Noleval

[Noleval]

Depression. 

Got prescribed Citalopram and Delorazepam in medium doses.

After several months nothing changed.

Doctors escalated, introduced Zyprexa (5mg) (note: never had psychotic symptoms).

I was "treatment resistant", so they added Lithium (I never exceeded the toxic dosage).

Been going like that for about 2 years.

No progress whatsoever with the psychiatrist. I developed a network of friends and started studying all the philosophy and self-help I could. I felt stronger. I didn't trust the psychiatrist for a lot of evident reasons, including the fact that she wanted me to keep taking AP life-long, so I fired him/her.

For seven months then I was quite fine. I was much more impulsive and reckless in many aspects but I started to work again with success and I started excercising, losing a lot of weight and building my muscles and confidence up.

Something "legal" happened, I had to be sent to a recovery structure.

For a month I was put on 20mg Aripiprazole daily.

Developed psychosis for the first time in my life. That really scared me.

I was put on Delorazepam, Clotiapine, Valproate and 75mg Lurasidone daily. I was in that place for two years (can't remember the exact doses).

Worked with another psychiatrist when I got out. Started from 6mg Invega and 2mg Alprazolam to 1.5mg Invega and keeping the benzodiazepine at the same level.

Gained tons of weight, blood levels got completely destroyed (tryglicerids, cholesterol, sugars).

I also developed "slipping hands" - parkinsonism like symptoms, numbed feelings, difficulties concentrating, low energy, extreme impulsive behaviour and letargia.

Had to move to another city to start a new job - which I have training for - but I couldn't hold it due to the aforementioned parkinsonism effects (it was a precision work), social anxiety and stress vulnerability.

Currently went back to 3mg AP and 2mg Alprazolam.

The dose is way lower than what I used to take but probably due to the long exposure to those chemicals I find impossible to skip the daily dose.

 

I try to be as positive as possible but the situation is quite dire - suffered hard for the stigma from friends and family and I find myself relying on somebody's else resources to keep on living.

 

I'm here to try to taper and get advices. I can afford an appropriate weight scale and I know how to make % and proportions, even solutions, but I noticed when I took the split 1.5mg of AP pill that energy levels, mood and withdrawal symptoms weren't as manageable as with the complete pill.

 

Should I go with the orthodox 10% monthly reduction dosage? What would be better to scale off first? The AP of the benzo?

 

Sorry if I may seem a little blunt, I don't mean to, but I really need help to get things back on track and no professional seems to be eager in doing that. 

 

Thanks for any answer in advance.

 

[Altostrata]

Welcome, @Noleval

 

If you have a movement disorder, it's probably from the antipsychotic, and you probably would want to taper off that first. How's your sleep? What times o'clock do you take your drugs, with their dosages? 

 

On 8/3/2022 at 6:40 PM, Noleval said:

I noticed when I took the split 1.5mg of AP pill that energy levels, mood and withdrawal symptoms weren't as manageable as with the complete pill.

 

Do you mean you cut your daily 3mg paliperdone in half, you noticed increased symptoms?

[Noleval]

15 hours ago, Altostrata said:

Welcome, @Noleval

 

If you have a movement disorder, it's probably from the antipsychotic, and you probably would want to taper off that first. How's your sleep? What times o'clock do you take your drugs, with their dosages? 

 

 

Do you mean you cut your daily 3mg paliperdone in half, you noticed increased symptoms?

Hello Altostrata,

 

the movement disorders include some extrapiramidal symptoms (my hand's little finger is almost always straight and I have to force it to go back into a normal position), minor akatisia (my feet and legs sway every now and then), my mouth muscles are pulling my lips downwards and my teeth are gritting.

 

My sleep is deep, I quite don't dream anymore since I've been taking the medications (just nightmares, one every 1 month on average) but it's too long: I sleep for ~14 hours everyday. I usually wake up after 10 hours of sleep but I find myself too tired and demotivated to get out of the bed, so I fall asleep again and reach the 13-14 hours. I take them at 10PM and at the moment I'm on 1.5 paliperidone and 2mg delorazepam.

 

By cutting my 3mg paliperidone in half I noticed in the previous months that I'm "less stable" on the symptoms, i.e. brain fog, dizziness, chronic fatigue and a feeling of anhedonia. That doesn't happen every time and I find it quite random. A psychiatrist told me that it's because the outer layer of the pill has pharmacokinetic proprieties that allows the medication to be released on longer period of times and avoids sudden releases of it into the organism.

 

Changed my dietary habits a lot in the last period: getting Omega-3 from salmon, cutting almost all animal fats (I used to like them a lot, now I'm quite disgusted if I try or "forced" to eat them) and focusing on fresh vegetables, lean meat and a small dose of whole grain carbohydrates.  What is sure is that if I take the whole pill I am able to wake up sleeping less, even if confusion, fatigue, anhedonia and cognitive impairment are stronger (and I frankly feel like a zombie).

 

It's been two days since I've started having three cups of coffee when I wake up, 300mg+300mg of Magnesium at the beginning and in the middle of the day and various vitamines (C 160mg, E 24mg, Niacine 32mg, K 150mg, Pantothenic acid 12mg, A 1600mg, D 10mg, B6 2.8mg, Riboflavine 2.8 mg, Thiamine 2.2mg, Folic acid 400mg, Biotine 100mg, B12 5mg, Zinc 20mg, Molibdenum 100mg, Selenium 110mg, Iodium 300mg and Chromium 80mg) and 240mg Gingko Biloba. Those dietary advices came from a couple of medics (who aren't psychiatrists). Even if sleep is still too long I feel that the energy levels, the toleration of stress, mental clarity and motivation are much better.

 

In a moment of rage, two days ago, I decided to not take the medications: teeth grinding and muscle stiffness got worse, had pain on the left side of the head and teeth (the doctors aforementioned said it most probably was the trigeminal nerve) and had to take both medications in order to stop it. Pain was coming and going for almost all the subsequent day but today it's stopped. 

 

What about the tapering? Should I get a mortar and pestle, a two (or three?) digits scale and start the 10% AP reduction? Should I eat the powder or put it in a liquid (water, oil?) Any idea for how long should I go with the 1.35mg dosage before cutting it down again?

As a side note, I'm visiting a psychiatrist soon who appears to be expert on drugs withdrawals so I'd be happy to share what he/she says about it and discuss on this forum.

 

Thank you for your reply,

 

N.

[Altostrata]

10 hours ago, Noleval said:

By cutting my 3mg paliperidone in half I noticed in the previous months that I'm "less stable" on the symptoms, i.e. brain fog, dizziness, chronic fatigue and a feeling of anhedonia. That doesn't happen every time and I find it quite random.

 

If these symptoms follow a dosage reduction, it's likely that they're withdrawal symptoms. When did this happen? Have these symptoms gone away?

 

Is this psychiatrist going to help you taper your drugs?

 

10 hours ago, Noleval said:

It's been two days since I've started having three cups of coffee when I wake up

 

Why are you drinking 3 cups of coffee in the morning?

 

What times o'clock do you take your drugs, with their dosages?

[Noleval]

As I said it's quite randomical. As I changed my dietary habits it seems that it almost got away.

 

As for the psychiatrist, I'll know once I get to speak with him/her - as said in the previous post I had to move from where I was.

 

I should have said that those three cups of coffee are espresso-sized cups, so the total coffee intake is much lower than it would have seemed. I take them because they help me feel less tired and I feel much more motivated to get outside, getting chores and personal objectives done throu the day. I can guess it has something to do with the D2/D3 dopamine receptor (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4462609/) availability that is otherwise hampered. I noticed an improvement of mood and motivation before looking for the specific activity of caffeine on the brain, so I guess it's not a placebo.

 

I take the drugs at 10PM.

[Altostrata]

Why do you take paliperidone and delorazepam together at 10 p.m.? Are you groggy in the morning, is that why you're drinking 3 cups of espresso?

 

Are you currently experiencing these symptoms? When was the last time you made a dosage reduction?

On 8/8/2022 at 9:03 AM, Noleval said:

brain fog, dizziness, chronic fatigue and a feeling of anhedonia.

 

[Noleval]

On 8/10/2022 at 1:58 AM, Altostrata said:

Why do you take paliperidone and delorazepam together at 10 p.m.? Are you groggy in the morning, is that why you're drinking 3 cups of espresso?

 

Are you currently experiencing these symptoms? When was the last time you made a dosage reduction?

 

I take them at 10PM because that's an habit that was instituted by my previous practitioner: take them before sleep.

Today I had insomnia even if took them, but whatever...

 

Dosage reductions are on my signature, but I'm happy to elaborate them further:

had a reduction from 3mg AP to 1.5mg AP in May under the supervision of a pratictioner.

Reinstated to 3mg due to work stress by another.

Got back by myself to 1.5mg as the side effects of 3mg were too heavy for me to handle.

 

Now feeling quite fine. Something is awry but not as much as it was before. So I guess it's an amelioration.

[ChessieCat]

 

Please answer these questions

 

 

On 8/10/2022 at 9:58 AM, Altostrata said:

Are you groggy in the morning, is that why you're drinking 3 cups of espresso?

 

On 8/10/2022 at 9:58 AM, Altostrata said:

Are you currently experiencing these symptoms?

 

brain fog, dizziness, chronic fatigue and a feeling of anhedonia.

[Noleval]

8 hours ago, ChessieCat said:

Are you groggy in the morning, is that why you're drinking 3 cups of espresso?

 

 

 Yes.

 

QuoteOn 8/10/2022 at 1:58 AM, Altostrata said:

Are you currently experiencing these symptoms?

 

brain fog, dizziness, chronic fatigue and a feeling of anhedonia.

 

 

 

Yes.

[Altostrata]

Your combination of paliperidone and delorazepam at night is causing you to be groggy the next day.

 

When you take too many "brakes" at once, your nervous system can resist with activation or insomnia.

 

Antispsychotics such as paliperidone taken long-term are high-risk for serious adverse effects. (Please read up about adverse effects of all your drugs.) If I were you, I'd gradually reduce it, see Tips for tapering off paliperidone (Invega)

[Noleval]

Ok, thank you a lot. 

 

I believe the best way out of this is by switching to risperidone in liquid form, then start the tapering.

 

I'll post any news as soon as possible.