Andra: guidance for deprescribing benzo, antipsychotic and antidepressant cocktail

[Andra]

Hi , 

I am Andra. 

Thank you for this amazing site. It is very useful. 

I am helping my 23 years old daughter to taper off  clonazepam, risperidone and sertraline. The  doses  were not so abysmal, however the psych recommended  ECT. When we refused the psychiatrist  ramped up the dosage to maximum. From cannabis induced psychosis the diagnostic morphed into MDD with psychotic elements. 
Under a different psychiatrist’s supervision we began tapering of the benzo . Starting tomorrow August 4 , it will be 0.
The next is The AP and then the AD. 
 

[Frogie]

 

@Andra

 

Welcome to SA. We are a volunteer ran site helping people taper off psychiatric medications, or have tapered off and are now healing.

 

It is easier to speak directly with the person that is tapering off the medication. Is there anyway your daughter would be willing to speak with us personally? It's hard to know what symptoms she is having or how she is doing through a third party. However, in the meantime I'll give you some links that you can read and get started.

 

Why taper by 10% of my dosage?

Taking multiple psych drugs? Which drug to taper first?

Tips for tapering off risperidone (Risperdal)

Tips for tapering off sertraline (Zoloft)

 

 

 

 

Here is some important information about how these drugs actually work.  This explains why we get symptoms from going off of these medications:

 

How Psychiatric Drugs Remodel Your Brain

 

 

This helps you understand what withdrawal syndrome is: 

 

Video on Recovery from Psych Drugs

 

 

Stability is really important when we are tapering off psych meds.  Please read the link about stability:

 

Keep It Simple, Slow, and Stable

 

 

 

Here are some links you might find useful.

 

cannabis-marijuana-hashish-thc-cbd-cannabidiol-or-hemp-oil

The Windows and Waves Pattern of Stabilization

 

Stabilising After a Reduction - What Does That Mean?

Withdrawal Normal Description

Dr. Joseph Glenmullen's withdrawal symptom checklist

 

 

We don't suggest supplements on here as they can be stimulating. We do suggest magnesium and omega as they have been found to be calming to the central nervous system (CNS). If she would like to try one, try it in a small amount and wait a few days before introducing the other.

 

Magnesium

Omega 3 Fish Oil

 

 

I hope your daughter will read these links and reach out to us with any questions.

 

 

[Andra]

Dear Frogie, 

 

Thank you for the links.

We were thinking about getting dr Joseph Glenmullen’s  book.

We also got  dr Joanna Moncrieff’s book about coming off meds. 

I’ll try, to convince her to get in touch. Hopefully she will. 
Best, 

A

[Frogie]

@Andra

 

You are very welcome.

 

I hope your daughter will come on and talk with us.

 

Please let me know if you and your daughter have any other questions I can help you with.

[Andra]

Hi all , 

 

This is an account of where my daughter is at day 4 after withdrawal. 

 

Some minimal tremors, and twitching. 
Sleep 10-11 hours per night.

When asked what is the most noticeable improvement - feels calmer, can focus more. 

Less pacing - solves with reading, walking in nature, drawing. 

More initiative. Plans for future. 
A sense of accomplishment after succeeding the taper.

We will go much slower with the rest of medication. The taper was done as per the physician’s recommendation. She seems unaware of the slow tapering/asymptotic methods.    

Reads a lot and  open conversations about  herself. 

Worried about distant future, life. 

 

Swimming half an hour a day at open air community pool since June 24, 2022. 

Bike rides

Nature/forrest walks

Music

Being alone

Parents available anytime  ( lives at home, we work from home) After the initial shock, lots of support.

 
Acupuncture since June 16. Once a week for 6 weeks, and afterwards twice a week. Moxibustion at home,around 8.45 pm,  as recommended by practitioner, quiet jazz music in the background.

It helped tremendously. 
Psychotherapy from June 26

Epsom salts baths

Magnesium bisglycinate 100 mg

 

Balanced Diet and  no coffee, no alcohol, no sugar, no fast food. 
Cigarettes - 4-6 per day. We do not encourage and try to keep it to a minimum.

 

During the two months tapper period the following symptoms:

crying spells, day two-three after reducing the dose

Self harm attempts - 1/ each first 3 tapers

Dreams - some very good, some unpleasant.

Pacing

 

Gestures that helped:

throwing/giving away books and clothes

Rituals - drinking one cup  genmai cha at candle light, in the evening, after moxa.

Minimal contact  with very few friends.

Singing while riding the bike.😊

 

 

 

 

 

 

 

 

[Andra]

Day 4 after withdrawing Clonazepam

 

Hi all , 

 

This is an account of where my daughter is at day 4 after withdrawal. 

 

Some minimal tremors, and twitching. 
Sleep 10-11 hours per night.

When asked what is the most noticeable improvement - feels calmer, can focus more. 

Less pacing - solves with reading, walking in nature, drawing. 

More initiative. Plans for future. 
A sense of accomplishment after succeeding the taper.

We will go much slower with the rest of medication. The taper was done as per the physician’s recommendation. She seems unaware of the slow tapering/asymptotic methods.    

Reads a lot and  open conversations about  herself. 

Worried about distant future, life. 

 

Swimming half an hour a day at open air community pool since June 24, 2022. 

Bike rides

Nature/forrest walks

Music

Being alone

Parents available anytime  ( lives at home, we work from home) After the initial shock, lots of support.

 
Acupuncture since June 16. Once a week for 6 weeks, and afterwards twice a week. Moxibustion at home,around 8.45 pm,  as recommended by practitioner, quiet jazz music in the background.

It helped tremendously. 
Psychotherapy from June 26

Epsom salts baths

Magnesium bisglycinate 100 mg

 

Balanced Diet and  no coffee, no alcohol, no sugar, no fast food. 
Cigarettes - 4-6 per day. We do not encourage and try to keep it to a minimum.

 

During the two months tapper period the following symptoms:

crying spells, day two-three after reducing the dose

Self harm attempts - 1/ each first 3 tapers

Dreams - some very good, some unpleasant.

Pacing

 

Gestures that helped:

throwing/giving away books and clothes

Rituals - drinking one cup  genmai cha at candle light, in the evening, after moxa.

Minimal contact  with very few friends.

Singing while riding the bike.😊

Looking at family photos. 
Expressing and acknowledging feelings in a  loud voice .  Ex - during a Sunday bike ride in the park, when everything looked like picture postcard - I said loudly “It’s so boring” . She said “yes it’s boring”, and after that, amazing joy, stamina, rode ahead, hands free. 
Looking at clouds, swings in the park. Reclaiming playfulness and spontaneity. 

 

Edited August 7, 2022 by ChessieCat
added topic title before merging with intro topic

[Altostrata]

Hello, @Andra

 

Good to hear your daughter seems to be doing well after going off the benzo. What are your tapering plans now?

 

We offer peer support for tapering here, but if you're following a psychiatrist's instructions, our approach may differ.

[Andra]

Dear @Altostrata, 

first of all - chapeau! I am absolutely impressed by the work everybody is doing here, and the way the forum is managed. 
The physician recommended decreasing the Risperidone to 5 mg from actual 6 mg. She wasn’t planning to, but my daughter got very emotional. The side effects, the prolonged isolation  after these Covid years.  
To me it looks a bit too fast, only 9 days  after benzo withdrawal. On the other hand, the dose is massive, the psychosis is completely gone, except from some minimal loops in her narrative, due to low self esteem.

Funny fact 😊 -  after one day, she ran out of the hospital because her 84 year old grandma  with Alzheimer, showed up in a psycho vision, and told her - Bid it, they put substances into your body here. Psychosis / non-psychosis her subconscious self defense system was still functional. Don’t get me wrong - the meds helped tremendously, we just don’t think this should be a life sentence.  

 

[Altostrata]

Thanks. 

 

We do not advise continuously making drug changes. After going off clonazepam, your daughter's nervous system may be in a fragile state, still adjusting to the disappearance of a strong drug. We usually advise at least a month of stability before initiating another drug change.

[Andra]

Thank you. My thoughts exactly. 
We’ll keep the dose for a longer time. 

[Andra]

In prep of starting tapering risperidone - D2 receptors

 

Dear Admins

please feel free to delete or dismiss the post if you find it misleading. 

 

Reading pharmacology articles quoted by M Horowitz, I found this spreadsheet charting the correspondence between risperidone dose and the amount of D2 receptors blocked.  ( unfortunately I have not saved the link. -author Leon?) 
6mgr Risperidone blocks about 79-81% D2receptors

4 mgrs Risperidone blocks about 73% of D2 receptors

2 mgrs Risperidone blocks about 66% of D2 receptors

I hope this helps with understanding the hyperbolic model - at half dose reduction one only unblocks 10% of the blocked receptors.

 

My understanding is that roughly from  

2-3 mgs down, a very slow taper is essential.
 

There might be other variables, of course, and the fact that there is no data beyond 2mg should also ring a bell about how these meds work. 
I am not a scientist, so take it with a grain of salt. 

 

Edited August 9, 2022 by ChessieCat
added topic title before merging with intro topic

[ChessieCat]

SA's recommended taper rate for all psychiatric drugs is to reduce by no more than 10% of the current dose followed by a hold of at least 4 weeks to allow the brain to adapt to not getting as much of the drug.

 

SA also strongly encourages members to listen to their body/symptoms and not reduce again until they are stable.  Also it is a good idea to hold on a dose if you are sick or experiencing additional stress in your life.

 

Some members find that they need to go slower than the 10%/4 week, reducing less and/or holding longer.  This is particularly the case when the doses get lower.

 

Why taper paper: dose-occupancy curves

 

Some members are using a different taper method, which takes longer but gives a person more control over their taper because they can hold at any time during a reduction cycle.

 

Brass Monkey Slide

[Altostrata]

Our 10% exponential taper approximates Dr. Horowitz's hyperbolic taper. 

 

Yes, with antipsychotics, it's very important to watch for withdrawal symptoms, as they can look like psychosis and send people back to the hospital unnecessarily.

[Andra]

Hi Chessie Cat and Altostrata, 

I am not encouraging anyone to go off at a super fast pace.  On the contrary. I just found interesting how misleading the tapering process could become considering that a dose of 4mgs R doesn’t seem much more different than a dose of 6 mgs R, in terms of binding D2receptors. One might think that it’s a breeze tapering from 6 to 5.5 mgs to 5 to 4.5 mgs and then, padaboum!!! In our particular case, maybe I sound totally off, I started questioning everything - the super high doses, the diagnostic, the insane push for ECT. The hospital experience was absolutely terrifying. The physician  never properly explained the side effects of the meds.  During the past months, while immersing myself in all sorts of literature, blogs, podcasts, I recognize many of the initial symptoms as possible side effects of introducing the meds, as opposed to  a reason for ECT. I am also appalled by our current psych’s inability to explain anything and the fast K taper followed by initiating R only one week after 0 K. 

[ChessieCat]

I've become very wary now about anything that a medical professional suggests regarding any type of drug.  I now do my own research BEFORE taking anything.  I've had several experiences where I didn't take the suggested drugs and managed to get a good outcome without them.

[Altostrata]

I know exactly what you mean, @Andra We are actually talking about basic psychopharmacology, and they should know it inside and out.

[Andra]

# Clonazepam 0mg August 03 2022

 

Dear all, 

 

since August 03 2022 Clonazepam is 0 mg. Withdrawal effects - some tremors, twitches, minimal  zaps, crying spells. On the positive side - “I feel calmer”. 

Since August 13-14 all wd effects faded. 
Also since August 14 sleep increased from 10 hours to 12 hours. 
I’ll keep you posted. 

 

Edited August 16, 2022 by ChessieCat
added topic title before merging with intro topic

[ChessieCat]

@Andra

 

Your Introduction topic is the place to post updates.  This keeps your history in one place and means you don't have to repeat your story.

 

And SA's mission isn't just help members get off their psychiatric drug/s, it is also to educate the medical profession.  See:

 

  

On 5/15/2011 at 5:22 AM, Altostrata said:

This site is also a research project. The personal stories on this site are documentation of an iatrogenic condition -- suffering caused by medical treatment -- that is almost always ignored, misdiagnosed, or denied by the medical establishment. Given the widespread prescription of antidepressants to tens of millions of people worldwide, withdrawal syndrome probably affects hundreds of thousands if not millions -- including newborns and children.

Antidepressant withdrawal syndrome can last weeks, months, or years. It can be distressing, debilitating, or even disabling. It may be adding to an increase in what is termed disabling mental illness.

With our documentation of antidepressant withdrawal syndrome, we hope to educate the medical establishment about this problem. Case studies are essential; they are evidence understood by doctors, the psychiatric industry, and government regulatory agencies. The have already informed numerous articles in major publications and scientific papers.

Our hope is, eventually, antidepressants and other psychiatric drugs will be prescribed rarely, and only in cases of extremely severe mental illness after less invasive treatments have been tried.

Please join Surviving Antidepressants in its mission to support, document, and educate about psychiatric drug withdrawal syndrome.

 

[Andra]

I’ll move my update to my introduction topic. Thank you ChessieCat. 

 

[Andra]

Day 15 after 0mg Clonazepam - No particular withdrawal effects. 

Also, contrary to SA advise -please do not take our schedule as a tapering model, we reduced Risperidone to 5mg since August 14, Sunday. As per doc’s reccomendation.  

No particular withdrawal effects so far. Next morning , August 15 a very engaging therapy session . 
Afterwards , contrary to the pattern, a deep midday nap. 
For the next two days - increased sleep. Almost 12 hours. 

August 16 -visit to psych doc. These are very stressful for all of us. The doc suggested replacing Sertraline with Mirtazepine, on the account that “it is a very well researched drug”.  We declined. No time frame for deprescribing, no reevaluation of the diagnostic. 

Nota bene: according to several drug interference studies Sertraline over 150 mg increases Risperidone plasma release. Not sure how to interpret this info, other than it is better not to stagger the Risperidone and Sertraline tapering. 
Wednesday morning - brief moment of confusion - almost like a fake memory. 
 It vanished immediately after a brief, calm conversation. 
Wednesday - anxiety in the evening. 

Thursday - first day without rumination, hummour, detached in a positive way. Long walks , swimming in the morning. Determined. A clear plan for the future. More mobility. 
 

Ongoing symptoms - irregular periods,  tremors , puffy eyes in the morning.  Sleep 10 -11 hours. Weight gain. Still ok because she was very thin. Inability to write well, research or focus for extended time. 

[Altostrata]

What is your daughter taking now, at what times o'clock and dosages?

[Andra]

200 mg Sertraline at 8.30 AM

5 mg Risperidone at 9 PM

 

Supplements - occasionally Magnesium, magnesium salts baths

 

[Altostrata]

Very possible the risperidone is making your daughter sleep a lot.

 

You may need to take special care in reducing risperidone, to minimize risk of withdrawal-induced supersensitivity psychosis. FYI Tips for tapering off risperidone (Risperdal)

 

[Andra]

Dear Altrostrata, 

 

We are between a rock and a hard place because of the mega dose. 
This was after we refused the ECT. considering the evolution - there was no need for ECT, and the symptoms could have been adverse effects to instating the meds. 
 

We do not want to risk anything.
 

 We even consider moving to a country with more clement, short winters and where we can have access to a private psychiatrist who can deprescribe safely. In Canada it is a nightmare. 

 

I don’t want to mention the logistic or financial implications, and the scare. 
 

Of course withdrawal psychosis looms around the corner if we do not taper slowly. 

 

We thought of tapering  first the AP to 0 / minimum and then the AD.

Hold 2 weeks 5 mgs

Reduce to  4mgs.

Hold 3 weeks reduce  to 3 mgs.

 

2.5 / 2 /  1.75 mgs/ 1.25/ 0.85/0.6/ 0.4/ 0.25/0.10/0 

Hold 3 weeks  or more if needed between each withdrawal. 

MH recommends 4/2.5/1.7 , and after 1.7 the schema is identical. 

 
This pushes us to  almost 9 months.
 

I’m terrified by the AD side effects/ taper after one year. 
Should we stagger ? Not in favor , but considering the dose…..

 

Should we hold  4weeks at  1.25 mgs? (this is roughly 50 %D2receptors).  
It is a gamble. 

As I’ve mentioned - apparently sertraline over 150mgs  increases the D2 occupancy. 

A

[Altostrata]

Your daughter seems to be doing well, why is forced ECT a concern?

 

How did your daughter respond to the reduction to 5mg risperidone on August 14? This is only 3 weeks after quitting clonazepam, had her withdrawal symptoms from that completely gone away?

[Andra]

Dear @Altostrata, 

My daughter responded very well to the first dose reduction of Risperidone. There were almost  no negative symptoms. 
Very good sleep. A bit of  anxiety/ grief during the third day in the evening, but nothing major. 
Sleep actually increased day 2 and 3 after the withdrawal.

On the other hand, more initiative, determination and figuring out plans for the future. 

Clonazepam withdrawal was a bliss - she said that she feels much calmer. 

Physical symptoms 
Hand tremors and twitches in the neck area. Brain zaps for a couple of days in the first week ( 3-10 august). The brain zaps and the neck twitches receded completely and they weren’t so serious   to interrupt the daily routine. 

 

Ongoing  symptoms:  muscle fatigue, cramps in the morning, dizinness, puffiness in the morning and vizible tremors untill she takes the  Sertraline. Lower intensity hand tremors , during the day.
Ennuresis - none during the past three weeks, several accidents during the day, during walks,  after having watermelon  and  drinking  water). Pacing sometimes, but otherwise reading for hours. 

I think that I have  been absolutely traumatized by the suggestion to undergo ECT, during her hospitalization.
After several weeks of reading , I realized that the catatonia and the nystagmus,( which  appeared in the hospital) might have been a strong reaction to sertraline, or other meds and /or the dose variation.

 

The physicians never mentioned this hypothesis. 

 
Since then , I have absolutely no confidence, and I wonder if the  huge dose of meds is necessary, or if it is meant to disguise TD.
 

I also question the physician’s suggestion to add/ switch to Mirtazepine, and the fact that our request for a withdrawal time frame / getting to the minimum dose has been dismissed. 

Maybe I worry too much.  
I only took aspirin, some antibiotics and cold syrup in my entire life. 
 
Andra

[Altostrata]

22 hours ago, Andra said:

Hand tremors and twitches in the neck area. Brain zaps for a couple of days in the first week ( 3-10 august). The brain zaps and the neck twitches receded completely and they weren’t so serious   to interrupt the daily routine. 

 

Ongoing  symptoms:  muscle fatigue, cramps in the morning, dizinness, puffiness in the morning and vizible tremors untill she takes the  Sertraline. Lower intensity hand tremors , during the day.

 

These are her ongoing clonazepam withdrawal symptoms?

 

22 hours ago, Andra said:

The physicians never mentioned this hypothesis. 

 
Since then , I have absolutely no confidence, and I wonder if the  huge dose of meds is necessary, or if it is meant to disguise TD.
 

I also question the physician’s suggestion to add/ switch to Mirtazepine, and the fact that our request for a withdrawal time frame / getting to the minimum dose has been dismissed. 

 

They don't know what they should about adverse drug effects and withdrawal. That is why this site exists.

[Andra]

Hi Altostrata, 

 

The clonazepam withdrawal symptoms are gone. Absolutely minimal in intensity in comparison to the first two dose reductions. 
 

The ongoing symptoms are from the Risperidone and Sertraline. Grossly over medicated. 

Today, a huge rainstorm  soaked us. And  I saw her old self - smiling and enjoying the moment. Never underestimate the power of nature. 

[Altostrata]

On 8/21/2022 at 5:12 PM, Andra said:

 muscle fatigue, cramps in the morning, dizinness, puffiness in the morning and vizible tremors untill she takes the  Sertraline.

 

After she take sertraline, these symptoms diminish?

 

How is she taking 200mg sertraline, in what size of tablets?

[Andra]

Hi Altostrata,

She takes Sertraline - 2x100 mg tablets at 8.30 in the morning. 

About 20 - 40 minutes after that the symptoms diminish. 

[Altostrata]

It sounds like she might be getting interdose withdrawal from sertraline as it wears off overnight, which is unusual but not impossible. I suggest she move one of those 100mg tablets gradually later, by an hour each day, until she's taking them 6 hours apart.

 

Please let us know how her symptoms change during this process.

[Andra]

Hi @Altostrata, 

 

This is an update of the progress.

 

Because we are continuing the Risperidone tapering we decided to be very conservative and not to split the Sertraline administration time.
 

 We reduced the sodium intake to a minimum. This helped with the eye puffiness. What also helped is the weather cooling significantly during the night. 
 

The tremors diminished once the Risperidone was dropped from 5mgs to 4mgs on August 28.
It went extremely smoothly so far,  almost unnoticed.

 

Sleep is excellent.  9-10 hours per night and an occasional nap during the day.  

4mgs Risperidone mean a D2 receptor occupancy of roughly 70 per cent. 2mgs roughly 60 per cent. 1.5 mgs  about 55 per cent. 0.75 mgs - 40 per cent. Basically when we are at 0.75 mgs we are actually half way from 6 mgs to 0 mgs. I leave this comment for those who taper of Risperidone. 2mgs to 1.5 mgs is nothing in comparison with 0.25 mgs to 0. Be very cautious when making the last cuts. 

We had a very encouraging  meeting with the staff at a compound pharmacy. They completely validated the plan, offered to help with the compound dose, advised to get rid of Risperidone first, and not stagger the meds tapper unless absolutely necessary. Unless the psychiatrist they acknowledged  the side effects of the medication. 

[Altostrata]

19 hours ago, Andra said:

They completely validated the plan, offered to help with the compound dose, advised to get rid of Risperidone first, and not stagger the meds tapper unless absolutely necessary.

 

Good to hear. Yes, we usually want to taper the antipsychotic first. What pharmacy did you consult?

 

19 hours ago, Andra said:

4mgs Risperidone mean a D2 receptor occupancy of roughly 70 per cent. 2mgs roughly 60 per cent. 1.5 mgs  about 55 per cent. 0.75 mgs - 40 per cent. Basically when we are at 0.75 mgs we are actually half way from 6 mgs to 0 mgs. I leave this comment for those who taper of Risperidone. 2mgs to 1.5 mgs is nothing in comparison with 0.25 mgs to 0. Be very cautious when making the last cuts. 

 

Yes, we are aware of this, it's why we advocate an exponential taper. Did you see Tips for tapering off risperidone (Risperdal)?

[Andra]

Thank you very much Altostrata.

 

Yes,  I went through every material possible. Horowitz and Chouinard. 
Dr Phelps’ ten steps taper schedule. Suggested last step 1/40 from the initial dose. I also read the entries and the comments on this site. 
 

The pharmacy we consulted is called 

Mortar and Pestle.  

 

 

[Andra]

September 11 - tapered Risperidone from 4mgs to 3 mgs. No symptoms so far. Sleep 10-12 hours. More confidence, increased decision making, more optimism. Continue swimming several times per week, walks - several times a day, yoga and pilates , each one time a week and psychotherapy sessions once per week. Study for school daily. 

[Altostrata]

Suggest the next reduction be smaller than 25%. Please let us know how you're doing.