Simon: Introduction

[simon]

When I try to put the details from drugs.com onto this forum it doesn't work. On their FAQs they point out that a profile cannot be shared with anyone else and that you have to print a copy and show it if you want to do that.

I copied it all out on this topic on Oct 5th. If that's not sufficient then i'll have to wait til I can get hold of someone better at IT than me.

 

Maybe the augmenting of ADs is a British bright idea, but I have read about it online in various papers. Or maybe its a way of saying that youre probably bi polar so we'll hedge our bets. All I know is that when, at first I was taking about 1000mg of it I went through six months of feeling suicidal nearly all the time. Then I reduced to about 500 and started to feel more myself. That was about 7 years ago.

 

Thanks for your help and advice

 

Simon

[dignan]

In my experience lithium is a very potent drug. For several years I was nestled inside lithium's “therapeutic” window.  It crashed me into an extended hibernation. My hypersomnia was so terrible that I was prescribed astronaut pills (Modafinil) to keep me awake for more than a few hours. I complained to my psychiatrist for years that I had horrible and extreme tiredness. He said that I was doing well and that my tiredness was an underlying “depressive” episode. 

Long story short, I came off of lithium and my energy was restored to me for the first time in three and a half years! And you know what my psychiatrist said? He didn’t believe me. He said that lithium cannot make people tired. 

 

Ultimately, I learned two lessons: The first is that psychiatry is so rigidly ideological that it cannot acknowledge any contradictory fact that befalls its pompous eyes. I even went before a “panel” of psychiatrists for “difficult” cases and not one of those myopic ideologues suggested that lithium may be the source of my fatigue. Point being, the “therapeutic” window is part of psychiatry's larger ideology or, perhaps, the mythology of psychiatry, a frightening anti-fable with terrible monsters and where nothing is ever learned. 

 

The second lesson I learned is to taper off lithium slowly. I rapidly tapered (over the course of several weeks) much too quickly. Initially, I didn’t even feel any adverse withdrawal effect; in fact, I felt like my old self for a weeks. Then it hit: I woke up vomiting and felt very ill for a week. Then it felt like a rebirth in a sense as I began to experience emotions again, but in a very intense way. From my experience, I believe it’s possible that lithium may have a delay-onset withdrawal (a phase two beginning several months later). Of course I can’t prove this and a slow taper may allow one to avoid all this. At least, that’s my plan now. I ended up back on several drugs, including lithium, but at a substantially lower dose so I am not having any fatigue issues at the moment. 

 

Anyway, that’s part of my lithium experience and sadly only part of my experience with psychiatry. 

[simon]

Dignan

Its good to get your reply.

Youre  the nearest match to the drugs im taking that ive found so far on this forum. Sorry if that's a cause for relief on my part, but it does show that value of this forum, that being so big, you can eventually find someone with similar experiences.

Ive always found that, researching a drug like lithium, its hard to find much recent information, as its quite an old fashioned drug and so called evidence tends to be stuck in the 70s or earlier. Newer and more expensive drugs take over and evidence switches to these new 'wonder' drugs.

Had I had access to a more enlightened psycho, those years ago I might have been advised to stick it out on just the ADs for a bit longer. But she thought that the situation was so desparate that something more was needed. But as ive said above, it was only by reducing the lithium myself to about 5-600mg, that I became more functional and the suicidal 'ideation' left me.

The drug Lyrica, I was almost put on a few weeks ago instead of a benzo. it has a different name over here. But as things stand ive decided to taper off  the benzo (as far as poss) and then begin the ADs at the slow rate favoured by this site.

Like you I haven't a clue what lies underneath this cocktail of drugs and it will take a long time to discover.

 

I was looking back at your posts and im sorry that you also have this back problem to contend with too. I have menieres syndrome that sends me into fits of vertigo from time to time and one or two drop attacks where you loose consciousness  for a very brief time; so no driving and other risky activities. But I can cope with that. What I cant cope with is the feeling that I don't experience emotion properly and cognitive ability is reduced by these ADs.

 

I wish you well with your recovery and taper from Lyrica.

Simon

[Altostrata]

Copy the link from the drug interaction report from the band at the top of your browser.

[Altostrata]

Posting this for Simon:

 

Interactions between your selected drugs

lithium ↔ citalopram

Applies to:lithium, citalopram

Major Drug Interaction

MONITOR CLOSELY: Lithium may enhance the pharmacologic effects of selective serotonin reuptake inhibitors (SSRIs) and potentiate the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A and 2A receptors. The exact mechanism by which lithium increases serotonergic activity is unknown. The interaction has been reported with fluoxetine and fluvoxamine and the serotonin-norepinephrine reuptake inhibitor venlafaxine. Symptoms of the serotonin syndrome may include mental status changes such as irritability, altered consciousness, confusion, hallucinations, and coma; autonomic dysfunction such as tachycardia, hyperthermia, diaphoresis, shivering, blood pressure lability, and mydriasis; neuromuscular abnormalities such as hyperreflexia, myoclonus, tremor, rigidity, and ataxia; and gastrointestinal symptoms such as abdominal cramping, nausea, vomiting, and diarrhea. Conversely, SSRIs may elevate the plasma concentrations of lithium and increase the risk of lithium toxicity. The interaction has been associated with fluoxetine, while citalopram and paroxetine reportedly do not cause the interaction.

MANAGEMENT: Caution is advised if lithium is prescribed in combination with SSRIs. Lithium levels should be assessed regularly and the dosage adjusted accordingly. Patients should be closely monitored for symptoms of the serotonin syndrome during treatment. Particular caution is advised when increasing the dosages of these agents. If serotonin syndrome develops or is suspected during the course of therapy, all serotonergic agents should be discontinued immediately and supportive care rendered as necessary. Moderately ill patients may also benefit from the administration of a serotonin antagonist (e.g., cyproheptadine, chlorpromazine). Severe cases should be managed under consultation with a toxicologist and may require sedation, neuromuscular paralysis, intubation, and mechanical ventilation in addition to the other measures.

ADJUST DOSE: Citalopram can cause dose-dependent prolongation of the QT interval. Theoretically, coadministration with other agents that can prolong the QT interval including lithium may result in additive effects and increased risk of ventricular arrhythmias such as torsade de pointes and sudden death. In a randomized, double-blind, crossover, escalating multiple-dose study consisting of 119 healthy subjects, the maximum mean increase in corrected QT interval from placebo was 8.5 msec for citalopram 20 mg and 18.5 msec for citalopram 60 mg. Based on the established exposure-response relationship, prolongation of the corrected QT interval was estimated to be 12.6 ms for citalopram 40 mg. Cases of QT interval prolongation and torsade de pointes have been reported during postmarketing use. In general, the risk of an individual agent or a combination of agents causing ventricular arrhythmia in association with QT prolongation is largely unpredictable but may be increased by certain underlying risk factors such as congenital long QT syndrome, cardiac disease, and electrolyte disturbances (e.g., hypokalemia, hypomagnesemia). In addition, the extent of drug-induced QT prolongation is dependent on the particular drug(s) involved and dosage(s) of the drug(s).

MANAGEMENT: Given the risk of dose-dependent QT prolongation, citalopram should not be administered at dosages greater than 40 mg/day. Studies have not shown a benefit in the treatment of depression at dosages above 40 mg/day. Hypokalemia and hypomagnesemia should be corrected prior to initiation of citalopram treatment and periodically monitored. ECG monitoring is recommended with concomitant medications that have demonstrated prolongation of the QT interval and/or underlying risk factors such as heart failure or bradyarrhythmia. Patients should be advised to seek medical attention if they experience symptoms that could indicate the occurrence of torsade de pointes such as dizziness, palpitations, irregular heartbeat, shortness of breath, or syncope.

mirtazapine ↔ citalopram

Applies to:mirtazapine, citalopram

Major Drug Interaction

MONITOR CLOSELY: Concomitant use of agents with serotonergic activity such as serotonin reuptake inhibitors, monoamine oxidase inhibitors, tricyclic antidepressants, 5-HT1 receptor agonists, ergot alkaloids, cyclobenzaprine, lithium, St. John's wort, phenylpiperidine opioids, dextromethorphan, and tryptophan may potentiate the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A and 2A receptors. Symptoms of the serotonin syndrome may include mental status changes such as irritability, altered consciousness, confusion, hallucination, and coma; autonomic dysfunction such as tachycardia, hyperthermia, diaphoresis, shivering, blood pressure lability, and mydriasis; neuromuscular abnormalities such as hyperreflexia, myoclonus, tremor, rigidity, and ataxia; and gastrointestinal symptoms such as abdominal cramping, nausea, vomiting, and diarrhea.

MANAGEMENT: In general, the concomitant use of multiple serotonergic agents should be avoided if possible, or otherwise approached with caution if potential benefit is deemed to outweigh the risk. Patients should be closely monitored for symptoms of the serotonin syndrome during treatment. Particular caution is advised when increasing the dosages of these agents. The potential risk for serotonin syndrome should be considered even when administering serotonergic agents sequentially, as some agents may demonstrate a prolonged elimination half-life. For example, a 5-week washout period may be advisable following use of fluoxetine and 3 weeks following the use of vortioxetine before administering another serotonergic agent. If serotonin syndrome develops or is suspected during the course of therapy, all serotonergic agents should be discontinued immediately and supportive care rendered as necessary. Moderately ill patients may also benefit from the administration of a serotonin antagonist (e.g., cyproheptadine, chlorpromazine). Severe cases should be managed under consultation with a toxicologist and may require sedation, neuromuscular paralysis, intubation, and mechanical ventilation in addition to the other measures.

lithium ↔ mirtazapine

Applies to:lithium, mirtazapine

Moderate Drug Interaction

MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients.

MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Ambulatory patients should be counseled to avoid hazardous activities requiring mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

diazepam ↔ mirtazapine

Applies to:diazepam, mirtazapine

Moderate Drug Interaction

MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients.

MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Ambulatory patients should be counseled to avoid hazardous activities requiring mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

diazepam ↔ citalopram

Applies to:diazepam, citalopram

Moderate Drug Interaction

MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients.

MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Ambulatory patients should be counseled to avoid hazardous activities requiring mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

lithium ↔ diazepam

Applies to:lithium, diazepam

Minor Drug Interaction

Hypothermia has been reported in one patient receiving both diazepam and lithium. On rechallenge, the hypothermia was reproducible for the combination, but not for the drugs individually. It is not known whether other benzodiazepines will have similar interactions with lithium.

diazepam ↔ magnesium oxide

Applies to:diazepam, magnesium oxide

Minor Drug Interaction

A number of studies have reported that antacids can delay the gastrointestinal absorption and reduce the peak plasma concentration (Cmax) of some benzodiazepines, including clorazepate, chlordiazepoxide and diazepam, although the overall extent of absorption is generally not affected. The exact mechanism of interaction is unknown but may involve delayed gastric emptying or cation binding of the benzodiazepine. As a result, benzodiazepine onset of action may be delayed and clinical effects diminished. However, one study reported a significant increase in diazepam absorption during coadministration with aluminum hydroxide, and there was a marginal increase in the onset of sedative effect. Aluminum hydroxide also increased the Cmax and systemic exposure (AUC) of triazolam in 11 dialysis patients such that their drug levels reached into the range observed for the matched controls. In contrast, another study by the same group of investigators found no significant effect of aluminum hydroxide on temazepam absorption or Cmax in 11 patients with end-stage renal disease. A multi-dose study also failed to find an effect of antacids on the steady-state levels of N-desmethyldiazepam, the active metabolite of clorazepate, although an acidic environment is thought to be necessary for the rapid conversion. Based on available data, the clinical significance of this interaction appears to be minor. As a precaution, patients may want to consider separating the administration times of benzodiazepines and antacids or oral medications that contain antacids (e.g., didanosine buffered tablets or pediatric oral solution) by 2 to 3 hours.

[Altostrata]

Serotonin syndrome is a very serious condition. You may experience it in a milder form of increased activation.

 

All of these interactions are additive. The more drugs you take, the higher the risk of idiosyncratic reactions that aren't on this list.

 

So much for "augmentation." If your doctor isn't paying attention to drug-drug interactions, he or she is negligent.

[simon]

Yes , thanks again for the above. I have just sent you a pm.

As ive said I need to bring it up with my GP and psychaiatrist ASAP. I do know that when my GP recently increased mirt by 50% temporarily, he had the go-ahead from the psychiatrist.

But it does seem a hell of lot of medication.

 

Simon

[Altostrata]

This is an odd drug combination no matter what the doctor thinks your diagnosis might be.

 

The anxiety and depression you feel might be from a drug-drug interaction. Anxiety is a sign of too much serotonergic stimulation.

[simon]

Yes, well ill be seeing the psychiatrist in 2 weeks and all I can do in the meantime is wait for that. It was his predecessor who prescribed it in the first place. Being on lithium I have blood tests every few months, so its monitored from that point of view. How you get to analyse if theres too much serotonin I don't know.

 

In your opinion, then how serious are these 'major drug interactions' in the above chart? Do they mean that i should be monitored for signs of the syndrome or just be aware myself of possible side effects?

 

It makes me think that, when things settle down for me, the first taper should be the mirt, to get that down to what it was a few weeks ago.

 

thanks for your time.

 

Simon

[Altostrata]

They are MAJOR interactions and indicate whoever prescribed that drug cocktail for you did not know what he or she was doing. If your psychiatrist approved your GP's additions, it's likely both are clueless about drug interactions. This would not be unusual.

 

Please read up on serotonin syndrome. There are no tests for it, you get very serious symptoms.

 

Excessive serotonergic stimulation can have lesser uncomfortable effects, too. Having all those drugs in your body long-term is not good for your general health.

 

You are taking 2 antidepressants plus lithium. Was the mirtazapine added because the citalopram was keeping you awake? What is the benzo supposed to do? Many people here were put on ridiculous cocktails as doctors sought to treat side effects of one drug with another, and then the side effects of the second drug with a third, and so on.

 

Even if they agree to minimize your drug burden, your doctors very likely do not know how to reduce any of these drugs (except, possibly, lithium) to minimize the risk of withdrawal symptoms. That probably will be up to you.

 

You need to show your psychiatrist the drug interaction report. I believe drugs.com gives you a way to print it.

[simon]

Thanks for your reply. Its really scared me. I mentioned serotonin syndrome to my GP the other day and  although hes aware of it does not think it an issue with me. Ive been on this cocktail for 7 years now. I don't know what the hell to do about it all, as now its only by taking a benzo that I can function properly.

Ill show the drug interaction chart to the psycho  in 10 days time. It could be that the increase in mirt is giving me the agitation that makes me need the benzo. Sleep is a big problem as is appetite.

Quite honestly it makes me feel like giving up totally. Ive been on and off some sort of meds for 35 years and think that its going to be impossible for me at 57 to ever get anywhere with the tapering much heeded by this forum. I cant go back, at the time I had family and children responsibilities and had no real knowledge or the possible dangers of drugs and not the time to investigate it fully. You do tend to trust your GP. If they can give you something to reduce the horrific symptoms of  depression then you take them. how was I to know that it was the constant stopping and starting on these drugs that kept me in a state of almost constant withdrawal!?

That's how I see it now and feel pretty cheated by it all. So much wasted time and energy just trying to stay normal and put on a good show. Ive been battling against chronic odds really and haven't a clue what to do about the feelings it leaves me with.

 

Simon

[Altostrata]

You may be experiencing excessive serotonergic stimulation that does not reach the point of serotonin syndrome, and you need the benzo to calm it down.

 

In my opinion, you are overdrugged. Your GP is not a good source of information about this.

[simon]

Ive become really reluctant to post on this forum over the last few weeks, as, instead of reducing on meds I have in fact increased. I saw it all happening and wasn't able to extricate myself from it due to the extreme anxiety and pain that I was in.

Yet this being a site of getting off ADs I feel I will just get a lot of shock and horror responses to what I have done. It actually makes me more frightened and suicidal, yet I have come to respect this place and follow the stories of others with interest and compassion.

At my appointment with my consultant last week he put me on a dose of benzos as a means to getting back onto citalopram which I unsuccessfully tapered from a few months back. So now im on 4 psyche drugs in total and feel completely drugged up . Rather envious of those who only have one to taper off!

I don't know where to go from here. I know the ADs are damaging me cognitively and emotionally and life is becoming meaningless.

If  I don't take the benzos I know ill go through the roof and I cant let my family see me suffer in that way. Its too distressing.

When  I get comments back saying im overdrugged, well I know that, its not a choice, I don't enjoy it , im not a recreational drug user for gods sake.

But I don't know where to go from here and feel that life is less and less worth going on with in this artificial way. It all has less and less meaning and giving up frequently seems the only option.

Simon

[dignan]

I was taking no drugs for almost five months this year. Then June came. Now I take three. 

 

Back at the start of the year, I had a terrific back. Now I neuropathy in my back.  

 

The ebb and flow of life...

 

I'm sorry you've experienced a drug increase. It sucks. I know. I am frequently angry (lately, withdrawal-induced anger) regarding the rampant incompetence in every facet of "health care" I've ever encountered. I am also profoundly drugged, struggle for meaning, and feel very discouraged about having to taper three drugs. 

 

People have successfully tapered from six drugs -- almost all our drugs combined -- so we still have a good shot at this.

[Petunia]

Hi Simon,

I'm glad you decided to post and let us know what's going on.  No shock/horror response from me, I'm just really sorry that this is happening to you and wish there was an easy solution.

 

How are you feeling now that you are on Diazepam?

 

I'm a little confused though.  Your signature states that you are tapering it by 2mg per week after only just starting on it.  What is your current plan?

 

Are you still wanting to come off/reduce your medications?

 

Perhaps you would consider looking for a new doctor who would help you, if this is still what you want to do. 

 

You have major, potentially serious drug interactions between the 3 drugs you were originally taking, if it were me I would be looking at finding a new doctor and tapering one of the antidepressants first. As others have mentioned, your current doctors don't seem to know what they are doing.

 

This is your life, and it has meaning, but you have to take back that meaning by taking back control of your life.

 

Please stay in touch and let us know how you are doing.

 

Petu.

[simon]

Dignan and petu, thanks for your replies.

Im taking 12 mg of diazepam and increased the lithium from 500 to 700mg ( a therapeutic dose, so called) The diazepam keeps me calm but numb. The idea is to eventually increase the citalopram from 20 to 40 mg when things have settled down.

I don't know how to taper any of this stuff when I am taking instructions from the consultant. I haven't even stabilised yet from the abortive attempt to get off citalopram back in  the summer.Its a mess with no easy answers. It would take an age to get off this stuff. But I still want to. And, yes, I want to take back control of my life; but what I have done is left it to the 'experts' and got into the present impasse.

Simon

[simon]

I showed the psychiatrist about the drug interactions and he didn't seem worried. Also that serotonin syndrome is not a problem at present.

[simon]

I really feel like jumping off a f******* cliff at the moment. That's not just saying its not fair, look at my dreadful lot. But when I read accounts by someone like Rhi; similar age, similar pile of meds to get off and the sheer timescale, I don't know if I have it in me to do the same. Im just piling on the drugs again now and getting nowhere fast.

I cannot live a happy life with ADs because I know for sure that they have had bad cognitive and emotional effects on me and will continue to do so; even if I do a slow taper. Where do people get the courage and staying power to do it?

In my case ive always relied on physical exercise and lively outdoor sports in order to inject into me the things that the meds deprived me of. People find me over active for that reason. I need to whip up emotion that's not there otherwise, so it gets a bit frantic. But since I got menieres disease I cant do these thing anymore as I have the danger of drop attacks etc. So mindfulness stepped in at that moment and allowed me to slow down and be more thoughtfull and reflective. Now I cant do that because the upset over citalopram taper and the extra s*** im now taking have wiped out the sensitivity to engage in meditation.

So I seem to have zero  motivation to begin getting off these drugs and the last two weeks have been full of suicidal thoughts as the only way of getting out of the mess.

Sorry to be so negative but it must effect others in similar ways.

the thing with me is that im so scared of the anxiety and depression involved in not taking drugs that I don't have the courage.

[Rhiannon]

Simon, may I make a couple of suggestions?

 

First: If you haven't yet gotten Anatomy of an Epidemic by Robert Whitaker, get it. You might not be in shape to read it now, but keep it around and read bits of it from time to time. It gives a lot of important background about the history and culture of psychiatry. Except in very rare cases, people who want to get off the spiral of continual hyperdrugging and cocktails, have to educate and assert themselves. The psychiatric system does not allow or encourage it. That book will help you understand how psychiatrists and doctors are trained and how they think, as well as help you see that you are not defective in any way.

 

Second: It doesn't have to be all or nothing. I have experienced SO MUCH improvement in so many ways, just by getting down to lower doses and by getting the whole dosage thing under my own control. I can't tell you how much difference it has made. (It has been so wonderful to be able to feel and weep and grieve my mother's passing. It is so wonderful to be able to connect with people, to really feel the deep wellbeing of the social animal that I am, something the ADs in particular took from me. It's so great to be getting some of my mental sharpness back. It's so great, after not being able to be much of a mother to my daughters at all, to at least be able to be a sane and strong mom for them now even though they are grown.)

 

Rather than giving in to hopelessness--nothing can be done, it's all out of my hands, that kind of feeling--you might think in terms rather of just having things be a bit better. I tell my health care providers that my goal is to be on the lowest possible dose of the fewest possible meds that I can be stable and functional and happy on. 

 

Realistically, at your age and with your history, you may find it best to shoot for "lowest possible dose of fewest possible meds." Your doctors should be supportive of the overall intention, even if they are ignorant about how carefully and slowly you must move to make it happen. At your (our) age, drug side effects become a greater and greater cause of morbidity and mortality and any competent GP knows that. They aren't likely to argue about the end goal, just about how to get there, and all I can say about that is, very very few doctors have the least clue about that part. 

 

As far as "Where do people get the courage and staying power to do it": I always have trouble with that question, because I think it's way harder to live on the drugs than it has been to taper very slowly off them. If the alternative is to stay on high doses or else taper slowly? Even if I keep tapering for the rest of my life, I feel SO much better now on these small doses than I ever felt on the doses and drugs my doctor gave me, I would be okay with it. I like feeling good. I am delighted to be getting back my zest and joy in life.

 

But perhaps it helps if you understand that my taper, while not completely painless, is not too bad. I feel way better now, tapering, than I ever did when I was taking the meds. I'm more stable and happier and more functional than I ever was on those high doses. It's not like a miserable taper where you quit too fast and then you are in hell and then you restart and then you're not so great and after a while you take less or skip days and then back in hell and then you go back onto the meds and feel more tolerable but never really well...I did that for 20 years, I remember it well. It's not like that now. Yes, it's slow, it's incredibly turtle slow and carefully controlled, but that slowness is what makes it so tolerable. So that makes it very easy to continue on this course. 

 

I mean if I had the choice to just be okay and not taper at all, I would do that. But you and I don't get that choice. We've been on the drugs. Our brains have been remodeled. We can't just stop taking them, we've tried, there's no future to that path. The choice is "stay on them" or "taper very slowly." Given that choice, well, it takes no superhuman courage for me to choose "slow taper."

 

So anyway--hopefully, there are some things to think about there that may help you.

 

And please don't worry about disapproval or shock or whatever, for deciding to go back on meds. I think everyone here (at least the mods) understands that these are very difficult choices and this is very real suffering and we all do the best we can with what we have and with what we know and with what we are faced with. 

 

My heart goes out to you. May you find a path that brings you peace.

[simon]

Dear Rhi

Thanks so much for replying to my post. Its given me a glimmer of hope and I know your method is the wise one even though it takes so long. I had begun to think that I was beyond the pail of this forum as the drugs seem to be going up and up.

It started a week ago when I finally got an appointment with the local consultant.

At that point I was taking citalopram 20, lithium up from 500 to 700 in the last 2 weeks, mirt from 30 to 45 in the last month and diazepam 6mg (over the last few weeks) having switched from1.5 lorezepam.

So his advice was to double up the diazepam and then later get the citalopram up to 40 because when you come off something suddenly or it fails to work ,then it can help to take a large dose for a while and later come down. All this was because I hadn't managed to stabilise  over the 3 months after trying to get off the citalopram.

So after seeing him I increased the diazepam but all that's done is made me calmer and given me better sleep. ( a few weeks ago on that dose I actually felt well for about 10 days,until I reduced it to 6mg. But it obviously doesn't work in an exact way like that, at lease not this time.

The thing is how to start taking this into my own hands and beginning a taper. I don't know where to start. As you can see, most of the drugs have been increased recently ,so I assume that I don't do a slow taper from where I am now, but go back to the level I was a few weeks ago? Its a nightmare to work out.

Im being very negative about the task and don't want you to thing im not grateful, but the last 2 weeks have been full of suicidal thoughts because I see that as the only way out. Once you start thinking in this way, positivity and optimism go out the window. I know for you its an obvious choice between tapering and staying on the stuff for life, but for me I find myself pulled by the choice of giving up on life completely.

I want it to work but find it all so complicated as to where to begin. Perhaps I just have to experiment. But in my present state I tend to just take anything that's going to stop the anxiety and fear.

If you have the time could you suggest a way to start?

I do have the book you mentioned and find it very hard going because I have enormous regrets in not finding such things years ago, and its a constant reminder!

Also, I notice you do a multi-taper and wondered if that's the best approach for me.

I cant thank you enough for taking an interest and have always found your posts so wise and articulate (so it must be having a positive effect on your cognitive powers)

Again many thanks for taking the time  Rhi,

Simon

[simon]

What if I started from a baseline of Citalopram 20

                                                        Mirtazapine40

                                                        Lithium     600

                                                        Diazepam 8mg  Stabilise at that for a while, that is, until im back to ground zero from my adventure with rapid tapering of Citalopram. Then consider if I can begin a very slow multi- taper or tapering of a single drug.

Does that sound wise, given that ive only recently upped the dosage of these drugs?

Any suggestions anyone?

[Altostrata]

What if I started from a baseline of Citalopram 20

                                                        Mirtazapine40

                                                        Lithium     600

                                                        Diazepam 8mg  Stabilise at that for a while, that is, until im back to ground zero from my adventure with rapid tapering of Citalopram. Then consider if I can begin a very slow multi- taper or tapering of a single drug.

Does that sound wise, given that ive only recently upped the dosage of these drugs?

Any suggestions anyone?

 

Yes, increasing the diazepam would give you better sleep, it's a sedative.

 

I don't understand your baseline -- aren't you taking Mirt 45mg, Citalopram20mg Lithium 700mg Diazepam12mg now?

 

Are you saying "What if I decreased the mirtazapine, lithium, and diazepam to these levels, stabilize, and taper from there?"

 

Are you suggesting you would lower those 3 drugs simultaneously?

 

If you're asking what would happen if you do that, I don't believe anyone could tell you. I think you would feel the difference in the diazepam, for sure.

[simon]

Yes the reason I thought to reduce these slightly was because ive only just increased them and have not been present in my system for any length of time. Of course I could keep at the new high levels and stabilse and taper from there. That's really my question, whether because of the short timescale at a higher dose I can afford to ignore that increase and baseline at a lower level.

Also I wouldn't be increasing the diazepam, as ive been prescribed 12mg of that, but think I can make do with 8mg.

But your resume of what I am asking is quite accurate.

Many thanks

[Altostrata]

I guess if I were you, I'd back down the dosages.

 

It's very irregular that a psychiatrist would raise dosage of 3 drugs at once. Proper procedure would be to raise one at a time and see if it helps.

 

Your doctor is throwing prescriptions at you hoping you'll stop asking for help.

[simon]

Rhi, could I ask you why you went for a multi- taper? I notice that you reduced each chemical at a different rate. Does this cause any confusion about where withdrawal might be coming from? And why is this method not advocated on this forum. Do  you know others who have done this? I am tempted by it but also realise that this may just be cos I want to get of the stuff more quickly.

Simon

[simon]

Im getting  more and more disillusioned with the course that ive got myself into. A couple of weeks ago I had an appointment with the consultant and he wanted me to be able to get back on the citalopram that caused all the problems 3 months ago when I tapered in 4-5 weeks and crashed a few weeks later. Since then I reinstated the dose of 20 mg and up til now I am still in a depressed state and think that that drug has not been doing any good to me at all. In the meantime ive been taking diazepam to cope with the depression and he doubled the dose of that to 12mg per day. The idea is that next visit I will double the dose of citalopram to 40mg as this sometimes helps to get the drug active again.

Right now as you can imagine im feeling more drugged up than ever.

What would happen if I simply gave up on the citalopram that isn't working? Would I just get withdrawal  from that even though it doesn't work?

Its a complete mess and although I want to trust the consultant, I just feel that im being drugged up  with more and more chemicals.

Im beginning to despair and leading a life of just existence  I don't know how to get out of this impasse Its no life and I haven't a clue how to get out of it. I want to taper all the drugs I take and yet as you can see im actually going in the reverse direction.

Simon

[simon]

What happens if a drug you are taking poops out? If you simply stop taking it do you go into extended withdrawal? My psych wants me to replace it with venlafaxine.

Simon

[mammaP]

Simon your psychiatrist hasn't a clue, and it makes me so angry that he is treating you this

way when he is supposed to be helping. Sadly it isn't uncommon and they carry on throwing drug after drug,

making things so much worse. Did you go back to the lower doses?  I would hold everything right where you

are at and just wait a wee while to stabilise a bit, then start a taper off the citalopram.  I would NOT switch to

vanlafaxine, it is MUCH harder to taper and has many side effects. I ended up doing my taper myself, in fact 

most of us here are doing our tapers on our own because doctors just do not understand the drugs they are

prescribing. They don't get the information, drug companies aren't going to teach them the bad sides of their

drugs.  As long as you go to them and tell them how bad you are feeling they will throw more drugs at you,

change doses because it is all they know. 

 

You CAN DO THIS, it will take time but you don't have to wait till you are off all the drugs to feel better. It will 

happen gradually as the doses get lower.  Your brain can and will heal, you just need to believe it. 

[simon]

Thankyou very much mammaP for replying. Im very scared and suicidal at the moment as im also on 12mg of diazepam and that seems to be having little effect now. So the anxiety has increased and i don't know what to do or how to get on without it. Ive been back on 20 mg of citalopram for 3 months now and that too has not stabilised me at all. It seems these drugs just eventually lose their effect. So I need something just to get through the day. In addition im also on the lithium and mirt.

I feel a wreck and need some help and don't know where to get it. I don't want to go onto venlafaxine but what is the alternative now? I certainly want to get off or onto low doses of all these drugs and cant believe the sheer amount of stuff ive got on over the years by going for help

 

Simon

[Altostrata]

1) Depression is a common side effect of diazepam and other benzos.

 

2) You may be suffering interdose withdrawal or rebound from the benzo. This could be surges of anxiety.

 

3) Serotonin syndrome, a potential result of your drug combination, is the extreme form of the reaction. Lesser effects could be overstimulation, etc.

 

4) Inability to think clearly can be a symptom of CNS depression, another potential result of of your drug combination.

 

Check drugs.com for side effects of all your drugs.

 

Please keep notes on paper about your symptom pattern relative to when you take your drugs. This can help determine which of your symptoms are side effects.

 

Can you see another doctor, one who will reasonably discuss minimizing your drugs?

[simon]

Could I just ask a general question related to my medications in the past. ive been looking though  my medical notes or the last 20 years and noting how drugs were changed from time to time.

6 years ago a psych changed my venlafaxine which I had taken for 7 years at 75mg and then for a few months at 150mg (it had pooped out), to a combo of mirtazapine, citalopram, and lithium. I notice that it took many months before I got any alleviation of my symptoms (and that did include greatly reducing the lithium myself from 1000 to 400)

Now when I came off the Venlafaxine it looks like there was no tapering involved, or hardly. Would the rationale for that have been that the mirt and cit are basically the same drugs so it wouldn't have mattered? Or simply that she wouldn't have accepted there being such a thing as WD?

So the fact that I didn't taper may well have meant that I spent the next 5-6months apparently not responding to medication, when in fact it could have been the pain of c/t of the Venlafaxine.

This would mean that I could probably have just converted to say cit, instead of seemingly needing this cocktail of drugs that ive spent the last 6 years on.

When psychs change meds do they do any sort of taper normally? Or are all SSRIs considered the same old stuff and theres no need to do so?

Id be interested to know your experiences. Id like to know as im seeing my GP shortly and wanted to discuss this with him.

 

Simon

[simon]

Does anyone have any idea about the above request? I know its a bit complicated and pedantic but I find these things important to know about as it helps with future dealings with these 'professionals'.

 

Simon

[mammaP]

Psychs seem to have no idea what they are doing when prescribing meds! I think it is very likely that you

were suffering from withdrawal, plus reactions from the other drugs being introduced at the same time. I 

had similar experiences with psychiatrists stopping and starting drugs, never with any tapering. Effexor

is an SNRI and the others are SSRI so they are different, but many people switch from SNRI to prozac

for tapering but it should be a cross taper, reducing one while increasing the other gradually.

[Rhiannon]

Simon your experience is sadly not uncommon. Have you read Anatomy of an Epidemic yet? I think with the questions that you are answering, that would be a good read for you and also important because you're dealing with a psychiatrist.

 

Many (most) of the people who end up on this forum have been switched around on meds and I think after the first med or two most of those switches are because of withdrawal and instability induced by the drugs and the CTs and the fast tapers and fast switches.

[simon]

Thankyou mammaP and Rhi, it does explain a lot if this is the case. And it really annoys me that im now on this cocktail that needs slow tapering instead of perhaps one drug that I could then get off more readily. If only I had been equipped then with the knowledge I have now things could have been a lot different. You really are in the hands of these experts who have no personal experience of the drugs themselves.

Anyway I have now decided to go it alone and gradually taper instead of taking the advice to go on higher doses of the same plus the reintroduction of Venlafaxine.

Am I right in assuming that diazepam has a very long half life, meaning that any reduction I take today will not register for about 2 weeks? One positive thing seems to be that I managed the cross taper from lorezepam several weeks ago to diazepam which means that reductions are easier to make.

I do have the book mentioned and have seen several utube videos of Whittaker . Also on the mad in America site are very interesting testimonies from Laura Delano which are quite inspiring, having been in the mental health system for 14 years and now fully recovered from false diagnoses in her early teens of bi-polar. She one day saw the 'Anatomy'  book and realised to her shock that she had taken just about every drug on the front cover of the book. id recommend watching her as a boost to what can be done. Shes now an activist in the mental health system, being 4 years off all those drugs.

[simon]

When you make reductions as part of a taper, is it not more reasonable (if youre on a multi-drug cocktail like me), to reduce on one, one month and then one of the others the next time and so on?

I just thought that, as each drug is interacting with the other, it could be a more balanced way to go about it. Otherwise youre left with an uneven proportion of the rest of the drugs in your system. Would it not be kinder to your CNS to evenly distribute the taper?

 

Simon