Whitelily: trying to withdraw from an antipsychotic (amisulpride)

[whitelily]

Was going well, and then forgot to take dose of AP's day before yesterday before going to sleep, so took normal dose last night, but only slept from midnight to 3.30am ish.  Feeling pretty exhausted and 'wired' today.  Hoping will get more settled again tonight. 

 

Generally I do feel tired a lot of the time, and I've now developed patches of dry rough reddish skin on my face.   

 

On more positive note, I really notice how helpful breathing exercises are. 

[scallywag]

Isn't it good to know that something, i.e. breathing exercises, works for you? Keep at it, someday it will become second nature to respond to difficulties with adjusted breathing.

[whitelily]

Thanks scallywag, yes, I'm glad that they're really helping.  (I just wasn't taking stuff in properly about the need to go slow and be aware of symptoms when I first began this thread).   

 

Just been thinking about how long its going to taper given that I may have to switch to 5% or go longer before drops because I seem to be so sensitive to dose change .... I didn't envisage it would years, but hopefully I will be able to get totally off them.

 

Thanks to everyone here for their help.    

[whitelily]

Just checking in:  making a 10% dose reduction to 60.8mg amisulpride, plus 10mg of the abilify, which is five weeks after the last change.  Going to keep close check on things because I got very edgy for a couple of days and had one early morning episode with heart racing/ not able to catch my breath after last reduction (cortisol rush?).  

 

Just to note something which has been encouraging -  after I dropped the last dose I no longer have cravings for cheese thankfully.  

 

However, I think it could be the abilify that is still giving me cravings for carbs/sweet things in the evening and Ive gained even more weight.  Trying to find ways to manage it better.

 

Still taking Vitamin C and found a better quality fish oil, but not applying Mg oil at the moment as funds are so depleted currently.

 

Skin has broken out in red peeling patches on arms and legs - been to doctor previously who said it wasnt contagious, looked like psoriasis and gave me cream (more pharmaceuticals) but I'm wondering if it could be low vitamin D.  This just seems to happen in winter and started a couple of years ago - as did a worsening of rosacea.    

 

I'm still doing breathing exercises, just about, but not as much as I think I ought to as counselor advised 3 or 4 times a day - so plan to step these up again.      

[whitelily]

Dilemma - not sure what to do.

 

I had to have my medication changed for the type II diabetes I have which was a result of weight gain and metabolic syndrome induced by the antipsychotics Ive taken.  

 

I have found a someone who has become an expert in diabetes and is now advising people how to radically change their diet and eventually withdraw from diabetes medicine.  However, this is what his office has said about linoglyptin, which I have been prescribed with, which apparently forces the pancreas to produce more insulin:-

 

This is a serious problem for two reasons:

1. Making the pancreas produce more insulin causes weight gain and an increase in insulin resistance, which further fuels your diabetes. This ensures that your diabetes will continue to progress and cause your health to further deteriorate, leading to one or more major diabetic complications.

2. Making your pancreas overwork may eventually wear out your pancreas (beta cells) and require that you go on insulin. This will ensure that you remain diabetic and be forever dependent on the diabetic drugs. 

 

Needless to say, my diabetic nurse or doctor did not advise me concerning how this drug works.  

 

I have a real problem controlling my appetite taking the antipsychotics, and I know I'm overeating but I haven't figured out a way to lessen it because the cravings seem so intolerable at times.  Of course, this is adding to my weight and fueling the diabetes.

 

I realise that you can't advise me on the diabetes.  But I wondered if staff could advise me whether it would be worth trying to withdraw from the antipsychotics a little faster, especially if I continue to seek extra counselling help?  

 

(And now that I've gone past the troublesome 200mg threshold with amisulpride).

 

After holding for five weeks since my last cut in dose of Amisulpride, I am feeling stable but of course it is very early on).  

[scallywag]

Amisulpride has a dose-occupancy relationship similar to other psychiatric medications in that below "therapeutic" dose dopamine receptor cell occupancy decreases very rapidly with small dose reductions.

 

Link to research study on amisulpride dose and dopamine receptor occupancy.

 

Reading figure 4 of the research study, this "uh oh" point or therapeutic dose seems to be around 300 mg amisulpride.

 

What this means for you:

Large and/or fast reductions in amisulpride are likely to worsen your current symptoms and may trigger new symptoms because your CNS (central nervous system) is having to adapt more rapidly than it can.

[whitelily]

Amisulpride has a dose-occupancy relationship similar to other psychiatric medications in that below "therapeutic" dose dopamine receptor cell occupancy decreases very rapidly with small dose reductions.

 

Link to research study on amisulpride dose and dopamine receptor occupancy.

 

Reading figure 4 of the research study, this "uh oh" point or therapeutic dose seems to be around 300 mg amisulpride.

 

What this means for you:

Large and/or fast reductions in amisulpride are likely to worsen your current symptoms and may trigger new symptoms because your CNS (central nervous system) is having to adapt more rapidly than it can.

hi Scallywag, thanks very much for your reply and the link to the report.  I'm thankful to be below 300mg - actually the worse crisis I had was at 180mg when that's all I was taking - but I guess the Abilify might now be acting as a buffer?  

 

I will go back to my GP and see if its possible to go back on metformin which doesn't look as if it has such a detrimental effect on the pancreas (at least from what I can tell), by crushing metformin tablets (due to difficulty swallowing), so that I can continue to steadily reduce the amisulpride.    

 

So far with this reduction things are going well.

 

Would you advise to completely finish withdrawal of the amisulpride, before trying to reduce any of the Abilify too?  I'm just quite concerned about my health now, particularly the diabetes (I dont seem to be able to lose weight) and if the Abilify isnt quite so troublesome to withdraw from, I wondered, out of some desperation to make faster progress, if I could gradually withdraw from that too before the amisulpride completely stops?

 

Thank you for your help.   

[scallywag]

I wouldn't suggest tapering Abilify and amisulpride at the same time.

If YOU feel it would be beneficial to reduce Abilify,

• taper amisulpride to an easy dose -- a dose in mg for which pharmacy has pills/capsules.
• Once you're there hold for 4 weeks, then
• make a 10% reduction OR LESS in abilify. Record your symptoms on paper while you hold for 4 weeks.

[whitelily]

Hi scallywag, thanks for your help.  I will see if I can find out which is considered most detrimental to sugar levels/ metabolic syndrome.    

[whitelily]

For reference, worked out equivalent doses of the amisulpride and abilify using dose equivalents from University of Oxford :-

 

https://www.psych.ox.ac.uk/publications/517030

 

amisulpride 38.3mg/d is equivalent to abilify 1.4mg/d

 

 

 

1mg of amisulpride = 0.03684mg of abilify

 

271.4mg of amisulpride = 10mg of abilify

 

27.14mg amisulpride = 1mg abilify

 

 

Given that both antipsychotics are linked to diabetes, which I have and which has been getting worse, and also abilify is linked to binge eating which I have had trouble with, think it would possibly be best to hold the amisulpride at 50mg for a month when I get there and then reduce the abilify, so that am reducing the largest dose possible at the moment.

 

Does this make sense?

[scallywag]

I get slightly different numbers for equivalencies:

 

1 mg amisulpride = 0.3655 mg aripiprazole

273.56 mg amisulpride = 10 mg aripiprazole

 

Regardless of the slight differences in arithmetic, reducing the medication with the highest dosage makes sense.

[whitelily]

Thanks scallywag - it's ages since I've done any maths, so the error was probably mine.  I'll aim to go ahead with that plan then - get to 50mg amisulpride, hold for a month, and then leave that as it is and start reducing the abilify by 10%.

[whitelily]

Well, I thought that perhaps Abilify wouldn't be as bad as Amisulpride - but my face has become red and inflamed, with rough, dry skin and apparently red dry skin is a side-effect.  I dont know why its becoming worse now.  Also, my eyes are dull now.  I'm eager to get down to 50mg Amisulpride so I can then start reducing the Abilify.

 

However, more positively, I think I may be getting food cravings under control - thank You Lord.   

[whitelily]

Hit a glitch two weeks ago - two days of paranoia.  Didn't reduce in the end because of this and have stayed at 60.75mg amisulpride.  I'm not really sure what to make of this - could be underlying illness?  Or could it be a late withdrawal effect (just over a month after being on 60.75mg).  

 

I don't know whether to try a 5% drop next or just stay on this dose for another couple of weeks before dropping again.  I can't really afford to get unwell like that as it puts a strain on people around me.  

 

Is anyone able to offer any advice or thoughts?

[Altostrata]

You might wish to hold for a bit. 

 

Was there any irregularity in the way you took your drugs? Did you skip any doses? Change your dosing schedule?

[whitelily]

sorry Altostrata, would have replied but unwell, so holding dose and needed to take step back for a bit.

[whitelily]

Hi, currently stable again after holding dose.  Am now certain I am dealing with c-ptsd, of which paranoia can be a symptom.  I appear to have developed diabetes insipidus - at least I have the symptoms of it (waking every hour at night needing to pee and thirsty despite taking metformin) - so have got to go back to the doctor.  

 

Alto - sorry not to reply before, but just didn't feel able to post.  From memory, I skipped one dose, but as written above, I think the paranoia has been an underlying symptom of c-ptsd, so trying to think of ways to tackle this.  Have no trust in mental health team and no advocate at the moment, so unsure what to do but have come across a c-ptsd workbook and am reverting back to some CBT.  

[whitelily]

Just checking in with update:  it looks like I was too hasty to go by what I had read my symptoms might be caused by - the problem of thirst and needing to pee might be to do with hormones according to my diabetes nurse, so I have had blood tests and have an appointment with the doctor scheduled.  

 

I had half a day where my brain seemed speeded up a few days ago - as thoughts were racing a little, then after that I have just wanted to mainly eat and sleep.  So I am taking things very slowly at the moment.  I just reduced the dose a a little on the 15th  (3.5%), and have decided to continue reducing very slowly until I get down to 50mg amisulpride (and then I will taper Abilify).  I am not quite sure how long to hold this dose for - i don't really want to hold it for as long as a month.

 

Food cravings seem to be crazy at times - thankfully I have discovered cauliflower rice at the supermarket, which is low cal and low carb and seems to curb hunger.  Also have been having courgetti.        

[whitelily]

Well, even after such a low dose reduction, I have been hearing voices.  Ugh.  That is the negative news.  It kind of crept up on me,  

 

The positive news is that after prayer and counseling I have made some progress on issues in my personal life.    

 

I have also been reading here on different threads about tapering at a much slower rate and am feeling much more positive about that approach.

 

So, holding for the moment until the voices hopefully ease off.     

[whitelily]

Hi, symptoms have eased off and I'm sleeping well. However, I have just been contacted by my pdoc who is aware that I have been dry-cutting the amisulpride and he began to coerce me over the phone to take the drugs even though according to my support worker I am managing well. I guess I should be used to this now, as it's happened so much.

 

I have an appointment coming up with him and the pharmacist (who had already said I could withdraw and would be able to get the liquid suspension of amisulpride - but the pdoc seems against this from what I could tell).

 

Could anyone point me in the direction at all of the best evidence so I can prepare to take information with me at the meeting, or any other tips? I don't think I have the energy to do much research and I'm concerned that he or they together will be trying to enforce drug treatment even though I am actually managing better when I stabilise on a lower dose.

 

Thanks for taking the time to read this.

[whitelily]

Since posting the above, I have contacted an advocacy service to see if they can have someone attend with me.

[whitelily]

Just checking in - have held dose of amisulpride at 54.26mg for a while because I had experienced some breakthrough symptoms.  The abilify is still at 10mg - aim to start reducing it when amisulpride gets to 50mg.  Progressing so slowly but decided better that than becoming unwell - have been making reductions of 2.5%.  I'm hoping that this is mainly an issue with the amisulpride (having to go so slow with reductions) because I think from what I remember it binds tightly to two receptors in the brain.     Sorry a bit vague here, quite tired.   

[whitelily]

Hiya, here to update - I cut the dose by 2.5% to 52.79mg amisulpride, plus the full 10mg dose of abilify on 9th July 2017 (yesterday).  I've started to get a post-nasal drip for which I'm taking a high dose of vitamin C to combat it - I hope it works.  

 

Also, I had become concerned about how I was doing cognitively so today I took the following online test :-

 

http://www.foodforthebrain.org/alzheimers-prevention/take-the-test.aspx

 

As I had thought, I'm not doing very well as I only scored 39.35 - where the expected average is 54.2.   They advise taking the test results to your GP.  Before I went on psych meds I remember my iq was 132-137 tested on two separate occasions.  Apart from continuing with withdrawal, I am wondering what else I can do practically to try and improve my score or stave off any further deteroriation apart from resume taking fish oil and Mg.    

 

I thought I'd write now what I think has been happening when I've got very unwell before and felt unable to respond here.  Essentially it was the onset of paranoia - and I think that it could be an extreme stuck emotion of fear, which I can trace back to an event way back when I was young.  

 

However, something I can't explain so well is having experienced a lot of synchronicity.  This has at times fueled/worsened the paranoia.

 

I currently have fewer mental health symptoms which I really glad about (I have poor motivation still and lethargy and am finding it difficult to do housework), but I do have some weakness in my arms and legs which has been coming on over the past couple of months - and now when I stand up I have to pause to make sure I am balanced - not sure if this is early aging or linked to the Abilify.  

 

So, now its even clearer still, what led to me getting so ill in the first place - a history of some trauma plus I had period of a number of months with very poor sleep due to being a new mum, in addition to which I can think of three more major life stressors that were happening (almost unbelievable to me that that happened now), and added to the mix I was prescribed Prozac - it was then that the first psychosis started happening.   No wonder it was such a crash, and with the combination of heavy meds I ended up on and little practical support not surprising that I never really got up and running again.  

 

I still find it difficult to comprehend how pdoc's can be so neglectful in terms of validating contributory factors to mental illness.  It's frustrating and I think detrimental to recovery  not to be heard by the very people who are meant to have an expertise in helping others.  And the DSM;  and the drugs.... the drugs.... what I can say - just speechless at the guesswork with the prescribing.                      

[whitelily]

Has anyone experienced postnasal drip and loss of appetite as a symptom of withdrawal?  

 

If so, what did they find helped most?  I was prescribed a nasal spray but it didn't work.  

Edited July 11, 2017 by scallywag
merged topics

[scallywag]

whitelily, I've moved your post/question to your introduction topic so that all your information, questions and answers are in one place.

 

Here's a link to discussions about changes in appetite, and increased and decreased weight.

 

Here are search results I got using the keywords nasal and/or sinus.

[whitelily]

thanks for taking the time to search the links scallywag - I shall check them out now 

[PoetJester]

Hi Whitelily,

 

I have been dealing with post nasal drip in wd.  after meals it's particularly bad.  Constant sneezing and nose blowing after every time I eat.  I thought maybe I had developed a gluten allergy.  I also developed awful fecal breath after just a couple beers last year in june.  I did some online searching and saw that intestinal parasites can cause the fecal breath.  I ordered some Kroeger's Wormwood complex online last Jan and took some and within 20 minutes had liked my first formed bowel movement in ages (usually they are like cow dung or wet concrete.  sorry if that's tmi).  I was defecating every half hour for 3 hours.  anyways after the first formed bowel movement, I had one that consisted of tons of dehydrated apple chunks from seemingly weeks back and later another movement with what appeared to be lots of 2 inch long worms and weird rice like larva.  it was incredible, and that evening for the first time in a couple years, I didn't sneeze at all after a big dinner (even one with pasta in it)  and my issues with fatigue had largely vanished.   it seemed like a breakthough, but on the third day of doing this wormwood parasite cleanse, (it hadn't really eliminated the poop breath which is what I had been going after although it did lessen it some) I developed kidney pains and had to give if up.  wormwood is known to be harmful to the kidneys of some who take it.  I did have two good days though where, my fatigue was gone and my after meal sneezing fits and congestion where also a thing of the past.   i am back to feeling awful, but for 2 days anyways, there was something.  later, i noticed a smell of ammonia on my breath which may be kidney damage from the wormwood.  things are not going terribly well over here.

 

I read your earlier post about the voices and ever since my wd from sertraline and olanzapine I have started hearing voices again and they are quite prevalent.  I have gotten used to it 3 1/2 years later, but I do miss normality.   

 

sorry if this letter sounds dull or like a commercial for parasite cleanse.  I am exhausted today (like most days) and just got up from a nap, but did want to send you some commiseration.  my present bowel problems are also causing a loss of appetite, too.  I am a mess with bloating and constipation now.  i hardly know when i am hungry and constantly feel full most of the time.  I think three years of wd and poor sleep has had a depressing affect on my digestive tract.  it hardly seems to work without some prodding of some sort now.  anyways.

 

 

poetjester

[whitelily]

13 minutes ago, PoetJester said:

Hi Whitelily,

 

I have been dealing with post nasal drip in wd.  after meals it's particularly bad.  Constant sneezing and nose blowing after every time I eat.  I thought maybe I had developed a gluten allergy.  I also developed awful fecal breath after just a couple beers last year in june.  I did some online searching and saw that intestinal parasites can cause the fecal breath.  I ordered some Kroeger's Wormwood complex online last Jan and took some and within 20 minutes had liked my first formed bowel movement in ages (usually they are like cow dung or wet concrete.  sorry if that's tmi).  I was defecating every half hour for 3 hours.  anyways after the first formed bowel movement, I had one that consisted of tons of dehydrated apple chunks from seemingly weeks back and later another movement with what appeared to be lots of 2 inch long worms and weird rice like larva.  it was incredible, and that evening for the first time in a couple years, I didn't sneeze at all after a big dinner (even one with pasta in it)  and my issues with fatigue had largely vanished.   it seemed like a breakthough, but on the third day of doing this wormwood parasite cleanse, (it hadn't really eliminated the poop breath which is what I had been going after although it did lessen it some) I developed kidney pains and had to give if up.  wormwood is known to be harmful to the kidneys of some who take it.  I did have two good days though where, my fatigue was gone and my after meal sneezing fits and congestion where also a thing of the past.   i am back to feeling awful, but for 2 days anyways, there was something.  later, i noticed a smell of ammonia on my breath which may be kidney damage from the wormwood.  things are not going terribly well over here.

 

I read your earlier post about the voices and ever since my wd from sertraline and olanzapine I have started hearing voices again and they are quite prevalent.  I have gotten used to it 3 1/2 years later, but I do miss normality.   

 

sorry if this letter sounds dull or like a commercial for parasite cleanse.  I am exhausted today (like most days) and just got up from a nap, but did want to send you some commiseration.  my present bowel problems are also causing a loss of appetite, too.  I am a mess with bloating and constipation now.  i hardly know when i am hungry and constantly feel full most of the time.  I think three years of wd and poor sleep has had a depressing affect on my digestive tract.  it hardly seems to work without some prodding of some sort now.  anyways.

 

 

poetjester

hi poetjester,

 

Thanks so much for your post and for being willing to share info to help.  I'm sorry to hear of whats been happening.  I really hope that you haven't got kidney damage - are you able to get them checked through your gp?  

 

I found what you've shared about parasites really interesting.  I once tried wormwood before in a powder which was made up into a drink but it tasted so awful I couldn't go through with completing the course of it, but I'm having trouble swallowing tablets so I think I'd have to try that again, :(.   I'm open to the fact that it could be something like parasites as I've been having digestive problems also, but I just put it down to general withdrawal issues (although I'm going extremely slowly now), although I had thought that they would perhaps cause an increase in appetite and over the past two days mine has dramatically reduced (the last time this happened I had sinusitus but I'm not aware of any swelling of my sinuses this time).

 

Regarding the wormwood, I am wondering if there's any other substance that can be safely taken as an alternative .... something for me to check ......  

 

Thanks too for sharing about the voices - yes, I am anticipating that I may need to up my coping skills with voices as much as possible if I'm to manage without drugs, or at least on a more reduced dose .  Will be over to check your thread to see how your withdrawal progressed....  

 

Take care,

 

whitelily      

[whitelily]

Quick update - took quite a bit of organic extra virgin coconut oil yesterday and within a day my post nasal drip has cleared up.  Can't think of anything else that could have done it unless it just got better by itself with some vit C, but it was so bad and change so quick that think it must be the oil - and I read online that someone else's also cleared up when they took it.

 

Have ordered a parasite cleanse as still have what I believe is IBS and think it would be good to do.   

[PoetJester]

On ‎7‎/‎12‎/‎2017 at 11:11 PM, whitelily said:

Quick update - took quite a bit of organic extra virgin coconut oil yesterday and within a day my post nasal drip has cleared up.  Can't think of anything else that could have done it unless it just got better by itself with some vit C, but it was so bad and change so quick that think it must be the oil - and I read online that someone else's also cleared up when they took it.

 

Have ordered a parasite cleanse as still have what I believe is IBS and think it would be good to do.   

Hey Whitelily,

 

Glad to hear that you got rid of the post nasal drip.  I was wondering how much organic extra virgin coconut oil is quite a bit?  I just got finished profusely blowing my nose and still have snot in my beard after my morning bowl of  granola and milk. 

 

poetjester

[whitelily]

On 7/16/2017 at 1:18 PM, PoetJester said:

Hey Whitelily,

 

Glad to hear that you got rid of the post nasal drip.  I was wondering how much organic extra virgin coconut oil is quite a bit?  I just got finished profusely blowing my nose and still have snot in my beard after my morning bowl of  granola and milk. 

 

poetjester

Hi poetjester, 

 

Had about five heaped teaspoons over course of day.  Had little more next day and nearly finished small jar but then lost appetite for it unsurprisingly.   At first I just wanted to keep eating it.   Also took about 1000mg vitamin c in powder which i diluted but had had that before.  

 

Maybe it would help to do combination?  Hope you find something that works soon.  Take care,

 

Whitelily

[Plshelp]

Whitelily. 

How have you been? Are you completely off the antipsychotics now? I tried to skim thru the pages. 

Thanks. 

[Trublu3]

On 12/07/2017 at 4:40 AM, whitelily said:

Has anyone experienced postnasal drip and loss of appetite as a symptom of withdrawal?  

 

If so, what did they find helped most?  I was prescribed a nasal spray but it didn't work.  

Hi whitelilly,

Newbie here. I was on amisulpride as well as anti depressants for many years and went cold turkey 4 months ago.

I wish I was encouraged to taper, as I've been in Hell. But things are starting to improve for me with regular counseling and CBT.

Yes I currently have postnasal drip and it's a relentless symptom. I've tried anticongestents, cough losengers, nasal sprays. Nothing works. You mentioned coconut oil worked for you. How much did you take, for how long, until the symptoms subsided?

Thanks for sharing your battle, it's helped me a lot.

[whitelily]

On 8/2/2017 at 6:37 AM, Plshelp said:

Whitelily. 

How have you been? Are you completely off the antipsychotics now? I tried to skim thru the pages. 

Thanks. 

Hi @Plshelp,  thanks for your msg.  I'm doing okay at the moment thanks.  I'm now on 50mg of amisulpride and 10mg of abilify and shall try cutting 2.5% of the abilify this weekend and holding for a week, so I've still got a long way to go but with very small cuts I find things a lot easier.  At the beginning I found it very hard to accept that I might have to go so slowly - I was so angry at being put on the drugs - but it's making a big difference doing it this way - thanks to the advice and guidance from staff and people here.  

[whitelily]

Hi, checking in.  After saying I would cut the Abilify by 2.5%, I found that the small part of the tablet I tried to cut off just crumbled to dust and I was left with approx 90% left to take - I have nothing spare of the abilify.  So I have been making a reduction of 10% for two nights and it's very early, but I'm just noticing already that I am sleeping more.  

 

I think I need to check out another way of making the reduction and wondered if abilify was water soluble.

[scallywag]

From Altostrata's first post in the Abilify tapering topic:

On 2012-03-11 at 7:34 PM, Altostrata said:

Dissolving tablets in water
I have no information about this. As near as I can tell, the ordinary Abilify tablet is insoluble in water (http://www.aapsj.org/abstracts/AM_2009/AAPS2009-003188.PDF ). You may be able to make a solution with the Abilify DISCMELT® Orally Disintegrating Tablets (available in 10mg and 15mg dosages); I don't know what the stability would be -- how long the liquid would be good.
 
For general instructions about making your own liquid http://survivingantidepressants.org/index.php?/topic/2693-how-to-make-a-liquid-from-tablets-or-capsules/

You can still make a liquid, it will be a suspension, in which the bits are visible, rather than a solution, in which the tablet is entirely dissolved.

 

In addition, it might be worth considering weighing your dose:

Using a digital scale to measure doses.