LHRG: Paroxetine withdrawal, now facing Olanzapine and Sertraline withdrawal

[LHRG]

Hello everyone,

I've been lurking for quite a while on this site, and now that my quest on being an healthy fully-functional humain being is getting serious, I thought it might be time for me to participate in this great subculture. I've found answers to question that psychiatry was only answering with more medication.

 

My journey starts in 2016, when I was prescribed 20 mg Paroxetine after a mild anxiety attack. Looking back, I am now quite angry at the GP who put me in this nightmare, without explaining anything about the drug. Paroxetine was quite effective, and I don't have much to say about this first time I was on it. It was a good time in my life. The only thing worth mentioning was that the first few weeks starting the treatment was absolute hell : anxiety and depression like I have never seen. I thought it was part of the process, so I powered through it. I decided to quit AD in late 2018 or early 2019. I don't remember having much withdrawal symptom, except for some lingering blurry vision. I stopped absolutely CT, as I was never told anything about tapering by my GP.

 

But after quitting, I began feeling a little off. Kind of anhedonic, bland, dull. I truly do not know if it has been the medication, some sort of bipolar disorder (I'll come to that in a minute), or the multiple trauma I have been through at that same period. Anyway, after struggling for a bit and having some SI, I started seeking the help of a psychiatrist in December of 2019. Since my first experience was quite good, and since I already knew the med (there's something about being comforted by the same things), I decided to give it another try to get me out of this slump. Once again, the first few weeks was absolute hell : tremor, crippling anxiety, absolute depression. I remember being miserable and helpless. But the drug kicked in, and it was a pleasant experience afterwards. This is were I started to think something was off with the med: I was far more euphoric and manic than the first try. I was talking very fast, my mind was very sharp, and I was sometimes quite agressive. I did not, however, prevent me from sporadic depressive, or rather anxio-depressive episodes. I decided to quit Paroxetine once again after 6 months of use, in the summer of 2020. And I stopped CT once again. I remember being a bit off for a few days, but nothing really serious.

 

Yet, the anhedonia wasn't getting better, and after some time, I noticed I was even more off than I used to. I went to therapy, I tried working out, I tried everything, but I still was quite out my own life. I got quite desperate, not feeling like my former self anymore.

 

Which is why, in an act of despair, I resumed Paroxetine in March of 2021. This is where hell broke loose. I deeply regret this. The first weeks were not as bad as the two other times, but I went full hypomanic. I was uncontrollable, very energetic, never tired, extremely productive. At the same time, I experienced tremor, vision problem with some sort of hallucinations (forms in my peripheral vision). My GP ruled this as a serotonin syndrome, and I think he wasn't wrong. He asked me to stop urgently the treatment, which I did : 3rd time CT. This time, it did NOT go well. I'm still to this day trying to get my head around the reasons why this time only, it became hellish. I had protracted withdrawal, with severe anxiety, full-blown depression (as in : cannot get out of my bed), and very annoyingly tinnitus and visual snow, which left me helpless and unable to function.

 

I had some windows and some waves, and I was able to do a few things during this time, but the symptoms were too strong. Although, at this time, I did not know about this website, and I was really puzzled by what was happening : the connection with the antidepressant struck me, but, on the other hand, every psychiatrist I saw during this period assured me that it wasn't possible, that protracted withdrawal was not a thing.

 

I did not know who to believe. It drove me absolutely crazy. After a massive crisis, I was admitted to the hospital on June 14th of this year. An awful experience, but I was able to find some calm after the storm. My case puzzled doctors. I was diagnosed with atypical depression. I was put on Olanzapine (15 mg, reduced to 5mg now), Sertraline (50mg, reduced to 25) and sent back home, still wondering whether I should trust my gut or the doctors.

 

Thankfully, I was redirected to a psychiatrist who truly believed me and listened to me. It was such a relief. I still tried Lamictal (seems to help, although I am not at therapeutic dose yet), as I think a (real) bipolar disorder was under the anhedonia-hypomanic pattern, but she supported me in the decision of getting rid of everything else, which are toxic to me and my damaged CNS. Stupidly, I tried to CT the Olanzapine and quickly was faced with severe anxiety, insomnia, sense of impending doom.

 

As of today, I suffer with :

- deep depression/anhedonia, which I believe is made worse by the antipsychotic : I feel like a zombie with no emotion, no motivation and no prospect : there a sense of nothingness in my life.

- sensorial issues : tinnitus, visual snow (really incapacitating)

 

Finding this site gave me some peace about what I was experiencing. My priorities right now are to taper off the Olanzapine (which I absolutely hate) and the Sertraline. I have been able to taper rapidly down to 3,75mg olanzapine and 25mg sertraline without much trouble except some anxiety spike from the antipsychotic. I actually think my CNS is quite robust, considering what I've put it through. Then I will dress the bipolar or pseudo-bipolar aspect, which I believe is the real cause of my anhedonia. 

 

I'd like to start my journey here with two questions 

- Which one of the Olanzapine or the Sertraline should I taper off first ? It seems like the antipsychotic make the antidepressant withdrawal a bit more easy, as I did not really have any symptom tapering down from 50 to 25 mg ?

- Is my case desperate ? I feel like I've done a lot of harm to my CNS, and I'm quite anxious that I'll never be able to go back to my real self. Is there any practice to help restore my CNS ?

 

 

Thank you all a lot for everything this site has already accomplished

 

[Altostrata]

Welcome, @LHRG

 

It is possible that you are among the people who have immediate adverse drug reactions (ADRs) to an antidepressant, which cause nervous system modification such that it persists long after they are off the drug, with emotional anesthesia a common symptom. See Adverse reactions to an antidepressant within a few doses -- how long for recovery?

 

We have a group of people with this post-drug syndrome, tagged "immediate ADR". After they go off the drug, they may have symptoms identical to withdrawal syndrome, likewise resolving very gradually over many months.

 

Your case is unusual in that you stayed on the drug and then tried it again 2 more times, with severity of ADR progressively increasing, Your nervous system was telling you that it does not get along well with the drug, resulting in your current post-drug neurological upset. This is NOT diagnostic for bipolar disorder and it's not atypical depression, regardless of what a psychiatrist might tell you. It's also not serotonin syndrome, but probably indicates serotonergics are not for you.

 

Like people who have post-acute withdrawal syndrome, your nervous system is upset and generating those symptoms. Coincidentally, low-dose lamotrigine can help stabilize people with severe post-acute withdrawal syndrome. We also have people here who have recovered with olanzapine or other antipsychotic as a crutch -- they are drugs that also tend to slow down neurological activity.

 

What times o'clock do you take your drugs, at what dosages? How did you feel after you initiated sertraline? Did you start sertraline and olanzapine at the same time?

 

To help us out, follow these instructions Please summarize your drug and withdrawal history in your signature You may need to use a computer to do this.

 

 

[LHRG]

Hi @Altostrata, thank you for your message and all these informations,

 

I'm still trying to figure out what exactly is happening to me. Immediate ADR is certainly a possibility. But, as you said, my case seems to be a bit unusual, and I do think that WD is only one of the factors at stake. The manic episodes which I experienced while on AD certainly seems to point out an underlying BPD, but on the other hand, it might also be a psychiatric category masking an adverse reaction. I also had a real traumatic episode after the first time I stopped Paroxetine, which certainly had played a major role in the depression I developed. The strange thing for me is that I did not experience WD (or at least very moderate and short-lasting) for the first two times I quitted Paroxetine. 

 

Lamictal seems to be quite effective. I'm in better mood, I experience less anhedonia, and I'm still titrating up to therapeutic dose.

 

I absolutely hate Olanzapine. It turned me into a zombie, feeling no emotion, and sleeping all day long. I think it also counteracts the energy and joy the lamotrigine is somewhat giving me back. The priority for me is to get rid of it, and then doing the same with sertraline. I'm currently tapering olanzapine fast, and, except a few nights of bad anxiety and insomnia (2-3 nights at each drop), it's going okay. I'm quite happy at the prospect of living without antipsychotics.

 

 

1 hour ago, Altostrata said:

What times o'clock do you take your drugs, at what dosages? How did you feel after you initiated sertraline? Did you start sertraline and olanzapine at the same time?

 

- I usually take my drugs at noon, because I just cannot get up in the morning if I take them in the evening. 

- Sertraline made no difference at all. But I do think olanzapine is counteracting its effect : I did try to quit olanzapine a few weeks ago, and i felt amazing in the short time before WD kicked in.

- I started sertraline and olanzapine at the same time. I started Lamictal afterwards, and I've been very slowly titrating up to avoid SJS.

 

A few questions :

- If this is ADR : from experience, how long does it usually last ? I'm not really functional at the moment and I'm trying to get better as well as I can.

- Is there anything I can do to make my CNS heal faster ? I currently take probiotics, fish oil, and I should probably take magnesium as well. I try to cut down on inflammatory food as well.

[Altostrata]

20 hours ago, LHRG said:

The manic episodes which I experienced while on AD certainly seems to point out an underlying BPD

 

This is a misconception held by many psychiatrists. Adverse reaction to an antidepressant is not diagnostic for bipolar disorder.

 

Since I've seen so many cases like yours, with adverse reactions and serial drugs, with elaborate attributions of symptoms to psychiatric disorders, I am skeptical that you've been getting away with going on and off drugs with no long-term effects, withdrawal or otherwise.

 

Olanzapine and related antipsychotics is a drug with significant health risks. It makes sense for you to minimize olanzapine first. However, it may be the drug that is enabling you to sleep. If I were you, I would not be complacent about those withdrawal symptoms. I'd taper it very carefully at a rate that does not cause withdrawal symptoms. See Tips for tapering off olanzapine (Zyprexa)

 

20 hours ago, LHRG said:

Lamictal seems to be quite effective. I'm in better mood, I experience less anhedonia, and I'm still titrating up to therapeutic dose.

 

 

If I were you, I'd stop increasing lamotrigine dosage if you're currently getting a good effect. We're not about "therapeutic" doses here, what we look for is a dose that's enough to take the edge off withdrawal or other iatrogenic symptoms. You'd want your nervous system to repair itself, not be controlled by yet another drug.

 

It sounds like you've been increasing your lamotrigine dosage while changing dosages of your other drugs. We advise against this -- change only one drug at a time, observe the results for weeks, not days. A dosage of lamotrigine that's too high will cause adverse effects, like any other psychiatric drug. If you change more than one drug at once, you won't know where a bad reaction is coming from.

 

Since you've been making so many drug changes over a year, its hard to tell the origin of your current symptom pattern. Paroxetine is a very difficult drug to go off, you may still have paroxetine withdrawal syndrome. Recovery from serotonin toxicity can take months. You may have had other ADRs from the other drugs you're taking, or adverse effects of drug-drug interactions, but attributed them to something else.

 

In situations where people are taking multiple drugs, we see progress when the situation is simplified: You need to maintain your drug regimen and schedule while reducing only one drug, to see what happens when that drug is removed. We often see that simply stop making a lot of changes at once causes symptom pattern to improve as the nervous system stabilizes even under a poly-drug burden.

 

Please let us know how you're doing as you reduce olanzapine.

[LHRG]

Thank you for your advices. I'm simplifying my poly-drug inferno : I'm keeping lamictal and sertraline stable, while I get rid of olanzapine.

 

Yesterday I had a massive crash, which I attribute to the last taper of olanzapine. Symptoms are pretty typical : extreme anxiety, insomnia, nausea, restlessness. I'm quite desperate at the moment, and I have some SI during the insomnia. I'm on a sick leave because of all this fuss, and I'm worried I won't be able to work anymore. I'm not a functional human being.

 

I may be tapering too fast, I admit I am quite impatient to quit olanzapine completely. Interestingly enough, I see withdrawal symptoms appearing each time 5 or 6 days after a drop, which probably has to do with the long half-life of olanzapine.

 

It seems like I have a particularly violent history with drugs. Am I doomed to live like this ?

 

Anybody with similar poly-drug history ? Any success story with such a complicated burden ?

[hayduke]

Hi @LHRG.  I can tell you olanzapine is no picnic, but you can get free of it with patience, good support and self care.

 

I didn't really have to deal with the poly drug issue, though my occasional use of a serepax/oxazepam script eventually led to me reacting paradoxically to the benzo and becoming more anxious. I don't use those any more.

 

You're right in that your nervous system has been through a lot with those drugs, and as Alto eloquently explained there, your body will be grateful for a fair period of holding where you are so it can stabilise, let you find some comfort, and plan a smoother taper down to zero.

 

On the bright side, you're not on a very high dose of olanzapine.  It's a good moment to take some deep breaths and reread Alto's post there, then start doing some research on your taper round the forums here and maybe some of the suggested books.  Nothing teaches you patience like tapering off these drugs, but you can do it.

 

Cheers

 

 

[hayduke]

https://www.survivingantidepressants.org/topic/6547-recommended-books-on-antidepressant-withdrawal/?tab=comments#comment-1983

[LHRG]

Thanks for the kind words.

I've been quite aggressive with the olanzapine taper (reading about antipsychotics, especially studies by Joanna Moncrieff and Mark Horowitz, scared me about the adverse effects of those nasty pills). 5 to 2,5 mg was fine, but I was struck with severe withdrawal symptoms (extreme anxiety, tremors, suicidal thoughts, deep depression) when I tapered down to 2,33mg. I think I will hold at that dose for a while ; my CNS is giving me signal that it doesn't tolerate that much change in such a short time. I'm not happy with that much medication, especially since I think all 3 are unjustified, but better safe than sorry. I'm also learning on the site how to taper more accurately and with smaller reductions, which I find tricky with the orodispersible wafer I've been prescribed

[manymoretodays]

Hi LHRG,

  

1 hour ago, LHRG said:

Hi everyone,

 

Is anyone using the orodispersible tablet to taper ? I'd like to know if making a water solution with it is possible.

I'm tapering from 5mg, and I powered through 5-2,5mg with short-lived WD symptoms (lifting in 3-4 days), but now I am stuck at 2,33 mg with severe and longer-lasting symptoms. I'm going to be way more conservative with the last reductions, but the small orodispersible tablets make it hard to make precise cuts. Is everybody using the regular tablet or is there a way to get through with the orodispersible ones ?

 

I left you a members name, over in the Zyprexa topic, who did use the orodispersible tablet in water method to complete their taper.

I also wanted to quote you over here too, so that your information stays together here.

 

And then you can review the above this post stuff too.  Yes, if I was you I might HOLD for quite awhile now, on the lower dose of Zyprexa that you have gotten to fairly quickly from 15 mg.  It sounds like you may be waiting out some WD symptoms now, or in a Wave.  

 

When did you get to 2.33 mg?  Date?  Can you add that to your signature?

 

And best, L, P, H, and G,

mmt

 

 

 

[LHRG]

Thanks for the quote ; I'll check the Zyprexa topic for the orodispersible solution.

 

I got to 2.33mg three weeks ago, from approx 3 mg (I know...). As always, it was fine at first, and 10 days later I had some horrendous, truly awful days, I thought I was going to die in the process. It lasted 4 days, then it got better, although I'm definitely not fine yet. Those days kinda scared me (the suicidal thoughts especially), so I'll hold until further notice.

Olanzapine is such a horrible drug. I'm a zombie on it, to such an extent I cannot work and find any pleasure, yet getting off of it is hell.

[hayduke]

@LHRG that's the quandary - being on it is quite uncomfortable, but coming off it quickly is more uncomfortable.

 

I agree with @manymoretodays in supporting your notion that a hold makes sense for someone in your position right now.

 

I actually held at 2.5mg for six months or so, took a break from the taper and just necked the pill every night.  Eventually it was time to continue the taper.

 

I noticed a big improvement in social functioning at 2.5mg.  Suddenly I was picking up much more nuanced conversation with my old friends which we all found very warming.  Along with better access to emotions from there, the door opened to serious therapy which has changed everything for me.

[LHRG]

Thanks @hayduke for sharing your experience, your story is a inspiration for me, and a testimonial that a micro-taper can help alleviate the worst of WD, and give time to the brain to adapt.

 

So far, I haven't seen a lot of difference in my daily functioning below 2,5mg, especially with anhedonia which is still very much here, but again, I'm still recovering from the last drop, and I'm also on Zoloft, which tends to numb emotions as well.

 

I'm slowly getting used to the fact that I'll be debilitated by this experience for a while, and that I'll surely need to adapt my career path. Things happens, let's say. EMDR therapy is probably a good idea for me, as well, in the meantime.

[LHRG]

Hello SA, 

 

After lurking a lot on the website, I'm in dire need of some advice on my situation.

 

As I mentioned above, I'm suffering from acute protracted withdrawal from paroxetine (Paxil), on top of which I've been added Olanzapine, Sertraline and Lamictal.

It has become quite clear to me that the bulk of my suffering is caused by my unfortunate history with Paroxetine. I've been medicated with Paroxetine 3 different times, each time CT, worsening a wide set of symptoms both physical and psychological, as many here with Paxil. I did not recognise my worsening condition as a withdrawal, which is a completely unknown phenomenon in my country.

 

As of today

- I'm slowly tapering off olanzapine, which exacerbated anhedonia and apathy. It's a strange process : I don't seem to have a lot of immediate withdrawal effects from each olanzapine reduction. But an interesting phenomenon emerged : the taper allows for my emotions to come back a little (I'm able to listen to music, cry, etc), yet the wave I experience tends to be darker and more suicidal.  My theory is that I am mostly suffering from paroxetine withdrawal, which comes to light again without the "protection" given by the sedative olanzapine. Either that or some kind of kindling making each wave worse than the previous one

- Sertraline and Lamictal does not seem to have any effect whatsoever. I'm willing to taper everything now.

 

It is NOT a comfortable situation. For a few months, I've been on sick leave from work, and I am not a functional humain being at all. This triggers a lot of depressive episodes : I am, or used to be, a very active mind with a PhD and a lot of projects for the future, and I am now basically a houseplant.

Recently, things have been getting darker : I swing between the anhedonic void of empty days and the crushing suffering of deep depression. The latter now tends to become actively suicidal. I am quite worried about myself, and I am not sure I am strong enough to endure the severity of the waves I experience right now.

 

My question is therefore : should I reinstate or should I power through this awful phase of withdrawal ?

I've been thinking a lot about reinstating Paroxetine at 1mg. Last time I foolishly (I didn't know SA at the time) tried to reinstate at 10mg, and it worsened things a lot, although depression completely faded away for the short time I was on it  I am pretty sure a small reinstatement could do wonder to help taming my suicidality. The idea would be to stabilize at 1mg for a long time, and then taper off over a long period, of several years.

1. Worsening the withdrawal when I'll taper off next time -> is it really certain that tapering off carefully will ease the pain ? Or will it just add another level of suffering to my already conflicted history with this medication. I am quite struck by Dr.Shipko's idea that tapering does not prevent the persistent dimension of withdrawal, and I fear I'll just make my life more miserable when I'll try to quit.

2. "Losing" the progress I've been making with this withdrawal (it's been 9 months off Paroxetine, and a few things have resolved in the meantime).

 

I am quite worried about taking Paroxetine again given the suffering I experience because of it (it feels like playing with fire), but it is a cruel dilemma : either sacrificing a indefinite number of years in a near-lethal amount of pain, losing my job and my social situation, of risking making things even worse.

 

 

 

 

[LHRG]

I forgot a important part of the quandary : 

I do have absolutely awful waves. The "normal", baseline withdrawal self is quite dark also, or rather dull, anhedonic. But I did have several windows, not completely back to my normal self, but each time a few days of good mood, some pleasures back, being able to read, daydream, these sorts of things. It certainly is an argument for not reinstating, as I can hope these windows will be more frequent and longer.

My symptoms did evolve a little also. Anxiety, panic attacks and DP/DR did disappear : it is now pure depression. My tinnitus seems to be getting quieter, although I am not sure if it is not just my brain getting used to it. A few of the strange little symptoms, such as hypnagogic hallucinations, earworm, also seems to be more manageable lately. I have dozens of other symptoms that are still very much there, but I have to acknowledge that there are a few signs that the monster that withdrawal is is evolving, even if its main presence, anhedonia and depression, is crushing me.

[LHRG]

Just bumping this thread. If anybody can offer some advice, I'd greatly appreciate it.

[LHRG]

Bump

[LHRG]

Any advice ? After reading @Altostrata's 2021 articles, as well as Chouinard, Fava and others, it dawned on me that what I experienced each time I reinstated paroxetine was kindling, compounded neuro-excitability which made each withdrawal worse and each reinstatement more "intense" in adverse effects (euphoria, visual disturbances, etc). I'm worrying that such a layering of drug change have made symptoms more chronic, or even "damaged" the neurotransmitters beyond repair. I also gathered that with each drug, I experienced only moderate acute withdrawal, but significant protracted withdrawal. I do not know if this means anything as for healing. As everybody with PWS, I'm afraid this would mean a permanent, or at least persistent damage.

In such a context, reinstatement seems a bit irresponsable to me, but what do I know : I get more confused the more I learn about this awful secret of psychiatry. If any SSRI vet here can offer some advice, that would be greatly appreciated.

 

[Altostrata]

Hello, @LHRG

 

Please stop tapering everything. We need to get a baseline for your symptom pattern. What times o'clock do you take your drugs, with their dosages? When were the last times you changed each of your drug dosages?

 

What month and year did you start sertraline and olanzapine? Please update your signature.

 

How did you feel after you started sertraline and olanzapine?

 

On 12/26/2021 at 1:51 PM, LHRG said:

But I did have several windows, not completely back to my normal self, but each time a few days of good mood, some pleasures back, being able to read, daydream, these sorts of things. It certainly is an argument for not reinstating, as I can hope these windows will be more frequent and longer.

 

When did these windows happen? 

 

On 12/26/2021 at 1:51 PM, LHRG said:

My symptoms did evolve a little also. Anxiety, panic attacks and DP/DR did disappear : it is now pure depression.

 

Please describe your "depression". How's your sleep?

 

 

[LHRG]

Hello @Altostrata. Thank you for your reply, and thank you for your recent academic articles. Quite useful to have something to cite when confronted to stubborn psychiatrists.

 

1 hour ago, Altostrata said:

Please stop tapering everything. We need to get a baseline for your symptom pattern. What times o'clock do you take your drugs, with their dosages? When were the last times you changed each of your drug dosages?

 

I ritually take everything at 8 p.m. I last change my olanzapine dosage mid-November, and I am now at 1.25mg. I do not experience withdrawal symptoms from olanzapine, but I try to remain reasonable. I keep at least 3 weeks between reductions. I did not change anything for sertraline and lamotrigine.

 

I tend to rush things, as I would like to have my system free of medication in order for it to heal. But I agree that it also need time and stability.

 

1 hour ago, Altostrata said:

What month and year did you start sertraline and olanzapine? Please update your signature.

 

How did you feel after you started sertraline and olanzapine?

 

I started both when I was admitted at the hospital (I now know that what happened then was an effect of kindling : I was in withdrawal from paroxetine, and taking an antibiotic made me awfully depressed and suicidal. I did not know anything about withdrawal then and bought into the psychiatric narrative. The beauty of psychiatry : I am now in a much worse state than before going to the hospital). 

 

Olanzapine was very sedative when I was at 5mg. I slept a lot (still do, but a little less), was extremely apathic, unmotivated, anhedonic (same, less intense but very much present). It made everything worse, which is why I'm eager to let it go as soon as possible. Sertraline did not have any sort of effect, even at 50mg. Lamictal did nothing as well. Kindling, I guess.

1 hour ago, Altostrata said:

 

When did these windows happen? 

 

There is no definite pattern. I had 3 or 4 windows since September. I am not sure if I should call them windows : it is more of a few days (usually 3 or 4) of good mood and more energy which makes the symptoms less present than a real remission of them. Still, these were good days, a much needed oasis. What gives me hope is that I sometimes catch glimpses of my former self, at certain times or in certain situations. It is quite a strange phenomenon, but I've noticed that I get a few hours of normalcy after a sexual intercourse : I guess my system can still produce serotonin, but needs to readapt to manage neurotransmitters more regularly.

 

1 hour ago, Altostrata said:

Please describe your "depression". How's your sleep?

 

Sleep is mostly fine. Olanzapine made me sleep a lot. I still have a propensity to sleep more than I should, and to fall asleep during the day. I do get insomnias here and there when I am not in a wave.

Depression is two things. There's the "normal depression" which is mostly anhedonia, some sort of "low normalcy", during which I cannot do much. Then, once or twice a month, I get what I call "falling in the well" : a crushing wave of despair, living minute-by-minute in angst. During these days, there is no hope anymore, and I get on the brink of suicidality. I am building a protocol to protect myself during these awful times. It usually last 2, 3 days, then back to anhedonia (some sort of protection I guess?). There is no pattern and stress triggers are a big factor : the stressful holiday period caused a very long "well" which I am just getting off of. I first thought those periods were olanzapine withdrawal, but I now know that they are independent from medication changes. Going through my personal history, I also realise that I have had these sorts of crisis on a regular basis for the last 2 years, ever since I first stopped paroxetine. I did not connect the dot.

 

 

I am unsure what to do next. I would like to get rid of olanzapine and sertraline in order to free my system from any toxicity. I think my CNS is heavily destabilised by my troublesome history with paroxetine. Reinstatement is risky.

 

[Altostrata]

You are taking olanzapine, sertraline, and lamotrigine at the same time at night? How long have you been on this schedule?

 

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

 

19 hours ago, LHRG said:

Depression is two things. There's the "normal depression" which is mostly anhedonia, some sort of "low normalcy", during which I cannot do much. Then, once or twice a month, I get what I call "falling in the well" : a crushing wave of despair, living minute-by-minute in angst.

 

This very well might be the effect of the drugs. Any one of them can cause this common adverse reaction.

[LHRG]

Thanks @Altostrata

3 hours ago, Altostrata said:

You are taking olanzapine, sertraline, and lamotrigine at the same time at night? How long have you been on this schedule?

 

Yes, I take everything at once. I used to be quite lenient when it comes to drug-taking time, but I've been regular at 8pm for a few weeks, probably two. Is it important ?  

 

3 hours ago, Altostrata said:

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

 

Here is the report. Not sure what to make of it, my psychiatrist warned me about all of this and I do not experience it.

3 hours ago, Altostrata said:

This very well might be the effect of the drugs. Any one of them can cause this common adverse reaction.

There's absolutely no doubt in my mind that those iatrogenic depressive episode are primarily caused by paroxetine withdrawal. They appeared ever since I first stopped paroxetine (in 2018), and they've gained intensity each time I've stopped (2020 and 2021). I thus think that my main problem is still the paroxetine withdrawal, which I tend to think as neurological change, even if I know that on this site, the general consensus is that healing is always possible. Probably the other drugs compounded this withdrawal, but they are not the first cause.

 

I'm in distress at the moment. I am not sure what to do. My main goal is to stop all psychiatric medication, but I am not sure I can endure any more withdrawal. I'm tempted to reinstate paroxetine at a low dose, but that is a risky move. Any advice is welcome, for guidance (what should I do next ?) as well as for means to survive the waves. I am getting suicidal during these.

[Altostrata]

It's very important that you take your drugs on a consistent daily schedule.

 

The professional version of the drug interactions report contains more information. Your 3 drugs all interact, and you're taking them AT THE SAME TIME. The combination may well be causing your ongoing symptoms:

 

On 12/26/2021 at 1:51 PM, LHRG said:

My symptoms did evolve a little also. Anxiety, panic attacks and DP/DR did disappear : it is now pure depression. My tinnitus seems to be getting quieter, although I am not sure if it is not just my brain getting used to it. A few of the strange little symptoms, such as hypnagogic hallucinations, earworm, also seems to be more manageable lately. I have dozens of other symptoms that are still very much there, but I have to acknowledge that there are a few signs that the monster that withdrawal is is evolving, even if its main presence, anhedonia and depression, is crushing me.

 

When were you admitted to the hospital? Please update your signature.

 

What was the effect of the olanzapine and sertraline you got in the hospital on your tinnitus? Why was the lamotrigine added?

 

Suggest you stop tapering and gradually move the sertraline one hour earlier each day until you're taking it in the morning. While you do this, please keep daily notes of times o’clock 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 o’clock on the left and notation (symptom or drug and dosage) on the right. Tracking your symptom pattern can show if your symptoms are adverse effects of your drugs.

[LHRG]

Thanks @Altostrata

1 hour ago, Altostrata said:

The professional version of the drug interactions report contains more information. Your 3 drugs all interact, and you're taking them AT THE SAME TIME. The combination may well be causing your ongoing symptoms:

 

All of my symptoms appeared with the paroxetine withdrawal. No doubt that the current medication and medication changes increased it though, but the main cause is the paroxetine withdrawal. I'm seeing a lot of similarities with other people withdrawing from Paxil on this site.

 

2 hours ago, Altostrata said:

When were you admitted to the hospital? Please update your signature.

 

My stay at the hospital is mentioned on my signature and in my first post. In March 2021 I reinstated Paroxetine and had some sort of adverse reaction (hypomania, visual disturbances...). I quitted cold turkey at 10mg, following the advice of my GP (didn't know about SA yet). After quitting, I had a lot of the usual Paxil withdrawals symptoms : sensory (visual snow, tinnitus), physical, psychological. In June 2021, I got an infection and was prescribed an antibiotic. It caused a massive increase in my symptoms, which brought me to the ER. I didn't connect the dots at the time, but it is clear now that I was very sensitive to medication, and an antibiotic reaction is pretty typical of WD. It was during withdrawal that I was prescribed olanzapine and sertraline, which I regret deeply now.

 

2 hours ago, Altostrata said:

What was the effect of the olanzapine and sertraline you got in the hospital on your tinnitus? Why was the lamotrigine added?

 

No effect whatsoever on the tinnitus or the visual snow. The lamotrigine was added in August because of a suspicion of bipolar disorder. Again, if I read SA beforehand I would have known that WD is often mistaken for a BPD. But I guess Lamictal can be useful to manage WQ symptoms if I am not mistaken ?

 

2 hours ago, Altostrata said:

Suggest you stop tapering and gradually move the sertraline one hour earlier each day until you're taking it in the morning. While you do this, please keep daily notes of times o’clock 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 o’clock on the left and notation (symptom or drug and dosage) on the right. Tracking your symptom pattern can show if your symptoms are adverse effects of your drugs.

Will do. However my symptoms do not fluctuate throughout the day, it is more of a weekly/monthly variation. Anyhow, I am planning on holding on the same medication for a few months, as my mood is getting dangerously low lately. I think my rapid tapering of olanzapine is to blame for that, and is compounding on the preexisting Paroxetine WD.

[Altostrata]

Thanks. Please understand the staff does not have time to read everyone's topic over and over from the first post. We often rely on the summary in the signature.

[julesb]

@LHRG I actually just made my own kefir today and i’m going to start drinking that for my gut microbiome. also I actually thought that i was withdrawing correctly from my doctors directions but obviously that wasn’t the correct way 

[LHRG]

No problem. I am glad you can offer some advice.

 

I am in an extremely low mood these days. The sole idea of being stuck in this situation is a heavy burden to me. But I guess reducing any medication right now would be for the worse. Anhedonia is an awful, awful monster to experience.

 

[hayduke]

On 1/3/2022 at 11:52 AM, LHRG said:

I am in an extremely low mood these days.

 

You are coming off that olanzapine way too fast for anyone's comfort.  What's your average monthly cut as a percentage of the previous month's dosage for the last while? 

[LHRG]

Thanks @hayduke

 

I truly do not know. I based my reductions on the way I feel after the previous one. The strange thing to me is that I do not seem to have any immediate withdrawal effect from each olanzapine reduction. But the anhedonia and waves of depression are not getting better, far from it. It is as if the olanzapine withdrawal does not exist by itself, but compounds the preexisting pattern from the paroxetine withdrawal.

In any case, I am holding from now on. I'll try another cut in a month or so, depending on how I feel. I'll follow the 10% rule then, it seems that my CNS needs stability.

 

I tend to rush through the withdrawal process because my existence has been at an all-time low for a few months, and I am eager to do whatever I can to change that. I desperately want to be off drug and let my CNS heal, because I have the time to do so now, and I am not sure I will have that much time in a few months. 

[hayduke]

4 hours ago, LHRG said:

I truly do not know. I based my reductions on the way I feel after the previous one. The strange thing to me is that I do not seem to have any immediate withdrawal effect from each olanzapine reduction.

 

I found it generally takes somewhere between 4 and 10 days before I really feel the effects of a particular cut.

 

Your body will not have had time to stabilise at the prior level before you've been making the next cut, and its workload just keeps adding up.  This is going to be a significant cause of your feeling poorly.

 

Why not sit down and calculate the size of those monthly cuts you've been making and seeing how far past the usual 10% you've been pushing?  You're already feeling the effects of why we don't suggest exceeding this.

Edited January 5, 2022 by hayduke

[LHRG]

5 hours ago, hayduke said:

I found it generally takes somewhere between 4 and 10 days before I really feel the effects of a particular cut.

 

Yes, I noticed that when I tried to stop cold turkey (it's more 7-10 days for me). But beside that, I do not experience this immediate withdrawal with smalled cuts. Which doesn't mean I don't experience protracted withdrawal, so I am going to follow your advice and taper more conservatively, with a liquid suspension, after I hold for a while.

 

I noticed you are now down to 0 with your own olanzapine taper. Was the drop to 0 difficult in any way ? Your taper was very slow, but olanzapine is such a powerful drug that I am afraid of rebound insomnia, anxiety or such.

[hayduke]

Going to zero was challenging rather than difficult.  I slept fine which was grand.

 

If you're not sleeping well enough, hold till you are.