☼ Tiggy: Is it withdrawal or bipolar depression?

[Tiggy]

Thanks for the kind words, everyone

[Altostrata]

Don't argue with your sister, put it forward in a letter that the Fish Hoek arrangement is all you will offer for your mother, full stop. Anything else is your sister's responsibility.

 

Don't take drugs so you can maintain this mockery of a relationship with your sister.

[Tiggy]

Thanks Altostrata. 
Somehow the stress went away, and even though I am troubled with insomnia right now, I am neither depressed nor anxious, which is wonderful. I've actually been planning what to do on the painting I want to return to in the morning.... that's a huge leap forward for me in what my brain has been willing to think about during this patch of darkness. Much love and appreciation x

[Tiggy]

A question about withdrawing off Respirdal:

1. Background info
Twice I've tapered and jumped off Respirdal at 0,084mg daily, and each time the resultant depression has been so suicidally chronic that I went back on again. The most recent time I jumped off on 16th March and went back on to 0,084mg daily on 2nd April. My depression and anxiety abated but was still unbearable, so on 7th April I upped the Respirdal to 0,125mg. Four days later, I am hugely more stabilised, but still very vulnerable and emotionally exhausted. 

2. My question
Once I am properly stabilised and have stayed that way for some time, I want to start the tapering process again, but more carefully. What I want to know is, before I begin that, do I need to stabilise myself at a dosage where the depression and anxiety are gone... in other words, should I raise my dosage some more before eventually tapering properly?

[SkyBlue]

Thanks Altostrata. 

right now, I am neither depressed nor anxious, which is wonderful. 

 

 

That is wonderful, Tiggy~! 

[ChessieCat]

You might find these topics helpful:

 

Withdrawal Normal Description

 

Stabilising After a Reduction - What Does That Mean?

Windows and Waves Pattern of Stabilization

[DoctorMussyWasHere]

@JanCarol

 

Your cold water recommendation is a winner methinks..

 

Interestingly Tiggy and I both woke up yesterday morning with the same thought: "get into the ocean". So yesterday we did a "biathlon" sorta thing: cycling 4km to (and from) the idyllic Dalebrook tidal pool, and doing a few lengths.

 

 

 

Tiggy reports a notable lifting of depressive symptoms, and the first positive thoughts about the future in ages.

 

I've sent Tiggy a link to Season 1 Episode 1 of The Doctor Who Gave Up Drugs.

[mammaP]

Wow that looks amazing! I watched those documentaries and he is really good. I am glad that Tiggy is feeling better and so pleased that she has you by her side. 

[DoctorMussyWasHere]

Thanks MammaP : )

 

We need each other equally, so the well being is crucial as far as I'm concerned. We've always known this, but never has it been so pertinent, and realising it has been a positive thing. We are pretty fortunate to have this aspect of mamma nature on our doorstep to assist with the mission. I must credit Tiggy's genius in forcing me to agree to move to this part of the peninsula last July : )

[DoctorMussyWasHere]

Tiggy:

"This morning is the least depressed I've felt in ages.

It's a cold, gloomy, wintery morning and I should be feeling terrible, but I'm not.

I'm putting on my shoes."

 

blimey.. I'll be out of a fake job soon!

[DoctorMussyWasHere]

Update / Progress Report

 

In a word: estrogen.

 

In several words: it turns out she had none at all. She started HRT on the lowest dose on the 10th May / 18 days ago, and it started to take effect by lifting her sporadic black depression within a few hours, which could have been placebo or coincidence. Regardless, despite it returning with a vengeance, the depression and night sweats are starting to lift.

 

In addition she started tapering Risperidone on the 18th / 10 days ago. We had a freak accident whereby the bottle marked as "1" in tiny 5pt Helvetica font rolled under the car seat after collecting it, so for two days she took pills from bottle marked "5", but she stabilised at 10% of prior dose, which she will remain on for three weeks.

 

 

 

ps. A recommendation for the South Africans on this forum: apart from their inclination to use tiny font sizes, I highly recommend Fagron Compounding Pharmacy. I don't think they even put a markup on the price at all to make up all those capsules at 0.0001 mg accuracy. This is NOT a sponsored message.

[mammaP]

Glad Tiggy is doing ok, she has a great doctor taking care of her! 

[DoctorMussyWasHere]

..several! .. by which I refer to you and the other Survivors who stepped in to help.

it's not quite over, but there's light..

Thank you, MammaP : )

[JanCarol]

That tidal pool looks magnificent!  Ocean water is special, too, because it's got just the right salts for a human!

 

How often can you go?

 

I'm glad that things feel more like management and less like crisis.

 

Doc - you didn't like your "fake job" anyway - though you've done good work!

 

I hope you see the sun today - and get your cold water adjustment soon!

[DoctorMussyWasHere]

Well it's getting very icy down here. We are not so far from the south pole.

We did swim last week, if you can call jumping in for a few seconds, swearing in Australian while flapping our arms about in shock, "swimming" ; )

 

Things have remained a bit anxious, anxiety being what she describes as depression.

Even when she describes it as dark, it's sudden and sporadic anxious-dark.

Not low-energy-sleeping-too-much-nothing-to-live-for-dark.

She has insomnia, not the opposite.

 

Last night I read Altostrata's post on benzos and some of the Ashton Manual.

I'm very convinced that's what this is - diazepam withdrawal after the sustained high dose in the hospital - which MammaP suspected.

 

 

That rules out using them to treat their own symptoms, including the Zolpidem, so the rocky times will continue for a bit, but will resolve.

 

..and it's not Bifocal Disorder - our name for a mysterious disease that suddenly starts when you turn 50 and requires you to "accept your illness", and "restore the chemical imbalance" by "taking your lithium", which clearly there must be an internal shortage of by that logic, which kinda makes sense 'cos my phone also needs lithium to keep it going.

(need I say "not"?).

 

 

All the other improvements we're working on will help:

• the Risperidone,
• then Lithium tapering,
• the high-strength EPA Omega 3,
• magnesium (without calcium now),
• exercise, which is still able to break through it,
• reduced stress from external factors, seeing as we monitor them,
• and last but certainly not least since it's the star of the show: the Estrogen HRT

..in a nice, tapered list.

 

 

Speaking of which, I made a sort-of prognosis chart, quantifying the unquantifiable, as it does, so it's speculative.

I think it could offer some placebo-effect feedback looping, though, so who knows..

 

What was interesting to find is that the green line - which is an average of the other factors - does roughly follow her general state.

 

 

 

Oh, and Melatonin for sleep, following the guidelines here on SA.

 

I dread having to update that signature ⬇︎

[DoctorMussyWasHere]

Granted, Tiggy is very lucky to have caught onto what was happening early-on, and that for others this journey is not quite as direct and straightforward.

But it does clearly indicate the causality, and backs up the central focus of this forum:

 

Slow tapering is required to avoid withdrawal syndrome. A syndrome which - unless you are aware it exists - will almost certainly have you "prove your mental illness", and be subject to a psychopharmacological debt trap.

 

 

Tiggy is on day two of the second-tier (0.1013mg) of the Risperdal taper.

Total day 23 of 105.

 

In her case, the 100% sure-fire anxiety / cortisol ice-breaker continues to be exercise.

A 15 minute / total 4km lap on bicycles works with 98% effectiveness by applying that excess cortisol to an actual activity.

 

Additionally in our anxiolytic arsenal, we have:

• Magnesium - 100mg x 4
• Fish Oil - omega-3 EPA 510mg | HPA 90mg x 2 x 2
• Vitamin E (to support omega 3) - 400 iu x 1
• Vitamin C - 1000mg x 2
• Estradiol (estrogen) - 1mg
• Baby Aspirin - 100mg x 1

This regime was determined from the information on the topic:
Waking with panic or anxiety -- managing cortisol spikes

 

With each passing day, as she improves firmly and steadily, my confidence in, and gratitude towards this forum is affirmed.

[DoctorMussyWasHere]

Today was another turning point, to where exactly we’re not quite sure.

 

Short version

What is recommended for when someone feels as if they are losing their mind?

It’s a state which usually passes after about two hours, although at the time there’s a fear that it will never end.

 

 

Long version

This may be a passing thing. The last one of this nature and magnitude was when Tiggy’s, shall we say elevation (rather than mania) suddenly turned to anxiety on the 20 January, 2017. My notes from that day:

 

Quote

She was irritable early in the day, but it changed. She suddenly became sad and tearfully acknowledged the burden on those around her for the first time.

Following that, in the evening she was experiencing emotional rushes, being lucid and not manic, but feeling inexplicable emotions running through her.

 

She saw some Trump-voting trolls on Facebook, and said if she engaged with them it would literally tear a hole in her heart.

The emotions in turn would switch to physical faintness and sweating.

 

It increased and she asked me to drive her to hospital at 2am. While at the hospital she felt it change suddenly, like she was drifting into outer space.

On that occasion she requested diazepam which they supplied, and it worked by allowing her to sleep.

 

 

On 9 June she had her HRT dose doubled: Kliogest, which is 2mg Estradiol, 1mg Norethisterone Acetate.

 

It relieved the menopausal night sweats for the first time last night, but she did feel an unusual wave of sadness.

 

During the day today she said the wolves of anxiety were very far away. At the periphery, but not present.

Something in her manner - like a distant look - made me wonder, however.

 

We decided to eat lunch at a café, and soon after sitting down she said she felt her mind slipping.

I suggested working off the cortisol by going outside and climbing the stairs. When she came back it was slightly better, but it didn’t last.

 

We left quickly and drove home. A 15 minute bike ride did seem to resolve it, or possibly it was coincidental.

 

 

This was not the anxiety of late. That wasn’t present.

She said this was closer to her original severe nervous breakdown on the 8 November 2016.

On that occasion her mind had "slipped" completely and she was briefly hospitalised.

 

At times like these she tends to fall back on mainstream narratives, and wonders if she will end up truly mad, living on the street..

 

While I have a massive arsenal of counter-info for most things and endless energy and love to support her, I don’t know exactly what this is.

I’m hoping it’s a passing state as it has been on those two other occasions, one severe (Nov '16), one not (Jan '17).

 

So while I’m mostly very sure she won’t go mad, I’m lost for a reassuring explanation, or a quick remedy.

Ok, a bike ride did seem to help this time, but I don’t think it would have helped on the 8 November 2016.

 

 

Any ideas?

Thank you all.

 

 

Side note: I have read that the combo of oestrogen and progesterone, while protecting against cancer, can cause mood swings. Progesterone is not exactly the same as progestin however. Also, today is around when my fictitious "mood" graph shows the estrogen crossing the halfway mark to full effects (3 months total). Anyway, oestrogen and mood is a mightily complex subject, and there's plenty else in the mix.

[DoctorMussyWasHere]

Today is a good day. An extremely good day, in fact.

She is marvelling at feeling completely normal for the first time since last October. Anxiety gone.

Whew, what a journey..

 

However the question of what, in the very short term, is recommended for when someone feels as if they are losing their mind, remains.

 

The rational advice is: "Sit it out. Chances are it'll only last a few hours, tops."

But rationality is exactly the thing that has slipped away.

 

The chemical advice is Diazepam, which works.. like a bomb, destructive properties included.

I think it's been the source of the anxiety, so I'd be extremely reluctant to recommend it.

 

Part of me wonders if the waves that break through the windows are now dipping in and out of another part of her nervous system.

So while she's generally better, maybe there's more to lose, and they wash back and forth through a more vital part of her psyche, which is scarier.

 

Or maybe she'll be fine from now on.

Holding thumbs.

[Altostrata]

Good to hear, DoctorM.

 

Yes, hormone supplementation can cause mood changes, and diazepam can cause rebound anxiety, in a vicious cycle.

 

Please urge Tiggy to hold on. Are there images that lighten her mood? You and she might make a collection of them so she can leaf through them when she feels down.

 

Pets are always good, too.

[DoctorMussyWasHere]

There was a period where the anxiousness overtook it, but as of two weeks ago, Tiggy has started painting again.

She had several works on an exhibition recently. They are less political, and more personal in nature.

 

This, from before the anxiety arrived depicts the looming spectre of it in the murky depths of the lake:

 

Lately they have become lighter:

 

 

She is starting a series on water birds, though they are onto her plans and keeping safely out of shot. Gonna need a bigger lens : )

 

[DoctorMussyWasHere]

Turbulence.

The last Risperidone drop - just over a week ago - was a rough one, anxiety-wise.

We are switching from a 10% to a 5% taper, every 3 weeks.

 

3		0.0911
3b	21 capsules X	0.0865	mg		1.8165	mg
4		0.0822
4b	21 capsules X	0.0781	mg		1.6401	mg
5		0.0742
6	21 capsules X	0.0705	mg		1.4805	mg
7	21 capsules X	0.067	mg		1.407	mg
8	21 capsules X	0.0636	mg		1.3356	mg
9	21 capsules X	0.0604	mg		1.2684	mg
		Total			8.9481	mg
		Tablets			18 @ 0.5

[Tiggy]

I have a question, which arose in relation to a very helpful article on benzodiazepine withdrawal which Altostrata borrowed from the Benzo Buddies forum. It described my symptoms perfectly .... the coming up for air for two days and then crashing into fear again as another part of my brain undergoes reconstruction. The author of that article was on benzos for 9 months and went through withdrawal for four years.. what unimaginable punishment. I have been going through this for a "mere" 4-5 months and I can't face any more of this. 
My question is, if I was only on benzos for a month in the first place, how much longer can this possibly go on? I know this varies from person to person, but surely there is some kind of rule of thumb of how long the body takes to heal?
 

[DoctorMussyWasHere]

As far as I understand it, in this case ie. on Diazepam for a month, typically about a year since being withdrawn.

In other words we'll have a better idea in January 2018.

 

I think the risperidone drops are triggering the benzo withdrawal symptoms, which is why we're decreasing the tapered amounts.

 

I've encouraged Tiggy to address the forum directly on this.

[DoctorMussyWasHere]

..tapered percentages, I mean.

[scallywag]

Tiggy, we're reluctant to say how long symptoms will last because time to recover unpredictable. We could say a short and "acceptable" duration, and set up an unrealistic expectation.  If we post a long estimate, people get discouraged and may feel the situation is hopeless.

 

For sure there's bell curve with an average time to recover and then variation around that. However, it's difficult to say where any person falls on that when they are taking more than one medication. To get a reasonable estimate you'd need to study people who'd been on the same medications for approximately the same number of months. Pharma manufacturers, the ones with the money, aren't interested in studying the negative effects of their products and have strong disincentives, i.e. profit and shareholder value, to do so.

[Tiggy]

Thankyou, Scallywag, I appreciate your commitment to acknowledging difference and not making a "one size fits all" judgement like a typical psychiatrist!  I knew that my post was a bit of an unanswerable cry of despair. I have to say that even though I still have terrible setbacks, there are signs that I am making great leaps forward, and I will keep those in mind when times are hard. It makes an enormous difference to have read the article I mentioned, for which I am eternally grateful to Altostrata and the rest of you caring folk.

[Tiggy]

Dear Forum, please can you help me with this question:

I have symptoms which perfectly match Benzo withdrawal and I was on put on Benzo's for a month in hospital in December. 
However, I have since proceeded with tapering off Risperidone. Could this be exacerbating the Benzo withdrawal symptoms? (it seems to be)
In that case, should I halt the Risperidone taper until the Benzo symptoms have receded?

Tiggy

[DoctorMussyWasHere]

Just tying up the loose ends here.

 

She stabilised, and for the longest window yet.

But we're holding for another 3 weeks, partly as a break, and partly as a comparison / test.

 

The terrifying attacks I mentioned a few posts back on June 26 seem to match the description for panic attacks.

The knowledge thereof is a recognised primary treatment, and they're not nearly as serious as they seem.

All a doctor would have had to have done was talk to her. Oh, and listened.

[mammaP]

It looks like a long hold would be the best right now. It would be best to wait until she has been stable for several weeks before restaring the taper. She was on so many drugs and has done so well, better than most thanks to all the support you give her. A rest from the changes will be good for her nervous system.  I am glad that Tiggy is feeling better now, waves are so debilitating but we have to hang on to the knowledge that they ALWAYS pass. I hope this window stays for a long time, she deserves it! 

[Tiggy]

Thankyou, Mamma P.

[DoctorMussyWasHere]

Thanks MammaP : )

[DoctorMussyWasHere]

Hi All,

 

Long time, and a tricky one.

 

Some potential financial woes are adding to the stress, and Tiggy has hit a long wave, which is taking its toll.

Is there anything (apart from money) that we can add to our arsenal - below - for anxiety?

• Magnesium - 100mg x 4
• Fish Oil - omega-3 EPA 510mg | HPA 90mg x 2 x 2
• Vitamin E (to support omega 3) - 400 iu x 1
• Vitamin C - 1000mg x 2
• Estradiol (estrogen) - 2mg
• Baby Aspirin - 100mg x 1

I wanted to add kava, but it's banned here.

I'm reading about B vitamins, but can't say I'm hopeful about another vitamin.

 

The stuff about anxiety and facing fears doesn't really apply here, since there's nothing external to face.

 

She's seeing a gyno next week.

 

Thanks

DM

[DoctorMussyWasHere]

Quick general question: What is the advice in the case of someone who has only been on 2.5mg Risperidone for a week?

 

The conundrum is if they do a standard 10% / 3 week taper it'll take almost a year to reach 0.5mg, or two years to reach 0.05mg.

During this time the duration may outweigh the risk of doing a much faster taper now.

 

I am anticipating actually advising someone, and hopefully they won't delay much longer in asking for the schedule which may change the longer they're on it.

So generally speaking I'm curious about the sliding scale of relative risks and tapering advice in this regard.

 

At the lowest extreme someone who has only taken it once could probably safely stop cold turkey, or something approaching it, the next day, right?

At the other end, at what point does the 10% / 3 week guideline become applicable?

[scallywag]

Before taking the risperidone, has this person taken any psychiatric or neuroactive medications?  If they were "psych drug naive" before the risperidone, they might try discontinuing in 25% steps while closely monitoring symptoms. Why was risperidone prescribed?

 

Edit:  After only a week, someone might try a 50% reduction for a week, then cut that in half to 25% of full dose for a week. As you probably know, these things aren't predictable. There's no way of knowing right now who can just stop after a brief exposure, who can get away with a fast taper, and who needs a slow taper.

Edited September 11, 2017 by scallywag

[DoctorMussyWasHere]

Hi Scallywag,

 

They were "naive" / clean before starting the risperidone as far as I know.

They are anti-meds generally-speaking, but I will ask them to make sure.

 

They have been diagnosed with borderline personality disorder.

Disorders aside, the set of behaviours that cause distress in them and in others are in the gamut of BPD.

The person is female, around 60 years of age.

 

They booked themselves into a local psychiatric hospital.

I'm guessing the hospital prescribed risperidone because they prescribe it for everything.

 

Just checking if I've got this correct:

A linear (straight) taper, not logarithmic (curved, never ending).

25% of starting dose

in 3 steps 75%, 50%, 25%

each step lasting 3 weeks?

 

They were advised to ask me for tapering help, not that I'm an expert..

They will contact me at some point,  but I can't offer my help preemptively because there are triggers around this topic.

 

I guess their delay will require a revised strategy, depending on how long they wait, in which case I can post here.

 

Thanks for advising

[mammaP]

Someone who has never taken them before could, as Scally says, cut 50% for a few days then off.  The longer on it the longer the taper. The 10% rule doesn't apply here because it is only a week. Hope Tiggy is doing well.