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

[ChessieCat]

54 minutes ago, Altostrata said:

Please keep daily notes on paper with times of day for when you take your drugs, their dosages, and your symptoms.

 

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]

Okay, after 12 days on 20mg liquid sertraline (the middle 4 of those being on 15mg), I still feel horrible. Head pressure, nausea, dread, and a misanthropic, raw moodiness. I am also wary of the ingredients in the prescription liquid, which includes BHT, a known histamine releaser. When I continue this decline, I might go with a compound pharmacy instead.

Should I just go up to 25mg (back to tablet), restabilize, then focus on Depakote?

I haven't been making a symptom journal, sorry. It seems to be pretty consistent throughout the day.

EDIT - I will speak to my functional doc tomorrow. He would likely agree. If I were to go back to 25mg Zoloft from 12 days of 20mg, is there anything I could expect? Is there potential for another "activation" period due to increasing the dose, common to SSRIs and certainly experienced when I first began?

[Altostrata]

Has there been any time in the last 12 days you felt more horrible or less horrible? How does your symptom pattern compare to a month ago? How has it changed?

 

What times of day do you take sertraline and your other drugs? We need to see your symptom pattern before and after you take your drugs.

 

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.

[Chziime]

I have felt the worst the past 3 days. Certainly worse than before I dropped Zoloft down. I felt like I was slightly getting used to being off Remeron and having dropped Depakote to 500. Hour-long morning meditations as well as .5mg klonopin helped.

First thing in the morning, I take Naturethroid 65, Baclofen 5, and Klonopin .25mg. At noon, Baclofen 5. At 3pm, NatureThroid 32.5,  Baclofen 5, and Klonopin .25. When I am winding down to bed, usually around 10pm, I take Depakote 500, Sertraline 20mg, and Xyzal 2.5mg.

[Altostrata]

Thanks. For your next post, please do this plus add your symptom notes:

 

19 minutes ago, Altostrata said:

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]

24 minutes ago, Chziime said:

EDIT - I will speak to my functional doc tomorrow. He would likely agree. If I were to go back to 25mg Zoloft from 12 days of 20mg, is there anything I could expect? Is there potential for another "activation" period due to increasing the dose, common to SSRIs and certainly experienced when I first began?

 

We don't know. We generally advise seeing what happens with a low dose first. If the low dose causes adverse effects, a higher dose will cause worse adverse effects. In addition, a higher dose will increase the drug-drug reactions with your other drugs.

 

There is also the risk of kindling in a nervous system sensitized by going on and off psychiatric drugs. You will not want to experience this.

 

Since you did not keep adequate notes over the last 12 days when you were taking 20mg Zoloft and 15mg Zoloft, we can't tell if you had adverse effects or what.

 

You're taking such a horrible drug cocktail, it's entirely possible your symptoms are caused by the drug combination. This makes it very hard to tell whether a Zoloft reinstatement is helping, and even more important to see those daily notes.

 

This is how we work. Unlike doctors, who don't have the time and patience to ask a lot of questions about your symptom pattern, we try to make informed guesses about what's going on.

[Chziime]

10 minutes ago, Altostrata said:

 

We don't know. We generally advise seeing what happens with a low dose first. If the low dose causes adverse effects, a higher dose will cause worse adverse effects. In addition, a higher dose will increase the drug-drug reactions with your other drugs.

 

There is also the risk of kindling in a nervous system sensitized by going on and off psychiatric drugs. You will not want to experience this.

 

Since you did not keep adequate notes over the last 12 days when you were taking 20mg Zoloft and 15mg Zoloft, we can't tell if you had adverse effects or what.

 

You're taking such a horrible drug cocktail, it's entirely possible your symptoms are caused by the drug combination. This makes it very hard to tell whether a Zoloft reinstatement is helping, and even more important to see those daily notes.

 

This is how we work. Unlike doctors, who don't have the time and patience to ask a lot of questions about your symptom pattern, we try to make informed guesses about what's going on.

I'll do my best to both remain on 20mg Zoloft as well as start a symptom journal. Should I include things I do such as meditation, exercise, etc, or should I stick to Sleep, Meals, Meds, and Symptoms?

What's so horrible about this cocktail? Because it has 3 GABAergics? Because it contains clonazepam? At least I'm off the Remeron...

[Altostrata]

5 minutes ago, Chziime said:

What's so horrible about this cocktail? Because it has 3 GABAergics? Because it contains clonazepam?

 

I'd LOL if it wasn't so horrible. Depakote is not primarily a GABAergic.

 

Just give a straight chronological account, starting in the a.m. when you wake up, of events that are significant to your drug dosing and symptoms resulting from it, including your sleep pattern.

 

Not so much meditation or exercise, unless they make you worse.

[Chziime]

Here's what I have so far:

2/18 - 13th day on 20mg Zoloft, down from 25mg.

7:30 - Get up, feel heavy, tense, depressed. Take NatureThroid 65mg, 5mg Baclofen 5mg, Klonopin .25mg.

9:30 - Feel better after meds and meditations

12:00 - Baclofen 5mg, Klonopin .25mg

1:00 - Still a little depressed.

1:15 - Eat

2:00 - 100mg MgGlycinate

3:00 - NatureThroid 35mg. Depression increasing.

4:00 - Baclofen 5mg. Begin Magnesium bath.

5:00 - Growing depression, head pressure.

6:00 - Nap

7:30 - Yoga

9:30 - Eat. Feel more neutral.

11:00 - Take Zoloft 20mg, Depakote 500mg, Mg 100mg, Xyzal 2.5mg

11:15 - Go to bed

11:30 - Head pressure. Tension/fatigue (partially from physical exertion).

12:00 - Fall asleep

 

2/19 (no waking up in middle of night)

7:00 - Wake up. Feel pain, head pressure, negativity/depression, can't seem to get up (morning mood lower since lowering zoloft)

8:00 - Get up, later than usual. NatureThroid 65, Baclofen 5, Klonopin .25

9:45 - Feel better after meditations. Klonopin .25. Lingering depression.

12:30 - Baclofen 5

1:00 - Eat

3:00 - Baclofen 5, NatureThroid 32.5
4:30 - Nap
6:00 - Yoga
8:00 - Eat
10:00 - Take Zoloft 20mg, Depakote 500mg, Mg 100mg, Xyzal 2.5mg. Go to bed.
11:30 - Go to sleep.

 

2/20 (no waking up in middle of night)

7:15 - Wake up. Bad mood, fatigue, unable to get up. Nausea.
8:00 - Get up. NatureThroid 65mg, Baclofen 5mg, Klonopin .5mg

I know my klonopin intake isn't as consistent as the rest. But my plan is .25mg when waking, then the other .25 as late as I can - though something I feel so awful in the morning from this wd that I feel I need to take it far earlier.

I've been waking up in such a horrible mood. After the Remeron drop and before the Zoloft drop, mornings were so (relatively) fresh. I still meditate and stretch for 1+ hour every morning, but my mood has been low going from 25mg to 20mg Zoloft. I feel like my emotions and moods are more extreme, though limited in scope in regards to the subjects about which I can think or feel.

A question - is nausea and GI upset a symptom of Zoloft w/d? Or can it also be from switching to this liquid solution?

[ChessieCat]

17 hours ago, Chziime said:

A question - is nausea and GI upset a symptom of Zoloft w/d? Or can it also be from switching to this liquid solution?

 

There are lots of existing topics on this site.  I like to use google and add survivingantidepressants.org to my search term.  Eg survivingantidepressants.org nausea:

 

digestive-problems-nausea-diarrhoea-bloating-gerd

 

And #35 on this list:  Dr Joseph Glenmullen's Withdrawal Symptoms

 

Some members do notice a difference when they change to liquid.

 

Q:  Did you make a reduction at the same time as changing to liquid?  SA suggests only making 1 change at a time.

 

Edited February 21, 2019 by ChessieCat

[Chziime]

Updates:

I am off Depakote and Baclofen entirely, and I lowered Zoloft to 12.5mg. I have been on that dose for 3 weeks and have been feeling withdrawals - strong depression, anxiety, fatigue, etc.
I also realized that my thyroid blood tests became slightly worse, so I switched from NatureThroid, which allegedly had sourcing changes, to NP Thyroid. I've been on NP for three days and feel a bit better.
Sadly, I am now on 1mg Klonopin/day, which felt necessary to deal with Depakote/Baclofen/Zoloft withdrawals.

In September, I am travelling for a few weeks, so I don't think it's wise to make any more drops at the moment. I will adjust to NP Thyroid, retake bloods (thyroid, salivary cortisol, minerals, etc), then focus on lifestyle/diet/meditation/movement.

My question: I am certainly dependent on 1mg/day Klonopin, as I have been on that dose for basically 3 months. To restate, 1mg/day is the highest dose of Klonopin I have EVER been on, taking it on and off for 12 years. I won't be able to drop Klonopin until after I fully drop Zoloft, which I can't do until after my travels in September. Are there any real downsides to remaining on such a high (for me) dose of Klonopin for at least another few months? Can it cause FURTHER dependence, further harm, etc, or should I just let it be, forget that I even take it, and really hone in on lifestyle?

Thank you!!

[Shep]

10 hours ago, Chziime said:

My question: I am certainly dependent on 1mg/day Klonopin, as I have been on that dose for basically 3 months. To restate, 1mg/day is the highest dose of Klonopin I have EVER been on, taking it on and off for 12 years. I won't be able to drop Klonopin until after I fully drop Zoloft, which I can't do until after my travels in September. Are there any real downsides to remaining on such a high (for me) dose of Klonopin for at least another few months? Can it cause FURTHER dependence, further harm, etc, or should I just let it be, forget that I even take it, and really hone in on lifestyle?

 

Three months is more than enough time to become dependent on the higher dose, so you may want to leave it there until you are back from travels and have come off the Zoloft and stabilized. 

 

Honing in on lifestyle sounds like the best path forward. Lots of self care and learning new non-drug coping skills will be helpful in the long run. 

 

10 hours ago, Chziime said:

Sadly, I am now on 1mg Klonopin/day, which felt necessary to deal with Depakote/Baclofen/Zoloft withdrawals.

 

This is a strong indication that you are tapering too fast, so please consider a micro-taper and / or more holds in the future so your benzo use doesn't escalate. 

 

Micro-taper instead of 10% or 5% decreases

 

The Brassmonkey Slide Method of Micro-tapering

[Chziime]

8 hours ago, Shep said:

Three months is more than enough time to become dependent on the higher dose, so you may want to leave it there until you are back from travels and have come off the Zoloft and stabilized. 

 

Honing in on lifestyle sounds like the best path forward. Lots of self care and learning new non-drug coping skills will be helpful in the long run. 

Thank you, yes, I agree.

So there's basically no difference in terms of dependence if I were to start weaning off of klonopin in, say, 4 months vs 6 months from now?

Even going down from 1mg to .75mg before September (without touching Zoloft) would be pointless, yeah? And I might feel some PAWS during my vacation?

This high daily dose may be interfering with my sleep, endocrine, etc systems, but ultimately, I need to accept that I got to this point.

[Shep]

17 hours ago, Chziime said:

So there's basically no difference in terms of dependence if I were to start weaning off of klonopin in, say, 4 months vs 6 months from now?

 

You may be more dependent on it in 6 months. But to what degree is unknown. All we know for sure is people can become dependent in 2 - 4 weeks. Beyond that, there's not much information. 

 

 

[Chziime]

Hi,

I believe I am on the final stretch. After holding on 12.5mg Zoloft for a few months, I switched back to the liquid solution (20mg/mL) and have been lowering by .025mL every 3 days, currently down to .475mL. By this plan, I will be off entirely at the end of the year.

I know that many of you might say I am going too quickly. I'd rather keep at this pace, but would slow down if it somehow becomes unbearable. So far, I've been getting through the days, functioning with my work (just enough...), and sleeping well enough. Still, if you think there's a specific medical reason I should slow down, let me know.

I have been feeling withdrawal symptoms... a sort of deep sadness, fear of the process, fear of stress itself, irritability/paranoia, body stiffness, disorientation, etc.

Mainly, I'm wondering if there's anything else I could be doing to help with this last stretch, in regards to diet, lifestyle, practices, therapy, anything?

Lastly, I do not want to keep a symptom journal. Sorry, I've tried it, but it just takes me too much out of my day-to-day life.

Thank you so much for your continued support.

[Shep]

19 hours ago, Chziime said:

I know that many of you might say I am going too quickly. I'd rather keep at this pace, but would slow down if it somehow becomes unbearable. So far, I've been getting through the days, functioning with my work (just enough...), and sleeping well enough. Still, if you think there's a specific medical reason I should slow down, let me know.

 

Many people find they need to slow down toward the end of the taper. The lower doses can be more problematic. This thread gives a good explanation:

 

Why taper? SERT transporter occupancy studies show importance of gradual change in plasma concentration

 

Are you holding each month or continuing to taper every 3 days? If you're not holding for a week or two after each month, these reductions may catch up to you.

 

20 hours ago, Chziime said:

I believe I am on the final stretch. After holding on 12.5mg Zoloft for a few months, I switched back to the liquid solution (20mg/mL) and have been lowering by .025mL every 3 days, currently down to .475mL. By this plan, I will be off entirely at the end of the year.

 

Reducing every 3 days means you're taken 10 reductions per month.

 

.025 mL X 10 = .25 mL reduction per month

 

.475 mL - .25 mL = .225 mL

.225 mL / .475 mL = .473

 

That's a 47.3% reduction.

 

How much water are you using to dilute the liquid Zoloft? What dose are you on now in milligrams? 

 

Please note the 10% taper method recommends a 10% dosage reduction every 4 weeks, with the 10% calculated on the last dosage. The amount of decrease is proportionate to the last dosage (not the original prescription) and keeps getting smaller.

 

20 hours ago, Chziime said:

Mainly, I'm wondering if there's anything else I could be doing to help with this last stretch, in regards to diet, lifestyle, practices, therapy, anything?

 

What you've got listed in the last line of your signature - Paleo diet, walking, yoga, biking, breathwork - all sound like good diet/lifestyle/practices. You can find more here:

 

Non-drug techniques to cope with emotional symptoms

 

[Chziime]

On 10/31/2019 at 4:59 AM, Shep said:

Are you holding each month or continuing to taper every 3 days? If you're not holding for a week or two after each month, these reductions may catch up to you.

 

How much water are you using to dilute the liquid Zoloft? What dose are you on now in milligrams? 

I continue to taper every 3 days. After a month of doing so, which should be in just over a week, I will reevaluate and possibly hold for a week before continuing the same plan.

I dilute it in a small glass, about 6-7oz. After drinking that down, I pour and stir another ~6oz into the glass to be sure to get any remaining solution.

I went from a stable .60mL (12mg) and starting lowering on 10/18, just getting down to .45mL (9mg) last night. I'm actually starting to feel better right now. I know withdrawal can hit harder at any moment, but so far I've dropped 25% and am hopeful.

[Shep]

22 hours ago, Chziime said:

I went from a stable .60mL (12mg) and starting lowering on 10/18, just getting down to .45mL (9mg) last night. I'm actually starting to feel better right now. I know withdrawal can hit harder at any moment, but so far I've dropped 25% and am hopeful.

 

Yes, withdrawal can definitely hit harder at any moment, even months after you come off. I would caution against this, Chzlime. This is way too fast.

 

I have a feeling the clonazepam is helping buffer your symptoms, but in a few weeks or months, you may experience the full brunt of the Zoloft withdrawal beyond what a benzo can help with.

 

Please note the benzo / SSRI combination can be an extremely difficult combination to come off of and many people don't experience the worst of it until they are nearing the end of the benzo taper. So the more you can do to protect your nervous system during your AD taper, the better. 

 

22 hours ago, Chziime said:

I dilute it in a small glass, about 6-7oz. After drinking that down, I pour and stir another ~6oz into the glass to be sure to get any remaining solution.

 

Instead of adding .60 mL of your liquid Zoloft into 6 - 7 oz of water, you may want to take 1 mL of liquid Zoloft (20 mg) and place it in 19 mL of water, giving you a total of 20 mL of liquid to taper with where 1 mL = 1 mg. 

 

This will allow you to easily decrease in much, much smaller rates than you're currently doing now. For more information, please see:

 

How to make a liquid from tablets or capsules

 

Also note this post from the Tips for Tapering Zoloft thread. 

 

Please update your signature to reflect when you started Klonopin. A direct link to your signature is here: 

 

Account Settings - Create or Update Your Signature

 

[Chziime]

On 11/3/2019 at 8:07 AM, Shep said:

 

Yes, withdrawal can definitely hit harder at any moment, even months after you come off. I would caution against this, Chzlime. This is way too fast.

 

Thank you. It hit me pretty hard today, especially with some emotional stress. I'm in the process of figuring out how much stress a certain loving relationship is worth 😕 it's tough, as she's one of my main supports. Anyway...

I started taking fish oil (a low dose, one cap/day of regular strength Nordic Naturals) a few days ago. Sometimes I feel like it's helping, and sometimes I can't tell if it's giving me more anxiety. How can I tell while withdrawing from SSRIs? Should I just stick with it?

Oh, and I had to cut my signature short because of a limitation on lines?

[Shep]

11 hours ago, Chziime said:

I started taking fish oil (a low dose, one cap/day of regular strength Nordic Naturals) a few days ago. Sometimes I feel like it's helping, and sometimes I can't tell if it's giving me more anxiety. How can I tell while withdrawing from SSRIs? Should I just stick with it?

 

Do you like fish? I eat a tin of sardines every day because I'm limited in being able to tolerate supplements. So if in doubt, you may want to get your nutritional needs from the foods you eat. 

 

11 hours ago, Chziime said:

Oh, and I had to cut my signature short because of a limitation on lines?

 

Any drugs prior to 24 months ago can just be listed with start and stop years, so you may be able to shorten the first three lines of your signature into one, if you think that might help. Anything that far back doesn't require much information, no narrative required, so you may be able to shorten it to just the year, name of drug, and dose. And possibly fit the first three lines into one. 

 

We're really paying most attention to the past couple of years. 

 

11 hours ago, Chziime said:

Thank you. It hit me pretty hard today, especially with some emotional stress. I'm in the process of figuring out how much stress a certain loving relationship is worth 😕 it's tough, as she's one of my main supports. Anyway...

 

You may want to check out some of the other sections on the forum. We have many, many discussions about this and it can help to know you're not alone.

 

Relationships and social life

 

Finding Meaning

 

 

[Chziime]

1 hour ago, Shep said:

 

Do you like fish? I eat a tin of sardines every day because I'm limited in being able to tolerate supplements. So if in doubt, you may want to get your nutritional needs from the foods you eat. 

 

Oh, I love fish! I eat Trader Joe's canned sardines (as well as their oysters, for different nutrients) a few times a week, but I think I'll switch over to a can a day instead and put the Fish Oil in the freezer to attempt once I'm off of the SSRI.

Thank you for the links. I'll be sure to read those topics.

[Chziime]

Update -- I am off of Zoloft for good! After weaning down from 12mg to 1mg over the course of a few months, I held on 1mg for at least a week and then dropped it entirely the last day of 2019. 

Now, a week out, I am starting to really feel some symptoms. Spontaneous mood swings, fatigue, pain, and a vague sense of isolation, like I cannot relate to people or things. I'm still keeping up with my healthy lifestyle, adding new habits like a gratitude journal, but there have been a couple days where I just have to completely step back and accept the fatigue. The sense of isolation is so unusual, though. It feels like paranoid at times... for example, I feel like I cannot relate to people, so I have this resentful feeling that it goes in both directions, that people don't care about me.

Is there a general timeline for how long acute sertraline withdrawal lasts? My intuition says I'll even out a bit in a week.

I'm seeing my doctor on Jan 31st and will discuss with him options of weaning off of klonopin. I'll probably do a combination of pills (do they go down to .25mg pills? I know there are .125mg Soltabs) and a liquid from my specialty compound pharmacy, so I can take pills for convenience and use the liquid for the weaning.

[Shep]

17 hours ago, Chziime said:

After weaning down from 12mg to 1mg over the course of a few months, I held on 1mg for at least a week and then dropped it entirely the last day of 2019. 

 

Going from 12 mg to 0 from October to January 1 would be a rate of about 4 mg reduced each month, or roughly reducing by 33% each month. 

 

That is way too fast, Chzlime. 

 

17 hours ago, Chziime said:

Now, a week out, I am starting to really feel some symptoms. Spontaneous mood swings, fatigue, pain, and a vague sense of isolation, like I cannot relate to people or things. I'm still keeping up with my healthy lifestyle, adding new habits like a gratitude journal, but there have been a couple days where I just have to completely step back and accept the fatigue. The sense of isolation is so unusual, though. It feels like paranoid at times... for example, I feel like I cannot relate to people, so I have this resentful feeling that it goes in both directions, that people don't care about me.

Is there a general timeline for how long acute sertraline withdrawal lasts? My intuition says I'll even out a bit in a week.

 

Anything is possible, but I'm not sure I'd count on stabilizing within a week. It can take months to years to recover, especially from a rapid taper. 

 

Are We There Yet? How Long is Withdrawal Going to Take?

 

You may want to reinstate a small amount, hold until you're more stable, and then micro-taper off the rest.

 

What dose were you on when you felt more stable? Even if it's just going back on 1 - 5 mg, it may be worth gaining some stability. You want to be as stable as you can because you still have a benzo to taper in the future. It's likely the benzo that's kept you as functional as you've been up to this point, but I'm not sure I'd rely solely on that.