wantmyhubbyback: zyprexa withdrawal symptom mgmt?

[wantmyhubbyback]

my husband was diagnosed about 18 months ago with MDD and GAD, and has been taking zyprexa (evil, evil drug), ativan, paxil, mirtazapine and gabapentin at various dosages.  as i learned more about these (he is too scared to do the research himself and refuses to look up anything on the web), it seemed that we should start with getting him off the zyprexa (originally 15 mg and then down to 2.5mg over the 18 month period.) but the movement from 2.5mg to 0, which has been in the last 2 weeks or so, has been extremely difficult and his doc is resistant to the idea of microtapering because "it doesn't work." the doc is an idiot and we must find a better provider asap who will write a microtapering Rx.
 
he continues to take the ativan (.5mg at night, sometimes during the day when he feels like he's "jumping out of my skin.")

he's taking 30mg of mirtazapine. the stupid doc wants to increase this to 45mg, because more is better.  last nov., the same stupid doc thought that it would be good to increase the paxil from 20mg to 30mg. that little experiment resulted in suicidal ideation, return to the ER and 5 days in the locked-down unit.

he's taking about 1200 mg/day of gabapentin, which stupid doc says is "benign" but it strikes me that NONE of these poisons are benign enough to stay on them for one more nanosecond than is necessary.

i'm also interested in your point of view on TMS. we have a facility nearby, it's covered by our insurance, and they claim they can deliver good results for folks with depression/anxiety issues.  we're getting ready to try this (i hope) before changing up any of the other meds so we'll know if in fact any improvement comes actually from the TMS vs. other change.

i should point out that i have been married to this man for 15 years, and have known him for nearly 20.  he was exceptionally normal for 18.5 of these years.  all of this pile of crazy started following a kidney transplant in the summer of 2012. he had had an earlier kidney transplant in 1986, which lasted 25 years, so we were optimistic abt this one.  in all of those 25 years, he had no psych issues.

initially he was fine following the recent transplant, but about 6 months later, everything went to hell in a handbasket, and nobody can tell us why.  all i can tell you is that my normally calm, collected, unflappable hubby has become agitated, anxious beyond belief, scared, irritable, timid, hysterical and a whole bunch of other not-normal behavior SINCE HE STARTED TAKING THE MEDS.  idiot doctor says the symptoms now are the underlying disease. but since hubby didn't have this disease before, doesn't it seem that the meds are in fact what's making him crazy?

does anyone have any suggestions on how to manage the zyprexa WD symptoms?  (especially the anxiety, fear/dread, "pit in stomach" feeling, racing thoughts?)

Edited August 11, 2016 by scallywag
tags added

[bluebalu86]

Hi Want

 

I don't have enough knowledge to help you but someone will be along soon with good advice. Just wanted to say welcome to the forum and I think it's great that you are so caring and supportive of your husband and understand what he's going through. A lot of us here struggle because our loved ones cannot understand what is happening to us. I wish you the best of luck 

[wantmyhubbyback]

I'm really worried about how this information is being misinterpreted.

 

It seems people are peeking in from the Internet on smartphones, failing to read the whole topic or even the entire first post, and thinking they can add Lamictal or something to their tapers to compensate for withdrawal symptoms.

 

DON'T DO THIS!!!!!! Don't count on being able to take a pill to fix whatever is wrong with you.

 

Anything you add may conflict with something you're already taking.

alto, would the same situation be true if you're ALREADY taking a drug(say, neurontin) to quell the anxiety that you get when tapering zyprexa? eg, going from 1200 neurontin to 1500?

[bubble]

Hello Want and welcome to SA,

 

first of all, I'd like to express the same feelings as Bluebalu about your caring support. I'm glad you have found this forum with all the information required for safe coming off of these drugs. I agree with all your conclusions and insights into how they work and agree that they explain the way your husband is feeling.

 

You are right. None of these drugs is benign and more isn't better. So I would support you in not increasing any.

 

If I understand it right, your husband discontinued Zyprexa 2 weeks ago and since then his symptoms increased? That's typical withdrawal and 2.5 mg isn't a small dose to jump off. If I were your husband, I would reinstate a tiny amount of Zyprexa. Reinstating saved me from horrible symptoms when I stopped taking "small' amount of 2.5 mg of my drug. You don't need a doctor who supports microtapering. There are no small enough doses of drugs available so we make them ourselves.

 

I'm typing from my phone so can't copy the links for you but you will find all the info you need in the Tapering section.

 

Once again welcome.

Bubble

[Meimeiquest]

My heart goes out to both of you. I went off Zyprexa about 2.5 years ago, jumping off about 0.6mg, and even that was way too steep a drop. But I did survive, nobody ever even wonders if I need it now. One option is reinstating a portion of the 2.5 mg, stabilizing, and then decreasing as described on this site, but one of the moderators will give you suggestions on that.

 

What changed with the kidney transplant? Did they have to change his immunosuppressant cocktail? Is this kidney working okay? Did something traumatic happen?

 

This is to me the most concise overview of stabilizing and tapering. http://survivingantidepressants.org/index.php?/topic/6632-the-rule-of-3kis-keep-it-simple-keep-it-slow-keep-it-stable/

 

It is also possible that he is over-activated from the AD's or having side effects from them. You need to closely look at how the symptoms have appeared compared to drug changes. He may need to keep a bit of Zyprexa on board to cover those issues while going off the more activating drugs.

 

I think several environmental changes are leading to the very common occurrence of disrupted gut bacteria which can cause the symptoms that you see, although it could be caused by many things. Also, irregular benzo dosing can cause something called inter dose withdrawal that is pretty brutal. If he needs to use it, he needs to use it in three evenly divided doses a day.

 

Those are my quick thoughts, and again, wait for one of the mods to clarify things. He is blessed to have you!

[Meimeiquest]

You would need to check with kidney doctor before doing this, but Epsom salts baths really help me when my brain starts toward chaos. Years ago, before coming to this site, my husband would load up the family when I was coming unhinged and take us for drives in the country. Sometimes a change of scenery helps break the cycle. Just writing about this is bringing up memories of horrible times. But I never feel like that anymore...you will get through it.

[wantmyhubbyback]

thank you all so much for your kind and helpful comments!

 

meimei ... What changed with the kidney transplant? Did they have to change his immunosuppressant cocktail? Is this kidney working okay? Did something traumatic happen?  -- you are asking the right questions.  initially, they changed his immunosuppressants to "better" ones (tacrolimus). unfortunately, this drug has a documented interaction with paxil. another idiot doc refused to acknowledge that, and i think it did in fact play a big part in the origination of the insomnia and depression that ultimately led to a week without sleep and the Rx for zyprexa. my hubby also contracted CMV from the kidney, and i think this may have had neurological implications.  in any case, he's now back on the original (non-psych-issue-causing) immuno meds, and the kidney is fine.

 

does anyone know about TMS (transcranial magnetic stimulation) and whether or not it works for folks with GAD? keen to have some reports from the real world vs. the med community.  http://www.medscape.com/viewarticle/824587

 

 

oh, my other favorite comment from the psych nurse who works with idiot doc: "don't believe what you read from people on the internet."  i think providers should be forced to read all of this commentary.  crowdsourcing seems to be as relevant in this area -- maybe even moreso -- as it does in everything else.

[bluebalu86]

My doctor said that I would get "induced psychosis" if I continue to read forums on the internet. I hate him. He's the one who put me in this situation and now blames the people on this forum for his mistakes. He is a despicable human being.

[Altostrata]

Welcome, wantmyhubbyback.

 

I moved your post here from the Taking Multiple Drugs topic.

 

 

I'm really worried about how this information is being misinterpreted.

It seems people are peeking in from the Internet on smartphones, failing to read the whole topic or even the entire first post, and thinking they can add Lamictal or something to their tapers to compensate for withdrawal symptoms.

DON'T DO THIS!!!!!! Don't count on being able to take a pill to fix whatever is wrong with you.

Anything you add may conflict with something you're already taking.

alto, would the same situation be true if you're ALREADY taking a drug(say, neurontin) to quell the anxiety that you get when tapering zyprexa? eg, going from 1200 neurontin to 1500?

 

 

In this situation, the person is tapering Zyprexa too fast. Slowing the taper is safer than upping or adding drugs to compensate for withdrawal symptoms.

 

It sounds like jumping off Zyprexa at 2.5mg was not a good idea and withdrawal symptoms have added to his problems. Reinstating 2.0mg might help (a little less to allow for the possibility his nervous system has partially adjusted to a lower dosage). See Tips for tapering off Zyprexa (olanzapine)

 

meimei has brought up excellent points, it could be your husband was reacting to the drugs he's taking for the kidney transplant, or some other iatrogenic cause. A course of antibiotics can cause psychological effects; it can take the nervous system some time to calm down from that.

 

Given your husband probably already has quite a drug burden from the kidney transplant, your doctor prescribing 5 additional psychiatric drugs has to be in the realm of incompetence. You definitely need a new doctor, one who will help your husband minimize ALL drugs. See Recommended doctors, therapists, or clinics

 

Also, please put ALL the drugs your husband takes in the Drug Interactions Checker http://www.drugs.com/drug_interactions.html and post the results in this topic.

[Meimeiquest]

It seems GAD is a recently developed word to cover a cluster of symptoms. MDD and GAD are fancy diagnoses for anxiety and depression. Which are symptoms, not diagnoses. People don't just up and develop these symptoms out of nowhere. You have to unravel back to the beginning sometimes to get at what is actually wrong, and then everything else may be just drug and withdrawal reactions. Many, many of us here have lived that. Was Paxil the first drug? What context was it started in?

 

Right now your husband is in withdrawal. A few people on this site have tried TMS as a treatment for withdrawal syndrome. You can do a web search with the terms survivingantidepressants TMS (internal search doesn't work properly).

[wantmyhubbyback]

given hubby's overall anxious condition, i think he'll be extremely anxious about our trying to do the microtapering ourselves -- math is not my strong suit and i got pretty confused abt the mg/ml discussions

 

however, i did have a conversation with a pharmacist at walgreens who said that most of the walgreen's pharmacists would be capable of compounding zyprexa into 10%-decreasing dosages -- they just need an Rx to do it.  detail; on that service is here

http://www.walgreens.com/topic/pharmacy/compounding.jsp

 

my bigger issue is how to find a doc to get that Rx since our current idiot doc doesn't believe that microtapering works. alto, thanks for the link you sent; there aren't any listings in wisconsin but we're not too far from chicago and could probably get there to see one of those.  will keep you all posted on how that works.  given the advice i've seen here, i think we are saying to reinstate at a lower dose (alto, 2mg seems to be pretty high to me? maybe 1 or 1.5mg and see if that's enough?) even at 1mg, the 10% math makes this a pretty long process (not complaining -- just wanting to ensure this is what you folks are recommending. is a new jump off of 0.3 too high?)

 

 

month            dosage       10% decrease

month 1         1.00             0.10

month 2          0.90            0.09

month 3          0.81            0.08

month 4          0.73            0.07

month 5          0.66            0.07

month 6          0.59            0.06

month 7          0.53            0.05

month 8          0.48            0.05

month 9          0.43            0.04

month 10        0.39            0.04

month 11        0.35            0.03

month 12        0.31            0.03 

 

i guess we'll get to know our compounding pharmacist pretty well

 

but first, before we go to the microtapering, we're going to try TMS so watch for my posts in that thread

 

thanks, everyone, for being so helpful!  hubby and i appreciate it and wish you all well with your respective recoveries.

[Altostrata]

want, I moved your post here, to keep the history together.

 

I suggested 2mg because your husband went off at 2.5mg. Why do you think that's too high?

 

You might search for holistic or integrative psychiatrists in your area, they tend to be a little more helpful with tapering. (Please let us know if you find one you can recommend.)

 

Any MD or DO can write the prescription for compounding, do you have a good relationship with any of your doctors?

 

(Very nice work with your tapering chart.)

[wantmyhubbyback]

Welcome, wantmyhubbyback.

 

I moved your post here from the Taking Multiple Drugs topic.

 

 

I'm really worried about how this information is being misinterpreted.

 

It seems people are peeking in from the Internet on smartphones, failing to read the whole topic or even the entire first post, and thinking they can add Lamictal or something to their tapers to compensate for withdrawal symptoms.

 

DON'T DO THIS!!!!!! Don't count on being able to take a pill to fix whatever is wrong with you.

 

Anything you add may conflict with something you're already taking.

alto, would the same situation be true if you're ALREADY taking a drug(say, neurontin) to quell the anxiety that you get when tapering zyprexa? eg, going from 1200 neurontin to 1500?

 

 

In this situation, the person is tapering Zyprexa too fast. Slowing the taper is safer than upping or adding drugs to compensate for withdrawal symptoms.

 

It sounds like jumping off Zyprexa at 2.5mg was not a good idea and withdrawal symptoms have added to his problems. Reinstating 2.0mg might help (a little less to allow for the possibility his nervous system has partially adjusted to a lower dosage). See Tips for tapering off Zyprexa (olanzapine)

 

meimei has brought up excellent points, it could be your husband was reacting to the drugs he's taking for the kidney transplant, or some other iatrogenic cause. A course of antibiotics can cause psychological effects; it can take the nervous system some time to calm down from that.

 

Given your husband probably already has quite a drug burden from the kidney transplant, your doctor prescribing 5 additional psychiatric drugs has to be in the realm of incompetence. You definitely need a new doctor, one who will help your husband minimize ALL drugs. See Recommended doctors, therapists, or clinics

 

Also, please put ALL the drugs your husband takes in the Drug Interactions Checker http://www.drugs.com/drug_interactions.html and post the results in this topic.

here is the complete list of hubby's drugs. sorry, when you're a kidney tx patient, the list gets very long...

 

atorvastatin calcitriol calcium carbonate cholecalciferol fenofibrate gabapentin levothyroxine mirtazapine pantoprazole paroxetine prednisone Ativan (lorazepam) Glucosamine & Chondroitin with MSM (chondroitin / glucosamine / methylsulfonylmethane) Metoprolol Tartrate (metoprolol) Myfortic (mycophenolic acid) Rapamune (sirolimus)

the major interaction between the psych meds appears to be the paxil - mirtazapine combo. idiot doc said "i love mirtazapine because it makes the paxil work better."

 

i have to admit that since taking the mirtazapine, hubby is sleeping significantly better and that has made a world of difference, and i do believe it's made it possible to get him to get off the zyprexa.  but i worry at the same time that when it comes to getting off the mirtazapine, we'll have a similar challenge (although there is not nearly the amount of content on "mirtazapine withdrawal hell" that there is about "zyprexa withdrawal hell."  curious to know from other mirt users about this?

 

there are a few moderate interactions listed between the other psych meds (gaba/mirt, gaba/paxil, paxil/mirt, everything with the lorezapam.) 

 

there's one moderate interaction between one of the kidney meds (sirolimus) and the mirt.  MONITOR: Coadministration of sirolimus or tacrolimus with other drugs that are also metabolized by CYP450 3A4 may result in elevated plasma concentrations of the macrolide immunosuppressant and/or the coadministered drug(s). The mechanism is decreased drug clearance due to competitive inhibition of CYP450 3A4 activity. Although clinical data are lacking, the possibility of prolonged and/or increased pharmacologic effects of the drugs should be considered. MANAGEMENT: Pharmacologic responses and/or plasma drug levels should be monitored more closely whenever a macrolide immunosuppressant or another substrate of CYP450 3A4 is added to or withdrawn from therapy, and the dosage(s) adjusted as necessary.

 

and there are several other moderate drug interactions between some of the kidney tx drugs, but his nephrologist -- who, coincidentally, is married to idiot doc -- seems to be on top of this stuff. hubby has a monthly blood draw -- sometimes more frequently -- to ensure that the levels of the tx drugs are where they should be.

 

so ... our current plan:

 

1) TMS until end of june (while still taking the mirt, paxil, gabapentin and ativan @ current dosages).  see how that goes.

2) irrespective of whether TMS works or not, begin july with 10% tapering of the mirt.  15mg to 5mg will take a year; to 1mg will take 2 years.

3) after the mirt, begin tapering the gabapentin

4) after the gabapentin, begin tapering the paxil

5) last taper is the ativan

 

does that make sense? each of these appears to be at least a year, maybe 2 -- not sure i like the idea of him being on the benzo for 5 more years. but it seems the advice here is to eliminate the activating drugs first. pls supply thoughts on the order of the tapers if you think it should be different.

 

rhi, i believe i saw somewhere that you have been successful in microtapering several drugs at once (but they are different from the ones hubby is taking)? do you think that would work with these meds?

[Altostrata]

If I were your husband, I would go off Zyprexa and then Paxil. Then gabapentin and mirtazapine.
 
It seems CYP450 3A4 is important to his transplant drugs. While the interactions checker picked up mirtazapine as a potential problem, any of the drugs who are metabolized via CYP450 3A4 will add to the problem -- the burden on CYP450 3A4, a liver enzyme, is cumulative.

 

I would check Flockhart Cytochrome P450 Drug Interaction Table to see whether any of his other drugs also utilizes CYP450 3A4. Substrates and inhibitors will add to the burden on CYP450 3A4.

 

(These cytochrome lists can have different results -- another good source of P450 cytochrome information for specific drugs is http://www.drugbank.ca/.)

 

Given your husband's extensive medication and health situation, it would be best if you were able to work with a doctor to minimize his drugs. I take it the "idiot doctor" is a PCP?

 

You might be able to find a P450 cytochrome expert on the Psychiatry or Pharmacology staff of a university.

[wantmyhubbyback]

alto, u r awesome. will follow up on these recos.

unfortunately, "idiot doc" is a transplant psychiatrist. i'm not sure he knows much about transplant OR psychiatry.

actually, the PCP is an awesome woman who at the very beginning of this referred to the psych drugs as "poisons." hubby is seeing her monday and i am confident she will both give us referrals to the docs from your list as well as Rx for compounding if the TMS doesn't work. 

 

pls also confirm that last taper is the ativan?

[Altostrata]

Yes, I would put Ativan last.

 

I don't think you need "idiot doc" on your payroll any more.

[wantmyhubbyback]

so the thing that is very surprising about hubby is that he is seeming to have trouble giving himself credit for achievements he's made  -- a year ago he was crying every day, unable to function. now he takes 3 classes at the local community college, volunteers in the IT department (he used to be a network administrator before his health declined) at a local non-profit, and is in general sleeping much better.  but he continues to talk about how he doesn't feel like he's making any progress, he has racing thoughts, negative thoughts, and he is worried about everything -- most prominently, the idea that he'll end up back in the behavioral health unit. any suggestions for helping him with these things?  

[wantmyhubbyback]

and today's news... unfortunately now the TMS doc is on some kind of international mission so we can't start the TMS for 3 weeks.  hubby is in bigtime WD and doesn't think he can make it thru that period.  but having spent 1 month in zyprexa WD he really doesn't want to reinstate it.  so we're going to take idiot doc's recommendation of increasing the mirt to 45mg.  i realize this is counter to the advice above and am very concerned that it may in itself cause a hospitalization -- this is what happened when idiot doc increased the paxil from 20mg to 30mg back in november when we tried to taper zyprexa for the first time (i know, i should have put this in the history but just wanted to cut to the chase given the length). i am starting to have my own anxiety issues over this.

 

for those of you who have been or are afraid that you may be facing another trip to behavioral health (one of hubby's biggest concerns) -- i'd like to know what your spouse or doc or therapist or other person may have said to you that was helpful? is there anything anyone else can do or say to help someone who has anxiety?

 

i am out of words to help this man whom i love more than life itself.  

[Adagiooo]

Dear wantmyhubbyback,

 

I'm so sorry for everything your husband and you have been through and are going through. I know from experience that he must feel like he's walking through hell and you must be suffering terribly watching your husband experience this. My heart goes out to you both. Please stay strong and love each other through this. He can make it. And you have to take care of yourself too.

 

I don't really have any technical advice to offer but one thing someone told me when I was experiencing excruciating anxiety after coming off of an antipsychotic too fast was that anxiety won't kill you. You may feel like you're dying but it won't kill you. If he can say that to himself over and over again he may be able to calm himself down some. Also, distraction really helps. If he can tolerate time on the computer or a tablet or flipping through magazines (as reading books is sometimes impossible with this kind of anxiety) he may find some relief.

 

I don't know if you use Apple products but there's a game/app called Match the Dots. I find it very soothing when I become agitated. I can totally understand your husband's desire NOT to go back on the Zyprexa. That may not be the best choice, but as one who has spent considerable time on antipsychotics I know that NEED to get off. No advice or judgement here, just want you to know there's someone out here who understands.

 

You two can do this. It's a very serious situation but he can be med free. I wish you both strength, hope and peace.

[Petunia]

Perhaps it might help your husband if he were to visit this site himself. Going through withdrawal from these kinds of drugs is like nothing you can imagine, unless you have been through it yourself. Being able to connect with other people who know what its like can help to ease the fear and feelings of isolation and hopelessness.

 

Is your husband reading this thread? Is he aware of the advice which has already been given?

 

I agree that your husband is most likely suffering from Zyprexa withdrawal and choosing not to reinstate but ride out the withdrawal is a valid option. But in my opinion increasing mirtiazapine up to 45mg is not a good idea. There is a risk his symptoms will become even worse.

 

for those of you who have been or are afraid that you may be facing another trip to behavioral health (one of hubby's biggest concerns) -- i'd like to know what your spouse or doc or therapist or other person may have said to you that was helpful? is there anything anyone else can do or say to help someone who has anxiety?

 

This is not just anxiety, please read through:  What is withdrawal syndrome?

 

I think your husband's concerns are valid, especially because his medical care is still in the hands of a doctor who doesn't understand what he's doing. I think doing nothing is a better choice than doing something which may cause further damage.

 

Please read back through this thread and have your husband do it also. I wish there was more I could do to help.

 

Petunia.

[wantmyhubbyback]

Dear wantmyhubbyback,

 

I'm so sorry for everything your husband and you have been through and are going through. I know from experience that he must feel like he's walking through hell and you must be suffering terribly watching your husband experience this. My heart goes out to you both. Please stay strong and love each other through this. He can make it. And you have to take care of yourself too.

 

I don't really have any technical advice to offer but one thing someone told me when I was experiencing excruciating anxiety after coming off of an antipsychotic too fast was that anxiety won't kill you. You may feel like you're dying but it won't kill you. If he can say that to himself over and over again he may be able to calm himself down some. Also, distraction really helps. If he can tolerate time on the computer or a tablet or flipping through magazines (as reading books is sometimes impossible with this kind of anxiety) he may find some relief.

 

I don't know if you use Apple products but there's a game/app called Match the Dots. I find it very soothing when I become agitated. I can totally understand your husband's desire NOT to go back on the Zyprexa. That may not be the best choice, but as one who has spent considerable time on antipsychotics I know that NEED to get off. No advice or judgement here, just want you to know there's someone out here who understands.

 

You two can do this. It's a very serious situation but he can be med free. I wish you both strength, hope and peace.

adagiooo -- many thanks for your supportive words and suggestions. hubby tries to distract himself with watching sports; i'm a big fan of the healing power of nature and so i try to get him to calm down via a 2-mi walk on a beautiful path near our home.  both of these seem to work a bit while we're doing them but in the other spaces of time he's still really nervous.  might try to get him into MTD -- sounds interesting!

 

he is right now also trying to cope with the insomnia and i'd be curious if you're finding ways to get/stay asleep. 

[wantmyhubbyback]

Perhaps it might help your husband if he were to visit this site himself. Going through withdrawal from these kinds of drugs is like nothing you can imagine, unless you have been through it yourself. Being able to connect with other people who know what its like can help to ease the fear and feelings of isolation and hopelessness.

 

Is your husband reading this thread? Is he aware of the advice which has already been given?

 

I agree that your husband is most likely suffering from Zyprexa withdrawal and choosing not to reinstate but ride out the withdrawal is a valid option. But in my opinion increasing mirtiazapine up to 45mg is not a good idea. There is a risk his symptoms will become even worse.

 

for those of you who have been or are afraid that you may be facing another trip to behavioral health (one of hubby's biggest concerns) -- i'd like to know what your spouse or doc or therapist or other person may have said to you that was helpful? is there anything anyone else can do or say to help someone who has anxiety?

 

This is not just anxiety, please read through:  What is withdrawal syndrome?

 

I think your husband's concerns are valid, especially because his medical care is still in the hands of a doctor who doesn't understand what he's doing. I think doing nothing is a better choice than doing something which may cause further damage.

 

Please read back through this thread and have your husband do it also. I wish there was more I could do to help.

 

Petunia.

oh, petunia -- how i WISH i could get him to spend some time in this forum! he refuses to do so, says he's already nervous enough and he's afraid that if he comes here somehow it will increase that anxiety vs. making it better.

 

so i basically try to talk him thru what i'm learning here.  mostly i say "there are loads of people who have just these same issues and you're not alone."  i share the advice you all have provided, and have gotten him to agree that we'll consult one of the docs who's on the micro-tapering list Alto shared.

 

unfortunately he wanted to follow idiot doc's advice of taking the mirtazapine up to 45mg from 30, so we'll have that much more to micro-taper down the road. initially it seemed to be helping as he was sleeping well a couple of weeks ago (that would be about 2 weeks into the WD).  but now the insomnia is getting worse.  he seems to fall asleep around 11 or midnight, sleeps until 2pm, stays awake and gets upset until 4am, takes an ativan and goes to sleep until about 7.  so... he IS sleeping a bit but it's not quality sleep.

 

i do think, on the positive side, that since he's been off the zyprexa he has more clarity of thought, he seems to be able to focus a little bit more, and so when he feels good (i'd say he has had 3 reasonably good days out of 10), he seems better than he was before. of course, on the bad days, he's more miserable than he was before.  he wants to see a transplant doc in addition to the microtapering doc, and he's also agreed to explore TMS.   my hope is that between these 3 outside opinions on his current state and the best path forward we'll find something that works for him.

 

he's also been doing CBT therapy for a year, and his therapist has offered helpful advice (although he doesn't like to follow her directions).  i imagine it's just really hard to bring yourself to do these exercises when your brain is challenged with just basic operating mode.

 

it's really hard, as someone who's not suffering from anxiety, depression, or other similar, to appreciate just how this feels.  someone told me it's a little like the feeling you get when you rock back on the 2 rear legs of a 4-legged chair... that precarious feeling of any minute possibly falling backwards and possibly not being able to control it....  i do this often to remind myself how uncomfortable he is.

[Meimeiquest]

Skimming through...has anyone written to you about inter dose withdrawal when Ativan is not taken regularly? It's half life is usually short enough that it doesn't last anywhere close to 24 hrs. He might want to take his same dose, but divided into three even doses, or ore bigger bedtime dose and two littles so he takes some every eight hours.

[Petunia]

Meimei makes a very good point about the way your husband is taking Ativan, it could very likely be causing rebound, interdose withdrawal because of its short half life. Spreading the dose out through the day might be a good idea. If you would like some help with this, please start a topic in our benzo forum here:

 

Members-only benzo forum

[wantmyhubbyback]

update -- hubby near crashing after 6 wks of zyprexa WD. reinstating @ 5mg -- in my view, WAY too high but idiot doc says 2.5 not enough. good news is that tms doc finally back in town and idiot doc actually supports this non-drug option, so hopeful hubby will start that next wk. a positive study on tms effectiveness for treating GAD @ http://www.medscape.com/viewarticle/824587

we're also seeing another transplant psych doc and a microtapering doc from the SA reco'd list next week.

 

i'm bummed abt the 5mg reinstatement -- just made the microtaper a muuuuuch longer journey

;(

[wantmyhubbyback]

meimei and petunia ... i mentioned this to idiot doc and he claims inter-dose w/d not true. of course, he also thinks hubby has relapse amd not w/d. will c if docs next week r more enlightened.

[wantmyhubbyback]

now idiot doc thinking would be good to cross-taper zyprexa to abilify, geodon or seroquel. i don't see any benefit to this--  they all appear to be poor choices from a w/d perspective. any advice on this? easier/faster to microtaper any of these?

[Petunia]

Unless your husband is having an obvious adverse reaction to zyprexa, then there is no benefit from switching to another drug, in fact it will cause further destabilization, he has only just reinstated zyprexa. Please read through this topic for what to expect when reinstating:

 

About reinstating and stabilizing to stop withdrawal symptoms

 

Tips for tapering off Zyprexa (olanzapine) - Surviving ...

 

 

I don't think you need "idiot doc" on your payroll any more.

[wantmyhubbyback]

bit of an update on hubby:

 

today was day 5 of TMS. i am really optimistic about how this is working for him.  they do 8 minutes with the headgear on the right side of his head for anxiety, and then 37 mins on the left side for depression. the noise is quite loud but they give him earplugs, and hubby distracts himself with sports on the tv they have in the room with the TMS machine. he says it's not uncomfortable.

 

although he was initially very anxious about the treatment, he twice has fallen asleep in the chair! and he leaves the therapy a changed man, pretty much like he used to be.  later in the evening this effect seems to wear off and he gets a little more agitated, but that seems to be lessening too.  however, he continues to have very negative thoughts in the mornings... this has been a constant for the last 18 months.  we're going to continue the TMS (possibly going to 2 treatments/day to accommodate a new job that hubby wants to take when he's not super- anxious about it) and see if it continues to help.  it is only 60% paid for by insurance, and the bill is steep (our portion is $6k). we are fortunate to have the resources for this; i know not everyone does.

 

today we also saw one of the docs referenced on the list alto provided. he's based in northern illinois and has a specialty in benzo reduction.  he seemed to be an ok guy, although he did not address our very specific questions about microtapering as much as i would have liked.  he did, however, have hubby do the genesight test and i will be very curious to see what comes of this.  if i'm right and zyprexa in particular and the other crap in general is not something that hubby should be taking, then at least i can throw it at idiot doc and hopefully THAT will be enough to convince him.  we saw him again yesterday and he refused to lower the 15 mg zyprexa does because "it's too soon."  hubby is having bigtime motor control, weakness, depth perception and akathasia issues in addn to some irrational thinking thrown in for good measure.  i'm hopeful these symptoms will not be permanent.

 

i have a question for the moderators around the simultaneous tapering of multiple drugs at once (because if we try to do these 5 sequentially, hubby will be on the benzo for waaaaaay too long) -- alto or other, do you think that zyprexa and paxil can be tapered together or in a staged way as has been discussed elsewhere in the site? if we could team up the zyprexa/paxil for the first year or so, and the mirtazapine/gabapentin for the next, that would be great. but believe me, i understand now all too well mammap's signature about the lower you go, the slower you go, and if this takes 10 years in a sequential fashion, then i'm ok with that too.

 

appreciate any guidance anyone can provide.

[Altostrata]

Yes, it's unfortunate we have to deal with this, the doctors not being much help.

 

Why are you talking to idiot doc at all? You do not have to keep seeing him. He isn't helping at all. Better to use your energy talking to someone who's more helpful or at least neutral.

 

Reducing more than one drug makes unraveling an adverse reaction very difficult. If you lower more than one drug at a time and severe withdrawal symptoms result, what do you do then?

 

Given your husband's drug cocktail, why do you think staying on the benzo for any length of time is more harmful than the other drugs?

[wantmyhubbyback]

Yes, it's unfortunate we have to deal with this, the doctors not being much help.

 

Why are you talking to idiot doc at all? You do not have to keep seeing him. He isn't helping at all. Better to use your energy talking to someone who's more helpful or at least neutral.

 

Reducing more than one drug makes unraveling an adverse reaction very difficult. If you lower more than one drug at a time and severe withdrawal symptoms result, what do you do then?

 

Given your husband's drug cocktail, why do you think staying on the benzo for any length of time is more harmful than the other drugs?

alto, tx.  idiot doc is the only transplant psychiatrist in our area, and hubby is opposed to seeing a psychiatrist who isn't a transplant psych. there are a couple of others in chicago, which is about 2 hrs south of us, and we are seeing them in august.  also we are  moving to florida @ year-end and i'm hopeful there will be one or more "good" ones there.

 

take your point on the adverse rxn and not being able to have a controlled experiment.  but i thought there were some -- rhiannon maybe?-- who were doing a very slow microtaper of multiple drugs successfully.  i was just curious about whether certain drugs could be reduced together.

 

the thing about hubby's long term usage of ativan (or any of the other meds) is, as you pointed out earlier, the cumulative effect on the CP450 cytochrome.  it really feels to me like every year on the psych meds is possibly taking away 3-5 years of his overall lifespan.  the likelihood that a patient in his 60s would qualify for both a liver/kidney transplant (especially given the difficult time we had in finding a kidney match 3 years ago due to his antibody levels) is very slim.  

[LoveandLight]

I am really touched by this thread and the support your giving your husband

[Altostrata]

Want, the cumulative effect of multiple drugs reduces lifespan. Benzos per se are not as destructive as some.

 

It seems to me the transplant psychiatrist is not adding any value whatsoever. Why do you need to have a psychiatrist on your payroll at all? Any doctor can write a prescription for psychiatric drugs.

 

Yes, Rhiannon microtapered several drugs at once, after she had years of experience understanding her withdrawal symptom pattern. This is essential if you're going to taper more than one drug at a time.

 

You need to find out what does what by controlled experiments, reducing one drug and then observing (and recording) the results.

 

Even so, microtapering often does not speed up the process. It can reduce drug interactions, as they are usually dose-related.

[jammin83]

I wouldn't taper anything else until he is feeling better from the zyprexa. I have been off of it now for about 7 months but I have taken it here and there at times to get some relief. I still take seroquel at night but it was a mistake to change drugs. Zyprexa is no joke. I have kicked plenty of substances in my day and it has been harder for to quit than anything 10 fold. If you look at the binding profile of zyprexa it takes over multiple systems besides just D2 receptors. The brain is working in overdrive to repair all the damage that this drug causes. It would be a mistake to add any extra stress to this process. 

 

As far as him not giving himself credit, I can relate to that. Some things from an outside perspective seem like they are better but it takes a very long time to start actually feeling better and after so many months it feels like its never going away. I am about 10 months into my withdrawal now. This past week I am actually feeling a lot better than I have been and am not really manic or depressed but I still don't feel great. There is something about the withdrawal that makes you feel very sad and pitiful and hopeless I have recognized now as more of a symptom than how I really feel. It is the worst feeling in the world. Everything seems and feels wrong. I still am having some similar issues as your husband but I am beginning to see a major improvement but I have been off of it now for about 7 months. I had the racing thoughts, the mania, depressions, it's too many symptoms to count but I felt like death until recently. I think I am on the last leg of it now and it is actually more tolerable than it has been. I have to come off of gabapentin next but it can't be as bad. 

 

Zyprexa will be the hardest drug for him to quit and he needs a lot of support. I don't know how many days I sat there thinking about suicide because the way that my mind and body felt. It is indescribable and tortuous. I went off way too fast but it was too late by the time I realized what was happening. There is no easy way to come off of this drug. There is no easy way around the feelings but they will improve with time. It's probably good he is taking the mitrazapine so he can get some rest. 2.5 mg is obviously way too high to jump off of. I would shoot for below 0.5 mg before considering jumping off. It is insanely powerful stuff. 

 

I really don't think a therapist is going to be able to help but so much. There is something physiologically going on that is making him feel so bad. There is a good chance he won't be as sensitive to the other drugs and might be able to get away with more aggressive tapers. Zyprexa is a beast and it would be wise to just take it slow and focus on getting him off of that first before even considering anything else. Everything else will be a lot easier than this stuff, no walk in the park but it's important to not rush AP tapers. They seem to have the slowest recovery time.  

 

Good luck I know it can be a battle, but remember that progress from APs isn't always linear. Sometimes it will seem like it gets worse before it improves. Hang in there. 

[Altostrata]

Zyprexa will not necessarily be the most difficult drug to quit. Ativan is probably going to be tough.

[jammin83]

I don't think it will be too bad. He's on a low dose of one of the weakest benzos. At least benzos can be pretty reliably tapered. Your through most of it in a month even if you go pretty fast. Zyprexa was way harder for me. GABA drugs are notoriously hard to quit but they aren't quite as toxic either.