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Staz

Staz: Poly drugged & trying to get drug free

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Staz

Hi everyone,

I've been on and off a slew of drugs since having depression starting in March 2016. I'm in the U.K. so was treated by our NHS who initially put me on mirtazapine then when that didn't work they introduced me to prozac at 25mg and my anxiety went sky high. I'd been on and off prozac several times in the last 20 years but the reaction was horrific. To calm me down they put me on Diazepam at 15mg until I became so ill I was hospitalised for 2 weeks in May 2016. Prozac was withdrawn and replaced by Escitalopram which gave me the same severe reaction. To counter this I was put on Lyrica at 300mg and within 10 weeks became suicidal so I've just finished a taper from lyrica and am still suffering withdrawals after 8 weeks off the med. To try and counter my increasing depression lofepramine was prescribed along with Quetiapine at 150mg. The lofepramine did nothing so I tapered off of that but the quetiapine was kept in place by my shrink. My Lyrrica withdrawal was painful and my shrink added Dosulepin as an A/D. All this time I was kept on diazepam.

I'm now trying to untangle this mess and am suffering badly with depression and anxiety and none of my medication appears to be helping. I've made the decision to get off of as many meds as I can and am unsure of the order in which to reduce them. I feel I've been the victim of psychiatry and any advice would be appreciated.

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scallywag

Staz -- Welcome to Surviving Antidepressants (SA)

 

You've been through a lot in the 17 months.  Unfortunately sometimes a drug that was previously effective or neutral can cause a problem at a later time. It's possible that either your exposure to mirtazapine or the way it interacted with prozac sensitized your CNS (central nervous system).

 

Thank you for posting a clear signature.  One thing I'd like to confirm -- are you still taking mirtazapine? Rereading your post and your signature, I'm not 100% certain. Also, am I correct in assuming that your doses of quetiapine, dosulepin and diazepam haven't changed since you started taking them?  If that's incorrect, please add the date you started your current dose to the relevant line in your signature.

 

Tapering off a medication in 8 weeks can be a painful experience for many if not most people, even if the drug was having negative effects.  Our approach to discontinuing medications is a conservative, harm-reduction approach: decrease ONLY one drug at a time by reducing dose by no more than 10% once per month. You can read more about that in these topics:

Before you begin tapering -- what you need to know.

Why taper by 10% of my dosage?.

 

You ask a very good question about where to start when you're taking more than one drug.  This discussion has suggestions about that:

Taking multiple drugs? Which to taper first.

 

Here are our topics relevant to your medications:

Tips for tapering off Remeron (mirtazapine)

Tips for tapering off Seroquel (quetiapine)

Members-only benzo forum -- tapering benzos like diazepam is different from other psychiatric medications so we have a special forum for those discussions

 

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.

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Staz

Hi Scallywag,

Yes I'm still on mirtazapine at 15mg. My dose of quetiapine was changed from 75mg to 150mg MR 3 months ago but has not been changed back to 150mg IR. Sorry if I didn't make this clear in my profile. I will amend it.

Thank you for the information and links you've provided.

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Staz

Hi,

I'd like some advice please on which drug to taper first form my cocktail as shown below. I've just managed to get off of Lyrica after 10 months on it and despite all my meds I'm very depressed and anxious and having suicidal idealisation. Could this be part of the Lyrica w/d and when and which med should I tackle first. I should say I'm not psychotic and my Dr put me on seroquel as the A/D lofepramine was causing me to lose sleep. Due to no change in my condition my Dr upped my seroquel from 75mg to 150mg nightly and that has failed to work as well.

Any thoughts would be appreciated.

Staz

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scallywag

Staz, because you're still having symptoms from the RAPID Lyrica discontinuation, we'd suggest EITHER holding steady with your current medications and doses OR possibly reinstating a very, very small dose of Lyrica to see if it eases your symptoms.

 

What is your symptom pattern?  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.

 

You can either post those notes each day for a few days (3-4) or post 3-4 days worth of notes all at once in a single post.

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Staz
6 hours ago, scallywag said:

Staz, because you're still having symptoms from the RAPID Lyrica discontinuation, we'd suggest EITHER holding steady with your current medications and doses OR possibly reinstating a very, very small dose of Lyrica to see if it eases your symptoms.

 

What is your symptom pattern?  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.

 

You can either post those notes each day for a few days (3-4) or post 3-4 days worth of notes all at once in a single post.

Ok thanks Scallywag. I will hold any further tapers until my Lyrica w/d's stop. I don't have the option of reinstating the Lyrica as my shrink doesn't believe in w/d's carrying on for long periods after stopping drugs and I've not got any spare tablets left over.

Staz

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Staz

My Dr won't prescribe anything with out my shrinks say so ChessieCat. That's the way it works in the UK.

 

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scallywag

Staz,  what you're looking for with respect to your symptoms is stability -- no major swings within a day or from one day to the next. It may be that symptoms lighten and stop, or it may be a kinda-rotten-everyday-normal.  That's where a symptoms log becomes important; it's too easy to forget what has actually happened.

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Staz

It's rotten every day kind of normal Scallywag. Minor variations only I'm afraid. I've forgotten what feeling happiness and joy is like. My life has been 18 months of drugs hell. It's like living in a horror movie day after day every time I wake up.

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Staz
On 9/13/2017 at 3:13 AM, scallywag said:

Staz,  what you're looking for with respect to your symptoms is stability -- no major swings within a day or from one day to the next. It may be that symptoms lighten and stop, or it may be a kinda-rotten-everyday-normal.  That's where a symptoms log becomes important; it's too easy to forget what has actually happened.

It's rotten every day kind of normal Scallywag. Minor variations only I'm afraid. I've forgotten what feeling happiness and joy is like. My life has been 18 months of drugs hell. It's like living in a horror movie day after day every time I wake up

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Staz

After many changes of meds to try and control my depression by shrink has suggested adding to those meds I already take. He wants to add either Lithium or lamotrigine. The other options are to take me off my dosulepin and try another a/d called aglomelatine or just taper off of diazepam and slowly remove all the other meds. I don't feel strong enough to cope atm and each day is endless agony. I've resorted to having a couple of beers an evening to try and get my mind to slow down but I know I can't rely on that and will create a bigger problem for myself so I'm cutting that out.

 

Does anyone have any experience with Lamotrigene or could offer any advice as it seems counter intuitive to add yet another med to my cocktail but I've read it works for treatment resistant depression for some? Any advice or views would be greatly appreciated.

Staz.

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baroquep

Hi Staz, I've moved your recent post back into your introduction topic and would ask that you post all of your questions there.  We have a policy of one topic per member and it is best to keep all of your information in one place.  I just noticed that you increased your Dosulepin dose from 75mg to 175mg ... and are now wanting to add another drug ... are you planning on tapering off of your medication or are you looking to find a medication that will help with your depression?  I am confused as to what you are trying to do?

 

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Staz

Sorry baroquep.

I'm just looking at the options my shrink has given me. My dosulepin TCA has been increased from 75mg in May to 175mg in October and has given me no benefit so the options are to leave everything as is and add a mood stabiliser as per my post or come off of dosulepin and add in another a/d called aglomelatine. After 18 months of not responding to treatments I'm really at my wits end and can't see an end to my suffering.

The odd thing is I always responded to prozac but when this episode started I was put on mirt then that failed after a few weeks and prozac re introduced. I nearly went mad with anxiety so the prozac was stopped after 21 days and the escitalopram added. Same result and down the poly drugged trail I went. My depression wasn't this bad before the meds.

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ChessieCat
On 09/09/2017 at 6:16 AM, Staz said:

I've made the decision to get off of as many meds as I can

 

And the title of your topic is:  trying to get drug free.

 

Your last post mentions options of more/different drugs by your shrink.

 

Surviving Antidepressants is a peer support site providing information and support for coming off drugs safely.

 

5 hours ago, Staz said:

My depression wasn't this bad before the meds.

 

These drugs can cause the issues which we are told they fix.  The book Your Drug May Be Your Problem by Dr Peter Breggin has a chapter talking about this.

 

There is also a thing called medication spell binding.  Dr Breggin talks about this in one of these Simple Truths About Psychiatry - Series of 10 by Dr Peter Breggin

 

My personal opinion is that what you are experiencing is being caused by the drugs you are taking.  I don't think taking a different drug or adding an additional drug to "fix" what is being caused by the original drugs is the answer.   Personally I think it would be better for you to be reducing your drugs by tapering.

 

I have been taking an antidepressant for 25 years.  It wasn't until my dose got lower that I started feeling my emotions again.  It wasn't until this happened that I realised that I had been numb for all those years.  I also experienced times of depression during that time and from what I have learned since being a member here, I would not be at all surprised if it was caused by the AD.  Now I'm not saying that I would not have experienced some depression if I hadn't been on an AD.  I do think that being numbed by the AD made it harder to use non drug coping techniques.  I would just give in to the depression because I didn't have any mental energy, whereas now I feel more alert and am better able to use techniques to get me through the times when my mood is more depressed.

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Staz
32 minutes ago, ChessieCat said:

 

And the title of your topic is:  trying to get drug free.

 

Your last post mentions options of more/different drugs by your shrink.

 

Surviving Antidepressants is a peer support site providing information and support for coming off drugs safely.

 

 

These drugs can cause the issues which we are told they fix.  The book Your Drug May Be Your Problem by Dr Peter Breggin has a chapter talking about this.

 

There is also a thing called medication spell binding.  Dr Breggin talks about this in one of these Simple Truths About Psychiatry - Series of 10 by Dr Peter Breggin

 

My personal opinion is that what you are experiencing is being caused by the drugs you are taking.  I don't think taking a different drug or adding an additional drug to "fix" what is being caused by the original drugs is the answer.   Personally I think it would be better for you to be reducing your drugs by tapering.

 

I have been taking an antidepressant for 25 years.  It wasn't until my dose got lower that I started feeling my emotions again.  It wasn't until this happened that I realised that I had been numb for all those years.  I also experienced times of depression during that time and from what I have learned since being a member here, I would not be at all surprised if it was caused by the AD.  Now I'm not saying that I would not have experienced some depression if I hadn't been on an AD.  I do think that being numbed by the AD made it harder to use non drug coping techniques.  I would just give in to the depression because I didn't have any mental energy, whereas now I feel more alert and am better able to use techniques to get me through the times when my mood is more depressed.

I appreciate your response Chessie and agree with your overall synopsis of my situation. When you are poly drugged and suicidely depressed  where do you go.?My shrink gave me options as per my post and I think the only way is off but from a position of strength. I've come off of lyrica, escitalopram, prozac and  lofepramine in the last 18 months so my question to you is which is causing the disabling depression of my current meds? Where do I start and with which drug? Can I hang on that long or is adding another drug to help me ease of the rest a valid strategy as my depression is now considered unipolar and treatment resistant. I have the option of staying in the life threatening pit of misery or just maybe add a mood stabiliser. The choice is mine. I can stay where I am and try and stabilise before cutting one of the meds or maybe get some relief from another drug which has worked for some. The root cause is as you suggest. The path to take to reach my goal is a little less clear. Thanks for your opinion on the subject. also Dr Breggin I admire but he has a reputation of being selective with his clients although I agree with a lot of his ideas on the subject. Dr Healy here in the UK has also written extensively on the subject.

 

Staz.

 

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ChessieCat

Are these the drugs you are currently taking?  Mirtazapine, Quetiapine, Dosulepin and Diazepam

 

If you are still taking Mirtazapine, please move it to the bottom of your signature so all of the current drugs are together.  Thank you.  Account Settings – Create or Edit a signature

 

Taking multiple psych drugs? Which drug to taper first?
"If you're not having an adverse reaction from the other medications, taper the most activating drug first. This is usually an antidepressant or stimulant (ADHD drug)."

 

That was a really big jump in dose of Dosulepin.  It is not available in the USA so it doesn't show up in the interaction checker we use.  However I've found another one here which does:  https://reference.medscape.com/drug-interactionchecker

 

It is usually best for the member to do their own check, but this one was a bit tricky to use so here are the results:

  • dosulepin + mirtazapine

    dosulepin and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.

  • diazepam + quetiapine

    diazepam and quetiapine both increase sedation. Use Caution/Monitor.

  • diazepam + dosulepin

    diazepam and dosulepin both increase sedation. Use Caution/Monitor.

  • diazepam + mirtazapine

    diazepam and mirtazapine both increase sedation. Use Caution/Monitor.

  • quetiapine + dosulepin

    quetiapine and dosulepin both increase sedation. Use Caution/Monitor.

  • quetiapine + mirtazapine

    quetiapine and mirtazapine both increase sedation. Use Caution/Monitor.

  • dosulepin + mirtazapine

    dosulepin and mirtazapine both increase sedation. Use Caution/Monitor.

 

I suggest you do a search on serotonin syndrome to see if you are experiencing this.  I had mild serotonin toxicity on 100mg Pristiq.  I was sweating a lot and had a feeling of being unsettled which could escalate into agitation/anxiety.  The sweating was an obvious issue but It wasn't until I reduced my dose that I realised how unsettled I had been.

 

Just thinking out loud here.  The sedating drugs may be covering up serotonin toxicity.  You might want to consider reducing the dose of dosulepin because that is the one which was increased by a large amount most recently and may be causing serotonin toxicity without you being aware of it.  Because you have only recently increased the dose you might be able to reduce faster than 10% x 4 week hold.  You could try 10% and see how you are after 3 weeks and maybe reduce again.  Or you could reduce by more than 10% but I wouldn't do anything more than 25%.  After getting your dose a bit lower on the dosulepin you could then start reducing one of the sedating drugs.

 

As I said, these are my thoughts.  I hope I've offered things for you to consider which can help you reduce your drug load.  The decision about how you do it is yours.

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Staz

Hi Chessie and thanks. That's some really useful information my friend. My Dosulepin was tapered up over a few weeks and I could probably reduce it quicker as a result. I hadn't considered seratonin toxicity but it would explain why I reacted so badly to Prozac which always worked for me when I was already on mirtazapine as I went straight to 20mg of prozac while on 15mg of mirt.  Going on and off prozac by itself hadn't ever caused me a problem in the past although that was years ago now. I'll cut my Dosulepin as you suggest as I think you might be onto something with your analysis of my meds. Thanks again and I'll amend my signature to reflect this and your request.

Staz

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Staz

You've really got me thinking now as the symptoms you describe Chessie were precisely what happened to me when the prozac was added to the mirt. The answer was to force feed me benzos and not on shrink or doctor ever mentioned this as a possibility. I know I should be tapering quetiapine first due to it's risks but knocking the dosulepin back may help me more in the short term.

Your research also explains why I'm so demotivated, tired and but anxious at the same time. I wish I'd posted earlier now.

Staz

19 hours ago, ChessieCat said:

Are these the drugs you are currently taking?  Mirtazapine, Quetiapine, Dosulepin and Diazepam

 

If you are still taking Mirtazapine, please move it to the bottom of your signature so all of the current drugs are together.  Thank you.  Account Settings – Create or Edit a signature

 

Taking multiple psych drugs? Which drug to taper first?
"If you're not having an adverse reaction from the other medications, taper the most activating drug first. This is usually an antidepressant or stimulant (ADHD drug)."

 

That was a really big jump in dose of Dosulepin.  It is not available in the USA so it doesn't show up in the interaction checker we use.  However I've found another one here which does:  https://reference.medscape.com/drug-interactionchecker

 

It is usually best for the member to do their own check, but this one was a bit tricky to use so here are the results:

  • dosulepin + mirtazapine

    dosulepin and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.

  • diazepam + quetiapine

    diazepam and quetiapine both increase sedation. Use Caution/Monitor.

  • diazepam + dosulepin

    diazepam and dosulepin both increase sedation. Use Caution/Monitor.

  • diazepam + mirtazapine

    diazepam and mirtazapine both increase sedation. Use Caution/Monitor.

  • quetiapine + dosulepin

    quetiapine and dosulepin both increase sedation. Use Caution/Monitor.

  • quetiapine + mirtazapine

    quetiapine and mirtazapine both increase sedation. Use Caution/Monitor.

  • dosulepin + mirtazapine

    dosulepin and mirtazapine both increase sedation. Use Caution/Monitor.

 

I suggest you do a search on serotonin syndrome to see if you are experiencing this.  I had mild serotonin toxicity on 100mg Pristiq.  I was sweating a lot and had a feeling of being unsettled which could escalate into agitation/anxiety.  The sweating was an obvious issue but It wasn't until I reduced my dose that I realised how unsettled I had been.

 

Just thinking out loud here.  The sedating drugs may be covering up serotonin toxicity.  You might want to consider reducing the dose of dosulepin because that is the one which was increased by a large amount most recently and may be causing serotonin toxicity without you being aware of it.  Because you have only recently increased the dose you might be able to reduce faster than 10% x 4 week hold.  You could try 10% and see how you are after 3 weeks and maybe reduce again.  Or you could reduce by more than 10% but I wouldn't do anything more than 25%.  After getting your dose a bit lower on the dosulepin you could then start reducing one of the sedating drugs.

 

As I said, these are my thoughts.  I hope I've offered things for you to consider which can help you reduce your drug load.  The decision about how you do it is yours.

 

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Staz

After reading the Quetipine/ Seroquel advice I think that will be the next taper. My shrink wants me off it at the rate of 25mg every 2 weeks which was ok until I hit 50mg. I've held at this dose for a month now. When would it be sensible to re start a 10% taper as I don't feel holding has really changed anything for me? The depression is still there but I'm sleeping 6 hours or so a night now. any advice from those who have tapered this drug would be appreciated.

Cheers

Staz

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Staz

Ok. I've gone for it and dropped from 50mg of Quetiapine /seroquel to 37.5mg last night. I'm going to hold at this dose until Christmas. In the New Year I'll be doing 10% cuts from 37.5mg.

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