Spice: My Intro

[Spice]

Hey, my wife has recently crashed because of the advice, before reading forums like these, given by a overseer.

She has been on antidepressants and an antipsychotic with a Benzo thrown in.

With the use of carefully measured microvitamins and minerals she was under the illusion that small tapers (less than 10% of the previous dose over 2-4 weeks) would be sufficient, waiting for the withdrawal symptoms and stabilising as much as possible before continuing but got to a point when she was in mental agony with the beginning of psychosis, suicidal idealisation and some mania.

The trouble was that she had crippling headaches beginning in differing areas of her head than moving to the jaw (8 -10 out of 10) the pain now radiates down her neck to shoulders and further on to arms and legs. She was able to see an Osteopath and given advice of ICE and light massage of trigger points, gentle exercises and Naproxen (NSAID)

Before seeing the Osteo. we advised our GP and they prescribed Gabapentin (neurontin) for nerve pain. She didnt take well to this and it sent her over the edge to a catatonic depressive state. It was stopped and 2 weeks on she has increased 2 of the 4 meds (the antipsychotic and the recently (6 weeks) SNRI Remeron (mirtazipine).

She has had a hard time with the pain and the withdrawal and is still in a bad way.

Her parents and myself, around our jobs have been giving her 24 hour attendance.

She wanted me to put this out there for advice as GPs generally do not know much about withdrawal and many don't know that people 'want' to taper and rid themselves of these evil drugs.

• Before the crash she was on 0.9mg of Prozac from originally 10mg at Christmas 2012,
• Mirtazipine from 15 to 0 at 10%of last dose over 3 years last dose 7 weeks ago (reinstated 7.5mg 1 week ago) 
• Lorazepam 0.1mg divided over 4 doses per day with careful weighing 
• Flupenthixol (fluanxol) 0.125mg from 1mg and updosed to 0.5mg 2 weeks ago, 1 mg now.

A mess as can be seen but she still wants to be drug free as she has never had a good day on Meds in 17 years (except for our wedding day 5 years ago).

 

Originally put on Seroxat for anxiety at the age of 17 she has battled ever since. She last crashed in 2010 when she came off all the meds over 6 weeks from smallish doses when we visited a Costa Rican organic clinic using IVs to help wean (obviously too fast as we found out).

 

We have not up dosed the Prozac and the Lorazepam is used regularly with some PRN for rough times.

 

Our thoughts -

• Will she stabilize at 7.5mg of Mirtazipine if protracted withdrawal was a reason for feeling bad after being stopped for 7 weeks?
• Will the up dose of Flupentixol help as it seemed to, last crash in 2010?
• Does she need to up dose the Prozac

No questions about the Benzo other than it will be kept 'til last.

 

WHEN she stabilises we will taper 1 at a time and slowly - any ideas on which first? (the forum prefers the antipsychotic as read)

 

Sorry for the long post and the bump but if any help is out there then please do - also willing to take criticism as it is expected for reducing 4 at the same time, however slowly!

 

May thanks to you all in advance. Rob (husband of Spice) will make sure

 

• List of symptoms. Actively suicidal ( though hasn't got the energy to carry it through, and is monitored)
• Psychosis
• Severe depression
• weakness and exhaustion
• adrenaline and anxiety
• nausea and dizziness
• severe PMS
• Fast pulse (in 90's but not AF)

[Altostrata]

Welcome, Rob. Those are complicated questions.

 

I'm moving this to the Intro forum as responses particular to your wife will be a departure from this topic in the Tapering forum.

 

Did she reduce all her medications at once?

 

Can you see Dr. Peter Haddad in Manchester or David Healy in Wales?

[Spice]

Ok, yes if you could move it to the appropriate forum that'd be great.

Rob

[Altostrata]

Did she reduce all her medications at once?Can you see Dr. Peter Haddad in Manchester or David Healy in Wales?

[Rhiannon]

I am having a hard time understanding what drugs were taken when, for how long, and when they were tapered, and how fast. If you could do a sig line (I think there's a sticky at the top of this forum explaining how) with her med history that would be helpful, or even a post making it very, very clear.  Like which drugs were taken at what doses from when to when, reduced at what doses from when to when, etc.

 

What does come across is that it sounds like she's been up and down on several meds some number of times, and also has had at least one too-fast taper and crash in the past.  And she has had some intense symptoms and is having them again now.

 

What I see in those situations is that people are generally extremely sensitive to future tapers and need to taper very, very, very very slowly in the future.  

 

From your wife's symptoms which you describe, which are much like mine have been in the past, I think you need to plan for this tapering process to take several years.  I generally think one or two years per med.  I would say that's the place to start--realize this is going to be a long-term project, and use this time while she's stabilizing to learn more about what that's going to involve. As you are doing.

[mammaP]

I am so sorry your wife is suffering like this and glad she has a supportive family to help her through this.

The staff here are excellent and will do their very best to help. One thing that I noticed in your intro 

was that she was prescribed vitamin and minerals, which can actually make things worse. 

there is a board with topics on supplements and tests here which might help.

 

http://survivingantidepressants.org/index.php?/topic/606-important-topics-about-tests-supplements-herbs-treatments/

[Spice]

Ok, sorry have been busy with work so able to catch up now. Signature line done [ / ] The answer to one question is yes the meds were all reduced at the same time though very small amounts - you'd think we would have learnt but as the half life's are all different it turned out difficult to realise which w/d was making her feel rotten and when!

We are at the point now that we need to stabilise enough to be able to see the wood for the trees. The Mirtazipine at 7.5mg up from 0 after 6 weeks off was chosen because of the sedative effect and it worked in the past! The Fluanxol from a very small amount 0.125 to 0.5 then quickly 1mg as this seemed to be the one that brought her back online in 2010. We are 2 weeks in now and using the Lorazepam less as a PRN but continue on 4 very small pieces weighed and filed!

Symptoms at the moment, how she describes it . . . . . . . Severe mental torture,

restlessness - no peace ,

severe depression to the point of being actively suicidal.

Intense derealisation and depersonalisation.

Intrusive out of character thoughts.

Agitation. Fatigue, weakness, nausea and dizziness.

Adrenaline rushes.

Big factor is pain that started in head, like migraines (thought to be hormonal) then radiated down to jaw then down back to hands and legs. Saw osteopath who said due to spasms in neck compressing nerves so now icing, resting, warming, gentle trigger presses and suffering. Also in her words "she is in a torture chamber".

So in summary - from January before we had to reinstate and up dose Went from Prozac 10.5mg to 0.9mg been at that level for 10 weeks now. Flupentixol 0.5 down to 0.1mg Mirtazipine 4 mg to 0 and Lorazepam 0.25 to 0.1mg. Have been seeing the doctor about nerve pain tried Naproxen, diclofenac ( suppository) Gabapentin all to no real success - in pain all the time.

What do people think about a Prozac increase to get stable (as it has been 2 weeks since other 2 increases)?

Many thanks to All in advance. Rob and Han

[Altostrata]

Making changes, either increases or decreases, in more than one drug at a time is confusing.

 

No one, including me, knows exactly what's going on. I suppose you might increase the Prozac slightly to see if it might help, but make sure to keep everything else steady.

[Spice]

It has been 2 1/2 weeks since reinstating Mirtazipine and up dosing Flupentixol and no two days ever seem to be the same - I would have said there was a little stability then it all falls apart and suicidal idealisation, mania and severe depression steps up again.

Why are no two days ever the same in withdrawal? You don't get a break to find out what is working and what is not - it's all such a frustrating mystery that continues to strip your partner of life and you feel helpless.

We see a psychiatrist at home on Friday and I can't imagine what they will think . . .

Do we updose the Prozac after 11 weeks at 0.9mg? Do we reduce or stop it? Is that the cause of any of the fluctuations (such a small, non therapeutic dose)? Any ideas would be appreciated - Rob

[Spice]

Thanks AltoStrata for the input and all others for the well wishes.

[Altostrata]

It usually takes about 4 days for a dosage change to fully register in the bloodstream.

[Rhiannon]

Thanks for the excellent sig line! Can you tell us how fast she went down on the Prozac, and when?

 

Given a history like that, it's going to take a while (many months, roughly maybe six months give or take, maybe longer) to get some stability. Everything you're describing is unfortunately a fairly typical outcome for someone with a history like hers, in my experience.

 

In my (fairly experienced) opinion the absolute best thing you can do right now (really pretty much the only thing) is just quit throwing new chemical changes and chaos at her brain, keep everything very stable and consistent, and give her as much lifestyle type support as possible.  

 

I suppose you could try an increase in the Prozac, but given the complexity of her history it's very hard to predict what effect that would have. And I'm of the opinion that once someone's in the place she's in now, throwing any kind of changes into the system is more likely to just prolong the process and make it harder.

 

Unfortunately in all the work I've done with people in this kind of situation I have never seen even one time where there was any kind of quick fix. The only fix I've seen work consistently is patience, strict consistency with meds (dosing, timing etc), and time.

 

My guess is that she's going to continue to feel terrible for a while, with ups and downs, but very gradually the roller coaster will smooth out and the better days will outnumber the hellish days.  Then if she continues to hold and not change the meds, eventually the improvement will plateau out. At that point (which as I say may be many months) you can start to think about an extremely conservative and very slow taper.

 

All just my opinions. But I've done a lot of this and seem to be getting pretty good at it.

 

Also, let me add:  We find it's quite common for extremely small dosage variations to have a big effect, especially for people whose CNS's are already sensitized by previous med changes, withdrawals, crashes, etc.  

 

The whole notion that a "non-therapeutic" dose is insignificant actually doesn't appear to be correct. There's not necessarily much of a connection between what dose is "therapeutic" in someone taking a med with no history and no other meds on board, and what happens with variations in doses in someone who's in withdrawal chaos.  

 

Very small fluctuations, especially at small dosages, seem to have a large effect.  It appears that it's more logarithmic than linear; that is, the amount of the change relative to what you're already taking (the proportion or percentage change) actually affects the outcome more than the actual size of the dose, large or small.  It's an interesting effect and it appears to be pretty robust, although there's a lot of individual variation.

[Spice]

Thank you so much Rhi and Alto. Have taken that all and will put it to plan and action. One more question - the Lorazepam cannot be taken from the situation so can we continue to put a divided dose 4 x daily to keep from the ups and downs of short half life withdrawal whilst she stabilises as she is? A the 7.5 reinstated Mirtazipine enough to leave as is to act as an Antidepressant? Thanks for the replies - have good days

[Spice]

We came down on the prozac from 10.2mg to the 0.9mg from January to may this year

[Rhiannon]

Oh yes, that's quite fast. See what Alto thinks about reinstatement of some of that. I'm not sure about the timing since May. Alto's better at reinstatement stuff than me. But with that being so fast and so recent, yes, it might be worth considering a partial reinstatement to a slightly higher dose of the Prozac, that might actually be more stabilizing than destabilizing.  Let's see what she says.

[Spice]

Yes we really don't know what to do with prozac for the best.

We also have the issue that because we've been using a higher dose of lorazepam between 0.25 and 0.5 about a few times a week for the last month every time we go back down to the regular 0.1 a day she goes into even deeper withdrawal 3 days after each higher dose of lorazepam??

[Altostrata]

Please clarify that statement about lorazepam.

 

The only way to find out if a little more Prozac will help -- assuming Prozac withdrawal symptoms are involved -- is to increase the Prozac dosage slightly and see, holding everything else steady.

[Spice]

Lorazepam was one of the drugs we were tapering and it had been reduced from 0.25 to 0.1mg since the beginning of the year.

 

Since the adverse reaction to the gabapentin for pain a month ago we had to use some lorazpam at a higher dose of between 0.25 and 0.75mg a few days a week on top of the normal 0.1mg that she takes.

We did this because initially it was the only thing that calmed down the muscle spasms in her neck and back but then was also needed to calm down the actively suicidal behaviour and rolling round on the floor in mental agony etc.

 

Now we seem to be in a cycle of using this higher dose every few days with the 0.1mg on the other days leading to being very up and down on the lorazepam dose and presumably going into withdrawal from the higher doses in between.

 

In a very difficult position as she is in acute physical pain all the time and we just get gabapentin, amytriptline and codeine thrown at us by the drs. On top of the mental torture this isn't a nice combination.

[Altostrata]

Again, it's difficult to tell if the symptoms are Prozac withdrawal or from the inconsistent benzo dosing with interdose withdrawal.

 

Again, the only way to determine if increasing Prozac would help is to increasing the dosage slightly while holding everything else constant (or inconsistent, as with the benzo dosing).

 

You might keep notes on paper about the daily pattern of symptoms. This will help determine where they are coming from.

[Skyler]

You might want to average the increased lorazepam doses she is taking over the the several day cycle, then add that amount to the .1 mgs. she takes daily. My guess is this will be a help...

 

Skyler

[Spice]

Thank you alto and skyler - we have considered increasing the benzo as it seems to be causing a lot of issues.

Either she's going into benzo withdrawal from the higher dose in between OR the benzo is masking the prozac/Mirtazipine withdrawal and when it wears off the underlying withdrawal is much more evident.

I would say the latter option IF we had just started up the benzo from scratch but because she's been on it a few years and we're also in wihdrawal from it already its very difficult to know.

[Skyler]

I would say the latter option IF we had just started up the benzo from scratch but because she's been on it a few years and we're also in wihdrawal from it already its very difficult to know.

 

Hi Spice,

 

Ive was active on benzo forums for several years and read thousands of posts... were I a betting person, I'd put money on bezo  WD.  And that WD could well be complicating the AD issues. 

 

I've seen the pattern you describe a number of times and the following usually took care of the symptoms. For example, if you have been giving a total of 1 mg. more (for ease of the example) every 4 days, add .25 mgs to the daily dose and see if the roller coaster stops.  Hopefully you will have an answer in a day or two.

 

Skyler

[Rhiannon]

I agree with Skyler, at this point I think it would be appropriate, given her symptoms, to get her onto a consistent dose of lorazepam, equal doses at equal time intervals, probably something like 4-6 doses per 24 hours. If she wasn't already so miserable and destabilized you might be able to get away with occasional erratic dosing, but under the circumstances I think it's best to get everything as steady as possible.

 

The point of the equal doses spread out (as you probably know) is to try to keep blood levels fairly steady rather than having roller-coaster ups and downs. Lorazepam is short-acting and blood levels peak about two hours after it's taken and then begin to drop.

 

Skyler's great at figuring out schedules and dosing for stuff like this (sorry Skyler I don't mean to be "volunteering" you for something! but you are...)

[Skyler]

I agree with Skyler, at this point I think it would be appropriate, given her symptoms, to get her onto a consistent dose of lorazepam, equal doses at equal time intervals, probably something like 4-6 doses per 24 hours.  I think it's best to get everything as steady as possible.

 

Spice, open a thread about this on the benzo subforum?  Your daughter needs a consistent daily dose, and at this point, dosing 4 times a day would get her stable the fastest, while allowing the smallest possible increase.

[Spice]

Have any of you guys got ANY idea how to deal with chronic pain in withdrawal? Talking about every muscle aching and burning, joint pain, constant severe headache, muscles spasms in neck and back - completely debilitating. Sounds like fibro type pain but never had it before apart from the headaches.. Could it possibly be prozac withdrawal?? We've tried every painkiller that we can and they all cause adverse psychological reactions, what an earth are you supposed to do with this?

 

Thanks

Rob

[Altostrata]

I found acupuncture to be helpful. Choose a reputable practitioner with whom you can communicate well.

[Spice]

Yes we had been thinking about acupuncture, apparently there's something called ear acupuncture which may be a bit gentler on the system.

We have an appointment with a neurophysio to see if they can help with some of the basics as well.

[Rhiannon]

Pain seems to be a typical withdrawal symptom. It's hard to say in this situation which piece in particular is causing it, but for me, physical pain is typical when I'm cutting either the AD or the Lamictal too hard, especially the AD.  Are you still considering adding in a bit more Prozac? Might help, might not, I guess the only way to know would be to try it.

[Spice]

Thank you. The dr has prescribed low dose elavil/amitriptyline for the pain which we haven't taken yet. We're so torn over the prozac issue whether to go up again, stay the same, we just don't know - shes been on this dose of 0.9mg for 12 weeks now, its a very difficult call.

 

We're on the first full day now of dosing the lorazepam 4 times a day x 0.06mg after having a few days at 5 a day dosing at 0.05mg.

[Altostrata]

What doctors think is "low dose" can be too much for a sensitive nervous system. If you decide to cross-taper with ami, I would start with a fractional dose, perhaps made up as a liquid.

[Spice]

What's a cross taper in this situation? She's given us 10mg tablets of the ami. There's no room to even assess or work on getting stable mentally when she's in such constant pain and we don't know what's causing what!

[Altostrata]

Your guess is as good as any. Start very low by splitting tablets or use a liquid, allow 4 days for dosage changes to take effect, go by reduction or increase in symptoms. If symptoms increase, you're going in the wrong direction.

 

Can you contact nearby university psychiatrists to find out if any has any expertise? I am dubious that a GP can handle this.

[Spice]

We've seen a psych last week and she suggesting upping Mirtazipine to 15 from 7.5 and/or increasing prozac.

 

The ami is strictly for the pain but it doesn't leave us with any idea what to do with the other drugs and then shed be on 5 meds

[Altostrata]

That doctor sounds like she's guessing with not very much common sense and throwing prescriptions at the problem.

 

One should certainly not make changes in several drugs at once. You won't know which is working.

 

Cross that doctor off your list.

[Spice]

Hey all, thanks for your input. We saw the neuro physio yesterday and went through her history, She seemed to think with authority, that my wifes muscles in her neck are being used wrongly in that the superficial muscles are doing the work that the core stability muscles should be doing. Caused probably by the amount of time spent in bed and 'searching' for answers on the tablet or phone. As this has been quite long term we are needing to re-educate the core muscles and relax the superficial. This will be a long term re awakening and possibly painful and uncomfortable but a must.

Let this be a little bit of a 'heads up' to those too exhausted to sit at the computer to do your learning. My advice is hourly neck and head exercises (range of movements) to keep the muscles, that hold our 'heavy heads', upright and moving and full of oxygen rich blood.....

The 6 times daily lorazepam adding to a total 0.27mg approx seems to be more stabilising so will continue this. We have an appointment with a neurologist in 2 weeks (private so $$$) but specialises in headaches, by this appiontment she will have had 2 weeks of exercises and some more hopeful stability. Thanks to all - no other med changes.

[Spice]

Could I just get some encouragement if anyone is able to offer some. It's spice here (the wife). I haven't been out of control/psychotically depressed for a few days but I'm still having out of control periods of feeling actively suicidal as the depression, mental torture and physical pain is so great

Yesterday my husband had to go to work for 6 hours and its the first time I've been on my own in 6 weeks. I think I may have had a window as the depression lifted maybe 10% enough for me to feel safe on my own. Today however is back to te total blackness and I'm afraid that the process of stability isn't happening as I'm just trying to get though each minute.

 

We are on a steady dose of lorazepam now but still unsure about prozac/Mirtazipine increases. I don't want to increase but its so hard to hold on and stay alive.

 

It'll be 4 weeks tomorrow since we reinstated Mirtazipine and 13 weeks today on 0.9mg prozac.

Really looking for some encouragement.

Thanks, we're so appreciating the help we've received.

Spice.