Bullitt1968: one-time method for reducing and discontinuing psychotropic drugs

[Bullitt1968]

Did someone here about that or has experience with it?

 

One-time method

 

The one-time method is a way to reduce severe withdrawal crises without restarting the drug, stopping withdrawal or risking hospitalisation.

 

In this method, the drug to be reduced is taken once again in the initial dosage. This is done in addition to the reduced dose. In this way, the withdrawal problem can be counteracted. Suddenly, the substance is available again in abundance and the body, which has been put on alert by the withdrawal, can calm down.

 

The procedure can also be extended to two or three days and the single dose gradually reduced again. Afterwards, one should return to the current reduction level. This is maintained until the condition has stabilised. Then the reduction can be continued.

 

Patients who experience an improvement in their severe symptoms as a result of the single dose will no longer be fooled into thinking that their symptoms are caused by a new phase of the disease. After such an experience, they know with certainty that their crisis is withdrawal-related.

 

The one-time method can also be used more frequently within a long-term withdrawal phase to prevent the withdrawal from having to be broken off.

 

"Enough swallowed. Withdrawl off psychotropic drugs successfully and permanently" by Dr. Peter Ansari and Mahinda Ansari, page 111 and 112

 

 

Edited April 5, 2022 by ChessieCat
reduced font/unbolded

[ChessieCat]

Hi Bullitt and welcome to SA,

 

SA's tapering protocol is a harm reduction method and recommends that you reduce by no more than 10% of the current dose followed by a hold of about 4 weeks to allow the brain to adapt to not getting as much of the drug.

 

Jumping up and down in doses may cause issues and the nervous system may become sensitised.  Also, the effect of changing drugs and doses is cumulative.  What might have worked for you before might not work the next time you try the same/similar thing.

 

Why taper by 10% of my dosage?

Dr Joseph Glenmullen's WD Symptoms Checklist

 

Post #1 of this topic has links to various drugs with information in the first post of those topics about ways to get non standard doses:

 

Important topics in the Tapering forum and FAQ

 

Please create your drug signature following these instructions:

 

Instructions:  Withdrawal History Signature

 

This is your own Introduction topic which is the place to ask questions about your situation and where you can journal your progress.  This keeps your history in one place.

[ChessieCat]

If you are referring to reinstating, after having gone off the drug completely, please read Post #1 of this topic:

 

About reinstating and stabilizing to reduce withdrawal symptoms

 

SA's recommendation is to only makes small increases/decreases.

 

[Bullitt1968]

Hi I am Markus from Germany,
Can anyone tell me which drugs have akathisia as a side effect? I get severe akathisia every time I try to reduce fluoxetine, as described by the MISSD Foundation. (see Handout) 
 

I also take pregabalin, promethazine and valium. Have tried and stopped quetiapine and doxepin. I could only find akathisia as a side effect in the package leaflet for fluoxetine, and this is strongly downplayed as restlessness and restless legs. 

In the German package insert for fluoxetine (SSRI), akathisia is described like this:
 

Quote

Akathisia/psychomotor restlessness.
The use of fluoxetine has been associated with the development of akathisia, which is characterised by a subjectively unpleasant and distressing restlessness and need to move, often together with an inability to sit still or stand still. This is most likely to occur during the first few weeks of treatment. For patients who experience such symptoms, a dose increase may be harmful.

The leaflets of all the other medicines did not mention akathisia.
 

Can these medications have akathisia as a side effect or increase it?

I have written to the MISSD Foundation but have not received a reply.

Is there a remedy for akathisia that relieves akathisia? 
 

 

What I have tried until now

 

I have tried meditation, act exercises, self compassion meditation, lavender, gaba, omega 3, vitamin D3+K2, ergometer training to total exhaustion, acupressure, acupuncture, magnesium, ultradian healing response according to Ernest Rossi. Nothing helped. I had acathisia before in 2017 after my psychiatrist at the time, discontinued fluoxetine using the official method, so very quickly and in leaps and bounds. I only got through the akathisia then because I was back on benzodiazepines, which I had successfully come off twice 5 years earlier.

 

I can't go any higher with any medication anymore, but maybe there are other remedies or methods I don't know yet that help.

 

What helps those who have or have had akathisia?

 

My discontinuation story from the beginning of last year until now.

 

Last year I was down to 20mg on fluoxetine, then I tried microtapering, which many sufferers in withdrawal forums had used successfully.

In the meantime, I know about Dr. Taylor's and Dr. Mark Horowitz's scientific work, with whom I exchange information, because I have translated their scientific work into German with Dr. Horowitz. This article advises against microtapering and with good reason.
 

Unfortunately, I only came across this article after microtapering. I was successful with Microtapering and was able to stop the Fluoxetine, for 10 days I felt really good and thought I had made it! Then on the 11th day came the akathisia, I went back up to the full 60 mg with the fluoxetine on the instructions of my psychiatrist, maybe it would have been enough to go back up to the 20 mg at which I was still stable before the microtapering, but I was panicky and strongly suicidal, I had compulsive suicidal thoughts forcing themselves on me, as described in MISSD. 

I then had to increase the promethazine from 10 mg to 100 mg and the diazepam from 7.5 mg to 50 mg and was prescribed 300 mg of pregabalin.

After the 3 worst weeks of my life with continuous severe akathisia and anxiety. The akathisia was gone again.
 

Now I have many side effects from the other medications.

An attempt to reduce fluoxetine by 5% a year after the severe akathisia ended after only 2 days of severe akathisia. Before that I was able to reduce fluoxetine to 20mg using the 10% method as I said. Now my nervous system is so sensitive that it notices the slightest change.

I've also been taking 600mg of 5-HTP for a while, so I've been able to reduce it down to the 20mg, because before that I couldn't get down a mg either. I measure the serotonin level in my body several times. The last time was at the beginning of the year. The serotonin level is well above the normal range, but the consumption measured by the degradation product 5 HIES of serotonin is much higher. My body metabolises serotonin but consumes more than I can supply.

I hope someone can help me.

I'm a member of the German Society for Social Psychiatry and I have a website, an infoportal, that educates about, sorry, all that ****. I moderated and advised in a German withdrawal forum for 2 years.

Kind Regards

Markus

 

handout missd akathisia.pdf

[Altostrata]

Hello, @Bullitt1968

 

17 hours ago, Bullitt1968 said:

This article advises against microtapering and with good reason.

 

Dr. Horowitz's work does not advise against micro-tapering.

 

17 hours ago, Bullitt1968 said:

I was successful with Microtapering and was able to stop the Fluoxetine, for 10 days I felt really good and thought I had made it! Then on the 11th day came the akathisia, I went back up to the full 60 mg with the fluoxetine on the instructions of my psychiatrist, maybe it would have been enough to go back up to the 20 mg at which I was still stable before the microtapering, but I was panicky and strongly suicidal, I had compulsive suicidal thoughts forcing themselves on me, as described in MISSD. 

I then had to increase the promethazine from 10 mg to 100 mg and the diazepam from 7.5 mg to 50 mg and was prescribed 300 mg of pregabalin.

After the 3 worst weeks of my life with continuous severe akathisia and anxiety. The akathisia was gone again.

 

What dates did all these events occur?

 

Exactly what drugs are you taking now, including 5-HTP, at what dosages and times o'clock? 

 

You are aware that reducing 5-HTP after habitual use will also bring on withdrawal effects? Were you tapering Prozac and 5-HTP at the same time?

 

17 hours ago, Bullitt1968 said:

Now I have many side effects from the other medications.

 

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

 

 

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

[methuselah]

I think bullitt is probably referring to this from Horowitz.  While he does say that mini tapering is preferred over micro tapers, I think it’s relative bc SA advised microtapers would still have to adhere to the 10% or less rule which would adhere to a hyperbolic taper.  Just my .02

 

 

[Onmyway]

@methuselah, I had wondered about that part of the paper as well. I had always thought that microtapering would be more gentle but it depends on the ultimate cumulative percentage, I guess. I wish they were more detailed in what they meant. A daily 1% decrease would be much worse than a monthly 10% but the Brassmonkey microtaper would be ok, is what you're saying. I think a microtaper is perhaps better for someone who has been tapering for a while, knows their symptom pattern and can be alert to issues before they accumulate.

 

OMW 

[Altostrata]

We have a detailed topic on microtapering. We advise that people understand their withdrawal symptom pattern, which means allowing adequate observation time before the next reduction, while using it -- not jump into making a micro reduction every day.

 

I am sure Dr. Horowitz would agree with this if someone cannot tolerate larger reductions.

[Bullitt1968]

@Altostrata

Thank you very much for your answer:
This is not correct. Dr Horowitz advises against microtapering, and with good reasoning, including the accumulation of withdrawal symptoms where one no longer knows which reduction was responsible.

The nervous system can never recover from microtapering and is under constant stress. Under "Some practical consequences of these principles" Taylor and Horowitz write:

 

Quote

 

The model proposed also resolves a quandary often raised by patients and treating physicians: whether to ‘micro-taper’ or ‘mini-taper’. ‘Micro-tapering’ involves miniscule decrements in SSRI medication every day or week. ‘Mini-tapering’ involves step-wise larger decrements, with longer intervals in between decrements (generally, weeks). ‘Mini-tapering’ appears more sensible than ‘micro-tapering’ (although both are linear methods).

Withdrawal symptoms are reported to last for several weeks (or longer) after medication discontinuation in a significant proportion of patients ^9,13. Given this pattern, ‘micro-tapering’ presents the possibility of cumulative withdrawal effects superimposing upon one another. This would make it difficult to establish which reduction (or set of reductions) were responsible for symptoms experienced. It therefore seems prudent to decrease the dose of medication, allow a significant period of time to elapse while withdrawal effects resolve, before commencing the next decrement.

 

Signature will follow.

Kind Regards

Markus

 

[Bullitt1968]

Methuselah yes I do.

[Onmyway]

33 minutes ago, Bullitt1968 said:

@Altostrata

Thank you very much for your answer:
This is not correct. Dr Horowitz advises against microtapering, and with good reasoning, including the accumulation of withdrawal symptoms where one no longer knows which reduction was responsible.

The nervous system can never recover from microtapering and is under constant stress. Under "Some practical consequences of these principles" Taylor and Horowitz write:

 

Signature will follow.

Kind Regards

Markus

 

Actually neither the mini tapering nor the microtapering recommended by SA are linear, they are both hyperbolic.  That means they are both a  percentage of the previous dose rather than a set (same) amount every day/week/month.

 

The micro tapering referred to in Horowitz et al is not well defined and as such it's not clear we are talking about the same things.

 

And while withdrawal symptoms might last for a few weeks, the point of microtapering is to be so gentle that one does not get noticeable withdrawal symptoms at all as the reduction is so small.

 

I'm currently doing about 0.2% reductions every day. When I feel difficult symptoms or have a stressful life event I stop and wait for a few days. I find it more flexible. If something stressful happened 7 days after a larger drop I would have no way to react. I didn't start to do this until 3 years into withdrawal/reinstatement/tapering and knew my pattern of symptoms and adjustment. I am also not promoting/recommending it, people can decide what works for them. I just don't think that as long as the reductions are cumulatively less than 10% of previous dose a month and people follow their body -  microtapering is any worse in practice.

 

Theoretical arguments can exist in either direction, in the end we don't have good empirical evidence of which is better. 

Edited September 5, 2022 by Onmyway

[Altostrata]

Having discussed this at length with Dr. Horowitz, I can assure you that if needed, he would endorse a systematic microtaper if there was an appropriate understanding of symptom pattern.

 

On 9/4/2022 at 12:32 AM, Bullitt1968 said:

I was successful with Microtapering and was able to stop the Fluoxetine, for 10 days I felt really good and thought I had made it! Then on the 11th day came the akathisia

 

Perhaps you can explain the microtapering method that you used above, which appears to have failed. Were you also changing other drugs, such as 5-HTP, while you were tapering Prozac?

 

If you want to skip doses, as you described in your initial post, feel free to do that. We do not recommend it and will not support it.

 

But before any further discussion, please summarize your withdrawal history in your signature.

 

(Please post links to documents so nothing need by downloaded.)

[Bullitt1968]

@Altostrata

Thank you very much for your answer. I also had a longer discussion with Dr Horowitz, he clearly advised me against it, but by then it was already too late.:
 

What about my questions about akathisia? Are there any scientific papers about it and are there people here in the forum who have experienced or are still experiencing akathisia and what has helped them?
 

Since I have repeatedly experienced akathisia when reducing even small reductions of 5%, it is logical that this will happen again the next time I try. So I need a strategy on how to reduce the SSRI fluoxetine, which is the main problem, firstly because it has akathisia as a side effect and secondly because you can't take akathisia for long, at least I can't, 3 weeks was already very bad!
 

I can say about my history that everything that could be done wrong by psychiatrists in clinics and outpatient therapy was done wrong from the beginning.

I first had to find out how to reduce and stop the medication properly. Several doctors and psychiatrists tried their hand at it. They did the withdrawal too quickly and in too big steps. It took me years to find help! By the time I found out about a forum for those affected in Germany, I had already had more than 10 failed attempts at withdrawal. 

My nervous system has become more and more sensitised and now reacts very strongly to the smallest changes.

With every failed attempt, something remained, a symptom that manifested itself, an existing one became stronger or a new one was added.

So I already have a whole range of chronic withdrawal symptoms. 

Translated with www.DeepL.com/Translator (free version)

[ChessieCat]

I don't think it is good idea to microtaper Prozac because of the very long half life of the drug which means that withdrawal symptoms might not appear for 2-3 weeks after a reduction:

 

On 7/3/2011 at 4:11 AM, Altostrata said:

Prozac has the longest half-life of any SSRI. After you take it for a few days, half-life is about 16 days. Fluoxetine itself has a half-life of 2-4 days, but as it is processed, your body creates an active antidepressant metabolite, norfluoxetine, which has a half-life of 7-15 days. So Prozac keeps on extending its half-life as it is metabolized.

According to http://en.wikipedia.org/wiki/Fluoxetine , fluoxetine and norfluoxetine inhibit each other's metabolism, extending the half-life of the drug. Because the half-lives are so long, the full effect of Prozac on the brain may not be felt for several weeks.

fluoxetine (1-6 days) ---> norfluoxetine (up to 16 days) ---> other metabolites

 

 

 

 

[Altostrata]

1 hour ago, Altostrata said:

Perhaps you can explain the microtapering method that you used above, which appears to have failed. Were you also changing other drugs, such as 5-HTP, while you were tapering Prozac?

 

I am unable to follow what you did with your drugs.

 

What exactly were the symptoms you describe as akathisia?

 

I would rather find out where you are right now in your drug dosing rather than argue about microtapering.

[Bullitt1968]

@Altostrata

 

It's all in the first post: The worst are the suicidal thoughts that automatically force themselves upon me, the morbid behaviour, the strong inner restlessness, as if I were burning up inside or it was tearing me apart. Then I just lie curled up in bed. I can't do anything to alleviate the symptoms, I only have mindfulness meditation and self-compassion meditation. Psychotherapeutically, I have a lot of skills from ACT Acceptance and Commitment Therapy to compassionately accept what is happening.

 

This is bearable for me for a day or a week but if it lasts longer it is hell, I was in this hell for 3 weeks until the medication levels built up again from the fluoxetine.

 

That was last summer, when I reduced from 20 mg fluoxetine to 0 mg with microtapering. After 10 days, the akathisia set in.

 

On the advice of the local psychiatric outpatient clinic, I not only had to reduce the fluoxetine back to 60 mg (it might have been enough to go back to 20 mg when I was still stable, but I was in a strong panic and followed the advice), I also had to increase promethazine from 10 mg to 100 mg (maximum dose).

 

Also Valium from 7.5 mg to 40 mg (maximum dose).

 

Plus 300 mg of pregabalin. Dr Horowitz, whose thesis I found when it was too late, advised me not to try microtapering again and not to do anything for a year so that the nervous system could calm down. That is what I did. Then a few weeks ago I tried a new withdrawal, only 5% reduced from 60 mg to 55 mg fluoxetine. Already on the 2nd day I got severe akathisia, as described.

 

I went back up to 60 mg, this time some of the symptoms of akathisia remained. These include strong inner restlessness and physical tension from head to toe. A strong tingling in the whole body, before only arms and legs.

 

I now wake up every morning with intense anxiety, which was not the case before trial with microtapering,, when I had no anxiety at all but severe stomach pains.

 

Since I obviously can't reduce the fluoxetine anymore, which worked before the microtapering. With the help of a nutrient expert and treatment with 5-HTP, vitamin D3+K2, omega-3 fatty acids and others, I was able to reduce it to 20 mg.

 

The serotonin level was measured more often, in the body, it doesn't work in the brain. Most serotonin is produced in the intestine 85%.

 

At first, the 5-HTP was not metabolised at all, the value was almost 0.

 

Only when I managed to reduce the fluoxetine to 40 mg was the 5-HTP metabolised. The serotonin level is now above the normal range, but still within the therapeutic range. By measuring 5 HIES, it could be determined that the 5-HTP is metabolised, but the consumption is far above the normal range, up to 10-fold.

 

I have not had a serotonin syndrome so far, but I have a serotonin deficit syndrome as described by Prof Roemmler.

 

Antidepressants strongly reduce the serotonin level with the duration of use. Serotonin has important tasks in the human organism, it regulates appetite and satiety, which is why you gain so much weight when you take antidepressants, there is no longer a feeling of satiety.

 

A distinction is made between the central and peripheral areas.

 

Functions in the "peripheral area" are:

 

• Wound healing
• Blood clotting
• Liver and heart functions

 

Functions in the "central nervous system" include:

 

• sleep regulation
• Sensation of pain
• Control of emotionality
• Cognition (memory, concentration, recall)
• Regulation of body temperature
• Appetite and satiety

 

In my case, pretty much all of this has been disturbed by long-term use of fluoxetine since 2009.

 

The fluoxetine has turned a previously healthy brain into a pathologically altered brain.

 

And now I am trying together with my new psychiatrist at the Charite Berlin, whom Dr. Horowitz recommended to me, the two of them are friends. My psychiatrist is in charge of the newly founded special consultation "Accompanied Discontinuation of Psychotropic Drugs".

 

I will try to dose Doxepin up to 150 mg next. I had been taking it for a while and had no problems stopping it. When the doxepin is at 150 mg, I will try to reduce the fluoxetine slowly. The doxepin should then replace the fluoxetine and I will continue to take the doxepin, because it has been good for me for a long time.

 

 

If that doesn't work either, I don't know what will. As it is now with all the chronic severe withdrawal symptoms, it's not a life worth living. It's survival and that has nothing to do with life. I've been surviving for a very long time, almost 10 years.

 

My wish would be to have the security and guarantee of assisted suicide as an exit. Unfortunately, this is forbidden in Germany.

 

In the US I could just buy a gun, but that's almost impossible in Germany and that is right for me!
 

If I had this exit, I wouldn't keep falling into this suicide trap, triggered by akathisia and its symptoms, the automatic and compulsive driving to suicide, in complete powerlessness.
 

I would be aware that I have an exit when I can't stand it any more.
 

I am a Buddhist and have certain ethical and moral principles that do not allow violent suicide and I would not be able to do it at all, would be afraid that it would not work and I would end up in a wheelchair or someone innocent would be traumatised, like a train driver running me over.

I hope it is understandable. Signature with full history follows.

This is a short video where a person asks Thich Nhat Hanh if assisted suicide in Buddhism is ok.
 

Translated with www.DeepL.com/Translator (free version)

handout missd akathisia.pdf

[ChessieCat]

5 minutes ago, Bullitt1968 said:

Then a few weeks ago I tried a new withdrawal, only 5% reduced from 60 mg to 55 mg fluoxetine.

 

This is an 8.33333% decrease, not 5%.

[ChessieCat]

3 hours ago, Altostrata said:

But before any further discussion, please summarize your withdrawal history in your signature.

 

If you cannot create a drug signature at this time, please list your current drugs and doses and the times you take them in a post.

[Bullitt1968]

@ChessieCatIt is 3. 5 % from 60 = 3. . So i reduced from 60 mg to 57 mg.

[Altostrata]

Please answer the questions I ask you. If you don't care to do that, I'll spend my time answering other topics.

[Bullitt1968]

@AltostrataI will do, but please read my posts, because I answered your questions in it. And I did not want to

Quote

Perhaps you can explain the microtapering method that you used above, which appears to have failed. Were you also changing other drugs, such as 5-HTP, while you were tapering Prozac?

I changed nothing, not medication or NEMs like 5-HTP. The Method was to fast for Prozac, I know now, because of its long half life of 8 Weeks, you could taper a lot with microtapering in 8 Weeks, I did not know the long half life of Prozac.

 

Quote

What exactly were the symptoms you describe as akathisia?

I described the symptoms above, but repeat it : 

The worst are the suicidal thoughts that automatically force themselves upon me, the morbid behaviour, the strong inner restlessness, as if I were burning up inside or it was tearing me apart. Then I just lie curled up in bed. I can't do anything to alleviate the symptoms, I only have mindfulness meditation and self-compassion meditation. Psychotherapeutically, I have a lot of skills from ACT Acceptance and Commitment Therapy to compassionately accept what is happening.

 

· Irritability, I woke up in the morning and did not know where I am and what day or time it is.

· Hostility
 

Quote

If you want to skip doses, as you described in your initial post, feel free to do that. We do not recommend it and will not support it.

I wonder, where that came from? I never wanted to skip doses. I did not unterstand why you say that? I only described that, the one time method in the book auf Peter Ansari and asked, if someone has experience with it, thats all.

 

Quote

I would rather find out where you are right now in your drug dosing rather than argue about microtapering.

I also did not want to argue about microtapering any longer. I would like to know which psychotropic drugs can trigger and intensify akathisia. Acathisia is only mentioned in the leaflet of Prozac but not in the leaflet of Promethazine, Lorazepam or Pregabalin. I am looking for studies, articles and personal experiences.

 

          For current Medication see signature.

[Altostrata]

Nope, I'm not going to weed through your posts to find the information I need, nor am I going to debate your symptom history with you. It's actually a holiday here in the US, sunny and warm, and I have other things to do with my time.

 

12 hours ago, Bullitt1968 said:

Also Valium from 7.5 mg to 40 mg (maximum dose).

 

You're taking 40mg Valium per day? With 5mg lorazepam and 300mg pregabalin?

 

What exactly are you taking now, at what times o'clock and dosages? How do you feel before and after each dose?

 

What are your most prominent current symptoms? Are they better or worse at any particular times of day?

 

I am dubious we can work with your theories of serotonin and experiments with 5-HTP. It appears to me that you are vastly overdosed in all your drugs and that is why you have symptoms of activation, as opposed to akathisia. Please put ALL your drugs in this Interactions Checker and post the report or a link to it in this topic.

 

Please be advised that if you continue to dwell upon suicide, we must refer you to face-to-face help in your vicinity. As an online community, we cannot respond to emergencies, we don't even know the real names of our members.

 

[Onmyway]

@Bullitt1968we find that vitamin D and B vitamins cause anxiety/activation and potentially akathisia in people in withdrawal and recommend people don't take them unless deficient. You can do what you want with that information.

Edited September 5, 2022 by Onmyway

[Bullitt1968]

@Altostrata

 

 

Maybe there is also a language barrier. I am from Germany my English is passable, I translate what I answer with an online translator which is very good.
 

Please be aware that my cognition and concentration are very poor. I may make mistakes when typing that I don't notice even after looking at it for the third time, I do, I read what I write 3 times to avoid that, but I don't always succeed. 

 

Daily drugs:

Morning Medication:

When I wake up in the morning (time is very variable between 7 and 9), I have severe anxiety, not akathisia.
Tightness in the chest
Tingling throughout the body
Strong muscle tension
Suicidal thoughts
listlessness
Nausea
Abdominal pain
Derealisation

I then take 2mg of Tavor, I switched from Valium to Tavor as the Valium makes me too tired. I also take 300mg pregabalin, 60 mg Prozac, 50 qu L-thyroxine. I have hypothyroidism.

After that I feel better, the severe anxiety symptoms are gone.

 

I also think I am taking too much medication, but without it I would have severe akathisia.

 

1 hour later I take the NEMS: 5,000 i.e. vitamin D3+K2, vitamin B complex 2 capsules (I can still list what is in there and how much I take. Please be patient, I have to translate first.
 

200mg magnesium citrate, 8 mg omega 3 fatty acids.
 

At noon, around 1pm

 I take another 200mg of magnesium citrate, plus 50mg of promethazine and 1mg of lorazepam. Plus 300 mg 5-HTP and another 200 mg magnesium citrate.
 

Now the anxiety is even more reduced, I am calm and sedated, concentration and cognition is worse than in the morning, I also have blurred vision (side effect Pregabalin).

Evening:
 

from 18:00 in the evening I take another 50mg promethazine, 300 mg 5-HTP, 1 mg lorazepam.

My condition is now stable, sedated, hardly any anxiety, but very depressed.

At night 1 mg Lorazepam if needed and lavender as well as 500 mg Gaba.

After that I usually sleep very well, but wake up too early with the panic.
 

Akathisia:

I have the feeling, that you doubt that I had akathisia, last year with the crash the 3 weeks long and also now when trying to reduce Prozac now? Is that right?
 

Do you know MISSD and how it describes akathisia? I had most of it in the 3 weeks last year and if I reduce even 5% now, I get it after 2 days at the latest.

Do you know how the MISSD Foundation and how they describes akathisia? Here it follows:

 

Quote

Definition of Akathisia from MISSD Foundation: 

· Akathisia is a disorder, induced as a side effect of medications (including SSRIs and antipsychotics), which can cause a person to experience such intense inner restlessness that the sufferer is driven to violence and/or suicide.

·

Symptoms

Symptoms of akathisia are an increase in:

· Physical/Inner Restlessness

· Anxiety/Panic Attacks

· Agitation

· Impulsivity

· Aggressiveness

· Insomnia (not a problem)

· Irritability (I wake up in the morning at did not know, where I am and what day or time is)

· Hostility

MISSD Foundation

 

The worst for me are the suicidal thoughts that automatically force themselves upon me, the morbid behaviour, the strong inner restlessness, as if I were burning up inside or it was tearing me apart. Then I just lie curled up in bed. I can't do anything to alleviate the symptoms, I only have mindfulness meditation and self-compassion meditation. Psychotherapeutically, I have a lot of skills from ACT Acceptance and Commitment Therapy to compassionately accept what is happening. This all appears trying zu reduce Prozac after 2 days.

Interaction checker see uploded files. I hope, I have answered your questions. It is difficult for me because of poor concentration.

drugs-interaction-checker.docx

Edited September 6, 2022 by Bullitt1968
add file drugs-interaction-checker

[Bullitt1968]

@OnmywayI have severe defjance because I have a lot of 

various food intolerances. I have to avoid lactose, fructose, gluten and histamine as much as possible and there is not much left that I can eat.

If I consume just one of them, I get severe colic and cramps in my stomach during the night at the latest, which can last up to 5 hours. They come in waves. I don't take in enough nutrients and vitamins through food, the deficiency has been confirmed by laboratory tests and is checked regularly.

[Bullitt1968]

@AltostrataI have no intention of harming myself, as mentioned violent suicide is against my ethics as a Buddhist.

[ChessieCat]

1 hour ago, Bullitt1968 said:

Interaction checker see uploded files.

 

Please see the following:

 

On 9/5/2022 at 5:43 PM, Altostrata said:

(Please post links to documents so nothing need by downloaded.)

 

9 hours ago, Altostrata said:

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

 

[Bullitt1968]

@ChessieCatI have communicated all this. Here is the link to the interaktion checker, hope you can open itL

Drug Interaction Report

[Onmyway]

6 hours ago, Bullitt1968 said:

@OnmywayI have severe defjance because I have a lot of 

various food intolerances. I have to avoid lactose, fructose, gluten and histamine as much as possible and there is not much left that I can eat.

If I consume just one of them, I get severe colic and cramps in my stomach during the night at the latest, which can last up to 5 hours. They come in waves. I don't take in enough nutrients and vitamins through food, the deficiency has been confirmed by laboratory tests and is checked regularly.

For vitamin D I try getting it from the sun esp in the summer and take only as much as I need - you need about 400 IU, not 5000 IU a day. 

Naturopaths load people with these vitamins which in healthy people might be helpful but in people in withdrawal can make them worse. 

 

Again, up to you what you with with that information. I once took 20000 IU due to deficiency and was so agitated wanted to get out of my skin. Didn't realize it was the vit D until much later. 5000 IU did the same. 

 

OMW

 

[Bullitt1968]

@Altostrata

I think I have answered your questions as best I could. I would be grateful if you or someone else would answer my questions.

 

I value your knowledge and experience. What I don't like is the way you communicate with people who are suffering, like me. You know how it feels, you can empathise, can't you? I also counseled in a weaning forum for 2 years and compassion, understanding and mutual appreciation were always important to me!

I would appreciate it if you could see me as a suffering being who wants others to see and empathise with this suffering.

I am usually excluded when I mention this to admins or moderators in withdrawal forums u Facebook groups. It is not my intention to accuse you of lacking compassion, I am sure you have that, but perhaps it has been lost a little.

I don't know what will happen now, maybe you'll shut me out now, I can't help that. We all owe you a lot, your knowledge and experience are very valuable!

Best regards and namaste

Markus

 

[Altostrata]

I don't have time for an academic discussion of akathisia, there are other places where you can find that. In my world, if you overdose yourself with benzos, for example, and you get paradoxical activation, it's not akathisia, it's something you can control.

 

Please keep daily notes of times o’clock you take your drugs, their dosages, and your symptoms throughout the day. We need to know how you feel before and after taking each drug, and your symptoms in between. Post 24 hours of notes at a time in this topic, in a simple list format with time o’clock on the left and notation (symptom or drug and dosage) on the right. This can show if your symptoms are related to your current drug regimen.

[Onmyway]

@Bullitt1968, 

we are all volunteers here and have limited time and many suffering people needing our help. Some of us are also going through withdrawal and have the same concentration/exhaustion/anger/agitation etc issues. As a result it is really helpful when people work WITH us rather than argue with us. People have all kinds of opinions on all kinds of topics and most arguments are not worth our time (we also have jobs/families/other things). The SA wisdom is probably better than most research papers out there and our learning has come from observing thousands of cases and when you do that patterns start to emerge. Is our advice clinically tested? No. And where there is good clinically tested advice we provide it but you understand that such clinical studies are very few. Most doctor/naturopath/random forum person advice is not clinically tested either. 

 

We assume that if people come here they are looking for information/advice which we try to provide as best as we know. What people do with that information is up to them. SA is different in that its main goal is to provide advice and information rather than emotional support. Many do find emotional support here but that usually comes from other members rather than the moderators. 

 

We also often get people who want to either follow their doctors' advice which is contradictory to ours or follow some random readings or theories or beliefs or naturopaths - there are plenty of people who want your money our there and will provide bad advice. These members are often rude, disrespectful, demand a lot of attention. They invariably crash, come back in a few months and then want more and more help. It is really frustrating for us to deal with people like that. I am in no way saying that you are one of those members but when people start arguing with us we become weary. We need to limit our efforts to those we can help. Right now we don't know if we can help you - you seem to have very strong beliefs about various things and it is not clear that if we invest the effort you will actually follow our advice. 

 

In the end we provide information, the responsibility of how that information is used belongs with the user. They are the ones who will bear the consequences of those decisions. What will not tolerate is when someone creates their own problems when they have clearly been given good advice and then comes demanding more and more help and advice and repeatedly refuses to follow it. I am not saying that is you at all. Just trying to get you to understand that we don't have unlimited resources. 

 

What Altostrata and I have been telling you is that you are WAAAAAAY OVER medicated. You are taking too many psych medications and at extreme doses. You are medicated with mostly sedating drugs but some people who are on sedating drugs end up having paradoxical reactions to them. A paradoxical reaction is an opposite reaction when a sedating drug become activating.  Akathisia is basically an extreme form of activation (restlessness). People in withdrawal are sensitized to all kinds of psych drugs and as a result end up very activated. On top of all that you are taking lots of vitamins and supplements also in extreme doses. Those can also cause agitation and activation. I have advised you to stop these or take them only in the daily required doses rather than massive amounts. If you check your B-vitamin supplement you might discover that it is 1000% of your daily dose rather than 100%. While removing them may not automatically fix things, they will be like small drops in a big ocean and we may be able to get you to a stable enough place so that you can start weaning off of these drugs even if slowly. As your drug burden goes down you will feel better. 

You can read up on our knowledge of kindling here: 

 

One of the principles of SA is to try to achieve stability - and if you are sensitized and keep changing your drugs stability becomes harder to achieve. Lots of people struggle with that (I did!). 

What I would advise for you is to lower your supplement burden first - esp the stuff that does not need to be tapered. Then slowly start lowering the massive doses of drugs that you are taking. (I am unclear if you are still on diazepam, you mention it in one of your posts but not in your signature). 

 

You asked us for remedies for akathisia. We don't really have any and as far as I know nobody does. We try to stop the causes of akathisia - if it is too much medication or an adverse drug reaction, you can deal with that. By listing your symptoms you will help us understand if you are suffering from ADRs.  We will generally not advise you to add more medication. 

 

I would also advise you to look on the symptoms forum - there are plenty of tips to help with anxiety/sleep etc. 

 

OMW 

 

 

[Bullitt1968]

@Altostrata

 

I understand that. I wonder if it still makes sense for me or leads to insights. 

From the beginning, everything that could be done wrong was done wrong for me by the doctors and psychiatrists. Many failed attempts at withdrawal because the doses were taken too quickly or in too large steps. I think it is no longer possible to distinguish which symptom is caused by which drug. Somehow they all have the same effect on the brain.

I think that's right for mild cases, but unfortunately I'm a severe case. I already have all these symptoms. 

What do you think? And actually I just wanted to know which of the drugs can cause or increase akathisia and I'm still waiting for that answer and if possible I would like an answer to that if you or someone else can tell me. I am looking for studies, experiences and findings

I have the feeling that we are talking at cross purposes,

It was not my purpose to have a academic discussion with you. Obviously no one can answer my question. I know what I have experienced in last summer, that was akathisia. What could else lead to such symptoms prescribed by MISSD Foundation. 

There is no reason to be not polite, mindful, compassion. I did not say, that I have know Akathisia, but when I try to reduce Prozac, I get severe akathisia, als in last summer.

So I see, you could not or would not help me. 

In this video Thich Nhat Hanh mentions 4 mantras. Replace "Darling" with persons name and replace "love" through "compassion" People who suffer want more than anything else to be recognized , to be seeing while suffering.

Thich Nhat Hanh talks with Oprah about the four mantras of love

 

Please do not understand this as teaching but as a chance.
 

May you be safe and secure. 
May you be completely safe and secure. 
May you be at peace. 
May you be healthy. 
May you be mindful, compassionate and understanding. 
May you be courageous and persevering. 
May you be able to accept each moment as it is now.
May you be happy and content. 
May you experience love and friendship. 
May you live with ease and serenity. 
May you be free wherever you are. 

These sentences do not mean that this is the way it is or that this is the way it will be. They mean that whenever it is possible it should be so, that is what I wish you from 

with all my heart. 


bye

[Altostrata]

If you would go to the trouble of posting daily notes as requested, I may be able to analyze your current symptom pattern and resolve any overdosing.

 

You hold a belief that you are an exceptionally severe case requiring eccentric drug treatment, which makes you resistant to other explanations. If you prefer to carry on your drug experiments and ad hoc dosing, we cannot offer you peer support here.

 

Please let us know when you want to decrease your drug burden.

[ChessieCat]

3 hours ago, Bullitt1968 said:

I did not say, that I have know Akathisia, but when I try to reduce Prozac, I get severe akathisia, als in last summer.

 

It has already been mentioned that you may be getting a paradoxical reaction from the sedating drugs.

 

If you take too much sedating drugs it can have a paradoxical reaction (works the opposite way) where your body/brain fights to keep you awake because if you are too sedated your brain reacts to keep you alive.  See the drug interaction below where I have highlighted several things in red.

 

Antidepressants are usually activating drugs.  There is a possibility that as you reduce the Prozac (activating drug) then the sedating drugs cause more sedation because there is less Prozac to counteract the effect, and you then get a stronger paradoxical reaction from the sedating drugs.

 

Here are the results from a different drug interaction checker Medscape Drug Interaction Checker:

 

Serious - Use Alternative

• fluoxetine + promethazine

  fluoxetine will increase the level or effect of promethazine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

Monitor Closely

• promethazine + fluoxetine

  promethazine and fluoxetine both increase QTc interval. Use Caution/Monitor.

• fluoxetine + 5-HTP

  fluoxetine and 5-HTP both increase serotonin levels. Modify Therapy/Monitor Closely.

• pregabalin + lorazepam

  pregabalin, lorazepam. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• pregabalin + promethazine

  pregabalin, promethazine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• pregabalin + fluoxetine

  pregabalin, fluoxetine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• promethazine + lorazepam

  promethazine and lorazepam both increase sedation. Use Caution/Monitor.

 

 

[Ninabird]

9 hours ago, Onmyway said:

I once took 20000 IU due to deficiency and was so agitated wanted to get out of my skin. Didn't realize it was the vit D until much later. 5000 IU did the same. 

My Vitamin D is sadly in the single digits. I also had extreme agitation from the D supplement. I am in NorCal so I will have to stick with the D from the sun right now.