Adrianctn: adverse reaction to Prozac

[ihadakathisia]

I replied via PM to scallywag and downtongirl.

[downtongirl]

Thanks!

[Altostrata]

adrian, it seemed you were doing better "With the help of lamotrigine, melatonin and the other very helpful advice I got here." What has changed?

 

Another month has passed.

Short version:

Sleep Great. Akathisia improving. Multiple good functioning days. I was able to work 1day/week.

Long:

With the help of lamotrigine, melatonin and the other very helpful advice I got here.... I am able to sleep a normal full 8 hours of sleep every day.

During this past month I've been debilitated by "akathisia" type symptoms (inner restlessness, terror, agitation). This horrible symptom appeared around month 5.

It's showing signs of improvement now on month 7. But by God, this is worse than any pain, anxiety, depression, fatigue that I've experienced.

Its intensity varies. It is not anxiety as doctors misdiagnose.

When intense, I would do anything to escape it.

I'm on a daily dose of Valium of 1mg. It has helped during the horror of akathisia. I've taken 2-5mg twice to make akathisia bearable.

I've tested Propranolol, Clonidine, Cyproheptadine, Alcohol for akathisia. Limited results. Benzos worked best, but the others seem synergistic to benzos, helping me take a lower dose.

I'm working my lamotrigine dose up (very slowly!). I have some intuition/research (and some anecdotal evidence from the web) that it might help akathisia, along with benzos.

The course of my neurotoxic reaction to Prozac is in line with Shipko's description. An acute phase in months 1-5, with physical and mental symptoms (pain, depression etc). Starting month 5, mostly only akathisia.

Talk soon,

Adrian

[ihadakathisia]

Hi Alto,

 

Thank you for replying. I did not change anything medication wise.

 

But August brought a much stronger wave (then July) of mental pain/agitation/restlessness. Chest muscles clench. I cannot focus on anything else (TV, conversations), I'm barely able to eat. I walk alot. Last night it also severely disrupted my sleep. The pain/restlessness was almost unbearable.

 

When/if I cannot bear the akathisa anymore, what can one do:

- raise lamotrigine?

- re-instate minuscule Prozac (but I had akathisia on it and off it)

- try ultra low Mirtazapine

- try ultra low Cogentin / Artane

 

My intention is to fight through it without meds until I cannot survive it anymore. Maybe it will stop for good, like it did 1 week in July.

[Altostrata]

Did you increase lamotrigine? If so, when, and how much are you taking? How about the diazepam?

 

What has changed since July 21?

[ihadakathisia]

Hi Alto,

 

Akathisia came back July 29, with 1 episode. Then worsened gradually.

 

I raised lamo on August 5, by 0.02.

 

On August 14 by 0.04. Akathisa worsened August 14 (day+first broken sleep) and last night (again broken sleep).

 

Yestersay was a full akathisia day, no breaks (night and day).

 

Current lamotrigine : 0.76mg

Current diazepam: 1.1mg (constant since July 5 - raised from 0.6mg)

 

I also take 20-40mg propranolol/day, 0.15mg/day clonidine

[Altostrata]

What times of day do you take each of your drugs, and their dosages? Do your symptoms follow any daily pattern?

 

You'll need to keep notes over several days to see if there's a pattern.

[ihadakathisia]

Hi Alto. Yes, I keep detailed notes of each day.

Recent patterns:

1.Sleep deterioration :

Last 2 nights 3-4 wakings, previous 3 nights - sleep more agitated, 1 early waking

 

2.Akathisia deterioration:

1h (29th july,1.5h (30th),... 10h (14th august), full day 15th Aug (but 1h nap))

 

 

Propranolol 20mg, Clonidine 0.075 2x/day at waking and 5pm

Melatonin 8pm

Diazepam 9pm

Lamotrigine 9.30pm

 

Sleep 10.30pm - 6.30am

[Altostrata]

What are your symptoms of akathisia?

 

What are the effects you feel of propanolol and clonidine?

 

You may be getting a paradoxical reaction from diazepam. Please discuss in our benzo forum http://survivingantidepressants.org/index.php?/forum/29-members-only-benzo-tapering-discussion/

[ihadakathisia]

Akathisia for me = intense internal restlessness, i feel the need to walk/shake; chest muscles contract; my body vibrates and it is difficult to do simple operations (i will drop things); my cognition and focus also get lost - can't cook/watch tv/basic care; sometimes I feel mental pain/head pain along with this. The distress is very intense. Sometimes I also feel terror/fear when in this.

 

Propranolol and clonidine sedate me - they reduce the intensity of Aka. If I double the dose, they will make me sleepy. BP/heart rate are still ok.

 

Could it be benzo paradoxical?

These symptoms first appeared before I touched any benzos (around May 1). First. in short episodes. Then, the need to walk the entire day. In June, after 1 month, I started taking benzos to help me eat through this.

 

Benzo post here: http://survivingantidepressants.org/index.php?/topic/12369-adrianctn-benzos-for-akathisia-should-i-taper/

 

Thank you for the help.

[Altostrata]

My intuition is that you have reached tolerance on your benzo dose, see http://survivingantidepressants.org/index.php?/topic/12369-adrianctn-benzos-for-akathisia-should-i-taper/?p=234162

 

I don't know if increasing lamotrigine would help. Did you discuss this with the akathisia specialist?

 

I would not take mirtazapine.

[ihadakathisia]

Thank you. Will test higer dose of benzo and report

 

Akathisia specialist says lamotrigine should be increased to therapeutic dose...

 

What is a safe titrate up rate for lamo?

[ihadakathisia]

No influence on double benzo dose. I will keep it steady.

 

Better on Cyproheptadine, 1mg + 1mg, around 6PM (and standard cocktail). A strange pressure, headache; but akathisia 1/10.

 

I paced inside my house 25,000 steps today. But the mental horror took a far higher toll on my body and mind. It is a relentless horror. I could not eat lunch. Better from 6PM to now sleep time.

 

I increased lamo by 8% tonight. I will continue to increase every 4days/week, hoping for a response and being careful on side effects...

[ChessieCat]

Hi adrian,

 

Please keep daily notes on paper of doses, times and symptoms.

[UnfoldingSky]

Hi Adrian,

 

I got your PM but have yet to respond to it.  I wanted to see your thread again first before answering it.

 

How is the akathisia, is it diminishing any?  I hope you are doing well.

 

The reason I wanted to look here was I thought I read that you were on Propranolol and Valium together.  You are still taking the Valium daily then?

 

If so, and I can't ascertain if this is true or not, since I'm not a medical professional, but, I was on that combination and on the very last day of tapering off Propranolol I found a small passage that says there's an interaction between the two.  (Go figure it has to happen the last day...)

 

I have yet to meet a professional who knows anything about this but you might want to ask the akathisia specialist if you are still seeing them (or possibly a pharmacist) in case it's having some effect on you.

 

Here is the passage I found:

 

Drug Interactions Benzodiazepines

Propranolol can inhibit the metabolism of diazepam, resulting in increased concentrations of diazepam and its metabolites. Diazepam does not alter the pharmacokinetics of propranolol.

 

(taken from:  http://www.rxlist.com/inderal-la-drug/clinical-pharmacology.html)

[UnfoldingSky]

Okay I just noticed that was posted for Inderal-LA, which is the long-acting version.  However, on the same site for the regular version it lists the same thing.  So I guess it still may be relevant.

[ihadakathisia]

Hi US,

 

Thank you so much for replying.

 

The akathisia is still very bad most of the day. It starts at 5-6 am. I have to start walking, can't eat lunch usually as it's intense. Looking at my journal, it's been getting worse.

 

It diminishes in the evening, luckily.

 

I'm pretty much completely disabled and house bound. It's hard to be alone. In the evening, when it's low, I'm so tired from it.

 

I don't know how I will survive this.

 

Thank you for this on Propanolol and Diazepam. I still take them in small doses. They don't seem to help much

 

It's 8 months since I stopped the horrible drug. I only took half a pill for 4 weeks. I can't believe I had every symptom listed here and now akathisia in a severe form.

[UnfoldingSky]

I'm so sorry it's not improved, Adrian, I know it's so hard to go through.  If you are feeling too alone with it and can manage it you can always post here, many of us have been through it/are going through it, so there are lots of understanding people around.

 

And I know it's so unbelievable what the pills are capable of doing.  But it will get better, don't lose hope!

[KT38]

Hi! What do you feel in your body with the akathisia? Do you have what feels like a radiating electric current (not shocks) running through your body and something is nagging you on a cellular level? And sometimes with EXTREME anger and irritability even though it's not you?  I have that and I had an adverse reaction, too, but I tried SSRIs for 2 months ugh.

[Christian]

Hi US,

 

Thank you so much for replying.

 

The akathisia is still very bad most of the day. It starts at 5-6 am. I have to start walking, can't eat lunch usually as it's intense. Looking at my journal, it's been getting worse.

 

It diminishes in the evening, luckily.

 

I'm pretty much completely disabled and house bound. It's hard to be alone. In the evening, when it's low, I'm so tired from it.

 

I don't know how I will survive this.

 

Thank you for this on Propanolol and Diazepam. I still take them in small doses. They don't seem to help much

 

It's 8 months since I stopped the horrible drug. I only took half a pill for 4 weeks. I can't believe I had every symptom listed here and now akathisia in a severe form.

[Christian]

Adrian

I had akathisia for 4-5 months. I called it anxiety in my thread as I thought movement was a requirement to have it. But it was that internal, electric chemical anxiety that was constant. It left a couple months ago. I now can walk through my house or go in public without feeling amped up. My problem now is it crashed my adrenals. My point is try not to dwell on it. I know it's hard not to but continued stress could lead to adrenal fatigue. I suggest if you can read, read books. Hope things settle for you. We are on the same timeline so I'll check in from time to time.

[ihadakathisia]

Hi

 

Christian - maybe the Mirtazapine (remeron) helped with akathisia?

 

I'm minimizing stress as mich as possible. So you are feeling very tired now (this adrenal fatigue)? Maybe this is also from Mirtazapine, a side effect?

 

KT38 - I get anger/irritability because of the intensity of this suffering. It eats all my resources. I detailed how I feel in a post above.

 

Sebding good healing thoughts to all of you.

[Christian]

I don't think anything helps akasithia. I heard some use benzos. I think it's just gotta run its course.

[ihadakathisia]

Hi Christian.

 

Looking at withdrawal akathisia / tardive along with its intense dysphoric state (generalized mental pain/discomfort, terror, etc)

 

For some SA members (Fresh, ckichen etc) , akathisia turned to be a life-threatening situation. They resolved it by introducing another drug or reinstating.

 

For some other SA members, the intensity was lower and their symptoms resolved in time (nz11, UnfoldingSky etc).

 

Other people I corresponded with have a reduction of intensity in time, but no remission ( worse case 9 years, but is functional at work). Others like Josh Jensen see no change.

 

Other 2 unfortunate SA members probably took their own life (bluebalu, wiltig).

 

Benzo people also experience something similar - but somewhat milder usually - I've been in touch with many.

 

Another interesting pattern is window /waves - which I and several others are experiencing.

 

Using anectodal evidence from members, looking at the literature, speaking to doctors, it seems : if you get withdrawal /tardive akathisia, the best algorithm is:

1. Reinstate if possible

If not

2. Force through if bearable (expecting an avg 1-2-3 years of symptoms)

If not

3. Try propranolol/clonidine, b6/vit C - safer meds.

If not:

4. Choose poisons : antihistamines, benzos, melatonin, red wine(dr healy) etc.

If not:

5. Choose worse poisons: triptans(Zolmitriptan study), donepezil, benztropine, biperiden, ondansetron, memantine, amantadine.

If not

6. Choose worse poisons: tryciclics, anti convulsants, mirtazapine/mianserin(ht2a/c hypothesis) etc

 

Hope this heps someone/sometime.

[Christian]

Oh geez. I lucked out as it went away in 90-120 days. Now I have horrific, bedridden fatigue from the hell I endured. I couldn't imagine having it for years. I didn't mean to sound like I was an expert on it or to question your approach to it. I hope things improve.

[UnfoldingSky]

Adrian, how are you doing?  Any improvements lately?  Are you tapering?

[ihadakathisia]

Hello everyone. 

 

For anyone suffering from akathisia in a late "tardive" form, I have some good news.

 

The months of May, June, July, August and part of September brought ever increasing akathisia and disabling symptoms. 

 

Although in contact with a knowledgeable doctor - about akathisia and drug withdrawal - I chose to ride it out. I would rather die than take other poisons. And akathisia vanished suddenly in the late September. 

 

I am still very disabled. But I am surviving. I am still experiencing waves and windows of many horrifying symptoms. But every 1-2 days, for a couple of hours or more, I feel normal. 

 

I'm currently taking 

(a) fish oil

( mangesium

© melatonin at nightfall 

(d) 1.1mg of lamotrigine for sleep

(e) very small dose of clonidine/propranolol

 

Wish all of you well. 

[scallywag]

Adrian -- Your akathisia disappeared? That's great news -- thank you for posting it. It's a sign that underneath your severe symptoms your CNS (central nervous system) is working to transform and to heal. I hope that you'll soon see another symptom vanish overnight.

[UnfoldingSky]

Not to minimize your ongoing struggles Adrian but it's so great to hear that the akathisia has gone! I'm so excited for you!  I was just wondering how you were too when I found this note, I'm so very glad to hear of your improvements.

[rapunzel2]

Adrian, how are you doing? I need your help! Who is that akathisia specialist????????????? please write me!!!! or even call. I pm you my phone.