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Dr. Bob is Robert Hsiung, MD,
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Posted by qbsbrown on August 7, 2009, at 9:34:07
In reply to Re: Dosing Scott, posted by SLS on August 7, 2009, at 7:30:45
> I think the cognitive effects will dissipate. You know, one is supposed to start at 400mg and increase by 100mg or 200mg every week. You've gone faster than that, so side effects must be expected to be more prominent at first.
>
> I would continue with the Tegretol. If you feel the need, you can take a bit more diazepam, but my feeling is that this won't be necessary in a few more days. Try to push past the side effects.
>
>
> - ScottWell I actually was at 400mgs for 6 days, so not that much out of the norm right.
My night was pretty good (my last 3 days have been seemingly improved), but I was up in the middle of the night (I have intrusive thoughts 24/7), and the sunrise/sunlight sensitivity came back. This seems to only go away after raising the Tegretol dose. This went away yesterday after my first night of 600mgs, now has gone away after 2 days of 600.
Today is day 3 on 600mgs, do I want to hold for at least 5 days? I wonder how high I will have to chase it. I saw a prominent bipolar doc that said he gets his patients to at least 1200mgs, but I'm sure it's different for benzo wd.
I think i'm a very fast metabolizer obviously.Regards,
Brian
Posted by SLS on August 7, 2009, at 9:47:09
In reply to Re: Dosing Scott, posted by qbsbrown on August 7, 2009, at 9:34:07
> > I think the cognitive effects will dissipate. You know, one is supposed to start at 400mg and increase by 100mg or 200mg every week. You've gone faster than that, so side effects must be expected to be more prominent at first.
> >
> > I would continue with the Tegretol. If you feel the need, you can take a bit more diazepam, but my feeling is that this won't be necessary in a few more days. Try to push past the side effects.
> >
> >
> > - Scott
>
> Well I actually was at 400mgs for 6 days, so not that much out of the norm right.
>
> My night was pretty good (my last 3 days have been seemingly improved), but I was up in the middle of the night (I have intrusive thoughts 24/7), and the sunrise/sunlight sensitivity came back. This seems to only go away after raising the Tegretol dose. This went away yesterday after my first night of 600mgs, now has gone away after 2 days of 600.
> Today is day 3 on 600mgs, do I want to hold for at least 5 days? I wonder how high I will have to chase it. I saw a prominent bipolar doc that said he gets his patients to at least 1200mgs, but I'm sure it's different for benzo wd.
> I think i'm a very fast metabolizer obviously.
>
> Regards,
>
> BrianI think you are on the right track. I think it is ideal to wait for the WD symptoms to stabilize before beginning your taper. Waiting 5 days to raise the dosage to 800mg seems prudent. You could get a blood level of Tegretol, but I am not sure how useful that would be. You would want to find the minimum dosage necessary to allow you to taper the diazepam successfully. The best way to go about this is to titrate the dosage clinically and observe the results.
- Scott
Posted by qbsbrown on August 7, 2009, at 10:05:05
In reply to Re: Dosing Scott, posted by SLS on August 7, 2009, at 9:47:09
> > > I think the cognitive effects will dissipate. You know, one is supposed to start at 400mg and increase by 100mg or 200mg every week. You've gone faster than that, so side effects must be expected to be more prominent at first.
> > >
> > > I would continue with the Tegretol. If you feel the need, you can take a bit more diazepam, but my feeling is that this won't be necessary in a few more days. Try to push past the side effects.
> > >
> > >
> > > - Scott
> >
> > Well I actually was at 400mgs for 6 days, so not that much out of the norm right.
> >
> > My night was pretty good (my last 3 days have been seemingly improved), but I was up in the middle of the night (I have intrusive thoughts 24/7), and the sunrise/sunlight sensitivity came back. This seems to only go away after raising the Tegretol dose. This went away yesterday after my first night of 600mgs, now has gone away after 2 days of 600.
> > Today is day 3 on 600mgs, do I want to hold for at least 5 days? I wonder how high I will have to chase it. I saw a prominent bipolar doc that said he gets his patients to at least 1200mgs, but I'm sure it's different for benzo wd.
> > I think i'm a very fast metabolizer obviously.
> >
> > Regards,
> >
> > Brian
>
> I think you are on the right track. I think it is ideal to wait for the WD symptoms to stabilize before beginning your taper. Waiting 5 days to raise the dosage to 800mg seems prudent. You could get a blood level of Tegretol, but I am not sure how useful that would be. You would want to find the minimum dosage necessary to allow you to taper the diazepam successfully. The best way to go about this is to titrate the dosage clinically and observe the results.
>
>
> - ScottSo we could get to 800mgs and hold 5 days, then either begin taper, or keep upping the tegretol? Hopefully 800mgs is the ceiling.
I hope we are going in the right direction. I am in very high tolerance wd, and sitting around and holding the dose probably isn't helping much.
Thanks Scott
Brian
Posted by qbsbrown on August 7, 2009, at 10:31:58
In reply to Re: Dosing Scott, posted by qbsbrown on August 7, 2009, at 10:05:05
And I really hope that I get that "grounded" feeling back. Feeling like I'm floating isn't much fun lol.
Brian
Posted by qbsbrown on August 7, 2009, at 12:22:53
In reply to Re: Dosing Scott, posted by qbsbrown on August 7, 2009, at 10:31:58
Scott, it seems that the immediate version is still only lasting about 4 hours. do you think that going to a higher dose might aleviate this? Or perhaps taking it 4 times a day?
Or would you go w/ the ER version? I don't know why, but the ER version scares me because of the Trileptal like effects it was inducing.
In theory, it should be this exact med, but longer lasting, correct?
Brian
Posted by qbsbrown on August 7, 2009, at 12:52:07
In reply to Re: Dosing Scott, posted by qbsbrown on August 7, 2009, at 12:22:53
Ideally, I would like to stay on the generic 3x a day. My hope is that higher levels would diminish the short action. Is this possible?
Brian
Posted by qbsbrown on August 7, 2009, at 13:42:02
In reply to Re: Dosing Scott, posted by qbsbrown on August 7, 2009, at 12:52:07
LOL, do you love my obsessive writing? This is what happens when it wears off.
If i dose 4 times a day, how often would i take it? If I was awake at 6am, then to bed at 12am?
6-10-4-10?
Posted by qbsbrown on August 7, 2009, at 16:43:42
In reply to Re: Dosing Scott, posted by qbsbrown on August 7, 2009, at 13:42:02
I take the generic, and my weird obsessive/compulsions stop w/ in 30 mins.
Brian
Posted by 49er on August 8, 2009, at 9:20:58
In reply to I took some depakote Scott, posted by qbsbrown on July 25, 2009, at 15:16:02
Hi Brian.
I speaking from the perspective of someone who slowly tapered off of 4 meds down to my current one (Doxepin).
What I am about to say I have learned from being on Paxil Progress Boards, which is run by an RN, not a crazy scientologist.
Reducing psych meds is not like quitting Benadryl. Because your brain needs time to adapt to the neurochemical changes these meds have made throughout the body, reducing a med too quickly is like throwing the car in reverse at 60 miles per hour. You may be one of the lucky ones who can cold turkey without any problems but you won't know until it is too late.
In case you think I am wrong, read posts by people on this board who tapered real fast and suffered greatly.
About using a med to taper, well, you will have to then get off that med when the time is right. And people have had a horrific time coming off of Depakote.
I am not going to be a hypocrite and say not to use anything since I have used supplements. But really, when I think about it, very few (mainly fish oil capsules) have been really helpful. The rest of them have contributed to withdrawal symptoms.
Also, I realize that people have symptoms so severe such as insomnia that they have to take a med. I know there are exceptions to every rule.
But generally, I feel you are playing with fire by adding something an already unstable nervous system.
And by the way, I tapered slowly off of Remeron, one of my meds, even though it caused a hearing loss. I felt tapering too quckly would be a disaster and my hearing didn't get any worse by going slow.
Brian, I know I have made faces when people have said this but it is true. The only thing that solves withdrawal problems is time. There are no shortcuts.
But tapering slowly does allow you to have some type of life. I am living proof.
Finally, I wanted to address a point you made in another post that I was going to respond to. Calling people like me fringe groups and antipsychiatrists does nothing to add to the discussion. I could call you all nuts for believing in meds so much but of course, i would never do that as we all have different experiences.
And believe it or not, my slow tapering method could help people who have no interest in tapering off of meds but find that the doses they take are too much for their bodies.
I am pleading for civility instead of name calling. We all want the same thing which is to lead fulfilling lives. Just because we have different ideas doesn't mean that anyone's opinion is less valuable than the next person's.
49er
Posted by SLS on August 8, 2009, at 9:51:20
In reply to Re: I took some depakote Scott, posted by 49er on August 8, 2009, at 9:20:58
There are other perspectives regarding the rapid detoxification of benzodiazepines:
**************************************************
Oxcarbazepine in rapid benzodiazepine detoxification.
Croissant B, Grosshans M, Diehl A, Mann K.Department of Psychiatry, Psychotherapy and Psychosomatics, Teaching Hospital Sigmaringen, University of Tuebingen, Sigmaringen, Germany. [email protected]
OBJECTIVE: This study aims at evaluating the tolerability and efficacy of the antiepileptic drug oxcarbazepine in benzodiazepine detoxification in ten patients. METHODS: In this case study of an inpatient withdrawal program, each of the ten patients was detoxified using oxcarbazepine and completed withdrawal successfully without the occurrence of withdrawal symptoms. The detoxification program followed an outlined dosage scheme with oxcarbazepine increase and benzodiazepine tapering. RESULTS: The rapidity of benzodiazepine detoxification using oxcarbazepine was remarkable, benzodiazepine withdrawal being completed in as little as 11 days. CONCLUSIONS: The results support the assumption that oxcarbazepine is a valuable drug for inpatient benzodiazepine withdrawal programs.
**************************************************
It is nice for you to care about others.What would happen if you were to learn that using Tegretol makes it possible to discontinue diazepam within a matter of weeks.
I have been on Depakote several times at dosages that exceeded 1500mg. I never experienced any kind of withdrawal syndrome that required a slow taper. The rate of taper was that which was deemed prudent so as not to produce a seizure. Other than that, no problem. I had an equally uneventful discontinuation of Trileptal.
Where did you find your stories regarding Depakote withdrawal?
- Scott
Posted by ron1953 on August 8, 2009, at 14:48:36
In reply to Re: Anyone had a successful rapid detox from benzos? » qbsbrown, posted by SLS on July 19, 2009, at 14:05:22
"Successful" is a relative term. After being on Klonopin for 7 years @ 2+ mg/day, and failing a couple of taper-off attempts, I went cold turkey. I really didn't know what to expect, and it was worse than I might have guessed. The "rebound anxiety" was really bad, and I didn't sleep at all for a few days, but I didn't feel as if I was in medical danger. The worst of the symptoms began to subside after about a week. The total readjustment took several more months. Even though it sucked, I was glad to be done with medications, once and for all. While white-knuckled cold turkey may not be recommended, it's faster than anything else. Oh, and I had my wonderful wife to keep an eye on me while I went through it.
Posted by SLS on August 8, 2009, at 17:59:31
In reply to Re: Anyone had a successful rapid detox from benzos?, posted by ron1953 on August 8, 2009, at 14:48:36
Years ago, I had the privilege of having to discontinue Klonopin using what today would be considered a rapid taper. I had been taking it for about two years. I remember having those lightning flashes going off in my head. It was hellish.
- Scott
Posted by 49er on August 9, 2009, at 16:44:20
In reply to Re: I took some depakote Scott » 49er, posted by SLS on August 8, 2009, at 9:51:20
> There are other perspectives regarding the rapid detoxification of benzodiazepines:
>
Scott,Are you being sarcastic about my caring about others?
Regarding your study, if I posted something like that that had just 10 people, you would greatly criticize me for the small study sample.
But more importantly, just because people are fine after 11 days doesn't mean they won't get hit with withdrawal symptoms 2 months later. That study would have more validity if people were followed for a year.
Here are patient reports of side effect which I admit doesn't make for a study. But remember, people weren't believed about ADs causing weight gain only for that to change later.
http://www.askapatient.com/viewrating.asp?drug=18723&name=DEPAKOTE
Here is a google search of depakote withdrawal:
49er
> **************************************************
>
> http://www.ncbi.nlm.nih.gov/pubmed/18821451?ordinalpos=6&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
>
> Oxcarbazepine in rapid benzodiazepine detoxification.
> Croissant B, Grosshans M, Diehl A, Mann K.
>
> Department of Psychiatry, Psychotherapy and Psychosomatics, Teaching Hospital Sigmaringen, University of Tuebingen, Sigmaringen, Germany. [email protected]
>
> OBJECTIVE: This study aims at evaluating the tolerability and efficacy of the antiepileptic drug oxcarbazepine in benzodiazepine detoxification in ten patients. METHODS: In this case study of an inpatient withdrawal program, each of the ten patients was detoxified using oxcarbazepine and completed withdrawal successfully without the occurrence of withdrawal symptoms. The detoxification program followed an outlined dosage scheme with oxcarbazepine increase and benzodiazepine tapering. RESULTS: The rapidity of benzodiazepine detoxification using oxcarbazepine was remarkable, benzodiazepine withdrawal being completed in as little as 11 days. CONCLUSIONS: The results support the assumption that oxcarbazepine is a valuable drug for inpatient benzodiazepine withdrawal programs.
>
> **************************************************
>
>
> It is nice for you to care about others.
>
> What would happen if you were to learn that using Tegretol makes it possible to discontinue diazepam within a matter of weeks.
>
> I have been on Depakote several times at dosages that exceeded 1500mg. I never experienced any kind of withdrawal syndrome that required a slow taper. The rate of taper was that which was deemed prudent so as not to produce a seizure. Other than that, no problem. I had an equally uneventful discontinuation of Trileptal.
>
> Where did you find your stories regarding Depakote withdrawal?
>
>
> - Scott
Posted by SLS on August 9, 2009, at 18:48:30
In reply to Re: I took some depakote Scott, posted by 49er on August 9, 2009, at 16:44:20
> Are you being sarcastic about my caring about others?
Absolutely not.
- Scott
Posted by qbsbrown on August 9, 2009, at 19:20:08
In reply to Re: I took some depakote Scott » 49er, posted by SLS on August 9, 2009, at 18:48:30
Well, today is day 5 on 600mgs, 200-200-200, generic.
Some how, god only knows, I was able to go for a long car ride, get on a ferry boat, and spend a weekend around people at a cabin on a beautiful island.
That said. The new trend is this. I take the dose, and I get the bad depression/dysphoric feeling for about 4 hours, then it seems to wear off, and I have a bigger sense of normalcy day by day, less depression, more socialization, less paranoia. But by the time to take the next dose, I"m ready and need to.
It used to be that the med would only work for 4 hours then wear off.
Now this is the same weird physical depressive feeling i get in my head then if i were to take anything gaba related, even niacinimide.
In your opinion, is this the spike of the immediate releaase w/ the gaba giving my feeling of depression and dysphoria, then wearing off and feeling better? Even though it's wearing off after 4 hours, it's still affecting my brain, and in my blood correct?
Do you think that if I were to take the ER version, that I would either feel better, because I'm not getting a big spike, and peaks and valleys, or is there the possibility that the ER version could just be making me feel depressed much and much longer, because the gaba is being released longer?
I appreciate your help and ideas and any suggestions you can offer.
Kind regards,
Brian
Posted by qbsbrown on August 10, 2009, at 1:33:10
In reply to Scott, new trend. Your theory?, posted by qbsbrown on August 9, 2009, at 19:20:08
Well, we can go to 800mgs tomorrow like we talked about, after 5 days. Or do you think that I should wait 2 more days to make it an even week?
And I could go either 250-250-300, or 200-200-400. I'm thinking that the latter sounds better.
I guess i can stick w the generic. At least i know how i react, and that i can go out and do things.Last time I had bad dysphoria, i upped the dose, and it helped rid some.
My typing is still a little shaky, so still some wd and sxs adjusting to 600mgs.
But seriously, I don't care about dysphoria and/or depression, I just want off all of this crap. These psychotropic meds have ruined my life for the past 10 years, and I'd like to get it done with.
Most experts and benzo sites, would advocate decreasing by 1mg, every 1-4 weeks. I'm assuming that you would think other wise, and to try to get off quicker. Am I assuming correct?
Regards,
Brian
Posted by qbsbrown on August 10, 2009, at 1:50:16
In reply to Re: I took some depakote Scott, posted by 49er on August 8, 2009, at 9:20:58
I toally hear you 49er. I don't know you, and wasn't referring to you in any way, shape or form. I agree with almost all that you said. I don't like psych meds, and i want off all of them, and to resume my life. that's all.
I'm sorry if you took offense to something that I wrote, as it was not directed towards you, or anyone else on this board.
Best to health for all of us.
Regards,
Brian
Posted by SLS on August 10, 2009, at 6:53:49
In reply to Re: Scott, new trend. Your theory?, posted by qbsbrown on August 10, 2009, at 1:33:10
Although I try to stay away from theory and go with what works empirically, I am sure there are specific reasons for why you are experiencing these post-dose phenomena.
Tegretol potentiates GABA receptor stimulation and blocks sodium channels. With hyperexcitable glutamate neurons, you might get a combination of anxiety and dysphoria at the same time towards the end of the dosing period. Until the sodium channels become occupied again, the anxiety would persist during a time when increased GABA receptors occupancy produces the dysphoria. I am still mulling all of this over, so I am sure I've got it wrong.
Anyway, you can increase the dosage of Tegretol whenever you feel comfortable. It might prevent interdose loss of glutamate suppression and stop the rollercoaster ride.
I am glad that you are getting out more and functioning better.
- Scott
Posted by qbsbrown on August 10, 2009, at 9:41:43
In reply to Re: Scott, new trend. Your theory? » qbsbrown, posted by SLS on August 10, 2009, at 6:53:49
> Although I try to stay away from theory and go with what works empirically, I am sure there are specific reasons for why you are experiencing these post-dose phenomena.
>
> Tegretol potentiates GABA receptor stimulation and blocks sodium channels. With hyperexcitable glutamate neurons, you might get a combination of anxiety and dysphoria at the same time towards the end of the dosing period. Until the sodium channels become occupied again, the anxiety would persist during a time when increased GABA receptors occupancy produces the dysphoria. I am still mulling all of this over, so I am sure I've got it wrong.
>
> Anyway, you can increase the dosage of Tegretol whenever you feel comfortable. It might prevent interdose loss of glutamate suppression and stop the rollercoaster ride.
>
> I am glad that you are getting out more and functioning better.
>
>
> - ScottWell, it seems that the dysphoria has rubbed off for the most part. I think it was more of a situational thing. Where I haven't been in many social situations, because they have been too difficult to tolerate, and just the pressure stemming from it.
I think perhaps that 4 doses might be more prudent. Is it ok to dose at 6am-10am-2pm-10pm? Or is that last space too much? I might find that if I dose at 10, that I won't need the 2pm so early. I begin to do my strange obsessional/compulsive quirks around 10am, and it seems to alieviate it w/ in 30 mins, so i'd like to do it then
I'm sure that you are more for advocating the ER version, but it just seems to act so much differently, I don't know why.
Regards,
Brian
Posted by qbsbrown on August 10, 2009, at 9:44:52
In reply to Re: Scott, new trend. Your theory? » qbsbrown, posted by SLS on August 10, 2009, at 6:53:49
Do you think the ER version might prevent all of the interdose crap?
Brian
Posted by qbsbrown on August 10, 2009, at 12:43:30
In reply to Re: Scott, new trend. Your theory?, posted by qbsbrown on August 10, 2009, at 9:44:52
do I try to hold 800mgs for 1-2 weeks then begin tapering? Or just hold 1 week?
Brian
Posted by qbsbrown on August 10, 2009, at 15:31:45
In reply to Re: Scott, new trend. Your theory?, posted by qbsbrown on August 10, 2009, at 12:43:30
Wow, adding that 200mgs sure hit me. Started to sweat, typing woresened, anxiety, felt on the brink of a nervous breakdown. I hope that this all passes. I hope that I made the right choice with this med.
I know that it's expected to rev up my symptoms for a couple of days, just as it has in the past.Is dosing at 6-10-2-10 ok?
Brian
Posted by qbsbrown on August 10, 2009, at 16:57:40
In reply to Re: Scott, new trend. Your theory?, posted by qbsbrown on August 10, 2009, at 15:31:45
Do you think that 1000mgs is pushing the limit? It'd be nice to be able to dose every 4 hours til bedtime, so i don't get the interdose.
I guess we'll see how 800 plays out.
Brian
Posted by SLS on August 10, 2009, at 17:31:54
In reply to Re: Scott, new trend. Your theory?, posted by qbsbrown on August 10, 2009, at 15:31:45
> Wow, adding that 200mgs sure hit me. Started to sweat, typing woresened, anxiety, felt on the brink of a nervous breakdown. I hope that this all passes. I hope that I made the right choice with this med.
This is not what I was hoping to hear. You seem to report progress in that you are functioning better and going out more, etc. Then you report nearing a nervous breakdown. I cannot justify suggesting that you continue with this drug trial. The object was to make things better and not worse. I do not believe that 1000mg will serve you any better than 800mg. It sounds like you are experiencing withdrawal to me.
You might need to follow a taper schedule similar to what 49er recommended. He has his Babble-Mail enabled, so you can send a message directly to him. Tell him I said hello.
Discontinuing Tegretol might allow you to feel better as the blood level of diazepam will increase as a result.
- Scott
Posted by qbsbrown on August 10, 2009, at 17:53:13
In reply to Re: Scott, new trend. Your theory?, posted by SLS on August 10, 2009, at 17:31:54
> > Wow, adding that 200mgs sure hit me. Started to sweat, typing woresened, anxiety, felt on the brink of a nervous breakdown. I hope that this all passes. I hope that I made the right choice with this med.
>
> This is not what I was hoping to hear. You seem to report progress in that you are functioning better and going out more, etc. Then you report nearing a nervous breakdown. I cannot justify suggesting that you continue with this drug trial. The object was to make things better and not worse. I do not believe that 1000mg will serve you any better than 800mg. It sounds like you are experiencing withdrawal to me.
>
> You might need to follow a taper schedule similar to what 49er recommended. He has his Babble-Mail enabled, so you can send a message directly to him. Tell him I said hello.
>
> Discontinuing Tegretol might allow you to feel better as the blood level of diazepam will increase as a result.
>
>
> - ScottIt seemed to be an initial scary reaction (this has happened at other increased doses). Now settling in a bit. Much more comfy. W/o the tegretol, i can not leave the house. I can't afford to do or have that, there are things that I HAVE to be able to attend. If i were to discontinue, the flood gates of more racing thoughts would be worse, and i would return to being housebound.
I think that i'm in it for the long haul. If I do well at 800mgs for 5-7 days, then i think it might be good to continue to 1000mgs (because i could dose every 4 hours, perfect), then begin tapering.
Let me know what you think.
Regards,
Brian
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Psycho-Babble Withdrawal | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
[email protected]
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