Brainhole: Nortriptyline withdrawal while a hot mess

[Brainhole]

I am beginning a nortriptyline taper and cut from 20mg to 18mg two nights ago. I started nortriptyline 3 years ago for migraine prevention, post concussion issues and nerve pain. Fast forward to now. I have started having severe migraines much more frequently. I had brain surgery a year ago to remove a tumor. I also started having hemiplegic migraines (they can resemble a stroke or seizure). An ER trip for a migraine showed some EKG abnormalities. My neurologist and cardiologist said to start tapering off the nortriptyline as it might be causing cardiac issues and is obviously no longer helping with migraines. 

 

I am extremely worried about what I am facing. I went through benzo withdrawal 10 years ago and it was hell on earth. I also got off baclofen (affects gaba b receptors) in December after a 4 month taper. I have been told brain surgery takes 2 years for your brain to fully heal. I have a lot of stress in my life and other health issues. 

 

I have heard tricyclic antidepressants are a beast to get off of and am pretty scared. I am already struggling and not looking forward to another drug withdrawal. I have learned my body is quick to addict to meds and slow to regain normalcy after getting off them. 

 

Any help, guidance and support is very appreciated. I know from experience that doctors discount the severity of wd syndrome. 

Edited April 21, 2021 by Gridley

[Gridley]

Welcome to SA, Brainhole.

 

As you may know, we recommend tapering by no more than 10% of your current dose every four weeks.  Your taper from 20mg to 18mg falls within that guideline.  However, some people need to taper more slowly.  As you continue your 10% taper, you can gauge whether you need to slow down or not.

 

Why taper by 10% of my dosage?

 

This link is specifically about tapering Nortriptyline, including how to get the nonstandard doses you'll need for your 10% taper.

 

Tips for tapering off nortriptyline 

 

I have tapered a tricyclic (Imipramine) and the experience, though it caused symptoms, they were tolerable.  I tapered Imipramine before I discovered this site and tapered too fast (10% every three weeks) and didn't know about weighing with a scale so made my doses by "eyeballing" it.  Had I known how to taper properly according to the methods of this site, the taper would've gone more smoothly.  So I wouldn't be terrified.  I'm currently tapering a benzo via the 10% method and it's going well.

 

Here is some information about withdrawal and the healing process.  

 

What is withdrawal syndrome.

 

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

 

The Windows and Waves Pattern of Stabilization

 

When we take psychiatric medications, the CNS (central nervous system) responds by making changes over the months and years we take the drug(s). When the medication is discontinued, the CNS has to undo all the changes it made. Rebuilding the neurotransmitter production and reactivating the receptor and transporter cells takes time -- during that rebuilding process symptoms occur.  

 

These explain the healing process really well.

 

Brain Remodelling 

 

Video:  Healing From Antidepressants - Patterns of Recovery

 

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium and omega 3 (fish oil). Many people find these to be calming to the nervous system. 

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

Add in one at a time and at a low dose in case you do experience problems. Get supplements that are single ingredient (not mixed with other types of supplements).

 

This is your Introduction topic, where you can complete your drug signature, questions and connect with other members.  We're glad you found your way here.

 

 

 

 

 

 

 

 

Edited April 21, 2021 by Gridley

[Brainhole]

This is more of an update, than an introduction. I was advised to get off nortriptyline asap due to some heart rhythm abnormalities in April. In May I was diagnosed with Mixed Connective Tissue Disease (autoimmune). My neurologist wanted me to quit nortriptyline by dropping 1 pill (10mg) then dropping the second a week later. I knew that wouldn't work for me. I have been tapering faster than recommended but also being pushed by doctors to do so for health reasons. I also couldn't start plaquenil for my autoimmune disease until I am off nortriptyline. 

 

I am down to about 3 mg now and the last 2 weeks have been rough. Nerve pain, muscle pain, headaches, anxiety, intrusive thoughts, depersonalization. I plan to just pause where I am and do a slow liquid taper off the rest. I am already going rogue at this point as my doctors think I am completely off the med. I will add my heart rate and rhythm are back to normal. I have plenty to slow down the last 3 mg.  My question to those who are more experienced. Will a month long hold help? At what dose do you typically step off a tricyclic?

 

Thank you in advance for any help and positive feedback. 

 

Brainhole

[ChessieCat]

Hi Brainhole,

 

SA suggests listening to your body/symptoms and not the calendar.  It is also suggested to NOT make a decrease when you are experiencing withdrawal symptoms.

 

Stability

 

WDnormal

 

Moderator brassmonkey has written more about WDnormal in his Success Story:

 

tao-of-the-brassmonkey

[ChessieCat]

3 hours ago, Brainhole said:

At what dose do you typically step off a tricyclic?

 

There is no specific dose to make your final reduction.  It is a very individual thing.  But generally it is better to get below 1mg.

 

when-to-end-the-taper-and-jump-to-zero

 

I went to 0.0025mg Pristiq but that was because I was dealing with other non-antidepressant issues and didn't want to confuse things by stopping Pristiq and then wondering what was causing any issues.

 

Brassmonkey went to 0.016mg Paxil.