Worthy: tapering advice wanted

[Altostrata]

13 hours ago, Worthy said:

Thank you so very much for your reply. I stopped taking the ativan twice a day at the beginning of July  as i thought as i had only taken the 1mg  for a short time it wouid be ok to go back to my original dose as i did not want to become too dependent on it.  

 

You made random changes in your drugs and now you feel worse. You added benzo withdrawal to your problems.

 

You have asked repeatedly for a tapering plan but followed none of our suggestions. This has been going on since last August. This is very frustrating.

 

You said you were able to obtain Ativan, did you not? I would put the Ativan back. You probably will get dependent on it. You'd taper it later. Taking Ativan twice a day may facilitate your going off the other drugs.

 

Whether or not you get dependent on Ativan is a moot question. You are already dependent on 3 other drugs plus a benzo.

[Worthy]

@AltostrataThank you for your reply.  Yes i realise i have been very foolish and now paying the price.  Yes ativan is available for now.  Our country is in political turmoil and economical crisis so never know what will be unavailable.  I will do my best,  under the circumstances,  to follow any advice you give me.  

[Shep]

On 8/11/2020 at 3:03 PM, Worthy said:

I realize I have been very foolish not following advice given to me on numerous occasions.  I now need to take your advice and start over as I am not coping.  Please can you help me start again with tapering advice and I will follow it.  My current doses are

cynbalta 12.8 mg from 60mg taken at 7am

mirtazapine 2.8 mg from 15 mg taken at 10pm

zyorexa .75 from 5mg taken at 10 pm

lorazepam .5mg from 1mg taken at 10pm

 

 

Worthy, please read this thread:

 

Taking multiple psych drugs? Which drug to taper first?

 

Please note that preserving sleep is the priority. So you'll want to stay on the drugs that help with sleep and tapering the most stimulating drugs first. 

 

Since lorazepam is the only drug you have a continuing supply of, I would leave that drug to last to taper. It also helps with sleep, so another reason to taper it last. 

 

Since the Zyprexa is down to .75 mg, if you're not having a lot of side effects such as weight gain and if it's helping with sleep, you may want to stay on that drug and taper the Cymbalta first. 

 

So this may be the best tapering order for you:

 

1. Cymbalta
2. Zyprexa
3. mirtazapine
4. lorazepam

This thread will get you started for tapering cymbalta:

 

Tips for tapering off duloxetine (Cymbalta)

 

 

[Worthy]

Thank you so very much for your reply.   I have a very limited supply of the zyprexa hence the reason for deciding  to taper that first.  I have been holding on the cymbalta mirtazapine and Ativan and have increased the Ativan to 1mg as advised to do by Alostrata.  .Do you recommend I stop tapering the zyprexa and switch to cymbalta.  Supply continues to be a major problem for me as borders closed due to covid and drugs not available in Zimbabwe where I live.  

[gardenlady]

@Shep Please see Worthy’s response to your post.

[Altostrata]

Please update your signature with your CURRENT drug schedule.

 

If you have to taper Zyprexa because of short supply, I don't know why you keep asking which drug to taper first. See Tips for tapering off olanzapine (Zyprexa)

 

If you've added a nightly dose of clonazepam, that should substitute as a sleep drug and enable you to go off Zyprexa.

 

@Shep @Frogie please check Worthy's benzo dosing.

[Frogie]

3 hours ago, Worthy said:

Thank you so very much for your reply.   I have a very limited supply of the zyprexa hence the reason for deciding  to taper that first.  I have been holding on the cymbalta mirtazapine and Ativan and have increased the Ativan to 1mg as advised to do by Alostrata.  .Do you recommend I stop tapering the zyprexa and switch to cymbalta.  Supply continues to be a major problem for me as borders closed due to covid and drugs not available in Zimbabwe where I live.  

How much Zyprexa do you take each day and what time(s)? Can you continue to get this?

How much Cybalta do you have and how long can you continue receiving it? 
 

You may want to stop tapering the Zyprexa if you are on short supply of the Cybalta. Like Alto said, if you are taking Ativan, you may be able to get off the Zyprexa. Shep advised you to taper the Cymbalta first.
 

Thanks,

Frogie

Edited August 20, 2020 by Frogie

[Shep]

 

 

On 8/3/2020 at 5:57 AM, Worthy said:

Current stock, of pills 

90 zyprexa @5mg

90 mirtazapine @ 15 mg

120 cymbalta @ 60 mg

30 Ativan @ 1mg

 

On 8/1/2020 at 4:18 PM, Worthy said:

The only drug that is available to me in this country is the Ativan so I would not have to reduce that.  

 

On 8/11/2020 at 3:03 PM, Worthy said:

cynbalta 12.8 mg from 60mg taken at 7am

mirtazapine 2.8 mg from 15 mg taken at 10pm

zyorexa .75 from 5mg taken at 10 pm

lorazepam .5mg from 1mg taken at 10pm

 

Cymbalta - 120 pills X 60 mg / 12.8 mg = 562 doses at 12.8 mg

mirtazapine - 90 pills X 15 mg / 2.8 mg = 482 doses at 2.8 mg

Zyprexa - 90 pills X 5 mg / .75 mg = 600 doses at .75 mg

Ativan - you posted this drug is available in your country, so you have an ongoing supply

 

17 hours ago, Worthy said:

Do you recommend I stop tapering the zyprexa and switch to cymbalta

 

That's up to you. As you can see from the amount of doses you have, you actually have more Zyprexa doses than Cymbalta doses at your current rates. And as you taper, your supply will last that much longer. 

 

If the benzo and mirtazapine are helping with sleep and you don't feel you need the Zyprexa, you could finish your Zyprexa taper first. But then I would concentrate on the Cymbalta. 

 

I know this isn't ideal due to the circumstances in your country, but you're at very low doses for all of these drugs except the benzo, so the stockpiled pills will last a long time. There really isn't any need to panic. 

 

[Worthy]

I am currently tapering Ativan and cymbalta as have no choice due to no medical insurance.  I am at low doses of both but having severe symptoms.   At .64mg Ativan and 7mg cymbalta.   I am dropping 7% every two weeks on the Ativan and 2 beads every two weeks on the cymbalta.  Can anybody advise me if I should speed up on the atuvan as am in tolerance and getting zero relief.  

[Altostrata]

I am sorry you are still in this bad situation, @Worthy

 

We cannot advise you on a way to go off your drugs more quickly and avoid withdrawal symptoms. If you go off quickly, your withdrawal symptoms probably will get worse. 

 

Ordinarily, we would advise you not to reduce 2 drugs at the same time, and go off Cymbalta before Ativan. 

 

If you're reducing Cymbalta and Ativan at once, there is no way you can tell if you are "in tolerance" from the Ativan. You might be getting withdrawal symptoms from either or both drugs.

 

As far as how to go off more quickly, your guess is as good as anyone else's. If you have no choice but to taper the way you're tapering, you have no choice but to cope with withdrawal symptoms.

[Worthy]

Many thanks for your reply.  If i stop the ativan taper and only do the cymbalta can you  help.  I am currently at 48 beads and dropping 2 beads every 2 weeks.  I am on .64mg ativan.   Can you help with a plan to go forward.  I dont know if i am still being afected by previous tapers.  

[Worthy]

The ativsn is way cheaper than the cymbalta so could just manage  to afford it  if it will help.  I really would like your advice on a new way forward.  

[Worthy]

Hello.  I used to be on this site but came off but now wish to try again as I am struggling with tapering off cymbalta and Ativan,  I have messed up by reinstating on the Ativan and now need help getting off both.   Can anybody help as pretty desperate.  Down to 4mg on the cymbalta (24 beads) and stupidly back on 2mg atuvan.  Please need guidance.  

[getofflex]

Welcome back.  I have merged your post with your Intro topic.  Please keep all your questions and comments about your situation in this one thread to avoid confusion and duplication of effort.  Thank you.  

 

We suggest that you only taper one drug at a time, and taper the most activating drug first.  That would be the Cymbalta.  This link explains more about that:  

 

Taking Multiple Psych Drugs - Which to Taper First

 

What withdrawal symptoms are you having at this time? Are Cymbalta and Ativan the only drugs you are currently on?  Can you please update your drug signature with your recent drug history?  Please add years to the dates in your drug signature - thank you.  

 

It would be especially helpful to have the details of your drugs in a concise vertical list (no symptoms), only drug names, specific dates (as best you can say for example early March if you don't recall the day) and dosages of each medication decrease or increase.  Use this format:

 

Drug name: date, dose, date, dose, date, dose…

Drug name: date, dose, date, dose, date, dose…

Etcetera

 

Please read the link below for instructions.  This will allow us to give you the best guidance.  

 

How to List Drug History in Signature

[Worthy]

Cymbalta withdrawal

 

Please can I hear from others who have been on cymbalta and Ativan,  I have been badly polydrugged.  Off all,the other meds but these two remaining.  I am currently at 23 beads cymbalta and 2mg Ativan.   Need suggestions of how to,get off the remaining two

 

 

Edited May 1, 2022 by ChessieCat
added Intro topic title before merging with intro topic and deitalicised font

[Worthy]

Thank you so much for your reply getofflex.  I am not sure how to update my signature as I find this site quite confusing. I have gone to my signature page and hope i have done it correctly.   Cymbajta and atuvan are the only two drugs I am still on.  I am at  24 beads cymbalta and 2mg Ativan.  I have been holding on both these but now need to get off.   I have not been on any other drug for over a year.  I wouid like advice on how best to taper the cymbalta.  After the cymbajta I will get off the atuvan.   Please can anybody help.  Imam having horrifuc withdrawl symptoms both physical and mental.   Major deoression and anxiety and no motivation to do anything

[getofflex]

I need more information before I can help you.  Exactly what increases or decreases have you made to your drugs in the past year?  I need drug names dosage in milligrams and dates of each dose change.  
 

Please keep a daily journal and post it in here. Please write the time o’clock on the left with what happened and what you did on the right.  Note when you eat, sleep, take your drugs and any other activities.  Do it for 24 hours so we can see your sleep pattern.  Note your symptoms throughout the day especially how you feel before and after you take your drugs.  We need to see if you are having adverse reaction to your drugs.  

[Worthy]

Thank you.  I have been decreasing cymbalta by 2 beads every 2 weeks.   I managed to taper off the atuvan by doing a skow taper but had to reinstate as my symptons were too severe.  I dont know if i am capable of doing a journal as cannot concentrate.  I know for certain i am having adverse reactions to the drugs as my symptoms are severe 24/7.  I get no telief from them when i take them.  I get couple of hours sleep a night but it's very broken restless sleep.   Do you think you or anybdody else can try to guide me.on how to do this in the  stste i find myself in.  I need guidance 

[Worthy]

My husband is going to.try explain my ativan history.

 

In July 2019, doctor started Worthy on 1mg daily.

On 1st Oct 2019 started reducing at 10% every 2 weeks until 25th Aug 2020, got to 0.5mg. 

Reinstated 2 months later, 28th Oct 2020 to 1.5mg by GP. But immediately started a slow taper to zero by 8th Feb 2020. The last 0.3mg was a water taper over 75 days. 

Reinstated by psychiatrist on 24th Feb 2022 at 2 mg daily. Started yet another taper on 27th April 2022, reducing 0.25mg a day.

This has all  been on drs advice but i dont believe the dr actually understands the dangers of benzos.  He has advised to either CT the cymbalta or just keep tapering slowly together with the benzo.  I do sincerely hope we can find a safe way to get off

 

Edited May 2, 2022 by ChessieCat
changed to member name

[ChessieCat]

Please use member name Worthy, not Worthy's real name.  Thank you.

[Worthy]

Sorry.   Can anybody help 

[Worthy]

I  am feeling quite desperate.   Is anybody able to give me any suggestions on how to get thorough this. 

[ChessieCat]

Q:  What drugs are you currently taking and at what time and dose are you taking them?

 

Please write them in a post, not your drug signature.

[ChessieCat]

2 hours ago, Worthy said:

I dont know if i am capable of doing a journal as cannot concentrate. 

 

We understand that it can be difficult to provide daily symptom notes.  To start with we need to see 3 consecutive days.  The staff  request daily notes because it is an important part of trying to work out what is happening .   Please see the following which explains the reason why SA staff request daily symptom notes.  There is also an example of the format:

 

  

On 9/28/2016 at 4:49 AM, Altostrata said:

 

Keep notes on paper about your daily symptom pattern and drug dosing

 

Are your symptoms worse at any particular times of day? A symptom pattern that occurs regularly over several days could mean the symptoms are from withdrawal, other adverse effects of drugs, or something else you do on a daily schedule.

 

In the course of discussion in your Introductions forum topic, you may be asked to keep notes on paper of your daily symptom pattern, including when you take your drugs, their dosages, and any symptoms. We ask this because there may be something we can do to reduce the symptoms.

 

What we need to see for every single day over several days is what symptoms you get before and after you take your drugs. If you're not taking any drugs and have withdrawal symptoms, we still need to see your symptom pattern throughout the day:

 

The time of day, dosage, and severity of symptoms are essential information. Include

 

- Time and dosage for all drugs taken throughout the day, psychiatric and non-psychiatric.

- Following each dose, note any symptoms. If you are having a reaction to the drug, it may take hours for a symptom to show up -- that's why we ask you to keep notes all day long.

- If you're not taking any drugs, your symptoms throughout the day.

- Your sleep pattern. Since so many drugs disturb sleep, if you find you're waking in the middle of the night, it could be from a drug you took earlier in the evening. If you're not taking any drugs, there may be ways you can improve your sleep.

And so forth. A diary, in chronological order, looking something like this:
 

Example:

DATE:

 

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

 

An appointments diary is perfect for this and can be bought at stationery stores. They have a page for each day with times for appointments which can be filled in with doses, symptoms etc as shown above. Or, you can copy and paste from a cell phone app -- but make sure the result is easily readable.

 

Please do not use spreadsheets, they are difficult to read online and some of us don't have Microsoft Excel to look at them. 

*If using a Google doc spreadsheet,  please copy over or transfer those daily notes, into a reply box in your Introduction topic.

 

 

 

[Altostrata]

@Worthy Unlike doctors, we cannot guess at where your symptoms are coming from, we need more information from you about your symptom pattern. Your symptom pattern controls your taper.

 

You are the only person who knows your symptom pattern. Please make every effort to supply the information we request, or we cannot help you.

[Shep]

5 hours ago, Worthy said:

I know for certain i am having adverse reactions to the drugs as my symptoms are severe 24/7.  I get no telief from them when i take them.

 

4 hours ago, Worthy said:

On 1st Oct 2019 started reducing at 10% every 2 weeks until 25th Aug 2020, got to 0.5mg. 

Reinstated 2 months later, 28th Oct 2020 to 1.5mg by GP. But immediately started a slow taper to zero by 8th Feb 2020. The last 0.3mg was a water taper over 75 days. 

Reinstated by psychiatrist on 24th Feb 2022 at 2 mg daily. Started yet another taper on 27th April 2022, reducing 0.25mg a day.

 

I don't think you're dealing with adverse reactions. It sounds like you're dealing with nervous system kindling from the repeated benzo withdrawal. Nervous system kindling means trauma to the nervous system from abrupt changes. Benzo reinstatements and updoses work best within a month of the reduction. Your nervous system is now likely hyper-reacting to a lot of things.

 

As Getofflex, ChessieCat, and Alto have mentioned, daily notes will help us to help you.

 

Keep a memo pad with you and when you take your drugs and any supplements, write down the time of day, the drug or supplement name and dose, and how you felt after you took it. See ChessieCat's last post for an example.

 

[Worthy]

Currently on 4mg cymbalta 24 beads take each morning at 7am 

On 1.75,mg ativsn take 7am 1pm and 7pm.   

[Worthy]

Thank you all for replying.  I only just started tapering the benzo again 2 dsys ago so should i go back to 2mg or just stick with the 1.75mg. I am a.mess.  I will try a daily memo but confused and not really sure i can do it.  Should i carry on with the cymbalta taper.   

[Worthy]

Trying to do hourly schedule but shaking too much and too weak.  Very very scared

[Worthy]

Is anybody able to comment on my lsst 3 questions.  I want to do this but not good.   

[Shep]

@WorthyPlease re-read your entire thread. We have tried to get you to taper the activating drugs first and hold the benzo until last. We have again and again emphasized a 10% reduction or less.

 

The below quotes are a snapshot of some of your drugging history.

 

And now you just made a reduction of Ativan from 2 mg to 1.75 mg, which is a 12.5% reduction of a sedating drug while you're still taking a stimulating drug. Yes, it's safe to go back up to 2 mg, but at this point, you may have kindled your nervous system.

 

While we sympathize with the problems you and others are having with drug supplies, costs, etc., please look at the long range picture.

 

You mentioned a few months ago that you had a steady supply of Ativan. Do you still have a steady supply of Ativan? If so, STOP TAPERING IT. You need to hold and stabilize before you completely crash your nervous system.

 

  

On 8/12/2019 at 3:12 PM, Worthy said:

 I am taking 60 mg cymbalta, 5 mg zyprexa and 7.5 mg mirtazapine.

  

  

On 1/8/2020 at 2:01 PM, Worthy said:

In my tapering I am 

1.6 mg on zyprexa out of 5 mg at night

6,9 mg mirtazapine out of 15 at night

23mg cymbalta out of 60 at night

I have not yet started the Ativan taper (1mg morning)

 

  

On 6/14/2020 at 1:52 AM, Worthy said:

 I am taking olanzapine .9 mg and mirtazapine 3.2 mg and .32mg Ativan at 10pm just before I go to bed.  I am taking cynnbalta 13.5 mg at 7am.  I have been tapering by 5% every two weeks.    I have been tapering since August 2019 at that rate.  

 

  

On 3/27/2022 at 11:58 AM, Worthy said:

Hello.  I used to be on this site but came off but now wish to try again as I am struggling with tapering off cymbalta and Ativan,  I have messed up by reinstating on the Ativan and now need help getting off both.   Can anybody help as pretty desperate.  Down to 4mg on the cymbalta (24 beads) and stupidly back on 2mg atuvan.  Please need guidance.  

 

[Worthy]

Thank you Shep.  It was a psychiatrist who told me to taper as he says benzo not good to stay on long term.  Will stop tapering straight away but shouud i cintunue the cymbalta taper.  

[Worthy]

6am       Bad sleep.  Restless.  Max 2 hours

7.30        Took 24 beads cymbalta plus .874mg ativan.  Extreme noise sensitivity

8 am.       Terrible tremors and extreme diarrhoea 

8.30          breakfast 

9.30          lying in bed still with vertigo 

10               bad diarrhoea and vertigo.  Still lying down

11                got dressed and up for a short while 

12      lunch

1         tried to sleep but too anxious 

2          no change

3          drank tea and moved to couch

5            vertigo and depression very bad 

6                     took .875mg ativan

7          ate supper

8           tremors bad

9           tried to sleep 

10 to 4  very restless sleep 

Waking all through the night

 

Is this what is required for daily note.   

[Shep]

19 hours ago, Worthy said:

Thank you Shep.  It was a psychiatrist who told me to taper as he says benzo not good to stay on long term.  Will stop tapering straight away but shouud i cintunue the cymbalta taper.  

 

None of these drugs are good to stay on long term, but for some reason, psychiatrists like to blame benzos more than other drugs.

 

Please stop tapering and hold all your drugs for now. You need to give your nervous system time to recover from the series of abrupt changes over the past few years.

 

19 hours ago, Worthy said:

7.30        Took 24 beads cymbalta plus .874mg ativan.  Extreme noise sensitivity

8 am.       Terrible tremors and extreme diarrhoea 

 

 

You may be dealing with drug interactions, as listed below. I would space out the Ativan from the Cymbalta by two hours and see if that helps.

 

Drug Interaction Report - cymbalta and ativan

 

Quote

Interactions between your drugs

Moderate

LORazepam

DULoxetine

Applies to: Ativan (lorazepam), Cymbalta (duloxetine)

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

 

[Shep]

19 hours ago, Worthy said:

Is this what is required for daily note.   

 

Yes, this is good. Thank you.

 

Please don't taper any of your drugs. As mentioned in my last post, you may want to move the morning Ativan from the Cymbalta by two hours to see if that helps with any potential drug interactions.

 

Please keep posting your daily notes.

[Worthy]

Sorry no daily notes today.   Tremors too severe to write