YachtRock: My Introduction and Journal

[YachtRock]

Hello and nice to meet everyone. I have been reading as much as I can the past two days and feel like it is time to introduce myself. THANK YOU for everything you all have contributed, this site is a game changer. So many questions answered and a new journey begins. You can see my drug history and four month taper in my signature over the spring/summer (my psychiatrist at the time recommended two weeks, go figure). I had planned on a few crappy months going into this. Oh if I had only found this site first...

 

Withdrawal didn’t kick in for at least two weeks, and slowly at first. I spent all of September and October dodging and weaving through good days and bad days, which I observed simply as “anxiety” (my original diagnosis) but with unusual physical symptoms. I journaled and kept calendar entries, mostly to record when I had to resort to Ativan (usually 0.5mg, occasionally 1mg). Other than for flight anxiety (two trips), I can count 17 times I took it over those two months, and only as a last resort. 

 

I had two sudden midnight “surges” (after feeling great) with shivers, out of control heart rate, even some diarrhea, which would last hours. I was convinced it was Serotonin Syndrome. The second one took me to urgent care the next morning for a heart checkup. A few days later a new psychiatrist then put me on Propranolol (beta blocker) as my primary concern was my heart. Propranolol immediately helped me observe and evaluate the “anxiety” I was experiencing which helped a lot. The new psychiatrist also had me stop 5-HTP after only a few weeks which was probably smart. I speak to him again this Friday, not sure what to share/ask given what I am learning here.

 

I am now clear on the fact that I am riding waves of withdrawal symptoms, anxiety responds to the unusual feelings and emotions created by the withdrawal and adds its own icing to the cake, but I am focused on observing and not reacting, and doing my best to “ride it out”. The most unusual part of this “pattern” has been the timing of it all - usually kicking into high gear in the evenings after dark (earlier and earlier in my part of the world). I am nervous about traveling this weekend (short flight) but also realize I need to try and have as “normal” a life as I can stand under these conditions. My wife is awesome, understanding and super supportive.

 

At 12 weeks in, I am not sure reinstatement is an option for me, even though I still have 5mg Trintellix in my drawer, and could try taking microdoses. Leaning toward a no, but I realize I may have run out of time to make that decision? I have read almost all the “required reading” but would still appreciate an opinion on that one.

 

Also considering stopping my multivitamin, turmeric and mulberry leaf extract and taking only my “Super Omega-3 Plus” (Fish Oil) and picking up magnesium pills. I just started the Probiotic so I could drop it too, but not feeling like it would impact all of this either way? I am intrigued by the Reishi 415 blend to get some non-psychedelic mushroom love.

 

Lastly my wife and I are thinking about therapeutic float tanks (she would love to do it again) and I have begun using our hot tub as part of my daily routine, along with many failed attempts at meditating. Anxiety was never something I handled well to begin with, and I realize now I must absolutely be on my game to dance this intricate dance. I will post any new thoughts, findings and curiosities on this thread as appropriate. I appreciate everyone’s support!

 

PS- I opted to not use the appropriate abbreviations as I wanted to easily share this summary with family
 

[getofflex]

Hello, and welcome to SA.  We are a volunteer-run community of people who have been or are getting off of psychiatric drugs.  You have come to the right place. Congratulations for getting off the Trintellix and the other drugs in the past! 

 

Thanks for giving us your drug history.  

21 hours ago, YachtRock said:

I spent all of September and October dodging and weaving through good days and bad days, which I observed simply as “anxiety” (my original diagnosis) but with unusual physical symptoms.

This sounds like it is probably withdrawal from the Trintellix.  You did pretty fast taper, and your nervous system is probably still trying to recover from getting off the meds.  Read on to find out more specifically how these drugs change us, and how recovery works.  

 

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

 

 

 

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

 

Keep it Simple, Slow, and Stable

 

Here is a link with checklists of common WD symptoms: 

 

Dr Joseph Glenmullen Withdrawal Symptom Checklists

 

21 hours ago, YachtRock said:

I am focused on observing and not reacting, and doing my best to “ride it out”.

It sounds like you already have some good coping techniques in place!  Here are some other techniques to cope with symptoms: 

 

Non Drug Ways to Cope with Withdrawal Symptoms

 

 

21 hours ago, YachtRock said:

Also considering stopping my multivitamin, turmeric and mulberry leaf extract and taking only my “Super Omega-3 Plus” (Fish Oil) and picking up magnesium pills. I just started the Probiotic so I could drop it too, but not feeling like it would impact all of this either way? I am intrigued by the Reishi 415 blend to get some non-psychedelic mushroom love.

I think this could be a good thing to do.  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. I see that you are already taking the fish oil.  You may want to reconsider the multivitamin.  These tend to have high amounts of vitamin B, which  tend to activate the nervous system, and can aggravate withdrawal symptoms. If you are having insomnia, vitamin D can keep you awake at night.  I'm not familiar with the other supplements. 

Magnesium

 

Omega 3 Fish Oil

 

You could consider doing a reinstatement to help with your symptoms.  

 

Question: Have you had any improvements in your withdrawal symptoms since quitting the Trintellix in August?  

 

Question: What symptoms are you having now?  

 

Question: How is your sleep, and eating, and basic everyday functioning?  

 

 

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. 

[YachtRock]

3 hours ago, getofflex said:

Question: Have you had any improvements in your withdrawal symptoms since quitting the Trintellix in August?  

 

Question: What symptoms are you having now?  

 

Question: How is your sleep, and eating, and basic everyday functioning?  

 

Thank you getofflex. I appreciate your quick reply. I can't exactly say there has been "improvement" over the past 11 weeks. Things kicked in at week 3 and have been steadily inconsistent for the past 8 weeks. It is almost like 4 days good, 3 days bad, 5 days good, 2 days bad, 3 days good, 3 days bad. Just all over the place. I am able to function and work, thankfully, and I realize my situation is not as dire as many others. But nonetheless, disruptive and disturbing. I have been able to be around others in social situations, with only slight anxiety (but also Ativan helping through others).

 

My anxiety about the "symptoms" is way lower this week since discovering this site, and less inclination to panic about it, but my symptoms have been:

• Low to medium levels of feeling "anxious, nervous and tense" with many episodes that got so intense I had to take Ativan
• Loss of appetite has increased in frequency the past month, trouble sleeping (generally falling asleep 2 hours later than I would normally) but again inconsistently. 
• Moderate (or stronger) Anhedonia MOST days (not getting joy or pleasure from my usual activities). Most TV/movie content is suddenly unpleasurable? 
• Chest "thumps" and brain "zaps" almost every day (though not as "zappy" as I recall with Lexapro, these are more dull "rushes" or "surges")
• Occasional, brief highs (rush of serotonin I assume) which last no more than an hour.
• The two late night multi-hour episodes of chest pain, racing heart, shaking/trembling and racing heart. But those were only in weeks 6 and 7, and were immediately preceded by the brief highs I mentioned previously
• Prior to starting Beta Blockers in week 8, I had racing/pounding heartbeats accompanying almost EVERY episode of higher anxiety and discomfort.

I will be posting/updating additional withdrawal symptoms as they occur.

 

4 hours ago, getofflex said:

I think this could be a good thing to do.  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. I see that you are already taking the fish oil.  You may want to reconsider the multivitamin.  These tend to have high amounts of vitamin B, which  tend to activate the nervous system, and can aggravate withdrawal symptoms. If you are having insomnia, vitamin D can keep you awake at night.  I'm not familiar with the other supplements. 

 

Decided to stop all my supplements and focus on Omega 3 (definitely) and Magnesium (maybe). I ordered "Doctor's Best Magnesium Glycinate Lysinate 100mg" pills, although still on the fence after reading all 16 pages of comments. My wife and I use ConsumerLab.com to research approved supplements and one of them recommended in that thread (ReMag) is NOT approved by them. But I was unable to reply to that topic (probably as this is only my 2nd post). But I wanted to share their findings, see https://www.dropbox.com/s/fi3hcumrv84ey77/ReMag ConsumerLab.png?dl=0

[getofflex]

If you want to, you could try a very small reinstatement of the Trintellix.  The purpose of this would be to reduce your withdrawal symptoms.  You would start with an extremely low test dose, and if that goes OK, we can take it from there.  I would suggest you start with 0.5 mg. These links will go into how to dose this very small amount.  If you feel significantly worse after the reinstatement, then stop the reinstatement right away. It will take at least a week for the reinstatement to get into you system and register with your brain, so give it at least a week.  

 

Tips for Tapering Trintellix

 

Trintellix Taper Advice for Going to Liquid

 

Once you stabilize on the 0.5 mg, then we can consider if you could increase the amount to help you further.  The reason we start with a very low dose is to reduce the risk of kindling, which means the nervous system becomes very sensitized by going off and on the drug.   Eventually, once we got your WD symptoms under control, we would then carefully and gradually taper off your reinstatement.  

 

Here is a link about reinstatement.  Read it, and let us know what you decide to do.  

 

About Reinstating and Stabilizing to Reduce WD Symptoms

 

14 hours ago, YachtRock said:

Decided to stop all my supplements and focus on Omega 3 (definitely) and Magnesium (maybe)

This sounds like a good plan.  

 

14 hours ago, YachtRock said:

I ordered "Doctor's Best Magnesium Glycinate Lysinate 100mg" pills,

Doctor's Best is a good brand.  I use their chelated magnesium.  

 

Keep us posted, and let us know how you are doing.  

[YachtRock]

2 hours ago, getofflex said:

If you want to, you could try a very small reinstatement of the Trintellix.  The purpose of this would be to reduce your withdrawal symptoms.  You would start with an extremely low test dose, and if that goes OK, we can take it from there.  I would suggest you start with 0.5 mg. These links will go into how to dose this very small amount.  If you feel significantly worse after the reinstatement, then stop the reinstatement right away. It will take at least a week for the reinstatement to get into you system and register with your brain, so give it at least a week.  

 

 

Thank you. At this point I am going to hold and stay as is for two weeks and monitor symptoms (now using a google sheet daily tracker). As this week has progressed, my symptoms have been decreasing a bit, and I could ride it out at this pace. But I realize the dreaded wave could be right around the corner too. 

[YachtRock]

Monthly update on my progress and symptoms. November was overall a positive month vs October and September, and I count almost as many good days as "mild/moderate" days (routine, minor symptoms that are still uncomfortable but bearable). We had a few events outside the house, a mostly successful short trip to California, other than our rental car being robbed and losing some stuff. That was a challenging day.

 

Seemed like most of the month was a window. Nothing extreme during this period until last night, where I had my 3rd midnight attack of heavy anxious thoughts and physical discomfort, trembling legs, my mind unleashed unholy hell and racing like mad. Heart rate slightly elevated, even with the beta blocker. I had managed to only take Ativan twice in the past month for flying, and made do without it for almost four weeks! But last night I relented and took 1mg around 2am after trying to suffer through it. Definitely a new variation of symptom for me, and I felt it building up all day. It was as if my subconscious dumped every single negative thought on me at once and it kept coming in waves while I lay in bed. Thoughts, words, sounds and even scary visuals. I was cognitively aware of what was happening but it was still extremely disturbing. My wife comforted me, helped with breathing, and all issues stopped until she rolled over to fall back asleep. Then it restarted immediately and I took 1mg of Ativan shortly after and finally fell asleep.

 

I did not continue my Omega 3 and only tried the Magnesium once, which appeared to lightly trigger some anxiety. I shifted my diet during this period and ate mostly comfort foods like cereal or pizza, still one coffee in the AM and avoiding alcohol or anything else.

 

I spent much of the month trying to understand if the symptoms were sparking anxiety or if naturally high levels of anxiety were causing the symptoms (chest thumps, smothering, increased sensitivity to temperature, loss of appetite). I believe it is the former, but ultimately a mix of the two.

 

Looking forward into the rest of December and early 2022, I have fears around a planned trip to the Bahamas for a friend's wedding, now exacerbated by Omicron! I find it odd to have such an extreme wave/episode the same day I wrestled with the wedding trip and even discussed it with my wife. Again making me wonder if I brought this on my ruminating on it all day and openly discussing it. I don't want to prevent my wife from seeing her family, but I am scared to be trapped on a remote place of the island for a week too, not to mention all the travel and COVID fears.

 

Lastly I am still somewhat sensitive to TV, movies and music. It is very puzzling. I am unable to sink into the couch, relax and enjoy or be entertained. I managed to get through two movies and a dozen TV episodes in the past month, but otherwise find myself needing to distract my brain with reading or video games. 

[getofflex]

On 12/5/2021 at 12:52 PM, YachtRock said:

I find it odd to have such an extreme wave/episode the same day I wrestled with the wedding trip and even discussed it with my wife. Again making me wonder if I brought this on my ruminating on it all day and openly discussing it.

It could very well be what triggered your anxiety and racing dark thoughts.  This same thing happens to me.  If I talk and think about certain negative things during the day, it tends to worsen my WD symptoms.  Stress can certainly worsen our withdrawal. 

 

On 12/5/2021 at 12:52 PM, YachtRock said:

Lastly I am still somewhat sensitive to TV, movies and music.

This is very common in WD.  I'm still sensitive to certain movies.  Personally, when I get agitated and anxious, I find it helps a lot to do something with my hands - for example, knitting, sewing, crafts, house cleaning, etc.  The repetitive mindless physical activity can be soothing, and distracting.  

[YachtRock]

What seemed like a short wave starting on December 4th has become an increasingly uncomfortable and disturbing process which has driven my symptoms and related anxiety through the roof. I had a bit of relief over the weekend, got my Covid booster shot last Saturday and began experiencing ear pain and the need to constantly clear my ear canal. So this added to the already bothering cold/flu symptoms that appear to be standard.

 

Perhaps it is my natural anxiety out of control that is making things worse, but the sum total of it all is not enjoyable and becoming increasingly disruptive to my life. My nearly month long streak of not taking Ativan through November came to a halt and I have now taken it 6 times over 11 days (0.5 or 1mg) just to cope, sleep or calm down. I think these are the REAL symptoms only now kicking in four months after I finished my fast taper.

 

In talking with my wife we have decided to try reinstatement in hopes I can stabilize back on Trintellix and chart a clearer path forward. I still have about 20 of the 5mg pills and have already ordered the digital scale everyone recommends. So we can produce a large number of doses in the 0.5-1mg range. I have read and re-read the reinstatement page and wonder if the long 66 hour half life of Trintellix means I would need more than a week to gauge/measure stabilization? I wonder if "most" here refers to the shorter HL medications?

 

Quote

After reinstatement, most drugs take about a week to reach full effect. Wait until you see the full effect before you make an increase -- and then make only very gradual increases.

 

I have written to my psychiatrist at KP to get his blessing on this approach (0.5mg for a week, if improvement and no bad reactions, increase to 1mg and stay there for a few weeks). This is because we will be out of town in early January for 11 days so I need to minimize risk of instability. I will do everything I can to focus on a positive outcome, realizing that this does not work for everyone, particularly after four months. Any help, guidance and encouragement is greatly appreciated, particularly around the doses and timings.

[getofflex]

7 hours ago, YachtRock said:

I have written to my psychiatrist at KP to get his blessing on this approach (0.5mg for a week, if improvement and no bad reactions, increase to 1mg and stay there for a few weeks).

Overall, this sounds like a good plan.  However, once you are at 1.0 mg, I would stay on that for several months, not just a few weeks.  Give your nervous system a chance to stabilize on the reinstatement.  Then, once you are stabilized on this, you can start a very cautious and slow taper, after you get back from your trip. 

[YachtRock]

8 minutes ago, getofflex said:

Overall, this sounds like a good plan.  However, once you are at 1.0 mg, I would stay on that for several months, not just a few weeks.  Give your nervous system a chance to stabilize on the reinstatement.  Then, once you are stabilized on this, you can start a very cautious and slow taper, after you get back from your trip. 

 

Thanks. If I feel "relief" at 1mg I will happily stay there for months. I am worried about needing to get back to 5mg before eventually tapering again. My psychiatrist gave me his blessing on this plan (along with some extremely kind words) so I will start on Friday afternoon once I get all the "supplies" together. Maybe by New Year's I can feel a little more stable? 

[getofflex]

20 hours ago, YachtRock said:

I am worried about needing to get back to 5mg before eventually tapering again

Try not to worry about this.  Just take things as they come.  Most people find relief from very low reinstatement doses, so no need to worry.  Please let us know how you are doing. 

[YachtRock]

Thanks @getofflex. Really appreciate your continued support! Without any Ativan I was able to have a calm evening last night, slept for 7 hours without issue, and have had low to no symptoms today so far. I managed to sit through an hour dental cleaning without a panic attack, which is a good sign. Maybe the start of a window, or maybe less anxiety because I am working on a "plan" of sorts.

 

My scale and capsules arrived today. Given my brain is a little fuzzy, I could use help making sure I am calculating this reinstatement dose correctly. I have the same Gemini 20 scale that everyone recommended.

• A single Trintellix 5mg pill is weighing 0.153 grams (multiple tests ranged from 0.152 to 0.155). Weighing 10 total came back at 1.534g
• Since I am trying to measure 0.5mg (10% of the "mgai") I would crush maybe two of the pills into powder, then weigh out 0.015 (15mg) of powder and transfer it into a capsule.
• I should be able to make 7 or 8 of these for the next week's supply?

I double checked the math here using a google sheet to calculate the dose weight of powder for both 0.5mgai and 1.0mgai.

If a 153mg pill contains only 5mg of the drug, that means that only 3% of the powder will contain trintellix. So the difference between 0.015 and 0.016 of power is not really that big. I would need a more expensive scale to be more precise I guess.

 

Should I be cross-posting this into another thread like this one?

 

[getofflex]

15 hours ago, YachtRock said:

Without any Ativan I was able to have a calm evening last night, slept for 7 hours without issue, and have had low to no symptoms today so far. I managed to sit through an hour dental cleaning without a panic attack, which is a good sign. Maybe the start of a window, or maybe less anxiety because I am working on a "plan" of sorts.

This is wonderful!  It really helps to have a night of good sleep, doesn't it.  

 

15 hours ago, YachtRock said:

A single Trintellix 5mg pill is weighing 0.153 grams (multiple tests ranged from 0.152 to 0.155). Weighing 10 total came back at 1.534g

Do your calculations based on the average weight of a single pill, which would be 0.1534 g.  

 

Yes, your math is correct.  I double checked it.  The exact amount comes to 0.1534 gpw (grams pill weight) contains 0.5 mgai.  I would round it to 0.15 instead of 0.16.  You don't have to buy a more expensive scale.  

 

Basic formula is: 1 pill contains 153.4 mgpw, and 5.0 mgai.  Divide this by 10 to get a reinstatement dose of 0.5 mgai, gives you a 15.34 mgpw.  This converts to 0.015 grams pill weight on your scale assuming your scale weighs in grams.  (1000 milligrams per gram) 

 

15 hours ago, YachtRock said:

Should I be cross-posting this into another thread like this one?

No, this is the place to post here, in your intro thread.  

 

Good luck, and let us know how it goes.  

[YachtRock]

Hi @getofflex (and everyone else). So I have now taken three 0.5mg reinstatement doses of Trintellix, and I am confused which way to go next. With the very long half life of Trintellix and the tiny doses, I realize it will take a long time to build up in my system (and ultimately leave my system). And having read the reinstatement page over and over, I don't know how to identify "kindling" and "adverse effects" or to judge a "bad reaction" properly. Reinstating after four months feels like such a crap shoot to begin with.

 

As I was preparing to start the reinstatement on Thursday, I actually felt pretty good. I had planned to start Friday afternoon. It was the best day last week according to my journal and symptom tracker. As I said there was low to no anxiety at the dentist and the evening was mild. On Friday I had to work a few hours in the morning (from home) and had some uncomfortable moments during meetings, then a bit of what I am calling a "surge" (adrenaline or serotonin?) and it was like the brain testing out new signaling. But it felt like my CNS was closer to "normal" than any point so far this month.

 

This left me super confused as I approached my 3pm time to take the first reinstatement, but I went ahead with it anyway. Still had a very mild evening Friday including a few hours out of the house. Saturday was also mild for the most part, had lots of calls with family, we decided to cancel our January trip and stay home (both related to my situation and Covid issues) which should provide some anxiety relief. Had some moderate brain/body discomfort for a few hours that went away, so I took my second reinstatement dose. Spent lots of time reading as TV continues to be triggering after a while.

 

Sunday morning started well, but I began feeling moderate symptoms in the morning while on my computer. Took my third dose. Things got better for a while but became increasingly uncomfortable into the evening. Thankfully no panic kicked in (maybe the beta blockers) but I was experiencing new brain sensations, needing to get up and walk around, strong short waves (not zaps). I immediately assume this is a sign of adverse reaction, kindling, etc. After battling this for an hour I relented and took 0.5mg of Ativan which brought everything back down.

 

Also I have had very unusual challenges getting to sleep. I am always tired, but the actual moment of falling asleep seems to come as a crescendo along with uncomfortable feelings and slight fear. It has taken a few tries some nights to peacefully drift off. This was new as of last week. But I am averaging 7 hours a night so no complaints. 

 

So once again I sit here wondering if I should continue the reinstatement and risk another bad evening (the morning has not started off great either). I wish I could compartmentalize the symptoms and describe them better for you. But they are definitely more cerebral than physical, other than maybe light nausea and fatigue.

 

[getofflex]

The thing about recovery from psych meds, is that it is nonlinear, and occurs in windows and waves.  So the question would be, is this uptick in symptoms just a wave, or is it from the reinstatement?  Or, were you in a window right before the reinstatement, which then closed?  

 

Our general guideline is: If you feel immediately significantly worse after a reinstatement, stop immediately. Only you can be the judge of that.  It is your decision to make.  However, what you don't want to do, is jump onto a reinstatement/updose every time you feel a little bit worse, or jump off just because you feel a little bit better.  That will just destabilize your nervous system further.  Note that it does take about a week for reinstatement to register with your system.  

 

 Please see: 

 

Keep it Simple, Slow, and Stable

 

Considerations About Stability - Stop Jumping Around

 

Let us know what you decide.  

Edited December 20, 2021 by getofflex

[YachtRock]

Thanks, I will continue with the reinstatement knowing it will really take until New Years before I can make a judgement call. Hoping last night was just a blip in the process or caused by whatever I was doing or not doing at the time. Desperately hoping I don't find out what significantly worse feels like 🤞 (sorry to be dramatic). I definitely believe in the Simple, Slow, Stable approach. 

 

 

[methuselah]

4 hours ago, YachtRock said:

Also I have had very unusual challenges getting to sleep. I am always tired, but the actual moment of falling asleep seems to come as a crescendo along with uncomfortable feelings and slight fear.

Ive had this too.  I believe it’s called…

 

Hypnagogia is the transitional state of consciousness between wakefulness and sleep. It's the opposite of hypnopompia, which is the transitional state that occurs before you wake up. During hypnagogia, it's common to experience involuntary and imagined experiences. These are referred to as hypnagogic hallucinations.

 

good luck with the reinstatement!

 

ps -  love the user name haha

[YachtRock]

2 minutes ago, methuselah said:

Ive had this too.  I believe it’s called…

 

Hypnagogia is the transitional state of consciousness between wakefulness and sleep. It's the opposite of hypnopompia, which is the transitional state that occurs before you wake up. During hypnagogia, it's common to experience involuntary and imagined experiences. These are referred to as hypnagogic hallucinations.

 

Thanks @methuselah. Yeah I think that sums it up correctly. I have certainly experienced both, although it was starting to become a regular thing this past week. So just accept it and let it go? My approach was to stay up a little longer (usually reading) until I am too tired to read and then try to fall asleep again. I guess I should not be surprised that this would come up given the changes still taking place in my brain. Have you found anything that reduces the likelihood of it, or tips on how to deal with it without fear?

[methuselah]

6 hours ago, YachtRock said:

 

Thanks @methuselah. Yeah I think that sums it up correctly. I have certainly experienced both, although it was starting to become a regular thing this past week. So just accept it and let it go? My approach was to stay up a little longer (usually reading) until I am too tired to read and then try to fall asleep again. I guess I should not be surprised that this would come up given the changes still taking place in my brain. Have you found anything that reduces the likelihood of it, or tips on how to deal with it without fear?

i wish I had a solution but there is nothing I know if to resolve it or avoid it. For me, it just comes and goes and can happen very randomly.  It’s honestly, at this point, a pretty mild symptom compared to some others I’m dealing with so I just kind let it happen (as if I have a choice) and eventually fade off to sleep. I noticed it to be more intense if I take a melatonin or unisom so I don’t take those anymore.  

[getofflex]

Here is something that can help a lot with symptoms - radical acceptance.  Please try to remember, that as bizarre and scary as WD symptoms can be, they are only temporary, and will eventually go away.  It's best to accept them, and not get upset or worried about them, which can make your suffering worse, and increase your anxiety.  We have a technique called "Acknowledge, Accept, Float".  

 

Acknowledge, Accept, Float

 

https://www.dbtselfhelp.com/html/radical_acceptance_text.html

 

 

Edited December 21, 2021 by getofflex

[YachtRock]

Thanks @getofflex, and especially for the encouragement yesterday. I took my 4th dose yesterday afternoon. I am happy to report low to no symptoms yesterday (other than more of the Hypnagogia falling asleep issue) and a good start so far today. Rather than rushing to increase the dose to 1mg at the end of this week, I will stay on 0.5mg through the end of the year.

[YachtRock]

Quick followup. Took 6th reinstatement dose this afternoon and so far so good. Past 48 hours have been light/no major symptoms other than lethargy? Have really tried to dial back and take it easy. Had a few stressful events and managed to get through them fine (hectic trip to the grocery store, some family drama, a little work stress). Will keep posting on my progress.

[getofflex]

15 hours ago, YachtRock said:

Quick followup. Took 6th reinstatement dose this afternoon and so far so good. Past 48 hours have been light/no major symptoms other than lethargy? Have really tried to dial back and take it easy. Had a few stressful events and managed to get through them fine (hectic trip to the grocery store, some family drama, a little work stress). Will keep posting on my progress.

That's excellent.  I think you did well to slow down and take it easy.  That is the first thing I do, when I'm having any WD issues.  Go ahead and stay on this dose for a while.  If it were me, I would stay on it a couple of months to make sure my system was stabilized before making further reductions. 

Edited December 23, 2021 by getofflex

[YachtRock]

Thanks @getofflex. Just hours after my last post things started to escalate out of nowhere. Creeping anxiety from late afternoon (possibly triggered by a specific work issue) developed into lots of discomfort, physical symptoms returned from last week (head pressure, ear pain, fatigue, chest tightness) along with that general sense of dread. Did my best to deploy all the Acceptance, Float, Relax techniques but it kept getting worse and more uncomfortable into the late evening. Had to take an Ativan to get to sleep around 1230am after wrestling with it for hours. A short walk helped a bit, as did reading at times. But on the whole it seemed to have ended the short window I was enjoying. Current plan is to stick with 0.5mg through the end of December but may need to increase reinstatement dose to 1mg in January. Not planning any reductions anytime soon.

[methuselah]

@YachtRock I’m with you man,  I’m having my worst day today after a decent day yesterday.  God it’s awful.  Seriously debating a Xanax or slight .5mg updose at this point.  

[YachtRock]

59 minutes ago, methuselah said:

@YachtRock I’m with you man,  I’m having my worst day today after a decent day yesterday.  God it’s awful.  Seriously debating a Xanax or slight .5mg updose at this point.  

 

Hang in there @methuselah! You don't want that monkey on your back again. Stay strong buddy.

[methuselah]

16 minutes ago, YachtRock said:

 

Hang in there @methuselah! You don't want that monkey on your back again. Stay strong buddy.

@YachtRock Thanks dude.  Sent you a pm.  Let me know

[YachtRock]

I hope everyone had a restful holiday break. Update on my status as we start the last week of 2021:

• Continue to track symptoms daily (almost hourly at times). Using Dr. Glen Mullers symptoms list but also assigning a numerical score to each symptom then totaling these scores per day (in Google Sheets). Still getting it dialed in but I believe this will give me a better analysis of improvement or decline over time (higher score = bad). Unfortunately this puts MORE focus on my symptoms, making it harder to accept/ignore them.
• Where I have had less daytime and evening symptoms overall since reinstatement, I have had more sleep/late night issues, experienced light dizziness at times (new), and slightly more nausea. While I can recognize some "improvement" I am not ready to claim any "relief" from symptoms. 
• I have taken the reinstatement dose of 0.5mg for 10 days (having stopped 5mg 137 days ago). My total symptom "score" vs the 10 days prior is down 17% (lots of room for error/inaccuracy in all the scores). The other new symptom I have seen is red flushing in my cheeks and neck, which appear in the evening roughly 4 hours after I take my dose. This is not even on Dr. Muller's symptom list. After lots of reading, it could be either withdrawal or coming from the microdose of Trintellix (maybe proving it is taking effect). Ironically Propranolol is one of the things prescribed for rosacea/flushing which I take twice a day (10mg doses). Will keep monitoring this.
• I have noticed increased sensitivity to sharp, sudden loud sounds. Particularly when the rest of my environment is quiet. And my ears are still ringing and seem to feel clogged when experiencing other types of physical discomfort. Might even be an early warning that symptoms are starting to build?
• My Anxiety score is only down 3% vs prior 10 days, but I have had many more days with "elevated heartrate" as a result of the anxiety, usually in the late evening or after I am in bed (part of the the sleep issues mentioned earlier). I have also noticed more chest pain, tightness or discomfort overall. But honestly I will take chest pain over brain issues! I took a total of 1.5mg of Ativan vs 2mg the 10 days prior to reinstatement (but 6mg since the beginning of the month, 9 separate days, as compared to only 2.5 in all of November).                 ).
• Diet has largely been the same, some low carb Keto with my wife, some "average" lightly healthy, no alcohol, no supplements right now. Made Zucchini bread with erythritol and almond flour last night but my wife says it is too sweet and the "swerve" aftertaste is not great.
• Activity level has been low with the horrible weather we have had. A handful of trips to run errands, pickup groceries, drop-off gifts, but all included some level of anxiety, worry, concern.
• The evenings that I streamed a few episodes of TV shows (mostly Sci-Fi/Fantasy) seemed to correlate to late night anxiety and sleep issues. I continue to try and replace this with reading but even the music biography I am reading now has been stressing me out for some strange reason! Perhaps it is not the content itself but the fast paced, rapid fire nature of the material and the need for your CNS to try and process what you are experiencing. Watching a nature documentary for example does not yield the same outcomes, but a Ken Burns documentary on the history of New York or Hemingway both left me anxious and uncomfortable.

Though it pains me to say this, I believe I should increase to 1mg Trintellix this weekend and see if there is further improvement (that was the original plan). Still not thinking about any reductions or tapers as this is a long way off yet. @getofflex you seemed to suggest I should stay at 0.5mg for much longer than two weeks?

 

Bottom line: I have had better Christmas breaks. The winter storm threat was causing anxiety last week and has turned out to be nothing but flurries and colder weather. It has been nice to do literally nothing, or very little. But the reality of "work" will kick back in soon. I think I am still dealing with a full December wave of various intensities, as I desperately hope a true "window" will feel better than the mild symptom reductions. But I can count a few small wins along the way, which I know are important.

 

I have attached a screenshot of the basic graph of daily scores in December. I color day of the month for "overall" symptom levels (blue=mild, lavender=moderate, peach and orange=not enjoyable at all). AGAIN I have been tweaking this process all month so lots of room for error. Hopefully I can be more accurate in January.

 

 

 

 

 

 

[getofflex]

On 12/27/2021 at 2:54 PM, YachtRock said:

While I can recognize some "improvement" I am not ready to claim any "relief" from symptoms. 

I'm sorry that you are experiencing an increase in nighttime symptoms.  It may possibly be at least partly caused by this:  

 

On 12/27/2021 at 2:54 PM, YachtRock said:

The evenings that I streamed a few episodes of TV shows (mostly Sci-Fi/Fantasy) seemed to correlate to late night anxiety and sleep issues. I continue to try and replace this with reading but even the music biography I am reading now has been stressing me out for some strange reason! Perhaps it is not the content itself but the fast paced, rapid fire nature of the material and the need for your CNS to try and process what you are experiencing. Watching a nature documentary for example does not yield the same outcomes, but a Ken Burns documentary on the history of New York or Hemingway both left me anxious and uncomfortable.

Unfortunately, our nervous systems become extremely sensitive during withdrawal, and stuff like this can cause us anxiety and stress. I've known some people to get stress responses during WD even to eating or bathing.  Any stimulation at all can cause issues for many of us. You might benefit from just reading something very boring and bland at night.  You may consider incorporating a time of meditation, to give your nervous system a break from stimulation.  This can help a lot to relax and calm down the nervous system. 

 

Not only that, you reinstated a week before Christmas, and life tends to get pretty intense for most during this time.  I try to keep my Christmas very simple and understated, but just dealing with the extra crowds in the grocery stores, the extra traffic, people tend to be more hyped up and stressed, etc, can cause more stress than we realize.   Stress alone can also ramp up our nervous system, and increase or cause symptoms.  

 

On 12/27/2021 at 2:54 PM, YachtRock said:

My total symptom "score" vs the 10 days prior is down 17% (lots of room for error/inaccuracy in all the scores)

It sounds as though the reinstatement is helping, at least somewhat.  It can take weeks to even a couple of months for a reinstatement to fully take effect, so to speak. It sounds like you are using some good coping techniques.  By the way, the techniques won't necessarily reduce or eliminate the symptoms, but they will make the symptoms easier to bear and cope with.  You may consider increasing your reinstatement to 0.75, or 1.0 mg. , but I would give it a little more time first, if it were me.  Keep up the good work!  Excellent job on tracking your symptoms and scoring them.    

Edited December 28, 2021 by getofflex

[YachtRock]

I can now say I felt "relief" last night. Either a window continued to open or the reinstatement just started working slightly. The first part of the day yesterday was very bleh... no desire to do anything and felt tons of malaise and slight chest symptoms. I spent about two hours listening to Claire Weekes videos to better understand her approach. I took my 12th dose around 3pm yesterday and started feeling noticeably more calm and collected around 5pm, which lasted through the evening and this morning! As of 12pm today the window started closing and anxiety/symptoms were creeping back in. Will be interesting to see if relief comes again after my 13th dose today but I am encouraged.

[getofflex]

17 hours ago, YachtRock said:

Will be interesting to see if relief comes again after my 13th dose today but I am encouraged.

Just remember, reinstatement is not a magic fix.  There is no quick fix for withdrawal.  Reinstatement helps to reduce symptoms and make it more bearable, and you may still have the windows and waves.  We also need to learn to "tough it out" as they say, when we have symptoms.  The link on non drug coping techniques has a huge amount of non drug ways to help you cope with your symptoms.  

 

I'm very glad you had a window last night. It's great that you are spending some time with Claire Weekes.  Keep up the good work. 

 

[YachtRock]

@getofflex well last night very much proved your point. I continued to feel much better through early afternoon. We went out for a drive (cabin fever) and picked up some fast food on the way home. I indulged on a burger and small shake, watched a little TV then was reading on the couch. I had "creeping" anxiety and symptoms since we had left the house hours before. They very suddenly started ramping up quickly and uncomfortably at home. Around 730pm I felt a wave of discomfort, fear and... I don't even know what to call it. It came on fast and strong and jolted me to my feet. Was like my brain had a short circuit. I was instantly panicking but calmed down quickly. Had to keep moving around doing things but heavy head symptoms persisted for a long while. It was like smothering but beyond just a chest sensarion. I finally took Lorazepam to ensure I could sleep peacefully and not struggle. But that was no fun, and so horrible just 24 hours after feeling so great.

 

I certainly tried to tough it out, even remember thinking to myself "do your worst" (Weekes) well it certainly did! My pulse was normal but my BP was 160/101 which concerned me. It has only ever been that high once before. Also learned I should probably avoid Tylenol and Advil when taking Propranolol.

 

Still on the fence about increasing my reinstatement dose. I have felt both significantly better and significantly worse in the past 36 hours.

[YachtRock]

Happy New Year @getofflex. Wishing you and your family a wonderful and better 2022.

 

Unfortunately the negative trend continued the past few days. My psychiatrist completely missed by video appt yesterday afternoon. New Years Eve was challenging, with an unexpected trip to see friends, an unexpected detour on the way home, then capped off last night with fireworks until 1am that really bothered me for the first time ever. While in the car I felt chills which progressed to head pressure and ringing ears, then I could not stop fighting it all the way home. It is hard to accept and float while driving around at night! Clearly something triggered me or I became over stimulated.

 

I slept less than 5 hours, spent this morning reading posts and threads on reinstatement and suffering with chest tightness and sharp chest pain and increasing anxiety. This peaked around 11am with intense discomfort and panic and was forced to take 0.5mg Lorazepam for relief. Not how I hoped to start the new year.

 

I hope you are faring better this weekend!

[getofflex]

1 hour ago, YachtRock said:

New Years Eve was challenging, with an unexpected trip to see friends, an unexpected detour on the way home, then capped off last night with fireworks until 1am that really bothered me for the first time ever.

Yes, this is a very challenging time of the year.  I believe that the holidays are a big stress factor, and this alone can trigger a wave and WD symptoms.  I, for one, did not fall asleep until well past midnight, due to fireworks, tension in the family due to teenage attitude about going out last night, and some other things that are too personal to go into here.   

 

If it were me, I would hang in there and see if things don't settle down now that the holidays are over. I, for one, am relieved they are over.  I personally think there is too much hype around this time of year.   Being stimulated by all this hype can certainly trigger our nervous systems in withdrawal.  

[YachtRock]

@getofflex I think that is true for most people. In my case the holidays were easy going, very little work stress and only slight family stress (we don't have kids or family nearby). Next week I have to resume my semi normal job. I have tons of flexibility (I started the company) but lots of stress and expectations. So that is probably going to create more triggers for me than the holidays did 🤔. I will stick it out with my initial dose a while longer but may have no choice than to start updosing until I level out in some way, even if it is painfully slow.

[getofflex]

18 hours ago, YachtRock said:

I will stick it out with my initial dose a while longer but may have no choice than to start updosing until I level out in some way, even if it is painfully slow.

Sounds good.  I'm glad you are being patient with this.  If you updose, only updose slightly to avoid kindling - say 0.75 or 0.1 mg Trintellix.