DD44: please help, currently on mirtazapine and gabapentin

[Altostrata]

If 7.5mg works, why not give that a couple of months, then try again with the 7.4mg capsules. They'll last that long, won't they?

 

It's not logical that your nervous system would immediately know it got 7.4mg instead of 7.5mg and keep you awake all night. Ordinarily, it would take a couple of hours for mirtazapine to reach peak plasma. It spends some time leaching into your system.

 

Still would serve you well to learn meditative and other stress reduction techniques.

[DD44]

On 1/28/2020 at 10:52 PM, Altostrata said:

If 7.5mg works, why not give that a couple of months, then try again with the 7.4mg capsules. They'll last that long, won't they?

 

It's not logical that your nervous system would immediately know it got 7.4mg instead of 7.5mg and keep you awake all night. Ordinarily, it would take a couple of hours for mirtazapine to reach peak plasma. It spends some time leaching into your system.

 

Still would serve you well to learn meditative and other stress reduction techniques.

 

[DD44]

Could you explain what you mean by peak plasma? Usually I take my Med around 9-10 and then by 12 I’m out. Not sure what you meant. Today I tried to make my own capsule with my own pill. It was definitely a process. Not sure when I’ll try my own “compound”. I came back to site  today to look up how I would measure how much to take away. If the capsule weights .03 and the pill weights .08. Then my compound should weight .11, correct? 
just trying to figure out then what for example 7.2 would weight ... 

[Altostrata]

What happened to your 7.4mg capsules? Did you get used to them?

 

"Peak plasma" means the amount of time it takes for the tablet to dissolve and get into your blood stream at full strength.

 

@brassmonkey will help you with calculations.

[DD44]

I only did one night at the 7.4 capsule that night was not good so I went right back to my normal the next day I truly would not mind as long as I’m not having zero nights but zero nights for me where I’m sitting up at 4 AM is just not tolerable

 

so I’m really thinking if I can make my own capsules this would be so much more cost affective 

if I use the compounding pharmacy then I’ll be spending 500 a year on this prescription 

 

really would like to just get good at making my own 

 

@brassmonkey alto said you can help me understand calculations 

I’m very bad with math and such 

last night I made a capsule but I want to be sure it’s the forest weight before I take it 

 

my pills weight .080 and the capsules weight .030. My mg is 7.5. To me that meant I’d I want to make a 7.5 capsule then it should weigh about .11 . Would this be correct ? Also my pill has a coating, they look like paint chips when I grind it down (not sure this matters but I thought it was worth noting) 

[Altostrata]

Why are you trying to make 7.2mg capsules?

 

If you feel better at 7.5mg, take 7.5mg. You may not be ready to taper yet. Taper when you feel more confident.

 

What is your current daily drug schedule, including all drugs?

[DD44]

@Altostrata

 

i currently only take 7.5 mirt between 9-10p.

 

i take vitamins in am, turmeric, boswellia, fish oil, glutamine, probiotic 

 

magnesium and melatonin at night 

 

I am ready to taper. I’m confident and I want it. But 0 nights are my boundary. Even a 4-5 night is ok. But I know myself and I know what happens to me when I let that happen, I put myself at risk. I am very determined and want to begin a taper even if it’s just small. I picked 7.2 just arbitrary, anything that’s no more than a 5% decrease I feel should be okay. 

[Altostrata]

If you can't tolerate a decrease to 7.4mg, why do you think a decrease to 7.2mg would be better?

 

4 minutes ago, DD44 said:

But 0 nights are my boundary.

 

This means you're not ready to taper -- you're afraid of the risk of zero sleep. My guess is this is what was keeping you awake when you were taking 7.4mg.

 

You can taper at any rate you want, but we cannot promise you it will not disturb your sleep. You have to be able to cope with this. Any drug change may have a transition period.

 

I recommend you not reduce from 7.5mg mirtazapine until you're okay with the idea of missing a night's sleep or two.

[DD44]

Ok so I can try 7.4 again, and if I go more than 2 nights I go back I guess 

 

I really wanted to make my own capsule and see it that worked 

 

also- the only way it’s keeping me up is if it’s deep in my subconscious 

 

I have gone into every transition feeling very good, not thinking at all about the decease - I do my same night routine and don’t think twice about it- until I realize I’m still awake at 3am. Even then I don’t freak out at all. I really feel you have the impression I’m fretting the night of a change or decrease, in not at all. I’m not sitting awake waiting to see what happens iv become too accustom to drifting no problem 

 

so I don’t know what the issue it honestly 

[elbee]

19 hours ago, Altostrata said:

19 hours ago, DD44 said:

But 0 nights are my boundary.

 

This means you're not ready to taper -- you're afraid of the risk of zero sleep. My guess is this is what was keeping you awake when you were taking 7.4mg.

 

I agree with @Altostrata that while a part of you may want to be off the drugs, you are not ready to taper based on your "0 night" control criteria. I have expressed this perspective to you several times previously . . .

 

  

On 1/27/2020 at 8:52 AM, elbee said:

On 1/6/2020 at 11:50 AM, elbee said:

I have struggled with sleep my whole life too, so I know the effects of not sleeping, and how scary and frustrating sleep deprivation can be. I have gone to "those scary places" many, many times. I have had to do a lot of work on sleep hygiene, sleep routines, evening routines, morning routines, etc. I have discovered that how authentically I live my life each day effects my sleep. I have had to do a lot of work on managing fears and anxiety when I haven't had enough sleep, and finding techniques to do that. Sleep for me, like it sounds like for you, has been a "measurement tool" for how "good or bad" I'm doing. If I'm not able to sleep, I'm doing "bad" and things are "bad" and I spiral from there. For me, my FEAR of not sleeping has played a huge roles in my not sleeping. If this is the case for you, then generally speaking, making any change that you are fearful of will effect your sleep. So yes, part of the issue seems to be that some of us have become incredibly sensitized to getting off these drugs. And part of your issue is probably your fear of not knowing what's involved as you would taper to get off of them. 

 

On 1/27/2020 at 8:03 AM, DD44 said:

I just want to feel like I’m in control

 

Most likely, you will need to experience the fears and other discomfort associated with releasing some control in this tapering process. As I have described above in my own experience, this is what I had to do. As I also described in my experience, after each change I made that produced "unacceptable" consequences, those consequences would eventually subside and my life would "normalize." As long as NOT experiencing "0 nights" are a control requirement for you in your tapering process, then most likely it will arise as a barrier with any of the changes you would make in your process.

 

As long as you treat a "0 night" as a control criteria ("boundary"), then it will be the ejection button that will prevent you from tapering regardless of your approach. You mentioned that you thought you would not have "0 nights" if you shaved a little off one of your pills. I suggested you go for it to test it out. You have since deviated from this approach. It's up to you, but I don't feel like I have any additional information I can provide you at this point.

Edited February 4, 2020 by elbee

[DD44]

I just I should specify and say multi 0 nights in a row. I dunno what to say to you guys. I’m not sitting up at night worried when Iv made a change. At this point I would really just like someone to direct me on my King my own compound at home, as I stated a couple times that’s what I’m trying to do and just would like so clarification on it so I can get it right. Any assistance in that area would be appreciated. I don’t think there’s any point anymore in discussing my 0 night issue 

 

and I appreciate everyone’s input but I can’t stress enough that Iv never been scared or worried about a reduction (and how it will effect my rest) Iv gone into every change thinking thoughts like this is nothing, going to work out, no big deal and so forth. I went to it every time very positive and optimistic. I don’t think everyone is going to get a true sense of my demeanor and attitude about it through just these messages so no point in beating a dead horse. 
 

and when I said I want to be in control 

I meant control as in that I can reduce even if it’s by .1 and its not a big issue. I meant I don’t like feeling like the med has some power over me. Which I know at this point I can’t just stop taking but I want to feel like I’m driving towards not needing it no matter how slow the drive 

[Altostrata]

If I were you, I'd stay on 7.5mg for another month, then use your 7.4mg compounded capsules again.

 

Shaving a tablet is not going to reduce it by less than 0.1mg and introduces inaccuracy into the situation.

[DD44]

I’m still kind of unclear as to why no one will give me a little help For doing my own compound at home(just the measurements, and wing things). Frankly I’d like to save the money, and even the compound pharmacist said that it would be ok.

[DD44]

Anyhow sorry there is so much back and forth. 
 

I appreciate everyone’s help and time spent. I know I can be strong willed. 
 

as stated before, if someone can simply help answer a couple questions about making my own compound at home that is what I would Find most helpful at this point. I am set on doing it that way for now. Thanks again 

[brassmonkey]

Hi DD44-- by making your own compound I am assuming that you want to use the pills you have available and make capsules of a specific dose with them.

 

The weight of an empty capsule doesn't matter.  All it is a carrier.  They will vary in weight just a little so unless you work one capsule at a time the finished weight of the capsule won't work as a quality check.

 

In a previous post you mentioned that your pills weigh .080. This would translate to 80mgpw (milligrams pill weight), and they have a strength of 7.5mg,  We will refer to this as 7.5mgai (milligrams active ingredient).

 

Dividing the strength (mgai) by the weight (mgpw) gives us a ratio called the AIC (Active Ingredient Concentration). This ratio will stay constant if you reduce either side by a given percentage. So if you reduce the mgpw by 10% the mgai will also be reduced by 10%.

 

If you take a whole pill and put it into a capsule you now have a compounded capsule with a strength of 7.5mgai.

 

The next step would be to remove a percentage of the mgpw. Let's say 10%.  Multiply 80mgpw by 0.9 and this will give you the weight of a dose that is 10% less than the original. 80 X 0.9 = 72.  Crush one of the pills into a fine powder and weigh 72mgpw with your scales.  The display will show 0.072. Put this powder in a capsule.  You now have a compounded capsule with a strength of 6.75mgai  because of the AIC ratio. 

 

For the next reduction you would use the same calculations, except you would start with 72mgpw instead of 80mgpw.

 

If you wanted to do a 5% reduction you would multiply by 0.95.  For a 2.5% reduction you would use 0.975.

 

That really is all there is to it. Now what were those questions you had? 

[DD44]

@brassmonkey so I understand now how to calculate how much powder should go in the capsule. 
 

I guess my question/issue was (and reason why I thought that the weight of the capsule mattered) was that I’m weighting the powder but then the process of getting it into the capsule makes me think I’m losing some powder along the way if it doesn’t weigh - let’s  just say .11 for this example. if i were taking a full pill and putting it into a capsule that weights .030. The process of getting the powder from the crushing container to a funnel to inside the capsule is one I have not mastered yet. I think I understand what you’re saying is that I shouldn’t really need to weight a finished capsule if I already weighed what went inside of it. But I guess I just wonder about the variable of lost product when it’s being transferred. Sorry if that was confusing hope it made sense and I can get it figured out. Thank you so much for your detailed response above. 

[brassmonkey]

I see your point and yes, there will be a little lose of powder while making the transfers. But there is a way around it. Don't clean up after your self. There will be a tiny amount of powder that will stick to the surface of the pan and the funnel, this is a one time thing if you leave it there.  Only so much can stick and once it's there all the rest will just slide through. If any more sticks it will be such a small amount that it doesn't count. You could actually "precoat" your tools before making the measurements and transfers.

 

I mentioned the AIC for your medication as being .09mgai.  This means that for every 1mgpw of powder there is .09mg of active ingredient. Unless you spill the powder all over the place the amount that sticks to the tools will only be a couple of mgpw at the most, so it doesn't contain vary much active ingredient.  These tiny amounts only come into play at the very end of a taper during the last three or four reductions.  Unless a person is extremely sensitive to the medication they don't make a difference.

[DD44]

@brassmonkey

thank you so much for the detailed response. But just so I’m clear- should the final capsule weigh the amount plus the capsule ? So in my case .08 + .03 = .11 final weight ? Or as long as I’m close to a .1 would that be ok? 
 

I ask this again because when I made my first capsule the other day it actually took me 1 - 7.5 plus some attitudinal material from a second pill to achieve .11. This isn’t a big deal once, but over time I don’t think I could keep that up 

[Frogie]

DD44:

 

You don’t weigh the capsule at all. It just holds the powder. So, all you weigh is your powder you made from your pill and then pour it in the capsule.

 

I’ve been doing this since June 2019 with my Xanax with the help of Brassmonkey. All I do is crush my Xanax, weigh the powder and pour it in the capsules every month. I decrease the powder by 10% a month. I don’t wash or wipe off my scale or funnel as Brassmonkey said not too. I don’t think I’m losing that much powder a month. It’s minuscule if I am.

 

Does that make sense?

 

 I hope I didn’t step on your toes @brassmonkey just thought I could help by explaining what I did😊

 

Take care,

 Frogie xx

[brassmonkey]

Does the scale you have measure to three decimal places (0.001)? 

 

No problem Frogie, you have plenty of experience with this.

Edited February 6, 2020 by brassmonkey

[DD44]

@brassmonkey yes it does 

[brassmonkey]

Good.  It can be rather important to work with all three digits, and we need to be as accurate as possible. 

 

At the beginning of a taper there is a period of "setting the standard" for the taper.  The initial doses and first reduction may not be as accurate as on would like, but on the higher doses the small discrepancies don't matter as much.  Working in a standard and organized fashion with good repetition of the process the first small differences will wash out and not cause any problems. If you want to round up the amount with a little extra powder, it's not going to hurt anything, but will probably be more bother than it's worth.  The need to round up will disappear after the first reduction anyway. From there you would just be doing a calculated weight that is less than the weight of a full pill so you will start to have a little bit of extra left over from each pill. (save this for a free dose when the amount builds up).

 

All told, I wouldn't worry about the little bit of extra.

[DD44]

Switched over to my own home made compound last night (a complete 7.5 simply put in a a capsule) 

 

wasn’t so good... I don’t know right now

really a bit frustrated by it

 

went in with a positive attitude feeling optimistic 

 

maybe my body just doesn’t like the pill crushed? Maybe it’s my subconscious I don’t get it 

 

all I know is I want to begin ... a bit sensitive this morning so yea ...

 

I have a lot of reasons for wanting to begin my taper and be Med free

many things that are good that could come from it . Idk 

[DD44]

Hey @brassmonkey

 

so I know some have cautioned against chipping away at my pill but Iv found with a set of tweezers (I know strange) I can actually get very accurate weights. Just want to know from you if I decide I want to go this route would I still do the same calculations. Basically if I want to do a 5% drop would I do 80 x .95 which would give me 76 meaning my new pill should now weight .076 ? 

[brassmonkey]

Yes, that is the correct calculation. How you get the pill to that weight is up to you.

[DD44]

@brassmonkey @Altostrata 

hey guys 

so I had started scratching and meticulously weighing pills (calibrated scale every time) and things we going well. I think I went to .076 and after about a week or two of that I might have gotten over confident. I’m now sitting at .073 and not reacting as well. Should I go back up to .076? During the 1-2 weeks at .076 I had some disruptions (waking here and there) but no 0 evenings (which having two zeros in a row is basically my boundary, where I feel like I should assess what I’m doing and maybe adjust)  I don’t want to necessarily go back up to .080 (full dose I started at) 

 

Just let you let me know what you guys think. I realize that I might’ve gotten a little overconfident and that I really just need to be slow if that means only 5% a month versus what I tried to do which was jump to about 8 to 10% in one month then I’m willing to except that 100%.

[Altostrata]

Please give details of how you're not reacting as well.

 

What drug are you tapering? Is .076 weight or dosage? We prefer notes in dosage. Please update your signature.

[DD44]

@brassmonkey knows what I’m saying I’ll update signature when I’m near a computer (I sent these messages thru my email) 

mirtazapine (only thing I’m on)

.076 is the total weight of the pill

the weight untouched is .080 

 

I take 80 and x by .95 or .90 to get my new weight 

I scratch with tweezer and get an exact weight (the only variable is the coating on pill) 

 

no responding well as in had a night with only 4 hours rest suddenly and then last night was 0 and started to have dark thoughts 

body aches from no rest. Rest is my main issue 

and 0 nights is my boundary 

 

I had a good bit of nights with waking or difficulty before I jumped down to .072 (too fast In retrospect) which I’m fine with 

but a zero where I feel like I’m wide and hopped on caffeine isn’t ok w me. I believe I should go back to .076 and then stay there for a month, stabilize, and then track everything and not try to speed up like I did 

perhaps no more than a 5% decrease per month. I tried to do 10% in less than a month.... so yeah hope that clear it up 

[DD44]

Also to add

im feeling a bit down

agitated

lonelier than normal 

sad

anxious about the evening 

a lot of this I feel is based around having a bad experience the last two nights however I have learned the best thing to do for me is to do my best to not dwell on anything 

 

*edit*

and based on communications here it looks like I have tried to do a 10% drop in less than two weeks

so this is my fault essentially 

 

im really hoping I can stabilize on .076

[DD44]

@Altostrata @Shep @elbee tagging people so my messages doesn’t go unnoticed 

 

checking in 

my second batch of meds seemed to weight less that my first batch (batches in 30) is this normal? 
 

I haven’t made at changes really because I can’t seem to feel stable for what I would deem long enough. Last three evenings have been particularly difficult, while I was doing ok last week. Not really sure what to do at this point, or sucks to feel like my mind really just responds to any little change. My daytime is unexpected but of course if I’m not getting rest my mood and productivity deteriorate. Pretty frustrated 

[elbee]

Hello @DD44. It's not clear to me what you mean by your batch weighing less. It looks as though you were working with @brassmonkey with your measurement questions?

 

On 2/28/2020 at 4:36 PM, DD44 said:

and based on communications here it looks like I have tried to do a 10% drop in less than two weeks

so this is my fault essentially 

 

im really hoping I can stabilize on .076

 

You didn't check in here for a while after the above post (about 2 months). Did you hold at .076 and that is where you are at now when you wrote this (below) on Friday?
 

On 5/8/2020 at 12:31 PM, DD44 said:

I haven’t made at changes really because I can’t seem to feel stable for what I would deem long enough.

 

[DD44]

@elbee @brassmonkey

in the past two months I had dropped to .074 and then was holding. It was just shaky and didn’t seem like it was working. I mean batch as in my pills are batched by 30. The first batch of 30 weighed .0.79-.080. So I was going off that. Then the second batch weighted more like .076-.077. So was wondering if maybe batch two had less medicine in it? I opened batch 3 (I got three months worth since covid) two nights ago and tried .075. Batch 3 seems to weigh .078 untouched. Did better the last two nights, still shaky but very manageable. 

[elbee]

@DD44 I don't think there is any way to say for sure what is going on with the weight variance of your pills. It's unclear to me and probably unclear to you if that variance is reflective of any variance in dosage or if it's other factors. I think that would need to be something you bring up with whomever it is that's creating the pills for you. In my taper, whenever I got shaky I would hold until I wasn't as shaky. Some people may do a slight increase, but I never did. I knew that when I would hold, eventually healing would occur and it would get better. I too struggling with wanting to push, I don't think that's uncommon for many of us. I learned with experience though that holding when in doubt always produced the best results.

[DD44]

@elbee

 

im trying to be and Believe I’m being extremely patient

But my progress is so slow. To only be at .075 from .078/9 and it’s may. That’s basically a 5% decrease in about 3 months... just seems like my body really doesn’t want to let go. I have no daytime symptoms. Everything hinges on ability to get rest. If I go more than 2 days without, I know I need to figure it out because everything starts to fall apart (my mood, physically feel unwell (and seriously don’t want to mess with my immune system during this time)

I don’t have any true anxiety or depression

i really hate the weight I’ve gained. And that I can’t seem to lose any (I only want to lose ten pounds)... small vent and also adding some context ... any words of wisdom or encouragement welcome 

thanks 😌

[elbee]

7 minutes ago, DD44 said:

just seems like my body really doesn’t want to let go.

 

I relate to this. While "parts" of me wanted to get this done, be finished with it, suck it up and push through . . . other "parts" of me had very different ideas. Most of my life, I paid attention to the "push through parts" and ignored the rest. That, in retrospect, is how I ended up on the drugs in the first place.

Getting off, I discovered I had to listen to the parts of me that "didn't want to let go" and bring some gentleness, love and patience to them -- things that had been mostly absent in my life starting at a very early age. I found I simply couldn't go faster in this process than the "parts that didn't want to let go" were OK with. Yes, it required a lot of patience and it wasn't quick nor was it easy. But in the tapering process, I learned a new way to live and I'm ever so grateful for that today.

 

Go gently.

[Altostrata]

@DD44, how are you doing?