Jac12844: scared

[Jac12844]

I would put information in my signature, but I can't figure out how. I have been off and on more psychiatric meds than I can count over the last 20 years. Most of them were SSRI's but a few were mood stabilizers, atypical antipsychotics, and benzodiazepines. I didn't seem to have trouble stopping or starting medications until about 3 years ago, but I didn't understand what was happening. In Sept 2020 I had a terrible experience when I reduced paxil from 5mg to 2.5mg and tried to reinstated to 5mg after 2 weeks. After 4 days of reinstating, I ended up with extreme anxiety, agitation, and suicidal thoughts. I couldn’t tolerate the 2.5mg dose anymore and would get anxiety rushes each time I took a dose so my psych NP advised me to stop and switch to very low dose Vraylar. I stayed on that until early December. I was having some intrusive thoughts on it and some thoughts of suicide so I tried to switch to Effexor which I have been on many times in the past. It did not work. I kept getting adrenaline rushes and anxiety from 1/3 of a 37.5mg pill. I only took 4 doses. It sent me into a hole it seems. It made the Vraylar not work right and I was extremely depressed and anxious and developed more intense intrusive thoughts about death, derealization, and abnormal thinking that I have never experienced. I was on a very low does so my psych NP advised me that I could just stop. That was 2 weeks ago. The intrusive thoughts, abnormal thinking, and most of the derealization have subsided. However, for the past 2 weeks I have had extreme anxiety, fear, agitation, fear of being alone, insomnia, tinging, and burning sensations on my skin, trembling, and restlessness. I feel like my nervous system is ruined. I have taken a few doses of klonipin which have helped but I know this is not a long term solution. I’m terrified and thinking about going inpatient as I don’t know what else to do. I have been laying on the couch with my husband for the last two weeks mostly feeling terrified. I can't continue this way. I know the idea here is to get off of meds, but I don't know if I can do that. Has anyone had luck going inpatient. I'm scared to go and scared not to go. I'm scared of trying a medication and scared of not.  Any help is appreciated. I'll add that I am still taking trazodone 50mg-100mg to sleep as well. 

Edited January 5, 2021 by manymoretodays
forgot to add

[Altostrata]

Welcome, @Jac12844

 

Did the Vraylar help while you were taking it? What is your current symptom pattern? Does trazodone help you sleep? When did you start taking it? How often are you taking Klonopin?

[Jac12844]

Thank you for your reply @Altostrata. The vraylar helped some while I was taking it. Mostly my anxiety and sleep. It did give some intrusive thoughts of suicide occasionally. I didn't realize it was from the vraylar until I got off of it. After I tried to switch to effexor, things went south with the vraylar. I had more intrusive thoughts, intense derealization, and odd thoughts about how things would be sad when I was gone (suicide related without actually thinking about suicide). That seems to have lifted since I got off of it. (Unless it was just from trying the effexor) I just think it's odd that a few tiny doses of effexor triggered all of this. My current symptom pattern is extremely severe anxiety/panic/fear/agitation accompanied by trembling, burning and tingling sensations on my skin, and a fear of being alone. It seems to come in waves. Then insomnia kicked in. The trazodone does not seem to be helping the insomnia right now but it used to to a certain degree. I've  been taking it for about 7 years with a  3 month break in there. The klonopin is helping me get between 3 and 6.5 hours of sleep right now. I have spent over 2 weeks laying on the couch having my husband hold me. I'm guessing this might be non movement related akathisia (although do have trembling and some restless leg sensations)?. I have never experienced anything like this in my life. I'll add that I did TMS in Oct and Nov. I started taking the klonopin about a week ago (.25 occasionally) and it was helping some. I saw the psychiatrist yesterday as a last ditch before going inpatient because I can't handle the extremely severe anxiety/fear/panic/agitation. He wanted to try me on another serotonin drug but I was too scared. He wants me to take klonopin consistently for a week (.5 in the day and 1mg at night) and see him again. I KNOW this is not ideal, but I couldn't handle how I felt before. The klonopin is helping keep the extreme symptoms at bay. I'm wondering now if it's better for me to stabilize on the klonopin and eventually start a slow taper from it. I'm absolutely terrified of trying other antidepressants after how horribly deregulating the paxil was in Sept and now the tiny dose of effexor. Do you see people have freak outs like this from trying antidepressants even though they've been fine for years? Also are there doctors that are familiar with iatrogenic brain injury and are willing to work with that? Thank you for all of your help. 

[Shep]

On 1/3/2021 at 4:32 PM, Jac12844 said:

I'll add that I am still taking trazodone 50mg-100mg to sleep as well. 

 

Hi, Jac. Welcome to SA. 

 

Not taking the same dose of trazodone every day could be causing some of your problems. 

 

Also, please note trazadone has an active metabolite, mCPP. While Trazodone can help you sleep, its active metabolite can make you feel sick, anxious, and out of control the next day.  So some of your symptoms may be side effects of this drug. For more, please have a careful read of at least the first post in this thread:

 

Tips for tapering off trazodone (Desyrel)

 

On 1/5/2021 at 9:00 PM, Jac12844 said:

He wants me to take klonopin consistently for a week (.5 in the day and 1mg at night) and see him again. I KNOW this is not ideal, but I couldn't handle how I felt before. The klonopin is helping keep the extreme symptoms at bay. I'm wondering now if it's better for me to stabilize on the klonopin and eventually start a slow taper from it.

 

1.5 mg Klonopin is a high dose to start out on. It only takes 2 - 4 weeks to become dependent on this drug. Some people become dependent in only a few days. 

 

If you are going to stay on this drug, you may want to consider if you really need this high a dose. Klonopin is 20 times more potent than Valium and many people find they can get relief on a much lower dose of .25 mg when first starting this drug. 

 

What time(s) of the day are you taking your drugs? Are you taking any supplements? If so, please list them. 

[Jac12844]

Hi @Shep, thank you for your reply. I didn't think about the fluctuation in trazodone causing problems. Also, it's very interesting to read that the metabolite can cause problems. I've always felt less stable since taking trazodone. That explains a lot. Sometimes I could get away with only taking 25mg. Other nights it was 50 or 100. 3 nights ago I didn't take any trazodone and the last 2 nights I only took 25mg. Should I stay at 25mg or go to 50mg? I seem to be less activated with less trazodone (or maybe it's the klonopin helping too). 

 

Regarding the klonopin, the doctor told me he wanted me on that dose for a week in order to stabilize and then I'd see him back. He was kind of frustrated with me because I was too scared to try the serotonin drugs he was recommending after having a pretty bad reaction to attempting to switch to effexor. I've been taking .25 klonopin at 10:30am, and .25 at 4pm consistently for the last 3 days. 3 nights ago I tried 1mg at bed (9pm) but woke up at 3:30am. I have trouble with middle of the night waking (I usually split my trazodone dose throughout the night because of this) so the next night I took .5mg at bed (9pm) and woke up around 2am and took .25mg along with 25mg trazodone. Yesterday I was feeling like there is too much klonopin in my system and I slept for 3 hours hours on the couch in the evening so I only took 12.5mg trazodone at bed 9pm (and no klonopin). I woke up around 1am and took 12.5 trazodone and .125mg klonopin and woke around 5am. I started taking .25 klonopin on 12/29/20 but only took 4 doses sporadically. I've been more consistent with it since 1/4/21. I feel like I've noticed a little more depression these last 2 days. If I can get away with less klonopin I'd prefer that. I'm just nervous that the doctor will be upset. 

 

I'm not taking any supplements. I'm extremely sensitive since my bad experience reinstating paxil in September and react to everything. I am eating a lot of prunes and drinking prune juice every night because I tend to get constipated. I drink between 8 and 12oz of coffee in the morning again for constipation (sorry for TMI). 

 

Do you have any explanation for me as to why I had this horrible reaction to attempting to switch to effexor in early December? Do my symptoms of extreme anxiety/fear/agitation/trembling/fear of being alone/etc sound like akathisia to you? 

 

Thank you for all of your help! 

 

Jac12844

 

[Shep]

19 hours ago, Jac12844 said:

Sometimes I could get away with only taking 25mg. Other nights it was 50 or 100. 3 nights ago I didn't take any trazodone and the last 2 nights I only took 25mg. Should I stay at 25mg or go to 50mg? I seem to be less activated with less trazodone (or maybe it's the klonopin helping too). 

 

I would pick the lowest dose that helps with sleep. 

 

Are you using less trazodone since you started taking Klonopin?

 

19 hours ago, Jac12844 said:

Yesterday I was feeling like there is too much klonopin in my system and I slept for 3 hours hours on the couch in the evening so I only took 12.5mg trazodone at bed 9pm (and no klonopin). I woke up around 1am and took 12.5 trazodone and .125mg klonopin and woke around 5am. I started taking .25 klonopin on 12/29/20 but only took 4 doses sporadically. I've been more consistent with it since 1/4/21. I feel like I've noticed a little more depression these last 2 days. If I can get away with less klonopin I'd prefer that. I'm just nervous that the doctor will be upset. 

 

First, don't worry about the doctor being upset. That's the least of your problems. This doctor is ignorant and has been lying to you about the dangers of these drugs. Please see:

 

How to talk to a doctor about tapering and withdrawal? What to expect?

 

If you continue to listen to this person, you're going to end up very sick. What you put into your own body is your concern, not your doctor's. All you need from this doctor is a prescription so you can do a taper. Use him as a tool for getting the drug and use your own research here on SA to set up your taper. 

 

The increase in depression over the past few days is a sign that you're taking too much Klonopin. Please note that benzodiazepines such as Klonopin are central nervous system depressants, so they do cause this as both a side effect and a withdrawal effect. 

 

Please add the exact date your started Klonopin to your signature.

 

Account Settings - Create or Update Your Signature

 

19 hours ago, Jac12844 said:

I'm not taking any supplements. I'm extremely sensitive since my bad experience reinstating paxil in September and react to everything. I am eating a lot of prunes and drinking prune juice every night because I tend to get constipated. I drink between 8 and 12oz of coffee in the morning again for constipation (sorry for TMI). 

 

Do you have any explanation for me as to why I had this horrible reaction to attempting to switch to effexor in early December? Do my symptoms of extreme anxiety/fear/agitation/trembling/fear of being alone/etc sound like akathisia to you? 

 

Yes, it does sound like you have akathisia, along with sensitivities to drugs, foods, and supplements. From the thread One theory of antidepressant withdrawal syndrome:

 

 

On 5/24/2011 at 10:59 PM, Altostrata said:

My guess is: The first phase of withdrawal, the acute phase, is the initial shock of withdrawal, with the most defined symptoms, such as brain zaps and nausea and possibly waves of unusually intense "depression" and "anxiety" -- actually, emotions generated by the neurological upset. Later, glutamatergic hyper-reactivity and autonomic instability take over. Often the autonomic instability causes wide hypersensitivity to drugs, supplements, and even foods.

 

The changes you experienced by going on and coming off a series of antidepressants likely triggered this. 

 

Please start a daily drug and symptoms journal. It's possible you'll do better on less Klonopin, perhaps even rapid tapering off it since you've only been on it a few days. Keeping a daily log may also help you be more consistent with your trazodone. Instructions for the journal are here: 

 

On 9/27/2016 at 2:49 PM, Altostrata said:

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

 

 

[Jac12844]

Thank you @Shep for your reply. The trazodone only helps some for sleep. The klonopin has helped more but I'm still waking in the middle of the night and needing to take a dose. Yesterday I tried to get away with .125mg of klonopin at 10am, 4pm, and bedtime along with 25mg trazodone (10pm last night). I woke at 1am with anxiety and took .25mg klonopin. I woke with anxiety at 3:30am again and took 12.5mg trazodone. Although it helps me sleep a little, I do feel like it causes some anxiety. I have been able to use less trazodone since I have the klonopin. 

5 hours ago, Shep said:

Yes, it does sound like you have akathisia, along with sensitivities to drugs, foods, and supplements. From the thread One theory of antidepressant withdrawal syndrome:

 

It's possible you'll do better on less Klonopin, perhaps even rapid tapering off it since you've only been on it a few days. 

 

 

@Shep I know it's not ideal to be on klonopin but it's keeping the akathisia away. I'm terrified to get off of it because the akathisia was horrifying. How long does akathisia usually last? Is it possible that it will never go away? Is it from trying to effexor or going off the vraylar due to the bad symptoms it started causing after trying effexor? Do people stay on benzos for akathisia for a while and then eventually very slow taper off? I'm really scared of the akathisia. I can't live like that. 

 

I know this isn't ideal, but do people ever use other meds to get them through akathisia? I've heard propranolol can help. 

 

Also, I've been on the klonopin for about 9 days. What would a rapid taper even look like. Would that mess me up further? 

 

I'll start keeping a daily journal. Here's what I have put together for yesterday and so far today. Thank you again 

 

1/7/21
10:00am .125mg klonopin 
Noon lunch 
2:00pm extremely tired, wanting to sleep 
4:00pm .125mg klonopin 
4:30pm dinner 
5-7pm watched TV with husband, made list of happy memories,

7:15 8oz prune juice 

7:30 went to zoom AA meeting,

9:00pm fell asleep on couch for a bit
10:00pm bed .125mg klonopin and 25mg trazodone (think the trazodone gave me anxiety?)

 

1/8/21
1:00am woke up with anxiety took .25mg klonopin 
3:30am woke up with anxiety took 12.5mg trazodone 
6:45am woke with anxiety got up
7:10 morning coffee 
7:30 started period (sorry tmi)
7:55 am breakfast 

8:30 feeling tired 

9:30 feeling depressed and anxious, thoughts of not wanting to live - took .25mg klonopin 

[Jac12844]

@Shep here's more of my day today: 

 

11:30 Lunch
12:15 went to mom's had some anxiety, still had thoughts of not wanting to live
3:00pm laid on couch with husband. Felt a little better emotionally.

3:40 .125 klonopin 

[Altostrata]

Hello, Jac.

 

It sounds like you got withdrawal syndrome from Paxil, and then going on and off a bunch of drugs has made your nervous system sensitive to all drugs. After you stop jumping around from drug to drug, it may take some time for your nervous system to settle down. You will need to be patient with this process.

 

On 1/7/2021 at 6:34 AM, Jac12844 said:

Do my symptoms of extreme anxiety/fear/agitation/trembling/fear of being alone/etc sound like akathisia to you? 

 

This does not sound like akathisia. It sounds like you are having unpleasant symptoms because of adverse drug effects or withdrawal, and you are reacting to the symptoms with fear and maybe catastrophizing, making the symptoms worse.

 

On 1/5/2021 at 6:00 PM, Jac12844 said:

The trazodone does not seem to be helping the insomnia right now but it used to to a certain degree. I've  been taking it for about 7 years with a  3 month break in there.

 

Have you always taken trazodone irregularly? You might also have trazodone withdrawal. 

 

Your extraordinarily irregular dosing of all of your drugs probably is causing problems. If I were you, I'd pick a low dose of trazodone, such as 12.5mg, and take it at the same time every night. Let us know the effect in your daily notes. It may not help you sleep right away. Do what you can to stay calm.

 

You are on a path to become at least physiologically dependent on Klonopin. It may subdue the drug-related symptoms, but if you take it irregularly, you may experience breakthrough withdrawal symptoms from Klonopin and possibly paradoxical reactions when you do take it. The best way to take it is on a regular twice-a-day schedule, such as .125mg 12 hours apart. Most likely, you will need to taper off.

 

I am sorry you're going through this. If I'm not mistaken, you have no intention of going off your drugs? Please be aware we do not treat depression, anxiety, or any other psychiatric disorder here. What we do is provide tapering advice and support for people with withdrawal syndrome. We're not going to be able to help you find another drug cocktail that will make you feel okay.

 

 

[Shep]

14 hours ago, Jac12844 said:

@Shep here's more of my day today: 

 

11:30 Lunch
12:15 went to mom's had some anxiety, still had thoughts of not wanting to live
3:00pm laid on couch with husband. Felt a little better emotionally.

3:40 .125 klonopin 

 

Jac, thanks for doing your symptoms notes. Please post 24 hours at a time. This makes it easier for moderators to read. Thanks. 

 

7 hours ago, Altostrata said:

I am sorry you're going through this. If I'm not mistaken, you have no intention of going off your drugs? Please be aware we do not treat depression, anxiety, or any other psychiatric disorder here. What we do is provide tapering advice and support for people with withdrawal syndrome. We're not going to be able to help you find another drug cocktail that will make you feel okay.

 

Alto makes a good point here. I had assumed you were here to taper, but re-reading your posts, I'm not as clear. Please let us know if you're looking to taper off this drug cocktail. 

[Jac12844]

@Altostrata and @Shep thank you both for your replies. 

 

8 hours ago, Altostrata said:

After you stop jumping around from drug to drug, it may take some time for your nervous system to settle down. You will need to be patient with this process.

 

Do we have any idea how long this could take. I know it's going to be different from person to person but is there a rough estimate? I think I'm looking for hope. 

 

8 hours ago, Altostrata said:

 

8 hours ago, Altostrata said:

Have you always taken trazodone irregularly? You might also have trazodone withdrawal. 

 

The last 3.5 years I've taken it more erratically. After I tried going off all psych meds for 3 months in 2017 when I got back on them nothing worked the same and trazodone hasn't been as helpful for sleep like it was previously. Before 2017 12.5mg of trazodone would make me sleep all night. Now it can take 50mg to put me to sleep and another 50mg to put me back to sleep. Since going cold turkey off vraylar 3 weeks ago my sleep has been horrific. The klonopin has helped some with that. How long does it take to be able to sleep again? How long can a person go without sleep? 

 

8 hours ago, Altostrata said:

You are on a path to become at least physiologically dependent on Klonopin. It may subdue the drug-related symptoms, but if you take it irregularly, you may experience breakthrough withdrawal symptoms from Klonopin and possibly paradoxical reactions when you do take it. The best way to take it is on a regular twice-a-day schedule, such as .125mg 12 hours apart. Most likely, you will need to taper off.

 

I have been erratic with my klonopin dose, I know. From 12/29/20 through 1/3/20 I was taking  it very sporadically. I took .25mg about 6 times. I saw my doctor on 1/4/21 and he wanted me taking  .5 in the day and 1mg at night. That was too much and causes depression and thoughts of death. I tried  .25mg 4 times a day for 2 days or so. The last day I've tried to back down to .125mg 4 times a day. Do you think I can just switch to  .125 twice a day? Will I get withdrawal symptoms? What do those look like? My sleep has gotten worse since lowering the dose of klonopin. I don't want to be on klonopin but I couldn't handle the extremely intense anxiety/fear/agitation/panic that I was experiencing. Would it be wise to stay on the klonopin and let my body stabilize a while or try to get off now. This is all so confusing and scary. 

 

8 hours ago, Altostrata said:

 

I am sorry you're going through this. If I'm not mistaken, you have no intention of going off your drugs? Please be aware we do not treat depression, anxiety, or any other psychiatric disorder here. What we do is provide tapering advice and support for people with withdrawal syndrome. We're not going to be able to help you find another drug cocktail that will make you feel okay.

 

I would love to get off all my medications. I'm just absolutely terrified. I've never felt so bad in my life. I'm scared that I've messed my brain up beyond what I can handle trying to heal. I didn't know this could happen. I'm open to getting off all meds I just want to be able to survive the process. 

 

I've wondered about attempting to reinstate a very small amount of vraylar and then taper from there and see if that helps. However, I was having a pretty bad reaction to vraylar when I stopped so that terrifies me as well (extreme depression, derealization, intrusive thoughts of death, etc.) I also did Transcranial magnetic stimulation in Oct-Nov 2020. Do you think that could be contributing to any of this? 

 

@Altostrata and @ShepPlease don't give up on me I am open to and appreciate any and all feedback. Thank you so much. 

 

Here is my last 24 hours. This starts the morning of 1/8 and goes into the early morning hours of 1/9. Is this format okay? 

 

1/8/21 (yesterday)- 1/9/21
6:45am woke with anxiety got up
7:10am morning coffee
7:30am started period
7:55am breakfast
8:30pm feel tired
9:30pm feeling depressed and anxious, thoughts of not wanting to live - took .25mg klonopin
11:30pm Lunch
12:15pm went to mom's had some anxiety, still had thoughts of not wanting to live
3:00pm laid on couch with husband. Felt a little better emotionally.
3:40pm .125 klonopin
5:20pm dinner
7:30pm drank prune juice and laid on the couch with my husband
8:30pm fell asleep on couch
9:30pm went to bed, .125mg klonopin 12.5mg trazodone
3:30am woke up took 12.5mg trazodone. Not sure I slept anymore
5:00am .125mg klonopin hoping to sleep more but did not

 

 

Thank you 

[Altostrata]

I see you are still taking your drugs "as needed", which is not how to get your nervous system settled.

 

12 hours ago, Jac12844 said:

9:30pm feeling depressed and anxious, thoughts of not wanting to live

 

This may be withdrawal from the Klonopin doses you're taking at night. This is exactly how Klonopin creates a need for more Klonopin. @Shep how to resolve the Klonopin dosing?

[Jac12844]

1 hour ago, Altostrata said:

I see you are still taking your drugs "as needed", which is not how to get your nervous system settled

 

@Altostrata thank you for your reply. Please help me understand what to do differently so I can stop doing this.

 

Thank you 

 

[Jac12844]

@Shep and @Altostrata here is my daily log from yesterday. What is a better way for me to dose my klonopin? I've been taking it 4 times a day- sometimes .125mg, and sometimes .25mg. Thank you for your help. I'm sorry that I've been doing things incorrectly. 

 

1/9/21 
6:00am got up and had coffee feeling tired but decent emotionally 
7:30am breakfast (pear, prunes, cashews) 
8:00am somewhat anxious 
8:30am took a shower and mood declined. Feeling depressed/hopeless 
9:30am AA meeting 
10:00am thoughts of not wanting to live, slight anxiety 
10:30am .125mg klonopin 
11:00am extremely emotional thought about going inpatient 
11:30am talked to friend about going inpatient 
12:30pm lunch 
2:30pm laid on couch with husband 
4:00pm .25 klonopin to see if it helped regulate emotions 
5:00pm feel more calm 
5:30pm dinner 
7:00pm dozed on couch 
9:30 went to bed .125 klonopin 12.5mg trazodone 
3:00 woke up took
3:30 took .125mg klonopin and 12.5mg trazodone slept a little longer 
 

[Shep]

On 1/9/2021 at 9:19 AM, Jac12844 said:

I also did Transcranial magnetic stimulation in Oct-Nov 2020. Do you think that could be contributing to any of this? 

 

Please see:

 

TMS (Transcranial Magnetic Stimulation)

 

On 1/9/2021 at 9:19 AM, Jac12844 said:

Here is my last 24 hours. This starts the morning of 1/8 and goes into the early morning hours of 1/9. Is this format okay? 

 

Yes, this is perfect. Thank you.

 

8 hours ago, Jac12844 said:

9:30am AA meeting 

 

That's great you're no longer drinking. When did you stop?

 

Please note that Klonopin - and all benzodiazepines - affect the same neurotransmitters as alcohol. They both affect GABA receptors and many people are prescribed benzos when coming off alcohol.  Prior to December 29, 2020, were you ever on a benzo? If so, please list the name(s) and dates. 

 

After reading your journals, it looks like you've been taking a total of 25 mg trazodone and 0.25 mg Klonopin at night (along with varying Klonopin during the day).

 

On 1/9/2021 at 9:19 AM, Jac12844 said:

8:30pm fell asleep on couch
9:30pm went to bed, .125mg klonopin 12.5mg trazodone
3:30am woke up took 12.5mg trazodone. Not sure I slept anymore
5:00am .125mg klonopin hoping to sleep more but did not

 

8 hours ago, Jac12844 said:

7:00pm dozed on couch 
9:30 went to bed .125 klonopin 12.5mg trazodone 
3:00 woke up took
3:30 took .125mg klonopin and 12.5mg trazodone slept a little longer 

 

A few thoughts:

 

I would work on sleep hygiene so you're no longer falling asleep on the couch prior to going to bed. Use your bedroom for sleep and your living room for reading and watching tv, etc. And it looks like you're getting about 5 - 6 hours of sleep a night before you wake up at 3:30 and take more drugs for more sleep. I would stop doing that. Really work on setting up a more consistent bedtime routine and if you do wake up early, find some distractions to stay busy and your mind occupied. I wouldn't continue to drug yourself hoping for more sleep. In time, your sleep will improve. Right now, your nervous system is really craving a consistent schedule. 

 

What do you think about this schedule? 

 

9 AM - 0.125 mg Klonopin

9 PM - 12.5 mg trazodone and .0.125 mg Klonopin

 

Here are tips to help with insomnia:

 

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

 

You're doing a great job with the notes. Please continue posting them. 

[Altostrata]

Looks good to me, Shep. @Jac12844 you may have to white-knuckle through few days while the Klonopin dosing gets evened out in your bloodstream. If you take more Klonopin off-schedule, this will prolong the time to settle to a baseline.

[Jac12844]

@Shep and @Altostrata thank you for your last posts. I ended up going inpatient for suicidal ideation on Jan 10th. I got out Jan 15th. While I was in the hospital they started me on 250mg depakote ER and 25mg Luvox as well as trazodone, gabapentin, hydroxyzine, and .5 klonopin as needed. When I got out my regular psychiatrist switched me from Luvox to Lithium 300mg ER. I was experiencing intense tingling/burning sensations on my skin throughout my body accompanied by anxiety which we thought was the luvox but is still occurring. My psychiatrist wanted me to use gabapentin for anxiety but when I tried it with the lithium it seemed to make things worse. I've been trying to only take klonopin every few days because it seems to increase suicidal thoughts when I take it. I took .5 on 1/20 due to extreme  anxiety. I feel the anxiety has ramped back up. The lithium seems to be activating and I'm having pretty bad insomnia. I know this is not ideal. I'm wondering if I have kindled due to all the medication switches in the last 6 months (but really the last 20 years)?? My body does not seem to be tolerating any meds well but my psychiatrist is chalking it up to me having bad anxiety and is encouraging me to continue taking medication. I'm wondering if I need to get off it all so my nervous system can heal? I would appreciate any feedback or advice you have. I feel like a bigger mess has been created than before I went inpatient. I am constantly dealing with tingling/burning sensations on my skin throughout my body as well as anxiety. The klonopin helps some. @Shep I was on various benzos in the past before I got sober. Until recently I hadn't taken any since Feb 17th, 2012. Thank you both for your feedback/advice. 

[Jac12844]

@Shep and @Altostrata do you think the insomnia, anxiety, and activation could be from the lithium? Or maybe the klonopin coming out of my system as well? I definitely have had worse insomnia since starting the lithium. I've been on it for 5 days and have had increased energy. Yesterday and today I've felt some agitation as well. I'm also wondering if depakote could cause tingling/burning sensations, anxiety, and insomnia? This is all such a mess. Thank you for your help. 

[Jac12844]

@Shep I just read the link you posted to me before about TMS and I'm concerned that this may be cause problems for me as well. 

[Shep]

19 hours ago, Jac12844 said:

I ended up going inpatient for suicidal ideation on Jan 10th. I got out Jan 15th. While I was in the hospital they started me on 250mg depakote ER and 25mg Luvox as well as trazodone, gabapentin, hydroxyzine, and .5 klonopin as needed.

 

This is an insane drug cocktail. Please decide if you wish to come off these drugs or continue down the path of psychiatry. I'm sorry you're in this position, but we're not medical professionals here, so sorting through this is really beyond what we can do. 

 

However, I can give you two options to think about:

 

• rapid taper off the new drugs (you'll need to stay on the ones that you were already on) and work on non-drug ways of handling upticks in symptoms without going inpatient and losing control over your own agency and what you put into your own body (please see your ability to self-manage).

     OR

• work with your psychiatrist to get stable and then come back to this forum to get help with a taper

We can help you taper off your drugs, however, you need to be in the right place and right frame of mind. At least you know you have options and that when you're ready to taper, you know where you can come to get help. 

[Jac12844]

Thank you for your kindness @Shep. I have some decisions to make. What would be the best way to rapid taper the 250mg depakote ER? I've been on it about 2 weeks? How about the 300mg lithium ER? I've been on it for about a week. I appreciate your help. 

[Shep]

You could rapid taper off both those drugs by 25% every few days. 

 

That will leave you with the drugs you were previously taking - Klonopin and trazodone.  

 

I would settle into a consistent dosing schedule, such as the one mentioned earlier: 

 

On 1/10/2021 at 4:46 PM, Shep said:

What do you think about this schedule? 

 

9 AM - 0.125 mg Klonopin

9 PM - 12.5 mg trazodone and .0.125 mg Klonopin

 

Please post your thoughts. 

[Jac12844]

Hi @Shep. Thank you for your response. 

 

Both the depakote and lithium are extended release tablets. How do I taper with extended release medication? 

 

Regarding the consistent dosing schedule, the klonopin gives me suicidal thoughts when I take it which is part of what sent me inpatient. I have been trying to only take it every few days to minimize the suicidal thoughts. Is there a faster way to get off it? I know that's not ideal but I don't think taking it consistently is safe for me. What about substituting gabapentin and then tapering that? I did take some gabapentin the last 2 days to help with anxiety that may be due to klonopin withdrawal. I know that's probably not ideal either. 

 

Thank you for your help @Shep. I appreciate it. 

[Shep]

22 hours ago, Jac12844 said:

Both the depakote and lithium are extended release tablets. How do I taper with extended release medication? 

 

You likely aren't dependent yet (it takes about a month to become dependent). And you're looking at getting off these drugs very fast. You've only been on Depakote for 2 weeks and Lithium for 8 days. I would try to get off within a week at most. 

 

Since once the tablet is broken, extended release tablets become immediate release, here is some info on the half-lives: 

 

For Depakote, the half-life is 9 - 16 hours (from this Medscape article), so you could dose it twice a day as you rapid taper. 

 

For Lithium, the half-life is about 24 hours (from this Drugs.com article), so you're fine taking it once a day. 

 

 

22 hours ago, Jac12844 said:

Regarding the consistent dosing schedule, the klonopin gives me suicidal thoughts when I take it which is part of what sent me inpatient.

 

You reported this in your signature: 

 

Quote

 

Dec 20 Stopped Vraylar due to intrusive thoughts of death and abnormal thinking. 

 

 

 

And you posted this earlier in January: 

 

On 1/5/2021 at 9:00 PM, Jac12844 said:

The klonopin is helping me get between 3 and 6.5 hours of sleep right now.

 

 

Many people experience suicidal thoughts due to insomnia. So I'm not sure the Klonopin is causing your suicidal thoughts. It could be adding to them (benzos are central nervous system depressants), but you already had them from Vraylar. 

 

You're also taking Trazodone, and as I noted earlier in your thread, trazadone has an active metabolite, mCPP. While Trazodone can help you sleep, its active metabolite can make you feel sick, anxious, and out of control the next day.  

 

22 hours ago, Jac12844 said:

What about substituting gabapentin and then tapering that? I did take some gabapentin the last 2 days to help with anxiety that may be due to klonopin withdrawal. I know that's probably not ideal either. 

 

When you're ready to taper, please come back to the forum. I've given you the best advice I can give for your most recent additions of Lithium and depakote and now you're posting about another new drug you've just added in. 

 

Please work with your doctor and come back once you're truly ready. Right now, you need to stabilize on a consistent dosing of whatever drugs you end up on and then, once you're stable, you'll be ready to taper. 

[Jac12844]

Lithium (and trazodone) withdrawal and new health symptoms

 

Hi everyone! I have been tapering lithium since March of 2022. I was at 150mg IR for about a year before I started the taper. I've been reducing by 10% a month or slower. I'm currently at 90mg and have been there for 2 weeks. I've been doing fairly well other than some dark thoughts occasionally and irritability. In the last few months a few things have happened with my health and I'm trying to figure out if it's related to withdrawal or something else. I should also note that I have reduced my use of trazodone quite a bit as well. I am down from 75mg a night to about 6mg a night. My last cut was in July of this year. 

 

The health issues that have come up are: constipation, bad dry eyes, weight gain, right upper quadrant pain (possible ulcer or gallbaldder, we're not sure yet), low functioning gallbladder, chemical smelling bowel movements (sorry for TMI), irregular periods, and probably more I'm not remembering. This summer we also did a mold remediation in our attic and had the attic painted with paint that includes calcium hydroxide (lime) to keep mold from growing.

 

I guess I'm trying to figure out if the symptoms I'm having are lithium withdrawal (could be trazodone, but I've come off that before without this happening) or from the mold remediation and/or lime paint. Has anyone experienced any of these symptoms from lithium withdrawal? Thank you for your feedback!! 

 

Edited November 5, 2022 by ChessieCat
added topic title before merging with intro topic

[ChessieCat]

Thank you for updating your drug signature.

 

Please do both of these drug interaction checks for all drugs you are taking currently and copy and paste the results in a post.

 

Drug.com Interactions Checker
Medscape Drug Interaction Checker

 

In a new post, please list the dates and dose reduction for lithium and trazadone for at least the last 6 months.

 

In the same post as the above please also provide a list of the times and doses that you take all of your drugs.

 

I will ask the other staff for their assistance.

[Altostrata]

Hello, @Jac12844

 

Have you had kidney and liver function tests recently? If I were you, I'd have a thorough medical checkup.

 

It sounds like you have been tapering trazodone at the same time you've been tapering lithium? We advise people to taper only one drug at a time. We are not able to tell if your current problems are from tapering trazodone, lithium, mold exposure, a medical problem, or something else that's going on.

 

What combination of drugs and dosages were you taking when you began to feel worse?

[Jac12844]

Tapering Lithium: Compunding pharmacy issues?

 

I've been slowly tapering Lithium since March. I've reduced from 150mg to 80mg through a compounding pharmacy. I'm reducing about 10% a month, sometimes longer, but no shorter than 3 weeks. I've had four occasions (out of about 10 batches) when the prescription to lower the dosage has felt like I've gotten a much higher dosage of Lithium (I feel like I get side effects of a higher dosage). This includes derealization. This has happened at two different compounding pharmacies. Both places have been perplexed. I notice the side effects within about two hours of taking the new dose. When I lower without an issue, I feel withdrawal depression at about day 10 but it passes. Could this be the pharmacy accidentally giving me a higher dose a few times? Has anyone had problems with compounding pharmacies?  Or is it possible that only occasionally I react immediately to a dose reduction? Any other thoughts are welcome too. Thank you!

Edited December 13, 2022 by manymoretodays
merged from tapering forum, title added

[manymoretodays]

Hi Jac, @Jac12844

Questions specific to you and your case should go right here in your Introduction topic.

That way everything is together and we can see what has been offered.

 

So....you'll find your most recent post above.

Here is our topic on:

Getting compound custom dosages at compounding pharmacies(US, UK, Canada, and elsewhere)

this might shed some light ^

I would think that the pharmacies that compound and are in the compounding network of pharmacies do it the same way. 

2 different pharmacies, and then the same symptom immediately.....I might attribute that to a WD(withdrawal symptom).

I don't know a whole lot about compounding, and again going through that topic link may help.

 

Are you still dual tapering, tapering 2 drugs at the same time?

And then maybe 3 weeks between tapers could be extended to 4 weeks, with the Lithium to see if that makes any difference.

Can you stay with one pharmacy from here on out for compounding........I mean just in case they vary a little in their procedure?

 

Okay, I hope that helps a bit.  Others may chime in too now, who are following your case.

Best.  L, P, H, and G,

mmt

 

* can you edit into your signature some dates please, with the Lithium, rather than "currently", as obviously currently is no longer current, update dose changes with dates as well.  Depakote as well, please.

AccountSettings/updates-edits  Be sure and hit SAVE at the bottom when done

 

Tips for tapering off Lithium
Tips for tapering off sodium valproate and valproic acid(divalproex sodium, Depakote, Depakene)

 

And after updating your signature.....would you just note in a reply what you are taking now, by name(s) and dosages, and note the time of day that you take your drug(s)

That will help.  Thank you.

Edited December 13, 2022 by manymoretodays

[Jac12844]

Thank you! I will make these updates and give an extended reply in the morning. I'm currently holding at 6mg of trazodone since July. I'm tapering lithium. I haven't been on Depakote for almost 2 years. 😊