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A Tale of Antipsychotic Switching and Withdrawal

Switching antipsychotic medication in a med cocktail can produce withdrawal and side effects and be hard on the patient. More at Breaking Bipolar blog.

Recently I switched from antipsychoticX (aX) to antipsychoticY (aY). I despise changing medications; however, this change was necessary due to the general lack of success of the previous cocktail.

And in spite of the fact that given the tiny doses there shouldn’t have been any dramatic effects from this change, naturally, there were. A medication change is pretty much always pain on a stick (that hits you, a lot).

Switching Tiny Antipsychotic Doses

For many years now I’ve been on multiple meds. We call this polypharmacy, or, if you like, cocktail hour.

And while there are many combinations whose effects can be predicted, (in the case of fluoxetine and olanzapine they even combined forces into one pill) most of them we cannot. And if you’re on more than two meds? Well that’s just a game of guess-and-check.

In my case, I was on half of the smallest available dose of aX. By all medical accounts this shouldn’t:

  1. Produce any therapeutic effects
  2. Product any withdrawal symptoms if removed

Both of those are wrong.

Antipsychotic Switching Shouldn’t Have Done This

So, I went from half of the minimum dose of aX to half of the minimum dose of aY. And (insert colorful expletives here) life went to hell in a handcart.

The day following the switch I was so fatigued I could barely move and I was inconsolably weepy with a predilection towards pretty severe thoughts of suicide. This particular day was followed by similar days that also included:

  • Muscle and joint pain
  • Early morning (like 3am) awakenings and an inability to get back to sleep
  • Headaches
  • Dizziness, lack of coordination
  • Runny nose
  • Fever
  • Anxiety
  • Chills
  • Shaking / tremor
  • And probably other things I don’t remember.

Um, Really?

Yes. Really.

And Then It Got Worse

I started wild rapid-cycling.

It was around about this time that I talked to a doctor.

Removing One Antipsychotic, Adding Another

See, these two things should have balanced each other out (sort of). But they didn’t. They just produced an intolerable hell.

My doctor looked at the symptoms and thought the withdrawal from aX was worsening the symptoms of getting on aY, so he recommended remaining on aX until aY could reach a steady state in my blood stream.

Righty then. Two antipsychotics no waiting.

And Today

He was right about that. Adding aX back fixed a lot of the problems but not all of them. The mood swings, albeit with somewhat reduced amplitude, appear to be mine to cherish. Hopefully they will even out as the med reaches full titration. We’ll see. And then, if it all works out, we can remove aX again. And see what happens. Lucky me.

Reactions to Switching Antipsychotics Will be Unique to You

This is my experience and you are unlikely to share it exactly. The thing about polypharmacy is that we don’t really know how each med interacts with the others and some essentially “turn up” the efficacy of others. We don’t know why. They just do.

 

And for whatever lucky reason I tend to over-over-overreact to medication changes. Always have. One med, two, six, doesn’t matter, if you want to see side effects, give me a call.

So, That Can’t Possibly Be Worth It

I understand why you might think that but the described hell is a requirement for things to get better. Yes, it makes every breath unbearable for a while, but that’s the only shot at making life better.

It’s like this. People going through radiation and chemotherapy do it to get better. These treatments can absolutely destroy a person. It can kill them, actually. But it’s their shot at life. Everyone understands that they will have to survive interminable pain to have a shot of getting better.

Psych meds can be just like that. I’m not saying they always are, but for me, they often are. And just like with cancer you might have done all that work only to find out it didn’t fix the problem. And then you have to try something equally painful. Or more painful. Them’s the breaks kids.

Nothing in life is free and when you have a disease things get really, really expensive. But what it comes down to is pretty simple. Live through the pain or die. It’s up to you.

Important Note

If you experience the kind of side effects or withdrawal I’m talking about see your doctor immediately.

Olanzapine – Zyprexa
Fluoxetine- Prozac

You can find Natasha Tracy on Facebook or @Natasha_Tracy on Twitter.

Author: Natasha Tracy

Natasha Tracy is a renowned speaker, award-winning advocate and author of Lost Marbles: Insights into My Life with Depression & Bipolar.

Find Natasha Tracy on her blog, Bipolar Burble, Twitter, Google+ and Facebook.

20 thoughts on “A Tale of Antipsychotic Switching and Withdrawal”

  1. Could be, but 5 or 6 Ritz crackers fills the bill either way. It w orks for me and after trying the usual cafeteria of meds I’m happy to have it. So far the side effects have been minimal.

  2. Hi April,

    FYI, I don’t know about Latuda, but some antipsychotics require a certain number of calories to be taken with them for proper metabolism in your body. They _must_ be taken with that much food otherwise they won’t get into your blood stream properly.

    – Natasha

  3. I take Lautuda (40mg) and Seroquel (100mg) along with Ambien and Buproprion (300mg). I found that the Seraquel and the latuda toghether have enabled me to take lower doses of each and reduce the side affects. The prupose fo the food is to protect the stomach. I may not take 350 calories when I take it, but I usually eat a few crackers when I do. My pdoc recommends taking the Lautuda with dinner. Made me really sleepy so I take it just befor I start my nightly routine and the an hour later I take the Seroquel. I know I was going in every direction at the same time and staying up for 23 or more hours with out sleeping, never mind eating. We are all different so give it some thought. Maybe a very gradual increase will make it easier to tolerate the meds. I just know that without them I would not be alive today. By the way my pdoc is available 24/7 or has someone covering for him. I am always just a phone call away from help. The problem for me was making myself call and ask for help in the first place. That almost led to disaster twice and now I have promised both him and myself not to wait. Good luck all of you.

  4. Hi Ken,

    It _is_ scary. It always is. And taking the time to think about it is OK and prudent. You’re the one that has to take the pills not your doctor.

    The only thing I can say is slower is better. The more slowly you make the change the more you can stop any adverse effects early.

    Good luck.

    – Natasha

  5. Im having some problems and the doc asked if i wanted to change “crazy pills”. So i said yes I could try. She gave me Latuda. I’m currently on Seroquel 200 mgs. (for 2-3 years now) & its ok but things seem to be going downhill slowly. I had a severe problem with muscle movements and i DO NOT want to go back there. So, I havn’t started the Latuda yet & dont know if i really want to. I know the Seroquel and its not perfect but its the best crazy pill i been on so far. She did give me instructions to add Latuda slowly and reduce the Seroquel slowly. I just dont know. Its scary to make changes like that.

  6. Switching antipsychotic therapy presents a complex and difficult undertaking procedure in the treatment of psychiatric entities both for patients and for therapist. As You mentioned above, there is a rule that is named as “crossing-over” in passing from an antipsychotic to another, but unpredictable phenomenon may to occur. The main guide line in this hardy intercassion is to avoid polypragmasy, i.e. it shouldn’t use many psychotrophic remedies simultaneously. It ought to be carefully if patient take in the same time any other medication or has got any other disease. Beside this, it is important to prepare mentally the respective patient in advance how to admit this change in the long-term treatment, as is antipsychotic therapy. In a word, every patient should to overwork in itself compliance and adherence as well. The ways are numerous, and everyone could to find out the most appropriate manner for himself.

  7. Hi Wendy,

    I’m sorry to hear how hard medication has been for you. I certainly hope you find a new treatment plan that works better for you.

    I have to make something clear though –

    – I did _not_ say just to sit through _any_ amount of pain. Some pain has to be handled in other ways.

    Just to remind you, I actually went back _on_ the original antipsychotic to allow the second antipsychotic full time to enter my bloodstream. Sometimes that’s the right choice (and sometimes it isn’t).

    For you, I definitely recommend working with your doctor to find the right schedule for you. And _please_ contact emergency help if you need it over the weekend.

    For many, meds have to be tapered _extremely_ slowly. You may have tapered them too quickly and that is why you are experiencing such awful withdrawal symptoms. Getting onto a lower dose might be a good goal for you but you just may have to take it a bit more slowly.

    Be well.

    – Natasha

  8. Hi guys, I am also on multiple psych meds and have been on 800mg Seroquel for several years as part of the mix – and other mood stabilisers/anti-psychotics since then. I went up from 60kg to 125kg due to mood stablisers, which are also anti-psychotics and have been begging my psychiatrists (several on a row) to get me off Seroquel. So I am now going off it (or at least to a much lesser dose) and am down to 300mg. Well, all the side effects of coming off such a high dose of such a high powered med.. Everything people have posted above. My sleep is just SO BAD. And while I get Night Terrors, which is a form of psychosis at normal times, it’s happening more now.

    I have been told now to stop going down and sit where I am and see whether my system will adjust and things wll even out. But I don’t know. I’ve had such side effcets from psych drugs, even neasr death that anything can happen and I certainly think things are out of control now – my finctionality os dropping rapidly. I’m in Aus and it’s Sat lunchtime and we are now in a long weekend and I can’t call my psychiatrist or his psych nurses until next week to get more advice, so I am stuck for the moment.

    I am very clear now that I need to reduce the Seroquel though, as even having gone doen 100mg yo 200mg, my appetite dropped right out – to norml and I lost 12kg without even exercising – I have a normal appetite for the first time in years. And my READING. I lost my beloved career as a PR Mgr due to my inability to do the work that had come so easily for YEARS. Now I am down on the Seroquel, I am reading books right through, really quickly, and while that’s great it makes me sad that being over-medicated might have lost me my career – and then my house as a result of that.

    I’ll take on board what has been said about sitting through the pain of a meds reduction to get where I need to be. It gave me strength just to read that. Thank you.

    Michele, I am like you, I would love to get on the fewest meds possible and at the lowest dose possible.

  9. Hi Michele,

    “My old pdoc used to just keep adding new meds and never taking me off of other ones”

    That’s a really common problem. The doctor is generally scared of making you worse. Depending on what type of state you’re in mentally, this can be a very real fear.

    But a plan to reduce medications is great when possible. Just take it _extremely_ slowly, one med at a time and hopefully you’re find a reduced amount that works for you.

    Good luck.

    – Natasha

  10. I’m on ten (yes you read that right) meds. I just got a new pdoc and he wants to bring me down to just three. I’m excited but scared at the same time. My old pdoc used to just keep adding new meds and never taking me off of other ones even though I requested it several times. It’s like he didn’t know what to take me off of. well nothing is working so what difference did it make. I hope this works and I get down to taking just a few meds. That would make me happy.

    Good luck with your med change, I hope all goes well.

    Michele

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