BeatAnxiety: New Here, struggling with the discontinuation

[BeatAnxiety]

Here are the current symptoms I am experiencing:

 

1.  Pain around my trunk area.  This is managable as long as I don't try and do any physical activity like bike ride, run, jog or some other activating activity.  Then there is a few hours of delay and the pain gets intense.  Ice helps.   I am seeing a physical therapist for this. My general practioner is referring me to an internal medicine specialist and a neurologist, but those appointments will take months. Both are stumped as to why I am having pain.  PTs did some manipulation and told me that if I had a pinched nerve or ruptured disk I would be flying off the table screaming. 

2.  Non-specific chest pain.  I get this in the afternoons when the Xanax dosage would be at it's peak plasma concentration.

3.  I have had insomnia for 25 years. So, although I am having it on and off this is likely not necessarily attributed to med withdrawal.  Insomnia is simply an anxiety symptom I have had most of my adult life.

4.  I am having diarehha or loose stools once-twice per day and have had this for over a month now.  Consistent but not normal.

5.  Tinnitus was the trigger mechanism that drove me to ADs 16 months ago.  I believe Xanax XR takes this symptom down by 75%.

6.  My anxiety and depression are far worse than before ever starting medication.  I am in CBT but my symptoms are so intense it is difficult to concentrate on this treatment.

 

I will update my supplements in my signature block but am only doing a sublingual B-12 in the AM, Magnesium Citrate with dinner and my fish oil is gradually up to 1500+ EPA/DHA.

 

My Psych Dr believes all of these symptoms are attibuted to anxiety and not related to medication/withdrawal. He thinks I need to be on an AD to relieve the suffering until these symptoms are stable and then we can taper all we want for as long as we want.  My Dr says that protracted withdrawal like this is rare and "gutting it out" is not the best strategy.  My belief is that all but # 3 are the effects of neurotoxicity and protracted withdrawal.  I think Xanax contributes to muscle weakness.  Put a weak muscle under stress and guess what you get...pain.  Many athletes lament benzos for this reason.  I am in week 6 of being off ADs after a 16 month run on a variety of SSRIs and SNRIs as you can see.  I want off of Xanax XR too and we are going to have that discussion.  I have Shipko's book on the subject.  Been on it for 10 weeks.  I would want to take at least that long to get off of it...or get it down to a low dose.

 

Thoughts?

[Altostrata]

How rare does your psychiatrist think protracted withdrawal may be? No matter how rare it is, it's possible you are suffering from it.

 

Do you have any Cymbalta left?

[BeatAnxiety]

I do but not much.  

[Altostrata]

How about opening the capsule and trying 5 beads? If it's Cymbalta withdrawal, this might help. If no immediate bad reaction, try it for 5 days at least to see how it affects you.

[BeatAnxiety]

I meet with my Dr tomorrow and will discuss.  We pretty much established that the SNRIs and SSRIs are problematic and genetic testing confirms this.  If I can figure out how to create a link somewhere I will post my Genomind results here.  They highly recommend an AD that has a different mechanism of action and is in a different class of drugs.  If I have to introduce an AD, I would prefer to try one from a family that I haven't tried (and failed on) yet.  I was on Cymbalta for 22 days and half of that was tapering off.  I've been off for 6 weeks.  My remaining Cymbalta capsules only contain 6 beads of 5 mg each.  The generic brand I was given has the large beads in them.

 

Remeron may do a couple things:  Gets us into an atypical med and one that enhances sleep.  Start with a low dose of 7.5mg.  Monitor closely for adverse reactions for a few days.  If it is a bad actor, abandon quickly and find Plan B.  This also avoids the TCAs which I want to steer clear of.  

[Altostrata]

In general, we don't see much success in treating an iatrogenic condition caused by drugs with new drugs. More often, additional drugs cause worse iatrogenic symptoms.

 

This is why we advocate helping the nervous system repair itself by supporting it with non-drug therapies.

 

If you try anything new, please take a very, very low dose, a small fraction of a normal dose, to see how it affects you. That way, if the effect is adverse, the damage is limited.

 

It sounds like you and your doctor want to experiment with more drugs. Let us know how it goes.

[BeatAnxiety]

My new Dr does not want to re-instate another antidepressant until we can get the right specialist to evaluate the pain symptoms I am having.  Given my medication history and reaction to side effects and adverse events he wants to hold until we get a diagnosis for pain…and he is going to call a personal friend who is a physiologist and try to get me an appt ASAP as a personal favor.  

 

We are also switching me from Xanax XR to the immediate release version so we can titrate down if we need to.  This is consistent with Shipko's book.  You can't come of of XR unless you switch modalities.  He thinks the XR may be doing as much harm as is good and wants to back off a bit.  So, for now I'm stuck with no more ADs and just Xanax to get through the storms.  

 

And, of course, I have all of you folks to complain to.    

[tezza]

Welcome to the group, BA! I'm sorry you're going through this but you are not alone.

 

Alto is very knowledgeable about the drugs and how they work.

 

Other members and mods are very helpful, as well!

 

Wishing you the best!

[BeatAnxiety]

I am entering week 8 of being off of 16 months of various antidepressants.  I am now in chronic pain and seeing a physiatrist later this week and also have a referral to a neurologist.  Anxiety and depression are now off the charts.  If things don't improve soon I will need to quit my job as I'm becoming unable to function.

 

Will see what the diagnosis is from these Drs first.  All I can say is being on ADs…even at the worse moments and with all the side effects was nothing compared to the situation I now face.  This has been all waves and no windows.  All I can say is if you are considering coming off of SSRI or SNRI medications, think about it carefully.  Had I known this I would never have even considered stopping the meds.

[Rhiannon]

Actually, the meds were causing you a lot of trouble, according to your initial post.

 

The thing to do is never start them to begin with, let alone get jerked around on and off various changes and dosages over such a short period of time, the way you did.  I certainly wouldn't be taking the advice of the doctors who did that to you.

 

Coming off of them is quite do-able if done slowly. We aren't just pulling this information out of a dark hole somewhere, we actually have learned a thing or two from working with many hundreds of people in situations similar to yours. Believe it or not, we're not stupid.

 

I've also seen what happens when people stay on the meds because they can't get off them without horrible withdrawal reactions. Over time these drugs often (especially in people who don't do well right from the beginning) lead to increased disability and suffering, lost jobs, broken marriages, ruined lives. I've seen it over and over again. (I can't remember...have you read Anatomy of an Epidemic yet?)

 

Staying on them isn't the solution either. 

 

If you're considering coming off SNRI or SSRI medications, take your time and learn how to do it right. Then do it right. It works.

[NewMe]

If I may offer some input...

 

I experienced intense, unfathomable pain when coming off SSRIs and Benzos pretty much CT. The pain caused stress which led to more anxiety and the trots. 

 

I feel Alto and Rhi are on target with suggestions. 

 

No matter what you decide, I wish you peace and recovery.

[BeatAnxiety]

If anyone has any advice on what I should consider doing at this point let me know.  I can't go back in time and do a 4 month taper now.  Maybe introducing a low dose of something to see if I can get stable might help…and then do the tiny taper idea down the road.

 

My Dr Rx'd Buspar.  I took it for a few days a couple weeks ago and abandoned it after what I thought were intolerable SEs.

 

Will not do anything until I talk to the physiatrist/osteopath on Thurs about my pain issues.  

[mammaP]

Trying the buspar again and abandoning it will have caused even more chaos.

Your poor brain and nervous system has taken a battering from so many drugs.  I'm glad that your new 

doctor isn't as eager to throw more drugs at you.  I experience similar pain to what you are describing,

trunk pain that is like a band right around my mid section. It is excruciating at times and totally debilitating.

I know that mine is caused by the effexor and worsened by inactivity on my part. 

 

When there is no exercise the muscles are not being strengthened and the lower back becomes unstable

and not strong enough to support the upper body. Then the other muscles try to compensate and the result

is pain. That is how my physio explained it and it made sense to me. I have to exercise in some way every day.

Even just reaching and stretching helps eventually. The pain is less than it was on effexor full dose but worsens 

when I am in a wave, then it is excruciating again and exercise doesn't help it makes it worse!

I am getting to know my body and the pain, when to lie still and when to move.  

 

You think that this is much worse than what you experienced on the drugs, but believe me, if you had stuck with

them, with the reactions you were having, you would have got much much worse. I was bedridden at one point 

before I started to taper, and would have stayed that way if I hadn't decided to get off.  My doctor didn't have a

clue, most don't, and I had to go it alone following guidelines I found online. I still tapered too fast and ended

up in withdrawal but it was much less severe than if I had cold turkeyed. 

 

As it stands. you will heal with time. I know that is hard to take and you want something to help but more drugs can

make it much worse.  Alto suggested a few beads of cymbalta, maybe that is what you could try. I know your doctor

doesn't agree but it won't harm as much as too high a dose or a different drug altogether might do. 

 

It's a tough call and I am sorry that you are feeling so bad, but it is what we are all going through in varying stages

and supporting each other.  I hope you find some relief soon, I really do, your nervous system will settle down and get better

but it needs time and stability. 

[BeatAnxiety]

I see you are doing Tramadol at night…does it help?  I see it has some anti-depressant properties.

[Rhiannon]

Did you quit the Xanax XR and go to regular Xanax? If so, are you dosing multiple times per day to keep your blood levels even? If not, please look through some of the threads in the members-only benzo section where we discuss that topic. You may have to read around a bit but it's been discussed extensively there in various member threads.

 

Xanax has a very short action and when the blood levels drop people often experience an exacerbation of anxiety and panic. The way to prevent that is to dose multiple times (every four hours or less) to keep blood levels even.

[Rhiannon]

If anyone has any advice on what I should consider doing at this point let me know.  I can't go back in time and do a 4 month taper now.  Maybe introducing a low dose of something to see if I can get stable might help…and then do the tiny taper idea down the road.

 

My Dr Rx'd Buspar.  I took it for a few days a couple weeks ago and abandoned it after what I thought were intolerable SEs.

 

Will not do anything until I talk to the physiatrist/osteopath on Thurs about my pain issues.  

 

 

As regards your doctor thinking you should be able to drop quickly off low doses:

http://survivingantidepressants.org/index.php?/topic/6036-why-taper-paper-demonstrates-importance-of-gradual-change-in-plasma-concentration/

Check out the charts starting on page 4 and you can see why "low" doses still correspond to high receptor occupancy that must be tapered. Also that the "therapeutic" dose of these meds is probably overkill most of the time--they're actually prescribed at pretty high doses even to start.

 

Your doctor sounds dangerously ill-informed about psych meds to me (this is a crazy number of meds to be put on in such a short period of time, and after you had an initial bad reaction to the first one you should never have been tried on the others). Unfortunately this is fairly common. I would begin to contemplate the possibility that he might not be your best source of information and support for making choices and decisions about using these kinds of drugs. 

 

Your situation is a bit tricky as you get bad effects from taking the drugs but you're also having withdrawal effects. Usually in this case the best thing to do is to reinstate on the smallest dose you can take that will help alleviate the withdrawal effects somewhat while minimizing the deleterious side effects. I would recommend trying a small dose of Cymbalta, maybe 5 mg, and see if that helps with the brain zaps and other withdrawal symptoms.

 

I'd also recommend checking out the website cepuk.org and getting hold of a copy of Anatomy of an Epidemic by Robert Whitaker. 

 

I'm a little confused about what drugs you're still taking and at what dosages.

 

Xanax is tricky. If you only take it once or twice a day, but you do take it more than once or twice a week, it can cause rebound anxiety due to interdose withdrawal effects. Something to take a look at maybe eventually.

 

Go back and read the early part of your thread. There are other excellent posts there giving you good advice as well.

[BeatAnxiety]

Pain Dr is ordering MRIs. That will take weeks.

 

What I am struggling with the most is the lack of any definitive evidence that widespread debilitating pain is a symptom of prolonged antidepressant withdrawal. Anectodes on some forums show some evidence but despite the large amount of information on SSRI discontnuation symptoms, I can't find any scientific or medical description of chronic pain being an AD withdrawal symptom. The lists of symptoms are long and troublesome but nothing on chronic pain.

 

This is what has my Psych Dr baffled. In 32 years of practice he has NEVER seen a single patient complain of pain as being associated with being triggered by or coming off of ADs. Not a single case in thousands of patients treated. ZERO. And hours of web searching reveal nothing that ties my elevated pain to AD withdrawal. It is the only symptom I am struggling with beyond a return of depresssion and anxiety to pre-med levels only worse.

 

I have 2 brothers that stopped ADs rapidly with no WDs whatsoever. One off Effexor and the other stopped Lexapro tapering over a couple weeeks. Baffling.

[Altostrata]

The symptoms called paresthesia and myalgia can be pain. See http://survivingantidepressants.org/index.php?/topic/325-papers-on-diagnosis-of-antidepressant-withdrawal-syndrome/

 

Withdrawal syndrome is poorly documented, and prolonged post-discontinuation syndrome hardly at all. Don't expect to get any doctors to agree with you. The best you can do is use your own judgment and work with someone who is reasonable and helpful.

[BeatAnxiety]

I think I have number of issues going on:

 

1. In think SSRIs caused some neurotoxic damage that I am now having to cope with as ongoing pain even though the meds were stopped. I would point out that ny Dr at the time was genuinely concerned about the myalagias and parathesias I was having and thus wanted me off the meds sooner rather than later.

 

2. I don't think I have fibro and have seen a physiatrist who is starting with MRIs and will go from there. I can't get a referral to a neurologist for 9 months unless I want to go outside the insurance system. Getting a diagnosis for SRI induced neurotxicity is unlikely and what would be the treatment? Perhaps nerve damage will heal with time.

 

3. My pain takes the form of low grade chronic pain in my low back, hips and sides that will flare up tremendously over a period of an hour or so and then last for 2-3 hours or until I can lie down. The pain will spread to my neck and chest area as well. It is as though I am having a panic attack, perhaps I am, but the symptoms are excruciating pain. This occurs almost every day in the mid-late afternoon. Exercising earlier in the day seems to exacerbate the pain worse later although I can usually exercise to some degree without pain...which is even more bizarre. Xanax does not help this in any way.

 

4. Another theory is Tension Myositis Syndrome. TMS is simply pain being brought on by anxiety and suppressed emotions. The pain is real but being produced by tension. I fit the classic profile for TMS. The SSRIs may have served as simply being the trigger event.

 

http://en.m.wikipedia.org/wiki/Tension_myositis_syndrome

 

Otherwise I have no idea what is happening.

[Altostrata]

I agree, there is no point in pursuing a diagnosis of SSRI-induced neurotoxicity.

 

I would look for non-drug symptom relief such as acupuncture.

 

BTW, many people do better with fish oil and magnesium supplements, see
http://survivingantidepressants.org/index.php?/topic/36-king-of-supplements-omega-3-fatty-acids-fish-oil/
http://survivingantidepressants.org/index.php?/topic/1300-magnesium-natures-calcium-channel-blocker/

 

Magnesium is a muscle relaxer. You can apply magnesium oil to your skin. Have you tried this?
 

[BeatAnxiety]

I am taking fish oil and Magnesium citrate. I'll try the oil.

[tgirl]

How are you doing?