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Peking2: antipsychotic dependence

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ChessieCat

Sorry, yes I did miss it.  I've put a heading above it so that it is easier to see.

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Peking2

Topic title:  I need guidance to taper

 

I have been on antipsychotics and antidepressants for six years. I had become dependent very early on but was never told by psychiatrist. This I see is often the case with psychiatry. I was taken off 10 mg Aripiprazole on November 2018 in a matter of few days by my psychiatrist since then Humpty Dumpty is trying to get together. I didn't know of this site then and my psychiatrist refused to acknowledge that this problem was dependence according to her withdrawal doesn't last longer than twenty days. I can see clearly it has been nearly an year with me. I reinstated 15 mg Mirtazapine in May and 50 mg Sertraline in July. Since then I have slowly stabilized with the waves and windows pattern of stabilisation. I can foresee a total recovery happening soon. 

 

Since I'm taking two drugs and want to wean off Mirtazapine first I want some help. I know 10% method is advised but should I for that consider the grand total of 65 mg to estimate the cut. This I'm not sure about. I also want to know if I could replace Mirtazapine dose with a hike in Sertraline. I want to get rid of Mirtazapine for its weight gain effects. I could then stay long term on Sertraline it's very little and I don't want to bother much after enduring the hell of cold turkey. How should I go about tapering Mirtazapine to zero? I take 50 mg sertraline and 15 mg Mirtazapine.

 

Edited by ChessieCat
added topic title

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ChessieCat

Topics merged.

 

Drug Interaction Report

This report displays the potential drug interactions for the following 2 drugs:

  • mirtazapine
  • sertraline
 
Major (1)
Moderate (0)
Minor (0)
Food (2)
Therapeutic Duplication (1)

Interactions between your drugs

Major

sertraline mirtazapine

Applies to: sertraline, mirtazapine

Using sertraline together with mirtazapine can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should seek immediate medical attention if you experience these symptoms while taking the medications. 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. 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

Drug and food interactions

Moderate

sertraline food

Applies to: sertraline

You should avoid or limit the use of alcohol while being treated with sertraline. Alcohol can increase the nervous system side effects of sertraline such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. Talk to your doctor or pharmacist if you have any questions or concerns.

 

Moderate

mirtazapine food

Applies to: mirtazapine

Alcohol can increase the nervous system side effects of mirtazapine such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with mirtazapine. Do not use more than the recommended dose of mirtazapine, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

Therapeutic duplication warnings

Therapeutic duplication is the use of more than one medicine from the same drug category or therapeutic class to treat the same condition. This can be intentional in cases where drugs with similar actions are used together for demonstrated therapeutic benefit. It can also be unintentional in cases where a patient has been treated by more than one doctor, or had prescriptions filled at more than one pharmacy, and can have potentially adverse consequences.

Duplication

Antidepressants

Therapeutic duplication

The recommended maximum number of medicines in the 'antidepressants' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'antidepressants' category:

  • mirtazapine
  • sertraline

Note: The benefits of taking this combination of medicines may outweigh any risks associated with therapeutic duplication. This information does not take the place of talking to your doctor. Always check with your healthcare provider to determine if any adjustments to your medications are needed.

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ChessieCat

You taper each drug separately and the calculations are made only on the one drug you are tapering.

 

Current dose of mirtazipine is 15mg.  If you want to make a 10% reduction, multiply 15mg x 0.9 = 13.5mg

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Peking2
27 minutes ago, ChessieCat said:

You taper each drug separately and the calculations are made only on the one drug you are tapering.

 

Current dose of mirtazipine is 15mg.  If you want to make a 10% reduction, multiply 15mg x 0.9 = 13.5mg

 

After stabilizing I wish to replace Mirtazapine with Sertraline how could I go about that? This because after enduring cold turkey I do not want to immediately start weaning off process and I want to stop weight gain associated with Mirtazapine

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ChessieCat

Please update your drug signature.

 

If you have changed doses please of either drug please add all the dose changes and dates:

 

Mirtazapine:  dose, date; date, dose;

 

Sertraline:  dose, date; date, dose;

 

Account Settings – Create or Edit a signature

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Peking2

It has been updated

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ChessieCat

Thank you.

 

If it was me, I'd be trying a 10% reduction of the mirtazapine without increasing the sertraline.

 

However, I'll let the other mods know as see what they think.

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Peking2
On 9/9/2019 at 2:19 PM, ChessieCat said:

Thank you.

 

If it was me, I'd be trying a 10% reduction of the mirtazapine without increasing the sertraline.

 

However, I'll let the other mods know as see what they think.

I want to ask something. In the months earlier if I took any stimulant my nervous system reacted harshly I'm much better now and cannot notice any effect if I drink Pepsi once in a while. One thing how can it effect me if I were to consume caffeine regularly through soft drinks. My symptoms are quite bad though still. I am going through the windows and waves

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Altostrata

Peking, I read back through your entire Intro topic.

 

It looks like you're using a phone to read the site and have missed answering many important questions. Please answer the following:

 

1. Does mirtazapine help you sleep?

2. How do you feel before and after taking mirtazapine?

3. How do you feel before and after taking sertraline?

4. What times of day do you take your drugs? Have you been taking them on a regular schedule?

5. What is your sleep schedule? How are you sleeping?

 

What symptoms are still "quite bad"? If you are feeling nervous or have surges of anxiety, I would NOT drink any caffeine. Caffeine has a very long half-life. A caffeine drink in the afternoon can keep you awake at night.

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Peking2

I'm so sorry I missed answering your questions I really am using a phone but I don't know whether it was the phone or my mental condition was so poor that I didn't see. 

 

1 It's been five months and Mirtazapine doesn't help sleep anymore

2 Mirtazapine really has very little or no effect

3 Sertraline sometimes leads to the release of cortisol and a small dip in mood before going up again

4 I take between 12 - 1 am sometimes it can be later or earlier. Schedule is regular

5 I don't sleep well. I have been trying to go off Melatonin and sleep around 2 and 3 am often I wake up for sometime to sleep again this makes my condition very bad intolerable for rest of day

 

My case is quite pathetic I was addicted to these drugs after my psychiatrists always took me off them in a matter of days I went into chaos this led them to diagnose me again and put me on meds I realised this after suffering for 7 years. I'm now trying to get normal.

 

I am going through waves and windows the thought pattern is almost normal now. My stress tolerance is still bad but markedly better from being not there at all. I am seriously troubled with a persistently low mood and depressive symptoms they are not as bad as the mood. My mood is constantly very low. The rest of the things require mild tinkering. I am not in that much anguish anymore and I'm trying to come at peace. I have seen I become happy now and can enjoy things. 

 

All my mental functions were in disarray now they're much better I can actually comprehend listen to someone. I can also pay attention and concentrate on things like reading. This will get better with more time. My memory and retention are infinitely better.

 

This process has been very gradual but has taught me to not mess again and trust psychiatrists again. I see that my body releases cortisol occasionally as part of recovering. The quantity of cortisol has gone down it's much lower. Maybe not a lot of time is left in becoming recovered totally. I have not been able to tolerate updose of both the meds the nervous system reacted harshly. 

 

There's a kind of muscle/artery stretch on my head which I seem to feel on my nose it is very strange often I feel a sound of it's movement/release. It has lessened over time with recovery and I'll be 100% when it is completely over. It's very hard. The muscles are of the of the entire head and extremely bad. When they contract I feel the worst. All this is quite a web. I don't know what it is? It puzzles me. I have not been able to find anything similar to it on this forum either

 

 Mood seems to be the last of things to improve as the belly is the last to go back after weight loss. How could I go about improving my mood?

 

I do not know how much time but I feel that I will get to my original and never will I ask more of this punishment it is the worst thing that can happen. 

 

Edited by ChessieCat
removed quote, unbolded text

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Altostrata
58 minutes ago, Peking2 said:

3 Sertraline sometimes leads to the release of cortisol and a small dip in mood before going up again

 

What does "release of cortisol" mean?

 

Mirtazapine helped you sleep in April, correct? Did it stop helping when you added sertraline?

 

If you take both sertaline and mirtazapine at 12-1 a.m., please do this: Move the sertraline by an hour day until you're taking it earlier, such as noon or 10 a.m. or whatever time in the first part of the day is convenient for you. Be sure to keep daily notes about your drug schedule and symptom pattern.

 

I think the sertaline might be interfering with your sleep.

 

What time of night do you take melatonin? Does it help you sleep for a few hours?

 

Good to hear that otherwise, you've seen some improvement. This is good, we don't want to shake it up.

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Peking2

I sometimes have sleep problems not always. I could sleep easily though I can't notice Mirtazapine causing sleepy feeling any longer it happened until recently not any more. I can feel it is Cortisol since after waking up I have anxiety because of Cortisol which happen to a several times in the day. 

 

Do you think I should updose to make the recovery faster? I notice that after healing for sometime I can updose

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Peking2

Mirtazapine has caused me to gain a lot of weight. This is doubly bad after years of gaining weight on anti psychotics only now have I been able to shed weight. Mirtazapine makes me thirsty all the time. How could I go about replacing it with Sertraline?

 

I want to cut Mirtazapine into 7.5 mg raise Sertraline by 12.5 mg and after 3 weeks stop Mirtazapine. 15 mg Mirtazapine is equal to 25 mg of Sertraline. 

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Altostrata
On 9/10/2019 at 3:17 PM, Altostrata said:

 

What does "release of cortisol" mean?

 

Mirtazapine helped you sleep in April, correct? Did it stop helping when you added sertraline?

 

If you take both sertaline and mirtazapine at 12-1 a.m., please do this: Move the sertraline by an hour day until you're taking it earlier, such as noon or 10 a.m. or whatever time in the first part of the day is convenient for you. Be sure to keep daily notes about your drug schedule and symptom pattern.

 

I think the sertaline might be interfering with your sleep.

 

What time of night do you take melatonin? Does it help you sleep for a few hours?

 

Good to hear that otherwise, you've seen some improvement. This is good, we don't want to shake it up.

 

Peking, I need you to answer my questions before I can make suggestions.

 

If you're taking mirtazapine for sleep, sertaline is not a substitute.

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Peking2

I take Melatonin 10 mg for sleep. I reduced Mirtazapine to 11 mg 1/4 th of the pill is gone it has sit well with me. I'll give it 3 weeks to settle down before another cut. I raised Sertraline by 12.5 mg but my nervous system reacted to it. So I came back to 50 mg. So now my plan is to reach 100% stability before acting again. My weight is under control for time being. I can foresee nervous system returning to factory settings very soon. This will make my task easier. I'll only come off Mirtazapine and stay on Sertraline for a year. I can't take more suffering than I've already had.

 

Answer to your question I take Melatonin for sleep. Mirtazapine doesn't make me sleep anymore. 

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ChessieCat

From this topic Melatonin:

 

On 4/7/2011 at 11:26 AM, Altostrata said:

Large doses of melatonin do NOT aid sleep -- they might cause your oversensitive brain to wake up, instead. I found when I took more than 2mg of melatonin, I was weepy in the morning. If you get this or a paradoxical reaction (waking) or are dopey in the morning, it's a sign you're taking too much.

 

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Peking2

Ok I will reduce the dose or sleep naturally. But Mirtazapine doesn't help sleep

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kiki2015

Hi Peking, I'm kiki. I know just how you feel about the problems with impulse control. I was wondering if you had experienced memory problems as well. I definitely couldn't remember faces and places I have been to seem unusual. I am desperate for help. I have been like this for over 5 years...yes! 5 years this became apparent to me. I have been desperate ever since. I've tried to change my diet, take supplements. Nothing has worked. I've also experienced tics. I was wondering if you had experienced this. I've been on abilify since 2007 and on AP since I wàs 18. I'm now 35. I'm amazed and upset when I hear about psychiatrists drawing graphs, speaking about dependence. They seem to make an effort with others. In 17 years they have made little to no effort and that little effort came after they were pushed by complaints and having an advocate. 

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Peking2
1 hour ago, kiki2015 said:

Hi Peking, I'm kiki. I know just how you feel about the problems with impulse control. I was wondering if you had experienced memory problems as well. I definitely couldn't remember faces and places I have been to seem unusual. I am desperate for help. I have been like this for over 5 years...yes! 5 years this became apparent to me. I have been desperate ever since. I've tried to change my diet, take supplements. Nothing has worked. I've also experienced tics. I was wondering if you had experienced this. I've been on abilify since 2007 and on AP since I wàs 18. I'm now 35. I'm amazed and upset when I hear about psychiatrists drawing graphs, speaking about dependence. They seem to make an effort with others. In 17 years they have made little to no effort and that little effort came after they were pushed by complaints and having an advocate. 

 

I have been on antipsychotics and antidepressants since the age of 14 now I'm 21. I've been to three different psychiatrists. I think I only had Maladaptive daydreaming this being unknown to psychiatry I was put on antipsychotics. Soon I got into dependence. Dependence causes me disconnect to reality, thoughts, low moods, depression. This was assumed to be illness and was medicated for years until last November my British psychiatrist told me about substance dependence/addiction. She didn't believe it lasted more than 20 days. I came across this forum after enduring six months of cold turkey's hell. Now I'm stabilising I think I'll come to factory settings soon.

 

As for memory I didn't have much memory problems my problem was thoughts and disconnect to reality. I had difficulty staying in reality. I have taken a long list of antipsychotics and antidepressants. You should read into this forum's stories it'll help greatly for your problem. For different people symptoms of dependence can come in many forms. If your problem is dependence then you should switch to a antidepressant like fluxoetine or sertraline avoid paroxetine since it's difficult to come off it. Then tapering will be easier and you can stay on it longer. 

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