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Altostrata

Tips for tapering off Zyprexa (olanzapine)

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herewego

Hi Altostrata,

I took the 24 hr old refrigerated ODT Olanzapine/ORA-Plus solution last night and I slept a solid 8 hrs and felt groggy for much of the day, so I am thinking it must still be effective when kept refrigerated for that long. Perhaps when my doses are lower yet I can see if it lasts 48 hrs refrigerated like the crushed table form in water can.

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Evoldnahturt

I spoke to that compounding pharmacist again today and got him to further explain on the oxidation issue.  He said that the thieno group in the molecule, which is a sulfur (not sure if that's relevant), is what oxidizes.  He explained that this group doesn't seem to have any active metabolites, so the fact that it oxidizes, in his opinion, shouldn't be a problem.  I've learned not to trust pharmacists (or anybody in the medical field, for that matter) and like the fact that the idea that I came up with (using a scale and dividing piles) doesn't rely on that being true.  Possibly more importantly is that my method gets around the problem of trying to homogenize the drug in a solution, which I suspect may be a real problem.  I hope it doesn't feel like I'm beating you over the head with this.  Maybe your way is better.  I am just concerned that it may not be.  Even if I'm right, if you're not sensitive enough to dose reductions or updoses, it may not be a problem.

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herewego

Hey, I hear you. I totally agree that the olanzapine does not evenly disperse in just water alone but quickly sinks to the bottom. Do you have concerns with the olanzapine evenly dispersing in the ORA-Plus? Just eye - balling it, it seemed to me to evenly disperse and suspend in the ORA-Plus. But if you experienced otherwise or were told otherwise by a pharmacist please detail what you observed or heard. I certainly want to be successful at tapering and am open to using a good scale if need be. It's nice to know from your info that the olanzapine is likely evenly dispersed when you make it into a powder, so using a scale is an option too.

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Evoldnahturt

I wasn't able to see the Olanzapine in the ORA-Plus, so I couldn't tell how well dispersed it was.  I'm not sure at what point it would become a problem, but the pharmacist suggested that at low enough doses, it would become a problem for him.  My scoops came in the mail.  I intend to weigh ten scoops of Olanzapine on a scale.  I'll divide the weight by ten to get the average weight and use that to figure out how many mg (of the active ingredtient) is in a scoop.  I'll do that several times for each scoop size I have to get an average and figure out what the standard deviation is.  I suspect the scale will be less accurate than these scoops at this weight, but I'm not sure that I can prove that.  I'll post the results of the tests here.  I have a feeling these scoops are going to make the taper a lot easier will and allow me to get more consistent doses.  I played with the smallest scoop a little and roughly estimated that the taper from 2.5mg could last between 4.75 and 5.41 years before the piles become too small to manage.  The dose of Zyprexa would be 0.00684mg and 0.00294mg respectively.  The difference between 2.5mg and 2mg is about two months, so it should take about as long for you, herewego.  I should have a closer estimate after I'm done testing.  I'm going to have to order five more of each scoop so I can dump them all at once before the scale shuts itself off.  It might be around a week before I get to this.  If these scoops look like they're going to work out, I'll come up with a taper plan and will post the details of that as well.  I hope you're feeling well today.  Take care of yourself!

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Evoldnahturt

I should clarify.  The pharmacist said he would have no problem "doing the math" to dilute the Olanzapine to the right amount.  His concern was that at low doses, it wouldn't be homogenized enough to give you consistent doses.  He said his compounding "should" be safe at as low at 0.25mg.  The other pharmacists refused to compound at lower doses.  Some would go as low as 0.5mg and others would only compound 2mg.  He also mentioned that he would be able to homogenize it better in a liquid.

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Altostrata

Rather than confusing your pharmacist, you could ask him to compound at a higher dose, such as 1mg/1mL, and simply take less in a 0.5mL or 1mL oral syringe.

 

You will still need a prescription for any type of compounded drug.

 

What are you doing with the scoops?

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Evoldnahturt

I'm considering using scoops to measure when I get to amounts too low to weigh on a scale.

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herewego

If my ORA-Plus mixture seems to be working the lowest I will be able to go to is either .025 mg or .0125 mg. The .025 mg would be if I only dilute the 5 mg ODT in 20 mL. I will also try diluting it in 40 mL, but I am wondering if 5 mg of pill will dilute in the bigger amount of 40 mL - it may be too little amount of pill in too much solution, but I will see how it looks when I get to that point. Currently I am diluting the 5 mg ODT in a 10 mL solution of ORA-Plus & water.

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Altostrata

Yes, your 5mg tablet will make a suspension in 40mL. 40mL is not very much liquid.

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herewego

Good to know. I also just saw in the past few days the topic in tapering on using a syringe. I didn't know syringes could be found as low as 1 or .5 mL so that should help too.

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Astrid

the only thing i can find here are tablets & i'm wondering if it is safe to just cut off what one consider a 10%? & then just keep making the pill smaller as you taper along...

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erer

the only thing i can find here are tablets & i'm wondering if it is safe to just cut off what one consider a 10%? & then just keep making the pill smaller as you taper along...

That would not be very precise. As the amounts get smaller and smaller your cuts will be less and less accurate. 

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Evoldnahturt

the only thing i can find here are tablets & i'm wondering if it is safe to just cut off what one consider a 10%? & then just keep making the pill smaller as you taper along...

 

Hudgens did something similar to what you're suggesting with good results.  I agree that it would become very difficult to make cuts the closer you get to the end.  Listening to your body and long holds might mitigate the risk of getting sick:

 

http://survivingantidepressants.org/index.php?/topic/10072-hudgens-success-story/?p=181314

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Altostrata

We recommend making a liquid, which can be more consistently measured, or weighing tablet fragments with a scale, than trying to trim a tablet by eye.

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Evoldnahturt

We recommend making a liquid

 

Zyprexa isn't water soluble

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scallywag

We recommend making a liquid

Zyprexa isn't water soluble

Evold -- there are earlier posts in this topic about using a compounding liquid such as ORA-plus

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Miko789

 the only thing I can find here are tablets, is it safe to  cut orodispersible tablets quarters with a pill cutter?

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erer

Is Zyprexa/Olanzapine also an antihistamine like Seroquel? I cannot seem to find a conclusive answer to that question online.

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lucyinthesky
1 hour ago, erer said:

Is Zyprexa/Olanzapine also an antihistamine like Seroquel? I cannot seem to find a conclusive answer to that question online.

 

Yes, it is. Olanzapine reduces H1 receptor (Histamine).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3485633/

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arwilliams

Has anyone successfully switched from Zyprexa for Seroquel for taper(I know this isn't exactly a taper question and might be borderline against the rules)?

The are technically both antipychotics though.

Zyprexa has the highest affinity for h1 receptors of any medication.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC487011/

 

On top of that the pills are so small it is borderline impossible in my experience to cut the pills(Yes I do have a precision scale).

 

I am considering trying a high dose of Seroquel because it comes in liquid form or the larger pills which are easier to cut.

 

Right now I am on 2.25mg cut from 2.5mg of Zyprexa.

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Altostrata

ar, please read the beginning of this topic.

 

Zyprexa and Seroquel are two different drugs. I would not make that switch unless it was a last resort.

 

Some of our members have successfully tapered using the Zyprexa wafers. Please use search in the Introductions section to read of other tapering Zyprexa.

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arwilliams

It appears to me that the a crushed tablet would be stable for quite a long time but in liquid it may not.

 

Or am interpreting the link incorrectly?

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Altostrata

You seem to have a lot of doubts about the tapering tips we've provided at the beginning of this topic. You may feel more confident if you get a liquid compounded:

 

Quote

Using a liquid to taper: Pharmacy compounding
At a very low dose of olanzapine, if you are sensitive to dosage reductions, you may wish to request a prescription for a liquid from a compounding pharmacy. This will enable tapering by a fraction of a milligram.

A pharmacy compounding formula using crushed tablets is here http://www.pharminfotech.co.nz/manual/Formulation/mixtures/olanzapine.html
It is also attached to this post. (It notes olanzapine is "practically insoluble in water.")
 
You will need a prescription written for the custom-compounded liquid. The only drawback is this can be quite expensive.

 

The pharmacy will put an expiration date on your liquid.

 

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Evoldnahturt

Arwilliams, I'm currently using micro scoops as the amount I'm working with is almost too small to weigh on a scale.  I believe this is the safest way to taper medications that are classified as "practically insoluble" in water once you get down to a weight that a milligram scale can't measure precisely enough.

 

Extra-large red scoops:  https://amzn.to/2IK8OcB

 

Large blue scoops:  https://amzn.to/2kpqYBO

 

Small yellow scoops:  https://amzn.to/2seIMnJ
 

I weighed ten scoops from each sized scoop individually and divided the weight by ten to get the weight per scoop.  I did this many times for each scoop size and went with the average.  I then weighed an entire pill to get the mg dosage per weight.  Let's say a 2.5mg tablet of Zyprexa weighs 95mg on a scale.  That's 0.0263157894736842mg (dosage in mg) per mg weight on a scale (2.5mg / 95mg= 0.0263157894736842mg).  Let's say you determined that the amount of Zyprexa that a red scoop holds weighs 6.25mg.  Multiply the dosage in mg per mg weight (0.0263157894736842mg) by this number to get the dosage each red scoop will give you (6.25mg x 0.0263157894736842mg = 0.1644736842105263mg).  Now you just adjust the number of scoops you need from each scoop size to get whatever dose you want.  Once you get to where you need less than what the smallest scoop provides, you take one of those scoops and divide it in half.  Then you divide each of those halves in half again.  You will then have four somewhat equal piles.  You divide the dosage that that scoop gives you by four to get the dosage of each pile.  You can divide piles as many times as you want to get to the dosage you need.  I'm going to try to create a post to make this information more digestible soon and to guide people through the process of how to get this all set up.  Feel free to PM me in the meantime if you're interested in considering this method and would like some more input on how I accomplish this.

 

 

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Evoldnahturt
21 minutes ago, Altostrata said:

You seem to have a lot of doubts about the tapering tips we've provided at the beginning of this topic.

 

He should have doubts, the advice is bullsh*t

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Altostrata

And yet many people have managed to taper Zyprexa with these techniques. The wafers are a favorite method.

 

"Practically insoluble" in water has not been an impediment to those who are utilizing suspensions to taper other "practically insoluble" drugs. A compounded liquid would be a suspension.

 

Thank you for detailing the method you have found. I believe you are weighing powder made from tablets:

 

10 minutes ago, Evoldnahturt said:

Arwilliams, I'm currently using micro scoops as the amount I'm working with is almost too small to weigh on a scale.  I believe this is the safest way to taper medications that are classified as "practically insoluble" in water once you get down to a weight that a milligram scale can't measure precisely enough.

 

Extra-large red scoops:  https://amzn.to/2IK8OcB

 

Large blue scoops:  https://amzn.to/2kpqYBO

 

Small yellow scoops:  https://amzn.to/2seIMnJ
 

I weighed ten scoops from each sized scoop individually and divided the weight by ten to get the weight per scoop.  I did this many times for each scoop size and went with the average.  I then weighed an entire pill to get the mg dosage per weight.  Let's say a 2.5mg tablet of Zyprexa weighs 95mg on a scale.  That's 0.0263157894736842mg (dosage in mg) per mg weight on a scale (2.5mg / 95mg= 0.0263157894736842mg).  Let's say you determined that the amount of Zyprexa that a red scoop holds weighs 6.25mg.  Multiply the dosage in mg per mg weight (0.0263157894736842mg) by this number to get the dosage each red scoop will give you (6.25mg x 0.0263157894736842mg = 0.1644736842105263mg).  Now you just adjust the number of scoops you need from each scoop size to get whatever dose you want.  Once you get to where you need less than what the smallest scoop provides, you take one of those scoops and divide it in half.  Then you divide each of those halves in half again.  You will then have four somewhat equal piles.  You divide the dosage that that scoop gives you by four to get the dosage of each pile.  You can divide piles as many times as you want to get to the dosage you need.  I'm going to try to create a post to make this information more digestible soon and to guide people through the process of how to get this all set up.  Feel free to PM me in the meantime if you're interested in considering this method and would like some more input on how I accomplish this.

 

 

 

I hope people who do not trust making their own liquid will be able to follow your method. A video probably would be most appreciated. 😊

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arwilliams

Another reason Seroquel might be a good jump medication for last resort is that Seroquel has a 6 hour half life while Zyprexa's is more like 30.

 

This would give your brain time to reset during the day potentially.  Of course it takes longer then 6 hours for medication to clear your system.

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Altostrata

There are many drugs that might be easier to taper than Zyprexa. The problem is, your nervous system is dependent on Zyprexa and we don't know if it will accept a substitute.

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Evoldnahturt
12 minutes ago, Altostrata said:

There are many drugs that might be easier to taper than Zyprexa. The problem is, your nervous system is dependent on Zyprexa and we don't know if it will accept a substitute.

 

This would be my concern.  They're both atypical antipsychotics, which may or may not mean that these drugs are similar enough for this to work.  I have to imagine that it's, at the very least, risky.  Maybe you understand this well enough to feel confident that this is the safest option.  My lack of understanding in this area would cause me to try to avoid making a switch to a different drug.  I freaked out when it looked like Teva might go under because that would mean I would have to switch brands of the same medication, which has caused problems for some people.  I have to imagine switching drugs is even riskier.

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Altostrata

Simply because they are somewhat arbitrarily classified as "antipsychotics" with sleepiness as a common side effect, you cannot assume olanzapine and quetiapine are interchangeable. The two drugs are not close chemical relations:

 

Olanzapine C17H20N4S

 

Quetiapine C21H25N3O2S

 

Compared in more detail here

EXCLI J. 2014 Oct 13;13:1163-91. eCollection 2014.

Clinical pharmacology of atypical antipsychotics: an update.

Mauri MC1, Paletta S1, Maffini M1, Colasanti A2, Dragogna F1, Di Pace C1, Altamura AC1.

 

Quote

 

Olanzapine (OLZ) is a thienobenzodiazepine derivate structurally similar to clozapine....

....

Quetiapine (QTP) is a dibenzothiazepine derivate....

 

 

The literature on switching from one drug to another mentions withdrawal symptoms and other adverse reactions in the course of the switch. Swap olanzapine for quetiapine at your own risk.
 

 

Reviewing this topic, I see members have reported success tapering olanzapine by

  • Getting olanzapine capsules compounded to custom dosages
  • Making a liquid with orally dispersible tablets (discard remainder after dosing)
  • Using the pharmacy liquid for do-it-yourself suspensions

As we explain in the topic about making your own liquids and many, many other places, many drugs are not very soluble in water, yet you can make a usable suspension with them. Very frequently, new members will express concern about specks and cloudiness in their homemade suspensions. They are seeing binders and such from the tablet.

 

There is always going to be a measure of inaccuracy in do-it-yourself liquids. We have answered questions about this over and over in How to make a liquid from tablets or capsules and other topics in the Tapering forum. There was a pointer to this in the first post in this topic.

 

We urge people to be consistent and accurate in their dosing, but we do not require or expect perfection.

 

We do appreciate your reading the prior posts in this topic and links we have provided, they will answer many of the questions you would ask.

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lucyinthesky
On 5/25/2018 at 1:44 AM, arwilliams said:

Has anyone successfully switched from Zyprexa for Seroquel for taper(I know this isn't exactly a taper question and might be borderline against the rules)?

The are technically both antipychotics though.

Zyprexa has the highest affinity for h1 receptors of any medication.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC487011/

 

On top of that the pills are so small it is borderline impossible in my experience to cut the pills(Yes I do have a precision scale).

 

I am considering trying a high dose of Seroquel because it comes in liquid form or the larger pills which are easier to cut.

 

Right now I am on 2.25mg cut from 2.5mg of Zyprexa.

 

Hello!

i am currently switching from zyprexa to seroquel, the reason being that the side effects of zyprexa are too detrimental to the quality of my life (even if i’m tapering off anti-psychotics, It will still take 1-2 years). I’ve been on seroquel before with no side effects and my plan, once I’ve made the switch is to begin a gradual taper off Seroquel. 

 

Olanzapine affects more receptors than Seroquel, but the key one for me, histamine receptor as it affects sleep is fairly similar in effects- meaning sleep is unlikely to be disrupted. By contrast, when I tried to switch from olanzapine to ability (another antipsychotic but it doesn’t target histamine receptor), I had chronic insomnia and point blank could not sleep. 

 

Indeed I’m mid-way through the transition to seroquel and my sleep has been fine. The only other effects I’ve noticed are my depression lifting, more energy, less sedation—basically a reduction in all the awful effects of olanzapine. 

 

I will update once olanzapine is fully out of my system. 

 

However if the only reason you’re looking to make the switch is because of tapering method, I also reinforce the fact that you can make a suspension liquid from olanzapine fine— even th regular kiind. 

 

 

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BobJoe

Just a warning to you guys. I tried to quit olanzapine cold turkey and  fucked up my heart by accident. Now i have problems with heart electricity and might need a stimulator in near future. 

So dont try to go cold turkey!

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Altostrata

Thanks so much, @lucyinthesky and @BobJoe Very much appreciate your adding your wisdom about tapering olanzapine to this topic.

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wantmyhubbyback

hi, all. hubby successfully tapered from 20mg olanzapine over 2 years. he'd been hospitalized 2x when trying to jump off from the "low" 2.5mg dosage.

 

the last part of the taper was via compounding in 2mg, 1.75mg, 1.5mg, 1mg and .5mg dosages.  followed this forum's suggestions for long slow taper with at least 2 months or so at each dosage, esp at the 1mg and .5mg dosages.  hubby did have issues with sleep after coming off and so doc moved him to 100mg seroquel.  (he's also still on 7.5mg mirtazapine and 100 mg trazadone for sleep but we've been working to reduce these as well).

 

the seroquel seems to work well enough to get him to fall and stay asleep. the bigger issue is that he still (into the 5th year, sadly) wakes up with racing thoughts and high anxiety.  still taking .5mg ativan mornings for this.

 

the zyprexa was an evil drug and i hope that all who are trying to get off of it can do so.

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Spideygsm
51 minutes ago, wantmyhubbyback said:

hi, all. hubby successfully tapered from 20mg olanzapine over 2 years. he'd been hospitalized 2x when trying to jump off from the "low" 2.5mg dosage.

 

the last part of the taper was via compounding in 2mg, 1.75mg, 1.5mg, 1mg and .5mg dosages.  followed this forum's suggestions for long slow taper with at least 2 months or so at each dosage, esp at the 1mg and .5mg dosages.  hubby did have issues with sleep after coming off and so doc moved him to 100mg seroquel.  (he's also still on 7.5mg mirtazapine and 100 mg trazadone for sleep but we've been working to reduce these as well).

 

the seroquel seems to work well enough to get him to fall and stay asleep. the bigger issue is that he still (into the 5th year, sadly) wakes up with racing thoughts and high anxiety.  still taking .5mg ativan mornings for this.

 

the zyprexa was an evil drug and i hope that all who are trying to get off of it can do so.

wantmyhubbyback,

 

Sorry about the rough ride your Hubby is going through. My last dose of Zyprexa was about 12 weeks ago. I'm no expert by any means regarding medical advise. I've been dealing with mental health issues my entire life. I started with Ritalin when I was 8 so by the time I was nine I was a drug addict. I have experience with Zyprexa, Seroquel, Latuda, Geodon and Lithium. I was on lithium for a long time. I was only on Seroquel and Latuda for a few weeks to just over a month because I literally couldn't stay awake. I had the opposite reaction with Geodon. It made me go full blown manic. Zyprexa worked best for me. I was on it for about 15 years. My problem is my body kept building up a tolerance and I got up to 30mg. At that point I got serious side effects and had to stop ASAP. I tapered from 30mg to zero in about 3 months. Right now I'm sitting on a prescription for Abilify which I have yet to fill. After my Zyprexa withdrawal, I want to do everything I can to stay off antipsychotic drugs once and for all. 

 

Zyprexa was very difficult for me to get off of. Probably because I was on a very high dose and took the drug for a long time. I had a really hard time once I tapered below 2.5mg similar to what your Hubby has experienced.  The withdrawals increased even more after my last dose of Zyprexa, and then the worst symptoms occurred 4 weeks after my last dose. Don't know why, just happened. I'm unfamiliar with your hubby's medical conditions. Do he require an antipsychotic for a true mental health reason? As much as possible, I want to stay away from trading one addiction for another. Seroquel is known to be very difficult to withdrawal from. I've been through Benzo withdrawal before and it was very intense and lasted about 60 days. I only mention it because your husband taking Ativan (which I've also taken, Klonipin, Xanax, Ativan, Valium). I experienced a lot of withdrawal symptoms coming off Zyprexa. The worst were probably insomnia and anxiety. I still have insomnia and anxiety but the anxiety is tolerable. It resolved at about week 9.

 

If I had a choice of how to withdrawal from Zyprexa (which I didn't) I would strongly follow the advice from this website. I'd do even smaller tapers near the end and don't put a timeline on how long to hold at a specific dose. Let Hubby's body tell him when to make the next taper. On previous attempts your Hubby's had issues with the last few and final tapers. Probably too much of a drop and probably not holding the taper's long enough. For me, nothing improved my sleep or anxiety. I was desperate and was put on Ambien for sleep which did nothing and Valium for anxiety which also did nothing. I got off those when they weren't working so I didn't have to withdrawal from those also. At about week 9 my when my other symptoms were resolving themselves, my Doctor prescribed Trazodone for sleep. May have helped a little bit (instead of 0-1 hours sleep I'd get 1-2 hours sleep). My sleep has improved the past week after I started pure CBD oil 1-1/2 weeks ago. I said in a previous post, I don't know for sure whether the improvement is from the Trazodone, the CBD, or if my withdrawal condition is resolving itself. I think it's the CBD. Last night I started tapering off the Trazodone. Not enough benefit to justify taking it.

 

I wish your Hubby luck. I know this website is pretty anti-drug. I know I'll never be able to be drug free because of my mental health. However, I want to take as few medications as possible, the least dangerous, and at the lowest dose possible. If Hubby is only taking Seroquel for sleep, I'd look elsewhere. Antipsychotics are very dangerous and I think should only be used for people who are a harm to themselves or others such as me. I think using these type medications for sleep is way too much overkill. I would even say putting the patients life into danger. Instead of taking Benzo's for anxiety, I'm taking Gabapentin which helps with pain and anxiety. I used to take Propanolol for anxiety which also worked. However, I got really low blood pressure (which the drug is supposed to be used for) and had to stop. I've taken sleeping pills for insomnia as well as Trazodone (which doesn't help me) and CBD oil. Honestly, the CBD oil has worked better than prescription sleeping pills. All I'm trying to point out is that there are less dangerous medications and treatments than antipsychotics. Exercise is by far the best drug out there. It has helped me deal with my illnesses better than any drug. However, one must stick with it and don't stop.

 

Hope your Hubby gets well. Read some others experiences getting off Zyprexa. Everybody is different. What I experienced may be completely different than what others have experienced. The best results do seem to come from people tapering a little bit and over a long time. Don't put any timetable on when to make a taper or put a timetable on when Hubby will get better. I think putting a timeline can just add stress.

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