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DD44: please help, currently on mirtazapine and gabapentin


DD44

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Hi guys. @Altostrata or anyone else who you think might be able to discuss with me. 
 

I know everyone’s stance of not adding any new drugs. But Iv been holding since October and not sleeping and I’m not healing. I’m not improving. I’m seeking out the advise of a more experienced psych on withdrawl and drug swapping. I’m by no means going into this blindly and have not made a final decision. Sleep is the single most important element for the body to heal and be able to adjust off these drugs. 
 

My biggest question to the forum is

 

if I decided to try a very low dose of a ssri - how many weeks can I give it before I run the risk of withdrawl issues with it. My hope would be that I would see some kind of improvements within a week or two. I’m considering a low dose 2.5 of lexapro- but I’m consulting new doctors before I make a final choice. To me - if I go to the doctor and tel them what’s happening with me they’re going to offer me Seroquel- an anti psychotic. To me trying a ssri is a lesser of evils since seroquel would be recommended purely for it’s off brand sedative effects. I don’t need more reliance on sedatives. My thought process is if a low dose ssri was helpful in calming me down anxiety wise - then perhaps I can start to get more than 1 hour of sleep a day, and be on a better track to healing. I really hope the forum doesn’t abandon me for considering something that isn’t their advise as I do really value everyone here and the support matters to me whether I follow things you guys ask to a tee or not. I’m not improving and I need some movement here. Thanks to anyone who cares to chime in 

 

D x 

-JAN 18' - aug 18’ -22.5mg temazapam + 7.5-15mg remeron  for insomnia. —Aug 18’ temazapam switched to ambien 10mg

-AUG 18’ - April/May 19’ Taper off remeron 

-Mid july 19’ - one week of  200mg Gabapentin c/t  —-mid July 19”-  3 weeks of 50mg trazadone fast tapered 

-July 19’- began random use of .5 Xanax rarely to get rest 

- Mid Aug 19’ - one day of viibryd, 7 days of cymbalta 30mg, 3 days of seroquel 25-50mg

-Aug- 1 wk of Klonopin .5-.75 fast taper 

-Sep 19’ tried trazadone 50 again (still on ambien 10mg)  some time in sep 19’ was c/t off 10mg ambien because was thought to have become ineffective

-oct 7 c/t trazadone and restarted 7.5 remeron holding since 

12/3/19  at 7.5 after a 2 day attempt compounded 7mg. Jan 2020  dry taper from 7.5 |Oct 1 at 6.4 high disruption to sleep began |oct 20? Updosed to 6.6 |oct 26 updosed to 6.8 holding 

supplements mag gly, .3 melatonin, vit c, tumeric, boswellia, beef organs 

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Are you using a scale to get an accurate dose?    If not, please see:    Using a digital scale to measure doses     The only time we don't recommend crushing up a

I decided to just go with 7.49    I should switch over on Jan 3   l keep everyone updated 

ill be discussing getting liquid from the compounding pharmacy with my psych thursday. any tips or things to remember to talk about are welcome.   thanks guys.... hope this works out soon. 

  • Administrator

SSRIs are not sleep drugs.

 

Did mirtazapine ever help you sleep? Why not increase mirtazapine a bit?

 

When and how did you go off Ambien?

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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1/18

11am got rest, out of bed around here 

12-2 cleaned up, did hair, worked on TikTok 

Ate lunch, tuna on toast with lentil soup 

3pm piano and relaxing 

430 went on a walk 

530 called my mom, she upset me 

6p went food shopping 

8p home and ate a light ISH dinner

830 dad called, upset me greatly 

10p took 6.8mg Mirt, called my warm line support to help me calm down 

1040 shower 

1115 stretches are some melatonin 

1130-1230 journaling in low light 

1 lights out 

3am wide awake, took 8mg ambien, need rest, have work today 

5-10a got some very light broken rest 

1030a out of bed, feel soso 

-JAN 18' - aug 18’ -22.5mg temazapam + 7.5-15mg remeron  for insomnia. —Aug 18’ temazapam switched to ambien 10mg

-AUG 18’ - April/May 19’ Taper off remeron 

-Mid july 19’ - one week of  200mg Gabapentin c/t  —-mid July 19”-  3 weeks of 50mg trazadone fast tapered 

-July 19’- began random use of .5 Xanax rarely to get rest 

- Mid Aug 19’ - one day of viibryd, 7 days of cymbalta 30mg, 3 days of seroquel 25-50mg

-Aug- 1 wk of Klonopin .5-.75 fast taper 

-Sep 19’ tried trazadone 50 again (still on ambien 10mg)  some time in sep 19’ was c/t off 10mg ambien because was thought to have become ineffective

-oct 7 c/t trazadone and restarted 7.5 remeron holding since 

12/3/19  at 7.5 after a 2 day attempt compounded 7mg. Jan 2020  dry taper from 7.5 |Oct 1 at 6.4 high disruption to sleep began |oct 20? Updosed to 6.6 |oct 26 updosed to 6.8 holding 

supplements mag gly, .3 melatonin, vit c, tumeric, boswellia, beef organs 

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@Altostrata

i know ssris are not sleep drugs but at this point I’m very depressed and anxious. It’s vicious cycle that is a occurring. I’m not getting any rest and it’s causing me to be more and more depressed and frustrated. I’m trying every single thing you guys recommend EVERYTHING. I honestly cannot keep up like this I’m going to end up in a psych ward or in a ditch. I know you guys aren’t trying to to turn your backs on me but when I say I may need to try something else I may need to because I feel like I’m at the end of my rope. Some days I feel ok and then days like today I spend driving around aimlessly after work screaming my head off, pretty much a complete manic episode, out of pure frustration that nothing that I’m trying is working.

I got off ambien some times in 2019 when I was sick. I don’t remember when. I have used it 3 times in the last two weeks out of desperation and it helped a tiny bit. I choose to use ambien over Xanax or klonipin, feeling it was the lesser of evils. 

 

Mirtazapine 7.5 did help me sleep from January 2020 to October 2020 (I went from 7.5 down to 6.6 and at 6.6 is when problems began, 4 months ago. I was hesitant to updosed my Mirt because it’s the drug I believed to make me sick but I guess I have to choice at this point? I’m at 6.8 and the most I would updose is to 7.5. Which would mean Iv made zero progress on tapering. I guess unless we want to count my “taper” as starting from 15mg in September 2018. 

Iv said it a million times I do not expect perfect sleep during withdrawl or whatever it is I’m doing but getting 0 every night my health is just declining, and I can’t see how I’m doing any healing when I’m missing one of the fundamental factors. 
 

I really need some help I don’t know what else to say. I don’t want to do something stupid. I want my life back, I have so much I want to do and I can ******* do a thing most days because I feel totally off. Don’t know what to say 

 

-JAN 18' - aug 18’ -22.5mg temazapam + 7.5-15mg remeron  for insomnia. —Aug 18’ temazapam switched to ambien 10mg

-AUG 18’ - April/May 19’ Taper off remeron 

-Mid july 19’ - one week of  200mg Gabapentin c/t  —-mid July 19”-  3 weeks of 50mg trazadone fast tapered 

-July 19’- began random use of .5 Xanax rarely to get rest 

- Mid Aug 19’ - one day of viibryd, 7 days of cymbalta 30mg, 3 days of seroquel 25-50mg

-Aug- 1 wk of Klonopin .5-.75 fast taper 

-Sep 19’ tried trazadone 50 again (still on ambien 10mg)  some time in sep 19’ was c/t off 10mg ambien because was thought to have become ineffective

-oct 7 c/t trazadone and restarted 7.5 remeron holding since 

12/3/19  at 7.5 after a 2 day attempt compounded 7mg. Jan 2020  dry taper from 7.5 |Oct 1 at 6.4 high disruption to sleep began |oct 20? Updosed to 6.6 |oct 26 updosed to 6.8 holding 

supplements mag gly, .3 melatonin, vit c, tumeric, boswellia, beef organs 

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  • Administrator

In what ways do you think mirtazapine made you sick?

 

I see you are taking beef organs. This type of supplement may contain substances that may be keeping you awake. I don't know what boswellia does, please Google to see potential adverse effects.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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@Altostrata


I meant when I originally tapered from 15mg in sep 2018 to 0mg In may 2019- I became unbearably ill. That’s when I first came on this forum. I was getting no sleep, diarrhea all day for 6 months (June 2019- dec 2019) lost 20 lbs, couldn’t eat, wanted to die etc etc 

when I reinstated 7.5 In December 2019 my symptoms vanished by Jan 2020

 

I’m not taking beef organs and haven’t for some time 

also not taking boswellia either 

 

 

I take tumeric, magnesium and just began fish oil. Just haven’t updated my signature 

-JAN 18' - aug 18’ -22.5mg temazapam + 7.5-15mg remeron  for insomnia. —Aug 18’ temazapam switched to ambien 10mg

-AUG 18’ - April/May 19’ Taper off remeron 

-Mid july 19’ - one week of  200mg Gabapentin c/t  —-mid July 19”-  3 weeks of 50mg trazadone fast tapered 

-July 19’- began random use of .5 Xanax rarely to get rest 

- Mid Aug 19’ - one day of viibryd, 7 days of cymbalta 30mg, 3 days of seroquel 25-50mg

-Aug- 1 wk of Klonopin .5-.75 fast taper 

-Sep 19’ tried trazadone 50 again (still on ambien 10mg)  some time in sep 19’ was c/t off 10mg ambien because was thought to have become ineffective

-oct 7 c/t trazadone and restarted 7.5 remeron holding since 

12/3/19  at 7.5 after a 2 day attempt compounded 7mg. Jan 2020  dry taper from 7.5 |Oct 1 at 6.4 high disruption to sleep began |oct 20? Updosed to 6.6 |oct 26 updosed to 6.8 holding 

supplements mag gly, .3 melatonin, vit c, tumeric, boswellia, beef organs 

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  • Administrator

You got withdrawal syndrome from going off mirtazapine in May 2019 and felt better when you reinstated 7.5mg.

 

You're taking 7.5mg mirtazapine at night? Does it make you sleepy at all?

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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@Altostrata

 

i tapered from 7.5 in January 2020 to 6.6 by October 20’ and then it just kinda fell apart with little warning and never got back on track. That’s when I spoke to you about stopping the beef organs (I did stop months ago) 

 

Mirt was helping me sleep well from Jan to oct 

 

I have made almost no ch ages other than trying to add back in magnesium gly 400mg and .3mg of melatonin because I took them for all of 2020 and had no issues I only recently fell off them because I’m so out of sorts and nothing seems to be working 

 

Iv updosed to 6.8 and have been holding since oct with little improvements in sleep 

-JAN 18' - aug 18’ -22.5mg temazapam + 7.5-15mg remeron  for insomnia. —Aug 18’ temazapam switched to ambien 10mg

-AUG 18’ - April/May 19’ Taper off remeron 

-Mid july 19’ - one week of  200mg Gabapentin c/t  —-mid July 19”-  3 weeks of 50mg trazadone fast tapered 

-July 19’- began random use of .5 Xanax rarely to get rest 

- Mid Aug 19’ - one day of viibryd, 7 days of cymbalta 30mg, 3 days of seroquel 25-50mg

-Aug- 1 wk of Klonopin .5-.75 fast taper 

-Sep 19’ tried trazadone 50 again (still on ambien 10mg)  some time in sep 19’ was c/t off 10mg ambien because was thought to have become ineffective

-oct 7 c/t trazadone and restarted 7.5 remeron holding since 

12/3/19  at 7.5 after a 2 day attempt compounded 7mg. Jan 2020  dry taper from 7.5 |Oct 1 at 6.4 high disruption to sleep began |oct 20? Updosed to 6.6 |oct 26 updosed to 6.8 holding 

supplements mag gly, .3 melatonin, vit c, tumeric, boswellia, beef organs 

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  • Administrator

Why don't you updose to 7.5mg mirtazapine, rather than add another drug?

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

Link to post

@Altostrata

 

sure I’ll try that 

 

I was trying not to lose the little bit that I have tapered but I’m running out of options 

-JAN 18' - aug 18’ -22.5mg temazapam + 7.5-15mg remeron  for insomnia. —Aug 18’ temazapam switched to ambien 10mg

-AUG 18’ - April/May 19’ Taper off remeron 

-Mid july 19’ - one week of  200mg Gabapentin c/t  —-mid July 19”-  3 weeks of 50mg trazadone fast tapered 

-July 19’- began random use of .5 Xanax rarely to get rest 

- Mid Aug 19’ - one day of viibryd, 7 days of cymbalta 30mg, 3 days of seroquel 25-50mg

-Aug- 1 wk of Klonopin .5-.75 fast taper 

-Sep 19’ tried trazadone 50 again (still on ambien 10mg)  some time in sep 19’ was c/t off 10mg ambien because was thought to have become ineffective

-oct 7 c/t trazadone and restarted 7.5 remeron holding since 

12/3/19  at 7.5 after a 2 day attempt compounded 7mg. Jan 2020  dry taper from 7.5 |Oct 1 at 6.4 high disruption to sleep began |oct 20? Updosed to 6.6 |oct 26 updosed to 6.8 holding 

supplements mag gly, .3 melatonin, vit c, tumeric, boswellia, beef organs 

Link to post

I feel like I’m falling apart I 
I updosed last night from 6.8 to 7.5.. I know it needs some time to help 

 

but I was so desperate I took some hydroxizine and about .12 mg Xanax 

mans this morning I feel so horrible 

 

it wasn’t the Xanax because Iv had that a couple times now and it helped. Along with some ambien. 
 

Was the hydroxizine. I just don’t know what to do. Um going to lose my job at this rate 

I have to be able to feed myself and pay my bills. I don’t have anyone to move in with or non or dad to run to. I really don’t know what to do anymore 

-JAN 18' - aug 18’ -22.5mg temazapam + 7.5-15mg remeron  for insomnia. —Aug 18’ temazapam switched to ambien 10mg

-AUG 18’ - April/May 19’ Taper off remeron 

-Mid july 19’ - one week of  200mg Gabapentin c/t  —-mid July 19”-  3 weeks of 50mg trazadone fast tapered 

-July 19’- began random use of .5 Xanax rarely to get rest 

- Mid Aug 19’ - one day of viibryd, 7 days of cymbalta 30mg, 3 days of seroquel 25-50mg

-Aug- 1 wk of Klonopin .5-.75 fast taper 

-Sep 19’ tried trazadone 50 again (still on ambien 10mg)  some time in sep 19’ was c/t off 10mg ambien because was thought to have become ineffective

-oct 7 c/t trazadone and restarted 7.5 remeron holding since 

12/3/19  at 7.5 after a 2 day attempt compounded 7mg. Jan 2020  dry taper from 7.5 |Oct 1 at 6.4 high disruption to sleep began |oct 20? Updosed to 6.6 |oct 26 updosed to 6.8 holding 

supplements mag gly, .3 melatonin, vit c, tumeric, boswellia, beef organs 

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  • Moderator
manymoretodays

Hey DD44,

You may have overdid with the Xanax, Ambien, and hydroxizine.

If you took all of those in one night.

 

And yes, much patience required after an updose.

As you wait to see whatever you reacted too, there are several things you can try.

 

Nondrug coping

^ see the whole indexed list in the first post there

Acceptance

Mindfulness and Acceptance

Radical Acceptance

Emotional Spirals

Any self soothing, calming that you have become practiced with and that helps?  Sometimes it can be calming videos or audios, or baths, or getting out of bed, when hit with insomnia and/or cortisol awakenings and doing something briefly calming, rather than reaching for one, or two, or 3 pills.  Could you perhaps try some weak chamomile tea? 

Insomnia, cortisol awakenings

Breathing, just breathing, and practicing this until it helps

4-7-8 breathing

 

And stop catastrophic thinking in it's tracks......that never helps.

Working with Anxiety and Withdrawal
Withdrawal causing repetitive or intrusive thoughts, rumination, and increased panic

What IS going well, or what are you thankful for.  You've got family that you could go to, even though you don't like that idea.....but some......don't even have that.  You are learning, what helps, and what does not help in WD, and with your present neuro dys regulation/function. 

And oh so sorry, editing in here, no one to run to?  Many of us with the same, and have managed some way, some how........even when it all feels so totally undoable.  It gets better.  I promise.  It will.  Trite, but be your own bestie.....friend and confidant.......have faith in healing, and getting to a better place.  Reach on out to others, here or on the ground.  You can PM with members too, so that it doesn't all have to be out here in public view.  Still tough with covid precautions, but you might be able to find someone or something local to become connected with, that helps.  Helping the other members even to get oriented to the site, might feel good, and give you a bit of calm between the waves of storm.  Are they any safe warm lines in D.C. that you could call, and talk to someone on, without threat of hospitalization? 

 

To search on just about any topic here too- you can just use your main browser, then type in survivingantidepressants.org and then add the topic that you are looking for, or your symptom that you are feeling awful with.

 

Also, never hesitate to read and then offer support to another member, in their Introduction, or in a topic in Symptoms and Self Care.  Or via PM.  Use the little envelope icon in the upper corner.  Just be aware that most members all need support too. That can sometimes take one right out of their own misery, at least for a little while.

 

Do keep us posted, and updated, with this recent updose.  Thank you so much.

And hugs DD44.

 

L, P, H, and G,

mmt

 

Edited by manymoretodays
in black

Started with psycho meds/psychiatric care circa 1988.  In retrospect, and on contemplation, situational overwhelm.

Rounding up to 30 years of medications(30 medication trials, poly-pharmacy maximum was 3 at one time).

5/28/2015-off Adderal salts 2.5mg. (I had been on that since hospital 10/2014)

12/2015---just holding, holding, holding, with trileptal/oxcarb at 75 mg. 1/2 tab at hs.  My last psycho med ever!  Tapered @ 10% every 4 weeks, sometimes 2 weeks to

2016 Dec 16 medication free!!

Longer signature post here, with current supplements.

Herb and alcohol free since 5/15/2016. 

None of my posts are intended as medical advice.  Please discuss any decisions about your medical care with a knowledgeable medical provider. manymoretodays

 

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@manymoretodaysthank you for your very thoughtful and detailed response. I likely took almost too much time yesterday reading through as much of the resources as i could. and much of it was helpful.

 

just to clarify i didn't take xanax, ambien and hydroizine in one night, i took xanax and hydroxyzine. 

 

outline of 1/21/21

1130 out of bed (very sick  (no sleep, pain in head, emotional turmoil), believe it was the hydroxyzine)

12-445 work, (work with one 6year old girl, did my best and felt less sick by about 3pm)

ate various snacks, granola bar, fruit

450 appointment to discuss medical marijuana (was approved, but understand i need to be very cautious with any of that-i dont want to get high, i only would like something that would help with sleep while trying to taper Mirtazapine, rather than benzos or sleeping pills)

ate muffin and protein shake

6p-8p bodywork (facia work, rolfing? some of you may have heard of it, its been very helpful the last three years for my pain issues,)

1030- 7.5 Mirt

9p-1130p reading through the info manymoretodays sent

1a get in bed and read a little. roll over and try to rest, might have gotten some very light rest but not deep sleep

2/3am? i never look at clock when i wake- took 5mg ambien and .12 xanax.

330p-10 much more restorative deeper sleep

11am awake with lightbox, feel much better than yesterday

 

@Altostrata when reading through the info manymoretodays send me, i came across a thread where you were discussing cortisol being too high around bedtime (i was always a night owl, so this may be me) and a supplement you tried called Seriphos? you said that it helped now and then in the post. I was wondering if i could try to while still on 7.5 of mirt? I do not want to be resorting to xanax or ambien but in certain times I just need some rest or I am at risk of losing my job, and I cannot do that. I dont have a husband or any family to live with and have to pay my rent, bills etc. Also I see people saying that Valium is a better choice than xanax? If i am going to be using it when things get too difficult is that a better option. I truly understand that this forum doesn't support the idea of adding new drugs, but I am only using things when I feel Im in danger of hurting myself or losing my livelihood. I realize I may need to deal with getting rid of other medications or help later on, but honestly nothing could be as bad as this Mirt, for whatever reason it is relentless with me. I am working really hard to do everything that everyone is suggesting. I hope someone can hear where I am coming from at this point. 

 

Any feedback is appreciated. And I do thank Alto and Manymoretodays and everyone else who is taking time out of their day to help me. i do believe I'm going to beat this but I'm accepting at this point my path isn't linear. 

 

-JAN 18' - aug 18’ -22.5mg temazapam + 7.5-15mg remeron  for insomnia. —Aug 18’ temazapam switched to ambien 10mg

-AUG 18’ - April/May 19’ Taper off remeron 

-Mid july 19’ - one week of  200mg Gabapentin c/t  —-mid July 19”-  3 weeks of 50mg trazadone fast tapered 

-July 19’- began random use of .5 Xanax rarely to get rest 

- Mid Aug 19’ - one day of viibryd, 7 days of cymbalta 30mg, 3 days of seroquel 25-50mg

-Aug- 1 wk of Klonopin .5-.75 fast taper 

-Sep 19’ tried trazadone 50 again (still on ambien 10mg)  some time in sep 19’ was c/t off 10mg ambien because was thought to have become ineffective

-oct 7 c/t trazadone and restarted 7.5 remeron holding since 

12/3/19  at 7.5 after a 2 day attempt compounded 7mg. Jan 2020  dry taper from 7.5 |Oct 1 at 6.4 high disruption to sleep began |oct 20? Updosed to 6.6 |oct 26 updosed to 6.8 holding 

supplements mag gly, .3 melatonin, vit c, tumeric, boswellia, beef organs 

Link to post

DD:  If you have updosed to 7.5 mg., it may take some days to get readjusted for blood levels.  I know because this happened to me in 2017.  It took me about 35 days to get stabilized after I updosed from 1.87 mg. to 3.75 mg.  I think my posts are still around this site somewhere.

 

Hope this helps...

Shebon

Started 3.75 mg. remeron 4/2013.  Had tapered off benzo 4/2011.  1/2020 began 5th or 6th taper off Remeron.  Am doing a modified CITA taper--started 6 nites at 3.75 mg. then one nite at 1.87 mg. (half dose).  Currently (6/4/20), 5 nites at 1.87 and 2 nites at 3.75.  I stay on each phase for one month - it will take me around 7 mths to be at 1.87 mg nitely (1/2 of normal dose of 3.75 mg.)  4/10/20 -  2.67 mg. Remeron/day; 5/10/20 - 2.39 mg.;  6/10/20 - 2.11 mg.; 7/11 1.87 mg.  My first BIG benchmark!  9/1/20 - 1.75 mg; 10/6/20 - 1.60 mg.; 11/16/2020 - 1.48 mg.   Never got this far before!  WATCH out for hyperthyroid symptoms if you take any thyroid meds -- they mimic WD taper symptoms -- The lower one goes with the AD, you might need less thyroid med....1/20/2021 - 1.35 mg. (low histamine diet too)

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Yeah it helps a bit. Any words of wisdom you have for how you got down below 7.5 successfully would be so helpful. Thanks and I’ll also review your story a bit 

-JAN 18' - aug 18’ -22.5mg temazapam + 7.5-15mg remeron  for insomnia. —Aug 18’ temazapam switched to ambien 10mg

-AUG 18’ - April/May 19’ Taper off remeron 

-Mid july 19’ - one week of  200mg Gabapentin c/t  —-mid July 19”-  3 weeks of 50mg trazadone fast tapered 

-July 19’- began random use of .5 Xanax rarely to get rest 

- Mid Aug 19’ - one day of viibryd, 7 days of cymbalta 30mg, 3 days of seroquel 25-50mg

-Aug- 1 wk of Klonopin .5-.75 fast taper 

-Sep 19’ tried trazadone 50 again (still on ambien 10mg)  some time in sep 19’ was c/t off 10mg ambien because was thought to have become ineffective

-oct 7 c/t trazadone and restarted 7.5 remeron holding since 

12/3/19  at 7.5 after a 2 day attempt compounded 7mg. Jan 2020  dry taper from 7.5 |Oct 1 at 6.4 high disruption to sleep began |oct 20? Updosed to 6.6 |oct 26 updosed to 6.8 holding 

supplements mag gly, .3 melatonin, vit c, tumeric, boswellia, beef organs 

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