smk1234: I want to taper Luvox, but terrified

[Dejavu]

Smk1234, I know you are frightened and concerned at the moment, but @Altostrata is trying to help you. As someone who has seen more AD withdrawal cases than most doctors, she has specific reasons for the information she requests of people. All the mods on this forum are strictly volunteers, spending their free time helping other people in need. I hope you will realize that Alto is not the enemy, and this forum is the best source for help with getting your life back. Please do yourself a kindness and comply with her requests for information. Wishing you the very best.

[smk1234]

Hi BrassMonkey, I didn't feel my response was "snarky" and that certainly wasn't my intention. I felt that the moderator was being a bit snarky to me and I was a little taken aback to be responded to that way on a site like this. I was just pointing out how I felt. I thought I had given my med history previously, that's when the moderator started talking about the SSRIs I'm on and the blood pressure meds??  I'm trying to do this all on my phone and maybe not seeing everything I should.

 

I will get online later on my desktop and write them all again. Again, I didn't mean to come across the wrong way. Thanks.

[ChessieCat]

The drug signature allows the moderators to see your drug history at a glance and means that we don't have to read back through posts to find the information.

 

Please keep it simple.  Include ALL drugs.  What is needed in the drug signature.  Details of dates, drugs and doses for the last 2 years.  Anything older than 2 years just a summary.

 

Instructions:  Withdrawal History Signature

Account Settings – Create or Edit a signature

[smk1234]

I tried to open the link you have for Instructions for drug history signature and it came up as an error. I tried entering my history onto the signature and it kept saying too many lines.

 

Here is my history, could you suggest how to enter it into the signature?

 

Luvox- 200mg past 20 years, cut to 100mg 7/2020, then increased back up to 150mgs 3 weeks later/ end of July . Currently still on 150mgs.

Pristiq - started on 50mg 4/2020, slowly increased to 150mg since the beginning of July of 2020. Currently on 150 mgs 

Trazodone- 50mgs since summer 2019, was just increased to 100mg 8/2020

Propranolol- started prn summer 2019, ended up slowly increasing to up to 40mg per day by 1/20. Currently on 20mg (10mg 2X) per day for the past month.

Clonidine - started mid July 2020 .1 mg 2X day. I've cut it down on my own to .1 mg at night and .5 mg day .

Gabapentin - started 8/3/20 300 mg 3X day, in past couple days cut back down on my own to 300mg 2X day

Long history of various other a/ds  Xanax and Ambien for 10+ years, did cross to Valium and off since 12/15

 

@Altostrata, I really apologize for coming across the wrong way if I did. I'm not thinking clearly and trying to look at this site and type on my phone is confusing because all of the replies are mushed together. I'm just so darn frustrated with everything right now. A year ago I was just on Luvox, Trazodone, and propranolol and it was my plan to try to get off of all psych meds. Starting this past March I got hit with the worst anxiety of my life that absolutely knocked my socks off. It was so bad I agreed to add the Pristiq as I felt so bad. I really think this has to do with me getting close to menopause - I tried some birth control pills and hormones but either didn't really help or made me feel worse and my gyn said I should stop hormones and just treat with psych meds. I was devastated as I had already added the pristiq and it wasn't helping enough. So I got to the end of my rope and ended up in the hospital where they added Clonidine because I was opposed to more psych meds. It kind of took the edge off a bit, but not really. It was in the hospital they cut the Luvox from 200mg to 100mg. I didn't really feel anything for the first couple weeks, but on week 3 a severe depression hit me. My psychiatrist outside of the hospital told me to raise the Luvox to 150mg to see if that would help. I think it has a little, but I still feel awful. I didn't sleep for 3 days last week and ended up back in the hospital for 3 more days. The dr there increased the Trazodone and wanted me to try gabapentin for the anxiety. So now a year later I've added more meds to my plate and feel worse than ever. I plan to ask my dr about getting off the Clonodine and propranolol. I really feel that cut of Luvox was too much for me. I am praying that if that is the case I will eventually adapt to it and feel more stable.

[ChessieCat]

5 minutes ago, smk1234 said:

Gabapentin - started 8/3/20

 

Is the date 8th March or 3rd August?

[ChessieCat]

Just to clarify.

 

Are you currently taking the following drugs?

• Luvox
• Pristiq
• Trazodone
• Propranolol
• Clonidine
• Gabapentin 

 

[ChessieCat]

Link to drugs.com full interaction check:  https://www.drugs.com/interactions-check.php?drug_list=1128-9754,2796-12488,2228-0,1956-0,704-0,1147-0

 

From the above interaction check:

Therapeutic duplication warnings

Therapeutic duplication is the use of more than one medicine from the same drug category or therapeutic class to treat the same condition. This can be intentional in cases where drugs with similar actions are used together for demonstrated therapeutic benefit. It can also be unintentional in cases where a patient has been treated by more than one doctor, or had prescriptions filled at more than one pharmacy, and can have potentially adverse consequences.

 

Duplication

Central Nervous System (CNS) Drugs

Therapeutic duplication

The recommended maximum number of medicines in the 'Central Nervous System (CNS) Drugs' category to be taken concurrently is usually three. Your list includes four medicines belonging to the 'Central Nervous System (CNS) Drugs' category:

• Luvox (fluvoxamine)
• Pristiq (desvenlafaxine)
• trazodone
• gabapentin

Note: The benefits of taking this combination of medicines may outweigh any risks associated with therapeutic duplication. This information does not take the place of talking to your doctor. Always check with your healthcare provider to determine if any adjustments to your medications are needed.

Duplication

Antidepressants

Therapeutic duplication

The recommended maximum number of medicines in the 'antidepressants' category to be taken concurrently is usually one. Your list includes three medicines belonging to the 'antidepressants' category:

• Luvox (fluvoxamine)
• Pristiq (desvenlafaxine)
• trazodone

Note: The benefits of taking this combination of medicines may outweigh any risks associated with therapeutic duplication. This information does not take the place of talking to your doctor. Always check with your healthcare provider to determine if any adjustments to your medications are needed.

 

__________________________________________________________________________________

 

From https://reference.medscape.com/drug-interactionchecker:

Serious - Use Alternative

• trazodone + clonidine

  trazodone decreases effects of clonidine by Other (see comment). Avoid or Use Alternate Drug. Comment: Inhibition of uptake by adrenergic neurons.

• trazodone + desvenlafaxine

  trazodone and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.

• clonidine + propranolol

  clonidine, propranolol. Either increases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

• fluvoxamine + desvenlafaxine

  fluvoxamine and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.

• fluvoxamine + trazodone

  fluvoxamine and trazodone both increase serotonin levels. Avoid or Use Alternate Drug.

Monitor Closely

• propranolol + clonidine

  propranolol, clonidine. Mechanism: pharmacodynamic synergism. Modify Therapy/Monitor Closely. Non selective beta blocker administration during withdrawal from centrally acting alpha agonists may result in rebound hypertension.

• gabapentin + trazodone

  gabapentin, trazodone. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• gabapentin + desvenlafaxine

  gabapentin, desvenlafaxine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• fluvoxamine + gabapentin

  fluvoxamine, gabapentin. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coaadministration with CNS depressant may result in fatal respiratory depression. Use lowest dose possible and monnitor for respiratory depression and sedation.

• fluvoxamine + trazodone

  fluvoxamine and trazodone both increase QTc interval. Modify Therapy/Monitor Closely.

• desvenlafaxine + propranolol

  desvenlafaxine will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Desvenlafaxine inhibits CYP2D6; with higher desvenlafaxine doses (ie, 400 mg) decrease the CYP2D6 substrate dose by up to 50%; no dosage adjustment needed with desvenlafaxine doses <100 mg

• fluvoxamine + clonidine

  fluvoxamine, clonidine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. CNS derpressant effects enhanced.

• desvenlafaxine + fluvoxamine

  desvenlafaxine will increase the level or effect of fluvoxamine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. With higher desvenlafaxine doses (eg, 400 mg) decrease CYP2D6 substrate dose by up to 50%; dose adjustment not necessary with desvenlafaxine doses <100mg

[ChessieCat]

29 minutes ago, smk1234 said:

Luvox- 200mg past 20 years, cut to 100mg 7/2020, then increased back up to 150mgs 3 weeks later/ end of July . Currently still on 150mgs.

 

 

On 7/30/2020 at 5:18 AM, smk1234 said:

I wound up inpatient a couple weeks ago for all of this and the dr there cut my Luvox down to 100mg from 200mg.

 

So you increased back to Luvox 150mgs?

 

Was this at the recommendation of your doctor?

[composter]

Since you had trouble updating your drug history signature I’ll walk you through it:

 

On the menu bar to the right hand side, select Account, then Account Settings. On the menu that appears on the next screen select Signature. Type and save the signature. 
 

Thank you for working with us and answering the questions above. 

[smk1234]

@ChessieCat yes I just started the gabapentin earlier this week, but already cut it down on my own. And yes the dr okayed me increasing the Luvox to 150mg because my depression has been so severe.

Edited August 9, 2020 by composter
Fixed tag and deleted duplicate paragraph

[smk1234]

@composterthanks. I was able to get to the signature area but it wouldn't let me save it said too many lines. Could you suggest how much to cut out of what I wrote?

[smk1234]

@ChessieCat Yes I am currently taking all of these meds.

Edited August 9, 2020 by composter
Fixed tag

[smk1234]

I would like to updose the Luvox back to 200mgs to see if it helps stabilize me, but my Dr doesn't want me to now that the Pristiq is onboard and the Trazodone was increased. I feel trapped this is such a nightmare. I feel like all I can do is pray that I get used to the 150mgs of luvox

and my brain readjusts. Then I will have to start a very slow taper. I am also going to ask about going off the clonidine and propranolol. This depression is debilitating.

[ChessieCat]

15 minutes ago, smk1234 said:

I just started the gabapentin earlier this week

 

What was the reason for starting the gabapentin?

[composter]

57 minutes ago, smk1234 said:

Luvox- 200mg past 20 years, cut to 100mg 7/2020, then increased back up to 150mgs 3 weeks later/ end of July . Currently still on 150mgs.

Pristiq - started on 50mg 4/2020, slowly increased to 150mg since the beginning of July of 2020. Currently on 150 mgs 

Trazodone- 50mgs since summer 2019, was just increased to 100mg 8/2020

Propranolol- started prn summer 2019, ended up slowly increasing to up to 40mg per day by 1/20. Currently on 20mg (10mg 2X) per day for the past month.

Clonidine - started mid July 2020 .1 mg 2X day. I've cut it down on my own to .1 mg at night and .5 mg day .

Gabapentin - started 8/3/20 300 mg 3X day, in past couple days cut back down on my own to 300mg 2X day

Long history of various other a/ds  Xanax and Ambien for 10+ years, did cross to Valium and off since 12/15

I would cut out extraneous words like “slowly” and for current doses say “Current: 20mg”. Also say “increased to” and “cut to” instead of “increased back up to” or “cut back down to”.

 

3 minutes ago, smk1234 said:

I feel like all I can do is pray that I get used to the 150mgs of luvox

and my brain readjusts.

 

Ok how recently did you updose to 150 from 100 mg of Luvox? You mention above that it was end of July. It can take about a week to see if the updose is improving your symptoms. Can you tell if symptoms have improved in the past week?

 

Did you have no symptoms appear UNTIL the 2 weeks after cutting from 200 mg to 100 mg Luvox? Was this the only medication/dosage change made around this time?

[ChessieCat]

5 minutes ago, smk1234 said:

I would like to updose the Luvox back to 200mgs to see if it helps stabilize me, but my Dr doesn't want me to now that the Pristiq is onboard and the Trazodone was increased.

 

And gabapentin has been added as well.

 

Increasing the Luvox could possibly make things much worse than they are now.

 

Did you read the interaction reports that I posted?

[smk1234]

@ChessieCatyes I did see what you posted about interactions. ugh. The gabapentin was added for my initial problem of severe anxiety. They mentioned adding things like seroquel or abilify which I refuse and I'm running out of options.

[smk1234]

@composterit was a week this past Wednesday that I updosed to 150mg so it's been 10 days. When I was in the hospital the same time the Luvox was cut they added Clonidine to help with anxiety.

[ChessieCat]

smk you are on a ridiculous cocktail of drugs and some of them are at very high doses.

 

I will be honest and tell you that you are at a crossroads.  Either you continue allowing yourself to be poly drugged or you make the decision that you will do what needs to be done to at least reduce your drug load.

 

Something that you may not realise is that drugs and/or drug combinations can turn paradoxical.  As an example a drug that is sedating can become activating.

 

It is going to take some time for this to get worked out, but if you can work with us we can try to get your drug load reduced.  Please note that SA provides support to help people reduce or get off their drugs.  If you want to reduce your drugs then we will try our best to assist you.  However, we can't do it for you.  We can only offer suggestions.  You might find this topic helpful:  how-to-talk-to-a-doctor-about-tapering-and-withdrawal-what-to-expect

 

Something that you need to understand is that if you go to your doctor complaining about your symptoms their usual response is to try to find a drug.

 

At this time it would be best not to make any changes to your drugs.

 

Please provide a daily symptom journal.  We need at least 3 consecutive days.  Please post a complete 24 hour period in one post.

 

Here are the instructions which also provides an example of what is needed.

 

 

[ChessieCat]

In case you are concerned about acting on suggestions from a forum, Altostrata created this site in about 2011.  She experienced withdrawal syndrome from stopping her drug and doctors did not recognise what it was.  This is more about her here including a video.  about-altostrata-withdrawal-syndrome-since-2004

 

You might also be interested in knowing that we have 2 members (possibly more but I can't remember who they are) who have managed to become drug free after being poly drugged.

 

GiaK          withdrawn from a cocktail of 6 psychiatric drugs that included every class of psych drug.

 

Shep          Drug free May 22, 2015 after 30 years of neuroleptics, benzos, z-drugs, so-called "anti"-depressants, and amphetamines 

 

Edited August 9, 2020 by ChessieCat
added forgotten link

[smk1234]

@ChessieCatI appreciate your honesty. Do you not even think it's a good idea to ask my dr next week about getting me off of the Clonidine and possibly propranolol?

 

Yes I know my meds are in a bad place. I would very much like help with reducing some of these. I was frightened about my wellbeing before I agreed to start adding more meds over the past few months and now I'm frightened about the situation I'm in with all of these meds and now this severe depression I didn't have before.

 

I will track my symptoms like you suggest.

[smk1234]

@ChessieCatthanks for the additional info. I will look through all of this. Thank you for your advice, and sorry again for the confusion and any ill feelings on my part earlier. Also it looks like my signature change finally saved:-)

[ChessieCat]

12 minutes ago, smk1234 said:

Do you not even think it's a good idea to ask my dr next week about getting me off of the Clonidine and possibly propranolol?

 

Just hold on everything at this time.  Don't make any changes otherwise the symptom notes will not give a true picture of what is happening.

 

11 minutes ago, smk1234 said:

Also it looks like my signature change finally saved

 

Yes I can see your signature.  Please change the 8/3/20 date to read 3 Aug 2020 so that there is no confusion.  Thank you.

 

If you know the exact dates for the drug/dose changes during 2020 please change those too.  Thanks.

 

We don't need the wordiness.   This is a better  just:

 

Drug name:  dose, date; dose date; etc

Drug name:  dose, date; dose date; etc

 

So and example:

 

Trazodone- 50mgs since summer 2019, was just increased to 100mg 8/2020

 

Trazodone:  50mgs, month 2019; 100mg, date Aug 2020;

[Altostrata]

18 hours ago, smk1234 said:

Starting this past March I got hit with the worst anxiety of my life that absolutely knocked my socks off.

 

Before this happened, had you perhaps accidentally forgotten to take any of your drugs, added any drugs, or changed dosages or your drug schedule in February or March?

 

According to your signature, at the time you were taking Luvox, trazodone, and propanolol, is that correct?
 

18 hours ago, smk1234 said:

I tried some birth control pills and hormones but either didn't really help or made me feel worse and my gyn said I should stop hormones and just treat with psych meds.

 

When did you do this? Steroids can also have adverse effects of "depression" and "anxiety".

 

18 hours ago, smk1234 said:

My psychiatrist outside of the hospital told me to raise the Luvox to 150mg to see if that would help. I think it has a little, but I still feel awful. I didn't sleep for 3 days last week and ended up back in the hospital for 3 more days. The dr there increased the Trazodone and wanted me to try gabapentin for the anxiety.

 

Most likely, the increase in Luvox caused the sleeplessness. The increase in trazodone and addition of gabapentin were unnecessary.

 

16 hours ago, smk1234 said:

@ChessieCatyes I did see what you posted about interactions. ugh. The gabapentin was added for my initial problem of severe anxiety. They mentioned adding things like seroquel or abilify which I refuse and I'm running out of options.

 

Who is "they"? How may doctors have prescribed your psychiatric drugs? Are you taking other kinds of drugs as well? If so, please put ALL your drugs in the Drug Interactions Checker https://www.drugs.com/drug_interactions.php  and copy and paste the results or a link to them in this topic.

 

Please consider whether you have had a role in this. Have you asked your doctors for the addition of specific drugs? If so, if you intend to reduce your drugs, you need to stop increasing them. If you're having reactions bad enough for hospitalization, something is going very wrong with your drug treatment. Also, they don't seem to know what they're doing in the psychiatric ward, either, which is not unusual. Nobody you're consulting knows how to mix just the right cocktail, they're all faking it.

 

You need to become an informed drug consumer. Read about the adverse effects each of your drugs on drugs.com before you accept a prescription. Then, if you have a bad reaction, at last you'll know if you're experiencing an adverse effect, even if your doctor doesn't. Here's the information about Luvox, for example.

 

You should be aware that the combinations of Luvox, Pristiq, and trazodone and 2 types of blood pressure drugs represents poor medical practice. The idea of adding gabapentin and Seroquel or Abilify to your current cocktail is absurd. If this is your psychiatrist's style, you need a new psychiatrist.

 

Further, Luvox is not popular in the United States because of its adverse effects, particularly upon the liver. Taking multiple drugs puts a further burden on liver and kidneys. When was the last time you had liver and kidney function blood tests? If not recently, you should arrange this. For example, if your liver is not functioning properly, you could be feeling ill from that.

 

It appears you or your doctors have been chasing "depression" and "anxiety" by continually adding more drugs. What do you mean by "depression"? Please describe how you're feeling now compared to when you were "stable".

[smk1234]

@Altostrata

No, at the time this all started in March I hadn't made any recent changes to anything. I was only on Luvox 200mg, Trazodone 50mg, and Propranolol 30-40mg. Actually, now thinking back, I was trying to cut back on the propranolol just a little bit though.

 

I started on birth control pills in April. (after my symptoms had started) I truly feel like the increase of anxiety could be due to me being in perimenopause. I had gone to my gyn and she wanted me to try bcps to see if they would even out my hormones. I was on them for almost 3 months and didn't notice much of a difference. About a month ago I stopped those and she had me try regular hrt / Prempro, but I had a bad reaction to that and she just wanted me to stop all hormone treatment for now and try to control my symptoms with more psych meds. (I was devastated as I was so hoping this could be something that hormone treatment would help and not psych meds) I had been so against more psych meds, but my symptoms were unbearable and I had hesitantly agreed to start the Pristiq in April and it hasn't helped much either.

 

Yes "they" are the psychiatrists. The Pristiq hasn't been helping and they kept suggesting other meds to try like Abilify or Seroquel but I refused. I started propranolol about a year ago to take prn, for anxiety and palpitations.. (which I now realize can be due to perimenopause) since I can't take benzos and I thought it sounded like the most benign of the meds to help. I started to have to take the propranolol on a regular schedule but have felt it's lost it's effectiveness too. When I was in the hospital the first time about a month ago, because I was so hesitant of more psych meds, they suggested the Clonidine. It kind of took the edge off, but now I don't feel much either.

 

Oh yes, I know it's partially on me because I agreed to take more meds, previous to 5 months ago I was so against any other meds and wanted to get off all of this stuff, but I tell you the anxiety I started feeling was so much worse than anything I'd ever felt and I've been so desperate to feel better. I had also said I would never take HRT, but all of my resolve against psych meds and hormones went out the window because I've been so miserable. I am single and have had to take time off work - and I am so desperate to get this under control and be back at work. So this is how all of this mess got started. I am trying to get in with a new psychiatrist, but the one I am interested in can't get me in until September due to vacation.

 

The "depression" I started feeling over a week ago I haven't been feeling all of the past months. It's hard to describe, but it's like a heavy, aching feeling in my head (not like a headache or anything physical) , a terrible sadness and like I just want to cry all the time. The "anxiety" I started feeling in March has been like surges of severe anxiousness whooshing through my body, internal tremors, inability to relax, some crying, etc.

 

.

[Altostrata]

1 hour ago, smk1234 said:

Yes "they" are the psychiatrists.

 

How many psychiatrists are you seeing? Have you discussed minimizing your drugs with any of them? I find it incredible none of them noticed you're taking hefty dosages of 3 antidepressants, any two of which should not be prescribed together.

 

Quote

I was trying to cut back on the propranolol just a little bit though.

 

It's pretty obvious you are in the habit of "adjusting" your drugs. Whatever you did, you went to the hospital with an adverse drug reaction, not a sudden spurt of psychiatric disorder.

 

Did this new "depression" occur BEFORE you increased trazodone, Luvox, and gabapentin? Which doctor added these 3 drugs?

 

Are you really interested in decreasing your drugs? You seem to be very much convinced that what you need is more drugs for this "depression".

 

 

[smk1234]

The psychiatrist I usually see no longer works in the hospital so I saw a different one in the hospital. Yes, the one in the hospital wanted me to go down on the Luvox even more.

 

Yes the depression occurred before the increases, but soon after the initial 50% cut if luvox. It was so bad and I was out of the hospital so I called my regular psych and he said try increasing the Luvox a little to 150mg but not the initial 200mg. I ended up back in the hospital and the hospital dr increased my Trazodone and added gabapentin. 

 

Yes I do want to decrease the meds, but at a slower, safer rate.

[Altostrata]

14 hours ago, smk1234 said:

Yes, the one in the hospital wanted me to go down on the Luvox even more.

 

That is the only doctor who knew the correct direction for your drugs, not increases of everything. You are taking enough psychiatric drugs to stop a horse.

 

Because of the number of your drugs and the high dosages of all of them, I don't see any easy way for you to reduce them. They don't blend together in a nice stew. What they do is push against each other until some equilibrium (homeostasis) is reached. This is not necessarily an equilibrium that makes you feel good. If you take out one drug, the others leaning against it will move around until they reach a new homeostasis. During this period of adjustment, you may feel better, you may feel worse, you might not feel anything.

 

When you cut Luvox by 50% in July, the adjustment generated acute withdrawal symptoms. Last March, you probably got withdrawal or some other adverse reaction from a drug change, maybe the propanolol reductions.

 

Although we advise changing only one drug at a time, given your very high drug burden, I would back out of all the drugs you added since the beginning of August:  50mg trazodone and 600mg gabapentin. You've been on them at most 10 days. If you continue, they will be incorporated into the homeostasis and it will be harder and harder to drop them.

 

If I were you, I'd immediately cut 25mg trazodone and 300mg gabapentin, wait 3 days, then drop the rest, 25mg trazodone and 300mg gabapentin. Then at least you'll be back to where you were at the end of July, on 5 drugs instead of 6.

 

From there, I'd work on reducing Pristiq by 25mg at a time. 150mg is a truly excessive dose.

 

You may or may not feel these reductions. If you feel them, you should be aware they are the result of the drug reductions and your system trying to rebalance. Most likely, they will dissipate in a week or two. From experience, you should be aware that if you go to the hospital, they probably will add random drugs as they've done before. Few doctors know how to handle withdrawal or even recognize it. Your current psychiatrist doesn't know what to do. To avoid this, you'll have to be patient and cope with any withdrawal symptoms.

 

I don't know what criteria you have for a new psychiatrist, but if I were you, I'd look for one who will help you minimize your drugs, not someone who can work miracles with depression, which you may not have anyway, having been on psychiatric drugs for 20 years.

[smk1234]

@Altostrata

 

Thank you for the detailed reply.

 

To clarify,  after reducing the trazodone and gabapentin you'd suggest the best move would be to not move the Luvox down anymore and just concentrate on the Pristiq, right? And to continue tapering that until I'm off of it completely before attacking the Luvox again?

 

What about the Clonidine and propranolol? I haven't been on the Clonidine all that long.

 

I missed another question you asked above about current lab testing. Yes, ive had my blood drawn several times this year and it's been normal, including the liver function tests. (bUT I've only been on Pristiq since April)

 

 

[Altostrata]

You're on 6 drugs. You have to start somewhere. Ordinarily, we advise changing only one drug at a time. You need to allow time after a drug change for the adjustments to settle down.

 

1 hour ago, Altostrata said:

If I were you, I'd immediately cut 25mg trazodone and 300mg gabapentin, wait 3 days, then drop the rest, 25mg trazodone and 300mg gabapentin. Then at least you'll be back to where you were at the end of July, on 5 drugs instead of 6.

 

You would need to see what happens for a month after you make the above drug changes. Unless there's an emergency, you won't be making any more changes for at least a month.

 

I would work on backing out of Pristiq after that. That will take several more months, at least. Depending on what happens, you might not go off it completely before reducing the other drugs.

 

Please let us know how you're doing as you make these changes in gradual stages.

[ChessieCat]

I suggest that you daily symptoms notes.  Sometimes improvement can be missed because it is only very slight.  For instance, when we have the flu we can feel horrible 100% of the time.  But that is subjective.  On day 3 of the flu we might be feeling just a tiny bit better than we had been but because we still feel awful we don't notice it.

 

You might also find it helpful to rate your symptoms.   Rate Symptoms Daily to Check Patterns and Progress

 

This is an example of a daily symptoms journal:

DATE:

 

6 a.m. Woke with anxiety
8 a.m. Took 2.5mg Lexapro
10 a.m. Stomach is upset
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. Feel a bit better
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. Feeling dizzy
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 but got back to sleep

[ChessieCat]

It is important that you try to stay as calm and as patient as possible during this time.  When we panic we can make bad decisions.

 

We strongly encourage members to learn and use non drug coping techniques. 

 

Non-drug techniques to cope

 

Claire Weekes' Method of Recovering from a Sensitized Nervous System

 

Audio:  First Aid for Panic (4 minutes) Female voice - getselfhelp.co.uk
 

Audio:  First Aid for Panic (4 minutes) Male voice - getselfhelp.co.uk
 

Audio:  How to Recover from Anxiety - Dr Claire Weekes

 

Acceptance

 

This website has some excellent self help resources.  Scroll down the page to see the list:

 

https://www.getselfhelp.co.uk/selfhelp.htm

 

  

On 4/9/2020 at 10:31 AM, brassmonkey said:

 

AAF: Acknowledge, Accept, Float.  It's what you have to do when nothing else works, and can be a very powerful tool in coping with anxiety.  The neuroemotional anxiety many of us feel during WD is directly caused by the drugs and their chemical reactions in the brain.  Making it so there is nothing we can do about them.  They won't respond to other drugs, relaxation techniques and the like.  They do, however, react very well to being ignored.  That's the concept behind AAF.  Acknowledge, get to know the feeling involved, explore them.  Accept, These feelings are a part of you and they aren't going anywhere fast. Float, let the feeling float off as you get on with your life as best as you can.  It's a well documented fact that the more you feed in to anxiety the worse it gets.  What starts as generalized neuroemotinal anxiety can be easily blown into a full fledged panic attack just by thinking about it.

 

I often liken it to an unwanted house guest.  At first you talk to them, have conversations, communicate with them.  After a while you figure out that they aren't leaving and there is nothing you can do to get rid of them.  So you go on about your day, working around them until they get bored and leave.

 

It can take some practice, but AAF really does work.  I hope you give it a try.

 

 

[smk1234]

Help with Pristiq

 

I started taking Pristiq in June and worked my way up to 150 mg. I  had started having some really bad, crazy anxious symptoms last March. I don't really think the Pristiq ever did much for me. I got a new psych dr in August and she wanted me to start getting off of it, thinking it might actually be cAUSING more symptoms at this point, (anxiety, palpitations) I have just been making small, dry cuts of the 25mg pills like either 12.5 mg or 6.25  mg, and it hasnt been too bad, I still get palpitations though. When I got down to 100mg, the strangest thing happened--- I started to feel almost too good, i would say it would be what I would imagine mania would be, but I am definitely not bipolar. I also felt really keyed up, like I would get a jolt feeling in my heart. I couldnt stand it so a couple weeks ago I dropped a whole 25mg to 75mg... the 'mania' feeling went away in a day, but I still had the jolting feeling in my heart and some internal shaking... This past Sunday I went against my judgement and took out a whole  25mg to a total of 50 mg, I felt better for about a day, then Monday I started developing severe anxiety that progressed and i thought i was dying. I went back up to 75 mg Tuesday, and feel a bit better, but I still have this inner shaking, intense irritability. and just not feeling right.

 

Can someone explain why I would suddenly develop 'manic' -type feelings at 100mg when I didn't have that at 150mg?

 

I need some guidance as to what to do now to feel better. Should I cut a 25mg in half and add to the 75mg to be 87.5? Could what I'm feeling now be still part of the cut I made from 100 to 75?'

 

I am so scared ive read stories about how awful this med is. I don't know what is from what anymore.

 

I couldn't figure out how to update my signature, but my current meds are:

Luvox 150mg,

Clonidine .1 mg

Metoprolol 25mg

Trazodone 50 mg

Pristiq 75 mg

 

Edited November 19, 2020 by ChessieCat
added topic title

[ChessieCat]

 

 

 

2 hours ago, smk1234 said:

I got a new psych dr in August and she wanted me to start getting off of it, thinking it might actually be cAUSING more symptoms at this point, (anxiety, palpitations)

 

And I think that this new psych has got it right.  As had the doctor who reduced the Luvox, but you went back up to 150mg.

 

You are taking 3 serotonergic drugs (Pristiq, Luvox/Fluvoxamine, trazodone).  There is very high probability that you are experiencing seronotin syndrome/toxicity.

 

I experienced mild serotonin toxicity when I was taking 100mg Pristiq.  I felt agitated/restless, had trouble concentrating, my heart would "flip" (some people probably describe this as missing a beat), my diastolic blood pressure increased a lot, lots of sweating even in cold weather, tight/sore/cramping muscles.

 

As my dose got lower (50mg) all of these symptoms improved.  The lower my dose got the better I felt.

 

1 hour ago, smk1234 said:

This past Sunday I went against my judgement and took out a whole  25mg to a total of 50 mg, I felt better for about a day, then Monday I started developing severe anxiety that progressed and i thought i was dying. I went back up to 75 mg Tuesday, and feel a bit better, but I still have this inner shaking, intense irritability. and just not feeling right.

 

2 hours ago, smk1234 said:

I need some guidance as to what to do now to feel better. Should I cut a 25mg in half and add to the 75mg to be 87.5?

 

You state that you feel a bit better.  That is a good sign. DO NOT increase to 87.5mg.

 

It takes about 4 days for a dose change to get to full level in the blood and a bit longer for it to register in the brain.

 

You will need to stay on 75mg until your symptoms improve before making another reduction.  And it would be better if you make smaller reductions from now on.

 

See this topic which explains how to get your dose:

 

Tips for tapering off desvenlafaxine (Pristiq)

 

Why taper paper: dose-occupancy curves

 

2 hours ago, smk1234 said:

Clonidine .1 mg

Metoprolol 25mg

 

These drugs both reduce blood pressure.  Serotonin syndrome causes high blood pressure.  As your serotonin drug/s are lowered you will need to check that your blood pressure is not getting too low which can cause dizziness and fainting.  However, I suggest that you see a doctor regarding reducing your blood pressure drug/s because it could be dangerous if you reduce them yourself.

 

 

If you had returned and asked for assistance about how to reduce your Pristiq we would have advised you not to reduce from 75mg to 50mg.

 

It is difficult for SA staff to assist members who do not return for advice.  We do not make members take SA's advice/suggestions.  However SA is a very busy site with a lot of members needing assistance and moderator time is limited.  SA's focus is on helping the members who do want to follow our suggestions.

[smk1234]

@ChessieCat. thank you so much for your reply. I've heard the thing about dropping 10% at a time, but was so alarmed how I started to feel at 100mg I thought I'd just give a bigger cut a go. It is still puzzling why I wasn't feeling that so much at 150mg.  My dr didn't seem to think it was serotonin syndrome, but maybe that the original problem I had had calmed down and so the pristiq dosage was  becoming too much for me.

 

I'm terrified right now that I am not going to feel better and that there is some harm to my body going on.  How long did it take you to get from 100mg to 50mg? How long would you anticipate me having to hold before considering another cut? (in general)

 

Again, I am terrified right now. I will check back before I do anything else.

 

 

 

 

 

[ChessieCat]

5 hours ago, smk1234 said:

My dr didn't seem to think it was serotonin syndrome,

 

It might be because you are on blood pressure meds.

 

My doctor didn't pick up that my blood pressure increased after my Pristiq was increased.

 

5 hours ago, smk1234 said:

How long did it take you to get from 100mg to 50mg?

 

I dropped from 100mg to 50mg Pristiq and found SA after 2 weeks of withdrawal symptoms (extreme cog fog).  I managed to updose to 75mg.  I started tapering after about 2 months I think because I was trying to get my dose lowered quickly.  But it was too soon and I got ear pain.  So I did a tiny increase and the ear pain went very quickly.  After that I stuck to doing no more than 10%.  But once I got to 50mg (a whole tablet - no 25mg in Australia) I did a 3 month hold to allow my brain a chance to catch up.  I did a 7 week hold when I got to 20mg because I had plenty of capsules.  Because I get my tablets compounded I've had to adapt my taper using 0.125mg as the minimum capsule.  However, I recently discovered that the capsule contents will easily dissolve in water so now I can get the dose I want.  Please note that the tablet will NOT dissolve.  The larger parts just clump.