Bulldog: an Introduction with a few questions

[Bulldog]

Hello everyone - I'm Bulldog.  This is going to be a long post, as I feel it might resonate with some of you.  I need community and some internet hugs if I'm being honest.  

 

Before I get into the history of myself, my main question at the moment is:

1.  I read somewhere on the site that one can experience w/ds after coming off one a/d while being put on another a/d (that wasn't the same or it's sister medication).  Does anyone have experience with this?  I tapered off Desvenlafaxine from about Jan 2023 to May 2023 (very quickly compared to Surviving Antidepressant standards...50mg --> 25mg --> zero in a few months) and I had absolutely BRUTAL w/ds (to say the least, I'm keeping it very, very brief) and due to these w/d symptoms they put me on Nortriptyline since July 2023 and I'm taking 125mgs of it.  It stabilized me for the most part but these past 8 months or so I've been feeling hyperemotional, hyperaware, major d/p d/r, zombie-like, "feeling like the soul is being ripped out of my body", etc etc...all while having a few surprisingly good "feeling normal" weeks here and there.  These past two weeks have been very tough, hence why I'm here.  I'm guessing these are w/d symptoms lingering from the DesV even though I'm on Nortriptyline??

 

About me:

I've always been an anxious person since birth.  I was 3 months premature and spent 3 months in an incubator, which probably set me up for a life of mild to major anxiety and some mild depression.  I'm an overthinker and a worrier.  Fast forward to  being out of college and as I was a musician it was rock star living.  Drinking, smoking pot, but none of the really hard drugs.  I had a g/f that thought I was bi-polar so I went to my PCP and after check-boxing a 7 or so question pamphlet, there I was on Zyprexa.  I only took this a couple months.  I'm not bi-polar (for the record).  

 

The **** hit the fan when I moved down south for three years in 2008.  Again, it was rock star living and living by myself and far from home I ended up had some traumatic experiences there, where my anxiety absolutely blew up and took over.  Add traumatic experiences plus drinking too much, eating crappy food, being dehydrated and taking Advil on an empty stomach I developed 7 years of gastritis so I was in constant pain and in my head with anxiety, somatic symptoms, etc - it was the perfect storm.  During this time I moved back to the Midwest in 2011 and I couldn't step into a big box store or sit through a movie without feeling like I was going to pass out - you know the feeling, wobbly legs, d/p d/r, dizziness, panic attacks like crazy.  I should note all during this time I've had a tremendous support system in my parents and brother.  

 

I went to see a psychologist in 2013-ish as well as a psychiatrist and had I known then what I know now I wouldn't have taken a/ds, or if I did, it would have been short term.  I don't blame the system, I was in very rough shape and needed help, so why question being put on meds?  These doctors were supposed to help and boy did I need it.  I tried Escitalopram, Fluoxetine, Alprazolam and finally landed on Venlafaxine in 2014-ish, which sort of helped but I was waking up every hour and having horrible nightmares so I decided to come off it in 2020 and when I did the w/ds were quite brutal.  Unbelievable depression, etc, and I had to restart it in April of 2021 due to w/ds, just to switch to Desvenlafaxine in April of 2021.  I tried to taper off it in early 2023 (see first paragraph) but let me tell you I got unbelieveable w/d symptoms.  There were times I didn't know who I was, where I was, what was happening to my body, strange somatic symptoms like a tearing-open-of-my-abdomen-anxiety-blast, "hot flashes", major hyperawareness (being aware that I'm aware of being aware of the fact I'm talking to people, writing this post, etc - that has certainly continued to this day) and while I've had IBS-C since before meds, my gut has been a painful mess every since. I still get bad panic attacks and I know that these w/d symptoms have changed me - being a musician I used to not be afraid of the stage but now I am, plus "the thought of doing XYZ things" just leads my brain and body to tell me "you can't handle that", like getting a girlfriend or going on a vacation.  Who would put up with me, this hot mess of a dude who has fallen so far?  

 

These past two weeks have been very hard, it's like these somatic symptoms keep morphing into something different.  I know what major D/P D/R is, but I'm having that plus feeling nerve-pain-hot-flash-blasts and (for lack of a better term) "spongy out of body confusion" which are "new" or at least a morphing of previous symptoms, but man are they concerning.  Hence the questions in bold above. 

 

In summary, I tell myself: 

I feel like I'm going crazy.

One's mind can only handle so much before it cracks - am I going to crack and be put into a mental institution?  I was very close to admitting myself due to DesV w/d.

I tell myself I have a mental illness, I'm now crippled and I'll never be the old me.

I was/am(?) barely able to handle DesV w/d, if I want to come off Nortriptyline and be free of a/ds once and for all, I won't have the strength and fortitude to suffer 3+ years of w/d symptoms

I am, and have been, faking being ok and I'm exhausted "not feeling like myself".

 

 So that's me and my journey in a very small nutshell.  If anyone has any advice, moral support, suggestions, answers to my questions or just letting me know I'm not alone I'd very much appreciate it.  

[Catwoman73]

Hi @Bulldog, and welcome to SA!  We are a community of volunteers providing peer support in the tapering of psychiatric medications, and their associated withdrawal syndromes.  

 

If you could kindly complete your drug signature, we would greatly appreciate it.  This is the summary of your drug history that appears at the bottom of each of your posts.  This is helpful for us moderators, so we don't have to weed through a lot of posts to understand where someone has been, and where they're going when we visit your intro thread.  To complete this, click on the following link, fill in the box with all the info you can recall, and click save.  That's it!  You should update your signature as you make changes, to keep it current.  Have a look at mine at the bottom of this post to get an idea of the general format.

 

Your Drug Signature\

 

The short answer to your above questions, yes, you will experience withdrawal from your first antidepressant, even after starting a second one.  There are very few universal truths in withdrawal science right now- we're still learning a lot.  But one thing we do know is that taking another antidepressant to mitigate the withdrawal effects from antidepressants just does not work.  In some situations, it can make things much worse.  It looks like you've been on a revolving door of medications over the years, and this can create a situation where you subsequently become hypersensitive to these medications, and they may not act as they are supposed to.  What you are experiencing presently could be a combination of things- withdrawal from the initial rapid taper of desvenlafaxine, start up effects of nortriptyline in the context of having been on multiple meds over the years, and possible some hypersensitivity to these medications. 

 

Here is a link describing how these medications affect our brains.  It's important to understand this, in order to figure out how you got to this place.  Unfortunately, this is not information you will get from most medical doctors, even psychiatrists.  They just don't know or understand this, sadly. 

 

How Psychiatric Drug Remodel Your Brain

 

You have already discovered that we recommend tapering at a rate of no more than 10% of your current dose, no more often than every four weeks.  This is known as hyperbolic tapering, and has been proven to slowly and gently release the receptors in the brain from these drugs, and therefore reduce withdrawal symptoms.  Read about hyperbolic tapering in the following links.  Again- not information you will get from most medical doctors.   

 

Why Taper by 10% of my dosage?

Why Taper?  SERT Transporter Occupancy Studies

 

Your symptoms all sound like they are the result of taking psychiatric drugs, fast tapering and/or switching drugs frequently over the years, combined with the effects of alcohol and drug use.  Have a look at the list of typical symptoms linked below.  You've given your nervous system one heck of a lot to deal with!  The good news is that the nervous system can and will heal.  The bad news, and the hardest part of all this, is coming to terms with the fact that it's going to take time, work, and a great deal of self-care to get yourself well again.  

 

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

 

Before I give you any specific thoughts on your situation, I want to know a bit more about the nortriptyline.  Specifically, you say that it stabilized you for the most part- can you describe what symptoms have gotten better since starting it?  And you say that over the last 8 months you have had a bunch of evolving symptoms- do you feel like things have been getting worse over this time?  The reason I ask is that I am concerned about the hypersensitivity piece in your case.  How do you feel after you take your dose, and over the following 24 hours?  Have a read through the following thread, and see if you feel any of this applies to you:

 

Hypersensitivity and kindling

 

And yes, I know you were trying to be brief, but the details really do matter lol- I like thorough descriptions!

 

Some general advice while I wait for more details- your brain can heal.  It happens all the time around here.  You haven't ruined your life, and what you are experiencing right now is not YOU.  It is ONLY the drugs.  I want to assure you that this can get better. 

 

There are a few things you can do to help facilitate healing.  Eat a healthy, whole foods diet, stay hydrated, get adequate rest/sleep, and avoid all neurologically active substances, like caffeine, alcohol, nicotine, and recreational drugs.  Using these things are like pouring gasoline on your symptoms.  I would absolutely not recommend adding any further psychiatric drugs, either. This is for two reasons- first of all, the results are unpredictable.  If you are indeed hypersensitive at this point, adding more drugs will just make you worse.  And, adding another drug will just mean further tapering and withdrawal down the road.  And there's not a soul out there that wants to prolong this journey!

 

We strongly recommend learning some non-drug methods of coping with your symptoms.  We have many, many threads on this subject- I will link some of them below.  You will likely be able to find some of your own as well.  For me, mindfulness practice has been the cornerstone of my ability to cope.  I am happy to give you some advice on how to start with this if you like!  I also find meditation, time in nature, engaging in artistic activities, and swimming to be extremely helpful with symptom management.  It may sound like this is all small stuff in the face of the symptoms you are experiencing, and you may be thinking, how on earth am I going to meditate my way out of this?  Lol- I get it!  I would have thought the same previously.  But here's the truth of the matter- the only way out of this is through.  There is no magic- you have to do the work to take care of yourself, and give your body and nervous system time to heal.  Check out some of these threads for advice on non-drug coping mechanisms:

 

Non-drug techniques to cope with emotional symptoms

 Easing your way into meditation for a stressed-out nervous system

Music for self-care: calms hyperalertness, anxiety, aids relaxation and sleep

Ways to cope with daily anxiety

"Change the channel" - dealing with cognitive symptoms

Dealing With Emotional Spirals

 

As you heal, and maybe you've already experienced this, you will experience good days/weeks/months, and some terrible days/weeks/months.  This is an absolutely normal part of the healing process that we refer to as the windows and waves pattern of stabilization.  You can read more about this in the following link.  It is a really good idea to start a symptom journal while going through the healing process.  I track my drug dosages, my supplements, my daily activities, and foods.  I rate my symptoms on a scale of 1-10, in order to help me identify my windows and waves, and possibly identify triggers for waves.  Just as an example, I have certainly discovered that intense exercise is the devil for me through using my symptom journal.  I am best keeping it very gentle for now.  You can use the symptom checklist I linked above as a template for a symptom journal, if you wish. 

 

The Windows and Waves Pattern of Stabilization

 

A quick word about supplements.  We only recommend two here- magnesium and omega-3 fatty acids.  Do be careful with any supplement you choose to take, however- just like we can become hypersensitive to our psych meds after multiple switches, we can also become hypersensitive to all sorts of other things.  Other medications, supplements, and even foods!  This is why that journal is so important- it makes it much easier to identify if something is giving you problems.  If you choose to try our recommended supplements, start with a very low dose to see how you fare.  You can titrate the dosage upwards slowly over time.  

 

As you can see, the key to pretty much everything is to move slowly, and keep yourself stable.

 

Hopefully this gives you a bit of food for thought.  Once I hear a bit more about your nortriptyline, I can help you figure out what the next steps should be.  

 

Most of all, I want you to know that you've come to the right place.  We are happy to help you find your way!  It's a challenging journey, but you have a huge community here who all understand, and who can help cheer you on!

 

This is your introduction topic- each member gets one intro topic.  Please post updates, questions and concerns on this thread.  But don't hesitate to explore the rest of the forum- there's a great deal of good info here!  And if you feel up to it, feel free to read and comment on the intro threads of other members.  A word of support goes a long way, and this will help you build a community of people who truly understand what you are going through, making the journey much less lonely.  

 

I look forward to hearing from you, and following along with your healing journey! ❤️‍🩹

 

 

[littlebird]

16 hours ago, Bulldog said:

I need community and some internet hugs if I'm being honest.

You're in the right place! Welcome, internet hugs deployed. Life gets so much better when we start figuring out our meds and finding what works, hope you're feeling better very soon.

 

16 hours ago, Bulldog said:

Again, it was rock star living and living by myself and far from home I ended up had some traumatic experiences there, where my anxiety absolutely blew up and took over.  Add traumatic experiences plus drinking too much, eating crappy food

I was just thinking when you mentioned being a musician, lesser known factors of playing music include not enough sleep, poor quality sleep when you get it if touring, not the healthiest diet at times, being put into strange situations with untrustworthy people when you're not on your home turf, being pushed to drink drink drink even if it's not really feeling that good, depending on what you play and if you help the drummer - quite a lot of physical labor before and after shows, sometimes very energetic shows that are serious workouts, being exposed to more illness than your average job, not being able to take sick days, etc, etc.

 

It's hard work! Not easy on the body, or the mind. 

 

16 hours ago, Bulldog said:

I tell myself I have a mental illness, I'm now crippled and I'll never be the old me.

I fall into this thinking too sometimes, more than I'd like, but the mind is extremely plastic and able to heal and change. The folks who seem to do the best with managing meds (and getting off them completely, see success stories for details) also have a big ole toolbox of coping skills plus therapists and/or support groups. Healing is absolutely possible, but it is easier with focusing on all the factors that contribute to wellness and with a support system.

[Bulldog]

7 hours ago, Catwoman73 said:

You've given your nervous system one heck of a lot to deal with!

@Catwoman73 It's funny - I hadn't put much thought to my journey and now that you mention this, I realize how much I've been through.  Going on medications, dealing with side effects, coming off medications, going through w/ds, trying new ones, dealing with major emotions quitting drinking, coming off the new ones, going back on old ones...whew!  As there was no "off" or "brake" while on Venlafaxine, I was smoking a lot of weed around 2021-2023, too.  

 

7 hours ago, Catwoman73 said:

Before I give you any specific thoughts on your situation, I want to know a bit more about the nortriptyline.  Specifically, you say that it stabilized you for the most part- can you describe what symptoms have gotten better since starting it?  And you say that over the last 8 months you have had a bunch of evolving symptoms- do you feel like things have been getting worse over this time?  The reason I ask is that I am concerned about the hypersensitivity piece in your case.  How do you feel after you take your dose, and over the following 24 hours?

So when I was going through the beginnings of what would be Desvenlafaxine w/d, those symptoms were absolutely brutal.  Much like Superman pulls open his dress shirt, it felt like someone was ripping my stomach open and in doing so it felt like a ripping of anxiety through me.  The depression was otherworldly, so much so I attended an Intensive Outpatient Program for 6-8 weeks.  I had such severe constipation I was crying my eyes out in pain and got an ultrasound (it showed I was very plugged up).  There were times when an out-of-body wave would hit me and I wouldn't know what was happening and who I was for a few moments.  You know the feeling of sliding into a hot bath?  Add pins and needles to the end of that, plus add that "quick shake" feeling when you get the heebie-jeebies and that's what that wave felt like. I felt scared of thinking of things, like going to a baseball game or meeting a woman for a date.  When I watched movies I would feel very uncomfortable just watching what was happening on the screen. 

 

So going on the nortriptyline certainly helped "right" the depression ship and the ripping sensations went away.  However, as a I realize now the w/d symptoms from DesV were still alive and well: My anxiety remained very high; so much so I joked that if I hovered my hand over a cymbal I could get it to vibrate.  Constipation and lower abdomen pain are a constant.  Also, I was hyperemotional in that I was very quick to anger and I was crying at the drop of a hat.    

 

These past two weeks, however, have seen the return of the hot bath/pins and needles sensations, feeling scared of normal/random things, which is very distressing as I though once I went off the DesV and on the nortriptyline, I had rid myself of the DesV w/d symptoms, much like when I went off of Venlafaxine and then to DesV (which I realize are sister drugs so that would make sense I was much better w/d-wise on those).  

 

I take my dose at night so I can't say what I feel like when I sleep and over those 24 hours I can't really pinpoint what I'm feeling at a given moment.  

 

I have to say I am proud of myself for going to the Metallica concert at Soldier field, being the designated driver to the concert, being around 60,000 people, and driving all the way back to Milwaukee in that traffic without feeling too anxious is a big win for me.  I always have an "emergency Clonazapem" and didn't feel the need to take it.  However, going to the Brewers game two nights ago was a 180 degree turn from that - see the hot bath/pins and needles and out of body symptoms and there you have it.  I made it through but I was in a world of hurt.  

[Bulldog]

7 hours ago, littlebird said:

I was just thinking when you mentioned being a musician, lesser known factors of playing music include not enough sleep, poor quality sleep when you get it if touring, not the healthiest diet at times, being put into strange situations with untrustworthy people when you're not on your home turf, being pushed to drink drink drink even if it's not really feeling that good, depending on what you play and if you help the drummer - quite a lot of physical labor before and after shows, sometimes very energetic shows that are serious workouts, being exposed to more illness than your average job, not being able to take sick days, etc, etc.

 

It's hard work! Not easy on the body, or the mind. 

You've hit the nail on the head, @littlebird.  Funny you should mention "help the drummer" -- I AM the drummer, lol, so it been 30 years of my body taking a beating, as well as lugging my gear (and many of the other band member's gear).   Lots of drinking, partying, bad diet, being hungover, pre-partying, playing the 2-4 hour gig, drinking during the gig, and the cycle repeats.  Add a day job on top of that and during the week you're drinking at night, so it's dry-heaving and being majorly hungover at work, playing a gig or two on the weekends, and heck, it wouldn't be Wisconsin without sports so we like to drink during that, too.  

 

It took me a long time to grow up and mature, that's for sure.  I quit drinking in 2015, quit weed in late 2023.  Much like some of these AA speakers saying pretty much that their dreams came true after quitting drinking - yeah that didn't happen.  Even after all the therapy work I've done I'm coming to realize a whole-body-and-mind reinvention MUST be in the works - we're talking nutrition, water intake, exercise, spine and posture work, time for self-care, etc, all have to be priority #1.  All of the bad stuff catches up to you one way or the other. 

 

My biggest fear, aside from 3 years of DesV w/d plus if I decide to come off nortriptyline would be double-dosing myself with w/d symptoms, is having something major (parent dying, etc) happen while I'm in such a horrendous mental and physical state.  I barely kept it together last year with DesV w/ds.  

[Catwoman73]

It sounds to me, particularly based on this...

 

On 8/15/2024 at 9:48 PM, Bulldog said:

 I have to say I am proud of myself for going to the Metallica concert at Soldier field, being the designated driver to the concert, being around 60,000 people, and driving all the way back to Milwaukee in that traffic without feeling too anxious is a big win for me.  However, going to the Brewers game two nights ago was a 180 degree turn from that - see the hot bath/pins and needles and out of body symptoms and there you have it.  I made it through but I was in a world of hurt.  

 

....like you are having very typical withdrawal windows and waves from the rapid desvenlafaxine taper, probably combined with generalized nervous system instability from ally have been through over the years.  This is so very typical- feeling ok one day, and not the next.  Keeping a symptom journal would absolutely help you see this pattern very clearly.  Under the circumstances, I would continue to take the nortriptyline for now, as starting to taper right now, while still destabilized from the desvenlafaxine,  is likely to destabilize you further.  Unfortunately, the only answer is to withdrawal is take good care of yourself, and give it time.  Like you said here...

 

On 8/15/2024 at 10:06 PM, Bulldog said:

  Even after all the therapy work I've done I'm coming to realize a whole-body-and-mind reinvention MUST be in the works - we're talking nutrition, water intake, exercise, spine and posture work, time for self-care, etc, all have to be priority #1.  All of the bad stuff catches up to you one way or the other. 

 

This is critical.  Not only will this help you in the short term, in getting through withdrawal, it will help you stay healthier for the long term.  Additionally, continuing to work on managing emotions, including anxiety, in the context of your everyday life is VERY important.  Practicing mindfulness and meditation, on top of cognitive behavioural therapy techniques such as challenging negative thoughts and beliefs will start to retrain your brain to respond to stressful stimuli in a positive way, without psychiatric medications.  It takes time for these techniques to really take hold and start making a difference, but it's worth putting the effort in to incorporating them into your day. 

 

I know this is going to be hard, but I would strongly recommend avoiding taking clonazepam.  It may help you in the short term, but in the long term, it will only prolong your journey by continuing to keep you destabilized, and possibly producing a habit that you will have to break down the road.  This will mean another taper, and more withdrawal.  Not something you want to endure, I'm sure!

 

On 8/15/2024 at 10:06 PM, Bulldog said:

My biggest fear, aside from 3 years of DesV w/d plus if I decide to come off nortriptyline would be double-dosing myself with w/d symptoms, is having something major (parent dying, etc) happen while I'm in such a horrendous mental and physical state.  I barely kept it together last year with DesV w/ds.  

 

This is really where the practice of mindfulness comes in.  Worrying about the future, and what might happen, is not helpful, and can make you feel significantly worse.  I know it's difficult to be mindful when you are struggling with anxiety (trust me... I know lol!), but learning to break those anxious thoughts is an a very important skill.  After all- there's little  you can do about how long your body is taking to heal (outside of taking care of yourself, as previously discussed), and you have no control whatsoever over what may happen to your loved ones.  

 

To start practicing mindfulness, there are a couple of things you can do.  First of all, try this grounding exercise: when you find yourself ruminating about these things, stop, and focus on what your senses are telling you.  Identify five things you can see, four things you can touch, three things you can hear, two things you can smell, and one thing you can taste.  Breathe deeply and calmly while doing this.  It can help break you out of negative thought spirals. 

 

Secondly, try to stay present when going about your daily activities.  For example, go for a walk.  Instead of focussing on your thoughts, focus on your surroundings.  Appreciate the appearance of the blue sky, children playing in the park, the feeling of the breeze on your face, the sound your shoes make as they are hitting the pavement.  If your mind wanders, that's ok- acknowledge the thoughts and bring your mind back to focussing on what is immediately present in your environment. 

 

The more you do incorporate these practices into your every day life, the more you will create new pathways in your brain, allowing you to respond in healthier ways to stress (both external, and internal stress, caused by our own thoughts).  It may not feel like it's doing much now, but with commitment and dedication, mindfulness becomes very automatic, and you no longer get into these thought spirals.