Survivor1: sleeping after trazodone (and benzo)

[Survivor1]

I am getting worse by the day.  I seem to have acute withdrawal symptoms, but I had stepped up the max dosage of mirtazepine that I have been on (2.5 mg) since 2 weeks ago.  At that time I felt wd symptoms diminishing, but now I feel really sick, slept only 1 hour last night.  Any idea what might be going on? Should I keep holding? Any help is appreciated.

[scallywag]

These medications affect the GI-tract; constipation could be an adverse effect of the medication or a withdrawal symptom.

 

Are you keeping notes of your symptoms? If not, please keep notes on paper of your symptoms and the times of your dose(s). This post has a useful format for a daily log:

Take notes of doses and symptoms.

 

 

Please post a notes from a few recent days in a row as a single reply or multiple replies here in your intro topic.

[Survivor1]

I have been keeping notes of my symptoms always.  Constipation is new.  Since I take these meds for sleep, the timing is at around 9:30 every night.  (Only Naturethroid is taken during the day.)

 

My other symptoms are random, but are they withdrawal or paradoxical effects of the drugs?  I assume paradoxical effects start almost immediately upon starting/restarting the drug, and not a while after?

[scallywag]

It's hard to know if the symptoms are a reaction to the medication or withdrawal. Please post a few days worth of your symptoms and doses notes.

[Survivor1]

Symptoms (and ratings, 10 most severe)

 

12/31/16:  Shaky 4/10, rapid and loud heart rate 6/10, anxiety 3/10, faint twitches 1/10.  Sxs lasted all day. 4 hrs sleep, feeling unrested. No appetite in evening. constipation.

1/1/17:  Same as yesterday, fragile, sxs all day with window at 9 pm

1/2/17:  Awake for most of night, loud and thumping heart, jerks in limbs at night. Day: Weak legs, constipation, Heart rate decreased in morning, anx 1/10 but increased 3/10 in late morning and improved later in day. 3 hrs sleep.

1/3/17: 2 hrs sleep, head jerks at night, heart rate fast but not thumping.  Anx improved 1/10.  Mood noticeably good.  Watched TV with pleasure after a long time.

1/4/17: 4 hrs sleep, no rapid heart rate and body jerks at night, anx 1/10 early morn, but by 8 am, heart rate and anx increased 4/10.  By 11 am, both improved. Feeling frightened. Worried that sleep meds will no longer work and cannot see myself out of this mess. Mood really off today (what a difference in 1 day!). Weak legs/disoriented. Unmotivated.

 

As you can see, the main symptoms are insomnia, rapid heart rate, myoclonus, anxiety, constipation, lack of appetite.  But they are very random in occurrence.

 

Doses of meds: trazodone 62 mg, mirtazepine, 2.5 mg, seroquel 5 mg. all taken at night between 9:30 and 10:30.  

[scallywag]

Thanks for posting those notes. A time-based log provides more useful detail to identify patterns. Please look at this post:

 

Take notes of doses and symptoms.

[Survivor1]

SW,  I will wait for a few days to post a time-based log, as I have not been doing it that way in the past.

 

In the meantime, I had a window yesterday. I felt better in all respects: low anxiety, heart rate not speeding, mood up.  However, today I am slammed.  Anxiety sky-high, heart rate ramped up, little sleep, sea legs.  I am puzzled - even though I have seen some decent days, I have subsequent days that are terrible.  I thought that I should see small improvements as time goes on, but I seem to be getting waves that are worse than the prior ones.  It has been two and a half weeks since my updose of mirtazepine and a month since reinstating seroquel.

 

Why do I feel as if I am in cold turkey withdrawal still?

 

Question about paradoxical vs withdrawal symptoms:  do people have windows while having paradoxical reactions or are they consistently feeling bad.  I am hoping that I am in withdrawal since I have seen some windows.  Any insight is appreciated.

[marie123]

Really it's all withdrawal. When I reinstated trazodone it felt like it was going "paradoxical", but really all it was was withdrawal symptoms. I was getting windows like you during this time. You are having windows and waves which will improve as time goes on. My experience has been slowly getting longer windows and the waves less intense. It took me months once I reinstated and not changing any doses/meds/supplements.

 

Marie

[Survivor1]

Marie,  thanks so much for responding.  I really needed that boost, since I was driving myself crazy that the drugs have pooped out on me.

 

Regarding your trazodone taper, how were the drops? How long did the wd last after each drop and which was your must difficult drop?  I may have a lot more questions once I start tapering, so be warned, lol.

 

How are you doing, by the way. I applaud you for your progress and wish you well on the remeron taper.

 

Best wishes.

[marie123]

Tapering off the lower doses are much more challenging for me. The drop from 1.1 to 1 took me about a month or so to feel better. I see you are now taking 62 mg traz. At that point I was taking off 10% a month and doing okay. Milder w/d symptoms for about a week or two when I was on the large doses and doing 10% per month. When I started making bigger drops that's where I got into trouble because they all accumulated. Six weeks before 10% drops you will do better, but wait until you are feeling much better.

 

Hang in there and hold steady. Good luck.

 

Marie

[Survivor1]

Thank you! I will hold steady.

[scallywag]

The improvement in symptoms isn't linear, as in every day is a little bit better than the last. On some days and weeks symptoms are stronger than on others. As Marie mentioned, we call the good days "windows" and the the heavy symptom times "waves".

The Windows and Waves pattern of stabilization

[Survivor1]

I am slowly understanding this non-linear healing ... at least I get some windows now.

[marie123]

Also, what I notice is whenever I get an intense/long lasting wave, I feel substantially better when the wave is over. It's like a new level of baseline. At some point you might start to notice this improved healing. Just to put it out there.

 

Marie

[AliG]

S.  It takes practice but you will get the hang of it . If you are getting some windows you are healing.  Thanks for visiting my thread with positive encouragement.

 

This does get so much better. Patience is needed.

Hang in there.

Ali

[Survivor1]

Hi all,

 

After having a good day a few days ago, I have been slammed.  Today again I am feeling VERY shaky, and heart rate is high.  I am beginning to wonder if I am having a reaction to mirtazepine, as I have not felt this bad since ct'ing from seroquel.

 

I am plagued by negative thoughts about poop-out, and the bits in JanCarol's post about kindling/tolerance.  How does one deal with poop-out if that is the case? 

 

Sorry for my negativity.  SW, AliG and Marie, I truly appreciate you all for trying to bring something positive to my experience.  Please indulge me if I keep repeating myself, sometimes I am just looking for reassurance that I will feel Ok at some point.

 

Thanks.

[marie123]

Hi Survivor. Thanks for your encouragement on my thread. I hope you are feeling a bit better. I would keep staying steady on your doses because I think any changes would not help at this point. Are you getting windows still? If so that's a very good thing and it will only improve with longer windows.

 

Marie

[AliG]

Survivor. I'm sorry you feel that you are getting slammed. It can feel like that some times but I think it sounds more like waves and not necessarily a reaction to Mirtazapine.

 

Hang in there. This does improve over time.

[Survivor1]

Marie, AliG,  thanks for checking up on me.  

 

I am happy to report that I have been getting more windows the last few days!  My heart rate is not as fast and thudding as before (this is what scared me into thinking I had serotonin syndrome earlier!!), anxiety is not all-day but just short episodes during the day, sleep has been 5+hours last three nights.  Yesterday, I ate dinner with enjoyment ... (now if only I could figure out what to do about the constipation ... lol)

 

I still have some sea legs, low motivation, myoclonus at night, and rumination about poop-out, but I hope these will go as I hold longer.  I will post again in a few days.

 

PS: Ali, I have been reading your thread and can't imagine how you managed on so little sleep for so long.  What were your coping mechanisms.  I feel that this is my achilles heel ...

[marie123]

When you feel more stable and ready you can try magnesium citrate called "Natural Calm". I've used it in the past for w/d related constipation. Make sure to start with a tiny amount like 1/4 tsp. It makes you more regular. I've having some of that now too and will restart it again soon when I'm feeling a bit better and more stable. It also relaxes you a bit so it can make sleep a little better. We take the same meds and both can cause it.

 

Marie

[Survivor1]

Hi Marie,

 

Thanks for the suggestion.  I take mag citrate already, but not everyday, so I should probably use it more regularly.  I can trace the constipation to starting mirtazepine, although the dose is not especially high. Did you have constipation from the mirt. also?

[marie123]

yes.

 

Marie

[Survivor1]

Having a wavey day today.  Strong anxiety all day, sea legs became heavy like loaded with lead.  Can barely feel when I place feet on floor - almost buckling.  Trying to cope by placing one foot in front the other (pun intended!), but difficult.  Also some low mood.  But, onward I go ...

 

At least I slept ok last night, 6 hours!  

[AliG]

Hi S.

 

Ali, I have been reading your thread and can't imagine how you managed on so little sleep for so long.  What were your coping mechanisms.  I feel that this is my achilles heel ...

 

I wish I had an easy solution for you but it was hard going for a long time. It sounds simplistic in retrospect but I had faith that after a certain period of time drug free that my normal sleep cycle would return and that is what happened. One of the main things was that I didn't panic. I accepted that I would be very tired for quite a while. That acceptance helped considerably. 

 

I did try various strategies and supplements. What did work to an extent was the sleep tips that we talk about here like keeping lights low , block out blinds etc. but during the worst of it nothing really helped at all and some things made it worse.

 

After a period of time I tried Melatonin again at a low dose and that helped to get my sleep pattern back but I think the timing was just right. After that I dropped it again pretty quickly. I didn't want to get stuck on anything long term.

 

It was mainly time and patience. 

[Survivor1]

AliG, your experience is so inspiring.  I hope I have what it takes to cope like you did when the going got rough.  A lot of my neuro-emotions come from the fact that I haven't even begun tapering, so in no way close to being drug-free!  Oh well...

 

Today is an ok day, anxiety spiked all day yesterday, but is better today.  Heart rate is back to thudding.  Sleep broken again... Am functional but, meh...

 

Hopefully my next post is more positive.

[Survivor1]

I have noticed a few symptoms these past few months that harken back to klonopin wd days:  severe rash on back, and very tender breasts (due to elevated prolactin levels).  I was also having severe myoclonus of the left inner ear muscles that was so painful I went to an ENT see whether the muscle needs to be severed to alleviate the pain.  I did not know it was from benzo wd. He advised waiting because the surgery is irreversible.  Eventually the ear myo went away.  These sxs were very disconcerting/painful the first time, but I managed because I told myself I was off the benzo.

 

 But now, I am hit with them again, and am still on my cocktail!  Having to go through these and other symptoms for what seems like nothing (no reduction in dose) is a bit hard to take.  The myoclonus in the ear is actually painful and disorienting and causes heightened anxiety.  It feels like I'm being slapped but from the inside of my head. I do see some improvement.  However, myo in other parts of the body along with smaller fasciculations are there in full force.

 

I was getting out of my funk these past few days, but yesterday since the anxiety ramped up, along with the unsteady, heavy legs, that I'm back in the low mood.  Ugh!  It's been 6 weeks since I reinstated seroquel, and four since I updosed mirtazepine.  I would have thought that I would be better than I am currently by now, but I guess the body will heal in its own time.

 

 

Good part: slept 6+hrs, but who wouldn't with 3 hypnotics! 

[Survivor1]

Oh, forgot to mention that today I took my dog to the vet for an infection on his paw.  Was given an antibiotic and topical solution for it.  The vet then suggested that if the two meds cause any unusual behavior, I could give him some trazodone to "chill out".  I flipped!  I told her that I have been having a hard time from discontinuing trazodone, why would I want to give it to my dog.  I probably overreacted.

 

She was visibly taken aback.  Said she did not know people took trazodone!  Poor pets.  Why would psychotropics be used on animals.  Seems inhumane.

 

For that matter, some years ago my cat had kidney failure and was not eating.  Another vet wanted to put her on remeron to stimulate her appetite (no wonder remeron sounded familiar when my doc gave it to me!).  She did not survive long enough to start the remeron.  But I may have given it to her since I did not know any better.

[Survivor1]

So, today brings a mixed bag.  

 

The heavy legs have improved much.  But anxiety is back with a vengeance, as is the heart thudding.  Strange, my heart feels as if it is thumping out of my chest, yet my fitbit says heart rate is "only" 80 bpm.  The rate varies at rest from 65 to 95 bpm throughout the day.  These two symptoms are the most severe, with improvements in the latter part of the day.  

 

Other sxs are body jerks/fasculations, inner ear myoclonus, rash on back, tender breasts.  But these are more manageable.

 

The wait continues...

[Survivor1]

Hello all,

 

I think I really need help.  These past few days have seen a worsening of sxs.  Body jerks are very strong, with head lifting off pillow, lower jaw moving violently, shoulder jerking wildly, and also strong fasciculations.  It was really scary.

 

Moreover, heart rate has not stabilized, it is becoming more erratic. Ranging from 65 - 100 bpm.  I have also developed paresthesia in the left leg: it feels numb yet like a cold burn, hard to describe.  Relieved by moving leg.

 

I am feeling shaky again.  Seems like my alerting system is not stabilizing.  Sleep has been broken/shortened.

 

I was wondering if I am actually having an adverse reaction to one or all the drugs because it seems odd that these sxs seem like in the acute phase of wd, and are either new (paresthesia) or showing no improvement with time.

 

My diary for the past few days are:

 

Jan 22:

6 am: body jerk and fasciculations, HR thumping, faint anx

All day: many ear myo episodes, many fasic, HR thumping up to 90bpm, anx moderate, pain in knees.

night: meds at 9:35 pm, fast sleep onset, 6+ hrs sleep

 

Jan 23:

6 am: hand jerk and neck fasciculations, HR thumping, faint anx

morn: HR variable 65-95 bpm, anx high

afternoon: HR normal, low to zero anx, weird feeling in  left leg

evening:  HR increases to above 80, faint anx

night: meds at 10:00, fast sleep onset, 6 hrs sleep

 

Jan 24:

6am: lots of fasic, violent lower jaw movement, low anxiety

morn: anx increase, HR variable 80-95bpm, slightly shaky

noon: 6pm: zero anx, HR variable

evening: ear myoclonus, HR variable 65-85

night: meds at 10pm, fast sleep onset, woke up at 12am, awake for 2 hrs, up again at 5:30 am. - 5+hrs sleep

 

Jan 25:

6am: strong shoulder jerks, fasics., HR thumping to 100! Anx high

morn: HR and and lower, ear myoclonus, heavy legs, shaky

 

Am feeling quite helpless.  I don't feel much different from the days I reinstated/updosed.  

 

Adverse reaction or not?  Body jerks, anxiety and rapid HR are a not a good combination!

 

All thoughts appreciated.

[AliG]

This sounds like withdrawal . It's hard to say. Keep taking notes on your symptoms and we can see if more of a pattern develops.

 

I would keep everything stable for now . Hopefully your symptoms will improve as a result.

[Survivor1]

AliG, thanks for responding.

 

Do you feel it's wd because I have some windows during the day?  A corollary: if an adverse reaction, the terrible feelings would be there 24/7, with no windows?

 

I will wait it out, but I was hoping for more improvements by now.

 

I so appreciate your coming to my thread with your encouragement/advice.  I really needed it today. Thanks!

[Survivor1]

Just clocked HR at 115bpm!  Also blood pressure high.  Really getting worried ...

[AliG]

Survivor.   Perhaps It would be worthwhile checking in with your Doctor to monitor your blood pressure , heart rate etc. to rule out any other possible causes. 

 

This will also help you with the worry and stress you're experiencing. I'm so sorry that you've seen little improvement but you have had some windows which is a positive sign. 

 

Please keep taking notes on your symptoms.

[Survivor1]

Hi AliG, I have gone to the dr. and she is monitoring.  I am pretty certain they are wd-related as my bp was perfect  until 09/16 when the seroquel wd started, and the hr was fine until a few months ago.  

 

Anyhow, I had a few really good days, and knew a wave was forthcoming.  And what a wave today!  Massive anxiety, and serious body jerks.  The last two nights, I took a slightly decreased dosage of mirtazepine (2.38 instead of 2.4), due to laziness in not wanting to be as precise as I should be.  I wonder if this is the cause, or it is just a wave.  If because of lower mirt dose, well I don't know if I have it in me to taper!   The reaction was overwhelmingly scary at such minute reduction.

 

Lord help me!

[Survivor1]

Hello all,

 

Wanted to update my situation.  I feel that many symptoms have improved:  less anxiety and constipation, legs are more normal (not heavy), sleep 6+ hours 

 

But I have a worsening symptom:  body jerks and twitches.  I had this when wd'ing from knonopin and tapering trazodone, but I could feel it diminish over time.  Now it is actually worsening as I hold.  I try to drift off to sleep, but the jerks jolt me awake.  Sometimes, it is scary.  I also hear noises (clicks/crash) in my head when trying to sleep. I also get these twitches and jerks during the day.  Do these go away while holding on the drugs?  I am worried that this is tardive dyskinesia TD and I will have to be off the drugs before I see improvement, since I see it worsening instead of improving.

 

I plan to hold for another two months at least.  Hopefully I see improvement in the twitching.  

 

Appreciate all thoughts on TD.  

[Survivor1]

Hello,

 

I have been trying to be positive over the reinstatement of seroquel and updose of mirtazepine in October.  But I am starting to get very worried over one particular symptom:  lots of body jerks and facial tics, with other fasciculations, including a return of brain zaps.  I have had these for awhile (since this past summer when I rapid tapered trazodone.  But now I feel that it is getting worse.  I began to notice the worsening early January, but thought that waves come and go, so ignored it.  Now I cannot ignore it.  It used to be that this sx was mainly at night, now I get during the day also.

 

What to do?  My seroquel dose is low, so I assume any movement disorder from antipsychotics should not be an issue?  But I am worried.  I do not feel that I can start reducing any med as I am clearly not yet stable, but if seroquel is the problem, should I start reducing it?  I have just re-started magnesium and fish oil.

 

Other current sxs are low level anxiety, short spikes in rapid HR, heavy limbs, all at random times.  These have improved somewhat over the last month.

 

Any ideas/advice?