Going Off Meds

I'm Bipolar - Year 7, June/July 2005

by Marcia Purse

For 11 weeks - from the second week of June to late August - I tapered off all my meds. They weren't doing much good anyway - at least, I didn't think so. (I was SO wrong!)

I didn't start out planning to go off everything, but along the way my psychiatrist and I decided I'd be a good candidate fo a new clinical trial of Seroquel (Quetiapine) vs. Paxil (Paroxetine) vs. placebo for treating bipolar depression. In order to be entered into the trial, I would first have to get all current medications out of my system. I was really intrigued by the idea. I've been medicated continuously since 1994, and except for the first year, when Prozac alone worked very well (it lost its effectiveness after 12 months), no single drug or combination has done a great job. So why not give up what wasn't working and try something new?

It really started arond the third week of May when Dr. Meyer made several medication changes. First, for depression he had me taper off Celexa and start Prozac (real Prozac, not Fluoxetine). Second, he had me cut my Wellbutrin dose in half and add a morsel of Zyprexa. These two changes were aimed at the agitation I was experiencing from my unrelenting anger over the bird feeder situation at work.

On June 9th I emailed him as follows:

Doc - seems like I've been on Prozac too long to start having side effects now, so maybe it's the godawful weather ... but I'm really struggling with daytime drowsiness this week, it is just terrible. I've dropped Zyprexa the last couple of nights but that hasn't helped. It IS rather warmer here at work than I would like but I have a fan. I've been sitting in relative dark ever since the bird feeders went down, but today I tried letting in more light to see if that would help the sleepiness - not so far, all it did was let in more heat, even though the sun is off that window. I have been trying to cut down on Naproxen ... taking a far lighter dose of Ibuprofen during the day. There's no info anywhere on Naprosyn withdrawal and I can't imagine that taking LESS of any painkiller would make a person sleepy.

Anyway, this is interfering with my job. Wondering if I should take all Prozac in the evening [instead of all in the morning], or split the dose between morning and evening? Or just wait it out and see if it goes away when the weather breaks (if it EVER DOES!)?

He didn't get reply immediately, and the next day I decided to go ahead and start taking the entire dose of Prozac in the evenings. This change pretty much took care of the daytime sleepiness. But four days later he emailed back succinctly: "Drop the Topamax." Whoa. Okay. I did this, too, and as far as I could tell, there was absolutely no difference in me without it. Unfortunately, Prozac wasn't doing any better than Celexa for my depression. I even went back to a full dose of Wellbutrin. It didn't help.

On June 28th at my next pdoc appointment we decided I would try to enter the Seroquel study. Because Celexa clears out of the body faster than Prozac, Dr. Meyer switched me back again, tapering one into the other. We also dropped Trazodone, one of my longest-use meds.

I'd mentioned trying to take a lower dose of painkillers in my June 9th email. With intensive chiropractic treatment, my back had been getting better; but on July 12th I slipped and fell in the back yard, seriously wrenching my right knee. A week later it was dramatically swollen and although not painful, so stiff that I couldn't walk without a limp. This was a disaster for my spine. In no time I was back to three-a-week chiropractic visits, and I doubled my Ativan dose from 1 to 2 mg.

The med changes to this point had not caused any problems:

• 50 mg Topamax to 0
• 25 mg Trazodone to 0
• .6 mg Zyprexa to 0
• 40 mg Celexa to 20 Prozac to 20 Celexa
• 300 mg Wellbutrin to 150 to 300
• 1 mg Ativan to 2
• 4 mg Gabitril - no change

However, two huge changes were on the way - one miserable and one wonderful.

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