Ks1994: Trazodone, Ativan, Lamictal, in hell

[Ks1994]

It is late and I will try to be brief but I know I probably won't be because I can't help but type the way my brain thinks and that is in awful run-on sentences and long paragraphs such as the kind you will see in this post.  I used to be a quite intelligent, witty person but that is all gone now along with many other things.  I cannot get into that right now for that would take up ...well, probably a couple hours of writing.  So.

 

I am currently on 50mg Lamictal (stuck on this, tried tapering, it has the least known side effects so I am leaving it), Ativan 2 mg at night (I started at 0.5 mg one year ago and it quickly escalated as stupid psychiatrists tried to find a cure for my debilitating insomnia which still exists), and now about 35mg Trazodone I suspect.

 

The main problem of this situation is there are too many factors.  Last year I had a manic episode that lasted two months where I probably maxed 1-2 hours of sleep a night.  I gained 30lbs in one month.  This was in July, and August.  I was put in a psych ward and force fed every bipolar med known to man.  I came home and still in a fairly manic state, dropped all of them cold turkey.  I do not know that I suffered side effects other than insomnia, because I was, well, manic.  Realization of the weight gain soon hit and my eating disorder from high school came back in full swing.  Only this time I could not lose the weight.  I am knocked onto the ground with debilitating depression, spending half the day in bed and the rest of the day starving (and not losing weight, furthering the depression).  My anxiety is through the roof.  I go to an endocrinologist who gives me thyroid med to help with my many hypothyroid-like symptoms.  I use this to lose the rest of the weight and end up taking more than I should.  I stayed on this from December 2012 until May 2013.  I lost a lot of muscle, a lot.  My hair fell out like never before.  All symptoms of course are still alive and kicking.   I started 0.5 Ativan around December, moved up to 1mg about January maybe, and then probably March or April was at 2mg.  Tried Lunesta and Ambien before and in combination with this but sleep mostly eluded me and I have not had a full night in well over a year now.  Best would be maybe, maybe 6 interrupted hours.  Where was I...  Entered treatment for eating disorder in June where I was given 100mg Trazodone for sleep, saying it was "nonaddictive" and there were no side effects.  Also taken off thyroid med.  I gained 10lbs in one month...and continued to gain.  It is now November and I have gained a total of 40 lbs.  I have been seeing a nutritionist and hormone tests reveal metabolic-syndrome/PCOS like symptoms.  I have no family history of any of this.  I have awful muscle weakness and my body/muscles cannot support my weight, and I have no idea if meds have caused/made this worse, but I cannot even do light activity without great leg soreness and a jump in weight (water retention?)  that confoundingly does not go back down but accumulates.  I can attribute a good 6+ lbs to this alone.  My arms shake when I eat food, and I know my arms don't weigh vastly much more, so I feel like this regime has eaten even more of my muscles and I honestly look like a hot mess.  Oh and I have awful acne which I can only attribute to the massive weight gain that is both the cause and what is perpetuating my hormonal catastrophe.  Back to the story, I foolishly stopped the Trazodone cold turkey in October and my weight quickly shot up, and I went back on within a week or two at 50mg.  In the past 2-3 weeks I have been taking about 1/3 of my 100mg pill.  I have had suicidal ideation for over a year now.  I feel my body is so thoroughly screwed up in every way and I have lost what is supposed to be some of the best years of my life to all of this mess.  I do not know what to do.  Everyone I turn to says I am not on the "right" meds because well gosh, my depression hasn't gone away, neither has my anxiety, and I clearly need some sort of help (*cough* medication)

 

I thank you if you have read all of this and can make any sense of it, and I would thank you even more if you could figure out what the f*** is going on with my body and what I can do, because I am completely alone and the doctors have all made me feel even worse/hopeless.  I have no life anymore.  My body does not even function normally anymore.  I have lost everything to all of this and I don't know where to begin, if there is even hope.  I don't know if I can make it through another year of this before I end up killing myself.

Edited November 20, 2013 by Petu
Added member name to title

[Petunia]

Hi Ks,

 

Welcome to the forum and thank you for posting an introduction.

 

I'm sorry you are going through such a difficult time, you are right that there are a lot of complicated factors involved, you seem to have been on and off a lot of medication too.

 

When you had a manic episode last year, was that the first time?  Were you on any medication at the time, or could something have triggered it?

 

Its not a good idea to suddenly change dosages of your medication because it could cause withdrawal effects and destabilization of your nervous system, making proper tapering much more complicated.

 

It would be helpful if you put your drug and withdrawal history in your signature, including information about what medications you have taken, when started and when stopped.  Instructions for how to do that are here:

 

http://survivingantidepressants.org/index.php?/topic/893-please-put-your-withdrawal-history-in-your-signature/

 

No one here can tell you what to do or advise you about a medical condition, but if you decide to come off some or all of your medications, we can provide a lot of help and support with doing that safely.

 

You will find a lot of friendly support here.

 

Petu.

[Ks1994]

Yes it was the first and only manic episode in my life.  I don't have an exact time frame but a few months prior I was switched from Lexapro to Prozac and then just stopped the Prozac cold turkey after feeling I didn't need it anymore which was obviously a mistake.  I did not experience any depressive/anxiety withdrawal symptoms during the mania but I guess none of that matters.  I am below rock bottom at this point and have no one to talk to about anything as everyone around me is pushing more medication, specifically Lexapro.

[Altostrata]

Welcome, ks.

 

A "manic" reaction to cold-turkey of an SSRI is a known withdrawal reaction.

 

We can't say what's going on with your body. It sounds like either the drug changes triggered an endocrine disruption or were coincidental with an endocrine disruption.

 

PCOS is a complicated condition. You might look for a specialist.

 

One way or the other, you will want to avoid making sudden changes in your drug dosages, as it seems you're sensitive to those.

 

What are you taking now? Do you have any side effects from the drugs that you can tell? It helps to keep notes on paper about daily symptom patterns.

[Ks1994]

I am on Trazodone, Lamictal, and Ativan.  I don't know what symptoms are coming from what and I don't know if I'm imagining symptoms but I do recall being normal and I did not have the muscle shakes/weakness, extreme weight gain that continues and worsens with movement (water retention I would hope since it doesn't make sense for it to go up that much at once), hot flashes, a very deep-seated depression, anxiety, breaking out painfully, generally overactive hormone symptoms that I won't get into including awful cramps.  I don't know if I should continue.  The PCOS symptoms are all from the rapid weight gain, I am sure, because all of my hormonal issues came after I had gained a significant amount of weight.

[mammaP]

Hi KS, sorry you feel so bad. Alto will be along shortly, I just wanted to say hi and welcome to SA. 

Hugs, MammaP 

[Jemima]

Yes it was the first and only manic episode in my life.  I don't have an exact time frame but a few months prior I was switched from Lexapro to Prozac and then just stopped the Prozac cold turkey after feeling I didn't need it anymore which was obviously a mistake.  I did not experience any depressive/anxiety withdrawal symptoms during the mania but I guess none of that matters.  I am below rock bottom at this point and have no one to talk to about anything as everyone around me is pushing more medication, specifically Lexapro.

 

Hyperactivity and insomnia are common withdrawal symptoms, especially when stopping an antidepressant cold turkey. They are often mistaken for bipolar and treated accordingly, which usually makes it all worse.  I don't think that reinstating Lexapro is a good idea as it is an extremely stimulating drug. I went off of it too fast two years ago and went through hellish withdrawal including a period of hyperactivity, irritability, and sleeplessness, often going for two to three days without any sleep at all.  I'm still recovering--almost there, though--thank God.

 

Welcome to the forum. You'll find lots of good information and friendly support here.

[ladybug]

KS, I don't think the rapid weight gain would cause the PCOS symptoms, but rather the rapid weight gain is symptom of PCOS. You said your hormone tests revealed symptoms of PCOS. What do you mean by that? Do you mean your tests came out abnormal and pointed to possible PCOS? I've done my fair share of reading on PCOS in the past, and your symptoms of rapid weight gain, acne, and hair loss would certainly point to that as a possibility. Have you noticed an increase in facial and body hair?

 

These pills are definite endocrine disruptors. I myself have been dealing with thyroid issues, no doubt caused by long term use of a SSRI. I would definitely not mess with your meds anymore, until you can figure out this PCOS thing.

[Rhiannon]

Hi KS--

 

When I was CT'd off a bunch of meds and started on a bunch more back in 2008 after a suicide attempt (due to trying to get off ADs), I had a bout of mania and ended up with a "diagnosis" of bipolar NOS.

 

I'm about as bipolar as I'm a fish.

 

Not that this is true for you as well, but it's certainly not uncommon. In fact I would venture a guess that the majority of bipolar diagnoses being given these days are to people having medication reactions. I think that's how we've ended up with all these new fancy kinds of bipolar, too. (Bipolar 2, bipolar NOS, "soft" bipolar, etc.)

 

Psych meds suck.  IMO of course.

 

You'll get good support and information here to help you untangle your health and med problems, and if you take it very slowly you can probably reduce your meds and get things under control.

 

Your symptoms sound very typical for someone with a history like yours (polypharmacy with multiple CT and med changes).  I'm sure the recent CT and reinstatement and then fairly large cut of the trazodone is contributing to your current misery. 

 

Personally I think you might want to consider bumping back up to 40 mg of the trazodone, or else staying where you are, but either way do not cut it further for now, not until you're feeling more stable and better, at which time you can taper off at a safe rate that won't result in you ending up on even more meds.

 

Hang in there, I think you can get to a better place. Please don't do any more sudden med changes!

[flower]

Withdrawal from trazodone is brutal...Take it very slow...It takes time to stabilize once the dose is messed with. Good luck.

[Ks1994]

Thank you for the replies everyone and I agree, as well as my current therapist and old therapist and mother, that the bipolar part is probably wrong, but I also am not sure, I feel like the medication situation could have somehow turned me bipolar.  I have the insomnia and the aggressive anger that matches with the disease.  But I feel like all of this is 100% a result of the medication and wouldn't have revealed itself otherwise.  I am most depressed about the weight gain and I don't know if it's Ativan messing with my thyroid or hormones, or Trazodone causing it, but I know they are certainly not helping the situation.  I also know going cold turkey would probably freak my body out again and cause more weight gain so I can't do that anymore.  I will stay on the dose I am at for Trazodone but I have also read that it is best to withdraw from benzos before trazodone because traz withdrawal, your body reacts just as it would with benzo withdrawal, and the traz masks the symptoms.  I hate them both so much though.  I know this isn't a benzo forum (I just registered on benzobuddies as well) but I don't know if my taking the whole Ativan dose at once at night is causing inter-dose withdrawal which I just learned about.  I can literally feel my stress levels rise almost 12 hours on the dot after I have taken it.

 

Flower, how long does it take to stabilize at a dose?  I was at about 40 +/- for a few weeks then dropped down to 33 because the third of the pill is easier to measure accurately.  I am having very bad symptoms but I almost can't tell anymore because I hit rock bottom a long time ago and the only difference is now I'm crying half the day instead of the usual once a day.  And the rest of the day I am otherwise not there (now) a.k.a. in a denial state (usually when attached to an electronic device is the only time the crying stops).  I would like to go down to 25 and hold there until I stabilize for a while, and then work on the Ativan only.  I wish I had an actual psychiatrist to consult with but every one I have gone to got me into this situation.  The one I have currently asked if I had tried doubling (DOUBLING) my 2mg Ativan dose to get to sleep.  We are looking for a new one and in the mean time I can't do any schoolwork.  I can't even talk, I just don't know what to say anymore.  I feel like I am becoming Sybil.

[mammaP]

Hi KS, my heart goes out to you, it really does. I am another one who was diagnosed bi-polar after 

being put on meds that caused mania, followed by 20 years of multiple meds and illness. I 

would agree also that you were misdiagnosed. Once you have tapered off them all you will feel so

much better, in fact you will probably feel better and better along the way. 

 

 Look here for benzo discussions http://survivingantidepressants.org/index.php?/forum/29-members-only-benzo-tapering-discussion/

 

My daughter had PCOS and put on a massive amount of weight, was tired all the time and felt cold all the time, even in mid summer

when everyone was out in shorts and tees, she had on a big winter jacket and was shivering. She did get better but I honestly can't

remember what she did or took that helped. 

 

I agree that you should not try any further cuts to any of your meds for now, and it might help to increase the trazadone just a bit, I

know it isn't what you want to do but might help you feel more comfortable. Then give your CNS time to stabilise.

 Alto suggests tapering the ADs first then the benzos because the benzo can help with the withdrawal symptoms. 

I hope that you can find some relief soon. It will get better, it just takes time and lots of patience.

[Altostrata]

You should also definitely put all the drugs you're taking into the Drug Interactions Checker here http://www.drugs.com/drug_interactions.html

to see if you're having an adverse reaction because of a combination. This is not uncommon.

 

Which drug do you think is causing you the worst problems? Do you get uncomfortable reactions after taking any of them? Sometimes this can be some hours later. This is why it's important to keep notes on paper about symptoms.

[Rhiannon]

Ks, if you're only taking Ativan once a day, I do recommend looking into changing to a multiple daily dosing regimen. Seems like the people I've known do well with every four hours, with Ativan, but even four times a day is better than just once. (Equal doses at equal time intervals is best if you can swing it, or sometimes with a longer break for sleep if that works for you.)

 

Usually it's recommended here to taper your AD first and then do the benzo (taper the most activating med first).  You can also taper down the AD for a while then hold it and taper the benzo down a ways and then hold it and continue the AD taper (if you're really wanting to get off the benzo).

 

The old advice on benzo boards (which I spent a lot of time on for several years) of "taper the AD first" is kind of an old chestnut from Heather Ashton, who did groundbreaking work on benzo withdrawal but didn't know much about ADs. I respect her greatly, but we've learned a lot in the last ten or fifteen years, and I don't think she's the final word on the subject. I have seen that people do seem to do better if they reduce the activating meds first, because benzo withdrawal is very activating in itself and if you compound that with the activation from an AD it can make the withdrawal from the benzo that much harder.

 

Just my opinion, but I think holding at your current dose of AD or a small increase for a while (at least three months, probably more) is advisable for you at this point. During that time you can educate yourself about slow tapering and work on getting your blood levels of Ativan smoothed out by more frequent dosing. (What happens with those short-acting benzos is you get a roller coaster effect and when the levels of the drug in your bloodstream drop you can actually get an increase in anxiety, insomnia, etc.)

[Ks1994]

Thank you for the replies.  The problem is I don't know what is causing the most problems.  The weight is the most problem.  I don't know if Ativan and/or Trazodone are directly causing weight gain or interfering with my thyroid/hormones to cause weight gain.  I know that no one in my family has diabetes/prediabetes, PCOS, weight problems at my age, any of these issues.  My TSH has gone up for an unknown reason and I don't know if it's gone up further but last I checked it was almost 3.0 from about 1.3 (October and July respectively).  The likely cause of this is estrogen dominance supposedly which I am taking progesterone cream to fix, and that is supposedly going to help the high testosterone I have too.  I don't know if meds caused all this but I feel like they are doing nothing to help my endocrine system from what I read.  I take them both at the same time so it's impossible to tell what's causing what in regard to immediately noticeable symptoms.

 

I have asked on the other forum about doing twice daily doses (half am half pm) but I am afraid of this further messing up my system since it might be a shock not having 2mg at once?

 

I think I will have to just stay at this dose of Trazodone as I really, really don't want to backtrack at this point and have gone through all this hell for nothing, and I do know of at least one person who put on a significant amount of weight on it so I really want to take the least amount possible which right now is 33.3.  The weight is causing the depression, and if that is keeping the weight on, then... I honestly don't want to be on this med for three more months let alone up the dose for that long, but I guess I will have to hold this dose for a few weeks at least...  I thought that it was 10% every 10-14 days though?  I wish I had a way to actually weigh it out...  The benzo does not seem to be doing anything for the withdrawal symptoms, but I guess I can't know that because I'm tolerant to it...

 

I really appreciate your replies.  I haven't been able to do anything for the past several days except stay alive, barely.  I've just completely...bottomed out...

[Ks1994]

I have asked for 0.5mg Ativan to be cut down more precisely but I don't know when I can start tapering.  I talked to the psychiatrist about it and he doesn't seem to know a lot.

[Ellen042]

Hi KS.  I don't have answers for you- just mainly wanted you to know we're reading and care.  I have no experience with Lamictal.  I've not been on Ativan before, but my understanding is that it has a short half life like Xanax.  Most folks on these drugs can't take them once a day, but rather have to divide the dose over every 4-6hrs.  So I agree with the previous poster that spreading out your ativan intake may be beneficial.  You're not only dealing with weight gain, but also the psychological stress of weight gain.  In my experience, both benzos and trazodone numb your feelings quite a bit so that you don't even care about things like weight gain.  Tapering your meds may be making your weight harder to accept.  Not saying you should stop tapering- just know that you're more sensitive to and less tolerant of stressers when you taper ADs and benzos.  Furthermore, several here, including myself, have found that tapering trazodone coincides with weight gain.  Not fun! I've just now started my second period of the month while tapering trazodone (messing with my hormones???), and my breasts are about to pop out of my bra I'm so swollen.  Shoes and rings won't fit either.  Luckily for me, once I cycle, the water retention is gone.  So perhaps you're getting aggravating water retention in addition to any real fatty tissue gain.  If so, it's bound to ease up at some point.  Know that we're pulling for you.  wish I could do more...