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Adah: 6mg of Trazodone: A Lesson in Respect


Adah

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Thanks so much for this forum and all of the information here! I've been on psych meds for almost 20 years. Eventually, I'll add my history in bits. Even the last 2 years of my experience is a lot to cover. I started a multi-med taper about a year and a half ago. Seroquel, Trazodone, Perphenazine, Cogentin and Trazodone.

 

Today, I wanted to start with a hard lesson in humility and respect for these drugs that are carelessly marketed to the unhappy and anxious between episodes of Law and Order as the answer to all of our problems. Don't get me started on my Conspiracy Theory about that combination of advertising.

 

After quick initial drops (I'll talk about in later posts), I've been pretty good about doing a slow taper, rushing it a bit as tolerated every three to six weeks, but one med at a time. I've had some withdrawal symptoms along the way, but would quickly bump back up and they'd resolve. I've tapered down to 6mg of Trazadone from 200mg. I wishfully thought I could simply drop the 6mg without a further taper. I was hoping I could be one of those folks. It's such a little amount, right? Everything I've read here has told me No, but nothing speaks better than learning the hard way.

 

I tried to drop the last 6mg last night. Within 6 hours of missing my dose, I woke up in a sweat, full body akathisia, racing heart and a horrible feeling of panic I've all felt before when I've completely forgotten a 200mg dose. So I got up and took the dose which mostly resolved it, but I do have residual issues I know will take a few days to shake off. I am definitely one of those who will have more trouble tapering the last tiny little bit than I did at higher doses. It's shocking to me how powerful the reaction is at such a seemingly small dose. It horrifies me that I'm more aware of this even being a possibility than my psychiatrist is.

 

I've often concerned myself with why this is, why the last tiny bit is a harder road than, in my case, the first large jumps. But the more I find out, the more I realize how simplified our understanding of how these drugs affect us is.

 

This is how I see the journey of my med taper:

post-2310-0-29931000-1405450025_thumb.jpg

Edited by tezza
Added member name to topic title

5/12/2014

250 mg Seroquel

200 mg Lamictal

37.5 mg Trazodone

 

9/23/2013:
200 mg Seroquel (down from 800 mg 3/15/2013, down from 150XR in the am, 800 mg in the pm)
200 mg Lamictal
150 Trazodone
2 mg Perphenazine
.5 mg Cogentin (for side effects of Seroquel)

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  • Moderator Emeritus

Adah, check out this paper, in particular the charts beginning on page 4:

http://survivingantidepressants.org/index.php?/topic/6036-why-taper-paper-demonstrates-importance-of-gradual-change-in-plasma-concentration/

 

As you can see, the decrease in receptor occupancy starts as a gradual slope, but at lower doses it becomes practically a straight vertical drop. It's not a straight line, it's a curve. So a small dose does not necessarily correspond with "small effect." And the last little bit of the med has the greatest effect in terms of the changes in your brain.

 

That's why you can't just stop at 6 mg, and why we recommend tapering by 10% or less of your current dose not by a constant increment.

 

There's not something wrong with you. Your experience at this low dose is typical.

Started on Prozac and Xanax in 1992 for PTSD after an assault. One drug led to more, the usual story. Got sicker and sicker, but believed I needed the drugs for my "underlying disease". Long story...lost everything. Life savings, home, physical and mental health, relationships, friendships, ability to work, everything. Amitryptiline, Prozac, bupropion, buspirone, flurazepam, diazepam, alprazolam, Paxil, citalopram, lamotrigine, gabapentin...probably more I've forgotten. 

Started multidrug taper in Feb 2010.  Doing a very slow microtaper, down to low doses now and feeling SO much better, getting my old personality and my brain back! Able to work full time, have a full social life, and cope with stress better than ever. Not perfect, but much better. After 23 lost years. Big Pharma has a lot to answer for. And "medicine for profit" is just not a great idea.

 

Feb 15 2010:  300 mg Neurontin  200 Lamictal   10 Celexa      0.65 Xanax   and 5 mg Ambien 

Feb 10 2014:   62 Lamictal    1.1 Celexa         0.135 Xanax    1.8 Valium

Feb 10 2015:   50 Lamictal      0.875 Celexa    0.11 Xanax      1.5 Valium

Feb 15 2016:   47.5 Lamictal   0.75 Celexa      0.0875 Xanax    1.42 Valium    

2/12/20             12                       0.045               0.007                   1 

May 2021            7                       0.01                  0.0037                1

Feb 2022            6                      0!!!                     0.00167               0.98                2.5 mg Ambien

Oct 2022       4.5 mg Lamictal    (off Celexa, off Xanax)   0.95 Valium    Ambien, 1/4 to 1/2 of a 5 mg tablet 

 

I'm not a doctor. Any advice I give is just my civilian opinion.

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  • Moderator Emeritus

Also, it looks from your sig line like you've gone from 37.5 mg of trazodone down to 6 mg in less than two months. That's way faster than I would recommend. I think you'd be best off holding your dose for a couple of months now to make sure your body has had time to catch up with that dramatic reduction, before trying to reduce further.

Started on Prozac and Xanax in 1992 for PTSD after an assault. One drug led to more, the usual story. Got sicker and sicker, but believed I needed the drugs for my "underlying disease". Long story...lost everything. Life savings, home, physical and mental health, relationships, friendships, ability to work, everything. Amitryptiline, Prozac, bupropion, buspirone, flurazepam, diazepam, alprazolam, Paxil, citalopram, lamotrigine, gabapentin...probably more I've forgotten. 

Started multidrug taper in Feb 2010.  Doing a very slow microtaper, down to low doses now and feeling SO much better, getting my old personality and my brain back! Able to work full time, have a full social life, and cope with stress better than ever. Not perfect, but much better. After 23 lost years. Big Pharma has a lot to answer for. And "medicine for profit" is just not a great idea.

 

Feb 15 2010:  300 mg Neurontin  200 Lamictal   10 Celexa      0.65 Xanax   and 5 mg Ambien 

Feb 10 2014:   62 Lamictal    1.1 Celexa         0.135 Xanax    1.8 Valium

Feb 10 2015:   50 Lamictal      0.875 Celexa    0.11 Xanax      1.5 Valium

Feb 15 2016:   47.5 Lamictal   0.75 Celexa      0.0875 Xanax    1.42 Valium    

2/12/20             12                       0.045               0.007                   1 

May 2021            7                       0.01                  0.0037                1

Feb 2022            6                      0!!!                     0.00167               0.98                2.5 mg Ambien

Oct 2022       4.5 mg Lamictal    (off Celexa, off Xanax)   0.95 Valium    Ambien, 1/4 to 1/2 of a 5 mg tablet 

 

I'm not a doctor. Any advice I give is just my civilian opinion.

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Thanks for the welcome tezza  :)

 

Rhi, I don't entirely know what I'm looking at with those charts, but I do understand exponential growth and decay. Am I seeing saturation (receptor occupancy?) plummet at a faster rate as the dosage lowers linearly? 

 

I see now looking at my signature I've been dropping my dosage at a pretty fast clip. 37.5-->25-->12.5-->6. 

 

I've had some withdrawal symptoms along the way with the trazodone taper, 'brain zaps' and akathisia mainly, that increasing the dosage would alleviate, and then I'd lower back down a week after they subsided. Come to think of it, since dropping to 6mg, I've had more akathisia lingering. I'm having more trouble, and different trouble, than withdrawal symptoms I've experienced at higher doses. I'm in a rush of sorts because I want to start tapering the seroquel again because it makes me sleep 10 hours a day. I don't wake up; I fight my way out of sleep, and so much of my day is lost. Unfortunately, that doesn't change withdrawal, and today was a harsh lesson. I have to slow down.

 

I'm going back up to 12.5mg, and do my 10% tapers from there. I'll have to look through the boards to find a way to do that, as right now I'm cutting up pills that are mostly turning into dust and not neat little easily measured pieces, which I also have to wonder is affecting how evenly my body is metabolizing the trazodone. I can feel the sickness creeping back up on me, so I better take my doses and get to bed.

5/12/2014

250 mg Seroquel

200 mg Lamictal

37.5 mg Trazodone

 

9/23/2013:
200 mg Seroquel (down from 800 mg 3/15/2013, down from 150XR in the am, 800 mg in the pm)
200 mg Lamictal
150 Trazodone
2 mg Perphenazine
.5 mg Cogentin (for side effects of Seroquel)

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Another quick thought, if anyone has any experience with it, I'd like to hear it...

 

As you've tapered your meds, have you noticed more pronounced chronic pain? Or is that just me getting older? I swear there is a correlation, particularly after last night's debacle with the trazodone. I have an old back injury that is becoming an excruciating daily ordeal. I've been recently checked by my doctor and have been doing physical therapy, nothing seems worrisome, but it's like the nerves themselves are inflamed. 

5/12/2014

250 mg Seroquel

200 mg Lamictal

37.5 mg Trazodone

 

9/23/2013:
200 mg Seroquel (down from 800 mg 3/15/2013, down from 150XR in the am, 800 mg in the pm)
200 mg Lamictal
150 Trazodone
2 mg Perphenazine
.5 mg Cogentin (for side effects of Seroquel)

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  • Moderator

Oh Adah, welcome!

 

I've wondered the same about chronic pain!  Is it that I feel it more (less numb?) or that the withdrawal is causing pain?  Or is it just that I am older - 10 years older than when I started lithium, 30 years older than when I started psych meds - and have injuries and creaky bits?

 

It doesn't make it any easier!  I confess!  I nearly took a seroquel 25 the other night because I thought there was no way I was going to be able to sleep!  But I didn't, used some homeopathic thing instead, and put on (get this:  a blindfold, a pillow between my knees, a teddy bear to keep my shoulders "safe", a breathe-right strip, an elbow and knee brace!)  I finally took pain meds, it took me 2 hours to fall asleep. Then upon waking, the whole thing in reverse.  Hips, knees, back, neck, head.  Pain.  

 

And I do seem to recall that on full lithium, I was "feeling much better" - not so much time spend in physio or on ice for awhile.  

 

Now it seems like my lot is back to the ice, the icy-hot, and lots of cushions.  (my back hurts more in the daytime than at night).  

 

I'd like to see if anyone else has anything about this, or if there is a thread for chronic pain.  I'm not as clever at surfing the site as some.  But I will go look.

"Easy, easy - just go easy and you'll finish." - Hawaiian Kapuna

 

Holding is hard work, holding is a blessing. Give your brain time to heal before you try again.

 

My suggestions are not medical advice, you are in charge of your own medical choices.

 

A lifetime of being prescribed antidepressants that caused problems (30 years in total). At age 35 flipped to "bipolar," but was not diagnosed for 5 years. Started my journey in Midwest United States. Crossed the Pacific for love and hope; currently living in Australia.   CT Seroquel 25 mg some time in 2013.   Tapered Reboxetine 4 mg Oct 2013 to Sept 2014 = GONE (3 years on Reboxetine).     Tapered Lithium 900 to 475 MG (alternating with the SNRI) Jan 2014 - Nov 2014, tapered Lithium 475 mg Jan 2015 -  Feb 2016 = GONE (10 years  on Lithium).  Many mistakes in dry cutting dosages were made.


The tedious thread (my intro):  JanCarol ☼ Reboxetine first, then Lithium

The happy thread (my success story):  JanCarol - Undiagnosed  Off all bipolar drugs

My own blog:  https://shamanexplorations.com/shamans-blog/

 

 

I have been psych drug FREE since 1 Feb 2016!

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  • Moderator Emeritus

Yes, I'm told the term for how we have to taper is "exponential decay." Like radioactive half-lives...? Skim through that thread about the paper and you'll see the discussion of it. This post: http://survivingantidepressants.org/index.php?/topic/6036-why-taper-paper-demonstrates-importance-of-gradual-change-in-plasma-concentration/?p=85973  is good, where Alto flips the charts, makes it easier to see. That line that starts as a gradual slope then curves down and becomes a precipitous drop, is the receptor occupancy (how much effect the drug is having in our brains). As you can see, at lower doses a small change in dosage or plasma levels produces a very sharp change in receptor occupancy. That's why it's super important to make only small changes in dosage when you get to low dosage levels.

 

You might find that jumping back up to 12.5 is too much at this point; I would consider a smaller increase.

 

Our Tapering section has information on how to make your own liquid suspensions of meds if necessary. Some of them are already available in a liquid form by prescription. Also, compounding pharmacies can make whatever dose, or whatever strength of liquid, you need. Prescriptions require a cooperative doctor, however.

 

You're correct, it is VERY important to get control of your doses, and cutting pills at lower doses produces too much variation. I've used a milligram scale and a fingernail file to get more precise doses, but you have to waste the rest of the pill, and the math is trickier, and it gets really tricky at very small doses where you're working with a tiny fragment of pill. I personally am very satisfied with my home-made liquid suspensions.

 

And: Pain is one of the most common withdrawal effects from psych meds, especially ADs. Sometimes you'll see it described as "flu-like aches and pains." I find that for me, since chronic pain is something I already live with, it manifests as both a worsening of the pain I already have, and an increased sensitivity to pain in general, and sometimes additional more flu-like muscular pain.

Started on Prozac and Xanax in 1992 for PTSD after an assault. One drug led to more, the usual story. Got sicker and sicker, but believed I needed the drugs for my "underlying disease". Long story...lost everything. Life savings, home, physical and mental health, relationships, friendships, ability to work, everything. Amitryptiline, Prozac, bupropion, buspirone, flurazepam, diazepam, alprazolam, Paxil, citalopram, lamotrigine, gabapentin...probably more I've forgotten. 

Started multidrug taper in Feb 2010.  Doing a very slow microtaper, down to low doses now and feeling SO much better, getting my old personality and my brain back! Able to work full time, have a full social life, and cope with stress better than ever. Not perfect, but much better. After 23 lost years. Big Pharma has a lot to answer for. And "medicine for profit" is just not a great idea.

 

Feb 15 2010:  300 mg Neurontin  200 Lamictal   10 Celexa      0.65 Xanax   and 5 mg Ambien 

Feb 10 2014:   62 Lamictal    1.1 Celexa         0.135 Xanax    1.8 Valium

Feb 10 2015:   50 Lamictal      0.875 Celexa    0.11 Xanax      1.5 Valium

Feb 15 2016:   47.5 Lamictal   0.75 Celexa      0.0875 Xanax    1.42 Valium    

2/12/20             12                       0.045               0.007                   1 

May 2021            7                       0.01                  0.0037                1

Feb 2022            6                      0!!!                     0.00167               0.98                2.5 mg Ambien

Oct 2022       4.5 mg Lamictal    (off Celexa, off Xanax)   0.95 Valium    Ambien, 1/4 to 1/2 of a 5 mg tablet 

 

I'm not a doctor. Any advice I give is just my civilian opinion.

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  • Administrator

Welcome, adah.

 

Here's a topic explaining how to titrate trazodone http://survivingantidepressants.org/index.php?/topic/2883-tips-for-tapering-off-trazodone-desyrel/

 

There are topics for tapering your other drugs in the Tapering forum, too.

 

Why did you decide to go off trazodone first? Why are you taking Cogentin?

 

Withdrawal makes us more sensitive to pain because it raises sensitivities in general.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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