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Tiggy: Is it withdrawal or bipolar depression?

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I am 54 years old, and experienced my first manic episode, starting 1st November of last year, requiring a month of involuntary hospitalisation starting 14th November brought on by numerous stressors.


I was on Lithium and Haloperidol, from the 15th Nov, then ±900mg Lithium and 0.5mg Risperidone from the 15th Jan .


I started tapering the Risperidone from the Feb 16th. My last dose was 0.125mg on 15 March. How long will the withdrawal symptoms last?


The reason why I'm asking is I'd also like to know if I am experiencing withdrawal symptoms or bipolar depression? The intense depressive feelings arrive and leave suddenly and unexpectedly, sometimes lasting a few minutes, sometimes a few hours, after which I feel mildly depressed again, which is a general state.


I am able to be lifted, for example by gardening, good cooking, humour etc, during this general milder state. I have general anxiety about several factors which triggered the original mania, namely money (increased now, due to difficulty working), accommodation for my and my spouse's ageing parents who are both difficult to work with, those being by far the most major among other stressors.


I have found that very carefully-considered and rare - perhaps twice a week - use of Diazepam can also return me to this state from the more intense state.


I intended to start tapering the Lithium once I feel more stable and know myself better after this current tapering.


I apologise if this has been covered before, but I find reading and writing about my condition extremely stress inducing, which is to say getting to this point has not been easy. I am eternally grateful in advance for the help.

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Hi Tiggy and welcome to SA,


You have most probably tapered off the Risperdal too quickly.  Please see the following:


Tips for tapering off Risperdal (risperidone)


From Post #1 in this topic:


"As with other psychiatric drugs, do not taper Risperdal by taking a dose every other day! This causes a fluctuating level of the drug in your nervous system and can make you very sick.

To minimize the risk of withdrawal symptoms, we recommend a conservative taper of 10% from the previous dosage every few weeks. The amount of the decrease keeps getting smaller. Some people find they can go faster and some people find they have to go slower -- they can only tolerate decreases of a fraction of a milligram at a time. See Why taper by 10% of my dosage?
Very careful tapering is necessary when you have had psychotic symptoms. Such symptoms can appear as withdrawal symptoms; that will cause you to become diagnosed as relapsed and re-medicated. Read Psychiatrist: Some patients are better off without antipsychotics..."


Please create a drug signature Create Your Signature.  Please include details for the last 12-18 months of  all drugs, dates, doses and discontinuations & reinstatements.  If you can't remember dates, please write it as "early March" or "mid-August".  Please provide a summary of any drugs prior to that which can just be listed with start and stop years. Please include all prescription, non-prescription drugs and supplements you are currently taking. Phone Instructions:  Withdrawal History Signature. Please also remember to update it with date and dose whenever make a change so that it remains current. Thank you.


This is your Intro topic where you can ask questions and journal your progress.


One of the other mods who has more knowledge about these drugs will hopefully drop by soon and be able to give you additional information.

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Thankyou so much. I am composing my drug signature table and will post it shortly.

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I have created my signature. Thank you again.

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Hi. Tiggy's husband here.


I've been tracking her quite closely, that is: as closely as I could, which is to say she's been proactive about tapering until this point where she now knows that the meds are not so easy to withdraw from.



I hope it's ok that I respond in this capacity. I do believe it is preferable that I'm on-board, seeing as she finds it extremely difficult to manage this herself. She has asked me to post here, and I feel I am well-positioned to act on her behalf to this extent, seeing as I've been with her every step of the way: I watched the mania unfold from the start, not knowing what it was until too late.


I visited her whenever the state allowed it: four times per week. I stopped working, and devoted a solid 1.5 months to researching her condition and case particulars from various angles. In this regard the state hospital was completely lacking. I directly challenged their bipolar diagnosis based entirely on the DSM-5, and one sentence regarding past depression from Tiggy. It is worth noting that the head psychiatrist had never heard of unipolar or secondary mania. The meeting was promptly terminated when I calmly insisted that it existed, and suggested a quick Google search.


I mean it when I say her wellness has become my life's mission. My own (so-called) Aspergers has proved an asset in this regard.




I am 100% of the opinion that what she had was an episode of secondary mania brought on by lack of sleep and numerous extreme stressors. Although a certain amount of depression is to be expected after such a jolt, what she is currently experiencing is the result of both tapering too quickly, and the dual-tapering of lithium and Risperidone.


I am strongly of the opinion that Lithium is not needed in her case. Even the mainstream tends to agree on this.



She believes she can ride out the current instability without Risperidone, at which point we will - SLOWLY this time - taper the Lithium.

I am with her on this, pending advice from this forum. I think she has the following on her side:

  • The very short time on meds
  • The relatively-low dose of Risperidone she was on


I have one question at this point:

from what is known, is staying off the Risperidone - as she is currently - viable / advisable?



[1] Secondary Mania: diagnosis and treatment

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Just a word to endorse my husband's support.

Note: we made an error in writing up my current Lithium dose.

It is 500mg, not 1000mg. I have updated my signature to reflect this.

Thank you all.

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Hi Mr and Mrs Tiggy,  welcome to SA. It would be advisable to hold the lithium taper until the nervous system has stabilised. A reinstatement of risperdal could help, even a very tiny dose might make a difference, then when things settle you can taper from that small dose. It is better to taper one drug at a time so you know which one is causing any withdrawal symptoms. 

Can you tell us about the diazepam, how often you take it and the doses? Often people take it irregularly thinking it will be fine as needed but over time this can lead to interdose withdrawal.  


Is there a pattern to the symptoms?  Withdrawal comes in what we call windows and waves, a wave of withdrawal followed by a window where things improve. As time goes by the windows last longer and the waves get shorter. 




The fluctuations often lead doctors to believe this confirms their diagnosis of bi polar, or to diagnose it for the first time. It is usually a mis-diagnosis thanks to their DSM! 

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Hi MammaP,


"mr and mrs tiggy".. ha ha, thanks : ) that's going to stick with us, I can tell.


Congrats on your own taper success story!


I've been following this forum for the past month, and the challenge it represents to pharma-sponsored diagnosis, and indeed one's entire political world view is pretty earth-shattering to say the very least.



The decision to use Diazepam very carefully and selectively was based on something I read by David Healy, but I'll be damned if I can find it now.

(David Healy is mentioned on 450 pages on this website, so perhaps introducing him is not necessary. I am a rather obsessive web developer, and my ranking of "top players" in critical psychiatry - crudely based on web hits - is below.)


I can see I'm going to have to dig up that info on Diazepam, though before I can go further in explaining why I decided it may be ok. I am very open to the fact that it may well not be ok. In fact Diazepam sounded the first alarm bell when we heard the state hospital were pumping it into her system.


I'll try to find out more from Tiggy about when / what her Diazepam dosing has been.


I've also just remembered that she may be on Zolpidem (aka Ambien, Stillnox etc), so I'll have to get that info from her too and help her update her signature.

Possibly also relevant seeing as there's a link between Diazepam and Zolpidem usage, though I doubt the doctor had them both in mind.


Will check back shortly, hopefully within the next 12 hours.



Of possible note: the Tiggys have suddenly become rather avid cyclists, and hit a new distance record yesterday. Ok, it was only 12kms, but it's a lot for us, seeing as being physically fit for the current and looming battles has become imperative. A good bike ride along the shoreline seems to be the one thing that can flush the depressive rushes out without fail. Using a FaceTime call with earphones as walkie-talkies we are able to stay in constant audio contact.



Thanks again, MammaP!

Simply forcing ourselves to make the drug signature is already helping.


- DrMussyWasHere






Some Top Names in Critical Psychiatry

Crudely based on numbers of Google web hits, and probably incomplete, but it's a start.

(v = verbatim results)

  • David Healy
    70 600 v37 300
  • Robert Whitaker
    68 000 v52 500
  • Peter Breggin
    60 800 v48 200
  • Allen Frances
    56 100 v45 000
  • Michael First
    21 900 v21 800
  • Oliver James
    17 700 v79 700
  • Joanna Moncrieff
    16 600 v12 800
  • Peter Gøtzsche
    16 600 v8 100
  • Christopher Lane
    15 600 v29 400
  • Richard Bentall
    14 300 v9 720
  • Peter Kinderman
    9 980 v23 000
  • Ronald Pies
    9 350 v7 300
  • Heather Ashton
    7 650 v13 900
  • Volkmar Aderhold
    4 670
  • Martin Harrow
    4 160
  • Alvin Pam
    3 290
  • Jill Anderson
    2 920
  • Luke Montagu
    1 360
  • China Mills
  • Sami Timimi
  • James Davies
    18 200 v9 060
  • Stefan Ecks
    v2 410

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Tiggy has re-instated Risperidone at 0.0833mg daily.


The additional info, also now added to her signature is:

  • 7 February: Stilnox / Zolpidem, 12.5mg once weekly.
  • 5 March: 0.25mg Diazepam, once weekly.
  • 15 March: stopped Stilnox / Zolpidem.

Note: she was on 7.5mg Diazepam in the state hospital since 15 November, then abruptly withdrawn on the 20 December upon her release.

She says she used to spit them out occasionally, though can't remember how often.


The head psychiatrist told me they were using it as measure of brain activity.

In the beginning it had little effect, whereas by 20 Dec she was a drooling, shuffling zombie (great job, guys.. not).


This was also partly due to Haloperidol, lowered when I informed them, then switched to Risperidone on the 9 Jan by a private psychiatrist.



Thank you ever so much for the hand-holding.

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Thank you for the updates and signature, it helps a lot when we have all the info. Right away I can see that on the 15 March zolpidem and risperidone were stopped, then further down on 15 March "Since 15 March, occasional unpredictable jolts of high depression lasting a few minutes to a few hours"    


Looking back at the history there are such a lot of drug changes there is little wonder that Tiggy is having a hard time. Just one drug can rock the nervous system and there have been numerous drugs in a short time. ( The same happened to me, a breakdown due to stress then weeks in hospital with a 'bi polar' diagnosis and drugs to treat it ) 


Condensed version 

Nov 15  lithium 900 tapered to 500

November 15 2016 7.5 diazepam c/t Dec 20.

 November 15 Haloperidol  c/t Jan 15

 Jan 15 risperidone 0.5 tapered immediately for 6 weeks, quit 15 March

zolpidem once weekly  quit 15 March 

diazepam 0.25 reinstated 5 March once a week.


 Reinstated risperidone  0.833 30 March  


The diazepam in the hospital was long enough at high doses to cause dependence, and withdrawal and could be why she feels much better on taking one tablet, I am wondering if she ii worse when it wears off? 


What she needs now is stability, stable doses at the same time every day so that her brain and nervous system can recover.

It will take 4 days for the risperidone to reach a steady state in the blood, if she feels any worse she must stop right away . 


Cycling is excellent exercise and along the sea shore even better. I used to live by the sea and miss it terribly, it was very therapeutic just walking along the sand or standing at the waters edge in the moonlight listening to the waves lapping on the shore. Lovely memories to draw on.   :wub:


As your account is to support Tiggy and is not about yourselt could you copy Tiggy's signature into your own?  I just had to keep scrolling back to Tiggy's post to see the details and my memory is around 5 seconds so kept forgetting  :lol:

Edited by mammaP
added info

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Dear mammaP,
I want to thank you so much for your thoughtfulness and concern, and being here in a time of need. This depression is so horrible and I feel despairing about how to find a way out of this maze. I had no idea there were drugs so strong that they can catch you up in an internal loop like this, and now suddenly they own me.
I am simultaneously frightened of staying on them for too long and coming off them too soon, while my brain is still healing and needs their blanket to keep it safe. I tapered off them very soon because I was just sick of being like this and wanted to be my old self again, and now I can see I was naive to imagine it was so easy. I am worried that I have hurt myself by tapering them too soon after my breakdown, and I have been told that I need to stay on them for two years for my brain to fully recover. 
Do you think it is necessary to stay on them that long, and how long would you suggest I stay on them?

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Try not to worry Tiggy, All this was in a short space of time and really shook up your nervous system. The doctors are saying 2 years for your brain to heal from the breakdown with the help of drugs which is utter nonsense! You will get better, and risperdal is not quite as bad as some of the other drugs for tapering but has still to be tapered carefully because it is an anti psychotic stopping quickly can lead to psychosis, then ultimately more drugs.  Take care of yourself, make sure your diet is as healthy as possible

( I am sure you are eating well ). Don't overdo the exercise as you could wear out quite quickly, cycling is great but listen to your body. Magnesium is brilliant, and epsom salts baths are a good source of magnesium as it is absorbed through the skin. A supplement regularly will help too. Start low and increase. If you get diarrhoea it is too much. I find magnesium glycinate best, it is gentler on my stomach. (IBS) Fish oil is good for the brain and helps with brain fog the electric like sensations sometimes felt. 


Don't blame yourself for any of this, it is absolutely not your fault. Every one of us are here because we trusted our doctors and both you and I would have been fine with a few weeks in a hospital with good food, rest and gentle counselling. A week in a spa hotel would have been much more therapeutic AND cheaper if only they would see that! 


I am going to ask one of the others to look at your case, because I am wondering if the diazepam in hospital would have been responsible for a lot of this, it was a high dose and can quickly cause dependency which would  lead to withdrawal. I work more in the AD/AP side of things but we have some benzo experts who will take a look. 

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Oh wow, thankyou so much. This is very heartening. 
It would be great to think that if I just hang in and stop changing anything, I will stabilise. Stabilising is my life's aim right now.
Thank you.

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Once again, some slight modifications to amounts.


Before / incorrect

21 Dec - Lithium: .875, Haloperidol: 1
01 Jan - Lithium: .875, Haloperidol: 1
09 Jan - Lithium: 1000, Haloperidol: 0, Risperidone: 0.5
14 Jan - Lithium: .875, Risperidone: 0.375
After / correct
21 Dec - Lithium: .875, Haloperidol: 1mg
30 Dec - Lithium: .750, Haloperidol: 0.75
09 Jan - Lithium: .750, Haloperidol: 0, Risperidone: 0.5
14 Jan - Lithium: .750, Risperidone: 0.375
23 Jan - Lithium: .500, Risperidone: 0.25
Edit: to be honest I'm slightly confused about the exact dose of Lithium around the 9th of January. My records show it at 750mg, although I recall the private psychiatrist increasing the dosage to 1000mg at that point. Seeing as it was decreased again a week or two later, and seeing as we may be focussing on Diazepam, hopefully this is not too serious. If it is, please let me know and I'll see if I can dig further.

Some forensics was required to compile the data. I acknowledge the importance of this being as accurate as possible early-on, so apologies for the previous minor errors. I don't think the current adjustments are too drastic, and hopefully we are approaching the end of .. well, at least of what I can dig up.



MammaP, your are a life saver : )

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What I would love to know is (if it is possible to predict), how long does this kind of withdrawal last?
Is it just a few more weeks and I can wait it out, or is it going to be months of this.

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I've had a look at the history you've posted and thought it might be useful to look at all the medication changes made in the last 3 months. So I filled in the dataset so that there's a data point for every day since Dec. 21, 2016 and included all 5 medications: lithium, risperidone, zolpidem, haloperidol, diazepam.


You can view it here: A google doc spreadsheet


So that the changes can be seen, I've reported

Lithium data as 1000 mg, so 875 mg shows as 0.875 g (Lithium) and

Zolpidem data as 10 mg, so 12.5 mg dose shows as  01.25.

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Oh wow Scallywag, thankyou for the beautiful diagram. It's extremely clear and explanatory. I can point my finger at exactly when things started getting weird.

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I much prefer yours to mine, Scallywag ; ) .. nice job

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Your charts reminded me that JanCarol came up with this to visualize another member's dose and meds changes.


These charts paint quite the picture!  I'm sorry you were unknowingly bouncing your CNS (central nervous system) around like that.


I just discovered an interesting feature of this chart on Google Sheets -- if you put your cursor in the graph, the legend shows the dose of each of the meds on that day.


I know your chart and data were a google doc. Feel free to copy the one I linked to your Google Drive.

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I'm somewhat relieved to see the usage has been so up and down because it points to a cause, solution, and resolvable outcome.


The day-detail is pretty important. I've made a copy in my drive, and will certainly use that format going forward.


Thanks a million, Scallywag : )

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Please forgive me for jumping into the discussion.  From looking at Scally's excellent chart - that drop off of the Haloperidol in January was a huge event, and may take some time to clear.


Mr. and Mrs. Tiggy - congratulations on your bicycling.  Exercise is a most effective antidepressant, as is music, sunshine - and the great outdoors.  It always helps to have someone with you; I remember my darkest days, there was a friend who would walk 30 min with me in morning sunlight with her dog.  She saved my life, really.


My concern is this "mania."  Was there a bipolar diagnosis to begin with?  Have you been treated for bipolar prior to this "manic episode?"


It is extremely, extremely unusual to have "bipolar" onset at age 54.  It is extremely, extremely unusual to have a first "manic episode" at age 54.  


Mr. Tiggy also called DoctorMussyWasHere (great names!), said:


I am 100% of the opinion that what she had was an episode of secondary mania brought on by lack of sleep and numerous extreme stressors. Although a certain amount of depression is to be expected after such a jolt, what she is currently experiencing is the result of both tapering too quickly, and the dual-tapering of lithium and Risperidone.


I am strongly of the opinion that Lithium is not needed in her case.


As a "former bipolar" ("what?  there's no cure for bipolar!  it's drugs for life!" say the p-docs) who was toxically burdened by lithium, I agree it is probably not necessary.  BUT - she's been put on it, so a slow taper is in order.  There is a danger that, even if Tiggy never had a manic episode before - she can have one if she comes off the lithium too fast.


I'm really concerned about what stressors and sleep issues brought this "manic" thing on.  What did it look like?  Was it fast-talking, not-sleeping, spending money, grandiose ideas, endless energy stuff?  Or was it just jittery and anxious due to lack of sleep?


My concern is this:  was there a diagnosis and drugging before this "manic episode?"  Were there other medications which could contribute to it - such as fluoroquinone antibiotics, stimulants, cardiac drugs, steroids for pain?  The other thing to consider - is have you done a thyroid workup? 


I mean the whole panel:  not just TSH, but Free T3, Free T4, and reverse T3, as well as antibody tests TPO and TGAb.  It is extremely common for post menopausal women to suffer from thyroid malfunction in our toxic world.  Hashimotos can be working in the body for 3-5 years before it manifests in thyroid panels (but will show up in antibody tests) - and the fluctuation between hyper and hypothyroid can look a lot like "bipolar."


I hope I'm not confusing things - I just jumped in, and completely trust what the mods are looking at for moving forward.  It's important to keep things stable and smooth in order to successfully get off the drugs.   There is evidence that PRN dosing (as needed) is unhelpful in the long run.  An emergency dose of diazepam once or twice a month as Healy recommends can be helpful - just to give a body a rest from relentless withdrawals.  But it is not warranted when the main symptom is deep, abiding depression.  It will not help that. 


I just want to make sure there are not other drugs to complicate the issue, and that there is not a condition which has caused this whole mess to begin with.  It is extremely common for emotional distress which is caused by physical problems or normal human experience, to get a diagnosis slapped on it, and cocktails prescribed.


Tiggy - as for "bipolar depression" - that was the diagnosis I suffered from most of my life.  I had a documented "manic episode" when I was in my early 30's (and that was unusual enough, but there were circumstances - divorce - that led to it), and possible "manic episode" at age 18.  Also mitigating circumstances, as it was my first time living away from an oppressive home.  But the rest of my life was spent in depression.


If there is a thyroid issue - it is vitally important to come off the lithium, as it is damaging to thyroid.  It's how I lost my thyroid, and it should never have been prescribed in the first place - it is less used in the US where they have a fancier range of pharmaceuticals to draw from - but commonly used in Australia, UK, South Africa.  


Also - if you want to take magnesium, please don't take it bundled with calcium.  They cancel each other out, and it is unethical for vitamin companies to package it that way.  Please read about Magnesium and Omega-3 fish oil here.  Fish oil is also excellent for mood stabilisation, as is sunlight.


and - I hope that both of you see the sun today!

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Thankyou very much, Platinum Star!

I was not taking any medication before my breakdown, nor have I ever. Here's why I think I had this attack:

What happened last year was, I knew by February that it was going to be the hardest year of my life, and I was terrified. My extremely difficult, controlling, NPD mother was 86 and still living in our family home which she had been filling up with hoarded junk for 30 years, and the only way I could think of to get her out of there so we could start the hideous task of clearing it up was by persuading her to buy a house with a granny flat at the back, and move into it myself and look after her. My sister descended into a shrieking paranoid vortex of manipulative viciousness, claiming I was doing this so I could force my mother to sign over the family's entire resources to myself, before murdering her. Well, that was just one version. There were many. My mother stirred up the maximum of paranoia herself, invented multiple and multiplying claims that we had been cheated when buying the house, that it was going to fall down and we would all be destitute and homeless etc etc etc. Meanwhile, the responsibility to try to steer a calm and productive course lay on me alone, while I was subjected to relentless attacks for month after month after month. 

Somewhere in all of this I had an agreed deadline to produce a body of paintings for a gallery. The pressure to bring the family stuff to a conclusion (i.e. to get my mother out of the family house and into the granny flat and hand over the family house to my sister) was so intense that I tried to work at the painting faster by working straight through nights. Needless to say, everything that could go wrong with the paintings did go wrong, and I worked straight through 14 nights in a period of six weeks, so busy that when Simon brought me food I just grunted and went straight on working, leaving the food uneaten. 

The exhibition opened on the 26th of October and I broke down on the 8th of November. My subsequent hospitalisation had a massively welcome effect in causing the family to stop using me a punchbag. My mom is damaged, and really doesn't understand how annoying she is, but at least now I have permission to say that I just can't listen to certain things because they trigger me too much. My sister has only today, after all this time, finally decided that being abusive has been an unproductive strategy and she is going to try being constructive instead. 

So at long last we are no longer trapped in extreme emotional violence, and can proceed from here as merely dysfunctional, ordinary imperfect beings. 

The state hospital that I went to had psychologists as well as psychiatrists, and I got to speak to a psychologist once. She was not interested in my story and never relayed it to the psychiatrists. They wanted a diagnosis that I was bipolar, so they made one up, based on a report from a psychologist that I had seen 20 years ago that I had been depressed then. So.... a  20 year swing from depression to mania??? What utter bollocks. Also, I was very unhappy then but I got through it all without anti-depressants, so that's hardly extreme depression. I've never before come close to the kind of depression I've had recently, coming off this Respirdal, where the horror is so overwhelming I can easily see how people end their lives just to make it stop. 

So, where I am at now is that I want these drugs out of my system but I also want to minimise as far as possible having to go through this level of hell to get clean. 

I hope that all makes sense and wasn't too long-winded. :) Tiggy

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Good heavens!


Tiggy, that is a very plausible story of stress-induced behavior, not psychiatric mania.


I cannot improve upon the excellent contributions by our fine moderators ChessieCat, mammaP, scalllywag, and JanCarol.


Tiggy, what exactly is your "depression" like now? Is your mother still living in your granny flat? How are you sleeping now?


You need to allow for the possibility that the drugs you have taken have affected your sensitive nervous system. Like a plant that's fallen off a trellis, it will take some time for it to gradually grow up towards the sun again in a healthy equilibrium. This will be very gradual, you will need to use your thinking self to help it along.


(By the way, I also have an 86-year-old NPD mother, I would not want her living anywhere near me. And I can just imagine the drama with your sister, who could easily be played by my sister.)


Please keep daily notes on paper of your symptoms, your drugs, when you take them, and their dosages. This will be very helpful to identify drug-induced symptoms.

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Hey Tiggy - thank you for sharing your story:

The state hospital that I went to had psychologists as well as psychiatrists, and I got to speak to a psychologist once. She was not interested in my story and never relayed it to the psychiatrists. They wanted a diagnosis that I was bipolar, so they made one up, based on a report from a psychologist that I had seen 20 years ago that I had been depressed then. So.... a  20 year swing from depression to mania??? What utter bollocks.


In all of my studies of spiritual emergence, of mad pride, of walking away from drugs and psychiatry, this story is so common as to be sickening.


WHY wouldn't a psychologist want to hear your story?  And yet, time and again, this happens.  They want you to "report," to tick boxes on a chart - and the chart doesn't have any positive boxes, like "did you have any moments of joy today?" or "I like the way my body feels when I exercise."


Slow and steady wins the race.  


I wish I could tell you that since you were unmedicated prior to November, that you could just walk away - but I want to see you succeed.  The safest way to be successful is to do a slow taper, the 10% that Chessie recommended.


Once you stabilise, and we can get you off the Risperidal, we can start looking at the lithium.  It took me 5 years to lose my thyroid (on 900 mg per day) and 10 years to start damaging my kidneys.  Somewhere between there, I was driven to extreme depression - but I cannot tell which drug was worse:  the statin, the PPI, the antidepressant, the lithium.  Each drug I removed, I got better.


I had 2 strengths of lithium.  Immediate release 250 mg, and Extended Release 450 mg.  By using the 2 doses, I was able to dry cut most of the way down, using 2x a day dosing.  


Everyone is different, but I don't think you will suffer toxicity in the time we need to get you off of it.  How do you take your pills?  Are they XR (extended release?)?  Once a day?  Twice a day?  Are they monitoring your kidneys & liver (blood tests)?  Those tests should be given every 3 months - and - I have to say that I was suffering side effects, even when my p-doc said my bloods were fine.  So, as our Esteemed AltoStrata suggests, Keep notes on paper.


Also helpful for your notes on paper - foods, activities.  What makes you feel better?  What makes it harder?  This will help you to make the choices to feel better sooner.  I'm afraid in your case, alcohol will be on the negative side of things, and to be avoided.  That may also include gluten, dairy.


I've also been studying hydrotherapies for mood.  I just saw a BBC special, "The Doctor Who Gave Up Drugs" and he recommended regular cold water swimming for depression.  Not only does it lift mood, but enhances your stress response.  If you cannot do cold water swimming, consider starting your showers warm and soothing, but finish them by gradually decreasing the warm until it is cold, brisk, and stimulating.  As always, keep notes - and if it doesn't help - let me know!


I hope you and DoctorMussy see the sun today!

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Hi JanCarol and other esteemed helpers,


There's yet another medication she didn't even think of including, and the first menstrual blood in 5 years this morning indicates it very well may have played a strong role: Vagifem (estrogen). She was a little shy about mentioning it, but as her fake doctor I have no issue in taking on this role by her request.


She has been taking it since 3 March. She didn't mention it because her doctor had told her that since it was topical, not oral, there were no side effects.


Firstly, if she's been premenstrual for the first time in five years on top of everything else, it could explain some - if, not, much - of what she's been feeling.


Secondly, mood swings and depression are listed as a side effect of estrogen. Not sure if that's regardless of menstrual state?

In any case it seems the positive reports of estrogen have mixed implications (at least as shared by Dr. Phelps).



Doing a quick Google squizz, it appears estrogen also requires tapering, assuming one would want to get off it.

It is mentioned on 467 pages of this forum, though often in a positive light.


Beyond this, I have a male body, and would not presume to know any more than what I've read and been told.


Can anyone offer advice in this regard?


Many thanks,


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Dearest helpers,


Please note that we read and take account of all the advice and suggestions here, and take them very seriously, especially insofar as a specific route is suggested. This includes your disclaimers, which we respectfully acknowledge, and assume full responsibility for our actions.




With regards the question of whether it was true mania or not, without listing the symptoms which can be found in numerous places on the web, it most certainly was mania, which is something we are both in agreement about without putting any pressure on each other to come to this conclusion.


We are both freelancers, so I have been with her almost 24 / 7 since the day I met her in late 2010, and it is agreed between us now that I have have the insight to match her first-hand experience, both of which are given equal consideration.


Out of consideration to other users of this forum who may find the information triggery, we have agreed to rather provide the specific details of the manic episode privately only on request. I hope that’s ok.




As far as I know, the one thing the hospital did do right was to test for physiological and neurological causes, including thyroid, stroke and hormonal causes. I intend to double-check this information.


However secondary mania, although rare, is more predominant than bipolar in older adults, and has been known to occur as a result of even caffeine consumption. I’m not suggesting caffeine was the cause, but she did drink coffee to stay awake. I think it was a small, but essential factor, among ALL the other factors which came together to form a “perfect storm”. That’s my take anyway.




That all said, there has been no sign of mania returning, and every sign of it having left, non-manic-depressive rushes aside.


To quote even the mainstream literature “Because secondary mania generally does not require prophylactic treatment, it is questionable whether treatment with divalproex, lithium, or carbamazepine is necessary. Fortunately, the majority of deficits that accompany secondary mania in older adults resolve if the etiology is determined and treated.”


The etiology in this case, including sleep deprivation, was primarily psychological, and it is being treated by all the parties involved.





My only question is: does secondary mania have a - presumably single - corresponding depressive dip, and if so, how severe is it, and how should it be treated?


I realise that in the absence of truly-unmedicated case studies the data here is lacking or contradictory, but opinions are welcome.


Tiggy suggests: "perhaps I tapered, not only too quickly, but also too soon, so the depression I'm feeling is also a result of having been manic".



Please note that none of these questions diminish the importance of careful tapering. On the contrary it completely outlines the importance of a gradual taper, but possibly affects:

  • Drug to go back on
  • starting plateau dose (eg. 0.0833 Risp)
  • taper amount (eg. 10% of current)
  • taper-period (eg. 3, 4, 5, or 6 weeks)


Thank you again and again


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Tiggy reports that her night time depression has lifted, only to be replaced by extreme anxiety.

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Taking this one at a time, regarding the original concern about Diazepam, what is the recommended course of action?

If going back on, and then tapering, then please recommend:

  • starting plateau dose
  • taper amount (eg. 10% of current)
  • taper-period (eg. 3, 4, 5, or 6 weeks)

Thank you

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Hey DoctorMussy and Tiggy - 


Here's the thing.  Once she's been medicated, all bets on how her "natural progression" would go, are off.


The drugs - and the estrogen - add in multiple variables which make it difficult to say, "it is this!" or "it was that!" 


So really, all we know is to keep things stable.


I would not add back diazepam.  As she was only taking it weekly, she is unlikely to have developed tolerance to it.  


I'm going to refer you to the work of Kelly Brogan, for the diazepam.  She used to think they were fine to cushion the blows of psych drug withdrawal - but has since changed her mind:  http://www.madinamerica.com/2016/07/benzos-a-dance-with-the-devil/


She is a gynecologist/psychiatrist, focusing on women's issues.  Her first practice was trying to manage depression / antidepressants in fertile and breeding women - when she discovered that there really is no "safe" antidepressant.  Her paradigm was turned upside down (like yours, like mine) and she has worked incredibly hard to find new, evidence based, workable paradigms for treating women, moods, and fertility.


I'm also going to refer you to her book, "A Mind of Your Own," which addresses  hormone replacement therapy, birth control, a number of women's health issues.  You can read the first chapter, here:  http://kellybroganmd.com/amindofyourown/


I do know that topical hormones can be just as affecting as ingested ones.  That's why they use them.  Supposedly more gentle and natural - but they are still supplemental hormones.  

A quick search of Dr. Brogan's webpage turned up these:




Also - depression and anxiety.  


In order to survive this, Tiggy, you are going to need to develop strong Non Drug Techniques for Coping with Emotional Symptoms


Healing comes in Waves and Windows, so there will be good times, and challenging ones.  If you can look at your symptoms with curiosity, as if they were clouds in the sky, it will help immensely.  Observe them, acknowledge them.  Don't fight them.  There are a number of resources here at SA to help you with these.  

Here is one of my favourites:  Dr. Claire Weekes - Recovering from a Sensitized Nervous System


Healing a brain and nervous system is a complex process, more complicated than a broken leg (which is complex enough).  This video explains it quite well:

Healing from Antidepressants - Patterns of Recovery (by Toxic Antidepressants)  


and these cartoons, also describe the challenges presented from stabilizing and healing in withdrawal:

Withdrawal Dialogues - cartoons to encourage you


DoctorMussy - I know you have asked for timeframes.  There is still some discussion among mods as to how best to proceed.


I think the first thing we are waiting for is signs of stabilization. 


That the unrelenting depression - has relented a bit (and given way to anxiety) is actually a good sign.  It means things are changing.  The pendulum may swing back and forth a few times.


Keep a routine, keep the doses stable for now (though examine whether the estrogen is really needed), and strive to get that pendulum to still, to stabilize.


Then, Tiggy will probably be good with a 10% per month taper of risperidone, holding as symptoms arise.  When the risperidone is done, we can look at the lithium.  Can you answer my questions:  what is the dosage and type of lithium?  How does she take it?  1x or 2x a day?  Is Tiggy getting blood tests for kidney and liver function?


Also - that the hospital ran a thyroid profile is pretty meaningless.  Please re-read what I wrote about a complete thyroid profile, and Hashimotos.


at the very minimum antibodies, Free T3 and Free T4 need to be tested.  Most hospitals and doctors will only run TSH, which is a pituitary test, not a thyroid test at all.  It's like diagnosing the temperature by looking at the barometer.  There is a relationahip, and you can get some ideas - but it's not an accurate measurement, and doctors don't even agree on what ranges to use for TSH.


I know this is not a straightforward "Do this" kind of answer, but I'm hoping that these resources might lead you in a direction that is more wholesome and healing.

I hope you both see the sun today!

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Thankyou so much, Jan Carol!
I am so immensely heartened and encouraged to be receiving this wonderful, informative support.
I can't wait to start working through the links and understanding this all better.
I feel empowered to undertake this as I have been stabilising more and more each day since going back on the Respirdal, to the point where last night I only had a relatively short spell of anxiety and was able to actually counter the bad thoughts with rational answers.... I lay there battling the dark forces like an actual Jedi, and won :) I hear you that it may swing back, but am happy right now to have my head above the rim of the Sink-hole of Hades.

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Thank you so much JanCarol.




What is the dosage and type of lithium?

Camcolit 250mg


How does she take it?  1x or 2x a day?

2x (1 morning and 1 evening)


Is Tiggy getting blood tests for kidney and liver function?



She is obtaining it from her original psychiatrist at the state hospital because it is much cheaper, not that the private psychiatrist suggested tests either.


Although she is on a much lower dose than the one she was originally set after the original tests (875mg), she is looking a bit yellow, so I think tests may be in order.


She agrees that she needs to be tested, but says "what can I do about it except get off the Lithium?" which is to say she's concerned about health vs tapering rate.


Taking all this into account, we have decided to actively seek out a doctor or clinic that will do the tests according to our specifications, not theirs.

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If Tiggy is looking a bit yellow I would get the tests ASAP. Tests should be carried out regularly when taking lithium. 


Thankyou so much, Jan Carol!
I am so immensely heartened and encouraged to be receiving this wonderful, informative support.
I can't wait to start working through the links and understanding this all better.
I feel empowered to undertake this as I have been stabilising more and more each day since going back on the Respirdal, to the point where last night I only had a relatively short spell of anxiety and was able to actually counter the bad thoughts with rational answers.... I lay there battling the dark forces like an actual Jedi, and won :) I hear you that it may swing back, but am happy right now to have my head above the rim of the Sink-hole of Hades.

It is lovely to see such a positive response, this is the way through, staying positive one day this will be behind you and you will be getting on with life.  :)

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Thanks MammaP!

Yes, and she's been off-colour since she was released - about three months. Because I intended convincing her to taper, and because she yanked herself off at an even faster rate, I expected it to resolve with the potentially heavy toxicity well-below her original tested level. She's not quite as yellow as she was at this lower dose, assuming it is Lithium, which it probably is, but I totally hear you that is a definite concern.


It is indeed shocking that not one health professional has noticed this and recommended re-testing. She booked an appointment with her GP today for tomorrow, and will be armed with a well-informed list, thanks to SA!


Mood-wise, today was a good day : )



JanCarol, regarding my question about whether a Diazepam taper was advised, it related to a question by MammaP:


I am wondering if the diazepam in hospital would have been responsible for a lot of this. 



I'm just making 100% sure your advice is based on including the knowledge that she was on 7.5mg for a whole month while in the hospital. Your comment "as she was only taking it weekly" gave me pause..


thanks! : ) sorry if I'm being overly-pedantic.

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Dear Forum

I'd like to ask your advice about whether I should take a valium today, given that I last took one 9 days ago and have been off them since leaving hospital on the 21st of December last year.

I have been triggered by a terrible fight with my sister because I broached the idea that instead of having my mother come to live with me at the end of the year, I would rather buy her a place in Fish Hoek which is a community nearby with a high population of retirement homes and elderly people, and therefore has wonderful services like this http://www.fhhomenursing.comwhich are not available in my area. 

She says she wants to vomit whenever she is around me because I am so disempowering to her, taking decisions that will destroy her life. I haven't taken any decisions. It was an idea which I put forward for her response.

Now I am feeling very down and insecure, as if my house was a leaking lean-to lost in a cold blizzard in the middle of nowhere. I am afraid of the anxiety and depression which may wash over me in the night and keep me awake. Perhaps I should take a Stillnox? I haven't taken one of those for about a month.

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Hi there Tiggy nice to see there is another South African here and from the beautiful Cape as well. I'm in a very very small town in the Free state. Just,wish you were not needing to be on this forum like me but it is what it is. I found that our state hospitals are so full that our Drs just feed us pills and get on with the next person, they really don't know us at all and diagnose us with all kinds of things. I remember when I was feeling very very bad they kept saying take your antidepressants and I knew in my heart that these meds contributed to my breakdown. And that I was in withdrawal. Please go slow with your taper and listen to your own soul , there is no Dr that can help you like you can help yourself. Strongs

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How awful to have to listen to such abuse  :angry: . Try not to let your family force you into taking more drugs. I know that is easy for me to say and not easy for you to do. Is there anyone you can talk to who is not involved ? When I have had trauma with abusive family it helped a lot to talk to someone and cry, tears of frustration that were so therapeutic it felt like a huge boulder had been lifted. There are helplines such as the samaritans who will listen, you don't have to be suicidal. Can you walk away from your sister and let her get on with it. She and your mother don't seem to want your help and might be best left to their own devises until they realise just how much you do for them. They have made you so sick that you need to look after yourself and get better.  


We have a topic on toxic family where  members have posted their own experiences. 



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