dan86turbo: seeking advice on when/how to start tapering multiple meds

[dan86turbo]

Hi SA!

 

I have a rather long and storied history to tell, so I hope you'll bear with me.  I'll start from the very beginning, even though I don't think the early stuff matters too much.  I suppose it all adds context, since I've been on some sort of psychoactive med or another since before I was 10 years old.

 

I was diagnosed with Tourettes' syndrome as a child, and started on Tofranil around age 7 or 8 to manage the tics.  I stayed on this med through most of my primary school years and switched to gabapentin when I was in college, for reasons that I can no longer remember.  After a year or two of oversleeping my alarms for morning classes from the gabapentin, I switched again, this time to a combination of sertraline + topamax.  I was dealing with a good bit of anxiety and depression as well as tics by this time, so the sertraline handled the psychiatric symptoms while the topamax did the tics.  I was on this combination for close to 10 years with pretty good success.  I graduated college, moved to the west coast of the US, and started my job as a software developer at a major tech company.

 

Then in the summer of 2011 it all fell apart.  I was in a serious car accident that left me with a mild traumatic brain injury, as well as a lot of psychological trauma, as the car that I lost in the accident is one that I'd spent the last 10 years of my life restoring.  Shortly after the accident, I remember visiting my neurologist who normally managed the meds for my Tourettes, and telling him that I felt the meds "just weren't working".  I was dealing with intense depression and anxiety.  He recommended that I find a psychiatrist, as this outside his area of expertise.  And this is where things began to go downhill for me.  Over the next 10 years I would see half a dozen different psychiatrists, all of whom threw every psychoactive med in the book at me.  Including some very heavy-duty stuff like lithium and depakote.  One guy was convinced that the accident and head injury had put me into a mood "cycle", not too different from bipolar, even though I never saw true mania and was sleeping just fine at the time.  A fairly complete list of what I have tried can be found in my signature, though I'm happy to expound on anything that anyone has questions about.  After the first year, I started keeping a spreadsheet of meds, doses, and my notes on why we were changing or trying various things.  I am a nerd after all, and I do like data!  During this time I developed a severe and persistent brain fog that made it very difficult to continue with my work.  I spent a lot of time on mental health disability leave, and was ultimately laid off.  The brain fog persists to this day, and has actually gotten worse recently (more on that in a bit).

 

Things got better and worse with different med combinations over the years, and I even had a period from about mid 2018 - mid 2020 where I was actually enjoying life and symptoms seemed to be improving.   At the time I was on 100mg sertraline, 5mg olanzapine, and 50mg topamax.  Then in October of 2020 it all came crashing down again.  I picked up my refill of sertraline from the pharmacy and noticed that the tablets looked different from what I was used to.  I compared the bottle to the previous one and confirmed that the supplier had changed.  Over the next week or so I began to develop severe, explosive, anger about 1-2 hours after taking my dose.  I should mention that sertraline has always given me a bit of a short fuse, but I've generally been able to keep a lid on it.  Well, that completely went out the window now.  I called my psychiatrist and we met.  He decided the solution was to take me off of the sertraline CT.  Which, in hindsight, was probably not the best idea for a med that I had been on continuously for close to 20 years.  He attempted to "buffer" it with some prozac, but within 1-2 months I was having severe insomnia and panic attacks, and ended up checking myself into a mental hospital because I hadn't slept in close to a month and knew I was close to my limit.

 

The hospital didn't really help, and I checked myself back out a week later.  I continued working with my psychiatrist and we settled on a small dose of doxepin (10mg at the time) which seemed to help with the insomnia and gabapentin (started at 900mg, which was WAY too much for me... eventually tapered down to 150mg) to help with panic/anxiety.  About this time I moved from the west coast to be near family back in Ohio.  Which meant that I got to reset all of my medical providers, and put my mental health care on hold until I did.  I've spent the past 18 months trying to find a good psychiatrist and therapist here, and think I may have finally done so.

 

So, now to address the state that I'm in today.  I'm still extremely depressed.  I only shower about 1x / week.  None of my hobbies bring me joy any more, and so I generally don't engage in them.  I have severe brain fog that makes it hard for me to do the type of problem solving/intellectual work that I used to do.  I have a good bit of anxiety as well.  I go to bed around 9pm and don't get out of bed until 10am.  I'm convinced that the meds that I'm still on are at least part of the problem, combined with lasting sensitivity from CT off of the sertraline, and I'm trying to figure out where to go from here.  My current psychiatrist would like to see me taper one or more of my current meds, but I'm not sure where to start, as my nervous system seems to be sensitive to even tiny changes right now.  For example, I tried tapering doxepin about a month ago using the prescription liquid form, reducing my dose by 10%, and ended up suicidally depressed after 1 week, so I gave up and went back to my full dose.  I've been talking with my psychiatrist about attempting to taper the olanzapine, as I think it may be a big cause of my fog and general lethargy, but reading stories on this site have made me wary of just how difficult it is.

 

So I guess I'd like to appeal to those who have been there before... where does it make sense to start?  And am I at a place that I should even be attempting this?  I feel like I'm living in misery, but that I need to put myself through even more misery in order to get to a better place, if that makes sense.  And I'm just not sure that I'm prepared to do it.

 

Well, I've written a lot.  Hopefully I haven't scared everybody off.  Curious to hear what people have to say.

 

Thanks in advance, and thanks for letting me into your community, SA.

 

Dan

[Altostrata]

Welcome, @dan86turbo

 

You are currently taking Topamax, doxepin, and gabapentin? What times o'clock do you take each of your drugs, with their dosages? Please put ALL your drugs in this Interactions Checker and post the report or a link to it in this topic.

 

On 8/4/2022 at 1:54 PM, dan86turbo said:

My current psychiatrist would like to see me taper one or more of my current meds, but I'm not sure where to start, as my nervous system seems to be sensitive to even tiny changes right now.  For example, I tried tapering doxepin about a month ago using the prescription liquid form, reducing my dose by 10%, and ended up suicidally depressed after 1 week, so I gave up and went back to my full dose.  I've been talking with my psychiatrist about attempting to taper the olanzapine, as I think it may be a big cause of my fog and general lethargy, but reading stories on this site have made me wary of just how difficult it is.

 

Good to see your psychiatrist is supportive of your minimizing your drug burden. Too bad the specialty lacks the expertise to accomplish this.

 

When was the last time you made a change in any of your drugs? What happened after that?

[dan86turbo]

Thanks for the reply, Altostrata.  I am currently taking topiramate, gabapentin, doxepin, and olanzapine.

 

In the morning I take, around 9AM:

25mg of topiramate

 

In the evening I take, around 9PM:

25mg of topiramate

5mg of olanzapine

150mg of gabapentin

20mg of doxepin

 

I most recently tried to take a step down on the olanzapine a week ago, at the recommendation of my psychiatrist.  He had me attempting to step by 25% (cutting my 5mg pill into quarters).  That was way too much, and I only made it one sleepless, anxious night before I realized I needed a better solution, which led me back to this site.  I've spent some time reading here on and off over the past months, and after my bad experience last week read the entire thread on tapering zyprexa/olanzapine and decided to sign up for an account so that I could participate in the discussion instead of just reading.

 

Here's the report from the interactions checker.  I've actually run this report before, and the number of interactions has always worried me...

 

Interactions between your drugs

Major

doxepin  topiramate

Applies to: doxepin, topiramate

Topiramate can cause increased body temperature and decreased sweating, and these effects may be worsened when combined with medications like doxepin. Heat stroke and hospitalization may occur in some people, especially in warm weather and during vigorous exercise. Children are particularly susceptible. Talk to your doctor if you have any questions or concerns. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. You should drink plenty of fluids during warm weather and when exercising, and seek medical attention if you have decreased sweating or a fever. You may also experience drowsiness, dizziness, or lightheadedness when taking these medications together. Therefore, avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Major

OLANZapine  topiramate

Applies to: olanzapine, topiramate

Topiramate can cause increased body temperature and decreased sweating, and these effects may be worsened when combined with medications like OLANZapine. Heat stroke and hospitalization may occur in some people, especially in warm weather and during vigorous exercise. Children are particularly susceptible. Talk to your doctor if you have any questions or concerns. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. You should drink plenty of fluids during warm weather and when exercising, and seek medical attention if you have decreased sweating or a fever. You may also experience drowsiness, dizziness, or lightheadedness when taking these medications together. Therefore, avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

doxepin  gabapentin

Applies to: doxepin, gabapentin

Using doxepin together with gabapentin may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

doxepin  OLANZapine

Applies to: doxepin, olanzapine

Using doxepin together with OLANZapine may increase side effects such as drowsiness, blurred vision, dry mouth, heat intolerance, flushing, decreased sweating, difficulty urinating, abdominal cramping, constipation, irregular heartbeat, confusion, and memory problems. Side effects may be more likely to occur in the elderly or those with a debilitating condition. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

gabapentin  OLANZapine

Applies to: gabapentin, olanzapine

Using gabapentin together with OLANZapine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

gabapentin  topiramate

Applies to: gabapentin, topiramate

Using gabapentin together with topiramate may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

No other interactions were found between your selected drugs. However, this does not necessarily mean no other interactions exist. Always consult your healthcare provider.

Drug and food interactions

Moderate

gabapentin  food

Applies to: gabapentin

Alcohol can increase the nervous system side effects of gabapentin such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with gabapentin. Do not use more than the recommended dose of gabapentin, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

Switch to professional interaction data

Moderate

OLANZapine  food

Applies to: olanzapine

Alcohol can increase the nervous system side effects of OLANZapine such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with OLANZapine. Do not use more than the recommended dose of OLANZapine, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

Switch to professional interaction data

Therapeutic duplication warnings

Therapeutic duplication is the use of more than one medicine from the same drug category or therapeutic class to treat the same condition. This can be intentional in cases where drugs with similar actions are used together for demonstrated therapeutic benefit. It can also be unintentional in cases where a patient has been treated by more than one doctor, or had prescriptions filled at more than one pharmacy, and can have potentially adverse consequences.

Duplication

Central Nervous System (CNS) Drugs

Therapeutic duplication

The recommended maximum number of medicines in the 'Central Nervous System (CNS) Drugs' category to be taken concurrently is usually three. Your list includes four medicines belonging to the 'Central Nervous System (CNS) Drugs' category:

• doxepin
• gabapentin
• topiramate
• olanzapine

Note: The benefits of taking this combination of medicines may outweigh any risks associated with therapeutic duplication. This information does not take the place of talking to your doctor. Always check with your healthcare provider to determine if any adjustments to your medications are needed.

 

 

[Altostrata]

2 hours ago, dan86turbo said:

In the morning I take, around 9AM:

25mg of topiramate

 

In the evening I take, around 9PM:

25mg of topiramate

5mg of olanzapine

150mg of gabapentin

20mg of doxepin

 

Why do you take 4 drugs at the same time in the evening?

 

On 8/4/2022 at 1:54 PM, dan86turbo said:

I have severe brain fog that makes it hard for me to do the type of problem solving/intellectual work that I used to do.  I have a good bit of anxiety as well.

 

Any of the drugs you're taking can cause brain fog. Please look at the implications of the drug interactions report.

[dan86turbo]

18 hours ago, Altostrata said:

Why do you take 4 drugs at the same time in the evening?

 

I had been told by various psychiatrists over the years to take those drugs "at bedtime", and I suppose I never questioned it.  To me "at bedtime" meant "at the same time." There have been isolated instances where I have staggered my dosing when one of my doctors thought there was one drug interacting with another, but by and large, I've taken all of my AM meds at the same time, and all of my PM meds at the same time.  I suppose it might make sense to stagger them so that I can better track side effects?

 

18 hours ago, Altostrata said:

Any of the drugs you're taking can cause brain fog. Please look at the implications of the drug interactions report.

 

I've had that exact discussion with my past 3 psychiatrists, and the tricky bit has always been that I have found it very difficult to taper off of any of these meds, at least under their guidance.  Which is what has led me here.  I feel like I am likely over-medicated, and one or more of these meds are dragging me down, but I also feel trapped due not knowing which med to start tapering first, or how to go about tapering so that the effects of the taper are tolerable.  I've read a good bit about tapering (and micro-tapering) on this site, so I have some confidence that next time I attempt to taper, I have a better chance of tolerating it.  I am, however, still not quite sure which med it makes sense to attempt to remove first.  I suspect your answer to that may be to start spacing out my evening dosing and evaluate the effects/side-effects of each med from there?

[Altostrata]

It's too bad the psychiatrists, who get paid for their time, sort of recognize the problem but don't know what to do about it.

 

Yes, I would agree that your prescribers have overdosed you with a bunch of probably unnecessary drugs in a fairly typical but still reprehensible prescription cascade. Please allow me to say that I don't get paid for doing the work that they should be doing, and I don't like that.

 

On 8/8/2022 at 5:48 PM, dan86turbo said:

In the morning I take, around 9AM:

25mg of topiramate

 

In the evening I take, around 9PM:

25mg of topiramate

5mg of olanzapine

150mg of gabapentin

20mg of doxepin

 

Have you felt any benefit from gabapentin? Suggest you move 75mg earlier in the day, at noon.

 

Have you felt any benefit from doxepin?

 

Olanzapine is the most dangerous drug you're taking. What has been your experience tapering it?

[dan86turbo]

20 hours ago, Altostrata said:

Please allow me to say that I don't get paid for doing the work that they should be doing, and I don't like that.

 

I completely understand this, and I am extremely grateful that such a resource exists, and that you donate your time such that you do.   Is there any way that I can make a donation towards the upkeep of this site?  Having worked in tech for a couple of decades, I know that server space and bandwidth are not free, either.  I am living on limited resources myself, but am happy to help a little wherever I can right now.

 

20 hours ago, Altostrata said:

Have you felt any benefit from gabapentin? Suggest you move 75mg earlier in the day, at noon.

 

Have you felt any benefit from doxepin?

 

Both the gabapentin and doxepin were added after one of my recent psychiatrists CT'ed me off of sertraline in Oct of 2020, in order to address panic (gabapentin) and insomnia (doxepin).  They definitely solved those problems at the time, but now as I approach ~2 years out from the discontinuation of the sertraline, I question whether they're necessary at this point.  I can try breaking up my 150mg dose of gabapentin and taking 75mg of it midday.  I'd love to be off of it altogether at some point, as I know even at the low level I'm on it contributes to my foggy thinking.  I tried reducing the dosage on it (gabapentin) under the direction of another psychiatrist this past spring, fairly abruptly, from 150mg to 100.  My thinking got clearer, but I ended up very depressed.  Which is how this game with my brain seems to be going lately. 

 

As for the doxepin, I'm not sure what benefit I'm getting from it but, again, when I tried tapering last time, I ended up depressed.  I feel imprisoned, right now, by this cocktail of drugs.  I'm miserable being on them, and the steps I've taken to try and get off have just made me feel worse.  I also feel like none of my psychiatrists have really had a "plan" to get me off.  It's always "what if we try X? Well, that didn't work, what if we try Y?"

 

20 hours ago, Altostrata said:

Olanzapine is the most dangerous drug you're taking. What has been your experience tapering it?

 

Almost every time I've tried to taper the olanzapine I've dealt with severe insomnia and intense anxiety.  The most success I've had was one time about 4 years ago that I tried to taper where I ground up my pills and weighed the powder, reducing about 0.1mg at a time, every few weeks, with some long pauses.  I made it down from 5mg to 2.5mg over the course of a year.  Then at 2.5mg I got hit with intense Tourettes tics (olanzapine happens to be a very good Tourettes med, but that's not the reason I was put on it), and instead of riding them out I stupidly threw away my progress and went back to 5mg.  Every other time I've tried tapering I've done it by larger increments and the insomnia and anxiety have been enough to make me abandon the taper.  So, I think this tells me that I can tolerate tapering it if I move slowly enough, and have a plan to deal with the tics.

 

Thanks, again, for taking the time to listen to my story and offer thoughtful advice.

[ChessieCat]

3 hours ago, dan86turbo said:

Is there any way that I can make a donation towards the upkeep of this site? 

 

Thank you for your offer of a donation.  This is how you can do this:

 

Disclaimer:  Please note that you will not receive any extra assistance or special attention if you choose to make a donation (this may not be your reason but there are some people who would expect this).  It is not "fee for service".  The site is completely free to everyone and you will be treated the same as every other member on the site.

 

This is what the donation money is used for:

 

On 4/21/2011 at 12:49 AM, Altostrata said:

If you feel Surviving Antidepressants is helpful, please consider a voluntary donation.

 

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This site's purpose is only to provide support for people withdrawing, reducing suffering, and bringing the problems of withdrawal to the attention of medicine.

 

Your contribution will go towards expenses such as

 

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[Altostrata]

Splitting the gabapentin dose is relatively low-risk and one step towards eliminating the drug. That batch all at once at night is not good.

[dan86turbo]

Been a little while since I've checked in, so figured I should update things here.  I tried moving the gabapentin to a divided dose at noon and bedtime and it didn't go too well.  Ended up with severe insomnia that started immediately and didn't resolve after a few days.  It scared me since when I came off of the sertraline CT back in late 2020 I had insomnia for weeks, so I ended up reverting to taking 150mg of gabapentin only at bedtime and that resolved the insomnia immediately.  I am going to stick with that for now and wait for things to stabilize before making any other changes (currently waking up with anxiety and an upset stomach, which I attribute to changing around the gabapentin).

 

In the meantime I've been doing a lot of research on SA about the various meds that I'm on, and trying to figure out which one to get off of first.   From what I've read, it really seems like the next logical step is to try to eliminate the olanzapine.  I've been on it for a fairly long time (a little over 8 years), I've always fought with high A1c numbers since starting, and I worry about developing TD, since I already have another movement disorder (Tourettes) and don't need yet another to deal with.  I've ordered some supplies from Amazon to make my own liquid suspension from the olanzapine tablets that I have as per the Tips for tapering off Zyprexa (olanzapine) thread.  I'm planning to start with a 10% hyperbolic taper and see how I tolerate it.   Insomnia and anxiety are my primary concerns since those are what have cropped up in the past when I've tried to taper olanzapine too quickly.  I also have an appointment with my psychiatrist on Monday, and am going to run all of this by him.  So far, he's been supportive of my efforts to get off of these medications.

[Altostrata]

4 hours ago, dan86turbo said:

I'm planning to start with a 10% hyperbolic taper and see how I tolerate it.

 

Good idea. Please let us know how you're doing.

[dan86turbo]

Three nights ago I started transitioning from 5mg tablets of olanzapine to taking 1/2 a tablet (cut with a pill splitter) and 1/2 a tablet dissolved in 50mL of water.  I had read in a few threads that it's a good idea to transition to the liquid slowly as some people react to it differently.  I decided to start by doing 1/2 a tablet in water and once I was sure I was tolerating that OK to go to a full tablet in water, at 5mg, then start tapering once I had stabilized there.

 

I'm checking in because even just switching to the 1/2 tablet in water, I've noticed some reactions from my body.  Not sure If I'd call them WD symptoms or what.  The first night I took it I felt very hot in bed, even with the AC on in my bedroom.  I know the olanzapine and topirimate interact and can cause an elevated body temp, just seems weird that changing from a pill to pill fragments suspended in water would exacerbate that.  As well, I haven't been sleeping very well since I started with the liquid.  It's been taking me longer to fall asleep and I wake up during the middle of the night and have difficulty falling back asleep again.  Before making the change, I was averaging around 7 hours of sleep a night.  I've also been pretty down and depressed during the day, but I attribute that mainly to the lack of good sleep.

 

So, I'm just a little worried. I haven't even started reducing my dose and I'm noticing things happening in my body.  I've just changed from a 5mg pill to 1/2 pill + 1/2 pill suspension in water.  I worry how my body is going to respond to even a gentle taper if I'm noticing effects from staying at the same dose but changing the form that I take it in.  I surmise from this that my nervous system must be very sensitized right now.

 

Anybody have any thoughts or experience to share on this topic?

 

Thanks!

[Faure]

Hello, I’m sorry to read about your cocktail of drugs and the negative effect they are having on you. I’m with Alto in that it’s a disgrace the psychiatric ‘profession’ cause these problems and have no idea how to solve them.

 

I’m just chipping in to say do consider the BrassMonkey Slide method of tapering, it’s very gentle and you may find it smoother with your already very sensitised nervous system. I am just on the one drug and this method is agreeing very well with me. My WD symptoms are generally mild and short lived, reducing over time and in 15 months I have got down from 15 to 5.3mg.  My energy levels and mood have improved hugely.

 

Keep us posted as to how you’re doing. I hope you settle down with the liquid soon. This is something I’m going to have to get my head around in a year or so! For now I grind and weigh pills ☺️

[dan86turbo]

2 hours ago, Faure said:

I’m just chipping in to say do consider the BrassMonkey Slide method of tapering, it’s very gentle and you may find it smoother with your already very sensitised nervous system. I am just on the one drug and this method is agreeing very well with me. My WD symptoms are generally mild and short lived, reducing over time and in 15 months I have got down from 15 to 5.3mg.  My energy levels and mood have improved hugely.

 

Keep us posted as to how you’re doing. I hope you settle down with the liquid soon. This is something I’m going to have to get my head around in a year or so! For now I grind and weigh pills ☺️

 

Hi Faure.  Thanks for replying.  I just read up on the BrassMonkey Slide method.  I definitely like the idea of making a smaller cut, even if it is more frequently.  Slow and steady wins the race, right?  I've tried tapering the olanzapine a number of times in the past and had to abandon it, usually because I was going too fast and the WD symptoms became too much (anxiety + insomnia).  One time I did go slow, by cutting and grinding up my pills like you, but when I got down to ~2.5mg my Tourettes tics came back so intensely that I gave up then too.  I found the cutting/grinding process to be very frustrating, however, which is why I'm trying the homemade liquid/suspension this time.  Whenever I weighed out my powder, I'd do it 2 or 3 times in a row, and every time I'd get a different reading.   I tried a few different scales and just never found one that worked reliably for me.  I'm glad it's working for you.  I see you've gone down by almost 2/3rds of your dose in 15 months.  That's great!  I would love to be able to do the same with my olanzapine.  I've read in other peoples' threads that they felt like they starting to come alive again below 2.5... but I'm getting ahead of myself.  One step at a time!

 

Thanks again!

 

[Altostrata]

On 8/8/2022 at 5:48 PM, dan86turbo said:

In the morning I take, around 9AM:

25mg of topiramate

 

In the evening I take, around 9PM:

25mg of topiramate

5mg of olanzapine

150mg of gabapentin

20mg of doxepin

 

8 hours ago, dan86turbo said:

I know the olanzapine and topirimate interact and can cause an elevated body temp, just seems weird that changing from a pill to pill fragments suspended in water would exacerbate that.

 

The liquid form of the drug may be absorbed faster than the pill form. If you take olanzapine and topiramate simultaneously, you elevate the risk of drug-drug interaction. 

 

Can you take topiramate at least 3 hours earlier than olanzapine and your other nighttime drugs? As you can see, there is a boatload of interactions among them.

[dan86turbo]

On 9/1/2022 at 8:29 PM, Altostrata said:

The liquid form of the drug may be absorbed faster than the pill form. If you take olanzapine and topiramate simultaneously, you elevate the risk of drug-drug interaction. 

 

Can you take topiramate at least 3 hours earlier than olanzapine and your other nighttime drugs? As you can see, there is a boatload of interactions among them.

 

I moved the topiramate to ~3 hrs earlier and that seemed to mitigate the issues with high body temperature at bedtime.  It also made it a bit easier to fall asleep.  However, ever since I started taking the olanzapine in homemade liquid form I've been having issues staying asleep.  I wake up between 2-4AM and have trouble falling back asleep.  As well, I've been finding myself more and more depressed and inactive during the day.  I just want to sit around and kill time online instead of doing anything.  I even took a trip to see a good friend who I haven't seen in person in years over the weekend, and that didn't pull me out of my funk, so I attribute it to my change in meds.  I am beginning to think that I need to abandon the liquid taper and try something like, like cutting/weighing tablets, which I have done before with success.  If anybody has suggestions, I am happy to hear them.  Has anybody else here ever had problems switching to a homemade liquid of their meds?  It's frustrating that my body seems to be so sensitive to these small changes.

[Altostrata]

3 hours ago, dan86turbo said:

I wake up between 2-4AM and have trouble falling back asleep. 

 

How often does this happen?

 

You just changed the topiramate dosing. This can change the balance of everything else. It can take a week or so to settle down.

 

On 8/8/2022 at 5:48 PM, dan86turbo said:

In the morning I take, around 9AM:

25mg of topiramate

 

In the evening I take, around 9PM:

25mg of topiramate

5mg of olanzapine

150mg of gabapentin

20mg of doxepin

 

How do you feel before and after taking topiramate in the morning?

 

You are still taking 3 "brakes" at the same time at night. When you take too many brakes at once, this can cause a paradoxical reaction that might disrupt sleep. 

[dan86turbo]

19 hours ago, Altostrata said:

 

How often does this happen?

 

You just changed the topiramate dosing. This can change the balance of everything else. It can take a week or so to settle down.

 

 

This started happening shortly after I switched to taking part of my olanzapine dose as a liquid, and has happened every night since.  Changing the timing of the topiramate has not affected it, though it has fixed the body temp issues and made it a bit easier to get to sleep initially.

 

19 hours ago, Altostrata said:

How do you feel before and after taking topiramate in the morning?

 

You are still taking 3 "brakes" at the same time at night. When you take too many brakes at once, this can cause a paradoxical reaction that might disrupt sleep. 

 

I don't really notice much of anything after taking the topiramate in the morning, which makes me think that the side effects profile for it alone is fairly minimal, and what I'm feeling at night is from drug-drug interactions.  Does that seem likely?

 

Another wrinkle:  I saw my psychiatrist today, and he is hell-bent on starting me on another drug while I'm doing the taper.  He wants to reinstate a small dose of sertraline, even though it's been some time since I stopped, to see if I really am dealing with withdrawal symptoms.  I'm not sure I'm comfortable doing this, esp as I'm already messing around with timing and dosing on other meds.  How do I push back on this?  I'm the type of person who has a hard time saying "no."  I suppose I could accept the rx and then just not take it...?  I'm already on too many medications, I would really like not to add another to the mix and further muddy the waters, or destabilize myself even more.

[Altostrata]

You can say, "maybe later". You're already taking an antidepressant and you have a suspicious drug snarl at night.

 

I am thinking the next change might be to move gabapentin out of the nighttime batch. Can you get the liquid form?

 

Is topiramate supposed to be dosed in any particular way, such as divided doses 12 hours apart?

 

 

[dan86turbo]

On 9/7/2022 at 3:23 PM, Altostrata said:

You can say, "maybe later". You're already taking an antidepressant and you have a suspicious drug snarl at night.

 

I am thinking the next change might be to move gabapentin out of the nighttime batch. Can you get the liquid form?

 

Is topiramate supposed to be dosed in any particular way, such as divided doses 12 hours apart?

 

Thanks for the reply.  Sorry I've been a little while in getting back to this thread.  Trying to switch to the homemade liquid on the olanzapine did not work well for me at all.  It acted like when I've tried to increase my dose in the past, which is to say I ended up very depressed during the day.  Just sitting around the house with a frown on my face, not wanting to engage in life.  That was only at 2.5mg liquid + 2.5mg tablet.  So I figured I wasn't going to be able to make it to all liquid to start tapering, so I'm working on switching back to taking it as a tablet before trying another method of tapering... either grinding it up and weighing the powder, or filing down the tablets and weighing them.  I'm leaning towards the latter as I feel like my body will metabolize them similarly to a normal tablet.  A powder in a capsule might be absorbed too quickly, similar to the homemade liquid.

 

I am uncertain about moving the gabapentin out of the nighttime slot because it was prescribed to help me sleep, and when I tried moving even half of it to midday, I was unable to fall asleep.  I feel like my sleep right now is very delicate.  It takes very little to upset it, which frustrates me.  I feel like it limits what options I have for tapering these meds, at least if I don't want to spend half of my nights awake, staring at the ceiling.  Even switching back from the liquid olanzapine to the tablet, which I'm doing by 1/4 of a 5mg pill, has given me insomnia on the first couple of nights after I take a step, and I assume that should be a fairly small dose change.

 

I've always been told to take the topiramate in a divided dose, half in the morning and half at bed.  I'm not sure why, I know it has a fairly long half-life.  Though I do know when I've raised the dose or tried taking it all at one time, that it has made my brain fog worse.

[Altostrata]

22 hours ago, dan86turbo said:

I ended up very depressed during the day.  Just sitting around the house with a frown on my face, not wanting to engage in life.

 

If this is a withdrawal symptom, it is very unimpressive. Very commonly, olanzapine will make you demotivated and fatigued. Could this symptom be a drug effect, not due to the combination of liquid and tablet?

 

On 8/8/2022 at 5:48 PM, dan86turbo said:

In the morning I take, around 9AM:

25mg of topiramate

 

In the evening I take, around 9PM:

25mg of topiramate

5mg of olanzapine

150mg of gabapentin

20mg of doxepin

 

You are taking 4 drugs at once, any one of which might put a person to sleep. Please consider whether it is absolutely necessary for you to keep gabapentin in this absurd cocktail at night.

 

If you do not want to make any changes in your drugs, you don't have to. Please let us know when you want to reduce them.