Georgio: Starting Questions

[Georgio]

Dear Forum members!

 

I would like to ask you for help. In my signature you can see my abbreviated drug history. I used to believe that Psychiatrists knew what they were doing and I took everything they recommended. However, I have now come to the point where they have no idea what they are doing, they are just stuffing me with medication which is making me worse and worse. I have been suffering continuously since March 2019 and have basically lost touch with life, my job, my relationships etc.

I now think that all the psychiatric medication they have put me on since I was a kid has got me to this depth.

 

Here are my questions:

 

- I was perfectly fine on sertraline between 2003 and 2019, what could have happened to make it stop working?
- Since 2019 I have been on a lot of (quick) medication changes and none of them worked. What could be the reason?
- Am I allowed to start withdrawing medication even though I'm not currently doing well on any of these medications? (There's practically no class of medication I haven't tried, except MAO inhibitors, so I don't think any other medication will help.)
- Is it possible to withdraw the meds with such a history and get improvement/recovery? 
- If so, which of my current medications should I start with and how?
- Based on my history, what can I expect?   

 

[Onmyway]

Dear Georgio,

welcome to SA. What a story! It is not unlike some of the members here who have been on the, as we call it, merry-go-round of drug changes and switches. When I think of psychiatric drugs it amazes me what rough 'tools' they are and how irresponsibly psychiatrists use them on a trial-and-error basis leaving patients like yourself in incredible pain. 

 

The good news is, your brain is incredibly resilient (brain plasticity) and it can recover from it, the bad news is that it will likely take a lot of suffering and time before you get there. The recovery follows a pattern. 

The Windows and Waves Pattern of Stabilization - Symptoms and self-care - Surviving Antidepressants

 

You can read some of the success stories here, some of people, not unlike yourself who had been subject to irresponsible polypharmacy. 

 Success stories: Recovery from psychiatric drug withdrawal - Surviving Antidepressants

 

A few things have happened to you, you have reached what is called tachyphylaxis - this is when you stop responding to a drug that has previously been working fine. In a desperate attempt to fix it your doctor has prescribed everything he has in the process causing withdrawals from the drugs you have been taking and start-up problems for the drugs that you started on creating chaos. This is a good place to educate yourself about some of these issues.  Are We There Yet? How Long Is Withdrawal Going To Take? - Tapering - Surviving Antidepressants

 

Your goal now is to reach some level of stability so your brain can recover and if you choose to, get off of the psychiatric drugs which we can help you do in as painless a way as possible. ADs don't work much better than placebo in general Antidepressants and the Placebo Effect (nih.gov) 

 

The principle of tapering that SA uses when coming off of multiple drugs is to taper off the most activating drug first which in your case would be sertraline. You would go at a slow rate of no more than 10% of the previous dose every month. 

Why taper by 10% of my dosage? - Tapering - Surviving Antidepressants

Why taper? SERT transporter occupancy studies show importance of gradual change in plasma concentration - Tapering - Surviving Antidepressants

 

You can then start tapering the rest of the drug in the same way. Yes, this can mean many years of tapering but rushing it is usually worse. I will ask @Altostrata as well to have a look at your case as it is more complicated. She may suggest a different approach. 

 

I am hoping you will get some respite soon. 

 

 

[Altostrata]

Welcome, @Georgio

 

Did you ever forget to take sertraline, or take it off-schedule? 

 

When did the tremor start?

 

When did you start each of the drugs you're taking now?

 

Please put ALL your drugs in this Interactions Checker and post the report or a link to it in this topic.

[Georgio]

Dear Onmyway,

 

Thank you for your kind and informative reply. I have already read most of the links you recommended today.  🙂 The ones I have not yet managed to read I will. My problem is with "some level of stability", as I am no longer medically stable beyond what is described in my slightly expanded description in the "about me" section.

 

"I have 2-3 X 1-2 week good periods a year, but always relapse.

My main symptoms at the moment are: generalised anxiety, stomach ache, nausea, problems with concentration, dizziness, unsteady walking, headache, pressure in the back of my head, mild tremor, lack of motivation, anhedonia, distracted by people, noises because I hear all noises very clearly, moderate depression, short-term memory dificulties."

Is it possible to start withdrawal in this state?

 

I have no idea when I can get to a better state, but I want to get off the medication. 

 

[Georgio]

2 hours ago, Altostrata said:

Welcome, @Georgio

 

Did you ever forget to take sertraline, or take it off-schedule? 

 

When did the tremor start?

 

When did you start each of the drugs you're taking now?

 

Please put ALL your drugs in this Interactions Checker and post the report or a link to it in this topic.

 

Dear @Altostrata

 

- Before 2019, I didn't really care what time I took my sertraline, I just made sure it was 50 mg in the morning and 50 mg at night. Sometimes I forgot to take my evening dose, or the morning dose, but I never made up for it at any other time, only at the next due time. This was specifically written on the instructions for use of the medicine.

 

- The tremor is now just hand tremor, I just forgot to write it out. The tremor started about a year ago due to a medical malpractice when 3 mg of clonazepam was accidentally switched to 0.5 mg of alprazolam one day to the next. I got tremor spasms, my whole body shook uncontrollably, my muscles jumped. In addition to I couldn't control my hands normally. For example I reached over the glass, or if I managed to grab it my hand would jump back and drop it etc. It took months to get better but the hand tremor remained, I have difficulty in writing and it can get worse in stressful situations.  

 

- Xanax SR (alprazolam) 1 mg             started:                          August 2020

  Stimulotone (sertraline) 100 mg      restarted:                        August 2020

  Xanax (alprazolam) 1 mg                  started:                           October 2020 with a 3 months break taken away during a hospital stay. 

  Lyrica (pregabalin) 75 mg                 started:                          November 2020

  Trittico (tradozone) 50 mg               started with 100 mg      Feb 2021 with a 3 months break taken away during a hospital stay.

  Kwentiax (Quetiapine) 50 mg           started                           March 2021

  Xanax (alprazolam) 2 X 0.25 mg      started:                          4 days ago
  

- Only my current medication or all the medication I have used so far?

 

[Altostrata]

@Georgio, it could well be that sertraline "stopped working" for you because of your irregular dosing prior to the issues you report in 2019, which sound exactly like withdrawal symptoms. Irregular dosing can cause this.

 

I am sorry you have had such bad experiences with your drugs. 

 

3 hours ago, Georgio said:

- Xanax SR (alprazolam) 1 mg             started:                          August 2020

  Stimulotone (sertraline) 100 mg      restarted:                        August 2020

  Xanax (alprazolam) 1 mg                  started:                           October 2020 with a 3 months break taken away during a hospital stay. 

  Lyrica (pregabalin) 75 mg                 started:                          November 2020

  Trittico (tradozone) 50 mg               started with 100 mg      Feb 2021 with a 3 months break taken away during a hospital stay.

  Kwentiax (Quetiapine) 50 mg           started                           March 2021

  Xanax (alprazolam) 2 X 0.25 mg      started:                          4 days ago

 

You are taking all these drugs now, every day?

 

Why was 2 X 0.25 mg Xanax added 4 days ago? What effects are you feeling from it?

 

What effects do you feel from quetiapine?

 

What is your daily drug schedule, with times o'clock and dosages? How's your sleep?

 

Please put ALL your drugs in this Interactions Checker and post the report or a link to it in this topic.

[Georgio]

Dear @Altostrata!

 

This may have been the reason, but it did not improve with regular medication, nor with increasing the dose. 

Yes.

 

The added 2 X 0.25 mg xanax was the idea of the administrator of a Hungarian benzo withrawal site to find a dose that would stably cover my anxiety. I do not yet feel that it is more stable.

 

Quetiapine, along with tradozone, is such that when I take it, after about 30-60 minutes I'm unable to do anything but sleep, I can't think, my eyes close and I'm able to fall asleep wherever I am.

 

My present daily drug schedule:

9 am Xanax (alprazolam) 1 mg, Lyrica (pregabalin) 75 mg, Stimuloton (sertraline) 100 mg

1 pm Xanax (alprazolam) 0.25 mg

5 pm Xanax (alprazolam) 0.25 mg

9 pm Trittico (tradozone) 50 mg Kwentiax (Quetiapine) 50 mg, Xanax SR (alprazolam) 1 mg

 

 

Fortunately, I have been sleeping well for 1.5 years. About 6-9 hours a day, but sometimes I get so tired from all the anxiety of the day that I fall asleep after work, only to wake up for my evening medication, but I sleep longer into the morning, up to 14 hours. The quetiapine and tradozone were not needed to fall asleep, nor was the sedative, I was only given these by the doctor to knock out the morning anxiety. I also get the 1 mg xanax in the morning for this reason, but I still haven't managed to overcome the morning anxiety, which is very strong for me.

 

Drug interaction report: https://www.drugs.com/interactions-check.php?interaction_list_id=183471887&drug_list=133-0,2057-0,1937-0,2228-0,1979-0&types[]=major&types[]=minor&types[]=moderate&types[]=food&types[]=therapeutic_duplication

 

 

@Onmyway @Altostrata Onmyway wrote this:

"Your goal now is to reach some level of stability so your brain can recover and if you choose to, get off of the psychiatric drugs which we can help you do in as painless a way as possible."

 

My problem is with "some level of stability". What does this mean in your opinion?

Because I have 2-3 X 1-2 week good periods a year, but always relapse.

My main symptoms at the moment are: generalised anxiety, stomach ache, nausea, problems with concentration, dizziness, unsteady walking, headache, pressure in the back of my head, mild tremor, lack of motivation, anhedonia, distracted by people, noises because I hear all noises very clearly, moderate depression, short-term memory dificulties.

Is it possible to start withdrawal in this state? (I have no idea when I can get to a better state, but I want to get off the medication.)

 

Thanks in advance for your Kind replies and suggestions!

 

[Georgio]

Dear @Altostrata

 

How can we tell in withdrawal whether our symptoms are withdrawal symptoms or recurrent symptoms of the original disease?

Can the original disease not return at the end of withdrawal or years afterwards?

After all, the imbalance (depression, panic, anxiety) usually happened before the medication, unless someone was given psycho medication off-label for other symptoms.   

[Onmyway]

2 hours ago, Georgio said:

 

@Onmyway @Altostrata Onmyway wrote this:

"Your goal now is to reach some level of stability so your brain can recover and if you choose to, get off of the psychiatric drugs which we can help you do in as painless a way as possible."

 

My problem is with "some level of stability". What does this mean in your opinion?

Because I have 2-3 X 1-2 week good periods a year, but always relapse.

My main symptoms at the moment are: generalised anxiety, stomach ache, nausea, problems with concentration, dizziness, unsteady walking, headache, pressure in the back of my head, mild tremor, lack of motivation, anhedonia, distracted by people, noises because I hear all noises very clearly, moderate depression, short-term memory dificulties.

Is it possible to start withdrawal in this state? (I have no idea when I can get to a better state, but I want to get off the medication.)

 

Thanks in advance for your Kind replies and suggestions!

 

Hi Georgio, 

 

let me try to distinguish two things - withdrawal and tapering. Withdrawal in the way we talk about here are the symptoms and changes that occur as a result of removing a psychiatric drug from the system either by tapering or abruptly (cold turkey). We believe it results from  a state of disequilibrium that is created in the brain which is slowly resolved over time. You have stopped abruptly and switched between multiple drugs so your brain is already in some sort of disequilibrium which we can call withdrawal. 

 

I think what you are asking is whether you should start or wait to stabilize before you start tapering/removing more drugs from the system. And I think you are asking how you would know when you are stable enough. I will give you the two principles under which I have learned to operate here and you can make your own decisions using the personal information that you have about yourself and your situation that you can't transfer easily to me. Since you are going to bear the consequences of these decisions rather than me, it is only fair that you get to make them. 

 

Principle: Keep it stable. Hold.

The brain, as the rest of the body, strives towards homeostasis (stability) and achieves that through complex adaptations in multiple subsystems. So in general, not making changes to the system for a while allows it to achieve some level of stability as it adapts to the new conditions under which it is operating (new drug cocktail or no drugs). You have noticed for example that as you have stopped changing things the tremor has subsided and that is evidence that the body is adapting to the new status quo. So in general, holding (i.e. not tapering) and not adding anything to the system would help it achieve stability after withdrawal symptoms have set in. This is also how recovery happens when you stop all drugs eventually. 

This explains it with an excellent analogy. How psychiatric drugs remodel your brain - Symptoms and self-care - Surviving Antidepressants

 

However, there are other considerations - is the current system, even without changes,  harming you? This can happen: 

1) If there is an agent (drug) in that system that is harming you through adverse effects you are essentially 'sleeping with the enemy' and its removal might actually help the system balance faster. However, even if you remove an agent that is actively harming you, its removal can cause withdrawal symptoms during the process of adaptation to not having the harming drug (rock and a hard place problem). But, to make things even more complex, lots of adverse drug effects and withdrawal symptoms overlap so it is hard to know what is causing what in a state of polypharmacy which makes this situation difficult. This is one of the reasons why I think Alto is asking when your tremor started to try to understand whether one of the drugs specifically is causing adverse effects and should possibly be removed first or even faster in extreme situations. This is also why noting symptoms daily helps track issues when they happen. It's a bit of a detective work. 

 

2) If the combinations of multiple drugs causes the adverse drug effects, hence the interaction checker. 

 

3) If overtime tolerance/tachyphylaxis happens - some drugs, like the benzodiazepines can cause tolerance, i.e. as you hold, the same dose is not sufficient anymore to do what it did before for your symptoms. Other drugs may 'poop out' stop doing what they were doing and go paradoxical and cause worse symptoms. We can worry about that if they happen. 

 

Doctors and patients often think that drugs are like puzzle pieces and that they correspond to treating specific symptoms. Unfortunately, things are way more complicated -

1) drugs are not as specific as we think to do only one thing in the brain, even selective serotonin reuptake inhibitors likely have impact on multiple other neurotransmitters and specific neurotransmitters are not directly linked to specific symptoms necessarily - i.e. serotonin impacts mood but likely lots of other things that we don't even know about such as sleep etc. so when you take a drug to address specific symptoms, i.e. something that lowers anxiety may you may also directly cause mania  to that

2) even if the drug was that specific to target a specific part of the brain/chemical with great precision the change in that chemical/brain part will then cause realignment in a complex system such as the brain (secondary effects)which would cause cascading effects in the rest of the brain and the body.  

3) when you have multiple drugs, we don't know how they interact with each other and what their cumulative effects on the system might be

 

So it is naive/irresponsible to think that you can treat a specific psychiatric symptom with a specific drug or drugs. For example, for me alprazolam (xanax) used to cause lowering of anxiety and sense of general wellbeing whereas another drug clonazepam would cause lowering of anxiety, depression, nausea, dizziness, sleepiness. These two drugs belong to the same class of benzodiazepines.

 

So, how do you know when you are stable? Answer: when your symptoms are bearable - I felt much better after I stopped tapering for a couple of months, for example and the symptoms resumed when I started again. Brassmonkey has a few posts on withdrawal normal. May be worth reading. 

 

You may also work on trying to manage your symptoms - for example - use non-drug techniques to help you deal with anxiety. We are not saying here that if you try hard enough with these techniques you will get rid of withdrawal and if they don't work you are doing something wrong. But there are techniques that really help many people. Try to apply them as much as you can so that you can get some relief. Claire Weekes method seems to work for dealing with anxiety for many people. 

 

Non-drug techniques to cope with emotional symptoms - Symptoms and self-care - Surviving Antidepressants

Important topics about symptoms, including sleep problems - Symptoms and self-care - Surviving Antidepressants

 

Hope this helps! 

 

 

Edited August 22, 2021 by Onmyway

[Go2zero]

5 hours ago, Georgio said:

Dear @Altostrata

 

How can we tell in withdrawal whether our symptoms are withdrawal symptoms or recurrent symptoms of the original disease?

Can the original disease not return at the end of withdrawal or years afterwards?

After all, the imbalance (depression, panic, anxiety) usually happened before the medication, unless someone was given psycho medication off-label for other symptoms.   

I merged this post you made in the tapering directory with this thread. Please only post your questions and comments in this thread only. So all your information will be kept together. Thank you!

[Georgio]

6 hours ago, Georgio said:

Dear @Altostrata!

 

This may have been the reason, but it did not improve with regular medication, nor with increasing the dose. 

 

Yes.

 

The added 2 X 0.25 mg xanax was the idea of the administrator of a Hungarian benzo withrawal site to find a dose that would stably cover my anxiety. I do not yet feel that it is more stable.

 

Quetiapine, along with tradozone, is such that when I take it, after about 30-60 minutes I'm unable to do anything but sleep, I can't think, my eyes close and I'm able to fall asleep wherever I am.

 

My present daily drug schedule:

9 am Xanax (alprazolam) 1 mg, Lyrica (pregabalin) 75 mg, Stimuloton (sertraline) 100 mg

1 pm Xanax (alprazolam) 0.25 mg

5 pm Xanax (alprazolam) 0.25 mg

9 pm Trittico (tradozone) 50 mg Kwentiax (Quetiapine) 50 mg, Xanax SR (alprazolam) 1 mg

 

 

Fortunately, I have been sleeping well for 1.5 years. About 6-9 hours a day, but sometimes I get so tired from all the anxiety of the day that I fall asleep after work, only to wake up for my evening medication, but I sleep longer into the morning, up to 14 hours. The quetiapine and tradozone were not needed to fall asleep, nor was the sedative, I was only given these by the doctor to knock out the morning anxiety. I also get the 1 mg xanax in the morning for this reason, but I still haven't managed to overcome the morning anxiety, which is very strong for me.

 

Drug interaction report: https://www.drugs.com/interactions-check.php?interaction_list_id=183471887&drug_list=133-0,2057-0,1937-0,2228-0,1979-0&types[]=major&types[]=minor&types[]=moderate&types[]=food&types[]=therapeutic_duplication

 

 

@Onmyway @Altostrata Onmyway wrote this:

"Your goal now is to reach some level of stability so your brain can recover and if you choose to, get off of the psychiatric drugs which we can help you do in as painless a way as possible."

 

My problem is with "some level of stability". What does this mean in your opinion?

Because I have 2-3 X 1-2 week good periods a year, but always relapse.

My main symptoms at the moment are: generalised anxiety, stomach ache, nausea, problems with concentration, dizziness, unsteady walking, headache, pressure in the back of my head, mild tremor, lack of motivation, anhedonia, distracted by people, noises because I hear all noises very clearly, moderate depression, short-term memory dificulties.

Is it possible to start withdrawal in this state? (I have no idea when I can get to a better state, but I want to get off the medication.)

 

Thanks in advance for your Kind replies and suggestions!

 

 

Dear @Altostrata 

 

Did you find anything from my answers?

E.x.: Are there any drugs specifically causing adverse effects should possibly be removed first or even faster?

Or any other issue?

Can I tape more than one drug in same time? (because for example, with Brassmonkey methood the tapering the drugs one by one would take decades, and for example pregabalin, is not a hard pschio drug)

 

Thanx

[Altostrata]

I believe this may have been what happened, Georgio: You got withdrawal symptoms from taking sertraline irregularly in 2019. As usual, your doctor did not recognize this and overdosed you with 200mg sertraline, then added alprazolam etc. for the adverse symptoms of that. Someone went further and added more "brakes" (pregabalin, trazodone, more alprazolam, quetiapine) to quash your symptoms, and now you're suffering adverse effects from overdoing the sedatives, as well as drug interactions.

 

Did you notice the major interaction between sertraline and trazodone? Have you been getting a ramp up of anxiety in the afternoon?

 

9 hours ago, Georgio said:

My present daily drug schedule:

9 am Xanax (alprazolam) 1 mg, Lyrica (pregabalin) 75 mg, Stimuloton (sertraline) 100 mg

1 pm Xanax (alprazolam) 0.25 mg

5 pm Xanax (alprazolam) 0.25 mg

9 pm Trittico (tradozone) 50 mg Kwentiax (Quetiapine) 50 mg, Xanax SR (alprazolam) 1 mg

 

You increased alprazolam from 2mg per day to 2.5mg per day 4 days ago, is that correct? And you have not seen a beneficial effect?

 

Taking trazodone, quetiapine, and alprazolam at night to sleep is an excessive sleep cocktail. Why did you add trazodone and quetiapine to alprazolam? 

 

What is the pregabalin supposed to be doing for you? Why are you taking 3 drugs at the same time at 9 a.m.?

 

Did one doctor prescribe all these drugs?

 

17 hours ago, Altostrata said:

Trittico (tradozone) 50 mg               started with 100 mg      Feb 2021 with a 3 months break taken away during a hospital stay.

 

You stopped taking trazodone for 3 months. Which 3 months? What happened then? How did you go off trazodone? What effects did you feel from this? Why did you add trazodone again?

[Georgio]

- Maybe that was the problem, because I never had a panic attack before, I was given sertraline for GAD, Dysthymia, Somatization , and headaches earlier. 

 

However, there have been times before when I have not taken it too and had no problems. For example, when I went out partying and drank, I would repeatedly not take the evening dose and had not problems. 

 

Anyway, I switched to another generic drug just 2 weeks before I got panic attack, because my health insurance stopped subsidising the old one. I was suspicious of this too, but I checked the information leaflets and both the active ingredient and the accompanying substances were exactly the same. 

 

For about 3 weeks before the panic attack I was in a very bad mood and very tired, I slept a lot (I quit my job at the time because I was getting so upset with my stupid boss) I would say I was depressed, but then I just blamed it on the bad weather and my exhaustion at work. 

 

My panic symptom was very interesting by the way, and also very scary, because there was nothing wrong with me until my consciousness started to sink into sleep, at which point a scary feeling woke me up and that's how the panic started. My private psychiatrist at that time gave me alprazolam to calm me down and to prevent anticipatory anxiety from developing due to panic attacks.

  

After 3 weeks of 0 sleep with sertraline dosage increased to 200 mg, I was admitted to hospital in a near final exhaustion state. On admission to hospital, symptoms suggested serotonin syndrome, but this was not confirmed. 

 

I was given the current - as you mentioned - "brakes" much later. In the last 2.5 years I have spent a total of about 8 months in psychiatric hospital or psychotherapy hospital, plus I have approx. 5 private psychiatrists, which is why they tried so many medications on me (mirtazapine, escitalopram, vortioxetine, agomelatine, duloxetine, venlafaxine, paroxetine, imipramine, olanzapine, quetiapine, lamotrigine, clonazepam, alprazolam).

 

There was a period when I was taking 4 mg alprazolam per day. 

 

Starting and stopping these meds, was 1-2 weeks overlap max so this could be hard enough in my current situation too. 

 

I've been with the same state psychiatrist for 1 year now, my current meds have been her idea except for the last 2 X 0.25 mg + alprazolam.

 

This long history of medication is no coincidence, as I have been in terrible physical and mental state, and the psychiatrists just wanted to help me in their own way. 

 

There has been no major change of medication in the last 1 year, so I think we should start from the current medication, because it is already an inability to 

what prolonged drug effects and drug interactions came from the past are still present now.

 

- Considering that sertraline is a serotonin reuptake inhibitor and tradozone also acts on serotonin receptors, the warning about the major risk of serotonin syndrome was expected. My psychiatrist said that it is not that doses that can lead to serotonin syndrome. But I think it may play a moderate role in my symptoms.

 

My anxiety is most often most severe in the morning and then eases somewhen during the day, and then practicaly disappears from 6pm, and doesn't come back until next morning even if I don't sleep at all night. There have been times when it has completely disappeared in the morning hours and not come back until the next morning. I recently had a 2.5 week window where I had no any symptoms and was completely fine all day. ( note: bipolar disorder has been definitely ruled out by all tests.)

 

- Yes I upped the alprazolam by 0.5 mg with prior approval of my psychiatrist according to the recommendation of a benzo taper community leader to cover me the full day in terms of anxiety and get me in a more stable state to start a benzo taper. We also set up fixed medication times with him (9 am, 1 pm, 5 pm, 9 pm) Before that I didn't pay attention to the fixed times, Sometimes I took my evening medication at dawn because that's when I was lying down and then had the morning dose a few hours later. And I took alprazolam as needed, up to a maximum of 3 mg, as recommended by my psychiatrist.

 

To be continued.......

[Georgio]

 

- Since the 0.5 mg alprazolam increase, some days my anxiety is less severe, but it may get better with time. I don't know.   

 

-  The tradozone, Quetiapine, alprazolam cocktail has evolved historically.
My psychiatrist introduced tradozone as a new antidepressant alongside sertraline. As I have very severe anxiety the choice of tradozone, as a last resort that not yet tried in the antidepressant line was not a coincidence.  Tradozone is a strong anxiety reliever, but as it is also very anaesthetic, so she put it on at night first, increasing the dose to 100 mg. At that time (Jan-Feb 2021) I was taking 1 mg Alprazolam SR and 100 mg tradozone in the evening only. 

 

In March 2021 I was admitted to a psychotherapy hospital for 3 months. There I was told that it was unnecessary to take 2 antidepressants, so they stopped tradozone in 1 week, also they did not allow me to go up to 3 mg a day of alprazolam SR as needed, as previously discussed with my psychiatrist, but only allowed me to take 1 mg of alprazolam SR a day, in the morning. So from one day to the next they basically took 1/2-2/3 of my alprazolam away from me (1/2 because only took 3 mg on rare occasions previously). Instead they put me on 50 mg of Quetiapine at night. I was on this medication until June 2021.

 

When I came out from the psychiatric hospital my psychiatrist kept the 50 mg evening Quetiapine, restored the 100 mg Tradozone, and the evening 1 mg Alprazolam SR, than changed the morning SR alprazolam, to plain Alprazolam. The goal was to finally get rid of my very severe anxiety in the morning. The result was my morning anxiety reduced considerably, then I started doing my own exercise to relax, and started CBT etc., than some windows opened, without anxiety. However I was very depressed so my psychiatrist reduced my evening tradozone to 50 mg. That's how the current cocktail developed. Now I feel anxious again in the morning and depressed at the same time.

 

 - Pregabalin was also my psychiatrist's idea to reduce anxiety. By the way, I take 75 mg of prgabalin in the evening too, I just left it off the medication list.  
       
- Yes, all the medication was/is prescribed by my psychiatrist.

 

- As I wrote above the tradozone was withdrawn during my psychotherapy hospitalisation, between March 2021 and June 2021. I was anxious all through the hospitalization, from morning till night, but as I wrote above not only the tradozone was withdrawn but most of the alprazolam, and Quetiapine was introduced, so I can't decide which event had such a serious anxiety during my presence in the psychotherapy hospital.

 

 

I apologise for writing so much, but my medication history is very complicated and I had to explain everything to make it clear.

 

If you don't understand any of the above mentioned, please ask me!

It is clear from my whole story that there have been a lot of withdrawals, refills, restarts, so I certainly don't want to take any more medication or increased doses. 

In fact I want to get off all of it slowly, as it has just become clear to me how many mistakes have been made with me and I might be perfectly fine now if they hadn't happened.

 

I continue to look forward to your suggestions, or any further questions you may have, so that we can finally make a decision on which drug(s) to start reducing with, and which method to use.

 

Thank you again.  

 

[Georgio]

Dear @Altostrata!

 

I forgot to write your name hastag to the two text above!

So please let me know, if you can find it!

 

[Altostrata]

On 8/22/2021 at 3:46 PM, Georgio said:

However, there have been times before when I have not taken it too and had no problems. For example, when I went out partying and drank, I would repeatedly not take the evening dose and had not problems. 

 

Your luck may have run out. What we see is that when people do this repeatedly, their nervous systems become less and less tolerant of shenanigans.

 

On 8/22/2021 at 3:46 PM, Georgio said:

After 3 weeks of 0 sleep with sertraline dosage increased to 200 mg, I was admitted to hospital in a near final exhaustion state. On admission to hospital, symptoms suggested serotonin syndrome, but this was not confirmed. 

 

I was given the current - as you mentioned - "brakes" much later. In the last 2.5 years I have spent a total of about 8 months in psychiatric hospital or psychotherapy hospital, plus I have approx. 5 private psychiatrists, which is why they tried so many medications on me (mirtazapine, escitalopram, vortioxetine, agomelatine, duloxetine, venlafaxine, paroxetine, imipramine, olanzapine, quetiapine, lamotrigine, clonazepam, alprazolam).

 

This is a rather common pattern of misdiagnosis and mistreatment when someone has an adverse drug reaction. We have many members with similar stories.

 

Yes, the increase to 200mg sertraline may have caused excessive serotonergic stimulation (serotonin toxicity) short of serotonin syndrome.

 

On 8/22/2021 at 3:46 PM, Georgio said:

Yes I upped the alprazolam by 0.5 mg with prior approval of my psychiatrist according to the recommendation of a benzo taper community leader to cover me the full day in terms of anxiety and get me in a more stable state to start a benzo taper. We also set up fixed medication times with him (9 am, 1 pm, 5 pm, 9 pm) Before that I didn't pay attention to the fixed times, Sometimes I took my evening medication at dawn because that's when I was lying down and then had the morning dose a few hours later. And I took alprazolam as needed, up to a maximum of 3 mg, as recommended by my psychiatrist.

 

Taking alprazolam irregularly may be the cause of many of your symptoms, or at least those that are not caused by the rest of your cocktail. 

 

You must take ALL your drugs on a regular schedule or you will be causing your own problems. We can't help anyone who does that.

 

How long had you been consistently taking 2mg alprazolam per day, or have you been varying your daily dose from 2mg to 3mg, prior to the addition of the two 0.25mg doses in the afternoon?

[Georgio]

@Altostrata

 

Since 2020 August.

For about 2 weeks now I have been very careful to take my medication regularly and at the same time.

 

Now that I have answered all your questions, can you advise me on which drug(s) to start reducing with, and which method to use?

[Altostrata]

18 hours ago, Georgio said:

Since 2020 August.

For about 2 weeks now I have been very careful to take my medication regularly and at the same time.

 

I am confused. You changed your alprazolam dosing within the last 2 weeks. Did you vary your alprazolam doses (2mg-3mg per day) prior to the last 2 weeks? 

 

On 8/22/2021 at 12:53 PM, Altostrata said:

You increased alprazolam from 2mg per day to 2.5mg per day 4 days ago, is that correct? And you have not seen a beneficial effect?

 

Do you mean for 2 weeks, you've been taking your other drugs on a regular schedule?

 

How has your symptom pattern changed in the last 2 weeks? How has your symptom pattern changed since you added these two 0.25mg alprazolam doses? What has the additional alprazolam done for you?

 

I'm asking these questions because many of your symptoms may be from your irregular dosing of all your drugs. If they are from alprazolam in particular, we need to address that first. (Trazodone is another prime suspect.)

 

However, to figure this out, we need to see a baseline symptom pattern arising from a regular dosing schedule. With the increase in daily alprazolam starting only 6 days ago, you've only started to keep to a consistent dosing schedule.

 

We need the following over at least a few days: Daily notes of times of day you take your drugs, their dosages, and your symptoms throughout the day. We need to know how you feel before and after taking each drug, and your symptoms in between. Post 24 hours of notes at a time in this topic, in a simple list format with time of day on the left and notation (symptom or drug and dosage) on the right.

 

This can show if your symptoms are adverse effects from one of your drugs or a combination of drugs.

 

I'm sorry if this process seems complicated, but you are taking a lot of drugs and the lack of consistency makes figuring out what's going on very difficult. Please make this easier by incorporating the following information into your signature. 

 

 

Quote

 

- Xanax SR (alprazolam) 1 mg             started:                          August 2020

  Stimulotone (sertraline) 100 mg      restarted:                        August 2020

  Xanax (alprazolam) 1 mg                  started:                           October 2020 with a 3 months break taken away during a hospital stay. 

  Lyrica (pregabalin) 75 mg                 started:                          November 2020

  Trittico (tradozone) 50 mg               started with 100 mg      Feb 2021 with a 3 months break taken away during a hospital stay.

  Kwentiax (Quetiapine) 50 mg           started                           March 2021

  Xanax (alprazolam) 2 X 0.25 mg      started:                          4 days ago

 

 

Also, be sure to add the nighttime pregabalin dose to this:

 

Quote

 

21/08/2021 medication/day:  

9 am Xanax (alprazolam) 1 mg, Lyrica (pregabalin) 75 mg, Stimuloton (sertraline) 100 mg

1 pm Xanax (alprazolam) 0.25 mg

5 pm Xanax (alprazolam) 0.25 mg

9 pm Trittico (tradozone) 50 mg Kwentiax (Quetiapine) 50 mg, Xanax SR (alprazolam) 1 mg

 

[Georgio]

Dear @Altostrata

 

I'm working now, so I will answer you as soos as possible, but in the meantime, can you answer me the below quoted questions I asked earlier?

 

How can we tell in tapering whether our symptoms are withdrawal symptoms or recurrent symptoms of the original disease?

Can the original disease not return at the end of withdrawal or years afterwards? What is your experience in this question?

After all, the imbalance (depression, panic, anxiety) usually happened before the medication, unless someone was given psycho medication off-label for other symptoms.   

[Georgio]

@Altostrata

- I will describe it differently, 2 weeks ago I fixed the times of consumption of alprazolam and the other drugs (9 am, 9 pm) and 7 days ago I added 0.25 mg alprazolam at 1 pm, and 5 pm. Before the last 2 weeks I was taking 2 mg alprazolam and my other drugs 2 times / day (morning and evening), but not at so fixed times, and sometimes I take an extra 1 mg alprazolam, when I feel, it is needed. 

 

-The truth is that I have not noticed a correlation between the fixed alprazolam timing, the addition of 2 X 0.25 mg alprazolam, and the development of my symptoms. Maybe just that I am getting more depressed and sleepy. I think I am now tolerant to alprazolam, but it is a good idea to make a daily note to clarify this. I did the one today, I just forgot it at my workplace. Anyway it is very difficult, to make exact notes when I work. 😞

 

- Anyway, it's very difficult to take these notes when I'm working, especially as I usually have a lot of anxiety in between, and the anxiety depends on the stressors of the moment.

 

- Another important thing. I went to my psychiatrist today and indicated that I wanted to reduce my medication. He accepted this and immediately suggested 25 mg less Quetiapine in the evening. What is your opinion on whether I can reduce this medication to this extent one day to the next?

 

[Altostrata]

It's good your psychiatrist is willing to help you.

 

50 minutes ago, Georgio said:

- Anyway, it's very difficult to take these notes when I'm working, especially as I usually have a lot of anxiety in between, and the anxiety depends on the stressors of the moment.

 

As your drug cocktail and symptoms are complex, we will not be able to assist you without those daily notes. We will need the notes to give you any guidance in an informed fashion. Otherwise, anyone's guess is as good as ours.

 

In particular, we need to know when any of these symptoms is better or worse during the day, and how you feel before and after taking each of your drugs.

 

On 8/21/2021 at 2:15 PM, Georgio said:

My main symptoms at the moment are: generalised anxiety, stomach ache, nausea, problems with concentration, dizziness, unsteady walking, headache, pressure in the back of my head, mild tremor, lack of motivation, anhedonia, distracted by people, noises because I hear all noises very clearly, moderate depression, short-term memory dificulties."

 

What is your current sleep pattern?

 

Since you added 0.5mg alprazolam a week ago and are feeling no benefit but increased sedation, I would drop the additional two 0.25mg doses in the afternoon. I am perplexed why any benzo counselor would suggest this, except he might have believed your symptoms were withdrawal symptoms from reducing your total daily dose of alprazolam. However, it appears this may not be correct, your symptoms may have been from inconsistent dosing.

 

You are certainly overprescribed the sedative-type drugs you're taking at night. It's absurd to take trazodone, quetiapine, and alprazolam together. However, we advise changing only one drug at a time; the 0.5mg alprazolam will be easiest to drop since you started it only a week ago. (Still, we need to know if your symptom pattern changes after you stop taking these additional doses, in case you have become dependent on the increased daily dose in an unusually short time.)

 

It may very well be that a stable schedule of 1mg alprazolam at 9 a.m. and 9 p.m. provides sufficient benzo coverage to forestall any withdrawal symptoms.

 

Aside from the recent 0.5mg alprazolam, you have been taking the other drugs more than a month, each one is going to present the same challenge in tapering, including quetiapine.

 

I agree that quetiapine should be the drug to reduce next, as it is the one most often implicated in movement disorders. It was very stupid of your prescriber to add it.

 

However, the cocktail you take in the morning is also questionable. If you feel dopey at work, it's probably why.

 

Please make the changes in your signature I requested in this post, I and the staff refer to this information to advise you.

 

[Georgio]

@Altostrata

 

My Yesterday's baseline symptom pattern arising from a regular dosing schedule:

 

 

25/08/2021

Sleep 8 hours

8 am, Waking up with moderate anxiety

9 am, Xanax (alprazolam) 1 mg, Lyrica (pregabalin) 75 mg, Stimulotone (sertraline) 100 mg

9-12 am, anxiety increases. (stress at work)

12, I feel calmer, depressed, concentration difficult, lack of motivation, fear of everything

1 pm, 0,25 mg alprazolam

1-5 pm, depression, back of head pressure, loss of balance

5 pm, 0.25 mg alprazolam

5-6.30 pm, all symptoms improve

6.30 - 9 pm, no symptoms I am fine

9 pm, Xanax SR (alprazolam) 1 mg, Lyrica (pregabalin) 75 mg, kwentiax (quetiapine) 50 mg, Trittico (tradozon) 50 mg

9 pm lead fatigue

 

- OK, from tomorrow I will stop taking 2 X 0.25 mg alprazolam.

- I sleep 8-9 hours continuously.

- Am I to understand that you are recommending that I do not reduce the Quetiapine yet?

- I was only able to put the start dates of the meds in my signature as an attachment because the system wouldn't let me enter them.

 

[Altostrata]

58 minutes ago, Georgio said:

- Am I to understand that you are recommending that I do not reduce the Quetiapine yet?

 

 

That is correct, make only one drug change at a time.

 

58 minutes ago, Georgio said:

- I was only able to put the start dates of the meds in my signature as an attachment because the system wouldn't let me enter them.

 

 

You can condense the earlier part of your signature to add more detail to the current part.

 

Please let us know how you feel after you remove those 2 0.25mg alprazolam doses.

 

The quetiapine will need to be tapered, you cannot simply drop it.

 

1 hour ago, Georgio said:

9 am, Xanax (alprazolam) 1 mg, Lyrica (pregabalin) 75 mg, Stimulotone (sertraline) 100 mg

 

This absurd cocktail you're taking in the morning may be causing your mid-morning and afternoon symptoms.

 

Before reducing quetiapine, I might move the dosing of the 75mg pregabalin to later in the day, to relieve those mid-morning and afternoon symptoms.

[Georgio]

 

When should I switch to pregabalin and for what time?

All medicines have separate tapering will last decades.

 

I'm very bad condition and near to that I loose my work. 😞

[Altostrata]

We need to see what the change in alprazolam does before making another plan.

 

It is very possible that decreasing alprazolam, which would best be done soon while your risk of accommodation to the higher dosage is lower, will cause you to feel better at work.

 

I am sorry this is complicated. You have potential permutations of 5 drugs in combination. It wasn't anyone here who prescribed 5 drugs for you.

[Onmyway]

On 8/25/2021 at 11:11 AM, Georgio said:

Dear @Altostrata

 

I'm working now, so I will answer you as soos as possible, but in the meantime, can you answer me the below quoted questions I asked earlier?

 

How can we tell in tapering whether our symptoms are withdrawal symptoms or recurrent symptoms of the original disease?

Can the original disease not return at the end of withdrawal or years afterwards? What is your experience in this question?

After all, the imbalance (depression, panic, anxiety) usually happened before the medication, unless someone was given psycho medication off-label for other symptoms.   

Hi Georgio, 

 

the "chemical imbalance" thing is a myth. The whole field of psychopharmacology emerged by serendipity - certain drugs seemed to calm people down/make them happier by chance (read up on the discovery of chlorpromazine and imipramine),  then they went backwards and looked at what these drugs did in the brain and then decided what pathway was important to target. Also true of iproniazid. 

Chlorpromazine, the first antipsychotic medication: history, controversy and legacy | Articles (bap.org.uk)

Iproniazid - Wikipedia

 

In general, antidepressants are no better than placebos. This article should be quite eye-opening. 

Antidepressants and the Placebo Effect (nih.gov)

 

OMW

 

[Georgio]

Dear @Onmyway!

 

If so, why does it cause depression, panic, and anxiety withdrawal symptoms when we stop?

Why have you been taking it all these years?

What was your original problem for which you were taking antidepressants?

How are you doing with the low dose now?

 

[Georgio]

Dear @Altostrata!

 

My Yesterday's symptoms:

 

Sleep 8 hours

8 am, waking up with severe anxiety

9 am, Xanax (alprazolam) 1 mg, Lyrica (pregabalin) 75 mg, Stimuloton (sertraline) 100 mg

9-12 am, anxiety increases. (stress at work)

10 am, anxiety eases slightly, muscle tension starts

10 am - 1 pm, moderate anxiety

1 pm, 0.25 mg alprazolam

1 - 2.30 pm, drowsiness and fear, difficulty concentrating, short-term memory lapses

2.30 - 3.30 pm, nausea, fear, difficulty concentrating, short-term memory lapses

3.30 pm, fear, anxiety subsides, I feel absolutely shattered, I feel my brain has completely shut down.

5 pm, 0.25 mg alprazolam

Very strong anxiety.

I came home and had a crying fit at 43 years old, lying on my mother's lap.

8 pm, anxiety reduced

9 pm, Xanax SR (alprazolam) 1 mg, Lyrica (pregabalin) 75 mg, kwentiax (quetiapine) 50 mg, Trittico (tradozon) 50 mg

10 pm lead fatigue

[Altostrata]

I have suggested you stop those 2 afternoon 0.25mg alprazolam doses. The longer you stay on them, the harder it will be for you to go off.

 

1 hour ago, Georgio said:

5 pm, 0.25 mg alprazolam

Very strong anxiety.

 

This is an indication you are taking TOO MUCH alprazolam, and it is causing a paradoxical reaction.

[Georgio]

@Altostrata

 

You suggested it yesterday and I haven't taken it today. This was my symptom diary for yesterday.

 

As in Hungary now is night, I can send you my today's symtoms diary.

 

Today was a terrible day. 😞

 

 

27/08/2021

9 am, Xanax (alprazolam) 1 mg, Lyrica (pregabalin) 75 mg, Stimuloton (sertraline) 100 mg

I was not able to go to work today.

I was in bed all day and was very anxious. I can't eat anything.

9 pm, Xanax SR (alprazolam) 1 mg, Lyrica (pregabalin) 75 mg, kwentiax (quetiapine) 50 mg, Trittico (tradozon) 50 mg

 

 

[Altostrata]

5 hours ago, Georgio said:

27/08/2021

9 am, Xanax (alprazolam) 1 mg, Lyrica (pregabalin) 75 mg, Stimuloton (sertraline) 100 mg

I was not able to go to work today.

I was in bed all day and was very anxious. I can't eat anything.

9 pm, Xanax SR (alprazolam) 1 mg, Lyrica (pregabalin) 75 mg, kwentiax (quetiapine) 50 mg, Trittico (tradozon) 50 mg

 

What new symptoms did you get today? What time o'clock did these new symptoms arise?

[Onmyway]

9 hours ago, Georgio said:

Dear @Onmyway!

 

If so, why does it cause depression, panic, and anxiety withdrawal symptoms when we stop?

Why have you been taking it all these years?

What was your original problem for which you were taking antidepressants?

How are you doing with the low dose now?

 

Excellent questions Georgio,

 

When you introduce a new chemical into the brain, it adapts - the body strives towards homeostasis. When I first started SSRI, my anxiety was much worse for the first 4 weeks and the symptoms were actually similar to withdrawal - terrors, sweating, insomnia. That resolved over time.

 

I also got nausea/paresthesia/dizziness during withdrawal. It doesn't mean that the ADs were preventing these and now some hidden condition has been revealed that has symptoms o nausea/dizziness/muscle spasms etc.

 

I got my drug because I was struggling picking a major at school. I had also been grieving the death of a family member. I agreed to them because I believed the chemical imbalance baloney.

 

When I stopped tapering for almost a year I was actually happy and normal. I have started tapering very slowly again and it's kicking my butt. I'm ruminating, always on edge, anxious, have muscle spasms, insomnia, morning terrors and slightly easier evenings. I have no doubt that this is withdrawal and not some condition I have. There isn't even a clear definition of what depression and anxiety are as disorders.

 

Do read the article I sent you.

 

Also check out the book Anatomy of an Epidemic by Robert Whittaker.

 

[Georgio]

5 hours ago, Onmyway said:

Excellent questions Georgio,

 

When you introduce a new chemical into the brain, it adapts - the body strives towards homeostasis. When I first started SSRI, my anxiety was much worse for the first 4 weeks and the symptoms were actually similar to withdrawal - terrors, sweating, insomnia. That resolved over time.

 

I also got nausea/paresthesia/dizziness during withdrawal. It doesn't mean that the ADs were preventing these and now some hidden condition has been revealed that has symptoms o nausea/dizziness/muscle spasms etc.

 

I got my drug because I was struggling picking a major at school. I had also been grieving the death of a family member. I agreed to them because I believed the chemical imbalance baloney.

 

When I stopped tapering for almost a year I was actually happy and normal. I have started tapering very slowly again and it's kicking my butt. I'm ruminating, always on edge, anxious, have muscle spasms, insomnia, morning terrors and slightly easier evenings. I have no doubt that this is withdrawal and not some condition I have. There isn't even a clear definition of what depression and anxiety are as disorders.

 

Do read the article I sent you.

 

Also check out the book Anatomy of an Epidemic by Robert Whittaker.

 

 

@Onmyway

 

Can you work with these symptoms and lead a normal life?

What helps you cope with anxiety?

 

[Georgio]

6 hours ago, Altostrata said:

 

What new symptoms did you get today? What time o'clock did these new symptoms arise?

@Altostrata

 

There were no new symptoms. I've had many days like this, when I'm just tired of working with constant anxiety, and all I want to do is lie down and leave everyone alone, even if I'm still anxious.
 

[Altostrata]

Please let us know if you have a change in symptom pattern after stopping the two 0.25mg alprazolam doses.

 

[Georgio]

So far today

 

sleep well about 8 hours

28/08/2021

9 am, Xanax (alprazolam) 1 mg, Lyrica (pregabalin) 75 mg, Stimuloton (sertraline) 100 mg

9 am – 3 pm very strong anxiety.

3 pm - Depressed mood without anxiety

6 – 6.30 pm moderate anxiety

6.30 - I'm pretty much OK.

 

How long will we monitor the effects of stopping 2 X 0.25 mg alprazolam?

What is the next step?