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Tanha: never stabilize under diazepam but want to taper

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Tanha

Admin note - link to benzo forum thread:Tanha: Diazepam taper fails again and again - polydrug situation

 

Hello, 

i am in psychiatric hospital since march and am very sick.

my medication is the cause so I try to taper all the time. 

Mirtazapine 30 to 15 mg,

parallel quetiapine from 400 to 230 and after a couple of days back up to 250 mg, finished levomepromazin taper four weeks ago. Since a couple of days I have unbearable depression, sickness and akathisia. The updosing helped a bit with nausea. Very low blood pressure, too.

i think i have a serious problem now: 

i need to hold a while to stabilize but it doesn't work and I cannot hold longer than two weeks at a time because the diazepam (I keep the dose of 5 mg for a couple of months now after five terribly failed attempt to reduce it by 0,5 mg every 10 days) gives me interdose withdrawl. 

I also suffer from mirtazapinreduction and quetiapinreduktion quite severely.

Akathisia, sickness and depression are beyond everything I can stand any longer.

 

i need a tapering perspective, wether to taper Quetiapin or diazepam first and how long I must hold because I tried to hold before and things didn't get better for more than two months. 

What can I do? 

Edited by Shep
added admin note

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Tanha

lying in a German psychiatric hospital since march this year, almost bedridden and in constant pain, agitation and severe depression I place a few questions here for you and am curious what your opinion is on them. Akathisia is also a major issue and of course hopelessness. 

 

I stopped cymbalta in February and endet up on 45 mg mirtazapine, 400 mg quetiapine, got addicted from 8 weeks 2 mg Lorazepam, freaked out at the step from 0,5 mg to zero and restarted in may, switched to diazepam and am bedridden and in constant akathisia, sickening withdrawl, depression, all unbearably Severe. Suffer from Depersonalisation 24/7 since December. 

Things are getting worse day by day and I need to stabilize. 

That is tricky because the medication gives me terrrible sideeffects (low bloodpressure, interdose withdrawl, worsening Depersonalisation). 

The doctors don't allow me slow tapering although I did this on my own with levomepromazine until four weeks ago.

five times the benzowithdrawl failed traumatically and I am sitting on 5 mg for three months now. No way up or down due to increase in agitation and akathisia. 

I tapered quetiapine right from the first day taking it down to 200 mg and during a crisis doctors put me out to 400 mg immediately, which i tapered too fast until now. I tapered mirtazapine at the same time from 45 to 15 mg. 

I am in constant and absolutely debiliating withdrawl ever since. I cannot stabilize on any Dose because only withdrawl itself raises my bloodpressure a bit. And i want to find a cause and relief from akathisia. It started after lorazepamwithdrawl and mirtazapine dose increase in may.

Only the evenings are almost normal. 

I cannot concentrate on a feasable strategy how to continue. 

I continued tapering Mirtazapine and the quetiapine although I was and am in the worst possible agony. 

Did the last cuts four and two weeks ago and tried my first updose (230 to 260 mg quetiapine and 15 to 16 mg mirtazapine due to too bad depression and absolute sickness and want to raise it today to 17 mg because sleep and agitation are getting worse.

I read that sa recommends updosing in order to stabilize and that one must hold a dose for months to stabilize. 

I didn't change meds  for one month once and tried to endure agitation and pain but couldn't make it any longer. 

I cannot talk to the doctors about it because we have the deal if I experience physical or mental problems worsening I have to take an tricyclics antidepressant which gives me such fear because it is another "break" and bad for low blood pressure and doctors want me to stop Mirtazapin then cold turkey because the new ad doesn't work well with mirtazapin. I am not allowed to know which new ad I will get, if. 

Else I have to leave the clinic so I pretend to make progress but cannot do that much longer. 

Now i want to hold the dosage again but the dosage is not the right one and valium gives me worsening interdose withdrawl (burning skin and anxiety). 

I cannot go on like this an Need counsel of any kind. 

If you have a little counsel for me I'd be glad. 

 

Updosing quetiapine from 230 to 250 mg happened 5 days ago after too rapid reduction 16 days ago and mirtazapine reduction and updosing. Made akathisia my akathisia worse for a couple of days.

There is no relief but the agitation and sickness and depression are still the Worst. I fear that the akathisia and agitation and incredibly severe depression will never stop and even get worse if I don't find and stop the cause. 

I know I have prolonged withdrawl syndrome. The doctors don't believe in that. They think my problem is somatic depression and anxiety.

 

updosing Quetiapin by 5 mg today and 5 mg in 2 days back to 260 mg (came from 262 two weeks ago, didn't stanilize but continued to 230 mg which worsens depression, six days ago went up to 250 mg with no or little effect and raised mirtazapin  by 1 mg from 15 to 16 mg - after having reduced it three weeks ago from 20 to 15 mg and never Stabilized.) 

 

Today I will also rise mirtazapin by 1 more mg to 17 mg because of depression and sleep.

i hate these meds so much. 

 

What are my options?

sorry for this lengthy post. 

Any ides welcome.

 

yours

tanha from Hamburg

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Tanha

I forgot to say: each of my medications as well as withdrawl itself can cause my Akathisia.

 

same with The low  bloodpressure which gives me a Hard time, Too. 

I can regulate it a bit by keeping myself in acute (an der too fast) withdrawl because that state raised my blood pressure. But the other withdrawl symptoms and rebounddepression make this technique impossible (which I expected but I am very desperate about my blood pressure, mostly 95/60.) the low pressure combines with akathisia and restlessness/hyperarousel which is a terrible combi. 

 

Strangely I experience another interesting withdrawlpattern:

whenever i reduce quetiapine, the following days I experience real improvement with feelings and physical symptoms. This subsides after a few days and then withdrawl hits hard. That urged me to continue withdrawl but of course this is foolish to do.

 

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Tanha

My medication:

as doctors prescribe:

400 mg quetiapine 

30 mg mirtazapin 

5 mg diazepam

 

i take them as:

260 mg quetiapine 

16 mg mirtazapin

5 mg diazepam

(tapered 50 mg levomepromazine to 0 mg four weeks ago)

 

i must admit that I always tapered anything, often two things parallel because I was desperate and withdrawl helps me to raus my terribly low blood pressure for a while (as I Said). 

The latest new problem is the agitation/hyperarousel and anxiety  all day came back big time. 

That started with the Ct of cymbalta in march and never got under control except with 5 mg diazepam and 400 mg Quetiapine (or at least 300). I have never had anxiety or agitation before stopping cymbalta (120 mg for three years) and i fear this Ct damaged me for life. 

 

If feelings are coming back for a couple of hours or if I am able to go outside things get too overwhelming and agitation and anxiety worden of course. 

Getting into a normal life is absolutely beyond my imagination. 

Things are absolutely instable and painful and frightening. 

If I could get along with and without the medication better I still have a painful problem with Depersonalisation 24/7, the newly acquired anxiety, stressintolerance and severe depression. 

My perspective is not really goood. 

I will not be able to work or make appointments of any kind because I never know when things get too much or if I might have a stable phase.

i believe the medication keeps me from being suicidal. The same medication that I want to get rid of and that gives me unbearable sideeffects. 

I don't know my way and am afraid like hell. 

Never got out of sight of the psychiatric clinic I am in since may , cannot imagine to be able to eat other food than clinic food because any change gives me fear, cannot think of stop thinking and talking about pain and medication all the time (I really can't talk about anything else anymore, got obsessed with that), cannot stand myself or see myself focussing on any task in normal life except walking. 

Akathisia and hyperarousel and brainfog stop me from relaxing or even sitting for a while.

That makes me sad.

 

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Tanha

I have an urgent question:

 

put it myself in new trouble

 

i have reduced mirtazapin from 20 mg to 15 mg 28 days ago, in the third week depression got worse.

10 days ago I updose mirtazapin from15 to 16 mg.

 

parallel I reduced quetiapine from 262 to 230 mg 17 days ago and since five days after that anxiety gets worse slowly. After 10 days depression got severe (see above). 

 

11 days ago I made a mistake and took 245 mg quetiapine, 

Next day again mistake and took 215 mg,

next day again mistake and took 167,5 mg, 

next day panicked and took 280 mg to even out the level which was wrong, (next day for once felt amazingly good, but next day akathisia became worse for a couple of days,

since then I took 250 mg, wanting to do it as a general updose because coming down from 162 to 230 mg was too much and I wasn't stable before. 

At the day of dose change from 230 to 250 mg which is four days after increasing mirtazapin also from 15 to 16 mg I experience my hyperarousel coming back more and more. Yesterday this got really bad and urged me to do something. 

That's it want to increase quetiapine again by 10 mg and mirtazapin by 1 mg from 16 to 17 mg. I started to believe that the big reduction of mirtazapin from 20 to 15 mg worsens my sleep and I want to fix this because I am afraid that I won' t be able to sleep once I start reducing quetiapine (because I believe I damaged the sleep with the big mirtazapin reduction from 20 to 15 mg and the quetiapine covers this just up.) I wake up too early in the morning and I feel my sleep is medicationinduced and unhealthy otherwise.

Today symptoms improved a lot though (not the sleep but the nausea, sickness, pain). Hyperarousel and anxiety continue to stay quite bad. 

 

I am anxious and at the same time urged to updose mirtazapin 1 mg to fix the too big cut before. 

But it is the seconde updose within a short time and that means destabilization. 

I also don't know why my hyperarousel/agitation and anxiety raised quite a bit after updosing quetiapine and mirtazapin. Or is this withdrawl or general destabilization?

hyperarousel and anxiety is really getting bad since yesterday and give me a real hard time deciding what to do. 

I also feel muscleweakness getting stronger and motivation is a huge problem and still no chance to relax during the day due to akathisia (more mentally at the moment).

what must I do?

updose mirtazapin 

or

and quetiapine 

or and do nothing which is almost impossible? 

 

Tanha

 

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Tanha

Sorry for repeating myself but this hyperarousel/agitation is for me the most dangerous and frightening Condition. Akathisia and depression and anxiety are with it. Cannot relax or distract myself for one second. 

Need to come up with a plan, soon.

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Tanha

I am too afraid that it is still protracted cymbalta withdrawl that gives me this hyperarousel which i cannot live with. Only waiting for the next dose of quetiapine to endure the day fearing next. 

It has only been covered by quetiapine and diazepam but they poop out.

Can i heal while on these drugs and lying in bed depressed and anxious and too weak all day long?  

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Tanha

I am equally afraid that the quetiapine or mirtazapin work paradoxical after updosing: 

 

1. updosing mirtazapin from 15 to 16 mg

3. mistake updose quetiapine 230 mg (was on that for 10 days after coming down from 262 mg) to 280 mg

4. 250 mg quetiapine, the hyperarousel started this day late afternoon quite strong but short and stayed with me (getting longer and longer and stronger until today)

 

i know this "permanent" condition of hyperarousel from may/June/July where I endured this terrible condition all day long only waiting for the next dose of diazepam, quetiapine and Mirtazapin. 

It was a similar situation in that the medication was quite similar to now and I was in diazepamwithdrawl (now I am in interdosewithdrawl).

It was then that they doubled my quetiapine, doubled the diazepam an added the levomepromazine which I finished tapering five weeks ago Now. The hyperarousel got much better then, i believe it was covered up by the sedatives.

 

i can only think of the cymbalta having damaged me.

i can only think of how the hyperarousel and akathisia got worse when they raised my mirtazapin to 45 mg and while getting back to 30 mg. 

I can only think that i can only relax a bit after taking mirtazapin.

i can only think of medication, medication and medication in this condition. Yet it is impossible to continue like this as I did the last 9 months mainly stayed in bed due to all this. 

 

I wait and wait and wait for my depersonalize, depressed anxious and painful life to continue some Day. I cannot do this in this state because I can only think of medical relief for now. 

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Tanha

Right now it feels like I get a paradoxical effect of quetiapine after the recent dosechanges which would be the worst to happen because I rely on it and cannot taper it at the moment because my hyperarousel, anxiety and depression are very severe.

 

I take quetiapine since march with several updosing and downdosing.

 

i realize now that I get hyperarousel always two hours after taking the next dose (250 mg per Day in four doses a day.) 

 

I am totally unstable and cannot live without the quetiapine for Now  but this is a real bad situation.

 

What can I do? The hyperarousel is very physical and almost unbearable. I don't want to increase Diazepam. 

Can a reduction of quetiapine bring some relief soon? Dose a stable dose help?

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Tanha

Sorry if I tend to overwhelm anybody with my posts. It is just the constant suffering that makes me ask anybody for any help all the time.

yet any small feedback or idea is very welcome. 

Tanha

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Tanha

Please help me with my pattern of symptoms and the polytox tapering mess I do everyday.

i am suffering a great Deal. Although I know there is a very clear pattern of symptoms I cannot see it because I am always doing panicky dosechanges.

 

every day except the last two days I have a terrible condition around noon for 2 to 5 hours. 

It is mainly physical (nausea, flue-like, weakness, fatigue and incredibly severely depressed) but I have the idea that besides withdrawl from mirtazapin, quetiapine (and interdosewithdrawl of diazepam or perhaps a late onset of withdrawl symptoms after tapering levomepromazine a bit faster or protracted withdrawl from Ct cymbalta in march) also akathisia and severe depression itself could be a cause. 

 

I need to find out if I further updose of quetiapine or mirtazapin will stabilize my situation.

i reduced both over the last months a bit too fast and endured the pain.

whenever i reduce the dose of quetiapine symptoms vanish for a few days and come back worse afterwards. 

 

After cutting quetiapine from 262 to 230 mg 20 days ago and mirtazapin from 20 to 15 mg 4 weeks ago And enduring for a couple of days I couldn't make it any longer and decided to to my first updose long after the doctors last updose (200 to 400 mg quetiapine) many months ago. 

 

I increased mirtazapin 12 days ago from 15 to 16 mg and

quetiapine 8 days ago from 230 to 250 mg (the days before that I did a bit of a mistake mess by once taking 163 mg, next day 280 mg and felt perfect the next day only for this one day). 

 

The last two days the symptoms improved dramatically (although other symptoms occurred stronger like akathisia, Depersonalisation, hyperarousel, weakness). 

Today everything is almost as bad as before plus sleep is a little worse. Depresssion is absolutely severe but only for a couple of hours in the morning and this terrible physical situation I described above reappeared, yet a little Shorter. 

 

I am stuck, don't know where to go from here?

will another updose of quetiapine by 10 mg or mirtazapin by 1 mg bring relief of these (as I believe) withdrawl symptoms and finally bring me closer to a state of stability which I am lacking since march?

i desperately need to hold a dose for a while but not with these terrible symptoms. I endured them too long, lost too much weight and energy, was bedridden for months. 

 

I first thought of updosing quetiapine by 10 mg today (although this worsens akathisia for some days) and/or updosing mirtazapin by 1 mg. 

But i am very insecure because the last updose only gave me temporal relief with my noon-symptomes. Depression has improved a bit though but is still too bad to live with and maybe the symptoms are not withdrawl from quetiapine or/and mirtazapine but new sideeffects of these drugs or of any other cause.  

 

How can I find out soon what the problem is?

please, any idea welcome!

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SkyBlue
On 12/9/2018 at 5:32 AM, Tanha said:

my medication is the cause so I try to taper all the time. 

 

 

Hello and welcome to Sa.

 

It sounds like you are going through a lot.

 

Your thread has several pages worth of information. I'm going to approve your initial post so that it can be seen and responded to, and we can go from there. The most important part right now is to write a brief drug signature. Please, keep it brief.

To help us out, please create a brief drug signature using these instructions: https://www.survivingantidepressants.org/topic/18343-please-put-your-withdrawal-history-in-your-signature/

 

This will be your intro topic. Please keep all posts about your situation here instead of personal messages to moderators. 

 

A reminder that this is a volunteer-run site. A response may come in an hour, or it may be 2 days. It is different from a doctor's office or hospital in that people are posting and helping here as they are able, while dealing with their own withdrawal. 

 

Please look around the site for non-drug coping skills -- this will be good to develop as you are really going through quite a severe and difficult situation. 

Edited by SkyBlue
spaces

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Tanha

Thanx a lot

Any idea for my next steps is welcome

Anything will help since my situation is so debiliating as it is

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Altostrata

Welcome, Tanha.

 

Are you still in the hospital?

 

If you can, please stop changing the dosing and timing of your drugs. We need to find out which drugs, if any, are helping and which drugs are causing symptoms. Please note that taking more of any drug may not help because that drug may be causing the symptoms. When you increase a drug, side effects also increase.

 

What do you mean by akathisia? How are you sleeping?

 

This is very important: What times of day do you take your drugs, and their dosages? Do your symptoms follow any daily pattern?  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.

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manymoretodays

Hi Tanha and welcome from me too,

 

Yes, it sounds quite debilitating now.  A bit more detail in the signature will help.  This is the portion you see below others posts, unless viewing from a phone device.  Do your best to spell out the whole medication name.  You could just sum up what you recently discontinued, with the date.  And what you are presently on.

 

If your drug history is very long, the last few years will do. FOR READABILITY, SHORT LINES ARE BEST.

 

  • A list is easier to understand than one or multiple paragraphs
  • Include ALL drugs, doses, and dates (starting and stopping)
  • Any drugs prior to 24 months ago can just be listed with start and stop years
  • Please use actual dates or approximate dates (e.g. mid-June) rather than relative time frames (e.g. 3 months ago)
  • Spell out months (e.g. "January" or "Jan" as 9/1/2016 can be interpreted as 9 Jan 2016 or 1 Sept 2016)
  • Please leave out symptoms and diagnoses

 

Example:

2001–2002 paroxetine 
2003  citalopram 
2004  paroxetine
2008  paroxetine slow taper down to 2016 Aug off paroxetine
2016  citalopram May 20mg  Oct slow taper down
2018  citalopram 13 Feb 4.6mg 15 Mar 4.4mg 29 Apr 4.2mg

 

If you edit your signature, the new one replaces any prior signature. It will appear in your signature under all your posts, even your old posts. If you want to save the information in the old signature, copy it and save it in a file on your computer or in a post in your Introductions topic.

 

(As of 12/31/13: Signatures are limited to 12 lines of text.)

How to add or edit your signature

  1. Click on this link to open the correct page in User Settings:
    Create Your Signature in "Account Settings"
    2017-June 12 update: link works on desktop, tablet and mobile phone versions

Then, once there is a bit more clarity to the signature.

Go ahead and give us some daily notes, such as in this link:

Daily notes/drug and symptom logs

This format, ^ is what we need to see here, right on your introduction page.  This is what Alto is referring to above. 

 

Both of these things will help us to get a better idea of where you are at, with withdrawal, and then your present intake of medications/drugs.

 

I'm only guessing but it all probably feels like doing a giant small piece puzzle and/or like doing one of the tougher crossword puzzles.

Just take your time.  Write things out on paper first.  And then post.

Meantime, just stay put with your current drugs and dosages.

 

Love, peace, healing, and growth,

mmt

Edited by manymoretodays

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Tanha

Yes I am still in hospital and will be for some time. As I said I am almost bedridden, in severe pain etc.

thanx for your questions

 

i did and do take notes very detailed during all my taperingexperiments yet I have brainfog and cannot sort it out as you see below. 

I had to change doses constantly because only withdrawl itself raises my terribly low bloodpressure and Also keeping myself in acute withdrawl makes my worst symptoms go away for one or two Days. Afterwards they come back as bad as possible. Since I am with this terrible situation 20/7 (all evenings after mirtazapin are great) I only found this method giving me a day off of the agony. It is stupid I know.

 

i am not able to cut my problems short. I am very sorry for that but I cannot think straight for a minute. 

I know it is a lot to read and understand but I am really incapble of thinking strategic in any way. 

 

The medication overview is at the end

 

About the akathisia:

I do sleep but I believe only because of the meds. I cannot relax one seconde during the day, not mentally, not physically. I always want to jump out of my skin or walk walk walk

sitting is a terrible thing to do

i experience akathisia in different grades of severeness: 

the worst started a few days after getting off of Lorazepam in may after being addicted to it only for weeks. The step was 0,5 to 0 mg.

 

At the same time I had started mirtazapine and quetiapine with some heavy doseincreases and reductions during two Months.

it seemed to get worse again after increasing mirtazapin from 30 mg to 45mg. And after switching to 2,5 mg diazepam things didn't improve. I recall that the severe akathisia worsened day by day but I have to ask my wife if this is true. 

 

I couldn't walk upright and crawled in pain from the car to the hospital. Mirtazapin helps always for hours. Perazin did't help. 

Two doctors told me I had nothing yet I was yelling at them for hours begging for help. Pain.

 

Had this again after a crisis switch from diazepam to Lorazepam once in June. I think I hat something like tachycardia and insomnia for a couple of days after switching me back from Lorazepam 1 mg to diazepam 4 mg. Chlorprotixen has also been given during that crisis. 

 

Every dosereduction of 0,5 mg diazepam put me into crisis and inbetween I was bedridden 20h a Utterly sick but not depressed or anxious. Anxiety is new to me. 

After updosing to 15 mg diazepam

Things didn't' improve. 

Constant panic, musclepain and no sleep at all. I was too afraid to close my eyes not even once because it felt like fainting in a bad way. I kept my eyes open for four days in a row with legs higher than the body.

50 mg levomepromazine

200 to 400 mg quetiapine 

7,5 mg diazepam 

refuction of mirtazapin from 45 to 30 mg made a huge difference and I almost forgot akathisia until lately (perhaps because my taper brought me close to the dosages that I had during this crisis)

i have a lot of bloodtests and ekg and someone told me during this crisis my kidneys were once in trouble and I had sth like tachycardia. I am not sure about that but I can show the results. 

 

 

I have less severe akathisia every day now since a couple of weeks (difficult to say when it started again).

I know akathisia also gets worse with every dosechange of quetiapine

 

it could have been triggered again by anything even the levomepromazine withdrawl

or all my other tapering.

 

i have also mental aksathisia

which is different from my hyperarousel. 

I can differentiate between akathisia-dysphoria and my normal depression. I have skinburning and bad cramps without magnesium. 

 

I am terribly afraid of reducing the medication that covers the akathisia yet I don't know which one this is.

 

I have never been on a stable dose of quetiapine, always down, seldomly up for all the time until now.

 

I had akathisia 20 years ago I think with imap depot injection. 

 

 

Drug dosage during the day:

 

7:30 am

small breakfast meat, vegetables, no appetite, no hunger, bread I cannot eat although I used to love it

cup of oatmilk, ist and hemp protein

 

7:30 am, always feel good for the first 30 min up to 1 h, sometimes a little anxiety

55 mg Quetiapin

1 mg diazepam liquid

vitamine d

magnesium 200 mg

 

i think hyperarousel and neuro -anxiety only lately appear always 1,5 h After each take of quetiapine and Diazepam. I am not sure about depression but if I have the worst neuro-depressiv attacks they happen or start often soon in the morning but I very seldomly wake up depressed (I have overall depression and in addition most severe neurodepression as attacks once during the day, times vary).

akathisia is always worst during the morning but severety is not the same every day.

some days the fluelike nausea symptoms start also in the morning, but mostly this terrible condition starts around 10 am and ends between 3 or 5 pm.

the hyperarousel only started again a week ago. It had dissapeared for some months and was worse around august before they put up my medication doses and reduced mirtazapine from 45 to 30 mg.

 

11 am 

20 ml Noni juice

 

12 lunch: cannot eat potatoes or pasta, eat meat, vegetables, no hunger, no appetite

12 

55 mg quetiapine 

1,5 mg diazepam liquid

 

again lately 1,5 h always after this hyperarousel and sometimes anxiety comes up. 

 

My terrible time of symptoms is daily between 10 am and 3 or 5 pm. This condition has started after or late stage of levomepromazine taper while I also tapered mirtazapin and Quetiapine. It is so severe I don't have words for it. I can feel that akathisia is contributing to it.

it feels like painful depression and/or flu, have often nausea with it, i just feel incredibly sick like flue and pain and as if I am fainting but bloodpressure seems ok. I cannot live with that. This condition pauses always for two days after I reduce quetiapine as I said. Otherwise it is permanent. 

Before this phase I had for most of the year (I guess as long as I was on 30 mg mirtazapin) my terribly daily time between 4 pm and 6 pm. 

 

2:30 pm (vitaminjuice, concentrated)

Magnesium 200 mg
 

I can never rest after lunch due to akathisia and when I try to close my eyes slight dizziness starts and if my body relaxes I get an anxiety spike all of a sudden.

 

5:30 pm dinner

One cup oatmilk oats hemp protein

I cannot eat bread or other carb although I loved it. No appetite, no hunger: meat ang cucumber and tomatoe

5:30 pm

67,5 mg quetiapine 

1,5 mg diazepam

200 mg magnesium

 

less magnesium

gives me cramps

 

again hyperarousel and anxiety spike 1,5 h later (only lately)

otherwise all other symptoms get much better, often before medication

 

8pm

mirtazapine 16 mg

 

1 h later everything is much better than the rest of the day, very stable pattern since may

Lately I notice my heartbeat

soetimes i can fall asleep 1 h after mirtazapin

mirtazapin makes me eat the rest of dinner and lunch (mostly meat), sweets and two eggs, have craving for sweets
 
9 pm

72,5 mg quetiapine 

1 mg diazepam

 

soon after this medication I fall asleep. 

 

I have to go to the toilet lately quite often 2-4 times a night, I wake up always after the dream, but can fall asleep again, lately I wake up sooner and sooner but not yet before 5:30 am. I feel strange because I have never been like this: waking up and immediately being fully awake. Often dry mouth

 

i drink a lot of water

i loose weight all the time but am not yet underwigjt

 

i must say that I don't take meds as the doctors think I do. There is good reason for it (they don't taper and they forced me to take an trizyclic ad adding to the other medication with knowing that my bloodpressure is constantly much too low (95/60)

 

Medication as the doctors believe I take:

morning

100 mg quetiapine 

1 mg diazrpam

200 mg magnesium 

vitamin d 

 

noon

100 mg quetiapine 

1,5 mg diazepam

 

evening

100 mg quetispine

 1,5 mg diazepam

200 mg magnesium

 

8:pm

40 mg mirtazapin 

 

night

100 mg Quetiapin 

1 mg diazepam 

 

Thank you all for working through this

 

 

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Altostrata

You are taking a lot of quetiapine and diazepam.

 

How are you measuring your doses of quetiapine and mirtazapine?

 

As it appears you have a paradoxical reaction after you take the combination of quetiapine and diazepam tat 7:30 a.m., noon, and 5:30 p.m., if I were you, I'd reduce the quetiapine dosage by 10% at each of these times.

 

It will take at least 4 days for a dosage change to fully register in your body. Keep careful notes of your dosage and symptoms throughout the day. This will show if a reduction of quetiapine reduces your symptoms.

 

It may be that you don't need the quetiapine at all, but you will need to gradually reduce it to avoid withdrawal symptoms.

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Tanha

Thanx for the quick reply

 

I have a precision scale and cut tablets into pieces

 

" As it appears you have a paradoxical reaction after you take the combination of quetiapine and diazepam tat 7:30 a.m., noon, and 5:30 p.m., if I were you, I'd reduce the quetiapine dosage by 10% at each of these times."

 

do I understand that you want me to taper quetiapine quickly?

i don't comprehend the tapering you recommend fully.

 

does it mean I reduce 40 % of my daily dose?

 

are we talking about only one step as to find out if it reduces symptoms? Or what tapering Intervall did you have in mind?

 

big problem here: 

i reduced from 275 mg after 4 weeks to 262 mg

after 4 weeks (and parallel mirtazapin taper) to 230 mg

 

i really didn't make it and first time ever Updosed 8 days ago from 230 to 250 mg which actually only helped for two days. 

The depression and nausea and flulike pain was impossible to endure. Also akathisia is bad with every small dosechanges. I thought these are symptoms of too fast withdrawl.

 

I find it difficult to believe that I can sleep without Quetiapine.

 

taking this into consideration would you still say a bigger cut could show me a Way? 

Be honest!

tanha

 

 

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Tanha

I really want and need to cut quetiapine!!!

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Thanx for the quick reply

 

I have a precision scale and cut tablets into pieces

 

" As it appears you have a paradoxical reaction after you take the combination of quetiapine and diazepam tat 7:30 a.m., noon, and 5:30 p.m., if I were you, I'd reduce the quetiapine dosage by 10% at each of these times."

 

do I understand that you want me to taper quetiapine quickly?

i don't comprehend the tapering you recommend fully.

 

does it mean I reduce 40 % of my daily dose?

 

are we talking about only one step as to find out if it reduces symptoms? Or what tapering Intervall did you have in mind?

 

big problem here: 

i reduced from 275 mg after 4 weeks to 262 mg

after 4 weeks (and parallel mirtazapin taper) to 230 mg

 

i really didn't make it and first time ever Updosed 8 days ago from 230 to 250 mg which actually only helped for two days. 

The depression and nausea and flulike pain was impossible to endure. Also akathisia is bad with every small dosechanges,

 

I find it difficult to believe that I can sleep without Quetiapine.

 

taking this into consideration would you still say a bigger cut could show me a Way? 

 

 

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Tanha

Sorry for my wrong maths

it is not  

a 40% reduction you recommend. 

 

That cut being recommended  brings me back down again to 230 mg quetiapine, right. Puh. 

 

Symptoms of my first try to taper to 230 mg:

 

Day one after reduction:

 

Lack of concentration, dysphoria, akathisia worse, other symptoms much better

 

2. day

zero concentration, akathisia a Little better, short anxiety spike, shorter sleep, great mooD

 

3. Day

dysphoria, great mood, akathisia bad, afternoon hell started: 

burning skin, brainfog, movementdisorder, fluelike  symptoms, dizzy, feeling terribly cold 

 

4 day

worst akathisia all day, dizzy, evening with long and strong anxiety, dysphoria, no interest, depression fells like bad pressure, not able to attend any therapy

 

5. day

early wake (5 am), akathisia a Little better, 11 am bad nausea until 4 pm, dizzy, sick, bedridden, Bad depressions, Anxiety all symptoms very severe until 8 pm (mirtazapin), Bad musclecramps

 

6. day

All day bad Depersonalisation, bad depression, bad anxiety

Bad akathisia, could not attend any therapy, bedridden (but walking due to akathisia), severe anxiety after lunch, Bad dysphoria, emptyness, bad musclecramps

 

7. Day

musclepain and cramps, could not attend any therapy (bedridden), all day most severe depression in my life, all day fluelike pain, bad evening, total empty, anxiety

 

7. Day

anxiety, most severe depression (unbearable), akathisie worse and all day long, fluelike pain all day until 4 pm  (16 mg Mirtazapin instead of 15 mg)

 

8. day 

severe depression all day, akathisia a little better, all day terrible "flue", bedridden, burning skin, a little better in the evening

 

Updose to 250

mg 

Very little improvements but more hyperarousel

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SkyBlue

Do you have a scale and are cutting tablets in the hospital?

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Tanha

Yes, I do, 

the doctors initially wanted to help me taper mirtazapin slowly but then they said they won't cut tablets or make liquids so they said. After that they change their attitude towards me in that they got angry about "me determining the way of medical treatment". They urged me to take more antidepressions in order to have one medication I am not in control of but they are. I am not allowed to know the name of it. I consented because otherwise I had to leave the clinic they said. I cannot go home, really. Since then I pretend to feel slowly improving and attend all therapies although I can't. I think that makes them not longer urging the new medication on me. They haven't mentioned it for weeks. And my situation due to my withdrawlsymptoms is getting so severe I cannot lie to them much Longer. 

If they find out about my drugchanges they will make me leave hospital immediately. 

I am here for 8 months now and do not function at all. I cannot sit in a car or go to a shop. I am severely hospitalized. 

Sorry for telling a sad story here. 

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Tanha

By the way:

 

sleep and the midday terribly feeling sick situation is getting worse.

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Tanha

Since I reduced mirtazapin and quetiapine parallel i cannot say which one is giving me these sickening problems. 

I raised both a little but that doesn't help much. 

Mirtazapin from 15 to 16 mg after a big step down 4 weeks ago from 20 to 15 mg. 

Quetiapine up by 20 mg. 

This midday sickness is so terrible and enduring. Have it for so long now. Two months I guess. 

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Tanha

I also believe that I have a paradoxical reaction. I guess it started or worsened after the updose. Yet the withdrawl symptoms (I believe the middaysickness is withdrawl) are so severe I am stuck.

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Tanha

What do you guys and girls think?

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Tanha

It helps a lot to finally being able to talk to someone about all this. 

It really makes a difference.

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Tanha

Another question:

i reduced mirtazapine from 30 to 15 mg although I was instable. I had a reason for that because doctors wanted to switch me to another ad which they eventually didn't because I pretend to feel better (didn't want more ad experiments). 

Now my depression is a lot worse being on 15 for 4 weeks now and on 20 mg before.

Would it be a good idea to go up a bit?

i increased to 16 mg 12 days ago and quetiapine also but it doesn't help much with depression. 

It is so severe I am loosing my mind.

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Tanha

Thoughing things out (withdrawl) is a strange option.

This was my only strategy I could think of since my first attempts and crashes Ct cymbalta by medical advice and after that to taper diazepam and quetiapine beginning of this year. 

I have been withdrawing and touching things out in the extreme way many of us know. 

I had and have the opportunity to do this in a psychiatric hospital in Germany since march yet without doctors support. For good reason and at my very own risk they don't know about my withdrawl practice. 

 

Toughing things out out for me ment to endure a tormenting condition which gets worse all the time, one way or the other and now I have to do it differently but the possible options are very difficult to choose, specially being in constant pain/akathisia and severe depression. 

I am hospitalized and even if things would be perfect tomorrow the way back into real life is

incredibly frightening. 

 

for many of us toughing things out is similarly lifechanging and I guess not always the best or only option. Sa is the first place that presents different options and sooooo many real cases from which I try to learn and find a way of toughing things out but with a perspective. 

Cannot see it from here but I know from sa that it is a loooooong way and that I need help with decisions in moments when I feel urged to do panicky stuff with my medication. 

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Tanha

I read through my Symptome notes again 

and yes, I must consider that I suffer also from a paradoxical reaction of quetiapine and/or diazepam. Very important to know.

Thanx allostrata to make me read my notes more effectively. I kept too much details with it which makes things difficult to see clearly. 

 

The tough side to this is that my depression became so severe during my parallel taper of quetiapine and mirtazapine that I cannot cut quetiapine right now as Recommended and necessary. 

 

That leaves me with 2 options maybe one of them being more adviseable than the other????

 

1.

staying on current doses (16 mg Mirtazapin and 250 mg quetiapine) for quite long hoping that the depression is getting better which I believe is a matter of months if successful at all (am on ssri/snri high dose for 10 years and fear that my receptors cannot regenerate and/Or the last cuts were too much for my body and I end up in prolonged withdrawl for years which I really see myself in as things went up to now)

 

or 

2. 

i increase mirtazapin a bit (1mg) to speed things up to get rid sooner of the quetiapine/diazepam which gives me an unnecessary hard time 

(anxiety and hyperarousel always 1,5 h after taking the pills 4 times a day.) but that is a crapshoot. 

 

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Tanha

Depression is still getting worse. 

Unbelievably worse.

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Tanha

Allostrata wrote:

 

"I completely understand the feeling of emotional anesthesia and demotivation.

 

It does get better.

 

Be very cautious about interfering with adrenal function. Paradoxically, emotional anesthesia is probably a function of the adrenals working well and producing the anxiety hormone cortisol, like they've been instructed to do by the brain. Most withdrawal symptoms are due to this."

 

The adrenals don't need additional stimulation, and they don't need slowing down -- they govern other very important body functions. It's best to leave them alone.

 

It's possible that fellow recovered from time passing, and the adrenal supplements were coincidental."

 

now this leaves me even more confused. 

I thought my anhedonia and physical symptoms (severe sickness, depression, pain, ...) are withdrawl symptoms. 

I couldn't endure it so I updose quetiapine first time ever. 

Things didn't improve or only for two days. Anhedonia and depression got too severe as did the sickness.

 

now that it is almost certain that i react paradoxically to diazepam and/or quetiapine (1,5 h after taking pills four times a day I suffer from increase of hyperarousel and anxiety) I start thinking:

 

i so desperately long to find a dose to stabilize on since I am in psychiatric hospital and almost bedridden.

 

allostrata, you recommended that a dosereduction of quetiapine might help and I replied that I am too hesitant about it because I just had failed to reduce it. 

But now that things are almost equally bad I wonder:

 

do i continue and try to stabilize on my updose from a week ago which doesn't seem to happen (do. I wait for a month and more in this most severe anhedonia/pain/depression state)?

 

do I increase mirtazapin to alleviate depression (which I tapered too fast lately) or

 

do I reduce quetiapine again and soon as allostrata recommends (but then again I remember I didn't make it 10 days ago) 

my adrenals are way out of control I Am sure. 

Is the drug induced constant hyperarousel worsening anhedonia  and as such 

disabling any stabilization? 

 

Then again I am afraid of another dosechanging event so soon.

 

I am not functioning at all, no tv, no reading, nothing is Possible. Nothing at all but reading through sa.

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Songbird

Relaxation exercises helped me a lot with severe akathisia and anxiety.  See: Relaxation exercises, guided meditations, calming videos, sleep hypnosis

 

This is the one that helped me the most, because it starts with gentle movements and gradually slows the body down: 

https://www.survivingantidepressants.org/topic/6122-relaxation-exercises-guided-meditations-calming-videos-sleep-hypnosis/?page=2&tab=comments#comment-390065

 

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Tanha

Thanx a lot

my akathisia is too bad so any kind of meditation (which I used to do a lot) except walkingmediation is impossible. Tich nah tan is best for me. 

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Tanha
On 12/12/2018 at 9:21 PM, Altostrata said:

You are taking a lot of quetiapine and diazepam.

 

How are you measuring your doses of quetiapine and mirtazapine?

 

As it appears you have a paradoxical reaction after you take the combination of quetiapine and diazepam tat 7:30 a.m., noon, and 5:30 p.m., if I were you, I'd reduce the quetiapine dosage by 10% at each of these times.

 

It will take at least 4 days for a dosage change to fully register in your body. Keep careful notes of your dosage and symptoms throughout the day. This will show if a reduction of quetiapine reduces your symptoms.

 

It may be that you don't need the quetiapine at all, but you will need to gradually reduce it to avoid withdrawal symptoms.

Thanx for the very valuable information. 

Scanning my notes and experiences I agree that I do have a paradoxical reaction with quetiapine/diazepam. 

 

Cutting quetiapine soon is a must!

 

But

As I wrote I also have debiliating sideffects or withdrawlsymptoms from quetiapine/mirtazapin (severe depression, anhedonia, terrible nausea and overall sickness/pain for hours around Noon). I am good in toughing things out but that was/is too severe.

 

Now i try to figure out what is more valuable:

 

soon tapering quetiapine again to find my way towards stabilization no matter how hard it will be

or

staying on the updose of quetiapine from 11 days ago for at least a month or more hoping the terrible sickness could improve? Since yesterday it seems for the first time that this sickness gets less Severe, though anhedonia is getting worse day by day. 

 

I wonder what my strategy and timeline could be?

 

i am not functioning at all what gives me a worse perspective with every Day more in hospital. 

Doing my excercises though as best as I can.

 

getting any rest during the day is impossible with akathisia (due to withdrawl?) and hyperarousel (due to the paradoxical reaction). 

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Tanha
On 12/12/2018 at 7:26 PM, manymoretodays said:

Hi Tanha and welcome from me too,

 

Yes, it sounds quite debilitating now.  A bit more detail in the signature will help.  This is the portion you see below others posts, unless viewing from a phone device.  Do your best to spell out the whole medication name.  You could just sum up what you recently discontinued, with the date.  And what you are presently on.

 

If your drug history is very long, the last few years will do. FOR READABILITY, SHORT LINES ARE BEST.

 

  • A list is easier to understand than one or multiple paragraphs
  • Include ALL drugs, doses, and dates (starting and stopping)
  • Any drugs prior to 24 months ago can just be listed with start and stop years
  • Please use actual dates or approximate dates (e.g. mid-June) rather than relative time frames (e.g. 3 months ago)
  • Spell out months (e.g. "January" or "Jan" as 9/1/2016 can be interpreted as 9 Jan 2016 or 1 Sept 2016)
  • Please leave out symptoms and diagnoses

 

Example:

2001–2002 paroxetine 
2003  citalopram 
2004  paroxetine
2008  paroxetine slow taper down to 2016 Aug off paroxetine
2016  citalopram May 20mg  Oct slow taper down
2018  citalopram 13 Feb 4.6mg 15 Mar 4.4mg 29 Apr 4.2mg

 

If you edit your signature, the new one replaces any prior signature. It will appear in your signature under all your posts, even your old posts. If you want to save the information in the old signature, copy it and save it in a file on your computer or in a post in your Introductions topic.

 

(As of 12/31/13: Signatures are limited to 12 lines of text.)

How to add or edit your signature

  1. Click on this link to open the correct page in User Settings:
    Create Your Signature in "Account Settings"
    2017-June 12 update: link works on desktop, tablet and mobile phone versions

Then, once there is a bit more clarity to the signature.

Go ahead and give us some daily notes, such as in this link:

Daily notes/drug and symptom logs

This format, ^ is what we need to see here, right on your introduction page.  This is what Alto is referring to above. 

 

Both of these things will help us to get a better idea of where you are at, with withdrawal, and then your present intake of medications/drugs.

 

I'm only guessing but it all probably feels like doing a giant small piece puzzle and/or like doing one of the tougher crossword puzzles.

Just take your time.  Write things out on paper first.  And then post.

Meantime, just stay put with your current drugs and dosages.

 

Love, peace, healing, and growth,

mmt

Thanx a lot.

 

if sa could assist me a bit solving my intricate puzzle would be so great. 

As I said I am mostly bedridden since march and in psychiatry since may. I lost my social functioning and every day more here is making the way back to coming home tougher and Tougher. Anxieties pile up the more I have to live disconnectedly from the outsideworld. 

Anhedonia and cognitive functioning make any distraction els then walking impossible. Akathisia never allows me a minute of rest during the day. 

 

I know all this won't stop soon but at least I need a perspective.

 

thsnk you all

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