jr0104: nortriptyline nightmare

[jr0104]

Greetings fellow AD sufferers,

 

First off I cannot tell you how thankful I am for this website. For the first time in months I feel that I am not alone. Every Dr. I have seen has left me feeling like I am crazy but by reading your stories I know now that I am one of many who is suffering. Thank you for sharing your stories! Now here is mine....

 

I have struggled with migraines for much of my life. In November 2017, I landed in an urgent care facility due to an intense migraine. The Dr. there suggested that I begin taking Nortriptyline to help prevent migraines. A magic pill that could help relieve my headaches? Sign me up! I remember asking if it was an opioid because the last thing I wanted was to become dependent on something. She assured me it was not and sent my on my way. Ten days after taking Nortriptyline and upping my dose from 10mg to 40mg I landed in the emergency room. I was incredibly dizzy and was having chest pains. At the time I had no idea it could be related to the Nortriptyline but I did go back down to 10mg. Over the course of the next few months  I upped my dose to 20mg. From time to time I experienced side effects such as dizziness, although never really ever attributes them to the med (I thought it was an inner ear/vertigo thing).

 

In October of 2018, I decided it was time for me to stop taking the Nortriptyline since it did little for my headaches and I wanted to sort out what was a side effect and what was due to an underlying condition (like vertigo). I know this is incredibly ignorant but had no idea that you couldn't just stop taking this medication. Soooo I stopped. Cold turkey. Four days later began a hell that I never have experienced in my life. Head pressure, brain zaps, uncontrollable shaking, extreme dizziness,  shortness of breath, I thought I was dying. I landed in the emergency room where they did all sorts of tests, yet never put together that it was due to withdrawal. Several days later my symptoms persisted and I went back to the Dr. At the time we did put together that it was due to withdrawal and she advised me to get back on 20mgs of Nortriptyline. For the next several weeks  (from Nov to Dec) I continued to take 20mgs but my withdrawal symptoms persisted. I went to several Dr.'s and they are said that it wasn't possible that I could still be experiencing these symptoms being back on the med and it was all anxiety related. I was prescribed Klonopin and Xanax which I took very sparingly over the course of about 2 week (at this point I was more educated in withdrawal and knew I didn't want to get hooked on those although there were days I needed to take one to get through the day without landing in am emergency room). 

 

At this point my goal was to get off of this God-awful med. The Dr's I saw through my HMO (Kaiser) suggested that I do an every other day taper (one day 20mg, one day 10mg). I tried this for one day and the effects of withdrawal were crazy and I knew this plan would not work. I saw a psychiatrist through Kaiser who literally mocked the idea that I could be experiencing "withdrawal" from such a "tiny dose of 20mg." Through tears I told him that I just needed help getting off. I asked if I could switch to a liquid so I could micro-taper and he once again laughed at me and said that was "insane and he would never do that." He  also suggested I switch to 30mg of Cymbalta. By now (this was early December 2018) I was MUCH more educated in AD's and did NOT fill this prescription. I decided to go out of network and get an second psychiatrist's  opinion. In late December 2018 I met with another psych who was recommended as knowing more about the WD process. Thankfully this psychiatrist did write me a script to get the Nortrip compounded. He also suggested I cross taper with 10mgs of Prozac. On 12/31 I started to taper. I went to 19mg's of Nortrip. I did two days of the Prozac but after reading information on here i decided to discontinue it.   I am still experiencing WD symptoms. I realize now that I probably never re-stabilized on the 20 MG's of Notrip from the reinstatement after the 10 days cold turkey quit. 

 

From reading through posts here I know I will likely be advised to go back to 20mg and stabilize. I just really want to get off of this poison. I feel like my body is just rejecting it. I am having chest pains and dizziness. I would love to proceed with the 10% per month taper plan and am willing to do this even if it means these symptoms continue and I can just get off of it. After reading through many posts on here I now realize that even when I get down to 0 my symptoms may continue. The out of network psychiatrist is really expensive and requires monthly visits for refills. I wish this was not a factor in my tapering plan but it is, I can't afford to see him for years (and this is the only way I can get the script compounded). 

 

 

I also am wondering if I made the right decision of not doing the Prozac bridge. Could this help alleviate my symptoms?  I am hesitant to start that and have another issue of tapering another med.

 

If you have read this far, thanks for staying with me, you are a trooper. I really appreciate this community and hope that by sharing my story it will help someone just like other's stories have been a tremendous help for me. If anyone has any tips for me I would greatly appreciate it! 

 

 

Peace & Love  to you all on with your own tapering journeys!

 

 

[jr0104]

Just wanted to add a quick question to my story. Ever since switching to the compounded version my symptoms are more prevalent (mainly the dizziness). Can the liquid form be stronger than the pill form or do you think this is because I decreased from 20mg to 19mg? I started this taper before I read the thread about not decreasing doses if you switch forms of the medication. Thanks!

[Shep]

Hi, Jr. 

 

Welcome to Surviving Antidepressants.

 

18 hours ago, jr0104 said:

I also am wondering if I made the right decision of not doing the Prozac bridge. Could this help alleviate my symptoms?  I am hesitant to start that and have another issue of tapering another med.

 

I think you made the right decision.  Nortriptyline is a tricyclic antidepressant, which is a different class of antidepressant than Prozac, which is a SSRI antidepressant. The Prozac Bridge is primarily for people on drugs like Paxil (SSRI) and Effexor (SNRI) and are struggling to come off. From what you've written, your struggles with your earlier attempt was due to a cold turkey. After you stabilize on the reinstatement, you may do quite well with a very slow taper off your current drug, nortriptyline.

 

It sounds like you've already done quite a bit of reading on this site, but since I don't know where you're at in your reading, I'll go ahead and place some links for you, just in case you haven't seen them. 

 

Tips for tapering off nortriptyline 

 

How psychiatric drugs remodel your brain

 

Healing from antidepressants. Patterns of recovery video (4 minutes)

 

The Windows and Waves Pattern of Stabilizat

 

It's possible you may have reinstated at too high a dose. Even though you were only off for 10 days from that 20 mg dose, your nervous system may have become more sensitive and is hyper-reacting to that same 20 mg dose. For more, please see:

 

About reinstating and stabilizing to reduce withdrawal symptoms 

 

Since you've already made a reduction at 19.5 mg, you may want to hold and see if you can stabilize at that dose. 

 

18 hours ago, jr0104 said:

The out of network psychiatrist is really expensive and requires monthly visits for refills. I wish this was not a factor in my tapering plan but it is, I can't afford to see him for years (and this is the only way I can get the script compounded). 

 

Since nortriptyline is soluble in water, you can make a liquid version of nortriptyline yourself by dissolving your pill in liquid. Please see:

 

How to make a liquid from tablets or capsules

 

Or you can weigh it using a scale:

 

Using a digital scale to measure doses

 

While we recommend going no faster than 10%, as you've already mentioned, you may want to consider a micro-taper and proceed even slower than that. 

 

Micro-taper instead of 10% or 5% decreases

 

The Brassmonkey Slide Method of Micro-tapering

 

We don't recommend a lot of supplements, as many members report their nervous systems are simply too fragile to handle them. However, magnesium and fish oil tend to be calming to the nervous system and many people report they do help. Please only add in one supplement at a time and at a small dose. For more, please see:

 

 King of supplements: Omega-3 fatty acids (fish oil)

 

Magnesium, nature's calcium channel blocker

 

 

Quote

 

Started 20mg Nortriptyline Nov. 2017. Stopped cold turkey (didn’t know not to) October 18th, 2017. Experienced crazy withdrawal and went back to 20mg on November 2nd. Withdrawal symptoms persisted. Got prescription compounded and started to taper on Dec. 31st 2017 to 19.5 mg

 

 

 

The above quote is from your signature. Are these dates correct? From what you posted, your cold turkey and compounded prescriptions were done in 2018, not 2017. Please update the dates in your signature if they are incorrect. 

 

Please continue to use this thread to document your taper and to ask plenty of questions. 

[Shep]

10 hours ago, jr0104 said:

Just wanted to add a quick question to my story. Ever since switching to the compounded version my symptoms are more prevalent (mainly the dizziness). Can the liquid form be stronger than the pill form or do you think this is because I decreased from 20mg to 19mg? I started this taper before I read the thread about not decreasing doses if you switch forms of the medication. Thanks!

 

Yes, you could be reacting to the switch from liquid to pill. We recommend a gradual switch, such as taking 75% of your dose in pill form and 25% in liquid, and then 50% / 50% and then 25% in pill and 75% in liquid, and then finally switching over completely to liquid.

 

By not doing that, you may be getting upticks in symptoms. 

 

And also, you may be reacting to the decrease. It's best to do a gradual switch and then hold for awhile before making any decreases.

 

It's also possible you didn't give yourself enough time to stabilize on the reinstatement after you'd been off for 10 days. Add in the couple days of Prozac and the on-and-off use of Klonopin and Xanax, and your nervous system is a bit rattled. 

 

I meant to add in my previous post a caution on Klonopin and Xanax - you can become dependent on these drugs in as little as 2 - 4 weeks, even with periodic use. So I'm glad you're being very careful with these drugs. 

 

Please keep updating and let us know how you're doing. 

[jr0104]

Shep,  thank you so much for your very thorough and thoughtful response (I know that took quite a bit of time to read through all of that and respond). I agree with everything you recommended. I think that is very good insight about me reinstating at too high of a dose- it definitely felt like a shock to my system! I will move forward with your recommendations to stabilize on my current dose and then slowly taper. I also appreciate the encouragement that it can be done! I will heed your warning about the benzos. I haven’t popped one in almost a month and will aim to add to that streak (last time I did my hands turned blue so that kind of scared me away from them- good thing I guess!) 😉 Thanks also for catching the type-o in the signature. I will edit! 

  

Much Appreciation,

JR  ❤️

[Carmie]

Hi jr, 

 

I just wanted to say welcome to SA from me too. I don’t have the brain power to read through your introduction at the moment, but when I can I will. 

 

We will all win this fight one day though. 

 

Sending hugs🤗

[ChessieCat]

22 minutes ago, jr0104 said:

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.

 

headaches and head pressure

 

[jr0104]

Hello fellow AD Conquerors,

 

Have any of you experienced a burning sensation on the top/sides of your head?  At my peak of withdrawal I experienced brain zaps but this burning sensation feels different and is a little unsettling. 

 

 

[ChessieCat]

Here are links to some topics which might have some information, or you could post something in them.

 

burning-skin-burning-feet

 

head-symptoms

 

paresthesia-pins-needles-numbness-tingling-burning-sensations-aka-neuropathy

[jr0104]

Hi everyone. I know this is an older thread but I hope it finds someone who has experience with the Prozac Bridge. My question is does it matter which time you take your original SSRI and Prozac? I am down to 15mg of Nortriptyline which I take at 5pm. While I wanted to avoid it I gave into the Prozac bridge and now am taking 5 mgs in the morning (I used to take them at the same time but forgot  a dose of the Prozac one night and ended up taking it the following morning.) I am wondering if it’s more effective taken together or is staggering ok? Thanks! 

[Altostrata]

Hello, jr. I moved your post here because we can't answer questions like yours without the context of your Introductions topic.

 

When did you add 5mg Prozac? What has been the effect?

 

There are potential drug-drug interactions, see https://www.drugs.com/interactions-check.php?drug_list=1734-0,1115-648&types[]=major&types[]=minor&types[]=moderate&types[]=food&types[]=therapeutic_duplication&professional=1

 

Have you had any of these effects?

[jr0104]

HI Alto,

 

Thank you so much for your response.  I am in awe of all of you Mods on here you take the time to reply to everyone and we greatly appreciate your time and attention!

 

After having a difficult time slowly tapering (following the 10% per month guideline) I still struggled with side effects (mostly dizziness and head pressure). My Psych advised me to bride with Prozac (which I initially tried to do without but started about 2 weeks ago on 5mg). Thank you for posting the interactions. Yikes! As of right now I do not have a lot of those symptoms but I did notice that my heart rate has gotten very low since starting the Prozac. I wear a Fitbit and the data shows the when I started the Prozac my average resting heart rate went down by about 10 beats per minute (into the 50's). Not sure if this is Ok or not. I don't notice any positive effects from starting the Prozac. Perhaps I just need to give it more time? 

 

Thanks for all you do!!!!!

 

JR

[Altostrata]

What did your doctor say about reducing nortriptyline?