Alpha23: palpitations after switching from Prozac to Lexapro and back again

[FindRest]

2 hours ago, Alpha23 said:

How did you manage to get through the really hard times?

I had to stop working as there was no way I could function. Are you still able to hold down a job? If so, that is a very good sign. 
 

I went into therapy, sought out help in my church as well. I lived minute by minute. Sometimes literally. My number one job during that point was to stay alive. I tried to implement coping skills I read that helped others and is how I came across SA. It was very difficult. I’d say one of the things that helped me the most was to make a list of my symptoms and rate them every day from 1-10. Seeing that I was gradually making progress gave me that extra ounce of hope that things were improving. 
 

1 hour ago, Alpha23 said:

I should also add that I was taking SAMe with the Prozac over those 5 years of increasing the dose as I had read it was safe to do so

This is an important piece of information. SAMe should never be taken with ADs as it too affects serotonin and other neurotransmitters. In fact, Mayo Clinic states it can lead to serotonin syndrome when taken with other ADs. The symptoms of SS are:

 

“agitation, anxiety, restlessness, disorientation, diaphoresis, hyperthermia, tachycardia, nausea, vomiting, tremor, muscle rigidity, hyperreflexia, myoclonus, dilated pupils, ocular clonus, dry mucous membranes, flushed skin, increased bowel sounds, and a bilateral Babinski sign.

 

Do any of these apply to you? The good thing is that treatment for SS is pretty much what you have done … reduce your intake of the offending drug(s). This might explain some of your symptoms. 
 

When did you stop taking the SAM-e? I believe it too should be tapered, especially if you took it for 5 years. Please put this information in your signature.

 

I recommend reading this link and perhaps the links mentioned within it of others who went through SAM-e withdrawal:

 

https://www.survivingantidepressants.org/forums/topic/572-sam-e-s-adenosyl-l-methionine/

 

Edited April 22 by FindRest

[Alpha23]

1 hour ago, FindRest said:

I had to stop working as there was no way I could function. Are you still able to hold down a job? If so, that is a very good sign.

 

Unfortunately not. I've been on sick leave since February.

 

1 hour ago, FindRest said:

This is an important piece of information. SAMe should never be taken with ADs as it too affects serotonin and other neurotransmitters. In fact, Mayo Clinic states it can lead to serotonin syndrome when taken with other ADs. The symptoms of SS are:

 

“agitation, anxiety, restlessness, disorientation, diaphoresis, hyperthermia, tachycardia, nausea, vomiting, tremor, muscle rigidity, hyperreflexia, myoclonus, dilated pupils, ocular clonus, dry mucous membranes, flushed skin, increased bowel sounds, and a bilateral Babinski sign.

 

Do any of these apply to you? The good thing is that treatment for SS is pretty much what you have done … reduce your intake of the offending drug(s). This might explain some of your symptoms. 

 

Yes, I have many of those symptoms, including a bilateral Babinski sign.  Is there anything I can do? I'm really frightened now.

 

I stopped taking the SAMe at the end of February.

[FindRest]

4 hours ago, Alpha23 said:

Yes, I have many of those symptoms, including a bilateral Babinski sign.  Is there anything I can do? I'm really frightened now.

 

I think remembering that many of these symptoms are also standard withdrawal symptoms and some of them have many other causes as well is important. That being said, if you were suffering from SS (some also call it serotonin toxicity), you have already done part of what is recommended … reducing your dose (and stopping the SAM-e). There is no test for SS and doctors just rule out things and come to some conclusion based on their findings, and many don’t even believe in SS.

 

Managing the symptoms, whether it’s WD or SS, is about the same. I would venture a guess that what many of us have gone through at some point was SS in some degree. Try not to get frightened by the scary name. Of course, if you have any life-threatening symptoms you should seek help immediately, but those usually happen in rare cases and at the very beginning of the whole process when things start going downhill. Like heart issues, breathing issues, etc.. 

 

Here’s a thread discussing this:

https://www.survivingantidepressants.org/forums/topic/5711-serotonin-syndrome-or-serotonin-toxicity/page/3/

 

For what it’s worth, 5 years later and I can go through that list and say I have many, if not most, of those symptoms on any given day. Please know that the information I shared with you regarding SS was to inform not to induce fear. Use what you learn to help you make choices in both your taper and any future medication/supplement changes or additions. 

Edited April 22 by FindRest

[FindRest]

4 hours ago, Alpha23 said:

Unfortunately not. I've been on sick leave since February.

I’m sorry. I know the financial and emotional strain this puts on you. It’s a hard road to go down from a self-esteem point of view. It was very hard for me to put myself first, but in the end I had no choice.

 

4 hours ago, Alpha23 said:

.  Is there anything I can do? I'm really frightened now.

Try not to go down the rabbit hole of thinking things will never get better or imagine that they will get worse. That would be my biggest piece of advice. It’s very difficult to not go there when you’re in the thick of it. Remind yourself that it DOES get better and that TIME is usually the best healer. The symptoms you’re having are actually your body trying to make things better, to get back to some sense of stability. Don’t make any changes impulsively out of fear. 

[Alpha23]

 

2 hours ago, FindRest said:

I think remembering that many of these symptoms are also standard withdrawal symptoms and some of them have many other causes as well is important. That being said, if you were suffering from SS (some also call it serotonin toxicity), you have already done part of what is recommended … reducing your dose (and stopping the SAM-e). There is no test for SS and doctors just rule out things and come to some conclusion based on their findings, and many don’t even believe in SS.

 

I'm just wondering if this changes anything in terms of strategy. For example, should I still hold at 20 mg Prozac? Was it the correct decision to stop taking the SAMe CT or should it be tapered as suggested in the SAMe thread?

 

2 hours ago, FindRest said:

For what it’s worth, 5 years later and I can go through that list and say I have many, if not most, of those symptoms on any given day. 

 

I don't suppose you know anything about the bilateral Babinski sign? If I have the sign, does it mean that I might still be suffering from SS or could it also be caused by long term antidepressant use and/or withdrawal? When I Googled it, the advice was to get it checked out by a neurologist.

[FindRest]

11 hours ago, Alpha23 said:

I'm just wondering if this changes anything in terms of strategy. For example, should I still hold at 20 mg Prozac? Was it the correct decision to stop taking the SAMe CT or should it be tapered as suggested in the SAMe thread?

 

These are my own personal thoughts on the matter: Stopping SAMe CT may have been a blessing in disguise. Yes, you’ll have to pay the consequences of WDs from it, but they would probably be much less than the consequences of SS. Regarding Prozac, I think the only thing it will change is that you now know that going up in dose is not a good idea. The decision now is do you do a tiny taper (like 5%) and see if the symptoms get better, or do you not chance it getting worse and hold where you are. If it were me, I’d be rating my symptoms every day over a week or so and see if they are improving or getting worse. If they were getting worse, I think I might try a 5% taper (from my current dose) and rate my symptoms for another 10 days (due to half-life of Prozac). Then go from there. Does this make sense?

 

11 hours ago, Alpha23 said:

I don't suppose you know anything about the bilateral Babinski sign? If I have the sign, does it mean that I might still be suffering from SS or could it also be caused by long term antidepressant use and/or withdrawal? When I Googled it, the advice was to get it checked out by a neurologist.

I looked it up the other day and my first reaction was, “Isn’t this normal?” I tested myself as best as I could and I have it too! Not sure why and not sure how much of the population normally would test positive. Crazy, though! 
 

Neurologists are known to prescribe more psychiatric drugs very freely. If it were me, I’d hang tight as I haven’t seen much anecdotal evidence here that neurologists really help WD symptoms much at all. Remember that the worst symptoms would have happened already and you would have made a trip to the ER by now … mainly related to heart beat and blood pressure. 
 

If you’d feel better getting checked out by your primary care doctor to make sure your heart and other things are OK, that would be understandable. It may give you some peace of mind. OTOH, many doctors might look at you strangely for mentioning SS or the fact that you’re going through severe withdrawals as most don’t take it seriously and some don’t believe in either. However, I’m sure they’d be happy to prescribe you more drugs of their choosing. (Sorry about my pessimism with doctors. This experience has understandably changed my attitude towards them.)

Edited April 22 by FindRest

[FindRest]

Also, here is a thread that contains a link to “PDF Monthly List BLANK to Print”. It is a blank spreadsheet that I print and keep track of and rate my symptoms nightly before I go to bed. It’s helped me in many ways, especially when things get tough … by allowing me to go back in time and see that I went through something similar awhile back and it DID get much better. It also helped me make tapering decisions. 
 

You’ll need to scroll down about 6 entries to the post by “dalsaan” on June 8, 2012. You’ll find links to both a pre-filled symptom check list and a blank one. I liked the blank one best because I didnt want to put any other symptoms in my head to have to worry about.

 

 

Edited April 22 by FindRest

[Onmyway]

Hi @Alpha23

I am following your thread and the great advice that @FindRest is giving you. 

I wanted to chime in to say that serotonin syndrome is very rare and usually does not occur with the doses that you were taking. Sam-e is a contributor of serotonin and because the doses are not very well regulated it can definitely be implicated in serotonin syndrome but if you had SS you would know - even milder versions are so strong that they prompt people to go to the emergency room. Having said that, I do not suggest you go back to Same but suggest that you ride this out. Things will get better.

 

I found soaking in a bathtub with magnesium salts was quite helpful for the agitation. For continuous sleeping background dull music (i.e. no sudden piano keys etc) may help. Walking rather than exercising intensely is more helpful. Vigorous exercise increases cortisol and what you want is to lower is. Taking aspirin before bed may help with lowering morning cortisol (if aspirin is not contrainidicated for you due to bleeding risks for example. A fully dark bedroom would also help. 

 

What you are describing sounds like hypersensitivity from multiple changes rather than a serotonin syndrome. The difference is that your body is sensitive to the effects of the drug rather than the drug being in toxic quantities in your body that would impact biological systems adversely.  

 

You may have many of the symptoms that are there for serotonin toxicity but we need to be careful about symptom sensitivity and specificity. A brain aneurysm bursting may cause a headache but that doesn't mean that every headache is a brain aneurysm. There is  a case with someone with severe chest pains that mimicked agina/heart attack (20 year old.) 

After all the tests it was discovered that it was a thoracic outlet syndrome - an extra rib prevented blood flow to the chest with some movements but was perfectly fine without those movements. Not dangerous at all (though can have long term complications).

So please don't worry about serotonin syndrome. Try to keep your doses as stable as you can - don't add other things, cut things. The severity of these symptoms makes us believe that we can't get through them but these symptoms by themselves, as unpleasant as they are, do not actually endanger us. Akathisia sucks but it will not make us drop dead. Just bear them minute by minute. 

 

Please look up Claire Weekes. Many here find her teachings very helpful. 

Try short inhale, long exhale (activates the parasympathetic system).

Also find the thread on cortisol on this thread. All these symptoms will get better in good time. The hardest symptoms go away most quickly usually - akathisia, restlessness. 

 

Please take care, 

OMW

 

[Alpha23]

@FindRest & @Onmyway

 

Thank you both for the kind advice - it is much appreciated!

[Alpha23]

Hi @Onmyway

 

In hindsight, I'm not sure that dropping from 30 to 20 mg Prozac was the right move. I'm starting to think that maybe I should have just dropped down to the previous dose where I was stable (or maybe around 25 mg). I think I may have shocked my CNS more by making a big jump. I know stability is important, and it's risky going up and down, but do you think raising the dose very carefully and gradually is worth considering? I'm wary of doing this because one of my main symptoms at the moment is akathisia and I know Prozac is very activating. I'm just worried that dropping down too much might have made the akathisia worse. I've been on 20 mgs for 5 weeks now, so is too late to be thinking about a partial reinstatement?

[Onmyway]

Hi @Alpha23

 

You could try going up by 1mg and see what that does. If it makes things worse we know it's a bad idea. If it makes things better then we can go up further. 

 

How does that sound? 

 

Omw

[Alpha23]

Thanks for the response @Onmyway

 

Sorry for another question, but if I raise by 1 mg, how long do you think it would take to see any change in symptoms? This question has always confused me due to the long half-life of Prozac. Can I expect an immediate change, or would I need to wait a few weeks to see any changes?

[Onmyway]

Hi @Alpha23,

hard to know for sure. You should see some effect within a day or two but effects may accumulate and change over time. The long half life means that it stays in the body longer and so it will accumulate to the steady dose slower. The drug reaches a peak within 6-8 hours. If you felt a change within a few minutes, then I would think that would be a placebo/nocebo effect rather than a physical effect of the drug. If you didn't feel anything within a week then that would mean it is not making a difference. But the effects might change over time as the drug accumulates. 

 

Do you know how to get 1mg of the drug? There is a thread in the Tapering Forum on how to taper prozac and that tells you how to obtain the small dosages. 

 

Hope you start feeling better soon.

OMW

Edited yesterday at 11:10 AM by Onmyway

[Alpha23]

 

Thanks @Onmyway

 

I'm going to have a think about whether to raise the dose. If I do, I know how to make a liquid suspension from a hard capsule to get a smaller dose.