PortugueseSea: metoclopramide, akathisia and mirtazapine

[Altostrata]

On 4/20/2023 at 12:58 AM, PortugueseSea said:

- Intermittent neck and head pressure are still a major source of discomfort ----
- Burning or piercing sensation on head and or neck -----

Would the two above be best described as somatic sensations?

 

Yes

 

On 4/20/2023 at 12:58 AM, PortugueseSea said:

- The worst of all; lingering sense of discomfort/restlessness/ anxiety that makes it very very hard to relax.

 

A very common withdrawal symptom.

 

Many people find these to be helpful:

 

Magnesium, nature's calcium channel blocker 

Omega-3 fatty acids (fish oil) 

 

You might try a low dose of one at a time to see what it does for you.

[PortugueseSea]

6 hours ago, Altostrata said:

Yes

Thank you!

I guess that at this point these are a major component, restlessness per se seems to come as a result of long periods of discomfort that seem somatic sensation derived. It feels "different" from the diffuse restlessness I used to have that would better be classified as akathisia.

Now, it is as if there is a "source" to the discomfort, be it piercing, burning, pressure etc, akin to snake or spider bite. The uncomfortable sensation spreading from the "source" and, over time, leading to distress and fight or flight. Whether this could be, as a whole, describe as "focal akathisia" I do not know.

 

6 hours ago, Altostrata said:

A very common withdrawal symptom.

 

Many people find these to be helpful:

 

Magnesium, nature's calcium channel blocker 

Omega-3 fatty acids (fish oil) 

I am already on Magnesium Carbonate. It is part of my regimen along Vit E and more recently Quercetin. I am planning to only take Quercetin short term, maybe a couple months, for its anti-inflammatory and anti-oxidative properties. Fish oil is definitely on the cards!

This latest wave has been particularly taxing, thanks for taking the time to help me make sense of things!

My ADR/WD normal has become better over time, I can't forget that.

[Altostrata]

On 4/22/2023 at 7:02 AM, PortugueseSea said:

My ADR/WD normal has become better over time, I can't forget that.

 

Very important to keep in mind.

 

Magnesium citrate and glycinate are more absorbable than carbonate.

[PortugueseSea]

16 hours ago, Altostrata said:

Magnesium citrate and glycinate are more absorbable than carbonate.

Will look into potentially swapping! Thank you! My wave is over by the way, a relief as always.

[PortugueseSea]

Waves since coming off Mirtazapine:

 

April 1st - 4th;  Increased diffuse restlessness, neck and head focused discomfort. Probably triggered by drinking coffee. Well-being 3/10

April 14th - 23rd; Focal restlessness, neck and head piercing, burning or pressure somatic sensations. Some breathing discomfort. Well-being 3/10

 

Current ADR/WD normal well-being average 7/10.

[PortugueseSea]

Hello guys! Thank you so much for all the help until now!

I am again in need of some advice:

I have one single remaining symptom that is bothersome, this symptom is a piercing/discomfort sensation in the lower neck area. It can go from a nuisance from highly distressing.
As I am already two months off the mirtazapine I thought it would be okay to discontinue the quercetin and just stick with the Vit E and Magnesium. After I stopped this issue has gotten substantially worst but no other symptoms have increased in intensity.

I wonder if it is best to ride this out or if I should restart quercetin and stay on it for a little longer. 

Thank you everyone, as always.

 

[Chompoo]

@PortugueseSea I am 4 months off Mirtazapine and I still have significant histamine related issues. I think the histamine receptors take a long time to heal, not just 2 months. Why don't you restart the quercetin and see if that makes a difference? If not, you might want to look into starting the low histamine diet. It takes effort and you have to eat plain food for a while. But it has made some of my symptoms go away or reduce in intensity. That said, these symptoms did return in a recent wave for me. But at a lower intensity than before.

[PortugueseSea]

Hey Chompoo,

 

Thanks so much for replying! 

 

I think my symptoms have morphed over time, my akathisia is gone or mostly gone and I seem to be having histamine related anxiety, discomfort and burning sensations.

The chaos might have been brought about by the fact that I simultaneously changed magnesium types AND stopped the quercetin. The magnesium oxide doesn't agree with me I think. Stopping the Quercetin might have led to a histamine rebound.

That first change was unavoidable given that I moved back to Japan, the second could have been avoided.

 

Again, like always, this wave will pass. I think it is already passing. I just need to be a little bit more careful with things like this.

[PortugueseSea]

Waves since coming off Mirtazapine:

 

April 1st - 4th;  Increased diffuse restlessness, neck and head focused discomfort. Probably triggered by drinking coffee. Well-being 3/10
 

April 14th - 23rd; Focal restlessness, neck and head piercing, burning or pressure somatic sensations. Some breathing discomfort. Well-being 3/10

May 18th - ?; Mostly neck discomfort/piercing/burning and somatic anxiety. Probably triggered by a combination of stopping quercetin, changing my magnesium and lack of sleep/occasional ingestion of alcohol. May 24th it seemed it was letting off but the next day neck discomfort had just been replaced by agitation, emotional lability and somatic anxiety, "feeling wired". Well-being 3/10

 

Current ADR/WD normal well-being average 7/10.

[Altostrata]

8 hours ago, PortugueseSea said:

changing my magnesium and lack of sleep/occasional ingestion of alcohol

 

Occasional ingestion of alcohol is a more reliable destabilizer than changing the type of magnesium you are taking. Occasional drinking can set you back each time.

 

Is your neck pain in the front, in your throat, or in the back, around your spine?

[PortugueseSea]

10 hours ago, Altostrata said:

Occasional ingestion of alcohol is a more reliable destabilizer than changing the type of magnesium you are taking. Occasional drinking can set you back each time.

Thank you. I have become increasingly aware that alcohol must go the way of coffee. There have been many times it did not set me back in any way, but, expectedly, there have been times where it might have been the culprit. It is difficult, due to work, to not drink at all. That said, I must put my health first.

 

 

10 hours ago, Altostrata said:

Is your neck pain in the front, in your throat, or in the back, around your spine?

Rather than pain, I would categorizing as burning, pressure, a piercing sensation or 2 or all of those. It is in the back, lower part of the neck, beginning of the spine.

I have reverted back to the magnesium carbonate, though I think I will probably change to the glycinate after reading a bit of the Magnesium thread.

Do you have an opinion on the quercetin? I am starting to feel it was really helping given that this happened after I discontinued it.

Research on its anti-inflammatory and anti-oxidant properties seems solid.

Thank you, as always, Alto.

[Chompoo]

@PortugueseSea my opinion is the same as alto's. I think your wave was due to alcohol.

I have histamine issues - random sneezing, nasal drip before bedtime, itching that comes and goes, tingling foot, heart palpitations, acne etc.

I have taken quercetin for the last few months but it doesn't seem to make much of a difference to my symptoms. I continue to have them whether I take quercetin or not.

When I got on a low histamine diet, some of my symptoms disappeared (random sneezing, itching and tingling foot). When I eat something high histamine, they come back. Some of my symptoms also worsen when I eat the wrong food, like more heart palpitations than usual.

Some of my symptoms are always there, even with a low histamine diet and quercetin, like my nasal drip, acne and heart palpitations.

With time, some of my symptoms have gone away, like my nasal drip. Or lessened in intensity, like my heart palpitations.

In a wave, some of these symptoms make a reappearance again. And then they disappear again.

My conclusion is, at least for my own case, that diet has helped more with my symptoms than quercetin. And time. The symptoms go down or lessened in intensity on their own, because my central nervous system healed.

 

[Altostrata]

I don't have any opinion on quercetin.

 

Have you had a medical doctor look at your throat? Does the throat pain happen at any particular times of day? 

 

 

[PortugueseSea]

9 hours ago, Altostrata said:

Have you had a medical doctor look at your throat? Does the throat pain happen at any particular times of day? 

I don't recall ever mentioning throat pain. You might be referring to my neck? I have had a neck MRI and, besides two slight hernias, everything seems to be fine.
The discomfort is day-long, sometimes it turns into head discomfort. It is a common feature of both waves and WD/ADR normal.

 

9 hours ago, Altostrata said:

I don't have any opinion on quercetin.

Thank you. I think I will stay off a bit longer and see if this wave ends without me restarting it.

[PortugueseSea]

20 hours ago, Chompoo said:

my opinion is the same as alto's. I think your wave was due to alcohol.

That might as well be the case. I will post my alcohol history and refrain from it in the same way I am doing with coffee.

 

20 hours ago, Chompoo said:

When I eat something high histamine, they come back. Some of my symptoms also worsen when I eat the wrong food, like more heart palpitations than usual.

I have not noticed any variations with food but I am generally careful, eating a low carb, low sugar diet. My alcohol consumption was also generally minor as you will see. Unfortunately, our systems are too sensitive. 

Thank you so much for your advice and thoughts. I pray you have been feeling better.

 

[Chompoo]

@PortugueseSea thank you. I'm not sure if I'm feeling better because it's always 2 steps forward and 1 step back when it comes to healing. I used to take a boatload of supplements in the beginnng. But I didn't find them particularly helpful in alleviating any symptoms. I'm not sure if stopping quercetin is the reason why your throat pain is bad now. Healing is non-linear and often frustrating.
Throat pain or difficulty swallowing is a common withdrawal symptom. It went away on its own for many people with the passing of time. I hope this symptom will go away for you soon.
 

[PortugueseSea]

True that brother!

 

Just a clarification regarding my symptoms, I have no throat pain whatsoever.

 

Symptoms in order of severity:

 

(moderate to severe)       Somatic anxiety/inability to relax(mild to moderate akathisia?)

(moderate to severe)       Focal discomfort, normally in the back of the neck or back of the head, characterized by a burning, piercing, scraping or pressure sensation

(mild to moderate)           Breathing discomfort

 

 

[Altostrata]

You might get acupuncture for the neck pain, or chiropractic or osteopathic treatment.

[PortugueseSea]

19 hours ago, Altostrata said:

You might get acupuncture for the neck pain, or chiropractic or osteopathic treatment.

I starter applying cooling pads and it seems to help a bit. I used to go to a chiropractor, it is likely worth revisiting. Acupuncture, unfortunately, I can't tolerate.

After going back to Magnesium carbonate this wave seems to be calming down. I am thinking about adding fish oil to my regimen in one or two weeks to see if it helps with the restlessness.

[PortugueseSea]

Waves since coming off Mirtazapine:

 

April 1st - 4th;  Increased diffuse restlessness, neck and head focused discomfort. Probably triggered by drinking coffee. Well-being 3/10
 

April 14th - 23rd; Focal restlessness, neck and head piercing, burning or pressure somatic sensations. Some breathing discomfort. Well-being 3/10

May 18th - 28th; Mostly neck discomfort/piercing/burning and somatic anxiety. Probably triggered by a combination of stopping quercetin, changing my magnesium and lack of sleep/occasional ingestion of alcohol. May 24th it seemed it was letting off but the next day neck discomfort had just been replaced by agitation, emotional lability and somatic anxiety, "feeling wired". Well-being 3/10

 

Current ADR/WD normal well-being average 8/10.

--

I feel better than my previous baseline!
Four days into getting back to magnesium carbonate I recovered from the wave. I Introduced fish oil today. Very small dose, I will give you updates as I go along! 

[PortugueseSea]

Long story short:
 

 

I have had 15 pretty good days. I did not seem to react badly  to low dose fish oil so I will keep that and eventually slowly up it. Recently though, I changed from my usual magnesium, as it sometimes causes loose stools, to magnesium glycinate. I immediately got an increase in symptoms the next day, namely somatic discomfort and breathing discomfort. I am planning to keep taking the glycinate for one week, I might then just go back to my original carbonate if things do not improve within a week. I will likely just try to reduce my dose a bit and see if it helps.

Having a sensitive nervous system is exhausting.

I am sure once I find the right mixed things will become a little smoother. 

[PortugueseSea]

Waves since coming off Mirtazapine:

 

April 1st - 4th;  Increased diffuse restlessness, neck and head focused discomfort. Probably triggered by drinking coffee. Well-being 3/10
 

April 14th - 23rd; Focal restlessness, neck and head piercing, burning or pressure somatic sensations. Some breathing discomfort. Well-being 3/10

May 18th - 28th; Mostly neck discomfort/piercing/burning and somatic anxiety. Probably triggered by a combination of stopping quercetin, changing my magnesium and lack of sleep/occasional ingestion of alcohol. May 24th it seemed it was letting off but the next day neck discomfort had just been replaced by agitation, emotional lability and somatic anxiety, "feeling wired". Well-being 3/10

June 7th - ?; Mostly agitation, emotional lability and "feeling wired". The usual neck symptoms are less pronounced as of now. The likely triggers could be the change to magnesium glycinide, lack of sleep or emotionally unpleasant conversations with my parents, or a mix of the three. Well-being 4/10.

 

Current ADR/WD normal well-being average 8/10.

[manymoretodays]

On 5/22/2023 at 4:02 PM, PortugueseSea said:

I have one single remaining symptom that is bothersome, this symptom is a piercing/discomfort sensation in the lower neck area. It can go from a nuisance from highly distressing.
As I am already two months off the mirtazapine I thought it would be okay to discontinue the quercetin and just stick with the Vit E and Magnesium. After I stopped this issue has gotten substantially worst but no other symptoms have increased in intensity.

Hi there PortugeseSea,

Completely off the mirtazapine I see.

And are you back home with your wife and baby or young child now?

 

I thought I'd comment on the neck pain.

I think somatic fits, that it is of the body.

And I had it too.  Pronounced.  About 2 years ago, which would have been at around 4 years off everything psychoactive drugs for me.  I remember it starting prior to my dear late Muma's last illness.  Stiff neck really.....in the back, and a dull pain.  Range of motion with the neck intensified it.  By the time we had traveled to see my Mom, and then got through her last days, and early grieving I actually started wearing a cervical collar(an old one of my Dad's I found there) from time to time, just to stabilize my neck.  It did, the pain, increase with the stress of it all back then, and persisted for a few months I believe prior to taking leave.  I used ice, the collar from time to time, and ibuprofen.

 

And.  I really don't have a good explanation of medically what was happening to cause my own.  Had to be related to something nervous system I expect.  Just what though I do not know.  Mine was pretty distressing at the time too.

 

Did you trial quercetin back in, to see if that improved it at all since that post I quoted?  While making no other changes.

 

Oh....so many things I attribute to just being mysterious, even still, as far as getting to the roots of what goes on with my body post acute WD.  I wish I knew more sometimes, and other times just glad to not have any new labels of mystery illnesses.  I still have not hit a solid year without a Wave of some type, which I do find frustrating.......usually I find something new to help until I feel more back to baseline.  Currently just getting into see my functional doctor.  I've been having a lot of health anxiety.  And working my 12 step program.......doing some exploration of the- Adult Child of Alcoholic and Dysfunctional family program as well- just getting started with that so it feels like a wonderful new beginning.  I've been so plagued with some early childhood stuff and so.........freedom is on the horizon.

 

Arighty.  Great to see you posting.  Keep on updating and moving towards complete healing.  I'm less active here for a bit.....but around.  And often just reading.  Figuring it all out for myself I guess.....not that I will other than where to focus best, once I'm managing better with the day to day and all my emotions/feelings too.

 

Love, peace, healing, and growth,

mmt

Edited June 8, 2023 by manymoretodays

[PortugueseSea]

@manymoretodays, whenever I see you posted on my thread it brightens my heart. It does, thank you.

Yes! I am back with my wife and child and, furthermore, I am very functional! Back to work and a fairly normal life, despite all the suffering!

Thank you for telling me about how you dealt with your neck issues, it is weird. I have no pain whatsoever but I suffer from a burning or piercing sensation. I have tried icing it with a degree of success. I have bought these compresses and they bring some relief. I am pretty sure Ibuprofen could work too but... well... I am still too scared to medicate myself. Maybe I am being overly conservative?

It is all so mysterious isn't it, random and frightening. The nervous system is a wonder, what matters is we are walking our path towards healing. 

As for the quercetin, I ended up not reintroducing it as my wave eventually ended. Instead, I messed with my magnesium because of some loose stools and probably triggered my most massive wave in months in the process. Or it might have been stress? Or a total coincidence? Alas, I am riding that right now.

Of course, it is different from previous waves: constant agitation, head pressure and a degree of terror. It is like I was teleported back to last year. The neck stuff that bothered me so much? Not really here. It definitely is the nervous system as this degree of arbitrary fluctuations demands it should be. 

This too shall pass, I know. As the causative agent (1 year and 3 months out) and psych meds in general (2 months out) become further and further removed, things will continue improving.

I am so happy that you are taking active steps to improve your quality of life, family is definitely a key component of it. Feel free to reach out if you would like to talk. I find you very soothing and comforting, writing these words has been a light in the darkness during this terrible wave.

[PortugueseSea]

Important updates (June):

 

Key symptoms in order of importance (severity scaled from 0/10): 

 

Restlessness (6/10), Fear/Terror (7/10), Neck/Head somatic symptoms (4/10)

 

- A windows and waves pattern continues, though no pure windows yet. That said, I have had probably the best three or four days since this started.

- Despite the possible business implications of 100% stopping any alcohol consumption, I have decided as per the forums advice to not do so under any circumstances.

- Restlessness, the key symptom which makes this so difficult, has eased comparatively.

- Neuro-emotions, namely intense somatic fear/terror have become more prevalent. Believe it or not, I would rather have that than the restlessness goes, I will take it.

- There is a some correlation between the beginning of waves and life stressors, difficult conversations with parents were followed by instances of worsening, so did the few instances of alcohol consumption noted.

- I have decided to start MindBody therapy (use of visualization, amygdala calming exercises, acceptance etc.) due to the prevalence of these stressor induced worsenings in the hope that they might ameliorate said symptoms.

Again, thanks so much for the support guys.

[PortugueseSea]

Important updates (July):

 

Key symptoms in order of importance (severity scaled from 0/10): 

 

Restlessness (4/10), Fear/Dysphoria (8/10), Neck/Head somatic symptoms (2/10)

 

- Continued waves and windows pattern; Waves are around double the size of windows (between 7 and 15 days) while windows last between 3 and 6 days.

- Restlessness, the key symptom which makes this so difficult, has eased comparatively. My body is slowly relearning to physically calm down. This is a major victory as this is one of the three major symptoms remaining.
 

- Neuro-emotions continue to be a major problem; this month, during waves and even windows, dysphoria and, above all, fear, are constant. I feel like I am being chased by a serial killer all day every day. According to a mind body syndrome interpretation those emotions were likely at least partially presenting as physical discomfort (neck; head etc) and now that I am practicing somatic processing, which has to a large degree eased those physical symptoms, are showing full force qua emotions.

 

Does this make any kind of sense? Is it common for neuro-emotions to suddenly overwhelm you when you are on a recovery curve? I assume yes.

 

- Since I started somatic tracking my physical sensations have fluctuated more, moved location and largely improved! This is another major victory as this is one of the three major symptoms remaining.

 

All in all these are positive developments, although I feel too teary and scared out of my mind to feel it.

 

 

 

 

[PortugueseSea]

I just wanted to share my son will become three tomorrow.

I remember when he became two. I was sitting there at his birthday celebration holding back the tears from all the agitation and dysphoria. I felt I would not see his next birthday.
Well, I will. I am still struggling but I have achieved a lot in the last 365 days.

I hope you will post here around his 4th birthday noting another year of recovery. 

 

Thanks guys.

[manymoretodays]

Yes you have.  Come a long way PS!  Happy belated bday wishes to your son.  Yay!  Oh, to be 3.  Can't say I remember clearly.  Ask him?   Lately, my relax and peace comes....when posting here.  Is that weird or just cool?  I am however, limited stll....internet not well...yet.  I get bounced a bit with just using  my android.  By golly....I may learn to be brief, concise, and to the point.  Lol.  Do not hold your breath waiting though.  L, P, H, and G.  mmt

[PortugueseSea]

It is wonderful, magnificent, @manymoretodays, besides being cool!! Relaxation and peace are my final goals for healing. When I have that, I'll have everything.

 

As for your messages, well, they are healing, I can assure you. 

Today I quit a toxic job, I am transitioning to something that pays better and that will be kinder to my nervous system. Healing takes many shapes 😃

[manymoretodays]

Good for you on making neccessary changes!  Woohoo.  May it lead to greater relaxation and peace.

[PortugueseSea]

Symptom highlight:

 

DYSPHORIA

 

As I have mentioned, I have been struggling with dysphoria lately. Surprisingly, this has become more and more of a problem in the last few months; even as restlessness slowly subsides.

My interpretation of this is the following:

(Main cause: mirtazapine) I am 4 months off Mirtazapine, dysphoria having become a worse issue after coming off; thus, I attribute this constant debilitating dysphoria to coming off. I have always had dysphoria since the start of this mess, since the akathisia started. but not to this debilitating degree. As the dysphoria has gotten worse even as the restlessness and somatic sensations improve, it makes sense to attribute it to the mirtazapine. I hope it will calm down in the next few months.

 

Or could just the dysphoria get worse as the restlessness improves?

 

@Altostrata, I would really appreciate your take on this! 😃 Thanks in advance.

 

 

[Altostrata]

What do you mean by dysphoria?

[PortugueseSea]

45 minutes ago, Altostrata said:

What do you mean by dysphoria?

Extreme negative emotion; being on the verge of tears 24/7 for no reason. I am very functional and love my life but I feel like I am the verge of tears all day. Like my body has this overwhelming sadness in it. I don't feel hopeless and it is not rational. It is a neuro-emotion. I am attributing that worsening to coming off the mirtazapine fairly recently (4 months ago or so).

[Altostrata]

Yes, it's probably a neuro-emotion and probably will gradually go away.

[PortugueseSea]

Thanks Alto,

 

Sorry I am a bother sometimes; it's just that after 18 months stuck in fight or flight, if it isn't the restlessness, it is the dysphoria, if it isn't both...
I am a mess, despite the small improvements I've had.

 

I just want a couple hours of peace, that I don't get, to take a deep breath. A moment where I feel I won't blow up. I know it might be years before my system calms down enough for that, unfortunately. 

[Altostrata]

23 hours ago, PortugueseSea said:

I am a mess, despite the small improvements I've had.

 

 

The Windows and Waves Pattern of Stabilization

 

Are We There Yet? How Long is Withdrawal Going to Take?

 

"Is it always going to be like this?"

 

The importance of recognizing you're feeling good

 

Protracted Withdrawal or PAWS (post-acute withdrawal syndrome)

 

Progress! What withdrawal symptoms have gone away for you?