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A Tale of Antipsychotic Switching and Withdrawal

June 9, 2011 Natasha Tracy

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.

APA Reference
Tracy, N. (2011, June 9). A Tale of Antipsychotic Switching and Withdrawal, HealthyPlace. Retrieved on 2020, June 4 from https://www.healthyplace.com/blogs/breakingbipolar/2011/06/a-tale-of-antipsychotic-switching-and-withdrawal



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 BurbleTwitter, Instagram and Facebook.

Ruby
December, 16 2018 at 8:24 am

Hi there, I am on Parnate, Lamotrigine, Gabapentin 90mg and Olanzapine 2.5mg. The Olanzapine is for anxiety but weight gain has been a huge problem. My psych suggested a change to Latuda. I reduced Olanzapine to 3/4 dose for 2 weeks and then half dose for 10 days. That's when things went bad, waking at 5am with severe panic attack and anxiety related diarrhea. I went back up to full dose and was fine 24 hours later. I find it so hard to know if I'm experiencing withdrawal or relapse. How can I find out if Latuda can help with anxiety? It isn't prescribed for this. I want z drug tge same as olanzapine without the weight gain.

April
September, 29 2011 at 7:11 pm

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.

Natasha Tracy
September, 26 2011 at 9:44 am

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

April
September, 25 2011 at 4:26 pm

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.

Natasha Tracy
July, 21 2011 at 8:27 am

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

Ken
July, 19 2011 at 2:13 am

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.

Dr Musli Ferati
June, 20 2011 at 7:24 pm

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.

Natasha Tracy
June, 10 2011 at 4:58 pm

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

Wendy from Australia
June, 10 2011 at 4:40 pm

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.

Natasha Tracy
June, 10 2011 at 6:47 am

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

mef123
June, 10 2011 at 6:16 am

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

Natasha Tracy
June, 10 2011 at 6:13 am

Hi Hannah,
"Was told no, but it clearly says on their own web site take with 350 calories."
Well now, that would tick me right off.
It sounds like you've put a lot of thought into this. Good luck with your decision.
- Natasha

Hannah
June, 10 2011 at 3:08 am

Ugh, it ate my first whole post because I forgot to put in my email....grrr. Ok, to try it again...
I have let me dr's office know I'm not going on the latuda. My first question when I found out it was sedating was if I it had to be taken with food. Because if it didn't then I could take it as I went to bed and sleep off part of the sedation. Was told no, but it clearly says on their own web site take with 350 calories. If I have to do that I might as well stay on geodon and get used to its sedating effects, because that is the only side effect I had on it. Dropped my dose (with dr permission) because of the sedating side effect affecting work. But with the dropped dose I've become a bit paranoid and can't go anywhere other than work and home (the two places I've deemed "safe") without knowing someone will meet me there or go with me. My poor hubby is having to go to the grocery store and everywhere else that I HAVE to go to. From the info I've found I think I'd do better to go back to the higher dose of geodon (the devil I do know) than switch to latuda (the devil I don't know)! Thanks for the link. I refuse to let me drs willy nilly try stuff out on me to see how it works. I want information and to have an informed say in what I put in my body, especially when we are talking such powerful drugs.

Natasha Tracy
June, 9 2011 at 6:30 pm

Hi Kristine,
Thanks for sharing your experience.
I'm not so sure an "open" mind is really the best thing. I think an educated one is better. Before deciding to give something a shot I think it's important to know what it is you're giving a shot to.
It may absolutely be the best choice and awareness can help make that choice clear.
- Natasha

Kristine
June, 9 2011 at 5:36 pm

For what it's worth, Latuda is working for me, better than 7 other antipsychotics I've been on. I'm dealing with muscularskeletal side effects(always a problem for me with drugs in this class), but the othertwice effects I have with these drugs are mostly absent. I noticed benefits within a few days. The typical dose range is 40-80mg and I'm at 60mg. I too experience lots of side effects from psych meds, even from fractions of the lowest doses. I know drugs affect everyone differently, but I just wanted to share my relative success so far with Latuda so that you might give it a shot with an open mind. Good luck!

Natasha Tracy
June, 9 2011 at 1:31 pm

Hi Jake,
Yes, I used to think my doctor was trying to kill me. (OK, I never seriously thought that but it would have been plausible.)
Good luck.
- Natasha

Natasha Tracy
June, 9 2011 at 1:30 pm

Hi Lisa,
I know the Geodon feeling. I wasn't a fan.
- Natasha

Natasha Tracy
June, 9 2011 at 1:28 pm

Hi Hannah,
I can understand your trepidation. You might want to check the devil you don't know though because I think Latuda is pretty strong (and note, only FDA-approved for schizophrenia). A couple of numbers I pulled:
9.4% of people discontinued to due to adverse reactions.
15% reported akathesia (need to move muscles)
22% reported somnolence (sleepiness, sedation)
Not surprisingly, adverse reactions were dose-dependent.
Geodon's no picnic either, I'm just saying you might want to take a gander: http://www.rxlist.com/latuda-drug.htm
(Of course, your doctor may have specific reasons for choosing that drug for you, the only way to know is to ask.)
- Natasha

Jake
June, 9 2011 at 12:47 pm

Eeeeek! I am doing another med change and feel like I am dying. Not nice. I am coming off clonazapam. I feel like bugs are under my skin. I have done this many times in my life(changed meds). Always hellish but my body demands it so I am going for the ride.
Have fun Natasha.

Lisa Hancock
June, 9 2011 at 10:37 am

Good Luck to ya! Making the change! It took me many yrs to find that magic pill/pills to work n b tolerable. That was geodon, at first it kinda made me feel like coming out of my skin but it didn't last long at all. By time I left the hospital I felt better on. I would just go to bed and sleep!! To get thru that very funky feeling!

Hannah
June, 9 2011 at 10:17 am

My doctor is wanting to switch me from geodon to latuda. And I'm at the moment refusing because it scares me to death to do the changes. I HATE them. But then again, I don't know how long I can stand feeling like I do right now....

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