4mg unless I can eyeball dosages lower than that.

[Gridley]

37 minutes ago, marconyc said:

The scale is able to show decrements of up to 1mg but nothing smaller, so that's why I can use the scale to reduce from 10mgpw to 9mgpw to 8mgpw to 7mgpw but not in between. And Gridley may be right that while I'm able to measure decrements of as little as 1mg, for some reason the scale can only read down to 4mg at the lowest. I don't know why that would be--I would think it should be able to read down to 1mg, but it seems to only be able to go down to 4mg. 

 

That is exactly right.  I can go down by decrements of 1mgpw but not in between.  As for the 4mg low-end accuracy, that just the limit of the scale.  After that point Brassmonkey eyeballed it.  The details about how he divided the doses and how long he held between drops are in his signature.

[marconyc]

21 minutes ago, Gridley said:

 

That is exactly right.  I can go down by decrements of 1mgpw but not in between.  As for the 4mg low-end accuracy, that just the limit of the scale.  After that point Brassmonkey eyeballed it.  The details about how he divided the doses and how long he held between drops are in his signature.

Okay, thanks @Gridley

[manymoretodays]

Hi marconyc,

18 hours ago, marconyc said:

Sorry for all the confusion. First of all, the aripiprazole dosages in my signature are active ingredient, not per weight. Second, I must have made a mistake in how I've been writing the dosages per weight. When I started tapering, I did figure out that 2mg of active ingredient of aripiprazole shows as .090 on my scale, which I believe is 90mgpw (I moved the decimal point three places to the right). The dose I am now on shows up on the scale as .008, which should be 8mgpw, NOT .08mgpw, which is how I referred to it above. That's where I think the confusion lies here. 

Thanks, yes, I think we went through this last month too.  Here's what I found:

Here's the post from July 14th, where we clarified a bit.  I looked at your numbers and then following this post, brassmonkey "weighed in" too.

So yes, you will be trying to get somewhere between 8 mgpw and 7 mgpw. 

And yes, the gram readings, on the Gem20, don't allow for anything in between.  You'll see .008 or .007.

 

And hopefully this ^ clarifies and does not confuse further.

L, P, H, G,

mmt

 

[marconyc]

2 minutes ago, manymoretodays said:

Hi marconyc,

Thanks, yes, I think we went through this last month too.  Here's what I found:

Here's the post from July 14th, where we clarified a bit.  I looked at your numbers and then following this post, brassmonkey "weighed in" too.

So yes, you will be trying to get somewhere between 8 mgpw and 7 mgpw. 

And yes, the gram readings, on the Gem20, don't allow for anything in between.  You'll see .008 or .007.

 

And hopefully this ^ clarifies and does not confuse further.

L, P, H, G,

mmt

 

Thanks, @manymoretodays, much appreciated! I think I'm clear now on how to move forward with the tapering, including what to do once I get down to 4mg. 

[manymoretodays]

You're more than welcome marconyc.  And keep me updated on the baby too.  I am so excited for you and yours!

[marconyc]

3 hours ago, manymoretodays said:

You're more than welcome marconyc.  And keep me updated on the baby too.  I am so excited for you and yours!

Thanks @manymoretodays! So far, so good. My wife is in her 23rd week and really starting to show. It's getting real!

[marconyc]

Hi @manymoretodays It's been about 3 weeks at .16mgai (7mgpw) of aripiprazole. Everything was going well until Thurs, when my wife and I went to our OB for a bunch of routine pregnancy tests. Her blood pressure was  high so they had to do a full workup. The test results were all normal, and my wife and the baby are fine. But I started to feel a substantial uptick in my anxiety ever since then. It's been pretty rough the past few days. I'm still eating okay--maybe a little decrease in appetite--and sleeping decently, although I have trouble falling asleep. But I feel almost paralyzed with fear. It's like I want to curl up and not do anything. I'm getting through the work day but it's tough. I still managed to do all the things I normally do on the weekend, like visit my Mom and Aunt, go to the beach, have dinner with my wife, walk the dogs, play soccer...but underneath it, I could feel surges of anxiety. Today the anxiety is coming out in tears. I'm crying quite a bit (thankfully I work from home). I'm trying to reach out to friends for support. Even my Mom, who often isn't supportive, has been helpful today. 

 

Today is one of those days where part of me says, "Why don't you increase the aripiprazole?" I don't really want to. I just had a checkup and my blood sugar and cholesterol were a little high. I don't think it's due to the aripiprazole--I don't really watch what I eat because I exercise a lot--but still, aripiprazole can cause metabolic problems. It's just that this anxiety is intense right now. I'm not having panic attacks, but I feel like I could possibly have one. 

Edited September 9, 2019 by marconyc

[marconyc]

@manymoretodays @Gridley @RichT I'm feeling really crummy the past several days. Very intense anxiety but also depression. I'm finding it hard to get out of bed, I'm crying, I don't have much of an appetite, and I'm super tense. I think I'm feeling overwhelmed about the baby now that my wife is entering her third trimester. I'm also having trouble sleeping. I feel like I want to increase my aripiprazole, but I'm trying to resist. I need to function, though. 

[Gridley]

9 minutes ago, marconyc said:

I feel like I want to increase my aripiprazole, but I'm trying to resist

 

Feeling overwhelmed about the baby coming is certainly a natural reaction for someone in WD, and it is a definite stressor, which would account for your ramped withdrawal symptoms.

 

It's natural to look for relief, and It's up to you whether you increase. But if you can I would hold where you are.  You've gotten down so low and that's a real accomplishment, plus there no guarantee an updose would help.

 

My advice would be suspend the taper and to hold where you are until after the baby comes and things calm down a bit.  A three-month hold could really help.

[manymoretodays]

Hey marconyc,

I'm counting 20 days since your taper now. 

And you are mentioning the intense anxiety and also feeling really low at times.

Yes, you need to function......I know.  With any updose, and with your aripriprazole especially, you would probably not get any quick relief.

So let's see, are you keeping up with that therapist of yours?  Able to get some, any exercise in?  You might consider something less intense than usual even.

You are pregnant too marconyc, for all purposes, yet without the hormonal shifts that your wife is experiencing.  Take this into account.

And yes, agree with Gridley.  Very much so.  This is one of those major life stressors now.

 

Are you open to new non-drug coping, perhaps working on something more than what you already have in place?  I'll give you some linkages if you'd like.  To some good stuff.  Oh crying, oh bother.......I still have some tears that come, from time to time too.  And getting on out of bed.  I can relate.  I have a little routine of just wiggling my toesies and directing my thoughts towards that..."oh wow, I have toes, and working feet and legs, and body".  Then I usually go to some gratitude.  For everything I can think of.  Takes me out of the big old dread zone, start to my day.  Then out of bed.  One foot in front of the other.  And voila......it passes most days by noon.  That morning dread, ugh stuff.  It does.  It's not static either, not for me.  I think the season changing and all, kind of affects a lot of people, and me, oftentimes.

Take a day too, just one, if you need too marconyc.  To care for yourself really well.  I mean even give yourself a hug and all.

 

The metabolic syndrome.  It's a whole cluster of changes, when it occurs.  And again, as RichT said........you are on, and getting on even lower dosages.......and I don't think you need to worry about this a whole lot now.  Have you put on weight during the pregnancy?    Solly......had to ask.

 

Oh (((((marconyc)))))  Sending calming, big old oak tree vibes now.

 

Best,

L, P, H, and G,

mmt

 

Edited September 10, 2019 by manymoretodays
minor grammar, additional

[marconyc]

5 minutes ago, manymoretodays said:

Hey marconyc,

I'm counting 20 days since your taper now. 

And you are mentioning the intense anxiety and also feeling really low at times.

Yes, you need to function......I know.  With any updose, and with your aripriprazole especially, you would probably not get any quick relief.

So let's see, are you keeping up with that therapist of yours?  Able to get some, any exercise in?  You might consider something less intense than usual even.

You are pregnant too marconyc, for all purposes, yet without the hormonal shifts that your wife is experiencing.  Take this into account.

And yes, agree with Gridley.  Very much so.  This is one of those major life stressors now.

 

Are you open to new non-drug coping, perhaps working on something more than what you already have in place?  I'll give you some linkages if you'd like.  To some good stuff.  Oh crying, oh bother.......I still have some tears that come, from time to time too.  And getting on out of bed.  I can relate.  I have a little routine of just wiggling my toesies and directing my thoughts towards that..."oh wow, I have toes, and working feet and legs, and body".  Then I usually go to some gratitude.  For everything I can think of.  Takes me out of the big old dread zone, start to my day.  Then out of bed.  One foot in front of the other.  And voila......it passes most days by noon.  That morning dread, ugh stuff.  It does.  It's not static either, not for me.  I think the season changing and all kind of affects a lot of people and me, oftentimes.

Take a day too, just one, if you need too marconyc.  To care for yourself really well.  I mean even give yourself a hug and all.

 

The metabolic syndrome.  It's a whole cluster of changes, when it occurs.  And again, as RichT said........you are on, and getting on even lower dosages.......and I don't think you need to worry about this a whole lot now.  Have you put on weight during the pregnancy?    Solly......had to ask.

 

Oh (((((marconyc)))))  Sending calming, big old oak tree vibes now.

 

Best,

L, P, H, and G,

mmt

 

Thank you @Gridley and @manymoretodays I really appreciate it. I'm keeping up with therapy. My therapist is wonderful and uses an approach called internal family systems. I am able to do some of the work at home, which I've been trying to do. 

 

I have gained some weight during the pregnancy, yes. About 8 pounds. And I haven't been watching what I eat. Hopefully that's the reason for the increase in blood sugar and cholesterol. This has happened to me in the past, long before I was on aripiprazole, and everything went back to normal once I stopped eating too many burritos and ice cream. 

 

I'm keeping up with exercise, but I haven't been doing any meditation. I used to go almost every morning to a local Zen center for a 7am meditation before work. I could try to restart that. I think it would also help if I start reading a book I bought for expectant fathers. It might make me feel less anxious if I have some sense of what to expect.

 

It's so hard to believe that I'm still in withdrawal. Well, I realize that I'm tapering off of the aripiprazole, but sometimes I think I'm still dealing with withdrawal from my attempt at tapering the sertraline. It feels like the sertraline just doesn't work as well as it used to ever since withdrawal kicked in back in 2017. It's hard to tell, though, because I've had so many life stressors these past few years: big promotion at work and intense pressure to perform in an understaffed environment, my brother's stomach cancer, all the failed attempts at IVF, and now the baby about to come, which will necessitate my wife and I moving, maybe away from family and friends in order to afford raising a child. My wife isn't going to work, so I'll be the sole breadwinner. 

 

For now, I'll try my best to hold where I am, which is .16mgai (7mgpw) of aripiprazole. 

 

 

[Gridley]

14 minutes ago, marconyc said:

7am meditation before work. I could try to restart that. I think it would also help if I start reading a book I bought for expectant fathers.

Those are two excellent ideas.

[RichT]

Hi Marconyc,

 

sorry to hear you're having a difficult time. It’s natural to feel stressed under your current circumstances, I know I would. I think holding at your current dose and putting tapering aside for now sounds like a wise idea.

 

Have you thought of finding a support group for expectant fathers? I bet that sharing your experience with others going through the same thing could help you. 

 

Warmest wishes,

 

Rich

[marconyc]

8 minutes ago, RichT said:

Hi Marconyc,

 

sorry to hear you're having a difficult time. It’s natural to feel stressed under your current circumstances, I know I would. I think holding at your current dose and putting tapering aside for now sounds like a wise idea.

 

Have you thought of finding a support group for expectant fathers? I bet that sharing your experience with others going through the same thing could help you. 

 

Warmest wishes,

 

Rich

Hey, thanks @RichT. I hadn't thought of that, but it might be a good idea. Much appreciated.

[marconyc]

I'm feeling a little bit better today: a little less anxious, fewer crying jags, a little more able to concentrate on my work, appetite a little better. 

 

One of the most difficult symptoms for me during these periods of intense stress or withdrawal is what I call "hyperawareness of consciousness." I start to think about how it is that I'm able to think, speak, function, etc. I used to think what I was experiencing was simply depersonalization, but now I think the dissociation/depersonalization is only a part--and maybe a relatively small part--of my distress. It's the internal reaction in the form of this hyperawareness and the attendant obsessions that seems most difficult. All of it, I believe, is driven by emotions/sensations that I am trying to repress: fear, exhaustion, feeling overwhelmed, anger, etc. Grief, interestingly, is one of the emotions I'm actually able to feel and not repress, so I find that when I'm overwhelmed emotionally, thinking of my father (who passed away several years ago) allows me to cry and release some of the tension in my nervous system. 

 

I wish this was easier. It's been a long, difficult road ever since withdrawal kicked in at the start of 2017. I often wish I'd never tried to taper. I wish my psychiatrist had warned me of the dangers and given me better instructions for how to do it safely. But maybe I would have gone through this anyway, given all of the stressors in my life hitting me at the same time. I'd been on sertraline for a long time, so maybe it was pooping out. Anyway, sometimes I become terrified that I'll never feel like I did before withdrawal started, that I'll never feel as at ease in my skin. It makes me want to cry and scream.

[marconyc]

Just wanted to check in, as it's been a month since I last posted. I'm down to 5mgpw of aripiprazole. I held at 6mpgpw for a while and was feeling WD normal, so I reduced to 5mgpw yesterday. I've considered holding until my wife gives birth, which several of you suggested, but I'm so close (4mgpw will be my jumping off point). Maybe I'm being impatient. I'll see how I feel and will hold if I'm not doing well.

 

As I said, I've been feeling pretty good, although as the due date approaches (Dec 18), I am also feeling increased anxiety. Work has been busy as usual. I just got back from a 5-day business trip and it's taken me several days to recover. I'm still feeling kind of off--tired and emotional--but hopefully being able to rest this weekend will help.

 

I hope everyone is healing.

[Gridley]

6 minutes ago, marconyc said:

I've considered holding until my wife gives birth, which several of you suggested, but I'm so close (4mgpw will be my jumping off point).

 

Just another vote for holding off until your wife gives birth.  

 

4mgpw is how many mgai?

[marconyc]

5 minutes ago, Gridley said:

 

Just another vote for holding off until your wife gives birth.  

 

4mgpw is how many mgai?

Well, 7mgpw was .16mgai, so 6mgpw is probably about .14mgai, 5mgpw about .12mgai, and 4mgpw about .10mgai. Those are just estimates though. I'll have to do the calculations.

[marconyc]

27 minutes ago, Gridley said:

 

Just another vote for holding off until your wife gives birth.  

 

4mgpw is how many mgai?

 

I'll most likely hold until after the baby comes. Thank you for the advice. It's tempting to try to just finish the taper, and it seems like such a small amount of drug, but I trust the advice I've received here.

[Gridley]

19 minutes ago, marconyc said:

4mgpw about .10mgai. T

 

Good idea to wait.

 

You might consider going a little lower, into the .00's, like .01 if possible.  I know it's difficult working with those tiny amounts.  Just to take no chances.