Hillary75: Does this seem like a lot of meds

[Hillary75]

Hi,

 

I've been on 24 different antidepressants (TCAs, MAOIs, SSRIs, SNRIs, NDRIs), benzos, anti-psycotic (Seroquel) over the past 30 years for Major Depression, OCD, General and Social Anxiety.  Effexor, Zoloft, and clonazepam have given me the worst withdrawals in the past.

 

I have a public sector psychiatrist who I see 20 minutes every 6 weeks, she and the system are really overworked here in NZ.

 

I'm concerned because I still get suicidal ideation, libido disappeared 18 years ago, vertigo, headaches, extreme tinnitus, and now Ive been unemployed 8 months.

 

Does this seem a lot for a 50kg female? I take daily:

Zoloft 200 mg (max)

Wellbutrin 300 mg (max)

Gabapentin 900 mg

Cymbalta 60 mg

Clonazepam ~ 1.5 mg

 

Maybe I'm going through one of those phases of wanting to detox and to just see what I'm like without all these meds.

 

But I've just gone from 60 down to 40 of Cymbalta (psych knows and she seemed OK with it) and the withdrawal is tough, not as bad as Effexor, but 5 days in and its a struggle.

 

Thanks for listening, just interested in hearing opinions on long term AD use, and using multiple ADs at once.  I definitely feel like a guinea pig and hate the lack of objective tests in the psych field.

 

Best,

Hillary

 

Edited May 21, 2021 by Gridley

[Gridley]

Welcome to SA, Hillary75.

 

To give members the best information, we ask them to summarize their medication history in a signature -- drugs, doses, dates, and discontinuations & reinstatements, in the last 12-24 months particularly.

 

Account Settings – Create or Edit a signature.

 

Yes, you are on an awful lot of drugs.  I ran a drug interaction check using this link 

 

Drug Interactions Checker 

 

and found that you have three major interactions among your drugs.  This definitely does not mean you should stop anything abruptly.  But it is important to be informed.  You have major interactions between wellbutrin and zoloft, between wellbutrin and cymbalta, and between zoloft and cymbalta.  The details are at the end of this post.

 

I'm going to give you some of our basic protocols.  You can get off these drugs, but it will have to be done slowly and one drug at a time.

 

To start, we recommend tapering no more than 10% of your current dose every four weeks.  Your drop of cymbalta from 60mg to 40mg is a 33% drop.  

 

Why taper by 10% of my dosage?

 

We recommend tapering only one drug at a time; otherwise, if problems arise you won't know the cause.  Generally, we recommend tapering activating drugs first, leaving sedating drugs in place to be tapered later in order to preserve sleep.  SSRI's like Zoloft and SNRI's like Cymbalta are activating, as is the antidepressant Wellbutrin.  Gabapentin and Clonazepam are sedating.  

 

Taking multiple psych drugs? Which drug to taper first?

 

Why did you choose to taper Cymbalta?  Since Cymbalta is involved in two of your three major interactions and is activating, this drug is, all other factors being equal, a good choice to begin tapering.  This link is specifically about tapering Cymbalta, including how to get the non-standard doses you'll need for a 10% taper.

 

Tips for tapering off duloxetine (Cymbalta)

 

You've been on and off a lot of different drugs over the past 30 years, and the current symptoms you describe are typical of withdrawal.  Psychiatrists don't believe in withdrawal (that's what they learn in school and what the pharmaceutical companies, unsurprisingly, tell them).  Psychiatrists then misdiagnose withdrawal as "return of the underlying condition" and put patients on another drug and yet another (what we call the drug merry-go-round) hoping something will work.  

 

So that you have a better idea of the withdrawal you've experienced and are currently experiencing, here is some information on withdrawal and the healing process.

 

What is withdrawal syndrome.

 

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

 

The Windows and Waves Pattern of Stabilization

 

When we take psychiatric medications, the CNS (central nervous system) responds by making changes over the months and years we take the drug(s). When the medication is discontinued, the CNS has to undo all the changes it made. Rebuilding the neurotransmitter production and reactivating the receptor and transporter cells takes time -- during that rebuilding process symptoms occur.  

 

These explain the healing process really well.

 

Brain Remodelling 

 

Video:  Healing From Antidepressants - Patterns of Recovery

 

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium and omega 3 (fish oil). Many people find these to be calming to the nervous system. 

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

Add in one at a time and at a low dose in case you do experience problems. Get supplements that are single ingredient (not mixed with other types of supplements).

 

Regarding long-term psychiatric drug use, I recommend your reading "Anatomy of an Epidemic" by Robert Whitaker. He found that across the board, regardless of drug type (antidepressants, antipsychotics, benzos, etc.) people did better off drugs than on.

 

Anatomy of an Epidemic

 

Here's a video book trailer by the author, Robert Whitaker:

 

Robert Whitaker, author Anatomy of an Epidemic video (11 minutes)

 

I've given you a lot of information, and I know it can be overwhelming.  Please take your time reading through the links.  Regarding the Cymbalta taper, I'd hold where you are at present since your first reduction was large in order to let your system stabilize.  A three month hold would be good.

 

This is your Introduction topic, where you can complete your drug signature, ask questions and connect with other members.  We're glad you found your way here.

 

Interactions between your drugs

Major

buPROPion  sertraline

Applies to: Wellbutrin (bupropion), Zoloft (sertraline)

Talk to your doctor before using buPROPion together with sertraline. Combining these medications may increase the risk of seizures, which may occur rarely with either medication. In addition, buPROPion can increase the blood levels of sertraline, which may increase other side effects. You may be more likely to experience seizures with these medications if you are elderly, undergoing alcohol or drug withdrawal, have a history of seizures, or have a condition affecting the central nervous system such as a brain tumor or head trauma. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. You should avoid or limit the use of alcohol during treatment. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Major

buPROPion  DULoxetine

Applies to: Wellbutrin (bupropion), Cymbalta (duloxetine)

Talk to your doctor before using buPROPion together with DULoxetine. Combining these medications may increase the risk of seizures, which may occur rarely with either medication. In addition, buPROPion can increase the blood levels of DULoxetine, which may increase other side effects. You may be more likely to experience seizures with these medications if you are elderly, undergoing alcohol or drug withdrawal, have a history of seizures, or have a condition affecting the central nervous system such as a brain tumor or head trauma. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. You should avoid or limit the use of alcohol during treatment. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Major

sertraline  DULoxetine

Applies to: Zoloft (sertraline), Cymbalta (duloxetine)

Using sertraline together with DULoxetine can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should seek immediate medical attention if you experience these symptoms while taking the medications. Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

 

 

Edited May 25, 2021 by Gridley

[Hillary75]

Hi Gridley,

 

Thank you so much for your reply and so much information, it is all very helpful for me.

 

Apologies, I will try to add more info in my signature, I haven't been so good lately at keeping up with things.

 

I decided on Cymbalta because its the only one of my meds thats not subsidised, its $150 a month while the others are $5 each for a 3 month supply.

 

Complicating matters is I've been in recovery for a few years after 19 years of bulimia, which is risky with wellbutrin and I'm lucky I haven't had a seizure.

 

However I replaced the bulimia with daily drinking for the past 4 years. I never drank alone before this habit, before my 40s. I am getting better at drinking less because I don't want to take more drugs to address that problem which was what my psychiatrist wanted me to do.

 

Again thank you so much. I will check back again soon,

 

Best,

Hillary