boonana: Helping Mum with Polydrug Withdrawals.

[boonana]

Hi all, 

 

It's been a crazy few months since August... and yet it feels like we barely started on this journey. Not really looking forward to next year based on what I've seen...  

 

Anyway, some background, my 62yr old mum has on and off over the years experienced stress related throat symptoms - difficulty swallowing, lump in throat etc. All her visits to throat specialists yielded nothing (except for a slight hernia hiatus w/ GERD, which she was put on a PPI long term for). Unable to find the source of her discomfort, she became more distressed by it, resulting in a vicious cycle of cause and effect. Eventually she got put on Fluvoxamine 150mg, Olanzapine 2.5mg and Nordiazepam 11.25mg back in 2018 Nov. Previously she has been rx fluvoxamine on and off since 2004, and seem to have always gone cold turkey off them whenever she felt better. Her pdoc never warned her not to do so, nor suspected that her repeated visits and complaints of symptoms may have been due to withdrawal. She was previously rx benzos PRN but never took them until the TID prescription in nov 18. 

 

Fast forward to 2019, she started exhibiting symptoms of what i now know was tolerance withdrawal from benzos, increasing anxiety and visibly fearful, things shes never had before. In Aug 19 she switched a pdoc believing that the previous pdoc's meds werent working anymore. 

The new pdoc cold turkeyed her off the antipsychotic as well as her benzo, but rx clonazepam to her to be taken PRN, but only if she really needs it coz it's 'addictive' and thus bad. She was also switched to mirtazapine 30mg. 

This switch resulted in a tsunami of acute withdrawal symptoms to appear. Within weeks of zero sleep and many many disturbing symptoms, she became suicidal. I got involved at this point, but was otherwise ignorant of the real danger she was in. I knew she was in withdrawal, I just didnt know withdrawals could be so dangerous or last that long. The pdoc reassured me that everything will be okay, and that she's already looking better than when she first came in! (Turns out, it was because she had a clonazepam just before the appointment. Duh!) When things didnt relent by the end of august, and she became actively suicidal, i grew concerned and admitted her to a psych ward.

 

Bad mistake, because they misdiagnosed her as depression and did a major change to her cocktail of drugs again. They reinstated her on 10mg V, and switched her to 75mg Effexor XR, as well as loaded her on zdrugs for the duration if her stay(10+days). This mistake did help me figure out what went wrong though, as the switch to Valium helped me find benzobuddies and the ashton manual. Only then did the past month finally make sense. I was horrified at how arbitrary pdocs were making their adjustments to medications, and shocked that they would so blatantly tell me its her underlying illness that she has been masking symptoms of from me. Makes one wonder if she was so good at masking symptoms previously, why is she incapable of doing so now? 😕 They tried to cold turkey / rapid taper her off V again, but i insisted they reinstate her back on her benzo and do a proper taper instead. They agreed but only reinstated and discharged her with 8mg V with the instruction to taper her benzo at 1mg/mth. 

 

My discovery and obsession of benzo withdrawal has blinded me to the other two real dangers that she was in, that she was cold turkeyed off an antipsychotic, and put on venlaflaxine, a super short halflife snri. By the time I realize it may not just be benzo withdrawal, it was too late, she was already off olanzapine for 3 mths, and on effexor xr for the same amount of time. I raised my concerns, but the pdoc brushed away my concern again. 
 

These ill advised tapering instructions resulted in my mum entering a state of catatonia stupor in mid nov, and had to be admitted to the hospital for a week, after she couldnt stabilize on her 1mg cut to 7mg V. 

 

As of now, shes having a myriad of symptoms, including but not limited to dp/dr, akathisia, broken sleep, major brain fog cognitive dysfunction/memory issues, paranoia, confusion, dysphagia, anxiety, fear, panic, agoraphobia, constipation and other gi issues, and something im growing more and more concerned for, tardive dyskinesia (rapid eye blinking, chewing, lips smacking) which Im wondering if it was from the olanzapine cold turkey or the clonazapem use for 3 weeks after her first cold turkey. 

 

Most days, shes hardly present and would take a long time to register things i say, or execute simple instructions. Her cognitive skills fluctuates, but only from really bad to somewhat bad, never good or normal. Her anxiety has somewhat weaned but is still fearful and obsessively worried and paranoid. She bounced back from her catatonic state rather quickly, but is experiencing severe dp/dr and brain fog that hasnt relented for the 2 weeks since she got discharged from the hospital. Waves and windows throughout the day... 

 

Anyway.. her tardive dyskinesia concerns me... and got me reading up on more than just benzo withdrawal. Effexor has always concerned me, so on and off i'd be on SA reading up about it, but Ashton said to taper ADs after benzos so i never really questioned it, until I read the thread about tapering stimulating drugs first which got me thinking if we should get her off effexor first and do a long hold on her benzo instead... of course, i'm assuming her pdoc will be supportive but who knows 😕

 

Anyway... I'm currently holding her on 7mg V intil the end of the year, which will make it about 2+mths shes on that dosage. Will do a micro taper eitherway, drycutting V or counting beads for effexor XR. 

 

As of now, i started tapering her PPI omeprazole coz shes been on it for almost 4 yrs and that concerns me... as well as the Valium Interaction with omeprazole. 

 

for all I know, her anxiety and throat symptoms over the yrs couldve been caused by the PPI, coupled with her cold turkeying off her ADs on her own over the years, it seemed like a perfect storm waiting to happen... I wish back then I had known the things i know now, perhaps then she wouldnt be on these drugs or been cold turkeyed off them. It's painful to watch her usually high functioning self be reduced to someone whom I have to bring to the washroom otherwise she doesnt remember she has to urinate.  I really miss her. I wish I had read up more, because I had the exact same thing happen to me in my early 20s with ADs and antipsychotics (had a BS bipolar II diagnosis and even had 10 rounds of ECT done to me) but I was taught to embrace my mental illness and work towards recovery... but I always kind of knew it was BS because I knew I didnt become suicidal or had behavioral issues until i started on psych drugs, and that I didnt fully recover until i was off them for a couple of years (I learnt to act normal so my pdoc would take me off them). Anyhow... tons of regret not researching more when I was younger, coz I can see clearly now what happened to me back then, and what is happening to my mum now. 

 

Sorry for the long post. Been feeling very guilty and helpless lately over her current situation, and cant figure out what the next best step should be. 

 

Anyway, I hope everyones doing ok and making progress in their own journey to recovery. 

 

 

 

 

 

 

 

 

 

 

[Gridley]

Welcome to SA, noonana.  I'm very sorry about what the doctors and their drugs have done to your mother.  

 

We recommend tapering only one drug at a time.  Otherwise, if problems arise you won't know which taper is causing them.  As you've already read, we recommend tapering the activating drug first, leaving the sedating drug to act as a buffer to be tapered later.  In your mother's case, the drug to taper first would be the Effexor.  The drug interaction between omeprazole and valium is only moderate.  You would have to decide whether to taper that at the same time as the effexor.  I would lean against it.

 

We recommend tapering by no more than 10% of current dose every four weeks.

 

Why taper by 10% of my dosage?

 

The following link give specific instructions about tapering Effexor.

 

Tips for tapering off Effexor (venlafaxine)

 

The symptoms you describe are typical withdrawal symptoms.  

 

What is withdrawal syndrome.

 

Glenmullen’s withdrawal symptom list.

 

When we take medications, the CNS (central nervous system) responds by making changes over the months and years we take the drug(s). When the medication is discontinued, the CNS has to undo all the changes it made. Rebuilding the neurotransmitter production and reactivating the receptor and transporter cells takes time -- during that rebuilding process symptoms occur.  

 

This explains it really well:

 

Video:  Healing From Antidepressants - Patterns of Recover

 

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium and omega 3 (fish oil). Many people find these to be calming to the nervous system. 

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

Please research all supplements first and only add in one at a time and at a low dose in case you do experience problems.

 

This is your Introduction topic, where you can ask questions and connect with other members.  We're glad you found your way here.

 

 

 

 

[boonana]

Hi Gridley, thank you for the resources. 

 

As of now, I'm leaning on tapering her off Omeprazole or leaving her at 10mg, before beginning a taper off her effexor and subsequently the Valium. Not sure if thats the best approach but it seems that we are pretty much on our own with these things... doctors seem to not care much:/ She doesnt seem to be having any rebound reflux when we jumped from 40mg to 20mg, nor the time after we jumped to 15mg, but we're taking it slow. 

 

Anyway, she has moved in with me, together with my dad, so we're keeping an eye on her. She had a weird panic/terror state earlier where her lower body just turned stiff and she couldnt walk, just stood in place frozen. 

 

Was clearing her stuff out from the old apartment, and found a diary she kept that documented my medication history 10yrs ago, back when she was taking care of me. We naively believed that I was bipolar, and that I needed medication. 😕

 

I dont remember that much from that period of my life, both due to the meds as well as ECT done to me, but seeing my medical history, things are starting to make sense. 

 

I was on a cocktail of lamictal / lexapro / remeron and seroquel, and was tapered off all 4 mediation in 13 mths, step wise, tapered all 4 in the same period, but never more than one medication adjustment at any one time. This was the cocktail i ended up on, but i think I had major adjustments that unnerved by CNS earlier in my treatment which resulted in ECT given to me. 

 

Anyway, I'm wondering if there are others who have tapered down their drugs concurrently as well(but never more than one drug adjustment at once). It kind of make sense to me as well, because I worry that tapering her off the activating drug will untip the balance and cause a chemically induced depression instead, although at this point its hard to figure out whats a balanced dosage is. 

 

The jump from 150mg fluvoxamine to 30mg mirtazapine to 75mg effexor seem pretty intense as well. I wasnt able to find a equivalent  dosage calculator for ADs but according to this one table i found, it seems like 75mg of effexor is almost 50% less than the 150mg fluvoxamine she was on. Does anyone have a link to a AD dosage conversion calculator?

So its seems to me shes not just suffering from benzo withdrawal, but also a drop in serotonin levels and a drop in dopamine from her antipsychotic cold turkey...  

 

gosh, its crazy to think that pdocs can make such drastic changes to psych meds, destabilize you so much, and then turn around and try to misdiagnose you with an underlying mental illness. Do they really know what theyre doing? It scares me that perhaps they're just like me, guessing and hoping we're right. 😱

[Gridley]

15 hours ago, boonana said:

Anyway, I'm wondering if there are others who have tapered down their drugs concurrently as well(but never more than one drug adjustment at once).

 

You can look at Rhiannon's thread.  She did and is doing a concurrent taper. She is very knowledgable about these matters.  You can use the search function in upper right corner at the top of this page.

 

Google survivingantidepressants.org antidepressant equivalency    You will find several threads.

 

 

[planifolia]

Hi Boonana, sorry to hear how awful the pdocs have been. Unfortunately this is very common, even more so in South-east asia where there is little connection to the withdrawal knowledge and momentum understood in the western nations, particularly the US and UK. 
 

I am from Hong Kong, and the situation I experienced with docs is very similar to what you have experienced. However miraculously i met a doc that was withdrawal literate, but it wasn’t because she read publications by withdrawal researchers, such as professor ashton and healy, but she listens to her patients and and believes in her observations. I believe if you look around enough, you may be able to find a doc that maybe more understanding of withdrawal. There must be atleast one in the entirety of singapore. 
 

I wish your mum’s condition is hopefully getting better. Regardless, a slow and sensible taper she will eventually make it off and heal. Take care

[Superwoman]

Boonana,

It makes me so mad how inept most of these doctors are and how they don’t listen to their patients and hand out powerful drugs like candy.  If your mom has to be hospitalized again maybe a detox drug addiction facility would be better than a psych ward?  I did read on here that detox facilities do not know about antidepressant dependency and withdrawal.  However, she is also on a benzo and doctors do acknowledge that those are addictive.  At any rate I think a detox facility would be more knowledgeable about withdrawal in some regards for some substances.