Marsha: can I taper off geodon before gabapentin?

[Marsha]

My husband is taking me to the er this morning. I believe I have started to develop tardive dyskinesia. My mouth won't stop moving from side to side. Then again it might be bruxism from the rapid trazodone taper. I told the psychiatrist about it and he said that I didn't have td but I saw a video last night and I saw the very thing my jaw is doing among the different ways it presented in people with td.

[Meimeiquest]

I'm sorry. I would just say to really research any changes you make. No hidden warnings in saying that, I just know you are in a delicate place and there are, as you have already seen, professionals who do not understand it well.

[Marsha]

I'm sorry. I would just say to really research any changes you make. No hidden warnings in saying that, I just know you are in a delicate place and there are, as you have already seen, professionals who do not understand it well.

hi. Meimei. Can you explain more fully for me to really research any changes I make?

[Meimeiquest]

Well, if they want for you to increase or decrease the Geodon or switch to a different drug, just to make sure it's what you think is the best thing to do.

[Marsha]

Well, if they want for you to increase or decrease the Geodon or switch to a different drug, just to make sure it's what you think is the best thing to do.

thank you Meimei. From my research I thought when td presents you are supposed to be taken off the neuroleptic. But I certainly don't want to be put on another drug. How can I prevent that from happening?

[Altostrata]

Oh, Marsha, I am so sorry. I don't know what caused these symptoms. It's been a balancing act for you from the beginning, which you've been performing admirably.

 

I hope you're better now. Please let us know how you're doing.

[Meimeiquest]

I don't know if this link will come through, and it is complicated. But toward the end it recommends only 10% dosage reductions, so they are "thinking." I wear a mouth guard at night from Walmart, you might need something to protect your teeth.

 

http://emedicine.medscape.com/article/1151826-overview#a1

[Altostrata]

Good find, meimei.
 

Withdrawal dyskinesias may also occur as treatment with dopamine antagonists is decreased or withdrawn. They are often refractory to all therapeutic modalities. In addition to the prototypic orofacial dyskinesia, tardive syndromes also include a spectrum of hyperkinesias occurring during or after prolonged treatment with dopamine antagonists.
....
Abrupt cessation of dopamine antagonists may lead to an acute exacerbation of symptoms (which presumably were controlled by medication). Accordingly, caution must be exercised in reducing and discontinuing treatment. Life-threatening conditions, such as malignant neuroleptic syndrome, are exceptional situations in which immediate discontinuance may be justified.
....
Abrupt cessation of treatment with dopamine antagonists may precipitate a florid psychosis with delusions, hallucinations, and suicidal or homicidal behavior. Whenever possible, it is preferable to taper the dose slowly (by 10% increments of the original dose)....
....

Reducing trazodone too fast could indeed cause Geodon to be metabolized more rapidly, as Geodon needs cyp 2D6 to be metabolized and trazodone's metabolite mcpp blocks it.

[Marsha]

Thank you meimei and Altostrata. Rather than expose myself to the mental health system in this county (I can guarantee that I would be sent to a lock down psychiatric ward in the nearby adventiist health hospital which I have been many times) I will taper by 10% of the original dose and be off in three months. I was advised to taper this way by the psychiatrist when I voiced my concern about Td three months ago even though he said that I didn't show any symptoms of it. It was after the addiction doctor switched me from clonazepam to librium that I noticed my jaw moving back and forth. I have left a message for my current doctor and waiting to hear back. I don't know if this a good taper plan. Maybe I shouldn't do it. My jaw stopped moving this morning. So I'm thinking it may not be Td. I will wait to hear from the doctor. I don't know. It's all so stressful and confusing. I think I will continue to taper the way I have been doing unless I hear otherwise. Thank you very much meimei and alto.

[Meimeiquest]

Big hugs! If it is stopped moving, that is a good sign. I know I passed through many strange stages coming off Zyprexa. You just have to be careful because all your other tapering makes your brain more sensitive than if you were starting with Geodon. It isn't even necessarily too fast, it's just a lot when you are on many drugs. Is your sleep starting to come back? I would really hesitate to cut again until your sleep is recovering. Some people have gone to very frightening, dangerous places when they have stopped sleeping, it really isn't worth it.

 

Here's something to discuss with your doctor...I don't have much knowledge of QT prolongation, but I think it MAY be more related to drug levels versus length of exposure. It might be reassuring to know, or help you know how hard to push. Have you had an EKG?

 

I personally would have decided the same about the ER...don't know if it is the right choice or not

[Marsha]

Thank you meimei. I will see my doctor on October 12. I will discuss with her about the jaw movement and get a referral to a neurologist that specializes in movement disorders. My sleep is normal. So I will make another cut on Saturday. I have had many EKG's. My heart is normal. As regards the possibility of Td, years ago I asked the abuse psychiatrist about Td because I read about it in the pharmacy insert when I picked up my geodon one day. In the presence of my husband he said "You will not get tardive dyskenisia from taking geodon." Do you think that I have meritorious claim for a lawsuit? I have been told by a law firm that I do. If it turns out that I have td I. will file suit.

[Meimeiquest]

Well, that is ridiculous. My understanding, which could be wrong, is that it is related to how much damage their improper prescribing/advising causes. If it gives you a scary day, good luck. If you lose your job as CEO of a large corporation, that's another story. The damage has to be valued at enough for the lawyer to make a ton of money off the case as well. Because they work just off commission, they are pretty careful about taking claims. One lawyer told my sister only 10% of cases "win." So if a law firm is willing to take it, they must feel pretty confident. But what a doctor. If the attorneys aren't biting you can file a grievance with the state's medical board. I believe that article I sent said doctors should have a patient sign a consent that they are aware of the risk of TD. I am so glad to hear your sleep is back, that's a great sign.

[Marsha]

Well I made the cut from 60.3 mgs of geodon to 54.27 on Saturday. We'll see how I feel after the fourth day. Hopefully things will continue to go smoothly as they have been. My jaw movement I believe is just a habit so I'm not going to let myself become consumed with anxiety about tardive dyskinesia. My poor husband is having some withdrawal symptoms on the fifth day of his second citalopram cut. He made the mistake of tapering the benzodiazepine first and now the antidepressant taper is proving to be difficult. He has many health problems and cannot do any of the work of calculations and measuring and making up capsules. I have to do it for both of us. I just can't seem to get my head around making up liquid preparation of our drugs even though that is what I would prefer to do. I realize that both geodon and citalopram can be prescribed as liquid but taking part in liquid form seems even more complicated than measuring with the digital scale. What can I do to be able to make liquid tapering easier?

[Altostrata]

Great ideas, meimei.

 

Marsha, taking part in tablet form and part in liquid form is the easiest way to use a liquid. For example, if your cut to 54.27 Geodon works (cross fingers), you could take a 40mg capsule and 14.27mg in liquid form. Then, when you make your next decrease, you would take it from the liquid part. You'd keep on taking the 40mg capsule until your cut takes you under 40mg, then you'd do the same with a 20mg capsule plus liquid.

 

Under 20mg, it would be liquid only.

 

Sorry to hear your husband is having problems tapering citalopram. The same principle applies, if he'd like to use the liquid for tapering. He could take part in tablet and part in liquid for a while, then switch to all liquid.

[Marsha]

Thank you meimei and Altostrata. How would I measure out 14.27 mgs of liquid geodon? Altostrata, you mentioned in an earlier post to get an oral syringe that measures in milligrams. Would it measure 14.27 mgs? I have a 10 ml oral syringe, but it doesn't measure the fraction of the dose. What kind of oral syringe would measure 14.27 mgs of liquid? I see many members measuring out fractions of milligrams. How are they doing it?

[Altostrata]

Oral syringes measure in milliliters, the liquid measure. You need to convert your milligram requirement to milliliters.

 

Geodon liquid is available in 10 mg/mL, or 1mg in .10mL. To take 14.27mg, you would take 1.427mL. You could take this out in one draw with a 5mL oral syringe. See Using an oral syringe and other tapering techniques

[Meimeiquest]

You can get 10 ml syringes that measure in 1ml increments (maybe have 1/2 ml markings too) or 3 ml syringes that measure in 0.1 ml amounts. You need to choose one or the other, because there can be some variance between sizes, and you want consistency. I got mine from Amazon. Usually you can get them from a pharmacy. The 3 ml Monoject syringes I got have maintained their markings well. And I will admit to getting a box of 100 because I had lots to taper and at one time I dosed very frequently.

 

This is how I do it: Put a 20mg tablet/capsule of Geodon (open if it's a capsule) in a small container that has a rounded bottom, like a teacup as opposed to a coffee cup. I use a clear ramekin. Measure out your 20 ml of water. If using 3ml syringes, you would have 7 (or empty and refill, but keeping track can be hard.). Put the water on the drug and let it sit about 10 minutes. Stir it up with the syringe, and while stirring, pull out 14 and 1/4 ml or 14.3 ml (I round a bit). That's your dose. If you try to pull up 20 ml, you'll find it's a bit short...there's some physics principle involved that I can't remember. There are other ways, but that's what I do. The important thing is to always do it the same way.

 

You could use a 10 ml syringe, but you would need adequate markings.

[Meimeiquest]

Oops, sorry .i crossed with Alto.

[Marsha]

Thank you alto and meimei. The liquid tapering doesn't seem to be able to be as accurate as the way that I am doing it now by using a digital scale. I have gotten pretty good at getting the right amount of powder weighed and getting it into a capsule. I think I will stick to what I am comfortable with. At least for now. On another note, I saw my doctor today and she suggested that I alternate tapering geodon and librium. I agreed to give it a try. I do really need to be tapering off both of them. The 18 years of benzodiazepines have taken a real toll on my memory and cognitive functions. I don't know what I am going to do if insomnia happens from the geodon. It doesn't make me sleepy anymore. I am relying on the librium for sleep. What does one do for sleep if this happens? Any and all suggestions are appreciated.

[Altostrata]

That's a difficult question, Marsha. If reducing the Geodon has caused you to be reliant on Librium for sleep, it's likely reducing the Librium will bring up sleep problems. It's your choice.

[Marsha]

That's a difficult question, Marsha. If reducing the Geodon has caused you to be reliant on Librium for sleep, it's likely reducing the Librium will bring up sleep problems. It's your choice.

Thank you Altostrata. What I mean is that the geodon actually stopped putting me to sleep when I was taking 160mgs. That's why I was taking trazodone for sleep. But what I am wondering now is if at the low dose that I am on now would prevent sleep if I were to alternate tapering the geodon and the librium. In fact all the antipsychotic drugs caused insomnia. The doctor is not going to force me off the librium if I start to experience insomnia. She said she would maintain me on 50 mgs if I needed it. I'm inclined to think I will need the librium.

[Altostrata]

That would be my guess.

[Marsha]

Well I called the doctor and told her that I changed my mind about reducing the librium. I simply need to take it for sleep until I am off the geodon. But I need to be able to not be on geodon for two more years. I am desperate to get off this wicked drug. Is there any way that I can speed up the taper? Please, I don't want this taper to drag on for years because I need to get off the librium also as soon as possible. I feel desperate. I am crying right now. I read that after four months of slow tapering you can try to go faster. Oh somebody please help.

[Altostrata]

Marsha, your nervous system has to be your guide. If it tolerates your going faster, you can go faster. Otherwise, you have to balance your desire to go off against what symptoms you get.

[Marsha]

Marsha, your nervous system has to be your guide. If it tolerates your going faster, you can go faster. Otherwise, you have to balance your desire to go off against what symptoms you get.

ok. Thank you Altostrata. I have formulated a plan. I need to plan so that I can see the light at the end of the tunnel. I will see if I can taper the geodon every three weeks. That's what I did for my first two reductions and I was fine. I will taper for a year until I get to 10 mgs. Then I will alternate tapering the librium and the geodon until off both drugs. But if three weeks doesn't work I will do every four weeks. I just am a planner by nature. I need to see a taper plan in front of my face. It also makes my doctor happy. Does this sound reasonable? The reason why I waited four weeks this last taper is because I tried to taper at two weeks. I did it for two days and my nervous system didn't like it. I went down 10 percent on October third and have not experienced any withdrawal symptoms. What do you think?

[Altostrata]

Three weeks is a good compromise!

[Marsha]

Started to have some withdrawal symptoms on Sunday. Some fear creeped in during the day and I had it again on Monday which lasted for about four hours. I read that this is a common withdrawal symptom of geodon and that some people have panic attacks. Hope I don't get those. Just updating and keeping track of symptoms.

[Marsha]

No fear or panic symptoms today.

[JanCarol]

Hey Marsha - 

 

You are so brave!  You have done an amazing thing, escaping the terrible talons of psychiatry!

 

You wrote:

 

my husband depends on me to do all the research for helping him know what to say to the doctor and how to taper citalopram.

 

 

Yeah, hubby depends on me to figure it all out, too.   Thank goodness, he isn't on any sort of taper plan!  (at least he's a math nerd and can help me with the numbers)

 

He just takes what I give him.  When he had cancer, I wanted him to understand why he was taking the supplements I gave him.  What did the turmeric do, what did the AHCC mushroom do, the Indole-3 Carbinol, etc.  I believed that if he UNDERSTOOD them, he could boost their efficacy (even if it's just placebo).  But ah, well.

 

I guess I'm just the "medical nerd" of the family - but I agree, it would be nice to let go and Let God, sometimes.  Except we know we cannot let go and "let doc!"  egads.

 

I am concerned for the speed of your tapers.  It's tough when you are feeling pressured by the system - and by your own decline in health and cognition - to hasten your tapers.  If Alto's good with it, I'm good with it.  I just invite you to listen to your symptoms as you taper, and be willing to hold, if need be.

 

You're doing so well, so far!  I know it may not seem like it sometimes, but look how far you've come! 

 

Do you have anything to share with us about what you have regained, in your journey?  Self-empowerment?  Identity? Creativity? Energy?  Please, let's hear some good stuff - I suspect you of having some!  I know how much I've gained in the short time I've been in SA - I feel like I've got my personality back.  I care about things more.  I can get small tasks done, and it doesn't feel like cleaning the Aegean stables!  What is is like for you?

 

Good to meet you, and I hope you see the sun today!

[Marsha]

Hi JanCarol. Happy to meet you. Thank you for your concern about my taper. I have many things to be thankful for. But this topic isn't the place for me to post my hopes and joy that I I am going to experience in the very near future. It is about God's plan for mankind that brings me joy. I think there is a topic somewhere on SA where I can share my hope for the future. It's what keeps me going. I have been having extensive communications with the psychiatrist that experimented on me with so many drugs and he is very apologetic and contrite in his mistakes in conceptualizing my care and has agreed to go the distance with me in my tapering of geodon, gabapentin and librium. No rushing me like the others I have been seeing. He totally understands the slowness of tapers which I have explained to him. No more rush to and pressure to taper quickly. He is very sorry. I have been praying for a doctor to help me like this. Also, the reduction to 54.27 mgs has been successful and I am planning to taper to 48.84 mgs on October 24th if I continue to have stable sleep and no panic. I will definately hold longer if needed.

[Marsha]

I'm sorry, I don't want to be a burden to anyone here but I am terribly frightened of these drugs. I was absolutely immobilized with fear last night. I didn't get to sleep until 3 am. What is this? I'm so afraid I'm having a delayed response to the rapid trazodone taper. But the only symptom that I have is fear. And some sleep problems that mainly started with the geodon taper. In fact that is when the fear started too. I read you don't know what could happen during withdrawal and this frightens me as well. I'm looking at several years of drug withdrawal and I want it to be successful. I read from Monica. Cassani that iatrogenic injury manifests itself as this fear I am experiencing. I have tried to not give it a thought but it won't go away. It happens almost always at night. I will look and see what others have done to cope with fear. Does anyone have any other suggestions? Thank you so much everyone. This is such a wonderful forum.

[Altostrata]

It's quite common for people withdrawing to have surges of fear, Marsha. Yes, it could be from the trazodone taper.

 

This is one of those things that might come and go, per The Windows and Waves Pattern of Stabilization

 

It may happen only occasionally. If it persists, you may wish to hold on your tapering for bit.

 

Are you taking fish oil and magnesium supplements, see
http://survivingantidepressants.org/index.php?/topic/36-king-of-supplements-omega-3-fatty-acids-fish-oil/
http://survivingantidepressants.org/index.php?/topic/1300-magnesium-natures-calcium-channel-blocker/

 

The magnesium in particular is calming, it might help with that nighttime surge.
 

[Marsha]

It's quite common for people withdrawing to have surges of fear, Marsha. Yes, it could be from the trazodone taper.

 

This is one of those things that might come and go, per The Windows and Waves Pattern of Stabilization

 

It may happen only occasionally. If it persists, you may wish to hold on your tapering for bit.

 

Are you taking fish oil and magnesium supplements, see

http://survivingantidepressants.org/index.php?/topic/36-king-of-supplements-omega-3-fatty-acids-fish-oil/

http://survivingantidepressants.org/index.php?/topic/1300-magnesium-natures-calcium-channel-blocker/

 

The magnesium in particular is calming, it might help with that nighttime surge.

 

thank you Altostrata. I will read through the Windows and waves again and start taking fish oil and Albion magnesium glycinate again. What about Calms Forte and Lactium by Swanson?

[Altostrata]

I found Calms Forte and Lactium to be helpful. You may want to read our topics about them in the Symptoms forum.

[Marsha]

Here's a question? Since geodon moderately reuptakes serotonin, this might explain why I had such an easy time withdrawing from trazodone. Maybe I could delay any more geodon tapering and start to taper the gabapentin. No maybe not such a good idea. Geodon is the most toxic. Any thoughts on this subject?

[Altostrata]

Your guess is as good as mine, Marsha. Gabapentin has a different sort of psychopharmacological action from Geodon.

 

I would not make any assessments based on serotonin uptake. Most likely, reducing trazodone was easier because you had two other brakes on board, Geodon and gabapentin.

 

Are you taking Geodon and gabapentin at the same time of day?