Peking2: antipsychotic dependence

[Peking2]

In November I quit Aripiprazole 10 mg after 6 years on different antipsychotics. For the last two years since quiting I had been taking Quetiapine and Aripiprazole for thought problems. The other 4 years I took Risperidone. The dosage were not very high with the exception of Aripiprazole which I took 20 mg for sometime. My British psychiatrist told me I was psychologically dependent on antipsychotics and antidepressants and took me off medication as my treatment was complete. She gave me a ICD-10 diagnosis regarding dependence. I did not suffer from thought problems anymore it is true. She drew a graph to describe the effects of the drugs on my mind and mood. 

 

I passed six months till May in total hell and disarray. My mind went into chaos. I became hypersensitive to stress. I lost my senses and ability to think. I a largely self controlled person began to have serious emotional outbursts. Along with this I had bitter negative thoughts all the time. I had lost peace of my mind. I was a zombie with emotional spirals and lack of impulse control. I persistently had low mood. All this time my psychiatrist refused to accept that this was withdrawl or psychological dependence. According to her withdrawl and dependence didn't last so long.

 

In May I began Mirtezapine 15 mg it has helped me regain my former self. One thing which still troubles me is that Mirtezapine suits me perfect but any other thing like fluxoetine and caffeine can spoil the graph which I mentioned earlier. Their effect creates an imbalance such that I feel my mind going blank attention concentration limited. I fluctuate between high and low but cannot go in between. The feelings are extreme. I feel pressure on my eyes even. I fail to understand this phenomenon. Two days ago I drank 1.5 litre of zero sugar pepsi and this trouble began once more after nearly a month. Earlier it occurred when I tried to switch between fluxoetine and Mirtezapine.  

 

Another thing is what else could I do to remove this dependence. I would desire help in managing the graph and ensuring it's smoothness. And how long could I expect this state of mind to last? It has effectively changed my personality, mind temporarily. 

[Altostrata]

Welcome, Peking.

 

When people who have been on psychiatric drugs for a good while go off the drugs and suffer withdrawal symptoms, their nervous systems often become hypersensitive to drugs and sometimes even supplements and foods.

 

It sounds like your nervous system is in this sensitive state. This goes away very, very slowly -- over years.

 

What other drugs are you taking besides mirtazapine? What times of day do you take them? Do you take mirtazapine to sleep?

 

To help us out, follow these instructions Please put your drug and withdrawal history in your signature You may need to use a computer to do this.

[RichT]

Hi Peking2,

 

I came off Aripripazole 5mg quite quickly (almost  ‘cold turkey’) and suffered severe withdrawal symptoms because of it. I reinstated a small amount, while you started another drug which luckily seems to have helped you a lot. I recognise your symptoms! They can last a long time, much longer than most psychiatrists accept. 

 

If you fill in your signature the mods will be able to give you good advice.

 

warmest wishes 

 

Rich

[Peking2]

I have put the required information in the signature

[Peking2]

23 hours ago, RichT said:

Hi Peking2,

 

I came off Aripripazole 5mg quite quickly (almost  ‘cold turkey’) and suffered severe withdrawal symptoms because of it. I reinstated a small amount, while you started another drug which luckily seems to have helped you a lot. I recognise your symptoms! They can last a long time, much longer than most psychiatrists accept. 

 

If you fill in your signature the mods will be able to give you good advice.

 

warmest wishes 

 

Rich

The required information has been put into the signature and I wish to understand how to deal with hypersensitivity of my nervous system

[Altostrata]

Do you take mirtazapine to sleep? Does it work?

 

In what ways does your nervous system show hypersensitivity now?

[Peking2]

18 hours ago, Altostrata said:

Do you take mirtazapine to sleep? Does it work?

 

In what ways does your nervous system show hypersensitivity now?

My psychiatrist drew a graph to discuss my dependence problems. It was working smoothly with Mirtazapine 15 mg and I was expecting full recovery in few days after horrors of months. Just then I drank 1.5 litres of Pepsi Zero and the caffeine spoiled the graph. My nervous system then reacted harshly. Now I feel even food or Melatonin impacts powerfully. I haven't taken Mirtazapine after this stabilises I will begin Mirtazapine which is the only medicine which has worked for me. Yes I sleep with it easily though I don't if I don't want to.

 

My whole life was in chaos the feelings are very bad I cannot think straight I lose my senses even. I experience very powerful emotions. It is a great suffering. I am not same person even. Mirtazapine considerably improved me and was heading towards total recovery till taking Caffeine. I want to recover entirely can you suggest the way? Also how should I handle the hypersensitivity of the nervous system. And how should I normalise it after it gets effected the way it got. Earlier I tried to switch to fluxoetine and it became like this so after taking no medicine for few days restarting Mirtazapine brought me back on track.

[Altostrata]

I think you'll want to avoid caffeine and other stimulants for a good long while.

 

Be patient, let your nervous system settle down, this may take months. Don't make any other drug changes, it will confuse your nervous system. You will settle down little by little. Be sure to take 15mg mirtazapine at the same time each night. You can decide later about eventually going off mirtazapine.

 

What did your psychiatrist's graph look like?

[RichT]

A great thing to do with a hypersensitive nervous system is to spend some time in nature regularly. If you have access to a green space it can be a great help. 

 

Warmest wishes,

Rich

[Peking2]

6 hours ago, Altostrata said:

I think you'll want to avoid caffeine and other stimulants for a good long while.

 

Be patient, let your nervous system settle down, this may take months. Don't make any other drug changes, it will confuse your nervous system. You will settle down little by little. Be sure to take 15mg mirtazapine at the same time each night. You can decide later about eventually going off mirtazapine.

 

What did your psychiatrist's graph look like?

https://ibb.co/6DZq2b5 the graph image. I hope you understand and explain it to me since the psychiatrist who wrote it never explained to me. I'm concerned as I have to be in Chicago by August to start university. I believe I could stabilise when the graph is normal and mirtazapine is taken. But caffeine spoiled the graph which I then have to correct by quiting medicine for few days till it normalises then begin medicine again. This could lead me to 100% recovery which I was heading towards till mistakenly taking caffeine. I would be grateful if you could explain the graph to me and how I could manage it

[Altostrata]

The graph appears to show how a dose reaches peak plasma and then wears off. I don't know what it shows about the caffeine.

 

You need to keep taking a drug like mirtazapine to maintain steady-state. Don't stop taking it, or you'll get a dip and that causes withdrawal symptoms.

 

I would just stick with taking mirtazapine regularly if it helps you sleep, don't worry about going to Chicago in August. When you feel well, you can very gradually reduce the mirtazapine to go off.

 

 

[RichT]

6 hours ago, Peking2 said:

https://ibb.co/6DZq2b5 the graph image. I hope you understand and explain it to me since the psychiatrist who wrote it never explained to me. I'm concerned as I have to be in Chicago by August to start university. I believe I could stabilise when the graph is normal and mirtazapine is taken. But caffeine spoiled the graph which I then have to correct by quiting medicine for few days till it normalises then begin medicine again. This could lead me to 100% recovery which I was heading towards till mistakenly taking caffeine. I would be grateful if you could explain the graph to me and how I could manage it

 

It’s hard to understand the graph, but it seems to show ‘mood’ vs ‘time’, highlighting that dips in mood can be sudden, and can be brought on by stress.

 

warmest wishes,

 

Rich

[Altostrata]

10 hours ago, RichT said:

 

It’s hard to understand the graph, but it seems to show ‘mood’ vs ‘time’, highlighting that dips in mood can be sudden, and can be brought on by stress.

 

warmest wishes,

 

Rich

 

Good guess, but the graph seems to take pains to indicate a regular cycle, with a steeper ascent and a parabolic descent indicative of the peak plasma-half-life metabolization cycle in consistent dosing.

[Peking2]

18 minutes ago, Altostrata said:

 

Good guess, but the graph seems to take pains to indicate a regular cycle, with a steeper ascent and a parabolic descent indicative of the peak plasma-half-life metabolization cycle in consistent dosing.

Can you refer me to sources which would help me understand it better and deal with it. I now understand caffeine caused the cycle pattern and ascent and descent pattern to change. I want guidance in changing the cycle patterns the way it ascends and descends. Please elaborate the last two sentences. I appreciate your response

[RichT]

29 minutes ago, Altostrata said:

 

Good guess, but the graph seems to take pains to indicate a regular cycle, with a steeper ascent and a parabolic descent indicative of the peak plasma-half-life metabolization cycle in consistent dosing.

 

Yes that’s possible, although he’s got the decay curve parabola the wrong way up (unless it’s different for psychiatric drugs than other drugs)

 

Rich

[MRothbard]

I can't handle caffeine either. Not even a decaf coffee every other day. Sugar is a no go as well. Alcohol?? Forget about it.

 

Good news is If you can consistently stay off these things some stability will return.

[Peking2]

21 hours ago, RichT said:

 

Yes that’s possible, although he’s got the decay curve parabola the wrong way up (unless it’s different for psychiatric drugs than other drugs)

 

Rich

Can you explain to me this whole graph so I can better manage it?

[RichT]

28 minutes ago, Peking2 said:

Can you explain to me this whole graph so I can better manage it?

 

I can’t be sure what it means, Alto and I have done up with two different possible interpretations, but I think either way it’s saying it’s best to be stable in your dosages. Don’t stop and start depending on how you feel, but stay on the same dose. That way you won’t have such peaks and troughs.

 

R

[Peking2]

On 6/21/2019 at 9:52 PM, RichT said:

 

I can’t be sure what it means, Alto and I have done up with two different possible interpretations, but I think either way it’s saying it’s best to be stable in your dosages. Don’t stop and start depending on how you feel, but stay on the same dose. That way you won’t have such peaks and troughs.

 

R

How long do you think it would take for my brain to recover completely?

[Altostrata]

Peking, understanding that graph is not important to your recovery.

 

When you have a bad drug reaction, your nervous system very slowly repairs itself. This can take many months, usually in The Windows and Waves Pattern of Stabilization

 

Also read Are We There Yet? How Long is Withdrawal Going to Take?

 

It is possible you're having some adverse reactions to mirtazapine. What is your current drug schedule? Do your symptoms occur at any particular time of day? Please keep daily notes of times of day you take your drugs, their dosages, and your symptoms. You can post them in this topic with a simple list format with time of day on the left and notation (symptom, drug and dosage) on the right.

 

We need these daily notes to tell if you're having a reaction to mirtazapine.

 

[ChessieCat]

3 hours ago, Altostrata said:

Please keep daily notes of times of day you take your drugs, their dosages, and your symptoms. You can post them in this topic with a simple list format with time of day on the left and notation (symptom, drug and dosage) on the right.

 

We need these daily notes to tell if you're having a reaction to mirtazapine.

 

An example of what Alto needs:

 

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

[Peking2]

On 7/5/2019 at 12:17 AM, Altostrata said:

Peking, understanding that graph is not important to your recovery.

 

When you have a bad drug reaction, your nervous system very slowly repairs itself. This can take many months, usually in The Windows and Waves Pattern of Stabilization

 

Also read Are We There Yet? How Long is Withdrawal Going to Take?

 

It is possible you're having some adverse reactions to mirtazapine. What is your current drug schedule? Do your symptoms occur at any particular time of day? Please keep daily notes of times of day you take your drugs, their dosages, and your symptoms. You can post them in this topic with a simple list format with time of day on the left and notation (symptom, drug and dosage) on the right.

 

We need these daily notes to tell if you're having a reaction to mirtazapine.

 

I feel very bad when I wake up later than 2 o clock in the afternoon. I feel very bad if I stay up after 12 am. Anxiety bad behavior irrational thinking. 

 

I'm better when I wake earlier and sleep earlier. I have no stress tolerance I grow out of control literally.

Should I take Fish oil to help recovery. Can you suggest any other medicine which could help me get stable?

 

[Altostrata]

It is better for your nervous system to keep regular sleeping hours, roughly from nightfall to dawn. If I were you, I'd go to be before midnight and get up at a regular time in the morning.

 

Some people do poorly when they do not keep regular sleep hours or go without sleep.

 

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.

[Peking2]

On 7/8/2019 at 2:59 AM, Altostrata said:

It is better for your nervous system to keep regular sleeping hours, roughly from nightfall to dawn. If I were you, I'd go to be before midnight and get up at a regular time in the morning.

 

Some people do poorly when they do not keep regular sleep hours or go without sleep.

 

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.

Nobody warned me to wean off Aripiprazole and I left it cold turkey. Last year in July I was taking it 15 mg. Three years back I quit Risperidone cold turkey the psychiatrists never told me it needed longer than few days. I then lost my mind totally I became a wreck. So the psychiatrist put me on Quetiapine later replacing it with Aripiprazole so I was misdiagnosed while the trouble was only that I was addicted. How can I make my recovery towards normalisation faster? I have to start university. I have no concentration. I'm miserable I feel extreme emotions and cannot handle stress. I feel very low most of the times and the my ability with handling emotions is very poor. The only thing which could make it any better is medication. And I don't know whether reinstating would do. It has been 10 months since cold turkey and I'm scrambling to get my act together. I have become a shadow of my former self. I cannot feel a connection with the real world. I also have negative obsessive thoughts. I do not know what I could do to restore my former self. I'm taking fish oil. Had I known I would have weaned it off very slowly but I didn't know of this forum back then. The psychiatrist are of no help. I can have rages and behave very badly. I want to know if there is some way I could restore stability very soon

[Altostrata]

On 7/4/2019 at 12:17 PM, Altostrata said:

What is your current drug schedule? Do your symptoms occur at any particular time of day? Please keep daily notes of times of day you take your drugs, their dosages, and your symptoms. You can post them in this topic with a simple list format with time of day on the left and notation (symptom, drug and dosage) on the right.

 

We need these daily notes to tell if you're having a reaction to mirtazapine.

 

Still looking for these notes, it will help us answer your questions. We need to know your current symptom pattern and drug schedule.

 

Never quit a psychiatric drug cold turkey.

[Peking2]

1 hour ago, Altostrata said:

 

Still looking for these notes, it will help us answer your questions. We need to know your current symptom pattern and drug schedule.

 

Never quite a psychiatric drug cold turkey.

I take Mirtazapine 15 mg at 12 am. After lunch I take Sertraline 50 mg since 14 July. I did this hoping to calm myself down I have actually felt much better by introducing Sertraline it has made it bearable. I'm much quicker to normalise after stress it has improved compared to the horrors of earlier months. I feel a lack of connection to reality as if I'm unable to see everything around properly. I even have peace of mind now. Though mildly throughout I feel uneasiness and anxiety a twinkling of the horrors are left you could say the severity has become very reduced. Stress handling is greatly improved. I'm not original. My thinking is not good enough it's a long way from originality I just overcame obsessing over trivial things from the past many years ago or obsessive thoughts which feel real and troubled be. I'm in the middle progressing to total normality from total dysfunction. The extreme depression which sometimes set in face of stress comes for few seconds only. I'm not happy or in good mood either. I'm not fearful and a nervous wreck anymore. My concentration, attentiveness is poor. I have trouble focusing and remembering. I'm taking Omega 3 fish oils. Somehow my plan is that I stabilise myself on 50 mg Sertraline and then begin a very slow taper. My problem is acute three years ago I faced it far more worse coming off Risperidone so I was misdiagnosed and placed on Quetiapine and Aripiprazole and I held onto it till November 2018 when I quit once and for all cold turkey and all hell broke loose. Mirtazapine which I began at end of April helped me tremendously. I feel now it had stopped making further improvement. Should I continue with it? How much Sertraline dose be? How will stability return? And how long will it take?

[Altostrata]

Make it easy for us, please post daily notes in this format:

 

On 7/4/2019 at 3:34 PM, ChessieCat said:

 

An example of what Alto needs:

 

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

 

[Peking2]

57 minutes ago, Altostrata said:

Make it easy for us, please post daily notes in this format:

 

 

12 pm wake up anxiety irritability

3 pm lunch sertraline 50 mg anxiety goes away

4pm - 7 pm generally the best period feel good mood better the thoughts not so worse off anxiety

7 pm onwards monotonous routine stay at home surfing at iPhone worse than earlier generally uneasiness prevails cannot focus and pay attention cannot focus or remember strongly anxiety persists

10 pm dinner lack of connection to reality inability to feel things and see properly anxiety thoughts low mood 

12 am Mirtazapine bed anxiety

 

Mirtazapine which I began at end of April helped me tremendously. I feel now it had stopped making further improvement. Should I continue with it? How much Sertraline dose should be? How will stability return? And how long will it take

You could read the earlier answer for details

[Peking2]

I tried to take Fluxoetine in May but at that time my nervous system reacted very negatively. This time it went well with Sertraline and there was marked improvement. I hear Fluxoetine is easier to quit. Would replacing Mirtazapine 15 mg with Fluxoetine 20 mg be good at this time? How difficult is it to quit Mirtazapine? 

[Peking2]

12 hours ago, Altostrata said:

Make it easy for us, please post daily notes in this format

12 pm wake up anxiety irritability

3 pm lunch sertraline 50 mg anxiety goes away

4pm  feel good mood better the thoughts not so worse off

5:30 pm anxiety

7 pm cannot focus and pay attention anxiety persists

9 pm dinner anxiety tingling in the chest

10 pm dinner lack of connection to reality inability to feel things and see properly anxiety thoughts low mood 

12 am Mirtazapine bed anxiety

[Altostrata]

Anxiety increases after you take mirtazapine every night? 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.

 

22 hours ago, Peking2 said:

I tried to take Fluxoetine in May but at that time my nervous system reacted very negatively. This time it went well with Sertraline and there was marked improvement. I hear Fluxoetine is easier to quit. Would replacing Mirtazapine 15 mg with Fluxoetine 20 mg be good at this time? How difficult is it to quit Mirtazapine? 

 

I would not make further drug changes at this time. Every drug change incurs risk of nervous system destabilization. Mirtazapine requires slow tapering.

 

[Peking2]

I started Sertraline 50 mg on 14 July and already was on 15 Mirtazapine. Since then I have been undergoing though the waves and windows towards stabilisation though I'm still to reach 100%. I wonder if I could switch from Mirtazapine without effecting my recovery. I could stop Mirtazapine 15 mg and raise Sertraline by 25 mg. Mirtazapine has caused me to gain a lot of weight

[ChessieCat]

On 7/26/2019 at 3:47 AM, Altostrata said:

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.

 

Altostrata requested that you use the Drug Interactions Checker and paste the results here in your topic.

 

Please do this.

 

[Peking2]

 

Drug interaction report link:

 

https://www.drugs.com/interactions-check.php?drug_list=1640-0,2057-0

 

 

I have stabilised to a great extent. My dependence has bothered me for years. My psychiatrist told me about it very late. Sometimes in the middle of sleep I wake up for few minutes to sleep once more and my entire day is very punishing I feel very bad. I take both medicines at night at 12 am. Stabilisation has been gradual and slow I think in sometime I'll reach 100%. My nervous system was very sensitived I went through substance induced psychosis and depression. I lost my ability to think 

 

Edited September 4, 2019 by ChessieCat
added heading for link

[Peking2]

On 9/2/2019 at 4:18 AM, ChessieCat said:

 

Altostrata requested that you use the Drug Interactions Checker and paste the results here in your topic.

 

Please do this.

 

 

I want to get my nervous system back to normal. I have read the threads here they are very helpful especially the one on the windows and waves patterns of stabilisation. I am currently going through waves and windows. One thing I want to ask is I quickly have rebound of psychosis symptoms if I stop medicine for one or two days even. I want to stabilise for once and then taper very slowly

[ChessieCat]

On 9/2/2019 at 9:18 AM, ChessieCat said:

 

Altostrata requested that you use the Drug Interactions Checker and paste the results here in your topic.

 

Please do this.

 

 

You still haven't done this.