Sarita: I have experienced medication discontinuation syndrome 5 times in the last 2.5 years

[ChessieCat]

Print out and give him the following leaflet from the Royal College of Psychiatry website: 

 

Stopping antidepressants

 

Which clearly states:

 

Quote

 

 

Symptoms of antidepressant withdrawal

...

the feeling of an electric shock in your arms, legs, or head (those are sometimes called ‘zaps’ and turning your head to the side can make them worse)

 

 

 

[ChessieCat]

I am so glad that you posted about that Sarita.

 

Apart from the stupidity of advising you to drop your dose to get rid of brain zaps, the reduction from 150mg to 100mg is a 33% reduction.  And the second advised reduction is a 50% reduction.

[Altostrata]

Sarita, when did the brain zaps start?

 

Please be sure to take your psychiatric drugs at the same time each day. Taking them off-schedule can cause odd symptoms. With the alcohol, this could have caused your recent symptoms.

[Sarita]

The brain zaps occurred when I stopped taking doxepin cold turkey last December, they went away once Doxepin was re administered. I got them again when they upped my dose in May to 200 mg’s of doxepin because I started smoking marijuana and it altered how my medication worked. During the months of June and July the brain zaps were intense right before I fell asleep. I also got tingling in my arms and legs.  I told my new psychiatrist and he said I was on too high of a dose so he tapered me down to 150 mg’s in a matter of 2 months once I was down to 150 mg’s the zaps were not so intense but they have been consistent. I take my medicine at 10 pm and I get the brain zaps right before falling asleep at around midnight. That’s how I know I’m about to go to sleep.....once the mild brain zaps occur, I am asleep within 10 minutes 

[Sarita]

I was only on 200 mg’s for one month previously I had been on 150mgs of doxepin since last December. 

[Sarita]

Error

[Colonial]

Welcome, Sarita.

 

Reading your thread it seems your original "diagnosis" may have come from the heavy alcohol and marijuana use.  

Granted, you were using them as a coping mechanism but since you did not seem to have a "diagnosis" until this time your "breakdown" and accompanying issues may have been from the brain chemistry destabilization from those 2 drugs.  Also, as you saw the smoking continued to interfere with your medication, I really would recommend ceasing both substances permanently.  Your brain will heal but if you continue to bombard it with the 2 of them it will complicate your withdrawal and delay feeling better. Then you will not know if the symptoms are from too fast a taper or the complications of the alcohol and the pot.

 

I agree that you should relax and enjoy the holidays the best you can.  Worrying about the insomnia will only raise your anxiety and cause the very problem itself. After you have been stable for a period of time a slow decline in your medication will be the best preventative to keep the insomnia from reoccurring, as well as learning some awesome non drug coping techniques. Enjoy the Holiday tomorrow. 

[Sarita]

Colonial, thank you so much for taking the time to respond, yes, I agree, my breakdown was definitely drug induced. I have learned the hard way and I have learned a very valuable lesson. I can never drink alcohol or smoke marijuana ever again. I thought a couple of drinks wouldn’t hurt but it is clear that kind f thinking is gateway to destructive behaviors. I have never been a casual drinker. I appreciate your words of encouragement and wish you happy holidays this season. I have started cognitive behavioral therapy and hope this will help!  I’ve also started to implement a bike ride into my daily routine along with breathing techniques that help with my anxiety. A million times thank you once again for your words, I will take any advise I can get and I am so thankful for this site and the people in it ❤️ Happy Thanksgiving to all and I will enjoy my family and be thankful everyday for this little life of mine.

[Altostrata]

Hi, Sarita, what do the zaps feel like?

 

It sounds like you have become sensitized to doxepin, that's what's causing these symptoms shortly after you take it. We often see that people become sensitized after they go on and off psychiatric drugs repeatedly. You may be reacting to 150mg doxepin as though it was a higher dosage.

 

You might reduce doxepin by 10% to 135mg and see if that helps. Please let us know how you're doing.

[Sarita]

I don’t see my dr until Jan , is this harmful? 

[Sarita]

Would it be ok to go down to 125. I have 75mg capsule and 50 that I can use

 

[Sarita]

Sometimes the brain zaps feel like a quick sharp buzz In my head, other times It lasts slightly longer and not as sharp. Thank you so much for your help.

[ChessieCat]

Firstly, my apologies for the suggestion about not reducing.  I was unaware that brain zaps can be caused by sensitisation.

 

This topic explains how to get the dose you need.

 

tips-for-tapering-doxepin-sinequan-zonalon

 

Altostrata is SA's founder and has many years of experience.  She has suggested reducing to 135mg.  Please do not reduce by more than 10% at this time.

 

This is a recent interview with Alto and will help you to understand where/how she gained her experienced:  INTERVIEW with Altostrata, SA's founder    

 

[Sarita]

No need to apologize! Thank you so much, I will call my Dr. on Monday and ask him if he can prescribe me 100 mg’s and 50 milligrams (in 10 mg tablets) and start dropping 10 milligrams at a time. Should I hold each 10 milligrams drop for four, or six weeks? I have expressed my concern about making too large of a reduction but he insist I go down to 100 mg’s on my first drop regardless. I will make my plea once again and hope he is cooperative. He is part of Emergence Network System that assists me with my medications and sadly I am at their mercy because I cannot afford my medications without them 😢 once again, Thank you!!!!

[ChessieCat]

When talking with your doctor you could tell him that you would prefer to go slower.

 

how-to-talk-to-a-doctor-about-tapering-and-withdrawal-what-to-expect

 

You could take the majority of your dose in tablets and take the balance by making a liquid from a tablet.

 

From the Tips for Tapering Doxepin topic:

 

On 3/2/2013 at 6:47 AM, Altostrata said:

Make a doxepin liquid yourself from tablets or capsules

Doxepin is soluble in water. See How to make a liquid from tablets or capsules

Doxepin may degrade when exposed to light. If you make your own liquid, do not store it -- discard after you take your dose.

 

Use an oral syringe to precisely measure out doses as small as 0.01mg.

 

 

[Colonial]

Would you mind updating your signature line with, as close as the exact dates of you med drops as possible?

Only providing the month leaves a wide open variable.  A drop in June and then July could be 30 days apart or near 60.

Also, please provide the date you dropped the Dox in May and the exact day in June you began again at 200mg.

 

I've found 2 parameters for lowering meds helpful., the percentage drop per dose, and overall percentage in a 6 month period.

So depending on what date you started in June helps determine the total percentage you should only drop in 6 months.

 

On 11/25/2020 at 8:09 PM, Sarita said:

I got them again when they upped my dose in May to 200 mg’s of doxepin because I started smoking marijuana and it altered how my medication worked.

 

Your signature also doesn't say when you up dosed to 200 in May, it only says you stopped taking altogether it from presumably 150 mgs.

Please provide the date you dropped the Dox in May and the exact day in June you began again at 200mg.

 

Please understand we aren't trying to "nitpick" about what may seem insignificant details.

But we won't always have time to re read your entire thread to find information that may be missing that could be important in formulating advice. 

My personal opinion is that dropping another 25mgs all at once is now too high of a percentage.

That is 1/6th or 16.67%. Dropping to 135 would be 10%.

 

You don't want to destabilize yourself in a pandemic when help may not be available to you locally. 

You will need to formulate a plan on how to reduce going forward.

Either weighing out the med on a scale or making a liquid compound if you are not able to get a compounding pharmacy to do it for you.

I would first consider if any other pill sizes are on the market and you might be able to mix and match cutting them in half to getting closer to 135.

 

You can get to 131.50 with the 2 you have if they cut well into quarters and the doct isn't cooperative but see if you can get another prescription so you don't have to cut more than in half if you dont want to make a liquid. 

 

Edited November 27, 2020 by Colonial

[Colonial]

21 minutes ago, Sarita said:

Should I hold each 10 milligrams drop for four, or six weeks? I have expressed my concern about making too large of a reduction but he insist I go down to 100 mg’s on my first drop regardless. I will make my plea once again and hope he is cooperative.

 

That depends on how you do.

You need to wait a minimum of a month and then see how you feel.

Some people can drop 10% every 4-6 weeks, some need to drop smaller percentage amounts and hold 2 months.

 

[ChessieCat]

27 minutes ago, Colonial said:

A drop in June and then July could be 30 days apart or near 60.

 

Or only 1 day if the changes were made on 30th June and 1st July 😵

[Sarita]

Hello again, I updated my signature the best I could remember. I will make sure as I proceed to be very specific. Thank you for the information on how to talk to my doctor. I really appreciate all the feedback and do not take your suggestions as nit picking. I am forever grateful!!

[Sarita]

Hello, I was wondering why my antidepressant takes longer to work. It use to work within 30 minutes, then it started working 2 hours later and now sometimes 2.5 - 3 hours for it to kick in. Any ideas? Thank you in advance 

[Colonial]

Could you explain what you mean by "work"?

What is it you perceive it is doing or not doing in those time frames?

Thank you.

 

[Sarita]

Doxepin was Prescribed to me for insomnia. So by “work” I mean put me to sleep. 

[Colonial]

Because your introductory post is a general narrative (which is good to start) it is hard to decipher a few things.

On one end it seems you may have had insomnia before being hospitalized as a result of the alcohol and pot but I can't be sure.

Did you have it before you were put on the other psych meds at the hospital?

 

But then we have the issue of this:

 

On 11/25/2020 at 8:09 PM, Sarita said:

I got them again when they upped my dose in May to 200 mg’s of doxepin because I started smoking marijuana and it altered how my medication worked.

 

Where the Pot interfered with it's supposed effectiveness.

Can you be more specific as to when it used to work in 30 minutes and then when it only started to help in 2-3 hours?

Is this just recently again since May?

 

There are points in time with any drug that they simply stop "working" but I think there is more involved to it than that.

You also have to realize that if your trying to get off the medication, you have to find other ways to deal with the insomnia.

 

 

[Sarita]

When I first started using Doxepin back in 2019, it use to put me to sleep within 30 minutes of taking it. When I started smoking marijuana in April, Doxepin lost its sedative component shortly after in May, then when it was re administered June 2020i would take an hour or so to put me to sleep. Now, it takes anywhere from 2.5 - 3 hours to work. I still get 7-7.5 hours of sleep.

[Sarita]

How can I deal with the insomnia without becoming hospitalized 😢

[Colonial]

Well, you would need to stop doing things that provoke brain destabilization, like very rapid drug tapers and the alcohol and pot.

You have been on and off a lot of medications in only 27 months.

It's going to take your brain time to heal and sort through it all.

But if your getting 7 hours of sleep a night that is very good regardless of how long it takes to fall asleep.

When you have the insomnia how many hours of sleep are you getting a night?

 

[Colonial]

31 minutes ago, Sarita said:

How can I deal with the insomnia without becoming hospitalized

 

 

Tips to help sleep: so many of us have that awful withdrawal insomnia - Symptoms and self-care - Surviving Antidepressants

 

It seems by the amount of medication you are on it is being given more for anxiety and depression than Insomnia.

 

Also, perhaps it was the pot that was causing your insomnia, more than it was interfering with your medication, they are 2 different things.

Daily smoking can cause insomnia, and in a higher percentage of women than men.

So if your doing something to provoke insomnia, that is NOT the same as it is interfering with your medication to prevent insomnia.

 

Why don't you discuss with you doctor how marijuana affects your REM cycle sleep and commit to not using it anymore?

Then commit to using some of the helpful tips in the link above and you won't have to worry about the hospital. 

 

 

 

[Sarita]

When I went manic and in 2018 I had gotten about 3-4 hours in a span of about 4 days. I’ve never experienced chronic insomnia until I started coming off my meds cold turkey, then it is 0 sleep for days. In 2019, the 2 times I destabilized I would go about two weeks of chronic insomnia then was lucky that when I would re- administer Doxipin it would start working again, but during the weeks of zero sleep, I survived with whatever I could get my hands on. 20 milligrams of melatonin helped me sleep for about 3 days. I smoked marijuana mixed with shatter and that relieved the insomnia a few times but I didn’t do it all the time. I also survived with xanex a few days but knew that was not something safe. I also think it is a good sign that I sleep 7 - 7.5 hours regardless of how long it takes for the medications to put me to sleep. That didn’t happen before on the other meds I’ve been in . I am completely committed to getting better and will do whatever it takes not to be hospitalized and over medicated again!! I have told my Dr. how I feel I could live a life without meds and he is completely on board. But the agency where I get my meds, they are the ones saying I need to be on meds for the rest of my life. It is hard to get them to understand my situation. Thank you for all your advise, It is going to take a lot of work but I am definitely committed! I have not had insomnia since the end of May and like the previous time I got off my meds it was 0 sleep for weeks!!! Looking back , it is a miracle that I am now just one medication !

[Colonial]

5 hours ago, Sarita said:

I also think it is a good sign that I sleep 7 - 7.5 hours regardless of how long it takes for the medications to put me to sleep. That didn’t happen before on the other meds I’ve been in .

 

Again, it may not be that particular med helping the insomnia.

I think the insomnia is being provoked by the pot and the withdrawal, I don't think it's an independent issue.

 

You have been on a dose of Doxy for 6 months now which is enough time for your brain to be dependent upon it.

So you can expect that if you try to come off it too fast,  the WD insomnia may return.

But that is not the same as you need to stay on the  medication to treat insomnia.

Again, your on a much higher dose than what would be administered JUST for insomnia from what I can see about this med.

 

The agency that says you need to stay on the meds for life are misdiagnosing the WD symptoms and the consequences of the alcohol and pot use as an actual mental illness.  You were not mentally ill before you started using them and your reactions to psych meds seems quite typical. 

Since the doctor is on board with you getting off that is all that matters.

You can not be medicated against your will for a situation where you are not a danger to yourself or others.

If you do not want to have that situation occur you need to make a strong plan for going forward and stick with it.

 

You cold turkey' d the Doxy in Aug, 2019 and the insomnia was back in December, when you reinstated.

Things seems ok until you started the pot again in 4/2020 which led to more insomnia and CTing again...

And then reinstating with a lot of dose tampering until 8/2020.

 

However, only you know how much alcohol and pot your still consuming.

So I think if you stop the other drug and alcohol use and stop dropping your psych meds so fast, you will find the insomnia won't be an issue.

That's my personal suspicion as to why what is happening is.

I think your placing too heavy a causal relationship between taking the Doxy and it being a sleep aid.

 

Are you keeping a chart of when and how much alcohol and pot you are using?

You now need to decide for yourself if you can commit to being alcohol and pot free.

I think if you can do that for 6 months then you can go forward with a tapering plan.

 

I'm not sure what else we can offer you until you know which route you want to go, other than those great links.

 

 

 

[Sarita]

I think I understand what you are saying and that makes a lot of sense. The last time I smoked was May 2020 when the insomnia came back , I flushed down the marijuana I had just purchased because I was so mad with myself. I knew pot was a huge role in my manic episode in 2018 and couldn’t believe that I was putting myself through that yet again. In 2019 I had a couple of beers maybe a hand full of times and in 2020 I’ve had no more than 2 beers on 3 occasions. You are 💯 % right, I need to commit to my recovery and stop self sabotaging myself. I will speak to my Dr. about a plan to move forward. Thank you so much for taking the time, it is appreciated more than you know! 

[ChessieCat]

1 hour ago, Sarita said:

I need to commit to my recovery and stop self sabotaging myself.

 

That's great to hear.

[Sarita]

Hello, I went down from 150 mg’s to 135. I usually get 7 - 7.5 hours of sleep. Last night I fell asleep at around 12:30 am then I woke up at around 4:30. I laid in bed and fell back asleep at around 6:30 am and woke up again at around 8. Should I continue at 135 mg’s or should I go up to 145 and hold for a couple of weeks? Thank you for your guidance. Still got the brain zaps before falling asleep.

[Colonial]

You have been having sleep issues for awhile so I am not convinced that the first night after dropping the med is related but it could be.

While it is important to keep good notes on your progress after a med change sometimes things are just coincidence.

 

What is going to be important for you to understand is there is some amount of sleep disturbance that comes with withdrawal.

After a dose change some people notice symptoms for a week or more, even if mild.

You did sleep 5.5 hours, which is not too bad. I went for weeks only getting 2 hours or such.

So the question for each person is how much can you tolerate symptom wise before knowing if you should up dose and:

"Is the symptom even from the decrease?"

You very well may have had the night you had if you has still been on 150, you take it at night, I'm not convinced the 10% change is what woke you up.

 

So, while I applaud you for being someone willing to up dose if necessary and not be stubborn and just try to ride it out you also can't assume every bump in the road is reduction related or expect this process to be disturbance free.  This is important because the success of a taper relies on being able to stay at a certain dose and not yo-yoing up and down every time something doesn't go right, so it's a balance between the 2.

 

So last night was the first night of reduction, and you woke up at 4:30am, and your wondering if it's that first nightly drop waking you up less than 8 hours after taking it, is that correct?  I'm going by your signature line.

 

The question is going to come down to how secure you feel in your taper percentage drop before hand, since if your concerned that you need to updose after one night of loosing 2 hours sleep, your always going to be second guessing yourself, which will produce anxiety and make your symptoms worse. 

 

Again, while it may be drop related after only one night?  Maybe. But I don't think so, considering you take it at night.

I simply don't think it had the time to be of "negative difference" to be waking you up at 4 am.

Do you think you were nervous about trying the new dose amount and that anxiety could be the cause?

 

If you choose to up dose, you could try 140 or 142, but you need to remember you need to give your body time to adjust.

Going up to 145  " for a couple of weeks" is probably not sufficient, you really need to wait a month considering all of the problems you've had.

I realize there is a concern about now being sensitized to the med but changing dosages too often can be problematic.

 

You could try a second night at 130 and see how you do, you've only had one night at the new dose so far.

If you have a second bad night than maybe a small up dose is wise since, in my opinion, it's not 1 dose related it's your overall destabilization.

And if it's the destabilization than maybe a smaller percentage drop for a month is wise since you would be adding a med drop on top of your destabilization.

 

The issue is you feeling comfortable at the percentage reduction so your not constantly second guessing if the med drop was too much since symptoms are going to be some part of this process.  If your not comfortable with what you think is too high a drop your fear will sabotage the process and cause the insomnia. I know when I'm worried about things I don't sleep well either. 

 

I also don't know if you are now sensitized to the med and it's causing the brain zaps, if the sleep disturbances are not also part of a paradoxical effect.

Meaning taking the med at night may be what's causes the insomnia. 

Once a med becomes problematic in any way, it could be affecting you in others as well.

 

So it's up to you if you want to try a second night at 135 and see how it goes.

But think about what I've said because all of these principles interact and you need to be comfortable going forward.

 

 

Edited December 3, 2020 by Colonial

[Sarita]

Your words are very comforting, THANK YOU. When I woke up, I didn’t freak out like other times. I put my weighted eye mask back on and laid in bed doing breathing exercises I learned during my cognitive behavioral therapy. I wasn’t anxious before going to bed, I read my nightly devotional scripture and wrote in my journal. This also helps with my anxiety. I will try really hard not to second guess myself  and proceed with 135 mg’s, keep good notes and listen carefully to my body. A million times, thank you for taking the time to respond, it is so comforting hearing advice from people who have lived through similar experiences ❤️ God has been so gracious to me through all of this and I will not live in fear. Something I’ve learned through all of this, is fear is a liar 🙏❤️

[Sarita]

Hello, I have been in 135 mg’s of doxepin since Dec. 2,2020 and have struggled with sleep. I went from 7 hours of sleep down to 3-4 hours a night and am managing. Last night I had full blown insomnia and didn’t sleep at all. I was wondering if I should go back up to 150 mg’s. I’m worried , please advise. 

[Sarita]

Or should I keep pushing forward?