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DMV64

DMV64: Reinstate Saphris?

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Altostrata

I see your drug interactions report, thank you. 

 

I am a little confused. I didn't think you were taking Saphris and Geodon at the same time? You can see how that might cause problems.

 

There are lots of interactions with Saphris. Can you see any of the symptoms that distress you among the interactions?

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DMV64

Hello! 

Yes, I see all the interactions...just to be clear I am here because I do not want to be on all these drugs. The drug checker just makes it even more pressing although I am trying to be patient and not send myself into a tailspin.

I am not taking lithium anymore. In the extended drug history I wrote about that. I was only on it for a short while before I reinstated Saphris. Same thing for the Geoden.  Bubble had mentioned maybe not such a great idea to take these both out as same time as reinstate but it is done and I hope and pray it will be ok.

 I take Clonopin for anxiety. Gabapentin for bladder pain and it definitely works. Although I want to get that to the lowest dose possible.

I take vyvanse.for ADHD. I am considering dropping vyvanse-I am only on a tiny amount now and it exacerbates my panic limbic stuff. 

Saphris was added in for depression, since I cannot take SSRI.  

I thought I updated my signature but I will look at it now. 

I want off teh Saphris first. I am running into all kinds of titrate problems because it is sublingual. Even compounding pharmacies cannot do it. I am not sure what my options are here? If I can crush it without it disintegrating maybe I can use a jewelers scale. It will be impossible to make small enough cuts otherwise.

Thoughts?

-D

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DMV64

Todays update:

Feeling less panic today. Dropped Vyvanse because I am pretty sure it was aggravating my fight/flight, being a stimulant and all. Have slight feeling of tettering on edge of a fear plummet.

Took my 1 mg Klonopin this morning. Been reading a lot and learning. very inspired by Shep, who also was on antipsycotics. Feel hopeful. We can do this. Even if I have to do larger cuts and long holds. Today I feel hopeful.

: )

(member name removed by request)

Edited by JanCarol
Member name removed by request.

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DMV64

Reposted with permission from JanCarol:

Using another drug to taper is an absolute last resort.  They don't really hit the same things (regardless of what Docs say); it will give you another thing to taper.  Geodon might have different challenges, but not necessarily easier ones.

 

The way to do larger chunks is LONG HOLDS.

 

Using a microgram scale might help get your chunks as small as possible.

 

Saphris is a bear.  It's like they make them this way on purpose, knowing all the things that make tapering harder.

Each drug has a different challenge, as the drug companies give us:

1.  wrong pill sizes

2.  extended formulations that are difficult to split or liquify

3.  sublingual

4.  short half lives

5.  neurotransmitter complications

6.  bad information to doctors

7. buried side and withdrawal effects (i.e., they are called "relapses")

 

So - take the animal you've got (a bear), and make the best of it.

 

Long holds and a scale will be your friend.  With any luck, you might not even notice the taper.  Remember Non Drug techniques too - sun walks, weightlifting (especially good for neuroleptic withdrawal), yoga, meditation, mindfulness, breathing, more breathing.

 

 

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AliG

DMV. All good.  Maybe you should had checked in though before suddenly dropping your Vyvanse. Even though you want to be off : your brain has grown accustomed to it and with sudden withdrawal it tends to rebel and suffer. Whilst 5 mg may not seem very much -  it actually is . Much stronger than most doctors would have you believe. 5 mg is a substantial amount and should have preferably been very gently tapered.

 

Please let us know how you are feeling over the next few days. See how you go . I haven't fully read back over all your thread - do you have a consistent taper plan?

 

How are you feeling now ? Any symptoms? it would be great if you could keep notes.

 

When do you take your medication? Could you please post your notes here for the next few days. This will help us to get a clearer idea of what's going on. 

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DMV64

Hello.

I have stopped vyvanse before pretty easily. I realize this time could be different. However so far I feel better without the racing heart it create and exacerbates my already scrambled brain, but you are right, I will just have to see where it goes.

I am trying to stablize with a focus on getting off Saphris first which is sublingual so not easy. It has been suggested that I may need to make larger cuts and longer holds.

Right now I am about a 5. Anxious, but not in debilitating fear. Yesterday was very bad from the afternoon on. I do keep notes in my journal, do you mean keep them here?

I take Klonopin in morning

Saphris 2.5 mg at 6pm

Gabapentin split in 3 doses of 100mg each 11am,4pm,10pm

10mg Geoden 10pm

Thank you so much for your reply and help!

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DMV64

Afternoons are hard. Anxiety.  Fear. Been thinking should I split my klonopin dose? Half in am. Half in pm. Maybe not right now but soonish. 

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AliG

 Keep notes on paper about your drug dosages and daily symptom pattern

 

A symptom pattern that occurs regularly over several days could mean the symptoms are from withdrawal, other adverse effects of drugs, or something else you do on a daily schedule.

 

In the course of discussion in your Introductions forum topic, you may be asked to keep notes on paper of your daily symptom pattern, including when you take your drugs, their dosages, and any symptoms.

 

What we need to see for every individual day over several days is:

- Time and dosage for drugs taken in morning
- Time and description of any symptoms in the morning
 
- Time and dosage for drugs taken in afternoon
- Time and description of any symptoms in the afternoon
 
- Time and dosage for drugs taken in evening
- Time and description of any symptoms in the evening
 
- Time and dosage for drugs taken in middle of the night
- Time and description of any symptoms in the middle of the night (such as waking)
 
And so forth. A diary, in chronological order, such as:
 
6 a.m. Woke and vomited
8 a.m. Took 2.5mg Lexapro
10 a.m. Had diarrhea
10:30 a.m. Ate breakfast
11:35 a.m. Got a headache, lasted one hour
12:35 p.m. Ate lunch
4 p.m. Stomachache
5 p.m. Took 2.5mg Lexapro
6 p.m. Ate dinner
9:20 p.m. Headache
10:00 p.m. Took 50mg Seroquel
10:20 p.m. Headache got worse
10:30 p.m. Fell asleep
2:30 a.m. Woke, took 3mg Ambien (NOT "took 1/2 tablet Ambien")
2:45 a.m. Fell asleep
4:30 a.m. Woke with headache

 

An appointments diary is perfect for this and can be bought at stationary stores. 

They may have a page for each day with times for appointments which can be filled in with doses, symptoms etc as shown by Alto.

 

This style of posting would be helpful over the next few days if you can manage it. We can then establish a baseline and go from there.

 

Edited by AliG

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DMV64

Ok. I will try my best with this brain right now. 

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bubble

I must say I don't like how this is going: reinstated Saphris, cold turkey lithium, reduced Geoden, cold turkeyed Vyvanse: all in a matter of days.

 

There hasn't even been a chance for a pattern to form. We didn't even have a chance to suggest a course of action.

 

Now it will be impossible to say what caused what when things start going downhill.

 

And on top of all that thinking of tampering with Klonopin and discussing Saphris taper :(

 

And you say you didn't have problem stopping vyvanse before (it's just that you ended up adding all those drugs to deal with what followed). Also, what led you to conclude that it was vyvanse that caused you all those difficulties (and not for instance the fact that you have been bouncing so many other drugs?)

 

Our brain doesn't consists of separate departments which operate independently of each other nor does one drug 'fix' your anxiety, the other your depression, the third your ADHD, the fourth your bladder and so on. Things are a lot more complicated and everything is so much interconnected that describing things like that is just total oversimplification.

 

It seems you are mixing the cause and effect, act impatiently with the idea of let's fix things quickly and as a result complicate your situation even further. 

 

I'm sorry I can't be more positive at the moment.

 

Withdrawal mostly doesn't even begin to fully unfold within days and sometimes even weeks after discontinuing a drug. You just seem to pronounce symptoms you develop as a result of withdrawal as a new 'disorder' that you treat with a new drug. That's how you ended from one drug at 5 or 6 of them.

 

Unfortunately I don't see that your behaviour has changed since you got here. I apologise for being so blunt. Maybe things turn out fine. But maybe they won't.

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DMV64

I am sorry. I am trying to get better. I really need help and I feel now like I am doing the wrong things  : (

please don't give up on me. I am trying to hang on. 

 

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DMV64

I am not adding drugs. I never wanted to be in this position and like a lot of people wound up here for various reasons. Why do you think I am trying to solve things with more drugs. I am really struggling and I just am not totally sure why it seems you are angry. I am trying. I am in withdrawal. 

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DMV64

I am so upset. No i did not go off vyvanse and add things. I was already on those other things. I feel like I am being accused. And like I am being abandoned. If there is a course I should take pease suggest it. I  also did not say I was planning on tapering saphris or Clonopin now 

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bubble

I'm sorry you got so upset.

 

I was trying to give you an alternative view of your drug history and how you ended up on 5 drugs. I know that you didn't want that and that this realisation is upsetting.

 

Unfortunately, as I tried to explain, due to all the recent changes it is hard for me to suggest a course of action but I'm sure other mods will have ideas.

 

Please make sure you answer Alto's questions and describe your symptom pattern as Ali suggested to make things easier for them.

 

Best,

Bubble

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DMV64

Ok. I think I did answer most. I will reread. 

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bubble

Something happened with my phone and the message got sent repeatedly :( 

 

I just had another idea: I don't really think you are upset with me because after all I just summed up what is in your posts.

 

I think you are very upset and scared about being on all these drugs and struggling. 

 

Yes, you came here with 5 or 6 drugs (which you never wanted to take) but you are not a lost cause as you fear. 

 

There is a way out. It's just that this way out is not quickly stopping the drugs but starting to understand yourself and what is happening with you better. (And what has been happening with you: for instance prolonged use of benzos such as Klonopin is known to cause depression).

 

The immediate course of action would, as suggested before, be to stop making further changes.

 

Edited by bubble

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bubble
14 hours ago, Altostrata said:

There are lots of interactions with Saphris. Can you see any of the symptoms that distress you among the interactions?

 

This is a piece of information that would be useful to have.

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DMV64

 I will be sure to go over the drug interaction report and post the symptoms that distressed me. 

Right now I'm driving home from therapy but I will do it when I get home and I hope it will be helpful to me and anyone who is following

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DMV64

I am not making any more changes. Also, I am very aware that my benzo use is a very likely factor in my depression. I did titrate off Klonopin in 2010, took a while but I was on less. Was benzo free until I had the crash in 2011. I do not want that to happen again. 

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DMV64

Here are the things I find most distressing in  the drug interaction checker:

ziprasidone  asenapine irregular heart rhythm

clonazepam  ziprasidone

clonazepam  asenapine

gabapentin  ziprasidone

gabapentin  asenapine

all have impairment in thinking, judgment

difficulty concentrating

confusion

 

Also MEMORY LOSS

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Altostrata

Do you have irregular heart rhythm and the other potential symptoms you listed below?

 

8 minutes ago, DMV64 said:

Here are the things I find most distressing in  the drug interaction checker:

ziprasidone  asenapine irregular heart rhythm

clonazepam  ziprasidone

clonazepam  asenapine

gabapentin  ziprasidone

gabapentin  asenapine

all have impairment in thinking, judgment

difficulty concentrating

confusion

 

Also MEMORY LOSS

 

Did you start taking Klonopin after you started Vyvanse? As you realized, Vyvanse can cause anxiety.

 

But now that you've dropped some drugs, it could be your anxiety is caused by withdrawal, and we don't know from which drug. This is why we need you to hold steady on your drugs and take careful notes. At this point, I wouldn't make further changes until you can track your symptoms, when you take your drugs, and their dosages for at least a week. Try to take your drugs at the same time each day. Consistency is very helpful in figuring out what's causing what.

 

As you can see, your doctor or doctors have prescribed a grab-bag of drugs for you despite potential interactions, which doctors are supposed to avoid. This is not a good sign regarding quality of the care you've been receiving.

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DMV64

Hello!

I do not have the heartbeat thing although I find it scary. I do have the other symptoms on and off. I have been on Klonopin the longest, so Vyvanse came after Klonopin, considerably. I am holding steady now. I did have less anxiety today but more tears. 

I will track and keep to a schedule. And as I mentioned I am switching doctors. 

Thank you so much.

-D

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DMV64

We said not changes but --Maybe taking out the vyvanse today was harsh. Felt less anxiety but pretty bad on the depression.

What do moderators think for tomorrow? Leave it out? Put it back?

 

Todays log:

Woke up 630 Felt ok, a little anxiety

Did not take 5 mg vyvanse today to see if anxiety/fear is lessened

Took 1mg klonopin 8am

9am went for a run

11am 100mg gabapentin dose.

Felt less anxiety but sinking depression.

Crying afternoon

Therapy at 3:15

100 mg gabapentin 4pm

Depression

6:30 2.5 tab of Saphris

8pm very tired, lack of interest in anything.

8:35: Going to bed early, soon. last dose gabapentin 100mg, 10mg Geoden

 

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ChessieCat
On 13/09/2017 at 2:01 AM, DMV64 said:

Thank you for writing this about fear/anxiety! It i so helpful, especially the example. Just remembering fear is a response to a threat is helpful. The majority of my symptoms are extreme fear. I want to continue to find ways to work with that.

 

Claire Weekes was a doctor who suffered from anxiety and learned and also taught was to cope.  If you go to YouTube and type in Claire Weekes you will find lots of videos.

 

We also have a topic here on SAClaire Weekes' Method of Recovering from a Sensitized Nervous System

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DMV64

Than you!!  I am going to check it out! 

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DMV64

Checking in. Practicing floating through my symptoms as I have to teach a class this morning. 

I am holding on any changes.

 

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DMV64

Well, today has been close to unbearable. Really it is beyond anxiety, it is more like terror. I am using every methodology I know of: CBT, meditation, yoga, breathwork, reading here. All day the anxiety. I feel like I am hanging on by a thin thread and don't know what to do.

Anyone have suggestions? I am open!

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ChessieCat

Have you checked out the Magnesium topic?

 

I take magnesium twice a day.  I have found that it takes the edge off my anxiety.  When I have stopped taking it a few times the anxiety/feeling on edge has returned.

 

If you do decide to try it, please start with a small dose just in case you have a bad reaction to it.  Maybe dissolve some in water and sip throughout the day.  Or try an epsom salts foot soak, but only use a small amount to try it first.

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DMV64

I do take magnesium thank you though! I will try the epsom salt foot soak....actually now that I think about it, someone mentioned that to me.

I feel like I can deal with all the other symptoms but not this terror feeling all day.

: (

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DMV64

How do you get a tapering graph? Not that I am tapering yet...

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ChessieCat
15 hours ago, DMV64 said:

 I am so excited to read your message! It is very hopeful. And I'm really glad that there is a way to taper this!

 

I'm assuming that you have been in conversation with IHateSaphris by PM.  Has this member provided information about how they managed to taper a sub lingual drug?  If so, please start a new topic Tips for Tapering Saphris in the tapering forum so that other members can have access to the information as well.  Thanks.

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bubble
On 9/15/2017 at 5:00 PM, DMV64 said:

Dropped Vyvanse because I am pretty sure it was aggravating my fight/flight, being a stimulant and all.

 

What is the situation with Vyvanse at  the moment? Did you stop taking it completely on 15 Sept or did you reinstate it again?

 

Please update your signature.

 

When did you start taking it?

On 9/16/2017 at 2:37 AM, DMV64 said:

We said not changes but --Maybe taking out the vyvanse today was harsh. Felt less anxiety but pretty bad on the depression.

What do moderators think for tomorrow? Leave it out? Put it back?

 

We said no changes as in not stopping yet another drug especially cold turkey. I would reinstate it (put it back) as soon as possible. 

 

Judging by your symptoms you continued without Vyvanse. 

9 hours ago, DMV64 said:

Well, today has been close to unbearable. Really it is beyond anxiety, it is more like terror. I am using every methodology I know of: CBT, meditation, yoga, breathwork, reading here. All day the anxiety. I feel like I am hanging on by a thin thread and don't know what to do.

Anyone have suggestions? I am open!

 

Reinstating is the only way to stop withdrawal. No amount of coping methods will help you take the edge off a cold turkey. They will help you to deal with suffering but can't take it off completely.

 

You will get the relevant advice on the forum if you post your drug situation accurately together with the log of your symptoms. 

 

If I were you I would stick with this two things at the moment and repeat them if I didn't get the answer immediately because it is most important for you at the moment. Asking about other things diverts the discussion and then everybody loses focus from what is actually happening. There are a lot of people here, all seeking help and it is easy to overlook very important information if it is not presented clearly. We don't want to scare you but I think that is the only way you can be helped. 

 

This is what baroquep wrote for Quest but I feel it applies to you word by word (it applied to all of us at one point. When I first joined here it also took me a while to understand how to manage my situation):

 

HI there, sorry to hear that things are still so rough, know how hard it can be.  I really feel for you Quest, I have a fairly good idea of what you are going through but imagine it must be 10 times worse as I only had to deal with one change.  I know it is hard, but the only thing you can do right now is hold and try and find something that will help calm your mind.  If you change your sleeping pill prescription or antidepressant at this time, I can guarantee you this will just make things worse for you. (In your case it means changing any of the drugs you are taking). 

If I was in your situation, my first concern would be stabilizing my central nervous system and under no circumstances would I make any changes to my medication.  Your CNS needs a break from all the changes you've made over the last couple of years.  Every time you've made a change, your central nervous system has had to try and recalibrate to accommodate the change and it just hasn't had that opportunity.  If you add or change drugs at this point, you will likely make the anxiety even worse which will in turn disrupt your sleep even further.   Your sleeping will begin to regulate as your central nervous system stabilizes.  When the central nervous system has been destabilized it can be set off by something as inocuous as a vitamin never mind another drug.


One thing I did learn, thankfully very early on after reading story after story on this site, was that the people who seemed to be having the easiest time were the people that did long holds and made few if any changes.  When I saw my doctor back in March and they suggested I switch to Prozac, it certainly sounded tempting, but I knew better.  I'd already read all the stories about switching to Prozac and knew that it all the cases I'd read about, it didn't work, and just made things worse.  How could so many other people who actually had personal experience with these drugs be wrong?   So if I can try and guide you in any direction, it would be to hold where you are, keep a diary so that you can see the slow progression toward stabilization by staying the course and allowing your brain to rest and stabilize on the Effexor and Zoplicone. / the drugs you are currently taking Your CNS needs a very very long rest from all the changes so it can carve out a pathway to healing.  If it means cultivating blind faith that eventually things will get better please grab onto that hope.  Treat yourself with the utmost of compassion, and practice extreme self-care, give yourself a hug through the anxiety and just try and hold on.     

 

Mindfulness and Acceptance

Acceptance

Keep it Simple, Keep it Slow, Keep it Stable

 

You will first have to stabilize on the dugs you are currently taking: Saphris, vyvanse, Klonopin, gabapentin, AND Geodon. It will take months.

 

Maybe you will even have to updose Geodon if symptoms become too unbearable. Hopefully you can get away without havig to reinstate Lithium. 

 

So discussing how to taper Saphris was diverting the intention of everyone who came to your thread from the bigger picture of your situation.

 

You had just introduced Saphris and what was needed was just a very careful log of symptoms while keeping all the other drugs steady. While discussing tapering Saphris (which will only happen months form now) you diverted the attention from the fact that you stopped Lithium, reduced Geodon and then cold turkeyed vyvanse afer we explicitly said not to make any changes.

 

I was really trying to be very careful about the tone of conveying this information because I really wouldn't want you to get upset again. For your own good. While all the information you get here is very relevant there is a certain order of things. While your house is on fire it's just not the time to discuss which carpet would be best to buy. If you know what I mean.

 

Practicing non-drug coping skills is very important but it is even more important to address the basics and set you on the right course to begin with.

 

I would advise writing a more detailed log of your symptoms together with the times when you take all of your drugs and their symptoms and posting it every day for few days.

 

Also if in any way possible, look into the possibility of taking time off and focusing on yourself.

 

When it all started you were a single mom. It was very difficult to ride out symptoms and your primary goal was to stay functional. Now things are different. From what I could understand about your life situation it is not so pressing at the moment and your well being is really at a high need to be addressed. It is more important than being functional at all costs. 

 

Edited by bubble

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DMV64
3 hours ago, bubble said:

 

What is the situation with Vyvanse at  the moment? Did you stop taking it completely on 15 Sept or did you reinstate it again? I reinstated this morning after reading your message

 

Please update your signature. Ok

 

When did you start taking it? Vyvanse? Maybe 2 years ago. Was off it for about 1 month a year ago.

 

We said no changes as in not stopping yet another drug especially cold turkey. I would reinstate it (put it back) as soon as possible. Ok just did.

 

Judging by your symptoms you continued without Vyvanse. 

 

Reinstating is the only way to stop withdrawal. No amount of coping methods will help you take the edge off a cold turkey. They will help you to deal with suffering but can't take it off completely.

 

You will get the relevant advice on the forum if you post your drug situation accurately together with the log of your symptoms. I really am trying the best I can.

 

If I were you I would stick with this two things at the moment and repeat them if I didn't get the answer immediately because it is most important for you at the moment. Asking about other things diverts the discussion and then everybody loses focus from what is actually happening. There are a lot of people here, all seeking help and it is easy to overlook very important information if it is not presented clearly. We don't want to scare you but I think that is the only way you can be helped. 

 

This is what baroquep wrote for Quest but I feel it applies to you word by word (it applied to all of us at one point. When I first joined here it also took me a while to understand how to manage my situation): This was great!

 

 

 

You will first have to stabilize on the dugs you are currently taking: Saphris, vyvanse, Klonopin, gabapentin, AND Geodon. It will take months.

 

Maybe you will even have to updose Geodon if symptoms become too unbearable. Hopefully you can get away without havig to reinstate Lithium. I thought this yesterday, that I might need to updose Geoden. I only reinstated Saphris at 1/2 dose, so I could also updose there but it is harder being sublingual. Thoughts? 

 

So discussing how to taper Saphris was diverting the intention of everyone who came to your thread from the bigger picture of your situation. I guess that is what I thought I was doing.

 

You had just introduced Saphris and what was needed was just a very careful log of symptoms while keeping all the other drugs steady. While discussing tapering Saphris (which will only happen months form now) you diverted the attention from the fact that you stopped Lithium, reduced Geodon and then cold turkeyed vyvanse afer we explicitly said not to make any changes.

 

I was really trying to be very careful about the tone of conveying this information because I really wouldn't want you to get upset again. For your own good. While all the information you get here is very relevant there is a certain order of things. While your house is on fire it's just not the time to discuss which carpet would be best to buy. If you know what I mean. I understand. I am also operating kind of on half gas here so it takes awhile to understand.

 

Practicing non-drug coping skills is very important but it is even more important to address the basics and set you on the right course to begin with.

 

I would advise writing a more detailed log of your symptoms together with the times when you take all of your drugs and their symptoms and posting it every day for few days. Ok

 

Also if in any way possible, look into the possibility of taking time off and focusing on yourself. Since I own a business that really just opened I cannot totally do this but I do have a business partner who is picking up a bunch of my work.

 

When it all started you were a single mom. It was very difficult to ride out symptoms and your primary goal was to stay functional. Now things are different. From what I could understand about your life situation it is not so pressing at the moment and your well being is really at a high need to be addressed. It is more important than being functional at all costs. I really am trying to take it down. But also too much free time tends to bring more anxiety. Teaching is hard but when I am in it, I am out of this for the moment.

 

 

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DMV64
9 hours ago, ChessieCat said:

 

I'm assuming that you have been in conversation with IHateSaphris by PM.  Has this member provided information about how they managed to taper a sub lingual drug?  If so, please start a new topic Tips for Tapering Saphris in the tapering forum so that other members can have access to the information as well.  Thanks.

I asked Ihatesaphris to post the taper. I have not done it but we did discuss it.

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bubble
30 minutes ago, DMV64 said:

I thought this yesterday, that I might need to updose Geoden. I only reinstated Saphris at 1/2 dose, so I could also updose there but it is harder being sublingual. Thoughts? 

One change at a time, close monitoring of the symptoms for a week, detailed log of the symptoms and then we reassess.

 

How many days were you off vyvanse?

 

I suspect worsening of your symptoms was due to cold turkeying it. Now once you have reinstated, it might take even a few weeks before things come to the pre-cold turkey state. Maybe less but maybe more.

 

Not to mention that now we can't tell how reinstating Saphris is working. And there is no way to tell how CT lithium and reducing Geodon is affecting you either. It's all contributing and causing your symptoms. Not making any further changes and riding tge symptoms out is a way out.

 

The first thing that needs to be done is to wait for the consequences of vyvanse cold turkey to abate and keep still with no further changes.

 

There will be symptoms. The brain got badly traumatised. But you know what they say the best thing when attacked by a bear is: not do anything, keep still, don't panic and don't run (or in your case don't change drugs).

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