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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 130 to 154 of 212. Go back in thread:
Posted by SLS on August 6, 2009, at 13:12:23
In reply to Re: Dosing Scott, posted by qbsbrown on August 6, 2009, at 12:22:10
> What about the medication lasting a couple of hours, then totally fading off? Is it more beneficial to switch to the ER version, or to dose 4 times a day if/when ready to raise dose?
One is supposed to dose four times a day. However, once you are at a high enough dosage, you might be able to dose three time a day. You'll just have to experiment. At 600mg, I would first try 200mg every 8 hours. At 800mg, you could try 200mg-200mg-400mg.
- Scott
Posted by qbsbrown on August 6, 2009, at 13:52:09
In reply to Re: Dosing Scott, posted by SLS on August 6, 2009, at 13:12:23
> > What about the medication lasting a couple of hours, then totally fading off? Is it more beneficial to switch to the ER version, or to dose 4 times a day if/when ready to raise dose?
>
> One is supposed to dose four times a day. However, once you are at a high enough dosage, you might be able to dose three time a day. You'll just have to experiment. At 600mg, I would first try 200mg every 8 hours. At 800mg, you could try 200mg-200mg-400mg.
>
>
> - ScottI do have a fast med metabolism. I can feel the effects, then it completely wears off after a couple of hours.
I have been dosing 8 hours apart, along w/ the diazepam, and for sure feels like interdose wd.
I wonder about the ER version 3 times a day, but just taking that for 2 days, and having really bad memories of my trileptal day came back.
So I could hold this for 5 days, then try the 800 if tolerable. Then I could dose 250-250-300 would probably work better for me, or 2-2-4.
Or if on the ER version, I could go 200-200-400.
Why do you think that the ER version would mimic some effects of trileptal, that the immediate release doesn't?
Posted by qbsbrown on August 6, 2009, at 15:03:48
In reply to Re: Dosing Scott, posted by qbsbrown on August 6, 2009, at 13:52:09
Even with Trileptal, which is supposed to be 2 times daily, I had to take multiple times, due to my peaks and valleys.
Do you think that the ER version, 3 times a day is worth a week trial? Or the regular version 4 times a day? It seems to last about 4 hours.
Posted by SLS on August 6, 2009, at 15:45:16
In reply to Re: Dosing Scott, posted by qbsbrown on August 6, 2009, at 15:03:48
> Do you think that the ER version, 3 times a day is worth a week trial? Or the regular version 4 times a day? It seems to last about 4 hours.
My guess is that the ER version would serve you well. You probably just weren't taking enough at the time you experienced instability. However, I think you should stay with what you see is working right now. You need to be more patient and allow the blood levels to build up. I do think you will end up at 800mg, but you still need to be methodical in your titration.
- Scott
Posted by qbsbrown on August 6, 2009, at 16:01:09
In reply to Re: Dosing Scott, posted by SLS on August 6, 2009, at 15:45:16
So are you saying not to jump ship yet to the ER version quite yet? I mean it HAS to be the same med, just the extended version right?
How long would you advise staying on the generic immediate release, before switching?
As you can tell from my history, I have a bad habit of upping, lowering, changing, switching etc.
But if I feel a benefit from 200mgs, and that it fades w/ in a couple of hours, then isn't it common sense that a 200mg med that is extended released, would be of more benefit?
And how could/would it be acting just like the trileptal did? I promise it wasn't psychosomatic. It was strange, just after a few doses.
Regards,
Brian
Posted by SLS on August 6, 2009, at 16:42:29
In reply to Re: Dosing Scott, posted by qbsbrown on August 6, 2009, at 16:01:09
> So are you saying not to jump ship yet to the ER version quite yet? I mean it HAS to be the same med, just the extended version right?
It is up to you. In retrospect, do you believe that had you continued with the ER, you would be feeling better now?
> How long would you advise staying on the generic immediate release, before switching?
I would switch right now. 200mg three times a day.
Wait 5 days.
400mg twice a day.
Wait 5 days.
Begin taper of diazepam.
- Scott
Posted by qbsbrown on August 6, 2009, at 16:57:49
In reply to Re: Dosing Scott, posted by SLS on August 6, 2009, at 16:42:29
> > So are you saying not to jump ship yet to the ER version quite yet? I mean it HAS to be the same med, just the extended version right?
>
> It is up to you. In retrospect, do you believe that had you continued with the ER, you would be feeling better now?
>
> > How long would you advise staying on the generic immediate release, before switching?
>
> I would switch right now. 200mg three times a day.
>
> Wait 5 days.
>
> 400mg twice a day.
>
> Wait 5 days.
>
> Begin taper of diazepam.
>
>
> - ScottIn retrospect, me taking it for 3 days, and experiencing some of the exact horrible same things that I did on Trileptal scared the living the crap out of me, and I said I would not go back to feeling like that again. I am afraid that if i do go back, that those similar feelings will return.
If I took it, i'd rather stay at the 3 doses. Even at 800, I think i'd feel more comfortable going 200-200-400
I've taken 2 doses of 200mgs generic today, so it's a no go for today. I have a stressful event tomorrow, so I probably don't want to switch it up tomorrow after being on generic for 4 straight days do i? Or would it perhaps aleviate things for me, or my brain might be adjusting?
Saturday is wide open for me, and Sunday I have very little affairs going on. So the weekend could be a prime trial time.
Regards,
Brian
Posted by qbsbrown on August 6, 2009, at 17:41:41
In reply to Re: Dosing Scott, posted by qbsbrown on August 6, 2009, at 16:57:49
If I wanted to make the switch to the ER, and I've already taken 2 200mg generics today, can I start the ER tonight? Or best to start on a clean slate tomorrow?
Regards,
Brian
Posted by qbsbrown on August 6, 2009, at 20:16:36
In reply to Re: Dosing Scott, posted by qbsbrown on August 6, 2009, at 17:41:41
Yesterday was first night on 600. Some symptoms better, some worse. Did not wake up to the extreme first shade of light. I did have heart palpitations just from rolling over in bed.
Typing worse.
Some of my extreme obsessional/compulsive habits decreased.I was able to go to the mall today, and things were not depressing and/or dysphoric, good sign.
Dry mouth worse.
Interdose wd between diaz doses worse.
I think we're on the right track. Think need to get the dose up and start cutting the diazepam. I don't like to hold the diaz longer than 2 weeks, but looks like we might be looking at a month hold on this one. Longest i've gone is 3 weeks.
Now the major decision is to ER or not to ER, that is the question.
Thanks for the input.
Regards,
Brian
Posted by qbsbrown on August 6, 2009, at 20:45:20
In reply to Re: Dosing Scott, posted by qbsbrown on August 6, 2009, at 20:16:36
Wow Scott, I feel like my head is on fire, and that I'm speed. This happens. But it's better than being stuck in my hell of a prison.
I wonder if the ER version would help keep the flames out, or keep me in a worse hell of a prison. I wonder if the generic does what it does, wears off, then my head is OFF to the races.
Posted by qbsbrown on August 6, 2009, at 21:21:26
In reply to Re: Dosing Scott, posted by qbsbrown on August 6, 2009, at 20:45:20
Could this be the tegretol lowering the diaz? this is what it feels like when i cut the dose. Like i'm on speed, things going a million miles an hour, like my nails are dug in holding on for dear life. But it's not being depressed and being stuck in my head.
Your thoughts, observations?
Brian
Posted by SLS on August 6, 2009, at 22:20:07
In reply to Re: Dosing Scott, posted by qbsbrown on August 6, 2009, at 21:21:26
Tegretol will lower the blood levels of diazepam. I just don't know by how much.
- Scott
Posted by qbsbrown on August 6, 2009, at 22:25:46
In reply to Re: Dosing Scott, posted by SLS on August 6, 2009, at 22:20:07
> Tegretol will lower the blood levels of diazepam. I just don't know by how much.
>
>
> - ScottWell I'm back to feeling stoned, high, on acid/lsd and speed at the same time.
Isn't it defeating the purpose of a medicine that is supposed to help tapering, that actually lowers the blood levels?
So basically I'm decreasing my dose w/o actually decreasing it? Great.
I hate anticonvulsants in general because they slow down my racing thoughts a little, but so that i'm stuck and trapped in my head and can watch those thoughts. It takes a really large dose of an anticonvulsant to slow down the racing thoughts and to be comfortable.
Well are we back to square 1, or is this progress?
What is your advice?
Brian
Posted by qbsbrown on August 6, 2009, at 23:31:45
In reply to Re: Dosing Scott, posted by SLS on August 6, 2009, at 22:20:07
So I am 100 percent completely out of my mind now, lol. It's kinda funny. And the ironic thing is, is that anxiety is the last thing that i feel. i was just running a bunch of errands with my friend, which I would never do, and was just high out of my mind.
So either this crap is working, or has just completely lowered my diaz levels making me more out of my mind.
Regards,
Brian
Posted by SLS on August 7, 2009, at 7:30:45
In reply to Re: Dosing Scott, posted by qbsbrown on August 6, 2009, at 23:31:45
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.
- Scott
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. b.croissant@klksig.de
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
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Dr. Bob is Robert Hsiung, MD,
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