260 replies to this topic

[Driven]

FH,

Incredible information.  I so appreciate it.  I will need to re-read the water titration method you've outlined a few times.  With my heavy brain fog, I might have some questions.  I really appreciate the taper plan.

Here are some answers to your other questions/comments:

 

1.  You had asked about Seroquel since I mentioned it at one point.  I never filled the prescription and went with the Zyprexa per new team of doctor's recommendation.

2.  I take 5mg of Zyprexa every night between 8-9pm.

3.  I also struggle with low testosterone and have been managing that carefully with my dosing.  I have that pretty dialed in after doing some blood work to make sure I'm administering the correct amount. 

IMPORTANT:
It is worth pointing out that I did change up my supplement usage slightly per my naturopath's recommendation.  She has actually compounded a supplement for for me so they are all in a couple of capsules instead of taking everything individually.  This new compound also includes some new supplements that I was not taking previously.  I'm wondering if there is any correlation between heightened anxiety (and depression) due to these new supplements.  Below is my compounded medication dosage that i started taking around 6-7 weeks ago.

 

Compounded Medication Dosage:

 

Am Dose: Ascorbic Acid 500 Mg, Vitamin B6 150mg, P5p 100mg, Biotin 2000 Mcg, Vitamin B12 1000 Mcg, B1 10 Mg, B2 50 Mg, Riboflavin 5 Phosphate 10 Mg

Pm Dose: Ascorbic Acid 500 Mg, Zinc (picolinate) 70 Mg, Vitamin E 400 Iu, Biotin 2000 Mcg, Methionine 250 Mg, Vitamin A 20,000 Iu, Selenium 200 Mcg, Vitamin D3 2000 Iu, Magnesium (glycinate) 500 Mg

 

Thanks,
Driven

[fishinghat]

5mg of Zyprexa is the minimum dosage and shouldn't be too hard to come off of when the time comes.

low testosterone - When did you take your last testosterone blood test and was it since starting your withdrawal symptoms? Do you take your testosterone in the morning or the evening?

Compounded Medication Dosage:

Am Dose: Ascorbic Acid 500 Mg, Vitamin B6 150mg, P5p 100mg, Biotin 2000 Mcg, Vitamin B12 1000 Mcg, B1 10 Mg, B2 50 Mg, Riboflavin 5 Phosphate 10 Mg

Pm Dose: Ascorbic Acid 500 Mg, Zinc (picolinate) 70 Mg, Vitamin E 400 Iu, Biotin 2000 Mcg, Methionine 250 Mg, Vitamin A 20,000 Iu, Selenium 200 Mcg, Vitamin D3 2000 Iu, Magnesium (glycinate) 500 Mg

 

OK this is a horrible combination. This, I think, would make your withdrawal much worse.

 

In the next hour or two I will make you up a detailed description of the issues. More to follow.

[fishinghat]

Ascorbic Acid 500 Mg twice a day - probably not an issue.
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Vitamin B6 150mg, P5p 100mg
Horrible idea
Vitamin B6 Toxicity

https://www.ncbi.nlm.../pubmed/6308447
Although consumption of large doses of pyridoxine has gained wide public acceptance, this report indicates that it can cause sensory neuropathy or neuronopathy syndromes and that safe guidelines should be established for the use of this widely abused vitamin.

Vitamin B6 toxicity is the second most common toxicity seen in the ER.

RDA is 1.3 mg/d for men over 30. Your dose is around 200 times that as most of the P5p is converted to B6.
My wife developed Vitamin B^ toxicity from a stress tab supplement (5 mg/day). It caused considerable neuropathic pain and it took her 6 months to flush the extra B6 out of her body and 8 months for her nerves to heal.

https://www.ncbi.nlm...ooks/NBK114313/
Half-Life is 15 to 24 days.



https://www.ncbi.nlm.../pubmed/3041185
Pyridoxine neuropathy.
A case of sensory neuropathy in a young woman due to long-term ingestion of pyridoxine, with subsequent recovery, is described. Pyridoxine neuropathy may occur after the long-term ingestion of doses as low as 200 mg a day. Because of its widespread use in the community, both the general public and the medical community need to be aware of this recently described complication of megavitamin therapy.

https://www.ncbi.nlm.../pubmed/3630649
Pyridoxine (B6) overdose is described. It is the largest series of B6 intoxication hitherto reported. A raised serum B6 level was present in 172 women of whom 60% had neurological symptoms, which disappeared when B6 was withdrawn and reappeared in 4 cases when B6 was restarted. The mean dose of B6 in the 103 women with neurological symptoms was 117 +/- 92 mgs, compared with 116.2 +/- 66 mgs in the control group. There was a significant difference (P less than 0.01) in the average duration of ingestion of B6 in the neurotoxic group of 2.9 +/- 1.9 years compared with 1.6 +/- 2.1 years in controls. The symptoms were paraesthesia, hyperaesthesia, bone pains, muscle weakness, numbness and fasciculation, most marked on the extremities and predominantly bilateral unless there was a history of previous trauma to the limb. These women were taking a lower dose of B6 than previously described (1,2), which may account for the complete recovery within 6 months of stopping B6.
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Biotin 2000 Mcg twice a day - Not an issue.
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Vitamin B12 1000 Mcg
The recommended daily intake is 2.6 mcg per day. This dose is 384 times the recommended intake.
https://academic.oup...6/6/505/1538806
The pathophysiology of elevated vitamin B12 in clinical practice
Hypercobalaminemia (high serum vitamin B12 levels) is a frequent and underestimated anomaly. The aetiological profile of high serum cobalamin predominantly encompasses severe disease entities for which early diagnosis is critical for prognosis. These entities are essentially comprised of solid neoplasms, haematological malignancies and liver and kidney diseases. This review reflects the potential importance of the vitamin B12 assay as an early diagnostic marker of these diseases. A codified approach is needed to determine the potential indications of a search for high serum cobalamin and the practical clinical strategy to adopt upon discovery of elevated cobalamin levels. While low serum cobalamin levels do not necessarily imply deficiency, an abnormally high serum cobalamin level forms a warning sign requiring exclusion of a number of serious underlying pathologies.



Vitamin B12 supplements should not be taken unless a blood test shows a deficiency.
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B1 10 Mg
Vitamin B1 in high doses can lower other B vitamins and homocysteine. This is 10 times the recommended daily allowance. As this vitamin is water soluble it is easily excreted and should not be an issue.
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"B2 50 Mg, Riboflavin 5mg"
I don't understand this as vitamin B2 is the same as Riboflavin.
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Phosphate 10 Mg - Should not be an issue.
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Zinc (picolinate) 70 Mg
The recommended allowance for zinc is 11 mg/day. This is more than 6 times the recommended intake. The half life of zinc is about 9 months which allows zinc to accumulate in the body to toxic levels fairly easily.



A common source of extreme anxiety. People using zinc shampoos (dandruff) denture creams and supplements containing Zinc often develop severe anxiety.



Vitamin C can enhance zinc absorption.



If you take high doses of zinc long-term (50 mg or more per day for 10 weeks or longer ), be aware that it can cause copper deficiency, so you may need to supplement with copper as well.



Iron, copper, magnesium and zinc compete with each other for absorption.



https://www.ncbi.nlm...pubmed/23383172
High dose zinc supplementation induces hippocampal zinc deficiency and memory impairment with inhibition of BDNF signaling.

https://www.ncbi.nlm...pubmed/18574758
Zinc induces motor neuron death via a selective inhibition of brain-derived neurotrophic factor activity.

Zinc should only be used if blood tests show a deficiency.
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[fishinghat]

Part 2

Vitamin E 400 Iu
Vitamin E refers to a group of compounds that include both tocopherols and tocotrienols. Regular consumption of more than 1,000 mg (1,500 IU) of tocopherols per day may be expected to cause hypervitaminosis E with an associated risk of Vitamin K deficiency and consequently of bleeding problems. Vitamin E has many biological functions, the antioxidants function being the most important and best known. Other functions include enzymatic activities, gene expression, and neurological function(s). RDA is 15 mg/day.



Probably not an issue.
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Methionine 250 Mg
Methionine effects the concentration of vitamin B6, B12, choline, folic acid and magnesium.
Other than that should not be an issue.
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Vitamin A 20,000 Iu
RDA is 3000 IU with the upper tolerable limit being 5000 IU. This is 4 times the upper limit.



Anxiety is a side effect of Vitamin A deficiency and as such Vitamin A will bring the anxiety under control but it is recommended that this be done by dietary changes rather than by supplements due to the risk of toxicity.



Toxicity results from ingesting too much preformed vitamin A from foods (such as fish or animal liver), supplements, or prescription medications and can be prevented by ingesting no more than the recommended daily amount.



Diagnosis can be difficult but there are effective tests available. Hypervitaminosis A is usually treated by stopping intake of the offending food(s), supplement(s), or medication. Most people make a full recovery.



https://www.ncbi.nlm...ooks/NBK222318/
The half-life o0f Vitamin A is 128 days and allows for rapid build up of toxic levels.



Vitamin A should only be used if blood tests show a deficiency.
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Selenium 200 Mcg



The most common toxicity seen in the ER.



Selenium toxicity is most frequently the cause of allergic reactions to multivitamins. Most multivitamins provide 40 to 60 mcg/day (which does not include selenium from the diet) while the dietary intake is recommended at 55 mcg.


https://www.ncbi.nlm...les/PMC3153292/



Your dose is nearly 4 times the rda.
The upper safe limit is 400 mcg/day. However with a half life of 35 days it can be built up to toxic levels with time.
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Vitamin D3 2000 Iu
I posted a detailed review of vitamin D3 earlier in this thread. Vitamin D3 toxicity is becoming increasingly common and should not be taken unless a blood test shows a deficiency.
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Magnesium (glycinate) 500 Mg
Maximum dosage is 300 mg per day. Doses over this commonly causes hypermagnesemia (high blood magnesium) which can cause severe diarrhea and severe shortage of calcium in the body (hypocalcemia).



These dosages commonly cause severe anxiety. This has occurred with many members.



Magnesium supplements should NEVER be taken unless a blood test shows a deficiency. Also, most drs recommend a magnesium and calcium blood test every 6 months if supplementing with magnesium.
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[Driven]

FH,

 

Yes, I was wondering about this supplement combination and whether it might be doing more harm than good.  My wife attends my naturopath appointments with me and the doc and her both get me all pumped up about the supplement being set specifically for me and it should really help ease the symptoms naturally.  All I know, I feel really rough still and I keep reading about too much supplementation causing a possible adverse effect.  I don't know but we spent way too much money on a compounded supplement!

 

Whether it is Cym, Zyprexa, or Ativan, I have felt REALLY rough the last 1-2 weeks in particular.  Lately, I've been waking up with this HUGE black cloud over my mood and it has been really hard to fend off.  It just feels like everything is doom and gloom.  I hide it from my wife and kids but everything feels like a sort of trigger toward sadness.  The sadness feels very "chemically induced".  I'm constantly ruminating about I shouldn't be feeling like this and whether I'll ever be able to enjoy things again...and obsessing over probably having a long road ahead.  There are times throughout every day where the headache gets so intense that I sort of lose perspective of where I'm at, what I'm doing, very disoriented, and my purpose in life.  I went to dinner with a few family friends over the weekend and I felt awful the entire time.  I was not my "old self" where I was happily partaking in conversation.  I instead kept up just enough not to be rude and then tried to formulate a half-educated response when the discussion came my way.  I could hardly muster a few educated sentences together to show I was happy to be there.  So far from my my normal self and I know my wife was also bummed by my mood.  It's almost seems like if I'm not anxious then I am battling sadness.  I haven't really felt anything close to normal for several months and I'm concerned Zyprexa has made things worse.

 

I've heard you say it a few times about Cymbalta w/d and "fear".  I am sort of scared of everything.  Going to grab lunch, a short business meeting, anything puts a bit of fear in my mind.  I think about how I used to jump in the company sales car and drive half way across the state with no problem for a meeting.  Now, that feels completely unrealistic and I sort panic even thinking about it.  I hope that doesn't last forever because it is no way to live!

Today, for example, my symptoms look something like this:

5:45am woke up (after sleeping since 9:30pm) which is great.

- immediately felt INTENSE doom and depression upon waking with moderate anxiety.
 

6:15am went on a 2.5 mile run/walk.  My body hurts but I'm sticking to an exercise plan.  I have gained 25 LBs from Zyprexa without any diet changes which is frustrating.
 

7am - took morning supplements, bi-weekly testosterone injection, and 1/3 cup of coffee (have tapered WAY down in old caffeine habit).

- fought off moderate anxiety all morning gettiing ready for work.  I often shake and start crying in the shower as I just want this to end.
 

8am arrive at work. Moderate anxiety all morning.  Ruminating thoughts about trying to determine what is going wrong with this w/d and where I might be making things worse.  Bounce all over between trying to research Cymbalta w/d, vision issues, Zyprexa side-effects, Floater surgery, etc.  Anything that I can do to try and help research a fix I tend to obsess over.  Been working off and on at my desk but I'm really just ruminating about w/d fears, etc.

 

This is a new thought but I'm starting to wonder if I should try another SSRI (Lexapro) since that is what my doctor suggested we try only if the Prozac doesn't work (which it didn't).  Lexapro since my mom has been taking 20mg for 5-6 years with good success.  I don't want to go on any more medication but I'm still really struggling.  The depression is one thing but I HATE the anxiety and the panic I have about my vision issues.  I believe the "slow" uncoordinated (dream-like) symptom of my vision is tied to seritonin and my brain.  My vision really improved on the short stint with Prozac but the akathisia for 3-4 days was relentless.  

 

Driven

[fishinghat]

I will critique this first thing in the morning.

[frog]

Driven,

I just want to offer my support with what you're going through. I completely understand the obsessive thoughts and the fear of going anywhere and doing anything because you don't know what to expect from your brain and your body.

 

I feel like reading a little about how our brains work when it comes to our thoughts made me understand how much worse I was making things for myself by obsessing and trying to assign meaning to everything that I was going through. The long and short of it is that thoughts pop into our heads pretty randomly, if you've ever tried meditation you've probably noticed this. Meditation also helps us learn to let thoughts come and go and not get stuck on any one of them. What happens when you get stuck on a particular thought, especially a negative one is that it will quickly spiral out of control. Our brains are very good at gathering up connections, because that's what allows us to make sense of the world, so as you dwell on this thought, your brain is trawling through your memories and experiences looking for similar worries and fears and gathering them all up together and before you know it you're in a deep hole of despair. On top of that, thanks to the lovely Cymbalta, the fear and stress centers of our brain are extra activated so we're even more prone to this type of thinking during this process. It can be very hard to control those high emotional states during this time, but try to find something that can distract you away from these thoughts to break the cycle. Maybe it's reading, or watching an engaging TV show (Jeopardy helps me because I actively try to think of the answers ) or playing a game with your kids. Trust me I know it's WAY easier said than done but by giving into your brain's fearful thoughts, you're creating more fear if that makes sense? 

 

The Buddhists talk about something called a second dart. The first dart thrown at you is unavoidable. It's your headache, or your vision issues, etc. The second dart you throw at yourself. It's how you react to the first dart. 

[fishinghat]

"Whether it is Cym, Zyprexa, or Ativan, I have felt REALLY rough the last 1-2 weeks in particular. I'm concerned Zyprexa has made things worse."

I feel the same way. I would much rather see you wean off the Zyprexa than the Ativan myself but unluckily there is no way to tell which one is making you worse. The half life of Zyprexa is between 21 and 54 hours. If you consider the 54 hours (worst case scenario) then stopping the Zyprexa for 4 days will reduce your blood levels by 75%. This might be enough to see if the depression lifts or there are any signs of benefit. The risk is withdrawal effects kicking in. In any case you can always go back on the regular dosage and come out of the withdrawal in a few days.


"I've heard you say it a few times about Cymbalta w/d and "fear". I am sort of scared of everything."

Oh how well I understand.



"6:15am went on a 2.5 mile run/walk. My body hurts but I'm sticking to an exercise plan. I have gained 25 LBs from Zyprexa without any diet changes which is frustrating."

Probably a very bad idea. Weight gain or no weight gain the exercise is a strain on the already strained body. Most members found only very light casual exercise any benefit. A 10 minute slow walk for example. Exercising to the point of muscle aches is definitely a no-no as the muscle aches are due to build up of lactic acid in the muscles and lactic acid is converted to lactate which is a very strong anxiety causing chemical, Not a good idea. There will be time to loose the weight after coming off all this. I was on 6 meds they tried. Once stable and coming off the meds I lost 54 lbs that I had gained. All in due time. You must remove stress from your life as much as possible until the Cymbalta wean is over and stabilized.

"...bi-weekly testosterone injection, and 1/3 cup of coffee (have tapered WAY down in old caffeine habit)."
You need to track the severity of your depression on a chart. Testosterone injections are notorious for causing depression late in the 2 week cycle. Look for less depression the 2nd day after your depression and worse depression the last 2 days before your next injections. And by the way, no coffee. If you have cut back on your coffee during your withdrawal (which is a good thing) your current anxiety may (probably) be from caffeine withdrawal as well. If so it will pass in time.

"This is a new thought but I'm starting to wonder if I should try another SSRI (Lexapro) since that is what my doctor suggested we try only if the Prozac doesn't work (which it didn't). "

You MUST NOT change too many things at a time. You talk about reducing coffee -causes anxiety, weaning off benzos - possible benefit or withdrawal, stopping Zyprexa, starting Lexapro, losing weight which causes Cymbalta withdrawal to worsen (Cymbalta is stored in fat tissue). You can't do these things but ONE at a time or things will get much worse. Don't even consider adding a new drug or supplement at his time.

My proposal to you is to stop the supplement immediately. That is a recipe for a disaster.
Most likely (but not guaranteed) the Zyprexa is your cause depression. Stop it for 4 days and see what happens. Adjust from there as needed.

What comes after that depends on how you respond to the removal of the Zyprexa.

KEEP EVERYTHING ELSE AS IS. No other changes.

[Driven]

FH,

 

Great input and thank you.

Regarding the test with dropping the Zyprexa for a few days, that makes me a bit nervous as I had a tough time when I tried to go off completely after being on it 12 days or so and then tapering over 1 week.  Anxiety hit in the evenings pretty hard and sleep got restless and I jumped right back on after only a couple days off.  That was just over 3 months ago.  The current plan right now is to start my SLOW taper on 4/1/20 after we get back from a family/work vacation to Hawaii later this month.  I'm not sure the best approach but I am thinking the 10% / month taper and see how I respond.  Unfortunately, if it is the Zyprexa causing more grief, it will take some time to reach any level of benefit in the dose reduction.  At 6 months I'd be from 5mg to 2.5mg...and then 1.25mg after a year and then a long road even after that.  Based on what I've read, folks do feel a bit more "alive" once they get to 2.5 and lower.  I will need to respect the slow taper I'm afraid as it appears Zyprexa can be a wicked w/d if not done properly.  Mainly anxiety and insomnia are the two issues.  People talk about having really difficult sleep coming off it due to the histamine antagonist component to Zyprexa.  The folks that do the taper correctly have a WAY different outcome than those who go too fast. There are not many success stories on Surviving Antidepressants page for anyone that came off faster than a year for example.  Most get hit hard with SEVERE insomnia that can last a very long time.  I don't want any part of that as sleep is what landed me on it in the first place.  That said, I am SO gun shy about doing a taper incorrectly after this Cymbalta w/d that perhaps I will be able to taper off Zyprexa faster than 10%/mo.  

 

I hear what you are saying on the exercising.  I will slow things down a bit and see how I respond.  My run/walk has been hardly strenuous but it could certainly be adding to the w/d issues.  This exercise plan is so far from my old self which is frustrating but I'm trying to keep it in perspective.

 

I will track my depression. I was tracking all my symptoms for a bit and have gotten lazy with it as it has been depressing.  I meant to say my testosterone injections are twice a week (Sat and Wed).  I've had to work pretty hard to nail down my testosterone schedule and I think I'm on a good plan but it is hard to know.  I will say there is definitely a correlation to increased anxiety later in the day on the same day as "injection day".  I hate it but don't know how to get around that.  I find it ironic that my last doses of Ativan were also on a Sat and Wed.  My last bloodwork was 1/13/20 which was two days after an injection and my level read 760.  Before that it was 11/1/19 and 588 which was also two days after injection day.  Those ranges are where my doctors stated they want them.  As for the coffee, I weaned down 3-4 months ago to about 1/4-1/3 cup every morning.  I have not dropped below that level.  Maybe I should consider slowly going off it for good.  Let me know your thoughts on dropping coffee to zero?

 

I know, looking back and reading all my posts, I talk about changing a lot of things at once.  It has become really apparent to me that I want improvement to happen much faster than what is realistic.  My eye doctor keeps pressing patience on me as well as other doctors stating the same thing.  I am clearly caught in the whirlwind of obsessing about what is causing what and I just want to fix it.  Obsessing about how to fix everything is what got me started in this whole mess.  

 

I will stop the supplements immediately and see what happens there.  I already didn't take last night and this am's dose.  As for stopping the Zyprexa for around 4 days, I'm scared as heck to do that.

I will also be honest in saying that I'm dang confused about the Ativan.  For example, I took .5mg last Sat, TINY TINY crumbs each day since except taking .25mg yesterday am and .25mg last night since yesterday was BAD with anxiety. I've talked to two doctors and shared my exact usage and they said chances are VERY LOW that I've got a dependence to it.  I completely see your logic on possibly being dependent to a very low dose but I'm just hoping that I could sneak away from it without this long daily taper protocol starting at .165mg.  I'm just scared to start taking it every day and them definitely hooking myself to a dependency of another drug.

 

Thanks,
Driven

[fishinghat]

"Regarding the test with dropping the Zyprexa for a few days, that makes me a bit nervous as I had a tough time when I tried to go off completely after being on it 12 days or so and then tapering over 1 week. Anxiety hit in the evenings pretty hard and sleep got restless and I jumped right back on after only a couple days off. That was just over 3 months ago."

I guess I forgot about that. In that case you are right dropping or weaning the Zyprexa is out. Even if it is the cause of some/all of your depression then you are stuck with it for now.

"I'm not sure the best approach but I am thinking the 10% / month taper and see how I respond. Unfortunately, if it is the Zyprexa causing more grief, it will take some time to reach any level of benefit in the dose reduction. At 6 months I'd be from 5mg to 2.5mg...and then 1.25mg after a year and then a long road even after that. Based on what I've read, folks do feel a bit more "alive" once they get to 2.5 and lower."

that sounds like a reasonable plan. With the low dose you are on you should be able to handle that.


"I will need to respect the slow taper I'm afraid as it appears Zyprexa can be a wicked w/d if not done properly."

Especially when you are still having some withdrawal symptoms. I understand your fear of another withdrawal. It has taken me 7 years now to come off all the meds that I was on. So sslllooowwwww.


"I will say there is definitely a correlation to increased anxiety later in the day on the same day as "injection day"."

Because of the swings in emotion and fatigue most drs here use the gel. I went through about 6 to 9 months of playing with my dosage (gel) before getting it dialed in. In order tp avoid swings I had to take 2/3 my dose in the AM and 1/3 in the PM. That has finally got me stable. Are you self injecting or is the dr injecting you?

"As for the coffee, I weaned down 3-4 months ago to about 1/4-1/3 cup every morning. I have not dropped below that level. Maybe I should consider slowly going off it for good. Let me know your thoughts on dropping coffee to zero?"

You really need to stop but the timing is up to you depending on how you feel.

"My eye doctor keeps pressing patience on me as well as other doctors stating the same thing. I am clearly caught in the whirlwind of obsessing about what is causing what and I just want to fix it. Obsessing about how to fix everything is what got me started in this whole mess."
Oh how I understand.

"For example, I took .5mg last Sat, TINY TINY crumbs each day since except taking .25mg yesterday am and .25mg last night since yesterday was BAD with anxiety. I've talked to two doctors and shared my exact usage and they said chances are VERY LOW that I've got a dependence to it. I completely see your logic on possibly being dependent to a very low dose but I'm just hoping that I could sneak away from it without this long daily taper protocol starting at .165mg. I'm just scared to start taking it every day and them definitely hooking myself to a dependency of another drug."

Obviously stopping the Zyprexa is out as you have already done that "test" and it definitely had too much of a withdrawal to have any positive effects. Changing to an alternate ssri such as Lexapro is out because they will not but you on it at the same time you are taking already taking 2 antidepressants and the risk of serotonin syndrome is too great. Stopping the Zyprexa and starting the ssri (Lexapro for example) would put you in Zyprexa withdrawal with the Lexapro not providing any help as these two antidepressants have different mechanisms.

That just leaves you with three options

Hold steady until the Cymbalta symptoms end (How long and how bad, well that is anyone's guess.),
Wean slowly off the benzo.
Wean slowly off the Zyprexa which may provide some benefits on reducing the depression.

I am going to check on something.

[fishinghat]

6.3% of those taking Ativan experience depression as a side effect.

 

So Zyprexa first or Ativan?

 

Any other options?

[Driven]

HI Everyone,

 

It has been a bit since I've posted in an effort to try and distance myself from overdoing it so much in terms of online research, etc.  My therapist has been on me to refrain from overwhelming myself with so much w/d info, etc.  I understand his angle for sure but this site has provided alot of help and support for me. 

I am 9.5 months out since being off Cymbalta now, and I've started a very slow taper of the Zyprexa that I was put on.  I'm tapering the Zyprexa 5% every two weeks and will see how that goes.  It will be an 18+ month taper and I started last month.  To pick up from the last post above, I've managed to really only take the Ativan 1-2 times every week.  I went 2.5 weeks without any Ativan and didn't seem to notice any w/d related to it so I think I am safe (not dependent) on the Ativan.  

 

That said, I am still battling things badly.  My main symptoms are:

 

1.  Severe Anxiety -  My anxiety is still out of control and seems heaviest in the am and will dissipate a bit throughout the day.  I am still struggling badly to keep things together at both work and at home.  I take a very occasional Ativan or 50mg of Hydroxyzine which "might" help a touch.  The ativan does help but I've refrained to taking maybe 1mg per week as I'm scared as hell of it.

 

2.  Deep depression - I am really struggling with depression that is as bad (or worse) than it has ever been.  A vast majority of the depression is due to my vision as nothing has improved.  It has gotten a bit worse and some weird new symptoms have come up.  My vision is very grainy when looking at walls or in any low light.  This is along with the massive onset of floaters in both eyes.  These are not just a few random floaters that go away here and there.  These are constant and visible in any lighting condition and has made most activities very un-enjoyable.  I have a hard time working due to the mess of floaters on my computer screen, watching TV, driving has gotten more difficult, any room with flouresecent lights makes it look like I'm hallucinating, and a sunny sky is brutal to look at.  I can't get away from them and it is definitely driving a lot of both my anxiety and depression.  It is embarrassing to have floaters wreak so much havoc but this is definitely a really intense case.  I've been spending time with my therapist on trying to come to "acceptance" about this new vision normal which has been extremely difficult.  As of now, there is nothing the doctors will do in order to help due to risks/complications.

 

3.  Morning cortisol spikes - I am having a very difficult time with anxiety (almost panic attack) nearly every morning when I wake up.  Like a big rush of panic as soon as I wake up and realize I am battling this extreme depression and anxiety still.  This happens anywhere from 5-5:45am and it is very uncomfortable.  I've read about the cortisol spikes in the morning as part of w/d but I'm sad that this is so strong at 9.5 months off and It is wearing me out.

 

4.  OCD thoughts - this is basically what put me on Cymbalta in the first place last year.  Now, I am constantly obsessing about Cymbalta w/d and why I am not improving faster as well as OCD about my vision.  Fear is also a major issue.  Scared of this w/d lasting too long, fear of losing my wife and kids, fear of my vision being like this forever, etc.

 

All said, the physical headaches and overall sick feeling has been a bit better.  In most cases, my brain still feels like I have damaged it severely.  I have some pretty decent times where I feel "okay" physically but my vision is dragging my mood down so much.

 

I don't really want it but I've been thinking about whether another SSRI would help the severe anxiety and depression.  If you recall, the short introduction of prozac failed back in Dec and that is the last of an SSRI.  At the time, my doctor said we'd try Lexapro next if the Prozac didn't work but we kind of dropped that discussion when I got dependent on Zyprexa.  

 

At this point, I am really sad and scared that I've entered this new level of depression.  I am scared that I can't do this on my own without possibly trying another SSRI.  With that said, I'm so scared of how my body reacted to the Prozac that I don't want to get "kindled" if I tried to start a new SSRI.

 

I keep saying that at 9.5 months out, this could all still be Cymbalta w/d and that I will see steady improvement soon.  I don't know what to believe anymore. I do know that this constant level of anxiety is really bad for my health.  I am nervous about having a heart attack based on the extreme anxiety.

 

Thanks, 
Driven

[fishinghat]

"I went 2.5 weeks without any Ativan and didn't seem to notice any w/d related to it so I think I am safe (not dependent) on the Ativan."

That is a very good sign indeed.

This is late in the withdrawal to be having this much of an issue. Any ideas on why it is dragging on so long? I would expect some residual symptoms but not like this. Do you think this is a side effect of the Zyprexa and that it may fade as you come off it?

Hang in there. Things have to get better.

[Driven]

FH,

 

Thank you.  Honestly, I wish I knew on what is causing this to drag out.  I feel like I am fighting for my life.  I have slowly started to feel better with the exception of anxiety and depression.  I have constant ruminating thoughts about my vision and why so many things are going on with my eyes.  I start to think about everyone I've read getting better as the months pass but there are few that talk about the vision issues I am experiencing.  It has put me into a constant state of anxiety. I am obsessively checking my vision all day and watching laser floater removal or eye vitrectomy videos to tell myself there is at least hope for improvement if things don't settle down.  In addition to the floaters, I am still experiencing the slow gaze stabilization issue and some depth perception issues and something just feels off.  The retina specialist I saw, stated I may be experiencing slight binocular vision disorder.  I feel like something is off with my left (dominant) eye which he did agree with...All I know, when i alternate closing each eye, the object I am focusing on jumps down when my left eye is open.  They are not perfectly horizontal which is called vertical heterophoria.  He ran some simple tests and also noted he saw it as well.  In short, I feel very slightly cross-eyed all day every day.  This started when I jumped down from 90-60mg and went away for a month until I went completely off and it came back.  It has been constant since the week I went off last July with the exception of improving slightly when I tried the low dose of Prozac.  I don't know if it is a neuro issue or what but it is scaring me silly.  The retina specialist stated that the binocular vision (basically the brain not picking up on 1 crisp image between both eyes) could have caused my whole visual cortex to get in a hyper focused state, drawing more attention to floaters in comparison to normally being able to filter them out much better.  That does make some sense but it is hard to believe these are not new floaters given the extreme change in what I see now versus pre-Cymbalta.  In any rate, the solution for BVD (binocular vision disorder) is prism glasses where they find a lense that corrects the angle so the brain sees one image more clearly.  Of course with the COVID pandemic, things are moving VERY slowly as I continue to vacillate on these different eye theories.  I'm in limbo on getting the referral back to my ophthalmologist and finding out where to get tested for prism glasses and BVD.

 

All in all, I am no doubt getting hit with trickling Cymbalta effects based on the crushing head pain that i will inconsistently experience along with heavy brain fog that comes and goes. 

 

I agree, things must improve but I am still living in fear about how far this will go...

Driven 

[fishinghat]

I have often thought during your experience that this may be a side effect of the Zyprexa as it seemed to develop/worsen when you started on it.  One step at a time.

[Driven]

FH, 

 

I may have spoke too soon on being free and clear from an Ativan dependency.  I went about 2.5 weeks without any Ativan after that very small, sporadic use and it went okay with the exception of raging anxiety.  Then I took 1.5mg over the course of a weekend and then did the same thing the following weekend.  I then had to undergo a brain MRI and was very anxious about getting in the tube.  I took 1mg the day before the MRI and then 2mg for the test itself.  All went pretty well until I started developing VERY intense head pressure, ear pressure, and anxiety since this bigger dose mid-last week.  The weekend was horrendous in terms of these symptoms and as bad as any of the Cymbalta headaches I've experienced.  I woke up Sunday morning which would have been 3 days after taking the 2mg for my MRI test with intense head pressure and VERY disorientated.  Since then, I've been taking .5mg the last 2 days to minimize the effects.  

 

All said, here are the three possibilities on what I think is causing these intense symptoms:

 

1. Possible Ativan dependency withdrawal from intermittent dosing.

2. Zyprexa withdrawal from my 5% taper every 2 weeks.  I am 6 weeks in and at 4.27mg from my 5mg starting dose.

3. Or, this is still Cymbalta w/d but these symptoms aren't all that similar to earlier Cymbalta w/d.

 

I have a zoom meeting with my p-doc tomorrow morning and will be discussing all of this.  It probably won't be all that helpful but we'll see.  I am really struggling with the anxiety and my wife and I have separated for the time being.  All because my w/d is causing a major stress on the family unit and our two daughters.  

My anxiety is so high that I am actually considering just committing to a consistent daily dose of Ativan to help me through this patch and then slow taper when the time comes.  It is so hard to know what the right call is...

 

Driven

[fishinghat]

Data shows that going back on a benzo is only helpful for 50% of the patients and that it actually makes symptoms worse for the other 50%. Many drs recommend staying off a benzo for 2 years before trying to go back on because of the risk of these types of issues. I am sure the Cymbalta withdrawal is also making you more sensitive as well. In addition the Zyprexa withdrawal could be accounting for all these symptoms however with the headache issue I would lean more toward the Ativan.

 

If it is an effect from Ativan then taking 600 mg of N-acetylcysteine twice a day should help the symptoms some.

[Driven]

FH,

 

Thank you for your input.  I just had the call with my p-doc and we chatted through a few options:

 

1.  Stay with Ativan and keep dosing as needed and taper after the storm has settled a bit.

2.  Convert now to Valium due to longer half life and take Valium as needed for the anxiety.  Taper after the storm has settled.

3.  Stop Ativan and split my Zyprexa dose to where I'm taking a small dose in the am and still take a dose in the pm.  But not increase the total daily dosage amount and still continue to taper as planned  Note: I did try this already for a couple days and didn't notice much.

I don't know much about Valium.  You have any thoughts on this?

 

Thanks,
Driven

[fishinghat]

Valium is just another benzo like Ativan, oxazepam etc.  With the longer half life it is easier to wean off of. If this is the Ativan then it will settle down in around 2 to 4 weeks with a steady dose in the mean time. I would certainly put a hold on the Zyprexa weaning though. I would strongly suggest that you never wean two drugs at the same time. Seldom is this successful. I had 5 meds to wean off of after the Cymbalta withdrawal was over. It has taken me 7 years and I am off 4 and 90% off the last one. Weaning can be very successful but you must look at it in terms of years not weeks. These are very powerful drugs. 

[Driven]

FH,

 

First off, congrats on being 90% off of your last drug. That has been a journey and congrats on being disciplined with it.

Yes, I'm thinking all my issues are a combination of the inconsistent Ativan dosing coupled with the Zyprexa taper.  I am really in trouble here with the anxiety/panic.  I know the stress from the separation from my wife is also causing alot of issues.  At this point, he called in a prescription for me to try the Valium to see if it will help. 

I'm in trouble here and pretty scared.  I have anxiety pretty much all day until the evenings...

[fishinghat]

Good luck with the valium. I hope it helps and keep us posted.