Giovanni: Brother tapering Prozac and Abilify

[Giovanni]

Hi, I'm Giovanni.  I've been taking psychotropic medications for over 15 years, and I've been increasingly suspicious of their efficacy.  I've decided to take the plunge and finally taper off them.

 

I'm tapering Abilify (starting dose: 5 mg) and Prozac (starting dose: 40 mg).

 

I started tapering last month with Prozac.  I'm now on 36mg of Prozac + 5mg Abilify, and everything seems fine.

 

The recommendation I've heard is to cut 10% of your prior dose every month.  So my options for the next month are:

 

a) 32.4 mg Prozac + 5 mg Abilify

b) 36 mg Prozac + 4.5 mg Abilify

 

What's recommended -- (a) or (b)?  Should I taper one medicine first, or alternate? 

 

I know Abilify's mechanism of action is unknown, and it's thought to counter-act the negative affects of Prozac (correct me if I'm wrong), so I'm leaning towards (b).  With the alternating strategy, I'll reach a negligible dose (<= .5) of Abilify in 22 months, while I'll reach the same dose for Prozac in 40 months  (total time: 62 months --> 5 years).  So for roughly 18 months, I'll take Prozac without Abilify.

 

That's the plan.  I'm interested in these three things:

 

• similar attempts at tapering these two medicines.
• if my plan could be sped up somehow.  How would you do it?
• if there are any probiotics recommended for mental symptoms (I'm asking because of the recent study linking gut dysbiosis and schizophrenia).

 

Please critique and comment!

[Gridley]

Hello, Giovanni, and welcome to SA.

 

To give members the best information, we ask them to summarize their medication history in a signature -- drugs, doses, dates, and discontinuations & reinstatements, in the last 12-24 months particularly.

 

Account Settings – Create or Edit a signature.

 

Generally, we recommend tapering only one drug at a time.  Otherwise, if problems arise you won't know which taper is causing them.  However, there may be exceptions, such as if one of the drugs is an antipsychotic or is taken to counteract the negative effects of another drug.   Please read the following link, most importantly the first post, which discusses these variables, as well as alternating tapers.

 

Taking multiple psych drugs? Which drug to taper first?

 

We recommend tapering no faster than 10% of current dose every four weeks.  Some have to go more slowly.  The first post in the following link explains the importance of a slow taper.  In addition, there is information about a faster taper.

Why taper by 10% of my dosage?

 

Tips for tapering off Prozac (fluoxetine)

 

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium and omega 3 (fish oil). Many people find these to be calming to the nervous system. 

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

Please research all supplements first and only add in one at a time and at a low dose in case you do experience problems.  Regarding probiotics, Google "SurvivingAntidepressants.org probiotics" for a discussion.  I take a probiotic for an unrelated situation, but everyone is different.

 

This is your introduction topic -- the place for you to ask questions, record symptoms, share your progress, and connect with other members of the SA community.  I hope you’ll find the information in the SA forums helpful for your situation.  I'm sorry that you are in the position that you need the information, but I am glad that you found us.

 

 

 

 

Edited April 29, 2019 by Gridley

[Giovanni]

Thanks, Gridley.  For me, the relevant advice is:

 

Quote

To make this a little more confusing, if you are taking an antipsychotic, e.g. Seroquel or Risperdal, you may wish to discontinue that first, because of serious adverse health effects from antipsychotics, such as diabetes.

However, if you're taking an antipsychotic to counter an adverse effect of an antidepressant, such as sleeplessness or agitation, you may want to discontinue the antidepressant first.

Conceivably, one might systematically lower the antidepressant part way, then lower the antipsychotic. If sleep doesn't break up, continue to get off the antipsychotic. If it breaks up, stop lowering the antipsychotic, stabilize, and lower the antidepressant, managing the tapers in a way that preserves sleep.

 

The only way to do this is low and slow.  I need to evaluate my current symptoms and make a decision:

 

1) Do I feel too lethargic? ---> Cut Abilify

2) Do I feel too manic? --> Cut Prozac

 

Right now, I'm leaning towards (1).  I expect the next phase of the taper to start May 6th.

 

 

[Gridley]

45 minutes ago, Giovanni said:

1) Do I feel too lethargic? ---> Cut Abilify

 

I accidentally left out this link in my previous post:

 

Tips for tapering off aripiprazole (Abilify)

[RichT]

59 minutes ago, Giovanni said:

Thanks, Gridley.  For me, the relevant advice is:

 

 

The only way to do this is low and slow.  I need to evaluate my current symptoms and make a decision:

 

1) Do I feel too lethargic? ---> Cut Abilify

2) Do I feel too manic? --> Cut Prozac

 

Right now, I'm leaning towards (1).  I expect the next phase of the taper to start May 6th.

 

 

 

Hi Giovanni,

 

i’m coming off Abilify, and I think this is not going to help you decide how to taper. Abilify withdrawal can easily give you manic, anxious, panic, restless, insomniac and agitated symptoms.

 

Also my experience is that withdrawal symptoms with Abilify can take at least 2 months to appear after a dose reduction so if you alternate between the 2 drugs each month you will get confused as to which one is causing any difficulties.

 

R

[Giovanni]

1 hour ago, RichT said:

 

Hi Giovanni,

 

i’m coming off Abilify, and I think this is not going to help you decide how to taper. Abilify withdrawal can easily give you manic, anxious, panic, restless, insomniac and agitated symptoms.

 

Also my experience is that withdrawal symptoms with Abilify can take at least 2 months to appear after a dose reduction so if you alternate between the 2 drugs each month you will get confused as to which one is causing any difficulties.

 

R

 

Thanks for the input, RichT.  I'm looking over your and marconyc's topics (keep up the good work BTW):

 

RichT: coming off Abilify

marconyc: introduction

 

It seems both of you have had success tapering Abilify while still maintaining an SSRI (marconyc -- 200mg sertraline, RichT -- 40 mg citalopram).

 

Anti-psychotics are probably more dangerous than SSRIs (tardive dyskinesia) so removing them first would be ideal. 

 

If we experience manic symptoms while tapering Abilify, there seem to be two approaches:

 

Approach 1

a) Reinstate anti-psychotic to prior levels

b) Taper the anti-psychotic more slowly next time

 

OR

 

Approach 2

a) Reinstate anti-psychotic to prior levels

b) Taper the SSRI to a lower level, since they are "accelerators" and anti-psychotics are "brakes".

 

It seems approach 1 is more well-tested, and I haven't found accounts of approach 2.  Given this, I'll follow approach 1.  In retrospective, I should've tapered Abilify first.  Oh well, it was only one month ... on May 6th, I'll taper Abilify to 4.5 mg.

[Giovanni]

Hi, 

 

This is Giovanni's (35M) brother (31M), who has been helping with the taper.  It was his idea to decrease medicine, but I actually found this forum and other resources for him.  That means he hasn't been as invested in the tapering strategy as he should have.

 

My brother hasn't been following the recommended 10% per month dosage reduction, and in fact has been keeping poor records since 2021.  I can determine a taper of Abilify occurred to .442 mg from 5mg, along with a less rigorous taper of Prozac that occurred from 10mg from 40mg.  The details are in the signature.

 

Unfortunately, from what I can gather, my brother cold-turkeyed the last bit of Abilify and Prozac sometime early this year.  I don't know the exact details, and he doesn't really tell me when it happened.

 

Around May 2022 through now, my brother has been in a manic-depressive cycle. 

 

During his maniac phase, he has open conversations with himself - conversations others can hear.  He sometimes changes his voice when talking to a Cheech & Chong style character he has.  These conversations/internal monologues with himself can last a few hours.  I'm not sure if he hears voices or not.  He also sleeps at odd hours and is unemployed.  He lost his job during the COVID-19 pandemic and never got back on the bandwagon - he lives with me and our mother.  

 

His diet isn't the best.  Last time I checked, he was 330 lbs.  He eats fast food everyday, and he has money saved up from the time he was working while medicated.  He drinks large amounts of caffeine from energy drinks and coffee.  I've told him caffeine is linked to psychosis, especially during withdrawal with dopamine super-sensitivity.  I've tried to get him eating some fish oil and magnesium, but to no avail.  I'm afraid he's headed to 400 lbs.  

 

During his depressive phase, he is actually quiet.  But also prone to increased hostility and violence when approached.  We grew up in a turbulent household - alcoholic and abusive father, social isolation.  Even before medication, he would punch holes into walls and unfortunately be violent towards me + our mother.  The medication seems to have dulled this hostility/violent aspect for the past 10 years. 

 

Off the medication, some of this hostility seems to have returned.  On May 31st, he punched me during a contentious conversation.  On June 19th, he hit me and our mother for no apparent reason at all, out of the blue.  On July 10th (yesterday), he punched me and our mother during another conversion over fast food.  I'm grown and can take the hits (even though weighing 200lb less than him), but seeing him hit mom as been tough.

 

I wouldn't mind him re-instating Prozac again and doing a gradual taper from there, since serotonin deficiency is linked to aggression.  However, he is pretty much unresponsive to all my inquiries and discussions.  I've also suggested lifestyle changes (gym, job), but he's firmly in the pre-contemplation phase of change.  He deflects, jokes, and filibusters any attempt at conversation.  He even denies hitting us, which I think is disassociation?

 

My ideal scenario would convince him to do once a week CBT/DBT, along with exercise and diet changes.  Following the Soteria model, it's really up to him if he's willing to take medication.  I'm also interested in-patient retreats that de-emphasize medication (such as the Alternative to Medicine Center in Sedona -- is there anything similar in Calfornia?).  The issue is him accepting treatment, and I've tried the LEAP method.  

 

However, if he becomes violent again, I think we'll have to seek temporary institutionalization (it's happened to him before) and they might medicate him. 

 

I know this is not a forum that deals with domestic abuse or immediate crisis, but I just wanted to share for posterity.  I bet the drugs could have masked underlying issues, and the withdrawal may have exacerbated the underlying issues.  However, the key thing to note is the underlying issue exists nonetheless.  I'll definitely keep everyone posted if the outcome is good or bad.  If the outcome is very bad and I am unable to physically post an update, that is the only scenario in which I won't provide an update.

 

In summary, the taper started strong, but has been extremely difficult lately.  I recommend all future readers to rigorously follow the protocol and make lasting lifestyle changes before tapering.  

[ChessieCat]

I am sorry that you are in the position that you are in.

 

2 hours ago, Giovanni said:

such as the Alternative to Medicine Center in Sedona

 

Please see this topic:

 

alternative-to-meds-center-atmc-in-sedona-arizona

 

recommended-doctors-therapists-and-clinics

 

[Giovanni]

Thanks for the info on ATMC, ChessieCat, that definitely informs decision-making.  I think a local doctor in the SF Bay Area would be better then.  Inpatient retreats are somewhat like vacations.  Perhaps it's better to deal with and recognize triggers at home.

 

The biggest problem is the anger/blow-ups.  Before the medication, his anger/blow-ups were more well-defined, and had a clear cause.  That type of anger could be dealt with via therapy.

 

The medication withdrawal anger is more random and spontaneous.  It still has similar triggers/targets as the non-medication anger, but requires a much smaller dose of the trigger/target.  This makes sense in the context of serotonin deficits. 

 

Self-talk/internal monologues are likely liked to dopamine increases due to the Abilify withdrawal.  I don't view self-talk as a huge problem, though ideally he'd be focused on jobs/exercise.

 

The same situation with fast food/obesity.  Due to our upbringing/economic status, fast food has always been there and obesity has always been a problem for my brother.  The medicine withdrawal somehow exacerbates it - though I'm struggling to reason about the mechanism.  His past cold-turkeys were always associated with a large weight increase (sometimes from 280lbs to 360lbs).  I would consider the current episode a "partial cold-turkey".  

Junk food paradoxically increases dopamine in mesolimbic reward system, but decreases serotonin levels.  So fast food makes him more manic and depressed at the same time.  But he seems to want to fast food when he's depressed more, perhaps to make him more manic again?

 

Anyways, just talking out loud and journaling here.  I hope readers appreciate how "mental illness" is a complex bio-social condition, and these medications many times just add another confounding factor that makes solving the underlying bio-social factors more difficult.

[Giovanni]

Update:

 

While there haven't been any violent incidents towards family members since July 10th, my brother still is in some form of psychosis and has been acting erratically.  

 

Below is my accounting of recent incidents.  I'm documenting this for myself, for science and for others who may find it useful.  I might even use this thread as a daily journal.  

 

- September 8 --> 9th:  He went to eat fast food at night, but when he came back he was in a bad mood.  Me/mom didn't say anything to him.  He proceeded to throw his phone, tablets, and other items into the trash.  He also threw things and was mumbling in an upset manner.  He spilled Dr. Pepper all over the floor.  We isolated from him to prevent further escalation and went to sleep.

 

In the middle of the night, he seemed to make some sound (~2AM).  We found him sitting on the floor, unable to get up and talking to himself.  His mood was better, but he was not getting up from the floor.  He reassured us and we went back to sleep.  But he was still on the floor talking to himself when we got up (7AM), so he didn't sleep the entire night.  We made sure he was hydrated and fed while on the floor, and encouraged him to get up.  It was only at maybe 2PM or 3PM he found the mental energy to get up from the floor.  He didn't sleep during the day, and did manage to sleep at night. 

 

- September 10th:  I walked with him to the Jack in Box.  He ordered a meal costing $7.39, but somebody else entered the restaurant and he panicked he would get COVID or something like that.  He walked out without getting the meal, but also paying for it.  When I tried to use the incident as example of a cognitive distortion, he threw one or two insults at me (I didn't respond).

 

- September 11th - 12th:  He was engaged in an obsessive cleaning ritual in the kitchen since at-least 9AM that morning.  He was reorganizing the kitchen in some way and talking to himself along the way.  At approximately 12PM, I proceeded to try to get some food from the kitchen since it was lunch time.  He was hostile and said something to the effect of "do you need to eat"?  So I proceeded to wait until 2PM, when I tried again.  He once again was hostile, and sprayed me with Zevo when I entered the kitchen.  He threw a spoon, but not at me.  I pointed out his obsessive/erratic behavior and how it was disruptive to others.    I quickly entered the kitchen and got food. 

 

Even afterwards, he continued talking to himself and some of his comments were about me.  I tried to engage in some form of CBT with him at approximately 5PM - trying to tell him he's in a mental loop, catastrophizing and is engaged with obsessive behaviors.  I also said the only way out of these behaviors (besides medication) is first recognition of these behaviors.  He in effect filibustered what I was saying with non-sense and insults, and I did criticize him as well to get my point across (something to the effect "You've been having mental issues and medicated for 20+ years ... when will you get your act together?").

 

Later on (approximately 9PM), he probably started ruminating on my prior criticism.  He proceeded to take my items and throw them from one room to another room (all of my items - clothes, electronics, vitamins).  He broke a TV stand, causing glass to be on the floor.  He did this all while talking to himself, but with insults about me.  It was a constant stream of consciousness.  I did criticize him while he was throwing things, just to see if could control his emotions (something to the effect of "I criticized you and now you are throwing things .. point proven!").  

 

Interestingly, in some portions of his rage, he was able to calm himself down and say "I accept. I accept".  But moments later - even when I was quiet - some other thought would enter his head and continued to throw items.  In the end, I actually stopped talking at 11:09PM.  His rage against the items continued until 1AM.  He had some moments of sleep, but also woke and talked to himself. 

 

The next morning (Sept 12), he didn't exactly apologize, but invited me to a walk at approximately 10AM.  He did talk to himself, but was otherwise relatively pleasant.  I was able to offer my usual advice ("Don't have rage episodes.  Control your thoughts") without incident.  He managed to get consistent sleep during the night of September 12th.    

 

- September 14th: He tried to go to sleep, but woke up at approximately 11:00PM and went to the bathroom.  Outside the bathroom, he started throwing water bottles and metal glass, but aimed at the floor and not at anyone.  He didn't say anything and me/mother didn't say anything to him.  He then proceeded to chop onions and make himself some stir-fry.  He was able to sleep.

 

- September 15th:  I got him some Zevia, since he consumes soda regularly and this is a healthy variety (zero calories, zero caffeine, zero sugar).  I had gotten him a 24-pack previously and he'd consumed it all.  When he saw the Zevia in the fridge, he didn't throw it.  But he moved it out of the fridge, placed Zevia cans in my area and woke me up while I was asleep.  He insulted me in lewd terms (mentioning the Zevia) and ranted a bit.  This implies he is triggered by the existence of certain items.  

 

The most prominent consistent symptoms I notice are:

 

Inexplicable bouts of anger/rage

 

This is the most concerning aspect.  As I documented above, he gets angry about the smallest things and many times the origin of his rage is unknown to us.  He throws things, insults us, and deflects/filibusters.  3 violent incidents documented previously.  

 

If I were to guess, he is very particular about personal space and unwanted opinions.  Even benign infractions or comments throw him into a tizzy.

 

My best guess is this is related to Prozac withdrawal, as anger is a well-known side-effect of this. 

 

Manic self-talk  

 

He seems to talk to himself for hours on tangentially related subjects.  He has no friends, and only me/mom talks to him.  He usually enters "a zone" while on his tablet/phone and talks to himself.  

 

The subjects are very particular to him. This style of talk is difficult to reproduce as a neuro-typical person.  Things he references are WWE wrestlers, anime, race relations, politics, music -- you name it, it's likely included in this monologue. He defines archetypes/characters in his monologue, with a call and response aspect to it. 

 

For example, he simulated a conversation with Sitting Bull and a stand-in "WhiteGuy", and tied it into his own life. The association between subjects are very loose and have no clear endpoint/goal. I don't think he believes his characters (such as the stand-in "WhiteGuy") are real, but possibly metaphorical.

 

This constant word-salad/internal monologue is probably a result of Abilify withdrawal.    

 

Disordered sleep

 

He often takes naps of 1-2 hours in length, up to 3 times a day.  Sometimes, he does get a full night of sleep, but not with any consistency.  

 

Obsessive behavior

For example, he tried to turn on/off lights in a particular pattern for 2 hours while talking to himself.  We tried to reach him while he was doing this, but he seemed so lost in his own thoughts that nothing came though.  

 

Manic consumption of junk food

Most of his meals are either fast food or TV dinners (like Walmart Pizza).  He spent $30 on Jack in the Box and Chick-Fil-A yesterday, for example.  Previously, he used to cook for himself with some regularity.  He also buys items he never uses.

 

He's dialed back his caffeine consumption recently, and I haven't observed Rockstar/Monster energy drinks.  I can't tell you why he did it.

 

What should be done?

Don't know.  

 

Too late for a reinstatement and he doesn't have the cognitive insight needed to discuss treatment options.  We could've pulled the hospitalization lever a few times, but right now it's erratic behavior and mild violence.  Unless it escalates, I'm just going to keep trying to reach via talk therapy/LEAP method.  Hope things get better with time, no guarantees.   

 

I offer him my own brand of CBT sometimes, since I think he needs to hear a voice other than his circling/ruminating thoughts.  I'm the only other person he talks to (mom mostly stays away).

 

I do talk to him about things other than mental health - but I also think that should be discussed too.  How else would he gain insight into his erratic behavior?  He may find it triggering sometimes, but he needs to hear it.  I should be careful how much I push.  

 

All of these symptoms could be withdrawal symptoms, while psychiatrists will tell you it's the underlying disease re-emerging.  

 

I wish I could get him some non-medicinal treatment: good food, supplements, CBT, exercise.  Though he's either manic or angry and hard to reach. 

 

Easy access to fast food complicates things.  In Soteria, cooking was one of things residents did to build up confidence.

 

Open to tips, especially from those who have had rage and psychotic episodes.  

[Giovanni]

I find this interesting:

 

https://pubmed.ncbi.nlm.nih.gov/31192814/

 

Quote

Summary: These results support that ketogenic diet may present a novel therapeutic approach through restoring brain energy metabolism in schizophrenia. Randomized controlled clinical trials are needed to further show the efficacy of ketogenic diet as a co-treatment to manage both clinical symptoms and metabolic abnormalities inherent to the disease and resulted by antipsychotic treatment.

 

As I've documented, my brother's diet is terrible and consists mostly of junk food/fast food.

 

Since he is semi-psychotic (and paradoxically, with enough money to buy almost endless fast food), he obviously doesn't take kindly to my diet tips and becomes hostile (even with LEAP-like methods).

 

I know we can hospitalize him given his current symptoms, since he has been violent.  But they'll just pump him full of benzos, anti-psychotics and other questionable substances.

 

I wish there was a method to hospitalize him, but given a ketogenic diet for a few months instead of drugs ... I'd happily pay for the food/housing. 

 

Interesting what legalized coercive treatment allows and doesn't allow!

[eje91]

How is your brother doing now? I have been praying. 

[Giovanni]

Thanks for the prayers, @eje91.

 

Still going through cycles of anger (dysphoric mania?) and pure mania.  I wouldn't use the term psychosis, since there's no persistent false belief/delusion I've observed (i.e, "the CIA is watching me").

 

I believe a psychiatrist would characterize it as ultradian cycling bipolar (maybe hebephrenia).  Typically, those diagnosed with bipolar cycle between states a few times a year.  I am observing cycling a few times a week.

 

The key feature of his manic phase is pressurized speech.  This monologue goes on for hours at a time, and covers just about every topic you can think of.   It's essentially word salad/vomit with no known goal.  He often repeats thoughts with no clear goal for the conversation.  He takes hours to do even a simple task (go to the bathroom, cook something, eat something) since he's constantly engaged with so many unrelated intrusive sentences.

 

He also engages in repetitive obsessive behaviors, especially in regards to the lights in the apartment.  He turns them off and on, he plugs things in and out.  It has no clear pattern. 

 

It's extremely difficult to talk to him when he is engaging in pressurized speech.  He just ignores us and continues on.  It usually takes several minutes, and sometimes we have to put our hands on his back, to even get his attention.  He is sometimes hostile, other times not hostile.

 

Here's the most recent few days:

 

September 27 -- for some reason, he destroyed all of his phones and devices (4 devices) and threw them in the trash.  He just has a tablet left.  No known trigger. Angry state.

September 29 -- he took the car at 12:30PM and was out until 10PM (FYI, he has no jobs/friends).  He just visited fast food establishments and Walmart, while engaging in pressurized speech.  He got a ticket for running a red light from a police officer.  Manic state.  We actually managed to take the car keys from him, since he is no longer a safe driver.  

September 30 -- he finally slept at like 7AM.  He ate food prepared by mom, and not fast food.  He was somewhat quiet.  Mixed state.

October 1st -- He was quiet the entire day, mostly.  He just sat on his bed.  Played with tablet a bit.  Mixed state.

October 2nd -- He was in the bathroom at 7:30AM, and mom had to go to work (he can take up to many hours in the bathroom).  We had to convince him to leave the bathroom, so mom could use it.  He was upset at this, and started an 1-2 hour rant about it with many insults.  No violence. Angry state.

 

He slept at 11AM and was quiet afterwards.  He ate food from home again for lunch.   We agreed to get him fast food for dinner, but with home delivery rather the car.  He seemed to sleep at approximately 5AM/6AM October 3rd.  Mixed state

 

October 3rd -- Yesterday, when I went to work he was asleep, but by the time I arrived (7pm) he was engaged in pressurized speech.  He seemingly walked to fast food location for lunch.  He once again ate home cooking (two veggie sandwiches).  However, he talked the entire night with his pressurized speech.  I think he may have stopped talking for about 30 minutes between 9:30PM October 3rd and 11:30AM October 4th.  Manic state

 

October 4th -- He was mostly talking to himself until 11:30AM.  He ate a turkey sandwich that I had gotten him at approximately 6:00AM.  He was in the bathroom once again at 7:30AM, and we once again had to convince him to leave (took 20 minutes of talking just to get a response).  He finally managed to calm himself down starting at 11:30AM and go to sleep at 12:30PM.  At the time of writing (2:30PM, October 4), he is still asleep. Manic state so far.

 

I guess it could be characterized as a "wave and window" pattern, but also rebound bipolar too.  He's been off Prozac/Abilify for at least six months.  

 

Sleep seems to help the most, but it wears off during the day.  He takes Unisom sleep tablets and melatonin.  Dark therapy looks interesting to help get out this constant state of mania/anger:

 

https://psycheducation.org/blog/dark-therapy/

 

However, he doesn't have the cognitive insight to do something this complex.  It's like his planning and executive capacities are basically mush.  He struggles with basic tasks and runaway intrusive thoughts.  I'm just hoping things get better with time and hospitalization can be avoided.  

[eje91]

@Giovanni Thank you for the update. Your brother is blessed to have your Mom and you to look out for him. I will continue praying that he can avoid hospitalization. 

I have not heard of dark therapy before. I will have to look that up. 

[Giovanni]

Thanks for the prayers, @eje91. 

 

Here's my updated journal.  Unfortunately, he is now in the emergency psychiatry ward due to the mild violent episodes.  

 

I do this for science and to help those who might find themselves in a similar situation.  Some of the symptoms - like the 12+ hours of pressurized speech -- I have yet to find equivalent case reports online.

 

This isn't a definitive log.  I tried to pay attention to his sleep, but I have to go to work sometimes so it's possible I missed some times where is actually slept.

 

Tuesday, October 4th

 

He woke up at 4:45PM (sleep: 4 hours).  

 

He was still manic when he woke up.  He showered after waking up.  

I offered him dinner consisting of salmon and vegetables, which he declined in an hostile manner.  He wanted the car, but he’s not a consistent driver at the moment, so he was declined.  We offered to get him fast-food ourselves, but he also declined in a hostile manner.  (Hostility)

 

At 9:30PM, he tried to get fast-food.  There are actually 3 fast-food establishments within 10 minutes walking distance, and most close their doors at midnight (some drive-thrus open 24/7).  He still hadn’t arrived back by 10:30PM, so I went to look for him.  I found him, lost in his thoughts, on the sidewalk, moving very slowly.

 

I tried to direct him to his destination, but it was stop and start.  Eventually, he found some energy and made progress to Jack-in-box.  I gestured to him, but he accused me of being an “evil spirit” and seemed hostile since I was intruding on his sojourn.  I went back to the apartment due to this, but pointed him to the Jack-in-box.

 

Fast forward to 11:30PM, he still hadn’t arrived home, so mom went looking for him.  He was found at the Jack-in-the-Box right before closing, half-asleep after consuming some meal.  Mom gestured to him through the window, and he managed to get up.  He went home then, apparently recognizing both his mother and knowing he needed to get home. (Lost and confused) (Lack of focus) (Fast food consumption).

 

I think he went to sleep at maybe 3-4AM.  

 

Wednesday, October 5th 

 

When I went to work at 6:15AM October 5th, he was asleep (Sleep: 4 hours at-least).

 

When I arrived at the apartment from work at 7PM, he was showering.  Not sure what he ate for lunch, maybe fast-food.  (Fast food consumption)

 

He was hostile and once again tried to gain access to the car by claiming he had water bottles in it.  He was taken to the car, and was shown no water belonging to him remained.  The car was moved into another location, again for his safety and the safety of other drivers.  (Hostile)

 

He ate home-cooked food.  He was mostly quiet.  He went to sleep at 5AM, October 6th.  

 

Thursday, October 6th

 

He woke up at around 10:30AM (Sleep: 5 hours).

 

Mostly he showered and sat around until 1PM.  Then he went outside, for what I assume was another fast-food journey.  (Fast food consumption)

 

He came back at around 3PM.  He was mostly quiet.  

 

He ate a healthy dinner.  He went to sleep at 9:30PM, which was unusual. (Quiet) 

 

Friday, October 7th

 

He woke around 6:30AM.  He urinated and went to sleep in another room, waking at around 10:30AM (Sleep: 11 - 13 hours).

 

This was a large amount of sleep for him.  He ate a home-cooked meal he made himself (pasta and chicken) at around 1PM.  

He was quiet until around 6:30PM, and then the pressurized self-talk began again.  

 

He ate home-cooked for dinner.  Unfortunately, his self-talk wouldn’t stop.  By the time I went to sleep (1:30AM), he was engaging in his internal monologue.  He would turn off the lights and talk, but also turn them on and just walk around. (Rituals with lights).  

 

Saturday, October 8th

 

His manic self-talk was continuing when I woke (9:30AM).  It continued until 1:30PM, when I started cooking lunch for myself. (Pressurized speech time: 18 hours) 

 

He managed to find some focus from my cooking, and ate a healthy meal by himself.  

 

At 3:00PM, he left the apartment, presumably to eat fast-food.  He came back at 4:48PM.

 

At 6:00PM, he started showering.  He was a bit more quiet when he returned (7:05PM).  He started watching videos on Youtube include:

 

Green eggs and Ham 
Mario Party videos
Metal gear Solid videos

 

He ate a healthy meal at 9:00PM with potatoes. 

 

Also went out at 10:30PM, presumably for Jack-in-the-Box.  Came back at 11:15PM.  Went to sleep at midnight in the bedroom.   (Fast food consumption)

 

Sunday, October 9th

 

He woke up at 9:00AM. (Sleep: 9 hours)

 

Alternated between quiet and talkative until noon.  Ate healthy home cooking with potatoes at 12:30PM.  Cooked himself a meal at 3:30PM.   (Pressured speech rating: 4, Hostile)

 

Watched media on his phone from 3:30PM to 4PM.  Did not eat dinner.  Continued to watch the media, progressively engaging in self-talk more and more until I went to sleep (1AM).  Made lewd comments about mother’s private parts.  He went to sleep at 6:30AM next day. (Pressured speech rating: 7.5)

 

Monday, October 10th

 

When I came back to the apartment at 7PM, he was watching the media in the dark with no lights.  Slightly talking to himself.  I asked him what’s up, and he said “leave me alone creepy guy” after some prodding.  

 

Ate spaghetti made by my mother.  He wasn’t asleep by midnight. (Pressured speech rating: 5, Hostility: 5.5)

 

Tuesday, October 11th

 

Awake all night and exhibited pressurized speech, but didn’t move around that much (Pressured speech rating: 6)

 

At approximately 6AM, he walked to Safeway and got chicken liver, wraps, and magnesium.

 

At 7:30AM, he returned.  He was actually quite conversational and non-confrontational.  I managed to talk about dark therapy and amber glasses during this window. (Friendly episode)

 

I went to work at 8:00AM.

 

When I returned by 7:00PM, he was in the bedroom with the phone.  He went to sleep at 7:15PM.  He woke at approximately 9:15PM (Sleep: 2 hours).

 

He ate lentils prepared by mother.  Somewhat talkative towards the end.  (Pressured speech rating: 4.5)

 

Wednesday, October 12th

 

When I arrived at 7PM, he wasn’t there.  He came back from his outing (walk?) at 7:30PM.  He ate a healthy okra dish.

 

He started a cleaning ritual at approximately 10PM.  He would brush his teeth, go into the bathroom, turn on the light, and turn off the light.  He would also talk about unintelligible subjects.  This ritual continued at least until midnight, when I went to sleep.  I heard music throughout the night, indicating that he was consuming media and not asleep. (Pressurized speech rating: 6.5)

 

Thursday, October 13th

 

When I woke up at 7:30AM, he was awake and probably didn’t sleep all night.  Since he was quiet, I assumed the mania was subsiding and he’d be asleep soon.  (Pressured speech rating: 6)

 

He went to sleep at 9:30AM and woke up at 11:30AM (Sleep: 2 hours).

 

He went outside to eat via Jack-in-the-Box at noon, exhibiting near non-stop pressurized speech.  He returned at 2PM.  (Pressurized speech rating: 6.5)

 

He continued his monologue when he returned, and started consuming media on his tablet along with it (observation time: 7:20 PM.  (Pressurized speech rating: 6.75)

 

Friday, October 14th

 

Went to sleep at 6:30AM and woke up at 10:14 AM. (sleep: 4 hours)

 

Talked most of the day.  

Awake most the night.

 

Sunday, Oct 15th

 

Slept from 10AM to 6PM, with breaks. (Sleep: 8 hours)

 

Mostly quiet after, though the internal monologue increased throughout the night.  (Pressurized speech rating: 3)

 

Sunday, Oct 16th

 

Went to the FoodMaxx and bought multiple items, such as lime and chicken livers (Competency).  Not sure if he ate fast food or not.

 

He was talking to himself at 3:00PM.  I said “stop ruminating” and nothing else, not in an aggressive manner.  He attacked me by pushing my head against the wall, and holding his hand to my throat (for 1-10 seconds).  No injuries (Mildly violent episode)

 

I left the apartment right after he let me go and stayed outside for a few hours to let him calm down.

Threw away the chicken livers in the trash, which he got hours earlier. (Depressive anger)

 

Slept 10:00 PM to 2:30AM  (Sleep: 4.5 hours).

 

He started cooking for himself at 2:30AM.

  

Monday, October 17th 

 

He went for a walk from 7:30AM to 8:30 AM.

 

He slept from 9:00AM to 10:30AM (Sleep: 1.5 hours).

 

Talked mostly to himself all day.  Cooked for himself for lunch.  Asked me for a soda, and said “thank you”.  (Friendly episode)

Went to eat fast food at 10:00PM.

 

Went to sleep at 12:30AM.

 

Tuesday, October 18th

 

Woke up at 6:30 AM, made himself tea. (Sleep: 6 hours)

 

Went shopping, got a placard  that said “Home, Sweet Home”.  (Friendly episode)

 

Stayed awake the whole night talking.   (Pressurized speech)

 

Wednesday, October 19th

 

Went to sleep at 6:17AM and woke up at approximately 9:30AM.  Don’t know if additional sleep occurred. (Sleep: 2 hours)

 

Somewhat quiet at 6:30PM.  He actually initiated conversation with me, and was responding to mother’s questions such as “how are you”. (Friendly episode)

 

Stayed awake the whole night talking (with the light on).

 

He made coffee for himself at midnight. (Caffeine consumption)

 

He tried to make a dish consisting of potatoes and beans, but he couldn’t focus so it turned out to be inedible.  He made somewhat of a mess in the kitchen.  (Lack of cognition/focus)

 

Thursday, October 20th

 

At 6:30AM, he went to procure fast food for himself.  (Fast Food consumption)

 

He returned about 9:30AM, drank tea.  By noon he was in the room, attempting to sleep.  (Caffeine consumption)

 

He woke at 1pm (Sleep: 1 hour).  He went shopping twice.  The second time he bought an assorted variety of cookies (36 of them).

 

He was quieter throughout the day.  He even said “I love you” to me and our mother.  He ended up eating a home-cooked meal at 9PM (Friendly episode).  

 

He showered at 10PM.  By 11:15 PM, he was asleep.

 

Friday, October 21st

 

He woke up at 6:17 AM (sleep: 7 hours).   He ate some of his cookies with tea.

 

By 8:00AM, he was back to trying to sleep.  At 9:00AM, he went outside.  At 11:30AM, he came back to the apartment.  He was exhibiting pressurized speech.

 

At 1:30PM, he ate a home-cooked meal.  Until 5PM, he exhibited pressurized speech.  At that point, he went to the Jack-in-the-Box. (Fast food consumption).

 

When he returned at 6:30PM, he found mother sitting on his bed.  That upset him for some reason (violation of space neuro-emotion), and he threw her to the ground from the bed.  (Mildly violent episode) 

 

He threw mother’s medicine, threw a chair into the garbage, and poked the wall with his finger in a ritual.  He also flipped his bed (flipping out).

 

He went into the room and isolated himself.  He was quiet from then on.  

 

Mother then called the police.  He somewhat argued with the police officers in a manic way, but otherwise didn’t even notice when the police restrained him.  He was escorted peacefully to the emergency psychiatric department, where he is now in a 5150 hold.

[Giovanni]

The current symptoms are:

 

- Random violent episodes / rage attacks.  Never know what's going to set him off

- Pressurized speech + self-talk for up 12 hours at a time 

- Severely disturbed sleep patterns and circadian rhythms

- General lack of awareness and mental cognition

 

Also, one thing I forgot to mention but may be relevant is he was taking 125mg levothyroxine before he became manic/psychotic.  So he has some sort of hypothrodism, but that is linked with SSRIs from some cursory Googling.

 

He was taken to the psychiatry ward at approximately 7:45PM today.  I managed to reach the psychiatrist who would be attending to him at 8:40PM (before she had spoken to him, the psych ward number is available online).  I hold her the story, including his last taper amount (.5 mg Abilify, 5-10 mg Prozac).  I asked her not to add additional medication, and only low-dose of the original medications if needed.  

 

I will send a fax message to the hospital tomorrow also underlying this point.  I don't want additional poly-pharmacy, just stabilization on original medications.

 

@Altostrata@Shep @ChessieCat and other mods/admins, any suggestions on the dosing?  I suggested .1 mg Abilify first, based on the my reading of:

 

https://www.survivingantidepressants.org/topic/7562-about-reinstating-and-stabilizing-to-reduce-withdrawal-symptoms/

 

I'm not sure whether to try Prozac first or Abilify.  The worst symptoms are rage/violent episodes (serotonin deficits?) and manic 12-hour self-talk episodes.  The Prozac reinstatement dose would be 1mg.

 

I hope the psych ward people will listen to me.  I'm going to fax them some studies and how to re-instate properly for someone who's been off meds of 6+ months at-least.  I'm going to call them a few times a day just to make sure they aren't poly-pharmacying.  

[Shep]

14 hours ago, Giovanni said:

Also, one thing I forgot to mention but may be relevant is he was taking 125mg levothyroxine before he became manic/psychotic.  So he has some sort of hypothrodism, but that is linked with SSRIs from some cursory Googling.

 

 

When was the last time he had his thyroid levels checked?

 

When was he on levothytroxine? Please add dates to your signature. Is he still taking it? 

 

Lots of people get psychiatrized for thyroid issues. I would talk to his doctor about getting a thyroid check done before going back on psychiatric drugs. 

 

There are numerous medical journal articles about psychosis related to thyroid problems, as well as for people who've gone cold turkey off their thyroid meds. You can do a quick google search to find them. 

 

From your signature, you have him last on psych drugs at the beginning of the year. That was, what, maybe 8 - 10 months ago? A reinstatement that far out may not work. 

 

I would focus on the thyroid issue and see if you can get the thyroid bloodwork. 

 

We have a thread on thyroid issues here, which you may find helpful: 

 

Thyroid symptoms: hypothyroid, Hashimoto's

 

 

 

[Giovanni]

Thanks Shep for the information.  I actually came to that exact same realization on the thyroid issue yesterday, after reading Jim Phelp's website: 

 

Quote

 

“Here’s the logic:  as long as you and your doctor are careful, and don’t bump you up into hyperthyroidism, there is almost no risk in trying this approach.”

 

“Instead, in some cases, these hormones act just like lithium and valproate and other “mood stabilizers“. They help stop mood cycling — particularly, it seems, in people who have “rapid cycling”. This approach is generally used after a person has tried several of the well-known mood stabilizers, because there is only a little research about thyroid treatment to go on at this point (in part because there is no manufacturer in a position to make big money from the research, for one reason. Thyroid hormone has been around in several forms for more than 40 years).”

 

 

https://psycheducation.org/blog/thyroid-and-bipolar-disorder/

 

I think he's been on thyroid medication for at-least 10-20 years, off and on.  I don't have exact dates for this one.  

 

I actually gave a note to a police officer, asking them not to add any additional medicines besides Abilify/Prozac and to check his thyroid hormone levels first.  The officer said he'd give it to the psychiatric ward staff.  I also called the psychiatric ward at 8:40PM, before he was processed and explained the situation.

 

What do they do?  They gave him the standard cocktail (a B52) at 9:29PM and some additional psychiatry meds.  Here's the readout from his psych ward discharge form:

 

Quote

diphenhydramine 50mg (Benadryl) Last given 10/21/2022 9:29PM

haloperidol 5mg (HALDOL) Last given 10/21/2022 9:29PM

lorazepam 2mg (ATIVAN) Last given 10/21/2022 9:29PM

risperidone (probably 2mg) Last given 10/22/2022 8:16AM

trazodone (unknown dosage) Last given 10/22/2022 1:06AM

 

They essentially ignored everything I wrote or didn't even note it, and continued on their poly-pharmacy.  At-least with apipirazole/fluoxetine reinstatement, there actually exists a chance to "hit the right spot".  For this lack of basic due diligence, the field of psychiatry will have my undying hatred.

 

I sent them a 10-page case report fax explaining his symptoms - and asking for a thyroid blood test, dark therapy, a ketogenic diet, and if absolutely necessarily a .1 mg reinstatement of Abilify.  This happened at 12:30PM.  By 2:00PM, they called us and told us he was being discharged.  Less than 24 hours in the psychiatric ward and he was "treated".

 

Ideally, he'd be somewhere safe for at-least a month to root cause his condition.  The system is broken and makes everything worse.

 

The discharge papers gave us a diagnosis of "adjustment disorder with mixed anxiety and depressed mood" (whatever that is) and "obsessive compulsive disorder".  They simply haven't observed him for 1/20th of the time I have - no mention of pressured speech, sleep disturbances, and violent outbursts.  

 

Upon discharge (3PM), they prescribed 14-days of Abilify (2mg) and Prozac (20mg).  Those are the lowest doses the psychiatrists know.  I don't think those drugs were given in the psychiatric ward.

 

In the car back home, he exhibited the same symptoms (pressured speech) and OCD (by writing a note on the car seat with his hand).  The violent episodes are sporadic enough that it's impossible to know if it's "gone" or not with such a small sample size. 

 

He did seem somewhat calmer and did hug me.  He exhibited some insight into yesterday's violent episode, saying he felt mother was trying to break his bed on purpose. (Insight) (Kindness)

 

My mom insists, now that he has medicine - that she will personally administer it to him in the morning.  I feel for her, but I would love to see thyroid tests before trying that.  

 

Overall, I don't know what to do.  I might push for a thyroid test before the withdrawal from the B52 + risperidone sets in.  The best treatment plan is probably:

 

1) Check if thyroid reinstatement makes a difference

2) Try dark therapy/ketogenic diet along the way

3) Low-dose abilify (.1mg - 5mg) if absolutely necessary

 

Mom blames tapering for this entire mess, and wants to administer the full doses.  At-least we have a supply of Prozac/Abilify now.

[Shep]

16 hours ago, Giovanni said:

Mom blames tapering for this entire mess, and wants to administer the full doses.  At-least we have a supply of Prozac/Abilify now.

 

I'm glad you spotted the thyroid connection and can hopefully follow up on that with your brother. 

 

While he's living with his mother, he may find it more difficult to get off these drugs until he's able to control his behavior and not overreact when he's experiencing what are called Neuro-emotions. 

 

When he stabilizes to the point where he wants off the drugs, please have him post again on his thread. He posted at the beginning and was very organized and articulate. Hopefully he will be that way again. 

[Elaine5]

How is your brother doing? 

[Giovanni]

I haven't been keeping as detailed notes, but generally better. 

 

Immediately after the psychiatry ward [October 22], he was interested in taking the psychiatry medication at the prescribed dose (2mg Abilify, 20 mg Prozac).  The main reason he wanted it was because he felt it would help him sleep.

 

I cautioned him, given the information on this website that recommends reinstatement at a fraction of the original dose (if done at all).

 

He also ordered us a pizza [October 23] as his way of apologizing for his rage episode.

 

He took a minor reinstatement for 2 days [.1 mg liquid Abilify] after the psych ward episode.  He declined further medication after that, and I'm not one to push there.  He does eat all the vitamins I give him (omega 3, vitamin D, chelated magnesium).  

 

In terms of sleep, it's gotten a bit better.  He hasn't had multi-day insomnia for a while now - usually it's single day.  For example, he didn't sleep on:

 

January 14th -> January 15th

January 16th ->  January 17th

 

But he did sleep on (7-8 hours):

 

January 15th -> January 16th

January 16th -> January 17th

 

He did manage to sleep three nights in a row on a few occasions since October, including January 11 --> January 14th.

 

In terms of diet, he eats fast food less.  He always eats at home during the night, and mostly eats fast food during midday.  I almost feel he eats fast food as a way of going outside, since he has no job or friends.  On days on which it rains, he does not go outside.  So I estimate 40% fast food consumption at the moment.  He sometimes cooks himself, but it takes him a while [another reason for fast food consumption - easy to procure].

 

There hasn't been a violent episode (including throwing things) since October 21.  He cursed/ranted once, on the morning of January 16th (after he got sleep - morning cortisol?) when he lost his key-chain [which had special meaning to him given his rich inner world].

 

Cognition/focus is the most troubling aspect, and leads to other problems.  His endless vocalized internal dialogues continue unabated.  He spends 5 hours in the shower sometimes, just thinking one thought aloud after another.  He spent 2 hours putting on his pants, while doing a ritual turning off/on lights, walking around.  He also spent 8 hours cooking chicken liver and onions, where again the buik of his time was spent going back and forth, talking.  

 

But sometimes [more rare] he finishes showering in an hour, and cooking in 1-2 hours.  I cannot explain the variation other than perhaps waves/windows.

 

The times when he has trouble sleeping - he often tries to lie in his bed, but he still keeps mumbling while he's trying to sleep.  That makes him get up.

 

His endless dialogue mostly consists of a rich inner world, composed of "spirit animals", pop culture figures and historical icons. 

 

It includes Pulmolina -- the "greatest spirit cat in the universe", Walker Texas Ranger, Kiwi the psychic whale, weathermen, 15th century Ottoman janissaries, Puduḫepa (ancient queen of the Hittites).  He briefly alluded to a tree that gives him tips ("the tip tree").    

 

He also has various rituals he performs.  For example, he mildly scratches the top of my head sometimes as a form of identity verification.  Going off the OpenDialogue/Soteria model, I scratch the top of his head back.  

 

A psychiatrist may term this as "schizotypal" -- though it seems like a combination of random intrusive thoughts and perhaps archetypes he uses to communicate.  There's not much consistency or logic in it - it lacks "fixed false belief" characteristic of a delusion/hallucination.  

 

Interestingly, when he goes to get fast food, the dialogue stops inside the restaurant.     

 

There are a few times where he is quiet (bipolarity?).  This includes after a long-bout (12+ hours) of self-dialogue or immediately after waking up.  Those times are much less than the times he isn't.

 

His lack of cognition/focus makes doing things hard, i.e getting his thyroid checked.  He hasn't entered the car since we took away his keys due his poor cognition.  He'll agree to do a thyroid test, but doesn't have any insurance and forgets on the day he is supposed to go.  He then wanders off to his next task.  I've ordered a LetsGetChecked at home thyroid test, but getting blood from him will be a challenge.

 

So in summary:

• Still largely un-medicated.
• Sleep is still a problem, but seeing improvement.
• The diet is still not great.  At 330lbs, he might be a prime candidate for ketogenic approaches to psychosis/cognition.
• Thyroid still has not checked for cognition problems.
• Rage episodes seemed to be getting more sparse, not one violent incident since October 21.
• Biggest problem is cognition/loose associations/intrusive dialogue/short term memory
  • In contrast to some withdrawing anti-psychotics who experience no emotions/thoughts - he thinks about just about everything to the point he can't do anything.
  • He might do obsessive things (turning off/on lights, pacing, opening/closing doors, showering) as a way to deal with the thought explosion.
  • Basic functions (cooking, hygiene, grooming) are hard for him.  
  • Mostly spends each day in contemplation of his own thoughts.

 

I'm hoping that supplements (NAC just arrived) + time might improve his cognition to the degree that he can get regular treatment (thyroid/dietary/exercise/occupational).  Or that I can organize a trip to a clinic within a window of clarity.

[Giovanni]

Also, just to clarify:

 

My brother (who is the patient) has never posted, but does have the password to the account.  He wanted to taper in 2019, and I (patient's brother) found this website as a result.  He CT'ed in 2011, which ended him back in the psych ward and back on meds.  I created this account for him to avoid such an experience, and gave him the password via email, and started the initial topic.  We also share the email associated with this account, though he has others.  He never ended up posting on his own though.

 

In fact, he was a bit skeptical about the concept of this website [when he was cogent], saying that the posters here are a minority of having a very bad reaction to the drugs.  Though I think this case does indeed show exponential tapering is the way to go, especially for the last portion of the medication.  

 

He did manage his own taper on his own, though I did purchase the GEMINI-20 scale for him.  He made his own pills/weighed stuff for most of the duration.  Then he CT'ed atleast partially the last amount, and here we are now 🙂

 

So for future reference since he's never posted, you might refer to my brother [the patient] as Luigi (another Italian pseudonym) and me [the non-patient family member] as Giovanni.

 

If/when he does get better, I'll probably show him this journal.

 

[Shep]

2 hours ago, Giovanni said:

The diet is still not great.  At 330lbs, he might be a prime candidate for ketogenic approaches to psychosis/cognition.

 

Have you heard of Dr. Chris Palmer? He wrote the book Brain Energy, which details patients who've had success using this diet. He noticed that when some of his patients used it for weight loss, their psychiatric symptoms decreased. 

 

I'm skeptical that it's some sort of magic fix, but it could be a good tool in the toolbox. Here is Dr. Palmer discussing his book: 

 

Chris Palmer, MD — Brain Energy for Mental Health, The Potential of Metabolic Psychiatry, and More video (1 hour 52 minutes)

 

Fast food is incredibly unhealthy, so if he could move away from fast food and processed foods, he may find a lot of the chaos resolves. 

 

It's good you're looking after your brother and taking the time to research this. 

 

[Giovanni]

Yes, I saw Chris Palmer on various podcasts.  I actually suggested to the psychiatry ward that they put him on a ketogenic diet in my fax since they have the power to compel treatment and it's obvious he has metabolic issues.  But they have just did their standard procedure which was the B52.  
 

For acute psychosis, hospitals should probably be able to offer the ketogenic in wards.  A French doctor did it.

 

Quote

 

After witnessing marked improvement in seizures and autism behaviors in a family member within several weeks of having adopted a ketogenic diet, Dr. Danan became interested in the potential of the diet to improve the psychiatric and metabolic status of his most treatment-resistant patients, regardless of diagnosis. He created a metabolic psychiatry treatment program within his local hospital where patients with chronic mental illness who had exhausted standard psychiatric therapies could attempt a ketogenic diet in a supportive, medically supervised environment.

 

Dr. Danan admitted 31 of his patients with major depression, bipolar disorder, or schizophrenia to the Clinique du Castelviel in Toulouse where they were served a ketogenic diet in lieu of standard hospital fare.

 

Symptoms of depression and psychosis improved in all 28 patients who followed the diet for longer than two weeks, with improvements becoming noticeable within three weeks or less. 43% of patients achieved clinical remission, and 64% were discharged from the hospital on less psychiatric medication.

 

 

https://www.psychologytoday.com/us/blog/diagnosis-diet/202207/new-study-serious-mental-illness-improves-ketogenic-diet

 

Until the system changes, family members are stuck with a more gradual approach.  He was nearly 100% fast food after the CT - I wonder if his brain wanted more glucose/carbs after the removal of the anti-psychotic for some reason.

 

Now he's 40% fast food.  The progression I'm aiming for is:

 

Standard American Diet (SAD) --> Mediterranean --> Commercial Keto --> 3:1 Keto --> 4:1 Keto

 

Simply Mediterranean could be a massive win.

[eje91]

Sounds like a plan to go gradually from the SAD to Keto. I am currently trying to eat a Keto diet as well. 

I am continuing to pray for your brother, you and your Mom. Thank you for the updates. 

[SonSetFree]

@Giovanni

 

Hi, I watched a 3 hour interview yesterday with Dr. Chris Palmer and he shared a case study about someone that sounds like your brother.  Did you see that one?  This individual was around 350 lbs and suffered from schizo-typal audio hallucinations daily and general illusions of paranoia.  He managed to get on and stay on Keto and lost a massive amount of weight, over 150 lbs.  He is no longer dealing with the psychotic episodes and is functioning independently now.  

 

How is your brother doing?

 

-Son

 

 

 

 

[Giovanni]

Yes, I've seen that case report and it does give me hope.  Beyond the physical benefits of weight loss, there is a clear mental component: I'm doing something good for myself over an extended period of time.

 

If my brother goes to a healthy weight, it'd be a game-changer for him, since it's been a source of failure for him throughout his life. 

 

I have no major progress to report on the diet front though.  He still eats fast food once a day (more or less).  Fast food and junk food shopping are the only times of the day he goes outside, so there's some logical component to it. 

 

He actually doesn't get into the car now (even as a passenger) when we've tried to change up his routine, possibly because of bad memories of erratic driving.  

 

 Small gains:

•  He has accepted stevia instead of sugar, and doesn't buy his own sugar
•  I went shopping with him, where I put back unhealthy items he wanted, and he accepted it
•  He went to a small Mexican restaurant once, rather than the common big fast food chains he frequents.

Still, the extreme disorganization and endless self-talk make the long-term planning required by the ketogenic approach difficult.  He was up from 8PM (last night) to 8AM (today) trying to make oatmeal, but just ended up going to and fro in self-talk.

 

I've been researching different perspectives on this symptomatology. 

 

Bio-psychiatrists call this 'thought disorder'.  It could also be ultra-radian bipolar, since there's a consistent "one day on" (extreme monologue, no sleep) and "one day off" pattern (more subdued monologue, does go to sleep).  He occasionally gets multi-night sleep, when he has the psychic energy to use diphenhydramine at the right time.

 

The psycho-analyst Darian Leader defines psychosis in three subtypes: the schizophrenic, the paranoid and the melancholic.  

 

 

 

Schizophrenic means a predominance of disorganization symptomatology.  The key in this model is that disorganization is an adaptation to something else.  

 

Professor Andrew Moskowitz thinks "word salads" are a self-defense mechanism of obfuscation.  My brother engages in self-talk even though nobody is present, so could be self-obfuscation.  

 

 

 

(skip to 9:00 in video for thought disorder)

 

His self-talk does include things that weren't previously verbalized.  There were two sentences in last night's monologue where he describes an incident with our father (who was an abusive alcoholic), almost in passing.  If the incident was true, then it would be disconcerting/traumatic.

 

I've many success stories with people with the paranoid sub-type of psychosis:

 

 

There are less stories about the disorganized sub-type.

 

I've been reading up on Internal Family Systems too.  The 'parts' perspective does explain the multitude of behaviors I see: a disorganized part (most common), a quiet part (less common) and raging part (least common but most destructive).  I bought the book Self-Therapy by Jay Early and plan to give it to my brother.

 

There must be a part of him that has goals aside from fast-food/self-talk (it existed when on medication).  That part has been severely down-regulated.

 

I'm also cognizant of the bio-psychiatrist critique of the psycho-therapeutic approaches.  There was a place called Chestnut Lodge, which placed heavy emphasis on psychotherapy.  It did not produce results better than the naturalistic psychosis recovery rate.

 

Quote

"At the lodge, he stood up and, in essence, told all these giants of psychotherapy that there was not a shred of evidence that what they were doing with schizophrenia patients was helping, much less curing the disorder," Dr. Fenton said. "And the therapies were being advertised as cures."

 

https://www.nytimes.com/2006/05/23/health/psychology/23prof.html

 

(though, Robert Whittaker argues bio-psychiatry under-performs the naturalistic recovery rate).  

 

There is still the possibility that this thought disorder is iatrogenic and will heal with time.  He never had these symptoms before starting medication, and they only show up after he withdraws from medication.  My current strategy is to:

• introduce him to psycho-dynamic/IFS concepts: it definitely works for some people.  Why does he talk to himself all day and not have any goals?  That's the fundamental question that only he can answer.
• introduce him to potential goals: ketogenic diet and health improvements being the major one.
  • a job would also provide him structure too, if he wants it
• try to improve the environment.  Moving to a location where fast food restaurants are rare.

I am grateful that the acute withdrawal phase (the violent rage episodes, late-night erratic driving, multi-day insomnia) has been gone since October. 

 

I still can't say if this thought disorder is iatrogenic, so the "wait and see" strategy is only viable option.

[Shep]

16 hours ago, Giovanni said:

Bio-psychiatrists call this 'thought disorder'.  It could also be ultra-radian bipolar, since there's a consistent "one day on" (extreme monologue, no sleep) and "one day off" pattern (more subdued monologue, does go to sleep).  He occasionally gets multi-night sleep, when he has the psychic energy to use diphenhydramine at the right time.

 

There's a good day / bad day phenomenon with psychiatric drug withdrawal reported by a lot of people on these forums. 

 

How often is he using diphenhydramine? Please add that information to your signature. 

 

Sometimes diphenhydramine can cause problems in people with destabilized nervous systems due to withdrawal. For more, see: 

 

Antihistamines for withdrawal insomnia (diphenhydramine, doxylamine, hydroxyzine)

 

16 hours ago, Giovanni said:

I have no major progress to report on the diet front though.  He still eats fast food once a day (more or less).  Fast food and junk food shopping are the only times of the day he goes outside, so there's some logical component to it. 

 

I came across some videos of people doing Keto at fast food restaurants when I was researching Paleo and Keto. It's a way of doing "Keto on a budget" or if you're out in the world and need a quick meal.  Not ideal due to the quality of food, but it would be a way of getting outside to his favorite restaurants and still being able to do Keto. Basically, order the burger without the sauce or bread. This is a playlist from the channel KetoConnect:

 

Fast Food Guides - video playlist

 

It's best to cook from scratch with higher quality food, but this may be a way of getting your brother onboard with Keto, if his thinking allows him to process this information. 

 

16 hours ago, Giovanni said:

Small gains:

•  He has accepted stevia instead of sugar, and doesn't buy his own sugar
•  I went shopping with him, where I put back unhealthy items he wanted, and he accepted it
•  He went to a small Mexican restaurant once, rather than the common big fast food chains he frequents.

 

 

Great to hear about the gains, no matter how small! 

 

16 hours ago, Giovanni said:

a job would also provide him structure too, if he wants it

 

Or volunteering, if there's anything available in your area. Volunteering may be less stressful and more flexible, when he's ready. 

 

The fact that he's making small gains and not getting worse is a good sign that this is at least in good part iatrogenic. Healing happens slowly and with waves and windows, but it does happen. He's lucky to have a brother who's an advocate for him. I hope he eventually will be able to make an account here and chat with us. It may help him to chat with others with these types of so-called "severe disorders" are off the drugs and recovered. 

 

Please let us know if there are any updates on your brother's thyroid check.