Cat416: neophyte experience with medical system

[Cat416]

Thanks ManyMoreTodays

very much appreciated here is my Drugs interaction report: Propranolol has no effect but the combo of Lexapro and Seroquel affects the heart. my Psych is very aware of this and says my low dose should mean I’m OK but he lowered the Seroquel out of an abundance of caution. The beta blocker and the lowered Seroquel have had an effect. My heart rate is down 

Drug Interaction Report

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

• Seroquel (quetiapine)
• propranolol
• Lexapro (escitalopram)

Edit list (add/remove drugs)

• Consumer
• Professional
• Emailthis report

Major (1)

Moderate (1)

Minor (0)

Food (2)

Therapeutic Duplication (0)

Interactions between your drugs

Major

QUEtiapine  escitalopram

Applies to: Seroquel (quetiapine), Lexapro (escitalopram)

Using escitalopram together with QUEtiapine can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening, although it is a relatively rare side effect. You may be more susceptible if you have a heart condition called congenital long QT syndrome, other cardiac diseases, conduction abnormalities, or electrolyte disturbances (for example, magnesium or potassium loss due to severe or prolonged diarrhea or vomiting). Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or heart palpitations during treatment with these medications, whether together or alone. 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.

 

 

 

 

[Altostrata]

Why was 5mg Lexapro added in July, Cat? How do you feel before and after you take it in the morning?

 

When did you reduce to 50mg Seroquel? Your signature simply says "Feb" so it's only been a week or so?

 

Yes, please provide more detail in your daily drug and symptom notes, post 24 hours at a time.

[Cat416]

Hi Altostrata

 

i started the Seroquel (87.5mg) as well as the Lexapro at the same time in July 2019. The drugs were prescribed due to a chaotic rapid withdrawal from Gabapentin and Nozinan.

in December 2019, my psych started lowering the Seroquel because of Tachycardia and Akathisia. I tapered the Seroquel over December. My last reduction was 8 weeks ago now. I’m now at 50mg Seroquel, 5mg Lexapro and 15mg Propranolol. I’m struggling with especially fierce WD still. Although it’s lightened up a little over the last week.

 

10:00 pm I take 50mg Seroquel

7:30 am I take 10mg Propranolol 

8:30 am I take 5mg Lexapro 

12:00 I take 5mg Propranolol 

 

I do not feel anything bad after I take my pills. I notice no reaction to the Lexapro.

 

im thinking of starting to taper the Propranolol, then proceeding to the Seroquel then finally the Lexapro (Lexapro last because I have least trouble with side effects on it)

 

the symptoms I am currently struggling with are:

- waking up with Cortisol surges which last a long time...often until noon when it starts fading

- headaches

- nausea and malaise 

- burning/ tingling in arms, feet and face

- strange sensations in the brain

- general malaise 

- cold and hot sweats 

 

I am trying to work out whether to updose the Seroquel or not. A bit afraid to as the Akathisia problem may return. 
my only other alternative is to continue limping along until I hopefully stabilize. I am feeling very disabled and not able to live to engage in life normally. 
 

sometimes doing nothing rather something to “help” the situation can compound the problem. 
 

your perspective on the situation is appreciated. Do I wait this out and do nothing or try to do something?

Also, is my taper plan correct? Propranolol (to practise micro tapering), Seroquel which is giving me trouble and lastly Lexapro which does not appear to be giving me any trouble yet.

 

 

 

[manymoretodays]

On 2/20/2021 at 11:02 AM, Cat416 said:

here is my Drugs interaction report: Propranolol has no effect but the combo of Lexapro and Seroquel affects the heart. my Psych is very aware of this and says my low dose should mean I’m OK but he lowered the Seroquel out of an abundance of caution. The beta blocker and the lowered Seroquel have had an effect. My heart rate is down 

 

Hi Cat416,

Hmmm, I spied moderate drug interactions between the propranolol and Seroquel too.

I'm just going to provide the link again to Your Drug Interactions

On 2/21/2021 at 6:54 AM, Cat416 said:

10:00 pm I take 50mg Seroquel

7:30 am I take 10mg Propranolol 

8:30 am I take 5mg Lexapro 

12:00 I take 5mg Propranolol 

 

I do not feel anything bad after I take my pills. I notice no reaction to the Lexapro.

 

im thinking of starting to taper the Propranolol, then proceeding to the Seroquel then finally the Lexapro (Lexapro last because I have least trouble with side effects on it)

 

the symptoms I am currently struggling with are:

- waking up with Cortisol surges which last a long time...often until noon when it starts fading

- headaches

- nausea and malaise 

- burning/ tingling in arms, feet and face

- strange sensations in the brain

- general malaise 

- cold and hot sweats 

 

And then, this is good ^.  I'd like you to go a bit further though with it.  Your narratives of symptoms and possibles in that post are good too.

For ease of getting a nice, objective view though, try one using a format like this:

The time of day, dosage, and severity of symptoms are essential information. Include

 

- Time and dosage for all drugs taken throughout the day, psychiatric and non-psychiatric.

- Following each dose, note any symptoms. If you are having a reaction to the drug, it may take hours for a symptom to show up -- that's why we ask you to keep notes all day long.

- If you're not taking any drugs, your symptoms throughout the day.

- Your sleep pattern. Since so many drugs disturb sleep, if you find you're waking in the middle of the night, it could be from a drug you took earlier in the evening. If you're not taking any drugs, there may be ways you can improve your sleep.

And so forth. A diary, in chronological order, looking something like this:
 

Example:

DATE:

 

6 a.m. Woke with anxiety
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
10:00 p.m. Took 50mg Seroquel
10:20 p.m. Feeling dizzy
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

 

An appointments diary is perfect for this and can be bought at stationery stores. They have a page for each day with times for appointments which can be filled in with doses, symptoms etc as shown above. Or, you can copy and paste from a cell phone app -- but make sure the result is easily readable.

 

Please do not use spreadsheets, they are difficult to read online and some of us don't have Microsoft Excel to look at them.  You may link to a Google Doc or spreadsheet if you wish.

And then post 24 hour segments right here.  If you want to, add in to the right of the time, any non-drug coping done, and if it helped

 

Okay, best, and to better days for you, healing.

 

L, P, H, and G,

mmt

[Cat416]

Thank you MMT!

I looked at the Propranolol interaction with Seroquel. It can apparently have reduce blood pressure significantly. Thus is definitely not one of my problems. I have the opposite problem: high heart rate and high bp.

 

I have gotten an appointments diary and will make note of symptoms on a 24 hour basis. Will post once I have some info. 

[Cat416]

I am 57 and up until the introduction of psychotropic drugs I have been in excellent health. I had to go and see a cardiologist because my heart rate was so high (often as high as 170 bpm). The cardiologist said that the Seroquel was more than likely to blame. I don’t have QT interval problems or high bp. The Propranolol has definitely helped reduce the HR.

 

over the last five days the heavy ill feeling I am used to waking up with has lifted but now I seem to be cycling through a new phase of insomnia. It’s difficult to fall asleep. I’m getting maybe 3 hours of sleep a night. My psych wants to give me Trazzadone for sleep but I don’t want to add more drugs. Do I wait for sleep to settle before attempting to resume a slow taper? Afraid I’ll wait a really long time. Advice appreciated 

 

 

[Cat416]

Please I need help!

I reduced my Seroquel dose from 87.5mg to 50mg over the course of a month. My last reduction was 20 weeks ago now. I’m suffering greatly still with insomnia, nausea, headaches etc. But it is on the wane. The thing that is bothering me is waking up in the morning with severe agitation. I can’t work out if this is still WD or a side effect. Then I think maybe it’s tolerance. I’m really distressed. I want to get to. Stability point in order to continue tapering but each day is the same these days. Little progress. What should I do? Thanks for any encouragement 

[ChessieCat]

It might be cortisol.  Here is SA's topic:

 

early-morning-waking-managing-the-morning-cortisol-spike

 

[Cat416]

Thank you ChessieCat

[Cat416]

I’m desperately needing some direction. As you know I dropped 45% of my Seroquel dose theee months ago. As well I’m having side effects from Propranolol. My heart rate is often over 150 and I went to ER this week. Sinus tachycardia. Cardiologist says my heart is fine but I need to get off Seroquel. 
I’m suffering greatly from withdrawal every day. I’m trying to reduce the propranolol but I’m highly reactive to even small cuts. I’m losing hope. I wake up every day to hell. Do I ask my psychiatrist to put me onto a new anti psychotic that is perhaps stronger and does not affect the heart? I desperately need to stabilize but I am not. I’m living in torment. Please help!? 

[Greatful]

@Cat416  Hi Cat.  How are you doing?  You haven't updated for awhile.

[Greatful]

@Cat416  Hi, wanted to stop by and see how you are doing.

 The Seroquel is a fun drug😬  I ct'd it last March, I was only on it 6 weeks but boy did it send me into a state of paranoia.  Weird thoughts and almost delusional.  I really thought I was losing touch with reality.  It took many many weeks to feel like I might make it through the paranoia.  I am on Lexapro to. WE started it to help with the depression after I ct'd Seroquel.  Try and stay away form the Trazodone.  I am on that also.  Some how I became poly drugged last winter.  I'm still trying to recover.   As hard is it can get, try and not add any more meds to make it easier. 

 

Any how,  I hope things are settling down for you.

Let us know how you are doing

 

 

[Cat416]

Hello Greatful

thanks for writing. Appreciated! 
mom struggling with Beta Blocker WD now. Still have 50mg of Seroquel and 5mg of Lexapro on board. Feel beaten up and discouraged. The BB WD is so brutal too. 
please stay in touch! 🌹

[Greatful]

@Cat416  Hi there, how are things going?  I hope you are feeling better☺️

 

[Cat416]

WD or Side Effects?

 

I am now on 50mg Seroquel, 5mg Lexapro and 7.15mg Atenolol (beta blocker). 
I was told by my doctor that getting off a beta blocker is a cake walk. Well it is definitely not easy at all. I took five months to drop from 70% of my small dose. My last micro cut was nearly four months ago. I did this taper on the back of a terrible WD from dropping my Seroquel 45% (as OKd by my Psychiatrist). I did not realize I would also have horrific WD from the beta blocker as I was still having those from Seroquel (10 months ago was my last Seroquel cut). 

I began to realize that the beta blocker WD was much more intense than I ever imagined. I felt different WD symptoms from the beta blocker WD than that of Seroquel. 
 

I have now been holding everything for almost four months. I have seen definite improvement in the intensity of WD but it’s still a daily misery. Just when I think things may be clearing up, I slide back into intense WD. 
 

it’s making me wonder if in fact it is still WD or if it’s side effects…particularly from the beta blocker. I’ve checked patient portals for beta blocker WD experiences and many people talk about blow-back from quitting and having to resort to Valium or Ativan to cope. 
 

lately I’ve developed an internal tremor and a lot of burning sensations. Terrible headaches. Cannot figure out if it’s still WD or if it’s a reaction to the Atenolol. In which case I should perhaps get off it faster and prioritize it over the Seroquel in terms of WD sequence. Although I believe the Seroquel is helping out with the beta blocker WD. 
 

my CNS is pretty kindled. So I’m inclined to believe my torture is still beta blocker WD and not a side effect. My psychiatrist puts all my symptoms down to anxiety and wants to maximize my Lexapro dose. Im terrified to do this. Please help! I don’t know which way to turn…

 

Edited October 28, 2021 by ChessieCat
added topic title before merging with intro topic

[ChessieCat]

Each member has only 1 Introduction topic.  Please do not create any more Introduction topics.  The mods have merged many topics into your original Introduction topic.  This keeps your history in once place and means that you do not have to repeat your story.

 

[ChessieCat]

I will let the other mods know that you need some assistance.

 

Please start taking daily symptom notes following this example.  We need to see 3 consecutive days.  Please post 24 hour period in one go.  The following explains why and how:

 

  

On 9/28/2016 at 4:49 AM, Altostrata said:

 

Keep notes on paper about your daily symptom pattern and drug dosing

 

Are your symptoms worse at any particular times of day? A symptom pattern that occurs regularly over several days could mean the symptoms are from withdrawal, other adverse effects of drugs, or something else you do on a daily schedule.

 

In the course of discussion in your Introductions forum topic, you may be asked to keep notes on paper of your daily symptom pattern, including when you take your drugs, their dosages, and any symptoms. We ask this because there may be something we can do to reduce the symptoms.

 

What we need to see for every single day over several days is what symptoms you get before and after you take your drugs. If you're not taking any drugs and have withdrawal symptoms, we still need to see your symptom pattern throughout the day:

 

The time of day, dosage, and severity of symptoms are essential information. Include

 

- Time and dosage for all drugs taken throughout the day, psychiatric and non-psychiatric.

- Following each dose, note any symptoms. If you are having a reaction to the drug, it may take hours for a symptom to show up -- that's why we ask you to keep notes all day long.

- If you're not taking any drugs, your symptoms throughout the day.

- Your sleep pattern. Since so many drugs disturb sleep, if you find you're waking in the middle of the night, it could be from a drug you took earlier in the evening. If you're not taking any drugs, there may be ways you can improve your sleep.

And so forth. A diary, in chronological order, looking something like this:
 

Example:

DATE:

 

6 a.m. Woke with anxiety
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
10:00 p.m. Took 50mg Seroquel
10:20 p.m. Feeling dizzy
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

 

An appointments diary is perfect for this and can be bought at stationery stores. They have a page for each day with times for appointments which can be filled in with doses, symptoms etc as shown above. Or, you can copy and paste from a cell phone app -- but make sure the result is easily readable.

 

Please do not use spreadsheets, they are difficult to read online and some of us don't have Microsoft Excel to look at them.  You may link to a Google Doc or spreadsheet if you wish.

 

 

 

 

 

 

Edited October 28, 2021 by ChessieCat

[ChessieCat]

Please also post a list of the drugs you are currently taking and state the doses and the times.  This is a separate request from the daily notes.  This information might provide some insight so that daily notes may not be necessary, but please start the notes as well. Thank you.

[Cat416]

Thanks 

I take the following drugs at these times:

- Seroquel 37.5mg at 10:30pm. 
- Seroquel 23.5mg at 4:45 am

  - Atenolol 7.15mg at 6:45am

- Lexapro 5mg at 8:00am

 

i will send the three day log as I collect the data over the two days

 

 

[Altostrata]

4 hours ago, Cat416 said:

My last micro cut was nearly four months ago. I did this taper on the back of a terrible WD from dropping my Seroquel 45% (as OKd by my Psychiatrist).

 

@Cat416, it's likely your bad withdrawal was not strictly from reducing the beta blocker, but because you did it while still suffering withdrawal from this drastic reduction of Seroquel.

 

Why are you taking Seroquel twice a day? Are you taking immediate-release Seroquel? How do you feel before and after you take a dose of each drug every day?

[Cat416]

Hi Altostrata

yiu make some excellent points. I probably have some CNS instability after a CT on Clonazepan 2.5 years ago, then a CT from Gabapentin (given to me at rehab for the Benzo WD), then the 45% drop on Seroquel and then the reduction of the beta blocker. 
 

I actually feel ok after taking the drug. It’s in the middle of the night so maybe I don’t notice too much. I DO wake up with anxiety every morning but that has been going on for a year now.

 

I can sense that my system absolutely hates the beta blocker (I get horrible pins and needles from it), but I’m at a stage right now where I dare not taper anything until I feel I can cope with a cut. 
I have been struggling now for months with unbearable anxiety at times (much less now than three months ago), disturbed sleep at times, burning sensations, brain zaps, hot and cold flushes, Adrenalin surges (getting weaker), sweating, tremor, sore neck, severe headaches and brain fog. 
 

im trying to figure out what to do. Keep holding until I feel IK, get off the beta blocker ASAP. Or leave the beta blocker in place while resuming the Seroquel taper. 
I spoke to Dr James Wright (head of Pharmacology at UBC ) he is sympathetic towards WD communities (was featured in the movie Medicating Normal.  He said to focus on the Seroquel first. Not to add any new drugs and to only subtract. 
 

but the theory is fine while practise is different. I find myself in torment most days. I just don’t trust my doctors or Psychiatrist to help me out if my predicament. Im in so much pain. The anxiety is debilitating at times. When I researched Patient Forums on beta blocker WD I found many agony stories. We just don’t hear about them much on FB as beta blocker groups are very few and not focussed on WD. Most people are on them long term. 
 

I need to figure out what to do next. Keep holding or get rid of the beta blocker? Park the beta blocker (and Lexapro) and focus on the Seroquel. How long do I wait? My nervous system I know us very fragile. I’ve made some progress in the last 4 months since I stopped cutting the BB but I’m nowhere near normal or stable. Some days I feel like I’m serving a life sentence. 
yuyr insights appreciated 

[Altostrata]

Why are you taking a dose of Seroquel in the middle of the night?

 

We need more information about your symptom pattern. Please keep daily notes of times o’clock you take your drugs, their dosages, and your symptoms throughout the day. We need to know how you feel before and after taking each drug, and your symptoms in between. Post 24 hours of notes at a time in this topic, in a simple list format with time o’clock on the left and notation (symptom or drug and dosage) on the right. This can show if your symptoms are adverse effects from one of your drugs.

[Cat416]

I will track my symptoms

to answer your question about my 4:45am 23.5mg Seroquel dose;

my cardiologist said that I was getting Tachycardia from the Seroquel so he suggested I lower the dose , get off it or try splitting the dose. Getting off fast was not an option for me so I lowered the dose from 87.5mg to 50mg and split the dose. My psychiatrist wanted me to dose at night. I take immediate release 

[Altostrata]

Did the psychiatrist know what the cardiologist had said about tachycardia? Why are you taking Seroquel at all?

[Cat416]

Good question. My psychiatrist was a bit disturbed by the cardiologists report but did not argue. He suggested I lower my dose from 87.5mg to 50mg. Torture for eight months. 
mom on Seroquel because I was tapered off 600mg of Gabapentin in six days at the hospital. I was chaotic. The Seroquel helped. Now I’m struggling to get off it. I cannot rush. I’m waiting to stabilize before I can taper. But the beta blocker is getting in the way. I am not doing well on it but tapering is proving very tricky. I’ve now asked for compounded Ate pool reducing by 0.10mg at a time. 
thus is my dilemma. I know the Seroquel is a more strategic drug to get off but the beta blocker is unbearable…what to do. My distress level is high 

[Greatful]

@Cat416  I'm sorry you are struggling.  I have advice for the drug taper, the mods are much more qualified.  

I just want to try and hang in there until you figure this out.

I know that 8 months is a long time,  I have been working through my own mess since last Nov.  The healing is slowww.

You mentioned you have some small improvement, so hang on to that.   You will heal❤️

 

 

[Cat416]

Thanks Greatful

I’m feeling very discouraged. Are we able to communicate directly with each other? 
I get so confused as to where these terrible symptoms are coming from. You seem to have been through the mill yourself. You have a great attitude 

[Cat416]

So here is a three day log of my symptoms. I would appreciate understanding if this is likely still Beta Blocker withdrawal or side effects from Seroquel:

 

friday

4:45 an, take 12.5mg Seroquel 

6:45 am take 7.15mg Atenolol

8:00 am take 5mg Lexapro

8:30 get up with mild anxiety, innerctrenor, burning in hands and feet

9:30 extreme Adrenalin rush, burning in body, cold shivers

11:15, random goosebumps and cold shivers

11:45 feel OK

12:00 cold shivers, Parasthesia on scalp, legs, arns

afternoon was good. No symptons

7:30 pm mildly anxious

10:30pm 37.5mg Seroquel 

 

thursday

3:00am awake

4:45am 12.5 mg Seroquel 

6:45, Atenolol 7.15mg

8:00am Lexapro 5mg

9:00, on edge, burning hands and feet. Inner tremor

10:00am, high heart rate (150). On edge all afternoon, restless

3:30, tight neck, lots of low level Adrenalin surges all day. Temperature fluctuations 

7:30pm anxiety, headache and brain zaps

 

my days are similar to the above. 

 

[Ktven48]

The adrenaline rushes might be because you only take the BB in the morning - or is it extended release?

[Cat416]

Hi All

im still struggling with protracted WD. I’m losing hope. 
I last cut my Seroquel on Dec 2030. 87.5 to 50mg

i last cut my beta blocker Atenolol seven months ago I am now in 7.15mg (I cut from 20mg over five months)

I am also on 5mg of Lexapro 

when I speak to my psychiatrist he just says I need more Lexapro because I’m anxious. 
I am terribly distressed. 
I feel too weak to resume a taper

I an experiencing burning, brain sensations (twisting sensation), dizziness, tinnitus, freezing cold chills, blood pressure changes that can get very high, tachycardia, agitation, nervous tension, anxiety and more

i honestly don’t don’t know where to turn anymore. Please help! Do I just go ahead and bulldoze through my tapering or keep waiting to stabilize? 
I feel unable to cope with a taper but beginning to wonder if it’s now side effects. I’m terrified of the drugs I still have on board. If I can be assured that this is still WD, I can at least formulate a plan. Thank you for your help. 
ps I’m experiencing a lot of Adrenalin rushes every day. For some reason I am linking it to the beta blocker reduction. I’ve had a very bad WD from it. I’m hoping to just keep it on board and turn my attention to the Seroquel when I can but I’m very confused. Please help! 
Thank you in advance 

[Greatful]

@Cat416

You could tag a mod.  Do you know how to tag someone? do the @ key and start to type the persons that you want and then click on it

See your name I tagged you.  You will get a notification/tag  

 

I really wish the doctors would get it together......You are tapering drugs so that means you will have WD symptoms........My guess is that you need to hold for a little bit longer.  

Looks like you've had a lot of drug changes and fast tapers.......It can take awhile for the CNS to stabilize........I have not been on a beta blocker so I am in the dark on that one.......

My heart goes out to you❤️ you can do this. Let the mods give you a helping hand.........Don't up your lex or taper until you here from them.

 

What are you doing for coping skills?  

If you need to vent, talk I am here for you........Have you had a chance to connect with other members?

[Cat416]

Thank you for responding dear Greatful

your words reassure me. I think I agree that I’ve ticked the boat with rapid tapers from quite a number of drugs and I must wait. Tapering under the current conditions will just serve to knock me off balance again. 
I get fearful that it’s side effects because it’s taking so very long. 
I will not increase my Lexapro as advised by my psychiatrist. I will not move on tapering until I get better info. Hoping the moderators can give me a steer too. But your insight rings true to me. Thank you very much