Jyot: Struggling ... dont know is it a relapse or withdrawal

[Jyot]

(MOD NOTE:  this post was moved from another area of the site after the member's Intro topic was responded to)

 

Struggling ..dont know is it a relapse or withdrawal

 

I am from india.now i am in a confusion whether it is a relapse or withdrawal...where to ask i dont know...my doctor is very compassionate and says that it is a relapse...but i feel it like a withdrawal...what to do?

 

Edited June 7, 2020 by ChessieCat
added topic title and mod note

[Jyot]

I started  antidepressant nexito plus (combination of Escitalopram and clonazepam)for anxiety and OCD  on November 2015 and stayed on it till April 2016 and changed to zosert 50mg and klonopin anf stayed on it till march 2017 and stopped it.

Again restarted the zosert 50mg on August 2017 and stopped it on october 2017.

Again started it on december 2017 and updosed on february 2018 and stayed on it for 1year..then tried to taper it on april 2019 to zosert 50 mg again tapered to 25mg on may 2019 and stopped.

After 2 months of symptoms free my symptoms relapsed on august 2019 so i started 25mg and updosed to 50mg on september 2019 and becomes stable but again worsen on october 2019so updose to 100mg and stayed on it for 3 month sympoms are almost free but my worthlessness was there so my doctor changed to fluvoxamine 100mg .

My symptom improved with in a week and i again downdose to 50mg after 2 weeks.

I was very happy for 2 months and last month i feel symptoms came as intense and doctor told to updose it but i tried to stay on 50mg but eventually symptoms got worsen and again he add mirtazapine 7.5 to it.now i am stable on it.at the same time i feel very disappointed that i have to add mirtazapine to fluvoxamine..

I dont know what to do and i am very anxious that the number of drugs will increase as time goes...

[Gridley]

Welcome to SA, Jyot.

 

You've made many drug and dose changes over the last few years, including some very fast tapers and cold turkeys, all of which is very hard on the central nervous system. It is very likely that what you've been experiencing over the years was and is not  relapse but rather withdrawal, which psychiatrists don't believe exists.  

 

What is withdrawal syndrome.

 

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

 

Brain Remodelling 

 

When we take psychiatric 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.  

We are a site for going off psychiatric drugs and helping members deal with withdrawal.  Is it your wish to taper off your drugs?  

 

You need to be aware that there is a major drug interaction between fluvoxamine and mirtazapine.

 

Interactions between your drugs

Major

FluvoxaMINE may significantly increase the blood levels of mirtazapine. This may increase the risk and/or severity of side effects such as dizziness, drowsiness, restlessness, confusion, difficulty concentrating, impairment in thinking and judgment, dry mouth, constipation, low blood pressure, and heart rhythm abnormalities. In addition, combining these types of medications can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should seek immediate medical attention if you experience these symptoms during treatment.

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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) 

 

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 fund your way here.

 

 

 

 

 

 

 

 

 

[Jyot]

So which drug i should start tapering first?

Also whenever i start tapering or stop it my depression hits hard and i feel severe suicidal intrusive thoughts which i am unable to cope...so eventually i am forced to consult my psychiatrist.

[Gridley]

Joyt,

 

Of course, if you feel suicidal, you should definitely seek help.  I'm hoping that if you taper very slowly, as we recommend, you won't have the suicidal feelings.

 

We recommend tapering by no more than 10% of your current dose every four weeks.  Since you've had difficulty in tapering in the past, you might want to consider tapering more slowly, perhaps 5% of current dose every four weeks.  Psychiatrists almost always taper their patients too fast, producing the withdrawal symptoms you've had in the past.

 

Why taper by 10% of my dosage?

 

We recommend tapering the more activating (stimulating) drug first, leaving the more sedating drug to act as a buffer to be tapered later.  In your case, we'd recommend you taper the fluvoxamine first.  This link is specifically about tapering fluvoxamine, including how to get the nonstandard doses you'll need for your taper.  Are you taking immediate release or extended release?  The link explains how to taper both.

 

Tips for tapering off Luvox (fluvoxamine)

 

This link gives tips on how to talk to your doctor about tapering and withdrawal.

 

How do you talk to a doctor about tapering and withdrawal?

 

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) 

 

Add in one at a time and at a low dose in case you do experience problems.

 

Please keep us updated.

 

 

 

 

 

 

 

 

 

 

 

 

  

[Jyot]

One thing i have to say is i just started mirtazapine 7.5 last month MAY 13 ..it is hardly one month...and fluvoxamine 4 months back. So i stayed on Mirtazapine for only less than 1month..is there any advantage for me on tapering Mirtazapine?

[Gridley]

9 hours ago, Jyot said:

is there any advantage for me on tapering Mirtazapine?

You at risk for withdrawal after one month of taking an antidepressant.  It's better to taper the activating drug first so that the Mirtazapine can help you with sleep while you taper the fluvoxamine.

[Altostrata]

On 6/7/2020 at 8:45 AM, Jyot said:

My symptom improved with in a week and i again downdose to 50mg after 2 weeks.

I was very happy for 2 months and last month i feel symptoms came as intense and doctor told to updose it but i tried to stay on 50mg but eventually symptoms got worsen and again he add mirtazapine 7.5 to it.now i am stable on it.at the same time i feel very disappointed that i have to add mirtazapine to fluvoxamine..

 

Hello, Jyot. Not sure what you're asking. If you are stable on 50mg fluvoxamine and 7.5mg mirtazapine, why do you want to come off it?

 

When did you make these drug changes? To help us out, follow these instructions Please put your drug and withdrawal history in your signature You may need to use a computer to do this.

[Jyot]

2017 dec-sertraline 50mg

2018 feb-i skipped dose..so psychiatrist updose to sertraline 100mg

Stayed on it for 1 year.

Then i felt i am ok ..so i tried to taper it.

April 2019 -down dose to 50mg

May 2019 - 25mg and stopped it on may 28th 2019.

June and july was ok.

Then august suddenly symptoms came and i was in deep depression .so again restarted 25mg but symptoms began to worsen so updose to 50mg on september and I was going smooth and on october again worsened on 50mg so updose to 100mg.

But symptoms only partially improved on100mg despite i stayed on it for 3 month .

Again on January 21st 2020 my doctor switched it to fluvoxamine 100mg.

My symptoms magically improved with in 1 week.

Then i felt i was ok, i tried to taper so i down dose to 50mg on february 14 and i was doing well till May 4th.again symptoms worsened and i went to my psychiatrist and he told to updose fluvoxamine.

But i tried to stay on 50mg and symptoms got worsen that i feel severly suicidal.And Doctor told that if i have updosed it on that day itself  he wouldnt have to add mirtazapine.

Then he told that now i have to take mirtazapine 7.5 mg and fluvoxamine 100mg.

My next visit to psychiatrist is june 18.

[Jyot]

One more thing...I dont have any side effects on these drugs and drugs made me more stable and strong .

But I feel some sort of dissapointment being on antidepressants.

Also some times i feel how will be my character without the drug.And also i have read some articles on longterm anymtidepressants will deplete our bodys vitamin, calcium like stories.so i was horrified by that.So i tried to wean off it.

[Altostrata]

It's up to you to decide if you want to stay on the drugs. If you want to go off, you'll have to taper so you don't get withdrawal symptoms.

 

We don't treat depression here, all we do is provide support for tapering. We can't tell you whether you need to take the drugs or not. If you don't want to take them, you'll have to take responsibility for managing your emotional state and any withdrawal symptoms. That's your decision, not ours.

 

Please follow these instructions Please put your drug and withdrawal history in your signature