Some words on: Splitting the atom with pill-cutters and patience

Logically, as I move on to lower doses of medication, also the adjustments on the way to the next smaller dose need to become finer. Pill-cutters work great when it comes to halving tablets, or even splitting sufficiently large, round tablets into quarters. But unless you can get hold of low-dosage pills, the utility of this gadget has its limits. More often than not, my attempting to cut pills into exact portions smaller than one half, has resulted in me plucking minute white crumbs out of the pill-cutter and piecing them together to approximately one day´s dose. Some pills simply resist being cut precisely. To avoid such hassle, I prefer using my pill-cutter in combination with a method of spacing out the intake of the old, higher dose in favor of the next lower one. The underlying idea is to gradually diminish the average amount of the respective substance in my organism until reaching the following lower target dose. Here is an example of how I have been doing it:

graphic sertraline withdrawal

I came across this procedure in Dr. Peter Breggin´s book Psychiatric Drug Withdrawal, and have mentioned it briefly in an earlier post on this blog as well. The graphic above does not reflect the exact way Dr. Breggin helps his patients decrease their drug intake, but it is an adaptation of his idea to my own circumstances. Another way of doing it by blocking high and lower doses according to a weekly plan would be to take the new dose on one day of the first week, two following days of the second week, three following days of the third week, and so on. It could look something like this – red spaces represent the old, higher dose of a drug and blue spaces the new, lower one:

suggestion weekly withdrawal plan

As you can see, the concept is flexible. You or your doctor may come up with other variations, even shortening or lengthening the duration of each step in your withdrawal process according to your own needs. In addition, I have to point out, once again, that I am not a professional in the medical field. This blog documents my individual way of handling medication withdrawal, but I am in no way qualified to give anyone else instruction in this matter. My hope and purpose is to encourage you to acquire the means and the support you need to improve your health. If you believe the method of psychiatric drug withdrawal I am describing in this article might also be helpful in your case or for someone you know, please seek further information with professionals and consult relevant literature. I am sorry if I am repeating myself with this sort of disclaimer, but I truly do not wish for anyone to get hurt in the execution of domestic experiments with psychoactive substances.

Up to now, I have been faring well using this method of dose reduction. All that is necessary is to keep track of where you are at in your plan – and to have your plan for each dose reduction written out for your reference. Personally, I keep a handwritten list of days and corresponding dosages, and tick off day by day. This way, each decrease in dosage takes me around five to six weeks. After completing the change, I wait for another couple of weeks before I make any modifications to my intake of the other drug I am using. Thereby, I hope to make sure each alteration of my medication plan is well under control in that I can recognize any adverse reactions and, most importantly, relate them directly to specific changes I have made. In order to take psychiatric medications, and also in order to wean off them safely, it is vital to notice the effects using them – or ceasing to use them – has on you. When you experience negative side-effects or withdrawal symptoms, you need to find out what caused them. A clear-cut medication and withdrawal plan helps generate such transparency, provided you follow up on it diligently. Being structured also allows for making well thought-through modifications to your plan if things should not go smoothly. Suffering adverse effects is, in itself, a destabilizing experience. The less panic-driven and better informed your subsequent actions and decisions are, the more likely you are to get back on track and prevent a full blown crisis from developing.

At this point, I would like to remind you always to remain process-oriented, rather than goal-oriented. Diminishing psychiatric drug intake is not about reaching the lowest dose possible in the shortest amount of time possible. Your success in this area is not defined by numbers. Drug withdrawal is not a sport. It is a process, which in turn will be accompanied by further processes regarding your overall health, your attitude towards life, your relationships with others, and your personal development. All those processes and gradual shifts are what you are after. Do not attempt to force spectacular changes. Instead, care for yourself and intend to remain grounded enough to weather your everyday life. If, at some point, looking back you can say you are feeling better about yourself than a while ago, you are headed in the right direction. Let every step forward and every choice be the natural result of your inner development and a subtle stimulus for further growth. Do what you can, but never try to find out where your breaking point is by challenging yourself to your limits. Do not hurry. Keep in mind it is better to walk calmly and securely than risking to stumble, fall and having to pick yourself back up all over again. Take all the measures you can to stay at peace. Protect yourself, nourish yourself.

Funnily, at present I am reading a book about writing and just came across a sentence I wish to quote here: “We´ll see progress in time. But we can´t expect to every day.” (Louise De Salvo, The Art of Slow Writing). In other words: do not drive yourself bonkers with undue pressure, nor let anyone else do so. As long as you are honestly working towards your health and your life´s improvement, you are doing well. Or, regurgitating a quote De Salvo took from Stephen King, describing his return to writing after a devastating accident which forced him to undergo long and painstaking rehabilitation: it all is about “[…] getting up, getting well, and getting over. Getting happy, ok? Getting happy.” King was referring to his writing, but really these words describe the essence of healing. Take note, in particular, of how King uses the verb “getting”, which clearly denotes process. PROCESS! This is what you are looking for. Getting healthier and, why not, happier!

How it´s going – Completion of phase three

Hello Everyone!

I am now taking half of my original dose on both medications. So now I am on 75mg of Sertraline and 150mg of Quetiapine. There have been no unfavorable reactions to the dose reduction whatsoever. Again, I have to stress that I do not simply switch to a smaller amount of any of my medications from one day to the next. Every decrease in dose takes me about three weeks to complete. Also, I never modify the dose of both medications simultaneously, but do it one after another. This adds up to a total of six weeks for the change to be complete. I always start with the antidepressant, and finish with the anti-psychotic.

Given that I am feeling so well, I have decided to continue dose reduction throughout the month of December. I will take the Sertraline down to 50mg. In January, I will be travelling abroad, which is why I intend to wait with the further reduction of the Quetiapine dose until after the trip. I should point out that we will be visiting my partner´s family, and that I have made this same trip twice before. In other words: we will not be exposed to exotic stimuli and strange locations, but rather be welcomed into some sort of home from home. I find this important to mention because dose reductions are safest when there is no stressful situations or emotional turmoil ahead. Of course, these can come up unexpectedly at any moment and even in the middle of a dose reduction, but why deliberately risk any instability in the face of anticipated psychological pressure?

Once I am down to 50mg of Sertraline and 100mg of Quetiapine, which corresponds to one third of the original dose, I will not make any further changes for at least half a year. Frankly, I have not even clarified for myself if I should ever be completely medication free. The habit of popping those pills every morning and evening has become so strong and reassuring that the idea of not having them as a safety-net gives me vertigo. Knowing myself, I might be able to overcome that fear once I am getting closer to the right moment, but I am more of the one-step-at-the-time type, so for now I will be dealing with the next dose reduction and nothing beyond that. This tactic has worked fine for me until now, and not just regarding my medications but also other matters in life, so I shall stick to it.

I will keep you updated.

Felicia.

Finally, Moving On

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Hello Back.

I have kept this blog dormant for quite a while now, which I really feel lousy about. Luckily for me, it has been for all the right reasons. My life has changed considerably and kept me very busy.

After bringing a shitty contract with an abusive employer to a necessary end and having worked three jobs at the time throughout the month of June to bridge the gap, I am now very content with my new placement. Knock on wood, may it continue to go as well as it has begun.

Another source of stress is the disappearance of three of our pets, probably at the hands of a sociopath neighbor who had actually menaced us with “doing something” to them. We would love to denounce him, but unfortunately we have neither proof nor witnesses other than ourselves. Not knowing what happened to your little friends, nor where they are and how they are doing, weighs heavily on the heart. So does the inability to do anything about it.

Close friends have moved out of the country, but I hope to keep up contact with them – after all, this is the age of the internet! Hopefully, my partner and I will be able to visit them at some point. I do miss them.

I have even “survived” a reunion with close relatives without the feared psychological breakdown and without seeing anyone, including myself, resort to the dysfunctional patterns of behavior that have spoiled family meetings in the past.

My beautiful partner has supported me through all the changes and his part in everything having come out so positively is major.

I still have nasty nightmares on most nights. It had become better for a while, but they have returned. My subconscious keeps bringing up topics it wants to process and apparently fails at it, making another attempt the next night, and so on. In spite of this, I seem to get enough rest. I am productive at work and creative in my spare time, and enjoying both. My cognitive performance and concentration levels are fine.

A big setback, though, is that I am pretty much back to my original weight. It’s not like I have been binge-eating or anything. It has just come back on. Seven pounds lost, seven pounds gained. At least I am not heavier than I used to be. Still, I am frustrated at how I look. I have always had issues with certain body parts, as most people do, but these weak spots seem especially annoying now that I am not in my best possible shape. Back to square one! I’ll have to devise a good workout-plan.

Since my last post, I have not made any new modifications to my medication regimen. I decided that too much was going on to risk any additional instability. Today I’ve begun to lower my Sertraline dose. I have been taking 100 mg in the mornings for a few months, which is 30% less than the original dose. My next aim is to go down to 75 mg, which would be half of the original amount. Once this is achieved, I will follow up with the Quetiapine. I am confident it will work out. However, my partner will have a watchful eye on me and tell me if I act even weirder than I normally do.

I’ll be in touch.

Felicia

 

 

How It’s Going – Completion of Phase Two

I am now permanently on 200 mg of Quetiapine (Seroquel) and 100 mg of Sertraline (Zoloft), which means I am concluding phase two of my withdrawal plan. According to this schedule, as I had originally laid it out, I am supposed to stabilize these doses over the course of two to three months. However, given that I am experiencing no withdrawal symptoms or other anomalies at all, I might reconsider the duration of the stabilization period and possibly reduce it to somewhere between one and two months.

My current doses correspond to a 30% reduction of the amount I was prescribed when I first started taking my medications. I believe my organism is already perceiving some degree of relief. My overall well-being has been improving, certainly also thanks to a healthy diet and regular exercise. Mentally and emotionally, I feel perfectly functional and healthy. My partner is a great source of support, and I know I can trust him to report any unusual observations to me.

I am also pleased to see how each prescription of a hundred coated tablets now lasts one month longer than it used to. The medication supply that was meant to be good for three months is now sufficient for four. One could say I am 30% less stressed about getting my new prescription.

As for this blog, it has been slowly, but steadily, attracting more readers. My hope is for them to find useful or at least interesting information on its pages, be it for themselves or in order to help loved ones. I want to stress once more that your comments, questions and suggestions are more than welcome. Reader’s contributions make this kind of blog so much richer and so much more helpful. Feel encouraged to send me your thoughts and experiences – they will all be considered and responded to.

How It’s Going – Completion of Phase One

Yesterday night was, hopefully, the last time I ever took the old dose of Quetiapine, 300 mg. So from today onward I will be taking 250 mg of Quetiapine at night and 125 mg of Sertraline in the morning. If you have a look at my dose reduction plan, you will see that I originally planned to stay in this place for a while. However, as I have had no withdrawal symptoms or other adverse reactions to the dose reduction so far, I feel I should move on to the next dose reduction sooner. Thus, I shall begin lowering the Sertraline dose further next week, in the same way I have already done it once. This modification is to be followed by another dose reduction of the Quetiapine. My next aim is to reach a plateau phase with 200 mg of Quetiapine and 100 mg of Sertraline. This corresponds to a 30% reduction of the original dosages, which I find to be quite a significant change. Once I get there, I still plan to remain there for at least a few months.

The question now is whether I have noticed any changes so far. As for negative ones, luckily not! On the positive side, I do feel slightly more alert in the sense that I make faster decisions, seem to have an improved concentration and feel more open towards learning new things. A lot of this, admittedly, has to do with my recent changes in lifestyle and the accompanying shifts in priorities. Logically, I have some restructuring and decluttering to do. Nonetheless, I feel that I am mentally and emotionally better disposed to pull through with these reconfigurations. Lowering the dose of my medications may be contributing to that.

Physically, there have been slight improvements as well, although these most likely have to be attributed to factors other than medication withdrawal. My weight has been going down very gradually, which is probably mostly a consequence of my doing daily yoga routines and eating a low-carb diet complemented with veggie shakes. I have a very sweet tooth, but lately I have managed to steer clear of too much self-indulgence in this area. My partner and I have agreed we can be naughty – in culinary terms – every once in a while on special occasions, but certainly not on a daily or even weekly basis. Our naughtiness in other areas seems to be improving. Our relationship is thriving, yet it is impossible for me to say whether lower medication doses have anything to do with that. I suppose, and hope, that we are simply doing things right.

Lately, my sleep is less plagued by nightmares. I used to have them every night, and they were intense enough to have me wake up screaming every so often. Since I have moved in with my man, this has not happened again, although most of my dreams are still weird and unsettling. They very evidently deal with traumatic experiences as well as the fears and conflicts derived from those. As a result, my dreams are quite repetitive in topic, which makes me assume I have a considerable quantity of psychological knots to untie if I want to get rid of them. Several sources on psychiatric drug withdrawal explain that as you lower doses, emotions and thoughts may resurface that had been lingering under the surface of your drug induced stability. To me, that makes perfect sense, as the drugs do seem to suspend you from hammering away desperately at your worst conflicts. So, as a consequence of medication withdrawal, I expect some serious processing and coping challenges to lie before me. At this point in time, such challenges have not occurred to an extent that would make me consider seeing a psychotherapist. My partner is a great source of support, encouragement, comprehension and love. The list of his wonderful characteristics could go on and on. My close friends are caring and sincere. In other words, I have a support network that wants for nothing. Thanks so much for that!

All in all, I am happy about how everything is going. My initial fear of lowering medication doses has receded. I am still very careful and slightly apprehensive about the process, but so far I have felt motivated to think that as long as I proceed in a sensible way, I should be able to minimize risks. I am glad I have started this process.

My Personal Withdrawal Plan – Sources and Outline

Although I seem to tolerate my current medication plan quite well, I have been striving to wean off my pills, or at least decrease the dose I am taking. But before I altered anything, I needed information. Despite my recovery from psychosis I have developed a profound mistrust towards psychiatrists and psychotherapists. Out of all the professionals who saw and treated me, maybe 20% actually knew what they were doing. The other 80% either didn’t care to help me, or they wanted to be helpful but didn’t have any idea how, or they were abusive of their authority, or they needed therapy themselves. No joke.

As a result, my first thought was that I needed information to be able to distinguish a competent psychiatrist from a quack, so I could pick the right support for my undertaking. Yet, by continuing to read about mental illness, treatment options and psychoactive drugs, I became more knowledgeable and eventually felt I was able to make informed and more autonomous choices regarding my recovery and withdrawal process. One book in particular stood out as being clearly understandable for any reader and for promoting a holistic approach to the treatment of mental illness and to medication withdrawal: Psychiatric Drug Withdrawal – A Guide for Prescribers, Therapists, Patients, and Their Families. It is one of the more recent publications of Dr. Peter Breggin, who draws on over half a century of medical experience in psychiatry. As a defender of the patient’s freedom of choice, Dr. Breggin promotes what he calls a “person-centered, collaborative approach”. Instead of turning the patient into a depersonalized and passive onlooker of their own treatment, Breggin places the patient at the very center of his therapeutic model. Around the patient, he constructs a support network consisting of a prescriber of psychiatric drugs, a psychotherapist, and significant others (family members, spouses and friends). The prescriber and the therapist can be one and the same person, but do not have to be. What is indispensable, though, is that the patient’s wishes and decisions are taken into account at all times, and that all participants in the collaborative, person-centered approach are communicating efficiently and monitoring the patient’s health development. As the title of the book reveals, Dr. Breggin writes for health care professionals, patients and their significant others alike. None of the information he gives is classified exclusively for one or the other. All people involved have the same right and access to knowledge. The patient and his or her loved ones are empowered rather than patronized. You might be able to guess by now that I highly recommend this book. Further on, I will be reviewing more literature, but for now this is my starting point.

First of all, it is important to understand that there is no standard recipe for withdrawing from psychotropic drugs. Every organism reacts differently to changes. Also, it is impossible to foresee how long it will take to wean off medication or to securely establish a new dose. As a general rule, however, slower is better, and small changes in dose are safer than big ones. This is especially true for those who have been on psychiatric medication for a long period of time. Certainly, you often hear stories about individuals who have successfully gone “cold turkey” or got rid of their pills in the course of a few weeks or months, but they were taking a high risk and were extremely lucky. They were literally playing Russian roulette with their lives. Reducing medication doses is not a sport, and there is no competition going on in who gets there first. The only reasons for withdrawing on the fast lane are life-threatening or disabling side-effects, dangerous drug interactions, pregnancy and medical conditions that turn the use of psychoactive drugs into an additional health risk. Personally, I am not in a hurry. Luckily, nothing in my life forces me to withdraw, and I can take it as slowly and safely as I like. And I like it very safe.

Evidently, withdrawal is easiest to plan being on only one drug. Now, I am on two different medications which counteract one another and are thereby meant to keep me in balance. In the morning, I take 150mg of Sertraline (SSRI antidepressant), which should have a stimulating effect. At night, right before going to sleep, I take 300mg of Quetiapine (atypical antipsychotic), to sedate me. My aim is to reduce doses alternately, maintaining the proportion between both drugs. I will start with the antidepressant. If everything goes well, the antipsychotic is to follow. Again, if the new dose works fine for me, I will keep it up for a period of time and eventually attempt another reduction.

As for the monitoring of my progress, my partner is around me every day and is in the know about my withdrawal plan. He will communicate any observations and concerns to me, is reading the same literature as I and is following my blog. Other friends will also be part of my private watch team. I do have a prescriber, yet I admit I haven’t decided on the involvement of a psychotherapist. Frankly, I feel reluctant to do so. Right up to my psychotic break, I had been seeing a shrink for several years, and she was unable to identify any warning signs or put her finger on the deeper causes of my troubles. I believe I’ve had it for now, as far as psychotherapists go. Also, after the ride I’ve sat through, I am quite confident I know myself better than a therapist who sees me once weekly could. In order to boost my general health and well-being, I will work out regularly, stick to a healthy diet, sleep enough and enjoy relaxation therapies – occasional foot reflexology and back massages.

The following is an illustration of how I ideally wish to proceed. This plan, as for now, has five phases that may be subject to changes, depending on whether I tolerate the dose reductions. If I don’t, I may need to return to the previous dose and postpone further changes for a long enough while to become stable again. You will notice I haven’t planned a complete withdrawal. While I was figuring out the graphics, the thought of actually putting this plan into practice made me feel all wobbly. In the attempt of outlining a sixth and seventh phase I might have fainted and slipped underneath my desk. So, let this be good for now.

I apologize for the miniature format of the graphics. The originals are a good size, but for some reason, they won’t come out bigger once inserted into this post. You can upscale your view of this page on the bottom right of your screen.

withdrawal plan phase 1

withdrawal plan phase 2

withdrawal plan phase 3

withdrawal plan phase 4

withdrawal plan phase 5