I should qualify my enthusiasm for mowing the lawn. I have a large lawn & thus a rider mower which eases the challenge just a bit 🤣 But I’ll attempt to put in 2 miles on the treadmill this morning.

17 hours ago, Pokey449 said:

Morning @Chippy Got a better nights sleep last night. No rhyme or reason to it but I’ll take it. Feel halfway human today. Will make it to the health club today and mow the yard.

Great to hear mate! Hope you made the most of you day! Things are looking better for you recently. More to come.

@Chippy I can’t seem to get two good nights in a row. Only 4.5hrs last night and I woke up twice feeling pretty awful. I can’t discern if it’s cortisol related, my heart related or what. I awaken feeling sick/nauseous, that creepy crawly feeling comes & goes in waves drawing my body up into a ball, whole body pain that waxes & wanes. My smart watch EKG shows either “normal sinus rhythm” or “inconclusive” which is a little worrying. I’ve thought maybe it’s my breathing while asleep but my Cpap #s are good. The sxs happen when I’m both using cpap & when I’m not. I’ll wake up, allow the sxs,to wear off, go back to sleep only awaken again with the same miserable sxs. So I don’t know what the hell is happening in my body.

I’m 1 hour away from having my 2 half doses merged into one. I’ve been moving them nice and slow. I’ve been at the same total dose of 29.5mg 120 days now.

Thoughts??

4 hours ago, Pokey449 said:

My smart watch EKG shows either “normal sinus rhythm” or “inconclusive” which is a little worrying

I would not worry about "inconclusive". We do ECGs at work on patients all the time. Often the machine spits out all kinds of rubbish interpretations and the technician comes running to us doctors in a panic. When you look at the actual trace, it's fine. We got trained in medical school to look at the ECG as a whole. Computers (and smart watches) report every blip but lose sight of the big picture.

@Sminismoni Hi. Nice to hear from you. I had a polysomnogram 2 weeks ago and was in sinus rhythm all night. Then this past week I saw my cardiologist. They did an EKG, granted it was only like 15secs worth but it was clean. I have a history of AFIB & had 2 ablations is why I worry about my heart.

I have a 10minute email/voice message session with Horowitz this week. My primary question for him is about the fact that the mirtazapine & doxepin I’m on are both primarily metabolized by the same CYP enzyme, wondering about adverse drug affect as a result.

1 hour ago, Pokey449 said:

mirtazapine & doxepin I’m on are both primarily metabolized by the same CYP enzyme, wondering about adverse drug affect as a result.

What are you worried about exactly?

Mirtazapine and Doxepin are metabolised by several CYP450 enzymes. The only one they share as far as I know is CYP2D6. But that doesn't matter. Liver enzymes can handle a lot, certainly they can handle two drugs at once at small.doses. It isn't an issue really.

@Sminismoni the fact both drugs are metabolized primarily by CYP2D6 is what is concerning me. Worried one could be making the other toxic or decreasing the effect of one or the other. But yes they both are at low doses. I also take a very low dose (2.5mg) of a BP med that s also metabolized primarily by 2D6.

@Pokey449 I can save you the cost of a consult with Horowitz here and tell you that the fact they are both metabolised by CYP2D6 means nothing and is not causing toxicity or side effects. In short, we can fairly confidently rule out this issue as the cause of your symptoms.

We can think of Cytochrome P450 enzymes as akin to a large parking lot. Now lets say the parking lot has 100 car bays. A medication is like a car that "parks" in a bay as it is being metabolised. Let's say a single daily dose of a medication represents 10 cars. Even if you take 3 or 4 medications that are all metabolised by the same enzyme, there are still plenty of bays left. No fighting for a car space, no overflow, no "toxicity".

The only problem arises if:

1. you take massive doses of a medication e.g. you take 20 x the recommended daily dose in one go. In that case, if each tablet is 10 car spaces, you exceed the parking lot capacity, and things get toxic. This how people die from paracetamol overdoses

2. one of the drugs is an enzyme inhibitor (stops it from working) - lets say the 10 cars take 10 spaces but then each driver also puts traffic cones on the other spaces so that they aren't functional. In this case, the second drug would build up because there is nowhere left to "park" to get metabolised. BUT Neither Doxepin or Mirtazapine inhibit CYP2D6 action so this doesn't happen.

@Sminismoni thanks so much. Great way to explain how it all works. I like most of us here am so tired of not feeling well. I then go searching for other possibilities for the what seems like a never ending hell.

Thanks again for the enzyme kinetics lesson 😁

18 hours ago, Pokey449 said:

I’m 1 hour away from having my 2 half doses merged into one. I’ve been moving them nice and slow. I’ve been at the same total dose of 29.5mg 120 days now.

Thoughts??

I think you need to slowly put the doses back together as you are, once there hopefully a long hold at that dose and times will start to settle things down some more. It is good you have had a few better nights recently.

Hi @Chippy i would have never thought splitting and/or moving ones daily dose around a bit could be so discomforting but I guess that’s what’s occurred. I assumed as long as one’s total daily dose stayed the same when & how you take it shouldn’t matter?? I guess I was wrong???

I’ve been moving both 1/2 doses towards each other. From 8am and 4pm towards a 12 noon full dose. I chose 12 noon thinking that might help me sleep better through the night given doxepins 15 hour 1/2 life, thus maybe avoiding interdose WD issues at 3 or 4 a.m???

I’m definitely not stable st this time. My sleep has become progressively fractured. Now that I’m only 1 hour away from merging my 2 half doses things will start to settle.Sadly I’m nowhere ready to travel to be with my family. Wondering if I’m going to make it at all this summer 😢

57 minutes ago, Pokey449 said:

Hi @Chippy i would have never thought splitting and/or moving ones daily dose around a bit could be so discomforting but I guess that’s what’s occurred. I assumed as long as one’s total daily dose stayed the same when & how you take it shouldn’t matter?? I guess I was wrong???

I’ve been moving both 1/2 doses towards each other. From 8am and 4pm towards a 12 noon full dose. I chose 12 noon thinking that might help me sleep better through the night given doxepins 15 hour 1/2 life, thus maybe avoiding interdose WD issues at 3 or 4 a.m???

I’m definitely not stable st this time. My sleep has become progressively fractured. Now that I’m only 1 hour away from merging my 2 half doses things will start to settle.Sadly I’m nowhere ready to travel to be with my family. Wondering if I’m going to make it at all this summer 😢

@Pokey449 sorry to hear about your struggles. This journey is freaking terrible for us, but we must find strength and encouragement. Things will get better, but unfortunately, it will take a long time. I think moving will still be good for you and be closer to your family.

This journey makes us feel like we can't move, but it's all psychological. Even if we don't feel like doing something, we can still try to move on and ignore our mind....

Be strong. It's a hard journey but others in worst conditions have made it out. Hold for a long time...

Hi @Raymond thanks for the words of encouragement. Regarding going to see/be with my family I wished it was all mental that holds me back. I just plain feel physically miserable a lot of days. Too tired to drive or deal with the rush& chaos of air travel these days. Hopefully once I get settled back on a single full dose and hold there things will settle down.

Today I feel like I’m imploding. My entire life is a slave to dealing with this god damned poison that my psych PA should have never prescribed and I was to stupid to take. I’m fed up. I’m furious. I’m sick n tired of being sick n tired. I don’t know why today but this all has come crashing in on top of me. I want to scream!!! I vacillate between being scared to death I’m going to die and then wishing I would so this all can be over. So I don’t have to deal with it anymore. So I don’t feel so weak & beaten & pathetic that I think I must look like in the eyes of the people I love. What these poisons are doing or have done to all of us here is just so so sad.

20 hours ago, Pokey449 said:

Hi @Chippy i would have never thought splitting and/or moving ones daily dose around a bit could be so discomforting but I guess that’s what’s occurred. I assumed as long as one’s total daily dose stayed the same when & how you take it shouldn’t matter?? I guess I was wrong???

I’ve been moving both 1/2 doses towards each other. From 8am and 4pm towards a 12 noon full dose. I chose 12 noon thinking that might help me sleep better through the night given doxepins 15 hour 1/2 life, thus maybe avoiding interdose WD issues at 3 or 4 a.m???

I’m definitely not stable st this time. My sleep has become progressively fractured. Now that I’m only 1 hour away from merging my 2 half doses things will start to settle.Sadly I’m nowhere ready to travel to be with my family. Wondering if I’m going to make it at all this summer 😢

Unfortunately our brains are very sensitive to little changes even, more so when senstised as you are. The brain likes consistency and recieving the drug at a different time each day can be destablising for sure.

9 hours ago, Pokey449 said:

Today I feel like I’m imploding. My entire life is a slave to dealing with this god damned poison that my psych PA should have never prescribed and I was to stupid to take. I’m fed up. I’m furious. I’m sick n tired of being sick n tired. I don’t know why today but this all has come crashing in on top of me. I want to scream!!! I vacillate between being scared to death I’m going to die and then wishing I would so this all can be over. So I don’t have to deal with it anymore. So I don’t feel so weak & beaten & pathetic that I think I must look like in the eyes of the people I love. What these poisons are doing or have done to all of us here is just so so sad.

I share your frustration Pokey, I had a frustrated moment yesterday too. But I picked myself back up, once day at a time, stoic acceptant. It really is the only way, we have no control over this process, just have to accept and trust our bodies to do what they are best at.

I agree I sometimes think about what others think of me atm. Even neighbours I think can tell Im not as I was a couple of years ago, and as much as I advocate for myself well with a few friends and family who know my struggles, Im not convinced I get more than lip service from them, not sure they actually believe me.

@Chippy I only got 3hours sleep last night. The Akathisia was really bad last night as I couldnt lay still. What an awful side affect. I was up and down much of the night. Finally got up for good at 545. I’ve felt worse so I guess that’s somewhat of a positive way to look at my s****y night. I’ve only got 45 minutes separating my 2 half doses. I will be at a single full dose by weeks end. After that I’m not changing anything until I’m feeling consistently stable.

@Chippy now it’s all starting to hit me. Starting to feel the awful exhaustion, body aches,upset stomach, pain, blunted feeling. Going to be a lonnnggg day.

19 hours ago, Pokey449 said:

@Chippy I only got 3hours sleep last night. The Akathisia was really bad last night as I couldnt lay still. What an awful side affect. I was up and down much of the night. Finally got up for good at 545. I’ve felt worse so I guess that’s somewhat of a positive way to look at my s****y night. I’ve only got 45 minutes separating my 2 half doses. I will be at a single full dose by weeks end. After that I’m not changing anything until I’m feeling consistently stable.

Im really sorry to hear this Pokey, I agree, sit tight till everything settles down for you. This journey is so unpredictable from day to day.

19 hours ago, Pokey449 said:

@Chippy now it’s all starting to hit me. Starting to feel the awful exhaustion, body aches,upset stomach, pain, blunted feeling. Going to be a lonnnggg day.

Hope it wasn't as bad as you suspected mate. Fingers crossed you get a better sleep and wake more yourself. You certainly deserve it.

@Chippy with great thanks I got 6.5hours of pretty good sleep last night. Feel human today. I’ll be able to get some exercise in and run some errands. Was it a fluke or am I stabilizing from moving my 2 1/2 doses together?? I guess time will tell. The unpredictable nature of all this is so frustrating and hard to plan one’s life. I really want to go be with my family in Ohio but it’s been so up & down that I’ve not ready to plan a trip. Hopefully soon?!?!

@Chippy @Finni i got my voice memo from Horowitz this morning. He thinks what’s causing me so much trouble is basic WD from tapering the Doxepin. That I tapered it from 50 to 29.5mg to quickly and then moved my dose(s) around to abruptly. I went from a single dose to 2 half doses and am currently moving back to a single dose. His advice: slow down or hold where I’m at if discombobulated, which I have been, then move on slowly until I reach to where I’m only taking the single dose. My two 1/2 doses are only 30minutes apart now. So I will accomplish being at a single dose soon. I did manage to get a decent nights sleep last night so hopefully I’m close to achieving some stability???

I did ask him if he thought drug interactions was an issue since mirtazapine & doxepin are both metabolized in part by the same CYP2D6 enzyme in the liver. He did NOT think that was a significant issue which is congruent with what @Sminismoni told me. Thankfully!!!!!

I had also asked if taking my doxepin dose at 12 noon instead of 8am was a logical strategy to help avoid interdose WD in the wee hours which could be the culprit affecting my sleep then, as I keep waking in distress at 3-4am each day and he concurred that was a good strategy. So I’m going to stay put with a noon dose & hopefully I will get well stabilized….. and can get on with what remains of my life. I’ve not had a life of any quality lately 🤞🤞🤞🤞🤞

@Pokey449 This is such good news! It really does look like you're beginning to stabilize. Wishing you many more days (and nights) like this!

18 hours ago, Pokey449 said:

@Chippy with great thanks I got 6.5hours of pretty good sleep last night. Feel human today. I’ll be able to get some exercise in and run some errands. Was it a fluke or am I stabilizing from moving my 2 1/2 doses together?? I guess time will tell. The unpredictable nature of all this is so frustrating and hard to plan one’s life. I really want to go be with my family in Ohio but it’s been so up & down that I’ve not ready to plan a trip. Hopefully soon?!?!

Great news Pokey and this is the, third?, time in the last week or so....

Hope you made the most of your day.

Are you stablising? time will tell, I think it's possible your body prefers the non-split dose and is reacting to that.

I agree the unpredictable nature is very frustrating, I feel this point daily tbh. Hope you can get out to see them soon.

16 hours ago, Pokey449 said:

@Chippy @Finni i got my voice memo from Horowitz this morning. He thinks what’s causing me so much trouble is basic WD from tapering the Doxepin. That I tapered it from 50 to 29.5mg to quickly and then moved my dose(s) around to abruptly. I went from a single dose to 2 half doses and am currently moving back to a single dose. His advice: slow down or hold where I’m at if discombobulated, which I have been, then move on slowly until I reach to where I’m only taking the single dose. My two 1/2 doses are only 30minutes apart now. So I will accomplish being at a single dose soon. I did manage to get a decent nights sleep last night so hopefully I’m close to achieving some stability???

I did ask him if he thought drug interactions was an issue since mirtazapine & doxepin are both metabolized in part by the same CYP2D6 enzyme in the liver. He did NOT think that was a significant issue which is congruent with what @Sminismoni told me. Thankfully!!!!!

I had also asked if taking my doxepin dose at 12 noon instead of 8am was a logical strategy to help avoid interdose WD in the wee hours which could be the culprit affecting my sleep then, as I keep waking in distress at 3-4am each day and he concurred that was a good strategy. So I’m going to stay put with a noon dose & hopefully I will get well stabilized….. and can get on with what remains of my life. I’ve not had a life of any quality lately 🤞🤞🤞🤞🤞

Great to get some support and confirmtion from Dr H, I agree and would add that you tapered ontop of an already dysregulted nervous system from what I learned going through your history earlier this year.

Some good signs the last few days. More to come even it that progress may not be linear, you can see your body fighting to stablise.

Hope you get some decent sleep tonight mate.

@Chippy well as you say this does seem to be a linear process of improvement. I can’t seem to get 2 good nights sleep in a row. Last night was crap again. But guess I shouldn’t complain as there are folks here who can’t seem to get a single good night. I’m just hoping I can get stable enough soon so I can travel to see my family. Being home alone all the time is getting to me. It’s not psychologically healthy. Hopefully I settle somewhat soon. I’m only 30minutes away from merging my 2 half doses into a single daily dose. And honestly I don’t think 30 minutes amounts to much of a separation at this point.

@Pokey449 Sorry to read you had another day night, it is a bit like this getting stable, lots of ups and downs, but the better few days you have had recently is great news and there will be more that to come Im sure.