☼ LilBit: polypharmacy nightmare

[Martina23]

4 minutes ago, LilBit said:

 

CRAP.  After looking back at my notes for that time I just realized I got the dates wrong on my Temazepam taper.  It should have actually been 7/13-7/19/18,  I have corrected this in my signature.  I am sorry.  I am very certain that the total insomnia started after I abruptly discontinued the Lexapro/Effexor/Paxil or when I was taking them, as the total insomnia was the reason I wanted to stop the Restoril, because it had no effect on me anymore.  I do remember that I started the process of stopping it a few days after I started not being able to sleep.

 

9/5

 

11:00am  1500mg Depakote 

5:30pm   diarrhea/stomach upset

9:30pm   25mg Quetiapine 

9:30pm   25mg magnesium glycinate 

10:00pm  2mg diazepam

 

I took the diazepam and did not sleep last night.  Tossed and turned and got up a few times.   Of all my symptoms, the complete inability to get sleepy/fall asleep is really starting to scare me because each day I feel slightly worse or more tired, and I can see that it is really affecting my health.

Such a nice dog in avatar.

[LilBit]

The best way I can describe how I fell is like I am stuck between not being able to fall asleep and not being able to stay awake. It’s a truly terrible feeling, like I am being tortured to stay awake.

[LilBit]

I just left my pdoc appointment and this is the plan she came up with for me:

 

1x500mg depakote in AM and 2 in PM

Start using a light box in the AM

25mg seroquel for 2 more weeks and then go down to 12.5mg

1mg Klonopin at bedtime for sleep

10mg doxepin at bedtime for sleep

 

I am not sure why the change with the time of taking the depakote.  Also, still way   too fast I think on the Quetiapine taper.  I am desperate for sleep at this point (starting to feel sick) so can anyone weigh in on what the safest route at this point would be?  Obviously I want to be on as few meds as possible but the diazepam did not seem to do anything for me.   I cringed at the thought of taking Klonopin.

[Altostrata]

44 minutes ago, LilBit said:

I just left my pdoc appointment and this is the plan she came up with for me:

 

1x500mg depakote in AM and 2 in PM

Start using a light box in the AM

25mg seroquel for 2 more weeks and then go down to 12.5mg

1mg Klonopin at bedtime for sleep

10mg doxepin at bedtime for sleep

 

I am not sure why the change with the time of taking the depakote.  Also, still way   too fast I think on the Quetiapine taper.  I am desperate for sleep at this point (starting to feel sick) so can anyone weigh in on what the safest route at this point would be?  Obviously I want to be on as few meds as possible but the diazepam did not seem to do anything for me.   I cringed at the thought of taking Klonopin.

 

Is this the same doctor who has prescribed you 2 dozen drugs in less than a year? How effective has her track record been?

 

She wants to add 1mg Klonopin AND 10mg doxepin AT THE SAME TIME? Does this make sense to you?

 

Her plan is somewhat of a departure from our suggestions. You have a choice whether to try your doctor's plan or not. Please let us know how you're doing.

[LilBit]

No Alto this is the new pdoc, I actually like her so far.  No it didn’t make sense and when I asked her about it, she said the we can always reassess if it doesn’t seem to be helping. I don’t like the idea of taking both, I don’t like the idea of adding the doxepin in or reinstating the benzos with klonopin.  What would you recommend?  I feel like I am approaching a dangerous stage of the sleep deprivation at this point and don’t feel too well.

[SkyBlue]

16 hours ago, Shep said:

 

On 9/5/2018 at 6:11 PM, LilBit said:

I think I am gonna try the diazepam tonight.

 

Please let us know how you do. 

 

Some information on reinstatements: 

About reinstating and stabilizing to reduce withdrawal symptoms 

Notes on Benzo Reinstatement from the Benzo Support site

 

As mentioned, the diazepam may not have covered the withdrawal from stopping the other benzos, so what dose to reinstate is going to be tricky. Please keep up with your drug and symptoms journal, as your symptoms will be your best guide. 

 

LB, did you end up reinstating diazepam last night?

 

You asked what we would recommend—Shep recommended reinstating 2 mg diazepam. As you stated, your doctor has recommended something quite different. 

Like Alto said, you have a decision to make regarding which recommendations to take. We really can't help you decide between this site's recommendations and your doctor's. We can share information and ideas, but it's really your decision. 

 

Whatever you decide, please do let us know, and keep on tracking your dosages and symptoms. 

[Shep]

17 hours ago, LilBit said:

CRAP.  After looking back at my notes for that time I just realized I got the dates wrong on my Temazepam taper.  It should have actually been 7/13-7/19/18,  I have corrected this in my signature.  I am sorry.  I am very certain that the total insomnia started after I abruptly discontinued the Lexapro/Effexor/Paxil or when I was taking them, as the total insomnia was the reason I wanted to stop the Restoril, because it had no effect on me anymore.  I do remember that I started the process of stopping it a few days after I started not being able to sleep.

 

 

LilBit, thanks for clarifying things. This really stood out. Here is the timeline for your Lexapro/Effexor/Paxil use:

 

6/28-7/4/18 Paroxetine 

6/22-6/28/18 Effexor    

6/14-6/16/18 Lexapro

 

You were only on these drugs for a total of 15 days, so you weren't on any of these drugs long enough to have withdrawal from them, but it could well have been an adverse reaction. Alto mentioned this when you first landed on the forum, but from your earlier date listed for the Temazepam taper, we were more focused on the benzo. 

 

 

On 8/26/2018 at 12:21 AM, LilBit said:

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.

 

The above really sounds like an adverse reaction. 

 

Also, this is your lithium use:

 

11/2017-6/27/18 Lithium 

 

Lithium can be a very difficult drug to come off of and although you're now on depakote, which is also used as a so-called "mood stabilizer", it may not be covering the lithium withdrawal.

 

I think it's less about the benzo not working and more about the lead up to that 7/8 date of total insomnia which involved adverse reactions to three very potent antidepressants and before that, coming off lithium. 

 

Question - How did you taper off the lithium? 

 

17 hours ago, LilBit said:

I took the diazepam and did not sleep last night.  Tossed and turned and got up a few times.   Of all my symptoms, the complete inability to get sleepy/fall asleep is really starting to scare me because each day I feel slightly worse or more tired, and I can see that it is really affecting my health.

 

Please take a read of the reinstatement thread. I posted it earlier, but will post it again. 

 

About reinstating and stabilizing to reduce withdrawal symptoms 

 

It takes 4 days for your nervous system to register a reinstatement and it can take a number of weeks to stabilize. That thread will give you more information. 

 

An adverse reaction to an antidepressant can take awhile to sort out, as well as the effects of discontinuing the lithium. The best advice is to not add in more drugs. 

 

Your doctor wants you to take 1 mg Klonopin, but keep in mind that Klonopin is 20 times more potent than diazepam. You can see the equivalencies rates for all of your benzos and z-drugs here - Benzo Equivalency Table.

 

10 hours ago, LilBit said:

No Alto this is the new pdoc, I actually like her so far.

 

Please don't confuse someone who is nice with someone who is competent. For more on how doctor's think, please see:

 

What should I expect from my doctor about withdrawal symptoms?

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

 

You may want to check around to see if you can find a doctor who is competent. Here are some resources:

 

Mad in America - Provider Directory

 

Recommended doctors, therapists, and clinics

 

You may want to post on the Check In thread for members living in Texas and see if anyone has a recommended doctor near you:

 

Texas members, please check in here 

 

If you can't find a prescribing doctor but you find a therapist who is on one of these lists, you may want to give them a call and see if they recommend any prescribing doctors in your area. It would definitely be worth a few phone calls. 

 

It may take awhile to get through the adverse reaction, as well as deal with the fall out from the many other starts and stops from the other drugs. This is a thread written by moderator Brassmonkey that gives a good description of the adverse reaction experience:

 

Are We There Yet? How Long Is Withdrawal Going to Take? - Part 6-But I only took it for a Week  (Adverse Reactions)

 

I know the insomnia is rough, but you will survive this phase of withdrawal. Try to do as much self-care as you can and work on finding some non-drug coping skills to get you through.

 

Non-drug techniques to cope with emotional symptoms

 

Please let us know how you're feeling over the coming days and how the diazepam reinstatement is going. 

 

 

Edited September 7, 2018 by Shep
fixed link

[Shep]

On 8/28/2018 at 2:18 PM, LilBit said:

I stopped Abilify, Effexor, Lexapro and Paxil right before withdrawals started to happen so it is so hard to tell which drug caused them.

 

On 8/26/2018 at 12:21 AM, LilBit said:

  He added Latuda 40mg but it made me irritable, so he switched that to 5mg Abilify in 12/2017, no taper from the Latuda. 

 

I just noticed these on the first page of your intro.

 

Please add the Abilify and Latuda to your signature, along with the dates you took them. Please note that abrupt discontinuation of antipsychotics can also cause severe insomnia. 

 

But in time, you will go back to sleeping normally. 

[Altostrata]

Shep talks good sense.

 

18 hours ago, LilBit said:

No Alto this is the new pdoc, I actually like her so far.  No it didn’t make sense and when I asked her about it, she said the we can always reassess if it doesn’t seem to be helping. I don’t like the idea of taking both, I don’t like the idea of adding the doxepin in or reinstating the benzos with klonopin.  What would you recommend?  I feel like I am approaching a dangerous stage of the sleep deprivation at this point and don’t feel too well.

 

Kev, never ever change two psychiatric drugs at once. The best doctors know this.

 

If you add doxepin and diazepam at the same time and you get a bad reaction, you won't know which drug caused it. Which one do your reduce or quit?

 

If you add doxepin and diazepam at the same time and you do start sleeping, you won't know which drug is responsible. Then you're stuck on two drugs because you don't want to upset your sleep, correct? Your polypharmacy is like a magic charm -- which may be what your pdoc is counting on, the psychological comfort of knowing you're going after your symptoms with the kitchen sink.

 

If you add doxepin and diazepam at the same time, there's the problem of overkill, because diazepam alone should be sufficient. Why would you want to take two drugs that do the same thing?

 

If you add doxepin and diazepam at the same time, and your nervous system is already sensitized by your extensive record of adverse reactions, what could go wrong?

 

Kitchensinkism is a big, big problem in psychiatry. I hope you get the opportunity to educate your pdoc that you don't want to try more than one drug at a time, and at an extremel low dose.

[LilBit]

10 hours ago, Shep said:

 

Please add the Abilify and Latuda to your signature

 

I updated my signature with the Latuda, the Abilify is Aripiprazole (generic).  Thanks!

[LilBit]

Alto I completely agree with you.  Unfortunately it seems that she is so concerned with getting me to sleep that I guess she is not taking any of these things into consideration. She prescribed the doxepin first 2 weeks ago (which I did not take except for last night) and now wanting to add Klonopin (which i have not taken).  I am definitely going to look into Shep’s suggestions and check out the resources in the links provided.  What I am scared of, is that my total insomnia may actually be a result of an adverse reaction (and perhaps maybe not even withdrawal) which I know is rare and may not be likely but is not entirely impossible.  In addition I am going through withdrawals as well which are not making it any better.  The adverse reaction part is what scares me, because if neurotoxicity is involved from the combination of all of the meds I was on and this was the initial cause of the insomnia, then I have no idea what to do.  I don’t possibly see how I can survive on 4 more days (or more) of zero hours of sleep.  I already feel twice as bad as I did yesterday, with no sign of things getting better.

 

Shep,

 

Thank you for all of the information and the suggestions.  I am going to see if I can somehow get another script for diazepam so I can reinstate with confidence.  The Lithium “taper” was basically from 6/14-6/27 I moved down from 900mg to 600mg, then he had me stop it.  I really, really wish I would have found this site before all of this and had been better informed.  I also wish I would have known better, but we all know what they say about hindsight.

 

I want to think positive and have a good attitue so I can cope and get through this, but I am seriously concerned that something has happened to me that may not be able to be treated.  Last night, it seemed like every time I would drift off my body would jerk and I would wake and I was not sleepy, almost like my body is rejecting the sleep.  I don’t get sleepy anymore, and when I was sleeping it was for no more than 30 minutes to 2 hours at a time.  Also this morning when I was in bed and awake, parts of my body would slightly jerk.  This is new since all happened.

 

Again thanks for trying to help me and I will do my best to work with you to help you do that.

[LilBit]

9/6

 

I took 2mg of diazepam last night and did not sleep.  I spent most of the time either tossing and turning or getting out of bed.

 

12:30pm   akathisia/restlessness

9:20pm     Stomachache

9:30pm     25mg Quetiapine, 25mg magnesium glycinate, 1g Depakote

10:00pm   10mg doxepin

[Shep]

14 hours ago, LilBit said:

Shep,

 

Thank you for all of the information and the suggestions.  I am going to see if I can somehow get another script for diazepam so I can reinstate with confidence.  The Lithium “taper” was basically from 6/14-6/27 I moved down from 900mg to 600mg, then he had me stop it.  I really, really wish I would have found this site before all of this and had been better informed.  I also wish I would have known better, but we all know what they say about hindsight.

 

 

You're welcome, LilBit.

 

That lithium taper was very rapid, so you're no doubt still feeling that blow to the system. However, with all of the other changes in this cascade of polypharmacy, I would be hesitant to do anything more about the lithium than give yourself time to heal. 

 

14 hours ago, LilBit said:

I want to think positive and have a good attitue so I can cope and get through this, but I am seriously concerned that something has happened to me that may not be able to be treated.  Last night, it seemed like every time I would drift off my body would jerk and I would wake and I was not sleepy, almost like my body is rejecting the sleep.  I don’t get sleepy anymore, and when I was sleeping it was for no more than 30 minutes to 2 hours at a time.  Also this morning when I was in bed and awake, parts of my body would slightly jerk.  This is new since all happened.

 

Please don't beat yourself up over this. The vast majority of people, myself included, don't find this forum until we've already been injured by these drugs. We are doubly injured, not only by the drugs but also, we have been harmed by the ignorance of doctors, our supposed "healers". 

 

But the damage will fix itself in time. So please do keep a positive attitude, as this plays into neuroplasticity and will set yourself up for a better journey off these drugs. 

Psychiatric drugs damage sleep architecture. The jerking, especially while trying to sleep, is very, very common.

 

Hypnic jerks when falling asleep

 

 

14 hours ago, LilBit said:

9/6

 

I took 2mg of diazepam last night and did not sleep.  I spent most of the time either tossing and turning or getting out of bed.

 

12:30pm   akathisia/restlessness

9:20pm     Stomachache

9:30pm     25mg Quetiapine, 25mg magnesium glycinate, 1g Depakote

10:00pm   10mg doxepin

 

I'm very confused here. 

 

• Please add to your journal the time that you took the diazepam
• Did you change the dose of the depakote from 1,500 mg to 1 g or did you take part of your daily depakote earlier in the day? 
• Did you change the timing of the depakote from morning to night? 
• Did you add in doxepin and diazepam both in the same night? 

 

If your recent drug journal is correct, you are taking a massive amount of sedating drugs at night. This can cause a paradoxical reaction - the more you sedate the nervous system, the more it fights back to stay alert, which is the paradoxical reaction. 

 

Let's please discuss any more changes and the timing before you make any more adjustments. 

 

It may help to read a bit about how these drugs effect us and why it's so important to tread lightly, making only one change at a time. This thread is about antidepressants and serotonin receptors, but it could just as easily be about benzos and GABA receptors or antipsychotics and dopamine receptors: 

 

How psychiatric drugs remodel your brain

 

And this is a good post about how benzos affect us.

 

What is happening in your brain?

 

It may also help to read over some of the "tips for tapering off" threads about the various drugs you've been on:

 

Important topics in the Tapering forum and FAQ

 

If you scroll down to the "TAPERING OFF SPECIFIC PSYCHIATRIC DRUGS" section, you'll find a wealth of information for probably every drug you took over the past couple of years. Might be worth reading over so you really get a vibe for what you're dealing with and how to move forward. 

 

But again, let's please discuss any more changes and the timing before you make any more adjustments. 

[LilBit]

Thank you Shep, I will take a look at the information in the links you provided.  I have decided that I am not going to take the doxepin, and I have not been able to reinstate the diazepam because my psychiatrist does not want to give me a script for the 2mg.  I am afraid to start with the ones I have because I am not sure what I would do if I could not get another script for them.  She sent a 5mg script to the pharmacy, 10 tablets, to see if they will help me “sleep”.  She seems so focused on that so she is missing the big picture.  I am not sure what to tell her at this point.

 

As for the Depakote, the daily dose is the same, it was just the timing that was changed.  She has me taking 1 tablet in the morning and two at night.

 

Last night I was able to “fall asleep”, but the problem is I would get to the light stage of sleep where I was dreaming and it seemed every time my body wanted to get to the deep sleep I would wake up, so I was waking every 30 minutes or so.  The lack of sleep is really cathing up with me.  Thanks again for all of your help and I will definitely let you know before any changes are made.

[LilBit]

9/7

 

11:00am 500mg Depakote

 9:30pm  25mg quetiapine, 25mg magnesium glycinate, 1000mg Depakote 

[Shep]

When you're making note of your drug journal, please also add in your symptoms.

 

This is a great format to use. It will help to see your symptoms within the context of when you take your drugs and can be a great guide to navigating through your tapers. 

 

On 9/27/2016 at 2:49 PM, Altostrata said:

What we need to see for every individual day over several days is:

- Time and dosage for drugs taken in morning
- Time and description of any symptoms in the morning
 
- Time and dosage for drugs taken in afternoon
- Time and description of any symptoms in the afternoon
 
- Time and dosage for drugs taken in evening
- Time and description of any symptoms in the evening
 
- Time and dosage for drugs taken in middle of the night
- Time and description of any symptoms in the middle of the night (such as waking)
 
And so forth. A diary, in chronological order, such as:
 
6 a.m. Woke and vomited
8 a.m. Took 2.5mg Lexapro
10 a.m. Had diarrhea
10:30 a.m. Ate breakfast
11:35 a.m. Got a headache, lasted one hour
12:35 p.m. Ate lunch
4 p.m. Stomachache
5 p.m. Took 2.5mg Lexapro
6 p.m. Ate dinner
9:20 p.m. Headache
10:00 p.m. Took 50mg Seroquel
10:20 p.m. Headache got worse
10:30 p.m. Fell asleep
2:30 a.m. Woke, took 3mg Ambien (NOT "took 1/2 tablet Ambien")
2:45 a.m. Fell asleep
4:30 a.m. Woke with headache

 

An appointments diary is perfect for this and can be bought at stationery stores. 

They have a page for each day with times for appointments which can be filled in with doses, symptoms etc as shown by Alto.

 

[Altostrata]

2 hours ago, LilBit said:

I have decided that I am not going to take the doxepin, and I have not been able to reinstate the diazepam because my psychiatrist does not want to give me a script for the 2mg.

 

Why will she not give you a script for 2mg? Do you have 2mg tablets on hand?

 

If you'ved moved the timing of Depakote dosing, plus added 2 drugs at night, you have made more than one drug change at a time, and we don't know what is causing you not to sleep. You've introduced what's called confounding variables.

 

As Shep said -- and I believe we've extensively discussed before -- if you take a combination of "brakes" at once, the effect can be paradoxical.

 

We really can't interpret your drug and symptoms journal until you stop changing your drugs constantly. We can't help you at all if you change more than one drug at a time, except to remind you not to do this.

 

Your new pdoc seems to be inclined to maximal kitchensinkism. You might look around for a doctor who will work with you on minimizing drugs. Any doctor, even a GP, can prescribe these drugs, it doesn't have to be a psychiatrist.

[LilBit]

Thank you Shep—this is the format I have been using I think.  I just haven’t had any symptoms like that for the past couple of days, at least that I have noticed.  Mine are more the type that last all day or all the time, like brain fog, blurry vision, and tinnitus.  I will make sure to note anything I notice in my journal.

 

Alto thanks for the feedback and I apologize if I am complicating things. Hard to think straight lately.  I am not adding any more drugs as I will NOT be adding doxepin or Klonopin.  Only change is time of the Depakote.  She insisted on 5mg instead of 2mg—and a limited quantity at that—because like every other doctor I have seen she is just throwing pills at me to get me to sleep.  I will definitely be looking for another pdoc and discussing this with my GP.

[Shep]

17 minutes ago, LilBit said:

Thank you Shep—this is the format I have been using I think.  I just haven’t had any symptoms like that for the past couple of days, at least that I have noticed.  Mine are more the type that last all day or all the time, like brain fog, blurry vision, and tinnitus.  I will make sure to note anything I notice in my journal.

 

 

Does the Depakote make you sleepy? 

 

17 minutes ago, LilBit said:

She insisted on 5mg instead of 2mg—and a limited quantity at that—because like every other doctor I have seen she is just throwing pills at me to get me to sleep.

 

You could try reinstating at 1/2 a pill for 2.5 mg. This may buy you some time as you find a new doctor. 

Edited September 8, 2018 by Shep
added information

[Altostrata]

Even a quarter of a 5mg tablet might be sufficient.

 

LilBit, what exactly is your drug schedule now? This is meaningless without the symptom notes as well, which we've asked for numerous times:

 

4 hours ago, LilBit said:

9/7

 

11:00am 500mg Depakote

 9:30pm  25mg quetiapine, 25mg magnesium glycinate, 1000mg Depakote 

 

What we know about the Depakote is that it was upsetting your stomach -- a common side effect.

 

Did it upset your stomach when you took 500mg at 11:00 a.m.? Did you feel any effect? Did you get drowsy after taking it?

 

Did it upset your stomach when you took 1000mg at 9:30 p.m. last night? Did that combination of Seroquel and Depakote make you drowsy?

 

What time did you take the diazepam that was prescribed? What happened to the prescription for 2mg diazepam that you took on 9/6? Did you ever get a prescription for Klonopin from this new doctor?

 

Have you ever noticed Depakote having any beneficial effect? If so, what was it?

 

The lack of important information we've asked for many times is getting frustrating. If you don't care to answer our questions, perhaps face-to-face interaction with a doctor is the best route for you.

[LilBit]

2 hours ago, Shep said:

 

Does the Depakote make you sleepy? 

 

 

You could try reinstating at 1/2 a pill for 2.5 mg. This may buy you some time as you find a new doctor. 

 

The Depakote does not make me sleepy.  I will try this.  Thank you Shep.

[LilBit]

2 hours ago, Altostrata said:

Even a quarter of a 5mg tablet might be sufficient.

 

LilBit, what exactly is your drug schedule now? It is the one you quoted.  

 

Did it upset your stomach when you took 500mg at 11:00 a.m.? No   Did you feel any effect? No    Did you get drowsy after taking it?   No

 

Did it upset your stomach when you took 1000mg at 9:30 p.m. last night? No   Did that combination of Seroquel and Depakote make you drowsy?  No

 

What time did you take the diazepam that was prescribed?  Have not taken it yet, was waiting for Shep’s response regarding reinstatement.   What happened to the prescription for 2mg diazepam that you took on 9/6? I did not take diazepam on 9/6.  I Took it on 9/5 but then realized I should consult with Shep before continuing due to my limited supply.   

 

Did you ever get a prescription for Klonopin from this new doctor?  Yes but not taking it.

 

Have you ever noticed Depakote having any beneficial effect? If so, what was it?  No, I have not.

 

The lack of important information we've asked for many times is getting frustrating. If you don't care to answer our questions, perhaps face-to-face interaction with a doctor is the best route for you.

Alto please see above for answers to your questions.  again I apologize as my intention is to provide whatever information you need to assist me.   I am just having a very difficult time at the moment because this is not typical insomnia where people “can’t fall asleep” or “can’t stay asleep”.... This is a total inability to sleep, I don’t get sleepy, my body is begging me to sleep but my brain won’t allow it.  It is extremely debilitating and I am even having difficulty typing this post, I had to redo it several times due to errors.  I am now noticing alarming symptoms such as chest irritation and pain in various parts of my body.  I have gotten zero sleep in the past 3 days.   Doctors want to throw pills at it and no one seems to be able to help.  I do appreciate what you all are trying to do for me.

[Altostrata]

@Shep Lilbit has a prescription for Klonopin.

[Shep]

10 minutes ago, Altostrata said:

@Shep Lilbit has a prescription for Klonopin.

 

Lilbit, Alto is bringing up a valid point here - is it going to be easier to get a script for Klonopin than for diazepam? 

 

Your most recent benzo was diazepam, but if you don't think you'll be able to get a script for diazepam, you may want to consider the Klonopin. In order to taper, you'll need an ongoing supply. 

 

You will need to use a scale or liquid in order to get down to the small amounts needed (as mentioned earlier, Klonopin is 20 times more potent than diazepam). To get to a 2 mg diazepam equivalency, it would be only 0.10 mg of Klonopin. 

 

Please let us know your thoughts on that and if you need information on using a scale or doing liquid. 

 

I know you are incredibly sleep deprived right now and I apologize for all of the back and forth, but we want you to have all the information you need to make your decision. 

 

I hope you can get a script for diazepam, but just in case, here is some general information on the scale and liquid should you need to use the Klonopin: 

 

• Using a digital scale to measure doses
• Making a liquid from a tablet or capsules

 

[LilBit]

I should be able to get a script for the diazepam.  One more thing I just thought of.... this same pdoc wants me to be on the 25mg of Quetiapine for 2 more weeks, then 12.5mg and then stop.  Since we dont want to change more than one thing at the same time, does this mean I will be on quetiapine until I reinstate and taper off of the diazepam?  Just want to make sure I am doing this right.

[Shep]

1 hour ago, LilBit said:

I should be able to get a script for the diazepam.  One more thing I just thought of.... this same pdoc wants me to be on the 25mg of Quetiapine for 2 more weeks, then 12.5mg and then stop.  Since we dont want to change more than one thing at the same time, does this mean I will be on quetiapine until I reinstate and taper off of the diazepam?  Just want to make sure I am doing this right.

 

You've only been on quetiapine for 24 days, and if you weren't on any other drug, you might be fine doing that. However, you've got a very complicated history. 

 

At doses 150 mg or lower, quetiapine acts on histamine receptors (as opposed to higher doses when it acts on dopamine). So it's a drug that at that low dose, has a similar effect as the mirtazapine and trazodone, which also affect histamine receptors. One of the major withdrawal symptoms of coming off of histamine effecting drugs is insomnia. Add that to the adverse reaction to the SSRIs, rapid Lithium discontinuation, and benzo withdrawal, and it's no wonder you aren't sleeping. 

 

If you do decide to come off the quetiapine, please give yourself time to adjust to the benzo reinstatement and then reduce the quetiapine by a very small amount, perhaps doing a micro-taper to start so if there are problems, it's more easily managed. 

 

But let's leave that discussion for a bit later on and also get feedback from Alto and the other mods. 

[LilBit]

9/8

 

10:00am 500mg Depakote

12:00pm  dull pain and discomfort around both sides of abdomen

2:00pm  dull pain in my chest

5:00pm  stomach pain

9:30pm  25mg Quetiapine 

9:30pm  25mg magnesium glycinate 

9:30pm  1000mg Depakote

9:30pm  2mg diazepam

10:30pm  went to bed

11:00pm  not sleepy, got up—felt wide awake

11:20pm  went back to bed

12:15am  woke up, could not go back to sleep so got up, felt somewhat restless

12:45am  went back to bed

2:45am  woke up, could not go back to sleep so got up

[LilBit]

Is it possible that the diazepam could be having a paradoxical effect?  If so would I be better off taking at a different time of day like in the morning?

[Altostrata]

Did the diazepam have any effect at all? Did you feel sleepy for a while after you took it and then not sleepy?

 

How are you feeling this morning, 12 hours after you took 2mg diazepam?

 

What is our doctor's reasoning for taking you off quetiapine rather than Depakote, which is causing abdominal pain?

 

Please do not change more than one drug at a time. Please convey this simple principle to your doctor.

[LilBit]

This could just be my mind playing tricks on me, but it seems like the diazepam caused me to feel more awake.

 

This morning I felt my usual grogginess and tiredness, but not as much.

 

I don’t think she realizes the Depakote is causing me abdominal pain because I think I just realized this and have not conveyed that to her yet.  She advised me that she wanted to take me off of the Quetiapine since it was not helping with sleep and she wants me on few drugs as possible (but yet wanting to add Klonopin, Doxepin etc... ugh).

 

 I will be calling her tomorrow and letting her know this, as well as discussing only changing one thing at a time.

[Shep]

23 hours ago, LilBit said:

The Depakote does not make me sleepy

 

You were taking depakote 1,500 mg in the morning and now you're taking 500 mg morning and 1,000 mg at night.

 

If it doesn't make you sleepy, why the change in timing?

 

22 minutes ago, LilBit said:

I don’t think she realizes the Depakote is causing me abdominal pain because I think I just realized this and have not conveyed that to her yet.  

 

Is the abdominal pain adding to what is keeping you awake, especially now that you're taking it at night?

 

23 minutes ago, LilBit said:

This could just be my mind playing tricks on me, but it seems like the diazepam caused me to feel more awake.

 

It could be because you're taking the bulk of your sedating drugs now at night. As mentioned before:

 

On 9/8/2018 at 7:25 AM, Shep said:

If your recent drug journal is correct, you are taking a massive amount of sedating drugs at night. This can cause a paradoxical reaction - the more you sedate the nervous system, the more it fights back to stay alert, which is the paradoxical reaction. 

 

 

[LilBit]

I didn’t even realize that Depakote was supposed to be sedating... Probably because of the insomnia from all of the other drugs and changes!  I really need to get better at talking to these doctors because it looks like finding a competent one is going to be next to impossible.  I plan on calling her tomorrow.

[Shep]

LilBit, Alto and I have been reading and discussing your thread and here is the best we came up with. Since you've only been on Depakote for a month and it's causing an adverse reaction:

 

Please stop the 1,000 mg of Depakote you are taking at night. 

 

This will leave you with 500 mg in the morning. Hopefully, not having the stomach issues will help with sleep and also, may cut down any paradoxical effects. Even though you don't feel the depakote makes you sleepy, it's sedative effects could be causing a paradoxical reaction, which is why you don't feel it as sedating. I hope this makes sense. 

 

So your new schedule will be:

 

500 mg Depokate in the morning.

2 mg diazepam and 25 mg quetiapine at night

 

Please let us know how you do. 

[Altostrata]

Plus, since you've taken a few doses of diazepam over the last week -- diazepam has a very long half-life -- we're hoping the diazepam will kick in and substitute more constructively for the Depakote.

 

[LilBit]

Ok, this makes sense and I will give it a try.  Thanks so much to the both of you for your help and I will keep my fingers crossed!   One more thing, should I continue the magnesium for now since we are making these changes?  I believe I already know the answer but just want tp be sure. 😊

[Shep]

11 hours ago, LilBit said:

 I believe I already know the answer but just want tp be sure. 😊

 

Well, if the answer is to stay on the magnesium because you are already making another change (reducing the depakote), than you are correct. 

 

In your journal, you have 25mg magnesium glycinate, which is a low dose, so you should be okay to leave it as is.