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PLEASE NOTE IT IS DANGEROUS AND IN SOME CASES LETHAL TO STOP TAKING ANY MI MEDICINE WITHOUT CONSULTING YOUR DOCTOR.

Hi my name's Sarah and I'm from NZ.

I was diagnosed with BP three years ago and have been on lithium since the onset of symptoms. I am currently supplementing this with Olanzapine (for delusions/anxiety) and Lamictal (for depression). I am interested in weaning myself off the Olanz. as it is too strong a drug to take for just anxiety alone. I also want to get off the Lamictal (one drug at a time) but am scared of the depression that may come this this. Also in hindsight I am upset the doctor didn't recommend benzos instead of the Olanz - why are they so down on such a helpful drug? NB: I don't have an addictive personality and I am excepting drug abusers from this statement.

So my question is who has withdrawn from any of these drugs and what have your experiences been? Note that I am not advocating withdrawal - I JUST WANT TO FIND OUT MORE ABOUT IT as there seems to exist a vortex of knowledge when it comes to this topic.

I'm sharing some information I've gathered on this topic below. If you could contribute in any way to this knowledge that would be great... resources, facts, stories whatever. I think it's important to start with the facts.

Long-term studies / Drug safety

I am just now becoming fully aware of the fact that these are strong drugs. Olanz./Zyprexa is an atypical anti-psychotic only developed in the 90s and approved for treatment for BP based on tests conducted over a period of no longer than 12 WEEKS. Lithium has been used since the 50s I think so long-term affects may be more evidently studied.

Drug withdrawal

Anti-psychotic withdrawal procedures are practically unstudied. Ask your doctor and I guarantee he or she will know little to nothing about it. "Safe" withdrawal (ie: 10% decreases over a month) are unrealistic (imagine cutting that yellow wafer into ten equal sized pieces). Ironically, withdrawal symptoms are best treated by increasing dosages of the drug. Alternatively withdrawal symptoms can be treated with yet more drugs: anticholinergics, beta-blockers, prochlorperazine (Compazine), or benzodiazepines (http://www.medscape.com/viewarticle/529317). To top it all off withdrawal from anti-psychotics that have been used for long-term periods may ironically occasionally cause rapid onset of psychosis (http://psychrights.org/Research/Digest/NLPs/actadrugwith.pdf). For real?

Lamictal is apparently very difficult to withdraw from (antecdotal evidence).

Lithium withdrawal is linked to increased BP re-lapse rates (studied and commonly accepted fact).

"Cross-tapering" seems to be the currently advised plan - where you switch to a new anti-psychotic with overlaps between old and new drug. My doctor recommended it to me when I said I wanted off the Olanz. It is also recommended by this source: http://www.medscape.com/viewarticle/439736_3

Thanks for reading this far, awaiting your replies and advice with hope ;))

Sarah

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I wish I could give you some sage advice, but I quit my zyprexa and pdoc, cold turkey, at the same time, because he refused to look at ANY alternatives for me other than a drug that was making me suicidally depressed because of how utterly exhausted it made me and how much weight i was putting on.

Not overly clever of me, I know.

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Well, I have gone off both of those with no problems. I go on and off Zyprexa, so I have done that more than once. Lamictal should be tapered (in the same manner as how you originally started it) because there is a chance of seizures otherwise. With Zyprexa, I have dropped to a lower dose for a week (15 to 10) and then stopped. You could also do a third step (say, to 5mg) depending on your original dose.

Neither is particularly difficult to get off of, generally.

You seem very anxious about this. If you see a therapist, you might want to discuss your anxiety surrounding medications.

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Do you hope to actually improve your function in some way as a result in going off of the olanzapine? Or is it just that you perceive it as being too strong?

It seems that you wouldn't be taking it for just anxiety, given that you are also taking the lithium and lamotrigine - rather that the anxiolytic effect it might have would be a benefit of that particular drug, which was being prescribed for some other reason - delusions and anxiety are what you mention. If the delusions only occurred during an extreme of mood, then do you and your psychiatrist think this is a good time now to try reducing it?

Olanzapine has been studied in manic-depressive and schizophrenic populations for periods of much longer than 12 weeks. For clinical trials, it may have only gone through the 12 week periods. But you should be able to find a wealth of data for >12 week periods with even the most cursory search.

There is also quite a bit of real-life experience with discontinuation of antipsychotics of all stripes. Sorrel described her method of discontinuing Zyprexa. But, really, antipsychotics have been around for several decades now, and have been started and stopped many a time. My psychiatrist and I have gone through this with several of them. I can, in fact, guarantee you that if you asked her about discontinuing them, she could talk to you knowledgeably about the topic... as can quite a few psychiatrists and psychiatric NPs I know. So you might be pleasantly surprised if you asked around a bit.

Ironically, withdrawal symptoms are best treated by increasing dosages of the drug.

Tardive dyskinesia is sometimes initially worsened by dose reduction and that can be - unfortunately, in some cases - addressed by increasing the dose. This can be confusing, I realize that. Is that what you were referring to? This is an entirely different process. Tardive dyskinesia really isn't an antipsychotic "withdrawal" phenomenon, so that should be of some relief.

As far as Lamictal, I've had no particular difficulty going off of it as long as it was a slow controlled taper. Other than the fact that I really, really missed it.

As far as antipsychotics, I use Trilafon or Stelazine as 'rescue drugs' for a few months at a time for mood stabilization. I taper off over 1-2 weeks. No problems there. Same issues with the other ones I've tried in the past.

As far as lithium... It should not be stopped abruptly. If one does well on it, it shouldn't be stopped, unless there's a major contraindication. If it has to be stopped, it shouldn't be dropped faster than a serum level reduction of 0.2mmol/L per week or two, or maybe even slower per [link=http://www.igsli.org/" target="_blank]IGSLI[/link]. For myself, I've learned to not stop it. If I have to reduce it, I don't drop it faster than 0.2 every 2-4 weeks. Abruptly stopping lithium is very much associated with rebound mixed/manic states. (Unpleasant dysphoric ones, per the anecdotes. Also increased rates of severe depression.)

It's probably plain common sense and doesn't need to be said, but just in case: don't try this on one's own, and don't try more than one of these taper-offs at a time. One drug at a time.

Doing this without a psychiatrist's involvement is just sheer idiocy. About as smart as trying to TIG weld while juggling wolverine pups and talking on a cell phone. An all-around bad idea.

And since that's the kind of thing I'd do when I'm off the good old lithium, I thought I'd mention it anyway and just state the obvious. ;)

edited for paragraph I know I put in earlier. OK, fine, edited for dementia on my part, whatever.

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Forgive me if I"m reading incorrectly but it seems as if you are interested in not taking any medication at some point. Unfortunately that may not be a realistic goal for yourself. Some people are able to go without meds, but not too many if they have genuine bipolar.

The reason your doc probably won't prescribe you benzos is because they are addictive, even to people with no addiction history. They aren't supposed to be taken on a regular basis for an ongoing period of time. They are meant to be used "as needed" or temporarily. If you use them regularly you will find you will keep having to up the dose and you will have a difficult time withdrawing. I know I did. I've never even smoked pot. It has nothing to do with having or not having an addictive personality.

I am not sure why you are on lamictal and lithium. That is strange. They are both mood stabilizers and usually people are on one or the other. You could ask the doc what is up with that if you are looking to cut down on your meds.

Finally I'm going to give you my take on accepting medication... No one really likes having to take meds all the time. The bottom line is regardless of whatever we read about them that has scared us, for the most part it can't be scarier than the result of taking no medication. For many of us meds are a necessary "evil". We learn to incorporate them into our lives just like the other parts of a mental illness. It is no different than needing insulin for diabetes. I think it is good to be informed about meds, but reading about things that are upsetting and then trying to find ways to get away from medication will probably be a no-win situation for you if you are properly diagnosed. So many people decide they don't want medication anymore and then ruin their lives over what they do in the aftermath when they get sick. I'm just asking that you take all of this into consideration before you talk yourself out of medication.

PS: I'm not a doctor. Just been around all this crap long enough to know.

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Actually, the combination of lamotrigine and lithium is fairly common. Lamotrigine is not a wildly effective antimanic. It is a pretty good "antidepressant mood stabilizer." So as far as a general prescribing trend, I've seen that rather often, and it makes good theoretic sense.

Given that YB was taking the olanzapine for delusions and anxiety, I'm guessing that she was given that, rather than benzodiazepines, because olanzapine can be helpful in treating delusions, and benzodiazepines aren't.

I wouldn't know, of course, but that would certainly be a rational guess, and the anxiolytic property of olanzapine would be kind of a bonus there.

If the delusions were secondary to the bipolar disorder, then maybe lithium alone would be sufficient to control that process (most of the time.)

The thing is, a lot of people with bipolar disorder can function on a backbone drug or two (usually lithium and/or an antiepileptic) and then use something like olanzapine as a rescue drug seasonally or when they start to decompensate or get delusional. That's an increasingly supported approach, and it reduces overmedication and increases compliance with treatment.

Forgive me if I"m reading incorrectly but it seems as if you are interested in not taking any medication at some point. Unfortunately that may not be a realistic goal for yourself. Some people are able to go without meds, but not too many if they have genuine bipolar.

When I read yellowbutterflies' post, it doesn't seem to me that she wants off ALL medication altogether - she is interested in talking to her doctor about getting off the olanzapine and lamotrigine. So that could be the start of rejecting treatment, or it could be a way of trying to increase compliance by making the med regimen more tolerable.

Yellowbutterflies? What do you think? Is it about getting away from the meds because of treatment itself? Is it about getting better for some other reason? Is it about staying better but making treatment more tolerable? Is it about something else and I'm way off the mark here? ;) (that's usually it!)

I agree, by the way, CrB, most of us with manic-depressive illness don't do so well at all off medication.

I do think we develop past the point of them being a necessary evil, though; there's a point of rejection, then over-reaction (one way or the other - rejection or identification), then acceptance. And then we can move up and down that scale a few thousand times.

Anyway.

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I've moved the topic from the "alternatives" forum to the AP forum. St. John's Wort is not going to *help* you switch AAPs.

Hi my name's Sarah and I'm from NZ.

I was diagnosed with BP three years ago and have been on lithium since the onset of symptoms. I am currently supplementing this with Olanzapine (for delusions/anxiety) and Lamictal (for depression). I am interested in weaning myself off the Olanz. as it is too strong a drug to take for just anxiety alone. I also want to get off the Lamictal (one drug at a time) but am scared of the depression that may come this this. Also in hindsight I am upset the doctor didn't recommend benzos instead of the Olanz - why are they so down on such a helpful drug? NB: I don't have an addictive personality and I am excepting drug abusers from this statement.

It does not matter whether you have an addictive personality, and it's not a matter of "being down" on "such a helpful drug." Benzos will not do anything to reduce delusions, and they aren't a recommended treatment for bipolar disorder.

Edit: Silver explained the reasons for a AAP being used instead of a benzo better. The AAP does NOT have to be olanzapine.

I'm sharing some information I've gathered on this topic below. If you could contribute in any way to this knowledge that would be great... resources, facts, stories whatever. I think it's important to start with the facts.

Some of your "facts" on "drug withdrawal" are coming from an anti-psychiatry organization. They are making a point to display only the bad outcomes in order to support their point and scare the hell out of everyone.

Meanwhile, Crazy Boards and Crazy Meds/Crazy Talk are both pro-medication, and we spend a lot of time discussing how badly crap can go wrong ... we may not be doing it "right" but at least we're trying to be honest about it.

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hi,

i came off lamictal with no problems. nice & slow.

CrB wrote:

The reason your doc probably won't prescribe you benzos is because they are addictive, even to people with no addiction history. They aren't supposed to be taken on a regular basis for an ongoing period of time. They are meant to be used "as needed" or temporarily. If you use them regularly you will find you will keep having to up the dose and you will have a difficult time withdrawing. I know I did. I've never even smoked pot. It has nothing to do with having or not having an addictive personality.

I'd like to counter that statement. ive been on xanax for 4 years now - varying dosages. pdoc agrees its working. there are others on cb who have also been on benzos for an extended period of time and are not addicted or upping the dose.

pot is addictive?

db

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Thanks for the comments and help everyone!!! Every one of your comments has helped to reduce the anxiety and fear I have surrounding this issue... I will let you know in a few weeks how I'm going and whether I've managed to successfully come off Olanz or not.

: - )

Sarah

(Individual replies below.)

Dear Silver:

Thanks for giving me your accurate take on my situation.

My reasons for wanting to go off the Olanz are the side-effects of the drug. I am getting so frustrated with sleeping too long, feeling fatigued much of the time, feeling "drugged up" and forgetful and eating too much - all which reduce my functioning in one way or the other. Recent delusions have occurred during extremes of mood (usually associated with my cycles) and have lacked psychotic features so I feel this is a good time to live without antipsychotic medication.

Unfortunately I have tried to talk to my current pdoc and she couldn't or wouldn't give me any information about the best way to come off the Olanz. She is just a new doctor (registrar) and she is unable to give me any advice in the matter, although she did say she would support me.

NB: I read something about "discontinuation dyskinesia", a very rare condition which is associated with the discontinution of some antipsychotic drugs.

Lamictal helped me avoid at least two major depressive episodes in my life and I don't intend to go off it in the near future, especially not at the same time as the Olanz. Discontinuing lithium too quickly is also very dangerous. I do sometimes have my doubts about what good it is actually doing for me, though, as it just feels like a question of faith sometimes : - (.

RE: use of benzos for treating psychotic symptoms

I re-read one of the articles I downloaded and discovered something that you might be interested in

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Sarah:

Is a registrar still under the supervision of an attending (a more senior psychiatrist?)

If so, ask if you can meet with that physician as well, or see if she can discuss it with her attending.

Otherwise, it sounds like you have enough info to talk with her about maybe a partial reduction, then waiting a month or two to see how things are going, then another partial reduction, etc.

Don't forget: spring is not the best time for many bipolar people to be removing the antipsychotics/stabilizers in the northern hemisphere. Just a thought.

Discontinuation dyskinesia is extremely rare. Especially with olanzapine and its kin.

Benzodiazepines are indeed used to reduce the anxiety/agitation associated with psychosis. They are generally recognized as more helpful in schizophrenia, and as you've noted the best practice guidelines say that they are to be used with an antipsychotic concurrently. The antipsychotic remains the core of treatment. The benzodiazepine is just sort of extra bubble-wrap around the edges - it provides no structural support, so to speak. Big difference between reducing anxiety which may degenerate into psychosis and actually addressing psychosis. When someone is describing what you describe, I'd think that the benzodiazepine plus an AP (of whatever relatively calming ilk) would be inifinitely preferable. But I'm a belt and suspenders kind of person.

All that being said - if olanzapine's been helpful for the symptoms you've used it for, I'd really recommend keeping it in the toolkit for urgent use, even if you and your doctor try reducing it. That 'rescue drug' idea is really, really important.

Lamictal darned well IS a mood stabilizer, actually, in the US. I don't know about NZ, but it is here. It is also an anticonvulsant.

As I said, it's not the greatest antimanic, but it's a pretty strong antidepressant/mood stabilizer.

But it is on-label as a "mood stabilizer."

Oh - by the way. Just a thing.

This isn't a cannabis abuse potential thread. Any discussion of that, guys, please take it over to substance abuse or whatever relevant thread (or I will split any discussions that head into cannabis-land to over there.) I'd strongly recommend backing up any statements over there - not with citations from the NORML site, but something with a link to at least the level of a Pubmed-cited abstract.

We're talking about antipsychotics over here, not intoxicants. Thanks bunches for your understanding.

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Lamictal darned well IS a mood stabilizer, actually, in the US. I don't know about NZ, but it is here. It is also an anticonvulsant.

As I said, it's not the greatest antimanic, but it's a pretty strong antidepressant/mood stabilizer.

But it is on-label as a "mood stabilizer."

Here is an article that I didn't really read full through, but just thought I'd put here since it is about the FDA approval of Lamictal for BP. Even Lamictal's website is split Bipolar and Epilepsy.

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"Medscape" is a part of WebMD Health Professional Network that includes theHeart.org and eMedicine.com. Please clearly state which are the un-truths in my post and I will take the time to rectify them. This was just some preliminary research I made. It would be good if you could point out where I went wrong rather than just writing some unconstructive criticism. There is pro-medication and then there is over-medication!

http://psychrights.org/ is neither Medscape, nor even a research organization. Where you have gone wrong is using a site like psychrights to filter your search for outcomes. As I said before, they are very clearly interested in only publicizing the negative outcomes of any given treatment, the more negative the better. For thos interested in interested in the worst outcomes known to have occurred, it's a decent place to start, but it's not correct to turn around and tell people here that that's what they can expect.

If, however, you are honestly interested in what you can expect to happen, your best best is to start with the patient information sheets to find the types and percentages of adverse outcomes actually seen in drug trials. It's not entirely unbiased, but you may not be able to find objective research (not paid for by the drug company) showing that most people do not experience these problems, because to a researcher it's more often the uncommon or the unexplained outcomes that are of professional interest.

However, after your derisive comment about "unconstructive criticism" in the service of advocating "over-medication," I will instead leave you to your own designs. This has already taken up more of my time than you value.

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hi,

psychrights.org's mission is "how the legal system can help create a recovery culture in mental health systems." and is this [] close to sounding scientologist.

anywho...my last career was working in insurance litigation and i just dont see how the craziness of the legal system can change mental health other than making more people crazy. (its a joke ha ha).

db

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it's not correct to turn around and tell people here that that's what they can expect.

If, however, you are honestly interested in what you can expect to happen,

I think it's sad that you have to doubt my motives and accuse me of telling "people here" to expect to get rare reactions to withdrawing from medication. Why the f would I do that? Stop mis-reading into things. Stop assuming you are talking to an anti-medication looney trying to convert people.

Yes - you certainly are wasting your time. And don't pretend to be concerned about other people when you clearly just in it to rip me apart. Try seeing the world through rose-tinted glasses for a change, instead of through your suspicious grumpy ones... maybe you need to up your dosage a bit. Or maybe you get something out of being grumpy, good luck with your inter-personal relations.

I guess you just have nothing better to do than to totally mis-read me all the time. Good luck finding other people to pick on rather than doing your job. And moderate this!

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PS:

Before this mis-understanding gets completely out of hand the information DOES NOT COME FROM PSYCHRIGHTS.ORG - it just happens to be stored on their server for what ever reason (probably because it supports their biased claims).

It is a Review article called "Does antipsychotic withdrawal provoke

psychosis? Review of the literature on rapid

onset psychosis (supersensitivity psychosis)

and withdrawal-related relapse"

THE ARTICLE WAS PUBLISHED IN:

Acta Psychiatrica Scandinavica

...which claims:

"Acta Psychiatrica Scandinavica publishes high-quality, scientific articles in English, representing clinical and experimental work in psychiatry. The journal acts as an international forum for the dissemination of information advancing the science and practice of psychiatry. Original articles are welcomed, especially those that bring new knowledge or extend the present understanding of mental disorders. Equal priority is given to review articles."

The scientology tangent is way out, I'm not American and I don't even know what it is. I can't stand Tom Cruise... but that's another story.

Please be more informed and actually click on and download the link given before you chose to de-construct my research.

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yellowbutterflies,

you come to this with a past of promoting yoga and other interesting therapies. If i was nullOtrooper I'd respond the same way.

i'll admit i know nothing about the internet and techy stuff. however...isnt it funny that psychrights.org has "stored" the article you quoted on their website. i dont have the time to see what else is "stored" on psychrights.org. but as i posted their mission statetment - they want to change mental health thru the legal system. thats whats really crazy.

its obvious you want to be off meds.

thats it,

db

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Hi Sarah

I think you were quite clear in your original post that you were not advocating complete abandonment of a medication regime:

"Note that I am not advocating withdrawal - I JUST WANT TO FIND OUT MORE ABOUT IT as there seems to exist a vortex of knowledge when it comes to this topic."

I appreciated some of the links that you posted and your discussion point is more than valid - for all of us there will certainly come the time when we need to come off one drug or another - in my case it will be shortly be Seroquel as it no longer works (aside to make me fat despite careful diet & exercise!).

I have had many other meds fail to work & have come off them. At times when meds don't work, I do almost think it is all a complete waste of time.

That said I think it is a matter of just persevering until you find the right med (more likely, combination of meds). Coming off meds that don't work certainly needs to be a factor in all of this so the info you have researched is no doubt useful not to me but to many others.

Thanks for a stimulating post & I do wish you luck in finding a combo that works more for you.

Generica

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Hi Sarah,

www.comingoff.com is the only site I know well enough to recommend as to UK info about coming off psychiatric medication. I have gone to one of the groups the site runs before and heard what they have to say, generally it is balanced, obviously in favour of coming off.

Karuna,

The 'Harm Reduction Guide To Coming Off Psychiatric Drugs'.on the UK site is really useful.

My main personal motive for finding out more about this topic is my dad's lack of understanding of bipolar and mental health issues. Despite briefs from the doctors (they aren't called "briefs" for nothing) and joining a family support group he doesn't really know what I'm talking about half the time. NB: he has generally approached the situation from a "the doctors are taking care of Sarah but who's taking care of me?" angle. Very hurtful for me.

My dad believes that medication fixes and solves the problem for me. He doesn't acknowledge or believe in treatment-resistant cases and he completely refutes the possibility of a relapse on medication. He wants evidence that a relapse can occur on medication as he doesn't believe it from my mouth.

He believes treating mental illness with medication is curing it. He believes I am like a car and medicating me is like replacing my fan belt. When I try to explain to him what a side-effect is he looks at me with a blank stare and refuses to comprehend what I am saying. He can't understand the implications of being on Zyprexa for me - memory loss, concentration loss and 14 hour sleeps. For me the combination of side-effects is worse that the anxiety/delusions it is supposedly treating.

I just wanted to come up with some information to give him the other side of the story and the resource you gave me is perfect even if, and I admit it, it is biased. He is biased the other way so I hope I can balance out the argument. He is pretty stubborn though, and he has never suffered any form of mental illness his whole life so it will be difficult to sway his opinion - in fact I never have done even once in my life so many this is just one of my delusions... that I can make him see what it is like to be me.

Thanks for your support,

Sarah

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Hi Sarah

I think you were quite clear in your original post that you were not advocating complete abandonment of a medication regime:

"Note that I am not advocating withdrawal - I JUST WANT TO FIND OUT MORE ABOUT IT as there seems to exist a vortex of knowledge when it comes to this topic."

I appreciated some of the links that you posted and your discussion point is more than valid - for all of us there will certainly come the time when we need to come off one drug or another - in my case it will be shortly be Seroquel as it no longer works (aside to make me fat despite careful diet & exercise!).

I have had many other meds fail to work & have come off them. At times when meds don't work, I do almost think it is all a complete waste of time.

That said I think it is a matter of just persevering until you find the right med (more likely, combination of meds). Coming off meds that don't work certainly needs to be a factor in all of this so the info you have researched is no doubt useful not to me but to many others.

Thanks for a stimulating post & I do wish you luck in finding a combo that works more for you.

Generica

Thanks for understanding me Generica. You're awesome.

An update on my situation to all:

I've been off Zyprexa now for four days... the major side-effect is insomnia! Be aware of this if you're thinking of stopping the drug and have some crutches in place. The first night I was up until the birds came out and I resorted to going back on the Zyprexa because I had no other drugs in place. Since then I have been up until 2am and sleeping until at least 11am. I am recalling my dreams most nights, emotionally laden and a couple of nightmares and I sometimes wake up feeling exhausted. Never has sleep felt like such hard work!!! I'm seeing my doctor in two days and I want her to prescribe me some Lorazapam (wish me luck), 2mg usually does the trick to send me to sleep and its less of a hit over the head than Zopaclone. Other than that camomile tea and non-stimulating activity for 45 minutes pre-bedtime helps. Otherwise I'm great - memory and concentration are improving and I've got a handle on my delusions. The Zyprexa was just covering them over like a blanket so I couldn't see what they were. Now I can and it's very scary but I am also dealing with them.

Sarah

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