simack: Trying to taper off antipsychotic's (saphris/zyprexa).

[Madeleine]

I agree with last comment -- one day is not big deal. Just go back to dose you were at and it will sort itself out. Don't worry about it

[simack]

Thanks bhasski, hoping my sleep returns tonight

[rupa]

Simack

How are you?

[simack]

Hey Rupa, sorry for the late reply, I haven't been logging in here very often and just noticed your reply.

Things have been going along ok, I'm still suffering from a multitude of symptoms that are coming and going but overall manageable.

I tried to do a micro cut on the olanzapine a few weeks ago which failed. I had to go back to 3.75mg again.

I have to accept that I still can't taper at all at this point, I might have to wait and hold another year at this rate before I'm stable enough to start cutting again. 

My family is pushing me to go into a rehab facility here, which would most likely involve a double CT then being propped up with benzos for two weeks..... Not ideal.

I'm also very concerned about developing supersensitivity psychosis from the antipsychotics, my anxiety of psychosis send to be getting worse.

Still hanging in there praying for a miracle

[simack]

Hey hope everyone is doing ok, i just wanted to pop back in here and ask some advice, I've been holding for about a year and a half now and things were starting to level out for me... However last Monday I had some car troubles and had to get a lift to work from my dad. The problem was i accidently left my morning pristiq dose in my car and ended up skipping it thinking it wouldn't be a problem if i took it as soon as i got home from work... I did this, and it seemed to help the brain zaps that had already began to start. Then on Tuesday morning i decided i should take the pristiq as normal. About half an hour later hell broke loose... Severe mental akathisia came rushing back with a vengeance. I'm not sleeping more than three hours a night with constant internal distress. 

I was hoping it would settle down on its own if i just kept my doses at the usual amount however it doesn't seem to be working, it's been a week now and I'm starting to get scared this will be my new normal, is keeping everything the same my best course of action here? 

[Glosmom]

HI Simack,  Just wanted to say hang in there. Holding normal dosages usually helps and usually takes longer than we want.   Good job with holding for a year and a half and having things settle down.  Even if you have to ride this current wave for a bit, your history shows you know how to do that!!  Be patient and don't make any sudden decisions. Peace to you...

[simack]

Thanks Glosmom, I managed to have a two hour window today which hopefully is a good sign things are going to settle down. I just can't believe that missing a single dose by 12 hours could cause so much havoc.

[Carmie]

20 hours ago, simack said:

Thanks Glosmom, I managed to have a two hour window today which hopefully is a good sign things are going to settle down. I just can't believe that missing a single dose by 12 hours could cause so much havoc.

 

Hi Simack, 

 

Glad to see you got a bit of a window. I hope you get many more of those. 

 

It’s amazing how affected we are even with small changes, it certainly can cause havoc. I’m sorry this happened to you. I hope you stabilise soon. 

 

Sending hugs🤗

[simack]

Thank you Carmie

[Carmie]

On 7/31/2018 at 9:49 AM, simack said:

Thank you Carmie

 

Hi Simack, 

 

Just checking to see if you’ve started to stabilise yet?💚

[simack]

Hi carmie sorry for the late reply, i don't use this site much these days, yes things have thankfully started to stabilise, it took about a week for things to settle down for me. Just holding on for a while longer, thinking about what i med i should start to taper first

[Carmie]

On 9/6/2018 at 4:25 PM, simack said:

Hi carmie sorry for the late reply, i don't use this site much these days, yes things have thankfully started to stabilise, it took about a week for things to settle down for me. Just holding on for a while longer, thinking about what i med i should start to taper first

 

Hope all goes well when you start to taper again simack, 

 

Yes, we definitely need our holds. 

 

Im sorry you have to taper off three meds, must be hard to know what to do but the moderators always have good suggestions

 

Take care💚

 

 

[senseless]

Hi Simack,

 

How are you going?

[simack]

Hi senseless, sorry for the incredibly late reply but I'm not often active on this site anymore. Up to now I've been doing relatively ok, I would say I'm about 80% back to pre withdrawal most of the time. I do have waves here and there but not as intense thankfully. I've decided to resume tapering again after three years of holding. I'm cutting extra slow this time, I'm still on liquid olanzapine so I figured that would be easiest to lower first. Today is my first day with a -0.125mg cut. I slept well and was feeling pretty good,  but this afternoon I noticed that I felt a bit of the old withdrawal waves hitting again. It lasted about two hours then passed then returned, at this moment I'm feeling a little agitated and not quite right but I'm going it settles within the next two weeks before I continue the taper. How's things going with you? Hoping you are all doing ok and having the best Xmas you can with withdrawal

[simack]

. Just a quick update, I thought that after stabilising and holding for a three year period I would be ok to resume micro tapering...I was wrong, two days after cutting my zypexa down by 0.125mg I was thrown back into full on withdrawal again. I tried to ride it out but couldn't last longer than a week before up dosing back to 3.75mg.I just don't have the energy to fight through it anymore, after 6 years of withdrawal I'm tired of fighting. I'm still having extreme waves and Windows but I think I'm slowly getting longer and longer Windows now. I'm devastated, I have come to realise that this is as good as it will ever get for me now. If I can't level out after a three year hold I most likely never will. Where I was when I was stable wasn't much better. I was stable but still suffering symptoms, I was about 80% normal  but dead on the inside, a permanent zombie with severe cog fog, who just barley managed to hold down a job and provide for my family. I just want to make it long enough to see my daughter turn 18. 

[ThatOneGirlStitch]

@simack

Checking up on you. How are you doing?

[simack]

4 hours ago, ThatOneGirlStitch said:

@simack

Checking up on you. How are you doing?

Hi thatonegirlstitch, thanks for checking in on how I'm doing..I'm doing relatively ok, I'm still unable to taper even the slightest, I think I'm severely kindled and it looks as if it's going to stay that way. I've come to accept that now, I'm about 75% functional most days, I'm able to hold my job down just, my cog fog has me making silly errors frequently and my boss is getting tired of it quick. But I'm thankful I'm not suffering from akathisia or insomnia any more.  I'm going to have to stay at these doses for the rest of my life I think. It's not ideal but I'm managing  ok, it could be allot worse. Allot of other members aren't so lucky. How are things with you?

 

[ThatOneGirlStitch]

I'm sorry that you were kindled so badly. There was no way you could have possibly known. I read a doctor once saying that quality of life is more important in withdrawal than getting off the medicine quickly. I know of people who aren't able to taper. I'm so glad you are able to function most days. Cognitive function is emotionally frustrating, It's good the akathisia and insomnia are not with you. I know you may be severely kindled, but I still hope that you will improve with time. 

 

Currently I think I'm in a window. It's been nice and some symptoms have improved. I have three medication to come off of and I don't know if chances or in my favor so I'm afraid to start. I'm lucky I made it through my last wave, but even still I relate to "it could be a lot worse". So I'm enjoying while I can. I can't handle a lot of stress, so I stay in my house mostly. Being ok is the new good.

[simack]

Does sudden weight gain affect medication strength?

 

Hi all,  long story short, I was wondering if a sudden increase in body weight can affect the potency of medication? My insomnia is back worse than ever,  I've been holding doses for the past 4 years and the only thing I can think of that's changed is a sudden increase of 10kg in body weight. Is it possible that the extra weight is making my tablets less effective?

 

Edited January 4, 2022 by ChessieCat
added topic title before merging with intro topic

[Hopela]

When I was on Olanzapine I got the thought that perhaps one of the reasons I was getting fatter was that my body was actively trying to protecting itself from the toxin by growing potentially toxin absorbing layers of fat. The fat solubility of Olanzapine I don't know of but since it's not conveniently solvent in water for tapering it might be fat soluble and in that case like when you take fat soluble nutrients like vitamin D you need to take higher doses to get the same effect if you have more fat. And if you are tapering and have more fat stored Olanzapine you could be getting more olanzapine from the body itself after reaching 0 mg and could see withdrawal symptoms arise later due to it.

 

Diving a bit deeper: Basic drugs as opposed to acidic drugs tend to have better CNS penetration and a broader receptor affinity which would suggest psych drugs should be basic, and basic drugs are more fat soluble, so your fat levels could impact the effect of the drug. On top of that the acidity of your body  affects the fat solubility of the drug. So if you by chance or intentionally go on a diet to change your body pH the availiability of the drug due to pH dependent fat solubility could be different.

 

The pKa 7.8 of olanzapine suggests its's weak basic so high fat solubility in the blood that has pH 7.35-7.45

https://pubchem.ncbi.nlm.nih.gov/bioassay/781326#sid=103195217

More info:

https://derangedphysiology.com/main/cicm-primary-exam/required-reading/pharmacokinetics/Chapter 1303/factors-which-determine-lipid-solubility-drugs

https://pubs.acs.org/doi/abs/10.1021/jm501000a

https://www.news-medical.net/health/pH-in-the-Human-Body.aspx

[simack]

Thanks hopeless, it just seems strange that after 4 years of holding,  insomnia would come back out of nowhere, the only thing I could think of was the weight I've gained recently.  I might try a slight increase and get back on my ketogenic diet. 

[ChessieCat]

I think there are many other factors that can affect what dose of the drug we get and/or absorb.  Time of day we take the drug, with food / different food, without food, whether we are sick and our body is fighting a bug/infection, the rate of our digestion (contipation/loose bowels).

 

If you have been holding for 4 years and things have gradually worsened over that time than it might be drug poop out.  The general medical solution is to increase the drug.  So if it is poop out and you increased it might help, however down the track the same thing will happen.  And if you are thinking it is to do with weight gain you have already have a bias abd you will not consider poop out as a cause.

 

And the other thing to consider is Covid.  Not the virus / sickness itself but the impact of the last 2 years on us.  I think we are all "over it".  But it is still "out there" and we are having to get on with our lives.  But things are very different.  It has been, and still is, very stressful.  But it's been an low level stress over a long period of time, so some people don't realise what is causing it.

 

Anyway, just some things to consider.

[simack]

Thanks cheesiecat, I just had a chat with my local pharmacist and she seems to think it very unlikely to be weight related. What are my options if it is poop out thanks

[ChessieCat]

Brassmonkey was in poop out before he started tapering Paxil.  You could search for posts by him.  Terms:  poop-out, poop out, tachyphylaxis, tolerance

 

This is why he worked out his own way of tapering:

 

brassmonkey-talking-about-myself

 

tolerance-or-poop-out-or-tachyphylaxis

 

Tachyphylaxis, Reaching Tolerance or as It's Lovingly Known “Poop-Out”

 

From what I understand with poop out is that sometimes after making a reduction you actually feel a bit of improvement and then gradually start to feel worse, whereas for regular withdrawal it is more usual to feel the worsening after a reduction and then you start to improve.

[Hopela]

9 hours ago, simack said:

she seems to think it very unlikely to be weight related

Well she is contradicting "established consensus" then. Weight gain is seen as having a bidirectional causational relation to sleep even without drugs:

https://www.sleepfoundation.org/physical-health/obesity-and-sleep

Bad sleep can lead to weight gain but weight gain also can lead to insomnia, a drug presence won't necessarily change that weight gain can cause insomnia.

 

Related to psychiatric drug and weight I found article but they come to the wrong conclusion:

https://sci-hub.ru/10.1097/FTD.0b013e318237b0fa

Quote

the findings suggest that there is no relevant influence of body weight on
the dose-corrected serum level of several widely used antidepressant

The correct conclusion would be the findings does not suggest that there is a relevant influence...

 

They just don't have the statistical power to suggest, let alone prove, that there there is no influence. They just fail to prove there is an influence and see that as a suggestion that none exist. I think that is common behaviour. If i fail to run a marathon it suggests that marathons are impossible to run. Or does it? From a scientific viewpoint I would say that this behaviour is incorrect.  There can be circumstances where a suggestion could be implied, if the effort and quality was tremendous but I don't see it here. 

 

The enormous spans of serum concentrations, multiple orders of magnitude, for people given the same treatment are as shocking as always and greatly limits statistical power. There are also multiple obvious uncontrolled confounders. They point out limitations of it being retrospective study. The suggestion they believe in is opposite to the theoretical expectation I outlined from a short but relevant dive in, and the experience you had which of course could happen without a drug influence, but they only refer to something they call "intuitive presumption". Perhaps that's why they feel emboldened to have a suggestion.

 

Failing to run a marathon does not suggest it's impossible and the scientific theory remains that it's likely. Ie that substantial weight change will alter drug concentration to an extent that can be very noticeable for some individuals, for example 5%.

 

 

[simack]

Thanks hopeless, I haven't ruled it out completely yet. I need to get on top of my diet either way, I've let myself go since moving back in with my wife and children.  I've just taken a slight updose with the olanzapine and quetiapine in the hope I manage at least some sleep tonight. Fingers crossed. 

[ChessieCat]

10 hours ago, simack said:

I've just taken a slight updose with the olanzapine and quetiapine

 

Two changes at the same time?

[simack]

 

1 hour ago, ChessieCat said:

 

Two changes at the same time?

Sorry yes, I know it was a stupid thing to do but I was desperate,  jumping around on doses is the reason I'm severely kindled to the point I can't taper without extreme symptoms.  I did manage 10 hours last night, so it's poop out or body weight. Should I try reducing one at a time to find the lowest effective dose?

[simack]

So I tried keeping the seroquel normal and slightly increased the zyprexa last night. I'm back to zero sleep again. I. Guessing it's the seroquel either in poop out or weight is affecting its potency. Tonight I'll try increasing the seroquel and keep the zyprexa normal. Fingers crossed, I'm terrified at the moment I'm mea t to be back to work next week and need to get this sorted

[simack]

Just keeping a log to warn other people not taper like I have. Still on no Sleep, I increased the zyprexa and seroquel.. and still didn't get any sleep. I even went and got a new prescription of seroquel in case the other batch was heat damaged, still no luck.  No idea what I should do,  just praying things settle down by some miracle. 

[ChessieCat]

29 minutes ago, simack said:

No idea what I should do

 

I am going to be blunt (not as a mod just as a member).  I'm surprised that you say this.  You joined SA 4 months before I did.

 

Personally I think it would be better to stop trying to find a way to "fix" this and give your brain time by stopping messing with your drugs/doses.  The brain likes consistency.

 

Trying to find a solution can cause additional stress which does not help.

[ChessieCat]

After posting the above, I saw this posted by Alto to another member:

 

15 minutes ago, Altostrata said:

 

We want you to stop rocking the boat so we can see your baseline symptom pattern and which drug is doing what. Every time you make a drug change, you set this back 4 days to a week. That's 4 more days to a week that you have to cope with drug adverse effects.

 

 

[simack]

Ok yes I'm sorry, I get desperate and act recklessly,  I'm holding out on my normal doses to see what happens after a week

[ChessieCat]

No need to apologise to us.  It is you and your brain/nervous system being affected, not ours.

 

And in case you didn't notice, Alto liked the post where I quoted what she had posted to another member.

[simack]

Just updating my notes,  holding on 50mg seroquel and 3.75mg olanzapine. I'm managing about 3hrs sleep the past two nights.  I'm drifting off around 2am then waking around 3am back to sleep at 4am then wide awake and up at 6am. 5 nights left until I need to return to work, stressing greatly about losing my job

[simack]

I have a quick question please, how risky is it switching from generic olanzapine wafers back to branded zyprexa zydis? I've been talking to my Dr, he wanted to rule out the rare possibility my recent setback was caused by a bad batch of olanzapine since it coincided with when I started a new script.  I filled a new script but the only olanzapine where I live is all of the same batch. They've given me the branded to try instead.