Witsend: desperate for advice

[Witsend81]

Thank you both 

It seems like each day I have a predominant amplified emotion.  Yesterday it was feeling 'on edge'.  Today sinking sadness...

 

I'm just let the emotion sit on my shoulder while I try my best to get on with life.  Doesn't help that my son keeps disturbing me at night either...

[Witsend81]

Thurs 4 July

Slept well until son woke me up, struggled to get back to sleep.

Anxiety 6/10, burning sensory symptoms.

6.30am 15mg promazine 

7am 50mg sertraline 

Anxiety 5/10, burning sensory symptoms gone.

9am Irritable anxiety 5/10

12.30pm 20 mg promazine

1pm Anxiety 4/10

3.30pm Anxiety 3/10.  Feel numb, empty.

7pm Anxiety 2/10

8pm 20mg Promazine

9pm Anxiety 1/10

10pm Bed

[Sassenach]

Hello wits end

Out and about at the moment will contact you when I get back

You are going to be fine but but there is no reason why you should not feel the need for some support.

Do you have to go back to work next week?

Sassenach

[Sassenach]

@manymoretodays

 

Hi Witsend

On Wed 3rd you had not begun your promazine taper so it could not be responsible for you symptoms .

You began the taper yesterday 4th.

The symptoms you are experiencing sound like withdrawal.

What do you mean by sensory symptoms ie. which senses?

As you started Sertraline on 17th June we would expect that to be effective by now.

The fact that the Promazine taper is in the equation means it needs one of the supermods.

Good job on keeping your notes up to date.

I was asking about your return to work as any pressure or stress can exacerbate symptoms.

If you can answer the above questions it will mean your responses will be available to the bosses

 

Sassenach

 

 

[Witsend81]

Hi Sassenach

 

I've got a sick note from work for the next two weeks.  I'm hoping I'll be better enough to go back by then, feel really guilty about it all.

 

The burning sensory symptoms aren't new - they started when I restarted the citalopram back at the beginning of June.  They are like burning down my arms and into my hands, accompanied by a feeling of dread.  These happen less often now and of a lesser intensity.

 

I don't think the sertraline is fully effective no, but if I compare myself to this time last week, I have improved somewhat.  

 

Today is my second day of reduced promazine and I don't feel any worse for it.

 

Witsend

[Sassenach]

Hi Witsend

Manymoretodays has been looking at your posts above and will contact Alto tonight.

You are actually coping very well and better than most.

You will get better but as you observed there are ups and downs.

And this is what I mean about pressure.

13 minutes ago, Witsend81 said:

feel really guilty about it all.

It says a great deal about your personality but will not help you improve.

You have two weeks, concentrate on yourself and your son, relax, follow some of Manymoretodays suggestions which she is preparing now.

If you feel overwhelmed or just want to let off steam come on here and do so, someone will understand.

We are here to help you through this, we have all been there and know that sometimes our brains simply refuse to be logical.

Have a good evening.

 

 

Sassenach

[manymoretodays]

Good job Witsend!

Burning skin, burning feet

This can be a fairly common WD symptom.  And could be due to some autonomic nervous system dysfunction. 

 

8 hours ago, Witsend81 said:

Thank you both 

It seems like each day I have a predominant amplified emotion.  Yesterday it was feeling 'on edge'.  Today sinking sadness...

 

I'm just let the emotion sit on my shoulder while I try my best to get on with life.  Doesn't help that my son keeps disturbing me at night either...

 

Ayup.  Neuroemotions.

So, that's pretty normal WD.  And that sounds good, to let the emotion sit on your shoulder while do your best.  How old is your son?  Is school out, if he is that age?  That can make it tougher, when you are doing this.  I'm hoping that the work break helps you as well.  Do you have some friends, family that pitch in every now and then?  Are you able to pursue any of your own interests right now.  Hobbies, music, art.  Do try for a walk everyday if you can.

 

8 hours ago, Witsend81 said:

Thurs 4 July

Slept well until son woke me up, struggled to get back to sleep.

Anxiety 6/10, burning sensory symptoms.

6.30am 15mg promazine 

7am 50mg sertraline 

Anxiety 5/10, burning sensory symptoms gone.

9am Irritable anxiety 5/10

12.30pm 20 mg promazine

1pm Anxiety 4/10

3.30pm Anxiety 3/10.  Feel numb, empty.

7pm Anxiety 2/10

8pm 20mg Promazine

9pm Anxiety 1/10

10pm Bed

 

Today is day 2 then.  Of the 5 mg reduction in the promazine.

 

I agree.  I think you are doing great!  Not to downplay that this IS tough stuff.  Be very patient and kind with yourself right now.

It's going to take a bit for your nervous system to settle, from some of the changes last month. 

 

L, P, H, and G,

mmt

 

 

[Witsend81]

Thank you both 🙂

 

My son is nine, he is hard work (aren't they all).  Luckily his dad knows the situation and he stays with him a lot.

 

School hols at the end of the month, hopefully will be more stable by then 🤞

 

I'm my own worst enemy as far as patience is concerned, to a certain extent it helps because I push myself to move forward, but I've got to accept this process is going to take time, as you say.  I'm not going back to work until I'm sure I can handle it, after all, there's a lot at stake here.

 

Thank you again 

[enrico2910]

Witsend81, 

 

I know this drug pretty well ad I have been taking it for 9 years as you.  I tapered very smootly from 80mg to 20 mg.  Look at this graph that explains the SERT (serotonin trasporter) occupancy of citalopram. At dose of 40mg per day, citalopram occupies 87% of SERT.  At 20mg occupies 80%. So from 40 mg to 20mg you have just reduced occupancy of 7% (It's easier for your brain to adjust). But from 20mg to 10mg you pass from 80% to 70% (minus 10%), let's say easy but a little bit complicated for your brain to adjust. From 10mg to zero you pass from 70% to 0%. Very very very difficult for your brain to adjust in little time. 

 

For sure your brain will adjust soon to the new dose. Have patience. Once I went to Dubai for job (2 weeks) and over there antidepressant are not allowed. So I stayed 2 weeks without a megadose of 80mg. When I came back I was devastated but my brain and I assure you (your brain too) will adjust soon. Our brain is a fantastic machine. 0.5mg of melatonin 1hour before sleeping helped me a lot during that period. 

 

 

[Sassenach]

Good morning Witsend.

 

Hope today starts well and gets better.

Enrico's info is useful but do not consider adding drugs without medical advice.

I know you are too sensible to do so but we must point it out.

If you need  owt we are here.

Sassenach

[Witsend81]

Hi Enrico

 

Thanks for your input.  I'm actually on sertraline now after my GP swapped me - I had a reaction when I tried to reinstate citalopram at 10mg (I see from your signature similar happened to you when you first started taking citalopram in 2009).

 

I'm beginning to stabalise on the sertraline, I think, but it's a slow journey.  

[Witsend81]

Ay-up Sassenach

 

Noted.  Definitely avoid rocking the boat at this stage.

 

BW

[enrico2910]

1 hour ago, Witsend81 said:

Hi Enrico

 

Thanks for your input.  I'm actually on sertraline now after my GP swapped me - I had a reaction when I tried to reinstate citalopram at 10mg (I see from your signature similar happened to you when you first started taking citalopram in 2009).

 

I'm beginning to stabalise on the sertraline, I think, but it's a slow journey.  

 

Oh I didn't understood (really sorry) you swapped to sertraline. Yes definitely you have to stabilize. I though you were struggling to reinstate citalopram.

 

It happend. A stupid doctor gave me 20mg of citalopram for the very first time. Too much. I then re-started with an other doctor gently 1 drop (2mg) per time. 

[Sassenach]

Hi Witsend

Ay-up to you too.

Please do not forget yesterday's diary.

I'm worse than having your mum nagging you😁

How have your symptoms been today?

Thursday was sensory and anxiety.

Are these still with you.

Hope you are enjoying the good weather.

 

Sassenach

[Witsend81]

Hello from sunny Manchester ☀️☀️☀️

 

Friday 5 July

Slept ok. Vivid upsetting dreams.

6am Awoke, a few cortisol spikes but managed to settle.  Anxiety 4/10, sadness 5/10.

6.30am promazine 15mg

7am 50mg sertraline 

10.30am  Tired and irritable.  Anxiety 3/10.

Went out for a long walk.

12pm  Sadness/emptiness 6/10

12.30pm  20mg promazine

4pm  Negative emotions mostly subsided.  Tired.

8pm 20mg promazine

Feel more relaxed, very tired.

9pm Bed

 

Today I've felt less in the way of sadness, but have felt quite empty and spaced out.  Seem to be on a merry-go-round of symptoms.

 

[Witsend81]

It must be my crazy brain trying to recalibrate, I think by the afternoon it gets tired and decides to down tools.  Certainly don't feel worse, but each day brings it's own unique challenges.

[Sassenach]

Hi Witsend

 

You are doing all the right things particularly taking exercise and getting out. It can be hard but it helps.

Easier for me, have a dog who insists.🐕

The purpose of reinstatement is to reduce symptoms to a bearable level, not necessarily  to zero, but it does happen.

It sounds as though you are doing a good job of coping with them if that ceases to be the case please advise me.

The symptoms do come and go but as long as your baseline improves, hence one of the needs for your diary, you are on the right track.

The symptoms are WD related and you will find you tire more easily, it is normal.

You are also tapering a med which your CNS has to adjust to.

Overall I think you are coping really well and your positive attitude does you credit.

Enjoy the sun

 

Sassenach

[Witsend81]

Daww 😊 

 

Sat 6 July

Slept ok, woke 4.30am but eventually got back to sleep

6.30am Awoke, anxiety 3/10

6.45am 15mg promazine

7am 50mg sertraline 

7.30am Heart rate increased and burning sensations 

8am Anxiety/depression 4/10

9.30am  Anxiety/depression 3/10

10.30am Yoga.  A bit shaky.

11.30am Anxiety/depression 1/10

12pm 20mg promazine

3.30pm Spaced out and tired

6pm  Relatively relaxed

8pm 20mg promazine

9pm  Tired/headache but relaxed.

10pm Bed

[Sassenach]

Hi Witsend

 

Thanks for your diary.

Looking pretty good on percentage scale, how would you descibe the day overall?

Are you due another reduction tomorrow? If so take note whether you feel noticeably different.

I'm guessing you were an excellent school student😤.

Hope you have enjoyed the sun this weekend and had some time with your son.

 

Regards

 

Sassenach

[Witsend81]

Hi Sassenach

I reduced the midday promazine by 5mg today (a day early, which is my mistake). 

 

Felt really zombified this afternoon, and tired (but this seems to be a recurring theme now in the afternoon).  Still went out though, went to the park with a friend.  Felt a bit disconnected really.  

 

Yes, definitely a swot 😇

[Sassenach]

Did you feel ok this morning?

[Witsend81]

Anxious and restless, maybe a little more so, but not markedly so.

 

It was today's midday promazine that I reduced, which will appear in the notes tomorrow.  This afternoon I did feel quite depressed, probably because I felt so tired and zomied out, but that has lifted now. 

[Sassenach]

10 minutes ago, Witsend81 said:

Anxious and restless

 

10 minutes ago, Witsend81 said:

depressed

Unfortunately normal in WD but you are coping well if you include the Promazine reduction.

Incidentally your marks out of ten are a great help as they define the degree rather than just the symptom, even allowing for our minds fluctations.

We all make dosage mistakes. I took double dose of Escitalopram last week. I blamed the dog, what was your excuse.

As long as we do not make a habit of it only a bump in the road.

 

Sassenach

 

Edited July 7, 2019 by Sassenach
error

[Witsend81]

Thanks for your support, it's been invaluable.  I don't feel so alone in what I'm going through and that's made all the difference 😊

 

Have a lovely sunny evening 

[Sassenach]

That's what we are here for. You too.

[enrico2910]

3 hours ago, Witsend81 said:

Thanks for your support, it's been invaluable.  I don't feel so alone in what I'm going through and that's made all the difference 😊

 

Have a lovely sunny evening 

 

You are doing great! It will be stabilized soon and this period will pass. Be patient.

Good night.

E.

[Witsend81]

I really hope so Enrico 🤞

 

Sun 7 July

Slept ok (awoke midnight but went back to sleep)

5.30am Depression/anxiety 4/10.  Increased heart rate/muscle twitches

6.30am 15mg promazine

7am 50mg sertraline 

10 am Restless/agitation 5/10.  Dizziness.

12pm 15mg promazine 

2pm Spaced out/muzzy head 6/10

4pm  Spaced out/depression 6/10

6pm Tired but symptoms subsiding

8pm 20mg promazine 

9pm Anxiety/depression 1/10

10pm Bed

 

Hoping today will be a bit better, it was a tough day.  

[Sassenach]

Good morning Witsend

 

Sorry it was rough yesterday.

how do  you feel this morning?

 Sassenach

[Witsend81]

Morning Sass

 

Not too bad currently.  I'm just reminding myself this is a waiting game and I need to be patient...I'm certainly better this morning compared to this time last week.  This time last week I was sat on the end of my bed crying!  

[Sassenach]

Good.

Your mental strength and clarity are great assets.

Try and get some exercise today, it really does help although may be hard at the time.

Enjoy as best you can

[Sassenach]

Hi Witsend

10 hours ago, Witsend81 said:

Morning Sass

Have you been viewing Longroadhome's thread

How has today developed, no crying I hope?

Got the brain fog today but am I correct in thinking you are now down to 50mgs of Promazine and if so please update your drug signature.

 

Sass

[Witsend81]

Hello Sass

1 hour ago, Sassenach said:

 Have you been viewing Longroadhome's thread

No, but I will now!

 

No more crying 👍

 

Bit irritable and agitated this morn, but this afternoon/evening, feeling pretty ok

 

I'm thinking about returning t' mill next week, on phased return.  I'll see how the rest of the week plays out.  If I can handle it, it will help take my mind off things.

 

Signature updated 😇

[Sassenach]

She is the other person who calls me Sass.

If you going to look at her thread, don't do it unless you're broadminded😈

 

Sass

[manymoretodays]

Hi Witsend,

On 7/3/2019 at 1:10 PM, Altostrata said:

I suspect the promazine is making you tired. It is also a high-risk drug. Since you're taking 60mg a day (please verify this is so), your taper of 5mg every 4 days sounds reasonable to me. I would eliminate the morning dose first, then work on the afternoon dose.

 

Be sure to keep daily notes while you're doing this. If you get withdrawal symptoms, you'll have to go lower.

 

Please let us know how you're doing.

 

On 7/7/2019 at 10:28 AM, Witsend81 said:

Hi Sassenach

I reduced the midday promazine by 5mg today (a day early, which is my mistake). 

 

Felt really zombified this afternoon, and tired (but this seems to be a recurring theme now in the afternoon).  Still went out though, went to the park with a friend.  Felt a bit disconnected really.  

 

Yes, definitely a swot 😇

 

Why are you starting to reduce the midday promazine?  Instead of continuing with decreasing the morning dose and then eliminating it?

And including another couple of days notes from you below here too:

Friday 5 July

Slept ok. Vivid upsetting dreams.

6am Awoke, a few cortisol spikes but managed to settle.  Anxiety 4/10, sadness 5/10.

6.30am promazine 15mg

7am 50mg sertraline 

10.30am  Tired and irritable.  Anxiety 3/10.

Went out for a long walk.

12pm  Sadness/emptiness 6/10

12.30pm  20mg promazine

4pm  Negative emotions mostly subsided.  Tired.

8pm 20mg promazine

Feel more relaxed, very tired.

9pm Bed

 

Sat 6 July

Slept ok, woke 4.30am but eventually got back to sleep

6.30am Awoke, anxiety 3/10

6.45am 15mg promazine

7am 50mg sertraline 

7.30am Heart rate increased and burning sensations 

8am Anxiety/depression 4/10

9.30am  Anxiety/depression 3/10

10.30am Yoga.  A bit shaky.

11.30am Anxiety/depression 1/10

12pm 20mg promazine

3.30pm Spaced out and tired

6pm  Relatively relaxed

8pm 20mg promazine

9pm  Tired/headache but relaxed.

10pm Bed

 

Sun 7 July

Slept ok (awoke midnight but went back to sleep)

5.30am Depression/anxiety 4/10.  Increased heart rate/muscle twitches

6.30am 15mg promazine

7am 50mg sertraline 

10 am Restless/agitation 5/10.  Dizziness.

12pm 15mg promazine 

2pm Spaced out/muzzy head 6/10

4pm  Spaced out/depression 6/10

6pm Tired but symptoms subsiding

8pm 20mg promazine 

9pm Anxiety/depression 1/10

10pm Bed

 

I may go ahead and ask for futher input here, from the other mods, as well.

And thankyou Witsend for the continued notes!

 

L, P, H, and G,

mmt

 

 

 

 

 

[Altostrata]

I'm sorry, promazine was a terrible choice by your doctor. There may be no painless way to go off it. I would reduce it as quickly as tolerable.

 

I am worried about this potential cardiac interaction with sertraline:

 

On 7/2/2019 at 9:56 AM, Altostrata said:

....

Promazine-sertraline interactions https://www.drugs.com/drug-interactions/promazine-with-zoloft-1948-0-2057-1348.html?professional=1

....

 

Quote

 

Interactions between your drugs

Moderate

promazine sertraline

Applies to: promazine and Zoloft (sertraline)

MONITOR: Theoretically, concurrent use of two or more drugs that can cause QT interval prolongation may result in additive effects and increased risk of ventricular arrhythmias including torsade de pointes and sudden death. The risk of an individual agent or a combination of these agents causing ventricular arrhythmia in association with QT prolongation is largely unpredictable but may be increased by certain underlying risk factors such as congenital long QT syndrome, cardiac disease, and electrolyte disturbances (e.g., hypokalemia, hypomagnesemia). In addition, the extent of drug-induced QT prolongation is dependent on the particular drug(s) involved and dosage(s) of the drug(s).

MANAGEMENT: Caution and clinical monitoring are recommended if multiple agents associated with QT interval prolongation are prescribed together. Patients should be advised to seek prompt medical attention if they experience symptoms that could indicate the occurrence of torsade de pointes such as dizziness, lightheadedness, fainting, palpitation, irregular heart rhythm, shortness of breath, or syncope.

 

 

Your taking promazine and sertraline more or less together in the morning may be causing those heart rate symptoms and other unpleasant symptoms you feel about 10 a.m.

 

I would continue to reduce the morning dose of promazine, maybe down to 5mg to so to minimize the risk of breakthrough withdrawal from it, then work on the other doses.

[Witsend81]

Good morning all.

 

I decided to reduce the midday dose next as I get very tired in the afternoon - think promazine contributing to that, and leave evening dose alone.

 

I'm very worried about this drug also, is it reasonable to knock off 5mg a day?  I will knock a dose off today and see how I go.

 

I know one of the side effects of the sertraline is increased heart rate and dizziness - I hope this subsides, but admittedly it's the same as ever this morning.  I am prone to low blood pressure and dizziness - this was a problem whilst on the citalopram also.

 

Also getting a lot of muscle twitches in the morning.

 

Best wishes and thanks again for your input