Posted by bleauberry on February 1, 2010, at 18:08:23
In reply to Going off meds?, posted by myfranz on February 1, 2010, at 7:50:22
Coming off meds after that many years could be more traumatic to your system that you realize. If it is to be done, I would suggest doing it very slowly in very tiny steps. Probably a 3 to 6 month journey, working down doses in tiny steps (not the dose choices they give, but your own custom doses...cutting edges off pills, dumping powder out of capsules and making your own from empty gelcaps, etc.). For example, Abilify could be reduced by 1/4mg every 4 days. Stop at any point things go weird and let things stabilize before continuing.
I don't know what your doses are, but I think that is an important aspect when considering the apathy thing. The most likely culprits I suspect in your case are Abilify and Lithium, but the doses tell more than the actual drugs. For example, apathy on 15mg Abilify would be predictable, but apathy on 2.5mg would be less expected. Apathy on 600mg or higher of Lithium would be predictable, but apathy on 150mg-300mg much less.
I wouldn't suspect Traz right off, unless the dose is higher than sleeping doses (25mg-50mg). My least suspicion would be with Buspar, but again, the dose thing.
It could be possible, as a strategy that makes more sense to me, to eliminate one of the meds...whichever you and your doc figure is the least needed, least helpful, most likely an apathy causer. Lower the others, and see how it goes. From there, you could add something that is specifically anti-apathy. That is generally limited to Ritalin, Adderall, and Modafinil, and thus the importance of taking a hard look at the drugs you already have. Other anti-apathy meds would include Savella and a couple of the TCAs.
I just don't think stopping them all is a wise move. Maybe a long slow weaning process is reasonable and less risky. Somewhere along the line you and your team will have a good feel for where to go next. But if done too fast, or in steps that are too large, you could run into some very troublesome times.
Many meds do not work again after stopped. Sometimes they do, but a lot of times they don't. Another reason to go very gentle on the journey. For example if things completely fell apart and you all made the decision to go back to your original doses, it would not be surprising to many of us here that they don't feel like they used to and don't work and side effects are worse than before.
Some of us here have experienced a strange phenomenon that I don't think has been studied and doesn't have a name. That is, after stopping longterm meds, being clean for a few months, and restarting, we find we are super sensitive to even tiny doses, side effects are exaggerated bigtime, and meds don't feel at all like they used to. I have no idea how often this happens, my guess is it is probably a minority, but it is something to keep in mind.
poster:bleauberry
thread:935572
URL: http://www.dr-bob.org/babble/20100122/msgs/935629.html