flatrock: My Journey

[flatrock]

Hi.

My story is a bit complicated, sorry. Much of it is about Klonopin, but my main problems currently seem to be a result of Remeron (Mirtzapine) and a drastic forced reduction of the Klonopin 4 months ago. I apologize if this is the wrong place to discuss Klonopin (chlonazepam).

 

I'm 62. My overall diagnosis for the past 7 yrs is Fibromyalgia. I took 1.0 g Klonopin every night for several years for RLS, and it didn't seem to hurt me in any way. Occasionally my dr increased that dosage, as it is addictive - but I kept insisting on tapering down again. Sometimes I went down to .5 per night.  I was very consistent until the past year when many stresses caused huge anxiety and during those times my dr allowed me to take Klonopin as needed.

 

Anyway, I moved to a new area to be near my grandchildren 5 months ago. It triggered extreme anxiety and depression. I went to a new doctor who started me (4 months ago) wham-bam on Cymbalta and Remeron and Tizanadine (a muscle relaxant) (despite my telling him that my old dr had prescribed it for only occasional use for muscle cramps). At the time I was taking Klonopin (1.0) several times per day (6-8 per day) for the anxiety, as approved by my previous doctor. New dr insisted I immediately reduce to 3.0 mg per day. I suffered terribly from the quick reduction of the Klonopin. Jittery, shaky, anxious. That was 4 months ago... still haven't recovered.

 

He started me on 15 mg Remeron, then after one week up to 30mg. Although I liked the emotional effect Remeron gave me, I struggled terribly with crazy restless legs. I hear a certain number of patients get this side effect. It was bad, lasted sometimes a couple of hours. But then some nights I did not have it at all. I began to call it Russian Roullette RLS. To combat this RLS side effect, new dr approved of taking all of my 3 allotted Klonopin at night. I then slept great. BTW, I begged the dr to take me off of the Tizanadine, as it seemed to be causing extra anxiety, so he finally did. I'm back to using that only occasionally.

 

I've been on Cymbalta in the past and feel it is a good medicine for me. However, I suspect that the Klonopin mixed with Remeron caused problems. Or it's just the Remeron, I don't know. But the scariest thing going on for me is an "action tremor." When I am still, you can't see any shaking. But when I use my muscles in any way, I can feel the tremor, and there are certain moves I can do to show others the tremors. Also my heart rate tends to be quite fast - up to 100/minute. I never had that before. But today I meditated and it went down to 72. And my overall shakiness makes me scared and confused... I'm at that age when it could be something serious, but I'm trying to wait it out. My new dr kept saying it must be caused by the Remeron. I've been off of it for a week, and I'm hoping he's right.

 

I'm seeing a psychiatrist now, since my new dr did not want to prescribe the mood medications. A week ago he prescribed my 1.0 Klonopin to be taken - a total of 1.0 - at a steady pace, .25 morning, .25 afternoon, .25 bedtime, .25 middle of night. He thought that perhaps I'm experiencing "withdrawal" during the day by only taking the Klonopin at night, which was a pretty good idea, but it is not making a difference.

 

To further complicate my life, 2 months ago I was diagnosed as prediabetic, so my diet has also changed drastically. I'm not overweight and diabetes does not run in my family... I think I just had a bad year and ate/drank too much sugar. My mom was sick for that year and then died, I had a 4-month anxiety reaction to a normal dose of prednisone, and I moved. Some pretty big stuff.

 

This was really long. Anybody who reads through it - thank you for listening.

Edited December 3, 2016 by Shep
changed title, per flatrock's PM

[yyeehhaaww]

Oh, Flat, I am sorry for all you are dealing with.  I am glad you found us.  Howdy from Texas.  You have been through and still are dealing with a lot.  An Exper (Moderator) will be posting as soon as they can.  Hold on.. you are among people who understand a lot.

[flatrock]

yyeehhaaww, your sweet response has made me cry - it's a good cry - thank you.

[yyeehhaaww]

so very much UNDERSTAND.... I got one from catnapt earlier today.. it is amazing how we can help and touch one another no matter how far apart.   Close your eyes and feel my hug.  We care,

[flatrock]

Thank you so much!

[scallywag]

flatrock -- Welcome to Surviving Antidepressants (SA)

 

Thank you for posting an introduction and for creating a medication/withdrawal history signature.

 

It's infuriating that some doctors consider significant dosage decreases harmless. I'm sorry that you have had to deal with this ignorance and professional undereducation + misinformation.

 

To give us a fuller understanding and to help others who read your topic, would you post more about how you tapered off Remeron? 

 

It's possible that you'll experience withdrawal symptoms from discontinuing Remeron (mirtazapine) after your discontinuation last week. You may want to conduct a once-a-day review of your symptoms. The downloads (PDF, .docx, xlsx) at this linked topic are useful for that purpose:

Link: Glenmullen’s withdrawal symptom list

 

If you are looking for discussion about tapering benzo medication, you may want to look at our Members-only benzo forum. There are a number of informational topics pinned to the top of the list and discussion topics for individual member's tapers below.

Link: Members-only benzo forum

 

Here are links to 2 discussion topics about tapering:

Before you begin tapering -- what you need to know

Why taper by 10% of my dosage?

 

Here are some links for your current/recent medications:

Tips for tapering off Cymbalta (duloxetine)

Tips for tapering off Remeron (mirtazapine)

 

This is YOUR introduction topic -- the place for you to ask questions, record symptoms, share your progress, and connect with other members of the SA community.

 

I hope you'll find the information in the SA forums helpful for your situation. I'm sorry that you are in the position that you need the information, but am glad that you found us.

[flatrock]

Scallywag, thank you so much for your warm and thorough welcome!

 

The dr was worried about my tremor, and I think that is the main reason he wanted me off of the Remeron quickly. I was the one who said No, I'm NOT going to go directly back down to 15 mgs. But because I was on the Remeron for a relatively short period of time, the taper I did seemed okay - except that right now I ain't feelin' so great:

- First week at 15 mg

- about 5 weeks at 30 mg - this is when my tremors became really obvious

- about 2 weeks at 22.5 mgs

- about 2 weeks at 15 mg

- about 4-5 weeks at 7.5 mg (finally got first appt with psychiatrist at about 2 weeks at this level) - and then quit.

 

The same day that I quit the Remeron my psychiatrist put me on the low continual dosage of chlonazepam in hopes that it would help with the tremor, by keeping it consistent.

 

I agree that it's infuriating about the drastic drop my dr insisted on about the chlonazepam. I thought I was going to go crazy. I almost checked myself into the hospital I felt so awful. He was adamant that it's a bad medication and I should get off of it as soon as possible. He wanted me off of it within 2 weeks. I persuaded him to keep me at 3.5 mgs until my first appt with psychiatrist. While I waited for that first appointment, I very slowly tapered myself, .25 at a time, as it felt comfortable.

 

This same dr also took me off of Celebrex cold turkey at the same time. He was very worried about me. I'd been taking it daily for about 3 years and it is now "black boxed" with stroke and heart attack warnings. You can imagine what a mess I was, going without Celebrex, the drastic reduction in chlonazepam and the addition of both Cymbalta and Remeron.

 

I was on Cymbalta for a few years a while back and decided to taper off of it about 1&1/2 yrs ago - it has a b**** of a discontinuation syndrome, as you know. I made it through - but when my new dr wanted me to go back on it, I decided to stick with it, not try to decrease it - but also not to increase it. I have fibro, so it's probably a good med for me. In the past I've had no side effects.

 

So... a couple of years ago I was on twice the amount of Cymbalta, Celebrex daily, chlonazepam every night, I took my homemade Cannabis butter (I have my card) and I was a hard drinking party girl. What was I thinking?!?! I felt pretty good though! Now I'm a wreck, almost never drink, and don't use the cannabutter any more -- I feel like my system is very fragile right now and want to take good care of myself.

 

Thanks for the links, I'll check them out.

Why don't I find many people here talking about Remeron? Is it a new med, or an old one, or just unpopular?

 

Flatrock

[scallywag]

Thanks for the details about your taper from Remeron. 

 

There are a number of people dealing with tapers from Remeron on the site.  You can find them by clicking on the "Remeron" tag at the top of the page.

[flatrock]

I found the Remerons, thanks, very helpful. So far though nobody has mentioned tremors. I'll keep looking!

 

I printed out the daily check-in sheet for symptoms... It's going to be super helpful, thanks again for all of the links!

[Shep]

Hi, flatrock.

 

Yes, tremors are very common during withdrawal. Here's more a thread with more information:

 

tremors, shaking, body vibration, internal trembling

 

It's a sign of central nervous system (CNS) destabilization. I had them horribly earlier on, but now that I'm off all drugs, it's not nearly as much of a problem.

 

As you come off the drugs and heal, your CNS stops over-reacting to everything and calms down.

 

While many members report problems with a lot of supplements, a lot of us do quite well with fish oil and magnesium, as they can have a calming effect on the CNS. Here's information on that:

 

King of supplements: Omega-3 fatty acids (fish oil)

 

Magnesium, nature's calcium channel blocker

 

I don't use supplements, but I do eat a serving of fish every day for Omega 3 and I use Epsom salt baths as a gentler way of getting magnesium. So there's all sorts of ways of getting these. 

 

Please let us know how you're doing. 

[yyeehhaaww]

I have a hand tremor from lithium, do y'all think it is permanent?

[flatrock]

Shep, thanks for your response. What do you think about the tremor starting while taking the Remeron? That's what's worrying me, that it isn't just the typical withdrawal symptom, since it started while taking it. They came on slowly, so at first I shrugged it off. I noticed I couldn't roll my shoulders smoothly in a circle. Then maybe a week later noticed that I couldn't smoothly roll my feet/ankles smoothly. It took a couple of more weeks to notice a real tremor whenever I used any muscle. At least it's not involuntary tremors - hands jerking out of control, things like that. I'm just afraid, I guess, that the Remeron started a tremor that will never go away. 

 

That said, tonight, for the first time, a certain leg movement was slightly improved!

[flatrock]

Yeehhaw, I hope not!

[Shep]

Shep, thanks for your response. What do you think about the tremor starting while taking the Remeron? That's what's worrying me, that it isn't just the typical withdrawal symptom, since it started while taking it. They came on slowly, so at first I shrugged it off. I noticed I couldn't roll my shoulders smoothly in a circle. Then maybe a week later noticed that I couldn't smoothly roll my feet/ankles smoothly. It took a couple of more weeks to notice a real tremor whenever I used any muscle. At least it's not involuntary tremors - hands jerking out of control, things like that. I'm just afraid, I guess, that the Remeron started a tremor that will never go away. 

 

That said, tonight, for the first time, a certain leg movement was slightly improved!

 

 

When you added Remeron, you may have been getting both MAJOR and MODERATE drug interactions with your other drugs, especially Cymbalta.  This may explain the muscle issues and tremors, as I've highlighted in red below. 

 

I placed Remeron, Cymbalta, and Klonopin in a drug interaction checker and here is the report:

 

https://www.drugs.com/interactions-check.php?drug_list=949-2273,703-357,1640-1015

 

Major mirtazapine mirtazapine  duloxetine

Applies to: Remeron (mirtazapine), Cymbalta (duloxetine)

Using mirtazapine together with DULoxetine can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should seek immediate medical attention if you experience these symptoms while taking the medications. Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. 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

Moderate clonazepam  mirtazapine

Applies to: Klonopin (clonazepam), Remeron (mirtazapine)

Using clonazePAM together with mirtazapine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. 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

Moderate clonazepam  duloxetine

Applies to: Klonopin (clonazepam), Cymbalta (duloxetine)

Using clonazePAM together with DULoxetine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. 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

 

[flatrock]

Wow, this is so thorough, thank you. It can be scary stuff. Chlon has been a constant. Cymbalta I'd been on for several years, with about one year off.  The new dr started me on Remeron and Cymbalta on the same day.... so yeah, who knows what's what. The dr, pharmacist and I all think that my symptoms were not severe enough to be the serotonin syndrome, thank goodness. I'm just glad that I'm now off of the Remeron, and that I wasn't on it for very long. 

 

It's really nice to log on and see more friendly and helpful advice from you, thanks so so much!

[flatrock]

Just checking in...

 

High anxiety during the night and all day today. As I wrote on some other thread, I'm one big ball of anxiety!  I can tell my body wants me to increase the chlon. Also I can tell that I recently quit the Remeron. So it just is what it is. But that doesn't make it easy! I journaled, I meditated today, I wrote down my gratitudes, I had my quiet contemplative morning time, I practice mindfulness as much as possible. But it is challenging to sit there and notice one's anxiety and to just be with it, to just sit there with it. The urge is to do something for it, to take medicine, to take a drink, something, anything. Especially after a bad restless night - I just sat there thinking, well, that stunk, that was rough, what the heck? And then I just sat there with the after-feelings, the anxiety, the shakiness, the miserableness. Part of me felt like a big baby, that I was just being oversensitive and I should just grow up and get on with my life. Then the part of me that wants to be gentle with myself had no idea how to be gentle. I tried hugging myself. There, I did it just now too - that helps. It's really just a question of being okay with discomfort. 

 

Well, now I have to go be on grandma duty for a couple of hours... I hope everyone is doing AWAP (as well as possible)!

[flatrock]

Hello, just checking in to say I'm going to take a break for a while. Since I've already quit Remeron, I don't have any special challenges except enduring the after-effects, so, yeah, just going to take a break. I'm sure I'll be back on the site sometime soon.

[scallywag]

Take care. Please come back and let us know how things are going for you.

[flatrock]

Hi, I'm back and still struggling. Thanks Scallywag for your friendly message here.

Since I'm off of the Remeron, I figured I didn't need to be here - but for the general support, I do need to be here! It's been a rough road. It's been less than a month since I quit taking it altogether (very helpful to have one's history in one's signature!) so that helps me remember to be gentle with myself.

After getting a colonoscopy and all the prep (12/11 and 12/12), I hadn't been taking my chlonazepam regularly, and so for some dumb reason I thought I should just go ahead and drastically reduce chlonazepam this week. (I'll post this in the benzo forum) Oh geeze, I thought I was doing fine by cutting my amount in half - but today woke up feeling horrible, vomited, low fever, shaky. I either have the flu or awful withdrawal symptoms. I'm taking the amount right back up to where I was a week ago.

 

I've had so many medicines introduced and taken away in the past 6 months, half the time I don't know what's bothering me, you know? For the most part I function well, go out, see my kids and grandkids, go to activities... but then there are days like this when I feel like total crap.

 

Thanks to anyone listening.