Carbonek3 Intro

[carbonek3]

Hello all!

I've joined this forum after some serious soul-searching this week. While I have tried to read and absorb the rules, I am not yet hip to the culture here. Please forgive me if I make any newbie mistakes and let me know if I use terminology that makes you uncomfortable.

 

I have taken anti-depressents for the past seven years, following an episode that was diagnosed as MDD, but may have  been PTSD. I imagined the drugs would be a short term solution, not anticipating the difficulty of quitting a psychiatric medication while a full-time student holding multiple jobs.

 

After a prolonged struggle with substance abuse and illness, my dad passed away this November. I resumed counseling and sought a professional psychiatrist to seek extra support during the grieving process . Previously, I had been seeing a GP who spent about 5 minutes on me per appointment. I thought, naively, that a psych RN would be better able to help me with increased dosing, if needed, and would support me in my ultimate goal of beginning to taper off one of my meds this year.

The doctor began an initial taper of buproprion SR by 50 mg. I  reduced to 100 mg of buproprion and after a week and a half, feel slightly calmer, if otherwise foggy and fatigued. I had a mild episode of panic in the first few days.

At my last appointment, the doctor said she would like me to hold to the 100 mg of wellbutrin, start taking 1/2 to 1 mg of klonopin nightly,  reduce the celexa to 15 mg then 10 over a 2 week span, and then begin taking 25 mg of lamictal, to be increased to 75 mg as I tapered off celexa.

 

Given my recent and previous experience with celexa and buproprion withdrawal (celexa withdrawal included brain zaps with sides of dizziness that has made it difficult to stand) , I told her that I could not imagine reducing anything else so soon, let alone adding a new medication at the same time. She was very dismissive. I started my own research, and found this board.

While this recent diagnostic experience has cost me upwards of 600 dollars , it has awakened me to the fact that I need to be a better self-advocate --and has increased my resolve to reduce my medication and eventually live med-free. I do not want to start anti-convulsants.

 

Now I'm just at a loss as to how to manage my meds when I have a small income, need to pay for meds entirely out of pocket, and just blew a chunk of savings on this last psychiatrist. If anyone has any experience with

• telling a psychiatrist goodbye (I haven't yet cancelled my next appointment)
• finding a doctor knowledgeable in or at least consenting to slow tapering

I would greatly appreciate it!

Nice to "meet" you, and thank you for listening.

[Addax]

Hi Carbonk3. Welcome to SA.

 

A moderator will be a long shortly to advise and guide you, as they have a good deal more experience. Self advocacy is key in during tapering and withdrawal. Unfortunately doctors don't know that much about tapering and withdrawal of SSRIs and drugs like buproprion, and/or have had only very little exposure to it. You're the expert on you and how you feel. That being said, it sounds like your doc is a little more clued in than many of the doctors people here have experienced, myself included.

 

The rule of thumb here, as you may have discovered, is to taper no more than 10% of your current dose every 5 or 6 weeks or so. Of course that varies by person. Some need to go slower and hold at a dose longer depending on the severity of withdrawal symptoms.

 

You've stumbled upon a great website full of great information. I hope you'll explore it.

 

Again, welcome!

[Fresh]

Hi  Carbonek3 ,    welcome to SA.

 

In the Relationships section , there's a thread for NY members.   Someone there may have a doctor they can recommend.

You may be eligible for Patient Assistance programs available to supply meds.

 

If I were you , I wouldn't cancel my appt. with the psych. until you have a new doctor in place , just in case you want to go when the time comes.    When I left my psych. of 4 years , after I realized that his approach was incongruent with my own views (i.e.  I was taking a.d.'s , then he added a mood stabilizer for 18 months, which didn't help , then he started prescribing antpsychotics!!!)   I cancelled the next appt. and that was it.   You don't need to justify or explain yourself unless you want to.   

 

Good to have you here.

 

Best wishes ,  Fresh

[mammaP]

Hi Carbonek , welcome to SA.  How to say goodbye to your psych.....just cancel and don't make another appointment. 

That was a big cut of the wellbutrin at 30% and I would hold for a couple of months to stabilise from it before continuing to taper. 

It is good to see that you are feeling calmer though.

 

We recommend tapering one drug at a time and tapering 10% of the current dose every 4-6 weeks. 

Here are some links to tapering. 

 

Tapering wellbutrin http://survivingantidepressants.org/index.php?/topic/877-tips-for-tapering-off-wellbutrin-sr-xr-xl-buproprion/

 

Tapering celexa http://survivingantidepressants.org/index.php?/topic/2023-tips-for-tapering-off-celexa-citalopram/page__pid__19887#entry19887

 

Any side effects should lessen as the dose gets lower.   

Also a good read is the 3 KIS, keep it simple, keep it stable, keep it slow.   http://survivingantidepressants.org/index.php?/topic/6632-the-rule-of-3kis-keep-it-simple-keep-it-slow-keep-it-stable/

 

Any doctor can write the prescription for your meds, I hope you can find one that doesn't charge a fortune for doing it! 

[Altostrata]

Welcome, carbonek.

 

Are you seeing a psychiatrist or psych RN?

 

Have you been taking Klonopin? How much and how often? Why are you taking Welllbutrin with Celexa? Why does this practitioner want you to take Lamictal?

 

What are your current symptoms?

 

See our list Recommended doctors, therapists, or clinics Unfortunately, few doctors understand tapering or withdrawal syndrome.

[Rhiannon]

I also would like to know what the idea is with starting you on Lamictal, and also why adding Klonopin. 

 

These multi-drug cocktails can be pretty problematic, and Klonopin is a benzodiazepine, which are also pretty problematic in general, as a category, and very addictive and hard to get off of. If you do choose to take it I would start with a lower dose, maybe 0.25 mg, instead of 0.5 to 1 mg.

 

No point in ever taking more of a drug than necessary; lowest possible dose of the fewest possible meds seems like a sensible approach to me. If you're not in horrible crisis (and it doesn't sound like you are)--well, wow, if it were me, I would certainly question the necessity of starting on two more new psych drugs, both of which have been known to cause people a lot of trouble when they try to come off them.

 

If you haven't yet, I would recommend that you read the book Anatomy of an Epidemic by Robert Whitaker before adding any new meds to your regimen. Well, I'd recommend it regardless, I think it's pretty much required reading for anyone considering or taking psych meds.

 

Also, of course, ditto the slower taper, what you've described above is crazy fast.

[carbonek3]

@ Addax, Fresh, and MammaP --> Thank you for the welcome and advice.

 

@ Altostrata

 

Are you seeing a psychiatrist or psych RN?

Sorry that I wasn't clear. For the past couple years, I had been seeing a gp who spent very little time with me. I decided to try seeing a psych RN for better guidance, since I was hoping to taper off Wellbutrin. I have only had a few appointments with her and just finished a very prolonged initial consultation.
 

Why are you taking Welllbutrin with Celexa? Why does this practitioner want you to take Lamictal?

 

I began taking citalopram 7 years ago, after an episode of depression. I started the wellbutrin 4 years ago, to counter some of the somnolence and sexual side effects caused by the citalopram. During this period,I was finishing college and graduate school, and was in therapy to deal with a history of abuse. It didn't feel like a good time to come off my meds. Now that I am settled, in a long term relationship, working full time, and feeling very stable, I would like to try a reduction. The medication makes me feel more tired and less creative than I remember being, and I am not sure it is necessary at this point in my life. I'm also worried about long-term effects.

 

Have you been taking Klonopin? How much and how often? Why does this practitioner want you to take Lamictal?

I have never taken Klonopin or Lamictal. This was just prescribed to me last Wednesday, and I haven't filled the scrip. Getting the prescription for Klonopin and Lamictal was what actually led me to find this board.

I have seen four therapists, two gps, and one psychiatrist in the last seven years. (Due to moving from college to grad school to NYC.) This psychiatrist is the only one to have diagnosed me with Bipolar NOS, which is why she would like to start the Lamictal. I seriously question the Bipolar diagnosis. She dislikes SSRIs, and wanted to taper me off of them and add anti-convulsants to ease the process. She would like me to be on the Lamictal long term, with a possible side of wellbutrin and klonopin.

The psychiatrist agrees with me that I have never been manic, and that I am currently not depressed. She believes my current anxiety (which I experience as very manageable and low level) is a symptom of Bipolar NOS and that switching to Lamictal may help. I do not want to try any new drugs and think she is overprescribing. When I raised concerns, she was very dismissive. She told me that "90% of her patients are on lamictal and tolerate it well," which to me felt like a red flag. (90%?!)

I have a separate therapist who has been  supportive of my desire to reduce my medications. I would like to leave this psychiatrist and find a different way to manage my meds, even if it is just going back to the gp and tapering myself, while continuing therapy.

 

What are your current symptoms?

 

Currently, I feel pretty stable on 20mg citalopram and 100 mg buproprion SR. After reducing the buproprion by 50 mg slightly over a week ago, I actually felt calmer, but am also feeling a little foggy. The fog seems to be slowly lifting, however.

 

(Also, I am a perfectionist and have edited this a million times. I'm not sure if that shows up to a mod, but if it does and is annoying, I will henceforth suffer all typos to remain. )

Edited February 22, 2015 by carbonek3

[carbonek3]

@ Rhi

Thank you for the support and feedback on the prescriptions. When questioning a professional's advice, it is easy for doubt to creep in. I am fortunate that my mom, a friend with a pharmacy background, and my girlfriend of five years were all suprised by the prescription and are supportive of my refusing the scrip and looking for a different doctor.

I haven't read Anatomy of an Epidemic, but will get a copy!

[mammaP]

WOW that doctor is, errrmmmm, better not say    !   If the wellbutrin was to counter the sexual side effects of celexa then it might be best to taper celexa first so you won't be left with the same side effects once wellbutrin is finished. It will take time to taper slowly and carefully but it is much better in the long run because you will be able to keep working and hopefully have very little discomfort. Taper too fast and risk withdrawal which would lead to more meds and doctors will tell you that you need the drug for life because your illness relapses when you try to get off the meds. We've all been there and most of us have been diagnosed with bi-polar!  

 

Read the topics carefully so that you know everything before you start and can prepare well.  Wait to see how you react to the cut in wellbutrin, it can take a few weeks for withdrawal to be felt but hopefully you will be just fine. 

[carbonek3]

@ mammaP

Thanks for your advice!

At the time wellbutrin was prescribed, I was experiencing some depression related to grad school anxiety (the schedule is not exactly conducive to mental health) and the experience of moving across country alone. At 20 mg I have some manageable side effects. 40 mg made me feel drugged so I requested something different and was prescribed wellbutrin. I was more productive and social, but also more prone to anxiety, which is probably why the RN was considering bipolar NOS. On celexa, I was very stable for many years.

Tapering off celexa first would definitely be worth consideration, but my desire to start with wellbutrin is only because I suspect it may be easier for me personally. I also would like to get off something that I know lowers my seizure threshold before tapering celexa.

In the past I did a 40 30 to 20 taper of celexa (which I now know may be too extreme) and wound up with a short but intense withdrawal syndrome. I had brain zaps, dizziness, aches, confusion, and generally felt more depressed than I had before starting antidepressants. The main thing that pulled me through was my conviction that this was withdrawal and not my underlying state.

[Altostrata]

Carb, if I were you, I'd be very, very dubious about that bipolar diagnosis.

 

A psych RN usually works, nominally, for a psychiatrist, but receives even less training in non-drug therapies. I would avoid adding any other psychiatric drugs to your mix.

 

Rather, you might take inventory of your current psychological state. Do you still have a mental disorder requiring psychiatric drugs? It sounds like you were quite young when prescribed Celexa, and possibly never had MDD or PTSD at all. If you feel it's necessary, pursue non-drug therapies.

 

Other than getting refills of Wellbutrin and Celexa -- which any doctor can prescribe, even your GP -- I would not take advice from that psych RN any more.

 

I agree with mammaP, I would hold on the Wellbutrin and taper the Celexa. As you lower the Wellbutrin dosage, it's likely the adverse effects of the Celexa will become apparent again.

 

It's really unfortunate that, despite the adverse effects of Celexa, you have been taking it for so long.

 

For background, please read

Tips for tapering off Wellbutrin, IR, SR, XR, XL (bupropr...

 

Tips for tapering off Celexa (citalopram)

[carbonek3]

@ Altostrata

I think it is unfortunate that I have been on psych drugs for so long. I was very depressed at 19, but this was subsequent to moving to college, coming out of the closet, ending a long-term abusive relationship, and helping my mom secretly leave my dad due to escalating abuse -- all within the span of a few months. If I had tapered off the ADs some 6 months later or pursued an alternative treatment then, I may be in a different position today. I have had the experience of spending most of my (young) adult life on ADs, the years when many people are finding themselves and discovering their baselines. Like too many people, I trusted doctors and was not presented with alternatives.

I understand what you are saying about the Celexa and will read through both boards and think about this carefully. One of my main reasons for wanting to get off the Wellbutrin is that I think it makes me more restless and irritable, and my only symptom now is mild anxiety. I personally don't believe I currently meet the qualifications for anything in the DSM-V, nor have I been told that I do except by the RN.

Prior to  being medicated, the only diagnosis I had ever received was GAD. I think this was fair -- and that I have tendencies towards OCD. I guess I am afraid that stopping the Celexa first might be more likely to trigger anxiety, since taking it in the first place did make me feel calmer and the wellbutrin seems to be activating.

 

[Altostrata]

It's very possible you never had any significant psychiatric disorder. We have many, many people here who've gotten caught up in a drug merry-go-round the same way.

 

What you might do is reduce the Celexa some, then reduce the Wellbutrin, then go back to tapering Celexa. With your long history, if I were you, I'd taper Celexa very slowly.

[JanCarol]

Hey cabonek, 

 

Oh they love their diagnoses.

 

From my perspective, yes, you had an original crisis, which was answered by a pill.  When that pill started to interfere with your normal functioning, instead of removing the offender, they added another pill.

 

You got here just in time - if you trusted this system any longer, you would be a victim of polypharmacy.

 

I'm out of time right now, but consider that you are possibly not ill at all, only had the initial crisis.  One great place for exploring that is www.bipolarorwakingup.com.  Sean Blackwell has a great take on these crises - and sometimes there is real trauma and abuse involved (hence the PTSD) - but instead of looking at DSM codes and categories, it's more helpful to you, and to us, and to those around you - to talk about what you feel and think.

 

Example:  "I'm having a panic attack."   or "I am feeling fear about going to the mall."  which is more real?

 

Go to Sean Blackwell's site and see what you think about it:  Are you Bipolar?  Or are you Waking Up?

[carbonek3]

@Jan
Thank you for the advice and encouragement. I have heard of and am interested in the idea of spiritual emergence. I feel that vivid dreams, strong emotions, intuition, or even unusual perceptions such as hearing voices or seeing visions have long been a part of the human experiences, and should not necessarily be medicalized.

The psychiatrist I spoke of actually asked me about my dreams during her evaluation, and concluded that my history of vivid and lucid dreaming suggested bipolar illness. I would counter that my dreams have been a great source of inspiration and insight. I guess Carl Jung wouldn't have fared too well in her office.



 

[carbonek3]

Brief Update:

I stopped going to the aforementioned psychiatrist and am instead seeing a gp. She seems okay with my wanting to reduce my medications and also okay with my managing my own dosages -- though she is not particularly knowledgeable about psychiatric medications or the withdrawal process.
 

Because it took almost a month to get a first appointment with the gp, I stayed on 100 mg for most of this time. 50 mg is a big drop, but didn't appear to have any major effects. During the first week I felt the stirrings of panic while....drinking hot chocolate at a very crowded bakery. Maybe it was a sugar rush, but I think it was a twinge of agorophobia. NYC can do that to you. After a few weeks I felt entirely balanced, and if anything, more calm and less agitated.

Last Sunday I dropped to 75 mg. Possible effects at this juncture included two days of general loopiness, but that quickly subsided.

After another week, I plan on quartering my 75 mg pill and reducing by 18.75 mg every couple weeks or so.

I know that some people have reported difficulty with wellbutrin -- and I know I'm not out of the woods yet -- but I'm heartend that the process has been easy so far.

 

[Dane22]

Welcome CarboneK3. Lots to absorb here. You seem to have a good grasp on your current situation. So glad you found this site to help you reach your goals. As a newbie, you have my support! But I am in no position to offer advice or problem solving. Hopefully someday

 

I look forward to keeping tabs on your progress!

Dane

[freespirit]

Thanks for stopping by my thread Caronek3..thought I'd stop by yours. I'm glad you've been able to find a doc to work with...and quite honestly, happy to hear you trusted your gut and decided against the psychiatrist. It's a tough road, knowing when and whom to let go of, and who is worthy of trust.

 

I'm also new on here..and only been free of meds for 7 months..so too early to have much to offer in the way of advice. Wishing you a smooth taper.

[Altostrata]

Carbone, how are you feeling now? I'm a little concerned about your going off Wellbutrin so fast.