Chziime: tapering off low doses of mirtazapine, Zoloft, Depakote, baclofen, clonazepam

[Chziime]

Moderator note: link to benzo forum thread - Chziime: Taking klonopin daily vs every other day

 

Hi all,

I am a 29-year-old male who found out about this site from a Facebook support group for Mirtazapine withdrawal. I currently take five medications in relatively low doses:
-Mirtazapine 3.75mg (Since 7/2014)
-Depakote 750mg (Since 7/2014)
-Baclofen 15mg (Since 12/2014)

-Zoloft 25mg (Since 6/2015)
-Clonazepam on a scattered schedule of sorts. On average, .25-.375mg every other day (I avoid taking it 2 days in a row).

I'll try to explain this as simply as I can. I have been slowly coming down on Mirtazapine for a long while now, down from an initial dose of 60mg, and I'm on the final, but most difficult stretch. I had actually quit klonopin for a full four weeks this past July, showing that it's possible, but then I came down to 3.75mg mirtazapine from 7.5mg three months ago and "needed" the klonopin again as support. It was just too large of a Mirt jump, but I'm stable on 3.75mg now. In fact, I have a liquid solution of Mirtazapine, 3.75mg/mL, and have been on .85mL for a few days (1 to .9 for 11 days, now on .85 for 3 days).

My questions are...
1. Can I just continue going down by 5% Mirtazapine every 5 days, halting when/if I feel really bad wd symptoms? I know it's wayy faster than you might recommend
2. Should I continue taking klonopin at .25mg every other day, or should I take .125mg every day? The every-other-day has more of an anxiolytic effect per dose, but on days off, I look forward to the next day, perpetrating a psychological addiction. Taking it daily is probably better for a future drop-off, anyway.
3. The big question. After I get off of Mirtazapine, what's next? My intuition tells me Zoloft, especially since I was never on anything more than 25mg. Then Clonazepam, then Baclofen, then Depakote. A stickied topic on this forum says to get off of activators/antidepressants, then benzos, then other depressants.

I DO have herbal/supplemental remedies in mind to help with withdrawals (such as CBD and Black Seed Oil, the latter of which assists with benzo wd and GABA dysregulation). The problem is that these and many other supplements have effects on liver enzymes and can affect Zoloft and Mirtazapine levels, and thus I shouldn't take them until I am off of both Zoloft and Mirtazapine. (Side note - does Depakote metabolize through the CYP450 system?). So I am at a loss of what to do when anxiety gets out of hand, outside of lifestyle practices and some chamomile tea.

I know this is a lot of information, but it seems that everyone has a complicated case. I continue to dread this process and am eager to get it over with. I even took a liiittle extra klonopin (.625mg  ) today to deal with Mirt wd depression and tension.

Lastly - I have some endocrine dysfunction and overall have a sensitive system. This was a sudden issue 3.5 years ago, partially brought on by overmedicating, I think. I need to get off meds in order to allow my system to self-regulate, but the sensitivity makes it difficult to come off of! As I've said, coming off of klonopin was never too much a problem, but I am definitely psychologically addicted to it. I just don't want to make my situation worse...

Thank you for any advice!!!
 

Edited December 17, 2018 by Shep

[SkyBlue]

Hello Chz, and welcome to SA.

 

Please help us out by completing a brief "drug signature" including your recent history and dosage changes. List format, organized by date, is best. (You've given most of this info here; having it in a signature will show relevant information each time you post.) https://www.survivingantidepressants.org/topic/18343-please-put-your-withdrawal-history-in-your-signature/

 

 

How long had you been tapering the Mirt? Have you done 5% every 5 days all along? Yes, that is much faster than we recommend. I really wish these drugs weren't so dangerous to taper as fast as doctors tell us to. 10% really is the best way to go. With some exceptions, there are no "free rides," and we also can't recommend just slowing down when symptoms arise. It can take time for symptoms to arise, then it can be difficult to stabilize. We also don't recommend every-other-day dosing. 

 

21 hours ago, Chziime said:

I have some endocrine dysfunction and overall have a sensitive system. This was a sudden issue 3.5 years ago, partially brought on by overmedicating, I think. I need to get off meds in order to allow my system to self-regulate, but the sensitivity makes it difficult to come off of!

Wow, I hear that. Totally. I don't think I've heard it phrased exactly that way before, so what you wrote actually helps me as well (I'm also super-sensitive), so thank you. 

 

A couple of more things: 

 

1. Is there a reason you're on such low doses? It's good -- the less meds, the better, of course. I am just wondering if you had tapered down to those low levels, or had been on those doses the entire time.

 

2. As far as supplements go, we generally only recommend magnesium and fish oil, and starting slow with those. CBD is usually a no while tapering.

 

After you're done with Mirt, which I encourage you not to rush, there will be some time to stabilize, then we can look at which drug to taper next. 

Please keep notes on paper on your daily doses (including time you take each drug) and your symptom pattern.

[SkyBlue]

21 hours ago, Chziime said:

So I am at a loss of what to do when anxiety gets out of hand, outside of lifestyle practices and some chamomile tea.

I know this is a lot of information, but it seems that everyone has a complicated case. I continue to dread this process and am eager to get it over with. I even took a liiittle extra klonopin (.625mg  ) today to deal with Mirt wd depression and tension.

 

Here is a useful thread for coping with withdrawal anxiety and depressed mood:

https://www.survivingantidepressants.org/topic/1112-non-drug-techniques-to-cope-with-emotional-symptoms/

 

Developing an attitude of patience is also very important (very difficult, but can be done). This is a marathon, and the slower we go, the gentler it is on our nervous systems.

[Chziime]

17 minutes ago, SkyBlue said:

Wow, I hear that. Totally. I don't think I've heard it phrased exactly that way before, so what you wrote actually helps me as well (I'm also super-sensitive), so thank you. 

 

A couple of more things: 

 

1. Is there a reason you're on such low doses? It's good -- the less meds, the better, of course. I am just wondering if you had tapered down to those low levels, or had been on those doses the entire time.

 

2. As far as supplements go, we generally only recommend magnesium and fish oil, and starting slow with those. CBD is usually a no while tapering.

Ah, thank you! I'll add my signature now. For some reason, I couldn't figure it out, even though I work with technology.

I don't seem to react well to fish oil supplements - a histamine reaction, perhaps, but I haven't tried it in a while. I try to eat a fair amount of wild salmon and organic beef for Omega 3s.

I am on such a low dose of Mirtazapine because I came down from 60mg over the course of, I don't know, 2.5-3 years? It feels like I was on 60mg and eventually 15mg the longest.
Zoloft, I was put on 25mg to help with POTS, body pain, and related anxiety. It seemed to have done the trick at the time, pushing me towards even a slight normalcy. Depakote I was put on for anxiety (actually, initially to deal with side effects of 60mg Remeron!!) - I am not bipolar. Lastly, Baclofen I was on 30mg for a while - anything more made me dizzy, and I much later casually weaned down to 15mg because it seemed to worsen some of my physical symptoms (dizziness, shortness of breath, etc). But Baclofen was the nail on the coffin on awful OCD at the time.

 

[SkyBlue]

You're welcome. Thanks for completing the signature. 

 

How do you feel about going at 10%/month for tapering the M?

 

Here is more info: 

 

https://www.survivingantidepressants.org/topic/1024-why-taper-by-10-of-my-dosage/

 

[Chziime]

30 minutes ago, SkyBlue said:

How do you feel about going at 10%/month for tapering the M?

 

 

I'm not sure. I of course have mixed feelings. On the one hand, I successfully went from 7.5mg to 3.75mg in one jump, and the withdrawal symptoms (dizziness, depression) went away after 1.5 months, after which I seemingly returned to baseline. I know it is more difficult with lower doses, but I went from 1mL (3.75mg) to .8mL in just 16 days. I am having some withdrawal symptoms like increased anxiety/irritability, dizziness, head pressure, body stiffness, itchy skin, but it all feels so... manageable. I don't know, maybe I'm just so used to withdrawals, but I know it's still hard on my nervous system.

A major part of my impatience is that I am VERY eager to undergo ketamine infusions again, for once while I am not juggling medications. The last time (and not the only time) I had them, I was only 1 week out from a Mirt drop at a higher dose, so the infusions' benefits were confounded and blunted. I also am very eager to take supplements to manage my symptoms that are largely unrelated to medications (such as the aforementioned CBD, Black Seed Oil, Tulsi, Spirulina), but I know that's a no-no while withdrawing.

On my current plan, I will be at .75mL at the end of the week. I think I'm hold there and see where it takes me... does this all sound reasonable, or...?

[Chziime]

Quick question...

At the moment, I take klonopin .375mg every other day. Sometimes, if I'm feeling especially lost or depressed, I would take up to .5mg. Never more, and very rarely, if ever, do I take it at all two days in a row.

Will this be a problem once the time comes to wean off of klonopin, or is it still a pretty low dose? As I might have said, when other meds are the same, I don't have tooo much of a problem minimizing klonopin. In fact, I'm not sure if I've ever gone through real klonopin withdrawals, and I'm taken it on and off for 10 years.

I guess what I want to hear is, "One thing at a time, you'll be fine. Think about that when the time comes." Sigh!!!

[Chziime]

Hi all,

I am on the final stretch of my Mirtazapine taper, currently taking 65% of a 3.75mg liquid solution (but as you can see in my signature, I have a little ways to go after that with other meds).

When I was on 7.5mg/day, I successfully steered clear of klonopin for an entire month, but when I went down to 3.75mg, I needed scattered doses (rarely two days in a row) ranging from .25 to .625mg to deal with the wd anxiety for at least a month. Eventually, I came to a steady schedule of just taking klonopin every other day in .37mg doses (a dose at which, if I was stable on everything else, I could drop cold turkey quite easily). However, as I continued to lower my mirtazapine dose, I took more and more klonopin. The past 3 days I took .5mg klonopin. I do not by any means NEED it, I won't withdraw from it if I miss a day, but hell, do I crave it in these states. It's no coincidence that I was initially put on mirtazapine to deal with cravings, too.

This is beginning to cause me distress as I become disappointed with myself for increasing my klonopin intake and fear how it may be when I have to come off of it eventually. I've dropped it several times before, and frankly have never had anything more than a mild acute withdrawal, but it still worries me. Does anyone have any advice about what to do in these states when I feel mirtazapine (and soon zoloft) withdrawal depression, feeling like nothing "sticks" or "flows" in the mind without an assistant? Feeling like all I do is find ways to pass time? Feeling like an intellectual or artistic failure in moments of weakness?

I DO otherwise take good care of myself. I eat a 100% paleo diet, I do yoga and meditate, I take cold showers, and I go on long walks to help pass the time in a healthful way. It's not like my mind is in the wrong place. Klonopin is the only straggling habit that I can't seem to shake, and it's been entirely exacerbated by this mirtazapine withdrawal.

Thank you for listening. I'm sorry if anything has been repetitive - I tried to write as honestly as I could while both under the influence of my (admittedly low) dose of klonopin and the emotional turmoil of mirtazapine withdrawal. Thank you all

[Shep]

On 11/10/2018 at 6:42 PM, Chziime said:

This is beginning to cause me distress as I become disappointed with myself for increasing my klonopin intake and fear how it may be when I have to come off of it eventually. I've dropped it several times before, and frankly have never had anything more than a mild acute withdrawal, but it still worries me. Does anyone have any advice about what to do in these states when I feel mirtazapine (and soon zoloft) withdrawal depression, feeling like nothing "sticks" or "flows" in the mind without an assistant?

 

Please see:

 

Non-drug coping techniques

 

On 11/10/2018 at 6:42 PM, Chziime said:

When I was on 7.5mg/day, I successfully steered clear of klonopin for an entire month, but when I went down to 3.75mg, I needed scattered doses (rarely two days in a row) ranging from .25 to .625mg to deal with the wd anxiety for at least a month. Eventually, I came to a steady schedule of just taking klonopin every other day in .37mg doses (a dose at which, if I was stable on everything else, I could drop cold turkey quite easily). However, as I continued to lower my mirtazapine dose, I took more and more klonopin. The past 3 days I took .5mg klonopin. I do not by any means NEED it, I won't withdraw from it if I miss a day, but hell, do I crave it in these states. It's no coincidence that I was initially put on mirtazapine to deal with cravings, too.

 

Please note it only takes 2 - 4 weeks to develop a benzo dependency, even with periodic use. The half-life of Klonopin is 18 - 50 hours, so depending on how long it takes you to metabolize it, you may have enough in your system that you develop dependency, even with periodic use. 

 

The symptoms of AD and benzo withdrawal are very similar.

 

 In this article in "The Guardian," Dr. Peter Gøtzsche writes:

 

I began to realise the scale of the problem when I was persuaded seven years ago to become a tutor for a PhD thesis on whether history was repeating itself, by comparing benzodiazepines ("mother's little helper") with SSRIs. This research has established that people get as hooked on SSRIs as they did on benzodiazepines, and 37 of 42 withdrawal symptoms were the same for SSRIs as for benzodiazepines.

 

      The full article is here:  Psychiatric drugs are doing us more harm than good

 

      And here is the study in the PubMed database:

 

      What is the difference between dependence and withdrawal reactions? A comparison of benzodiazepines and selective serotonin re-uptake inhibitors.

 

Please start a drug and symptoms journal in this format:

 

Drug and Symptoms Journal Format

 

Also include supplements and the hours your sleep at night. 

[Altostrata]

Hello, Chz --

 

Why are you taking Depakote and Baclofen? What is your "endocrine dysfunction"? What was the "sudden issue 3.5 years ago"?

 

How was your need for thyroid hormone determined? When was the last time you had a liver and kidney function blood test?

 

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.

[ChessieCat]

This is an example:

 

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

[Chziime]

3 hours ago, Altostrata said:

Hello, Chz --

 

Why are you taking Depakote and Baclofen? What is your "endocrine dysfunction"? What was the "sudden issue 3.5 years ago"?

 

How was your need for thyroid hormone determined? When was the last time you had a liver and kidney function blood test?

 

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.

Hi,

Here is my drug interactions list:
https://www.drugs.com/drug_interactions.php?drug_list=318-0,918-0,3906-0,1640-0,2057-0,1173-10624,2189-4139&interaction_list_id=183205809

I began Depakote to initially help the irritability side effects of Mirtazapine. I began baclofen for anxiety. Some progressive psychiatrists use it for anxiety/addiction according to newer research.

My endocrine dysfunction, as I call it, is hypothyroidism (diagnosed by TSH and Free T3 tests - I also had antibodies last I checked) and low cortisol (diagnosed by 4x/day salivary cortisol test). I am going to retake the cortisol test once I'm off mirtazapine, which lowers cortisol.

Which tests are the liver/kidney tests? I regularly have gotten CMP and CBC, and they're always fine.

3.5 years ago, I was at a job and suddenly had what felt like a panic attack. Some pretext - I was also on clonidine at the time, taking a pretty high dose (.4mg that day, up from .2, to deal with acute nicotime withdrawal). I also took various adaptogenic herbs on top of the prescriptions, and I worked out a LOT. Lastly, I had some strong relationship stress. So... my body had a lot of things going against me. That one day, I had a nicotine lozenge in my mouth and got the panic attack as I was leaving to go home. I waited it out as usual, but nothing changed. I literally could barely breathe and felt like I was going to faint, had to constantly urinate, etc, and soon realized it was more than "just a panic attack." For the next couple year or so, I had POTS, awful tension/pain/anxiety, even cardiomyopathy... said to have been caused by a virus, but I'm sure the overload of meds (especially clonidine and baclofen) and possible acute adrenal crash didn't help. It's a long story, way too much to accurately type out here, but I've been recovering and I'm relatively active these days. I still have some heart palpitations and skipped beats, but don't really worry about it. I just need to get off all meds to truly get a baseline and allow myself to heal............

Sorry for the messy/scatterbrained post. I'm a bit stressed because I was in a snowy car accident a couple hours ago. It wasn't my fault at all, and I myself am not hurt, but hey... I handled it very well for someone in Mirtazapine withdrawal!

[Altostrata]

Sorry to hear you've been rattled by a car accident. I hope you're okay.

 

The incident 3.5 years ago sounds like an interaction or an adverse reaction to the various supplements you were taking, plus nicotine withdrawal.

 

If all of those drugs were prescribed by one psychiatrist, I would not call that physician "progressive" but "prescription-happy." Somebody is not paying attention to drug-drug interactions, as you can see in your interactions report, as some of your symptoms might be caused by those interactions. They can mimic or cause dysautonomia.

 

If one is having an adverse effect to a drug such as mirtazapine, the correct medical response is to reduce dosage or discontinue it, not to add a highly risky drug such as Depakote.

 

Depakote requires periodic liver and kidney function tests. LIver and kidney function panels also are among the blood tests one would get in a thorough annual checkup.

 

TSH and T3 are not sufficient to diagnose hypothyroidism. Antibodies only indicate a potential hypothyroid condition. One might have test results out of range for decades (as I do) and never develop symptoms of hypothyroidism. We have lots of people here who are taking thyroid hormone unnecessarily, especially since they're reporting mysterious symptoms in the context of polypharmacy. Across the board, doctors are poor at recognizing adverse effects of drugs.

 

Too-high dosage of thyroid hormone can cause anxiety, restlessness, and sleeplessness. It is stimulating.

 

What is your drug schedule? Do your symptoms follow any daily pattern? What is your sleep pattern? When do you get palpitations? Please keep daily notes on paper about your symptoms, when you take your drugs, and their dosages. Use a simple list format with time of day on the left and notation (symptom, drug and dosage) on the right.

 

Are you taking ginger because you have spells of nausea?

[Chziime]

6 minutes ago, Altostrata said:

Sorry to hear you've been rattled by a car accident. I hope you're okay.

 

The incident 3.5 years ago sounds like an interaction or an adverse reaction to the various supplements you were taking, plus nicotine withdrawal.

 

If all of those drugs were prescribed by one psychiatrist, I would not call that physician "progressive" but "prescription-happy." Somebody is not paying attention to drug-drug interactions, as you can see in your interactions report, as some of your symptoms might be caused by those interactions. They can mimic or cause dysautonomia.

 

If one is having an adverse effect to a drug such as mirtazapine, the correct medical response is to reduce dosage or discontinue it, not to add a highly risky drug such as Depakote.

 

Depakote requires periodic liver and kidney function tests. LIver and kidney function panels also are among the blood tests one would get in a thorough annual checkup.

 

TSH and T3 are not sufficient to diagnose hypothyroidism. Antibodies only indicate a potential hypothyroid condition. One might have test results out of range for decades (as I do) and never develop symptoms of hypothyroidism. We have lots of people here who are taking thyroid hormone unnecessarily, especially since they're reporting mysterious symptoms in the context of polypharmacy. Across the board, doctors are poor at recognizing adverse effects of drugs.

 

Too-high dosage of thyroid hormone can cause anxiety, restlessness, and sleeplessness. It is stimulating.

 

What is your drug schedule? Do your symptoms follow any daily pattern? What is your sleep pattern? When do you get palpitations? Please keep daily notes on paper about your symptoms, when you take your drugs, and their dosages. Use a simple list format with time of day on the left and notation (symptom, drug and dosage) on the right.

 

Are you taking ginger because you have spells of nausea?

Yes, although I respected the doctor, he was very prescription-happy.

I am sure that my dysautonomia symptoms will get better once I'm at least off Baclofen, but that one will come close to last, Remeron and Zoloft first...

I had a Depakote liver (and maybe kidney?) test once, and Depakote levels were below the range. I take a relatively low dose. I'm sure I'm fine on that front.

How would you diagnose hypothyroidism? I didn't ONLY get TSH and T3... also Free T4, Total T3/4, Reverse T3, everything recommended on StoptheThyroidMadness. Several months after my incident, my TSH jumped up to 7. In the past, it was always perfectly low in the range. I definitely had symptoms of hypothyroidism, but while increasing my Naturethroid dose, yes, I did become quite agitated while adjusting from 1gn to 1.5gn/day. The healing over time allowed me to make that increase. I don't know...

I take NatureThroid 1gn in the AM, .5gn at 3pm
Baclofen 3x/day, 5mg in AM, 5mg at noon, 5mg at 4pm
Depakote, Zoloft, and Mirt at night.

I'm not in the place right now to consider my symptom patterns, sorry. Nothing really comes to mind. I don't think I get palpitations at any specific time - it's hard to say, especially now that I'm in Mirt wd. I feel best in the later morning after taking NatureThroid and just chipping away at work/chores at home.  I eat dinner between 8-9pm, go to bed between 11-12 (with blue-light blocking goggles), but sometimes get slightly agitated from taking Remeron at night. I wake up around 8 and have trouble getting up, so I typically get up around 9. Lately, due to Mirt wd, I've been waking up early, like 7.

I have kept a drug/activity Excel sheet for years, but it doesn't yet go into the detail displayed on the above example.

I take ginger daily because it helps me digest the large meals I tend to eat, and just general stomach health and antiinflammation. It also is good for the mild nausea caused from Mirt wd.

[Altostrata]

Please get liver and kidney function tests. Even if they were once normal, the drugs tend to be wearing over time.

 

I need to know your drug schedule and symptoms before and after you take your drugs. Please keep daily notes on paper about your symptoms, when you take your drugs, and their dosages. Use a simple list format with time of day on the left and notation (symptom, drug and dosage) on the right.

[Chziime]

1 hour ago, Altostrata said:

Please get liver and kidney function tests. Even if they were once normal, the drugs tend to be wearing over time.

 

I need to know your drug schedule and symptoms before and after you take your drugs. Please keep daily notes on paper about your symptoms, when you take your drugs, and their dosages. Use a simple list format with time of day on the left and notation (symptom, drug and dosage) on the right.

It seems that liver and kidney tests are part of the CMP (Comprehensive Metabolic Panel), which I get every few months. Unless the standard ranges are inaccurate, they're always fine. I actually took a recent draw just 2 days ago.

[Chziime]

I am curious whether it's reasonable to lower Depakote from 750 to 500mg/day after dropping Remeron, but BEFORE dropping Zoloft, Klonopin, and Baclofen. The reason for this is because Depakote has some minor metabolic side effects, including slight food cravings. My only concern is that remaining on Depakote at 750mg would be a decent tool to deal with the more difficult withdrawals. What do you think? Is Depakote typically easier to wean off of?

 

[Chziime]

I have a symptom journal...



12/15

No Klonopin

Reduce remeron dose from .60 to .55mL (55% of 3.75mg) after 5 weeks on .60mL

 

12/16

.5mg Klonopin at 3pm

.125mg Klonopin at 8pm

Slept at 1am, unusually late for me

 

12/17 - BEGIN WRITING JOURNAL

7?am - Wake up for a few seconds

8am - Wake up. Mild nausea. Groggy and depressed, not feeling like getting out of bed.

8:30am - Get up. Take 65mg Naturethroid and 5mg Baclofen. Jump and shake body a little.

8:45am - Begin working on computer at home.

9:30am - Food (3 Brazil nuts)

11:30am - Finish work.Feel stiff, eyes heavy.

11:45am - Breathwork

1:30 - Food

2:00 - Take 5mg Baclofen, Ginger root capsule, Epsom Salt bath.

3:00 - Feel mild irritability, shortness of breath, and dizziness

4:00 - Take 32.5mg NatureThroid. Chiropractic treatment.

5:30 - Take 5mg Baclofen

8:00 - Some anxiety, stomach issues

8:30 - Dinner

10:30 - Go to bed and talk to friend, Take Depakote, Zoloft, Remeron, 200mg Magnesium Glycinate

11:30 - Go to sleep

No klonopin today

 

12/18

8:30 - Get up after some paranoid dream states. Take 65mg NatureThroid, 5mg Baclofen

9:00 - More energy, mild nervous energy

11:00 - Take .25mg klonopin

11:30 - Eat

12:45 - Eat, Take Ginger capsule, 5mg Baclofen

2:30 - Emotional stress

3:00 - Take .25mg klonopin

3:45 - Take 32.5 NatureThroid

5:00 - Takle Baclofen

6-9 - Drive, feel stiff, stomach issues, anxious

9:30 - Eat large salad, Take Depakote

11:15 - Take Zoloft, Remeron, 200mg Magnesium

11:30 - Go to bed

 

12/19

7:00 - Wake up, fall back asleep

9:00 - Wake up

9:15 - Get up. 65mg Thyroid and 5mg Baclofen. Groggy.

9:45 - Breathwork. Chest tightness and some obsessions.

12:00 - Lunch (Avocado, broccoli, bacon)

12:30 - Baclofen 5mg

2pm - Chamomile/Peppermint tea

4pm - NatureThroid

4:30 - Increased energy, almost hypomanic. Not uncomfortable. Baclofen 5mg.

6:30 - Anxiety

7:30 - Yoga. Feel better.

9:30 - Depakote 500mg

11:15 - Depakote 250mg, Zoloft, Remeron, 200mg Magnesium

11:30 - Go to bed. Some weird brain sensations (often after taking drug cocktail)

No Klonopin today

 

12/20

Vivid dreams

7:45 - Wake up

7:55 - NatureThroid 65mg

8:10 - Get up. Some grogginess. 5mg Baclofen, .25mg Klonopin (beginning plan of .25mg every day instead of .5mg every other day)

9:15 - Sun lamp for 20 min

9:40 - Increased energy

11:00 - Shortness of breath, some nervous energy

11:45 - Food

12:00 - Baclofen 5mg

Continued nervous energy

12:45 - Chiropractic

Feel a bit better. High blood pressure revealed at doctor.

3:00 - NatureThroid 32.5mg

4:15 - Baclofen 5mg

4:30 - Yoga

6:00 - Feel better

7:30 - Eat

8:15 - Kind of depressed

9:15 - Take 750mg Depakote, Zoloft, Remeron (lower to .50mL from .55), 200mg Magnesium

10:30 - Body stiffness. Go to sleep.

 

12/21

2:00am - Wake up, fall right back asleep

7:50 - Wake up to dawn alarm clock

8:00 - Get up. Take 65mg NatureThroid, 5mg Baclofen, .25mg Klonopin

8:20 - Feel alright. Mild nervousness, not uncomfortable.

9:15 - Breathwork

10:15 - Carrying heavy equipment for work

11:00 - A little sore, nauseous

11:30 - Eat (small meal)

11:45 - Mild GI upset, soreness

12:00 - Baclofen 5mg

3:00 - NatureThroid 32.5

3:45 - Eat

4:30 - Baclofen 5mg

12:30 - Take Depakote, Zoloft, Remeron (.50mL), 200mg Magnesium, go to bed

[Altostrata]

12 hours ago, Chziime said:

10:30 - Go to bed and talk to friend, Take Depakote, Zoloft, Remeron, 200mg Magnesium Glycinate

 

Please include dosage of the 3 drugs.

 

Do you eat Brazil nuts often? Why do you get a CMP every few months?

 

Since you were put on Depakote for Remeron side effects, since you lowered Remeron, it would seem you no longer "need" it. A 10% reduction of Depakote would be 75mg, if I were you, I'd reduce that nighttime dose. But do not change your Depakote dosing at the same time you decrease mirtazapine -- wait a month between drug changes.

 

You're taking such a strange basket of drugs, I'm not surprised you get "Some weird brain sensations (often after taking drug cocktail)."

 

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.

 

On 11/15/2018 at 4:28 PM, Chziime said:

I definitely had symptoms of hypothyroidism, but while increasing my Naturethroid dose, yes, I did become quite agitated while adjusting from 1gn to 1.5gn/day.

 

Please keep in mind that too much thyroid hormone can cause sleeplessness, nervousness, etc. Your need for thyroid hormone can change.

 

 

[Chziime]

19 hours ago, Altostrata said:

Do you eat Brazil nuts often? Why do you get a CMP every few months?

 

Since you were put on Depakote for Remeron side effects, since you lowered Remeron, it would seem you no longer "need" it. A 10% reduction of Depakote would be 75mg, if I were you, I'd reduce that nighttime dose. But do not change your Depakote dosing at the same time you decrease mirtazapine -- wait a month between drug changes.

 

You're taking such a strange basket of drugs, I'm not surprised you get "Some weird brain sensations (often after taking drug cocktail)."

 

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 keep in mind that too much thyroid hormone can cause sleeplessness, nervousness, etc. Your need for thyroid hormone can change.

I eat a few Brazil nuts every day, but actually stopped a few days ago due to concerns over mold and very variable Selenium amounts. I will get my Selenium rechecked in a couple months and possibly just supplement Methylselenocysteine instead.

My previous doctor ordered a CMP with every blood panel I ever got. I don't know why!

Yes, I think Depakote will be next after Remeron because of its metabolic side effects.

I was prescribed this cocktail by a very progressive psychiatrist, and I'm very, very used to people telling me it's strange I do feel like even though he prescribed a lot of well-studied supplements, herbs, and lifestyle modalities, he did indeed overprescribe medications at time. It doesn't matter - only forward.

https://www.drugs.com/interactions-check.php?interaction_list_id=183205809&drug_list=318-0,3906-0,1173-10624,2189-4139,2057-1348,1640-1015,918-483&types[]=major&types[]=minor&types[]=moderate&types[]=food&types[]=therapeutic_duplication

I am aware about thyroid levels changing over time in regards to all of this, and I will continue to get that checked every few months. Thank you!!

[Chziime]

Continued:

 

12/22

Vivid dreams

8:30 - Wake up

8:50 - Get up. Take 65mg NatureThroid, 5mg Baclofen, .25mg Klonopin

9:10 - Feel fine. A bit tired from going too sleep late.

Mostly a leveled day. Went on a walk and saw family and friends. Didn't record in journal. Meds are the same. Went to sleep late, at 1:30.

 

12/23

9:50 - Wake up

10:15 - Get up, 65mg Thyroid, 5mg Baclofen, .25mg Klonopin

Feel fine, a bit tired from sleeping late. Feel a mild Remeron wd fogginess, but not uncomfortable.

10:45 - Breathwork

11:30 - Eat

2:30 - 5mg Baclofen

2:30 - Eat

Still feel fine. Minor sensitions of Remeron wd, but still not uncomfortable.

3:00 - Walk

4:30 - 32mg Thyroid

5:00 - 5mg Baclofen

10:30 - .45mL Remeron (down from .50), 25mg Zoloft, 750mg Depakote, 200mg Magnesium

11:15 - Go to sleep

Didn't fall asleep right away, woke up once at night but don't remember how long. Probably 7-7.5 hours of sleep

 

12/24

8:15 - Get up. 65mg Thyroid, 5mg Baclofen, .25mg Klonopin

Feel a little confused from imperfect sleep, less Remeron.

9:00 - Chiropractic

10:15 - Eat

10:30 - Breathwork

11:15 - About to leave to Christmas family gathering. Feel fine. Any possible w/d seems balanced.

12:00 - Baclofen 5mg

3:00 - Thyroid 32mg

5:30 - Baclofen 5mg, Eat

8:00 - Dizzy, tired, eye strain, foggy. Mild, bearable Remeron wd

10:00 - .45mL Remeron, 25mg Zoloft, 750mg Depakote, 200mg Magnesium

10:30 - Go to sleep

11:15 - Go to sleep

 

12/25

Wake at 8:00

Have sensations of mild fear.

Get up at 8:45. Take Thyroid, 5mg Baclofen, .25mg Klonopin

10:00 - Eat

10:45 - Yoga

12:00 - 5mg Baclofen

12:30 - Breathwork

3:30 - Eat

4:30 - Dizzy, lying down

5:00 - 5mg Baclofen, Thyroid

7:00 - Home from Christmas. Still disoriented, a bit tired.

8:00 - Eat

12:30 - Take Depakote 750, Remeron .45mL, Zoloft 25mg, Magnesium 200mg, Go to bed

 

12/26

9:00 - Wake up, some anxious dreams

9:30 - Get up. Feel tired and disoriented. Take Thyroid, 5mg Baclofen, .25mg Klonopin

12:30 - 5mg Baclofen

2:00 - Feel a little grumpy

2:30 - Walk

3:50 - Take Thyroid

4:45 - Eat

5:10 - 5mg Baclofen

7:30 - Yoga

Had dizzy spell towards end of yoga. Uncoordinated eyes as well.

9:30 - Eat

11:40 - Depakote 750mg, Zoloft 25mg, Remeron .40mL (decrease), Magnesium 200mg

12:00 - Go to bed

 

12/27

7:45 - Wake up

9:30 - Get up. Feel very drained, took a while to get up. Take Thyroid, 5mg Baclofen, .25mg klonopin

10:40 - Chiropractic

12:45 - 5mg Baclofen. Still feel a bit irritable, grumpy. Eat.

1:30 - Walk

4:30 - 5mg Baclofen, Yoga

Spent time with friends

10:30 - Eat

1:00 - Zoloft 25, Remeron .40mL, Depakote 750mg, Magnesium 200mg

1:15 - Bed

 

12/28

Wake a couple times in the morning

Get up 10:00. Take Thyroid, 5mg Baclofen, .25mg Klonopin

1:30 - Eat

2:10 - 5mg Baclofen

Extra .25mg Klonopin

11:30 - .40mL Remeron, 25mg Zoloft, 750mg Depakote, 200mg Magnesium

 

12/29

Took some time to fall asleep, woke up once.

9:00 - Get up, feel a bit loopy and mildly depressed. Take Thyroid, 5mg Baclofen

10:00 - Take .25mg Klonopin

2:00 - 5mg Baclofen. Feel depressed.

2:15 - Bioenergetics, breathwork

2:50 - Take Thyroid, .25mg Klonopin





I'm starting to feel the depressive effects of my relatively quick Remeron taper (lower 5% of 3.75mg every 3 days). It FEELS right, though... I don't feel any major discomfort, stress, damage... just the better-than-expected sleep and mood disturbances. The past couple days I had a bit extra klonopin (.5mg instead of .25mg), but I won't make that a habit.

[Altostrata]

On 12/23/2018 at 1:58 PM, Chziime said:

I was prescribed this cocktail by a very progressive psychiatrist

 

Progressive, LOL

 

On 12/23/2018 at 1:58 PM, Chziime said:

https://www.drugs.com/interactions-check.php?interaction_list_id=183205809&drug_list=318-0,3906-0,1173-10624,2189-4139,2057-1348,1640-1015,918-483&types[]=major&types[]=minor&types[]=moderate&types[]=food&types[]=therapeutic_duplication

 

Well, you can see why you might feel off sometimes.

 

Your drug schedule appears to be haphazard. Why do you take Nature Throid twice a day? Dosing of your other drugs varies by hours each day. Inconsistent dosing can cause unpleasant symptoms, it's also important to keep to a regular dosing schedule in order to identify adverse effects.

 

Please identify a daily drug schedule you can stick to and post it here, with dosages.

[Chziime]

On 12/29/2018 at 4:26 PM, Altostrata said:

Your drug schedule appears to be haphazard. Why do you take Nature Throid twice a day? Dosing of your other drugs varies by hours each day. Inconsistent dosing can cause unpleasant symptoms, it's also important to keep to a regular dosing schedule in order to identify adverse effects.

I figure it's easier to have a steadier stream of T3 in the body with twice-a-day dosing. A lot of other people do this, too. What is the issue with that, lapses in consistency?

[Altostrata]

Nature Throid is not the only drug you're taking haphazardly. You're taking all of them on schedules that vary by hours from day to day, you're taking different drugs in combination on various days.

 

You're taking a potentially dangerous drug cocktail. In order to interpret your symptoms and see if you're having any adverse reactions from drugs, we have to see a consistent schedule and a record of symptoms before and after each dose. To track a drug effect, it's best if batches of drugs are not taken at the same time -- you can't tell which drug is causing the adverse reaction.

 

What symptom are you chasing with this hodgepodge of drugs?

 

What is a drug schedule you can stick to?

[Chziime]

After 2.5 years on only 25mg Zoloft, I got a liquid solution and went down to 20mg (1mL of the liquid prescription solution) for 4 days, and now I am on my 4th day of 15mg (.75mL).

I know what you're thinking - NO!!! TOO FAST!!! Of course, I am experiencing heightened anxiety which is markedly different from what I would experience when I came off of Remeron. It's like a surreal head pressure that extends downwards, down through the chest into the gut and back. It at times manifests as fear and emotional lability.

My functional doctor told me I should go back up to 20mg (1mL) or even 17.5mg, but I'm wondering if I should just stick with my current drop. What do you think? Am I causing my nervous system potential damage dropping 40% in just a week? It's such a low dose. He also recommended to try splitting the dose in two, so twice a day. But..... how can I deal with the specific w/d symptoms of Sertraline?

I am not averse to any alterations or suggestions - I just have a lot going on this week and am doing my best. Sorry if this is the wrong forum... I guess I am new to Sertraline wd (and very accustomed to Remeron wd) and am looking for specific tips. Thank you for any advice.

PS - This is my intro thread:

 

[ChessieCat]

I think it would be sensible to go back up to 20% 20mg.  You are reducing much too fast, as well as only recently stopping Remeron (Jan 2019) and reducing Depakote from 750mg 500mg (Jan 2019) according to the information in your drug signature.

 

Edited February 14, 2019 by ChessieCat
made correction

[ChessieCat]

5 hours ago, Chziime said:

It's such a low dose.

 

There is really no such thing as a low dose, it's about how much drug your brain currently needs.  At SA we talk in terms of lowest effective dose.  If you start getting worse than minimal withdrawal symptoms then you've reduced by too much and/or too soon.

 

Here's some additional information which might help you to understand what is happening:

 

Recovery isn't linear it happens in a Windows and Waves Pattern

 

Withdrawal Normal Description

When we take a psychiatric drug, we are adding chemical/s to the brain.  The brain then has to change to adapt to getting the chemical/s.  It might have to change something to do with A and then once that change has been made it affects B so another change has to be made and so on down the line.  It is a chain reaction, a domino effect.

 

The same thing happens when we take the drug away.  That's why it's possible to experience such a vast array of withdrawal symptoms, and they can change, and be of different intensity.

 

are-we-there-yet-how-long-is-withdrawal-going-to-take

 

These explain it really well:

 

Video:  Healing From Antidepressants - Patterns of Recovery

 

On 8/31/2011 at 5:28 AM, Rhiannon said:

When we stop taking the drug, we have a brain that has designed itself so that it works in the presence of the drug; now it can't work properly without the drug because it's designed itself so that the drug is part of its chemistry and structure. It's like a plant that has grown on a trellis; you can't just yank out the trellis and expect the plant to be okay. When the drug is removed, the remodeling process has to take place in reverse. SO--it's not a matter of just getting the drug out of your system and moving on. If it were that simple, none of us would be here. It's a matter of, as I describe it, having to grow a new brain. I believe this growing-a-new-brain happens throughout the taper process if the taper is slow enough. (If it's too fast, then there's not a lot of time for actually rebalancing things, and basically the brain is just pedaling fast trying to keep us alive.) It also continues to happen, probably for longer than the symptoms actually last, throughout the time of recovery after we are completely off the drug, which is why recovery takes so long.

 

AND

 

On 12/4/2015 at 2:41 AM, apace41 said:

Basically- you have a building where the MAJOR steel structures are trying to be rebuilt at different times - ALL while people are coming and going in the building and attempting to work.

It would be like if the World Trade Center Towers hadn't completely fallen - but had crumbled inside in different places.. Imagine if you were trying to rebuild the tower - WHILE people were coming and going and trying to work in the building!  You'd have to set up a temporary elevator - but when you needed to fix part of that area, you'd have to tear down that elevator and set up a temporary elevator somewhere else. And so on. You'd have to build, work around, then tear down, then build again, then work around, then build... ALL while people are coming and going, ALL while the furniture is being replaced, ALL while the walls are getting repainted... ALL while life is going on INSIDE the building. No doubt it would be chaotic. That is EXACTLY what is happening with windows and waves.  The windows are where the body has "got it right" for a day or so - but then the building shifts and the brain works on something else - and it's chaos again while another temporary pathway is set up to reroute function until repairs are made.  

 

[Chziime]

40 minutes ago, ChessieCat said:

I think it would be sensible to go back up to 20%.  You are reducing much too fast, as well as only recently stopping Remeron (Jan 2019) and reducing Depakote from 750mg 500mg (Jan 2019) according to the information in your drug signature.

Yes, I thought so. I'll start back on that tonight - thank you.

Is there any utility in splitting that dose in two, 10mg in the morning and 10mg at night, in regards to getting a steady blood level? Zoloft has a relatively long half life, and this liquid solution is uncomfortable to take, so I'm thinking 20mg at night is fine...

[ChessieCat]

I don't think you need to split the dose.

[ChessieCat]

Keep notes of your symptoms over the next week or so.  This will allow you/us to see if you might need to increase by a tiny bit more.

 

It takes about 4 days for a dose to get to full level in the blood and a bit longer for it to register in the brain.  It is important that you try and stay calm and as stress free as possible and not to panic.  When we panic we can make bad decisions.  We have had members on SA panic and ended up  increasing too soon and/or taking too much drug.

 

If your drug signature is correct, then you have made a lot of changes recently.  You need to give your brain consistency.  You many need to hold on the dose for 2-3 months, or maybe more, to ensure that you have stabilised.  You might also consider making a test reduction of less than 10% when you reduce next to ensure that you have stabilised.  It is better to hold for longer than to reduce too quickly.

[Chziime]

10 hours ago, ChessieCat said:

Keep notes of your symptoms over the next week or so.  This will allow you/us to see if you might need to increase by a tiny bit more.

 

It takes about 4 days for a dose to get to full level in the blood and a bit longer for it to register in the brain.  It is important that you try and stay calm and as stress free as possible and not to panic.  When we panic we can make bad decisions.  We have had members on SA panic and ended up  increasing too soon and/or taking too much drug.

 

If your drug signature is correct, then you have made a lot of changes recently.  You need to give your brain consistency.  You many need to hold on the dose for 2-3 months, or maybe more, to ensure that you have stabilised.  You might also consider making a test reduction of less than 10% when you reduce next to ensure that you have stabilised.  It is better to hold for longer than to reduce too quickly.

I went back up to 20mg last night and already feel a bit better today. I was worried about the initial SSRI "activation syndrome" returning after re-raising my dose, but theoretically, my blood levels are probably still closest to 20mg at this point.

Can Zoloft withdrawal cause GI issues and nausea? I believe so, given that that stuff can happen when first starting the medication. I'm just making sure it's w/d and not the distasteful liquid solution.

After stabilizing on 20mg Zoloft, I think I will drop Clonazepam. I had a couple people, including my functional doctor, tell me to put Zoloft on the backburner and get off of that before it truly becomes a dependence.

Also, if it means anything, my last Remeron dose was early January, like the 3rd or 4th.

Thank you again for your help - I will keep close tabs on my symptoms and keep telling myself that there is no rush...

[Altostrata]

Chessie means 20mg.

 

5 hours ago, Chziime said:

I think I will drop Clonazepam.

 

Do not under any circumstances drop clonazepam! When did you start taking it? How often do you take it? You may already be dependent on it, and there's no rush to go off. Generally, we advise tapering the benzo last. Other drugs are far more likely to cause organ damage. See Taking multiple psych drugs? Which drug to taper first?

 

Of all the drugs you're taking now, Depakote is the most dangerous.

 

For each drug you're taking currently, please show the date you started it in your signature.

 

Did you get any unusual symptoms from stopping Remeron (Jan 2019) and reducing Depakote from 750mg 500mg (Jan 2019)? What were they? Did they go away?

 

To answer questions such as "should I split the dose?", we need to see your daily drug and symptom notes. Please keep daily notes on paper with times of day for when you take your drugs, their dosages, and your symptoms. You can post them in this topic with a simple list format with time of day on the left and notation (symptom, drug and dosage) on the right. Post your notes here in your Intro topic.

[Altostrata]

Your current drug interaction report: https://www.drugs.com/interactions-check.php?drug_list=318-0,918-0,3906-0,2057-0,1173-10624,2189-4139,703-0

[Chziime]

6 minutes ago, Altostrata said:

Do not under any circumstances drop clonazepam! When did you start taking it? How often do you take it? You may already be dependent on it, and there's no rush to go off. Generally, we advise tapering the benzo last. Other drugs are far more likely to cause organ damage. See Taking multiple psych drugs? Which drug to taper first?

 

Of all the drugs you're taking now, Depakote is the most dangerous.

 

For each drug you're taking currently, please show the date you started it in your signature.

 

Did you get any unusual symptoms from stopping Remeron (Jan 2019) and reducing Depakote from 750mg 500mg (Jan 2019)? What were they? Did they go away?

I take .25mg clonazepam twice a day, total of .5mg. I certainly am dependent on it - it's been 1.5 months on my current dose, plus an extra 5 months on lower, scattered doses.

When I stopped Remeron, I mostly got the typical wd symptoms I would have gotten from a regular dose decrease, but I also got extremely itchy. I've had this in the past, and I believe Remeron masked a histamine issue I have. I started taking 2.5mg Xyzal to deal with the intense itchiness, and I still take it - I know the itchiness would return, but I do not know to what extent.

When I went from 750mg to 500mg Depakote, I was a bit irritable for a few days, but that evened out quickly. Even on 750mg Depakote, my blood levels were actually slightly below the effective range, and my liver tests are always great.

I was considering getting off of the benzo first, before Depakote and Baclofen, since the latter two would assist with the benzo withdrawal. Get rid of the heavy hitter, first. That's what my functional doctor and my own intuition tell me to do.

[Altostrata]

Is Xyzal effective? Has the itchiness decreased since you went off Remeron?

 

Please add Xyzal to your drug interactions report and post the link here.

 

Many people get itchy as a withdrawal symptom. Your assumption Remeron was masking a histamine issue may not be correct.

 

Withdrawal symptoms mean your nervous system and other systems attached to it have become unstable. Since you went off Remeron and reduced Depakote, your nervous system may be highly susceptible to being rocked by other drug changes.

 

Blood levels of Depakote mean nothing regarding withdrawal symptoms, they are used to maintain levels of the drug to smother psychosis. Depakote can still damage your organs even if you have "below effective" blood levels of the drug.

 

13 minutes ago, Chziime said:

I was considering getting off of the benzo first, before Depakote and Baclofen, since the latter two would assist with the benzo withdrawal.

 

Exactly opposite of our rules of thumb. We recommend keeping the benzo on board to counter withdrawal symptoms from going off the other drugs. We haven't see any evidence Depakote or baclofen are helpful for benzo withdrawal syndrome.

 

As I said before, Depakote is a far more dangerous drug. Recommend you taper that first.

[Chziime]

Okay, I'll keep that in mind about the Depakote when I see my doctor soon - thank you.

I am certain that the Remeron was masking histamine issues because before I started Remeron 4+ years ago, I had a lot of problems with supposed histamine intolerance, itchiness that would increase with stress, keep me up at night, etc. Remeron at 30mg stopped that entirely. I am also certain that the Remeron withdrawal compounded the reemerging issues. Either way, I still take Xyzal, and it still is effective for that.

So perhaps I should taper - Depakote, Klonopin, Zoloft, Baclofen, in that order? My doctor is insistent I get off the klonopin before zoloft, as it has more side effects and dependence issues.