BRsurvive: Getting Started, Short, Sweet, and Trazodone Taper Progress Concerns

[BRsurvive]

Hi, this is my introductory post but of course, I only decided to create an account and ask for advice AFTER spending a long time in a bad state.  So it will be suboptimal. My current situation has been draining my life and willpower and my ability to thing and type.  I have a PCP appointment tomorrow where I might be able to get some help.  My psychiatrist and I are not on speaking terms, she has rejected tapering options, and I am looking for a new psychiatrist.  I normally experience generalized anxiety and depression to the point where I am unemployable.  I am sitting around slowly trying to make any progress I can.

 

Current problem first: I have started a taper and I am considering if I should go back, stabilize, and start over.  I tried tapering trazodone 50 mg by 25% for 5 days (after my psychiatrist suggested cold turkey!  HA!).  Severe symptoms did not set in until day 2 (expected), but these symptoms have made me agitated, unable to sleep, unable to concentrate, and made it hard to eat.  I used to be able to legally use medical marijuana to help with my general symptoms, but this change in my brain chemistry seems to be overpowering the marijuana and it provides no noticeable effects.  

 

After day 5 I decided to do more work to help myself, and I have been reading posts on this site for a bit (mostly looking into ways to deal with getting my trazodone to 1/8 of a pill with accuracy.)  My goal is to get through this transition while minimizing symptoms.  I recently made it from 1mg of clonazepam to 0.75 mg of clonazepam so I was feeling confident.  

 

After day 5 I decided to at least attempt to split my pill to 1/8.  I am on day 2 of that and the symptoms are better but not by much.  It has been a long and difficult time and I am wondering if I should give myself some "normal" time, and start over from the top with better planning, more tools, etc.  Of course, if I start over, it will be hard to not think of all this suffering (which has affected my relationships) as meaningless.

 

Would anyone care to share some thoughts?

 

Introduction / About me:

I was recently diagnosed as Adult Autistic, so I've been undiagnosed and struggling for 40 years.

I have been seeing therapists since 2005.  I have been working with various medications since 2005 as well.

My primary issues are anxiety and depression.  I also have severe pain, stomach, and eye issues which adds to the complexity of finding treatments that I can tolerate.  I grew up in an environment which fostered negativity and anger, and I am on the long slow path to help myself with that.  

I left my job of 15 years as an engineer after it was clear that I wasn't improving and I wouldn't be able to be able to fulfil their requirements much longer.   Just in time for COVID to make the world more stressful and limited.  

Medical Marijuana has been a godsend, the only thing to start to turn my life around.  Of course my psychiatrist wants to connect anything negative in my life to my medical marijuana.  Medical Marijuana where I live is very much a wild west situation where nobody has very solid information and self-experimentation is the only way to go.  Honestly, the world needs a science and detail oriented site like this one, but for medical marijuana.  The worst part of medical marijuana for me is the inability to get consistent, repeatable results from it.

 

I would gladly add to and elaborate as appropriate, I am having difficulty right now.  Thank you.

Edited August 2, 2021 by manymoretodays
More to title and tags

[Shep]

Hi, @BRsurvive.

 

Welcome to Surviving Antidepressants (SA).

 

14 hours ago, BRsurvive said:

My psychiatrist and I are not on speaking terms, she has rejected tapering options, and I am looking for a new psychiatrist. 

 

The good news is as long as you have a doctor who will prescribe the drugs, you don't need one that's on board with tapering. You simply need your prescriptions refilled so you can take the amount of each drug that you wish to take. For more on speaking with doctors, please see:

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

 

However, if you do wish to find a doctor who's knowledgeable about tapering, here are some resources:

 

Recommended doctors, therapists, and clinics

 

Mad in America Provider Directory

 

Here is information on using marijuana during withdrawal. Please note that some people find it ramps up symptoms due to having a traumatized nervous system. So some people find it helpful, others find it causes problems. 

 

Cannabis, marijuana, hashish, THC, & CBD (cannabidiol) or Hemp oil

 

Here are some links to get you started:

 

Why taper by 10% of my dosage?

 

Taking multiple psych drugs? Which drug to taper first?

 

How psychiatric drugs remodel your brain

 

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

 

The Windows and Waves Pattern of Stabilization

 

 

Please verify that this is what you are currently taking: 

 

     Trazodone 50 mg

     Lexapro 10 mg 

     Clonazepam 0.75

 

Also, please let us know the time(s) of day you are taking each of these drugs, along with when you take medical marijuana and supplements. 

 

As you provide more information, we can help you set up a game plan for coming off these drugs. Please continue to use this thread to document your taper and to ask questions. 

[Shep]

@BRsurviveThis is an additional post to alert you to potentially dangerous drug interactions with your cocktail. As you provide more information about when you take these drugs, we'll be able to tell if spacing out the drugs apart from each other may help with any symptoms that are coming from these interactions. 

 

Drug Interaction Checker Report for Lexapro, Trazodone, and clonazepam

 

 

Interactions between your drugs

Major

trazodone  escitalopram

Applies to: trazodone, Lexapro (escitalopram)

Using escitalopram together with traZODone 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 contact your doctor immediately if you experience these symptoms during treatment. In addition, combining these medications can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening, although it is a relatively rare side effect. You may be more susceptible if you have a heart condition called congenital long QT syndrome, other cardiac diseases, conduction abnormalities, or electrolyte disturbances (for example, magnesium or potassium loss due to severe or prolonged diarrhea or vomiting). 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. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or heart palpitations during treatment with these medications, whether together or alone. 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

 

Moderate

clonazepam  trazodone

Applies to: Klonopin (clonazepam), trazodone

Using clonazePAM together with traZODone may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. 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

 

Moderate

clonazepam  escitalopram

Applies to: Klonopin (clonazepam), Lexapro (escitalopram)

Using clonazePAM together with escitalopram may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. 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.

[BRsurvive]

Thank you very much Shep!  You are doing good work.  I ended up giving up on my current try at tapering.  It took about 2 days on my original dosage for my brain to function normally.  It was pretty scary and I have a new respect for this drug.

[Shep]

13 hours ago, BRsurvive said:

I ended up giving up on my current try at tapering.  It took about 2 days on my original dosage for my brain to function normally.  It was pretty scary and I have a new respect for this drug.

 

Thanks for the update, BRsurvive.

 

What time(s) of day you are taking each of these drugs (and any supplements) and at what doses? 

[BRsurvive]

I have issues that make it hard for me to concentrate.  I keep getting started on this forum, but then I'll get distracted by finding gear to put trazodone in a suspension or looking for a scale that can handle the kind of tiny amounts I'd be weighing.  Then I run out of energy and I don't revisit the topic for months.  This is very bad for my health and life. 

 

So please forgive me for laziness in this post.  I only get a few hours a month to deal with this due to my problems with focus, challenge aversion, and depressive avoidance.  I used to be a smart person, but I am undercut in my ability to do certain things in the most educated way.  I recently got evaluated with Autism, so I'm learning that it might not be easy to communicate the degree of my difficulties to other people.

 

I want to get off of 1.5mg (3x0.5 per day) clonazepam after years of taking it, and 50mg trazodone after years of taking it.  My doctors have recommended I do this, but they don't support me with tapering, just cold turkey or go into detox, those are the options they find acceptable.

 

I've checked about finding smaller pills and run into full stop situations where I have to check with compounding pharmacies, do the song and dance with insurance, and with doctors who don't agree that I need to taper 😕

 

I know the 10% rule.  I'm thinking I'll just sit down with a month supply of clonaz and traz (start with one, maybe do both in parallel if things go well.  I'd be more patient but I'm unemployed and not on disability.). 

 

I'm thinking I'll get a monthly pill planner, and then just start shaving all my pills in advance.  If I shave them at the same time I'll get a feel for making sure it is a gradual reduction.  Any best tools for this other than a razor? 

 

Maybe I can 3d print something that helps with the process. (send me ideas and requests for designs for anything on this sub, I'd like to put my abilities to good use).

 

If I do this with the shaving and the day planner, is there anything I should REALLY be very careful of?

 

Thank you.

Edited August 2, 2021 by manymoretodays
Added Autism note, added tags, moved from Tapering forum(mmt) to Introductions and leaving unapproved until another mod can merge and respond

[manymoretodays]

Hi BRsurvive, and glad you are back, to plan further with your taper(s), @BRsurvive

I've got you merged up with your first Introduction topic now.  This will be the best place for some back and forth, and updates with your particular case.  You are not being lazy.  Sounds like this is all feeling pretty overwhelming and challenging though.  And unfortunately, I'm not able to just give you a one reply answer to all your questions right now.  I will get you flagged for some additional input as soon as possible from the rest of the staff.  And encourage you to just HOLD tight right now and be patient.  Do try if possible to check back, right here, more than once a month if you can.

 

Awesome on getting the signature done too!  Much appreciated.

Any updates, with drugs and current dosages could go there.  Just go to AccountSettings/signature, and then edit in any changes since you last did that.  Make sure and hit the Save button when done.

 

To keep it really simple, for right now, could you list the times on the left, and what drugs you are presently taking by name and dose.

Just do that in a reply.  That will be helpful, for whomever may come on to help you with further, future taper, planning.  💜

  

On 7/31/2021 at 3:00 PM, BRsurvive said:

I'm thinking I'll get a monthly pill planner, and then just start shaving all my pills in advance.  If I shave them at the same time I'll get a feel for making sure it is a gradual reduction.  Any best tools for this other than a razor? 

 

Pill shaving isn't the best method for a long haul taper really but I will give you the link to that topic below.

Just click on the upper right arrow to read.

 

Also please see:  The rule of 3KIS: Keep it simple, slow, and stable.

 

Best of the best to you.

Love, peace, healing, and growth,

mmt

 

 

 

Edited August 2, 2021 by manymoretodays

[BRsurvive]

Thank you.  I apologize, I need to process the responses.

[BRsurvive]

Hi, I drifted away from pursuing information here for a bit.  I still need to process the replies I've had.  The more important something is, the harder it is for me to face it.

 

I had a gene test done in 2018 and it had given me some results.  All along I had just handed the results to doctors.

 

I have had problems where doctors are surprised that, say, I don't experience clonazepam withdrawal until 2 days later.  I seem very over-reactive to medications.

 

This seems to be explained in the gene test, which shows I have compromised CYP450 metabolic pathways.  I apologize if I'm using the term incorrectly, I am having a hard time focusing on learning right now because of some effects going on.

 

15 years ago was the first time this came up and my medication has been "weird" ever since. 

 

Additionally, I have been using MMJ, which also competes for the pathway and is what helped me make this connection.  The MMJ pharmacist brought up the CY450 without either of us knowing I had a metabolism problem.  I could basically be affected by a small dose of MMJ for 15 hours.  Not in a good way.  Several of my other medications are in the pathway upon very cursory internet searches, including Lexapro.    

 

Even before ALL of this, the same gene report had overshadowed information about CYP450, because it showed that I had MTHFR which is an issue with how the body deals with B vitamins.  The medical community felt that I was taking the appropriate treatment (L-Methyfolate).  I had a blood test that showed only small lower-than-normal B12 levels. 

 

However, I have had transitory bouts of depression, where I just felt sapped to the core of my brain.  I had been told it was about my emotions.  They would last from days to months.  I have three times reproduced cases where I can take a generic B multivitamin and life the depression within an hour. 

 

INDEPENDENTLY, I had reported problems with unusual muscle cramps and my doctor thought I had a weird case of athlete's foot because of tingling in the feet.  This would also be explained as symptoms of a B12 deficiency.  Sorry I'm losing my ability to organize my thoughts.  

 

I had suffered from an undiagnosed "nerve damage" to both of my arms about 16 years ago and my life was redefined by the fact that using my arms hurts now. 

 

Many other possible symptoms are there and could be about B vitamins.  I know the internet can inflate self diagnosis, but I'm in a place where medical science has already missed big things and I am not improving.  

 

Of course I am having a hard time with doctors and people who don't identify with the sense of urgency I feel about this new information.   

 

[Shep]

What time(s) of day you are taking each of these drugs (and any supplements) and at what doses? 

[BRsurvive]

Thank you for your patience. 

 

First thing in AM: 

Lexapro 10mg

Clonazepam 0.25 +  (I use this symbol to indicate that I am partway tapering to 0.25. Currently about 1/3 * 1/2 mg tablet = 1/6 mg three times a day)

Adderall XR 15mg

Aciphex (Rabeprazole sod) 20 mg (for acid reflux, a Proton Pump Inhibitor)

Flonase (nasal spray for allergies) 

 

Mid Day: 

Clonazepam 0.25 +

Additionally: 

These have been recommended by a dietician:

Vitamin D3 1000IU

Tumeric Curcuma NF-kB "blend" 482mg.  Includes Black Pepper extract 7mg

Megafood "Multi for Men" multivitamin,

Thera tears Fish Oil (EPA: 450mg, DHA: 300mg, ALA: 450mg),  

L-methylfolate 15mg  (it also says Folate: 25,000 mcg DFE on the label)

 

 

Before Bed:

Trazodone 50 mg

Clonazepam 0.25 +

Xyzal (allergies): 5mg

 

Various chewable and liquid OTC antacids might be adding to my system? 

Mostly Gaviscon Chewable, which is:

Aluminum hydroxide 160mg

Magnesium carbonate 105mg

 

gatorade every other day to prevent bad muscle cramps.  (potassium deficiency caused by B12 issues?)

 

My MMJ intake is as needed and finding the right dose at the right time is tricky.

 

I will type up the contents of the B multi I have used in determining that I might have an issue in my next post.

Edited August 24, 2021 by BRsurvive
Typos in numbers, and clarification on medication dose.

[Shep]

12 hours ago, BRsurvive said:

Clonazepam 0.25 +  (I use this symbol to indicate that I am partway tapering to 0.25. Currently about 1/3 * 1/2 mg tablet = 1/6 mg three times a day)

 

I'm not sure what this means. Are you currently decreasing your clonazepam? Please let us know exactly how much you are taking and what your recent decreases have been.

 

Please stop tapering until we help you set up a game plan for coming off this cocktail. 

 

12 hours ago, BRsurvive said:

First thing in AM: 

Lexapro 10mg

Clonazepam 0.25 +  (I use this symbol to indicate that I am partway tapering to 0.25. Currently about 1/3 * 1/2 mg tablet = 1/6 mg three times a day)

Adderall XR 15mg

Aciphex (Rabeprazole sod) 20 mg (for acid reflux, a Proton Pump Inhibitor)

Flonase (nasal spray for allergies) 

 

Please note: THIS IS A DANGEROUS DRUG COCKTAIL.

 

I listed some interactions in an earlier post in your thread, and now you're listing a drug you hadn't posted about earlier - Adderall. Taking Adderall with Lexapro puts you at risk for a MAJOR drug interaction. From Drugs.com:

 

 

Quote

 

Interactions between your drugs

Major

amphetamine  escitalopram

Applies to: Adderall (amphetamine / dextroamphetamine), Lexapro (escitalopram)

Talk to your doctor before using escitalopram together with amphetamine. Escitalopram may increase the effects of amphetamine, and side effects such as jitteriness, nervousness, anxiety, restlessness, and racing thoughts have been reported. Combining these medications can also 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 contact your doctor immediately if you experience these symptoms while taking the medications. 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.

 

 

 

How long have you been taking Adderall? Please update your signature to reflect the date and dose you started this drug. A direct link to your signature is here:

 

Account Settings - Create or Update Your Signature

 

12 hours ago, BRsurvive said:

These have been recommended by a dietician:

Vitamin D3 1000IU

Tumeric Curcuma NF-kB "blend" 482mg.  Includes Black Pepper extract 7mg

Megafood "Multi for Men" multivitamin,

Thera tears Fish Oil (EPA: 450mg, DHA: 300mg, ALA: 450mg),  

L-methylfolate 15mg  (it also says Folate: 25,000 mcg DFE on the label)

 

If you haven't already added these in, please don't. Your list of drugs and supplements is already complicated enough. The simpler you can keep this, the better. 

 

[BRsurvive]

Deleted because of duplicate.

Edited August 28, 2021 by BRsurvive
I hit reply and it duplicated my most recent post.

[BRsurvive]

I typically get criticized for including too much information and I have problems determining where to draw the line.  The Adderall omission was an outright mistake though.  I had to push through anxiety to get the post done, and anxiety makes me dumb.

 

I have been on Adderall XR 15mg for 2+ years.  Before that I had been on different doses of Adderall, sometimes in a tablet form that I would cut or take as needed with my old doctor's approval.  Would it be helpful to dig up details on my Adderall history from before 2 years ago?  I've questioned whether it is used off label, the doctor said "does it help you" I said "yes" and that was the end of the discussion.

 

Clonazepam tapering:

From June 10 to August 22 I was taking 1/3 of a 1/2 mg pill, three times a day.  (each dose was 1/6 mg, so three times a day makes for 1/2 (0.5) mg total per day.)

 

Starting August 22, I moved my first dose of the day from 1/3 of a 1/2 mg pill to 1/4 of a 1/2 mg pill.  So for 5 days I have been taking 1/8 (0.125) mg in the AM and 1/6 (.167) mg at lunch and then 1/6 at night.  Total each day is now 0.458 mg total.

 

So I went from 0.5 to 0.458, which is 8% right?  It's not ideal that the reduction isn't split evenly through the day, I know.  This week has been rougher than many because of working with doctors and finding out what else is screwed up with my meds, but I'm not sure how much the reduction has had a hand in my stress levels.  Probably more than I want to admit looking back.

 

Updating profile now.

 

I appreciate the drug interaction warning.  I will have to go back and see how this interaction compares to the interaction with duloxetine, which I was switched over from.  Currently it looks like Lexapro has more issues with CYP450 than effexor did although I need something clearer to cite. 

 

I am used to reading these interaction warnings and they seem typical.  My understanding is that the risk of these reactions is assumed acceptable by the doctor and that they see the same information.   I've been called "oversensitive" a lot, and I know to expect some side effects regardless of what I take.  Before I started learning about CYP450, for instance, I thought all interaction talk was just a matter of rolling the dice, and if nothing made me particularly worse I didn't worry.  

 

Of course now that I know she ignored my CYP450 thing, it's easier to look at this critically.  I typically report so many problems that any of the listed interaction effects would be mixed in with the rest.  

[Shep]

21 hours ago, BRsurvive said:

So I went from 0.5 to 0.458, which is 8% right?  It's not ideal that the reduction isn't split evenly through the day, I know.  This week has been rougher than many because of working with doctors and finding out what else is screwed up with my meds, but I'm not sure how much the reduction has had a hand in my stress levels.  Probably more than I want to admit looking back.

 

Please stop tapering clonazepam. This thread will explain why we advise tapering benzos last:

 

Taking multiple psych drugs? Which drug to taper first?

 

How is your sleep?