☼ LilBit: polypharmacy nightmare

[LilBit]

Okay, I am a newbie to posting online and have spent the last 2 months searching Google since this happened to me, so please bear with me if this seems a bit long.  I just want to get my story out there so people can see what has happened to me and offer any possible advice.  

 

In October 2017, My GP put me on Lamictal for mood and 22.5mg Restoril for sleep. I have been on Restoril since 11/2016 roughly. At the time I had a diagnosis of BP2.  My pdoc at the time 2 weeks later switched me from Lamictal to Lithium by tapering the Lamictal from 150 mg to 100mg then 50mg every three days, he felt it would be more effective.    I went up to a dose of 1200mg of Lithium but it made me sick so we moved down to 900mg, which seemed to be effective.  He added Latuda 40mg but it made me irritable, so he switched that to 5mg Abilify in 12/2017, no taper from the Latuda.  That combo seemed to work for a while but then I felt emotionally blunted and numb, so my pdoc then lowered the dose to 2.5mg.  I felt better so I then (stupidly) quit CT the Abilify in May of this year.  At the same time he also tapered me off of Lithium which I was scheduled to stop taking on 6/27 due to constant diarrhea.  He then prescribed me Klonopin for anxiety.  I started feeling too high from it and was feeling depressed, so about a week and a half later was put on Lexapro. The Lexapro made me feel extremely sleepy and out of it, took from 6/18/28-6/21/18, stopped taking.  Pdoc then switched me to Effexor XR 37.5mg on 6/22/18, felt extremely depressed and anxious, did not take Klonopin or Valium.

 

 

I had little to not appetite and was not very talkative.  6/25-6/28/18 Felt much lest depressed, better than I had in the past month, taking Klonopin as needed for anxiety.  Stopped the Effexor today and the Lithium.  Started Paxil 10mg the same day.  At this point still taking 22.5mg Restoril.  I noticed since I started the Lexapro and stopped, I had been getting 3-4 hours sleep and started to feel thirsty.  When I started Paxil on 6/29, it was at night and I woke up several times and had stomach cramps.  Still had a stomach ache the next morning and felt depressed.  Depression and brain fog got worse over next few days, the dose was increased to 20mg after 5 days. I would wake up with sweats in the middle of the night so on 7/4 at the advice of my pdoc covering on-call doc I stopped the Paxil because I became suicidal.  At this point as of 7/8 all I was on was on Restoril for sleep.  I noticed tinnitus and felt extremely anxious and regular stress almost gave me a panic attack.  At this point I was having the following symptoms:  Tinnitus, anxiety, depression, insomnia, feeling thirsty and dehydrated, heart palpitations, brain fog, stress intolerance. Restoril seemed to have no effect now.  Pdoc prescribed me Ativan for anxiety and I told him I want to taper off of Restoril since not working any more.  He advised me to taper by taking 22.5mg 3 days, then 15mg 4 days, 7.5mg 3 days, then stop.  He also prescribed Mirtazapine 7.5mg for sleep.  I noticed the Ativan raised my heart rate.  On 7/16, as I started to doze off I got a brain zap.

 

Ever since this day I never get sleepy and have TOTAL insomnia, can never fall asleep on my own without some kind of medication.  Noticed increased palpitations and severe dehydration.  Hands and feet sweating.  On 7/18 I had a tingling sensation in my brain and then blurred vision in my right eye.  I also noticed a weird smell of some kind of chemical or paint on 7/19.  On 7/21 they advised me to switch from Trazodone to Mirtazapine 7.5mg for sleep again and also take Lunesta 3mg if needed (prescribed by a sleep specialist).  Still not getting sleep.  Now at this point I notice blurred vision and loss of appetite.  On 7/24 my pdoc wanted to put me on Zyprexa for sleep but I refused.  He prescribed Lorazepam to take as needed for anxiety.  On 7/25 high blood pressure, then after then went back down to normal.  At this point I feel like I am dying.    My sleep specialist tells me to try cognitive behavioral therapy. (Yeah right, Been there, done that!)

 

 7/27-7/30 I had been taking Lunesta for sleep and Ativan for anxiety (pdoc switched again because Lorazepam was not working), but sleep doc said long taper not needed to get off Ativan, withdrawals are psychological and not physical nothing will happen to me if I do not sleep and I don’t have to worry about withdrawals.  7/31  had muscle jerks when going to bed.  Lunesta stopped working so GP said try Hydroxyzine and then Trazadone again if Hydroxyzine doesn't work.  Of course this did not work, so my pdoc put me on Ambien CR 6.25mg and 1500mg Depakote as a mood stabilizer.  I tried this for a few days and still had trouble sleeping, getting 2-3 hours.  GP Prescribed Seroquel for sleep.  Took 8/16-8/17, 50mg and 25mg respectively, and did not sleep for more than 1-2 hours.  Now I am seeing a NEW pdoc, she has me tapering off of the 50mg Seroquel, taking 10mg Doxepin at night, 5-15mg Melatonin as needed, I am still on the 1500mg Depakote. I have totally gotten off of then Ativan by tapering using diazepam.  Each day I feel like I am worse than the day before.

 

I am trying to figure out where I go from here.... stay on the current dose of Seroquel and try to reinstate the drug that may have caused the HORRIBLE withdrawals and total insomnia I am experiencing now (either Abilify or Paxil), or follow my new pdoc advice and taper the Seroquel and see how it goes (whilst adding the doxepin and Melatonin, breaking the keep it simple rule)?   I am desperate and totally sleep deprived and getting worse by the day, which is why at this point I think she is just trying to get me to sleep.  I even have an EEG next week to check for problems there.   Thanks for reading.

 

Kevie

 

Edited December 16, 2021 by ChessieCat
Resized font

[ChessieCat]

Hi Kevie and welcome to SA,

 

Thank you for completing your drug signature.  Please add start dates, years and doses where you haven't included them. 

 

Also, please use Drug Interactions Checker and enter all the drugs you are currently taking (include ones you take as needed) and copy and paste the results in a post here in your Intro topic.

 

Your Intro topic is the place where you can ask questions about your own situation and journal your progress.

[LilBit]

Thanks for your reply ChessieCat, I pasted my drug interaction results below.

 

Interactions between your drugs

Moderate

doxepin  divalproex sodium

Applies to: doxepin, Depakote ER (divalproex sodium)

Before using doxepin, tell your doctor if you also use divalproex sodium. This combination may cause uneven heartbeats, extreme drowsiness, dizziness, confusion, blurred vision, and seizures. If you take both medications together, tell your doctor if you have any of these symptoms. You may need a dose adjustment or special tests if you take both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

doxepin  QUEtiapine

Applies to: doxepin, quetiapine

Using QUEtiapine together with doxepin can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening, although it is a rare side effect. You may be more susceptible if you have a heart condition called congenital long QT syndrome, other cardiac diseases, conduction abnormalities, or electrolyte disturbances (for example, magnesium or potassium loss due to severe or prolonged diarrhea or vomiting). Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or heart palpitations during treatment with these medications, whether together or alone. Avoid driving or operating hazardous machinery until you know how the medications affect you. 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

divalproex sodium  QUEtiapine

Applies to: Depakote ER (divalproex sodium), quetiapine

Using divalproex sodium together with QUEtiapine 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

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.

 

 

Edited September 1, 2018 by ChessieCat

[LilBit]

I should probably also mention that my new pdoc is thinking I should get off the Depakote since I am trying to reduce meds but that would be later since we don't want to make too many changes at once.   I have been so distraught over this, crying spells everyday and literally not getting much sleep, so very exhausted, but luckily I have a very supportive partner which helps.

[SkyBlue]

 

On 8/27/2018 at 2:59 AM, LilBit said:

my new pdoc is thinking I should get off the Depakote since I am trying to reduce meds but that would be later since we don't want to make too many changes at once. 

 

Hi Kev,

 

Yes, it is important not to make too many changes at once. When changing only one drug, it is easier to determine what's causing what.

 

It's a little hard to understand what you are currently taking, (you've really been through a lot).

Can you please clarify what you are currently taking, and what your most pressing questions are? There is a lot of information here, and I don't want this to get missed. 

 

As far as tapering, people tend to do best when reducing very, very slowly--at a rate of no more than 10% of current dose per month: https://www.survivingantidepressants.org/topic/1024-why-taper-by-10-of-my-dosage/

 

 

As someone who has also been suicidal because of Paxil, my heart goes out to you. You have really been through the wringer and through the drug merry-go-round. I'm glad you have a supportive partner. I'm glad you are here.

 

Edited September 1, 2018 by ChessieCat

[LilBit]

SkyBlue thanks for the reply...  I am currently on 1500mg Depakote which I take in the morning,  43.75mg Quetiapine which I take in the evenings.  My new pdoc just added 10mg doxepin in the evening and 5mg Melatonin in the evening.  5mg was too much so I am trying .3mg tonight.   I updated my signature with the current meds. 

 

I am scared because I am experiencing horrible tinnitus, depression, anxiety, crying spells, brain fog, among other things, but worst of all, total insomnia which has caused me to have to take short term disability from work.  I can't even function normally.  I was prescribed the Quetiapine by my GP before I saw the new pdoc.  I guess my pressing issue is getting out of this HORRIBLE withdrawal.  I have no idea which med withdrawal caused it, since I changed from Abilify to Lexpro to Effexor to Paxil and now I am afraid that my CNS is over sensitized and badly damaged.   Do I play Russian Roulette and try reinstating one of the previous meds and stay on Seroquel which I don't even need, or take forever to taper off of the Quetiapine and lose my chance of reinstatement and possibly never recover from the withdrawal syndrome?  I hate that I am even in this situation like many others.   

 

I am glad I am here too and having a great support system helps too, I just wish I would have found this site sooner because I never would have taken the damned drugs in the first place. 

 

[SkyBlue]

 

On 8/27/2018 at 10:06 AM, LilBit said:

 I updated my signature with the current meds. 

 

I am scared because I am experiencing horrible tinnitus, depression, anxiety, crying spells, brain fog, among other things, but worst of all, total insomnia which has caused me to have to take short term disability from work.  I can't even function normally.  I was prescribed the Quetiapine by my GP before I saw the new pdoc.  I guess my pressing issue is getting out of this HORRIBLE withdrawal.  I have no idea which med withdrawal caused it, since I changed from Abilify to Lexpro to Effexor to Paxil and now I am afraid that my CNS is over sensitized and badly damaged.   Do I play Russian Roulette and try reinstating one of the previous meds and stay on Seroquel which I don't even need, or take forever to taper off of the Quetiapine and lose my chance of reinstatement and possibly never recover from the withdrawal syndrome?  I hate that I am even in this situation like many others.   

 

I am glad I am here too and having a great support system helps too, I just wish I would have found this site sooner because I never would have taken the damned drugs in the first place. 

 

Thanks for the info. I've consulted with the other moderators, and either they or I will get back to you regarding next steps. I'm honestly not even sure where to start, since, as you said, your system is likely very over-sensitized. Please try to rest as much as possible. 

 

Edited September 1, 2018 by ChessieCat

[Altostrata]

Welcome, Kev.

 

I need this information: What times of day do you take each drug, and their dosages? Also indicate when you started that particular drug. Use a simple list format with time of day on the left and notation (drug and dosage) on the right.

 

Thanks.

 

[Carmie]

Hi Kev, 

 

I’m so glad you found this site too. It really is so helpful to be able to support one another. I’m sorry you have been put on so many meds n your crying spells are totally understandable. If everyone on this site put their tears into a lake I’m sure it would be full. 

 

Please give Alto the information she needs to help you. I know you’re very scared right now and everything is confusing, especially as you’re on different meds n have changed meds etc. 

 

Even if you don’t feel stable now please know you will eventually stabilise again. Make that your focus. Just try n distract yourself throughout the day. 

 

The moderators will help you to get some clarity as to what to do next, 

 

Wishing you all the best Kev n sending hugs🤗

 

 

 

[LilBit]

Alto here is the info you are looking for:

 

9:30am                  1500mg Depakote (started 8/2)

9:30pm                  43.75mg Quetiapine  (started at 50mg 8/15, tapered down to 43.75 on 8/25)

9:30pm                  10mg Doxepin (started 8/24)

9:30pm                  .3mg Melatonin (started 8/26)

 

Thank you everyone for your help and support. 🤗 Trying to stay positive since I was relatively fine and normal functioning before all of this and now not so much so.  My pdoc simply thinks I am depressed with anxiety and that I was misdiagnosed from the beginning.

[Altostrata]

Why are you taking quetiapine, doxepin, and melatonin at the same time? How are you sleeping since you started doxepin?

 

What does the Depakote do for you? Why did you quite diazepam when you did?

 

Was doxepin added to substitute for diazepam?

 

What does your current psychiatrist think of this mix of drugs?

[LilBit]

Alto,

 

I am taking Quetiapine, Doxepin, and melatonin at the same time because the new pdoc wants to replace the quetiapine with doxepin and melatonin.  She actually wants me to replace the 50mg quetiapine by decreasing to 25mg for a week, 12.5mg for a week and then stopping (which is in insane and of course i am not doing even though quetiapine wasn't helping much with sleep, I have reduced to 43.75mg instead).  Since starting the doxepin I seem to be sleeping a little better but hard to gauge because there are always so many changes.

 

Depakote seems to do nothing for me except make me lose my appetite, that was prescribed by the first pdoc, I would like to be off of it actually.  I quit diazepam because it was a substitute for the ativan i was taking and used to taper off of because I was becoming physically dependent on the ativan.

 

Doxepin was added by the new pdoc to help sleep, nothing to do with the diazepam.

 

Current psych seems to think this mix of drugs is ok.  

 

 

I know this is all so confusing so imagine how I feel!  My goal is just to get off of all meds, it amazes me how reckless doctors are with them.  Today and yesterday I feel very drowsy and tired, but still cannot sleep (I tried a nap as a "test").  Trying to stay positive. 

[LilBit]

I think I have have put a little too much info in my original post but I wanted to make sure I didn't miss anything. 😕  The short version is I was given a mood stabilizer and an antipsychotic and diagnosed as BP2 long time ago, when it may have just been the Restoril I was on for sleep making me feel depressed as benzos do, combined with depression and anxiety that I had.  The AP and eventually mood stabilizer were stopped  (with various anti-anxiety meds in between) and replaced with ADs, all started and stopped abruptly, and now I am left with an over-sensitized nervous system and withdrawals from hell including total insomnia.

 

Oh quick question, do you think that 43.75mg from 50mg on the Quetiapine was too much of a drop?  I know that is 12.5% but I don't have a scale to do an exact 10% reduction.  I also only have 100mg and 25mg tablets.  Suggestions on type of scale to get?

[LilBit]

14 hours ago, Carmie said:

 

 

Wishing you all the best Kev n sending hugs🤗

 

 

 

Thank you so much! 

[LilBit]

Another thing that scares me is that I just realized that I think I tapered the Diazepam too fast.   😢  I am keeping a daily journal of all of my symptoms.  I think if I can beat the insomnia I can at least return to work and then focus on healing myself and tapering off of the rest of the drugs.

[Lilabella]

Hi kevie,

I'm new to this as well, and well aware of the insomnia that Quetiapine causes. I hope you are finding some relief somewhere. 

It's not an easy drug to withdraw from. Please stay safe with your doses and I pray for you that you get some sleep. 

Lilabella

[Altostrata]

It's unlikely you have BPII or any variety of bipolar. You've probably had a series of adverse drug reactions. Even psychiatrists understand adverse drug reactions, tapering, and withdrawal very poorly.

 

 

On 8/28/2018 at 4:40 AM, LilBit said:

Alto,

 

I am taking Quetiapine, Doxepin, and melatonin at the same time because the new pdoc wants to replace the quetiapine with doxepin and melatonin.  She actually wants me to replace the 50mg quetiapine by decreasing to 25mg for a week, 12.5mg for a week and then stopping (which is in insane and of course i am not doing even though quetiapine wasn't helping much with sleep, I have reduced to 43.75mg instead).  Since starting the doxepin I seem to be sleeping a little better but hard to gauge because there are always so many changes.

 

Depakote seems to do nothing for me except make me lose my appetite, that was prescribed by the first pdoc, I would like to be off of it actually.  I quit diazepam because it was a substitute for the ativan i was taking and used to taper off of because I was becoming physically dependent on the ativan.

 

Doxepin was added by the new pdoc to help sleep, nothing to do with the diazepam.

 

Current psych seems to think this mix of drugs is ok.  

 

 

I know this is all so confusing so imagine how I feel!  My goal is just to get off of all meds, it amazes me how reckless doctors are with them.  Today and yesterday I feel very drowsy and tired, but still cannot sleep (I tried a nap as a "test").  Trying to stay positive. 

 

This mix of drugs is not okay, you can see the potential interactions yourself.

 

Your doctors are practicing kitchensinkism. You are complaining of not being able to sleep and they are prescribing every drug they can think of for sleep. This is nonsensical.

 

Psychiatric drugs fall roughly into two categories: Accelerators and brakes. Quetiapine, doxepin, and Depakote are all brakes. The problem with taking a bunch of brakes at once is that the nervous system feels smothered and fights back. That paradoxical reaction is what is keeping you from sleeping.

 

Going on and off psychiatric drugs very frequently causes sleeplessness, particularly going off diazepam too fast . It also causes the nervous system to become hypersensitive to all kinds of psychoactive drugs and sometimes supplements and foods, too. Regular doses of something like quetiapine can be too much and cause a paradoxical reaction; adding drugs to it makes the problem even worse.

 

The anxiety is a very, very common withdrawal symptom, or it could be a paradoxical reaction to all the brakes you're taking.

 

If I were you, I'd stop taking doxepin immediately -- more drugs only confuse the issue -- and cut the quetiapine to 25mg. Since you've been taking it only a couple of weeks, a fast taper off probably will be okay.

 

This is a slightly tricky maneuver, you may feel some upset for a few days. Please keep daily notes on paper about your symptoms, when you take your drugs, and their dosages. Use a simple list format with time of day on the left and notation (symptom, drug and dosage) on the right.

 

My guess is you need to reinstate a bit of diazepam, I'll ask @Shep to weigh in on this.

 

In my non-medical humble opinion, once you cut down the quetiapine and get some diazepam on board, the Depakote, another stupid "brake" idea, has to go.

 

The idea is to minimize drugs to a few gentle crutches so your poor nervous system can normalize.

 

PS Suggest you complain to your state medical board about your earlier psychiatrists misusing drugs in dangerous combinations.

 

Edited September 1, 2018 by ChessieCat

[LilBit]

Thanks for your advice Alto.  Yes this is complete nonsense and is getting way out of hand!  Your response leads me to some questions, and I am sorry that I have so many but I feel like I am actually getting somewhere now:

 

1.    Ok to go from 43.75mg Quetiapine to 25mg and taper from there?  Just want to be sure.

2.    I will stop doxepin immediately.   Is it diazepam that needs to be reinstated (remember I was on Restoril when withdrawals started), or one of the other drugs that started my horrible withdrawals in the first place on 7/8/18?  I stopped Abilify, Effexor, Lexapro and Paxil right before withdrawals started to happen so it is so hard to tell which drug caused them.

3.    When should I stop the Depakote?  Now or after I have tapered off of the Quetiapine?  If now, do I need to taper?

4.    Should I still try the Melatonin?

 

Again sorry for so many questions, I am just scared, have always been an anxious person so this is really getting to me and making me emotional.  I just want the old me back. 

[Altostrata]

 

On 8/29/2018 at 4:18 AM, LilBit said:

1.    Ok to go from 43.75mg Quetiapine to 25mg and taper from there?  Just want to be sure.

2.    I will stop doxepin immediately.   Is it diazepam that needs to be reinstated (remember I was on Restoril when withdrawals started), or one of the other drugs that started my horrible withdrawals in the first place on 7/8/18?  I stopped Abilify, Effexor, Lexapro and Paxil right before withdrawals started to happen so it is so hard to tell which drug caused them.

3.    When should I stop the Depakote?  Now or after I have tapered off of the Quetiapine?  If now, do I need to taper?

 

One step at a time. I would drop the doxepin and reduce the quetiapine to 25mg. We'll have to see what happens over a couple of weeks to assess next steps. Hopefully, a reduction in "brakes" will allow you to sleep. Sleep is healing.

 

If sleep improves, reducing Depakote will be next, to get it out of the way before you're on it for too long.

 

You were on diazepam long enough to become physiologically dependent on it (but maybe not). Adding a little may enable you to go off quetiapine altogether. However, it could be a little quetiapine, much less than 25mg, is enough of a crutch. It's better to work with what you're taking rather than adding or switching drugs. We need to know what quetiapine reduction does for you before going to diazepam.

 

I agree, Restoril or Lamictal or something probably was your initial problem, but we are far downriver of that now. The goal is 1) sleep; 2) reducing waves of anxiety.

 

Edited September 1, 2018 by ChessieCat

[LilBit]

Thank you for such a fast response.      I will go off of the doxepin and reduce the quetiapine to 25mg.   So just to be clear, no chance of helping this by reinstating any of the drugs that may have caused the withdrawal?  I have been off of Abilify for almost 3 months and the ADs for about a month and a half.  I used diazepam to taper off of benzos since they were no longer working after withdrawals started.  The symptoms I am currently experiencing (total insomnia, tinnitus, anxiety, crying spells, lack of motivation, affect on cognitive skills, brain fog, loss of appetite/nausea) are becoming unbearable.  I am doing my best and realize everyone is different and there are no shortcuts to recovery and that I have to accept that this may go on for months or years.  Thanks for all of your help, it means a lot.

[Altostrata]

It's impossible to unwind where the withdrawal symptoms started. You've probably compounded your nervous system uproar with adverse reactions to the many drugs you've tried.

 

Your symptoms are typical of psychiatric drug withdrawal syndrome, which is nervous system instability regardless of the drug. Stay calm, a lot of people here have been in a similar state and gotten through it.

 

Read

 

What is withdrawal syndrome?
 
The Windows and Waves Pattern of Stabilization

 

Diazepam is a benzo. It could be that ultimately this will settle your nervous system, but I would avoid another drug switch if possible. Besides, it's addictive and tricky to reinstate.

[LilBit]

Thank you Alto.  It just makes me sad that it took such a short period of time for me to get to this point, and now I could be looking at months, years of suffering or more.  My heart goes out to everyone who has gone through or is currently going through this hell and shouldn't have to, because of the lack of knowledge of proper psychotropic drug tapering.

[LilBit]

One more thing... is there any other suggestion you would recommend to help with sleep at this stage?  Should we just see if the changes we make do anything?  Before all of this started I was dependent on Restoril for sleep and that was working, but I understand now that sleep doesn't come in a bottle and drugs do not replace good sleep hygiene.  I have been practicing good sleep hygiene and doing CBT for insomnia over the past couple of weeks, but still seriously sleep deprived. I am just afraid that removing the doxepin and lowering the quetiapine is not going to help my sleep as I have total insomnia (never get sleepy) at this point.  Thanks 

[Gridley]

Have you tried magnesium?  It is calming to the nervous system and might help with sleep.  It's one of the few supplements SA recommends, along with omega fish oil.

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

Please research all supplements first and only add in one at a time and at a low dose in case you do experience problems.  Magnesium glycinate is one of the better forms of magnesium.

 

Another possibility to help with sleep is Melatonin.  Start with a very low dose, perhaps .5 mg.  

 

 

 

[Altostrata]

Excellent suggestions, Gridley.

 

Kev, I think you may be pleasantly surprised. You said there was slight improvement the last time you decreased quetiapine, but you started doxepin at the same time so you attributed it to doxepin. It could have been the reduction of quetiapine, which is more effective as a soporific at lower dosages.

[ChessieCat]

SA sleep topics:

Sleep problems - that awful withdrawal insomnia

 

Sleep Hypnosis, Guided Meditations, Calming Videos

[Shep]

 

On 8/28/2018 at 5:06 AM, LilBit said:

The short version is I was given a mood stabilizer and an antipsychotic and diagnosed as BP2 long time ago, when it may have just been the Restoril I was on for sleep making me feel depressed as benzos do, combined with depression and anxiety that I had. 

 

Kevie, when you say you were diagnosed as BP2 a "long time ago", when was that?

 

From your signature, your first psychiatric drug was Temazepam on 11/2016. Did you take anything prior to this? 

 

 

On 8/29/2018 at 4:04 AM, Altostrata said:

My guess is you need to reinstate a bit of diazepam, I'll ask @Shep to weigh in on this.

 

I'm parsing through the benzo use:

 

         Restoril  - dates???

        Temazepam 11/2016-11/7/2017

         Temazepam 11/21/17 - 7/20/18

         Klonopin        5/21 - 7/2/18

         Eszopiclone 7/21-7/30/18

         Lorazepam  7/25 - 7/20/18

         Ambien  8/3/18-8/10/18

         Diazepam   7/6/18 - 8/24/18

      

Part of your insomnia is likely benzo withdrawal. So what Alto suggests regarding the diazepam reinstatement makes sense. 

 

Your diazepam taper was, per your signature, "20mg daily - 7/6/18-7/10/18 PRN, tapered off from 8/1 to 8/24/18" which is a very rapid taper, especially after nearly 2 years of fairly constant benzo use.

 

You're making other drug changes right now:   

 

On 8/29/2018 at 4:55 AM, LilBit said:

I will go off of the doxepin and reduce the quetiapine to 25mg.   

 

 Let's see how you do with this change over the next couple of days. 

 

If the reduction of these drugs doesn't help, than I would go ahead and reinstate the diazepam. Please let us know more about how you tapered the diazapem, including:

• What was your diazepam taper rate from 8/1 to 8/24/2018?
• What was your last dose of diazepam before you stopped?

The answers to these questions will help us figure out the best reinstatement dose to recommend for you. 

 

I don't see Restoril listed in your signature. Please list this, along with the dates you took it. A direct link to your signature is here:

 

Account - Settings - Signature

 

As you report how you're doing over the next couple of days with the doxepin and quetiapine changes, we can better help you sort out if reinstating the diazepam is the next step to take. Benzo reinstatements are best done within 2 - 4 weeks, so you are well within that window of time. 

 

Please let us know how it goes. 

 

 

Edited September 1, 2018 by ChessieCat

[DMV64]

 

On 8/29/2018 at 6:10 AM, LilBit said:

Thank you Alto.  It just makes me sad that it took such a short period of time for me to get to this point, and now I could be looking at months, years of suffering or more.  My heart goes out to everyone who has gone through or is currently going through this hell and shouldn't have to, because of the lack of knowledge of proper psychotropic drug tapering.

 

I feel the same way. Although it took me some time to get to where I am, I am upset with the lack of knowledge and how I wound up here! Feel I should have known better.

 

Edited September 1, 2018 by ChessieCat

[LilBit]

Shep,

 

Thanks for all of your input.... I’m going try my best to answer all of your questions.   Everyone here has been such a huge help. I was diagnosed with BP2 in 7/2017 and actually was started on Lamictal then.  I updated my signature to reflect this.  I was switched from Lamictal to Lithium in 10/2017.  I don’t have the exact taper rate of the diazepam with me at the moment but will be sure to post it later.  I was on .25mg when I jumped off.  According to my pdoc there was “more than that in the dust on the kitchen counter” so it should have been safe to stop.  Temazepam is the generic for Restoril if that helps.

 

Last night I took .6mg of Melatonin about an hour before bedtime and 25mg Quetiapine about 30 minutes before bedtime which for me is usually 10pm.  I did not take the doxepin. I got maybe a couple of hours of broken up sleep with night sweats and feeling thirsty so I’m pretty tired today.  I sure hope tonight goes better.   Please let me know if there is any other info you need.   Thanks

 

 

[Shep]

 

On 8/30/2018 at 12:23 AM, LilBit said:

I don’t have the exact taper rate of the diazepam with me at the moment but will be sure to post it later.  I was on .25mg when I jumped off.  According to my pdoc there was “more than that in the dust on the kitchen counter” so it should have been safe to stop.

 

Thank you for additional information. Yes, .25 mg is a safe jump off point for diazepam, but tapering from 20 mg to 0 in only three weeks likely led to a bit of a crash landing. I wish your pdoc had been more informed in guiding you off this drug (and all of the other many, many changes). 

 

Sadly, most doctors don't understand these drugs. 

 

On 8/30/2018 at 12:23 AM, LilBit said:

Temazepam is the generic for Restoril if that helps.

 

I apologize for not catching that, Kevie. That does indeed help. 

 

Please keep posting your updates daily and over the course of the next few days, if you aren't sleeping better with the changes you're already making, we can discuss a reinstatement of the diazepam. 

 

Edited September 1, 2018 by ChessieCat

[Altostrata]

Hi, Kev. Hang in there, you've had a lot of drug changes recently. It may take a while for your nervous system to settle down.

 

Do you often get night sweats?

 

Your GP diagnosed you with bipolar II? What were your symptoms, before you took drugs?

[LilBit]

Thanks Alto.  It’s so hard when one day you are a normally functioning member of society and then BAM.... rug totaly pulled out from underneath.  But you know all about that as so many others here.

 

I don’t normally get night sweats.  My GP suggested it and a therapist at the time “confirmed” the diagnosis.  I was mainly depressed but I would have windows of happiness, and they saw it as rapid cycling BP2.

 

What scares me is that I was already an insomniac BEFORE this happened (hence being on the Restoril) so now the sleeplessness is really making daily life difficult.  Thanks to all of you who have weighed in with your feedback and who are trying to help me.

[Altostrata]

 

On 8/30/2018 at 4:50 AM, LilBit said:

 

I was mainly depressed but I would have windows of happiness, and they saw it as rapid cycling BP2.

 

I would take this with more than one grain of salt.

 

Yes, we know how bad the sleeplessness can be. But it's because your nervous system is riled up from the drug changes. Try to stay as calm as possible, you'll get through this.

 

Have you made your bedroom very dark, turned off the lights and stopped using electronic devices after 9 p.m.? Darkness triggers your natural production of melatonin, the sleep hormone. It's important to get that back into rhythm.

 

Edited September 1, 2018 by ChessieCat

[LilBit]

6 minutes ago, Altostrata said:

Have you made your bedroom very dark, turned off the lights and stopped using electronic devices after 9 p.m.? Darkness triggers your natural production of melatonin, the sleep hormone. It's important to get that back into rhythm.

 

Yes I have the blackout curtains on both windows (there are only 2 in my little loft apartment), I turn the temp down on the AC, turn down the lights and stop using computer/phone at that time as well.  

 

I can say this... like I mentioned in my extremely lengthy intro, the day before the sleeplessness occurred, I can pinpoint the exact day because that night as I was falling asleep, I got a brain zap and the next day it seemed like shivers of tingling/waves over my body whenever I got “sleepy”.  Then it was like the sleep “switch” was off.  Has anyone else here experienced that?

[Altostrata]

I would say that sleeplessness is probably the most common withdrawal symptom people deal with here.

[Shep]

 

On 8/26/2018 at 2:21 PM, LilBit said:

On 7/16, as I started to doze off I got a brain zap.

 

Ever since this day I never get sleepy and have TOTAL insomnia, can never fall asleep on my own without some kind of medication. 

 

Kevie, was this experience like the one described in this link? 

 

Exploding head syndrome or SSRI withdrawal?

 

I had quite a number of "exploding head syndrome" experiences - severe brain zaps - and it really rattled me to the core. Sometimes knowing that these experiences are felt by a lot of us going through this can normalize it and give you a bit of piece of mind. 

 

As Alto wisely stated, sleeplessness is a very, very common symptom for most people on this forum, but it does get better. 

 

Edited September 1, 2018 by ChessieCat