Catalyzt Considering Remeron Pulse

[Catalyzt]

You may remember me, Alto, I've posted a few times before, and over at BoringOldMan, always appreciated your input, and enjoyed this forum.

 

Okay, this may seem strange, but I am considering a quick series of "pulses" with Remeron to attempt reset some bad symptoms -- akathisia and mixed states -- that started after a terrible experience with Flagyl and a flare-up of my immune disorder, which is just like lupus, but a different antibody.

 

The symptoms are severe enough to make it difficult to concentrate at work-- I can attend to activities of daily living, but I have no self confidence.  Like, my supervisor will say, "Holy crap, you did a great job with that case-- but I'm concerned because you are so damn hard on yourself."  I don't care about the crying every morning, that's normal and part of life... but there are some very tricky plays I have to make in the next few weeks.  There is a new job I will be applying for which I desperately need, and I cannot-- canNOT-- show any lack of confidence.  Also, I have to get my father into an assisted living facility, and it's very hard to mange the constant calls with elder care facilities and adult protective services, and to think clearly about doing all the right steps in the right order to get him SSI benefits, etc.  I'm too distracted.  (20% of my support system also just became unavailable, though that's a separate issue.)

 

I know this is potentially dangerous, and I do not subscribe to the "chemical imbalance" theory of depression.  This would be something of a crap shoot-- but if I was going to try anything, I think Remeron is the candidate, because it's not an SSRI or SNRI, insomnia is a big part of the picture here, and contributes to the mixed states.  I only sleep about 4 hours a night.

 

I have been on Lorazepam 1 mg every day and Ambien 10 mg about 4 times a week. for... oh, about 10 years.  They work well for me, usually, and frankly, I'm not that worried about those two... if I skip a day of either one, it's not a big deal.  I kind of like skipping a day of Ativan, I get a little rush of energy, sort of like cocaine, which I dimly remember from the '80s, only mellower and without the crash, because you're stopping a drug, not starting it.  I know that Lorazepam is supposed to be so addictive you go into convulsions or whatever, but that just has not been my experience.  I know that probably sounds completely insane!  This post is not about those two drugs, though they certainly are not excluded from any discussion, I'm just providing that as background information.

 

I react very badly to SSRIs, 17 days of Paxil gave me a terrible sexual arousal disorder for over four years, fortunately that got repaired with group therapy about 4 years ago, very few residual symptoms.  So I am very, very wary of trying anything.

 

I have read a lot of literature that generally suggests that we have an adaptive compensatory response to all antidepressants, that doses prescribed are generally way too high, and the course of treatment is way too long.

 

What I am considering is something like this:

 

Week 1: Low dose Remeron on Saturday and Sunday night to restore sleep, none on Monday, Tuesday, or Wednesday, because I work Tuesday, Wednesday and Thursday, and then a dose Thursday night, with Friday off.

 

Week 2: Same thing.

 

Week 3: Dose on Sunday and Thursday only.

 

Week 4: Same thing.

 

Week 5: Dose on Sunday

 

Week 6: Same thing.

 

Week 7: No drugs.

 

I'm hoping to just give myself enough of a nudge to crack this mixed state and get through the next month or two.  The goal is to not give my brain time to set up a compensatory response.

 

I also exercise intensely-- I'm in my mid 50s and I'm swimming 3/4 of a mile 4-5 times a week, (pretty fast, too) hiking once a week, mountain biking twice a week, and doing some light weight work.  When I have time, I also body board and ski, even though I'm on blood thinners, which is a little manic and crazy, but I'm very careful, and the exercise is critical in avoiding mood swings that come with my illness.

 

I'm not sure I can get through the next month on so little sleep.

 

Very interested in your thoughts.

[Altostrata]

Hello, Catalyzt.

 

I have never heard of Remeron being taken this way and for this reason. But -- here are some people on crazyboards talking about taking it as needed for sleep http://www.crazyboards.org/forums/index.php/topic/4657-remeron-news-reviews-questions/

 

Unless you want to experiment with chemical flagellation, I cannot imagine why you would want to try to jolt yourself out of akathisia and "mixed states" by intermittently taking Remeron just to see what happens.

 

However, depressive symptoms can be a side effect of benzos, as can disordered sleep. It could be your benzo usage has finally gone south on you and you have a challenge ahead in reducing it.

 

If you've developed a physiological dependency to benzos and skipped doses -- with, as you've described it, mild withdrawal symptoms -- you may have triggered a neurological hypersensitivity that spells the end of your honeymoon with benzos.

 

What we've found is many people with injured nervous systems do well with fish oil and magnesium supplements, see

http://survivingantidepressants.org/index.php?/topic/36-king-of-supplements-omega-3-fatty-acids-fish-oil/

http://survivingantidepressants.org/index.php?/topic/1300-magnesium-natures-calcium-channel-blocker/

 

I urge you to try these first to calm your nervous system before jolting it with intermittent experimental doses of any psychotropic.

[Catalyzt]

Hey, Allo,

 

Yeah, the "Remeron pulse" is probably a stupid idea-- the kind of idea one should think of, chuckle at, and promptly forget!

 

I understand your feeling about benzos, and I'm sure I have some kind of dependence on them.  I'm just not real worried about it, and I don't think that's the cause of the mixed state/depression.... sure, it's on the list of possibilities, but pretty far down the list. 
 

I've had these states before I ever was on any psychotropic medication whatsoever, they are usually not that bad-- but there were two or three really, really bad ones, long before the benzos, and the worst had to do with a breakup and a job situation at the same time in '87.  This one feels just as intense at its worst, but fortunately, it's not constant like the episode in '87.  Back then, I was indoors for days on end smoking cigarettes with the shades down.  This time around, it goes away completely for 8 to 10 hours on some days because I've developed better coping mechanisms-- exercise and activating other parts of my social network, etc.  I have really good stretches on some days-- usually after workouts-- when I'm driving around listening to music and feeling good.

 

The situational stressors I am facing now are similar to '87.  I did lose two close friends recently, one who I can't see due to his alcoholism and abusive behavior, and another has stopped speaking to me for no reason I can figure (she was kind of like a little sister to me for five years, I am an only child and we have no children, and I am very attached to her.)  In addition to that, I have the job and elder care situations as noted above, both slow-motion crises that have been going on for years which would make anyone crazy.

 

I think your points are really well taken, and I will try the magnesium.  I would be very careful with fish oil right now because of Fukushima; no one should be eating anything that comes from fish anywhere in the Pacific.  Sure, the concentrations are low, but as an internal emitter, it doesn't take much Strontium or Cesium to be a game-ender, and it's started showing up on the Northwest coast.  Very sad. 

 

Thanks so much.  I knew this was an idiotic concept, I think I just wanted you to talk me out of it! 

 

--Cat

[Catalyzt]

I posted a few weeks ago about wondering if I should start Remeron; Allostrata wisely cautioned me not to, and I have not.

 

However, during a recent mixed episode, I noticed my blood pressure is getting awfully high -- 165/90, or thereabouts -- which is weird, because I'm in outstanding athletic condition for my age, I have reduced my alcohol consumption to almost nothing.  My diet is excellent, very low sodium, and my body weight is very low.

 

I have been under more stress during the past few months than I have ever been in my life, and for a longer period of time, mostly from elder care.  Anyway, I wondered if it might help to go after the blood pressure instead of using a neuroleptic.

 

Tenex, or Guanfacine, is an odd compound.  It does not seem to be any kind of neuroleptic, or affect serotonin or dopamine; it reduces nerve impulses in the heart and blood vessels.  It's also used to treat ADHD and anxiety / obsessional thinking by just kind of slowing down blood flow in the prefrontal cortex, some research suggests it improves spatial memory-- and mine is bad when I'm in a mixed or hyperaroused state of anxiety and depression.

 

Obviously, I will have a long talk with my doctor about this.  But has anyone heard about any psych side effects from this, or withdrawal symptoms, like PSSD or TD or any of the really bad symptoms that occur with SSRIs or atypicals or mood stabilizers?

 

I'm just thinking: Maybe if I try to control the blood pressure, and some of the jittery thinking that goes with it, all the meditation and exercise that I'm doing will work better to control my mood. 

 

Curious about your thoughts.

 

--Cat

[mammaP]

Hi Cat, I've merged your latest topic with your intro topic as it's one thread per person in introductions.

This means all your posts about your taper or withdrawal are in one place. 

 

I'm sorry I can't offer any advice on the medications you mentioned, I don't know anything about them so will

leave that for someone who does know. I'm sure someone will be along shortly.

[Altostrata]

If you've been taking benzos inconsistently, you may have sensitized your nervous system. Blood pressure dysregulation is a symptom of this kind of autonomic injury.

[cymbaltawithdrawal5600]

Cat, how is your bp doing now? Did you start the guanfacine?

[Altostrata]

Hello, @Catalyzt, how are you doing?

[Catalyzt]

Hey, Alto!  Thanks so much for hunting down this old thread! 

 

It is nice to be remembered.  It means a lot to me.  Thank you.

 

I can't believe my last post here was in 2014!!  I can barely even remember that I was considering Remeron!  Wow, that was back in the days when Mickey Nardo still walked the earth, when we were posting on Boring Old Man!  Dang, I miss that blog!

 

How did I not post about the solution / resolution of this episode?!  It was certainly one of the worst periods of agitation in my life!  I thought I was done.  I wasn't at all sure I'd even finish clinical training!

 

Here's what happened:

 

* In late March of 2014, I stopped using alcohol and recreational cannabis and started going to AA.

 

That resolved most of the symptoms.  And it makes sense: Group work helped with the Paxil recovery.  I now believe that what I experienced in 2014 was the result of metronidazole (Flagyl) and alcohol during a period of acute stress unlike any I had experienced before.  The core problem was alcoholism, which I did not realize, mostly for the usual reasons, but there were others: Due to my (autoimmune) medical condition, 'heavy' drinking (four or five drinks per night, though occasionally I could hold it to three drinks) that had worked in my late 40s and early 50s no longer worked, and caused the kind of terrible, endless rumination that others might get with a six-to-eight drink a day habit.  

 

Getting sober was like being shot out of a cannon.  I passed my exam, got my license, started playing rock and roll again.  I had a song used in an exhibit at a major museum in a big city.  I remember standing on the steps outside in my tuxedo, drinking seltzer water with my wife and friends, and thinking, "I know the pink cloud won't last forever, but the worst of whatever that was is over, and I'll remember this moment forever."  So far, that's how it's been.

 

* In early summer of 2016, I became weaker from the autoimmune condition and had trouble with the sports that helped keep my sane.  Under the guidance of my GP, psychiatrist, AA sponsor, and a $300-an-hour cannabis doctor, I started medical cannabis, 7.5 THC/ 7.5 CBD in the evening, 2 THC / 8 CBD in the morning.

 

I was able to resume sports again, and the rumination, akathisia, and near psychotic restlessness never returned at the same level.  I never smoked cannabis again.  I am really convinced that smoking cannabis is like some mad kind of polypharmacy-- hundreds of chemicals, right?  Lots of potential for things to not mix well!  The tinctures I started using have two to ten-- CBD, THC, THCA, and a handful of terpenes.  Expensive, medical grade stuff, oral formulations only.  (I have vaped a handful of times for severe stomach cramps with diverticulitis, but not in two years.  Too much like smoking cigarettes or weed.)  There also is not the explosive head rush of smoking cannabis, which can trigger paranoia and anxiety. 

 

Most days, I do not even experience any psychoactive effects!  When I do, it's like I wake up to take a leak at 2:00 in the morning, and I have some "odd" thoughts that remind me of being high.  Or, if I practice really late at night, say after 12:30, I might get some of the 'music sounds different' effect of cannabis.  I do find that if I dose at around 7:30 and I'm writing clinical notes at 9:30, it takes me a bit longer to write them-- but the notes, when I re-read them, are quite good. 

 

And my memory improved, though it's subtle.  I'd say this:  I think my essential, organic, non-drug-induced anxiety kicks in at about 7:00, and the Ativan (which I have continued) manages that pretty well.  Around 7:30, I take Ativan and the CBD / THC, and there's a period from 9:00 to 10:30 when I might get more restless and anxious-- and be more prone to forgetting where I've put my glasses or my phone, etc.  This usually lasts no more than 45 minutes, usually more like 25.  By 10:30, I become calm enough to remember.  I will see a visual image of my phone on top of the water purifier, or guitar amp, and yeah-- that's where it is.  That lasts through the following day!  Some mornings, I might not be able to find my favorite sunglasses and I'll have to bring my backups instead.  Most people my age have similar issues.

 

* In late summer of 2016, I was forced to reduce opiate painkillers from 7x per week to 5x per week.  I 'agreed,' but I really had no choice.  This was a mistake and was very destabilizing for a while... on the days that I don't take painkillers, I increase lorazepam to 1.3 milligrams.  So lorazepam increased to about 8 mg per week instead of 7 mg.  Basically, it increased half as much as the Norco decreased, so it's not a bad compromise, but still: The lorazepam is more dangerous than the Norco, which I've taken for decades without incident.  It was a senseless decision dictated by policy and antiopiate hysteria.

 

It was at this time that I lost complete faith in the US healthcare system.  That's not all bad, because I advocate for my patients even harder.  I have become more and more confident that most psychiatrists have no idea what they are doing, and I'm more willing to confront them.  That starting point?  It's safer for me and my clients.  It's time consuming, though-- and there have been times when I got it wrong, when my doctor or physical therapist or someone else on my treatment time was right.  But I still question every decision, and I thank my doctors for their patience, joke with them about it.  "Hey, no rheum patient, no CT patient ever agrees with their doctor.  I'm supposed to argue with my rheumatologist, isn't that part of the standard of care?"  Occasionally, disagreements get heated, but we usually laugh and move on.

 

* In mid 2019, I was forced to discontinue the Ambien.  I did this pretty much cold turkey, without incident.  This is my HMO GP forcing me to stop a drug that my private psychiatrist prescribed!  I have mixed feelings about this.  Here's what I think should have happened:  My GP should have consulted my psychiatrist and they should have hammered out a compromise: 30 to 60 pills per year.  I really didn't need to be taking it every night.  The problem now is that when I can't sleep, I take Benadryl, which is more dangerous because the half-life is longer and it's more anticholinergic.  But let's be honest: I did not need to take this medication every night.  I just got in the habit of doing so, and my sponsor and I really didn't realize it wasn't as necessary as anyone thought.  So I did not lose my time.

 

* Since 2019, my GP has periodically pressured me to stop Ativan.  I have refused, asked her to consult with my psychiatrist.  She has refused.  I remain convinced that for most people, benzos are far less dangerous than SSRIs, though I am also pretty convinced that some benzos-- particularly ativan-- are less dangerous than others (Klonopin or Xanax) which my clients tend to get into trouble with.  That may not be a popular opinion, but that's just what I've seen in my practice.   I had one client who was getting 3mg of Ativan a day for months from a pill mill!  I begged him to seek medical assistance when the pill mill folded up and went away, but he just... stopped!  And he was pretty jittery for a day or two, but that was it. 

 

* In 2020, I increased the evening cannabis to 10 / 10 THC/CBD to try to manage the pain on days I wasn't taking opiates.  It sort of worked, but was too psychoactive.  The morning dose of 2 / 2 sometimes kicked up the tail end of the evening dose, and I didn't feel quite right in the early morning, say from 7:30 to 8:30 AM.

 

* In 2021, I stopped the morning dose of CBD / THC completely, and decreased the evening dose slightly on days when I have an early call the next morning-- maybe 5 / 5 or 6/7 three times a week, and then no more than 8 / 8 on the other days.  I'm getting older, and I just want to be careful with it.  Once every two months or so i might have really terrible symptoms in the morning-- muscular stiffness, intense headache, etc.  If I'm working, I tough it out.  If I'm not, I take 2.5 mg THC-- I'm not that sure the CBD does much for acute pain, though having it in my system constantly does seem to tamp down inflammation.

 

When anxiety and rumination starts to kick up, I go hard at AA-- get a new sponsor, start working the steps, reaching out to newcomers-- and do more personal therapy, reach out to friends, write more music.  I have had some periods of depression, but honestly?  I think those are more like and adjustment disorder-- stress of getting older with an autoimmune condition, and the geopolitical and domestic chaos that's making everyone miserable.  I don't have MDD.  Very few people do; I believe major depressive disorder is actually very rare.  (Just like Mickey Nardo said-- that big "D" depression, I don't see it that often.)

 

I get very lonely sometimes.  The United States is a sh*tty place to grow old.  Thinking about this, it makes me a little sad, and even now, my eyes fill with tears as I write this.  I hate arguing with my doctor, and being abused by the system she is part of-- I have a lot of empathy for her, too.  After a recent trip back east for a show, I went back to the old dose of Norco for a few weeks, and had to ask for an early refill-- all of about three days early.  I was referred to a depraved neurologist who misquoted what I said and gave me a bogus diagnosis. 

 

I asked her what medications she would try if I stopped opiates, and she said-- literally-- "I have no idea.  There are hundreds of them."

 

This is depraved behavior by a medical professional.  I know most of the drugs she recommends are SSRIs, based on the peek I got at her pharmacological tool kit.  This enrages me; when **** like this happens, it takes me weeks to calm down, I schedule a lot of extra therapy, hit AA really hard, call my colleagues, and work out a little more than is healthy.

 

My GP and I resumed the 2022 dose schedule, opiates 5x per week, Lorazepam 8 mg. per week, THC / CBD either 8 / 8 or 5 / 5 in the evening depending on workload, no Ambien, Benadryl 5 mg once every two weeks if I can't sleep, zero alcohol, zero recreational drugs of any kind.

 

I am now 65 years old.  I don't know what the future holds.  I have plenty of problems; I get sad, frustrated, and angry.  I fear for the future of our country, I worry about my younger clients and the world they will be facing.  Sometimes I fall out of touch with friends, and I fear that I'm losing them forever, I realize that part of that is just getting older, and a lot of that really sucks.  I do my best to face my fear-- of loneliness, of big waves or bad conditions on the mountain, of death itself... and it seems like when I've finally made peace with it, my friends suddenly come charging over the hill, like a posse in some stupid Western, to remind me that I'm not really alone, even if some of my hardest moments are when I am alone.

 

But here is the part I hope will be encouraging to others:  My road rage is gone.  My psychotherapy practice is thriving, I love my work, my drop-out rate is low, and my clients do well.  My most challenging performances with my band, my best days skiing, my best days body boarding, my best days riding my eMTB, my last, best (and longest) single-tank scuba dive-- all of that occurred after I stopped Paxil, and after I stopped drinking and smoking weed.   All of that was also after two massive blood clots.

 

I still get attacks of terrible rumination; they come on the same way they did in 2014.  But they do not last.  Duration, at most, is 48 hours, but usually, more like 90 minutes.  In 2014, when I wrote my last post, the restlessness, the terrible rumination, went on for months.

 

I no longer fear the rumination.  When it comes, my attitude is like, "Coming for me again?  No problem, *******, bring it.  Let's do this.  Let's see what you got." 

 

And maybe that's a good thing.  I never want to forget what it was like.  I need to remember.

 

Thanks again for remembering me, finding my last post, and for this forum.  Glad you're still at it!

 

 

 

 

[Altostrata]

Good to hear! To bring everyone up to date, please summarize your drug and withdrawal history in your signature You may need to use a computer to do this.

[Altostrata]

@Catalyzt, dude, we still need that signature.

[Catalyzt]

Dude, I put it in months ago.  I'm not sure why it's not showing up.  I can see it in my profile.  It's way too long.  I'll try posting this message and see if that refreshes it somehow.

[Altostrata]

What's showing now is 1998 lorazepam.

[Catalyzt]

Okay, figured it out!  Sorry, I had 'history' and 'signature' confused.  The '1998 lorazepam' was a test.  Signature should be about right now.

[Altostrata]

Thanks! Now we can get the whole picture.

 

Why the continuing Ativan?

[Catalyzt]

It is, in my judgement, the least dangerous way of managing evening agitation and insomnia that has plagued me shortly after I first started having symptoms of MCTD.

 

My body is wracked by excruciating pain for several hours pretty much every day, and then feels completely normal at other times-- most of that is unpredictable except that I've always been a mess from about 8:00 until I fall asleep.  Relentlessly consistent.  I'm anxious, but the cause is absolutely physical, and I spent decades trying to rationalize that, as if I could somehow think or reframe my way out of something that is, absolutely and completely, outside my control. 

 

It was bad enough in the '70s, with everyone telling me it was in my head (except for my rheumatologist and psychiatrist).  If I'd been 17 in 2016 or so and reported my symptoms honestly?  They would have diagnosed me with Bipolar, and not Bipolar II, either.   I would have definitely wound up on neuroleptics, probably a psych unit-- and I came pretty close as it was.

 

Strenuous exercise, abstinence from recreational drugs, 12-step and meditation are helpful, but there's a level of discomfort that benefits from pharmacological intervention.

 

Sometimes, I wish I'd started Ativan in my 20s or 30s... but that would have meant stopping drinking at the same time, and obviously I couldn't do that, or I would have!  😜