dignan: pre-work for an eventual taper attempt

[dignan]

After I up dosed back to 81mg of Lyrica, things initialed settled down nicely. What began, however, was a roaming itch that comes and goes. Then, over the past few days, some anxiety has come back, and now major sleeping issues. Three nights ago I woke up in the middle of the night with an itch on my face and could not return to sleep. Last night I don’t think I slept more than an hour, if I slept at all. 

 

I will try some melatonin tonight. I tried a bit of magnesium but it was ineffective. I can only take so much magnesium, however, because I am taking lithium. Sleep is my main concern right now.

[Petunia]

Hi dignan, its going to take some time for your nervous system to settle down again, so please be patient:

 

• After reinstatement, the amount of time needed to alleviate withdrawal symptoms (stabilizing) varies according to the individual. Relief can be felt immediately, after some weeks, or after some months.
• Once you feel withdrawal symptoms are reduced after reinstatement, give your nervous system time to stabilize before attempting dosage reduction. Think in terms of months, not days.
• Be patient after you reinstate. Reinstatement may not immediately eliminate all withdrawal symptoms. You may still experience waves of symptoms, which usually lessen as time goes on.

this is from our reinstatement topic here:  http://survivingantidepressants.org/index.php?/topic/3079-about-reinstating-and-stabilizing-to-stop-withdrawal-symptoms/

 

You are probably having a wave of symptoms and they will lessen with time.  I hope the melatonin helps, do let us know.

 

Petu.

[dignan]

Thanks. I tried .3mg of melatonin. It was much of the same as the previous night. At the absolute most, I only slept an hour. 

 

I'm trying to be patient, I'm just nervous wondering when I'll receive a few hours of sleep again.

[Altostrata]

Please stay the course, dignan. You might try a higher dose of melatonin, maybe .5mg, for a few days.

[dignan]

I intend to stay the course, I'm just a wobbly now due to lack and sleep and the panic emerging from that. 

 

I wonder if taurine or Lactium may be of further assistance? I'm just to think of a few things now while I still have some clarity of thought.

[dignan]

I tried .5mg of Melatonin last night and I probably slept, in total, four hours. This is a major improvement on the previous several nights.

 

Today, however, has been my worst day for anxiety since around up dosing to 81mg of Lyrica (I will update my signature soon).

 

Hopefully the anxiety will settle... I sense panic is nearby... walking a lot.

[dignan]

It’s been 37 days since up dosing back to 81mg of Lyrica. I am still struggling.

 

For several weeks I was itchy, a vicious wandering itch that would “attack” one or two areas of skin. Next came several days of burning, prickling, or tingling skin, like little firecrackers going off under my skin — like paresthesia or something. Neuroemotions subsequently emerged, particuarly agitation, anger, and fear. These emotions are still cycling now, though sometimes they abate for a little bit. Over the past few days I’ve also experienced flu-like symptoms; and anxiety still comes and goes.

 

Yesterday, I had derealization and I felt a weird sensation in the left side of my head, like it had shut down or something. It was quite alarming. Thankfully, it passed.

 

I suspect I’m getting every Lyrica withdrawal symptom imaginable because my nervous system was still sputtering before I even began cutting. I also suspect I will by holding for a while as my nervous system tries to sort out this mess. 

[Altostrata]

Have you changed anything else recently?

 

Please put ALL the drugs you take in the Drug Interactions Checker http://www.drugs.com/drug_interactions.html and post the results in this topic.

[dignan]

I have not changed anything. 

 

Interactions:

lithium ↔ mirtazapine

Applies to: lithium, Remeron (mirtazapine)

Using lithium together with mirtazapine may increase side effects such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience some impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with thesemedications. Avoid driving or operating hazardous machinery until you know how the medications affect you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

lithium ↔ pregabalin

Applies to: lithium, Lyrica (pregabalin)

Using lithium together with pregabalin may increase side effects such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience some impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with these medications. Avoid driving or operating hazardous machinery until you know how the medications affect you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

mirtazapine ↔ pregabalin

Applies to: Remeron (mirtazapine), Lyrica (pregabalin)

Using mirtazapine together with pregabalin may increase side effects such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience some impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with these medications. Avoid driving or operating hazardous machinery until you know how the medications affect you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

[Petunia]

How is your sleep now dignan?  Has it improved, are you still taking melatonin?

[Altostrata]

As you can see, all your drugs are interacting.

 

How is the itching now?

[dignan]

Thank you kindly for responding. 

 

 

 

 

How is your sleep now dignan?  Has it improved, are you still taking melatonin?

 

My sleep is up and down but, generally, it has improved. I think I may be adjusting to sleeping somewhat less than I’m ordinarily accustomed to. I only used melatonin for a handful of nights. I stopped using it several weeks ago; I prefer to only use it when necessary. 

 

 

 

As you can see, all your drugs are interacting.

 

How is the itching now?

 

Over the last two days, things have generally improved. The itching has largely settled down. It mostly comes in waves and the waves have become weaker. Now it’s just down to occasional twinges so to speak. The flu-like symptoms and nausea are also dissipating.

 

I agree with drugs.com's analysis; I am definitely impaired.

[Petunia]

I'm glad to hear that things are starting to settle down since your updose.  Please give yourself plenty of time before you start tapering again and when you do, maybe consider 2% - 5% cuts rather than 10% as Rhi suggested in an earlier post.

[dignan]

Today, after nearly a three month hold, I've made a 5% reduction to Lyrica, from 81mg to 77mg. I will hold here for at least a month and then re-evaluate my situation. 

 

Originally I had the Lyrica compounded at a pharmacy. The pills they provided, however, had significant variances between them: more than 50% at times (thankfully the pills were only for 6mg). Needless to say, I was pretty angry. I went to another compounding pharmacy and soon began developing withdrawal symptoms. The way they compounded drugs made it impossible for me to double check their work. Eventually, it dawned on me that if I wanted a consistent does of Lyrica I needed to compound it myself. At first, it was challenging figuring things out, but now it is pretty simple and easy. 

 

I am receiving Intramuscular Stimulation (IMS) for my back injury. I have some nerve dysfunction. Sometimes it is difficult to determine whether a particular nerve dysfunction is the result of my injury or from Lyrica. 

 

I had an MRI recently. Afterward, I had major rocking vertigo and felt a rocking sensation, at various intensities, for the remainder of the day. I’ve occasionally experienced rocking and balance issues for the past few months. Sometimes I think that my body is actually moving from muscle twitching deep inside my body (or something).

 

I’ve had some major stress recently and my health began to deteriorate, mostly from anxiety. I have now eliminated that burden of stress as it was not worth it.

 

Even though it seems that healing will never come to pass, I am doing my best to achieve the impossible.

[Altostrata]

Hang in there, dignan.

 

I made a liquid myself with Lyrica and water, it was easy and worked fine.

[dignan]

Just over a month has passed since my 5% reduction (81mg to 77mg) to Lyrica. The first three and a half weeks went as expected: some minor withdrawal symptoms which quickly faded. Since Sunday, however, something has shifted. 

 

I first experienced anger, rumination, and inability to focus, which has since builded to intense waves of sickness and anxiety and a constant malaise. I also have body aches and pains which may or may not be associated with my Lyrica withdrawal. The small 4mg reduction in Lyrica does not seem to correlate with my level of suffering.

 

The worrier in me fears that I’ve hit Remeron tolerance. 

 

If this is indeed Lyrica withdrawal, then I can expect it to eventually pass, but it will take me a long, long time to taper this drug. The problem is I also have two other drugs to taper. Maybe Lyrica's toxic relationship to the other two drugs is making tapering even more challenging. And that’s the best case scenario. The worst case is Remeron tolerance... 

 

I'm trying to re-evaluate things. I guess for now I just sit tight and see if this current wave passes.

[dignan]

Last night I felt a strong sensation of heat in my hands, and then experienced hot and cold flashes all over my body, while shaking, feeling quite ill and having a roaming pain. It has me freaked out a bit as the last time I experienced hot and cold flashes was when I kindled on Paxil like five years ago. 

 

It is hard to fathom that this is from a 4mg reduction in Lyrica... as I'm having different symptoms than from my previous and much larger Lyrica reduction.

[Altostrata]

Your nervous system is still figuring it out.

[dignan]

I have a question regarding the halfway point of a water titration taper. I am looking to see what others have done in my situation and the results they’ve experienced.

 

I am presently tapering mirtazapine via water titration. I am now approaching 15mg, the halfway mark of the taper. 

 

Method Before the Halfway Point

 

I drop a 30mg drug tablet into 60/ml of water to form a drug solution. That means, for every 1mg of drug tablet, there is 2/ml of water. Up to this point, I have removed drug solution with syringes and consumed the remaining solution in the cup, the “dose.” The solution in the syringes is discarded. At present, I remove nearly half the drug solution from the cup; however, soon there will not be enough solution remaining to reliably pull up with a syringe.

 

Method After the Halfway Point

 

Do I now inverse the process? That is, do I now remove the “dose” with the syringes and discard the cup?  I mean, it looks like this is the only way to proceed. However, there are several issues with this.

 

Potential Issues

 

Removing 30/ml of drug solution theoretically removes 15mg of drug. Whether I am actually removing 15mg of drug, who knows. The most important thing thus far has been consistency as opposed to accuracy. But inverting the process causes a major shift in consistency.

 

1a. It seems clear I will be taking the same amount of drug solution. However, am I taking the same amount of drug? Do more or less drug particles get sucked into the syringe? 

 

1b. Is there any experiment to clarify this? I can see lots of white particles (the drug/filler or both) in both the syringes and cup. I am trying to see if I can evaporate the water and measure the particles left behind.

 

2. What about the drug left behind in the syringes? I use four syringes per taper. Even if I rinse the syringes, there will invariably be drug left behind there. This seems like a loss I must accept.

 

3. I am very sensitive to changes and conduct a micro taper (.05mg cuts) so a significant change to the “dose” will definitely be felt. I am concerned that the “dose” may change.

 

What have others done in my situation? What were the results?

 

 

[ChessieCat]

I can understand your concern.  Have you considered using pharmaceutical liquid such as Ora-Plus instead of water.

 

And there is this option:

 

On 11/04/2012 at 10:07 AM, Altostrata said:

Reduce by making a liquid with the "orally disintegrating" tablets
You may be able to dissolve the orally disintegrating tablets ("Soltabs") in water and use an oral syringe to take a measured dosage. I couldn't find any reports of doing this but, since the orally disintegrating tablet is designed to dissolve in saliva, it seems likely to work.

I would take the dosage immediately and discard the rest -- do not count on it keeping for any length of time. For instructions on how to make a liquid, see http://survivingantidepressants.org/index.php?/topic/2693-how-to-make-a-liquid-from-tablets-or-capsules/ If you do this and it works, please let us know in this topic.

 

[dignan]

I am not sure how switching to Ora-Plus is beneficial in my situation. The second method you mentioned is the one I wrote about as the only foreseeable option. Does anyone have any experience?

 

 

[dignan]

It has basically been six years since I last really updated my situation, so I thought I would do so.  

 

I am generally faring well. I have successfully tapered both Lyrica and lithium and by December it is my aim to be off mirtazapine as well. I don’t have any fear of finishing the mirtazapine taper anymore; I know I will be fine.  

  

While things are going much better now, it was not always this way. My first five years of tapering were, for the most part, increasingly insufferable. In retrospect, however, I think the bulk of my suffering was largely avoidable. I say this because, about a year ago, I took certain actions that precipitated a major turning point in my taper; at that time, most of what I had interpreted as “withdrawal” or “drug damage” began to disappear. I’d like to record that turning point here. 

  

First, though, I should say that my previous posts on this thread reflect my former point-of-view regarding my experiences with withdrawal and persistent pain. Back then, I thought that I had protracted withdrawal syndrome and a back injury, with the latter leading to persistent pain via “central sensitization”.  

  

With this perspective of myself and my life situation, both the withdrawal and persistent pain worsened and it became increasingly difficult to differentiate between the two. I experienced near-constant pain (to varying degrees), muscular dystrophy, weight loss, and frozen shoulders, torso, legs, etc. My activities were so limited I could not even make a meal for several years. Of course I saw a bunch of pain professionals and engaged in various forms of “therapies”—each of which ultimately made me worse. I attributed the persistent pain to possibly something along the lines of “drug damage”; that withdrawal had somehow made my nervous system more vulnerable to pain sensitization. 

  

I also experienced stuff that seemed like classic withdrawal such as flu-like symptoms, powerful emotional surges, “active nerves”, red scrotum syndrome, gum/teeth sensitivity to sugar/acid (eat a banana = throbbing pain for the rest of the day), heat waves, sensitivity to heat, vertigo, swelling, rashes/dermatitis/dry skin etc., various discomforting sensations, and so on. This was all annoying—and sometimes downright terrifying—but the persistent pain was the most consistently debilitating thing for me in terms of functioning. 

  

As I mentioned off the top, however, I am now faring well, and these dreadful things are largely a thing of the past. My turning point for both the persistent pain and withdrawal began more than a year ago. 

  

It started when I watched a Google Talks lecture (https://www.youtube.com/watch?v=0VyH1laOd2M&t) on a rather unorthodox theory on persistent pain. The basis for the lecture originates from the late John Sarno, a pariah rehabilitation physician who argued that the primary cause of persistent physical/psychological pain is unconscious emotional tension.

 

Initially, I considered Sarno a quack, some Freudian huckster, and I resisted any idea that my physical pain may have stemmed from my mind (my horrific experiences with psychiatry made me suspicious of anything of this nature). However, this seemed different: the more I read Sarno’s work (or listened, I couldn’t hold a book to actually read at the time), the more it became clear to me that I might be able to understand my pain as mind-based, yet in a non-pathological way. 

  

As Sarno theorized, I came to see that my physical pain was manifesting my unconscious emotional suffering; specifically, that my unconscious mind was deploying physical pain as a distraction from my unconscious emotions, which it interpreted as so powerful and threatening that they represented an existential threat to me, e.g. perhaps from acting on my emotional impulses or just imploding in rage (the conscious rage/other emotions are just the tip of the iceberg… ). So my unconscious mind created and/or perpetuated pain to redirect my focus instead. 

  

Sarno called this mindbody concept TMS (an acronym that has meant various things but now often referred to as The Mindbody Syndrome). While the TMS label irks me (I don’t like labels), Sarno’s perspective on the mindbody opposes the pathologization of human suffering; that is, TMS is not a “disease” or a psychiatric label, but a recognition that our mind can affect our body in various ways that we may perceive as painful or otherwise uncomfortable (this is obvious in minor mindbody experiences such as “butterflies” or blushing, but not so obvious in major mindbody experiences of persistent pain, which are often theorized as structural or neurological issues). 

  

As I implemented Sarno’s ideas into my life (there are various exercises and strategies to achieve this), I stopped viewing myself as someone with “chronic pain” and I recognized that the pain was diverting me from meaningfully addressing my unconscious emotions (e.g. rage at psychiatry, pharmaceutical companies, the drugs, childhood stuff, etc.). So I stopped “treating” the pain, giving up the delusion that anything was wrong with me; rather, I exclusively attended to my hurt spirit and emotions, which made the distraction of pain lose its purpose—and, therefore, the pain began to disappear.  

  

But here is the kicker: as the pain disappeared, so did the withdrawal. As I came to understand that the persistent pain was a trick of the mind and that I was actually healthy, I guess my unconscious took that message and applied it to withdrawal, because it stopped as well. I now see my experiences with protracted withdrawal and persistent pain as basically the same thing, serving a similar function: to distract. As a result, I’ve stopped thinking of myself as someone in “withdrawal” and it’s largely ceased its manifestation. 

  

To be clear, I still think that drugs (e.g. “antidepressants”) can cause physical dependency and produce a period of withdrawal that has a neurophysiological origin. Admittedly, it is not even entirely clear to me regarding the totality of my own experiences what was withdrawal versus TMS. There is a lot of grey area. I do suspect, though, that protracted withdrawal syndrome (or PAWS) may be perpetuated as a tactic of the unconscious that feeds on the memory of withdrawal for the purpose of distraction, possibly to make a person body-focused and thereby divert one’s attention from unconscious emotional tension/trauma. One clue to this (I think there are many clues) is that stress can make withdrawal so much worse (i.e. the focus shifts from the stressful situation to the body-experience of withdrawal). 

  

I think that the TMS model for healing, which is well-established and highly successful in particular peer-oriented communities for persistent pain, may be applied to those of us experiencing protracted drug withdrawal by possibly helping to lessen its intensity, shorten its duration, or reduce the risk of protracted withdrawal altogether. I’d also note that I’m not the first person on this forum—or other forums—to report success with this approach. I’m not a one-off. 

  

Finally, while I have given a more “psychological” orientation for TMS, you could also view it from more of a “scientific” lens if so inclined, and the video I linked to above does go more into the neuroscience of mindbody phenomena. One illustration is that it's demonstrated that an initial experience of pain may be learned to become persistent pain by our brains, in part, due to our attention on it; that is, pain can be learned as a conditioned response of neurological pathways (especially located in emotional centres in the brain, i.e. persistent pain is an emotional injury). These pathways can be intentionally rerouted, though, thanks to specific mindbody approaches and the neuroplastic nature of our brains. I think these theories for persistent pain may also apply to persistent withdrawal (although the speaker in the video does not mention it specifically, I know that he, among others, thinks likewise).  

  

I should also note that I am still slowly tapering! It still makes sense to me to slowly discontinue psych drugs because, as the people on this site are well-aware, they can cause hellish and dangerous withdrawal reactions. 

  

Anyway, I’ve really only touched on a few ideas here, mostly regarding my own experiences. I’ve tried not to make this update too long. There are lots of resources on this topic, though. 

[Altostrata]

That is quite the insight, Dignan. Thanks for coming back and sharing it.

 

Yes, I believe pain management counselors have found some non-drug techniques reduce the sense of pain. It could also be that your withdrawal syndrome was ebbing at the same time you delved into this practice.

 

At any rate, it seems you learned a lot about yourself, your inner life, and your abilities to cope.

 

Please continue to let us know how you're doing.

[Psum4444]

Hi I read in your post that you’re from Toronto.  I’m suffering from anxiety and I’m currently on Mirtazapine.. and I haven’t been doing very well on it I’m thinking about starting Paxil.  I would like to get some of your input.  

 

Edited November 4, 2020 by ChessieCat
removed quote

[dignan]

Hi @Psum4444. I sent you a PM.

[Boris]

I discovered Sarno back in 2007 due to chronic RSI but could never get anywhere with it and I ended up on Paroxetine due to this strange arm, hand, limb pain. I use to post over at the TMShelp forum. I wish I had stuck with it but I think I was in too much panic about my career as I'd just finished university. It would move around from arm to arm which is as you know is a key sign.

 

Each time I came off Paroxetine the arm pain would come back so I would go back on until in 2009 a reinstatement caused adverse effects. The adverse effects and the path I went down stopped me worrying about my arms and as you guess the pain never came back as I had a new fear.

 

I've noticed over the years how I can develop a fear of a symptom or sensation and then it can become 'chronic'. I'm definitely in this category of mind body illnesses and I have the childhood trauma to go with it. I have the classic symptom substitution as well, even my mother mentioned it's like I can't ever let go and be happy. I always have something going on.

 

My withdrawal and uncontrollable symptoms were very real but I do wonder how much I kept going over the years with my anxiety.

 

My last main symptoms is my urinary system and I'm now taking the approach with a physio who works from the mind body angle. I've always thought I had to resolve my past but with therapy I never had any relief. I've had more progress telling myself 'no emotional reaction' to sensations when they are bad recently.

 

I'm really happy to see how well you have done from your experience with the meds and also the chronic pain. I've never really seen any techniques apart from reading the books. I'll have to look into it again.

 

I've never been keen in the mind/body label as I don't see it as separate entities.

 

 

[dignan]

Hi Boris, 

 

Thanks for posting this! It sounds like you have a lot of experience with some of the more aggravating aspects of mindbody phenomena. Just reading over your thread shows, as you’ve pointed out, that you’re (like myself) highly susceptible to mindbody pain. The fact that you’re now revisiting the mindbody approach sounds like a really good idea. 

 

Like yourself, I also have childhood trauma, a really critical personality, and all that. I’ve also had therapy (psychodynamic, etc.), but the aim to resolve my trauma never really panned out—although it may have made me more aware of it. Thankfully, for a mindbody approach, it’s not necessary to resolve trauma or change one’s personality. It seems that the important thing is to deeply acknowledge emotional memories within oneself that are being purposefully obscured by the unconscious mind via the distraction of pain. 

 

It’s interesting to hear you say that you’ve made more progress by saying “no emotional reaction” to yourself when you experience uncomfortable sensations. You probably already know this but Sarno also says—and what really helps me when I feel uncomfortable sensations (which I used to interpret as protracted withdrawal)—is to think about what I’m emotionally upset about. Once I redirect the mind by thinking about what’s bothering me emotionally, the physical sensations I experience no longer have a purpose since I’m showing the mind that I’m not buying into its trickery/distraction. This process rewires the mind to start thinking about what’s bothering me emotionally rather than giving me pain/"withdrawal."

 

I also had urinary tract/pelvic floor issues for quite some time (it was kind of on and off, but often lingered around). I did physio for a number of years to address a range of what I perceived as physical issues and regularly performed many different exercises. For me to get better, I had to stop going to physio and doing exercises, but I had to have a lot of confidence in the mindbody process before I could do this.

 

I am somewhat familiar with TMShelp. I think it might be surpassed now by TMSwiki—a wiki and forum that has some useful and not so useful information. There are some interesting programs, though, and even brief discussions on drug withdrawal in the context of “TMS.”

 

In case you haven't heard, there is also a great book now by Steve Ozanich called The Great Pain Deception, the best “TMS” book that I’ve read outside of Sarno himself. I had to really absorb myself in a range of materials (including a short online course) to help imprint Sarno’s mindbody concepts into my unconscious mind as I learned it requires more than just intellectual understanding.

 

I’m not fond of the label TMS (I don’t see TMS as an illness and neither does Sarno), but as far as the term mindbody goes, Sarno joins the words mind and body together to show that they’re the same thing. I don’t see them as separate entities either.