snowdog: From anxiety to 3 antipsychotics due to medical error

[snowdog]

Took a lot of antidepressants during 2015 for anxiety. The last one was paroxetine, which induced a hypomania, according to doc (was more like an extreme irritability).

After that, I started my treatment for "bipolar 2" with lots of medication failures due to extreme side effects (I'm too sensitive to this kind of drug) . The only drug my body kind of "accepted" was quetiapine xr 50 mg.

In april 2021 doc made a mistake and gave me the wrong pills with a dosage of 300mg! Started having adrenaline rushes and heart issues. The pills (at least in my country) look the same! I realized only after 17 days, went back to 50 mg but developed what I recently discovered was a severe 3 months withdrawal. The doctor, to "manage" the withdrawal (although he never said was withdrawal, he said it was anxiety and panic), put me on 25mg of amisulpride, 1.25mg of olanzapine and 1mg of clonazepam (couldn't tolerate more than these). After 1 month of clonazepam, doc started a "taper" reducing 1 drop per week (in my country, clonazepam has this liquid formulation). After I completely stopped the clonazepam I entered on a terrible withdrawal, the doctor said it was normal and suggested increasing olanzapine to 2.5 mg. Took only one week and went down to 1.25mg again.

Found another doc who said I'm not bipolar and probably have some anger issues and general anxiety, but manageable through therapy. He said the meds made all the bad stuff I've been feeling during the last 6 years. Proposed to taper all meds during a long time, but since I'm too bad (feeling very tired) and the last drug was olanzapine (which he told me is a terrible and dangerous drug) and is in the same class as the others, he proposed try to be a "little" fast (not so little cuts every 4 weeks) because he thought my tiredness was from that. Went from 1.25mg (1/2 a pill) to 0.9325mg (3/8th a pill) and it was good. Then went from 0.9325mg to 0.625mg (1/4th a pill) and had only some tremors during 3 hours on two days. When I went from 0.625mg to 0.3125mg(1/8th a pill) I felt very bad for two days with extreme anxiety, insomnia and nausea, then I started slowly improving. Now it's one and a half weeks past and I feel a bit tired and have some chest pressure. Doc said to wait two months to make any changes in medications.

 

So, what's next? Since I'm at this low dosage should I taper more? At what dosage should I jump off from olanzapine? I bought a digital scale and the 1/8th a pill weighs 12mg. So I can do the 10% rule for 3 months until I hit the 9 mg of pill weight (0,2344 a dosage). After that the decrements will be 1mg, more than 10%. In this extreme case is it acceptable?

[hayduke]

Hi @snowdog.  Welcome to SA, and thank you for providing your drug history in your signature.

 

That's a very unpleasant experience you've been through there - condolences.  It's good to hear you've found a supportive doctor now - well done on being proactive about finding the right support for yourself.

 

As most doctors aren't aware of the need for many or most people to taper at 10% per month, or slower, you've been coming down off all those drugs a lot faster than that.

 

Your doctor's advice to hold where you are for some months is the right idea.

 

Since olanzapine and quetiapine are both in the same general class of major tranquillisers, it's quite irresponsible to prescribe more than one of these at a time.  You're on a very low dose of olanzapine now, so I wouldn't worry too much about its effects in particular at that level for a little while, especially as the quetiapine will be doing comparable things but much more so.  It's also good to hear that you've been feeling steady after your last cut, which was quite large, but hopefully will be mitigated by the steady dose of quetiapine for now.

 

How are you measuring out these small doses of these drugs?

 

If you are feeling reasonable after a couple of months, by all means make a 10% cut with the olanzapine.  If you tolerate that well you might be able to come down a bit quicker since the quetiapine is still covering a lot of that turf.  But wait and see.

 

Once the olanzapine is out of your system I would hold for a good while again to let everything readjust.  This will be a good time to plan and prepare for the rest of your taper.

 

I will post some links for you shortly.

[hayduke]

 

 

 

 

 

Should be a good start.  Amisulpride might be a good one to look at tapering next, after you're off olanzapine and steady.  Some people find it difficult and it might be easier to deal with while the quetiapine is still there, rather than on its own.  Again, one day at a time 🙂

[snowdog]

Thanx for all tips, @hayduke. I'm kind of not using too much internet due to trigger factors. So I'm avoiding reading too much stuff about withdrawals. 

 

After my first post I had one week of bad sleep, with two days of real insomnia, but I had no other symptoms. My sleep pattern has improved a lot by 3 and a half weeks mark.  Now I'm almost at five weeks mark since last reduction and I feel overall fine. I wouldn't say I'm 100%, but I'm ok. Last two weeks I'm doing some fast pace walks and now start jogging a little. I think this has improved my tiredness, but it may be some placebo effect, I don't know.

 

Next friday I'm going to an appointment with my current doctor and I'll discuss all thing with him. From time to time I will report my evolution here and leave my history! 

[snowdog]

On 11/30/2021 at 5:07 PM, hayduke said:

 It's good to hear you've found a supportive doctor now

He's a pretty good doctor. Actually, he knows this forum and others and knows about the 10% rule. The thing is, he thought we needed to go fast because of excess of medications of this class and the risks. After we saw how things went we would adjust the taper. He was very honest about all the taper and the risks of the drugs. I understand his thoughts, since I was on a terrible state the very first time I sought him.

 

On 11/30/2021 at 5:07 PM, hayduke said:

How are you measuring out these small doses of these drugs?

I was just dry cutting them, now I have a scale. Doc told me I can use the liquid method too, specially at the end if things get hard. Another idea is to find a compound pharmacy, but here it's illegal to work with some drugs that act at CNS.

 

On 11/30/2021 at 5:07 PM, hayduke said:

the quetiapine is still covering a lot of that turf

It's my doc hypothesis, since they hit a lot of the same receptors.

 

On 11/30/2021 at 5:17 PM, hayduke said:

Amisulpride might be a good one to look at tapering next

I hate this drug, it's a wreck for my libido (even at this very low dose) and at the same time does nothing besides that. My doc told me, the only thing I'm having with all this medications is probably the sleepiness from quetiapine and sides effects.

[snowdog]

I have a funny history to tell you guys. 

 

I made a bad review over google about my ex-doc office. After that, he tried to contact me (after 3 months of my last consultation). He sent me a message saying I needed adjustments of medication, because I was showing "symptoms" (it was just gaslighting, like if my bad review was just me going "nuts"). He also said he never did anything to harm me. For sure he had no intention to harm me, he just know nothing about medicines and diagnosis.

 

I didn't answer his message and after that he asked his secretary to send me an email telling me that if I have a "breakdown" it's just my responsibility, since I left the treatment. I answered this email, telling I doing fine with a new better doctor and I never abandoned treatment, just looked for a new opinion after he put me in a bad place for three months! I blocked his email and phones. I wish I could sue him, but my family thinks it's a difficult thing to prove.

 

It's a shame how bad these doctors are being trained.

[hayduke]

Good on you for being proactive about your needs.

[snowdog]

Things are well and soon I will jump off from Olanzapine and be only on Amisulpride 25mg and Quetiapine XR 50mg.  My doctor thinks it will be good to reduce some amount of the Quetiapine XR because of the sleepiness I feel during the day. The only thing is that he told me that there is no problem reducing the XR pill, but I read online that this is not good. I'm using a nail file and a scale. Any thoughts? I'm afraid of change to IR and have some bad reaction, or if I take a 25mg dose during the day I become more sleepy than with the XR.

[hayduke]

Sounds reasonable to come off the olanzapine first.  I would either leave it or the quetiapine for last and use it as a cushion against the amisulpride.

 

Made any more cuts yet?  How's your taper plan?

 

Cheers

[hayduke]

On 2/3/2022 at 7:16 AM, snowdog said:

The only thing is that he told me that there is no problem reducing the XR pill, but I read online that this is not good. I'm using a nail file and a scale. Any thoughts?

 

If you are doing this already, the slow release mechanism of the "XR" gets messed up, I believe.  I would want to switch to the non "XR" packaging before tapering that drug, or altering its tablet.

[hayduke]

 

[hayduke]

How ya getting on there @snowdog?

[snowdog]

Hi there, @hayduke!

 

I'm out of olanzapine for 1 month and 4 days now. The withdrawals was very mild, only one day (day 4 off) I had an "attack" with tremors, sweating and high blood pressure. It was nothing compared with the similar attacks I had during clonazepam or quetiapine (after that mistake I told in my initial post) withdrawal. It lasted about 2 hours and I just kept myself laying down. After this day I didn't had nothing that impact in my daily activities. Off course sometimes I have some light dizziness (although I not sure if it's withdrawal or a side effect off quetiapine) and a little increase in my blood pressure during the afternoon (but nothing too extreme, something like 14/9 and, if I'm moving, 15/10, but doctor said it is fine for now). My sleep is fine, only during 4 days I slept 6 hours, which was not that bad, and then the sleep returned to 8 hours.

 

My mood is very good and I'm back telling stupid jokes all the time to my family and friends. Also, I'm listening to a lot of music again (it's my passion). When I went out clonazepam I didn't listening to music for 2 months! 

 

I'll keep you up to date about the amisulpride taper. Thank you!

[hayduke]

That sounds really good @snowdog.  Please do let us know how you're getting on 🙂

[snowdog]

I'm 7 weeks out of Amisulpride. Almost two months. We tought it would be easier than Olanzapine, but the end was harder. I had almost one month of full symptoms, including heart and stomach issues with extreme anxiety and panic attacks. Things start to improve in the last three weeks, although my blood pressure usually goes up around 16:30 PM every other day.

[snowdog]

Now I'm almost three months out of amisulpride, had a lot of symptoms on and off. Things like headaches (three weeks in a row), chest pain, paresthesia (feeling like a sunburn in the chest, shoulder and face), urinary urgency and many others. My main issue now are fatigue and tachycardia (sometimes a peak in blood pressure too, but most the time it is good), which usually appears after exercises (even light ones, like walking), coffee or sometimes just when I stand up. I had an stomach flu three week ago, which made things worst. I think I developed some sort of POTS or dysautonomia. Thing is, I went to GP and cardiologist and, although they related the symptoms with withdrawal (which surprised me), at the end they only told me that it is high cortisol, so I don't have a proper diagnosis. I had an treadmill test and things are fine, just normal tachycardia.  In theory it doesn't make difference, but I want a medical license and it is close to impossible to have a license with just "anxiety" (since withdrawal is not believed by medical groups). I need the money, cause me and wife are paying for a new apartment where my mother in law lives now. I know it was kind of a bad decision now, but I was in full withdrawal when I signed the papers and spend all my economies, and the woman needed a house too (she pays a rent, but it doesn't cover entirely the monthly payments). With the license I would be able to receive part of my payments.

 

Another hypothesis is quetiapine is giving me these symptoms. I'm happy I'm just with 50mg quetiapine now, reducing the risks of the mix, but I'm holding to see if the things settle down a little more. I want to try to switch to the IR version in january. 

 

Well, you all can send me positive thoughts, so I can win in the new year eve lottery. I probably will create a NGO to help people suffering from medical intervention and withdrawal.

 

Sorry about you guys as therapists. I just need to get this off my chest.

 

 

[FireflyFyte]

3 hours ago, snowdog said:

Well, you all can send me positive thoughts, so I can win in the new year eve lottery. I probably will create a NGO to help people suffering from medical intervention and withdrawal.

 

Sorry about you guys as therapists. I just need to get this off my chest.

 

Sending you positive thoughts. I have found people here to be very supportive, and kind, and glad it is here as a resource.

[snowdog]

I found a simulator comparing XR vs IR blood concentration during the day in a scientific paper. I must say I didn't have the patience to read the article and just downloaded the code and made some adaptations for my dosage and adjusted the times to make the concentrations as close as possible. The X axis shows the time since the first dose you set in the simulator. Y axis show the concentration, based on a monte carlo simulation with the equations derived from real data collected from patients. The best curve for me is the curve where I divide IR in 4 doses, not in equal intervals. Source: https://www.mdpi.com/1999-4923/12/4/297

 

[hayduke]

Hey snowdog, well done persisting through the suckage.

How's your magnesium and omega-3 intake?  These are so vital here, without sustaining either I often find anxiety and the like can manifest.  Not sure why!

Magnesium in epsom salts or MgCl baths is a great way to take in magnesium.  Fish oil capsules and/or hemp protein powder are great sources of omega-3.

 

Yoga and vagus nerve exercises can be really helpful at putting your parasympathetic nervous system back into a calm, grounded state.  Have a look at Arielle Schwartz's videos, and Deb Dana in particular for guidance with that.  

Cheers 

Edited January 1, 2023 by hayduke

[snowdog]

Hi, @hayduke!

 

Things started improving in the last week of 2022. My POTS symptoms almost went away, then I realize they probably had to do to the tiny crumb of metoprolol I discontinued at the beginning of dec-2023. It's kind of funny, cause I never took more than half a pill of 25mg (it was an idea of my ex-pdoc to contain what  I now know it was cortisol rushes). All doctor told me to stop. Over time i usually reduced here and there a little bit and ended up stucked at literally 0.72mg, but wanted to stop first psych meds. Well, now it's done, but I had really three bad weeks. After the POTS symptoms, which bothered more was what I think was PVC's, feeling that like one to five times a day until the first week of 2023.

 

After new years eve I had a minor setback of symptoms for a few days of the beginning of january. I think it was due to the excess of (delicious) food and sweeties in the parties and in a trip in the first week of the year. When I came back from this trip I started feeling perfect fine, a real window. I went to the beach with my wife, although I was afraid of the extreme temperature, and things went fine. I ate healthy and drank lots of water. 

 

But not everything is good news. When I came back from the beach, I took a shot of B12 vitamin, following my GP's advice. Boy, things went really bad. I'm in a wave for three days now. Three hours after the shot I developed tremors and my heart start pounding. I was taking a shower. My blood pressure went as high as 180/100, right after I sit down. Then around 165-170/80-90 for one hour at rest. The next hour it decreased to 150/80. I was thinking of paying a visit to the ER again, but at the same time I knew it was withdrawals hitting me again. By the end of the same day I developed nausea and more palpitations. After felling better I went to the bed and I woke up 0:30 with racing heart and tremors. Again, my fight it was against my feeling of dying. After one hour things improved and I went to bed again. Off course the next day was my first day back to work and I woke up with tremors and other symptoms. Eventually it became an average anxiety and I went to work. The last two days were less severe, but with similar symptoms, just less intense and less prolonged. I don't recommend B12 shots for people in withdrawal. 

 

Now I have this weird feeling in my left arm, right on the deltoid muscle. It feels like I have some thing tied around.  I would not tell you that it was a pain, it is just a weird sensation. I was thinking it maybe could be a stroke (health anxiety again). 

 

Now I'm holding again for at least three months.

 

[snowdog]

I'm taking magnesium, but not omega-3. I will give a try to omega-3, I'm just afraid of my weak stomach. 

 

I don't have a tub at my apartment, so I bought a machine to make the foot soak after talking to a spa manager. She told me our feet is connected to all body, so it can help. A dear friend of mine gave me a aromatherapy kit. Lavanda oil is good for anxiety and headaches. I'm using ginger oil when feeling sick too. I feel they help. Off course, when in a extreme crises, it doesn't help too much.

 

I love Yoga. I developed insomnia after stopping my yoga classes in the past, which made me look for psychiatric attention (with other factors, as stress from work) . I will always regret this decision. 

 

 

On 1/1/2023 at 8:08 AM, hayduke said:

Hey snowdog, well done persisting through the suckage.

How's your magnesium and omega-3 intake?  These are so vital here, without sustaining either I often find anxiety and the like can manifest.  Not sure why!

Magnesium in epsom salts or MgCl baths is a great way to take in magnesium.  Fish oil capsules and/or hemp protein powder are great sources of omega-3.

 

Yoga and vagus nerve exercises can be really helpful at putting your parasympathetic nervous system back into a calm, grounded state.  Have a look at Arielle Schwartz's videos, and Deb Dana in particular for guidance with that.  

Cheers 

 

[hayduke]

I don't have a full bath here so make do with the foot soaks.  Daily if needed.

 

Yoga yoga yoga!  No point worrying about the past, just keep going.

Cheers

[snowdog]

Dear, @hayduke. Thanks for all support.

 

I'm doing the foot soaks with my wife. Actually, it looks like she loves the thing, a good point for me. We always loved the smell of lavender (now I realize I wrote lavanda - portuguese -  in a previous post).

 

My wave is getting better, but I still feeling a bit "numb" during the day, with weird feeling at my limbs (kind of numb too) and a hot feeling in my face (this is a common withdrawal symptom for me). As always, at night I feel better. Blood pressure is normal at rest for the last few days, but sometimes goes high when standing up or doing some effort, even light, after midday till the end of the evening (maybe my autonomic nervous system is still not full recovery, but I really think this daily pattern curious). I'm avoiding doing anything hard in the afternoon, mostly because of the symptoms.

 

It's a hard road to be in. Every day is a new symptom and health anxiety hits me hard. In addition to this, my brother is fighting a rare case of a tumor and one dear friend from our family is fighting cancer.  It's so difficult to stay calm during all these processes (yeah, I've got tears in my eyes right now at my work position). 

 

 

[hayduke]

Sorry to hear about the illnesses in your fam.  Part of healing from the numbing drugs is learning to handle more challenges without the wind blowing the tent over.

[hayduke]

Hey there @snowdog, how are you getting along?

Can I please also ask that you tidy up your signature, it's pretty long now!  We only need the dosage changes in there, life events log can just live in your intro thread here too.

Thank you

[snowdog]

Hi, @hayduke!

 

Things keep improving, but I had some set back by the mid of march cause I had covid-19 again!

 

I'm considering, with my family, moving to the country side. I live in a megacity, so, the stress is huge. My university has other campuses in the countryside and my family liked the idea, but I need to ask my boss's boss. My boss wants to help me!

[hayduke]

42 minutes ago, snowdog said:

Hi, @hayduke!

 

Things keep improving, but I had some set back by the mid of march cause I had covid-19 again!

 

I'm considering, with my family, moving to the country side. I live in a megacity, so, the stress is huge. My university has other campuses in the countryside and my family liked the idea, but I need to ask my boss's boss. My boss wants to help me!

Good to hear improvements.  Hope your recovery from covid went OK.

That sounds like a really good idea moving somewhere nicer, great your boss is on side.  Sometimes it can take some talking mgt into it, but I reckon it sounds like you could swing it.  Health concerns are a great reason and maybe all you need to say.  Another thing that might help if you have to keep the exact same role there, is regular reviews with a pre agreed plan on steps and resolutions to make sure everyone stays happy.  Your boss can help you with that.

Cheers

[snowdog]

I think I'm still in a kind of light wave after the covid-19. Altough I don't feel that bad, sometimes I feel a little dizzy during the day and, again, almost every day after 4pm my blood pressure spikes and goes above 140/80. Since I didn't have any changes in my medication I'm attributing these rebound of symptoms to covid-19. It's not that bad, but it's just weird. By the end of december to beginning of january, altough I had many symptoms on and off, my blood pressure were always around 120-130/70-80. Then I had some spykes after my b12 shot that went away after almost two months, but then I had the covid-19 and I'm again in the cycle. 

[snowdog]

I will keep this in a different post, but I want to talk about some things I realize went away or improved. I not sure if they were withdrawal o side-effect related.

 

- I realize my hair is stronger now, no more falling when comb them. Before I thought it could be my age, but now I'm sure it was medication.

- Most of the days, no more urinary urgency in the afternoon, and when I have it is like going to the restroom one time per hour.

- Another thing on the urinary field. Sometimes when I finished the job, when walking out the restroom, I kinda pissed in my pants a little bit. It was like there something left in the urethra. Now I don't have this issue at all.

- Sleeping 8 hours most of the days. I only have broken sleep in the days I have too much stress or emotion (sometimes positive).

- The sex drive is completely normal now, in all phases 🤭. 

- I'm again able to do some exercise, except some days after the evening, when POTS like symptoms appear. Anyway, I prefer to do them in the morning. During the day I don't have theses symptoms anymore.

[snowdog]

About my last days with some light symptoms. One thing we are thinking is that it has something to do with diet changes that I did in the last week affecting the way my body absorbs quetiapine.

[snowdog]

After a (long) while, I wish to share my last two and half months since my last post. My symptoms after covid-19 lessened bit by bit, but I was always with that kind of "crisis" in the afternoon (high blood pressure, tremors and etc). Working with my therapist/pdoc (it is the same person), I realized these symptoms didn't happen on weekends. After that, to reassure my perception, we had an extended holiday trip from June 8 to 11. I felt awesome these days! So, in the next week I started to analyse my days at work and look for some patterns.

 

I realized every time a toxic person came to my office (usually by the end of the morning or right after lunch), a felt the symptoms. Then, I also realized that when this person was at some medical leaves from long-covid at random times during the firsts months of this year, I also had almost no symptoms.

 

After that week of analysis, I tried to "hide" from that person, but you know that toxic persons are like vampires, and he always reached me some time during the day. In July 21st I talked to my superior and asked for help (I didn't want engage in a real "fight", to avoid stress, and she knew it and all about my taper, she even was really worried about this delaying my seroquel taper). She referred to our superior boss and said that I could use her office, until our boss would do something, so he couldn't find me. We were thinking our boss would do nothing, since these toxic person is about to make some surgery due to post-covid, and he said maybe "we could wait his long medical leaving and talk about it when he comes back", but for our surprise by July 22nd in the morning he changed his mind and had a confrontation with these toxic person.

 

After that day I'm perfectly fine and in 7 of July I started my switch from XR to IR. It was a agreement with my pdoc, since I thought it was enough time since my last taper and July is a month with few things to do at my job. So far so good, I only feel a little more sleepy in the morning for the past 12 days.

[hayduke]

It sucks when workplaces are made toxic by people like that.  Happens too often I think, glad you are getting the support to deal with it.

 

It's good you were able to identify what was causing your upsets, those kinds of feelings are a good 'sniff test' for narcissistic types, and you learn not to ignore that feeling when it comes up again.

[snowdog]

First month "birthday" from my seroquel taper. Hitting -10% today. I divided the reductions in order to make them smoother. Kind of a microtaper, but not everyday, since I'm limited by the weight taking in a 0.001g scale.

 

So far so good. I still a little sleepy/drowsy during the day, specially in the morning, but my sleep is good. It looks like seroquel IR is more prominent in this side effect, although in the past with th XR version I was always sleepy during the day.

[snowdog]

I fulfilled my initial goal of reducing 50% in around 6 months. So far so good.

[snowdog]

Down to 18mg of quetiapine. I had some bad flu last week (influenza) and started to get some random attacks, not sure if it is the virus or the last reduction (or a combination of both).