Pakadam Amitriptyline withdrawel/reinstating

[Pakadam]

Hi Everyone,

 

I'm glad I found this site, however maybe a little too late. 

 

I've recently come off amitriptyline (4 weeks ago) with withdrawel symptoms that have not yet resolved. The symptoms came on 6 days after ceasing and included nausea, panic attacks and headaches/brain zaps. The nausea resolved after 3 weeks and the brain zaps/headaches have reduced significantly. I still however have a lot of anxiety and regular panic attacks, my mouth is constantly dry and just don't feel quite right/stable. Insomnia has also been an ongoing symptom since ceasing: 2-3 hours each night.

 

I feel like I came off quite fast and am considering reinstating to stabilise and trying again at a later stage.

 

Would love some thoughts and advice from an y of the moderators. 

 

Thank you kindly, Pakadam 

[Pakadam]

Additional content added to my intro. 

[Altostrata]

Welcome, @Pakadam

 

What are the symptoms you're feeling now? How have they changed in the last week?

[composter]

Hi @Pakadam,

 

It does look like you have had trouble with tapers in the past, which is not uncommon. You may still be within the window to reinstate your medication and taper by tapering much more slowly. I encourage you to read through this link to understand the importance of 10% tapers.

Can you also share how you were making dose increments, such as 8 mg? Was this from a compounding pharmacy or were you weighing the tablets? 
 

I personally taper Amitriptyline using the liquid tapering method. You can dissolve 10 mg tablets into 10 mL water using a medical grade dosing syringe. And then draw up the dose you are taking with good accuracy.

Edited June 18, 2021 by composter

[Mia1]

I tapered off this drug completely about two months ago and know how challenging it can be. Daily meditation helped me with anxiety. My sleep is still disrupted but when I wake up I just focus on my breath. When thoughts come I just focus back on my breath. I do this until I fall asleep and I ALWAYS fall asleep. I just keep doing it for however long I’m up and I don’t worry about when I’m going to fall back asleep. Hope this helps!!

 

[Pakadam]

Hi Everyone, 

Thank you so much for the reply.

 

When I tapered from the 8mg I used a combination of capsules and liquid from a compound pharmacy. I knew to go slower than before so I dropped in 0.5 - 1mg lots every few days. This went ok and I only had minor symptoms. Sleep was generally good. When I got to 4.5mg the pain management team said "this is going well, let's speed it up". I was a bit worried but they reassured me that they do this all the time and that I'm safe. They were wrong.

 

For the first 3 weeks I had intense nausea and brain zap/shivers. Most of that has resolved.My symptoms in the last week have been extreme anxiety, panic, insomnia and constant dry mouth. I went to the emergency department 3 nights ago out of desperation. The pain management pain are trying to convince me it's all anxiety but I know it isn't. This is a much darker feeling than any anxiety I've experienced before. 

 

While I was waiting for my post to be approved I reinstated at 0.5mg as per the suggestion on the site. I have done this for 2 nights and didn't appear to have an adverse reaction. I could feel the presence of the medication but no significant change in symptoms. Sleep was a little better last night and I've had a couple of moments where the anxiety has reduced ever so slightly. 

 

I received a message from @composter who has advised me to reinstate at 4mg. I will do that tonight and see how things go. Composter also advised i might then need to decrease to 2mg depending on the reaction. What should I be looking out upon the 4mg reinstatement?

 

I should also mention that the doctors prescribed me valium to use during this time. I have not used this consistently as I'm aware of its addictive nature. It is something I don't really want to continue with from this point.

 

Thank you again and I await your thoughts and further advise.

 

Pakadam 

 

[Pakadam]

Hi again,

 

I've read through the importance of 10% tapers and understand this now. Thank you!

[composter]

Thanks for the update. Good to hear that you did not have any adverse reactions to reinstating to 0.5 mg for the past two nights.
 

I would leave the decision of what dose to reinstate up to you and how your body reacts. Perhaps a 2 mg reinstatement would be a good conservative approach for now. See if things improve, and then consider a 4 mg reinstatement if needed. If  you think you can handle a 4 mg reinstatement now you can do that. If your insomnia and anxiety improves that would be a good sign. 
 

Speaking from my experience, a reinstatement back to the full dose (10 mg) that I had been taking for several months was very helpful. However I was within a 2 week window of my taper. So your specific case may be different since you are 4-5 weeks out and you could benefit from a lower reinstatement. 

Edited June 19, 2021 by composter

[Pakadam]

Hi @composter. Yes, confirming that it has been 5 weeks since stopping and reinstating the 0.5mg dose.

 

I think I will be conservative and take a 2mg dose tonight. Will an adverse reaction be obvious? Anything in particular that I should look out for?

 

How long should I sit on the 2mg dose before considering increasing to 4mg?

 

The anxiety for the past couple of weeks has been very intense. I've had to take time off work. I am lucky to have good support through family and parents. 

 

For sleep, is melatonin use within SA guidelines?

 

Thank you so much:)

 

[Pakadam]

Hi again,

 

Perhaps just to rephrase my question: is an adverse reaction likely to appear soon after taking the drug, or the next day?

 

Thank you.

[composter]

4 hours ago, Pakadam said:

I think I will be conservative and take a 2mg dose tonight. Will an adverse reaction be obvious? Anything in particular that I should look out for?

An adverse or paradoxical reaction would be something like increased agitation and heightened symptoms. I believe this would show up within 24 hours of taking the dose. 

 

4 hours ago, Pakadam said:

How long should I sit on the 2mg dose before considering increasing to 4mg?

Perhaps 3-4 days to see if the 2 mg is making a difference. If it is not making much of a difference and you are not hypersensitive to that dose, then you can increase to 4 mg. The goal is to find a dose at which you do experience significant improvement to your symptoms but not too high that you would have an adverse reaction to. 
 

Again from my experience, when I reinstated after my withdrawal to half the original dose (5 mg) I didn’t experience much improvement to my symptoms. It was only after I reinstated back to 10 mg (original dose) that I noticed a marked improvement. Your optimal dose for stability might be lower than 8 mg but it might end up being 8 mg, because that was the most recent dose at which you felt stable. And as a result it is the dose that your nervous system is “molded” around. We prefer to try a stepped approach to avoid hypersensitivity. 
 

4 hours ago, Pakadam said:

For sleep, is melatonin use within SA guidelines?

You can review the thread on melatonin. Some members find they are hypersensitive to supplements but many are not. I personally found melatonin to be helpful for withdrawal-induced insomnia as well as Epsom salt foot soaks and chamomile tea. 

Edited June 19, 2021 by composter

[Pakadam]

Hi Everyone 

 

I decided to go with an even more conservative 1.5mg last night.  It didn't go well. I'm feeling very agitated and can't settle myself. It feels like an adverse reaction. I had a good day before taking the dose tonight and that was after taking 0.5mg last night. Should I return back to the 0.5mg dose as that seemed to be working?

 

Thank you,

[Pakadam]

Would love to hear from some of the moderators with advice on how to proceed.

 

Thank you.

[Strugglingmama]

Hello @Pakadam

 

I'm just curious how you are doing and what you ended up doing with the reinstatement? I came off nortriptyline (sister drug to amitriptyline) end of May and have been debating reinstating due to bad anxiety. Still can't fully decide.

 

 

[composter]

Hi @Pakadam, I am sorry to hear that the 1.5 mg was agitating. That is instructive for us that it’s probably best not to go to a higher dose reinstatement after 4 weeks off the drug. 
 

How are you doing now? Have you proceeded with a 0.5 mg reinstatement? 

[Pakadam]

I'm really not sure what to do. Would it be worth trying an even lower dose, such 0.3mg? Can that be enough in some cases? I need some stability.

 

Thanks,

Adam

 

 

[Altostrata]

Hello, @Pakadam. I would stay with 0.5mg. The 1.5mg dose will work its way out of your system over a few days. Your symptoms should decrease over this time. 

 

My approach is: If a little bit works, don't try to improve on it. Let your own body do the rest of the repair work.

 

[composter]

Let us know how you are doing when you get a chance @Pakadam. Like Alto said, your system should settle down soon from the 1.5 mg.

0.5 mg could be all you need for a reinstatement for your system to find some stability. Sending good wishes your way!

[Pakadam]

Hi @composter and @AltostrataSorry for the delay in my reply. Things have not been good. I ended up going to the ER due to extreme panic and anxiety along with body spasms and they referred me to a local crisis team. I didn't continue pursuing the reinstatement of the amitriptyline due to the severity of the situation. I started taking valium for the extreme anxiety and sleep. Although the valium helped things got a lot worse and I had to stop work and admitted myself to hospital: private hospital psych ward for three weeks. Very peaceful place that gave me and my family some respite. They started me on agomelatine/valdoxan and were not convinced that I felt my situation was due to ami withdrawal. I did have prior issues of anxiety/depression so perhaps not all of this is attributable to the ami withdrawal, but a large part of it feels like it is. The valdoxan doesn't appear to have done much and my sleep continues to be a serious issue. I tried thc/cbd oil and magnesium for sleep which helped a little but can only get a few decent hours if I take zopiclone. I've lost all motivation and interest in anything and still experience constant and debilitating anxiety. My family are extremely worried about my well being and lack of improvement. Prior to stopping the amitriptyline I was very active but now in bed most of the day. I am meeting with the psychiatrist tomorrow and want to insist on restarting the amitriptyline. I know I'm technically outside the usual window of reinstatement but not sure that things could be any worse. Would appreciate any advice, particularly in regard to the reinstatement. Am desperate and can't continue on like this. Thank you in advance.

[Pakadam]

Apologies if it feels like I'm asking the same thing as in my previous posts, but I'm struggling to know what to do. I understand it might be difficult to advise at this stage given the complexity of the situation. Thanks anyway in advance for any helpful thoughts. 

[Pakadam]

Hi @composter and @Altostrata, just another update. I saw a different doctor and psychiatrist this week and they recognised that what i'm experiencing is withdrawal. They instructed me to come off the valdoxan (only on for 3 weeks) and reinstate amitriptyline at 1mg for one week then increase to 2.5mg the next week depending on the response. I have done this for three nights and had no adverse reaction. Last night I actually fell asleep for 2 hours naturally which was the first time in a couple of months. I know this has been a wild journey for me and that you probably weren't sure how to respond to my previous posts. I just wanted to give you an update. Thank you and please let me know your thoughts, suggestions, if any. Thank you. 

[Strugglingmama]

@Pakadam

 I have been following your story and I want to say I’m happy you found a new doctor and glad to hear the reinstatement is going well. I replied previously that I’m withdrawing from nortriptyline. I see my doctor next week and am also going to discuss reinstatement. My biggest issue has been anxiety. I am 3 months out today so reinstatement is questionable for me at this time! 
 

Wishing you daily improvements ! 

 

[Pakadam]

Thanks for the @Strugglingmama. When I met with my doctor I armed myself with some compelling literature  including a journal article by @Altostrata. The doctor was very open minded and agreed with me that this was the situation. I think having that support have given me the confidence to reinstate. She was very careful to suggest starting at a low dose and increasing whilst monitoring symptoms. Because of my anxiety surrounding this, a member from the local crisis team comes to my home each night while I take the dose. They will do this for the next two weeks. There's been a lot that has happened, so much of it unnecessarily, but feeling like I'm on the right path. That moment of 2 hours of natural sleep was rarely the glimpse of hope that I needed. Hope it goes well for you and will keep you updated. 

[Pakadam]

BTW @Strugglingmama, I read several stories on a Facebook group of ppl reinstating several months after ceasing. One particular member reinstated 9 months after ceasing with complete success. For me I had to way up the pros and cons. I felt I had nothing to lose as things could have not gotten any worse. 

[Strugglingmama]

@Pakadam

 

that is wonderful to hear! Please keep me posted. All the best to you! 

[Altostrata]

3 hours ago, Pakadam said:

Hi @composter and @Altostrata, just another update. I saw a different doctor and psychiatrist this week and they recognised that what i'm experiencing is withdrawal. They instructed me to come off the valdoxan (only on for 3 weeks) and reinstate amitriptyline at 1mg for one week then increase to 2.5mg the next week depending on the response. I have done this for three nights and had no adverse reaction. Last night I actually fell asleep for 2 hours naturally which was the first time in a couple of months. I know this has been a wild journey for me and that you probably weren't sure how to respond to my previous posts. I just wanted to give you an update. Thank you and please let me know your thoughts, suggestions, if any. Thank you. 

 

2 hours ago, Pakadam said:

Thanks for the @Strugglingmama. When I met with my doctor I armed myself with some compelling literature  including a journal article by @Altostrata. The doctor was very open minded and agreed with me that this was the situation. I think having that support have given me the confidence to reinstate. She was very careful to suggest starting at a low dose and increasing whilst monitoring symptoms. Because of my anxiety surrounding this, a member from the local crisis team comes to my home each night while I take the dose. They will do this for the next two weeks. There's been a lot that has happened, so much of it unnecessarily, but feeling like I'm on the right path. That moment of 2 hours of natural sleep was rarely the glimpse of hope that I needed. Hope it goes well for you and will keep you updated. 

 

Good to hear you've found an understanding doctor, @Pakadam I hope you've helped educate all of your doctors.

 

I would like to remind you:

 

On 6/22/2021 at 3:47 PM, Altostrata said:

....

My approach is: If a little bit works, don't try to improve on it. Let your own body do the rest of the repair work.

 

 

As explained before, it will take some time for a dose of amitriptyline to ramp up to full effect. If you keep on increasing it, it may become too strong for you, as it did before.

 

Doctors have a different perspective on this and may be inclined to more aggressively treat your withdrawal syndrome. This can be a mistake.

[Pakadam]

Hi @Altostrata, thank you very much for your reply and reminding me of being cautious about increasing.

How long should I give the 1mg to take full effect?

In the event that more improvement in symptoms is needed how should I increase to avoid any adverse reactions?

 

Thank you kindly.

[Altostrata]

Amitriptyline takes 3-8 days to fully take effect. It would be a good idea to see how you do for a week before making a decision to increase. You cannot expect to be quickly returned to a pre-withdrawal state, it make take some time for your nervous system to settle down.

[Pakadam]

Great  thank you @Altostrata. I'll sit on this dose for one week, see how things go and provide an update to see where to go from there. Thank you again. 

[Strugglingmama]

@Pakadamjust wanted to check in to see how you are doing? 

[Pakadam]

Hi @Strugglingmama, thanks for checking in. It's possibly a little early to tell but have had some improvement with sleep which I take as a good sign: getting to sleep, which prior to the reinstatement was not happening. 

Have had some random headaches during the day but only mild-moderate, and certainly not any other alarming or adverse reactions. Exercise is not good for me atm as the nervous system is pretty sensitive to any cardio work. Certainly missing jogging and hope that I can return to that over the next couple of months once more stable. A gentle walk each day plus qi gong is all I can manage right now.

Tonight will be day 7 of the reinstatement.

@Altostrata and @composter, how does thus appear to be going from your knowledge and experience?

Thank you. 

[Pakadam]

My mood feels like it's levelled out a little more today aswell: no moments of despair and a lift from some of the depressive symptoms of the past few weeks. Fingers crossed the improvements continue! 

[Pakadam]

Sorry, one more thing:) I've been having regular acupuncture treatments as well which helps. I can feel my nervous system calming down a little during the treatments which gives me hope and the willingness to not give up and to keep going:)

[PsychologicalSafe15]

@Pakadam Are you having vivid dreams ?

[Altostrata]

A little improvement is a good sign. Let it work. Please update your signature and let us know how you're doing.

[Pakadam]

@PsychologicalSafe15 sometimes yes. I track my sleep using a fitbit so the dreams usually happen if I wake in the middle of the night, then back to sleep and wake during a REM cycle.