ArchieP: withdrawing from current use of moclobemide

[ArchieP]

Hey, folx, 

 

I'm ArchieP. I'm currently on 450mg of moclobemide daily with breakfast, which can be anywhere between 8:30 am and 1 pm, but it's typically 9 am. I've been on this dose for 7 days. Prior to that I was on 600mg for 3 weeks, and before that, 900mg daily - 600 in the morning, and 300 at lunchtime - for approximately 3 months. This was introduced over the course of a few days after rapid (also a few days) reduction / elimination of duloxetine 60mg. I was on duloxetine for approximately 1 year, prior to which I was on escitalopram for around 9 months - got up to 40mg daily. During this time I was also on lamictal for a couple months, and then brexpiprazole for roughly the same time. I can't recall the dosages of these, but I know I stopped taking both abruptly as I felt so awful and I was convinced it was their influence. I've also taken 5-15mg of diazepam, on average, 3 days a week,  for 2 years, though I stopped it completely 2 months ago. I currently take 15mg of zopiclone every night and have done so for around 2.5 years. I want to get off this, but I am just concentrating on the moclobemide at the moment. I am experiencing pretty much all of the symptoms on the Harvard psychs' list of withdrawal symptoms provided on this site - both physical and mental / emotional. There seems to be scant literature concerning withdrawal from reversible MAOIs. It generally doesn't seem to be associated with a withdrawal syndrome, however, my reaction has been extreme. Though it feels qualitatively different to withdrawal from SSRIs/SNRIs, it is still severe, debilitating, and terrifying. I guess I'm mostly looking for validation from others with similar experience / knowledge about this phenomena. Though I have pretty good support around me, as many have experienced, there's a lot of misinformation / ignorance amongst medical professionals. This, coupled with not really being connected to anyone who has been through this is making me feel isolated and like I'm losing my mind sometimes, whatever that means... I'm hoping fellow travellers will offer some guidance and encouragement, and I apologise if I'm not adhering to the groups guidelines correctly - the brain fog / inability to concentrate is severe - especially when it comes to screens. 

 

When I dropped from 900 to 600 I felt horrific for 3 weeks, and then had a few good days, and 2 days after dropping another 150 I feel similarly...

 

Mood swings

Dizziness / balance issues

Visual disturbance 

Sleep disturbance

Nausea

Terrible headaches 

Hypersensitivity to sound / light  / smells 

Extreme agitation 

Irritably / anger / aggression 

Panic 

Suicidal thoughts 

Muscular pain 

Like my gums are leaking battery acid / can get my mouth and teeth to feel clean

Insatiable or absence of appetite 

 

I greatly appreciate everyone's time and efforts, and feel some relief at having found this site. 

 

Cheers,

 

Archie. 

 

 

 

 

 

[ArchieP]

Is anyone there? I'm feeling hopeless and super overwhelmed by all the dense, technical info on this site and don't know how to proceed. I read that it can take 24hrs for a new post to be seen by a moderator, but because it's been longer than that I wondered if I'd done something wrong... Or maybe you folx are just overrun. 

I've tried to do a signature and found it near impossible to fit everything in 12 lines. I just  remembered that I've also been on 10mg Amitriptaline on and off for 2 years, usually no more than 10 days in a row. Hope to hear back from someone soon x 

[WiggleIt]

Hi ArchieP!

Welcome to the group.  I'm  glad you found this resource.  The community here has been my lifeline, and I hope you find the help here you need.

Yes, MAOIs can give withdrawal, just like any class of psych med can, so don't be alarmed.  There was a medical journal article I read years ago that included MAOIs, but, like all psych med withdrawal info, I got more support and knowledge from online support groups than I did from academic or medical resources.  

The reductions you've been doing on your MAOI actually strike me as really big jumps.  This site recommends the 10% taper method, where you taper by 10% of your current dose (not your original dose).  For example, after you hold at 450 for a while, your next reduction would be 10% of 450.  Here is a link to info about the 10% taper method:
 

If I'm understanding your signature correctly, your current meds are moclobemide (MAOI) and zopiclone (Z med).  Do I have that right?  The general guideline on this site is to taper the most stimulating med first, so you'd be looking at a case of holding your Z-med while you continue a slow taper of 10% of the MAOI.  Here's a link that talks about tapering multiple meds:
 

 
Don't worry if it takes you a while to orient yourself to the site.  You've posted everything swimmingly so far!  And you already have your signature going for quick reference, so thanks  That's WAY more than I managed to do correctly when I first got here!

As far as your symptoms go, I know they are terrifying, but I promise you that I felt every single thing you listed and I improved.  I even had crazy gum sensations and sought out the top periodontist in my whole state who repeatedly assured me there was nothing wrong with my gums.  With time, my gums also stopped being nightmarishly weird.  



  
  

[WiggleIt]

Hi Archie!  Looks like your follow-up comment came through while I was in the midst of typing my message to you.  We're here!

[ArchieP]

Thank you!!! I've read the two posts that you've linked me to. I guess I'm still struggling to figure out whether I should be reinstating to my previous dose, or even a portion of that, given the severity of my symptoms. I feel very conflicted about whether this is the best move after reading the info on this site. I also don't understand how I'd cut 45mg off my 150mg tablet, or if that's even the right calculation. I'm terrible with numbers 😕 

You have my current use correct 👍🏽 Definitely tapering the AD before the Z 

Sorry to hear about your weird gums and everything else! So glad to hear that you've experienced relief  

[WiggleIt]

If you were going to cut by 10%, you'd likely be looking at making a liquid solution to measure  your reductions, but before we get into that, it looks like you've been at 450 for less than two weeks.  How about giving yourself time to hold at that rate before considering another reduction or worrying about math just yet?

Also, is it safe to assume you've been physically cutting your pills, such as with a pill-cutter or something similar?

Give yourself time at 450 and, while you're holding, you can take as much time as you need to read through the Tapering section on SA about how to proceed with a liquid taper for a 10% reduction.  Also, I'll see if anybody else can join our conversation and give you some tips; people here have been through everything, and there are definitely liquid taperers in our community for you to talk to.

     

 

[ArchieP]

Thanks so much, Wigglet. Yes, it's only been 8 days, and I'm planning on waiting 4 weeks before considering another drop, or more if I haven't stabilised. You're right - I'm getting ahead of myself. Appreciate you recognising that and the gentle reminder. 

 

I haven't been using a pill cutter. The AD's come in 300 and 150mg tablets. I have both and I'm currently taking 3 x 150mg. 

 

Again, thank you. I'd really appreciate that. I'll have another look at the tapering guidelines with a focus on liquid x 

[Carmie]

Hi Archie, 

 

Glad to see you’re going to hold for a while. Clever move! 

 

Yes, do check out the thread on water titrating. I actually water titrate. I crush my tablet with a mortar and pestle n add water. I’m on a lower dose than you though, I’m crushing a 25mg tablet and adding 20ml of water. I’m not great with the math side of things but somehow managed to get myself down to 7.5mg. With these calculations every ml is 1.25mg. My head explodes every time I need to do my math.🧨😂

 

You would have to add more water to your tablets though as your doses are higher, so your calculations will be different. You should never taper more than 10% a month as you know. Now that I’m on lower doses I can only actually taper by 4% to 5%.

 

There’s plenty of time to figure out the math as you will be holding for a month or more now anyway. 

 

Wishing you all all the best with your continued tapering💚

[Altostrata]

Welcome, Archie.

 

Moclobemide is not widely prescribed and not at all in the US, I had to look it up. For future reference, https://en.wikipedia.org/wiki/Moclobemide

 

What times of day do you take your drugs, and their dosages? It's best to be very regular with your dosing, irregular dosing itself can cause odd symptoms.

 

Have your symptoms changed over the last week? How's your sleep?

 

Moclobemide has such a short half-life, depending on your symptom pattern, it might make sense to divide the dose.

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.

 

[ChessieCat]

13 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.

 

Hi Archie and welcome from me too,

 

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

[ArchieP]

Thanks, Carmie. I feel you with the head explosions! Yep. Just gonna reconsider the math closer to the time  

 

Thanks for the welcome, and the example, ChessieCat. 

 

Altostrata...yes. Moclobemide is an old school AD that gets prescribed in Australia, (where I am) when SSRIs/SNRIs fail, apparently. I was put on it when I was hospitalised. I had read the wiki page, and that it is not approved by the FDA in the United States. I take the full 450mg at 9am. I'm making sure I stick to that time. I feel like my symptoms have subsided somewhat over the last couple days. But still awful. My sleep, if one could call it that, is okay, because I take 15mg zopiclone every night (next thing to taper). I was advised by the prescribing psychiatrist during my second hospitalisation that I shouldn't take it after 1pm as it can lead to insomnia. Perhaps I could try taking half the dose in the morning, and half at lunchtime. 

 

15 February 

9 days post 150mg drop 

Woke at 7am. Felt anxious - clenching around heart and teeth - tired, tense. Ringing in left ear. Mild nausea. More acne. Slept okay (6.5hrs) after 15mg zopiclone. It's 2 days later in the week than I thought it was... 

8:50am - slight headache. Lethargic. Depressed. Dizzy 

9am - ate breakfast and had 450mg moclobemide 

9:20am - diahorrea 

Felt relatively okay until around midday, but notice consistent clenching of jaw, and dizziness when bending / standing 

12pm - intense fear / panic / anxiety about pretty much everything. Out of body sensations 

2:30pm - slight involuntary movement of hand and foot. Extreme sensitivity on right side of body...can't describe the feeling 

3pm - feel like the ground is moving 

4pm - headache sets in. Take 2 neurofen and 2 panadol. Does almost nothing 

6:40pm - disturbed by bodily sensations and exhausted and can't think straight. Have to lie down

[ArchieP]

9pm - teary. Emotionally erratic. Suicidal thoughts

[ArchieP]

6:30am - woke with terrible sense of dread and fear 

8am - still in bed. Slight headache 

8:30am - sad. Ringing in left ear 

9:30 - took approx 225mg moclobemide with breakfast 

11:30 - depressed. Headache. Went back back to bed. Pain behind my eyes when I move them 

1:30pm - took approximately 225mg of moclobemide with lunch. Have milder headache

2:10 - p bad headache 

3:20 - take 2 neurofen and 2 panadol 

4pm - still have headache - feels like brain is swelling - and teeth clenching Buzzing in left ear 

5:30pm - racy thoughts. Kinda up 

6:30pm - extreme sensitively on right side of body. Very agitated. Angry. Panicked 

9:30pm - anxious - rapid breathing or forgetting to breath. Teeth clenching 

10pm - teary. Bad headache. More acne. Just took 15mg zopiclone. Ringing in left ear

[ArchieP]

17/2/19 

6:30am - exhausted. Woke up with period - nearly 2 weeks late 

8:30 - extremely tired and irritable 

10:20 - breakfast and 225mg moclobemide 

11:30 - irritable. Teary 

12:30 - nauseated. Dizzy. Emotional 

1:15 - strange sensations in right side of chest and upper right side of back 

2pm - snack and 225mg moclobemide. Bit of a headache. Feel like I'm falling when I close my eyes and try to sleep 

2:45 - crying at everything 

6pm - unbearable sensations in right side of body, mainly focused around my chest

7:30 - headache. Tired. Chest is burning  

9:30 - just awfully sad

[Altostrata]

I see you split the moclobemide dosing just 2 days ago? Have you ever taken it like this before?

 

The split dosing is going to take at least 4 days to take effect. It looks like you get nausea, headache, and dizziness as a side effect after you take the drug. This may go away in a few days. Please continue to keep daily notes.

 

How has the change affected your sleep?

 

 

[ArchieP]

Yes. But not on this dose. I used to take 600mg in the morning and 300mg in the afternoon. 

 

Okay. Thanks. Will do. 

 

Don't think it's made any difference... 

[Altostrata]

Are you still taking zopiclone? Please include it in your daily notes.

 

Why did you start taking an antidepressant in the first place?

[ArchieP]

Yes. I take 15mg every night. Okay 

 

I started taking AD's 2 years ago after experiencing extremely severe, chronic major depression since I was 12. I'm 40. I had therapy for several years. It was a last resort 

[Carmie]

Hi ArchieP, 

 

How are you doing?

 

Could you please put in your daily symptoms log for the last few days so Alto can have a look at it. Thank you.

 

I hope you’re coping okay. This really is a hard journey, but we will heal eventually. We all wish it was quicker, but we can’t do much about that.

 

 Do you have any distractions that can help you get through the bad days. They won’t get rid of your symptoms, but it’s good to focus on something else even if you’re anxious or anhedonic. 

 

Wishing you all all the best in your healing journey 💚