Knosretep: don't know what to do - clonazepam and Zoloft and extras

October 22, 2021

Hello everyone,

Quick intro here....been on Sertraline a long time, then switched up, then went off completely for IVF reasons and got hooked on Clonazepam. Started tolerance withdrawal and made a massive (stupid) taper and now scrambling.

2013 ???? - Sertraline (Pfizer) 50mg

2015 ???? - Sertraline (Off brand) 50mg

2021 Jan 4 - Valosine 75mg

2021 Jan 15 - Sertraline 0mg

2021 April 20 - Amitriptyline 2mg

2021 May 1 - Amitriptyline 1mg

2021 May 16 - Valosine 0mg

2021 May 16? - Clonazepam 2mg @ bedtime (possibly earlier)

2021 Aug 20 - Sertraline (Pfizer) 25mg

2021 Sept 3 - Sertraline (Pfizer) 50mg

2014 Sept 28 - Found Benzo Buddies

2021 Sept 29 - Clonazepam 1mg @ bedtime

2021 Sept 29 - Diazepam 2.5mg @ middle of night

2021 Sept 29 - GABA supplement @ bedtime

2021 Sept 3 - Trazodone 50mg @ bedtime

2021 Sept 3 - Hydroxyzine Hydrochloride 25mg @ bedtime

2021 Sept 6 - Diazepam 1.25mg @ middle of night

2021 Sept 13 - Trazodone 25mg @ bedtime

2021 Sept 13 - Trazadone 25mg @ middle of night

2014 Sept 14 - Diazepam 0mg

2014 Sept 14 - Clonazepam 0.9mg @ bedtime

2014 Sept 17 - Mirtazapine 15mg @ bedtime

2021 Sept 17 - Hydroxyzine Hydrochloride 12.5mg @ bedtime

2021 Sept 17 - Trazodone 0mg @ middle of night

2021 Sept 19 - Mirtazapine 7.5mg @ bedtime

2021 Sept 19 - Mirtazapine 7.5mg @ middle of night

2021 Sept 21 - Hydroxyzine Hydrochloride 0mg @ middle of night

2021 Sept 21 - Trazadone 0mg @ middle of night

Currently:

Sertraline (Pfizer) 50mg

Clonazapam 0.9mg @ bedtime

Trazadone 25mg @ bedtime

Mirtazapine 7.5mg @ bedtime

Mirtazapine 7.5mg @ middle of night

GABA supplement @ bedtime

My sleep crashed after cutting the Clonazepam to 1mg, falling to 1 hour the night before getting Trazodone the next day. I'm lucky I didn't suffer a seizure or worse. From reading this board it sounds like I should leave the Clonazepam alone and start tapering the Sertraline 50mg as the Mirtazapine is allowing me to "sleep" right now a few broken hours per night? I was already in poor shape before I cut the Clonazepam from tolerance withdrawal and now I'm worse.

I have no clue what to do right now.

Edited October 22, 2021 by ChessieCat
unbolded

October 23, 2021

Hello, and welcome to SA. We are a volunteer-run community of people who have been or are getting off of psychiatric drugs.

Can you please give us specific information about your drug history for all drugs you are on and have been on, especially for the past 18-24 months? It would be especially helpful to have the details of your drugs in a concise vertical list (no symptoms), only drug names, specific dates (as best you can say for example early March if you don't recall the day) and dosages of each medication decrease or increase. Please read the link below for instructions. This will allow us to give you the best guidance.

How to List Drug History in Signature

I'm a little confused by this:

On 10/22/2021 at 5:09 AM, Knosretep said:

2013 ???? - Sertraline (Pfizer) 50mg

2015 ???? - Sertraline (Off brand) 50mg

2021 Jan 4 - Valosine 75mg

2021 Jan 15 - Sertraline 0mg

2021 April 20 - Amitriptyline 2mg

2021 May 1 - Amitriptyline 1mg

2021 May 16 - Valosine 0mg

2021 May 16? - Clonazepam 2mg @ bedtime (possibly earlier)

2021 Aug 20 - Sertraline (Pfizer) 25mg

2021 Sept 3 - Sertraline (Pfizer) 50mg

2014 Sept 28 - Found Benzo Buddies

2021 Sept 29 - Clonazepam 1mg @ bedtime

2021 Sept 29 - Diazepam 2.5mg @ middle of night

2021 Sept 29 - GABA supplement @ bedtime

2021 Sept 3 - Trazodone 50mg @ bedtime

2021 Sept 3 - Hydroxyzine Hydrochloride 25mg @ bedtime

2021 Sept 6 - Diazepam 1.25mg @ middle of night

2021 Sept 13 - Trazodone 25mg @ bedtime

2021 Sept 13 - Trazadone 25mg @ middle of night

2014 Sept 14 - Diazepam 0mg

2014 Sept 14 - Clonazepam 0.9mg @ bedtime

2014 Sept 17 - Mirtazapine 15mg @ bedtime

2021 Sept 17 - Hydroxyzine Hydrochloride 12.5mg @ bedtime

2021 Sept 17 - Trazodone 0mg @ middle of night

2021 Sept 19 - Mirtazapine 7.5mg @ bedtime

2021 Sept 19 - Mirtazapine 7.5mg @ middle of night

2021 Sept 21 - Hydroxyzine Hydrochloride 0mg @ middle of night

2021 Sept 21 - Trazadone 0mg @ middle of night

From this it looks like you are taking different drugs on different days, and skipping some days. Perhaps I'm wrong. Or is this just to show dose changes? If you do your drug signature as explained in the link above, it will be a lot easier for us to understand your drug history. It would really help if you could list each drug, and then next to that, list each date and dosage of each change in dosage. See my signature for an example.

On 10/22/2021 at 5:09 AM, Knosretep said:

My sleep crashed after cutting the Clonazepam to 1mg, falling to 1 hour the night before getting Trazodone the next day.

Did the trazodone restore your sleep? I hope so. We suggest you taper your activating drugs first, and only taper 1 drug at a time.

Which Drug to Taper First

On 10/22/2021 at 5:09 AM, Knosretep said:

From reading this board it sounds like I should leave the Clonazepam alone and start tapering the Sertraline 50mg as the Mirtazapine is allowing me to "sleep" right now a few broken hours per night? I was already in poor shape before I cut the Clonazepam from tolerance withdrawal and now I'm worse.

That is correct. However, since you have made many drug changes recently, I would suggest you stay on your current drugs and doses for several months to give yourself a chance to adjust, and to heal. Here is a link about tolerance withdrawal:

Tolerance, or Tachyphylaxis

Here is some information about how these drugs actually work. This explains why we get symptoms from going off of these medications, and why it's so important to taper so slowly and carefully, and be very cautious about changing our doses:

How Psychiatric Drugs Remodel Your Brain

This helps you understand what withdrawal syndrome is:

Video on Recovery from Psych Drugs

What is Happening in Your Brain

Windows and Waves Pattern of Stabilization

Tapering is best done extremely slowly, and we generally taper by 10% of the current dose no more than once every 4 weeks, so that the taper becomes exponentially smaller. We suggest only tapering 1 drug at a time. That way if there is a problem, you know what is causing the problem. Plus it is less overwhelming to your nervous system.

Why Taper by 10% of my Dosage

Also, as we are recovering, we suggest keeping things slow, simple, and stable.

Keep it Simple, Slow, and Stable

Considerations About Stability - Stop Jumping Around

Here are some techniques to cope with symptoms:

Non Drug Ways to Cope with Withdrawal Symptoms

We don't suggest many supplements, but 2 that many of us find helpful are magnesium and omega-3 fish oil. Here are the links for info about those. It is suggested to add one at a time, and start with a low dose to see how it affects you.

Magnesium

Omega 3 Fish Oil

I can give you more guidance about what to do when I see your drug signature, and have a clearer idea of what is going on.

I've given you quite a bit of information here. Please read through it, and mull it over, and we will take it from there. In the meantime, take care of yourself, and take heart. We in this forum have been through this, and we understand first hand the pain and discomfort you are going through. Please know that the brain is amazing in it's healing abilities. It takes time, but healing can and will happen.

Edited October 23, 2021 by getofflex

October 23, 2021

@Knosretep Hi wanted to stop by and welcome you to SA. Unfortunately that means you are in a world of hurt, scared, panicked, lost on what to do, for this I am very sorry. Once you learn how to get around the site, you will find all these emotions are very familiar around here, you are not alone. Learning all you can will help empower yourself to work you way out of this.

Post here and ask all the question you need to, there is no wrong question, and you can never ask to many.

Connecting with other members can really make a difference in your recovery. Some how it is validating to learn you are not alone.

Work with the mods on how to get your drugs in order and you will be fine.❤️

October 25, 2021

On 10/24/2021 at 3:39 AM, getofflex said:

I'm a little confused by this:

From this it looks like you are taking different drugs on different days, and skipping some days. Perhaps I'm wrong. Or is this just to show dose changes? If you do your drug signature as explained in the link above, it will be a lot easier for us to understand your drug history. It would really help if you could list each drug, and then next to that, list each date and dosage of each change in dosage. See my signature for an example.

Thank you for posting my thread, and for all the links and for responding. I'm not taking drugs on different days or skipping some days, I was just showing dose changes, which I've been doing way too rapidly as I realize now. I will go back and modify my post to make it easier to understand.

On 10/24/2021 at 3:39 AM, getofflex said:

Did the trazodone restore your sleep? I hope so. We suggest you taper your activating drugs first, and only taper 1 drug at a time.

It restored it for about a week, then started pooping out, so when I went to my psych 1 week later, I was prescribed Mirtazapine instead.

On 10/24/2021 at 3:39 AM, getofflex said:

Which Drug to Taper First

That is correct. However, since you have made many drug changes recently, I would suggest you stay on your current drugs and doses for several months to give yourself a chance to adjust, and to heal. Here is a link about tolerance withdrawal:

Tolerance, or Tachyphylaxis

Here is some information about how these drugs actually work. This explains why we get symptoms from going off of these medications, and why it's so important to taper so slowly and carefully, and be very cautious about changing our doses:

How Psychiatric Drugs Remodel Your Brain

This helps you understand what withdrawal syndrome is:

Video on Recovery from Psych Drugs

What is Happening in Your Brain

Windows and Waves Pattern of Stabilization

Tapering is best done extremely slowly, and we generally taper by 10% of the current dose no more than once every 4 weeks, so that the taper becomes exponentially smaller. We suggest only tapering 1 drug at a time. That way if there is a problem, you know what is causing the problem. Plus it is less overwhelming to your nervous system.

Why Taper by 10% of my Dosage

Also, as we are recovering, we suggest keeping things slow, simple, and stable.

Keep it Simple, Slow, and Stable

Considerations About Stability - Stop Jumping Around

Here are some techniques to cope with symptoms:

Non Drug Ways to Cope with Withdrawal Symptoms

We don't suggest many supplements, but 2 that many of us find helpful are magnesium and omega-3 fish oil. Here are the links for info about those. It is suggested to add one at a time, and start with a low dose to see how it affects you.

Magnesium

Omega 3 Fish Oil

I currently take Fish Oil too, just 1 capsule per day.

On 10/24/2021 at 3:39 AM, getofflex said:

I can give you more guidance about what to do when I see your drug signature, and have a clearer idea of what is going on.

I've given you quite a bit of information here. Please read through it, and mull it over, and we will take it from there. In the meantime, take care of yourself, and take heart. We in this forum have been through this, and we understand first hand the pain and discomfort you are going through. Please know that the brain is amazing in it's healing abilities. It takes time, but healing can and will happen.

Thank you for this.

October 25, 2021

On 10/24/2021 at 4:05 AM, Greatful said:

@Knosretep Hi wanted to stop by and welcome you to SA. Unfortunately that means you are in a world of hurt, scared, panicked, lost on what to do, for this I am very sorry. Once you learn how to get around the site, you will find all these emotions are very familiar around here, you are not alone. Learning all you can will help empower yourself to work you way out of this.

Post here and ask all the question you need to, there is no wrong question, and you can never ask to many.

Connecting with other members can really make a difference in your recovery. Some how it is validating to learn you are not alone.

Work with the mods on how to get your drugs in order and you will be fine.❤️

Thank you Greatful! ❤️

October 26, 2021

On 10/24/2021 at 11:50 PM, Knosretep said:

It restored it for about a week, then started pooping out, so when I went to my psych 1 week later, I was prescribed Mirtazapine instead.

This sentence (saying "instead") implies you are no longer on the trazodone. So you are no longer on the trazodone? If not, indicate this on your drug sig please, along with the date you stopped taking it. I need to know how long you were on the trazodone.

Also, please put in your drug sig that you jumped off Sertraline cold turkey in January 2021, then got back on it.

The diazepam history should also be in the drug sig. The drug sig looks a lot better, but is still missing pertinent information. I can better advise when I get answers to the previous questions. We are unpaid volunteer staff and are spread pretty thin, so don't have the time to go back and read lengthy posts, hence we need to see details of your drug history at a glance. Thank you.

You said " I was just showing dose changes, which I've been doing way too rapidly as I realize now. " In this case, I believe it may be best to leave your drug schedule the same, and give yourself some time to stabilize. Your nervous system probably needs time to adjust to all of the dose changes. We suggest only tapering one drug at a time, the most activating drug first. However, if it were me, I would hold off on doing any more tapering until my system became stable. You mentioned that your sleep had crashed. I would wait until my sleep was at leas tolerable, and my other symptoms were minor to none, before doing any more dose reductions.

Please keep us posted, and let us know how you are doing. Good luck! 🙂

Edited October 26, 2021 by getofflex

October 27, 2021

15 hours ago, getofflex said:

This sentence (saying "instead") implies you are no longer on the trazodone. So you are no longer on the trazodone? If not, indicate this on your drug sig please, along with the date you stopped taking it. I need to know how long you were on the trazodone.

Sorry for the confusion. I don't see any way to edit my initial post, but I've updated my sig, and also realized I had a bunch of dates off by a month in my sig previously. It should be correct now. Brain is not working well at all.

I'm still taking 12.5mg of Trazodone. I was going to jump to 0mg after a week of 12.5mg but it seems like I should just hold. It did restore my sleep when I first started it, but after a week it started pooping out already.

15 hours ago, getofflex said:

Also, please put in your drug sig that you jumped off Sertraline cold turkey in January 2021, then got back on it.

Okay, updated.

15 hours ago, getofflex said:

The diazepam history should also be in the drug sig. The drug sig looks a lot better, but is still missing pertinent information. I can better advise when I get answers to the previous questions. We are unpaid volunteer staff and are spread pretty thin, so don't have the time to go back and read lengthy posts, hence we need to see details of your drug history at a glance. Thank you.

I understand and appreciate what you do! Thank you! If its still not clear I'm happy to update further.

15 hours ago, getofflex said:

You said " I was just showing dose changes, which I've been doing way too rapidly as I realize now. " In this case, I believe it may be best to leave your drug schedule the same, and give yourself some time to stabilize. Your nervous system probably needs time to adjust to all of the dose changes. We suggest only tapering one drug at a time, the most activating drug first. However, if it were me, I would hold off on doing any more tapering until my system became stable. You mentioned that your sleep had crashed. I would wait until my sleep was at leas tolerable, and my other symptoms were minor to none, before doing any more dose reductions.

Please keep us posted, and let us know how you are doing. Good luck! 🙂

Last night I woke up a 2nd time in the middle of the night while it was still dark out (I don't check the time in the middle of the night because I don't want to worry even more about how little or poor sleep I'm getting) and took another 7.5mg of Mirtazapine to ensure that I would get back to sleep because I'm so afraid of my sleep crashing again.

I had been taking 7.5mg around midnight when I would start to feel a bit sleepy, and then another 7.5mg when I would wake up in the middle of the night (exact times unknown), but those 2 doses would keep me asleep during the night. My other symptoms I feel like I can tolerate right now, but insomnia is the one that really scares me, because I know it will make everything else worse. If it happens again tonight then I don't know what I'll do. I don't want to have to keep bumping up Mirtazapine if my sleep continues to deteriorate, but I feel like its holding me together right now.

October 28, 2021

Hi @Knosretep,

welcome to SA. I am sorry you are suffering. It seems like your most distressing symptom is insomnia and you are trying to treat it with a massive dose of sedatives - mirtazapine, diazepam, clonazepam and trazodone + a massive dose of melatonin (the right dose is 0.3-1mg for melatonin). This worries me. I am trying to consult with the other moderators on what to advise you about that but here is the drug interactions checker for these drugs. You are risking both a serotonin syndrome and drowsiness/dizziness.

Drug Interaction Report - Drugs.com

Also, I see that you are taking a multivitamin. Some of the vitamins in those can cause agitation especially if they are in regular or high doses. In withdrawal we tend to be sensitive to lots of supplements. I would stop that unless you are vegan/vegetarian and can't get your required vitamins through food.

Regarding the insomnia, because you have made so many change, it may be a bit bad for a while but chances are that it will get better. Your worrying about it creates a vicious circle (I was there!) which increases the insomnia. I slept for no more than 2-4 hrs a night for 4 months and it got better when I realized that not sleeping would not kill me. It's not pleasant and it impacted my work but I did not get seizures or psychosis or collapsed etc - all of which were my worries. It helped to be reminded that new parents go on 2-4 hrs of sleep for quite a long time and survive. Again, it is NOT fun but you can survive it and get through it. Can you get some break from work at least for a bit?

Here are some non-drug tips to help with insomnia which is one of the most common symptoms of withdrawal.

Tips to help sleep: so many of us have that awful withdrawal insomnia - Symptoms and self-care - Surviving Antidepressants

Things that seem to help: blackout curtains - complete darkness or if you can't have that, you can try eye masks (we tend to be very sensitive to light in withdrawal). Some people find background noise soothing (noise machine/youtube/spotify). I personally liked a channel on sleep hypnosis from Spotify (don't remember it any more because I am able to get about 6 hrs of sleep these day though I would prefer 8-10), earplugs (I get startled easily from noise), blackout curtains. Some people find help with weighted blankets.

I am also looking at your signature and trying to get an overview of the drugs. I feel like it may be more useful if you did it by dates as there have been so many changes that it is hard to understand if they are written by drug. How about this version? It allows me to see better what you are currently on. I know you followed the instructions for the other version but because of the so many recent changes, it makes it hard to keep track of what is added/subtracted/tapered/cut and when. May I suggest this version. Is it correct? I tried to reconstruct it from your signature.

2013 - Jan 4, 2021 - Sertraline 50mg

Jan 2021 Valosine 75 mg (1/4)

Feb 2021 - Valosine 75 mg

Mar 2021 - Valosine 75mg

April 2021 - Valosine 75mg, Amytriptiline 2mg (4/20), Clonazepam 2mg

May 2021 - Valosine 75mg, Amitriptyline (5/1-1mg, 5/16 -0mg), Clonazepam 2mg

Aug 2021 - Sertraline 25 mg (re 8/20), Clonazepam 2mg

Sep 2021 - Sertraline 50 mg (up 9/3), Clonazepam 2mg, Diazepam ( 9/29 - 2.5mg)

Oct 2021 - Sertraline 50 mg, Clonazepam (10/14 - 0.9, 10/24 - 1mg), Trazodone ( 10/03 - 50mg, 10/17 - 25mg, 10/21 - 12.5 mg), Mirtazapine (10/17 - 15mg), Diazepam ( 10/6 - 1.25 mg, 10/14 - 0mg)

Supplements: Multivitamin, Fish Oil 1x per day, Melatonin 15mg.

2013-2021 Sertraline 50mg Jan4 0mg (direct switch to Valosine)

2021 Valosine Jan4 75mg May16 0mg

2021 Amitriptyline April 20 2mg May1 1mg May 16 0mg

2021 Sertraline Aug20 25mg Sept3 50mg
2021 Clonazepam - April 2mg Oct 1mg Oct 14 0.9mg Oct 24 1mg (Reinstate)
2021 Trazadone - Oct3 50mg Oct17 25mg Oct21 12.5mg
2021 Mirtazapine - Oct17 15mg

2021 Diazepam - ???? 5mg as needed Sept29 2.5mg Oct6 1.25mg Oct14 0mg
Supplements: Multivitamin, Fish Oil 1x per day, Melatonin 15mg.

Hope you start feeling better soon,

OMW

October 28, 2021

6 hours ago, Onmyway said:

Hi @Knosretep,

welcome to SA. I am sorry you are suffering. It seems like your most distressing symptom is insomnia and you are trying to treat it with a massive dose of sedatives - mirtazapine, diazepam, clonazepam and trazodone + a massive dose of melatonin (the right dose is 0.3-1mg for melatonin). This worries me. I am trying to consult with the other moderators on what to advise you about that but here is the drug interactions checker for these drugs. You are risking both a serotonin syndrome and drowsiness/dizziness.

Drug Interaction Report - Drugs.com

Hi @Onmyway

Yes, this is correct. I know that if my sleep goes, all my other symptoms will get worse. Melatonin never did anything for me my whole life, and if its potentially harming me, then I can taper down. I thought maybe even if I didn't seem to fall or stay asleep with it, it might at least maintain my sleep rhythm so that I get tired at night and am mostly awake in the daytime.

6 hours ago, Onmyway said:

Also, I see that you are taking a multivitamin. Some of the vitamins in those can cause agitation especially if they are in regular or high doses. In withdrawal we tend to be sensitive to lots of supplements. I would stop that unless you are vegan/vegetarian and can't get your required vitamins through food.

Okay, I guess I can stop taking it for a while and see. It might be hard to know though because of how unstable I am currently.

6 hours ago, Onmyway said:

Regarding the insomnia, because you have made so many change, it may be a bit bad for a while but chances are that it will get better. Your worrying about it creates a vicious circle (I was there!) which increases the insomnia. I slept for no more than 2-4 hrs a night for 4 months and it got better when I realized that not sleeping would not kill me. It's not pleasant and it impacted my work but I did not get seizures or psychosis or collapsed etc - all of which were my worries. It helped to be reminded that new parents go on 2-4 hrs of sleep for quite a long time and survive. Again, it is NOT fun but you can survive it and get through it. Can you get some break from work at least for a bit?

Sorry to hear you've also suffered with the insomnia cycle.

When my sleep crashed before it was like 4 hours, 3 hours, 2 hours, 1 hour...and I was totally wrecked by such a short amount of low sleep. My symptoms were unbearable. I guess it would have eventually gotten better, but I also have a lot of other stress factors going on right now contributing to my poor mental state.

I will refrain from taking another 7.5mg of Mirtazapine tonight if I wake up twice again and just sit with the insomnia. A few days into Mirtazapine 7.5mg kept me asleep the whole night, but only for 2 nights.

6 hours ago, Onmyway said:

Here are some non-drug tips to help with insomnia which is one of the most common symptoms of withdrawal.

Tips to help sleep: so many of us have that awful withdrawal insomnia - Symptoms and self-care - Surviving Antidepressants

Things that seem to help: blackout curtains - complete darkness or if you can't have that, you can try eye masks (we tend to be very sensitive to light in withdrawal). Some people find background noise soothing (noise machine/youtube/spotify). I personally liked a channel on sleep hypnosis from Spotify (don't remember it any more because I am able to get about 6 hrs of sleep these day though I would prefer 8-10), earplugs (I get startled easily from noise), blackout curtains. Some people find help with weighted blankets.

Already doing as much sleep hygiene as possible, I think. I sleep in a separate room from my wife now, mask, earplugs, cold, dark. The only thing the room is used for is sleeping. I did own a weighted blanket before and I didn't find it had any beneficial effect on my sleep unfortunately. Before sleep, I will listen to nighttime affirmations or guided relaxation/awareness, and only use my screen enough at lowest light setting with yellow light filter to start/stop the audio.

I should note that before when my sleep crashed, I was sleeping in the same room as my wife with horrible sleep hygiene, and she has to use the bathroom 3-4x a night which, if I was awake when she returned to bed, the movement would send ripples of anxiety through me. So, I guess not sleeping through the night should be better now and maybe I don't have to fear it as much.

6 hours ago, Onmyway said:

I am also looking at your signature and trying to get an overview of the drugs. I feel like it may be more useful if you did it by dates as there have been so many changes that it is hard to understand if they are written by drug. How about this version? It allows me to see better what you are currently on. I know you followed the instructions for the other version but because of the so many recent changes, it makes it hard to keep track of what is added/subtracted/tapered/cut and when. May I suggest this version. Is it correct? I tried to reconstruct it from your signature.

2013 - Jan 4, 2021 - Sertraline 50mg

Jan 2021 Valosine 75 mg (1/4)

Feb 2021 - Valosine 75 mg

Mar 2021 - Valosine 75mg

April 2021 - Valosine 75mg, Amytriptiline 2mg (4/20), Clonazepam 2mg

May 2021 - Valosine 75mg, Amitriptyline (5/1-1mg, 5/16 -0mg), Clonazepam 2mg

Aug 2021 - Sertraline 25 mg (re 8/20), Clonazepam 2mg

Sep 2021 - Sertraline 50 mg (up 9/3), Clonazepam 2mg, Diazepam ( 9/29 - 2.5mg)

Oct 2021 - Sertraline 50 mg, Clonazepam (10/14 - 0.9, 10/24 - 1mg), Trazodone ( 10/03 - 50mg, 10/17 - 25mg, 10/21 - 12.5 mg), Mirtazapine (10/17 - 15mg), Diazepam ( 10/6 - 1.25 mg, 10/14 - 0mg)

Supplements: Multivitamin, Fish Oil 1x per day, Melatonin 15mg.

Yes, that's correct. I will use that version if its easier to understand. Thank you for doing that!

6 hours ago, Onmyway said:

2013-2021 Sertraline 50mg Jan4 0mg (direct switch to Valosine)

2021 Valosine Jan4 75mg May16 0mg

2021 Amitriptyline April 20 2mg May1 1mg May 16 0mg

2021 Sertraline Aug20 25mg Sept3 50mg
2021 Clonazepam - April 2mg Oct 1mg Oct 14 0.9mg Oct 24 1mg (Reinstate)
2021 Trazadone - Oct3 50mg Oct17 25mg Oct21 12.5mg
2021 Mirtazapine - Oct17 15mg

2021 Diazepam - ???? 5mg as needed Sept29 2.5mg Oct6 1.25mg Oct14 0mg
Supplements: Multivitamin, Fish Oil 1x per day, Melatonin 15mg.

Hope you start feeling better soon,

OMW

Thanks again @Onmyway, you are very appreciated!

October 28, 2021

Hi Knosretep,

I don't think you need to taper the melatonin and the multivitamins. I would stop them now.

Regarding the mirtazapine, I would personally taper it quickly since it is new in the mix and likely has not created dependence. But it does have risks of destabilizing things temporarily so I understand if it is too much. But the risk of serotonin syndrome (which can be life threatening) is not negligible, so if you continue taking it, be on the lookout. If you had been taking it for a while, the advice would be to leave it be but I think it might be worth taking it out of the cocktail. Of course it is up to you but if it is not helping with sleep, then why add more trouble. After that, I would not change anything for a long time - 6 months or a year so that your system gets a chance to stabilize. These drugs are potent at very low doses (let me know if you want to read the research on this but for citalopram for example for which the regular dose is 20mg, about 50% of the effect is achieved at 2.5 mg). So even if you think that the doses you are taking are small, they are very impactful. And these drugs are not things you can add and subtract at will the way many psychiatrists think that you can; they cause long term (not permanent) changes in the brain (and the rest of the body) as the system adapts to the drugs and the brain is a very complex system. Hence the destabilization when things change and the need for very slow tapering - like getting things away from a trellis.

With the change in sleeping situation, I suspect that your sleep will get better. And while insomnia does indeed suck and may make other symptoms worse, you can get through it. Don't underestimate your resilience and your ability to 'bear' things. A lot of this path of withdrawal is full of things you just have to bear, you can't change them with a pill or with an injection, just have to get through them. The sooner you accept that, the easier it will get. The more you fight, the more you will activate yourself and create extra anxiety. I wonder if it will help you to set rules such as - "I will worry about sleep only if I have not gotten more than 6 hours total in 8 days." Yes, you can survive on that for a while. And yes, your body finds ways to get rest even if it is not sleeping. I have done so during withdrawal, during a hyperthyroid state, caring for sick people.

The background noise/music is not to just help you sleep but to prevent you from waking up. Please read the thread carefully - it is supposed to deal with the alerting response - the idea is that your body thinks you are dying when you are falling asleep and it is jerking you into wakefulness. Background music or noise can make it not worry about it.

It might be helpful to add magnesium to your supplements, as it helps calm the system down. Start low and see its effects on you. Can you try magnesium salt baths? They can be very calming as well.

Take care of yourself. You can get through this!

OMW

Edited October 28, 2021 by Onmyway

October 28, 2021

Hi Knosretep,

I have consulted with some of the other moderators and they have suggested that it is possible that this much melatonin can cause a paradoxical reaction - i.e. make you sleepless rather than sleepy.

Melatonin: Side effects, uses, dosage, interactions, and more (medicalnewstoday.com)

Would you be able to provide us with daily symptom notes with the time you take your drugs. For example something like this. We can then see how your drugs may impact you and try to decide whether timing or dosage may need to change.

6 am wake up, have sertraline, breakfast

9 am anxious

12 pm anxiety increases, take 1.5mg diazepam

1 pm lunch, sleepy

7 pm 12.5 mg trazodone

10 pm sleep

Also, why did you decide to switch from sertraline to venlafaxine? Can you pls update your signature to venlafaxine from valosine, that brand name is not common and I missed that it was venlafaxine which is a drug that causes some of the most severe withdrawal effects and it's important to know. What caused you to make all of these changes, what were your symptoms? Can you start tracking your symptoms daily as well by rating them on a scale of 1 to 10 with the drug burden and the date in the first two columns? And the rest of the columns would be a symptom - nause (1-10), anxiety (1-10) etc.

Hope this helps,

OMW

Edited October 28, 2021 by Onmyway

October 29, 2021

9 hours ago, Onmyway said:

Hi Knosretep,

I have consulted with some of the other moderators and they have suggested that it is possible that this much melatonin can cause a paradoxical reaction - i.e. make you sleepless rather than sleepy.

Melatonin: Side effects, uses, dosage, interactions, and more (medicalnewstoday.com)

Thanks! I read the whole thing. It seems there are many tangible benefits for using 1-10mg for a limited period of time, but it also warns against using it if you're experiencing depression, which I certainly am. I'll drop down to 5mg per night and see how things go.

9 hours ago, Onmyway said:

Would you be able to provide us with daily symptom notes with the time you take your drugs. For example something like this. We can then see how your drugs may impact you and try to decide whether timing or dosage may need to change.

6 am wake up, have sertraline, breakfast

9 am anxious

12 pm anxiety increases, take 1.5mg diazepam

1 pm lunch, sleepy

7 pm 12.5 mg trazodone

10 pm sleep

My mornings and nights are the only semi routines that I keep, and my daytimes are varied. I try to get out of the house as much as possible during the day to keep from wanting to nap/ruminating/akathisia. I'm very lucky that my job consists of providing email/discord support for products that I sell online, and that I'm able to forgo any active development during this time. It also means I have no where I have to be and nothing I have to do that forces me to keep busy.

Since shortly after the drop in Clonazepam, I no longer feel hunger so I make note the time I eat, and try to eat a few hours later. I've lost 2kg in the past month.

??? Wake up

9:30 Finally get out of bed, breakfast, Vitamin, 50mg Sertraline, 0.5mg Clonazepam (shifted from bedtime to eventually start a liquid taper and not drink at night exacerbating nighttime peeing)

10-11:30 Gym (Weightlifting, treadmill walking...trying to increase pace slowly)

3-5? Anxiety often, although its decreased a lot since starting Mirtazapine, sometimes none.

5 Feed dogs. 5 through 9 Almost every day, take my dogs for a walk between 15 minutes and 1 hour.

5-7 Anxiety often, although its decreased a lot since starting Mirtazapine, sometimes none.

9-10 Sometimes anxiety, usually a lot less than during the day, lately rare.

10pm Cold shower

10:30-11:30 Go to bed, 12.5mg Trazodone, 0.5mg Clonazepam

11:30 through 12:30 7.5mg Mirtazapine

??? Middle of night 7.5mg Mirtazapine

9 hours ago, Onmyway said:

Also, why did you decide to switch from sertraline to venlafaxine? Can you pls update your signature to venlafaxine from valosine, that brand name is not common and I missed that it was venlafaxine which is a drug that causes some of the most severe withdrawal effects and it's important to know. What caused you to make all of these changes, what were your symptoms?

Updated sig.

I think some backstory would be helpful:

In 2009 I recovered from a MDD using Sertraline 50mg and Ambien (normal dose), in what I now know to be an amazingly remarkable, complete recovery in around 6-8 months. A few months later I quit the Sertraline CT and a few days later I started crying out of the blue, but that was the only negative symptom that I remember. Several months later I quit the Ambien CT as well, and experienced maybe a week or two of bad insomnia, but no other AD symptoms. In 2013 I was depressed again and started Sertraline 50mg again, and made a pretty quick recovery and decided to just stay on it forever.

I moved from the US to Thailand in 2015 and started taking a different brand of Sertraline. I think it never worked as well as I had many periods of lesser AD. In Thailand, you can get AD medication OTC. I tried switching to another different brand, and then to Fluoxetine, and then also trying to completely go off medication...all these attempts I was able to do without any tapering down or up as I'd done so before without much consequence. I ended up back on the same brand of Sertraline that I started with and just dealt with the AD symptoms.

In late 2020 stress from attempting to buy a house and fights with my wife found me obtaining and occasionally taking Diazepam as needed to counter panic attacks and calm me down to sleep.

In January 2021 I finally went to psychiatrist who recommended trying Venlafaxine as it was an SNRI and might work better. It seemed to help my mood, but I still had problems going to sleep and was noticing I was grinding my teeth, so I asked my psychiatrist if I could/should take Amitriptyline at night and he said I could try it. The combo seemed to work pretty good. We wanted to conceive but I had low sperm count/quality, and when the IVF clinic was about to operate on me to retrieve sperm directly from my ******** I read that SSRI's had a huge negative impact on sperm count/quality. I talked to the IVF and also my psychiatrist about stopping my medication for 3 months while taking something to boost fertility so I could try to produce without needing surgery. My psychiatrist okay'd this, and I asked for 3 more months of Clonazepam to help me sleep as I was no longer going to be taking the Amitriptyline, which he also okay'd. I'd gotten some Clonazepam when I first switched to Venlafaxine as I told the psychiatrist that I was taking Diazepam at night for sleeping, but I don't remember how much or how often I was taking it. I didn't think much about quitting Venlafaxine CT after my previous experiences, and because the psychiatrist didn't object to my plan, and I also didn't know it was notorious for severe withdrawal effects.

9 hours ago, Onmyway said:

Can you start tracking your symptoms daily as well by rating them on a scale of 1 to 10 with the drug burden and the date in the first two columns? And the rest of the columns would be a symptom - nause (1-10), anxiety (1-10) etc.

Yeah, I should have been doing this from the start.

9 hours ago, Onmyway said:

Hope this helps,

OMW

Thank you again!

October 29, 2021

7 minutes ago, Knosretep said:

Thanks! I read the whole thing. It seems there are many tangible benefits for using 1-10mg for a limited period of time, but it also warns against using it if you're experiencing depression, which I certainly am. I'll drop down to 5mg per night and see how things go.

See Post #1 of this topic:

melatonin-for-sleep

October 29, 2021

Knosretep,

From your account seems like mirtazapine is working in curbing anxiety then?

From your symptoms recount it also seems like most of your symptoms are resolved through keeping busy?

If you are stable, our advice is usually to hold and not make any changes until you are ready to come off of the drugs. Change only destabilizes the system. But from your account I also don't think that you want to get off of these drugs?

You seem to be under the impression that they are like candy and can treat symptoms by taking them when and in whatever combination you can think but the reality is that all of these drugs cause changes in thousands of minute ways in the brain as the brain adapts to them. When you take away the chemical then the brain goes into chaos trying to quickly readapt and you get all these symptoms.

Some people are able to get away by cutting them cold turkey a few times but their luck runs out as the brain is sensitized each time changes are made. Others start experiencing symptoms even while on the meds.

There isn't much that can be done for withdrawal as often new additions and changes only make things worse. So if you do want to come off of these drugs, you'd need to lower your dose in an exponential manner by no more than 10% a month.

Hope our advice above helped. We do not provide support/advice for finding the right cocktail or the right drug or experimenting with adding/subtracting new meds. We do provide support and information for coming off of psychiatric drugs with minimal withdrawal symptoms.

Take care of yourself and good luck with the IVF

OMW

October 29, 2021

18 hours ago, Onmyway said:

Hi Knosretep,

I don't think you need to taper the melatonin and the multivitamins. I would stop them now.

Regarding the mirtazapine, I would personally taper it quickly since it is new in the mix and likely has not created dependence. But it does have risks of destabilizing things temporarily so I understand if it is too much. But the risk of serotonin syndrome (which can be life threatening) is not negligible, so if you continue taking it, be on the lookout. If you had been taking it for a while, the advice would be to leave it be but I think it might be worth taking it out of the cocktail. Of course it is up to you but if it is not helping with sleep, then why add more trouble. After that, I would not change anything for a long time - 6 months or a year so that your system gets a chance to stabilize. These drugs are potent at very low doses (let me know if you want to read the research on this but for citalopram for example for which the regular dose is 20mg, about 50% of the effect is achieved at 2.5 mg). So even if you think that the doses you are taking are small, they are very impactful. And these drugs are not things you can add and subtract at will the way many psychiatrists think that you can; they cause long term (not permanent) changes in the brain (and the rest of the body) as the system adapts to the drugs and the brain is a very complex system. Hence the destabilization when things change and the need for very slow tapering - like getting things away from a trellis.

With the change in sleeping situation, I suspect that your sleep will get better. And while insomnia does indeed suck and may make other symptoms worse, you can get through it. Don't underestimate your resilience and your ability to 'bear' things. A lot of this path of withdrawal is full of things you just have to bear, you can't change them with a pill or with an injection, just have to get through them. The sooner you accept that, the easier it will get. The more you fight, the more you will activate yourself and create extra anxiety. I wonder if it will help you to set rules such as - "I will worry about sleep only if I have not gotten more than 6 hours total in 8 days." Yes, you can survive on that for a while. And yes, your body finds ways to get rest even if it is not sleeping. I have done so during withdrawal, during a hyperthyroid state, caring for sick people.

The background noise/music is not to just help you sleep but to prevent you from waking up. Please read the thread carefully - it is supposed to deal with the alerting response - the idea is that your body thinks you are dying when you are falling asleep and it is jerking you into wakefulness. Background music or noise can make it not worry about it.

It might be helpful to add magnesium to your supplements, as it helps calm the system down. Start low and see its effects on you. Can you try magnesium salt baths? They can be very calming as well.

Take care of yourself. You can get through this!

OMW

I didn't see this previous post until I'd just responded to your following one. Thank you for writing so much! I don't think I have time to respond fully before I leave, but I did reduce my melatonin to 5mg last night, didn't take the 3rd 7.5mg of Mirtazapine in the middle of the night last night, and only took half of a vitamin this morning....and today I've felt almost unimaginably reduced symptoms...some completely absent that were quite bad just yesterday! I don't know if it could possibly be from these 3 small changes, but I'm incredibly grateful for the respite.

October 29, 2021

8 minutes ago, Knosretep said:

I didn't see this previous post until I'd just responded to your following one. Thank you for writing so much! I don't think I have time to respond fully before I leave, but I did reduce my melatonin to 5mg last night, didn't take the 3rd 7.5mg of Mirtazapine in the middle of the night last night, and only took half of a vitamin this morning....and today I've felt almost unimaginably reduced symptoms...some completely absent that were quite bad just yesterday! I don't know if it could possibly be from these 3 small changes, but I'm incredibly grateful for the respite.

This is wonderful news. Please keep a log of systems for a week and we can go from there.

October 30, 2021

On 10/28/2021 at 11:31 PM, Onmyway said:

Hi Knosretep,

I don't think you need to taper the melatonin and the multivitamins. I would stop them now.

Because yesterday was a great reduction in anxiety and WD symptoms, I didn't want to change anything and I just took the same 5mg melatonin and 1/2 multivitamin. So far so good today. I'll try a few more days to possibly draw a solid correlation and then try stopping them to see if that further reduces.

Quote

Regarding the mirtazapine, I would personally taper it quickly since it is new in the mix and likely has not created dependence. But it does have risks of destabilizing things temporarily so I understand if it is too much. But the risk of serotonin syndrome (which can be life threatening) is not negligible, so if you continue taking it, be on the lookout. If you had been taking it for a while, the advice would be to leave it be but I think it might be worth taking it out of the cocktail. Of course it is up to you but if it is not helping with sleep, then why add more trouble. After that, I would not change anything for a long time - 6 months or a year so that your system gets a chance to stabilize. These drugs are potent at very low doses (let me know if you want to read the research on this but for citalopram for example for which the regular dose is 20mg, about 50% of the effect is achieved at 2.5 mg). So even if you think that the doses you are taking are small, they are very impactful. And these drugs are not things you can add and subtract at will the way many psychiatrists think that you can; they cause long term (not permanent) changes in the brain (and the rest of the body) as the system adapts to the drugs and the brain is a very complex system. Hence the destabilization when things change and the need for very slow tapering - like getting things away from a trellis.

Right now, I think the Mirtazapine is the only thing helping me to sleep, so I'm wary to taper it. In 2009, I don't think I started any healing until I got a prescription for Ambien. Even though I didn't feel rested at all on it when I first started taking it, I was able to "sleep" through the night such that I didn't worry about being awake all night. The 12.5mg Trazodone and 0.5mg that I take at bedtime don't seem to make me drowsy at all, so I'd rather taper the Trazodone or Sertraline to counter the risk of serotonin syndrome. I read that Mirtazapine has a high poop-out rate and terrible WD symptoms and I'm worried about continuing to take it, but I feel like I would fall back to no sleep and become completely destabilized without it. Taking or stopping it both sound bad, but at least if I take it I might have the option to slowly taper later? I think it might also be helping a lot with anxiety right now.

Quote

With the change in sleeping situation, I suspect that your sleep will get better. And while insomnia does indeed suck and may make other symptoms worse, you can get through it. Don't underestimate your resilience and your ability to 'bear' things. A lot of this path of withdrawal is full of things you just have to bear, you can't change them with a pill or with an injection, just have to get through them. The sooner you accept that, the easier it will get. The more you fight, the more you will activate yourself and create extra anxiety. I wonder if it will help you to set rules such as - "I will worry about sleep only if I have not gotten more than 6 hours total in 8 days." Yes, you can survive on that for a while. And yes, your body finds ways to get rest even if it is not sleeping. I have done so during withdrawal, during a hyperthyroid state, caring for sick people.

I have accepted that things will be bad for probably a long time. In 2009 I had amazing support from family and friends, no one depending on me, no business to run, no benzo WD, and my brain was much younger and hadn't been subjected to so many psychiatric drugs and changes. Such is not the case anymore.

That's amazing you were able to get through that. Clearly you were able to get past worrying about not sleeping and not let that create extra anxiety like you say.

Quote

The background noise/music is not to just help you sleep but to prevent you from waking up. Please read the thread carefully - it is supposed to deal with the alerting response - the idea is that your body thinks you are dying when you are falling asleep and it is jerking you into wakefulness. Background music or noise can make it not worry about it.

The AC is quite loud so I think that does a good job of providing noise.

Quote

It might be helpful to add magnesium to your supplements, as it helps calm the system down. Start low and see its effects on you. Can you try magnesium salt baths? They can be very calming as well.

Yeah, I was reading that thread the other day and seeing how highly recommended it is. Bathtubs are rare in Thailand, but I can get a big rubber tub and try soaking. IBS has been one of my symptoms so that's probably a better option than digesting one of the various forms of magnesium, and the soak might help with muscle soreness and muscle twitching too.

Quote

Take care of yourself. You can get through this!

OMW

Thank you for the amazing support!

Edited October 30, 2021 by Knosretep
changed psychotropic to psychiatric

October 30, 2021

21 hours ago, ChessieCat said:

See Post #1 of this topic:

melatonin-for-sleep

Thanks for posting this! Definitely makes me reconsider continuing on 5mg...

October 31, 2021

20 hours ago, Onmyway said:

Knosretep,

From your account seems like mirtazapine is working in curbing anxiety then?

Its possible maybe the extra 7.5mg Mirtazapine in the middle of the night the 2 previous nights helped? Maybe melatonin/multivitamin reduction? Seems like too short of time to pinpoint anything.

20 hours ago, Onmyway said:

From your symptoms recount it also seems like most of your symptoms are resolved through keeping busy?

Not resolved, but keeping busy keeps my mind focused on other things and stops the worry cycle from creating further anxiety/symptoms.

20 hours ago, Onmyway said:

If you are stable, our advice is usually to hold and not make any changes until you are ready to come off of the drugs. Change only destabilizes the system. But from your account I also don't think that you want to get off of these drugs?

Pfizer brand Sertaline seemed to help, or at least not prevent me from recovering in the past. But, after going through everything and doing more reading this time, it seems best to eventually get off and stay off any drug as much as possible to prevent possible tolerance WD problems in the future.

20 hours ago, Onmyway said:

You seem to be under the impression that they are like candy and can treat symptoms by taking them when and in whatever combination you can think but the reality is that all of these drugs cause changes in thousands of minute ways in the brain as the brain adapts to them. When you take away the chemical then the brain goes into chaos trying to quickly readapt and you get all these symptoms.

No, not at all. In 2009 I was already depressed when my gf broke up with me, and I went to the doctor to ask for something to help and was prescribed Effexor. I took it for 3-4 days and became suicidal, quit CT, and then experienced months of terrible MDD and anxiety symptoms. I should have definitely tapered down on all subsequent medication that I took, but I think the first time doing it with the Sertraline and not experiencing bad WD effects made me think it was okay as long as I wasn't in a terrible mental state when doing so. When I tried switching medications, it was always just 1 drug at a time, and I always experienced bad initial side effects for 1-2 weeks. All the additionally added drugs in 2021 were done at either my psychiatrists suggestion or with his approval.

20 hours ago, Onmyway said:

Some people are able to get away by cutting them cold turkey a few times but their luck runs out as the brain is sensitized each time changes are made. Others start experiencing symptoms even while on the meds.

There isn't much that can be done for withdrawal as often new additions and changes only make things worse. So if you do want to come off of these drugs, you'd need to lower your dose in an exponential manner by no more than 10% a month.

Hope our advice above helped. We do not provide support/advice for finding the right cocktail or the right drug or experimenting with adding/subtracting new meds. We do provide support and information for coming off of psychiatric drugs with minimal withdrawal symptoms.

Take care of yourself and good luck with the IVF

Yes, thank you. We've put any IVF stuff on hold indefinitely until I'm in a much better state. Adding pregnancy/newborn right now seems like a recipe for disaster.

20 hours ago, Onmyway said:

OMW

I just met my psychiatrist this morning to discuss the past 2 weeks, and the best way to eliminate the cocktail that I'm currently on going forward.

His recommended order of reduction is:

1. Trazodone to 0mg

2. Sertraline to 25mg

3. Clonazepam Morning to 0mg

4. Clonazepam Bedtime to 0mg

5. Sertraline to 0mg

6. Mirtazapine to 0mg

He thinks its okay to just drop 1/4 pill increments, but I've already got all the flasks/beakers/graduated cylinders to do liquid tapering so I will do that to minimize risk of destabilization on my weakened CNS.

Thank you for all the help and guidance! I know its a long road in front of me but I'm feeling positive that I can make it!

October 31, 2021

12 hours ago, Knosretep said:

Its possible maybe the extra 7.5mg Mirtazapine in the middle of the night the 2 previous nights helped? Maybe melatonin/multivitamin reduction? Seems like too short of time to pinpoint anything.

Not resolved, but keeping busy keeps my mind focused on other things and stops the worry cycle from creating further anxiety/symptoms.

Pfizer brand Sertaline seemed to help, or at least not prevent me from recovering in the past. But, after going through everything and doing more reading this time, it seems best to eventually get off and stay off any drug as much as possible to prevent possible tolerance WD problems in the future.

No, not at all. In 2009 I was already depressed when my gf broke up with me, and I went to the doctor to ask for something to help and was prescribed Effexor. I took it for 3-4 days and became suicidal, quit CT, and then experienced months of terrible MDD and anxiety symptoms. I should have definitely tapered down on all subsequent medication that I took, but I think the first time doing it with the Sertraline and not experiencing bad WD effects made me think it was okay as long as I wasn't in a terrible mental state when doing so. When I tried switching medications, it was always just 1 drug at a time, and I always experienced bad initial side effects for 1-2 weeks. All the additionally added drugs in 2021 were done at either my psychiatrists suggestion or with his approval.

Yes, thank you. We've put any IVF stuff on hold indefinitely until I'm in a much better state. Adding pregnancy/newborn right now seems like a recipe for disaster.

I just met my psychiatrist this morning to discuss the past 2 weeks, and the best way to eliminate the cocktail that I'm currently on going forward.

His recommended order of reduction is:

1. Trazodone to 0mg

2. Sertraline to 25mg

3. Clonazepam Morning to 0mg

4. Clonazepam Bedtime to 0mg

5. Sertraline to 0mg

6. Mirtazapine to 0mg

He thinks its okay to just drop 1/4 pill increments, but I've already got all the flasks/beakers/graduated cylinders to do liquid tapering so I will do that to minimize risk of destabilization on my weakened CNS.

Thank you for all the help and guidance! I know its a long road in front of me but I'm feeling positive that I can make it!

Hi Knosretep,

my advice would be to stabilize first before you start tapering. And given destabilization from the various changes I'd give that at least a few months. I think then you could decide to taper or wait longer depending on how you are feeling. We recommend tapering at no more than 10% of your previous dose every 4 weeks. We also recommend tapering one drug at a time though there are members who opt for much lower tapering but of all of their drugs - so maybe 2% of your previous dose every 4 weeks but for all of your medicines. We recommend to go to a very low dosage before you jump. (0.01 mg or less for citalopram is what I am planning for my jumping point but that is only planning, depending on my symptoms things could be slower.) If you follow our guidelines then this is going to be years of tapering but hopefully at a minimum of withdrawal symptoms.

Here are the threads on that.

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

There are micro-tapering options as well

The Brassmonkey Slide Method of Micro-tapering - Tapering - Surviving Antidepressants

You might want to track your symptoms during that time so can alter strategy if things change significantly.

Recording drug schedule and symptoms to track patterns and progress - Tapering - Surviving Antidepressants

You are seeing a relief right now which is great but beware of the windows and waves pattern in withdrawal

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

When people are in a window, they tend to be brave with cutting their doses (I have done that myself and regretted it) and if I were you I'd wait a while for stabilization before attempting a cut.

This might help explain what is happening to you.

What is happening in your brain? - Symptoms and self-care - Surviving Antidepressants

How psychiatric drugs remodel your brain - Symptoms and self-care - Surviving Antidepressants

I hope you find this information helpful. All decisions are yours in the end.

OMW

Edited October 31, 2021 by Onmyway

November 3, 2021

Thanks again @Onmyway

I plan to hold at least 2 more months minimum before thinking about tapering. I'd been in a window but accidently missed my nightly dose of Clonazepam and that's thrown me off for 2 days so far, feeling terrible.

November 4, 2021

On 11/3/2021 at 5:34 AM, Knosretep said:

Thanks again @Onmyway

I plan to hold at least 2 more months minimum before thinking about tapering. I'd been in a window but accidently missed my nightly dose of Clonazepam and that's thrown me off for 2 days so far, feeling terrible.

Oh, so sorry to hear that Knosretep,

this is the nature of this journey unfortunately. The thing to be grateful for is that you had a window this early in the process, that means that you are on the road to recovery and going well on it. Keep things stable and let's see how things develop. Missing one dose of clonazepam should fix itself out in a few days at most.

Hoping for some more respite for you and for strength and patience! This is such a difficult journey! Please keep us updated on how things are going.

OMW

November 10, 2021

Hi @Knosretep

just checking on how you are doing!
Hope things are getting better.

OMW

November 11, 2021

Hey @Onmyway

Thanks for checking in on me. I've been tracking symptoms and had my best day so far since doing so. One of my major stressors is now very unlikely to happen so I'm hoping I continue to have good days.

I've incorporated extra magnesium supplements and will be upping to 278mg since I've had no negative effects at 140mg. Still unable to sleep through the night, and still very difficult getting out of bed everyday.

We're moving house in a week which I know will be stressful, but after that if I continue near these levels of symptoms for a few weeks, then that's stable enough for me to start tapering.

November 15, 2021

Hi @Knosretep, these look great, I like the colors.

Keep tracking the symptoms. I would hold for a few weeks longer than you feel necessary in case you get hit by a wave i.e. to make sure that feeling OK is not just due to a window but you are properly stabilized.

Based on SA principles you would start tapering the most activating drug first which in your case is sertraline. However, you are then left with lots of sedating agents so let me check with other mods on what the best thing to do is here.

Hope you are staying well,
OMW

Edited November 15, 2021 by Onmyway

November 18, 2021

@Onmyway

The last few days I've been experiencing worsening sleep quality, and have developed a burning legs symptom, which I also remember experiencing in 2009.

Also, my anxiety as chest tightness and heartburn has dropped proportionally to the severity of the burning legs, such that I'm now experiencing almost neither of either.

This morphing of symptoms is closely correlated with my magnesium supplementation, and I realize that obviously doesn't imply causation.

The burning legs is less debilitating than chest anxiety, but if it is the magnesium causing it and the increased insomnia, then I think discontinuing would be better as my motivation to get to the gym and do other things is greatly diminished now.

I'm going to stop taking the magnesium for a few days and see if that has any effect.

I'll continue holding everything else.

November 18, 2021

Hi @Knosretep

It's great about the anxiety. The burning legs sensation is a common symptom - it's a form of neuropathy. It's unlikely to be from the magnesium but we don't really know in withdrawal, things can create paradoxical reactions. Had you changed your magnesium intake right before then by a lot? How much were your taking? I think it's a good idea to experiment for a few days but in general stability is better. I remember lowering melatonin had helped with sleep before. I wonder if going down even further will help more - 5mg is about 10x more than you need still.

I also see that you are using ashwagandha from time to time. It is a psychoactive substance and for me personally can have a very strong effect even from just a tea (so I've stopped it). I'd be careful with it. The amount you're listing is also massive.

I suspect you're just in a wave and this will get better without changes to magnesium but some experimentation might be ok.

Best

OMW

November 18, 2021

4 minutes ago, Onmyway said:

Hi @Knosretep

It's great about the anxiety. The burning legs sensation is a common symptom - it's a form of neuropathy. It's unlikely to be from the magnesium but we don't really know in withdrawal, things can create paradoxical reactions. Had you changed your magnesium intake right before then by a lot? How much were your taking? I think it's a good idea to experiment for a few days but in general stability is better. I remember lowering melatonin had helped with sleep before. I wonder if going down even further will help more - 5mg is about 10x more than you need still.

Thanks for the quick reply @Onmyway

Unfortunately I haven't kept exact records of supplementation (which I will do going forward) but I started magnesium at 140mg roughly a week and a half ago (1/4 the only non additive pill at the pharmacy), which was when my anxiety started lowering and the burning legs faintly started, and then bumped it up to 340mg (a half pill). At first the burning legs would start in the evening, then 5pm, then 3pm, and today its started at 2pm. I didn't track the burning legs symptom yet because at first it was just a bit discomforting. The drop in sleep quality and motivation has been pretty close with the magnesium intake, although initially my overall scores went up because the drop in anxiety was so great.

4 minutes ago, Onmyway said:

I also see that you are using ashwagandha from time to time. It is a psychoactive substance and for me personally can have a very strong effect even from just a tea (so I've stopped it). I'd be careful with it. The amount you're listing is also massive.

Yes, I was using it more frequently when I was completely off SSRIs for 3 months earlier in the year, and it would take 2 500mg pills to have any effect. The new bottle I got is 1500mg, and I've only taken 1 pill maybe 3-4 times since buying a few weeks ago.

4 minutes ago, Onmyway said:

I suspect you're just in a wave and this will get better without changes to magnesium but some experimentation might be ok.

Best

OMW

Yes, very possible a wave caused by the move has been the cause of all these symptoms and sleep changes. I really hope so.

November 18, 2021

Hi @Knosretep,

that doesn't sound like a lot of magnesium but still worth checking. It might be good to note supplement changes in your symptom tracking and notes as well to have a better idea of potential causality. Magnesium is harmless in general at those doses BUT we are also different during withdrawal. Do you know what kind of magnesium you are taking (citrate, chloride, glycinate etc.). Their absorption rate varies.

Moving houses is quite stressful even when positive so an uptick in symptoms would be expected but as things calm down hopefully the symptoms will subside.

Take good care of yourself

OMW

November 18, 2021

@Onmyway

Magnesium chelate.

November 25, 2021

I've reinstated the Magnesium as unfortunately it's been a week since stopping and having finished moving and I'm still having rough days. Still no solid causation but I've got a lot of the pills left and at least it didn't seem to be hurting.

November 25, 2021

@Knosretep

How are you doing? From a fellow Minnesotan, Happy Thanksgiving☺️

November 28, 2021

On 11/26/2021 at 4:33 AM, Greatful said:

@Knosretep

How are you doing? From a fellow Minnesotan, Happy Thanksgiving☺️

Hi @Greatful

Happy Thanksgiving 🦃.

There is a place here with an amazing Thanksgiving buffet that is better than anything I ever had back in the US. I was joined by my wife and 8 friends and tried to enjoy it but it was a bad day for me and I mostly just sat in silence. It was still nice to see my friends and they all know what I'm going through and offered encouragement, so I'm thankful for that.

The following couple days have been a bit better, but the mornings are still so difficult.

How was your Thanksgiving?

November 28, 2021

@Onmyway It just occurred to me today that I might not have ever hit tolerance withdrawal with the Clonazepam in Sept when my sleep started to falter, but it was possibly just a protracted withdrawal symptom of the Venlafaxine CT finally catching up to me, and the amount of Clonazepam unable to match to keep me sleeping. That would mean that tapering Clonazepam for fear of it giving me withdrawal symptoms was/is not necessary.

I still want to get off of it, but if this is correct, it would mean I'm not actually 'under the gun' to get off of it while its giving me withdrawal symptoms, because it might not be. Of course, the huge cut that I did is surely contributing to my symptoms now anyways, but thinking about it this way gives me more hope that I can eventually balance out and maybe be completely symptom free before tapering.

November 30, 2021

On 11/28/2021 at 2:01 PM, Knosretep said:

@Onmyway It just occurred to me today that I might not have ever hit tolerance withdrawal with the Clonazepam in Sept when my sleep started to falter, but it was possibly just a protracted withdrawal symptom of the Venlafaxine CT finally catching up to me, and the amount of Clonazepam unable to match to keep me sleeping. That would mean that tapering Clonazepam for fear of it giving me withdrawal symptoms was/is not necessary.

I still want to get off of it, but if this is correct, it would mean I'm not actually 'under the gun' to get off of it while its giving me withdrawal symptoms, because it might not be. Of course, the huge cut that I did is surely contributing to my symptoms now anyways, but thinking about it this way gives me more hope that I can eventually balance out and maybe be completely symptom free before tapering.

Hi @Knosretep,

I am not sure I understand your statement - tolerance is when a drug stops having the same effect at the same dosage and you need to increase the dosage to get the same effect. Withdrawal are the set of symptoms you get when you have stopped taking a drug or lowered your dosage. Do you mean that if you keep taking the same dose it's like you are slowly withdrawing?

In your case it would be impossible to know what caused what as there were so many changes and they compounded each other. But it is also not important to know. The solution is the same - hold until you stabilize and then start tapering very slowly, one at a time. We usually recommend tapering the most activating drug first, in your case sertraline. However, your sedative burden is quite high so it might be better to taper the clonazepam. When the time comes, we can ask the other mods as well what their recommendation would be. You could also taper all of them at the same time but at a much lower percentage - i.e. 2% each every 4 weeks. We recommend the 'one at a time' choice but some people have successfully done the latter.

In terms of whether you need to be symptom free before starting tapering - most people do not wait for previous normal but what we call withdrawal normal - i.e. bearable symptoms. I rushed mine and had to slow down after a couple of months because it was not sustainable - there is only so much you can 'bear' for a long time. You will know when you feel ready. The trick here is to account for the windows and waves - many of us feel very brave during a window and we start tapering or making larger cuts only to be slammed by a wave very quickly. So once you feel good enough, I'd suggest to wait for another few weeks. Hurrying this process only makes things worse.

In terms of tapering, you need to remember that it will take years at 10% a month for each drug. Withdrawal gets harder the lower the dosage gets and most people will not jump until they have reached a miniscule amount - something like 0.005mg or so as these drugs are very potent at the lower doses.

How are you feeling these days? Are things starting to settle after the move?

OMW

December 1, 2021

16 hours ago, Onmyway said:

Hi @Knosretep,

I am not sure I understand your statement - tolerance is when a drug stops having the same effect at the same dosage and you need to increase the dosage to get the same effect. Withdrawal are the set of symptoms you get when you have stopped taking a drug or lowered your dosage. Do you mean that if you keep taking the same dose it's like you are slowly withdrawing?

In your case it would be impossible to know what caused what as there were so many changes and they compounded each other. But it is also not important to know. The solution is the same - hold until you stabilize and then start tapering very slowly, one at a time. We usually recommend tapering the most activating drug first, in your case sertraline. However, your sedative burden is quite high so it might be better to taper the clonazepam. When the time comes, we can ask the other mods as well what their recommendation would be. You could also taper all of them at the same time but at a much lower percentage - i.e. 2% each every 4 weeks. We recommend the 'one at a time' choice but some people have successfully done the latter.

In terms of whether you need to be symptom free before starting tapering - most people do not wait for previous normal but what we call withdrawal normal - i.e. bearable symptoms. I rushed mine and had to slow down after a couple of months because it was not sustainable - there is only so much you can 'bear' for a long time. You will know when you feel ready. The trick here is to account for the windows and waves - many of us feel very brave during a window and we start tapering or making larger cuts only to be slammed by a wave very quickly. So once you feel good enough, I'd suggest to wait for another few weeks. Hurrying this process only makes things worse.

In terms of tapering, you need to remember that it will take years at 10% a month for each drug. Withdrawal gets harder the lower the dosage gets and most people will not jump until they have reached a miniscule amount - something like 0.005mg or so as these drugs are very potent at the lower doses.

How are you feeling these days? Are things starting to settle after the move?

OMW

@Onmyway

What I meant about the Clonazapam not having the same effect is that maybe I didn't actually hit tolerance, but maybe it stopped having the same effect because my insomnia from Venlefaxine became so bad that the Clonazapam sedation just couldn't keep up.

I was starting to have some incremental progressively better days after the move, but some domestic disputes the past two days have thrown me back into chaos. 😓

Knosretep: don't know what to do - clonazepam and Zoloft and extras

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