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Dr. Bob is Robert Hsiung, MD,
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Posted by herpills on February 1, 2010, at 12:15:38
In reply to Going off meds?, posted by myfranz on February 1, 2010, at 7:50:22
I think you could certainly get off some of those meds, but I know for myself (BPII) I have to be on *something* or its bad news. Maybe you might be able to just stay on the lithium.
herpills
Posted by myfranz on February 1, 2010, at 13:51:14
In reply to Going off meds?, posted by myfranz on February 1, 2010, at 7:50:22
I should have mentioned that my last "real" depressive episode was about 18 months ago. I'm not even sure at this point if I ever was bipolar maybe somewhere on the spectrum...not sure of much anymore.
Posted by Maxime on February 1, 2010, at 15:43:01
In reply to Going off meds?, posted by myfranz on February 1, 2010, at 7:50:22
If you are bipolar you should really stay on your meds. Is there a reason why you want to come off them?
I find that therapists often want patients to stop their meds, so don't go by what he/she tells you. Talk to your psychiatrist about it.
Posted by myfranz on February 1, 2010, at 18:03:34
In reply to Re: Going off meds? » myfranz, posted by Maxime on February 1, 2010, at 15:43:01
> If you are bipolar you should really stay on your meds. Is there a reason why you want to come off them?
>
> I find that therapists often want patients to stop their meds, so don't go by what he/she tells you. Talk to your psychiatrist about it.
I should say that my therapist was as neutral as Switzerland about this until I brought this up. Even now, he is not pressuring me and wants to talk to my psych about this as well. He is more than willing to listen. While I do not want to revisit depression/mania again I don't want to feel stupid anymore. I feel dull witted, not as funny as I once was and have lost enthusiasm for many, many things. This is no longer living in my book.Has anyone here tried going off meds, success and failure stories welcome.
Posted by bleauberry on February 1, 2010, at 18:08:23
In reply to Going off meds?, posted by myfranz on February 1, 2010, at 7:50:22
Coming off meds after that many years could be more traumatic to your system that you realize. If it is to be done, I would suggest doing it very slowly in very tiny steps. Probably a 3 to 6 month journey, working down doses in tiny steps (not the dose choices they give, but your own custom doses...cutting edges off pills, dumping powder out of capsules and making your own from empty gelcaps, etc.). For example, Abilify could be reduced by 1/4mg every 4 days. Stop at any point things go weird and let things stabilize before continuing.
I don't know what your doses are, but I think that is an important aspect when considering the apathy thing. The most likely culprits I suspect in your case are Abilify and Lithium, but the doses tell more than the actual drugs. For example, apathy on 15mg Abilify would be predictable, but apathy on 2.5mg would be less expected. Apathy on 600mg or higher of Lithium would be predictable, but apathy on 150mg-300mg much less.
I wouldn't suspect Traz right off, unless the dose is higher than sleeping doses (25mg-50mg). My least suspicion would be with Buspar, but again, the dose thing.
It could be possible, as a strategy that makes more sense to me, to eliminate one of the meds...whichever you and your doc figure is the least needed, least helpful, most likely an apathy causer. Lower the others, and see how it goes. From there, you could add something that is specifically anti-apathy. That is generally limited to Ritalin, Adderall, and Modafinil, and thus the importance of taking a hard look at the drugs you already have. Other anti-apathy meds would include Savella and a couple of the TCAs.
I just don't think stopping them all is a wise move. Maybe a long slow weaning process is reasonable and less risky. Somewhere along the line you and your team will have a good feel for where to go next. But if done too fast, or in steps that are too large, you could run into some very troublesome times.
Many meds do not work again after stopped. Sometimes they do, but a lot of times they don't. Another reason to go very gentle on the journey. For example if things completely fell apart and you all made the decision to go back to your original doses, it would not be surprising to many of us here that they don't feel like they used to and don't work and side effects are worse than before.
Some of us here have experienced a strange phenomenon that I don't think has been studied and doesn't have a name. That is, after stopping longterm meds, being clean for a few months, and restarting, we find we are super sensitive to even tiny doses, side effects are exaggerated bigtime, and meds don't feel at all like they used to. I have no idea how often this happens, my guess is it is probably a minority, but it is something to keep in mind.
Posted by morganator on February 1, 2010, at 18:31:59
In reply to Re: Going off meds?, posted by bleauberry on February 1, 2010, at 18:08:23
Great advice Bleauberry.
I definitely would not go off all medication. I did this once and a month later I was back in the hospital.
Eventually you may be off all of the medications you listed and you may be on others that you feel much better on. Just make sure it is a gradual transition, one that minimizes the risk for destabilization.
Lithium is a great medication that may offer neuroprotecion. Maybe you just need to lower the dose. I am going to start taking a low dose myself. If you have to be on a higher dose to prevent mania, try to lower the dose as much as you can without feeling less stable. Hopefully you can do this and feel a difference.
I would also look into switching to an antidepressant that will hopefully give you more of an "alive" feeling. This may take a little guessing and trial and error.
Unfortunately, for those of us that fall under the wide spectrum of bipolar, there simply are enough treatments out there that help us with depression and mania and allow us to feel normal like everyone else at the same time.
Posted by 49er on February 1, 2010, at 18:44:18
In reply to Going off meds?, posted by myfranz on February 1, 2010, at 7:50:22
> I am about to broach this subject to my psychiatrist, and already have the support of my therapist. Diagnosed bipolar, stronger depressive side, but now believe that some of the depression I have felt for the last couple of years is more like emotional numbness rather than clinical depression. I honestly can not describe it any better than that. I realize this would have to be done slowly and it may not work. I have been on meds for 16 years, currently Abilify, Lithium, Trazodone, and Buspar. Had a series of ECT 6 years ago (big regret) and I was hospitalized once about 7 years ago for suicidal ideation, no attempts. History of alcohol abuse, sober for over 20 years.
>
> For those you went off meds, I'd love you to share your experiences, both good and bad and in between.
>
> I see my therapist 2 x's a week so there is great support there, I won't be doing this alone and I always know I can go back on them.
>
> Thanksmyfranz,
I started tapering off a 4 med cocktail of Adderall, Wellbutrin XL, Remeron and Doxepin in 2006. I am currently at around 3.64mg of Doxepin.
If you do decide to taper, please do it very slowly. The Paxil Progress Boards recommends 10% of current dose every 3 to 6 weeks. With your heavy duty meds, it might be necessary to go more slowly.
It hasn't been easy but it has been one of the best decisions I have made in my life.
I am curious, on what basis where you diagnosed bipolar?
Anyway, I hope this helps. Obviously, my drugs aren't as powerful as yours but hopefully, knowing that someone has almost tapered will be helpful.
49er
PS - I have been on meds since 1995
Posted by janejane on February 1, 2010, at 20:03:58
In reply to Going off meds?, posted by myfranz on February 1, 2010, at 7:50:22
If the major problem is emotional numbness, I wonder if you're experiencing apathy caused by the drugs. If this is the case, lowering your dosages or tweaking might be a better solution than going completely off.
Posted by myfranz on February 2, 2010, at 7:23:21
In reply to Re: Going off meds? » myfranz, posted by Maxime on February 1, 2010, at 15:43:01
Thanks for all the reasoned and thoughtful replys. My doc and I did decrease the Abilify to 2.5mg and the Lithium to 750mg about 4 months ago--I see no difference whatsoever. The trazodone is at 150mg and the buspar at 60mg. I am not even sure if going off the meds will help as I suspect the ECT txs as a contributor to the mental and emotional dullness. I swear my IQ dropped 20 pts after that! My psych has been known to say that therapy can be just as good as meds, and now that I can go to therapy 2xs a week (insurance finally covers it) I do see a difference. Hope my psych puts his money where his mouth is. I'm tired of feeling like a dull-witted moron. Okay that is some hyperbole but I think most people on meds know what I mean.
Posted by Maxime on February 2, 2010, at 16:17:07
In reply to Going off meds?, posted by myfranz on February 1, 2010, at 7:50:22
I'm bipolar type II and like you, have more of a problem with depression. I had to off my meds to washout because I was starting an MAOI. Those 3 weeks of the washout period were hell. I went off my antidepressant slowly and it was still hell. I became suicidal and depressed like never before. I thought that surely I would take my own life because I didn't want to wait for the Parnate. I somehow got through those 3 weeks and then started the Parnate and started to feel better.
If you do decide to go off your meds, do it very slowly. But I hope that you will decide to stay on them.
Posted by inanimate peanut on February 2, 2010, at 22:21:42
In reply to Re: Going off meds? » myfranz, posted by Maxime on February 2, 2010, at 16:17:07
if I could go back to every time I have gone off meds and stop myself, I would. Don't assume you can go back on them if you stop them. As bleauberry already said, it doesn't work that way for some (I would suspect a decent number) of people. Every time I was stable on meds and went off them for some reason, I destabilized myself and then the meds wouldn't work when I went back on them. I know it's easy to get lulled into a "I don't need them" mentality after you've been stable for awhile, but it's very possible that the only reason you haven't had an episode for so long is because you have a combo of meds that work. If you *have* to do something, I agree with several of the other posters that you might try going down on your doses *very slowly* or target just one drug (I would recommend not going off lithium, as it does offer the neuroprotection). As you said, it may not even be the drugs responsible for your current state of mind-- it may be the ECT. In that case, going off the meds would get you nowhere except possibly destabilized. Therapy is great but it can only do so much for biological imbalances. Sorry-- this is my soapbox-- I completely messed up my life and don't want to see anyone else mess up theirs.
Posted by myfranz on February 2, 2010, at 23:33:01
In reply to worst decision(s) of my life, posted by inanimate peanut on February 2, 2010, at 22:21:42
This whole situation is so agonizing. Until now I have been the most compliant pt you will ever meet. That's almost 16 yrs of compliance. Maybe it has something to do with being a nurse, a "yes dr" mentality! I mean I ALWAYS finish my antibiotics! I see my dr next Tuesday and I have already left him a message about this, and so has my therapist. I have got to believe my therapist sees something in me to think I am ready for this. I too see a strength I have never seen before. If it is not the meds (my symptoms) and it is the effects of the ECT I guess I'm sunk and stuck--a sad prospect. Sorry no question here, just a rant.
Posted by myfranz on February 3, 2010, at 0:00:31
In reply to Re: worst decision(s) of my life, posted by myfranz on February 2, 2010, at 23:33:01
I should mention one thing that I only just realized. Since my meds were decreased about 4 months ago, I have published for the first time. One non fiction piece and 3 poems. Let's even say the first one was a fluke. Is this a glimpse of me being "off" meds-- what else am I capable of without them? Certainly the meds did not just kick in! I fully admit that the meds have saved my life over the years, but now it seems my "life rope" is choking me.
Posted by morganator on February 3, 2010, at 1:56:09
In reply to Re: worst decision(s) of my life, posted by myfranz on February 3, 2010, at 0:00:31
Have you tried exercise and yoga? Both of these can stimulate your mind and give you more energy. They may or may not help, it was just a thought.
I would not get off meds completely. There really is no point in it. Just keep tinkering with doses and also consider a new antidepressant that wont make you feel apathetic.
Both the ECT and years of depression and bipolar episodes can damage your brain. This very well could have something to do with how you feel. If this is the case with you, you need try to do what you can to reverse some of this damage.
Posted by Lou Pilder on February 3, 2010, at 7:40:40
In reply to Going off meds?, posted by myfranz on February 1, 2010, at 7:50:22
> I am about to broach this subject to my psychiatrist, and already have the support of my therapist. Diagnosed bipolar, stronger depressive side, but now believe that some of the depression I have felt for the last couple of years is more like emotional numbness rather than clinical depression. I honestly can not describe it any better than that. I realize this would have to be done slowly and it may not work. I have been on meds for 16 years, currently Abilify, Lithium, Trazodone, and Buspar. Had a series of ECT 6 years ago (big regret) and I was hospitalized once about 7 years ago for suicidal ideation, no attempts. History of alcohol abuse, sober for over 20 years.
>
> For those you went off meds, I'd love you to share your experiences, both good and bad and in between.
>
> I see my therapist 2 x's a week so there is great support there, I won't be doing this alone and I always know I can go back on them.
>
> Thanksmyfranz,
You wrote,[...off meds...share...]
I am delighted to read your posts here. You see, I have a perspective that could be different from those here concerning what you have written here.
In my experiance, I see that you are in a blessed state now. I base this on what you have written and see that you could be having what has been revealed to me as the start of Great Tribulation. This tribulation is about a great agonizing, pressuring and testing experiance that could be beyond what you think that you could endure.
I am your brother and companion in this tribulation if you would like and are wanting to overcome what is ahead of you when you discontinue the chemicals that have been in your systems for years. You see, it has been revealed to me that those that are willing to overcome tribulation can have a helper. This helper has been revealed to me as a Rider on a White Horse. And in an encounter with Him, He said to me, "Let not your heart be troubled. If you believe in God, Believe in me also. These things I have spoken to you that in me you might have peace. In the world you will have tribulation. But be of good cheer, I have overcome the world."
Lou
Posted by ihatedrugs on February 6, 2010, at 12:00:26
In reply to Going off meds?, posted by myfranz on February 1, 2010, at 7:50:22
I know exactly how you feel as I just went off meds about a month and a half ago. I'm still taking klonopin at night in case I get too anxious. I don't know how long this will last, as of the last few days I have begun to feel down again. I did pretty well during the first month. The reason I stopped was I was supposed to go through a washout period from Emsam but I was actually feeling pretty good, so I decided to continue on a -let's say extended washout. I have been on pretty much every antidepressant except for most maois (just emsam). I honestly believe that while these meds have perhaps, kept me functional, each year that goes by they have taken a piece of ME. I sometimes think back at the young woman I used to be- depression and all- and feel such inmense sadness for all that remains of me are vestiges of who I used to be.
I'm so tired and disillusioned at the medical/pharmaceutical establishment for giving us substandard meds that only seem to mask one problem and create numerous ones. I don't know what I will do. I am supposed to start lexapro with a small dose of nortriptyline but the thought of more weight gain (50lbs so far), loss of libido, lack of motivation, increased stupidity, brain zaps, memory loss, and all the other insidious offenders we have to put up with, have made me wait and hope for a miracle. After all, I think a miracle has a better success profile than any of the meds I have taken.
Will I have to go on meds again? I'm pretty sure I will. It is just a matter of time for the beast to show its ugly face again. The problem is what meds? I'm supposed to go back to Lexapro but I have already tried it. How many trials and errors do I need to go through and if they work it is only temporarily. This is why I'm taking my chances with no meds. I'm tired of thinking what else is there? I'm tired of going to this website looking for answers and hoping someone knows of a new drug showing great promise. I'm just tired and understand why you want to go off meds. I truly hope it works out for you. I'm not so sure it is going to work out for me either way so it will be just a matter of which of the two evils cause the least damage.
Posted by myfranz on February 6, 2010, at 12:24:15
In reply to Re: Going off meds? » myfranz, posted by ihatedrugs on February 6, 2010, at 12:00:26
Hi Ihatemeds and all! Thank you for your sensitive post, I felt as if I was reading my biography, including the emsam. I see my dr on Tuesday, and I think he will be more understanding than I originally thought. But I admit I am scared, not of him but of the huge possible leap this is. I guess I can say I'm intelligently scared--better than reckless. My guess is that my dr will ask me what I want to decrease first. My guess is the Abilify since I'm only taking 2.5mg now. Question: anyone with Abilify withdrawal experience? Thanks!
Posted by bulldog2 on February 6, 2010, at 12:49:24
In reply to Re: Going off meds? » ihatedrugs, posted by myfranz on February 6, 2010, at 12:24:15
> Hi Ihatemeds and all! Thank you for your sensitive post, I felt as if I was reading my biography, including the emsam. I see my dr on Tuesday, and I think he will be more understanding than I originally thought. But I admit I am scared, not of him but of the huge possible leap this is. I guess I can say I'm intelligently scared--better than reckless. My guess is that my dr will ask me what I want to decrease first. My guess is the Abilify since I'm only taking 2.5mg now. Question: anyone with Abilify withdrawal experience? Thanks!
My guess is that bi polar depression will not disappear. I agree to be on the least amount of drugs you need but you will probably always need somthing. But good luck in this endeavor.
Posted by emmanuel98 on February 6, 2010, at 19:37:22
In reply to Re: Going off meds? » ihatedrugs, posted by myfranz on February 6, 2010, at 12:24:15
Question: anyone with Abilify withdrawal experience? Thanks!
I cycled on and off abilify because it caused weight gain for me. But I never had any withdrawal effects.
Posted by ColoradoSnowflake on February 6, 2010, at 22:18:20
In reply to Re: Going off meds?, posted by emmanuel98 on February 6, 2010, at 19:37:22
Ihatedrugs:
Hi: I thought you liked Emsam? Did it stop working? Side effects?
Thanks
Posted by floatingbridge on February 7, 2010, at 12:09:37
In reply to Re: Going off meds? » myfranz, posted by ihatedrugs on February 6, 2010, at 12:00:26
Hi ihatdrugs,
I'm sorry you still going through this. I hope the washout / drug- free period lasts for you. I think many here share the disenchantment with meds. I know I do.
The other night, my husband reminded me of myself in my twenties and thirties. I had problems then, but still. Who was that woman? Yes, I feel sad, too.
It's all crazy-making to me.
Take care and god bless in an agnostic sense,
fb
(hugs)
Posted by floatingbridge on February 7, 2010, at 12:19:02
In reply to Re: Going off meds?, posted by myfranz on February 2, 2010, at 7:23:21
Myfranz,
I was able to stop abilify w/o any effect (except relief). I'm not BP and have never experienced mania. I went from 10 to 5, to 2, then 0, with about 10 day lengths between decreases. That's just my experience. It was not a good med for me-- flattening.
Take it slow and be flexible. It's easier to avoid a crisis than pull ones self out of one. Have a plan with you pdoc, and a backup plan.
Be safe, and good luck,
fb
Posted by myfranz on February 7, 2010, at 12:30:27
In reply to Re: Going off meds? » myfranz, posted by floatingbridge on February 7, 2010, at 12:19:02
Floatingbridge: Thank you for your wise and caring post. I'll post more after I see my Dr. on Tues. I have a good feeling about his reaction though. I had called him last Monday to prepare him for this conversation, via a VM. He never called me back, very unusual for him and I thought the worst. Then he called me yesterday, a Sat. no less! We talked very briefly about what was on my mind--he did not voice an opinion, but I feel he will at least listen. I just want me back because everyday on meds I am forgetting who that is/was. Maybe I'm foolhardy, but i have to try. Again thank you for your insight!
Posted by Phillipa on February 7, 2010, at 19:28:21
In reply to Re: Going off meds? » myfranz, posted by floatingbridge on February 7, 2010, at 12:19:02
That was a very high dose glad you weaned off easily. Love Phillipa
Posted by floatingbridge on February 7, 2010, at 19:36:39
In reply to Re: Going off meds? » floatingbridge, posted by Phillipa on February 7, 2010, at 19:28:21
Yes, very easy. But I was on less than a year and was not trying to deal with any mania or hypomania. I don't know if those conditions would make a difference...
fb
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