theskul: Should I reinstate?

[theskul]

On 12/15/2019 at 6:07 PM, Sassenach said:

I suggest you wait at least a further week to ensure you are stable before beginning another taper.

 

Now it is close to a week since you posted this. I am not feeling stable. I feel so fragile inside and have horrible anxiety [edit: I pace around the house quite a bit] about never getting better. [edit: But sometimes I feel better, but the fear of never getting better is close by]

 

My medication is stable since 8. Des.

 

But I am thinking about starting to taper soon, maybe in a few days. What do you think? Doing a small cut and see how it goes.

 

I'm so confused and scared about what to do about my Keto Diet, because it may affect the GABA system.

[Shep]

19 hours ago, theskul said:

I feel so fragile inside and have horrible anxiety [edit: I pace around the house quite a bit] about never getting better. [edit: But sometimes I feel better, but the fear of never getting better is close by]

 

I understand the fears. It will help to build up your non-drug coping skills while you're holding. Here are some ideas:

 

Non-drug techniques to cope with emotional symptoms

 

What you wrote about "the fear of never getting better." Please note this can lead to emotional spirals. This thread help: 

 

Dealing With Emotional Spirals

 

When you start to have these fears, trying "changing the channel." Here's how: 

 

"Change the channel" -- dealing with cognitive symptoms

 

You may find guided meditations or breathing meditations very helpful. Here's an example:

 

The Breathing Space by Jon Kabat Zinn video (4 minutes)

 

Dr. Claire Weekes also has some great techniques:

 

Dr. Claire Weekes - How To Recover

 

20 hours ago, theskul said:

But I am thinking about starting to taper soon, maybe in a few days. What do you think? Doing a small cut and see how it goes.

 

I'm so confused and scared about what to do about my Keto Diet, because it may affect the GABA system.

 

Because you're feeling so unstable, I would hold for another week and see how you feel. Also, you may want to resolve your diet issues before you begin tapering. 

 

We aren't nutritionists here, so we can't give you any more information than what the staff and members have posted in the various threads dealing with the different diets folks have been on during withdrawal. You may want to join a Keto forum to get more information. This is one:

 

Ketogenic Forums

 

I can't vouch for it, as I'm not a member and not versed in this particular diet, but you may find more information there about Keto's role in GABA. 

 

The best advice is to pick a healthy diet that contains proteins, veggies, and fruits. A diet low in sugar and caffeine is best, and of course, avoid alcohol. Remember to drink plenty of water throughout the day. Most of us get through this without going on a restrictive diet, but if you do find Keto helpful, there's no reason not to do it. 

[theskul]

Thank you so much. I'm thinking about restarting my antidepressant. As I understand it can be dangerous to go back to your normal dose.

I was on 10mg Prozac since September, increased around 1. des to 20mg and stopped CT around 4. des.

 

I'm wondering what dose I should try. I could try Prozac or I could try Zoloft(which I've never tried and I understand has a shorter half-life).

 

I told my doctor I was in such a fragile state and asked what we could do. He said that if I wanted, I could try 50mg  Zoloft to start with if I wanted extra help with my anxiety. He said that drug works better on anxiety than Fluexetine. I told him I would think about it.

 

But I think he knows nothing about anti depressant withdrawals. I would really appreciate your thoughts. I know they are not medical advice.

I'm also seriously considering easing out of my Keto like diet. I simply haven't found many people who have success with it in combination with Benzos.

[theskul]

My main concern is about dose if I reinstate and if it is generally ok to switch to a shorter-acting antidepressant, like Zoloft.

[Sassenach]

Hi Skul

 

If you wish to try reinstatement it is important to understand that will need to make further med changes.

The only way reinstatement is effective is continuity.

It is also necessary for us to able to monitor you daily to ensure the reinstatement is working and you are not suffering adverse effects.

It is better to return to the last drug you were taking ie Prozac.

It is also one of the kinder SSRI's and easier to taper off.

If you decide to reinstate you would be better staying with your Keto diet as changing could make monitoring your progress more difficult.

We would need a daily diary posted in the following format;

DATE:

 

6 a.m. Woke with anxiety 5
8 a.m. Took 2.5mg Lexapro
10 a.m. Stomach is upset
10:30 a.m. Ate breakfast
11:35 a.m. Got a headache, lasted one hour
12:35 p.m. Ate lunch
4 p.m. Feel a bit better
5 p.m. Took 2.5mg Lexapro
6 p.m. Ate dinner
9:20 p.m. Headache 3
10:00 p.m. Took 50mg Seroquel
10:20 p.m. Feeling dizzy 6
10:30 p.m. Fell asleep
2:30 a.m. Woke, took 3mg Ambien (NOT "took 1/2 tablet Ambien")
2:45 a.m. Fell asleep
4:30 a.m. Woke but got back to sleep

 

The numbers are severity on a scale of 0-10.

 

If you wish to go ahead get back to me and I can suggest a dose.

@Shep has asked @Altostrata to comment.

That may be after Christmas if they are both busy over the holiday.

 

Sassenach

 

[theskul]

49 minutes ago, Sassenach said:

If you wish to try reinstatement it is important to understand that will need to make further med changes.

Thank you so so much. I guess you don't want me to change my Valium dose either. So no other dose changes. For how long would that be?

 

[Altostrata]

Hello, theskul. How has your symptom pattern changed over the last 2 weeks?

 

What is your current drug schedule, with dosages? Are your symptoms better or worse at any times of day? What are your worst symptoms now?

[theskul]

Drug Schedule:

• 11:00 Valium 1.25mg
• 17:00 Valium 1.25mg
• 22:00 Olanzapine 0.9mg
• 23:00 Valium 2.5mg,  Melatonin 1.9mg

 

Symptom pattern changes over the last 2 weeks:

• Akathisia has gone down/disappeared.
• Harder to focus on distractions and human contact. I get uneasy and mainly want to focus on my issues.
• Fear/Panic is lower but can be really bad at times when I feel there is no way out of this for me.
• Sleep better but only around 6 hours.
• memory/concentration problems worsening
• Harder to go out and interact with people.
• Feel more and more disconnected from my loved ones and everything. Very limited human contact even though I am with my family.(what is this?)
• Motivation and activity level is going down. I do basically no chores.(what is this?)
• Starting to wake up in the morning with palpitations(my heart beating hard) and some anxiety.

 

I am calmer later in the day.

 

My worst symptom: There are 3 that worry me especially

• Disconnection from loved ones and everything
•   I feel uneasy especially if I am not focusing on my issues.
• I am also very worried about when I start to panic or feel like I have no way out of this.

 

It is also very worrisome that I don't know what some of those symptom changes are, and why they are happening.

[theskul]

I was looking at the symptoms from PAWS and it fits fearfully well!!

[Sassenach]

 

1 hour ago, theskul said:

I was looking at the symptoms from PAWS and it fits fearfully well!!

Where W/D is concerned you can make symptoms fit pretty much anything.

Frightening yourself or " fear of the fear " is totally counterproductive.

You have had a year of almost constant drug and dose changes, enough to guarantee W/D symptoms and they are much more commen than PAWS.

20 hours ago, theskul said:

Disconnection from loved ones and everything

derealization-or-depersonalization-dr-and-dp/

20 hours ago, theskul said:

I am also very worried about when I start to panic or feel like I have no way out of this.

non-drug-techniques-to-cope-with-emotional-symptoms/

http://anxietystuff.weebly.com/

non-drug-techniques-to-cope-with-emotional-symptoms/

http://www.cci.health.wa.gov.au/resources/consumers.cfm

You can and will recover from this but it takes time.

 

Sassenach

[theskul]

9 minutes ago, Sassenach said:

derealization-or-depersonalization-dr-and-dp/

Could also be anhedonia?

 

Thanks a lot for your encouragement.

 

Regarding reinstating a small dose of Prozac, when could we start to look at that?

[Sassenach]

Prefer to wait until @Altostrata has seen your reply.

She has much more experience than me with polydrugs.

[Altostrata]

theskul you are taking 5.5mg diazepam per day, plus olanzapine.

 

On one hand, the diazepam probably has reduced your symptoms of drug-induced activation, whether from withdrawal or an adverse drug reaction.

 

On the other hand, common side effects of diazepam are fatigue, foggy brain, depression, demotivation, apathy. As you started diazepam December 8, it's probably just now reaching full effect.

 

Many people take diazepam only once a day. You are taking it 3 times a day. Why are you doing this? How often do you get palpitations in the morning? When did this start?

 

If you find yourself overly sedated, you may be taking too much diazepam, att @Shep (The palpitations might be a symptom of paradoxical reaction.)

 

The keto diet is stressful and can cause production of more stress hormones. If you're still experimenting with this, you may be causing your own symptoms.

 

[theskul]

9 minutes ago, Altostrata said:

Many people take diazepam only once a day. You are taking it 3 times a day.

I saw it done in the Ashton manual, although on higher doses. I do it to even out the effect from the drug.

 

9 minutes ago, Altostrata said:

The keto diet is stressful and can cause production of more stress hormones. If you're still experimenting with this, you may be causing your own symptoms.

I have been taking little more carbs over the Christmas. I am thinking about easing out of the diet.

 

9 minutes ago, Altostrata said:

f you find yourself overly sedated, you may be taking too much diazepam

Yes, I don't know what the right dose for me should be.

[theskul]

32 minutes ago, Altostrata said:

theskul you are taking 5.5mg diazepam per day, plus olanzapine.

5mg Valium. And also 2mg Melatonin. I have been thinking about reinstating a microdose of Prozac. And ease out of keto.

 

What do you think is adviceable?

[theskul]

5 hours ago, theskul said:

I have been thinking about reinstating a microdose of Prozac. And ease out of keto.

@Sassenach and @Altostrata. I apologize. Sassenach suggested I should stay with my Keto diet if we introduce a microdose of Prozac. I will follow that advice if we decide that is the way to go.

 

However, I was thinking that I should start with going out of Ketosis now. As I understand, Altostrata thinks it's probably not a good idea while struggling with withdrawal symptoms. And I don't see too many people online using it in early tapering of Benzos. How does that sound as a starting point? I also just have a bad feeling about this diet for me at this point. [Edit: I also suspect that my body is in bad shape after all the meds and changes I've had over the past half a year, so a Keto diet with all of the electrolydes could be too much for my body to handle]

 

If you have different opinions, I'm all ears.

[Altostrata]

Apologies for the error, 5mg diazepam.

 

Yes, it makes sense to change from the keto diet now. It shouldn't take long.

[theskul]

I've been adding some carbs but still having quite high fat intake. The result has been that my ketones in my urine vary during the day.

• I seem to feel calmer when I measure high ketonse, and very distressed when I measure low Ketones.
• Also, calmer during the evening, distressed during the morning and day.

So it may be connected to time of day or the ketones. [Edit: I also felt calmer later in the day before I started changing the diet]

The distress is alarmingly high. I don't want to kindle myself. I'm not sure how to proceed.

[theskul]

I am thinking: How much distress can I allow myself to feel before giving up and maybe go back into ketosis or updose my Valium? I can take some beating, but I'm not sure how much is healthy for me, if you know what I mean? I don't want to injure me further.

[Shep]

8 hours ago, theskul said:

I am thinking: How much distress can I allow myself to feel before giving up and maybe go back into ketosis or updose my Valium? I can take some beating, but I'm not sure how much is healthy for me, if you know what I mean? I don't want to injure me further.

 

Whatever your diet, it needs to be consistent. What kinds of foods are you adding in now that you're leaving the keto diet? Could any of those foods contain histamine, gluten, dairy, etc that you may be having a reaction to? 

[theskul]

3 hours ago, Shep said:

What kinds of foods are you adding in now that you're leaving the keto diet?

Whole-grain rice, some fruits and nuts. Small sugary treats. And I have been eating alot of diary on my keto diet.

[Shep]

It could be the sugar - many of us have increased symptoms due to eating sugar. You may want to limit sugar and see if your symptoms improve. For more, please see:

 

Sugar: Its effect on mental health and withdrawal