slowlybacktome: looking for help to taper Pamelor / nortriptyline

[slowlybacktome]

I suffer from chronic migraines and have been on numerous medications over the past 10 years to try to treat them.  I hestitated for many years before starting any type of AD to treat them and went through all of the courses of preventatives before caving and trying to treat my migraines with AD.  I plan to do a signature soon, but need to track down my medications that I've taken in the past.

 

Most recently, my neurologist prescribed a short course (1 month) of olanzapine and abrubtly switched me to tizanidine on December 12, 2017.  I went into horrible withdrawal on December 26, 2017.  I had no idea what a c/t change would do to me and even though I'd taken prozac and effexor in the past for migraines, had never been through anything like this.  She wanted me to reinstate the olanzapine which I was afraid to do and ended up seeing a general practitioner who my mom has been seeing for the past 20 years.  She introduced klonopin and prozac for me to help with insomnia, anxiety.  I started at .5mg klonopin and 10mg of prozac on January 2 2018.  I stayed on the prozac for two weeks and it made me sick so she told me to alternate everyother day for a week and stop.

 

Nortriptyline was introduced after prozac starting at 10mg for two weeks and then to 25mg while still taking .5mg of klonopin.  She wanted me off of the klonopin, indicating that it should only be take short term and told me to just stop taking it.  I was terrified to do so and found benzo buddies.  Based on my short term use, they suggested a quick taper.  I made it to .125mg and started the withdrawal rollercoaster and went back up to .25mg to stabilize on February 24 2018.  On my follow up visit, I relayed a miriade of side effects that I'm getting from nortriptyline:  blurry vision, constant migraine, froggy voice, dry mouth.  So she said to stop the nortriptyline by dropping from 25mg to 10mg.  Take the 10mg for five days and then stop.  Again based on my olanzapine scare, I decided to go from 25mg to 20mg for seven days and then drop to 17mg by taking out the powder and weighing it.  I started on 20mg on February 28 2018 and dropped to 17mg on March 7.  I started feeling withdrawal symptoms four days ago:  burning skin in arms hands and chest, heart palpatations, anger, anxiety, lethargy, sleeping less, chills/hot flashes, sweaty hands.  I spoke with my pharmacist last night (my doctor is out of town for two weeks) and she suggested I go back up to 20mg which I did last night.

 

I'm at the end of my rope.  I think my CNS is still sensitive from the olazapine withdrawal in January-February and any changes are having a major impact.  I don't know where to go from here.  At my last follow up my doctor says that I must be sensitive to the medication and maybe I need to be on klonopin long term.  I left feeling like she just washed her hands of the situation.  I just want to be off of both meds.  I'm OK with staying on klonopin while I taper off of nortriptyline, but am really looking for advice on how to move forward.

 

Do I hold at 20mg for a while?  Go back up to 25mg and stay there for a while?  And then how do I start tapering again?

 

Please help!

[Altostrata]

Welcome, slowly.

 

What exactly are you taking now, at what times of day? Do your symptoms follow any daily pattern?

 

What we've seen here is that going on and off psychiatric drugs often makes the person hypersensitive to other drugs and even some supplements and foods. Your nervous system has had some shocks and is under stress now. Very few doctors understand the risks in switching or going off drugs.

 

Please stop changing your drugs for now, take each at the same time each day.

[slowlybacktome]

I am now taking 20mg nortriptyline, .25mg klonopin and 3mg of melatonin each night about an hour before bed. 

 

My symptoms don't seem to follow any set pattern.  The burning comes and goes but seems to be more intense when I wake up in the morning.  My anxiety also seems to ebb and flow during the day, although mornings seem to be the roughest.

 

Thank you for your reply! 

[Altostrata]

Why do you take 20mg nortriptyline at night? Does it make you sleepy?

 

When did burning in the morning start?

[slowlybacktome]

The doctor told me that it could be sedating and would help with the insomnia that I had from olanzapine withdrawal.  I'm actually not sure if it's helping me with sleep.  I fall asleep around midnight and have been waking up around 5:30am.  If I can sleep until 5am I consider it a good night these days.

 

The burning was happening during the olanzapine withdrawal and had mostly gone away.  I would feel a slight/burning itch every once in a while, but it came back when I lowered my dose of nortriptyline.  Probably around day 6 or 7 after the drop from 25 to 20mg.  It happens in the morning, but does come back throughout the day.  

[Altostrata]

How often does the burning happen? Since March 1, has it been happening less often?

 

Please keep daily notes on paper about your symptoms, when you take your drugs, and their dosages.

[slowlybacktome]

It’s on and off throughout the day.  I’d say I wake up to it each morning, it goes away for a few hours and comes back again, will stay for about an hour, go away and come back.  But I have not seen a set pattern on time or activity.

 

I was feeling it less less and less until March 4th when it came back again.  It’s a burning feeeling under the skin in my upper chest, lower arms and hands.  My hands will also have a pins and needles feeling and my right hand specifically will feel almost numb and cold to the touch.  

 

This morning when I woke the burning was less and just feels like a minor itch right now.  I’ve been back on 20mg (after dropping to 17 for four nights) for two nights.

[slowlybacktome]

I wanted to add that I received an email from my doctor's assistant.  The doc is out of town until 3/18, but I'd asked them to fill a prescription to take two 10mg capsules per day.  My original 10mg prescription was for one per day and I would have run out.  A substitute doctor filled the script for one month.

 

So, my thoughts are to stay at 20mg of nortriptyline and .25mg of klonopin until my body is stable and I'm feeling better.  I'll have to talk to my doctor again to get a longer 20mg per day prescription.  Does this sound like the right course of action?  After my body stabilizes do I tackle klonopin or nortriptyline first?

 

Today I've experienced what I've been calling anxiety (tightness in my stomach and overall feeling of unease).  I'd never had anxiety before my withdrawal from olanzapine, so I think that's what it is.  I've also had an upset stomach today which is a new symptom.  Living in the northeast during the winter, there are a lot of bugs going around so it could be unrelated.

[slowlybacktome]

Hi all-

 

I’ve been trying to navigate through the site to find out a few things to get me ready for my taper, which I know won’t happen for a while but I’m a program manager and I feel better when I have a plan in mind and on paper.

 

i did find a link on which to taper first - AD or Benzo and I do want to taper my AD first based on what I’ve read.  Although now that I’m on 20mg, I’ve had a couple of migraine free days which for me is quite an accomplishment.  My tinnitus has also decreased significantly.   Is there a link to tapering nortriptyline?  Also, I wanted to add tags to the top of my intro so that I can hopefully connect with others who may be tapering the same prescriptions.  

 

One last thing... I read in a couple of posts that magnesium and fish oil can help with symptoms.   Is there a link?  I’m wondering what dose to take along with time of day.

 

Thank you!

[Gridley]

slowlybacktome,

 

Here are some links you will find helpful:

 

Taking multiple psych drugs? Which drug to taper first?

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

Please research all supplements first and only add in one at a time and at a low dose in case you do experience problems. I take about 1500mg of omega a day, divided into three doses.  Start low on the magnesiums as it can have a laxative effect.  There are many different types of magnesium; I like magnesium glycinate.

 

At Surviving Antidepressants, it is recommended that a person taper by no more than 10% of their current dose with at least a four week hold in-between decreases.  The 10% taper recommendation is a harm reduction approach to going off psychiatric drugs.  Some people may have to taper at a more conservative rate as they are sensitive to even the smallest drops.  
 

Before you begin tapering what you need to know

 

What is Withdrawal Syndrome?
 

Why taper by 10% of my dosage?

 

Brain Remodelling

 

Tips for tapering off nortriptyline 

 

 

 

[slowlybacktome]

Hi everyone - I really need some help.  The past two days I’ve felt very bad.  This morning I woke up to stomach cramping, nausea, sweating/flushed feeling, tightness in my stomach and burning of my face arms chest and hands and the sound sensitivity is back. I’ve been taking the same medication each night.  This is the fifth day that I’m back to 20mg after dropping to 17mg.  

 

Will this improve?  Should I go back to my original dose of 25mg or stay at 20mg?  I just feel like I’m not stabilizing.  I think my signature has my doses and changes.  Please help.

 

 

[Gridley]

Your drop from 25mg to 20mg was 20%, far too fast, compounded by the drop to 17mg.   You tapered too fast, which is why you are experiencing these typical withdrawal symptoms.  

Glenmullen’s withdrawal symptom list.

 

It is destabilizing to jump around in dosage.

 

When did you drop to 17mg and how long did you stay there?  Please indicate the dates in your signature.

 

Please indicate the date you went back to 20mg.  Would that be March 12?

 

You have been on 20mg for 5 days and on 17 mg for _____ days..  In that time you brain has adapted to the lesser amount of the drug.   Do not go back to 25.   It will be be too much. Hold at 20mg.   Give it time.  It may take a while for you to stabilize.  Throw out the calendar and listen to your body.  Do not rush it.

 

 

 

 

 

 

Edited March 16, 2018 by Gridley

[slowlybacktome]

I can't figure out how to change my signature.  I tried, but I'm not sure it worked.  I'll look again after I reply

 

I dropped down from 25 to 20 on February 28, stayed there until March 6th (7 days). 

 

On March 7th I dropped to 17mg and started feeling pretty bad (the first day of the drop so I figured that it was likely from my drop to 20 that I was just starting to feel).  I went back up to 20mg on March 11th (after 4 days) and have stayed there.  I take my dose at night so I've been on 20mg for 5 nights. 

 

I realize that my drop was too fast.  I was going much slower than the doctor wanted and should have realized that even 20% was too fast.  I was hoping not to have to deal with titration or weighing powder.  My doc and pharmacist tell me that only capsules are available.

 

In my rational head, I know it makes sense to stay on 20mg since I'm still able to function and just ride this out until I stabilize.  It's just so disappointing to wake up each morning thinking that I'll feel better and actually feeling worse.  

[Gridley]

 

Here's the link to change your signature:

 

Account Settings – Create or Edit a signature.

 

As you taper, you going to have to deal with titration or weighing powder on a scale.  Here's the information from the "Tips for tapering Nortryptiline" link above.   Making a liquid is popular here.  I've been using the Gemini-20 scale and am happy with it.

 

"If you wish to weigh the powder, see Using a digital scale to measure doses

You will probably find using a liquid to be much more convenient when tapering by amounts smaller than 10mg.

Use nortriptyline oral solution to taper

In the US, nortriptyline comes in an oral solution (10 mg/5 mL or 2mg in 1mL) by prescription.

Make a nortriptyline liquid yourself from tablets or capsules

Nortriptyline is soluble in water. See How to make a liquid from tablets or capsules

Use an oral syringe to precisely measure out doses as small as .01mg."

 

According to this link, in the U.S. nortryptiline does come in an oral solution.

 

 

•  

 

 

Edited March 16, 2018 by Gridley

[slowlybacktome]

I've been on 20mg after my short 17mg reduction for 10 days.  I was hoping to be feeling better than I am right now.  I still feel what I describe as anxious with my stomach feelling tight and thinking about normal activities makes me feel overwhelmed.  My skin burning/itching has been improving.  Lately it's been on my back.  Two nights ago my tinnitus that had gone away when I made the drop from 25 to 20 has come back.  It's just occasional, but concerning because I thought that I had moved past it.  Just recently I've had some heart palpitations.  My appetite is alternating between being starving and not hungry at all.  

 

I'm still hanging on with 20mg per night of nortriptyline and .25mg klonopin.  I'm just hoping that the symptoms take a turn soon and I start feeling better. 

 

I got an email from my doctor yesterday saying "It is unusual that you should have so much difficulty coming off after such a short period of time. I do think you are extremely sensitive to medication. The nortriptyline is not addictive and it should not be as difficult to get off of it as the clonazepam. You may want to taper by doing 20 every other day at at some point for a while and then we can go from there. I think you will likely feel it no matter when we do this so it is a matter of timing and I think you should probably feel better within a day or two after adjusting the dosage.
It is a safe medicine so alternately you can simply continue on the 20 mg until we see you again.
I am open to however you want to taper down off of the nortriptyline."

 

I definitely didn't feel better a couple of days after dropping.  Is there anyone on the board that is also using nortriptyline?  I'd really like to connect with someone.  

 

[Gridley]

Since January, you have made five changes to your dosage.  It may take a while for you to stabilize.  Give it time.

 

Do not taper doing the every-other-day method that the doctor suggested. Skipping doses is equivalent to reducing your dose by 50% and is NOT recommended by SA. 

The thing you need most is a stable dosage, and alternative day dosing is like playing ping-pong with your brain.

 

Skipping Days vs Every Day Dosing Graph

 

 

 

 

[slowlybacktome]

I definitely don’t plan on tapering every other day.  I guess I’m disappointed that she’s making me feel that there’s something wrong with me that I’m experiencing these symptoms.

 

I’m not sure if this is withdrawal related or a head cold, but I’m feeling ear/head/sinus pressure- when I pop my ears the ringing stops for a little.  I’m not sure if taking something to help head pressure/cold will make anything worse.  Does anyone have experience taking something like sudafed while using ADs?

[ChessieCat]

I did a google search on survivingantidepressants.org sudafed and found the following:

 

cold-medicine-and-withdrawal

 

drugs-to-avoid-in-withdrawal

 

From:  sudafed-as-an-aid-to-tapering-snris

 

 

On 16/07/2013 at 7:01 AM, GiaK said:

Sudafed would be playing with fire for a lot of folks...

 

a lot of us develop sensitivities to a lot of medications when we're in withdrawal and post withdrawal and Sudafed and similar drugs are high on the list...

 

proceed with caution...sometimes these sorts of helpful substances go south on us. 

 

[slowlybacktome]

Ugh - thanks for looking it up for me!  I guess it could just be withdrawal related but the weather here is Pennsylvania has been crazy and there’s a lot of sickness going around.  We got 10 inches of snow today and last week was fairly warm.  The pressure and temperature changes and doing my head any favors.

 

Is there any suggestion on what could help with a sinus or head cold and is “safe” to use?

[ChessieCat]

One of my withdrawal symptoms is ear pressure and blocked feeling.

 

vicks-nasal-stick/

 

nasal-rinsing-for-allergies-via-neti-pot-or-squeeze-bottle/

 

sinus-congestion-sneezing-and-runny-nose/

 

nasal-irrigation-caution/

 

please-help-first-cold-since-withdrawal/

[slowlybacktome]

Thank you!  I remembered that I have a new neti pot and just used it.  Keeping my fingers crossed that it helps

[slowlybacktome]

The neti pot helped with the head pressure, which I think helped with the tinnitus.  It isn't as bad today.  Luckily it's never been 24/7 which gives me reson to believe that it's not going to affect me long term.

 

Most of my symptoms are getting better, but I can't seem to lose the anxiety.  I've never had anxiety before my c/t of olanzapine in December.  I was feeling alot better right before I started to decrease my nortriptyline.  The side effects of the nortriptyline weren't great, although bearable, but it didn't seem to be helping my migraines.  Nortriptyline is supposed to help with anxiety.  Does it make sense that my anxiety is high after a dose reduction?  I'm wondering if when my body settles down from the dose changes, is it likely the anxiety will go away?  

[slowlybacktome]

Still fighting anxiety.  I was away for the weekend at my daughter’s cheer competition and got back home late last night.  I didn’t sleep well and was up on and off throughout the night.  Maybe that’s why it seems so much worse today.  I can deal with the head pressure and tinnitus and itchy skin if only this anxiety would go away.  

 

I have a couple of questions:

 

Had as anyone tried CBD oil to help with anxiety?  Based on what I’ve been reading, it sounds like it could be an option to get me through this rough patch until I’m stable on this new dose.

 

My sleep has not been very good.  I currently take one 20mg dose at night.  I’ve read that ADs are stimulating although they can cause sedation early on.  Should I consider splitting my dose between morning and evening?  Or moving it to morning to see if that helps my sleep?

 

I’m still taking .25mg klonopin and 20mg nortriptyline per night with 3mg melatonin .  I’ve added 400mg magnesium per night.

[Carmie]

Hi slowlybacktome, 

 

Just checking in to see how you’re doing. Sending hugs🤗

[slowlybacktome]

Hi Carmie!

 

I am doing well.  I was able to taper off of nortriptyline after I finished my klonopin taper.  I ended up getting liquid nortriptyline and that really helped with my taper.  I was able to reduce 1mg at a time that way.  I finished my taper in October and didn’t have any horrible withdrawal symptoms.  My second taper was much better.

[Carmie]

3 minutes ago, slowlybacktome said:

Hi Carmie!

 

I am doing well.  I was able to taper off of nortriptyline after I finished my klonopin taper.  I ended up getting liquid nortriptyline and that really helped with my taper.  I was able to reduce 1mg at a time that way.  I finished my taper in October and didn’t have any horrible withdrawal symptoms.  My second taper was much better.

 

That’s fabulous slowlybackhome, 

 

You are an inspiration to others on here. Thank you so much for sharing. Could you please update your signature so others can see how your taper went. Thanks again. 💚

 

 

[ChessieCat]

Please update your drug signature:  Account Settings – Create or Edit a signature

 

Thank you.

[Altostrata]

Good to hear you're doing better.

 

This calls for our cheerful "here comes the sun" symbol ☼ to be added to the title of your Intro topic, to show you're recovering.

 

Please continue to let us know how you're doing. I hope you will add your story to our Recovery Success Stories eventually!

[Carmie]

Yay slowlybackhome, 

 

You got a here comes the sun symbol. I’m hoping to get one of those myself one of these days. Looks like a long road still ahead of me but I will get there. 

 

Thanks for sharing your positive news, it’s very encouraging 💚

 

 

[jr0104]

I am so happy to have read this thread and to see that you have successfully tapered from Nortriptyline. I am currently struggling with this myself. The head pressure you described is exactly what I am going through. Thank you for sharing your success story. I feel so trapped and it is inspirational to know that there is a light at the end of the tunnel.

[slowlybacktome]

SSRI experience and withdrawal

 

I was on this site a few years ago recovering from an unintentional cold turkey of a drug my neurologist had prescribed as a migraine cycle breaker.  I’d ended up on a few medications trying to improve my symtoms.  I eventually recovered and healed.

 

Fast forward to perimenopause and I was hit with tremendous anxiety, racing thoughts and insomnia.  I tried supplements, hormone therapy and nothing helped.  There were no triggers, I was just constantly in a high anxiety state.  So, my GP prescribed 15mg of Mirtazapine due to my severe insomnia (I was sleeping 1-3 hours per night) and anxiety.  I felt better within days.  After 6 weeks, I had signs of anxiety coming back.  My thoughts were racing, I wasn’t able to concentrate.  So, my doctor was concerned that a higher dose of Mirtazapine would cause insomnia and she added lexapro.  That’s went things went south.  The side effects were like nothing I had felt before starting any type of medication.  Foggy brain, derealization, nausea, diarrhea, panic attacks, depression, migraines, and paresthesia.  I decided to look for a psychiatrist and made an appointment.  I tried to stick it out with lexapro  for two months, but the symptoms didn’t improve so I was cross tapered over to Zoloft.  After one month of the same symptoms, my psych took me off of Zoloft with a quick taper.  I felt horrible the entire time I was on lexapro and Zoloft.  She added gabapentin to try to help the burning skin and nerve pain that I got when starting lexapro and then also increased the Mirtazapine.  So that’s where I am today. 

 

I’m five weeks off of Zoloft and taking 300mg of gabapentin along with 30mg of Mirtazapine.  I’m still experiencing withdrawals from Zoloft which is why I’m here.  My biggest physical symptoms are my skin issues.  The burning is gone but it’s been replaced with tingling/ prickly/raw skin all over.  My hands, feet, face, tongue and knees seem to be the worst.  Emotionally, I’m all over the place.  Some days I’m depressed, disassociated, and others I just feel flat and sad that I’m unwell.  Cognitively, I have brain fog and bad memory retention.

 

My plan at this point is to stay on my current doses of gabapentin and Mirtazapine and try to let my body heal from the SSRI upset.  It’s just so hard to stay the course and not adjust anything to try to improve faster.

 

I’ve updated my signature with my medication for 2020.  It gave me a 12 line maximum error so I had to eliminate  my earlier medication use.  
 

Thanks for reading!

 

 

Edited September 13, 2020 by ChessieCat
added topic title

[ChessieCat]

Please put your previous drug history in a post.  Once posted, please copy the share link and add that link to your drug signature so that we can access it easily if needed.  Thank you.

 

I've asked the other mods for their assistance.

 

 

[slowlybacktome]

Olanzapine 2.5mg Nov 17-Dec 15 2017

Tizanidine Dec 16 - Dec 27 2017

Klonopin Jan 2 - Sept 2018

     Liquid Tapered from .5 to 0

Prozac Jan 2 - Jan 16 2018

Nortriptyline Jan 16 - Jul 2018

     Liquid taper 

     

[ChessieCat]

I've condensed your new history and combine the old and new histories.

 

I've also added years to the old history that were missing.  PLEASE CHECK that they are correct.

 

After checking it, please copy and paste the following into your drug signature.  Thank you.  Account Settings – Create or Edit a signature

 

2017 - 2018:

Olanzapine:  2.5mg Nov 2017 - Dec 15 2017

Tizanidine:  Dec 16 2017 - Dec 27 2017

Klonopin:  Jan 2 2018 - Sept 2018 (liquid tapered from .5 to 0)

Prozac:  Jan 2 2018 - Jan 16 2018

Nortriptyline:  Jan 16 2018 - Jul 2018 (liquid taper)

2020:

Mirtazapine:  15mg March 2020 - July 2020; 22.5mg July 2020 - Aug 2020; 30mg Aug 2020 - current

Lexapro:  5mg May 13 - May 30 2020; 10mg May 27 - July 12 2020; 5mg July 14 - July 17 2020

Zoloft:  12.5mg July 14 - July 17 2020; 25mg July 18 - July 31 2020; 12.5mg Aug 1 - Aug 5 2020; 6.25mg Aug 6 - Aug 9 2020

Gabapentin:  100mg Jul 25 - Aug 9 2020; 300mg Aug 10 - current

[ChessieCat]

So that your situation can be assessed please keep daily symptoms notes for 3 consecutive days, posting a 24 hour period in one go. 

 

On 9/28/2016 at 4:49 AM, Altostrata said:

 

Are your symptoms worse at any particular times of day? A symptom pattern that occurs regularly over several days could mean the symptoms are from withdrawal, other adverse effects of drugs, or something else you do on a daily schedule.

 

In the course of discussion in your Introductions forum topic, you may be asked to keep notes on paper of your daily symptom pattern, including when you take your drugs, their dosages, and any symptoms. We ask this because there may be something we can do to reduce the symptoms.

 

What we need to see for every single day over several days is what symptoms you get before and after you take your drugs.

 

 

Example:

DATE:

 

6 a.m. Woke with anxiety
8 a.m. Took 2.5mg Lexapro
10 a.m. Stomach is upset
10:30 a.m. Ate breakfast
11:35 a.m. Got a headache, lasted one hour
12:35 p.m. Ate lunch
4 p.m. Feel a bit better
5 p.m. Took 2.5mg Lexapro
6 p.m. Ate dinner
9:20 p.m. Headache
10:00 p.m. Took 50mg Seroquel
10:20 p.m. Feeling dizzy
10:30 p.m. Fell asleep
2:30 a.m. Woke, took 3mg Ambien (NOT "took 1/2 tablet Ambien")
2:45 a.m. Fell asleep
4:30 a.m. Woke but got back to sleep

[Altostrata]

Hello, Slowly.

 

Sorry you've had this setback. Your nervous system is still sensitive to psychotropics. Sounds to me like you had a reaction to too much mirtazapine -- you're still taking too much mirtazapine -- and all the other stuff made a bigger mess.

 

19 hours ago, slowlybacktome said:

So, my GP prescribed 15mg of Mirtazapine due to my severe insomnia (I was sleeping 1-3 hours per night) and anxiety.  I felt better within days.  After 6 weeks, I had signs of anxiety coming back.  My thoughts were racing, I wasn’t able to concentrate.  So, my doctor was concerned that a higher dose of Mirtazapine would cause insomnia and she added lexapro.  That’s went things went south.

 

Weirdly, your doctor observed excessive activation from too much mirtazapine, was concerned about adding to it, so she added an even more activating drug.

 

My guess is you will need to reduce mirtazepine. We do need to see your drug schedule and daily symptom notes.