AiyahC: My tapering intro

[AiyahC]

Hi! I read Robert Whitaker's anatomy of an epidemic in June 2019 which started me on my tapering journey. I originally assumed that the rate psychiatrists used to cross taper using the existing doses available was okay. As a result I did a fairly fast taper partly psychiatrist supervised from 160 mg of my ziprasidone to 120 to 80 to 60 mg. I also not at the same time of course, tapered off attarax 25 mg 3x daily to 25mg 25 mg and 20 mg. Than 25 20 20 mg, 20 20 20 mg and than 10 10 10 mg and than 0, 10 mg 10 mg and so on with minimal rebound anxiety which I waited for it to pass before tapering more, tapered off 100 mg of trazodone going from 100 to 75 to 50 to 25 to 0, and tapered down my cymbalta from 90 to 60 to 30 mg. This took me from June 2019 to the end of september 2019 which i understand is fast and im luckily i experienced little to no withdrawal symptoms. At the end of september I  came across the withdrawal project, Links on Robert Whitakers website, and this site and realized I'd been going fast. Oct 8th I started a liquid titration of my ziprasidone going down to 50 mg. No problems yet. I am currently at 50 mg ziprasidone, 30 mg Cymbalta and 2 mg of Xanax which I take twice a day but am slowly shifting to spreading the dose to three and than four times a day (half a mg each). The plan if all goes well is to taper off my ziprasidone, wait 2 weeks, start tapering my cymbalta, wait two weeks and start tapering Xanax last. From my research the Lay tapering community reccomends 5 to 10% of the month's previous dose once a month if you are doing cut and hold and psychiatrists who specialize in tapering reccomend 10% of the original dose every 2 to 4 weeks doing cut and hold. I decided to go closer to 10 percent of the original dose for now every two weeks and if I run into any problems I will slow it down and do a smaller taper. So that's my introduction for now! Thank you for being here.

[AiyahC]

I heard it's protocol to provide the drug interaction report. Other than increased sleepiness which has decreased with lower doses I haven't had any interactions.

Drug Interaction Report

This report displays the potential drug interactions for the following 3 drugs:

• Geodon (ziprasidone)
• Cymbalta (duloxetine)
• Xanax (alprazolam

Major (0)

 

Moderate (3)

 

Minor (0)

Food (3)

 

Therapeutic Duplication (0)

Interactions between your drugs

Moderate

ALPRAZolam ziprasidone

Applies to: Xanax (alprazolam), Geodon (ziprasidone)

Using ALPRAZolam together with ziprasidone 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 vitaminsand herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

ALPRAZolam DULoxetine

Applies to: Xanax (alprazolam), Cymbalta (duloxetine)

Using ALPRAZolam 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 vitaminsand herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

ziprasidone DULoxetine

Applies to: Geodon (ziprasidone), Cymbalta (duloxetine)

Using ziprasidone 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.

Switch to professional interaction data

No other interactions were found between your selected drugs. This does not necessarily mean no other interactions exist. Always consult your healthcare provider.

Drug and food interactions

Moderate

ALPRAZolam  food

Applies to: Xanax (alprazolam)

Grapefruit and grapefruit juice may interact with ALPRAZolam and lead to potentially dangerous side effects. Discuss the use of grapefruit products with your doctor. Do not increase or decrease the amount of grapefruit products in your diet without first talking to your doctor. Do not drink alcohol while taking ALPRAZolam. This medication can increase the effects of alcohol. You may feel more drowsy, dizzy, or tired if you take ALPRAZolam with alcohol. Talk to your doctor or pharmacist if you have any questions or concerns.

Switch to professional interaction data

Moderate

ziprasidone  food

Applies to: Geodon (ziprasidone)

Alcohol can increase the nervous system side effects of ziprasidone such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with ziprasidone. Do not use more than the recommended dose of ziprasidone, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

Switch to professional interaction data

Moderate

DULoxetine  food

Applies to: Cymbalta (duloxetine)

DULoxetine may cause liver damage, and taking it with alcohol may increase that risk. You should avoid or limit the use of alcohol while being treated with DULoxetine. Call your doctor immediately if you have fever, chills, joint pain or swelling, excessive tiredness or weakness, unusual bleeding or bruising, skin rash or itching, loss of appetite, nausea, vomiting, dark colored urine, or yellowing of the skin or the whites of your eyes, as these may be symptoms of liver damage. 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.

[AiyahC]

I should mention that a high level of anxiety is the norm for me along with panic attacks at least a four times a week with physical panic symptoms every day. My psychotic symptoms are 0 and have been for awhile. Depressive symptoms are at a minimum. Since some of my symptoms are present at high levels even with medication it's only if there is an increase that I'll know I need to go slower. I have two therapists and am doing work at home as well mostly with anxiety, panic, and trauma. I am also working to understand my psychosis better to integrate that experience and prepare in case symptoms return. I have made a measured decision along with my therapists and partial cooperation from my psychaitrist to work through my conditions through psychotherapy.

[Altostrata]

Welcome, AiyahC.

 

Thanks for the very complete Introduction topic!

 

On 10/15/2019 at 11:38 AM, AiyahC said:

should mention that a high level of anxiety is the norm for me along with panic attacks at least a four times a week with physical panic symptoms every day. My psychotic symptoms are 0 and have been for awhile. Depressive symptoms are at a minimum. Since some of my symptoms are present at high levels even with medication it's only if there is an increase that I'll know I need to go slower.

 

Do the panic symptoms happen at any particular time of day? Please keep daily notes of the times of day you take your drugs, their dosages, and your symptom pattern, including your sleep, and post them in this topic. It is possible some of your symptoms may be paradoxical from drug interactions, daily notes will help us figure this out.

[AiyahC]

I will keep a log and post! Thank you for the advice!

[AiyahC]

10/19/2019

10:45 am woke up
10 hours of sleep woke up twice. Once to go to the bathroom and once at 9:45 am after which I fell back asleep for another hour.

Woke up with numbness and tingling in face (some of my panic attack symptoms). Bearable but unpleasant and distracting. No noticeable mental component. I'd rate it a 5 or a 6 out of 10.

10:50 am took 1 mg alprazolam, 30 mg cymbalta, 1000 IU of vitamin D and 65 mg of iron.

11 am breakfast

11:30 numbness and tingling significantly reduced.

12:13 numbness and tingling completely gone

1:10 PM numbness and tingling back bearable but unpleasant and distracting. Little to no mental anxiety component. 4 or 5 out of 10

1:15 PM lunch

1:45 PM numbness and tingling dropped to a 3 or 4 slight mental anxiety component

2:23 PM finished 26 minute walk numbness and tingling down to a 2 or 3

2:45 PM took 0.75 mg alprazolam

3:11 numbness and tingling down to a 1 to 2

4:30 numbness and tingling up to 3 to 4

5pm ate dinner

5:25 PM numbness and tingling gone

6:30 anxious from environmental stressors shallow breathing slight numbness and tingling. Used coping skills.

7pm 0.25 mg alprazolam

8:30 numbness and tingling 3 to 4 low mental anxiety.

8:45 ate a snack

9:15 numbness and tingling reduced to 1 or 2

10 pm 50 mg ziprasidone 5 mg melatonin
Numbness and tingling at a 1 or 2
11:30 pm bed

 

Physical panic symptoms were a bit more constant than normal. Will be posting  a log for today 10/21 tomorrow. I think it is important to note that having physical panic symptoms apart from obvious mental anxiety or panic started a bit over 2 years ago a couple months after a series of medication changes. I was tapered quickly off of klonopin and put on a series of three different non benzodiazepine anxiety medicines in succession of about 5 months followed by  a change in my antipsychotic from abilify to ziprasidone. Could it be protracted withdrawal symptoms? From quick tapers/quick cross tapers? It's not unbearable but it is very unpleasant and distracting. It gets unbearable if I don't carefully regulate my eating and sleeping or forget to take my alprazolam.

[AiyahC]

Daily log Oct 21st 2019

9 am woke up 9 hours and 15 minutes of sleep
Tingling and numbness 4 or 5 out of 10

9:05 AM breakfast

9:30 AM 1 mg alprazolam, 30 mg cymbalta, 1000 IU vitamin D, 65 mg iron

10:45 AM numbness and tingling gone. Mental anxiety at a  4 or 5

11:45 numbness and tingling 5 or 6 mental anxiety 6 or 7.

12 pm lunch

1pm therapy

2pm reduced mental anxiety to a 2 or 3 numbness and tingling 3 or 4 took 1mg alprazolam by accident normally do 0.75 mg.

2:30 snack

2:53 PM numbness and tingling 1 or 2 mental anxiety 2 or 3

3:12 PM finished a 12 minute walk

3:30 PM numbness and tingling 1 mental anxiety 2

3:40 PM ate a half portion of dinner because I have therapy at 4:45 pm

4:45 PM therapy

6 pm ate rest of dinner

6:30 PM numbness and tingling 1 mental anxiety 1

7:30 numbness and tingling 3  mental anxiety 2
Took my 0.25 mg dose of alprazolam. Wasn't sure what to do since I accidentally took 0.25 mg extra earlier but was afraid of interdose withdrawal.

9:12 PM numbness and tingling 3 mental anxiety 2

10 pm 50 mg geodon 5 mg melatonin

10:30 PM numbness and tingling 5 or 6 mental anxiety 4 took a lavendar chamomile bubble bath had peppermint tea and snack

10:52 PM numbness and tingling down to 3 or 4 mental anxiety 3

11:10 PM went to bed

Got to sleep about 11:30  PM

Higher mental anxiety today due to external factors and high emotions. 

[AiyahC]

Oct 22nd 2019

 

9:53 AM woke numbness and tingling a 4 or 5 mental anxiety 2

10:05 AM took 1 mg alprazolam, 30 mg cymbalta, 1000 IU vitamin D, and 65 mg of Iron

10:30 AM breakfast

11 am numbness and tingling gone. Mental anxiety 2

12:20 PM lunch numbness and tingling still gone

1:05 PM had a banana numbness and tingling 2 or 3 mental anxiety 1

2:10 PM finished an 18 minute walk. Numbness and tingling 2 mental anxiety 1

2:20 PM took 0.75 mg alprazolam

3:15 PM snack numbness and tingling gone
Mental anxiety 1

4:30 pm did sensations/emotions check in. High mental anxiety 7 or 8  Numbness and tingling 5

5 pm ate dinner

6 pm numbness and tingling down to 3 mental anxiety 4 or 5

8 pm numbness and tingling 4 mental anxiety 4

8:15 PM took 0.25 mg xanax

8:45 PM numbness and tingling at a 7 mental anxiety at a 6 had a snack of peanuts and a glass of milk


9:15 PM finished a 10 minute mindfulness meditation and laid under my weighted blanket numbness and tingling 6 mental anxiety 4

9:50 PM took lavendar chamomile bubble bath and journaled. Numbness and tingling 4 mental anxiety 3

10 pm took 40 mg ziprasidone and 7.5 mg of melatonin. Numbness and tingling 1 mental anxiety 2

11:10 PM numbness and tingling 1 mental anxiety 2 went to bed.

Asleep by 11:30 PM

[AiyahC]

Oct 23rd 2019

8:45 AM woke up. Slept 9 hours and 15 mins. Woke up once to go to the bathroom and woke up at 6 am and 7 am. Fell back asleep  quickly all three times. Numbness 4 tingling 1 mental anxiety 1 or 2 but not anxious about any one thing in particular.  Kind of just baseline anxiety.

9:25 AM took 1 mg alprazolam, 30 mg Cymbalta, 1000 IU vitamin D, and 65 mg iron

9:30 am breakfast

10:15 am numbness and tingling 1 baseline anxiety felt okay


11:45 numbness and tingling 1 baseline anxiety. Felt pretty good

12 pm lunch felt pretty good

Around 12:30 numbness and tingling began to increase to a 2 and than a 3 mental anxiety 2
At 12:56 pm.

1:30 PM ate a little food settled a practical matter numbness and tingling 1 mental anxiety 2 took 0.75 mg alprazolam

2:24 PM numbness and tingling 1 mental anxiety 3 preparing to spend a few days with my brother. Anxious about catching the train and various rhings.

2:35 PM severe mental anxiety about multiple things 8 Numbness and tingling 7 exhausting physically and mentally but bearable. Nothing outside of the realm of my experience.
 
3pm imagined my self place under weighted blanket did audio journaling. Mental anxiety 4 Numbness and tingling 4 or 5 had a snack

3:30 PM feeling much better mental anxiety 3 numbness and tingling 2

5:30 pm made it to my brothers mental anxiety 2 numbness and tingling 1

5:45 PM ate dinner

7 pm to 9:30 PM went to philosophy meet up did very well numbness and tingling 1 mental anxiety 2

9:30 PM to 12 pm talked with my brothers girlfriend numbness and tingling 1 mental anxiety 1

10 pm took 40 mg ziprasidone, 10 mg melatonin

12 pm numbness and tingling 1 mental anxiety 2 took lavendar chamomile bubble bath

12:30 went to bed

[AiyahC]

9 am woke up 8 and a half hours of sleep. Woke up once to go to the bathroom at 7 am and once sometime after that. Got back to sleep quickly both times. Numbness and tingling 2 upon waking mental anxiety 1

10 am took 1 mg alprazolam, 30 mg cymbalta, 1000 IU vitamin D, and 65 mg iron numbness and tingling gone

10:15 am ate breakfast

11:10 am numbness and tingling gone baseline anxiety

12:30 lunch baseline anxiety feeling pretty good

1:17 PM mental anxiety 2 numbness and tingling 1

2 pm mental anxiety baseline numbness and tingling gone. Took 0.75 mg alprazolam.

3:20 pm mental anxiety 1 numbness and tingling 1 snack

4:30 pm mental anxiety 1 numbness and tingling 1

5:30 same as 4:30 pm

6pm ate dinner

7pm baseline anxiety no numbness or tingling

8:24 numbness and tingling 2 mental anxiety 3 anxious about external factors took 0.25 mg alprazolam

9 pm numbness and tingling 3 anxiety 4 anxious about external factors

10 pm took 40 mg of geodon and 7.5 mg of melatonin

11:30 numbness and tingling 3 anxiety 5 anxious about external factors

12 am went to bed anxiety 5 Numbness and tingling 2
 
Around 12:45 am got to sleep

It was amazing what being at my brother's did for my anxiety and my physical anxiety symptoms. Baring when I got anxious about the details of going home this afternoon.

 

I also was really careful with how I was eating which seems to help. If I don't eat enough the physical symptoms flare up.

[AiyahC]

Oct 25th 2019

Woke up 9:45 am got 9 hours of sleep numbness 4 tingling 2 anxiety baseline

10 am took 1 mg alprazolam, 30 mg cymbalta, 1000 IU vitamin D, and 65 mg iron

10:15 am breakfast

11 am numbness 1 tingling 2 anxiety 1

11:30 am numbness and tingling 2 anxiety 3

12:30 PM numbness and tingling 1 anxiety 2

1 pm lunch

2pm numbness and tingling gone anxiety baseline

3:10 numbness and tingling 3 anxiety 2 forgot to take medicine at 2 pm took 0.75 mg alprazolam

4:18 PM numbness and tingling 2 anxiety 1

5:30 dinner numbness and tingling 1 anxiety has baseline

6 pm numbness and tingling gone anxiety baseline

7:30 PM numbness and tingling 2 anxiety 1

8 pm numbness and tingling 2 anxiety 1 took 0.25 mg alprazolam

9 pm numbness and tingling 1 anxiety 1

10 pm same as 9 pm took 40 mg ziprasidone and 5 mg melatonin

10:30 PM went to bed

Got to sleep around 10:50 pm

 

[AiyahC]

Oct 26th 2019

6:30 am woke up numbness 3 tingling 2 anxiety baseline

7:15 am breakfast

9 am numbness and tingling 1 anxiety 1

9:45 am 1 mg alprazolam, 30 mg cymbalta, 1000 IU vitamin D, 65 mg iron. Numbness and tingling 2 anxiety 1

12 pm lunch numbness and tingling 1 anxiety 1

2pm numbness and tingling gone anxiety 2 took 0.75 mg alprazolam

4 pm numbness and tingling 1 anxiety 1

5 pm dinner

7 pm took 0.25 mg Xanax

8 pm no numbness or tingling anxiety baseline

9:30 PM numbness and tingling 1 anxiety 1

10 pm took 40 mg geodon and 5 mg melatonin

11 pm numbness and tingling 2 anxiety 3

11:30 PM went to bed

Fell asleep around 11:45 pm

[AiyahC]

Oct 27th 2019

9:45 am woke up 10 hours of sleep numbness and tingling 2 anxiety baseline took 1 mg alprazolam, 30 mg cymbalta, 1000 IU vitamin D and 65 mg iron.

10 am breakfast numbness and tingling 1 anxiety 1

11 am to 1:15 PM mass and lunch. Numbness and tingling 1 anxiety baseline

1:50 PM took 0.75 mg alprazolam

2:15 PM numbness and tingling 3 anxiety 1

3:30 same had a snack numbness and tingling calmed to 2 anxiety 1

4:30 same had another small snack

6:15 PM had dinner

6:30 numbness and tingling gone baseline anxiety.

7:30 numbness and tingling 2 anxiety baseline small snack of carrots

9:30 numbness and tingling 2 anxiety base line

10:15 pm took 40 mg of ziprasidone and 5 mg of melatonin

11 PM numbness and tingling 3 anxiety 1 had a snack of peanuts

11:15 PM numbness and tingling 2 anxiety 1 went to bed

Got to sleep around 11:30 PM

[AiyahC]

Oct 28th 2019

9:07 am woke up. Around 9 and a half hours of sleep woke up once to go to the bathroom and once at 8:45 am fell back to sleep quickly. Numbness 2 and tingling 1anxiety baseline

9:20 am 1 mg alprazolam, 30 mg cymbalta, 1000 IU vitamin D, and 65 mg iron

9:30 am breakfast

9:50 numbness and tingling gone

12:30 PM numbness and tingling 4 anxiety 3 started eating lunch

1:05 PM numbness and tingling 3 anxiety 3

1:20 PM numbness and tingling 6 anxiety 5 took 0.75 mg alprazolam using various coping skills panic 5

1:30 numbness and tingling 6 anxiety 5 panic 5

2pm numbness and tingling 4 anxiety 4 still using various coping skills panic 3

2:10 PM went for a 10 minute walk. Numbness and6 tingling 3 anxiety 3 panic 1

2:20 PM left for therapy doing breathing exercises on the way panic 1

2:55 PM arrived at therapy splashed cold water on my face numbness and tingling 1 anxiety 3

3 pm therapy good session anxiety 1

4pm numbness and tingling 1 anxiety 1 off to second therapy appointment.

4:45 PM numbness and tingling 3 anxiety 2
Start of second therapy appointment

Hard to concentrate during therapy. I thought if be okay if I brought snacks but putting off dinner until 6 pm after having so much anxiety earlier in the day set me over the edge. Numbness and tingling 4 anxiety 4

5:45 PM numbness and tingling 5 anxiety 5

6 pm dinner got some relief numbness and tingling dropped to 2 anxiety 3 took 0.25 mg alprazolam

7:30 PM numbness and tingling 3 anxiety 3

8:30 same had a link to trauma I experienced pop up in an anime I was watching spent about half an hour processing emotions anxiety and physical symptoms went down while I was processing emotions

9:15 PM did some more processing

9:30 PM numbness and tingling 4 anxiety 5

10 pm took 40 mg geodon and 10 mg melatonin

10:15 tried to go to bed but hungry and numbness and tingling 4 anxiety 5 kept me awake.

10:30 ate carrots and peanuts still hungry so I tried to eat a bowl of cereal. Got nauseous and threw up. It's been a long time since I've gotten that anxiety symptom.

10:45 PM went back to try to sleep numbness and tingling 3 anxiety 5

Got to sleep around 11:45 PM

I think taking my medicine 15 minutes early and delaying my lunch by half an hour after not eating alot of calories for breakfast combined with some external factors led to the first panic attack and than having no chance to eat something substantial before my second therapy appointment caused severe anxiety to my already sensitized thrown off balance self. Won't be scheduling appointments like that again even if there is no other option unless I figure out a better eating solution. Anxiety hasn't been that bad in awhile. It was pretty tortuous although not out of my realm of previous experience.

Feeling much better this morning (Oct 29th)

[AiyahC]

Nov 5th

9:30 am woke up numbness and tingling 1 anxiety baseline. Slept 9 and a half hours woke up once to use the bathroom fell asleep quickly.

9:40 am took 1 mg alprazolam, 30 mg cymbalta, 1000 IU vitamin D, and 65 mg iron

12:15 PM lunch numbness and tingling 1 anxiety 1

1:30 pm numbness and tingling 1 anxiety 1

1:40 pm took 0.75 mg alprazolam

3:30 numbness and tingling 1 anxiety 1

5pm dinner

6:30 numbness and tingling 2 anxiety 2

7:20 PM took 0.25 mg alprazolam numbness and tingling 1 anxiety 2

8:30 numbness and tingling 1 anxiety baseline

10 PM took 30 mg ziprasidone and 10 mg melatonin
 
11 pm snack numbness and tingling 1

11:45 PM bed

Fell asleep around 12 am

 

I had a few days where my sleep schedule was off due to my staying up until 12:30 am reading one night and than taking an hour and a half to fall asleep. Than I was out of the habit of recording my day and had a few days were I recorded only a small part of the day. Apparently I'm sensitive to my bed time routine changing. Just staying up a little later and not taking my lavendar chamomile bubble bath threw my sleep schedule off. I still slept, just got to sleep late and woke up late and felt off.
 

[AiyahC]

Nov 6th

9:30 am wake up 9 and a half hours of sleep. Woke up once to go to the bathroom got back to sleep within 15 minutes. Numbness 3 tingling 2

9:45 am took 1 mg alprazolam, 30 mg Cymbalta, 1000 IU vitamin D and 65 mg iron.

10 am breakfast numbness and tingling gone anxiety 1

11:20 PM numbness and tingling 1 anxiety 2

12 pm numbness and tingling 2 anxiety 2 ate lunch

1 pm numbness and tingling gone anxiety 2

2 pm numbness and tingling 2 anxiety 5
External factors
3:30 PM numbness and tingling 1 anxiety 4 external factors discovered my car was dead because I left my keys in the ignition but not running just half way turned on. missed therapy as a result.

5 pm dinner

7 PM took 0.25 mg alprazolam

7 PM to 9 pm watched movie and talked to friend numbness and tingling 1 anxiety 2

10 pm took 30 mg ziprasidone, 10 mg melatonin

11 pm numbness and tingling 0 anxiety baseline

11:30 PM bed

Got to sleep pretty much right away
 

[AiyahC]

Nov 7th

7:30 am woke up numbness and tingling 0 anxiety 2 slept 8 hours

3:45 am I've been a horrible mess all day severely anxious about my car

6:15 PM dinner numbness and tingling 1 anxiety 4

7 pm to 9 pm Watched some anime after dinner and calmed down. Car is fixed. Numbness and tingling 0 anxiety 1

 

7:30 took 0.25 mg alprazolam

10 pm took 30 mg ziprasidone and 10 mg melatonin numbness and tingling 0 anxiety 1

11:30 went to bed. Fell asleep quickly



 

[AiyahC]

Nov 8th 2019

9:47 am woke up numbness and tingling 0 anxiety baseline

10 am  took. 1 mg alprazolam, 30 mg cymbalta, 1000 IU vitamin D, and 65 mg iron

10:15 am breakfast

11:15 PM numbness and tingling 0 anxiety 1

12 pm lunch

1 pm still no numbness and tingling anxiety 2

2 pm numbness and tingling 1 anxiety baseline
Took 0.75 mg alprazolam

4 pm no numbness and tingling anxiety baseline

5 pm dinner

5:50 PM numbness and tingling 1 anxiety 1

7:30 PM numbness and tingling 1 anxiety 2

9 PM took 0.25 mg alprazolam forgot to tale it earlier. Numbness and tingling 1 anxiety 2

10 pm numbness and tingling 0 anxiety 3 took 30 mg ziprasidone and 5 mg melatonin

11:30 PM bed fell asleep quickly


 

[Altostrata]

Thanks for the notes. Can you single-space them in the future?

 

On 10/21/2019 at 8:20 AM, AiyahC said:

I think it is important to note that having physical panic symptoms apart from obvious mental anxiety or panic started a bit over 2 years ago a couple months after a series of medication changes. I was tapered quickly off of klonopin and put on a series of three different non benzodiazepine anxiety medicines in succession of about 5 months followed by  a change in my antipsychotic from abilify to ziprasidone. Could it be protracted withdrawal symptoms? From quick tapers/quick cross tapers? It's not unbearable but it is very unpleasant and distracting. It gets unbearable if I don't carefully regulate my eating and sleeping or forget to take my alprazolam.

 

Aiyah, is this why you're taking such an unusual basket of drugs? To treat the symptoms you got from drug changes a couple of years ago? Why did you originally go on sertraline, trazodone, risperidone, Xanax, and mirtzapine in 2015? Did you go on all these drugs at once?

 

When would you say symptoms are worse? What does "numbness" mean? Where is the tingling? Is some tingling constant?

 

Why do you take Cymbalta and alprazolam at the same time in the morning?

 

[AiyahC]

Hey altotrata, in 2015 I experienced an uptick up depression and anxiety symptoms and an increase in what I did not know at the time to be psychotic symptoms. I was first prescribed sertraline by my family doctor. A month or two later I was referred to a psychaitrist by my therapist because I was having really bad insomnia (started before the sertraline I think but my memory is hazy). I was prescribed trazodone for sleep and than a month later risperidone for the psychotic symptoms. I had had panic attacks before but I got a really bad one in late April or May 2015 and my psychaitrist prescribed Xanax as needed. I had a hospital stay mid to late may and they added mirtzapine because I had little to no appetite and had lost a lot of weight. 

 

Because of my history of psychotic symptoms, depression and anxiety I've been on some mixture of anti depressant, anti psychotic and anti anxiety medication since 2015 but Xanax became scheduled instead of as needed after the switch from abilify to ziprasidone  and the taper off of klonopin and into a series of non benzo anxiety meds. I really regret that now because it's obvious my body is very dependent on it and it  doesn't seem to do much for my anxiety anymore besides keeping symptoms from exacerbating from not having the Xanax for too long a period of time.

 

I haven't had psychotic symptoms in over a year and nothing constant in at least two years. I seem to be doing fine with lowering my dose so far. Honestly I never felt the medicine helped a whole lot with any of my symptoms - my psychotic symptoms were already lessening when I was put on ziprasidone and the risperidone and abilify really didn't do anything but sadly I bought into the medical model of mental illness until last June and thought psychiatry was my best option.

 

 I am not as groggy as I was now that I am taking less of the geodon. And I don't feel the need to take naps like I did when I was at my original dose of 160 mg. I still sometimes sleep 10 hours but 9 hours has become more common and it doesn't take me a good hour and a half to wake up any more.

 

I would say symptoms are worst just before I take my next Xanax dose or after a few hours of not eating or if I am at all short on sleep. Or if i have too much caffeine.

 

It's hard to explain but I lose some feeling in my face and sometimes hands and feet, more or less depending on how bad it is and the tingling feels kind of like pins and needles but am not exactly satisfied with that explanation. I used to only get it when I was having a really bad panic attack but it became more frequent and not always attached to a panic attack a month or two after the before mentioned medication changes.

 

As for taking the Cymbalta and the Xanax at the same time, that's mostly for convenience sake I suppose. I'm supposed to take the Cymbalta in the morning and I usually am experiencing numbness and tingling when I wake up so I've been taking them together. Would that cause a problem?

 

 

[Altostrata]

What were these "psychotic" symptoms?

 

When you take two drug together and have an adverse reaction after, we can't tell which drug is causing the adverse reaction.

 

Is your doctor aware you take alprazolam all day long?

 

When did you develop "essential tremor" and tardive dyskinesia? Have you recovered from either?

 

That's an absurd combination of psychiatric drugs for any condition. Please continue to post 24 hours of daily symptom notes at a time, single-spaced.

[AiyahC]

Hey, my psychotic symptoms were paranoia, paranoid delusions and hearing voices. They gradually got better over the space of two to 3 years until I was no longer having anything but occasional paranoia and an occaisonal voice. Haven't had even that in over a year. The antipsychotics didn't really seem to have an effect other than making me really sleepy and energyless. I had an MRI and and the other test where they put electrodes on your head to make sure it wasn't neurological. Tests came back normal

 

I can try spacing out the Cymbalta and the Xanax a little. Would an hour be sufficient?

 

Yes, My Xanax is currently prescribed as 1 mg 2x daily at scheduled times and 1 mg as needed. I haven't been taking the as needed but I split up my afternoon dose into 3/4 in the afternoon and 1/4 in the evening because my anxiety was giving me alot of trouble at night and I suspect it's withdrawal symptoms. I want to space my Xanax out into 4 0.5 mg doses but I didnt want to touch it while I am tapering the ziprasidone for fear of doing too much at once. 

 

The essential tremor started around the same time as my psychotic symptoms which was before I was on any medication. I still have it but it isn't as pronounced as it was. I'm still not sure if it is an essential tremor or something else. The tarkive dyskinesia started last year with mouth movements it wasnt noticeable to me but was noticeable to my psychaitrist. I honestly am not sure if I still have it but the anti psychotics are definitely at fault and I am a little mad that my psychaitrist didn't immediately try going down on the ziprasidone. I will have to ask someone close to me or my psychaitrist whether I am still showing symptoms. At least it is mild enough that I am not aware of it.

 

Will do! I will try to start posting a journal again tomorrow. And I agree it is absurd. Unfortunately it's not uncommon.

 

 

[Altostrata]

How long have you been taking Xanax on that schedule? I'd like to bring @Shep on this to consult. Quite often, the benzo in the mix is causing problems.

 

1 hour ago, AiyahC said:

The tarkive dyskinesia started last year with mouth movements it wasnt noticeable to me but was noticeable to my psychaitrist.

 

What was your drug mix at that time? Why did your psychiatrist not reduce the antipsychotic then?

[Shep]

3 hours ago, AiyahC said:

Yes, My Xanax is currently prescribed as 1 mg 2x daily at scheduled times and 1 mg as needed. I haven't been taking the as needed but I split up my afternoon dose into 3/4 in the afternoon and 1/4 in the evening because my anxiety was giving me alot of trouble at night and I suspect it's withdrawal symptoms. I want to space my Xanax out into 4 0.5 mg doses but I didnt want to touch it while I am tapering the ziprasidone for fear of doing too much at once. 

 

We can work on setting up a schedule to space out the Xanax. Xanax has a half-life of 6 -12 hours, so depending on how fast you metabolize it, you may be fine with just 3 doses a day. You'll want to keep taking it an hour or two away from the ziprasidone due to the drug interaction. 

 

Please confirm how much Xanax you're currently taking - you state you want to space it out into 4 0.5 mg doses (which is 2 mg total), but from your drug and symptoms notes, it looks like you're only taking 1 mg in total. 

 

On 11/9/2019 at 12:10 PM, AiyahC said:

10 am - took. 1 mg alprazolam, 30 mg cymbalta, 1000 IU vitamin D, and 65 mg iron
2 pm - 0.75 mg alprazolam
9 PM - 0.25 mg alprazolam
10 pm - 30 mg ziprasidone and 5 mg melatonin
 

 

I'm concerned about the high dose of melatonin you're taking, as well as the fact that you're not consistent with the amount. 

 

Do you need melatonin to sleep? It looks like you're currently getting as much as 10 hours of sleep some nights, probably from the ziprasidone. Please be consistent with how much melatonin you take each night. You may even want to reduce the dose gradually over the next few days. Please see this thread for more information:

 

Melatonin for sleep

 

Please update your signature to reflect the other drugs you're taking besides ziprasidone in the last three lines of your signature.  A direct link to your signature is here:

 

Account Settings - Create or Update Your Signature

 

[AiyahC]

16 hours ago, Shep said:

 

We can work on setting up a schedule to space out the Xanax. Xanax has a half-life of 6 -12 hours, so depending on how fast you metabolize it, you may be fine with just 3 doses a day. You'll want to keep taking it an hour or two away from the ziprasidone due to the drug interaction. 

 

Please confirm how much Xanax you're currently taking - you state you want to space it out into 4 0.5 mg doses (which is 2 mg total), but from your drug and symptoms notes, it looks like you're only taking 1 mg in total. 

 

 

I'm concerned about the high dose of melatonin you're taking, as well as the fact that you're not consistent with the amount. 

 

Do you need melatonin to sleep? It looks like you're currently getting as much as 10 hours of sleep some nights, probably from the ziprasidone. Please be consistent with how much melatonin you take each night. You may even want to reduce the dose gradually over the next few days. Please see this thread for more information:

 

Melatonin for sleep

 

Please update your signature to reflect the other drugs you're taking besides ziprasidone in the last three lines of your signature.  A direct link to your signature is here:

 

Account Settings - Create or Update Your Signature

 

 Hi shep! I am taking 1 mg of xanax in the morning, 0.75 mg in the afternoon, and 0.25 mg in the evening. Setting up a schedule to pace out the Xanax would be great! For the first two doses after 4 hours I start to feel interdose withdrawal from the Xanax. My anxiety gets worse and I get physical panic attack symptoms even if im not mentally panicky. The evening dose i can go 5 to 5 and a half hours from the afternoon dose before i start to feel it.

 

I have had bad insomnia in the past and was on trazodone for that. If I had researched more I would have realized getting rid of the trazodone before getting off all the others was a mistake. The melatonin, taking a bubble bath, staying away from screens two hours before bed and a weighted blanket have done the trick consistently for the last 3 months. I normally take 5 mg of the melatonin but on nights I'm particularly anxious or afraid i won't sleep I'm guilty of taking 7.5 mg or 10 mg. Once I'm asleep I'm normally fine. I know the ziprasidone makes me sleep more than the average person. My energy level and grogginess have gotten better as I've reduced the dose and I don't take as long to wake up. I'll try not to take more than the 5 mg of the melatonin and keep it consistent.

[AiyahC]

18 hours ago, Altostrata said:

How long have you been taking Xanax on that schedule? I'd like to bring @Shep on this to consult. Quite often, the benzo in the mix is causing problems.

 

 

What was your drug mix at that time? Why did your psychiatrist not reduce the antipsychotic then?

 

I've been taking the Xanax on that schedule for a year and a half.

 

At that time I was on 160 mg of ziprasidone, 90 mg cymbalta, 100 mg of trazodone, 2 mg of Xanax scheduled and 1 more mg as needed, 25 mg of attarax 3x a day and 10 mg of bethenechol 3x a day. I was definetely over medicated and if my therapist hadn't pointed it out and suggested I read anatomy of an epidemic (she had recently read it and thought of me) I still would be.

 

Apparently to my psychaitrist the tarkive dyskinesia wasn't severe enough for her to feel she needed to lower the dose. Fortunately because of the absurd amount of sleep and low energy I was having she did some time after that  started lowering the dose. I dont really understand why she didn't do it immediately as a smaller maintenance dose would have made more sense even coming from a biomedical model of mental illness as I haven't had symptoms in a long time.

 

 

[Altostrata]

Aiyah, since your episodes of panic might be related to alprazolam (how often do you forget to take it on schedule?), getting your dosing schedule regular will be very important to the next stage of tapering anything. @Shep will help you with this.

[Shep]

 

On 11/30/2019 at 9:37 AM, AiyahC said:

I am taking 1 mg of xanax in the morning, 0.75 mg in the afternoon, and 0.25 mg in the evening. Setting up a schedule to pace out the Xanax would be great! For the first two doses after 4 hours I start to feel interdose withdrawal from the Xanax. My anxiety gets worse and I get physical panic attack symptoms even if im not mentally panicky. The evening dose i can go 5 to 5 and a half hours from the afternoon dose before i start to feel it.

 

Thanks for verifying your Xanax dose. 

 

You mentioned wanting to space it out 4 times a day. This is an example of a 4-times-a-day dosing schedule: 

 

9 AM - .5 mg alprazolam

10 AM - 30 mg cymbalta, 1000 IU vitamin D, and 65 mg iron

12 PM - .5 mg alprazolam

4  PM - .5 mg alprazolam

9 PM - .5 mg alprazolam

10 PM - 30 mg ziprasidone and 5 mg melatonin

 

What do you think about this schedule? 

 

If you decide to do this, it's best to gradually move your dose one hour per day. These are the steps over the coming days to get where you're at to this schedule:

 

CURRENT SCHEDULE:

 

10 AM - 1 mg alprazolam, 30 mg cymbalta, 1000 IU vitamin D, and 65 mg iron
2 PM - .75 mg alprazolam
9 PM - .25 mg alprazolam
10 PM - 30 mg ziprasidone and 5 mg melatonin 

 

DAY 1

 

9 AM - .5 mg alprazolam

10 AM - .5 mg alprazolam, 30 mg cymbalta, 1000 IU vitamin D, and 65 mg iron
2 PM - .75 mg alprazolam
9 PM - .25 mg alprazolam
10 PM - 30 mg ziprasidone and 5 mg melatonin

 

DAY 2 

 

9 AM - .5 mg alprazolam

10 AM - 30 mg cymbalta, 1000 IU vitamin D, and 65 mg iron

11 AM .5 mg alprazolam
2 PM - .75 mg alprazolam
9 PM - .25 mg alprazolam
10 PM - 30 mg ziprasidone and 5 mg melatonin

 

DAY 3

 

9 AM - .5 mg alprazolam

10 AM - 30 mg cymbalta, 1000 IU vitamin D, and 65 mg iron

12 PM -  .5 mg alprazolam
2 PM - .75 mg alprazolam
9 PM - .25 mg alprazolam
10 PM - 30 mg ziprasidone and 5 mg melatonin

 

 

DAY 4

 

9 AM - .5 mg alprazolam

10 AM - 30 mg cymbalta, 1000 IU vitamin D, and 65 mg iron

12 PM -  .5 mg alprazolam

3 PM - .75 mg alprazolam
9 PM - .25 mg alprazolam
10 PM - 30 mg ziprasidone and 5 mg melatonin

 

 

DAY 5

 

9 AM - .5 mg alprazolam

10 AM - 30 mg cymbalta, 1000 IU vitamin D, and 65 mg iron

12 PM -  .5 mg alprazolam

4 PM - .75 mg alprazolam
9 PM - .25 mg alprazolam
10 PM - 30 mg ziprasidone and 5 mg melatonin

 

DAY 6

 

9 AM - .5 mg alprazolam

10 AM - 30 mg cymbalta, 1000 IU vitamin D, and 65 mg iron

12 PM -  .5 mg alprazolam

4 PM - .5 mg alprazolam

5 PM - .25 mg alprazolam
9 PM - .25 mg alprazolam
10 PM - 30 mg ziprasidone and 5 mg melatonin

 

DAY 7

 

9 AM - .5 mg alprazolam

10 AM - 30 mg cymbalta, 1000 IU vitamin D, and 65 mg iron

12 PM -  .5 mg alprazolam

4 PM - .5 mg alprazolam

6 PM - .25 mg alprazolam
9 PM - .25 mg alprazolam
10 PM - 30 mg ziprasidone and 5 mg melatonin

 

 

DAY 8

 

9 AM - .5 mg alprazolam

10 AM - 30 mg cymbalta, 1000 IU vitamin D, and 65 mg iron

12 PM -  .5 mg alprazolam

4 PM - .5 mg alprazolam

7 PM - .25 mg alprazolam
9 PM - .25 mg alprazolam
10 PM - 30 mg ziprasidone and 5 mg melatonin

 

 

DAY 9

 

9 AM - .5 mg alprazolam

10 AM - 30 mg cymbalta, 1000 IU vitamin D, and 65 mg iron

12 PM -  .5 mg alprazolam

4 PM - .5 mg alprazolam

8 PM - .25 mg alprazolam
9 PM - .25 mg alprazolam
10 PM - 30 mg ziprasidone and 5 mg melatonin

 

 

DAY 10

 

9 AM - .5 mg alprazolam

10 AM - 30 mg cymbalta, 1000 IU vitamin D, and 65 mg iron

12 PM -  .5 mg alprazolam

4 PM - .5 mg alprazolam
9 PM - .5 mg alprazolam
10 PM - 30 mg ziprasidone and 5 mg melatonin

 

 

If you find that taking .5 mg alprazolam so close to the ziprasidone is problematic, you could take the alprazolam at 8 PM instead of 9 PM. 

 

Please post your thoughts on this schedule.