BadMedicine: tapering off sertraline / Zoloft and olanzapine / Zyprexa

[BadMedicine]

@morgana. Thanks for your kind words. I think we are all helping each other with our individual experiences. That is how we are going to get there - and we all will with patience- by supporting each other and learning from each other’s experiences.

 

Hi @Venkat. Nice to meet you and thanks for stopping by my thread. I’m doing OK thanks. Very slowly trying to get off this poison. It is a frustratingly slow process but is reasonably comfortable so far. I see from your signature that you are also tapering olanzapine. I hope it is going well for you.

 

Take care, BM

[Venkat]

Thank you @BadMedicine

 

It is really heartening to hear when someone on olanzapine say they are comfortable. It's very amazing. Hope all of us are able to say that some time sooner. 

Keep it up . Best wishes with you. 

 

Regards, venkat 

[hayduke]

Hey BM.  How ya getting on?

[BadMedicine]

Hi @hayduke. Thanks for stopping by. Things are going reasonably smoothly. Due to drop to 2.08mg which feels like a bit of a milestone but am going on a bike trip on Wednesday and Thursday so am putting it off till after that.

 

Sleep is still good. Still getting 9 hours or so most nights with only 1 awakening so pretty pleased with that. Had been feeling really tired for a bit though despite good sleep. Been really busy at work so put it down to that but actually I’m still busy but the fatigue has lifted a bit so think it may have been withdrawal related.

 

Woke up in a very good mood both days at the weekend. Makes me really paranoid that I’m getting withdrawal mania but my husband said I was behaving normally so maybe it’s just a window of getting some positive emotions back that have been gone so long I haven’t noticed that I was missing them! Hope that makes sense. Back to a more usual baseline today so didn’t last long anyway. 

 

On the subject of dopamine super sensitivity. At what dose do you think you were done with the dopamine part of the tapering? I know dopamine binding efficiency of olanzapine is lower than for serotonin. I am worried about getting the withdrawal psychosis that happened when I reduced too fast and wondered when this starts to become less of a risk.

 

Thanks. BM.

[Venkat]

You seem to be doing well too @BadMedicine.Happy for you.

It gives great pleasure and hope when someone on olanzapine is doing so well.

Is 2.5mg the magic number, I guess so.

Thanks for the post BM ,it meant much to me. Good luck. 

 

Regards, venkat 

[hayduke]

On 8/16/2021 at 6:49 PM, BadMedicine said:

Hi @hayduke. Thanks for stopping by. Things are going reasonably smoothly. Due to drop to 2.08mg which feels like a bit of a milestone but am going on a bike trip on Wednesday and Thursday so am putting it off till after that.

 

Sleep is still good. Still getting 9 hours or so most nights with only 1 awakening so pretty pleased with that. Had been feeling really tired for a bit though despite good sleep. Been really busy at work so put it down to that but actually I’m still busy but the fatigue has lifted a bit so think it may have been withdrawal related.

 

Woke up in a very good mood both days at the weekend. Makes me really paranoid that I’m getting withdrawal mania but my husband said I was behaving normally so maybe it’s just a window of getting some positive emotions back that have been gone so long I haven’t noticed that I was missing them! Hope that makes sense. Back to a more usual baseline today so didn’t last long anyway. 

 

On the subject of dopamine super sensitivity. At what dose do you think you were done with the dopamine part of the tapering? I know dopamine binding efficiency of olanzapine is lower than for serotonin. I am worried about getting the withdrawal psychosis that happened when I reduced too fast and wondered when this starts to become less of a risk.

 

Thanks. BM.

 

That all sounds really good.  You sound comfortable with that gradual taper.

After therapy a couple of years ago I had a real 'high' one morning and was a bit worried, but realised I was fully functional and having good interactions with people instead of the time in the past where I felt that way but was getting sketchy.  It settled down again, too.  Emotional releases coming back to equilibrium.

I don't think you'll run much risk of psychosis the rate you're going, and obviously self monitoring fine.

If anything does come up, just hold, and if you feel you need to talk to a therapist about it, why not. 

@DataGuy had some good maths on the dopamine RO curves.  It's all speculative though at these low doses.  My sense of dopamine levels coming back up during the taper has usually been bounded by akathisia (time to hold!) or what I sometimes feel concern is incipient TD in my finger movements etc.  It generally settles down though so I worry about that less lately. 

I haven't had much akathisia for quite a while now, although when I've overindulged it can give me a nudge not to get too cocky yet.

I think most of the action at this stage is probably serotonin related, and I'm not having too much trouble with it for now.

 

Cheers and enjoy your bike ride!

[BadMedicine]

@Venkat. Thanks for your kind comments. I’m glad that my experience is giving you hope. It hasn’t all been plain sailing. I initially went too fast. Got hit with really bad withdrawal symptoms and had to re- instate to 2.5mg but since I have been doing the water titration it has been much smoother. Although it requires immense patience it really does seem to be the way to go. I know you are having success using this method too. What dosage have you got to now? Are you noticing any easing of the side effects now you are at lower dosages?
As for whether 2.5mg is the magic number. I can’t answer that question because I dropped from 5 to 2.5mg at the same time as dropping 12.5mg sertraline, then 3 months later I dropped to 1.8mg olanzapine. I was really destabilised for quite a while so didn’t notice the benefit of the lower dose. But I can for sure say that now I have stabilised and got down to 2mg I can feel my personality starting to come back. I definitely have more feelings and have started to make jokes again which I haven’t done for a long time. I also find myself genuinely laughing occasionally. I can only hope it continues to get better the further I go. I do still have a few bad days - where I find myself crying over very small things. Don’t know whether that is a result of currrent tapering or leftover destabilisation from big drops last year but they are getting fewer and further apart.

 

@haydukeThanks for your words of wisdom. It’s reassuring to know that you have experienced some of the fluctuations in mood that I have during your taper and come successfully out the other side. I will make sure I hold if anything even slightly alarming comes along and lasts for longer than a few days. Best wishes for your ongoing taper. 

[Venkat]

Hi @badmedicine , I am on 3.37 mg of olanzapine. Yes , there definitely is some change but still not good enough. I still haven't got back my personality, genuine laughter , feelings, self confidence etc..

 

My mom passed away last week, I couldn't even grieve, went about the rites with out emotions. 

 

You are doing really well, though with a few hiccups, keep going BM , we will follow you. 

 

Regards, venkat 

 

 

[BadMedicine]

So sorry to hear about your mother passing @Venkat. It is tough to lose a parent.

 

And sorry you are still experiencing such bad effects from the olanzapine. I think lack of emotion is one of the worst especially in situations like this. Keep plugging away with the reductions. I’m sure things will gradually improve for you as you get lower. You are doing really well with your taper as well. Unfortunately there seem to be no short cuts when it comes to getting off this poison. It certainly tests ones patience to the limit!

[Venkat]

Thanks a lot @BadMedicine.

[BadMedicine]

Just a quick update. Am now just under 2mg. Had a bit of a self- inflicted wobble recently. Went to a wedding and got really drunk. Bad move while trying to withdraw from this stuff. Sleep which had previously been good about 8- 10 hours dropped to 6 and had a return of crying spells, that was a withdrawal symptom from dropping the sertraline. Lasted 3 days and was very relieved when things returned to withdrawal normal. Lesson learned I think. Might not be so lucky next time!

 

Definitely feel, outside the self inflicted ramp up in withdrawal symptoms, that the last couple of cuts have been a bit harder than previous ones. Getting a bit of depression creeping in. Wonder if I’ve reached a steep section of receptor binding curves. Manageable though so I will keep moving forward at the moment.

[Venkat]

Yes @BadMedicine you are doing well. Keep going at your own slow pace. 

[BadMedicine]

@VenkatThanks very much for your reply and your encouragement. It means a lot.

 

Another quick update. The cuts have definitely got harder recently. Hardly noticed them at the beginning but noticing that after the last two cuts I have started getting symptoms about a week later. This last cut disrupted my sleep a bit. Nothing too drastic. Just felt a bit lighter and with more dreams and a few more awakenings. That has resolved but a quite bad depression has set in now which hasn’t gone away. Exercise lifts it for a few hours to a day but then it comes back again. Would like to get to 1.875mg which is 3/4 of a 2.5mg tablet before I hold but that is 2 more cuts away. Might have to be sensible and go against all my instincts to keep forging forward and hold where I am for a bit. Need to play the long game and take a hit now to hopefully give me a better chance of success of getting off completely. 

[hayduke]

Good on you guys, stay well.

 

BM I know that feeling so well, there’s such satisfaction in round numbers.  Bodies don’t care about that stuff though, why not sit where it’s comfy till you’re set for the next reduction.

 

Cheers

[BadMedicine]

Thanks @hayduke. Yes have followed your advice and am sticking where I am for a bit. I am starting to feel better so hoping my brain is catching up with the adjustments it needs to make and I’ll be able to continue on the way down pretty soon.

[BadMedicine]

Well I was able to carry on down after an extra week of holding at 1.97mg. Have reached a bit of a milestone. I am at 1.875mg which is 3/4 Of a 2.5mg tablet. Last time I was at this dosage after reducing by 1/4 directly down from 2.5 my sleep was poor, I had nausea, cortisol spikes early am, waking with a sense of dread and bad anxiety. I had to up-dose and stabilise for nearly a year before being able to continue my taper. However this time after tapering 5% of previous dose a month I am comfortable. Sleep is really good. Anxiety is minimal. No nausea. I do have a mild depression which is persisting but it is manageable and I am fully functional holding down a full- time quite stressful job. I feel like my emotions are coming back. I find myself genuinely laughing now from time to time which is really encouraging. motivation is better and getting enjoyment out of hobbies is happening more often.

Breaking new ground from here. Have a 2 week hold then will start down again. Looking forward to getting to 1.25mg. 

[hayduke]

Yay you're on the way!

 

😛

[Venkat]

Thanks for the positive post @BadMedicine. It lifts up our spirits. 

You are right, rushing only makes tapering difficult. 

I am glad and happy for you that you are living a almost normal life. 

Hope someday I too reach your state. Ofcourse all others as well. 

Take care. 

[BadMedicine]

Cheers guys. @Venkatyou will get there too. Unfortunately slow and steady seems to be the only way except for a lucky few. But as you get lower you will start to feel the positive benefits starting to appear. The whole tapering process does require inhuman levels of patience though!

[morgana]

its good to see more than one or two are finding there way...its good to see you are one of them @BadMedicine, wishing you warm wishes...morgana
 

[Venkat]

Thanks for your encouraging post BM. As morgana said, it is a good feeling to see a few getting there.

 

Can you kindly update your signature for our sake BM.

[BadMedicine]

Thank you @morgana and @Venkat. Signature is updated! 

[BadMedicine]

I got down to 1.875mg by dissolving a quarter of a tablet and then reducing by 2.5% every 2 weeks. Apart from after initially dissolving the quarter which led to a month of elevated mood and sleep disturbance it went pretty smoothly. There was some depression creeping in towards getting to 1.875mg but that lifted after a few weeks and I felt better than I have done for a while. Daily life is definitely easier. I am definitely feeling more emotion. Nearly cried at a film yesterday which I haven’t done for a while and talking to people is getting more natural - less forced feeling.

I’ve now started on down from 1.875. was nervous about initially dissolving the next quarter as that definitely ramped up symptoms for a bit last time. Sleep was slightly perturbed for a few weeks but nothing too bad. Was still getting 8 hours but I just felt less sleepy in the evening and it was a bit broken. So Have forged on with the reductions and am now on 1.79mg. Sleep is good but I do feel low. Think it is partly withdrawal symptoms and partly just frustration by how long this is all taking knowing that although I have seen improvements I’m still not the person I used to be. Was always really enthusiastic about everything and really sociable and I am a far cry from that. There have been glimpses of my old self which is what motivates me to continue but it is just so hard. 
 

Well I guess there isn’t anything to do but continue on down. I have to try and hold onto the positives I have seen and know that it will be absolutely worth it in the end and this is the best way to try and make it a lasting success without the need to go back on higher levels of the medication.

[hayduke]

That is so good to hear @BadMedicine.  Yes there's lots of low mood patches after the cuts, but keeping it at this sort of pace helps make it navigable, and the weekends and time with friends balance it out during the taper.  Great as access to emotions improves hey...feeling love and friendship again without feeling like you're wearing a wetsuit!

[Venkat]

Nice to see your update @BadMedicine.

As you said remembering the positives keeps us going and that is so true.

Also true that not being ourselves hurts.

Happy to know about your improved emotions. Great going Badmedicine. 

Wishing You a speedy recovery. 

[Rrsfc]

Tapering It's a little complicated, it's not easy, but you're doing so well, you should really be proud of yourself. Keep going, all the best! 

[BadMedicine]

Thanks @hayduke for your comments. Your experience with this process is invaluable and it’s good to know that what I am experiencing is par for the course when tapering this drug. Yes improved emotion is a welcome relief - it’s the essence of humanity and brings a richness to relationships and experiences. 
 

Thanks @Venkat for your reply and encouragement. It means a lot. We will get this done together and get back to our old selves. 
 

Thanks @Rrsfc for your encouragement as well. It definitely helps keep me going. It truly is a hard process but you are right I should feel good about the progress I have made. It’s all too easy to lose sight of that when getting to the end still seems so far away. 

[Rrsfc]

I've been rereading your last post and thinking how the drug affects us all differently. I remember when I tried to get off last time I felt more emotion too, but when I got up again I didn't get blunted again, I remained more emotional at 2,5mg. When you said you're still not yourself at the dosage I can see how our systems are different and that psychiatrists should be more careful on the dosage, because some people are very sensitive to this drug. I'm glad you are safely coming down and handling it so well. I think things will work out for you if you continue to be patient. With this drug we have to be so patient and be attuned to our body and what he's telling us...

[BadMedicine]

Hi @Rrsfc. I agree with you that psychiatrists need to be more careful with the dosing. There is a reference to a paper somewhere looking at dopamine receptor occupancy at 2.5mg. The range of binding was astonishing going from about 20% at the lowest to about 60% at the highest. I’ve always been quite sensitive to everything. Couldn’t sleep for nearly 36 hours after drinking a red bull at University so think I am probably towards the higher end of the binding even at these low doses!

Thanks for the encouragement for the tapering. Unfortunately a week or so after posting my last update I had to updose slightly. I had very mild psychotic symptoms start to develop. It coincided with a very stressful period at work so I think the reductions plus the stress was too much for my brain! I really do think though that it is mostly a super sensitivity reaction as I have stabilised by just going back to 1.875mg solid tablet. I’m very happy about this as 1.875mg is significantly better than 2.5mg!
 

I definitely have trouble transitioning to the liquid formulation as when I dissolved the first quarter I had a ramp up of symptoms for a month then once that settled everything went much more smoothly. This was not long after dissolving another quarter so may have been equivalent to a larger drop. I will stay where I am for a couple of months just to make sure everything has settled down and then try again to get the oral solution from the GP. If not I’ll have to try dissolving the next quarter again but give it longer before making any further reductions after that.

[Rrsfc]

I also had mild psychotic symptoms at that dosage, maybe it's not a coincidence. Maybe there's something sensitive about that dosage. I should've done what you did (I updosed to 5mg 🙄). I'm glad you could get through this rough patch safely. 1,875mg is awesome, you have to be happy with yourself for being able to go down safely this far. You can hold at this dosage a few weeks/months, whatever feels right for you, and then go down again. This time  I Will definetely respect my symptoms more and if I get psychotic I won't bring the big guns befores trying to updose slightly. The last time I tried to taper I updosed sometimes and it was a good decision, don't feel bad for doing it if it works for you. If a cut was too high I would updose 50%. So I would still have a cut but a really small one. I wish you all the best, hope you can hold steadilly and drop even more safely. I believe we'll get there eventually, but we have to be very patient... This forum is very important, we can support each other and learn from our mistakes.

[hayduke]

On 1/15/2022 at 2:41 AM, BadMedicine said:

Unfortunately a week or so after posting my last update I had to updose slightly. I had very mild psychotic symptoms start to develop. It coincided with a very stressful period at work so I think the reductions plus the stress was too much for my brain!

 

Neat how such a small updose can even it out, huh.  I did that 3 or 4 times overall I think.  I always took it as a prompt for a longer hold, a month or two, even more if you need it.

 

External stresses are definitely something to factor in to the calendar, even waiting four days to make a cut for a work trip or something is the way to go.

 

The better you tune in to what your body's telling you, the sooner you can respond to the situation.  Good to see you thinking about your footwork at these lower doses.  

[BadMedicine]

@Rrsfc Thanks for your reply. I am very happy that I have managed to get to a point where I am stable at 1.875mg. First time I tried to drop directly from 2.5mg to 1.875mg and I was all over the place: insomnia, anxiety, nausea and eventually psychotic symptoms that led me back to 2.5mg. Now thanks to a slow taper 1.875mg is enough to stabilise. Makes me think that if I can slowly get further down that threshold for stabilisation,  if I encounter problems, should get lower as well. Hopefully you’ll be fine with your taper but if you do hit trouble it is definitely worth trying a small updose. I noticed I wasn’t dealing with the stress very well and should have updosed slightly before I did. Might have been able to get away with a smaller increase. It is definitely worth nipping any signs of trouble in the bud before they escalate. It may mean it takes a bit longer but as you say patience is what is going to get us safely off this drug. It is very powerful!

Interesting that you also got mild psychotic symptoms at this dosage. I have read a lot of olanzapine threads on this site and nearly everyone says 2.5 to 1.25 is the hardest bit. Gets easier at the really lower doses. I suspect the receptor occupancy curves are quite steep here so although we are making small reductions we are probably unmasking a lot of receptors and olanzapine binds to about 17 different receptors so it is probably causing chaos!
 

Interestingly on this subject I was reading an article about people who’d previously been diagnosed with psychosis who had successfully got off their medication. Almost all of them suffered some degree of psychosis during withdrawal and went back to low doses of the drugs for a bit to get over it but after they’d been off it completely for a year they no longer had any problems. Seems like if you can get through this period you lose the supersensitivity susceptibility that the drugs cause. 

 

@haydukeYes these lower doses definitely require careful negotiation. I will be more mindful of external stressors from now on. I had got into a  must make the next reduction on a particular date mindset whereas I might have been better holding for a bit until things settled down a bit at work. I guess it’s all a learning experience and will definitely be sure to put this into practice with the continued taper. I am planning on quite a long hold where I am though- probably a couple of months. 

[hayduke]

13 hours ago, BadMedicine said:

I have read a lot of olanzapine threads on this site and nearly everyone says 2.5 to 1.25 is the hardest bit. Gets easier at the really lower doses. I suspect the receptor occupancy curves are quite steep here so although we are making small reductions we are probably unmasking a lot of receptors and olanzapine binds to about 17 different receptors so it is probably causing chaos!

 

I had a looong hold at 1.25mg.  I'd got down to 1.21 or something and it was not gelling after weeks.  Back to 1.25mg and gradually the woolliness or whatever vaguely intolerable feeling subsided, or I adapted, and the next round went fine.  From memory my intuition was that I was suddenly looking at bigger changes in serotonin levels.  Not that the dopamine left the picture, but akathisia was less frequent after that.

 

13 hours ago, BadMedicine said:

Interestingly on this subject I was reading an article about people who’d previously been diagnosed with psychosis who had successfully got off their medication. Almost all of them suffered some degree of psychosis during withdrawal and went back to low doses of the drugs for a bit to get over it but after they’d been off it completely for a year they no longer had any problems. Seems like if you can get through this period you lose the supersensitivity susceptibility that the drugs cause. 

 

Well, it's firmly established that withdrawing from these major tranquilisers can produce the symptoms they are prescribed to treat.  IIRC there are many instances of people put on these drugs who only experienced these symptoms, for the first time, during withdrawal.

I'm increasingly of the view that in many cases of what gets called psychosis, unprocessed trauma is emerging and parts of the brain are literally going offline during the flashback.  Not what the parent who abused you wants to have witnessed.  I bet those "crisis" teams have some war stories there.  Larkin et al have done great research in the book Trauma and Psychosis.

For our purposes, if you get any disturbing symptoms short of NMS or other medical emergencies, slow your taper until they settle!  Poor sleep, anxiety, excessive irritability, unmanageable DR/DP, dissociation, akathisia, etc etc.  All great clues to hold 🙂

[Rrsfc]

Thank you for sharing what you've learned, I didn't read as much on the subject, although I read about the 17 receptors 🙄. Sometimes reading too much frightens me, makes me anxious. I am so happy to have found you all, finally I'm not feeling so alone. I am a bit afraid of getting those strong symptoms, but things will be what they'll be, nothing more nothing less. @BadMedicine I believe we have things in common taperwise, hope you are still doing well holding. When in a hold I tend to get impatient so I try to focus my mind elsewhere. We have to be so consistent and cautious with this drug, it takes a lot of discipline and stability on our part to be able to taper it successfully.  @hayduke thank you for taking the time to help us out, what you do is so incredibly important to us...

[BadMedicine]

@haydukeI re-iterate what rrsfc said. Many thanks for your replies and sharing your experience with the taper process. It really is invaluable information to help us navigate this difficult process.

 

@Rrsfc. Still doing well holding thanks. We do appear to have quite a lot in common with our experiences tapering off this drug. Hopefully our shared experience will help us successfully and safely get down to zero. 

I can understand your fear of symptoms as you begin the taper process but by going slowly they are generally tolerable and any problems usually iron themselves out pretty quickly. It was definitely the combination of stress combined with the reductions that tipped me to a state that wasn’t manageable. Hopefully you’ll have a smooth taper but if there are times when life events put a strain on the taper process you can always take evasive action before any big problems arise. Slowing down the taper or even updosing slightly might be all that’s needed to keep things safely in track.

[SeekingMeaning]

Just wanted to let you know I'd been thinking of you and stopped by your thread to see how you're going.  I'm still holding a stable pattern myself as I've been interrupted in my tapering by imminent major surgery.  When the time comes to tackle my olanzapine taper I shall be going through your thread with great concentration to try and get tips on how best to manage it. x