catalunya: Welp, here I am! A Luvox and Lyrica mess!

[catalunya]

hi everyone - 

 

this site has been a lot of help, although i thought that i should join as i need additional support and advice as i've never been on doses so low before, am having tapering difficulties, and don't want my tapers to fail as i have three failed tapers behind me. 

 

anyhow, i suffer from panic disorder and generalized anxiety disorder pretty badly and have since i was a small kid. i saw a clinical psychologist while young and was eventually placed on medication (paroxetine/paxil) at around age 15 after i falling completely dysfunctional. i'm 31 now. i tried to wean off of paroxetine far too quickly at age 25 and relapsed into a state of complete dysfunction again -- ultra-intense rebound anxiety and agoraphobia -- after my psychiatrist suggested that i follow a far too rapid tapering schedule. i found myself in the ER and left with a prescription for klonopin and was told to take it while reinstating paxil. i very quickly found myself a new psychiatrist who specialized in anxiety-spectrum disorders and was switched from paxil to cymbalta. she also kept me on klonopin which was prescribed at 2mg/day in the ER and increased the following week to 3mg/day by the new psychiatrist. i was working full-time and was also a full-time grad student at the time and wasn't stable as i'm only a partial responder to the benzodiazepines; a few weeks after the cymbalta/klonopin combination wasn't working, lyrica was instated. i rather quickly was back in remission, although now on three drugs instead of just the initial paxil. 

 

i should state that i initially tried to wean off of paxil after ten years of taking the drug (and ten years of remission from panic disorder and generalized anxiety disorder) because the sexual side effects were horrific and the emotional blunting was disconcerting. if those were problematic on just paxil, they increased tenfold on cymbalta, lyrica, and klonopin. i've since discovered that klonopin isn't the largest of sexual nor emotional offenders, although it definitely has a negative effect; rather, the ssris/snris and lyrica are the greater offenders with regard to sexual and emotional functioning. 

 

after a few years on that combination, i moved and complained to my new psychiatrist that i was sexually dead and totally apathetic during my youth and that wasn't acceptable. he tapered me off of cymbalta while titrating me up on lyrica as he told me that lyrica doesn't typically have a harsh sexual-side-effect profile and that it's much easier to wean off of than ssris/snris - hah! that wasn't/isn't the case at all. the transition wasn't smooth and i was in and out of the ER for the next few months. klonopin was left at 3mg/day. that dose hasn't changed for the past six years. 

 

i began a lyrica taper in 2011 with the help of the same psychiatrist who tapered me off of cymbalta and titrated me onto a higher dose of lyrica following pfizer's tapering recommendations. too fast, fell completely ill and non-functional again. panic 24/7, agoraphobia, no appetite, inability to do function at a basic level. i was admitted to the hospital and was placed on this and that only to find myself back on lyrica at 900mg/day, luvox at 300mg/day, and klonopin left as it was at 3mg/day.

 

i began a slower taper in may 2014 with the hesitant approval of my psychiatrist given my background of relapsing into states of complete dysfunction and my apparent inability to taper off of anything without extreme withdrawal/discontinuation symptoms and/or the return of the original symptoms for which medication was prescribed in the first place. he didn't know how to go about tapering me off the medications given my past attempts, and so the ashton's methodology was initially followed for both luvox and lyrica.

 

i am currently concurrently micro-tapering both luvox and lyrica using liquid suspensions that i prepare myself using methods that i learned from this site. i use graduated cylinders to measure the water and draw the doses using oral syringes. 

 

i am currently taking daily 3mg of klonopin (which, again, hasn't changed since it was first introduced six years ago), and as of today (6/28/15) i am down to 19.69mg of luvox and 9.16mg of lyrica. 

 

i'm running into problems as i sort of near 0 (again, i started the taper in 5/14 taking 300mg luvox per day and 900mg lyrica per day). 

 

i realize that i may have to stay on low doses of these medications in order to maintain functionality -- i hold down a full-time job and live independently, although i'm single as the sexual side effects hinder dating even on the doses i'm on now but not to the same extent -- the dating problem is only compounded by withdrawal symptoms and a strong predisposition to panic. i don't know how low i can get down to on these meds while maintaining stability (and right now i'm only semi-stable - able to do basic things, but hindered greatly in many ways) and i don't want to risk another relapse accompanied by another hospitalization and/or risk having to updose significantly only to try once again. it seems as though i've been trying to taper forever now -- like, years of my life have been taken from me. 

 

i hold here and there when i feel that i need to, although generally i am micro-tapering daily with reductions of .030mg/luvox and .005mg/lyrica. i've only recently (within the past month or so run into problems at this rate -- during the months prior to june (april and may) i was micro-tapering daily at a rate of .050mg/luvox and .015mg/lyrica with occasional blips during which i would hold. i've hit a roadblock. even the smallest things are intensely difficult. i am currently holding the doses on both luvox and lyrica. 

 

i'll post my med history/tapering schedule in a to-be-created signature soon, but the above outlines pretty much where i am now. i need help, support, positive guidance, particularly from anxiety sufferers. 

 

i just want my life back -- to be able to enjoy things without intense anxiety, to be able to find a romantic partner and marry, to be able to taper without such great discomfort. i'm discouraged and lonely. i don't have an understanding support network and the very reason i'm trying to withdraw from the drugs -- to regain sexual and emotional independence -- isn't improving to an acceptable level. so i question whether i'm putting myself through a whole lot of suffering all for naught. 

 

thanks in advance for your support and guidance!

 

[Iamfine]

Hello catalunya. It's tough getting off these drugs isn't it? I am also tapering Luvox (already quit Klonopin). I'm going much faster than you but I've only been on the Luvox a short time, down to 20 mg from 150. How did it work for you at 300? I know these people recommend a 10% taper and hold until you're stable, then another 10% from that dose, and so forth. Some people seem to have to get down to 1 mg or even lower before jumping off, but that has not been the case historically for me. Each person is individual but I think the key is to hold at a certain level until you are stable before cutting again, that is if you are stable while on the drug, which is not the norm for me. Good luck to you and I will follow this thread with interest since we have a couple drugs in common. (I've never used Lyrica, one of the few I haven't tried). I also know that these people recommend only cutting one drug at a time.

[LoveandLight]

god luck to you. I think you'll find good help here. Wishing you success this time around.

[catalunya]

thank you both for your encouraging words! i absolutely cannot follow a 10% reduction. i mean, i'm tapering lyrica at the 1/100th of a milligram level and having problems. luvox can be tapered ever so slightly more aggressively, and by aggressively, i mean at a turtle's pace and not a snail's. a peculiarity that runs contrary to what a lot of people find works best for them is that i fare better with much more frequent smaller cuts, i.e., a daily micro-taper, rather than an taper in which i cut a slightly larger amount followed by a consistent holds. at least that's what was working for me throughout the past year and some months -- at present i'm having difficulties both physically and emotionally with regard to the taper.

 

iamfine, it's very tough getting off these drugs and i am one who needs to taper (at least at this stage) at an excruciating slow rate and even then i am not avoiding moderate withdrawal symptoms. ugh. as for the question regarding luvox, 300mg worked well enough to control panic in conjunction with lyrica and klonopin. it has a harsh side-effect profile, though. i am so apathetic on the drug at higher doses and it kills the entire sexual spectrum as does lyrica. luvox also has a tendency to kill my creative curiosity, which i suppose goes along with apathy. the drug feels a lot like paxil in many ways save for it being more sedating. i know luvox is traditionally prescribed to treat ocd, although after having been through nearly all of the ssris/snris the drug worked better than any of the others within the aforementioned respective classes (save for paxil) in treating refractory panic disorder and generalized anxiety disorder perhaps due to it's slightly unique pharmacological profile, e.g., sigma-1 agonism. who knows. 

[Iamfine]

I like the idea of making tiny daily or weekly cuts instead of one bigger cut every month or so, that's kind of what I am doing with the Luvox now. I still have Seroquel and Geodon to cut but i will do those after I get shed of the evil Luvox. More educated people will be along soon to help you more. Good luck!

[bubble]

Hello Catalunya and welcome to SA.

 

First of congratulations with your taper so far. There are a few observations I'd like to make when looking at your tapering. Micro-tapering (a kind of) works good for me too. I have also found it that with benzo I just can't make a 10% cut and hold longer but I make a lot smaller cuts let's say every 10 days.

 

However,the problem with these drugs is that they have a delayed response. This is particularly important to note when making daily cuts. In that case the withdrawal can build up and catch up with you at a later stage. That's why periodical longer holds are very important to make sure your brain has caught up with all the changes.

 

The second thing I notice about your taper is that it's actually not as slow as you think. If you were at 300 mg in May 2014 following the 10% rule even from that starting dose

[bubble]

(sorry I accidentally pressed the send botton)

 

In 12 months you would have reduced by 120% which would be somwhere around 60 mg and you are at around 20...

 

This becomes particularly important at lower doses as you near 0 as you have yourself painfully witnessed. There is a great article here which explains why that happens:Why taper? Paper demonstrates importance of slow tapers.

 

The only "cure" for that is going extra slow. I pay attention that my monthly decreases don't exceed 10% altogether.

 

Given everything said, and a flare up in your symptoms, I'd warmly recommend a longer hold, at least one month.

 

I believe you will start getting your personality back and see your side effects dimimishing not only when you are off the drugs completely but also now already as you are approaching lower doses. Our moderator Rhianon writes about such experiences in her thread a lot.

 

Nice to have you here and I believe we can help each other on this challenging journey.

 

Best,

Bubble

[catalunya]

thank you for your thoughtful response and advice, bubble. after going through my notes, i created a signature which shows my most recent tapering rate and doses at the first of past few months. it shows that, indeed, my taper has been quicker than i thought, although i suppose i didn't notice as i hadn't run into problems with the taper until recently. i do think at this stage that i really am going to have to hold for longer periods of time. 

 

again, i really do get discouraged because i am tapering at an extremely slow pace and with minimal improvement on the side-effect front which is greatly hindering my quality of life. not to say that being panic stricken via withdrawal effects, panic disorder and/or generalized anxiety disorder, or a combination of the two aren't also hindering my quality of life, but rather that the uncertainty of placing myself through a painful process (both emotionally and physically) may be all for naught in that the ultimate goal is not guaranteed. it just takes a rather large psychological toll that's added to the physical toll the reductions are having. 

 

i'm hoping that i'll see improvement on both fronts aforementioned so as to give me a bit more hope!

[catalunya]

hi, bubble - i submitted the previous post before seeing your follow-up post. i'll find the article in a bit and read through it, but yes, i agree that holding at this point is best so as not to avoid relapsing which i've had happen a number of times within the past few years. 

 

thank you for the warm welcome to the community!

[Altostrata]

Welcome, catalunya.

 

At what times of day do you take your drugs? Do you find that Lyrica makes you sleepy?

 

Why are you tapering the two drugs simultaneously?

 

Many people do better with fish oil and magnesium supplements, see
http://survivingantidepressants.org/index.php?/topic/36-king-of-supplements-omega-3-fatty-acids-fish-oil/
http://survivingantidepressants.org/index.php?/topic/1300-magnesium-natures-calcium-channel-blocker/
 

[catalunya]

hello altostrata! thank you for the welcome!

 

i take luvox and klonopin in the morning and i take lyrica split in two doses -- once in the morning along with the other two drugs and once in the late afternoon.

 

so basically, luvox 19.69mg qam, klonopin 3mg qam, lyrica 4.58mg bid (9.16mg total). 

 

lyrica made me very sleepy when i was taking much larger doses of the drug and if i happen to make a slight error in measurement with the oral syringe and unintentionally updose by even a fraction of an amount (recall that the daily micro-taper reductions were going well at .015mg per day and most recently at .005mg/day), then i fatigue easily, although not nearly to the extent when i was taking 900mg/day of the drug. i was essentially placed on such large doses of the medications as the psychiatrist felt it necessary to rapidly stabilize me and that was achieved, but after stabilization occurred and overmedication was clear, the doses weren't tapered down to more appropriate levels -- they still wouldn't have been acceptable due to the side-effect profiles, but still. 

 

i am tapering the two drugs simultaneously because i could do so without problem up until recently and because both drugs are causing quality-of-life impairing side effects as mentioned above. starting a taper of either one alone would have robbed even more years away from me. i just don't want the drugs to get in the way of my life goals; i want to also enjoy my youth without letting it completely slip away. they may get in the way of my personal goals -- there's no guarantee that i'll be off either drug completely and i kind of think that i may have to stay on a low dose of one, if not both of the drugs in order to maintain stability given my history with regard to refractory anxiety. the habituation/dependency to klonopin only convolutes things even further, although i'm terribly afraid to touch that drug as it isn't causing the majority of my problems (i don't think) and with a hospitalization stay and ER visits galore with the removal of lyrica and/or an ssri/snri, i can't fathom what a benzo withdrawal would be like for me. i'm just not physically nor emotionally ready for yet another taper. i mean, at the rate i'm tapering now, if i'm able to successfully complete either the lyrica or the luvox taper, it will take an additional number of years and i'm fine with that as long as i remain functional and begin to regain more of my true personality and sexuality. because that hasn't happened to an acceptable degree yet (although there has been noticeable improvement), i become very discouraged. 

 

i take zinc as it affects glutamate in some way that is helpful with regard to the lyrica taper. i also take fish oil, although i find that magnesium calms me temporarily only to ramp me up after five or so hours. i don't know why that is -- totally paradoxical, but it exacerbates symptoms, which admittedly have been pretty mild until recently where i hit a major roadblock. that said, after holding for even a day, i do feel noticeably -- not completely -- better than the day or two before. 

[bubble]

It's great that even taking one day break is making you feel better! I believe holding longer will make it possible for you to start enjoying benefits of low doses.

 

I also very much want to come off the drugs but after so many failed attempts I realise that rushing will not only make me feel unwell but will ultimately lead to staying on them longer... So I just have to find the balance. Staying on drugs a few months longer is definitely preferable to not coming off at all or becoming very dysfunctional.

 

I also believe that holding will give you this much needed hope and positive encouragement when you start feeling your long term symptoms/side effects lessening.

 

As Alto pointed out we recommend tapering one drug at a time because in this way we can see what is causing what. So maybe along with holds you can consider holding your Lyrica taper till you come down with Luvox. 

 

I ran the drugs you are taking the drug interactions checker and here is what the report said:

 

clonazepam ↔ fluvoxamine

Applies to: Klonopin (clonazepam), Luvox (fluvoxamine)

Using clonazePAM together with fluvoxaMINE may increase the effects of clonazePAM. Contact your doctor if you experience extreme drowsiness, confusion, muscle weakness, loss of balance or coordination, feeling light-headed, or fainting. If your doctor does prescribe these medications together, you may need a dose adjustment or special test to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

clonazepam ↔ pregabalin

Applies to: Klonopin (clonazepam), Lyrica (pregabalin)

Using clonazePAM together with pregabalin may increase side effects such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience some impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with these medications. Avoid driving or operating hazardous machinery until you know how the medications affect you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

fluvoxamine ↔ pregabalin

Applies to: Luvox (fluvoxamine), Lyrica (pregabalin)

Using fluvoxaMINE together with pregabalin may increase side effects such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience some impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with these medications. Avoid driving or operating hazardous machinery until you know how the medications affect you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Also have a look at this article: http://survivingantidepressants.org/index.php?/topic/6036-why-taper-paper-demonstrates-importance-of-gradual-change-in-plasma-concentration/

It explains why it is so important to go extra slow at low doses (contrary to what we might think that they are insignificant...)

Strange reaction to magnesium. Most people find it safe but it seems your system seems to be extra sensitive.

Best,

Bubble

[catalunya]

hi bubble, 

 

yes, there are definitely interactions between the drugs i'm taking. they potentiate one another to provide for greater anxiolysis and since the benzodiazepine is not being touched and because luvox potentiates klonopin via a decrease in the clearance of the drug and because lyrica potentiates klonopin via a synergistic effect, the result of decreasing either is particularly harsh. i'm only realizing this now after what i thought was already a slow, rather smooth taper, but now has turned into a very, very slow uncomfortable taper. 

 

i hope that the side effects will decrease. i mean, i know that the withdrawal effects will decrease based on past experience with the current taper rate i'm following, although i'm not sure that the bothersome side effects will abate. in either case, as you pointed out, i can't wind up in the hospital again or have to increase the dose of either drug substantially, taking a number of steps backward -- i do have a number of failed tapers behind me as well as a complex history of instability when things are changed. 

 

what i'm trying not to think about is how long the taper will take to complete -- it's not a question of a few additional months on the drugs, but a number of additional years. i don't want to think about how many years tapering at a rate of .005mg/day of lyrica will take (1,836 days or roughly 5 years if i were able to reduce daily NOT including holds). that's excruciatingly slow and that's only lyrica. luvox will take equally as long and i could easily find myself in my 40s and still tapering more than a decade later. i mean, i guess it's better to lower than not do anything at all, although i need greater signs of situational improvement as a motivator because, well, as it stands, i'll be tapering for quite a long time to come. 

 

i either have an extremely sensitive nervous system, am experiencing a return of symptoms for which i was placed on the drugs, or a combination of the two. in any instance, i cannot let myself relapse into a state of psychosocial dysfunction and my overall quality of life must improve, so i must continue tapering, although very slowly, listening to my body's response and with a lot of prudence. 

 

thank you all for your wonderful advice and encouragement even if i do still feel quite discouraged. it's comforting to know that i am not alone in this battle even if i'm slated to complete my tapers (should i be able to) many years from now. 

[catalunya]

as an addendum, i decided more than a year ago to taper both drugs concurrently because they both cause sexual dysfunction on a grand scale. i only know this as i've been on klonopin with an ssri sans lyrica and i've also been on klonopin with lyrica sans an ssri. that's the rationale behind the multi-drug taper. it may not be wise to continue tapering both at present. i'll have to see how my body responds when i begin to reduce yet again. perhaps the reductions of luvox need to be ever smaller. i don't know. i don't really think i can taper lyrica more slowly than i am now. i mean, i can, but .005mg reductions are pretty tiny. 

[bubble]

What can I say... I understand your situation very well: I'm 38 and would very much like to have a child. Due to so many years on drugs I was never able to have any but actually wasn't ready for other reasons. Now I have two drugs to taper and I wonder about the time on my biogical clock...

 

We have the best information we can get here and I (must) believe that we will manage...

 

Let's try to at least find a middle way...

 

Keep us posted.

 

Bubble

[catalunya]

I definitely will -- I still have hope! I also must have hope. That's all I really need -- a middle way. I don't care much if I have to stay on low doses of my current medications so long as my quality of life is improved, I'm able to maintain stability and achieve personal (romantic) goals. I very much wish to reach this point in the near future after so many years wasted -- stable with regard to anxiety, but wasted in many other aspects of life. Life is so short and it passes so quickly that I ruminate over what has been lost and what may never be far too frequently. I don't know how to break that habit, although I will continue pressing on as much as I am able while hoping for the best. 

 

Best of luck to you as well; given your signature, you are making great progress, progress that's pretty consistent. I hope that you aren't experiencing withdrawal symptoms that are terribly impairing. I also hope that you are able to achieve your personal goals, and it seems that you just may be able to provided you have a committed, romantic partner. I'm wishing you the very best!

 

Those tapering prudently will all (or mostly all) make progress toward our respective goals, even if that progress doesn't reach our ideals or isn't ideally timed. 

 

Thanks again, Bubble. 

[catalunya]

i need advice from those who are microtapering either daily or with short holds. when i take longer holds and then reduce the dose by really any amount, my body usually has an exaggerated response than if tapering daily with holds here and there that are rather short in nature. anyone having read through the thread knows that i recently ran into major problems and i am now terrified to make any change to the dose because the symptoms became so severe really rather suddenly. 

 

i then read the article on plasma concentrations and sert occupancy at various doses and realized that even at 19.69mg of luvox per day, the sert occupancy is probably really rather high and the smallest of dose reductions are impacting me greatly as the curve is much steeper at the lower end and i'm sort of at the lower end, although i'm nowhere near 0 with regard to luvox. i assume this to be true for lyrica as well in a slightly different manner and with other neurotransmitter systems, e.g., the glutamatergic and the noradrenergic systems are probably pretty important and i'm probably experiencing a large influx of both glutamate and norepinephrine which is throwing everything off. 

 

i don't really know what my question is because my thoughts are all over the place -- i'm sort of in a place of despair and desperation and extreme fear of taking any further steps because of the extreme reactions that recently popped up that are reminiscent of the failed taper symptoms i've been through in the past. i'm not sure if i'm hitting or have hit the lower limits of what my body can handle and am now stuck on these doses or if i can continue to taper but lose stability every time i make a dose reduction even if the holds are quite long. 

 

the fear surrounding these drugs and any changes, particularly since i've fallen unstable recently to an extent that i haven't seen since my last failed attempt, is intense.

 

i'm currently holding both drugs at their respective doses. somehow i had an easier time when i make slight changes to both drugs at once than either alone -- luvox reductions made me sleepy and lyrica reductions ramped me up and somehow they balanced each other out. this isn't the case any longer. i am experiencing extreme anxiety after any reduction, both drugs concurrently or either drug independently. 

 

help! advice? anything? hold for an extended period of time and try to resume? i feel like the fear is only making things worse but i have no idea how to stop it given my current predicament. 

[Altostrata]

SERT occupancy rates do not tell the whole story of how the drugs exert their effects, it's only indicative of why certain phenomena occur in tapering.

 

Please do not overthink neurotransmitter activity. No one knows how this works.

 

9.16mg is not a high dose of Lyrica. Is it supposed to help you with anxiety?

 

If I understand your story correctly, you have been micro-tapering Lyrica and Luvox and recently hit a roadblock. When did you hit that roadblock? What were the symptoms? Have you been holding at one dosage level since?

[catalunya]

hello altostrata -- thank you for taking the time to respond. 

 

i realize that i'm on a rather low dose of lyrica at present. i'm taking around 1% of my original prescribed dose. 9.16mg now/day vs 900mg initially prescribed/day. i'm still on a significant dose of the ssri, though. 

 

i'll try not to look too deeply into the sert occupancy rates; i just read the article as it was suggested that i do so. 

 

i hit that major roadblock around two weeks ago. i have lost my appetite, have experienced extreme, debilitating anxiety, suffered from insomnia, suffered from migraines, suffered from bruxism, and suffered from severe panic attacks within this time period. i have held the dose since symptoms emerged around two weeks ago and i am still having difficulty in day-to-day functioning. 

 

i don't know what to do as i don't want to give up on my hopes and dreams in life but i can't risk relapse and my current taper rate is extremely slow. 

[Altostrata]

Have those symptoms improved over the last 2 weeks?

[catalunya]

they have to a very limited extent. i am still having major difficulties doing even the smallest of things. 

[Altostrata]

Because you were tapering 2 drugs at once, it's impossible to figure out what caused those symptoms.

 

I suppose you could updose Luvox slightly and see if that helps.

[catalunya]

so, after holding for what seemed like forever in limbo my anxiety has lessened to a degree that's tolerable -- depression not so much as there is uncertainty surrounding the taper. i'm not on solid ground, but i'm neither in quicksand. as i continue to hold the doses of both drugs, i am going to concentrate on lowering luvox in the future (should i be able) and hold lyrica for the time being perhaps lowering by a smidgen super infrequently and by a smidgen, i really mean a smidgen at .005mg. 

 

anyhow, though, back to tapering luvox -- now that i've hit my first major roadblock during this taper and experienced some of the very same symptoms (outlined in posts above) during past failed tapers that resulted in complete destabilization and that ultimately placed me back on the same medications at the original doses, so i worried. i didn't have to updose, thankfully, and this window gives me hope that i will completely stabilize on the doses that i'm on as i have done in the past. 

 

that said, i don't know how to move forward with the taper now that i'm relatively sure i'll be able to make a luvox decrease at some point in the future. i'm looking to luvox and not lyrica for three reasons - 1. i'm already on a pretty low dose of lyrica, 2. i'm splitting my lyrica dose up into two and i fear that taking nearly nothing in the afternoon will leave me too unstable, and 3. i'm taking a much higher dose of luvox with regard to relativity and proportionality than lyrica. 

 

the difficult part? i cannot taper at a rate of 10% of the previous dose per month via one drop and then hold -- i fall much too unstable and these sorts of tapers have failed me in the past. i now have reached a point where i cannot taper at a cumulative rate of 10% per month. for those who microtaper, which was working best for me on a daily basis with only infrequent breaks but isn't now, how do you break that up? what do you suggest given that i need to now taper extremely slowly? 10% of my current dose of 19.67mg of luvox would be 1.967mg -- i won't be able to drop that much over a period of a month, not by a long shot. 

 

i've also learned, as an aside, that fluvoxamine inhibits the metabolism of clonazepam, essentially making klonopin feel stronger than it would be without, which i'm habituated to by now, but may account for some of the extreme reactions i'm having tapering luvox (or lyrica, which also potentiates the effects of klonopin via a different mechanism).  

 

advice anyone? i don't think that i should give up and stay at these reduced doses just yet as i am working toward achieving personal goals (as outlined in previous posts) and stagnancy will mean i went through all of this for nothing and throw me into the depths of depression which i'm trying to claw my way out of at present. 

[Altostrata]

Holding for a month is not a long hold. You might wish to hold for a few months, or when you're feeling substantially more stable, and then making another attempt at reducing Luvox.

 

Also see http://survivingantidepressants.org/index.php?/forum/29-members-only-benzo-tapering-discussion/regarding adjusting or tapering clonazepam.

[catalunya]

thanks for the response, altostrata. would you suggest that i touch clonazepam? i don't think it would be wise to manipulate a benzo that i've been on for years at the same dose without interruption given my instability at present. i mean, i don't know, that's just my gut feeling. 

[Altostrata]

I don't know what's going on with clonazepam. It's possible that when you upset this weird balance among your drugs, you'll have to look at the clonazepam, too.

[catalunya]

i don't know what's going on with klonopin either, only to say that luvox and lyrica affect its perceived potency. i don't think that at this point it would be wise to manipulate clonazepam. perhaps at some point down the line when i'm stable and have reduced life-hindering side effects to an acceptable degree i'll consider a benzodiazepine taper, although i'm in no place right now physically nor psychologically to endure yet another grueling process given my past failed lyrica and ssri/snri tapers. 

 

i mean, i know that luvox inhibits the metabolism of klonopin, although luvox hasn't been by any means the only drug to give me major problems during a taper. i've had very similar reactions while tapering paroxetine, duloxetine, and pregabalin. 

[bubble]

Hello Catalunya,

 

thank you very much for taking the time to consider my situation and for your support. In response to your question, not only am I not impaired but most of the time I feel better than in all those years without proper tapering. I was aware that Xanax is addictive from day one so I was constantly trying to reduce it. I was doing it all wrong with the end result that I was in constant withdrawal constantly going up and down in doses and destabilising myself dreadfully. At the same time I was convinced that I'm an incredibly anxious person that needs drugs to be fixed ;( I didn't know about ADs and as a result I had several CTs again not knowing that I was going through withdrawal but just being scared how ill I was. It's so very sad for me to remember those days. I actually try not to think about them because it's too painful. I sorted out my psychological issues through therapy a long time ago and these drugs did me so much harm...

 

If only I had found SA sooner. But I'm lucky that I found it at all. I don't want to think what would've become from me...

 

Goining back to your question about micro-tapering I will share with you my experience. Maybe it will help you. I hold between cuts for at least 10 days. It takes 4 days for the change of dose to register in the brain so if there is any withdrawal I feel it on day 5. Then I wait for at least another five days for things to settle down. Sometimes I have to wait longer. I also can't cut 10 % at once. I don't know if it would make sense for you to try this way. 

 

Regarding the small doses, mine are really miniscule but I manage. I'm tapering off of 0.81 mg at the moment divided into 5 daily doses! So in evey dose I now get 0.16 mg. I somehow feel that if I tried to taper every day I would lose control over the process because I wouldn't be able to feel withdrawal until it created a significant pile up which would then take a long time to clear and would really disable me. This way I'm almost fully functional and I can live my life as I want to (with a few exceptions)... If I cut too much I feel cortisol rising and I am quite anxious and very irritable. This is usually followed by depressive symptoms such as very low energy, loss of interest in things and difficulties with concentration. My most persistent symptom is constant fatigue and irritability. There might as well be loads of others but I choose not to pay attention to them I have to rest a lot and need to have a lot of down time on my own in nature or just watching TV or reading a book. This limits my social functioning but I can live with that. Given the horrors I've been through following CTs I'm very grateful for functioning the way I do. 

 

One more thing. I can't believe myself thinking of 3 or 4 ocassions when I CTed drugs and I was feeling horrible but still managed to work and not even take a sick leave. It was horrible to go to work every day, to get up, get ready, commute, struggle with tasks, be around people... But at the same time it was distracting and I was holding onto this appearance of normalcy for dear life. I just thought that if I let go I would drift away to some abyss. Now I give myself more slack and I'm not so awfully scared of my bad episodes because I know what is gong on and what is more important I don't think they indicate the final deterioration of my "mental health" which will only result in my going completely "crazy".

 

I take more time off when feeling particularly bad and just treat myself to more sleeping, walking in nature and other kind of restoration. I hide behind some physical symptom and it usually happens in winter months. Actually I then become a lot more unwell both physically and mentally than in other parts of the year...

 

This has been my experience so far

 

Wishing you the best of luck.

 

Bubble

[catalunya]

hello bubble!

 

thank you very much for the detailed response on how you are implementing your taper. many of your symptoms should you taper too quickly parallel mine -- my most persistent symptoms are fatigue, depression, and extreme anxiety.

 

admittedly it is quite difficult for me to fathom the notion that a mental ailment has nothing to do with neurophysiology gone awry somewhere. not that psychotropics aren't causing a whole lot of harm, but just that mental ailments in general are regarded here as nothing more than slight variations of the norm that never necessitate medical intervention. i'm not necessarily of that school of thought, but that's a topic for another day. 

 

how that ties into my own experiences, though, as a refractory sufferer of inexplicable panic and persistent anxiety is quite the conundrum. there is no question that at certain points of complete instability during my lifetime i really did need extra help in the form of modern medicine. whether i need maintenance doses has been the longstanding question, although i've always either tapered and failed miserably, relapsing into a dysfunctional state, or tapered and managed with great difficulty for some time after which i, again, relapsed into a dysfunctional state. 

 

thus, i think i've made it a realistic goal to cut back on my medications -- i'm wholly convinced that i was and perhaps still am overmedicated as i was once stable on one medication and now am on three -- to a degree that allows for a compromise between anxiolysis and manageable (read: not terribly life-impairing) side effects. do i need one? possibly. am i stuck on three? possibly, although the doses may be manipulated so as to provide for a reasonable balance in what i'm aiming to achieve. as an aside, i've also gone through years of therapy with a variety of  clinical psychologists throughout my years, although it simply hasn't been enough.

 

i think that i'll follow a variation of your tapering method once i regain stability and see how it goes. i may or may not have hit the lower limits of what my body can handle after becoming habituated on the substances for a great many years -- or be nearing the lower limits, anyway. i may, conversely, simply hit a bump in the road and may be able to continue tapering up until i reach that point. 

 

a quirk that needs to be mentioned is that i suffer from extreme muscle tension along with heightened reflexes when untreated or inadequately treated for panic disorder and generalized anxiety disorder. this isn't an unusual symptom, although what is unusual and particular to me is that the extreme muscle tension and the heightened reflex that impacts all aspects of my life is the gag reflex. i have an ultra-sensitive gag reflex that flares during panic or heightened anxiety and it can be a 24/7 thing if i'm on no medication at all. i've suffered from this since i was a very small child and i've been admitted into the general hospital after losing a tremendous amount of weight via vomiting tied to the reflex (nausea is not present and plays no part) when physicians couldn't figure out what was wrong with me -- a small child can't really communicate adequately what is going on and only later did i realize was connected to anxiety. this is of great concern as not only may i fall dysfunctional, but my physical health is compromised greatly should i relapse as the reaction is strong enough to halt the ability to speak, eat, drink, move -- live, essentially -- and i've wound up in hospital or the ER a number of times as child, teen, and adult when things have gone awry. i'm simply not able to hold onto some façade as i suffer solely internally.

 

i don't know what more to say about that, only that i can't risk a complete relapse as it puts my both physical and mental health in great jeopardy.   

 

thank you for taking the time to respond -- greatly appreciated.

[Altostrata]

You might find magnesium oil helps with the muscle tension.

[catalunya]

hi guys and gals,

 

after holding for a while, i took alto's advice and i updosed luvox from 19.67mg/day to 20mg/day about four days ago it's clear that it wasn't enough of an increase. according to my notes i was stable or having good days, rather, at 21mg/day although who knows how much hadn't caught up to me at that point yet. anyhow, do you think that an increase of one milligram from 20 to 21 will help or do you think i should make a larger jump up? 

 

i am having severe symptoms that are impairing daily functioning. 

 

thank you in advance for your suggestions and help!

[catalunya]

well, no one has commented yet, so i'll respond just to keep track electronically here. i updosed several days ago after i felt i was slipping backward at the risk of relapsing and having to reinstate back to full doses yet again (this is my fourth attempt at tapering) and so in order to try to prevent that from happening i went from 19.67mg/day of luvox to 20mg/day of luvox. that wasn't enough.

 

this morning i took 22mg/luvox and have also increased lyrica from 9.15mg/day to 10mg/day. 

 

i have no idea what i'm doing other than trying frantically to prevent a relapse and to prevent full reinstatement of my original doses. i feel very down about it all to say the least but hopefully i will place myself back into remission as looking back at my notes at those doses i was feeling fine and wasn't hindered in day-to-day life to any great extent.

 

i'm hoping for the best because i can't handle this being my fourth attempt and having it fail as well. 

[bubble]

My strategy so far when I cut too much was to ride the symptoms out: just wait for thrm to settle down and then wait some more.

 

But I didn't cut on a daily basis so I guess there was not that much delayed wd catching up with me.

 

I totally understand how you are feeling and it's hard to tell what to do. However, changing doses either up or down is usually not a good strategy because it is stability that helps the CNS to rebalance itself.

 

I think the way you are approaching this is good: updose just a bit and wait. If the symptoms don't get worse in that time even if they don't get better I would hold rather than increase. But if you feel that more than you can take is coming your way, it will be time to reconsider.

 

This time you have much more knowledge than ever before so you will make it.

[catalunya]

thank you, bubble, for your kind, encouraging, and insightful response -- i very much appreciated it!

 

i did feel a bit better after the first increase, but not nearly enough and i was teetering on the edge of an emergency-room crisis. i visited my psychiatrist yesterday who said to increase a bit further until i had reached originally prescribed doses (300mg/luvox and 900mg/lyrica). i wound up updosing both luvox and lyrica -- lyrica from 10mg to 14mg and luvox from what i had stated in my last post, 20mg to 22mg/day. she was not happy that i was tapering at all and threatened to stop treating me as i was a non-compliant patient. i told her that i would reinstate to full doses (although i'm not going to). rather, i just need access to the medication given my extreme responses. 

 

lyrica is much faster acting and likely to provide stabilization more quickly while the ssri increases, from past (failed) taper experiences, will be felt much later on. i need to be on solid ground because i risk complete dysfunction and reinstatement at full doses if i don't quickly stabilize. this has been the case during my past three failed tapers after i spiraled downhill into holes of inability to manage the most minute day-to-day tasks and so i'm terribly frightened out on top of everything else.

 

thank you again for responding and i hope that the dose increases will be enough to place me on solid ground. as my doses are rather low, even with the current increases and even if i have to updose a bit more, my goal at present is to stabilize because i've been tapering for years and i can't physically nor emotionally handle tapering for some time. as soon as i stabilize i will be holding until i feel ready to proceed (if i ever feel ready to proceed). i anticipate at least a year of not touching anything. as everyone knows here, some more than others in terms of symptom severity, withdrawal can be absolute hell, removing an otherwise functional person from the world and placing him or her into a situation so gravely intense that life itself is questioned.

[Altostrata]

catalunya, please let us know how you are doing. Also, consider finding another doctor. Any doctor can prescribe these drugs, it doesn't have to be a psychiatrist, and you don't need the anxiety in dealing with this one.

[catalunya]

i will find another doctor, alto. i have already contacted my general practitioner via email and am to make an appointment on monday. he may be willing to prescribe the medications for me, although likely not in the state i am in currently which is why i'm trying desperately to stabilize. 

 

i will also update to let users know how i am doing. hopefully much better sooner rather than later!

 

thank you very much for your suggestions and concern.