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Kairos: gradually improving after serotonin toxicity


Kairos

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Hi there,

 

So I've been lurking on here for the past few months, and some of the advice and reassurance I've been getting from reading threads here has really helped turn things around for me after a truly hellish time, so I wanted to lead with thanking you all for that. It's been nice just to not feel alone in all of this. Now, I'll get into some of my history.

 

I started out taking 50 mg of sertraline after a deep depressive episode that I'd been trying and failing to fight through alone for years in about 2016. I took sertraline for a few years, and started having what brief blackouts for a few seconds or less. This was pointed out to me while I was driving with a family member, and ran a light that I hadn't even realised I'd gone past. 

 

After the sertraline struggles, I went on 75 mg of venlafaxine, which didn't really help my depression and I started to feel much worse mentally and really struggling with insomnia. 

 

In January of 2019, I was prescribed mirtazapine to help these symptoms, I started out on a low dose, and we later upped it to 30 mg. This helped greatly for years. I started sleeping fully, and gradually found some emotional stability, with maybe some minor side-effects, dry mouth, appetite fluctuations, morning grogginess, but that was about it.

 

I still don't know if these two things are related or not, maybe I was just unlucky? However, in June of 2021, I was feeling extremely emotionally happy. But I started to notice tinnitus and a constant feeling of fullness and pain in my ears. I was prescribed a course of antibiotics, but they didn't really help. I later saw an ENT specialist who diagnosed me with eustachian tube dysfunction. A few months later, I started having a feeling of tightness in my chest, trouble breathing, irregular heartbeats, etc. A few ECG tests after a trip to my GP indicated I had pericarditis. After two weeks of ibuprofen, I was supposedly in the clear. And I was, for a little bit, but then I started having more chest pains, tightness, and palpitations again, along with frequent burping, abdominal discomfort, cycling between diarrhoea and severe constipation for several days at a time. I was also having a lot of vision problems (significantly increased floaters, particularly when I look at a bright or white light source, redness, dryness, and photosensitivity). A 72-hour ECG came back mostly clear, and doctors told me I probably had sinus arrhythmia, which is quite normal and usually completely asymptomatic. My blood pressure was normal too. I was put on omeprazole for acid reflux, which helped for a while, but I eventually ran out. Since my gastrointestinal symptoms had settled, I was told to just ride out the chest issues, and that they were likely anxiety.

 

I tried this for a while, and then I started experiencing some other things, sudden leg and arm twitches, tremors, closed-eye hallucinations when sleeping, increased heart palpitations, neck stiffness, and headaches and tenderness at the back of my head. Having researched some of these symptoms to try and figure things out, I spoke to my doctor, who inspected me for signs of infection as a lot of these symptoms lined up, except for the closed-eye hallucinations and tremors. I was told there was nothing wrong. I brought up the potential of having an adverse reaction to the mirtazapine, and he recommended we wait a little longer. 

 

I came back a few weeks later with a lot of the same symptoms as well as sharp pain in my kidneys, increased urination at night, extreme anxiety and agitation, and a return of my gastrointestinal issues, whilst still having all of the other issues. I was given a prescription for a lowered dose of mirtazapine to 15 mg and told to taper over the course of a month. By now, it was December. I'd already started to try to improve my diet and improve some of my habits to manage my acid reflux after the pericarditis scare, no coffee (god, I miss it), no alcohol, much better eating habits, and daily exercise through brisk walking/jogging on the treadmill. This helped a little, but while exercising one night, I felt faint after only five minutes, and had severe chest pain, which hadn't happened before. I stopped and called my local hospital's non-emergency number and explained my symptoms and history. I was taken in via ambulance, inspected by paramedics and quickly examined. A brief ECG while I wasn't having palpitations and a blood test returned normal, so I was told something my chest pain and tenderness was "maybe something muscular" and released.

 

I continued to take my lowered dose, and noticed an increase in whatever muscular chest pain I was having, an overall feeling of dullness throughout my body, increased tremors, acid reflux reaching my throat and causing vocal instability, temperature sensitivity, and a lot of brain fog. One night, I stayed up a little later than usual, and noticed that some of the brain fog and dullness eased significantly for a while. I took my dosage before bed and woke up the next day feeling as awful as I had before. I discussed this as a phone appointment with another doctor at my GP surgery, and was advised to stop the mirtazapine immediately without completing the taper. I did so, and felt significantly better for a few days.

 

Then, I guess the withdrawal symptoms must have caught up with me, because a lot of the feelings I'd had returned with a vengeance. Although I stopped having the hallucinations, improved photosensitivity, tremors, full-body dullness, chest tightness, and brain fog, my acid reflux and indigestion got even worse, and I started having nerve pain, symptoms that seem to line up with peripheral neuropathy, constant gurgling in my legs, loss of appetite, extreme anxiety, heart palpitations that felt completely different to the previous ones, and a complete inability to sleep. After a few days of this, I had sharp chest pain after a sudden palpitation that radiated to my left arm. And then I started struggling to breathe. I returned to hospital, was inspected again, returned normal tests (although they had issues drawing blood from my arms), and was sent home again, being told that it was probably indigestion and my breathlessness was a result of a panic attack on the journey to hospital. After discussing my SSRI withdrawal, the hospital advised me to see my GP and restart omeprazole now that I'd been off my mirtazapine for a few days.

 

It's been about a month since I was in the hospital there, and I can say with certainty that things are getting a lot better. I'm no longer having heart palpitations, my flank pain is mostly gone, I haven't had that full-body nerve pain for a while, my appetite's back, and my anxiety's at least manageable now, a lot of the peripheral neuropathy symptoms are improved, I'm sleeping for at least 4 hours on my worst nights, and I think my tinnitus is finally improving. I'm still suffering with increased urination at night, that gurgling sensation in my legs, irregular heartbeats/inconsistent heart rate, bradycardia, constant tiredness, acid reflux/indigestion (I'm on omeprazole again now, but I'm still having some symptoms), as well as some strange pains in my neck and back, mild muscular pains, a nasal drip and occasionally runny nose, an intermittent cough, and most recently a new kind of chest pain around my sternum that only seems to flare up occasionally (possibly costochondritis, or heartburn, but I'm medically undiagnosed at the moment so it's hard to say for sure). That's most of it, at least, there might be a few other minor things I'm forgetting or I don't think are related to withdrawal, but we're gradually unpicking all of these issues. As for things that have helped me, I'm taking a marine magnesium supplement every night that seems to really calm me and help me sleep, and prevent the nerve pain. I've also found that CBD oil or tea seems to help calm my anxiety and nerves during the day, a hot bath does absolute wonders, and the jogging was helping to stabilise my heart rate from some worrying inconsistencies into something manageable as well as calming some symptoms. 

 

It seems every week or few days or so, some old symptom goes away and a new one takes its place, and while I absolutely hate the uncertainty and constant change, things do seem to be getting better overall. That being said, I've felt pretty rough today, this new chest pain's been taking the wind out of my sails and got really bad after I used the treadmill yesterday, so I've decided to avoid that strenuous exercise until it settles. I've discussed it with my doctor and we're keeping an eye on it for now. Things still feel quite worrying and challenging, but nowhere near as terrifying as they used to be, for at least a solid month I had no idea what was going on, and I was convinced this all might kill me. The advice I've found here so far has really helped. I just wanted to share my story, provide some advice for anyone else who is still struggling, reassure anyone else out there that it does get better, and see if any more experienced people on this forum had any advice or similar experiences with the issues I'm still having. Thanks for reading and all the advice!

 

Kairos

Edited by Karma
name update

February 2016 - 50 mg sertraline after major depressive episode

June 2019 - Switched from sertraline to 75 mg venlafaxine after discovering negative reaction

January 2019 - Switched to 15 mg mirtazapine for insomnia

Summer 2019 - Mirtazapine dosage increased to 30 mg due to continued insomnia

December 2021 - Constant medical issues throughout 2021 eventually indicate serotonin toxicity, tapered to 15 mg mirtazapine for 5 days

December 2021 - Continued acceleration of symptoms and seeking medical advice prompted cold turkey cessation

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  • ChessieCat changed the title to Callum: Gradually Improving after Serotonin Toxicity
  • Moderator

Welcome to SA @Kairos

What a scary set of events with adverse reactions and withdrawal. Hopefully that is the last of it but be aware that you may have a windows and waves pattern of symptoms - it might get better, then worse again, then better again. 


Can I ask you to write your signature so we can have your drug history to advise if you need advice and for others to see what you have been on and overcome? Here is how you'd do it: 

How to List Drug History in Signature - Introductions and updates - Surviving Antidepressants

 

These links can help explain some of what was happening to you, in case you haven't seen them yet: 

The Windows and Waves Pattern of Stabilization - Symptoms and self-care - Surviving Antidepressants

What is happening in your brain? - Symptoms and self-care - Surviving Antidepressants

How psychiatric drugs remodel your brain - Symptoms and self-care - Surviving Antidepressants

 

So glad you found your way to us! Welcome to our lovely community, 

OMW 

Edited by Karma
name update

"Nothing so small as a moment is insurmountable, and moments are all that we have. You have survived every trial and tribulation that life has thrown at you up until this very instant. When future troubles come—and they will come—a version of you will be born into that moment that can conquer them, too." - Kevin Koenig 

 

I am not a doctor and this should not be considered medical advice. You can use the information and recommendations provided in whatever way you want and all decisions on your treatment are yours. 

 

In the next few weeks I do not have a lot of capacity to respond to questions. If you need a quick answer pls tag or ask other moderators who may want to be tagged. 

 

Aug  2000 - July 2003 (ct, 4-6 wk wd) , citalopram 20 mg,  xanax prn, wellbutrin for a few months, trazodone prn 

Dec 2004 - July 2018 citalopram 20 mg, xanax prn (rarely used)

Aug 2018 - citalopram 40 mg (self titrated up)

September 2018 - January 2019 tapered citalopram - 40/30/20/10/5 no issues until a week after reaching 0

Feb 2019 0.25 xanax - 0.5/day (3 weeks) over to klonopin 0.25 once a day to manage severe wd

March 6, reinstated citalopram 2.5 mg (liquid), klonopin 0.25 mg for sleep 2-3 times a week

Apr 1st citalopram 2.0 mg (liquid), klonopin 0.25 once a week (off by 4/14/19- no tapering)

citalopram (liquid) 4/14/19 -1.8 mg, 5/8/19 - 1.6 mg,  7/27/19 -1.5 mg,  8/15/19 - 1.35, 2/21/21 - 1.1 (smaller drops in between), 6/20/21 - 1.03 mg, 8/7/21- 1.025, 8/11/21 - 1.02, 8/15/21 - 1.015, 9/3/21 - 0.925 (fingers crossed!), 10/8/21 - 0.9, 10/18/21 - 0.875, 12/31/21 - 0.85, 1/7/22 - 0.825, 1/14/22 - 0.8, 1/22/22 - 0.785, 8/18/22 - 0.59, 12/15/2022 - 0.48, 2/15/22 - 0.43, 25/07/23 - 0.25 (mistake), 6/08/23 - 0.33mg

 

Supplements: magnesium citrate and bi-glycinate

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  • Karma changed the title to Kairos: Gradually Improving after Serotonin Toxicity
  • 1 month later...

Wow..  This is me post mirtazapine..   it's now 3+ years.. and slowly improving.. but the gut issues, leg paresthesia, temperature sensitivity and sinus issues are still occurring daily.. 

Chronic IBS since 1990

Former smoker (1992- Jun 2017)

Prescribed mirtazapine for sleep in Aug 2017 after IBS flare-up following Nicotine cessation.

Mirtazapine 7.5mg 8/17 to 5/18

Mirtazapine 3.75mg 5/18 to 1/19

Off Mirtazapine since 2/19.

Vit B, Vit D+K2 and Magnesium Glycinate as needed.

On Ayurvedic herbs for GI issues - Guduchi since Jul 2020, Indukantham since Oct 2020

On Ashwagandha 1g since Nov 2020

 

 

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  • 3 months later...

@Kairos

How are you doing? 

1996-2018 - misc. polypharmacy, incl. SSRIs, SNRIs, neuroleptics, lithium, benzos, stimulants, antihistamines, etc. (approx. 30+ drugs)

2012-2018 - 10mg lexapro/escitalopram (20mg?)    Jan. 2018 - 10mg -> 5mg, then from 5mg -> 2.5mg, then 0mg  -->  July 2018 - 0mg

2017(?)-2020 - vyvanse/lisdexamfetamine 60-70mg    2020-2021 - 70mg down to 0mg  -->  July 2021 - 0mg

March-April 2021 - vortioxetine 5-10mg (approx. 7 weeks total; CT)  -->  April 28th, 2021 - 0mg

August 2021 - 2mg melatonin   August 1, 2022 - 1mg melatonin   March 31, 2023 - 0mg melatonin

2024 supplements update: electrolyte blend in water sipped throughout the day; 1 tsp cod liver oil blend (incl. vit. A+D+E) w/ breakfast; calcium; vitamin C+zinc

 

Courage is fear that has said its prayers.  - Karle Wilson Baker

love and justice are not two. without inner change, there can be no outer change; without collective change, no change matters.  - Rev. angel Kyodo williams

Holding multiple truths. Knowing that everyone has their own accurate view of the way things are.  - text on homemade banner at Afiya house

 

I am not a medical professional; this is not medical advice. 

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  • 1 month later...

Hey how are you feeling? Have you experienced heartburn & GI issues it feels like I have IBS. Have these gone away for you yet? Was it naturally over time or did you take something? I don’t know what to do 

April 2022- Only 1 celxa pill 10mg

had an adverse reaction & never took anymore again 

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Hi, @Arieland @peaceandlove, I've been doing pretty well lately. Still a few lingering issues, but I'm feeling mostly functional.

 

Yeah, heartburn and GI issues have been part of my experience. The heartburn's subsided, I've started really watching what I eat, as I had acid reflux for a while. I took omeprazole for a while which helped, but it caused some other issues so I'm not sure I'd fully recommend it. Eat a good amount of fibre, reduce sugars and make sure your sugar intake is from natural sources, eat a good amount of protein, reduce or completely avoiding alcohol, caffeine, and carbonated drinks, and eat a banana each day would be my advice. What I have currently and am still struggling with is gastritis, which might line up with your experiences too. If that sounds like what you've been having, I'd recommend taking a probiotic yoghurt. I've been taking one each morning, and it hasn't completely fixed everything, but it's a lot more comfortable now

February 2016 - 50 mg sertraline after major depressive episode

June 2019 - Switched from sertraline to 75 mg venlafaxine after discovering negative reaction

January 2019 - Switched to 15 mg mirtazapine for insomnia

Summer 2019 - Mirtazapine dosage increased to 30 mg due to continued insomnia

December 2021 - Constant medical issues throughout 2021 eventually indicate serotonin toxicity, tapered to 15 mg mirtazapine for 5 days

December 2021 - Continued acceleration of symptoms and seeking medical advice prompted cold turkey cessation

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  • ChessieCat changed the title to Kairos: gradually improving after serotonin toxicity

Hi @Kairos

Good to hear from you, thanks for checking in with an update!

I'm glad you're "doing pretty well" and "mostly functional".

Sounds like you're improving and well on your way to recovery!

Congratulations on having made it this far, and keep up the good work. 

Healing is happening <3

A.

 

1996-2018 - misc. polypharmacy, incl. SSRIs, SNRIs, neuroleptics, lithium, benzos, stimulants, antihistamines, etc. (approx. 30+ drugs)

2012-2018 - 10mg lexapro/escitalopram (20mg?)    Jan. 2018 - 10mg -> 5mg, then from 5mg -> 2.5mg, then 0mg  -->  July 2018 - 0mg

2017(?)-2020 - vyvanse/lisdexamfetamine 60-70mg    2020-2021 - 70mg down to 0mg  -->  July 2021 - 0mg

March-April 2021 - vortioxetine 5-10mg (approx. 7 weeks total; CT)  -->  April 28th, 2021 - 0mg

August 2021 - 2mg melatonin   August 1, 2022 - 1mg melatonin   March 31, 2023 - 0mg melatonin

2024 supplements update: electrolyte blend in water sipped throughout the day; 1 tsp cod liver oil blend (incl. vit. A+D+E) w/ breakfast; calcium; vitamin C+zinc

 

Courage is fear that has said its prayers.  - Karle Wilson Baker

love and justice are not two. without inner change, there can be no outer change; without collective change, no change matters.  - Rev. angel Kyodo williams

Holding multiple truths. Knowing that everyone has their own accurate view of the way things are.  - text on homemade banner at Afiya house

 

I am not a medical professional; this is not medical advice. 

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On 8/6/2022 at 11:41 AM, Kairos said:

Hi, @Arieland @peaceandlove, I've been doing pretty well lately. Still a few lingering issues, but I'm feeling mostly functional.

 

Yeah, heartburn and GI issues have been part of my experience. The heartburn's subsided, I've started really watching what I eat, as I had acid reflux for a while. I took omeprazole for a while which helped, but it caused some other issues so I'm not sure I'd fully recommend it. Eat a good amount of fibre, reduce sugars and make sure your sugar intake is from natural sources, eat a good amount of protein, reduce or completely avoiding alcohol, caffeine, and carbonated drinks, and eat a banana each day would be my advice. What I have currently and am still struggling with is gastritis, which might line up with your experiences too. If that sounds like what you've been having, I'd recommend taking a probiotic yoghurt. I've been taking one each morning, and it hasn't completely fixed everything, but it's a lot more comfortable now


how’d you get gastritis??

April 2022- Only 1 celxa pill 10mg

had an adverse reaction & never took anymore again 

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14 hours ago, peaceandlove said:


how’d you get gastritis??

Supposedly it's quite common with withdrawal from complex antidepressants such as mirtazapine. Since that was what I was on, that's been at least part of if not all of my GI issues.

February 2016 - 50 mg sertraline after major depressive episode

June 2019 - Switched from sertraline to 75 mg venlafaxine after discovering negative reaction

January 2019 - Switched to 15 mg mirtazapine for insomnia

Summer 2019 - Mirtazapine dosage increased to 30 mg due to continued insomnia

December 2021 - Constant medical issues throughout 2021 eventually indicate serotonin toxicity, tapered to 15 mg mirtazapine for 5 days

December 2021 - Continued acceleration of symptoms and seeking medical advice prompted cold turkey cessation

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  • 3 months later...
On 8/13/2022 at 4:14 AM, Kairos said:

Supposedly it's quite common with withdrawal from complex antidepressants such as mirtazapine. Since that was what I was on, that's been at least part of if not all of my GI issues.

How does gastritis feel like ?

April 2022- Only 1 celxa pill 10mg

had an adverse reaction & never took anymore again 

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  • 1 year later...

Hey @Kairos - did your eustachian tube dysfunction heal and your tinnitus? I’m experiencing both, think the Eustachian tube dysfunction could be causing the tinnitus - but the tinnitus could also be a separate issue on its own. 

2014-2018 3 years of 50mg Sertraline

Tapered by reducing the amount of days taking the medication - never the dosage for about 5 months. 

2-3 weeks from last dose started feeling anxious took 1x  50 mg (stupidly) and for the next week began experiencing withdrawals 

Reinstated at same dose for 2 weeks 5 days then with advice of doctor CT 

5 weeks of withdrawals - first window of 6 days 

2018-2023 Prozac 20mg. 
2022-2023 took 1 x 20 mg a week / 1.5 weeks - seemed to still be stable 

2023 October I came off CT

2024 18th March - reinstated at 20mg for 4 days 

22nd March - went down to 0.4 which I am now holding for 7 days so far 

 

supplements - lions mane, magnesium and omega - 3 

 

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