Rhettsgirl: small decrease causing havoc?

[Rhiannon]

I think given how strong your reaction to cutting from 80 to 75 was that you might be better off starting with a smaller reduction this time. I would hate for you to get hit so hard that you get discouraged. We always want to go hard at first, but so often people end up back on their original dose because they overdid it, and then feeling worse than ever. Read back over your thread and remember how it was when you went from 80 to 75. Patience really, really pays off with tapering.

[rhettsgirl]

Thank you! I will heed your advice and definitely go very slowly. I’m in no hurry to feel as badly as I did last time. I have a stressful job that’s not going to help my situation.   I very much appreciate your feedback. Thank you!!

[Faure]

I’ve nearly completed week 1 of the brass monkey slide and it has been pretty good. So far I can recommend it! If this is as bad as it gets it’s very manageable. I’m very sensitive to dose changes however WD effects have mostly been mild and short lived and I’m looking forward to the next reduction. One slightly difficult night when I reminded myself it could be so much worse but was really only the high end of mild.

[rhettsgirl]

Good for you! I'm so glad to hear it! I know that it's unlikely that we'll feel nothing, but mild should be workable. Congratulations for having the courage to start your journey. I think it will be just a little blip on your radar of life and you'll be free in no time!! Be proud of yourself. Thank you very much for your post.

 

I'm waiting until September to start, but I am feel a lot more positive about it thanks to you and others on this forum who have jumped in. I was meant to start last year, but 2020 was a bit rough. I was filling in for my boss who had breast cancer and my daughter developed IBS -- so not the best time in my life to start. I'll be back soon to be an active member to both give and receive encouragement in my journey. I know people who have gone back to read my intro are probably thinking I won't go through with it. But, I'm a stubborn and determined and I will do this!!

[Faure]

Making a plan is important! See you in the autumn☺️

[rhettsgirl]

It's September. I'm back and I haven't started my decrease yet. I have been having anxiety attacks which began as I was planning my decrease. I thought they would pass, but now I'm back to square one -- to having the anxiety attacks as badly as I did 19 years ago. The anxiety was what made me decide to start taking an antidepressant in the first place.

 

It's illogical. I know if I go down slowly, the withdrawal will most likely be manageable but I can't get my brain or ruminating to cooperate with me. I thought I had my anxiety under control for the most part but I can't stop paying attention to the panic. I don't know when I've ever felt more discouraged. Any ideas? Has anyone else ever felt this way? What did you do?

Edited September 12, 2021 by rhettsgirl
spelling error

[rhettsgirl]

I've finally started my taper off of Nortriptyline 75mg. Because I was so sensitive to a decrease in dose when I tried to reduce by 5mg (which was well within the 10%) I decided to go very, very slowly. I  borrowed a scale from work which measures .0000g. I decided to decrease by

1 mg at first to see how I felt. Today will mark day 14 which is when I started having problems last time. I plan to hold one more week to see if I still feel well.

 

This is going to be slow going especially if I wait 3 weeks between 1 mg decreases. It would take me over 4 years to get off of this stuff. Hopefully I will find that I can decrease a little faster than that.

 

Not sure if anyone is reading this since I didn't get a response to my last post, but I'm here and I'm working toward my goal finally! 

 

Wish me luck! And thanks for reading if you've gotten this far.

[thenextguy]

5 hours ago, rhettsgirl said:

I've finally started my taper off of Nortriptyline 75mg. Because I was so sensitive to a decrease in dose when I tried to reduce by 5mg (which was well within the 10%) I decided to go very, very slowly. I  borrowed a scale from work which measures .0000g. I decided to decrease by

1 mg at first to see how I felt. Today will mark day 14 which is when I started having problems last time. I plan to hold one more week to see if I still feel well.

 

This is going to be slow going especially if I wait 3 weeks between 1 mg decreases. It would take me over 4 years to get off of this stuff. Hopefully I will find that I can decrease a little faster than that.

 

Not sure if anyone is reading this since I didn't get a response to my last post, but I'm here and I'm working toward my goal finally! 

 

Wish me luck! And thanks for reading if you've gotten this far.

 

Thank you for keeping us posted. It's been a long journey! Best of luck!

[Faure]

Glad to hear you have started, well done.  I started meditating at the start of the pandemic, it kept me just calm enough to keep going with the huge change in working from home. It was so effective I have kept it up most days and can now use it when I start feeling anxious to calm me. It’s the Jon Kabat Zin guided body scan. I highly recommend it. It didn’t work in emergencies in the past as I think it’s a skill you have to build over time, but it definitely works now and has had a good impact on many areas of my life ☺️ Hope you keep feeling good as the 14 days passes. 

[rhettsgirl]

So, I was feeling very encouraged by the end of week 3 which was yesterday. Felt great, no symptoms, actually less anxiety on a daily basis then I've felt in a long time! So, I decided to decrease the dose by another 1 mg (total reduction of 2 mg). Yesterday was the first day of the new dosage and I wasn't anticipating any problems today. Then at work all of sudden, BAM! I had an overexaggerated feeling of anxiety that swept over me and didn't feel like my normal anxiety. It took me by surprise!

 

Should I go back and stabilize on the 1 mg dosage or wait it out a couple days and see if it was just a fluke? I don't want to add a decrease if I'm just beginning to feel withdrawal feelings from the first 1 mg change, but at the same time, I don't want to draw this process out forever either. The fact that I'm an anxious personality isn't helping me either.

[Faure]

I’m not qualified to give advice so I won’t! Suggest you tag a mod for advice. @Rhiannon commented earlier in your thread so maybe she can help☺️

[rhettsgirl]

13 hours ago, rhettsgirl said:

So, I was feeling very encouraged by the end of week 3 which was yesterday. Felt great, no symptoms, actually less anxiety on a daily basis then I've felt in a long time! So, I decided to decrease the dose by another 1 mg (total reduction of 2 mg). Yesterday was the first day of the new dosage and I wasn't anticipating any problems today. Then at work all of sudden, BAM! I had an overexaggerated feeling of anxiety that swept over me and didn't feel like my normal anxiety. It took me by surprise!

 

Should I go back and stabilize on the 1 mg dosage or wait it out a couple days and see if it was just a fluke? I don't want to add a decrease if I'm just beginning to feel withdrawal feelings from the first 1 mg change, but at the same time, I don't want to draw this process out forever either. The fact that I'm an anxious personality isn't helping me either.

 

[rhettsgirl]

1 hour ago, Faure said:

I’m not qualified to give advice so I won’t! Suggest you tag a mod for advice. @Rhiannon commented earlier in your thread so maybe she can help☺️

I’m not sure how to tag anyone. How do you do that?

[Faure]

I did it already! To do it you type the @ symbol followed by whoever’s name you want to tag like @rhettsgirl☺️

[rhettsgirl]

Constant anxiety

 

I have decreased my Nortriptyline by only 2 mg over the past 6 weeks. The first three weeks were fine. At the beginning of the 4th week I had an overwhelming feeling of anxiety come over me and gradually over the next few weeks it has come to stay and it’s almost constant.  What can I do?

 

Edited October 31, 2021 by ChessieCat
added topic title before merging with intro topic

[ChessieCat]

I've moved your new topic to your Introduction topic.  Your post is about your own situation.  Your Introduction topic is the best place to ask questions and journal your progress.  This keeps your history in one place and means that you do not have to repeat yourself.

 

59 minutes ago, rhettsgirl said:

I have decreased my Nortriptyline by only 2 mg over the past 6 weeks.

 

 

Please update your drug signature with dates and doses for your reductions.  Thank you.  Account Settings – Create or Edit a signature

 

Generally if you start to notice an increase in any symptom/s after a reduction it means that you have reduced too much and/or too quickly.  Because your drug signature does not contain the tapering information I do not know what percentage you have reduced by and when.  When tapering we need to listen to our bodies/symptoms and taper according to those.  If you notice a pattern that your symptoms do not start until more than 4 weeks after a reduction then you need to adapt your taper regime to take that into account.

 

There are many existing topics on SA where members discuss various issues.  To find them, use a search engine and add:  site:survivingantidepressants.org to the search term.  In this instance I search for anxiety and found this topic:

 

ways-to-cope-with-daily-anxiety

 

Many members find that magnesium is calming and helps to reduce anxiety.

 

[ChessieCat]

Some things that I have found that might help to explain things.  Please note that these are just possibilities, not definitive answers.  Whatever the reason, if you keep notes on paper you can look back and see if there is a pattern and try to adjust according to that.

 

From:  https://reference.medscape.com/drug-interactionchecker:

 

• zolpidem + nortriptyline

  zolpidem, nortriptyline. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• zolpidem + chlordiazepoxide

  zolpidem, chlordiazepoxide. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

 

Generally the half life an a psychiatric drug is from about 18-26 hours (just a bit of an estimate).  However nortriptyline has a varying half life see the following quote from https://www.drugs.com/answers/what-is-the-half-life-of-nortriptyline-172473.html

 

If you happen to be a person for which the half life is 90 hours, equal to 3.75 days, then that might be reason your withdrawal symptoms do not start showing up until after the 4 week mark.

 

Quote

 

 

The elimination half life of nortriptyline is between 16 and 90 hours.

It takes 5.5 elimination half life's for a drug to be cleared from ones system. So it could take a maximum of 495 hours i.e. 8.25 days (5.5 x 90 hours) for nortriptyline to be cleared from ones body.

See Also: Drug Half Life Explained
https://www.drugs.com/article/drug-half-life.html

 

 

 

 

 

 

3.75

[rhettsgirl]

My anxiety has grown steadily worse over the last week and this weekend was horrible with little sleep. I am planning to go back to the 75mg and stay there. I know that's quitting, but I felt great at 75mg.

 

My question is - can I go right from the 73 mg to 75mg or should I move up to 74 mg first for a while and then to 75 mg?

 

My dosages are in my tagline but to make it easier I dropped to 74 mg on 9/26 through 10/16. I dropped to 73 mg on 10/17 and I am there presently - planning to go back to 75mg. Do I make the jump from 73 mg directly to 75 mg or have few weeks of 74 mg in between.

 

Please someone give your opinion. Thanks!

[Altostrata]

I'm sorry you've had this difficulty, @rhettsgirl Did you feel okay at 74mg?

 

Did you make any other drug changes in September or October?

 

What drugs are you taking now, at what times o'clock, what dosages? 

 

 

[rhettsgirl]

I did feel ok at 74 mg for 3 weeks. That's when I decided to go down another 1 mg - to 73 mg. The day after I changed to 73 mg was when the anxiety started to happen. I don't think I would have experienced a reaction from a 1 mg decrease after only one day, do you? I made no other changes to either medications.

 

I currently take my Nortriptyline around 6 pm and 10 mg of Chlordiazepoxide at bedtime. 

 

Thank you for such a swift response. 

[rhettsgirl]

Does anyone have a suggestion for me?

[ChessieCat]

If you do want to increase, I think it would be better to only go back to 74mg at this time.  It is better to increase gradually than to risk taking too much.  And as you said that you felt okay at 74mg before.  That doesn't mean that you will feel the same this time on the 74mg dose, but the updose might provide some relief and ease your withdrawal symptoms.

 

It generally takes about 4 days for a dose to get to full level in the blood and a bit longer for it to register in the brain.  My suggestion would be to stay on the 74mg for 1 week and then reassess.  If you have noticed improvement during that week, then it might be a good idea to wait for a 2nd week and then reassess.

 

The idea of updosing is not to get rid of the withdrawal symptoms completely but to bring them to a bearable level.

 

I think it would be a good idea when you go back to tapering to hold for at least 4 weeks after a reduction, not 3 weeks.

[rhettsgirl]

Thank you so much!!

[rhettsgirl]

I updosed to 74 mg on November 3rd. Now I haven’t slept more than 5 hours the last two nights even with prescribed sleep meds. 
 

Today I started out mostly calm but tired and resigned and then a huge wall of extra potent unbearable anxiety came over me. I’m trying to keep it together here at work. Things are getting worse instead of better. My doctor prescribed ambien for sleep and will allow a lorazepam a day. I’m afraid to even tell him how I feel. He’ll never believe I could feel this bad. Has anyone ever felt like this and gotten better? I am a Christian and would never kill myself, but I could picture euthanasia pretty strongly just to put me out of my misery. Tell me someone has felt this bad and gotten better. I need hope. 

[Altostrata]

You are already taking a benzodiazepine, chlordiazepoxide. Your doctor wants to add another, plus Ambien, also a benzo-like drug? If you take lorazepam and Ambien regularly, you will become adapted to them, too.

 

Please put all your drugs in the Drug Interactions Checker https://www.drugs.com/drug_interactions.html and paste the report or the link to it in this topic.

 

How do you feel before and after you take each of your drugs?

 

On 11/3/2021 at 3:03 PM, rhettsgirl said:

That's when I decided to go down another 1 mg - to 73 mg. The day after I changed to 73 mg was when the anxiety started to happen. I don't think I would have experienced a reaction from a 1 mg decrease after only one day, do you?

 

Yes, you may have experienced a reaction in one day.

[rhettsgirl]

 

@Altostrata - I've attached the drug interaction report. Drug Interaction Report - Drugs.com

 

I am extremely aware that I could become habituated to the Ambien or lorazepam. I am very concerned about that!!!  I am trying to not take them, but I have a very stressful job that I can't quit and when the magnified anxiety feelings come over me, I can't function. I can't think. I can't do my job.  I have taken one lorazepam for three days in a row. I tried Ambien for sleep last night. It didn't work, so I won't be doing that again anyway.

 

As for how I feel before and after I take each of the drugs, I feel no immediate effects from the Nortriptyline or the Chlordiazepoxide. I felt only a bit more calm after taking the Ambien (nothing enough to make me sleep). But when I do break down and take the lorazepam, I feel relief within about 15 minutes. I was trying to not take the lorazepam when the anxiety was constant because I know about the addiction possibility. But, what I got from that was insomnia -- because my  body was/is so revved up. My doctor thought short term, I could take lorazepam when absolutely needed and hopefully my system rights itself soon so that I don't have the strong need to be calmed down and I can just use my normal coping skills for anxiety. 

[Faure]

Hello, I’m so sorry such small decreases have caused you to feel this way. I can’t offer any advice but I do hope your system settles down very soon. 

[rhettsgirl]

I appreciate your kind words. Thanks!