Nomad: olanzapine, alprazolam withdrawal nightmare

[ChessieCat]

3 minutes ago, Nomad said:

I wonder if my usage of “old” medication is part of the problem. I’m using Xanax that is now 8 months old. 

 

Possibly.

 

6 minutes ago, Nomad said:

@bijayThat’s an interesting method of tapering. Eliminates the need to split tablets into minute fractions.Thank you for sharing

 

SA recommends taking the same dose at the same time on a daily basis.  The brain likes consistency.

[Frogie]

Although, Benzobuddies.org is a wonderful site and has helped many, many people, SA suggests only doing a 10% taper per month.

 

Xanax is a difficult benzo to taper off of. I'm doing it right now. But this site and the knowledge they have here, I am able to to it.

 

I don't think 8 month old Xanax is a problem. It may be just wd that you are going through. But I'm not an expert. I only know from my experience

 

I hope I helped just a little.

 

Take care,

Frogie xx

[Nomad]

The moderators have stopped responding which leads me to think that there is no hope for alleviating my insomnia. Thank you everyone for your insight and help up to this point. Now I need to decide how to proceed from here...I’m not going to continue living like this. There must be something else I can do. And so the quest continues. Good luck to everyone and God bless.

[hayduke]

Hey Nomad.  I don't think it's that there's 'no hope', but more given that it looks like you've tapered off the olanzapine really fast - not sure why - I don't think anyone has general advice for how to achieve the best outcome when tapering faster than 10%/mo.

 

This is why the max 10%/month guideline is pretty universal from most of the WD pioneers since Breggin - it's hard to manage predictably after that and usually considerably more challenging.

 

Not saying you won't be able to navigate it.  There are many threads on self care, insomnia etc on here which will help.  All the best

 

 

[ChessieCat]

From your drug signature:

 

November 2019:  Quit Abilify. Started 1.25mg Olanzapine. 

Nov 2019- January 2020 Reduced Xanax to .5mg

Jan 26 2020: Stop Olanzapine.
Feb 6 Reinstated Olanzapine 1.25mg

January 30 Increased Xanax back to 1mg

March 2020 Changed dose of Xanax 1mg to .75mg

April 4-Jun 12 2020: Taper Olanzapine. Stopped at .1mg

July 4 2020: Reinstated Olanzapine .1mg

 

You've made a lot of changes in the last 9 months.  Your poor brain is probably very confused by all of this.  The brain likes consistency and every time there is a drug and/or dose change it takes times for the brain to adapt to the change.

[Nomad]

Some new developments... I have realized for a couple years now that my hyperhydrosis and subsequent electrolyte deficiency after strenuous exercise exacerbates my insomnia. (Insomnia is a symptom of electrolyte deficiency) I also noticed that electrolytes containing glucose seemed to improve my sleep. Last night after hiking I took a glucose tablet with a small amount of other sodium, and potassium electrolytes. Incredibly, I slept for 6 hours and 45 straight through without waking up once! This morning I felt so amazingly good, it’s hard to describe! I know that antipsychotics affect sugar and glucose levels, but typically in a hyperglycemic way. Could withdrawing from an antipsychotic make you HYPOglycemic? My research today told me that hypoglycemia can result in insomnia and a host of other symptoms including mood swings, irritability, concentration problems and heart palpitations. All of which I have been experiencing but attributed directly to withdrawal from Olanzapine and the neurological effects due to WD. Now I’m suspicious that glucose levels may be playing a major role as well. However after only one night of restored sleep this is merely a hypothesis. I’m planning on taking a similar amount of glucose again tonight and see what happens.

[bijay]

That is great you were able to a get decent night of sleep with the addition of glucose and electrolytes.  Even if it’s not a perfect solution at first, give it a good trial run, fine tuning doses maybe as you go.

 

Drinking a lot of water during the day can also deplete electrolytes.  I’ve moved away from my constant water drinking habit and leg cramps that can wake me up at night have stopped.

 

One thing that has helped me recently is when I started having a good run of sleep, I also listened to the same, short ten minute meditation after turning off the lights.  I don’t really meditate, its the soothing voice has become a signal to me that sleep is on the way, kind of like a conditioned response.  Just a little trick worth trying.

[Nomad]

Thanks, @bijay for your insight. Meditation and breathing exercises have been helping a lot to stabilize my mood and helping a little with sleep also. 
 

It’s just a hunch at this point but given how infamous Olanzapine is for affecting blood sugar regulation, it could be a significant part of the withdrawal equation somehow. 

[Nomad]

On 7/23/2020 at 8:00 AM, hayduke said:

Hey Nomad.  I don't think it's that there's 'no hope', but more given that it looks like you've tapered off the olanzapine really fast - not sure why - I don't think anyone has general advice for how to achieve the best outcome when tapering faster than 10%/mo.

 

This is why the max 10%/month guideline is pretty universal from most of the WD pioneers since Breggin - it's hard to manage predictably after that and usually considerably more challenging.

 

Not saying you won't be able to navigate it.  There are many threads on self care, insomnia etc on here which will help.  All the best

 

 

Hi, @hayduke the reason I tapered quickly was that I did not want the taper to be that much longer that the time that I was on the medication to begin with. I followed the taperingstrip.org schedule. This appears to have been a mistake on my part. The taper was obviously too fast.
 

Does anyone have advice on reinstatement at this point? 

[ChessieCat]

3 hours ago, Nomad said:

Does anyone have advice on reinstatement at this point? 

 

You reinstated 0.1mg Olanzapine on July 4 2020. 

 

Q:  Are you still taking it and at the same dose?

 

Q:  Are you asking if you should increase the dose?

[Altostrata]

@bijay Is that chart from BenzoBuddies?

 

We emphatically do not recommend tapering by varying dosage from day to day or skipping doses, particularly with a short-acting drug such as Xanax.

 

Changing dosing can cause a tendency to kindling, where withdrawal symptoms get progressively worse.

 

Yes, reducing a benzo too fast can cause sleeplessness. @Nomad why are you taking Xanax rather than clonazepine or diazepam?

 

On 7/23/2020 at 7:42 AM, Nomad said:

The moderators have stopped responding which leads me to think that there is no hope for alleviating my insomnia.

 

This seems unreasonably cranky since 2 moderators had already responded to you.

[bijay]

@altostrata The chart was given to me by a psychiatrist I saw specifically for help in getting off clonazapam.  It was developed by a Canadian doctor, Cara Tannenbaum, of McGill.  It was working very well for me until I stupidly tried to wean off Amitriptyline after a missed dose.  For context here is the full patient brochure from Tannenbaum:

 

http://www.criugm.qc.ca/fichier/pdf/BENZOeng.pdf

[Nomad]

17 hours ago, ChessieCat said:

 

You reinstated 0.1mg Olanzapine on July 4 2020. 

 

Q:  Are you still taking it and at the same dose?

 

Q:  Are you asking if you should increase the dose?

After no significant improvement on .1mg I increased to .2 mg July 21. Still no significant improvement on .2mg as of last night. (The amazing full night of sleep I had two nights ago appears to be a one-off mystery. All the other nights recently have been consistently bad.)  Yes, I’m wondering if I should increase the dose further and what should my limit be if I see no improvement. 

[Nomad]

17 hours ago, Altostrata said:

@bijay Is that chart from BenzoBuddies?

 

We emphatically do not recommend tapering by varying dosage from day to day or skipping doses, particularly with a short-acting drug such as Xanax.

 

Changing dosing can cause a tendency to kindling, where withdrawal symptoms get progressively worse.

 

Yes, reducing a benzo too fast can cause sleeplessness. @Nomad why are you taking Xanax rather than clonazepine or diazepam?

 

 

This seems unreasonably cranky since 2 moderators had already responded to you.

I have tried Clonazepam and lorazepam in the past for insomnia and neither allowed me to sleep like the alprazolam(xanax) did. - My apologies for the crankiness. I was getting to end of my rope.

[Altostrata]

What is your daily drug schedule, with times of day and dosages?

[Nomad]

1 hour ago, Altostrata said:

What is your daily drug schedule, with times of day and dosages?

9:00am .2mg Olanzapine 

10:30pm .75mg Xanax; 25mg diphenhydramine; .5mg melatonin

[Altostrata]

Your main problem is poor sleep, is that correct? How has your sleep pattern changed since you increased Xanax to 1mg on January 30?

 

Do you take diphenhydramine every night? When was it last effective for sleep?

 

How do you feel in the morning, before you take olanzapine?

[Nomad]

My mood has been challenging but manageable. My main problem now is sleep disruption. I can fall asleep but then wake up 2-4 hours later. Throughout my taper of Olanzapine from April 4–Jun 12, 2020 my sleep was tolerable (.75mg alprazolam, 25mg diphenhydramine, .5mg melatonin every night). I would go to sleep about 11:00pm and wake up around 4:00am. Then, about one week after June 12 2020, the date I finished the Olanzapine taper, my sleep became much worse. I’m now going to sleep at 11:00pm and waking up at 2:00am. Sometimes even earlier. 
 

In the morning I feel like I have a mild “hangover”, a miserable feeling in my head. I have experienced this for many years now when my sleep is particularly bad. (Even before I started Olanzapine and was still on Abilify) This feeling resolves typically upon eating breakfast. 

[Nomad]

Over the last several months my sleep consistently deteriorated after reducing the dose of Olanzapine or Xanax too quickly. In the past I have reduced my dose of Xanax at times when my sleep has improved a little. Now I realize that dropping either medication too quickly will make my sleep worse.

[Altostrata]

Please read my questions carefully and answer them completely. Thanks.

[Nomad]

14 minutes ago, Altostrata said:

Please read my questions carefully and answer them completely. Thanks.

Your main problem is poor sleep, is that correct? Yes

 

How has your sleep pattern changed since you increased Xanax to 1mg on January 30? Overall my sleep was good enough after Jan 30 (generally uninterrupted from 11:00pm to 4:00am) to then decrease the Xanax to .75mg, March 2020.

 

Do you take diphenhydramine every night? Yes 

When was it last effective for sleep? Approximately one week after June 12 when I discontinued Olanzapine.

 

How do you feel in the morning, before you take olanzapine?

I feel like I have a hangover until I eat breakfast.

[Altostrata]

It sounds like the diphenhydramine isn't doing anything and may even have gone paradoxical, keeping you from sleeping. If I were you, I'd go off it by cutting in half, then half again, then off over a week.

 

Diphenhydramine may also be causing your hangover. Please let us know of any significant symptom pattern changes while you do this.

 

If no change when you're off diphenhydramine, you probably have benzo withdrawal from the Xanax decrease in March.

 

How do you feel before and after you take olanzapine in the morning?

[Nomad]

How do you feel before and after you take olanzapine in the morning?
I do not feel anything unusual. I do not notice any change before or after taking the Olanzapine 
Ok, I will make those changes to diphenhydramine, and report back. 
 

Thank you for your insight @Altostrata

[Nomad]

I’m very curious why you do not think it is primarily the Olanzapine withdrawal that is disturbing my sleep..?

[Altostrata]

It's more likely your shenanigans with Xanax.

[Nomad]

I see.

[Nomad]

It’s odd though that the sleep problems seem to coincide chronologically with the changes to the Olanzapine dosage.

[Nomad]

After decreasing diphenhydramine sleep has gotten worse. I’m at 1/4 of a 25mg tablet and had to Increase melatonin from .5 to 1mg. Unfortunately the tinnitus which I have had for several years seems to get worse along with my sleep. Around July 1 it got annoyingly worse. Then two nights ago it jumped up a couple notches to a level that Is impossible for me to block out.I have been relying heavily on meditation and  breathing exercises to maintain mental stability and now the ear ringing is making that extremely difficult. - Everything was going well throughout my Olanzapine taper through April and May until I discontinued after .1mg (June 12) Should I continue reinstatement at a higher dose to try to restore my sleep? (I’m currently at .2mg). If the ear ringing gets worse it could be game over.

[Hopela]

Hi nomad,

Sorry to hear of your withdrawal problems. Like me you have a olanzapine cold turkey history. Your following Olanzapine taper of 10 weeks or so was fast. On my last failed taper I spent 14 weeks in the same range and failed when jumping from 0.12mg. Based off your account and having read other account that "all hell broke lose" when jumping a 0.3mg needing to reinstate much higher I think we should go lower than 0.10mg before jumping and resist the will to rush off the last dose so that we are really adapted to that dose before leaving it. Others say even if you taper slowly you will still get withdrawal problems some days or weeks after quitting and the earlier you get off it the better chances of a "full recovery". I don't believe there is any scientific proof that full recovery is possible from Olanzapine though. But being on Olanzapine is damaging so we need to balance getting off quickly with tapering slowly, as individual factors determine, and then be prepared that some withdrawal problems can hit us no matter how slowly tapered, depending also on individual factors. But staying on that last dose some extra time is probably good and having your life set up for problems when jumping.

 

Given that you were off 3 weeks and the above considerations I would think 0.2mg could be enough as far as Olanzapine goes. I had just 6 days of 0mg before needing to reinstate and had to gradually go up to 0.25mg before settling in at 0.16mg. We're all different though. And my sleep was abysmal to start with so getting just some hours is good for me.

 

I'm trying kiwi and theanine for sleep. I'm keeping the room as dark as possible and possibly very cool (15 °C can help! and a foot or arm outside the cover!). Having the mobile phone in another room helps some people.  My goal is to rest in bed, if I sleep thats great. Closed eyes all the time. Even if going up to bathroom and no lights then too of course (and sitting down...)

 

With tinnitus I try to disconnect any alarming thoughts/feeling from the ringing itself so that it won't cause such a reaction automatically. I'll turn, think of something calm, think of the ringing as the ringing of calmness, which I don't think works very well but Im trying.

 

Hope you find some improvements.

 

 

 

 

[Nomad]

44 minutes ago, Hopela said:

Hi nomad,

Sorry to hear of your withdrawal problems. Like me you have a olanzapine cold turkey history. Your following Olanzapine taper of 10 weeks or so was fast. On my last failed taper I spent 14 weeks in the same range and failed when jumping from 0.12mg. Based off your account and having read other account that "all hell broke lose" when jumping a 0.3mg needing to reinstate much higher I think we should go lower than 0.10mg before jumping and resist the will to rush off the last dose so that we are really adapted to that dose before leaving it. Others say even if you taper slowly you will still get withdrawal problems some days or weeks after quitting and the earlier you get off it the better chances of a "full recovery". I don't believe there is any scientific proof that full recovery is possible from Olanzapine though. But being on Olanzapine is damaging so we need to balance getting off quickly with tapering slowly, as individual factors determine, and then be prepared that some withdrawal problems can hit us no matter how slowly tapered, depending also on individual factors. But staying on that last dose some extra time is probably good and having your life set up for problems when jumping.

 

Given that you were off 3 weeks and the above considerations I would think 0.2mg could be enough as far as Olanzapine goes. I had just 6 days of 0mg before needing to reinstate and had to gradually go up to 0.25mg before settling in at 0.16mg. We're all different though. And my sleep was abysmal to start with so getting just some hours is good for me.

 

I'm trying kiwi and theanine for sleep. I'm keeping the room as dark as possible and possibly very cool (15 °C can help! and a foot or arm outside the cover!). Having the mobile phone in another room helps some people.  My goal is to rest in bed, if I sleep thats great. Closed eyes all the time. Even if going up to bathroom and no lights then too of course (and sitting down...)

 

With tinnitus I try to disconnect any alarming thoughts/feeling from the ringing itself so that it won't cause such a reaction automatically. I'll turn, think of something calm, think of the ringing as the ringing of calmness, which I don't think works very well but Im trying.

 

Hope you find some improvements.

 

 

 

 

Thank you so much @Hopela for taking the time to message me. It’s helpful to hear someone else’s experience whether positive or negative. It helps me to know that I am not alone in this struggle. It’s interesting too that you deal with tinnitus. I also have been trying to think of it as a comforting sound, just to deal with it.  I also appreciate your detailed information regarding your Olanzapine taper. Yes, we’re all different but it does provide some context and perspective to this process. 

[Nomad]

On 7/21/2020 at 6:45 AM, Frogie said:

Although, Benzobuddies.org is a wonderful site and has helped many, many people, SA suggests only doing a 10% taper per month.

 

Xanax is a difficult benzo to taper off of. I'm doing it right now. But this site and the knowledge they have here, I am able to to it.

 

I don't think 8 month old Xanax is a problem. It may be just wd that you are going through. But I'm not an expert. I only know from my experience

 

I hope I helped just a little.

 

Take care,

Frogie xx

Thank you too @Frogie for your reply also. I’m definitely factoring your info into my future plans to taper the Xanax, as long as I can get past the Olanzapine.

[Altostrata]

On 7/25/2020 at 2:03 PM, Nomad said:

Some new developments... I have realized for a couple years now that my hyperhydrosis and subsequent electrolyte deficiency after strenuous exercise exacerbates my insomnia. (Insomnia is a symptom of electrolyte deficiency) I also noticed that electrolytes containing glucose seemed to improve my sleep. Last night after hiking I took a glucose tablet with a small amount of other sodium, and potassium electrolytes. Incredibly, I slept for 6 hours and 45 straight through without waking up once! This morning I felt so amazingly good, it’s hard to describe! I know that antipsychotics affect sugar and glucose levels, but typically in a hyperglycemic way. Could withdrawing from an antipsychotic make you HYPOglycemic? My research today told me that hypoglycemia can result in insomnia and a host of other symptoms including mood swings, irritability, concentration problems and heart palpitations. All of which I have been experiencing but attributed directly to withdrawal from Olanzapine and the neurological effects due to WD. Now I’m suspicious that glucose levels may be playing a major role as well. However after only one night of restored sleep this is merely a hypothesis. I’m planning on taking a similar amount of glucose again tonight and see what happens.

 

Did you ever replicate this experiment? Are you on a specific diet>

 

On 7/26/2020 at 8:24 PM, bijay said:

@altostrata The chart was given to me by a psychiatrist I saw specifically for help in getting off clonazapam.  It was developed by a Canadian doctor, Cara Tannenbaum, of McGill.  It was working very well for me until I stupidly tried to wean off Amitriptyline after a missed dose.  For context here is the full patient brochure from Tannenbaum:

 

http://www.criugm.qc.ca/fichier/pdf/BENZOeng.pdf

 

Whatever the source, that tapering schedule makes no sense for short-acting drugs such as Ativan. A jagged drug schedule means a jagged symptom pattern. We do not recommend it.

 

On 7/27/2020 at 12:09 PM, Nomad said:

9:00am .2mg Olanzapine 

10:30pm .75mg Xanax; 25mg diphenhydramine; .5mg melatonin

 

Is the tinnitus worse at any particular times of day? How do you feel in the morning now, before you take olanzapine?

 

Why do you take olanzapine in the morning (apologies if I've asked this before)?

[bijay]

@Altostrata  You are right, this might have worked for me but could be dangerous for others. My apologies to the forum members. 

[Nomad]

Did you ever replicate this experiment? Are you on a specific diet>

 

I did try to replicate it. I took the same amount of glucose (approx. 1000mg) at the same time of day (7:30pm), but unfortunately I did not achieve the same results with my sleep. One variable was that the day that it worked I had taken a 3-4 hour hike in the afternoon, however the day I tried to replicate it I only took a short walk. I have not tried to replicate it again but I have been eating something every 3 hours or so since then in an attempt to level blood sugar. I have experienced hypoglycemic symptoms much of my life, but have never been diagnosed officially. My diet consists of whole grain hot cereal and some pork or eggs for breakfast, a light lunch, typically a sandwich or nuts and yogurt. For dinner, chicken or beef, kale and a sweet potato or whole grain pasta. Now I’m adding apples, nuts yogurt etc between meals as snacks. (Also I think it’s notable that In the past I drank 3-5 alcoholic drinks per day. Typically microbrews and or bourbon. For the past six months I have reduced that to 1-3 drinks per day. The past two weeks no liquor at all.)

 

Whatever the source, that tapering schedule makes no sense for short-acting drugs such as Ativan. A jagged drug schedule means a jagged symptom pattern. We do not recommend it.

 

 

Is the tinnitus worse at any particular times of day?

 

The ringing is constantly loud now whereas a month ago it seemed worse mainly in the morning.

 

How do you feel in the morning now, before you take olanzapine?

- I feel physically quite weak in the morning, and in general just horrible, because of the lack of sleep. I force myself to do breathing exercises and walk at least 1-2 hours per day. I typically feel better in the afternoon after eating and exercising. 

 

Why do you take olanzapine in the morning (apologies if I've asked this before)? 

 

In the past I always took it at night. I switched to the morning in this last reinstatement to see if it improved my sleep. But I have a hunch that it may have actually made it worse. Or maybe the reinstatement is just not working this time. I’m not sure at this point. 

 

Edited August 3, 2020 by ChessieCat
unbolded, coloured and spaced

[Altostrata]

3 minutes ago, Nomad said:

the day that it worked I had taken a 3-4 hour hike in the afternoon

 

It's pretty well known that a substantial amount of exercise improves sleep. How about trying hiking or a lot of walking again?

 

4 minutes ago, Nomad said:

(Also I think it’s notable that In the past I drank 3-5 alcoholic drinks per day. Typically microbrews and or bourbon. For the past six months I have reduced that to 1-3 drinks per day. The past two weeks no liquor at all.)

 

It's very possible that your unpleasant symptoms are the effect of your drinking on your withdrawal syndrome. Did the tinnitus start after an ingestion of alcohol, by any chance? Your nervous system is strained by withdrawal, we often see alcohol makes this worse.

 

You may have reinstated olanzapine because of this symptoms made worse by alcohol, not withdrawal symptoms from olanzapine. Needless to say, no more drinking or you will be making your own problems.

 

6 minutes ago, Nomad said:

In the past I always took it at night. I switched to the morning in this last reinstatement to see if it improved my sleep. But I have a hunch that it may have actually made it worse.

 

Yes, ordinarily olanzapine makes people sleepy. Taking it in the morning for the purpose of sleep makes no sense. If I were you, I'd gradually move it towards the evening, but a couple of hours ahead of Xanax.

 

If you suffer from hypoglycemia and don't have a problem with milk protein, you may want to take undenatured whey protein isolate before bed, it can keep your glucose level. This may help you sleep.

 

[Nomad]

19 minutes ago, Altostrata said:

 

It's pretty well known that a substantial amount of exercise improves sleep. How about trying hiking or a lot of walking again?

I hike often and have all my life, but in 14 years of dealing with medication and sleep issues, I never experienced an amazing restful sleep like that! I didn’t even wake to use the bathroom. Typically what I have experienced is after very strenuous exercise and the resulting hyperhydrosis, my sleep worsens unless I take glucose and electrolytes. That wonderful night sleep is still a mystery to me. Of course there is a reason for it but I have not deduced it yet.

 

It's very possible that your unpleasant symptoms are the effect of your drinking on your withdrawal syndrome. Did the tinnitus start after an ingestion of alcohol, by any chance? Not after alcohol but in the morning after a particularly sleepless night. Your nervous system is strained by withdrawal, we often see alcohol makes this worse.

 

You may have reinstated olanzapine because of this symptoms made worse by alcohol, not withdrawal symptoms from olanzapine. Needless to say, no more drinking or you will be making your own problems.

 

 

Yes, ordinarily olanzapine makes people sleepy. Taking it in the morning for the purpose of sleep makes no sense. If I were you, I'd gradually move it towards the evening, but a couple of hours ahead of Xanax. Roger that! Will do.

 

If you suffer from hypoglycemia and don't have a problem with milk protein, you may want to take undenatured whey protein isolate before bed, it can keep your glucose level. This may help you sleep. I will definitely try that.