RichT: coming off Abilify

[RichT]

I have been on quetiapine 200mg, citalopram 40mg and Abilify 5mg daily. I have been functioning well on this combination. My psychiatrist advised me to stop Abilify when I was ready as he said taking two antipsychotics is not recommenced. I noticed a slight tremor in my hands about three months ago and thought that this might be the time to stop Abilify. I stopped 11 weeks ago. I cut to 2.5mg for three weeks with no ill effects, then stopped altogether 8 weeks ago. Generally, I haven’t been too bad, just feeling some tiredness and confusion, but sleeping ok and not feeling anxiety. However, in the last 10 days I seem to have taken a turn for the worse, which started with feelings of anxiety. To compensate, I raised the quetiapine to 250mg. I am in Spain at the moment  (until 11th April) and my psychiatrist is in London so I made that decision myself. The anxiety has receded but in the last 24 hours i felt some  disassociation and suicidal thoughts - feeling very ill. A local doctor here gave me some Clonazepam to take but I don’t want to take it regularly as the last thing I want is to be hooked on benzodiazepines.

 

i realize that I have stopped pretty suddenly, so I need to think about continuing as I am vs going back on and tapering more slowly. 

 

I would love to hear other people’s thoughts and experiences - this is a pretty lonely road!

 

many thanks,

 

rich

[manymoretodays]

Hi RichT and welcome to surviving antidepressants,

Sounds like a fairly decent psychiatrist to have you not continue on 2 neuroleptics/antipsychotics. 

Unfortunately......like many though, not too well versed on harmfree tapering.  I think you are experiencing withdrawal(WD) symptoms now.

Ooof, so sorry......

 

I've moved your post from tapering to the Introductions topics. 

This will be the place for you to ask questions specific to your situation, and acts as a journal for you.   You've now introduced yourself to this community and other members and moderators can communicate with you here as well. 

 

If you could put your withdrawal history into a signature that would very helpful.

Take a look at this post to see what we would like to see there:  Please put your withdrawal history in your signature

I also extracted most of the pertinent information below.

The signature can be seen below your post, when signed in, unless you are viewing from a phone device.  However, you can still create a signature from your phone device.

It helps us all to view your current situation at a glance.

 

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

 

 

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

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Edited March 28, 2019 by manymoretodays

[manymoretodays]

 

10 hours ago, RichT said:

However, in the last 10 days I seem to have taken a turn for the worse, which started with feelings of anxiety. To compensate, I raised the quetiapine to 250mg. I am in Spain at the moment  (until 11th April) and my psychiatrist is in London so I made that decision myself. The anxiety has receded but in the last 24 hours i felt some  disassociation and suicidal thoughts - feeling very ill. A local doctor here gave me some Clonazepam to take but I don’t want to take it regularly as the last thing I want is to be hooked on benzodiazepines.

 

Tips for tapering off Abilify(aripiprazole)

from ^...... Abilify has a very long half-life -- estimated at 4-7 days -- but still needs tapering.  What this means is that basically it may take longer than many of the drugs we deal with here to feel withdrawal symptoms. 

So.......I think your current symptoms that started 6-7 weeks after your last dose of Abilify  are due to WD.

 

According to medical knowledge, reinstatement is the only way to alleviate withdrawal symptoms.   
About reinstating and stabilizing to reduce withdrawal symptoms

Do you have any Abilify left?

 

Good idea with the clonazepam to limit any usage now so as to avoid another dependency.  Dependencies on benzo's, in general, can develop in only 2-4 weeks of regular or intermittent usage.

Please include any clonazepam usage in your signature as well.

 

Let's get you going with the signature, and then see how you feel about reinstatement, after taking a look and read through that link.  Keep in mind that we would recommend less of a reinstatement, than the whole 2.5 mg dose that you came off of 11 weeks ago.   I can check with the other mods on just how much to reinstate, if you are interested in that option.

 

Lot's of non-drug techniques to cope with WD symptoms are here on site too.  See if you can find anything in the first indexed post there that might help with the anxiety and ill thoughts.  It's WD.  Hang on.

 

And oh.......have the tremors improved since you decreased and then went off the Abilify?

 

Love, peace, healing, and growth,

manymoretodays

 

 

Edited March 28, 2019 by manymoretodays
links added, minor further edits

[RichT]

5 hours ago, manymoretodays said:

 

 

Tips for tapering off Abilify(aripiprazole)

from ^...... Abilify has a very long half-life -- estimated at 4-7 days -- but still needs tapering.  What this means is that basically it may take longer than many of the drugs we deal with here to feel withdrawal symptoms. 

So.......I think your current symptoms that started 6-7 weeks after your last dose of Abilify  are due to WD.

 

According to medical knowledge, reinstatement is the only way to alleviate withdrawal symptoms.   
About reinstating and stabilizing to reduce withdrawal symptoms

Do you have any Abilify left?

 

Good idea with the clonazepam to limit any usage now so as to avoid another dependency.  Dependencies on benzo's, in general, can develop in only 2-4 weeks of regular or intermittent usage.

Please include any clonazepam usage in your signature as well.

 

Let's get you going with the signature, and then see how you feel about reinstatement, after taking a look and read through that link.  Keep in mind that we would recommend less of a reinstatement, than the whole 2.5 mg dose that you came off of 11 weeks ago.   I can check with the other mods on just how much to reinstate, if you are interested in that option.

 

Lot's of non-drug techniques to cope with WD symptoms are here on site too.  See if you can find anything in the first indexed post there that might help with the anxiety and ill thoughts.  It's WD.  Hang on.

 

And oh.......have the tremors improved since you decreased and then went off the Abilify?

 

Love, peace, healing, and growth,

manymoretodays

 

 

 Thanks very much manymoretodays. Thanks for confirming that these are probably withdrawal symptoms. Yes, I do have some  abilify left. I’ve read the link on reinstating to reduce withdrawal symptoms, that’s very useful, but slightly worrying too. But, that’s the truth of the situation I guess.  What’s interesting about the symptoms is that they bear no resemblence to other milder symptoms that i’ve had and they came completely out of the blue - I was feeling ok the day before.

 

I saw my Spanish doctor today and we discussed these symptoms.  He said it was possible that some of my latest symptoms related to my increased dose of quetiapine, which I started 10 days ago, as well as withdrawal effects. I’ve never been on such a high dose of quetiapine so that may the case. Anxiety and suicidal thoughts are known side effects of quetiapine. So we’ve agreed to taper the quetiapine down to 225mg over the next 10 days. He’s asked me to take 0.25mg of Clonazepam twice a day until then. 

 

Having read what the link says about reinstating as soon as possible, which I did after seeing the doctor, I may fade out the Clonazepam a bit earlier to see where I am with things. I’d be interested in your thoughts.

 

if we find the effects are definitely withdrawal effects, then I would be interested in trying reinstatement. So yes, please check what the best dose would be. I was on 5mg at the beginning of the process, 2.5mg for three weeks, then nothing.

 

yes, the tremors have gone completely.

 

thanks for all the links and helpful comments

 

best wishes,

 

Rich

[manymoretodays]

3 hours ago, RichT said:

I saw my Spanish doctor today and we discussed these symptoms.  He said it was possible that some of my latest symptoms related to my increased dose of quetiapine, which I started 10 days ago, as well as withdrawal effects. I’ve never been on such a high dose of quetiapine so that may the case. Anxiety and suicidal thoughts are known side effects of quetiapine. So we’ve agreed to taper the quetiapine down to 225mg over the next 10 days. He’s asked me to take 0.25mg of Clonazepam twice a day until then. 

 

Hi RichT,

Thanks for getting your signature done so promptly.  Looks like you've been on both the citalopram and quetiapine for 11-12 years now.  I went ahead and removed your full name from your signature and just added that you are still on both the citalopram and quetiapine.  If you would add the doses of those drugs that you are on to the signature too,  that would help us a lot in giving you input, suggestions, and information.  Thanks.

 

Why was the Abilify/aripiprazole added to your long term cocktail?

 

Great idea with the quetiapine, to lower that dosage back down to where you were at.  I think your Spanish doctor is okay too, with the exception of pushing the clonazepam on you.

If I were you......I'd sure look at and then try some of the non drug coping BEFORE resorting to clonazepam.   I don't want to confuse the picture too much.  And even 10 days of usage is risky.  Could you consider perhaps just an occasional dose of .25 mg prn(as needed, and no more than 2 doses of the .25 mg per day.......and even with the as needed, do not go longer than 10 days)?

 

And Yes, hard to know which is WD and which are adverse effects of your medications.

How long ago did you increase the dose of Seroquel/quetiapine to 250 mg?  I'm hoping it was only a few days back or even a week ago.......as then hopefully you won't have to struggle with WD effects from that.

 

My experience with taking Seroquel/quetiapine WAS depressing.  It gave me a rather unreal feeling after I took it at bedtime and never really completely wore off.  I also experienced quite a bit of orthostatic hypotension, as well as the beginning of the "metabolic syndrome" on it.  Very glad I came into finding more information about the harms of the biological treatment model and the current mental illness paradigm. 

Do you have any interest in becoming drug free, or getting to the lowest dosages possible with your citalopram and quetiapine?

 

I'm going to go ahead and load you up with some more links below, in case you have not read them prior to joining up here.

 

Dr. Glenmullen's withdrawal checklist

^ you'll find pretty much the whole gamut of WD symptoms that we get and see here on his list

 

Why taper by 10% of my dosage

^ a good starting point for a harm free taper and why

 

Brain Remodelling

What is withdrawal syndrome?

^ in the first post there you'll find an index of many informative posts about WD that can be applied to WD from any psychotropic medication.

The windows and waves pattern of withdrawal

 

Good news on the tremors RichT!  That's great.

And I will ask for further input for you on a good reinstatement dose of your aripiprazole/Abilify.  I'm glad you are open to trying this.  And once you do get going with a small dose, keep in mind that it may again take a full week to a couple of weeks until you feel relief from your present anxiety, depression, and SI.  Do you have a support system, person or people with you now who you can call on?  Do stay safe RichT, this won't last forever.

 

Love, peace, healing, and growth,

manymoretodays

 

 

Edited March 28, 2019 by manymoretodays

[marconyc]

I've been trying to taper off of 1mg of Abilify for a few months now. It's not easy, even at such a small dose. I'm down to 0.25mg and definitely feeling withdrawal. The moderators here have been very helpful, and their advice about tapering has been validated by studies showing the nonlinear effects of dosing--in other words, research backs up what the moderators here have been saying, which is that the lower you go, the slower you may have to go. 

[RichT]

Thanks manymoretodays

 

 Why was the abilify added?

 

i had an episode of depression last winter and it was prescribed to help me recover.

 

how long have you been on 250mg of seroquel?

 

10 days. I’m hoping I should be able to decrease this quite easily. I aim to go to 225mg tomorrow.

 

re the Clonazepam, I understand your concerns. At the moment i’m planning to take it as prescribed for 3 days, and then see what the minimum I need is after that. 

 

If i’m still feeling withdrawal effects at that point, it might be time to consider restarting Abilify. We’re travelling back to England soon, and it’s much less relaxing than here in Spain!

 

I do have an interest in getting to the lowest possible doses of citalopram and quetiapine.

 

Thanks for all the kind words of support, and for looking into a starting dose for Abilify. . When i’m back in the uk I have a psychiatrist that I trust completely, and I have a partner with me in Spain I can discuss things with.

[RichT]

43 minutes ago, marconyc said:

I've been trying to taper off of 1mg of Abilify for a few months now. It's not easy, even at such a small dose. I'm down to 0.25mg and definitely feeling withdrawal. The moderators here have been very helpful, and their advice about tapering has been validated by studies showing the nonlinear effects of dosing--in other words, research backs up what the moderators here have been saying, which is that the lower you go, the slower you may have to go. 

Thanks marconyc!

[RichT]

Hi manymoretodays,

 

I've taken my prescribed clonazepam for a couple of days, with improvement to my agitation and disassociation, but I'm feeling acute distress today. Clearly clonazepam doesn't fix everything and it's only a very short term sticking plaster in any case.

 

So if you are able to give me any guidance on reinstatement of abilify in the near future, I'd receive it very gratefully.

 

With thanks and best wishes

 

 

[manymoretodays]

 

1 hour ago, RichT said:

I've taken my prescribed clonazepam for a couple of days, with improvement to my agitation and disassociation, but I'm feeling acute distress today.

Can you elaborate a bit on your "acute distress"?

We really don't subscribe to using benzo's to treat the WD from the other medications we see here.  Have you thought about, rather than taking it on a daily schedule, just using it prn, as needed, after trying your best to cope with non-drug coping skills.  And then not exceeding that original 11 days you were going to go with........even with prn use.

 

It's hard to say if you are experiencing a wave now, from your rapid Abilify WD, or an effect of the clonazepam.  And then I'm feeling a bit ambivalent about suggesting more polypharmacy in your case.  I mean you would/could potentially be on the quetiapine, citalopram, small reinstatement of Abilify, and clonazepam..........Yikes to that!!!!!! 

See if you can access the drug interactions checker here:  Drug interactions at Drugs dot com

 

Did you make a change to your quetiapine dose yet?  It's best to only make one change at a time in your medications/drugs.  That way we may be able to see what is causing what.

 

The following will help when a more experienced mod comes by.  Try and be patient. I know it's tough right now and your struggling.

Go ahead and post a day or even 2 days of drug and symptom logs here on your introduction.

Keep it simple.  Note the date at the top.  Then time on the left, drug name and dosage on the right, as well as briefly any symptoms.  Include your sleep patterns and any supplements that you might use.   Use that link to help guide you and I'll copy over a sample note here too:

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

 

If I were you......I'd definitely avoid any alcohol and limit caffiene as well right now.

 

Love, peace, healing, and growth,

mmt

 

[marconyc]

Hey @RichT I'm really sorry you're going through this. Withdrawal is brutal.

 

I have found exercise to be helpful in managing my symptoms. I know it sounds too simple. It's certainly not a cure-all. But at those times when I feel like I'm jumping out of my skin, walking or running or biking a few miles in the park can make a difference. If nothing else, it distracts me until the worst feelings subside. I also meditate, but when I'm really agitated, I need to move. Another simple but effective distraction is socializing. Again, I know it sounds too simple, but I have found that spending too much time alone aggravates my symptoms, and being in social settings sometimes helps to distract me.

 

Of course, there are also times where exercise or being with other people is too much for my nervous system, but most of the time, I find those things helpful. 

 

Finally, I've found talk therapy to be a lifesaver. 

 

Hang in there. 

[RichT]

Hi manymoretodays,

 

Thanks for your helpful and wise reply.

 

by acute distress I mean a kind of emotional pain that makes me want to cry.

 

yes, I’ve gone down to 225mg of quetiapine and i’m going to stay there for a long while. I’ve tolerated 225mg before without problems, and had little difficulty in going down by 25mg in the past.

 

I understand exactly what you say about polyPharmacy! my plan was to give the doctor’s plan a chance for 3 days, but it’s not something i’m going to stick to in practice. I think I may exit from the plan after 2 days, ie today, after my experience today. I will move onto a prn basis for the Clonazepam and use as little as possible so that i’m ready to restart Abilify as soon as possible. I do practice mindfulness techniques and do regular exercise which definitely helps with my symptoms.

 

i am avoiding alcohol and caffeine at the moment.

 

It sounds like it’s best to start Abilify reinstatement without Clonazepam - i’m happy to do that.

 

what do you think the criteria should be for beginning the reintroduction of Abilify?

 

Many thanks,

 

Rich

 

 

 

 

 

[RichT]

11 minutes ago, marconyc said:

Hey @RichT I'm really sorry you're going through this. Withdrawal is brutal.

 

I have found exercise to be helpful in managing my symptoms. I know it sounds too simple. It's certainly not a cure-all. But at those times when I feel like I'm jumping out of my skin, walking or running or biking a few miles in the park can make a difference. If nothing else, it distracts me until the worst feelings subside. I also meditate, but when I'm really agitated, I need to move. Another simple but effective distraction is socializing. Again, I know it sounds too simple, but I have found that spending too much time alone aggravates my symptoms, and being in social settings sometimes helps to distract me.

 

Of course, there are also times where exercise or being with other people is too much for my nervous system, but most of the time, I find those things helpful. 

 

Finally, I've found talk therapy to be a lifesaver. 

 

Hang in there. 

 

Thanks so much Marconyc!

[powerback]

51 minutes ago, RichT said:

by acute distress I mean a kind of emotional pain that makes me want to cry.

If you have a quite comfortable place to process your emotions ,then cry all you need to.in the last 2 weeks ive balled crying and its very cathartic for me [I come from a toxic male environment so I'm ive been distancing myself from that environment for some  years  now   . Normal emotions are turned off with meds so they will rush back .

Never stop learning  and take care.

[RichT]

1 minute ago, powerback said:

If you have a quite comfortable place to process your emotions ,then cry all you need to.in the last 2 weeks ive balled crying and its very cathartic for me [I come from a toxic male environment so I'm ive been distancing myself from that environment for some  years  now   . Normal emotions are turned off with meds so they will rush back .

Never stop learning  and take care.

 

Thanks Powerback!

[powerback]

2 minutes ago, RichT said:

 

Thanks Powerback!

🤝

[Altostrata]

Welcome, RichT. I take it all your drugs are to treat depression?

 

You had a close call with a very serious adverse effects of antipsychotics such as Abilify and Seroquel. Please be aware that increasing the Seroquel has increased your risk of developing a movement disorder from that as well. 200mg Seroquel per day is already a substantial dose.

 

Please put ALL your drugs in the Drug Interactions Checker https://www.drugs.com/drug_interactions.php
and copy and paste the results or a link to them in this topic.

 

You might also look up the side effects of any of your drugs on drugs.com, and review potential interactions in your cocktail should any new drug be prescribed.

 

Citalopram and  Seroquel must be taken on a regular schedule. If you take them off-schedule by even a couple of hours or accidentally skip a dose here and there, they can cause symptoms such as "episode of depression," "disassociation and suicidal thoughts," anxiety, or "emotional pain that makes me want to cry." A change in your drug schedule according to time zone can destabilize your nervous system.

 

manymoretodays has given you excellent advice about reinstating to reduce Abilify withdrawal effects. However, it's possible that is not your major problem and I hesitate to suggest you take Abilify again for the symptoms you describe. I am also concerned about the increased risk from upping your Seroquel dosage.

 

Given it's half-life of 75 hours, Abilify "washes out" of your bloodstream after about 19 days. It's less likely that you are suffering from Abilify withdrawal than inconsistent dosing. Let's look at the timeline -- when did you change your drug schedule during your travels?

 

I would advise you to go back to 200mg Seroquel and be careful to take it and your 40mg citalopram at the same time each day according to your body clock, not the time zone clock. Avoid using clonazepam if possible. Your symptoms should start to fade. Please let us know how you're doing.

 

As for withdrawal-induced distressing thoughts, see

 

Even suicide is just a thought that you can let pass by, like a cloud through your mind.

 

As powerback suggested, there may be benefit to experiencing your feelings. Not every negative feeling requires a pill.

 

Good suggestion about the gentle exercise, @marconyc

 

 

[RichT]

Thanks Altostrata,

 

i’ve been In Spain for 6 months continuously and i’ve always taken my citalopram and quetiapine at the same time every day. So I think that’s not likely to be a factor here. But it was definitely worth considering. I can certainly go back to 200mg quetiapine.

 

withdrawing Abilify really is the only moving part here, so I think it is likely to be the cause of my symptoms.

[RichT]

Here are my drug interactions. I have ecgs to check on long qt syndrome and other cardiac effects, all normal to date.

 

best wishes

 

Interactions between your drugs

Major

 

 

Using citalopram together with QUEtiapine can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening, although it is a relatively rare side effect. You may be more susceptible if you have a heart condition called congenital long QT syndrome, other cardiac diseases, conduction abnormalities, or electrolyte disturbances (for example, magnesium or potassium loss due to severe or prolonged diarrhea or vomiting). Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or heart palpitationsduring treatment with these medications, whether together or alone. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

 

 

Using QUEtiapine together with ARIPiprazole may increase side effects such as drowsiness, blurred vision, dry mouth, heat intolerance, flushing, decreased sweating, difficulty urinating, abdominal cramping, constipation, irregular heartbeat, confusion, and memory problems. Side effects may be more likely to occur in the elderly or those with a debilitating condition. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

 

 

Citalopram may increase the blood levels of ARIPiprazole. This can increase the risk and/or severity of side effects such as drowsiness, seizure, Parkinson-like symptoms, abnormal muscle movements, and low blood pressure. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. Contact your doctor if you experience agitation, aggression, confusion, convulsions, muscle spasm, or movements that you can't stop or control such as lip smacking, chewing, puckering, frowning or scowling, tongue thrusting, teeth clenching, jaw twitching, blinking, eye rolling, shaking or jerking of arms and legs, tremor, jitteriness, restlessness, pacing, and foot tapping. Also be alert to symptoms of low blood pressure such as dizziness, lightheadedness, fainting, and/or increased pulse or heart rate. Avoid driving or operating hazardous machinery until you know how these medications affect you, and use caution when getting up from a sitting or lying position, especially at the beginning of treatment or after an increase in dose of ARIPiprazole. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

No other interactions were found between your selected drugs.
Note: this does not necessarily mean no interactions exist. Always consult with your doctor or pharmacist.

[RichT]

Here, separately, are the Clonazepam interactions with quetiapine. The interactions of Clonazepam with my other drugs are exactly the same as this.

 

best wishes

 

Moderate

 

 

Using clonazePAM together with QUEtiapine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

[Altostrata]

That first report indicates your adverse reaction to Abilify and possibly other symptoms were caused by drug-drug interactions. As you can see, citalopram and Seroquel both tend to enhance side effects from Abilify.

 

But please be aware that Seroquel alone can cause very serious side effects. One of clonazepam's side effects is depression.

 

While you have been in Spain, have you gotten a prescription from a different drug manufacturer? Have any of your drugs expired? Have any of them been exposed to heat or light?

 

In addition, you are taking fairly high amounts of drugs and the body as it ages loses its ability to process them. Having adverse reactions also reduces tolerance.

[RichT]

Hi Altostratus,

 

thanks very much for helping to find out the cause of my problems.

 

I suspect you’re right that the tremor was caused by drug to drug interactions. My suspicion of this is what lead me to come off Abilify.

 

yes, i’m aware of the possible side effects of seroquel and I keep an eye out for them. So far I have tolerated it very well. I have ecgs to check for cardiac effects.

 

yes, I have had drugs in Spain from a different manufacturer from the uk, but that change has not occurred recently.  None have expired. They are kept in a cool room with dim light.

 

thanks and best wishes

 

 

[RichT]

Hi Altostratus and many more days,

 

I have stopped the regular Clonazepam after taking it for 2 days. I had some anxiety during the night, and some now, but it’s bearable. 

 

Is it possible to develop a plan for going forward?

 

my thoughts are that the best thing is to stabilise as quickly as possible so that I can restart the abilify as soon as possible. I’m aware from your guide to reinstatement that’s it’s best done before withdrawal effects have been experienced for a long period. So far i’ve only had 2 really bad days of withdrawal symptoms.

 

for that reason, I think it might be better to stick to the 225mg dose of quetiapine for a while.  I’ve taken that dose for periods of a couple of months without any problem, my psychiatrist is fine with it, and it will take less time to adjust from taking 250mg for 10 days. 

 

What are your thoughts?

 

many thanks and best wishes 

 

[RichT]

Daily log 1

30th March 

 

00.00 took 200mg quetiapine

01:00 some anxiety, but managed to get to sleep

08:30 woke with moderate anxiety

09:30 breakfast

10:00 took 40mg citalopram, 25mg quetiapine

11.00 took 0.25mg Clonazepam as anxiety strong

12:00 - 2300 anxiety moderate.  upset stomach.

 

Tomorrow I try without Clonazepam. Today was half the dose compared to the previous 2 days 

 

 

[RichT]

I’m feeling quite worried about things as i’m not sure what to do - it would really help if someone can help me plot a way to get to the beginning of a reinstatement for Abilify.

 

‘Assuming that’s the right think to do

 

many thanks and best wishes 

[Altostrata]

2 hours ago, RichT said:

10:00 took 40mg citalopram, 25mg quetiapine

11.00 took 0.25mg Clonazepam as anxiety strong

 

I'm puzzled by this. Your symptoms got worse after you took citalopram and quetiapine? Did you always find citalopram to be stimulating?

 

Weren't you taking 250mg quetiapine per day? Did you add the 50mg in the morning? What was the effect of the larger morning dose? When did you reduce it?
 

Because you've already experienced a serious adverse effect of Abilify, and because you're already taking a substantial dose of a drug that may cause a movement disorder as well, I would reinstate a very low dose only if your withdrawal symptoms are intolerable.

 

An antipsychotic-induced movement disorder may become permanent. Your nervous system is already stressed by the drugs, that is what the movement disorder indicated. As you get older, your nervous system becomes more susceptible to adverse reactions. I would move very, very cautiously in adding or increasing drugs from now on.

 

If the severity of the withdrawal symptoms is decreasing, in a low-stress environment, you may well stabilize without reinstating Abilify. Not every symptom requires drug treatment.

 

A lot of people find fish oil and magnesium supplements helpful, see
https://survivingantidepressants.org/index.php?/topic/36-king-of-supplements-omega-3-fatty-acids-fish-oil/
https://survivingantidepressants.org/topic/15483-magnesium-natures-calcium-channel-blocker/

 

Try a little bit of one at a time to see how it affects you. Taken in small doses throughout the day, magnesium (citrate or glycinate) can be calming.

 

It's up to you to decide, is the severity of your withdrawal symptoms decreasing? Are your symptoms intolerable? Is the risk of adding Abilify back in worth it? If so, I would try only 0.25mg--.50mg Abilify. Please let us know how you're doing.

[RichT]

Thank you very much indeed Altostratus,

 

Today, my symptoms did get worse late morning. Normally that’s not the case.

 

I cut back to 225mg 3 days ago because I wasn’t sure whether 250mg (which I went up to from 200mg 10 days before) was causing me problems, or whether it was wd from Abilify. 225mg I know I can tolerate well. So i’m sure now it’s not the quetiapine.

 

thanks for your advice. I fully understand the risk of movement disorders.

 

i’ll certainly look into those supplements.

 

my symptoms are getting worse, unfortunately, over the last week my anxiety has skyrocketed. Would it be wise, if i’m reinstating, to stop the Clonazepam ? 

 

Grateful thanks

[RichT]

Thanks again to Altostratus for a wise and compassionate post yesterday. It really helped me to see things clearly.

 

i’ve realised that a lot of my anxiety is due to worry that I’ve come off Abilify quickly and so I must be in for a terrible time, and also that we’re going back to England in 10 days and I won’t be able to cope there. Neither of these is necessarily (or even probably) true. So i’m trying to calm that worry and I do feel better. But it really can be scary sometimes! 

[RichT]

Hi all, I have felt much worse in the past day, with anxiety and suicidal feelings, and huge worry about a potential life change in the next year (first time I have worried about that). As I'm going back to the UK in 10 days, I decided to make an appointment with my psychiatrist there (whom I rate very highly). I explained the situation to him via email.

 

He said I should go back on the Abilify straightaway, and suggested a dose of 2.5mg (half what I was taking when I was on the drug).  I have taken one dose of 2.5mg 

 

That's a higher dose that altostrata recommended. I guess I need to be vigilant for adverse reactions.

 

Wish me luck, any thoughts and comments welcome!

 

R

 

 

 

 

[manymoretodays]

Hi RichT,

If I were you, I'd certainly consider reinstating with much, much less than that 2.5mg dose.  Considering all the variables, and the medications that you are already on.   You could, at least, for now, get a pill chopper, and only take 1/4 of the 2.5 mg dose or even less.   Your not going to be feeling much from this reinstatement for another couple of weeks anyway.  But those tremors might come back and hopefully they are dose dependent to some degree, so a smaller reinstatement just bodes better I think.

 

Go on back and review the previous posts and information.  The link to tapering Abilify should help.

 

Could be due to the addition of the benzo. 

Could be some WD, as well as neuroemotions  from the WD, added to situational stuff.  Many or most of us find ourselves with really enhanced emotions and feelings, that we are not used to being with, OR coping with in the beginning.  There are more indexed non-drug coping links in the one on neuroemotions too.  Hoping you can start to use some non-drug coping now too.

 

Hang on RichT,  I'm sending healing from all that ails us all,

Love, peace, healing, and growth,

mmt

Edited April 2, 2019 by manymoretodays

[RichT]

Thanks very much Many More Days

 

I’ve thought the same myself I must admit about the size of the dose, but I feel a dilemma because I don’t like not complying with my psychiatrist’s treatment plan. I could write to him and highlight the risk of tremor returning, and ask him if still thinks that dose is best.

 

I have some Abilify in liquid form so it would be quite easy to take smaller doses.

 

I think you’re right about neuroemotions. I’ve read that material and it was really helpful. I have not acted on any of my fears! 

 

i’ve only taken 0.125mg of the clonazepam in the past 3 days, and I hope to keep it at that level at the most.

 

Thanks for your your care and good wishes, I really appreciate them.

 

R

[marconyc]

@RichT You might simply ask your psychiatrist if it would be possible to start with a smaller dose and see how you do, with the understanding that you'll increase if you aren't feeling better. You could suggest 1mg but then just start with 0.5 on your own. 

[manymoretodays]

That's good to know you already have the liquid form.  It's really expensive stuff, so hopefully you have some coverage to pay for it.

Check the expiration date too, unless you just recently got this from the druggist/pharmacist.

And as long as you have only started with the one dose of aripip again........you might consider just going with the liquid for your reinstatement purposes.

 

Ordinarily, we do endorse a cross over, when changing formulations or brands.  As it's only one dose taken though......so far, and many weeks off already.  I think you'll be okay.  Without the crossover.  It's unlikely that you will get a lift from the aripiprazole for a couple of weeks anyway.  You may get an initial placebo effect.

 

55 minutes ago, RichT said:

I’ve thought the same myself I must admit about the size of the dose, but I feel a dilemma because I don’t like not complying with my psychiatrist’s treatment plan. I could write to him and highlight the risk of tremor returning, and ask him if still thinks that dose is best.

The thing is.......many if not most psychiatrist's have no clue about WD, nor do they have appropriate guidelines to follow as yet.  I mean they think they do, and most really do appreciate greatly being seen as the ultimate authority around the toxins that they prescribe.  So don't repeat my words to your shrink. 

 

Is this the same psychiatrist who put you on 2 neuroleptic/antipsychotic's for a shift in your mood downward?  Trust me......you are better off preserving your relationship with this person, but beginning to get less dependent on him/her.  Empower yourself with information and getting to know your own body and how to be healthier.

 

Okay.....off my soapbox.

L, p, h, and growth,

mmt

 

**and oooh, great idea marconyc.  Thanks for chiming in.

 

Edited April 2, 2019 by manymoretodays
elaboration, additional thoughts

[RichT]

Thanks marconyc!

 

Manymoredays,

Thanks!

 

no, it wasn’t him who put me on two antipsychotics - that was somebody in Spain! When I went to see him in the Uk after I got back from Spain, he immediately picked up on the fact that I was taking two antipsychotics and said it wasn’t a good idea. He said polypharmacy complicated things by increasing the interactions between drugs.

 

 

 

 

[RichT]

Hi all,

 

I emailed my psychiatrist based on marconyc’s suggestion and he said he was fine with me starting on a lower dose and seeing how I get on.

 

so i’ll Try 0.5mg and see how I get on!

 

wish me luck!

 

R

[Carmie]

10 hours ago, RichT said:

Hi all,

 

I emailed my psychiatrist based on marconyc’s suggestion and he said he was fine with me starting on a lower dose and seeing how I get on.

 

so i’ll Try 0.5mg and see how I get on!

 

wish me luck!

 

R

 

That’s great the psychiatrist is on board with a small updose Rich.

 

Sending hugs🤗