Edmunds: prolonged Wellbutrin withdrawal

[Altostrata]

When do you start to feel better?

 

We don't know which members are sending us donation because the PayPal names are different, but we received a donation from Southern California on October 9. If this was yours, thank you very much, it will help pay the bills.

[Edmunds]

I think you mean when do I start to feel better during the day. I would characterize the change as "less worse" rather than better. But it's usually mid to late afternoon. The hours when I feel a noticeable decline in distress sensations are late evening. The derealization doesn't really change at all from one day to the next, though it was much more manageable before I started the Effexor and Wellbutrin fast tapers in May and July 2019.

 

I did make a donation on Oct 9. That must have been me, then.

[Altostrata]

Have the withdrawal-related symptoms been improving over the last 2 months, staying the same, or getting worse?

[Edmunds]

I've had very little change in the past two months. The early morning (at about wake-up time, not 4 am) cortisol spikes have been more noticeable in about the past month. They are unpleasant but not extreme and dissipate after I've been up for a short time. A few weeks ago I had 3 straight days of what I would characterize as a window, noticeable drop in distress/anxiety. Then just a week ago, I had another nearly day-long encouraging window, but it closed the following day. The perceptual derealization fog has not changed at all in the past two months, though on the few low-anxiety window days I would have to say it bothers me less.

[Edmunds]

I’ve now been holding at 1.8 mg liquid fluoxetine for 9.5 weeks. During this period the derealization (foggy disconnect from my surroundings) has remained very aggravating, as well as low to moderate feelings of distress and mental fatigue. Sharp anxiety surges, however, have happened less often, some days never. @Altostrata has suggested I go back up to 2 mg fluoxetine, but I’m coping well enough, despite the constant discomfort to stay with 1.8 in hopes that at some point I can taper 10% of that amount. 

[Altostrata]

7 hours ago, Edmunds said:

Sharp anxiety surges, however, have happened less often, some days never.

 

This is good. This probably means your system is accommodating to the changes.

 

Updosing is not necessary if you feel you can cope.

[Edmunds]

Thanks @Altostrata for the encouragement.

[Edmunds]

I've been holding at 1.8 mg of liquid fluoxetine for ten and a half weeks now. Recently, anxiety surges have come back more often, as well as some sharper cortisol spikes in the early morning. Derealization fog remains very thick, plus strain and fatigue. I've also been on pins and needles since Tuesday waiting for the vote count in the US election to be completed. Nonetheless, I'm holding at 1.8 rather than backtracking to 2.0.

 

I'm wondering whether my too-fast fluoxetine drop from 6 to 1.8 is the main issue in my lack of progress, or whether my brain is continuing to rewire itself following my fast taper off Effexor back  in May 2019. Or more generally am I recovering, or trying to recover, from 33 years of being on ADs of one brand or another most of the time.

[Colonial]

9 minutes ago, Edmunds said:

 

 

I'm wondering whether my too-fast fluoxetine drop from 6 to 1.8 is the main issue in my lack of progress, or whether my brain is continuing to rewire itself following my fast taper off Effexor back  in May 2019. Or more generally am I recovering, or trying to recover, from 33 years of being on ADs of one brand or another most of the time.

 

All 3 plus the election for you as well it seems.

Any stress, including "good stress", like a new puppy or someone getting married can cause a spike.

 

The too fast Fluoxetine is probably aggravating the too fast Effexor taper, which probably aggravated or was complicated by the past brain tampering.

And to be fair being at this dose for 10 weeks is not all that long, in recovery terms, even though it feels like 10 years, to be sure.

 

I've Turned off the news and put on Sesame Street. 🤠

 

Edited November 6, 2020 by Colonial

[Edmunds]

@Colonial, thanks so much for that quick reply. It's almost as if you were sitting at your computer waiting for me to write!' What you say is very reassuring.

 

I've recently seen an integrative psychiatrist who is totally supportive of my WD strategy and has no interest in putting me back on ADs. But he remarked that my physiology is unusual in my finding it hard to terminate the fluoxetine. As other providers have done, he remarked about the long half life of fluoxetine/Prozac making withdrawal relatively easy for most. My experience with SA shows me, however, that a lot people have plenty of trouble with Prozac tapers even if they go relatively slowly.

[Colonial]

I am, I'm right here with Ernie and Bert and Big Bird. 🥰

 

My personal theory, as per my own experience with the Wellbutrin, is that the long half life meds aren't really any "easier" to get off of...

But the symptoms are so delayed that the connection isn't made that their WD related.

 

If I have symptoms 3 weeks after a Paxil drop but not until 3 months after a Wellbutrin drop, chances are it's going to be blamed on something else.

And if I hadn't already been on this site, I would not have known many of issues I was having were Wellbutrin related.

They would have been blamed on a host of other things or gone undefined.

 

And now?

We turn to Muppet reruns...🤠

 

 

[Edmunds]

You are no doubt right to stick with Sesame Street, but after finishing this message I can't resist checking CNN for vote tallies!

 

My introduction topic says "protracted Wellbutrin withdrawal." I'd like to change that because in consultation with my psych, I went off Effexor in May 2019 and Wellbutrin in July 2019, both way too fast. Because of its especially bad rep, I've always blamed the Effexor for the long withdrawal, especially anxiety and derealization for four months. Dealing with both Effexor and Wellbutrin and then the Prozac taper from January 2020 has probably added up to a heap of trouble.

[Edmunds]

@Altostrata @Colonial I badly need your advice today, though I think I know what it will be!

 

I decided two weeks ago to see an integrative psychiatrist, who would not, I knew, simply suggest I take another AD. I did this, not so much because of my continuing WD symptoms but because I started dealing off and on with symptoms of derealization and anxiety decades ago, long before I started taking any medication. This doctor, who gave me reason to trust,  seemed to understand my WD issues, but he made a number of recommendations. I came out of his office with a renewed feeling of hope. I subsequently acquired all the substances he asked me to get that presumably would help with my DR and anxiety. Here's the list:

 

Low dose Naltrexone. This is the one prescription medication so far to have shown in studies (limited to be sure) to be effective for treating dissociation disorder symptoms, including the DR that for me has become worse ever since I went off Effexor and Wellbutrin in spring/summer 2019. I started taking the Naltrexone nearly two weeks ago at 2.5 mg once a day.

 

Inositol for anxiety, taken in powder form with water, sipping throughout the day. This over-the-counter supplement I received and started taking just several days ago.

 

Theanine, also over-the-counter and for anxiety, a capsule  of 400 mg taken twice a day. I have taken it for a few days.

 

Hardy's Daily Essential Nutrients. This is a very complex multivitamin, which I ordered and just received several days ago. The doctor recommended titrating up to a dose of 8 capsules a day. 4 of these capsules (one serving) contain 25 different active ingredients, including, for example, 1,333% daily value of Thiamin! I started just a few days ago at 4 caps a day, though with much reluctance, despite its inconsistency with SA recommendations.

 

He also recommended my holding my liquid Prozac at 1.8 mg, which I'm doing.

 

So, as I suspect my SA moderators might have expected, three days ago I started feeling much worse: more intense anxiety throughout most of the day, scary intense DR, intermittent crying, and fatigue.

 

I emailed the doctor yesterday to report this, and this morning I'm waiting for a reply. I have not taken any of the Naltrexone or supplements so far today and almost certainly will not.

 

Your comments will be welcome to be sure.

 

 

[Colonial]

Posted Friday at 05:53 PM

"I've been holding at 1.8 mg of liquid fluoxetine for ten and a half weeks now. Recently, anxiety surges have come back more often, as well as some sharper cortisol spikes in the early morning. Derealization fog remains very thick, plus strain and fatigue. I've also been on pins and needles since Tuesday waiting for the vote count in the US election to be completed. Nonetheless, I'm holding at 1.8 rather than backtracking to 2.0.

 

I'm wondering whether my too-fast fluoxetine drop from 6 to 1.8 is the main issue in my lack of progress, or whether my brain is continuing to rewire itself following my fast taper off Effexor back  in May 2019. Or more generally am I recovering, or trying to recover, from 33 years of being on ADs of one brand or another most of the time."

 

So when you made this post on Friday, you had already been on this new cocktail for how long?  About October 26th?

My reply was based on what I THOUGHT was your current intake of drugs-supplements- time at current dose.

 

You have to see that if you start multiple items, do NOT inform us or update your signature line with the new medications, that not only can we not give you a proper opinion on why your anxiety might be spiking, but without realizing it, your actually, and I don't mean to say this to upset you but just being honest, your accidentally "wasting" our time coming in a reporting issues without giving us the full information as to why that could be.

 

Our help as a support staff is only going to be as reliable and effective as how honest you are with us as per your journey.

You have every right to seek medical help and go along with a suggested treatment plan, as is your right.

But you have to see there is a reason why the site does not recommend MORE Drugs as a solution to what is a drug induced problem...

As this is unfortunately the likely outcome in, at least in my opinion too high a percentage of cases, to recommend doing so.

 

I realize you may have thought you had dissociation disorder before the WD, But it is a normal WD event,

There was no reason to assume it would have remained a constant for you beyond the WD Period just because you had it so long ago in the past.

As the site motto is we try to help people get off of the drugs and not just rotate them for new ones, I really can't say "we" would have recommended more drugs.

Naltrexone is also really outside the scope of what I have experience with here, how it would have negatively effected your WD is unknown...

Except for the same principle as any other, that any other drug (allergy meds, anti-biotics,) can have a negative effect and destabilize your condition and make you worse.

 

As for what in that cocktail specifically or combined made you worse is anyone's guess and I really can't comment.

I just request going forward you be honest upfront with what you take so my time isn't "wasted" trying to produce a rational response to why your symptoms have changed. I try to support you, but I can't do that without a full picture.

Good luck! 

Edited November 9, 2020 by Colonial

[Edmunds]

@Colonial Your reply this morning was entirely justified, and I stand roundly chastised. I thank you. There's no doubt that I failed to notify SA right away about these various capsules because, out of my great frustration, I wanted to see what wonderful things might happen with the Naltrexone in just a few days, which apparently can be the case. So I didn't report the supplements either. No doubt, I was sure you would not think my taking new substances would be a good idea.

 

I will talk to the psychiatrist tomorrow but wrote to him that in the meantime I would not take medication other than the fluoxetine (and my usual magnesium, omega 3, and D3). I can't say where this will go tomorrow, but if I decide to resume taking any of these pills (unlikely), I will let you know immediately and change my signature.

[Edmunds]

@Colonial I forgot to say that the psychiatrist also recommended my seeing a somatic experiencing therapist, which I did last week and plan to again on Thursday. This has to do with my complex childhood trauma and does not involve any meds or supplements.

[Colonial]

I apologize if it sounded like I was chastising in a negative sense per se about trying the other meds, that was not my intention.

You have every right to seek and take any medical treatment you wish.

It only becomes complicated if we aren't updated as to what your taking and then you return with new or worsening complaints.

I just meant that if You had been upfront on the 6th about the other meds when you were having worsening symptoms, we all would have  a better "return" on the investment of Our time here working together. Hopefully things will smooth out for you soon.

 

And remember don't assume the derealization will be a permanent part of your reality again post WD.

Derealization, by itself with no other symptom of "supposed" mental illness, seems like it may have been a result of something environmental.

Did you have any other prior drug use to that symptom bothering you?  It seems odd to just "pop up" out of the blue like that by itself.

Regardless, you not need to assume the worst and rush to "treat" something that was from a "undefined cause" so long ago.

It may not represent itself again post WD.

 

Edit: Or childhood trauma may have been it's trigger but that is not to assume it would return these many years past.

 

 

 

 

 

Edited November 9, 2020 by Colonial

[Edmunds]

@colonial, I understood that you were cautioning me about my not reporting the new meds to SA promptly, not about my deciding to take them. I know now I should have revealed what I was doing right away.

 

I haven't explained my long history with dissociative disorder. Suffice it to say I've had episodes of DR starting when I was 19 and lasting from a couple of months to several years both before and after taking any medication at all until I first saw a psychiatrist. I also had years at a time with no DR at all. My first psychiatrist appointment was in 1987 when in my 40s and when I was having a harder time than usual with DR. Before then I never drunk alcohol or "experimented" with any so-called recreational drugs. The psychiatrists I saw in subsequent years all diagnosed me with depression, which I'm convinced now (as are recent providers I've seen) was basically wrong. DR can of course make one feel depressed, but it's allied closely to anxiety disorders, not depression.

 

After one unsuccessful bout with Prozac in the early 90s, I tried it again in 1997. Subsequently, the DR quite soon disappeared and stayed away for 17 years. Of course I thought Prozac was my miracle drug, but in past few years I've come to question that it had much to do with how I was feeling. In any case it stopped working in 2013, and moderate DR returned along with some anxiety. (A triggering episode in 2013 is not hard to identify.)

 

My signature shows the various meds I tried between 2013 and 2019, when I stopped taking Effexor and Wellbutrin. Regarding DR and DP, there is plenty of evidence of people having long bouts with them lasting far into adulthood despite a cause associated with childhood complex trauma. I've come to understand this, not thanks to most psychs I saw, who seem to know little about it, but from the talk therapists I started working with just about 5 years ago. In short, recurrence of dissociative disorders long after severe or, like mine, complex trauma, is not an odd occurrence. Most of the time until the Effexor/Wellbutrin break in spring\summer 2019 I dealt with DR as an unpleasant annoyance. It then got worse after that break than I had ever experienced it. And when I rushed the Prozac taper (big mistake) this past summer, the DR and anxiety jumped up a notch. I had never been getting anything but AD advice from psychiatrists, which is why I decided to see the integrative psychiatrist. I was no doubt clinging to any ship in the storm when I agreed to try Naltrexone and his other treats. Maybe I will try the Naltrexone again owing to its promise for relieving DR, but I'm quite sure this is not the time. I continue to have faith that the DR  and related anxiety will ease up once I get closer to recovery.

[Edmunds]

After a little more than a week on the new med and supplements prescribed and feeling worse the whole time, I decided to stop them all as of last Sunday. The integrative psych was fine with that, though he urged me to continue trying inositol powder for anxiety, even though it seems to be typically prescribed for panic attacks and OCD. I have not resumed taking it.

 

Then this morning I had a long crying episode after walking with my wife and feeling so derealized. That was followed by a greater surge of anxiety than I've had in awhile. It's now mid afternoon and the anxiety has abated quite a lot. This may just be a strong WD wave, I don't know. I'm holding at 1.8 mg liquid fluoxetine after nearly 3 months of no noticeable windows.

 

In addition to "somatic experiencing," for which I have an appt tomorrow, the psychiatrist recommended "safe and sound protocol" treatment based on Stephen Porges's research on the Vegas nerve. Have any moderators or members had experience with this?

[Edmunds]

In recent messages, I reported starting to take and then stopping 1 prescription and 3 supplements my integrative psych recommended. After doing further research myself, I've decided today to take one of them: inositol, which might at least get the edge off my anxiety, which is running high these days. This over-the-counter supplement is

is a sugar molecule that occurs naturally in the body. We may get about 1 gram of it day in our food. I take 2 teaspoons of it as a powder dissolved in water, sipping it throughout the day. A teaspoon is about 725 mg. The dr suggests going up to 4 teaspoons over a few days. I will add this to my signature right now.

[Colonial]

Does the doctor have research indicating this helps reduce WD induced cortisol spike enhanced "chemical anxiety" as opposed  to  "regular anxiety"?

2 different underlining conditions can both cause the same symptom but that symptom needs to be addressed differently dependent on the underling cause.

 

 

 

 

Edited November 12, 2020 by Colonial

[Edmunds]

Thanks for the question. The doctor has not said that inositol helps with cortisol anxiety specifically. I will ask him.

[Colonial]

It would be interesting to see if He's reported any of His other patients in WD benefiting from it.

The problem with WD is because the entire body is in a type of shock it doesn't work as properly together as it should.

During the worst of my WD my body stopped absorbing my thyroid med properly, I was almost hypo thyroid.

Since each of us are different (genetics, sex, the type of med, etc) it's so hard to tell what even "naturally occurring" compounds would do to a system in free fall.

I think that is something  naturalists and homeopathy specialist's don't realize...

 Your no longer working with a system that is otherwise functioning normally in all but one or 2 areas

The ENTIRE System is compromised, and all bets are off.

Hoping it works for you!

 

Edited November 12, 2020 by Colonial

[Edmunds]

This has been one of those days where I don’t know what to do with myself because of the nasty anxiety and heavy derealization. I’ve been holding at 1.8 mg of liquid Prozac for 11.5 weeks without any significant change in my mental state. All I can say is that I don’t seem to be getting steadily worse, though sometimes it feels that way. 
I’m well aware of my big mistake: I went from 6 mg to 1.8 mg in 11.5 weeks, the same amount of time I’ve now been holding at 1.8!

[Edmunds]

Some weeks ago @Altostrata suggested that if I'm having a hard time coping while holding at 1.8 mgs liquid Prozac, I consider going back up to 2.0 mgs. I replied that I was coping well enough to stay at 1.8 mgs. In the past several days, however, the anxiety has been more intense and tenacious. I've been at 1.8 mg for 11.5 weeks.

 

Is it too late to go back up to 2.0? If not, perhaps I should do that. If I do, I know that I probably won't see any relief for at least a week.

 

Increasing the dose by 0.2 mgs is just a few drops. Might that really make a difference in lowering the anxiety intensity?

 

For @Colonial

 This is my integrative psychiatrist's response to the quoted question regarding inositol:

On 11/12/2020 at 10:11 AM, Colonial said:

Does the doctor have research indicating this helps reduce WD induced cortisol spike enhanced "chemical anxiety" as opposed  to  "regular anxiety"?

2 different underlining conditions can both cause the same symptom but that symptom needs to be addressed differently dependent on the underling cause.

 

 

 

 

 

"Cortisol spike related anxiety is helped by adaptogens like ashwagandha at about 500 mg twice daily, but inositol also helps with the anxiety from withdrawl although it is not a cortisol stabilizer."

[Colonial]

On 11/11/2020 at 6:22 PM, Edmunds said:

After a little more than a week on the new med and supplements prescribed and feeling worse the whole time,

 

After 3 months at this dose, I think the worsening anxiety is the experiment with the Naltrexone and or the other supplements

I realize 3 months seems like an eternity to stabilize but it took me 4-6 months to feel significant improvement on different issues.

 

Could up dosing after 3 months help? Possibly.

But you have to realize if you accidentally make yourself worse with other drug experiments your prolonging that stabilization.

Up dosing now, right after that experiment, may not help you and could even possibly make you worse.

 

It better to try up dosing first before adding other drugs, or this is the conundrum you find yourself in.

Since if you had up dosed before adding the other drugs it may have helped, but now it may make you worse.

 

You may have accidentally booby trapped the chance for an up dose to work by re tampering with your chemistry with drugs it's never had before.

This is why we do not recommend additional drugs your brain is not already accustomed to since the added destabilization has now made your symptoms worse.

Since it is so soon after adding the Naltrexone and other supplements that made you worse I would caution you to think about if another med change is worth the risk.

 

 

[Edmunds]

Okay, thanks. 

[Altostrata]

Yes, you could try updosing slightly. With Prozac, it could take a couple of weeks to reach full effect.

 

The cortisol spike is a normal physiological occurrence in the early morning. Any anxiety might involve cortisol. It's not the cause of the anxiety, but a product. Those guesses of ashwagandha and inositol for anxiety are only guesses. Please search in the Symptoms and Self-Care forum for discussions about specific supplements.

[Edmunds]

Thanks @Altostrata Some days, like yesterday, the anxiety intensity level decreases enough that I want to carry on at 1.8 mgs of Prozac. On other days I think about updosing to 2.0. Because I haven't felt any evidence of linear progress since last August other than these day-to-day ups and downs, my thinking mind nags at me to try something different, thus my recent brief and unhappy experiment with naltrexone and additional suppements.

[Altostrata]

Up to you whether you want to updose to 2mg.

[Colonial]

 

Just checking in to say hello and to see if things are a little better since you've stopped the Naltrexone and other supplements and if you updosed or not and how that's going. If you did, please update your signature line with the date. Take care for now!

Edited November 22, 2020 by Colonial

[Edmunds]

@Colonial Thanks for your query. Since stopping Naltrexone and 2 other supplements on Nov 10 (after a short trial with them), I have not noticed any significant trend one way or the other in my symptoms, though fewer anxiety surges in the past few days. Symptoms vary of course from day to day. I am taking Inositol power as recommended by my integrative psychiatrist, and I put it on my signature.

 

I updosed from 1.8 to 2.0 mgs of liquid fluoxetine on Nov 16. Thanks for reminding me to put that change on my signature, which I have done.

 

I've also started Somatic Experiencing treatments twice a week. No noticeable effects yet.

[Colonial]

Thank God you semi stabilized and are noticing less anxiety surges!

All in all its still rather soon for that and the up dose.

Let us know after Thanksgiving if you feel any better!

Have a great Holiday! 🦃

 

[Edmunds]

Thanks for your encouragement. 

[Edmunds]

I have a question. I’ve been reading recent literature on trauma. People are often prescribed ADs because of their histories of anxiety and depression linked to traumatic experiences. When an individual stops taking an AD either CT or after a rapid taper, is the resulting withdrawal a form of trauma as well, a new traumatic experience that may benefit from treatment, though preferably not more ADs?

[Colonial]

It's definitely a physical trauma to your system and can be an emotional one as well if you don't know why what is happening to you is.

If you have no idea what's going on, you panic and that leads to a more traumatic experience than someone who knows what to expect before it happens

That being said, since one doesn't have to have a traumatic past to have a supposed diagnosis of anxiety or depression, it is person to person.

 

If your first real major trauma in life is a bad case of WD, because you took the med just because you got talked into thinking you needed assistance, that WD trauma can affect you more than someone who's already been around the block with serious trauma from multiple and or chronic horrific conditions, the WD will just be one in a line of succession of things to be dealt with and may not affect you in the sense of a new trauma they way it would someone else.

 

How you process that "trauma" really is up to the individuals character and make up and overall life experience.

How "trauma" affects us really can be just as much to do with our personal coping mechanisms and mental outlook on life.

If a person has been raised to believe life should be "fair" and had hover board parents who protected them from all suffering growing up they will fair worse, no doubt.

If your parents allowed you to live, to some extent, the consequences of life and your decisions and  exposed to the reality of random chance, you will be better off.

 

So in many ways if 2 people put in the same situation, depending on their past and the coping skills they were taught, one may be fine and the other traumatized.

That being said, we all need to NOT allow society or doctors to tell us what  should or should not traumatize us.

Psychiatry benefits from propping up the "victim mentality" so prevalent in an affluent 1st world culture where money can buy people out of consequences.

 

So I guess if the "treatment" is just going to reinforce how unfair life is, it's counter productive.

For me, the phrase itself: "treatment" in our society pre supposes the person can't handle an issue by themselves and needs "professional" assistance.

Everyone here knows where that got all of us.

So would "treatment" for dealing with the strain of WD be helpful?

Depends on the person and the mental presuppositions of those supposedly doing the "treating".

If their just going to reinforce the "victim mentality" you might be better off pulling up your own boots straps ans saying "no thanks", been there done that.

 

What would your idea of "treatment" look like in your situation, and what do you think your major issues are with the added complications to your particular case?

Maybe we can flesh that out better as a group to see if going forward with that would be of any benefit or just actually delay your heaing.

 

 

 

 

Edited November 23, 2020 by Colonial