KathyLoop: 30+ years of drugs

[KathyLoop]

Hi, thanks for having me.  It's been a 30+ year battle with major depression and anxiety. Tons of different drugs and treatments and hospitalizations. Lots and lots of suicidal years, including attempts. If anything I'm getting worse as the years go by... closer to suicide. The drugs are helping less and less, for shorter and shorter periods each time. I'm sick of them... sick of living this way. I've been completely disabled last 15 years... barely functioning... literally laying down 23 hours a day much of that time. I rarely go anywhere or do much of anything other than on computer.
 

Decided it's time to face life without these drugs. Doctor's on board. He generally supports me in whatever I want to do... I'm guessing he really has no clue what to do with me anymore, other than offering a new drug, which is really all his tool-box contains.

I'm about to start tapering off 40mg Viibryd, which I've only been on 5-6 months. Prior to that, I did a relatively quick taper off Citalopram/Mirtazapine. Managed 3 months completely off... absolute suicidal miserable dark hell. Viibryd brought me out of that quickly, but it lasted only a short time... darkness, apathy and laying in bed all day are back, even on it. Very recently, doctor tried boosting me up to 60mg for a week, but it just completely zombified me. And I said no more. Back to 40mg for a few days now.

 

Doctor tells me since I've only been on the current drug for 6 months, a super-slow taper is not necessary... he's recommending 30-20-15-10-5 at two-week intervals. He says the past 30 years of other drugs are out of my system and withdrawal from them is not an issue. It's not a 30-year issue, he says. All of these different drugs target different receptors and mechanisms in the brain, he says, so it's not a cumulative thing in terms of withdrawal from a 30-year habit.

 

My question is... is a super-slow taper necessary? After only 6 months on this drug? I would like to do the quicker version that he suggests.... and hopefully just get through what comes up, with the help of twice-weekly sessions with a Jungian Analyst (started seeing him 2 months ago and he recommends getting off the drugs too). Honestly, I just can't stand living this way any longer and I'm hoping there is something else on the other side of getting off the drugs. But who knows. 

 

My plan is to taper off the Viibryd while continuing with the various sleep meds I'm alternating among. And then, with Viibryd out, I'm guessing I might be able to actually sleep without any sleep meds and will just stop taking them. Since I've been alternating among them, I figure I won't have developed a tolerance to any. The alternating was on doctor's advice.

 

Open to any comments at all.... thanks so much for reading.

Edited December 14, 2020 by Shep
added username to title

[Shep]

Hi, KathyLoop.

 

Welcome to Surviving Antidepressants.

 

On 12/13/2020 at 3:03 AM, KathyLoop said:

Doctor tells me since I've only been on the current drug for 6 months, a super-slow taper is not necessary... he's recommending 30-20-15-10-5 at two-week intervals. He says the past 30 years of other drugs are out of my system and withdrawal from them is not an issue. It's not a 30-year issue, he says. All of these different drugs target different receptors and mechanisms in the brain, he says, so it's not a cumulative thing in terms of withdrawal from a 30-year habit.

 

My question is... is a super-slow taper necessary? After only 6 months on this drug?

 

Unfortunately, your doctor is very ignorant about withdrawal. This is not uncommon. You may want to show him this paper from the Royal College of Psychiatry:

 

"Stopping antidepressants" leaflet

 

And this article:

 

Psychiatry’s Top Experts Acknowledge Lasting Harms of Antidepressant Withdrawal

 

A 10% taper is recommended. It only takes a month to become dependent on antidepressants and only a few days to a month for benzodiazepines. And you do need to take into consideration your 30 year history, so you may even want to go with a micro-taper. We can discuss the details later on, but for now, please read over the below: 

 

Why taper by 10% of my dosage?

 

How psychiatric drugs remodel your brain

 

Healing from antidepressants. Patterns of recovery video (4 minutes)

 

The Windows and Waves Pattern of Stabilization

 

Again, chemical imbalance is a myth. Stop the lies, please.

 

 

On 12/13/2020 at 3:03 AM, KathyLoop said:

I would like to do the quicker version that he suggests.... and hopefully just get through what comes up, with the help of twice-weekly sessions with a Jungian Analyst (started seeing him 2 months ago and he recommends getting off the drugs too).

 

You may want to hold off getting involved in a lot of therapy right now. Please note withdrawal comes with a lot of neuro-emotions, which can be misinterpreted by anyone not familiar with withdrawal. Please see:

 

Neuro emotions

 

You may want to wait until you're very stable from withdrawal before going into any intense psychological discussions. You need to know who's the real you and what is coming from these false emotions. Treat yourself kindly right now. 

 

Simply adding in some non-drug coping skills may be best for now:

 

Non-drug techniques to cope with emotional symptoms

 

 

On 12/13/2020 at 3:03 AM, KathyLoop said:

My plan is to taper off the Viibryd while continuing with the various sleep meds I'm alternating among. And then, with Viibryd out, I'm guessing I might be able to actually sleep without any sleep meds and will just stop taking them. Since I've been alternating among them, I figure I won't have developed a tolerance to any. The alternating was on doctor's advice.

 

I can almost guarantee you're dependent on the sleep drugs. Zopiclone and lorazepam are closely related, both affecting the GABA system.  Also, GABA drugs often cause rebound symptoms and interdose withdrawal (going into withdrawal in between doses). Even with periodic use, you can become dependent on these drugs. Please see the latest FDA guidelines recently issues:

 

FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class

 

Per this FDA article:

 

Physical dependence can occur when benzodiazepines are taken steadily for several days to weeks, even as prescribed. Stopping them abruptly or reducing the dosage too quickly can result in withdrawal reactions, including seizures, which can be life-threatening.

 

Trazodone and Mirtazapine both affect serotonin. Trazodone often causes problems due to its active metabolite, meta-Chlorophenylpiperazine (mCPP) which causes anxiety the next day (for more, please see - Tips for tapering off trazodone (Desyrel). 

 

There's no guarantee that you are or aren't dependent on these drugs, but I would urge caution in discontinuing anything suddenly.

 

The first thing you should do is get on a consistent dosing schedule.  Do any of the drugs you take now help the most with sleep? The more information you can provide about this, the more we can help you set up a consistent dosing schedule. 

 

Please continue to use this thread to ask questions and to document your taper. If you can get on a consistent dosing schedule first, you'll set yourself up for a much safer and more comfortable taper going forward. 

 

 

[KathyLoop]

Thank you for all of the information. I've been doing a lot of reading for some time now.

 

I don't think I could attempt a taper without a therapist supporting me, as I am quite suicidal already. I need someone to see regularly to keep me going... to look forward to seeing... to share the awfulness with. But I am mindful of your comments in this regard. He is aware of my lengthy med history and encouraging the taper, suggesting that the meds are likely in the way of what we're trying to do in therapy.

 

I have someone looking after me, keeping me physically safe and willing to see me through this process, whatever it looks like. I'm not sure I can bear a taper lasting years, as things are quite unbearable now... I'm hoping there will be some change in me after the brain heals. So I am still thinking I might take it on a little quicker than is suggested here. At least at first... and see how I do with it.... then maybe going slower as the dose gets lower which, I understand, is when it becomes most important. If I was stable now and it was a matter of maintaining stability while tapering, a very slow taper might make more sense... but that's not my situation. There's been very little stability for the past few years... only a couple months when a new drug is introduced.

 

I agree the sleep meds will also be an issue. I will not stop them abruptly. I'm mostly alternating between Trazodone and Zopiclone, occasional Lorazepam. Mirtazapine doesn't work well, so I will omit that... I've probably only taken it 5 times total in the past few months. Zopiclone works "better" than Trazodone perhaps, though it's not reliable and I hate the taste it leaves the entire next day. I am already having trouble eating. I find if I take Trazodone a few nights in a row, it doesn't work as well, and it's not great to start with. I took it for 20 years straight at one point and it worked fine, but no longer. Lorazepam works the best of them all... I took it for 2 years straight at one point, slept like crazy... but I don't really want a benzo addiction. If you have any other suggestions for something that might be better for sleep, I'm sure my would doctor agree... he's quite willing to try anything I ask at this point.

Do you recommend tapering off just the Viibryd first, as I planned? And staying with a constant sleep med during this time?

 

Thank you for reading. I appreciate very much that you are assisting me, even though I don't follow everything you recommend.

[KathyLoop]

I haven't heard back from you. It looks like my post hasn't been approved yet. Just wondering if I said something wrong. Or if it's a matter of not wanting to help someone who isn't going to follow recommendations. Or maybe you're just busy.

 

I went from 40mg to 30mg of the Viibryd starting today. I will go slower as the dose gets smaller, but wanted to try to tackle that reduction at this time. I will see how I feel... maybe stay at 30mg for 2-3 weeks. I'm guessing you would recommend staying there longer. And then maybe reducing by 5mg next. I'm guessing you would've recommended only reducing by 5mg today.

 

I will understand if you don't want to interact with me while I'm not following your recommendations. Please let me know if this is the case. If you're still willing, I would appreciate the ongoing support very much. It's difficult for me... battling my own mind at every turn. But I realize you're not a therapist... likely just here to offer me guidance on how to reduce the drugs in a way that's been proven to work. 

[ChessieCat]

1 hour ago, KathyLoop said:

Or maybe you're just busy.

 

SA is a very busy site with a lot of members and is staffed by a small number of volunteers who are also tapering/post taper.  We assist members as we can.

 

Please be patient.

[ChessieCat]

On 12/14/2020 at 11:23 PM, Shep said:

The first thing you should do is get on a consistent dosing schedule. 

 

On 12/14/2020 at 11:23 PM, Shep said:

If you can get on a consistent dosing schedule first, you'll set yourself up for a much safer and more comfortable taper going forward. 

 

[Shep]

On 12/16/2020 at 12:51 AM, KathyLoop said:

Do you recommend tapering off just the Viibryd first, as I planned? And staying with a constant sleep med during this time?

 

Yes, this likely be the best path. Please see:

 

Taking multiple psych drugs? Which drug to taper first?

 

 

15 hours ago, KathyLoop said:

I went from 40mg to 30mg of the Viibryd starting today.

 

This is a 25% reduction. As listed in my first post, we recommend going no faster than 10% per month based on the last dose (not the original dose).

 

Please go back to the 40 mg Viibryd. You really need to get on a consistent dosing with the drugs you're taking at night for sleep. By making a large reduction while cycling through other drugs, you're confusing your nervous system and setting it up for a very unstable withdrawal. 

 

On 12/14/2020 at 7:23 AM, Shep said:

The first thing you should do is get on a consistent dosing schedule.  Do any of the drugs you take now help the most with sleep? The more information you can provide about this, the more we can help you set up a consistent dosing schedule. 

 

This information is important. If you can give us details on which drug(s) are the most helpful, we can help you set up a plan for consistent dosing. 

 

On 12/16/2020 at 12:51 AM, KathyLoop said:

I appreciate very much that you are assisting me, even though I don't follow everything you recommend.

 

15 hours ago, KathyLoop said:

I will understand if you don't want to interact with me while I'm not following your recommendations.

 

Are you interested in Surviving Antidepressants' harm-reduction protocol? 

 

If not, this isn't the right forum for you. You may want to check out Benzo Buddies.org. It's a large social site for people coming off psychiatric drugs, especially benzos, but a lot of members are polydrugged. It's a bit of the wild west, but they don't insist on any type of harm-reduction protocol. 

 

SA is being used in research studies, so we really need to stick with folks who are interested in what's considered the safest way to withdraw from these drugs. Here is an interview with this site's owner, Altostrata:

 

Surviving Antidepressants: An Interview with ****** Framer

[KathyLoop]

On 12/15/2020 at 10:51 PM, KathyLoop said:

I agree the sleep meds will also be an issue. I will not stop them abruptly. I'm mostly alternating between Trazodone and Zopiclone, occasional Lorazepam. Mirtazapine doesn't work well, so I will omit that... I've probably only taken it 5 times total in the past few months. Zopiclone works "better" than Trazodone perhaps, though it's not reliable and I hate the taste it leaves the entire next day. I am already having trouble eating. I find if I take Trazodone a few nights in a row, it doesn't work as well, and it's not great to start with. I took it for 20 years straight at one point and it worked fine, but no longer. Lorazepam works the best of them all... I took it for 2 years straight at one point, slept like crazy... but I don't really want a benzo addiction. If you have any other suggestions for something that might be better for sleep, I'm sure my would doctor agree... he's quite willing to try anything I ask at this point.

I've re-stated this, as I'm guessing you didn't see it the first time I wrote it. You asked me to provide more info about sleep meds and I did. I'd appreciate your advice on this.

[Shep]

Thanks, Kathy. I did miss the part about which of the sleep drugs works best, so thanks for the re-post. 

 

Please update your signature to list the months you were on each of your drugs the past two years.  We need this information to see if dependency has set in for any of these. We only need this for the 2019 and 2020. For more on how to set up a signature, please see:

 

Please summarize your withdrawal history in your signature

 

It's possible to become dependent on any of these drugs, even with periodic use. This is especially true for benzos. The latest FDA guidelines now say dependency is possible on only a few days: 

 

FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class

 

On 12/16/2020 at 12:51 AM, KathyLoop said:

I agree the sleep meds will also be an issue. I will not stop them abruptly. I'm mostly alternating between Trazodone and Zopiclone, occasional Lorazepam. Mirtazapine doesn't work well, so I will omit that... I've probably only taken it 5 times total in the past few months. Zopiclone works "better" than Trazodone perhaps, though it's not reliable and I hate the taste it leaves the entire next day. I am already having trouble eating. I find if I take Trazodone a few nights in a row, it doesn't work as well, and it's not great to start with. I took it for 20 years straight at one point and it worked fine, but no longer. Lorazepam works the best of them all... I took it for 2 years straight at one point, slept like crazy... but I don't really want a benzo addiction. If you have any other suggestions for something that might be better for sleep, I'm sure my would doctor agree... he's quite willing to try anything I ask at this point.

 

I would stop the zopiclone and only use Lorazepam. The lorazepam is the most effective for you and it will help cover any withdrawal issues from the zopiclone. It may not completely cover it, but if the lorazepam is effective for sleep, it will make you more comfortable. 

 

It sounds like you may have been affected by trazodone's byproduct, mCPP. For more on this byproduct and its effects, please see: 

 

Tips for tapering off trazodone (Desyrel)

 

 

If you can get by with just the lorazepam, I would stop the others. Lorazepam has a short half-life of 10 - 20 hours, so some of your symptoms during the day may be from interdose withdrawal (going into withdrawal in between doses). You may need to dose at least twice a day to not experience these symptoms. 

 

If you do go the lorazepam route, I would be very consistent. Because you have a previous history with long-term benzo use, you'll set yourself up for kindling if you keep making sudden changes. Please see:

 

Kindling

 

From that article:
 

Quote

 

Kindling, in layman’s terms, is as if the nervous system has a memory of the past withdrawal(s). This memory of prior withdrawal(s) and/or damage still remains imprinted within the nervous system and subsequent withdrawals and/or damage are worse because the nervous system recalls that it has been sensitized/damaged in prior withdrawal(s).

 

 

 

 

Because of your lengthy drug history, ECT, and rapid tapers, I would recommend getting on a steady dose of lorazepam twice a day and holding the Viibryd steady for at least a few weeks before making any reductions. And then you may wish to start out with a micro-taper of no faster than 5% per month. 

[KathyLoop]

Hi, just wanted to tell you that I managed to get off all the drugs. I tapered the Viibryd rather quickly, over a three-month period, as it was making me quite sick and I was very suicidal on it. I've been off it completely for almost 3 months now. I then took on a rather quick taper of the sleep meds as well... started by dropped the Trazodone, as again, it was making me sick every time I took it. Then I reduced the Ativan and Zopiclone to 3/4, then 1/2... and eventually just stopped, as I suspected they were making me feel sick too. I've been completely off them about a week and a half. My sleep is poor, but I'm doing relatively ok in general. I've started getting out for daily walks, spending more time up out of bed. Still doing twice weekly therapy. I have a lot of headaches and head ringing... general body soreness... severe fatigue, though that might be improving slightly. But none of this is new, other than the head ringing. I had all these symptoms while on the drugs. I'm also going through menopause, so all those symptoms could be related to that as well, including the sleep difficulties.

 

So I didn't follow this site's recommendations about the super-slow taper. I simply couldn't stay on the drugs that long, as I was so unwell on them. I just felt like continuing with this thread... I like things finished, I guess. I wouldn't say I'm out of the woods just yet, but it's definitely encouraging.

 

 

[Shep]

Thanks for the update, Kathy. Very glad you're doing as well as you are with all of those reductions. 

[KathyLoop]

Things have taken a turn, and I'm very suicidal. I probably overstated how well I was doing in my last post, as I hoped it would be true.

 

Wondering if you would recommend reinstating something, and then eventually trying again at a slow 10% taper? I was thinking Mirtazapine, as it would then just be one drug and I would be able to sleep on it. Or should I just try to stick it out and wait for things to improve?

 

Just to recap, I'm 3 months off antidepressants and a few weeks off sleep meds, but I've gone back to some ativan the past week and a half, to deal with rages and try to get some sleep. Sleeping very little. Added some alcohol to try to boost the ativan, though I realize this isn't smart. Just desperate. Doctor also prescribed clonidine recently for menopausal hot flashes and I suspect it's contributing to depression.

[Shep]

@KathyLoopThe best thing you can do is to stop trying to fix withdrawal symptoms with Ativan, alcohol, etc. This is very dangerous for someone with a destabilized nervous system and you're setting yourself up for kindling.

 

Benzodiazepine Kindling

 

Kindling, in layman’s terms, is as if the nervous system has a memory of the past withdrawal(s). This memory of prior withdrawal(s) and/or damage still remains imprinted within the nervous system and subsequent withdrawals and/or damage are worse because the nervous system recalls that it has been sensitized/damaged in prior withdrawal(s).

 

Please research holistic ways of getting through menopause. Adding in clonidine while also taking Ativan creates a potential "moderate" drug interaction. Also, combining multiple sedating drugs can cause a paradoxical reaction, meaning your nervous system is alerting and fighting to stay awake the more you try to dampen it down. Paradoxical and rebound reactions are very common with benzos. For more on the drug interation:

 

Drug Interactions Report - clonodine and ativan

 

For more on coping with menopause during withdrawal:

 

Older female issues: perimenopause, menopause, WD or something else

 

18 hours ago, KathyLoop said:

Wondering if you would recommend reinstating something, and then eventually trying again at a slow 10% taper? I was thinking Mirtazapine, as it would then just be one drug and I would be able to sleep on it. Or should I just try to stick it out and wait for things to improve?

 

Just to recap, I'm 3 months off antidepressants and a few weeks off sleep meds, but I've gone back to some ativan the past week and a half, to deal with rages and try to get some sleep.

 

 

Please list the drugs you are currently taking, any supplements, along with the time(s) of day you take them and the dose. Also, how long were you completely off "sleep meds" before adding back in periodic Ativan?

 

Edited June 24, 2021 by Shep
added more information and questions

[Shep]

18 hours ago, KathyLoop said:

Things have taken a turn, and I'm very suicidal.

 

I wanted to list this in a separate post to make sure you see it. If you are struggling and are afraid of acting on these thoughts, please seek support. 

 

For those who are feeling desperate or suicidal

 

Canada Suicide Hotlines

 

These thoughts are temporary and if you can get on a very consistent dosing schedule, avoid alcohol, and do some much-deserved self-care, you'll feel better. 

[KathyLoop]

Please list the drugs you are currently taking, any supplements, along with the time(s) of day you take them and the dose. Also, how long were you completely off "sleep meds" before adding back in periodic Ativan?

 

I'm completely off the Viibryd since March 2021. I was off all sleep meds for maybe 2 weeks before adding periodic Ativan with some alcohol because I started having uncontrollable rages and became very suicidal... banged my head through the wall one night, hacked a drawer apart with a butcher knife another night. This is not typical behavior for me. I've taken ativan 1mg at night for the past week or so, as it seems having so little sleep was increasing my rages. I've stopped the alcohol as of yesterday. Sleep is my biggest concern.

 

So current drugs:

 

0.025mg Clonidine, twice a day 8am, 8pm

0.5 - 1mg Ativan 10pm (last 6 days)... time has varied as I've been reluctant to take it every night again... so occasionally taking it middle of the night when I'm freaking out

200-400mg magnesium glycinate 9pm

Supplements at various times during the day: VitB Complex, Vit C, Vit D, multivitamin, Omega 3.

 

I've tried various things for sleep here and there over the last week, not regularly: melatonin, 5mg, OTC Happy Sleeper (contains 3mg melatonin, 50mg 5-HTP, 10mg B6, and a blend of valerian, gaba, glycine, passionflower, lemon balm, lavender, l-theanine) These on their own are not sufficient to get me much sleep.

 

 

 

 

[Shep]

18 hours ago, KathyLoop said:

I've taken ativan 1mg at night for the past week or so

 

You really are risking dependency. I would either come off Ativan now or stay on it, stabilize, and then do a gradual taper later. 

 

18 hours ago, KathyLoop said:

I've tried various things for sleep here and there over the last week, not regularly: melatonin, 5mg, OTC Happy Sleeper (contains 3mg melatonin, 50mg 5-HTP, 10mg B6, and a blend of valerian, gaba, glycine, passionflower, lemon balm, lavender, l-theanine) These on their own are not sufficient to get me much sleep.

 

A few thoughts:

• valerian, gaba, and passionflower all affect GABA. So does Ativan. So you're increasing your risk of developing dependency on a GABA drug and / or supplement
• by continuing to take so many sedating supplements, you may be creating a paradoxical reaction - the more you dampen down the nervous system, the more it fights to stay alert. So instead of inducing sleep, it's waking you up.
• the melatonin dose of 5 mg on its own and the Happy Sleeper which contains 3 mg melatonin are both very high doses of melatonin and may be causing paradoxical reactions - see Melatonin for sleep

The simpler you can keep your withdrawal journey, the better. Instead of taking supplements or benzos, please work on other ways of handling your insomnia. These tips may help:

 

Tips to help sleep: so many of us have that awful withdrawal insomnia

 

You've been off Viibryd for 3 months, so a small reinstatement may help. Please see:

 

About reinstating and stabilizing to reduce withdrawal symptoms

 

It's unclear how much of your insomnia is being causing by antidepressant withdrawal or if your symptoms are being complicated by all of these supplements and the use of Ativan. 

 

Please post your thoughts. 

[KathyLoop]

Thanks, Shep. I agree the melatonin and supplements are not helping. I likely came off the sleep meds too soon and too quickly, contrary to this site's advice, so that's on me. I thought they were making me sick, but it was likely just withdrawal... and adding sleep med withdrawal just made it worse. I will probably reinstate ativan and zopiclone for sleep, alternating as before... it seems neither one works well when taken repeatedly. I would rather avoid both drugs, but there are so few options for sleep and I figure I'm better medicated than dead... I seem to have become very suicidal since coming off sleep meds. So I will try them again for a while and see how I do. (There's a new option for sleep available in Canada called Dayvigo... not sure I want to go there but it's a future possibility.)

 

I think my insomnia is withdrawal related, as well as a chronic issue... I've been medicating sleep in some form for 30 years. I mainly took ativan the past few weeks because I was so desperate for sleep... and the melatonin and happy sleeper were just a brief recent experiment that seemed better than ativan, but failed. I suspect lack of sleep led to the rages and increased suicidality. Things like meditation, exercise, good sleep hygiene, etc. have not proved effective, but I will continue with them and add more if I can before I attempt another taper.

 

Reinstating Viibryd makes no sense to me as I was never really stable on it. I was very suicidal even on the full dose after the first month. I was considering Mirtazapine, as it would help with sleep and would be just one drug to eventually taper, but I want to try to avoid reinstating any antidepressants just yet... see if I can get through this and not have to do it yet again.

 

I agree keeping the withdrawal journey simple would be best. Trying, but desperation sets in. And I messed up, trying to do it all too quickly, contrary to your advice. I appreciate you continuing to advise me, despite my failing to follow advice.

[Shep]

12 hours ago, KathyLoop said:

I will probably reinstate ativan and zopiclone for sleep, alternating as before... it seems neither one works well when taken repeatedly. I would rather avoid both drugs, but there are so few options for sleep and I figure I'm better medicated than dead... I seem to have become very suicidal since coming off sleep meds. So I will try them again for a while and see how I do. (There's a new option for sleep available in Canada called Dayvigo... not sure I want to go there but it's a future possibility.)

 

I think my insomnia is withdrawal related, as well as a chronic issue... I've been medicating sleep in some form for 30 years. I mainly took ativan the past few weeks because I was so desperate for sleep... and the melatonin and happy sleeper were just a brief recent experiment that seemed better than ativan, but failed. I suspect lack of sleep led to the rages and increased suicidality.

 

Just some thoughts:

 

Alternating Ativan and Zopiclone may be causing some problems. Both of these drugs have extremely short half-lives, so you're going into withdrawal in between doses. This can cause issues such as suicidal thinking and rage. It can also kindle your nervous system by causing repeated trauma with repeatedly going into withdrawal due to the short half life. 

 

I just did a search for the drug you mention wanting to take - Dayvigo - and there's not much on the site about that, but it's in the same class of drugs as Belsomra, an older drug that's more common on the benzo withdrawal forums and known for causing problems including dependency, so I would approach with a great deal of caution. 

 

[KathyLoop]

Those are valid concerns. I agree all these drugs suck. But what is the alternative? To go without sleep indefinitely? Sleep deprivation also causes suicidal rage and thinking.

 

Or are you suggesting I pick one, either ativan or zopiclone, and stick with it every night? Stabilize for a while and then attempt a slow taper? I'm just worried taking one every day will develop tolerance quicker and then it won't work and I'll still have to go through withdrawal, unstable. But it sounds like you think tolerance is better than alternating/kindling? Is that accurate? And if so, is one drug better than the other for sleep, ativan or zopiclone?

[Shep]

25 minutes ago, KathyLoop said:

Or are you suggesting I pick one, either ativan or zopiclone, and stick with it every night? Stabilize for a while and then attempt a slow taper? I'm just worried taking one every day will develop tolerance quicker and then it won't work and I'll still have to go through withdrawal, unstable. But it sounds like you think tolerance is better than alternating/kindling? Is that accurate? And if so, is one drug better than the other for sleep, ativan or zopiclone?

 

Yes, I would stick with one - whichever one you feel works best - and take it consistently and then taper off. Or take both, but do so in a very consistent manner. The point is to be very consistent so you can develop a solid enough baseline to start a taper. Right now, the inconsistent dosing is making it possible to even get to a baseline where you know where you're at. This is one of the most problematic issues with periodic or irregular dosing. 

 

I'm basing this advice on the below information:

 

• You likely are already dependent on a GABA drug. Both Zopiclone and Ativan, although distinct drugs, still affect GABA. 
• You likely are already dealing with kindling from previous off and on uses of GABA drugs. 

Since you likely are already dependent and, due to kindling, need to protect your already traumatized nervous system, by dosing the drug consistently, you are at least removing one variable from a complicated withdrawal equation and simplifying your withdrawal. 

 

Just some thoughts. The insomnia is brutal, but if what you are currently doing is making it worse, perhaps changing course and going in a more consistent manner will help. It's definitely not a quick fix either way and part of your symptoms are no doubt due to plain old battle fatigue from being sick for so long, so self care is vital. 

[KathyLoop]

Ok, that makes good sense to me. Thank you so much for your quick response. I will try this. 

 

Any suggestion how long to stabilize before attempting the slow taper off the sleep meds? I'm only 3-1/2 months off the antidepressant, so my system's likely pretty unhappy from that still, especially since I did a fast taper, over about 3 months. But I don't want to stay on the sleep drug any longer than necessary, to avoid increasing tolerance and dependence. 

 

I have a lot of headaches and neck tension, head ringing, fatigue, mood swings, irritability. And of course insomnia. Those are my main withdrawal symptoms. My self care is improving... eating very healthy, getting out for daily walks, therapy twice a week.

[KathyLoop]

Couple more questions about dosing and interdose withdrawal and kindling...

 

In order to avoid all of that, does it make more sense to go with Ativan instead of Zopiclone, if I'm going to pick one? Since Ativan has a longer half life... I understand it's 12 hours, compared to only 5 hours for zopiclone. So there'd be less interdose withdrawal and kindling with Ativan?

 

And would you recommend dosing with 0.5mg ativan every 12 hours or one dose of 1mg at night before sleep? I'd prefer to do the latter, as I'm worried if I dose twice a day, it won't be effective for sleep, which is really the main reason I need to take it. But I understand the interdose withdrawal concern as well.... though with Ativan it would be less severe. Maybe 1mg at night for now? To get some regular sleep? Until I'm ready to start tapering... and then during the taper, split it up? I'm really just throwing out ideas here, trying to sort out what might work best for me, with your guidance.

 

(I tried Zopiclone Friday night and got some sleep, but felt like I was into withdrawal within a few hours of waking. I had much more energy than normal, but the whole day I was totally wired and super-anxious with racing worrying thoughts about anything and everything... major body tension and heart pounding... likely from ativan withdrawal as well, since I'd had it pretty much daily for the previous 3 weeks. Tried to stick with Zopiclone again for sleep last night, but I was so over-stimulated and could hardly sleep at all and was super-distressed... so resorted to ativan anyway in the middle of the night. I realize this is not in line with your recommendation... it will take me a bit of time to sort out how to stabilize and which drug to stabilize on... honestly wondering if it's even possible for me to stabilize on anything, as I haven't been stable on anything for about 3 years, but I'll give it a shot.)

 

Does it make any sense to use zopliclone for sleep and maybe 0.5mg ativan during the day for anxiety? Or best to just stick with ativan?

 

And on the clonidine issue... is it better to take HRT? The thread you referred me to on coping with menopause during withdrawal was long and overwhelming and confusing on this issue. Or did you mean to seek out holistic, non-hormone, non-drug approaches? I have some hope that hormones might help with many of the issues I've been experiencing my whole life, maybe from PMDD, but maybe that's wishful thinking. So just wondering if HRT is better than clonidine, or are both equally not advisable?

 

Sorry for the long post... let me know if you prefer multiple shorter ones, with one issue per post.

[Shep]

On 6/26/2021 at 10:36 AM, KathyLoop said:

Any suggestion how long to stabilize before attempting the slow taper off the sleep meds? I'm only 3-1/2 months off the antidepressant, so my system's likely pretty unhappy from that still, especially since I did a fast taper, over about 3 months. But I don't want to stay on the sleep drug any longer than necessary, to avoid increasing tolerance and dependence. 

 

 

Just a thought, Kathy, but I would be much more concerned about kindling than about dependency at this point. It's not just about this one drug and the effects of this one drug. It's about a very long history of psychiatric drugs. Consistency is going to be your best friend right now. 

 

 

15 hours ago, KathyLoop said:

Does it make any sense to use zopliclone for sleep and maybe 0.5mg ativan during the day for anxiety? Or best to just stick with ativan?

 

I would prioritize sleep. Whichever one works best, stick with that one at night. 

 

If you're able to cope with anxiety during the day without a drug, then you could stop the Ativan. However, if the anxiety is overwhelming and the buildup over the day makes it that much harder to sleep, you may want to take the Ativan during the day. Also, it's unclear (and likely unknowable) whether or not you are dependent on Ativan. So if you have severe anxiety or other symptoms during the day and it resolves by taking Ativan, then you may want to continue taking it. But please do your best to stick to an exact schedule and use non-drug coping in between doses. 

[KathyLoop]

Thanks, Shep. I've started 0.5mg Ativan twice a day, dropping the zopiclone. I slept 6 hours last night. Any recommend how long I should do this, before considering a slight reduction? I'm actually wondering if I'm starting at too high a dose. 

 

Also wondering if I have to stick to dosing every 12 hours? Or can I push the morning dose ahead if my symptoms are manageable, so that there's more in my system for night-time? 

[KathyLoop]

Or maybe 0.25mg during the day and then 0.75mg at night? Just trying to sort out the best way and then stick with it.

 

Right now, doing two equal doses, 12 hours apart. A bit lethargic, but maybe that'll ease as I get used to it.

[Shep]

15 hours ago, KathyLoop said:

Or maybe 0.25mg during the day and then 0.75mg at night? Just trying to sort out the best way and then stick with it.

 

Right now, doing two equal doses, 12 hours apart. A bit lethargic, but maybe that'll ease as I get used to it.

 

Do you feel over-drugged by taking .25 in the morning? If so, you could reduce that amount or take .125 mg in the morning and .125 mg in the afternoon, and then .5 mg at night. 

 

Does .5 mg give you enough sleep? 

 

I wouldn't spend much more time experimenting. The bouncing around can cause more problems. It's unlikely at this point that you'll find a magical amount that will relieve you of all of the problems. You just want something that gets you enough sleep and allows you to get through the day. If less will do it, you'll have less to taper from. 

[KathyLoop]

On 6/30/2021 at 5:07 AM, Shep said:

Does .5 mg give you enough sleep? 

No, I'm not getting much sleep. Don't know what to do.

[Shep]

I would pick the lowest dose you can and be consistent. At this point, you may not be able to fix the insomnia problem. The goal then would be to take enough of the Ativan that you're not dealing with acute withdrawal. Enough to take the edge of the most severe symptoms.

 

It's unknown if you've developed a dependency or not - do you feel when you take Ativan, that some of your symptoms resolve? Even if you aren't able to sleep, do other symptoms get better?

 

These kinds of questions can be helpful to determine the level of dependency you're at. Unfortunately, you're between a rock and a hard place when it comes to whether to continue on with the benzo or whether to stop. What is your gut instinct telling you to do? Sometimes that can be the best answer. 

[KathyLoop]

I think I likely have a dependency, as the Ativan does reduce symptoms. I agree the insomnia probably won't get fixed for now. I'll try to sort out my dosing... keeping symptoms in check without being too drugged during the day.

 

How long do you recommend stabilizing before starting a slow taper?

[Shep]

18 hours ago, KathyLoop said:

I think I likely have a dependency, as the Ativan does reduce symptoms. I agree the insomnia probably won't get fixed for now. I'll try to sort out my dosing... keeping symptoms in check without being too drugged during the day.

 

How long do you recommend stabilizing before starting a slow taper?

 

You'll have to be the guide here. It depends on your ability to tolerate upticks in symptoms, including worsening insomnia. 

 

Be sure you're doing all you can in the way of a healthy diet, getting enough water, taking gentle walks in nature, if possible. And then, as you're able, perhaps take a 3 or 5% reduction to test the waters. But again, make sure you're able to tolerate any upticks in symptoms. 

 

You may also want to try the Brassmonkey slide, as that will be gentler on the nervous system.

 

The Brassmonkey Slide Method of Micro-tapering

 

You can set up your slide at any rate you wish, taking smaller weekly reductions instead of a larger monthly reduction.

 

But again, make sure you're able to handle any upticks in symptoms. 

[KathyLoop]

Hi Shep. I'm reducing Ativan a bit, handling the symptoms so far. 

 

Can you advise how best to reduce the micro-doses I'm taking? You'll see from my signature what I've done so far. Should I just keep taking .01 off the two daytime doses and then .03 off the nighttime dose (assuming a 5% reduction) so that I maintain close to the same relative size of micro-doses as I taper? Or would I be better off gradually working towards 3 equal micro-doses? Or is it completely up to me, depending on how well I'm sleeping and tolerating symptoms? I'm just not sure how much to take off each micro-dose.

 

I realize I've reduced 10% fairly quickly already. I will likely hold where I am for a couple weeks now. I do tend to rush these things and have to remember to take it slow. I also realize that it's recommended to reduce 10% of previous dose... so the next reduction would be only .09, over a couple weeks perhaps. Am I correct on all this?

 

I'm managing some sleep... practicing good sleep hygiene... doing yoga nidra twice a day... getting out for daily walks... eating healthy. I had a 2nd covid vaccine last week and got hit with two days of severe depression, but otherwise, my mood has been relatively ok. Some irritability, but nothing extreme like before. No rages, much less suicidal... having days with no suicidal thoughts at all actually, and that's fairly new. Still tons of neck tension and some head burning but that's been the case since the Viibryd taper. Increased hot feeling the past week. Hard to tell what is withdrawal, what is menopause, what is covid vaccine.

[Shep]

11 hours ago, KathyLoop said:

Can you advise how best to reduce the micro-doses I'm taking? You'll see from my signature what I've done so far. Should I just keep taking .01 off the two daytime doses and then .03 off the nighttime dose (assuming a 5% reduction) so that I maintain close to the same relative size of micro-doses as I taper? Or would I be better off gradually working towards 3 equal micro-doses? Or is it completely up to me, depending on how well I'm sleeping and tolerating symptoms? I'm just not sure how much to take off each micro-dose.

 

This is highly individual. If you need to take the bulk of the Ativan at night for sleep, you may want to only taper the daytime doses and use non-drug coping techniques to help with any interdose withdrawal during the day, knowing you'll get some sleep at night. 

 

Some people like to target the middle dose first because they feel like having a nighttime dose for sleep and a morning dose for interdose withdrawal is enough to get them through the day. The half-life of Ativan is 10 - 20 hours, so depending on how quickly you metabolize it, you may be fine with just a morning and evening dose. A lot of the individual aspects have to do with the speed each of us metabolize these drugs. 

 

Other people like to taper all three doses at the same time in order to keep a consistent amount of the drug in their system. 

 

There's no right or wrong way. 

 

11 hours ago, KathyLoop said:

I realize I've reduced 10% fairly quickly already. I will likely hold where I am for a couple weeks now. I do tend to rush these things and have to remember to take it slow. I also realize that it's recommended to reduce 10% of previous dose... so the next reduction would be only .09, over a couple weeks perhaps. Am I correct on all this?

 

 July 19: 0.9 Ativan (.19, .19, .52) is listed in your signature, so your total Ativan amount is .9 mg. Yes, your reduction would be .09 mg if you wish to make a 10% reduction off the previous month's dose. 

 

Of course, you may want to go slower than that. Or switch over to the Brassmonkey Slide for smaller weekly reductions instead of a larger monthly reduction. Please see:

 

The Brassmonkey Slide Method of Micro-tapering

 

12 hours ago, KathyLoop said:

I'm managing some sleep... practicing good sleep hygiene... doing yoga nidra twice a day... getting out for daily walks... eating healthy. I had a 2nd covid vaccine last week and got hit with two days of severe depression, but otherwise, my mood has been relatively ok. Some irritability, but nothing extreme like before. No rages, much less suicidal... having days with no suicidal thoughts at all actually, and that's fairly new. Still tons of neck tension and some head burning but that's been the case since the Viibryd taper. Increased hot feeling the past week. Hard to tell what is withdrawal, what is menopause, what is covid vaccine.

 

Sounds like you're making great progress, Kathy. Very nice non-drug coping skills! And yes, it is hard to tell with so many variables, but as long as you're seeing overall improvements, especially over time, you're doing what you need to do. 

[KathyLoop]

Would you recommend switching to Valium? To taper that instead of Ativan? Because of the longer half-life?

 

I was doing ok and then about 4 days ago, started falling apart more. (Lots of personal issues, so I honestly don't know what is causing what.) You'll see from my signature that I reduced another 5% ... so I'm down 15% in a month. I realize 10% was the recommend. But I wasn't noticing any increase in symptoms after the first 10%, so I thought maybe I could just keep going. It's not awful right now, but it's definitely noticeable and really worrying me. I'm hesitant to go back up. Wondering if it'll settle soon if I just wait it out?

 

Also wondering if I should try to get off the clonidine first? Or deal with that after ativan?

 

I'm so confused. I just keep making it worse for myself, it seems.

[Shep]

13 hours ago, KathyLoop said:

Would you recommend switching to Valium? To taper that instead of Ativan? Because of the longer half-life?

 

No, I wouldn't recommend switching. You'll go into Ativan withdrawal and maybe the Valium will cover it, but maybe not. You're already splitting your Ativan dose, which takes care of the shorter half life. Switching drugs is always risky, especially for someone dealing with long-term polypharmacy and a fragile nervous system. 

 

13 hours ago, KathyLoop said:

I was doing ok and then about 4 days ago, started falling apart more. (Lots of personal issues, so I honestly don't know what is causing what.) You'll see from my signature that I reduced another 5% ... so I'm down 15% in a month. I realize 10% was the recommend. But I wasn't noticing any increase in symptoms after the first 10%, so I thought maybe I could just keep going. It's not awful right now, but it's definitely noticeable and really worrying me. I'm hesitant to go back up. Wondering if it'll settle soon if I just wait it out?

 

According to your signature, it's been 8 days since your last reduction. Benzo updoses work best within 2 - 4 weeks of a decrease, so you're well within a safe timeframe to updose. Since you're also dealing with personal issues, you may want to updose and go into a long hold and stabilize before making any more reductions. 

 

The fact that you didn't have any increase in symptoms after the first 10% is a great sign, but it sounds like you pushed the limits. Going forward, best to stick to the 10% or less reduction. There's no hurry and being functional makes it well worth the time spent with a slow taper. 

 

13 hours ago, KathyLoop said:

Also wondering if I should try to get off the clonidine first? Or deal with that after ativan?

 

I would focus on reducing one drug at a time. It sounds like you were doing well but rushed the Ativan taper. Reducing clonidine won't make up for a rushed taper of another drug. 

 

13 hours ago, KathyLoop said:

I'm so confused. I just keep making it worse for myself, it seems.

 

Stick to the 10% or less taper and you'll be fine. Please don't overthink this. It's really as simple as going slow and doing as much self care as possible. You're making progress, Kathy. 

[KathyLoop]

Thank you very much, Shep. I appreciate you answering all my questions and also the support. I'll probably stick where I am, at .85. I'm a bit better today, so maybe it's manageable, but I'll keep the updose in mind if it's not. And agreed, I rushed it. Can I expect the symptoms to settle down and stabilize any time soon? Or maybe that's impossible to answer. 

[Shep]

17 hours ago, KathyLoop said:

Can I expect the symptoms to settle down and stabilize any time soon? Or maybe that's impossible to answer. 

 

It's hard to say. If you're able to sort out any of the personal issues, you may find relief from that. Withdrawal is such a long journey that some of the bumps in the road are simply the life stressors that happen. Add in too fast a taper and it can take awhile for things to settle. But they will settle in time.