Arturo: Spanish polymedicated member - deciding which drug stop taking first

[Arturo]

Hello. This is Arturo, from Spain.

 

I suffer from chronic pain, generalised anxiety disorder and depression.

 

I have been taking different prescription drugs, but the last treatment consisted in:

 

Escitalopram 20mg (1-0-0)

Lyrica 75mg (1-0-1). I mean, 150mg daily.

Flurazepam 30mg(0-0-1) for insomnia.

 

As the insomnia improved, I tried to stop Flurazepam, but felt into a terrible withdrawal, with severe depression symptoms. I started taking it again and tried to tapper it off slower. Currently I am taking 7.5 mg each night.

 

I would like to cut off the Lyrica first because I feel dizzy and lethargic sometimes (but very anxious other times) and have gained a lot of weight. I think that I can have enough sleep, so I have cutted 25 mg (starting yesterday), so I am currently on 75-0-50.

 

My medium place goal is to suppress benzos and Lyrica and take only 10 mg of escitalopram. Long place, of course is 0.

 

¿Do you think this is a good strategy?

 

Thank you all. I am very happy to have found this forum. 

[SkyBlue]

Hola, Arturo, y bienvenido.

 

Good to meet you. You are in a good place here.

Thank you for filling out the drug signature. 

 

On 2/25/2019 at 10:58 AM, Arturo said:

 I tried to stop Flurazepam, but felt into a terrible withdrawal, with severe depression symptoms. I started taking it again and tried to tapper it off slower. Currently I am taking 7.5 mg each night.

 

I would like to cut off the Lyrica first because I feel dizzy and lethargic sometimes (but very anxious other times) and have gained a lot of weight. I think that I can have enough sleep, so I have cutted 25 mg (starting yesterday), so I am currently on 75-0-50.

 

Had you tapered the Flurazepam from April 2018 until now, going from 30 mg to 7.5 ? Can you tell us at what rate you tapered? 

I am wondering if you tapered it at 10% per month starting at your 30mg dose, cutting 3mg each time? 

And how recently have you decreased in dose? 

 

Depending on how sensitive you are (and you might be more sensitive because of recent drug changes), 25mg off the Lyrica actually might be a fairly large decrease. We find that people usually do best by tapering at a rate of no more than 10% of their current dose per month (so the actual amount of change each time is continually smaller). 

 

How are you doing generally -- are your dizziness, lethargy and weight gain your main symptoms? Do you feel in a good place to start reducing the Lyrica?

 

I share your same goals of wanting to come off these drugs. It is definitely possible, and it sounds like you are going about it in a careful and methodical way, which is excellent.

 

[SkyBlue]

A couple of more things: 

 

1. Put ALL the drugs you take in the Drug Interactions Checker at http://www.drugs.com/drug_interactions.html.

 

2. Here is some more info on "which to taper first" for those taking more than one drug. 

 

https://www.survivingantidepressants.org/topic/2207-taking-multiple-psych-drugs-which-drug-to-taper-first/

Although it is always up to the individual, of course, the info in that thread adds support to your decision to come off the Lyrica before coming all the way off the benzo. 

[Arturo]

Thank you for your response, SkyBlue.

 

Well... my tappering strategy has been quite awful until now. Lack of information and bad doc advise. Sound familiar?

 

Started at october 2017. Lorazepam and Paroxetine. Soon added Lormetazepam at night because Paroxetine gave me a terrible insomnia.

At november switched from Lorazepam to Clonazepam. It is supposed that it could help with neuropathic pain. At december switched from Paroxetine to Duloxetine for the same reason. The pain didn't get better and Duloxetine made me too anxious and activated.

 

February 2018. Switched from Duloxetine to Venlafaxine. I get worse and the insomnia also worsened (Lormetazepam tolerancy, I suppose). Talking to my doc, I decided to stop Venlafaxine (almost cold turkey). I was only on benzos until April. I didn't got better, but neither worse. Same grade of high anxiety and depression than before.

 

April 2018. I desperately returned to the doctor. I was then put on my actual meds:

Switched from Lormetazepam to Flurozepam 30mg for insomnia

Lyrica, 150mg for anxiety

Escitalopram 10mg.

 

At the begining, It seemed to work. Lyrica made me feel less anxious, and I started sleep well. As the doctor told me, I stopped Clonazepam (was only taking 0.5mg daily). Soon the effect of the meds started to be too strong. I started sleep too much and, specially in the mornings, I felt very tired and apathetic. The doctor said it was a signal that I can start quit benzos. He told me to get rid of Flurazepam in two months. Here in Spain you can only found 30mg capsules, and I known nothing about liquid preparations, so the strategy was start spacing the doses.

 

When I was taking one pill each four days, I started feel worse. But I still could have enough sleep, so I don't think it was withdrawal, and I continued tappering plan. I was less anxious than before, but more drepressed. One day, when it has been passed 10 days from my last flurazepam pill, insomnia returned and I decided to take one, only for that night. The next day my depression symptoms reduced a lot. I decided then to start the taper again and do it slower this time, and the doctor suggested to increase escitalopram to 20mg.

 

Now I know that I still did a very fast tapper, but I felt not as bad as the first time. Even I were off flurazepam for one and a half months (mid November - end December 2018) and still sleeping well and feeling a bit better than before, but then I started feeling worse again. I reinstated it, one pill each other day. Then I thought that I could open the capsule, divide the content, and put it into gelatine capsules. I did it with, dividing the content of each capsule in four parts. Why four? well, when I first started feel severe withdrawal symptoms, I was taking one pill each four days. That's the reason. That's my actual dosage: 30/4 = 7.5mg.

 

With Lyrica... I started think it was not helping anymore and I read a lot of awful things in the internet. Also I was too apathetic, lethargic sometimes (but very anxious others) and I had gained a lot of weight. I started reducing 25mg in my nightly dosage because, reading the (wrong) information of the laboratory, it seemed safe.

 

So this is the point where I am now. I have done a too much quick tapper, but I would like not to reinstate, if possible, and wait one more month looking for stabilisation.

 

I don't really feel in a very good place, but no doubt I have been worse. The point is that I think the meds are making me more damage than help.

 

In addition, my pain make me difficult to relax, but that is another story.

[SkyBlue]

13 hours ago, Arturo said:

Thank you for your response, SkyBlue.

 

Well... my tappering strategy has been quite awful until now. Lack of information and bad doc advise. Sound familiar?

 

So this is the point where I am now. I have done a too much quick tapper, but I would like not to reinstate, if possible, and wait one more month looking for stabilisation.

 

I don't really feel in a very good place, but no doubt I have been worse. The point is that I think the meds are making me more damage than help.

 

You're very welcome. 

 

Hmm, yes, lack of info, lack of informed consent, and bad doc advice. Yes, that sounds familiar! 

 

Thanks for updating your signature. I'm having some cognitive trouble at the moment, but it looks good. 

Very important: in your signature, you mention tapering Fl every other day. Going forward, please know that we strongly caution against that. I'm sure you know that by now.

 

I (and many others!) can definitely understand the position in which the drugs are causing more harm than help. 

 

One thought about your pain and overall wd experience: have you tried magnesium? It can be very calming. Most people do best starting with very small amounts. Here is more info: https://www.survivingantidepressants.org/topic/15483-magnesium-natures-calcium-channel-blocker/

 

The decision to reinstate is of course a very personal one. It sounds like you are, if not doing *great*, feeling stable enough to try to stabilize and not reinstate. 

 

Please keep notes on paper about your daily symptom pattern (and times you take the meds), and keep letting us know how you're doing. 

 

 

[Alanmane]

Hola amigo, 

Eres la primera persona del foro que veo que es de España, yo soy de Barcelona. Si quieres hablar sobre esto no dudes en mandarme un privado. 

 

Muhco ánimo 

 

Google translation for non-Spanish speakers:

 

Hi friend,

You are the first person in the forum that I see is from Spain, I'm from Barcelona. If you want to talk about this, do not hesitate to send me a private one.

 

Edited March 1, 2019 by ChessieCat

[Arturo]

8 hours ago, SkyBlue said:

you mention tapering Fl every other day. Going forward, please know that we strongly caution against that. I'm sure you know that by now.

 

Well, yes... by now. It is a very long life benzo, so I thought it was secure, ahem...

 

8 hours ago, SkyBlue said:

One thought about your pain and overall wd experience: have you tried magnesium? It can be very calming. Most people do best starting with very small amounts.

 

I'm on magnesium. It seem to help with wd. The pain... the problem is that it is a neuralgia (not muscular) and its treatment is complicated. There is not correlation between this pain and real damage. Anyway, the pain is not very intense, nor disabling. I've been living with it for more than one decade without major problems, but now I was failing in managing it cognitive and emotionally. I am in CBT for that. Maybe I will try a combination of B vitamin complex and ALA supplements. It seems to have helped other people with similar conditions.

 

8 hours ago, SkyBlue said:

The decision to reinstate is of course a very personal one. It sounds like you are, if not doing *great*, feeling stable enough to try to stabilize and not reinstate. 

 

Yes, that's the idea. Thanks a lot for your advice.

[Arturo]

Lyrica has a short half life (about 6 hours). It means that stationary state is reached in 24-48 hours.

 

It only has passed 8 days since my last jump, but as my whithdrawal symptoms have not worsened, I've decided to cut another 15mg in the morning dose:

 

Update:

Flurazepam: 7.5mg at night

Lyrica: 110mg (60-0-50)

Escitalopram: 20mg

[Arturo]

Topic title: Flurazepam, Lyrica, Escitalopram. Some mistakes and replanning. Doing right?

 

Hello all.

 

I thought I was not doing bad since my last lyrica cut. Only one week, but withdrawal symptoms didn't seem to feel so bad. I was thinking to make another cut today, stabilized in 100mg and start tapering escitalopram.

 

I have a bit of insomnia. Not much bad. I can sleep about 6 hours, then need to pee and sometimes I can get asleep again one more hour, sometimes not. Since I had have several not very good nights, I took some medical cannabis on wednesday night. It helped a lot with sleep, but the next day (yesterday) I woke up unable to control my thoughts and had a lot of anxiety along the day. Cannabis really helps me with my neuropatic pain and with sleeping, but now i know that I need to put it aside at least until my nervous system will be healed.

 

So, decision 1: No weed for now.

Another thing that seems is affecting is interdose withdrawal with lyrica. Attending my daily anxiety patterns, I think I can suffer of it, so I have decided to spread my intake in 3 doses, instead 2. And hold the actual dosage a bit more time, looking for stabilization.

 

And, Maybe now I need to taper Escitalopram first, since it is the most activating drug and I am currently taking a High dose. May be if I see that I am still sleeping well and with low anxiety, can try to alternate tapering. Or even try to (slowly) taper more than one drug at a time.

 

So my plan is:

- No weed

- Spread lyrica intakes and stabilize

- Taper Escitalopram first

 

Have sense to you?

 

Two more things: This morning I have made a mistake with my titration bottles and have taken 15mg of flurazepam, thinking it was Lyrica (Currently I am taking only 7.5 mg at night). Since it has a long half life, I hope it will not have much impact on my system.

 

And the last thing is, apart of escitalopram, Do you think it is better to taper Lyrica or Flurazepam first? They are both brakes. I am thinking that Fl first is better, because of benzo tolerance, and the actual dose is not very high, so I can completely taper one drug in a shorter time, but I'd like to read your opinion.

 

Thank you very much.

 

Edited March 15, 2019 by ChessieCat
added topic title / removed link to Intro topic

[Altostrata]

Hello, Arturo. What times of day do you take your drugs, and their dosages? Do you still feel dopey in the morning?

 

Yes, you may have interdose withdrawal from Lyrica, or you may be experiencing withdrawal effects from reducing it.

 

Do you find escilatopram stimulating?

[Arturo]

Hello, Alto.

 

Escitalopram 20mg in the morning, after waking up.

 

Lyrica 60mg at 10:30 a.m., 50 mg 10:30 p.m.

 

Flurazepam 7.5 mg before bed.

 

I don't find Escitalopram specially stimulant. I only think it's the more stimulating of the three.

 

I feel only lightly dopey in the morning and more anxious (sometimes extremely) in the afternoon. I have not noted a big change in this pattern after reducing Lyrica. Maybe a little worse the first 4-5 days.

[Arturo]

I am not stable at all, but I am not worsening, so I made another cut on Lyrica last friday.

 

I have reached a standard dosage, which I can take with standard prescription doses (100mg). Since my intake of flurazepam is much below the therapeutic range and my insomnia is not very bad, I will try to cut it before continuing tapering the other drugs.

 

The first days after each drop, I am using kava for anxiety. It really helps, but I want to use it only very sparingly, as a rescue tool. I have used medical cannabis again. Only very occasionally, if I need to rest well after a few bad nights. I have discovered that if I use a high CBD:THC proportion and the total amount is moderate, I can rest well with very little rebound anxiety the next day, so it is another tool. Also to use very carefully.

 

I am not really feeling very very good, but I am getting more optimistic about the future.

[Arturo]

Well... I need to tape flurazepam to 0 before may 30th. I've calculated the doses for daily microtapering. Since I have only taken it for a year and my actual dose is not very high (25% of the therapeutic dose) I hope to be well. It's a bit fast, i know, but I think I can manage it.

[SkyBlue]

2 hours ago, Arturo said:

Well... I need to tape flurazepam to 0 before may 30th. I've calculated the doses for daily microtapering. Since I have only taken it for a year and my actual dose is not very high (25% of the therapeutic dose) I hope to be well. It's a bit fast, i know, but I think I can manage it.

Hi Arturo,

 

If you feel comfortable sharing-- why do you need to stop the Flurazepam before May 30?

 

[Arturo]

Hi, SkyBlue. I don't really 'need', but it is a psychological date for various reasons.

 

I am going to make a travel to Rome that day (vacation) and I am not confortable with carrying my titration/scale/capsules equipment into the airport (I am only porting hand luggage).

 

Last november/december I stayed off Flurazepam for almost two months, and didn't very bad until I crashed, but, despite reinstation, I have never felt really stable. I think reinstation was too late for a benzo, so I don't expect to start a real stabilization until reached 0.

 

I also have a more or less good sleep. I do not have big problems with insomnia. More with daily anxiety, but I am also on Lyrica and Escitalopram, which are supposed to be useful for this condition. They both may act as brakes, I hope.

 

And, according Dr Petter Bregging, the most time you have been under a drug, the more time you need to taper. He suggest one month of tapering per year on medication.

 

All these facts, and my personal will made me take this decision. But, of course, if I start feeling too bad, I will listen to my body and hold for a time.

[SkyBlue]

It sounds like you have a good plan. I'm glad that you will hold if needed. 

[Juan]

Hola @Arturo @Alanmane ,

Feel free to DM me in Spanish, if you need me someday.

Hope you all are doing well.

Saludos,

Juan

[Altostrata]

Arturo, how are you doing?

[Arturo]

Hello, Altostrata. Thank you for your interest.

 

Following my plan, I had a horrible crash: I have tried to go too fast.

 

Reviewing the situation with my doctor, I reinstated Flz. I got better almost immediately. Then started to taper at a much lower rate and I am doing pretty well now. Only mild symptoms.

 

Now I am at 3mg. A very low dose. But still need to address lyrica and Escitalopram. But there is no hurry.

[Manny78]

Hello Arturo,how are you? I am from Spain,too.

 

Greetings

 

Manny

[Arturo]

Hi Manny. have you born in 1978? I do.

 

I've had ups and downs, but now I'm fine. Finishing with benzo taper. I have some symptoms, but the bad anxiety and depression, which are the worst of them, seems to have reduced a lot.

 

Next, I want to taper Lyrica, and then Escitalopram, but I'll go slow and steady.

 

Thanks for asking.

[Manny78]

Good afternoon, Arturo.Yes,I was born in 1978.I am from Galicia,and I am having a very hard time to come off of these drugs. 

At this moment,I am taking abilify 10mg,risperdal 1,75mg,klonopin 0,25mg and akineton retard 4mg.

Is your doctor cooperating with you to taper off all your drugs?My psychiatrist is not. I need to find a psychiatrist to help me. I really hate them. If you know a psychiatrist that would help me, I would appreciate it. 

Have a good day, 

 

Manny

[Manny78]

Is too much cutting off  0,25mg of risperidone?? 

[Arturo]

Hy, Manny. By now, yes, my doctor is (more or less) cooperating with the slow reduce with flurazepam and Lyrica. He wants me to stay on antidepressants (escitalopram) for more time. We will see...

 

This is a private psychiatrist in Madrid. I don't know much more of them...

 

I don't know much about risperodine, but 0,25 over 1,75 is about a 15%. Slightly more than the general recomendation (10%), but the reaction is very individual, so you can give it a try.

[Manny78]

Hello Arturo.I am glad that your psychiatrist is helping you out. I go to a public psychiatrist.