Witcherpie Posted February 20, 2023 Share Posted February 20, 2023 Hello I'm 23 male, started amitriptyline 20mg in Jan 2022, without prescription (worst mistake I've ever done) in hopes that it could help with my chronic hyperventilation syndrome (it's much better now thanks to buteyko exercises) The med didn't affect me in any capacity for a year, no sedation, sleepiness, no side effects either. Suddenly though, December 2022 I got some adverse reactions (so I had to start tapering) out of the blue that lasted till early February 2023, finally felt better for a while with the decreased dosage, but now the reactions came back full force again all of a sudden (adverse reactions: constant dizziness, weakness, pre fainting, unable to focus 100% my vision, feels like hypotension, can't walk or stand more than a few steps. The first time I've got these side effects I went to do blood test, cardiologist, and general doctor, they all said that I seem healthy from the tests results) So I don't know what to do, I'm afraid of tapering faster and getting withdrawal, but my side effects while on this drug are debilitating too. I've tapered by -10% of last dose on December 22, hold for 1 month, -10% January 23, hold 1 month, -10% February and want to try to taper now every 3 weeks, in hopes that I can eventually taper every 2 weeks. But I think I'll have to go even faster, so I don't know what to do. Thanks for your time. (buteyko as far as I know can lower blood pressure and make me feel all these symptoms even more?) 10 January 2022 Amitriptyline 20mg, 10 December started taper 18mg ,7 January 2023 16.2, 5 February 14.5, 4 March 13, 1 April 12, 29 April 10.5, 27 May 9.5, 17 June 8.5 (3 week taper, 1st hold), 8 July 7.5 (3 week taper, 2nd hold), 22 July 6.5 (2 week taper, 1st hold), 5 August 6 (2 week taper, 2nd hold), 19 August 5.5, 2 September 5, 16 September 4.5, 30 September 4, 14 October 3.5, 28 October 3, 11 November 2.5, 25 November 2, 9 December 1.5, 23 December 1mg, 6 January 0.5mg, 20 January 0mg! Link to comment
Witcherpie Posted February 22, 2023 Author Share Posted February 22, 2023 Or I could have reached tolerance withdrawal? It makes sense I guess 10 January 2022 Amitriptyline 20mg, 10 December started taper 18mg ,7 January 2023 16.2, 5 February 14.5, 4 March 13, 1 April 12, 29 April 10.5, 27 May 9.5, 17 June 8.5 (3 week taper, 1st hold), 8 July 7.5 (3 week taper, 2nd hold), 22 July 6.5 (2 week taper, 1st hold), 5 August 6 (2 week taper, 2nd hold), 19 August 5.5, 2 September 5, 16 September 4.5, 30 September 4, 14 October 3.5, 28 October 3, 11 November 2.5, 25 November 2, 9 December 1.5, 23 December 1mg, 6 January 0.5mg, 20 January 0mg! Link to comment
Moderator Emeritus Onmyway Posted February 24, 2023 Moderator Emeritus Share Posted February 24, 2023 (edited) Hello @Witcherpie, welcome to SA and thank you for completing your signature. What you are describing seem like dysautonomia - see if the symptoms below seem to match. It is a common withdrawal symptom - basically a dysregulated autonomic nervous system - often misunderstood or misdiagnosed. To help us understand better what is going on, let me ask you a few questions: Do your symptoms change during the day? What about in relation to when you take your medicine - i.e. "I get anxious/sleepy/sad 3 hrs after taking my medicine? When you cut your doses, do you get any different symptoms that may resolve slowly? Have you recently taken any alcohol or other psychoactive substances (supplements/vitamins/antibiotics) that may have prompted these symptoms? Have you had Covid recently? Edited February 24, 2023 by Onmyway "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 Link to comment
Witcherpie Posted February 24, 2023 Author Share Posted February 24, 2023 Hello @Onmyway, the symptoms do seem to match... Should I be worried that I have to deal with dysautonomia + withdrawal + tolerance withdrawal? My symptoms usually are worse early during the day (I take my med at night, and no I don't feel any effect from the med really, even hours later). I also don't feel any effect when I cut my dose. And for the last months no I haven't had any alcohol, but I used to gulp down the pills with beer usually during that 1 year. Haven't had covid either. I do notice a pattern though, that exertion (working out) triggers my symptoms. The first time they appeared was after a hard workout in the gym (it was really bad for a month+), and the second time very recently after I decided to try doing a workout again (it lasted for 4-5 days). Generally the really bad symptoms seem to come and go in waves, but there's always that feeling of dizziness/vertigo. I also do have a very bad habit of staying awake and sleeping very very late, 4-5 in the morning. But my problem is that I don't know what's happening. My symptoms didn't appear after a taper, so the cause is not withdrawal. Was it adverse reaction? Did the med just poop out? I only started to taper cause of the sudden symptoms. 10 January 2022 Amitriptyline 20mg, 10 December started taper 18mg ,7 January 2023 16.2, 5 February 14.5, 4 March 13, 1 April 12, 29 April 10.5, 27 May 9.5, 17 June 8.5 (3 week taper, 1st hold), 8 July 7.5 (3 week taper, 2nd hold), 22 July 6.5 (2 week taper, 1st hold), 5 August 6 (2 week taper, 2nd hold), 19 August 5.5, 2 September 5, 16 September 4.5, 30 September 4, 14 October 3.5, 28 October 3, 11 November 2.5, 25 November 2, 9 December 1.5, 23 December 1mg, 6 January 0.5mg, 20 January 0mg! Link to comment
Administrator Altostrata Posted February 24, 2023 Administrator Share Posted February 24, 2023 Hello, @Witcherpie What times o'clock do you take your drugs, with their dosages? How do you feel before you take amitriptyline compared with how you feel after taking amitriptyline? This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner. "It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein All postings © copyrighted. Link to comment
Moderator Emeritus Onmyway Posted February 24, 2023 Moderator Emeritus Share Posted February 24, 2023 (edited) 46 minutes ago, Witcherpie said: Hello @Onmyway, the symptoms do seem to match... Should I be worried that I have to deal with dysautonomia + withdrawal + tolerance withdrawal? My symptoms usually are worse early during the day (I take my med at night, and no I don't feel any effect from the med really, even hours later). I also don't feel any effect when I cut my dose. And for the last months no I haven't had any alcohol, but I used to gulp down the pills with beer usually during that 1 year. Haven't had covid either. I do notice a pattern though, that exertion (working out) triggers my symptoms. The first time they appeared was after a hard workout in the gym (it was really bad for a month+), and the second time very recently after I decided to try doing a workout again (it lasted for 4-5 days). Generally the really bad symptoms seem to come and go in waves, but there's always that feeling of dizziness/vertigo. I also do have a very bad habit of staying awake and sleeping very very late, 4-5 in the morning. But my problem is that I don't know what's happening. My symptoms didn't appear after a taper, so the cause is not withdrawal. Was it adverse reaction? Did the med just poop out? I only started to taper cause of the sudden symptoms. Hi @Witcherpie this is a known side effect of tricyclic ADs (amitriptyline is one of them) - especially the orthostatic hypotension (OH) part which is a part of the same nervous system dysregulation/dysautonomia means autonomic nervous system dysregulation. Here is a scientific article on this. These drugs increase the risk of OH more than 6 times. https://pubmed.ncbi.nlm.nih.gov/34752479/ It is also a withdrawal symptom. Not everyone in withdrawal gets it with the same intensity (but many get some of it - I had dizziness for example). It is possible that your nervous system is more vulnerable to these effects than others. So basically you are dealing with this as part of withdrawal rather than in addition to. Exertion can trigger symptoms. CFS is also considered a type of dysautonomia and exertion also triggers the symptoms there as well. Basically your nervous system is protesting. I'd avoid exerting myself if I were you - you can see what is enough exercise without triggering symptoms - many people find walking calming but not activating. Have a look at this thread - it may help deal with some of the morning symptoms which are due to the effects of cortisol which vary over the day. I personally have found help from high doses vitamin C (extended release if you can find) to deal with the morning terrors. https://www.survivingantidepressants.org/topic/17471-early-morning-waking-managing-the-morning-cortisol-spike/ So what is happening is that your nervous system seems dysregulated - it seems to have happened with the drugs (a common side effect) but that sensitivity is being triggered in withdrawal as well. OMW PS. I'd stay away from all alcohol which triggers withdrawal symptoms in many people. Also avoid psychoactive substances incl. some vitamins and supplements (B and D) unless you are deficient. Edited February 24, 2023 by Onmyway 1 "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 Link to comment
Witcherpie Posted February 24, 2023 Author Share Posted February 24, 2023 Hey @Altostrata, for the last couple months I take it everyday at the same time, 1 hour before midnight, 11 pm. But before that I would take it at 9pm (I tried to change the time after I got the symptoms, thought it would be better if I'd take it a bit closer to sleep time, cause I started noticing some palpitations when trying to sleep, now it's not as common). But generally I don't feel any effect really before or after taking the med, as I said I stay awake for about 5-6 hours after I take the drug at 11pm. Hi @Onmyway I was thinking that it might be vestibular system like dizziness/vertigo. So TCAs can cause OH by low blood pressure or something else? I see, I'll try walking when I feel better again. And I'm not touching alcohol again. But now that we talk about substances, I used to get lots of caffeine and nicotine while on the drug, now not as much but still do. So it's not possible to be poop out/tolerance withdrawal? That's what makes the most sense for me, the drug didn't affect me ever, it only did when it theoretically pooped out? If all this is just a side effect then it would be logical to take a faster taper approach? I'm trying to taper every 3 weeks now, and after that I'll try every 2 weeks. So far the 10% reductions haven't affected me. 10 January 2022 Amitriptyline 20mg, 10 December started taper 18mg ,7 January 2023 16.2, 5 February 14.5, 4 March 13, 1 April 12, 29 April 10.5, 27 May 9.5, 17 June 8.5 (3 week taper, 1st hold), 8 July 7.5 (3 week taper, 2nd hold), 22 July 6.5 (2 week taper, 1st hold), 5 August 6 (2 week taper, 2nd hold), 19 August 5.5, 2 September 5, 16 September 4.5, 30 September 4, 14 October 3.5, 28 October 3, 11 November 2.5, 25 November 2, 9 December 1.5, 23 December 1mg, 6 January 0.5mg, 20 January 0mg! Link to comment
Administrator Altostrata Posted February 24, 2023 Administrator Share Posted February 24, 2023 Did you ever take amitriptyline earlier in the day? Amitriptyline itself can cause dizziness, weakness, etc. FYI Your drinking alcohol with amitriptyline might have triggered this adverse effect. This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner. "It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein All postings © copyrighted. Link to comment
Witcherpie Posted February 24, 2023 Author Share Posted February 24, 2023 No I've never taken ami earlier than 9pm. Well yea but ami never even made me feel sedated, even with alcohol. And still it doesn't sedate or make me sleepy at all. So that's why I wonder if: the med just pooped out my intense workout taxed my CNS that day and triggered all these symptoms and so I got into tolerance withdrawal caused by a year on the same dose of ami Does that make sense to you too? If I'm mistaken and it's not a tolerance withdrawal, and it's just an adverse effect, then is a faster taper approach actually better in my case? (as long as I'm on the drug, the adverse effect will stay) 10 January 2022 Amitriptyline 20mg, 10 December started taper 18mg ,7 January 2023 16.2, 5 February 14.5, 4 March 13, 1 April 12, 29 April 10.5, 27 May 9.5, 17 June 8.5 (3 week taper, 1st hold), 8 July 7.5 (3 week taper, 2nd hold), 22 July 6.5 (2 week taper, 1st hold), 5 August 6 (2 week taper, 2nd hold), 19 August 5.5, 2 September 5, 16 September 4.5, 30 September 4, 14 October 3.5, 28 October 3, 11 November 2.5, 25 November 2, 9 December 1.5, 23 December 1mg, 6 January 0.5mg, 20 January 0mg! Link to comment
Administrator Altostrata Posted February 24, 2023 Administrator Share Posted February 24, 2023 I don't think we can say exactly what the cause is, but something happened in November-December 2022 to destabilize your nervous system. What we see here is that different things can do this. Most often, it's skipping drug doses, taking doses off-schedule, adding a drug, dropping a drug, taking an antibiotic, or drinking alcohol. Since you say you used to drink, that is a likely factor, maybe you did too much holiday drinking. Often, as happened with you, it takes people a few months to recover from this, but the drug may never work the same again. Covid can also cause this destabilization. Did you have covid? It could be you have long covid. This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner. "It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein All postings © copyrighted. Link to comment
Witcherpie Posted February 24, 2023 Author Share Posted February 24, 2023 Yes I understand, I just want to know if my theory about tolerance withdrawal according to your experience makes any sense? I did actually miss 1 dose that's very conveniently at 25 November (I was out in a concert till late). And at 5 December is the day when the symptoms first appeared. Is one missed dose really enough to cause all this? I doubt it but it could be. Never had covid, last 2 years I barely get out of the house in general. I'm unemployed too. Alcohol doesn't seem like a strong argument in my case, as if it was then I'd probably know it a lot sooner and not after a year. 10 January 2022 Amitriptyline 20mg, 10 December started taper 18mg ,7 January 2023 16.2, 5 February 14.5, 4 March 13, 1 April 12, 29 April 10.5, 27 May 9.5, 17 June 8.5 (3 week taper, 1st hold), 8 July 7.5 (3 week taper, 2nd hold), 22 July 6.5 (2 week taper, 1st hold), 5 August 6 (2 week taper, 2nd hold), 19 August 5.5, 2 September 5, 16 September 4.5, 30 September 4, 14 October 3.5, 28 October 3, 11 November 2.5, 25 November 2, 9 December 1.5, 23 December 1mg, 6 January 0.5mg, 20 January 0mg! Link to comment
Administrator Altostrata Posted February 24, 2023 Administrator Share Posted February 24, 2023 4 minutes ago, Witcherpie said: I just want to know if my theory about tolerance withdrawal according to your experience makes any sense? No, it appears you are experiencing adverse effects from amitriptyline. 4 minutes ago, Witcherpie said: I did actually miss 1 dose that's very conveniently at 25 November (I was out in a concert till late). And at 5 December is the day when the symptoms first appeared. Yes. Nobody who likes a drink now and then wants to hear it might have been the alcohol. Whatever it was, it's behind you, and your honeymoon with amitriptyline is probably over. It you want to continue to take it, it could be that as you reduce, you'll hit a low dose that does not cause noticeable adverse effects. PS It's likely that you won't be able to drink alcohol again for quite a while, as long as you're taking amitriptyline and maybe many months after you go off. This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner. "It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein All postings © copyrighted. Link to comment
Witcherpie Posted February 24, 2023 Author Share Posted February 24, 2023 I see, thank you Altostrata. I don't have any personal reasons to continue taking the drug, I never should have, I'm just forced because I'm afraid of withdrawal syndrome. Last question I swear, I just can't find definite answers to my questions I'm sorry. Is a faster taper advised when people experience adverse effects or does that usually make things worse? 10 January 2022 Amitriptyline 20mg, 10 December started taper 18mg ,7 January 2023 16.2, 5 February 14.5, 4 March 13, 1 April 12, 29 April 10.5, 27 May 9.5, 17 June 8.5 (3 week taper, 1st hold), 8 July 7.5 (3 week taper, 2nd hold), 22 July 6.5 (2 week taper, 1st hold), 5 August 6 (2 week taper, 2nd hold), 19 August 5.5, 2 September 5, 16 September 4.5, 30 September 4, 14 October 3.5, 28 October 3, 11 November 2.5, 25 November 2, 9 December 1.5, 23 December 1mg, 6 January 0.5mg, 20 January 0mg! Link to comment
Administrator Altostrata Posted February 24, 2023 Administrator Share Posted February 24, 2023 6 minutes ago, Witcherpie said: Is a faster taper advised when people experience adverse effects or does that usually make things worse? This is a difficult problem, because you will need to assess which is worse, adverse drug effects or the withdrawal symptoms you get from reducing your dosage. It is possible that if you taper too fast, you will have adverse drug effects and withdrawal symptoms. Hopefully, the adverse effects decrease as the dosage decreases, but the withdrawal symptoms may take over and be just as bad. We generally advise very gradual tapering at 10% per month to start. But if the adverse effects are intolerable or disabling, you may wish to risk a faster taper. I would make smaller reductions, such as 5%, more often, rather than larger reductions at a step. 1 This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner. "It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein All postings © copyrighted. Link to comment
Witcherpie Posted February 24, 2023 Author Share Posted February 24, 2023 16 minutes ago, Altostrata said: Hopefully, the adverse effects decrease as the dosage decreases This is what I'm hoping for. 18 minutes ago, Altostrata said: We generally advise very gradual tapering at 10% per month to start. But if the adverse effects are intolerable or disabling, you may wish to risk a faster taper. I would make smaller reductions, such as 5%, more often, rather than larger reductions at a step. I will do eventually 10% taper of last dose every 2 weeks or 5% every week and see how it goes. I'll keep this post updated, thanks 10 January 2022 Amitriptyline 20mg, 10 December started taper 18mg ,7 January 2023 16.2, 5 February 14.5, 4 March 13, 1 April 12, 29 April 10.5, 27 May 9.5, 17 June 8.5 (3 week taper, 1st hold), 8 July 7.5 (3 week taper, 2nd hold), 22 July 6.5 (2 week taper, 1st hold), 5 August 6 (2 week taper, 2nd hold), 19 August 5.5, 2 September 5, 16 September 4.5, 30 September 4, 14 October 3.5, 28 October 3, 11 November 2.5, 25 November 2, 9 December 1.5, 23 December 1mg, 6 January 0.5mg, 20 January 0mg! Link to comment
Administrator Altostrata Posted February 24, 2023 Administrator Share Posted February 24, 2023 If you must go off rapidly, 5% per week is preferable to 10% every 2 weeks. Please understand that this is not a guarantee that you will not have withdrawal symptoms from a relatively risky taper. This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner. "It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein All postings © copyrighted. Link to comment
Witcherpie Posted February 24, 2023 Author Share Posted February 24, 2023 I see, 5% per week is considered rapid? It's still gonna take about a year. I use the safe approach you have mentioned, stabilizing 2 times after each change to see the effects. 10 January 2022 Amitriptyline 20mg, 10 December started taper 18mg ,7 January 2023 16.2, 5 February 14.5, 4 March 13, 1 April 12, 29 April 10.5, 27 May 9.5, 17 June 8.5 (3 week taper, 1st hold), 8 July 7.5 (3 week taper, 2nd hold), 22 July 6.5 (2 week taper, 1st hold), 5 August 6 (2 week taper, 2nd hold), 19 August 5.5, 2 September 5, 16 September 4.5, 30 September 4, 14 October 3.5, 28 October 3, 11 November 2.5, 25 November 2, 9 December 1.5, 23 December 1mg, 6 January 0.5mg, 20 January 0mg! Link to comment
Administrator Altostrata Posted February 25, 2023 Administrator Share Posted February 25, 2023 5% per week would be more than 20% per month. This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner. "It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein All postings © copyrighted. Link to comment
Moderator Emeritus Onmyway Posted February 25, 2023 Moderator Emeritus Share Posted February 25, 2023 (edited) @Witcherpie just keep in mind that withdrawal symptoms can be as bad as or worse than the adverse effects you are experiencing and they may not occur immediately. They are also not always reversible with reinstatement. You are undertaking a very risky taper based on a theory that this is poop-out. However, that theory is based on two data points - one where symptoms occurred while on the ADs which has subsided in time (is it just time or tapering that made it better?) and another one while you were tapering which also has subsided (you said it lasted a few days). Both of these were caused by intense exercise, first one possibly alcohol. Before you do something very risky, please consider the less harmful approach - avoid strenuous exercise and see whether these symptoms will return. You can track other known external issues - stress, alcohol, supplements, Covid or other viral illness and their impact on your symptoms as well. It is up to you what to do as it is your body. But with these drugs drastic actions work less well and can harm more than the patient approach that allows for observation and adjustments. We have seen too many cases where things go wrong and then the person ends up in a worse situation for a long time. Pls be careful. Your theory may make you feel hopeful because it is offering the opportunity to potentially regain control of the situation by removing the drug fast. But that theory may be wrong. We simply don't know. And by the time you find out you may have destabilized yourself worse. Consider that the right 'non-action' may be better than the wrong action. OMW Edited February 25, 2023 by Onmyway 1 "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 Link to comment
Witcherpie Posted February 25, 2023 Author Share Posted February 25, 2023 I wouldn't consider a 10% drop every 2 weeks a rapid or fast taper. Most people with withdrawal syndrome made huge drops in a lot less time as far as I know. Like getting off the drug in a month (doctor's "advise"). Do you know anybody who got severe withdrawal from following your harm reduction approach of a faster taper @Altostrata? 10 January 2022 Amitriptyline 20mg, 10 December started taper 18mg ,7 January 2023 16.2, 5 February 14.5, 4 March 13, 1 April 12, 29 April 10.5, 27 May 9.5, 17 June 8.5 (3 week taper, 1st hold), 8 July 7.5 (3 week taper, 2nd hold), 22 July 6.5 (2 week taper, 1st hold), 5 August 6 (2 week taper, 2nd hold), 19 August 5.5, 2 September 5, 16 September 4.5, 30 September 4, 14 October 3.5, 28 October 3, 11 November 2.5, 25 November 2, 9 December 1.5, 23 December 1mg, 6 January 0.5mg, 20 January 0mg! Link to comment
Moderator Emeritus Onmyway Posted February 25, 2023 Moderator Emeritus Share Posted February 25, 2023 A 10% drop every two weeks is a fast taper. How many actual cases do you know of people who have gotten away with it? 4 hours ago, Witcherpie said: Most people with withdrawal syndrome made huge drops in a lot less time as far as I know. Like getting off the drug in a month (doctor's "advise"). It doesn't follow from this that your proposed speed will be safe. There are many people who can't do even 5% every 4 weeks and need to go slower. Again, it's up to you. You've been warned and informed. The decision, responsibility and consequences are all yours. OMW "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 Link to comment
Administrator Altostrata Posted February 25, 2023 Administrator Share Posted February 25, 2023 The reason this site exists is because people do get withdrawal from faster tapers. You can do it any which way if you don't mind risking withdrawal symptoms. Since it can take several weeks for withdrawal symptoms from amitriptyline to show up after a reduction, tapering faster than a reduction every month is higher risk than waiting a month between reductions. If you get withdrawal symptoms, restoration of the prior dose may or may not help. Your decision. This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner. "It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein All postings © copyrighted. Link to comment
Witcherpie Posted February 25, 2023 Author Share Posted February 25, 2023 On 2/24/2023 at 10:53 PM, Altostrata said: If you must go off rapidly, 5% per week is preferable to 10% every 2 weeks. On 2/24/2023 at 9:51 PM, Altostrata said: I would make smaller reductions, such as 5%, more often, rather than larger reductions at a step. Tapering faster than a reduction every month is higher risk? Did I miss something? Didn't you just tell me that 5% more often is better than for example 10%/2 weeks? (which both result in 20%/month) I said I am afraid of withdrawal, but I want to try your safe approach to a faster taper (10% for 1 month, 10% for 1 month, 10% for 3 weeks, 10% for 3 weeks, 10% for 2 weeks, 10% for 2 weeks) 10 January 2022 Amitriptyline 20mg, 10 December started taper 18mg ,7 January 2023 16.2, 5 February 14.5, 4 March 13, 1 April 12, 29 April 10.5, 27 May 9.5, 17 June 8.5 (3 week taper, 1st hold), 8 July 7.5 (3 week taper, 2nd hold), 22 July 6.5 (2 week taper, 1st hold), 5 August 6 (2 week taper, 2nd hold), 19 August 5.5, 2 September 5, 16 September 4.5, 30 September 4, 14 October 3.5, 28 October 3, 11 November 2.5, 25 November 2, 9 December 1.5, 23 December 1mg, 6 January 0.5mg, 20 January 0mg! Link to comment
Mentor Hanna72 Posted February 25, 2023 Mentor Share Posted February 25, 2023 (edited) Hi @Witcherpie 1 hour ago, Witcherpie said: Did I miss something I think you are misunderstanding this a little bit. If I could try to explain this as I have personally messed up a lot of tapering in my past, thinking I was going slowly but faster then I could actually tolerate. The mods are only giving you some advice so you will have a smooth ride while decreasing your dosage. You do not want to get bad withdrawals symptoms (believe me ) not to scare you, but if you could avoid it with the information that is on this site, I would if I were you rather be safe then sorry. 1 hour ago, Witcherpie said: 5% more often is better than for example 10%/2 weeks? (which both result in 20%/month) Yes it both adds up to 20% a month, but decreasing by 5% a week is a smaller cut that will give you some days to feel if it is affecting you. It’s just a more of a gentler approach then 10% per week. I would also add that it can take weeks for you to get withdrawals symptoms, so just be careful and stay safe. Hope this didn’t confuse you. My best wishes to you. Edited February 25, 2023 by Hanna72 1 1999-2020 20 mg Paxil Bridged with Fluoxetine to help me get off Paxil. 2022 Fluoxetine 15 mg 12/12 14mg 27/12 13mg jan 12mg feb 11mg mars 10mg, 9 mg 8,5 mg 7.6mg 7.0 mg 6,3 mg 5,6 mg 5,0 mg 4,5 mg 4,0 mg 3.6mg 3,2 mg 2,9 mg 2,6 mg 2,3 mg 2,0 mg 1.8 mg 1,6mg 1,4 mg 1,2 mg, 1,0mg 0,9mg 0.8mg 0.7 mg 0.6mg 0.5 mg 0,4 mg 0.3 mg 0.2 mg 0.1 mg getting ready to jump off. I am not a medical professional nor is this a medical advice. I only talk from my own experience. Link to comment
Moderator Emeritus Onmyway Posted February 26, 2023 Moderator Emeritus Share Posted February 26, 2023 @Witcherpie, anything above 10% every two weeks is a fast taper. "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 Link to comment
Administrator Altostrata Posted February 26, 2023 Administrator Share Posted February 26, 2023 1) We recommend starting with a 10% taper per month, based on the last (not initial) dosage. The month is allows time to see the effect of the reduction. If you get significant withdrawal symptoms, you will not want to make another reduction as large as 10%. As adverse drug effects tend to reduce along along with dosage reduction, even if you follow this conservative taper, it is likely you will feel less intense adverse drug effects after a few reductions. 2) If you are suffering adverse drug effects, you may wish to taper faster, such as 5%-10% every 3 or 2 weeks, but you need to balance the adverse drug effects vs risk of withdrawal if you taper too fast. You can have both adverse drug effects AND withdrawal symptoms, which you will not like. 3) If you are experiencing severe adverse drug effects, such as kidney or liver damage, you may wish to go off the drug within a week or so, or even quit it abruptly, again risking withdrawal symptoms, which might be severe and long-lasting but may be preferable to organ damage. 4) None of these methods guarantee you will not get ANY withdrawal symptoms, but a more gradual taper is likely to cause milder withdrawal symptoms. Is that a sufficient clarification? You get to pick your level of risk according to how severe your adverse drug effects might be. We cannot assess that. If you've been coping with them for months, going to work, etc., that would not be at the topmost severity. This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner. "It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein All postings © copyrighted. Link to comment
Witcherpie Posted February 26, 2023 Author Share Posted February 26, 2023 Right, anyways thanks for the replies. Lately I'm experiencing some insomnia (trouble falling or staying asleep even when I'm sleepy), but I don't know if withdrawal is the cause or something else (bad sleeping habits, my anxiety over something else). Today/tomorrow I'm supposed to taper again, I will probably not taper yet in case it is withdrawal and wait a week to see if my sleep improves. If it doesn't improve then I might take melatonin (some years ago it did wonders for me with only 1/3 of a capsule). 10 January 2022 Amitriptyline 20mg, 10 December started taper 18mg ,7 January 2023 16.2, 5 February 14.5, 4 March 13, 1 April 12, 29 April 10.5, 27 May 9.5, 17 June 8.5 (3 week taper, 1st hold), 8 July 7.5 (3 week taper, 2nd hold), 22 July 6.5 (2 week taper, 1st hold), 5 August 6 (2 week taper, 2nd hold), 19 August 5.5, 2 September 5, 16 September 4.5, 30 September 4, 14 October 3.5, 28 October 3, 11 November 2.5, 25 November 2, 9 December 1.5, 23 December 1mg, 6 January 0.5mg, 20 January 0mg! Link to comment
Administrator Altostrata Posted February 26, 2023 Administrator Share Posted February 26, 2023 Strongly recommend you get good sleep habits in place before tapering, because sleep disruption is common in withdrawal. If you reduce and your sleep gets worse, improving your sleep habits is the first thing we'll tell you to do. 1 This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner. "It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein All postings © copyrighted. Link to comment
Witcherpie Posted March 8, 2023 Author Share Posted March 8, 2023 The side effects have subsided now for a while, but I still don't feel ready to do anything besides chilling home, I've made a drop to 13mg from 14.5 at 4 February. I'm very hesitant to do any form of exercise cause I've noticed a pattern where exercise triggers my symptoms the next following days/weeks. Maybe should have stayed on 14.5mg a bit longer, if my symptoms come back in 2-4 weeks then it was probably too quick of a drop, if not then I can continue at the same pace. 10 January 2022 Amitriptyline 20mg, 10 December started taper 18mg ,7 January 2023 16.2, 5 February 14.5, 4 March 13, 1 April 12, 29 April 10.5, 27 May 9.5, 17 June 8.5 (3 week taper, 1st hold), 8 July 7.5 (3 week taper, 2nd hold), 22 July 6.5 (2 week taper, 1st hold), 5 August 6 (2 week taper, 2nd hold), 19 August 5.5, 2 September 5, 16 September 4.5, 30 September 4, 14 October 3.5, 28 October 3, 11 November 2.5, 25 November 2, 9 December 1.5, 23 December 1mg, 6 January 0.5mg, 20 January 0mg! Link to comment
Administrator Altostrata Posted March 8, 2023 Administrator Share Posted March 8, 2023 Maybe. It will take a couple of weeks for the decrease in amitriptyline to take full effect. Please let us know how you're doing. 1 This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner. "It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein All postings © copyrighted. Link to comment
Witcherpie Posted March 11, 2023 Author Share Posted March 11, 2023 So I've been having internal tremors/vibration mainly when laying down before sleep, it feels like constant mini earthquakes.. It's very unsettling It's probably a common withdrawal symptom but I'm not sure 10 January 2022 Amitriptyline 20mg, 10 December started taper 18mg ,7 January 2023 16.2, 5 February 14.5, 4 March 13, 1 April 12, 29 April 10.5, 27 May 9.5, 17 June 8.5 (3 week taper, 1st hold), 8 July 7.5 (3 week taper, 2nd hold), 22 July 6.5 (2 week taper, 1st hold), 5 August 6 (2 week taper, 2nd hold), 19 August 5.5, 2 September 5, 16 September 4.5, 30 September 4, 14 October 3.5, 28 October 3, 11 November 2.5, 25 November 2, 9 December 1.5, 23 December 1mg, 6 January 0.5mg, 20 January 0mg! Link to comment
Witcherpie Posted April 21, 2023 Author Share Posted April 21, 2023 So I'm genuinely doing a lot better the lower the dosage. My symptoms flare out very sporadically now and in much less intensity than before. So yea I'm doing better. I'll keep tapering and let you guys know, can't wait to reach 5mg and see how I feel. 1 10 January 2022 Amitriptyline 20mg, 10 December started taper 18mg ,7 January 2023 16.2, 5 February 14.5, 4 March 13, 1 April 12, 29 April 10.5, 27 May 9.5, 17 June 8.5 (3 week taper, 1st hold), 8 July 7.5 (3 week taper, 2nd hold), 22 July 6.5 (2 week taper, 1st hold), 5 August 6 (2 week taper, 2nd hold), 19 August 5.5, 2 September 5, 16 September 4.5, 30 September 4, 14 October 3.5, 28 October 3, 11 November 2.5, 25 November 2, 9 December 1.5, 23 December 1mg, 6 January 0.5mg, 20 January 0mg! Link to comment
Witcherpie Posted May 21, 2023 Author Share Posted May 21, 2023 Hello, I'm doing even better, soon will be the 7th drop I'll do. Seems like the lower my dosage the better I feel. I can do a lot more than before. I'm still kinda nervous to make drops more often than every 4 weeks, but I'll have to try, or just be patient. 10 January 2022 Amitriptyline 20mg, 10 December started taper 18mg ,7 January 2023 16.2, 5 February 14.5, 4 March 13, 1 April 12, 29 April 10.5, 27 May 9.5, 17 June 8.5 (3 week taper, 1st hold), 8 July 7.5 (3 week taper, 2nd hold), 22 July 6.5 (2 week taper, 1st hold), 5 August 6 (2 week taper, 2nd hold), 19 August 5.5, 2 September 5, 16 September 4.5, 30 September 4, 14 October 3.5, 28 October 3, 11 November 2.5, 25 November 2, 9 December 1.5, 23 December 1mg, 6 January 0.5mg, 20 January 0mg! Link to comment
Witcherpie Posted July 9, 2023 Author Share Posted July 9, 2023 So I'm on 7.5mg now, last post here I was on 10.5. Early June (last month) I've found a job as a waiter, standing many hours and walking a lot. To be honest I didn't think I would make it, but it seems like I manage just fine, which is surprising cause I was afraid of doing anything physical and now with this job I easily do 15-20k steps per day. Haven't felt any major adverse effects for a quite a while now (last "really bad" period was in February, 5 months ago). And last time I felt dizziness was just momentarily in 12th of April for a few minutes (3 months ago). So I've been trying to do 3 week tapers again. By my experience seems like I'm doing best with lower the dosage, so I'll try eventually even 2 week tapers if I'm feeling fine. Amitriptyline is really hard to find here, and it's very expensive too (a compounding pharmacy is supplying me from the other corner of my country), and I don't want to find myself stuck in a 3 year taper when there's a small possibility that the drug might be even harder to find in the next couple years. 10 January 2022 Amitriptyline 20mg, 10 December started taper 18mg ,7 January 2023 16.2, 5 February 14.5, 4 March 13, 1 April 12, 29 April 10.5, 27 May 9.5, 17 June 8.5 (3 week taper, 1st hold), 8 July 7.5 (3 week taper, 2nd hold), 22 July 6.5 (2 week taper, 1st hold), 5 August 6 (2 week taper, 2nd hold), 19 August 5.5, 2 September 5, 16 September 4.5, 30 September 4, 14 October 3.5, 28 October 3, 11 November 2.5, 25 November 2, 9 December 1.5, 23 December 1mg, 6 January 0.5mg, 20 January 0mg! Link to comment
Witcherpie Posted July 28, 2023 Author Share Posted July 28, 2023 So, foolishly enough I decided to add another drug in my daily life, topical minoxidil, which has the same potential side effects as amitriptyline. And I'm experiencing some slight lightheadedness/brain fog/blurry vision lately occasionally. I'm not sure if that's the cause, it could be that I'm also trying to fix my sleep pattern which results in poor sleep quality, or that I'm tapering every 2 weeks now. All of these 3 stressors have started last week, and now I'm feeling the side effect, so it's hard to know what caused it. Nonetheless, I will stop or reduce the minoxidil by a lot and we'll see how I feel. I will also prolong my next taper by 1-2 weeks. If I'm not any better in a week or two, then I'll go back to tapering every 3 weeks or 4, and get rid of minox. 10 January 2022 Amitriptyline 20mg, 10 December started taper 18mg ,7 January 2023 16.2, 5 February 14.5, 4 March 13, 1 April 12, 29 April 10.5, 27 May 9.5, 17 June 8.5 (3 week taper, 1st hold), 8 July 7.5 (3 week taper, 2nd hold), 22 July 6.5 (2 week taper, 1st hold), 5 August 6 (2 week taper, 2nd hold), 19 August 5.5, 2 September 5, 16 September 4.5, 30 September 4, 14 October 3.5, 28 October 3, 11 November 2.5, 25 November 2, 9 December 1.5, 23 December 1mg, 6 January 0.5mg, 20 January 0mg! Link to comment
Witcherpie Posted August 2, 2023 Author Share Posted August 2, 2023 I'm getting hit with old and usual episodes of pre syncope, lightheadedness etc. After 4 months of being completely fine, now I can't work or do anything once again. Perfect.. Anyways, I've dropped minoxidil, saw palmetto and bioting supplements, I will taper ami again in few days. If I'm feeling better then I'll keep going with the same taper schedule. I can't imagine staying on this drug for 2 years more, I have to just get off, I'm having adverse effects on this poison and I'll have to live with it for 2 more years? Nah, 1 year maximum, I don't want to have irreparable damage by having it on my system for 4 years total. 10 January 2022 Amitriptyline 20mg, 10 December started taper 18mg ,7 January 2023 16.2, 5 February 14.5, 4 March 13, 1 April 12, 29 April 10.5, 27 May 9.5, 17 June 8.5 (3 week taper, 1st hold), 8 July 7.5 (3 week taper, 2nd hold), 22 July 6.5 (2 week taper, 1st hold), 5 August 6 (2 week taper, 2nd hold), 19 August 5.5, 2 September 5, 16 September 4.5, 30 September 4, 14 October 3.5, 28 October 3, 11 November 2.5, 25 November 2, 9 December 1.5, 23 December 1mg, 6 January 0.5mg, 20 January 0mg! Link to comment
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