Jump to content
Snek

Snek: My daughter's withdrawal

Recommended Posts

Snek

Hello, and many thanks to this website for being so informative! I only wish that I had known about this site a few years ago (or even a few months ago). Here is why - 

 

My 19 year old daughter is, I believe, now going through Bupropion withdrawal. It's hard to know for sure because a virus *could* be partly to blame. Either way, she is too out of it to be her own advocate right now so I am trying to learn as much s possible so that I can best help her. 

 

My daughter began taking Bupropion (150mg) in the summer of 2016 for pretty severe depression. In the winter of 2017, Fluvoxamine 100mg was added for OCD. Gabapentin (900mg per day) was added about 9 months ago for nervousness. During this time we moved and had to switch doctors. The new doctor changed her Bupropion to the 150mg XL (extended release) formula about 6 months ago. She was previously taking the 75mg SR version twice per day.

 

It was soon after our move, which corresponded to the new doctor and new Bupropion formula, that my daughter's mental health seemed to take a downturn. In the past 4-5 months in particular she has stayed in bed most days with a low mood. She also started having a tremor in her hands and feelings of nausea off and on. I contacted her PCP in August this year to share my concern and was told it was probably a virus and that she would feel better soon...but she only got worse. A month later the nausea got so bad that she began vomiting all the time. After 5 days of this severe vomiting with no other viral symptoms, the doctors agreed to run tests. We found her ALT to be elevated, and this was concerning in regards to the Bupropion so it was agreed that she would stop taking the Bupropion. Her PCP recommended that she titer by half every 3 days. I thought that I was being cautious by making this a week instead of 3 days. Now, after a month, she is on 18.75mg every other day of the Bupropion SR. Her psychiatrist says she should be off it by now, but I have added this every other day titration at this point and I'm not sure where to go from here. The psychiatrist wants her off the Bupropion so that Lamictal can be started. I'm still not sure about starting another drug at this point! Anyway...

 

To make things even more complicated, we tested her blood for the Epstein Barr Virus (EBV) and her result was borderline (technically they call it "equivocal"). She had mono (which is caused by the EBV) two years ago and got very, very sick then. The fatigue she is experiencing could be related...or not. It's hard to tell. Her PCP feels her fatigue is depression related. The psychiatrist thinks it could have something to do with the EBV. She will be re-tested for EBV next week. 

 

And to make things even MORE complicated, her psychiatrist said we should take her off the Gabapentin by reducing one 300mg pill per week. I hired another psychiatrist to oversee psychiatrist number 1 and he said that we could reduce the Gabapentin every 2 weeks but that he did not want to wait longer than that because he wants her to start the Lamictal. We took away one pill almost two weeks ago. 

 

Right now my daughter's main symptom is fatigue. She is in bed 90% of the time. She had to drop out of college this semester. She is also super depressed. She was having intense nightmares and sleepless nights these past few months, waking up each morning screaming, but that seems to have gotten a bit better (no waking up screaming the past few weeks). The good news is that her tremor is gone! She does get a little more agitated than normal as well.

 

My daughter is currently taking fish oil (900mg/per meal) and vitamin D3 (5000IU/day) as supplements, and last night she took her first dose of Melatonin 0.3mg. 

 

She also takes birth control pills for PCOS. I believe that these pills might be behind her depression but at this point I don't want to jar her system further by removing/changing them. As soon as we can we will address this. 

 

My quandaries now are:

 

- How to proceed with Bupropion (currently on 18.75mg every other day - doctor does not want her to reduce more because he wants her to start on Lamictal).

- How to proceed with the Gabapentin (doctor says 1 pill per 2 week titer and I worry about this)

- Do we give Lamictal a chance?

 

Once she is stabilized, she will begin tapering the Fluvoxamine. We don't think it's really helping her. I now know that this needs to be done at 10% increments each month for years. We will think more about this when the time comes. For now I want to make sure that she is able to get through this Bupropion and Gabapentin withdrawal. If anyone here has any insight or knowledge to share then I would really appreciate it.

 

Thank you,

Snek 

(I chose this name because my daughter loves snakes and this is a cute word she uses for them - she does still smile when I show her pictures of cute snakes so I now love snakes too)

 

 

 

 

 

 

 

Share this post


Link to post
Snek

Hello, and many thanks to this website for being so informative! I only wish that I had known about this site a few years ago (or even a few months ago). Here is why - 

 

My 19 year old daughter is, I believe, now going through Bupropion withdrawal. It's hard to know for sure because a virus *could* be partly to blame. Either way, she is too out of it to be her own advocate right now so I am trying to learn as much s possible so that I can best help her. 

 

My daughter began taking Bupropion (150mg) in the summer of 2016 for pretty severe depression. In the winter of 2017, Fluvoxamine 100mg was added for OCD. Gabapentin (900mg per day) was added about 9 months ago for nervousness. During this time we moved and had to switch doctors. The new doctor changed her Bupropion to the 150mg XL (extended release) formula about 6 months ago. She was previously taking the 75mg SR version twice per day.

 

It was soon after our move, which corresponded to the new doctor and new Bupropion formula, that my daughter's mental health seemed to take a downturn. In the past 4-5 months in particular she has stayed in bed most days with a low mood. She also started having a tremor in her hands and feelings of nausea off and on. I contacted her PCP in August this year to share my concern and was told it was probably a virus and that she would feel better soon...but she only got worse. A month later the nausea got so bad that she began vomiting all the time. After 5 days of this severe vomiting with no other viral symptoms, the doctors agreed to run tests. We found her ALT to be elevated, and this was concerning in regards to the Bupropion so it was agreed that she would stop taking the Bupropion. Her PCP recommended that she titer by half every 3 days. I thought that I was being cautious by making this a week instead of 3 days. Now, after a month, she is on 18.75mg every other day of the Bupropion SR. Her psychiatrist says she should be off it by now, but I have added this every other day titration at this point and I'm not sure where to go from here. The psychiatrist wants her off the Bupropion so that Lamictal can be started. I'm still not sure about starting another drug at this point! Anyway...

 

To make things even more complicated, we tested her blood for the Epstein Barr Virus (EBV) and her result was borderline (technically they call it "equivocal"). She had mono (which is caused by the EBV) two years ago and got very, very sick then. The fatigue she is experiencing could be related...or not. It's hard to tell. Her PCP feels her fatigue is depression related. The psychiatrist thinks it could have something to do with the EBV. She will be re-tested for EBV next week. 

 

And to make things even MORE complicated, her psychiatrist said we should take her off the Gabapentin by reducing one 300mg pill per week. I hired another psychiatrist to oversee psychiatrist number 1 and he said that we could reduce the Gabapentin every 2 weeks but that he did not want to wait longer than that because he wants her to start the Lamictal. We took away one pill almost two weeks ago. 

 

Right now my daughter's main symptom is fatigue. She is in bed 90% of the time. She had to drop out of college this semester. She is also super depressed. She was having intense nightmares and sleepless nights these past few months, waking up each morning screaming, but that seems to have gotten a bit better (no waking up screaming the past few weeks). The good news is that her tremor is gone! She does get a little more agitated than normal as well.

 

My daughter is currently taking fish oil (900mg/per meal) and vitamin D3 (5000IU/day) as supplements, and last night she took her first dose of Melatonin 0.3mg. 

 

She also takes birth control pills for PCOS.

 

My quandaries now are:

 

- How to proceed with Bupropion (currently on 18.75mg every other day - doctor does not want her to reduce more because he wants her to start on Lamictal).

- How to proceed with the Gabapentin (doctor says 1 pill per 2 week titer and I worry about this)

- Do we give Lamictal a chance?

 

Once she is stabilized, she will begin tapering the Fluvoxamine. We don't think it's really helping her. I now know that this needs to be done at 10% increments each month for years. We will think more about this when the time comes. For now I want to make sure that she is able to get through this Bupropion and Gabapentin withdrawal. If anyone here has any insight or knowledge to share then I would really appreciate it. 

 

Thank you,

Snek 

 

Share this post


Link to post
Snek

I just read a post here about Bupropion tapering and it said to never skip doses. Gah! It feels like I can't do anything right. I consult with what appears to be the best doctors and study the scientific papers and still did not realize this. Today my daughter took her "last" Bupropion SR 18.75mg. I hope that the every other day dosing we've been doing the last 3 doses do not trigger a worse reaction. I wrote to her psychiatrist to share my concern and asked if we should go back to a low dose (what she is on now) spread out over the entire day every day and then taper from there...

Share this post


Link to post
manymoretodays

Hi Snek,

And welcome aboard.  Try not to beat yourself up.  And yes, many prescribers aren't aware of perhaps......best practices for withdrawing medications, and tapering.  I also think this doctor, prescriber is going way too fast, and making way too many changes right now.  Although, your daughter may be way overmedicated right now. 

Do you still have some buproprion available?

Has she had another liver function test done yet?  The ALT that you mentioned expediting the buproprion withdrawal?

If you could do a signature for us, with your daughter's medication/drug history that will really be helpful.

 Please put your withdrawal history in your signature.

This is the portion you see below others' posts, unless viewing from a phone device.  You can still create a signature with a phone device however.  Just follow the instructions in the first post there.

 

Did your daughter have an acute case of mono then, 2 years ago, prior to the medications and then the polypharmacy that she has been treated with?

Any positive response to medication(s)?

And as she is 19......I'm wondering if you might get her involved here, when possible.  I know you said in your first introduction that "she was pretty out of it" right now.  Of note.....I had what was called "the worst case of mono" back when I was 17.  I had just finished HS that winter and was pretty out of it for a few months.  I did continue pretty fatigued at times but headed on off to the University the following fall.  I have often wondered, and researched a bit on the EBV.  I think in any case......it could certainly play a role in her mood status and energy.

 
Here at Surviving Antidepressants, it is recommended that a person taper by no more than 10% of their current dose with at least a four week hold in-between decreases.  The 10% taper recommendation is a harm reduction approach to going off psychiatric drugs.
    
 
Try and get a good feel for, at least the information in the first post, or couple posts in each link provided.   I know this is a lot of information right now.  Good to have it all referenced in one place for you though too.
 
More on W/D(withdrawal)
 
 

 

When we take medications, the CNS (central nervous system) responds by making changes over the months and years we take the drug(s). When the medication is discontinued, the CNS has to undo all the changes it made.  The CNS likes stability. Rebuilding the neurotransmitter production and reactivating the receptor and transporter cells takes time -- during that rebuilding process symptoms occur.
 
We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium and omega 3 (fish oil). Many people find these to be calming to the nervous system. 

 

Omega-3 fatty acids (fish oil) 

 

This is your introduction/journal page where you have now introduced yourself to the community, you can ask questions here regarding your tapering, give updates, and just keep a record of your/your daughters journey.
 
Again, welcome.  Thank you for advocating for your daughter.  Let me know if you have any trouble with getting the signature done. 
All for now.
Love, peace, healing, and growth,
mmt

 

Edited by manymoretodays
additional, ALT, mono/EBV

Share this post


Link to post
Snek

Thank you, MMT. I do believe my daughter is overmedicated and can't believe they want to pile on more. The ALT, the drug's side effects of nausea and tremors, and the fact that the antidepressants did not seem to be working all contributed to the decision to stop taking the Bupropion. The ALT, of course, was the most concerning.  She has since had her ALT repeated and it was OK. I don't know if it's because she's on much less of the Bupropion or not. Her tremor and nausea are almost completely gone now.

 

I will create a signature.

 

My daughter had an acute case of mono almost 2 years ago. She was on the Bupropion then. At first the Bupropion seemed to help her. The change seemed to happen when we moved last year and got switched to Kaiser. The doctor there put her on the XL version of Bupropion instead of the SR she was on before, and I am thinking that it is possible that this new formulation was not as well absorbed by her body and that she went into withdrawal without us knowing for a few months (her PCP is the one who suggested this was a possibility to explain her decline after being switched to the XL). Before we began the official titer last month, we switched her back to the SR to make it easier to break up the dosage.

 

I'm sorry to hear about your experience with mono. When I had it as a teen, it was no big deal. When my daughter got it, it was a nightmare! She was down for several months and in constant 24/7 pain for 6 weeks. :(  

 

I have sent my daughter links to this group and encourage her to read it, but she does not want to even think about this stuff right now. She's at a point where she does not care what happens to her and until she cares I am going to care for the both of us. 

 

Thank you for the links and info. I think that we're going to taper off the Bupropion more slowly from this point out. Her psychiatrist says he's OK with that (though he thinks it is unnecessary). The doc called in an Rx for 100mg of Gabapentin (instead of the 300mg) so that she can titer more slowly there as well. Are we making a mistake by taking her off the Bupropion and Gabapentin at the same time? The Gabapentin never did anything for her.

 

We are not touching the Fluvoxamine until she is off the other meds and stabilized. I realize that this is one of the harder meds to stop, so she will definitely be doing an extremely slow 5%-10%/month taper for that. 

 

She was so tired the next day after that one 0.3mg dose of Melatonin that we decided to stop it for now. She can use it as a sleeping pill in the future should the insomnia return. We have some Magtein for her (a recommended form of Magnesium) but I don't want to add that until we get a better idea of how she is doing now. After reading here about Kindling, I want to slow things waaaay down...

 

Thanks again,

 

Snek

 

 

 

 

 

 

 

 

Share this post


Link to post
Altostrata

Hello, Snek.

 

What is your daughter's daily drug schedule now? Did her symptom pattern change while you were reducing buproprion? Please keep daily notes on paper about her symptoms, when she takes her 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.

 

If fatigue and depression are her most troublesome symptoms, gabapentin would be the most likely culprit. As you've probably realized, the doctors you're talking to do not have clue about what they're doing. What exactly is the point of adding lamotrigine?

 

See Tips for tapering off Neurontin (gabapentin)

 

Please put ALL her 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.

Share this post


Link to post
Glosmom

Hi Snek, Sorry for all you are going through. I am also helping to taper my daughter off of an antipsychotic (risperdal) so not that different from the gabapentin.  Antipsychotics are powerful and life altering drugs. Please continue to read up on how others have dealt with tapering.  I am with Alto....why would you add more drugs to an already complicated assortment? Doctors have no idea what they are doing most of the time with psych drugs.  They think you want them 'to fix it' so the only thing they are trained to do is throw drugs at it.   My daughter was on birth control to help regulate her periods when she was young and that drug too impacted her personality and moods.  She felt much better once she got off of it.  Letting our bodies be...without any meds...is the most natural and safe way to deal with life's issues. Good luck and stay strong! peace, glosmom

Share this post


Link to post
Snek

Thanks, Altostrata. I do keep a record of her dosing and symptoms. I bug her doctors with this data on a regular basis.

 

Her daily drug schedule now is: 

 

- Bupropion SR 18.75 mg every other day at 11am (this will be changing to twice per day of the same dose so we can titer better form there)

- Fluvoxamine 100mg once per day at 10pm

- Gabapentin 300mg at 9pm and 300mg at 11pm

- Kelnor (BC pills) at 10pm

- Fish oil with each meal

- Vitamin D with breakfast (her D was a little low)

 

I used that drug interaction tool when she first started these meds and I brought up my concern with her doctor about the major interaction between Bupropion and Fluvoxamine (another reason why I am happy she will be stopping the bupropion). At the time he convinced me that it was a risk worth taking. The sad thing is that the Bupropion seemed to help more than the Fluvoxamine at first, though eventually it stopped working.  Now she's stuck with the Fluvoxamine which I don't think is helping her much if at all.

 

I do agree that Gabapentin could be the main culprit now. Is it OK to be tapering off the Gabapentin at the same time she is tapering from the Bupropion? Should we stop the Bupropion taper, keep her at 18.75mg/day, and focus on getting her off the Gabapentin right now? 

 

The doctor wants to try the Lamictal because he thinks she may actually have a form of bipolar with no mania? I don't know if I agree with him. I have read studies where it has really helped some people, but at this point I just don't trust these meds.

 

Thanks again,

Snek

 

 

Share this post


Link to post
Snek

Glosmom, thank you! I hope that your daughter is doing well. This is all so scary...I wish I could go back in time and refuse to allow her to try any of these drugs. 

 

I've made the decision to put her back on 18.75mg of Bupropion ever day (from every other day, and this time it will be half of this dose twice per day instead of once) and keep her there until the Gabapentin is tapered more or completely. Then, once the Gabapentin is gone, we will address the Bupropion situation and then the Fluvoxamine. 

 

My daughter is on BC pills for PCOS and extremely painful periods. She refuses to stop them. She does have an Rv for the mini pill (progestin only) to switch to but I don't think we need to add this change to the mix at this time.

 

Best wishes,

Snek

Share this post


Link to post
Snek

Thought I would give an update since today is a bad day.

 

Since posting here last, my daughter has been pretty stable except that she continues to be very tired and sometimes gets a little nauseous (which I think is a side effect of the Fluvoxamine and/or Bupropion but it could be something else for all I know). We have made no new medication changes since I last posted. 

 

For the past month she has not vomited, but this morning she has vomited three times. I don't think it is a virus since she has not left the house in about a week. What is scaring me so much now is that the Fluvoxamine might be causing this...and she can't simply stop taking it! We have not even begin to taper it because she has been tapering off the Bupropion and Gabapentin. 

 

We have a phone appointment with a Kaiser Dr. in an hour. They will probably say "virus, now go get lost".

 

What if this drug is causing this symptom? She can't live like this for the years it will tape to taper. She is already a tiny 105 lb girl.

 

I want to scream.  

 

 

 

 

Share this post


Link to post
Carmie

Hi Snek, 

 

I’m so sorry your daughter is going through this. This journey is definitely not an easy one. What happened at the doctors? 

 

I see you left a message for altostrata the other day. If you leave a message for someone in particular please tag them so that they will get a notification, otherwise they may miss your post. Just put an @  in front of their name n a blue box will come down. Please press on the box like this @Altostrata

 

Sending hugs🤗

 

Share this post


Link to post
Snek

Thank you, Carmie.

 

The doctor asked her to try Pepcid for 14 days to see if it will help. My daughter has stopped vomiting and feeling nauseous since taking it. She still sleeps a lot. They think that since she stays in bed so much it is effecting her digestion. This is possible, I guess. If her digestion is still a problem after 14 days then they will refer her to a gastroenterologist to rule out other serious causes. 

 

The fatigue could be the Epstein Barr Virus (EBV). She got tested again and her result came back "Equivocal" which means the virus is acting up on a low level. The doctor said that this could be a recurrence of EBV (she had mono two years ago), and that these recurrences usually last 3-6 months but could go on for years. I don't see how it is possible to know if what is going on is EBV, something that involves these meds, or both. The doctor did say that she supports my daughter tapering from these drugs since they are not helping (and could very well be the culprit). 

 

The fatigue could also be from Gabapentin. Tonight she is tapering from 300mg Gabapentin to 200mg. We are tapering at a much slower pace than her doctors want. They are pushing for faster since her symptoms might be a reaction to the Gabapentin in the first place. She has not seemed to have any problem with going from 900mg to 300mg in a little over a month. Her problem with major fatigue really did seem to begin after she started taking Gabapentin.

 

We will be tapering the Bupropion and then the Fluvoxamine at 10% per month once she is off the Gabapentin. 

 

I ordered 9.375mg capsules of Bupropion from a compounding pharmacy and will let them help with the taper from there. Tonight I started to have some anxiety around compounding pharmacies, though. Are we sure they are safe? What if they mess up? Would it be safer for me to make a liquid for her? The pharmacy I ordered from has been in business since the 1980s. They do mostly vet prescriptions...is this normal?

 

So much to learn and be on top of! 

 

Thanks,

Snek

 

 

 

 

Share this post


Link to post
WiggleIt

Dear Snek,

I am a member here, and not a moderator.  I feel I need to clarify that before I add my two cents, especially since the mods here are most knowledgeable about tapers and med dosages.

Here are my two cents: Don't add Pepcid.  You're just adding yet another pill, even if it seems innocuous.  I was unlucky enough to be under the care of Kaiser doctors when my psych medication side effects and psych med withdrawal happened, and the horrors of what happened to me are directly the fault of Kaiser doctors.  Almost NO doctors know spit bout psych med dangers, but Kaiser doctors know the absolute least.  Additionally, the locked-down HMO system that Kaiser runs is a danger because they refuse to refer out or pay out in case you have to go to an expert outside of their system.    

If I were you, I would immediately start looking for doctors outside of Kaiser who are willing to listen about your daughter's case.  That's what I did, and I eventually found two doctors who took the extra step of saying, "We aren't familiar with this, but let us do more research now that we've met you in person."  Those doctors then contacted me and said, "We've looked through medical databases and looked at your medical records, and we have found other cases like yours due to psych meds, and we do believe that you are one of these cases who has been damaged."  So my new docs didn't necessarily know, either, but they did the academically and medically responsible thing by doing research.  Is there any chance you can find doctors like that?  You will be faced with paying out of pocket, because Kaiser will not refer you out and will not pick up your tab when you go out of their network.

I'm not saying that every doctor at Kaiser is awful (because me and my family did get some good care there), but I am saying that when it comes to psych meds they are the pits and their ignorance in this arena is flat-out dangerous.

However, the EBV and liver tests do sound like an okay to me (again, this is my personal opinion).

You are doing everything right so far.  Don't beat yourself up about not knowing about skipping doses.  NOBODY knows about that until we find online support groups!  I didn't know that my doctors were endangering me until it was too late.  I was bedridden, as your daughter is, but I'm no longer that way.  I am mobile and feel joy again.  I'm not an expert in PCOS or depression, but I do know for a fact that having you on her side is a HUGE boon to your daughter.  I'm middle-aged, but am not ashamed to say it was my mommy who saved me when the psych meds started hurting me.  

Share this post


Link to post
Snek

Thanks for your input, WiggleIt

 

I agree with you about Kaiser. I wish we had a better choice. I did not mention it before because I didn't think it was relevant, but I have already hired outside doctors to watch over what the Kaiser doctors are doing. In fact, we would never have checked for EBV had an outside doctor not recommended it. That said, I do not think it is a bad idea to see if reducing stomach acid helps before going into more intrusive tests/endoscopy. My daughter will not tolerate endoscopy well. And that said, she began having constipation (a side effect of Pepcid) last night so I think we're going to just go with Tums instead of Pepcid for now and hopefully avoid having to go down the gastroenterologist route. Her dad has GERD and she is very similar to him in many ways. 

 

When my daughter was born, she was severely intolerant to protein (could not even tolerate breastmilk) and she almost died. If Neocate (a formula made up of pre-digested amino acids that was invented just before her birth) did not exist she would not be alive today. She ate Neocate and nothing else for the first year of her life. Because of her rare condition, I have never been able to find a doctor who understands what is going on. There are no case studies to look at. She was one of 7 in the world with her condition at the time. I have no idea if what is going on now is in any way related to her infancy, but it does throw a kink in the matter. 

 

I was given a recommendation to a Psychiatrist who is supposedly very knowledgable about SSRI withdrawal, but he does not return my calls to make an appointment. I've called 6 times so far. 

 

 

 

 

 

 

Share this post


Link to post
Gridley

Snek,

 

I know you are anxious to get your daughter off the Gabapentin, but I am concerned you are tapering it too fast.  The most recent drop is 33%.  Withdrawal symptoms can be delayed by as much as four months.  Also, as you get to the lower doses, it is even more important to taper slowly.

 

Once you do get her off the Gabapentin, I would wait for three months before beginning the next taper to allow her system to heal and stabilize.

Share this post


Link to post
Snek

Gridley,

I appreciate your input. I am concerned too, but I am also concerned about the effects this drug has been having on her before the tapering began. She is no worse now than when she started tapering Gabapentin. If anything she is better. We are going a lot slower than even the highest paid out of network doctor she has seen recommends. Can you please link to the data/study that shows that withdrawal symptoms from Gabapentin can be delayed by as much as four months? I have not seen this, and I've looked!

 

This is a tough balancing act, and we seem to be damned no matter which course we take. I totally agree with you about waiting for her to stabilize before we start tapering another drug. 

 

 

Share this post


Link to post
ChessieCat

Not sure if this has been mentioned or you know about it:

 

On 5/25/2015 at 12:23 PM, Altostrata said:

Avoid taking aluminum or magnesium containing products (such as antacids) for 2 hours before your gabapentin

 

Share this post


Link to post
Gridley
28 minutes ago, Snek said:

Can you please link to the data/study that shows that withdrawal symptoms from Gabapentin can be delayed by as much as four months? I have not seen this, and I've looked!

 

Snek, I don't know of specific studies about delayed withdrawal symptoms with Gabapentin.  The possibility of delayed symptoms is a general rule when tapering psychiatric drugs.

 

Delayed onset of withdrawal symptoms

Share this post


Link to post
Snek

Gridley,

Thanks. I get what you're saying. What's hard here is that this drug is probably hurting her more while on it. It's like either she is dysfunctional now and for many more months during this taper, or she is dysfunctional now and many more months with another taper. The case studies I have read about Gabapentin withdrawal show problems with cold-turkey that are then rectified by reinstating and then using a taper that it is faster than what we are doing now - with good results. I am hoping that since she has some of her father's other weird neurological and digestive stuff that she will take this withdrawal as well as he did. He stopped a much higher dose of Gabapentin cold turkey a few years ago (not a good idea), had some symptoms of withdrawal, and then went back on it to taper off more quickly than she is now. He was OK with the taper, he feels so much better off this drug in fact, so I hope very much this is the case with her. That said, I will look into tapering more slowly from this point forward.

 

So hard to know what's the right thing to do. I have to admit I feel crazy for listening to strangers online over the many, many doctors she is seeing. Obviously if I trusted these doctors I would not be here. Gah!

Share this post


Link to post
Snek

ChessieCat,

Thanks for the heads up. I did not know this! 

Share this post


Link to post
WiggleIt

Dear Snek,

Delayed withdrawal, like so much of the knowledge in this support group, has been documented by firsthand patient experience that we've all shared with each other over years.  I don't know if any peer-reviewed studies exist about it.  If a delayed withdrawal happens, it can be hard to know if it's the return of original depression or if it's actually delayed withdrawal.  In my case, it was easy to know because I did not suffer from depression before meds (nor did I suffer from any physical problems before psych meds).  Also, my withdrawal hit fairly quickly, within 10 days after stopping meds, so it was obvious.

But I have read a lot of accounts here over the years of people who have become my friends, so I have some personal opinions about how to tell if something is delayed withdrawal.  IMO, if there are new physical symptoms after the psych meds and those physical symptoms did not exist before taking psych meds, then you're definitely looking at delayed withdrawal.  Also, if depression and mental health symptoms reappear worse than they were before psych meds, then it's possibly delayed withdrawal, although this one is a bit tricky because mental illness can sometimes get worse on its own over time even without psych meds in the mix.  But if both things happen together after quitting meds (weird, new, worsened physical symptoms and worsened depression), then it's probably wise to seriously consider that it may be delayed withdrawal.

I have to admit that I'm a bit hesitant to presume too much knowledge in your daughter's case because you said she suffered from severe depression before meds, plus she has PCOS and was born with the severe protein allergy, and those things are totally outside my realm of knowledge.  I may have a bit of a different view than others on this site because I don't think that it's inappropriate for some people with depression and mental illness to take meds, but I do think the meds need to be approached with much, much, MUCH more caution than doctors currently give, and I do think that the meds are overprescribed in this day and age.  Of the people I know in real life who are doing okay with psych meds, they are not on multiple meds at once, and they are also on low dosages.  I can't say what your daughter's future care will look like in terms of psych meds.  I don't know whether it's appropriate for her to be completely unmedicated for depression, but it definitely sounds like she was erroneously turned into a chemistry experiment with all the meds she was given at once. 

Not sure if this will help, but one of my physical therapists has PCOS, and she recommended this book.  She said it helped her a lot:

https://www.amazon.com/PCOS-More-Treatments-Polycystic-Permanently-ebook/dp/B00CMXXNMA/ref=sr_1_20?ie=UTF8&qid=1512660753&sr=8-20&keywords=PCOS+Syndrome
 

Share this post


Link to post
Snek

Dear WiggleIt,

 

Thanks, I get what you're saying about the power of first-hand experience and anecdotal evidence. When my daughter's psychiatrist asked me why I was wanting to give her what he called "homeopathic doses" of Bupropion rather than just stopping it altogether at 37.5mg, I told him it was because the most recent and thorough study done on this topic states that there is not enough research because nobody cares to fund it so the study looked at online community experiences to gather their data (they probably looked at this group, in fact) and that this data recommends a 10% per month taper. The psychiatrist then agreed to call the "homeopathic dose" into the compounding pharmacy. 

 

I suppose I am viewing the Gabapentin separately from the SSRIs she is on, from my personal and anecdotal experience as well as the case studies I've read. So far, she was worse before she began her Gabapentin taper and I hope it stays this way. I am learning that, from my research and from my husband's experience, that the last 300mg is the hardest to stop so instead of simply stopping the drug here we decided to taper by 100mg doses instead. I am open to changing this, though, and am now in the process of researching and heavy thinking before she goes down a level again. There's a lot to consider with her overall condition considered.

 

Last night, she had some insomnia which I think is normal when people drop a dose of Gabapentin. She did end up sleeping, though. I've read that Melatonin is helpful for Gabapentin withdrawal, but it is not recommended with Fluvoxamine (which she is on) so that stinks. Drugs.com says that the Fluvoxamine increases the effects of Melatonin. I'm thinking about maybe microdosing melatonin if things get bad with her sleep. She is currently sleeping around 18 hours a day, though, so I don't think she needs it now. 

 

Thanks for the book recommendation. As a PCOS sufferer myself, I am extra interested! 

 

Best,

 

Snek

 

 

Share this post


Link to post
Altostrata

Hello, Snek.

 

22 hours ago, Snek said:

Tonight she is tapering from 300mg Gabapentin to 200mg. We are tapering at a much slower pace than her doctors want. They are pushing for faster since her symptoms might be a reaction to the Gabapentin in the first place. She has not seemed to have any problem with going from 900mg to 300mg in a little over a month. Her problem with major fatigue really did seem to begin after she started taking Gabapentin.

 

Fatigue is a very well-known adverse effect of gabapentin. At one time, there was a fad in prescribing gabapentin for just about anything. Some doctors are still stuck in this fad. Worse, many doctors are not versed in recognizing adverse effects of any psychiatric drug, much less the combinations.

 

Also poorly recognized, withdrawal symptoms in general have not been studied in the long run. This is an area of deep mystery in medicine. That is why you don't seem to find answers. Very few doctors know anything about tapering or withdrawal. That is why this site exists.

 

What we see here is the nervous system adapts to a drug cocktail, even if the drug cocktail does nothing good. The adaptation affects many systems and hormones. When the drug is withdrawn, the nervous system does its best to chug along.

 

Initially, faltering might be attributed to stress or flu or whatever. It can take a while for the nervous system to fall into a clear state of new dysfunction, which is what we would call withdrawal syndrome. This is why we advise an observation period of a month between dosage reductions. If you make another reduction during a slow crash, it will make the crash worse.

 

We don't make any distinctions between gabapentin withdrawal symptoms and any other drug. We've had people here with severe withdrawal from all of them.

 

As your daughter was put on an irresponsibly large dose of gabapentin for her size (along with the rest of a ridiculous cocktail), it could be that 400mg represented an over-saturation of the drug. A cut to 300mg may still maintain saturation. We don't know if 200mg provides the same degree of saturation. She will get withdrawal symptoms when her nervous system senses a destabilization in dosage.

 

To see how your daughter is tolerating what can be a dramatic change in dosage, please keep daily notes on paper about her symptoms, when she takes her 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.

 

If everything else remains constant and her symptom pattern worsens after the gabapentin reduction, the reduction probably was too much. You may be able to stop the withdrawal symptoms with a slight updose, to 225mg for example. It's best if withdrawal symptoms are caught early, so you'll want to keep notes every day.

 

Please let us know how your daughter is doing.

 

PS There's no problem taking a bit of melatonin with fluvoxamine or any other SSRI. Melatonin dosing starts at 0.25mg-0.33mg; use lowest efffective dose and don't overdo it. Melatonin works best if you take it at nightfall and turn off all the lights. Don't expect miracles from it, what it does is initiate sleep. It has a half-life of only a few hours, it's not a sleeping pill.

Share this post


Link to post
WiggleIt

Totally unrelated: It's adorable that your daughter calls snakes "sneks."  I'm not a snake person at all, but I find that endearing.  I'm a lover of rats and mice (a.k.a. ratsies and micies), the poor, little innocent prey of sneks :blink:

Share this post


Link to post
Snek

Thank you, Altostrata, for taking the time to explain the mechanism and logic behind your advice. Tonight we bumped her back to 300mg. She was only on 200mg for one day. I will keep her here for another week and a half to make it a full month. In this time I can hopefully figure out a good plan with a good doctor. I am going to let her current psychiatrist know what you said. He seems like an open minded guy who cares. He is just concerned about her depression spiraling out of control, and I can't blame him. He had nothing to do with her getting on these drugs. 

 

I wish that her bloodwork was not showing EBV. If she is having a relapse of mono, then this would explain the fatigue. It's confusing. 

 

My fear is that I am going to keep her on a poison longer than she needs to be on it, unnecessarily. At the same time I fear that tapering too quickly will make her worse. I just joked with my husband that I need an antidepressant to combat the depression and anxiety I am experiencing now! (Please know I am not making light of mental illness - I have been diagnosed with Generalized Anxiety Disorder, PTSD, and Depression myself - I just never wanted to try medications for it. I resisted allowing my daughter to try them for many years...until it got so bad that she begged to try them while her previous doctor and previous psychiatrist told me it was an emergency situation and she needed these meds desperately. She was nearly an adult at the time, I caved...and I regret it). 

 

Best,

Snek

Share this post


Link to post
WiggleIt
6 minutes ago, Snek said:

it got so bad that she begged to try them while her previous doctor and previous psychiatrist told me it was an emergency situation and she needed these meds desperately. She was nearly an adult at the time, I caved...and I regret it)

 

Best,

Snek


Please don't beat yourself up!  We all do the best we can at the time with the information we have.

 

Share this post


Link to post
Snek

I'm a rat person too, WiggleIt - I've kept many as pets and loved them very much. I've never liked snakes, but my daughter has shown me they can be cute and sweet...it just depends on the type and how they were raised. I am now using snakes as a way to give my daughter something to look forward to. I've always said "no way" to her having a snake, but now I am saying that when we move and get settled in 6 months she can have a snake. Every day I ask her to think about what type of snake she wants, what type of set up, finding a good breeder, etc. The mice that she (not I) will feed the snake will be humanely raised and euthanized before feeding. The type of snake she wants, ball python, only eats every few months. 

 

Best,

 

Snek

Share this post


Link to post
Snek

Thanks, WiggleIt, I try not to beat myself up but then I beat myself up!

 

I just read your signature and truly hope that your physical symptoms heal more and more over time. Damn these drugs!

 

Snek

Share this post


Link to post
Carmie

Hi Snek, 

 

I love rats too. I love all animals really. Snakes as well, played with a big python a few months ago when I was down the Coast. So you are getting your daughter one, that’s nice of you despite the fact you don’t really like them. You might end up getting quite attached, you never know.🐍😁

 

I see you’ve been getting some great advice. Please don’t put a calendar on when you will start the tapering again. One should never taper according to a date but according to whether the person has stabilised or not. I know your daughter isn’t doing too bad at the moment, but as was stated withdrawals can sometimes be delayed. I remember once in the past when I didn’t hold long enough and tapered a bit too quickly I got such severe withdrawals about three months or so later.

 

When I’ve accidentally double dosed it has taken much longer than a week n a half to stabilise again. Others, also, when they’ve missed a dose or haven’t taken the whole amount have taken quite a while to stabilise again. Everyone is different though, some recover quickly from mistakes. Don’t worry about the mistakes you’ve made, most of us have done the same thing, especially before we knew how to taper properly.

 

Even once we’ve learnt how to taper properly because our brains are always in lala land it’s easy to make mistakes. You can’t change the past though, we can only move forward. 

 

Hope you have fun when you get your new pet, Sending hugs🤗

 

 

Share this post


Link to post
Snek

Thanks for your input, Carmie, and for the reminder to take this a day at a time! Sound advice. 

 

Update for today: She woke up early with nausea and nightmares this morning, took Tums, went back to bed, got up, ate Tums and breakfast. Tummy feels icky but not nauseous now. She is hoping to feel well enough for a friend to come over later in the day (fingers crossed). I am keeping a written record of her symptoms and times. 

 

I've been wanting to get her to move/walk some, but for the past 11 days our air has been too unhealthy to even try (we're in the SF Bay area). She has asthma, so an attack is the last thing we need!

 

I know everyone here is going through a hard time. I hope that we are all able to find a bit of goodness in today, even if for a moment.

 

Best,

Snek

 

 

 

Share this post


Link to post
Snek

Question:

 

Could my daughter's problems possibly stem from the fact that she is taking 1/8 pills of her Bupropion? She cuts them carefully with a pill cutter. We are waiting for the compounding pharmacy to fill her order, but I am suddenly wondering if maybe this small of a cut (that possibly might not be exact) could be causing the nausea? 

 

And speaking of compounding pharmacies, I am feeling worried that they could mess up her dosage big time or give her the wrong drug or something. Is this an unfounded fear? I have to check myself because I do have Generalized Anxiety Disorder. 

 

Thanks,

Snek

Share this post


Link to post
Snek

OK, I did more research on here and I answered my own question. She could very well be getting uneven Bupropion, so who knows if this is bothering her? I think I am going to follow this video to make a liquid suspension: 

 

 

Is there any reason why this would be a bad idea for Bupropion? I read that it is highly water soluble. I will start doing this for her once I hear back form the pharmacist to double check that this is OK. I am assuming that this does can then be put in OJ. Otherwise, I don't know how I'll get my daughter to agree to take it. 

 

Snek

Share this post


Link to post
Snek

More confusion - the pharmacist will not stand by making a liquid at home. They do not recommend cutting Bupropion, even the immediate release she is on. All of her doctors know we have been cutting this. Anyway, I am off to pick up form the compounding pharmacy now.

 

Snek

Share this post


Link to post
Snek

Just thought I'd update that there have been no changes regarding nausea since she switched to the compounded version of Bupropion. I imagine that if it was the broken pills that were bothering her then a change would be rather immediate, but she still gets nauseous in the wee hours of the morning. We are working with her doctors to rule out other causes, but now I am again suspecting that this is a (common) side effect of Gabapentin because she only takes it before bed and it is mostly during the night and morning when the nausea comes. In fact, the doctors first thought this was "morning sickness" before we ruled out pregnancy. 

 

I am thankful that Tums helps, and that we know to take it two hours away from Gabapentin. 

 

I am thankful that she has a Psychiatrist who is listening and caring and willing to work with and supports a slow taper (even if he does not have all the answers).

 

I am thankful that next week she begins an intensive outpatient program that offers a plethora of behavioral therapies and mindfulness medication. She is severely depressed right now.

 

I am thankful that she is alive.

 

I am thankful that we still have moments each day when we laugh. 

 

I am thankful for our dog, who makes her smile each day. 

 

There's more things I am thankful for as well - 

 

Happy Thanksgiving, everyone!

 

Snek

Share this post


Link to post
Gridley

That's great that there were no negative reactions to the compounded Buproprion.  You now have a consistent source of the drug.

 

Happy Thanksgiving to you, too!

Share this post


Link to post
Snek

Thank you, Gridley! One worry down...and a new worry now - 

 

I am reading about Serotonin Syndrome and worrying that my daughter has this...but I am hoping that my worry is unfounded. She does not have most of the symptoms, but she does have the nausea and she DID have the tremor before we tapered down from the Bupropion. Since the treatment for Serotonin Syndrome would be stopping her drugs cold-turkey, I would not this to be the case...but I am also worried that if she does have SS then she could be hurt more? Everything I've read says that SS occurs within hours of taking a new drug or updosing. She did not start getting nausea until after being on this drugs for around a year. The tremor began pretty soon after, though, but this was listed as a side effects of her meds. 

 

Somebody, please tell me that I am overreacting here.

 

Snek

Share this post


Link to post

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now
×

Important Information

By using this site, you agree to our Terms of Use.