Raspberry: Nightmare after 'treatment' and too abrupt withdrawal of sertraline and mirtazapine

[Raspberry]

In early December 2014 I was prescribed sertraline (50 mg) and mirtazapine (around 20 mg) to combat depression. I had many side effects, including muscle tension and pressure in the head that were downplayed by my doctor as possible symptoms of anxiety. Hoping that these were just start-up side effects I decided to keep taking the medications for at least two months to see the full benefit. The medications helped my mood, but the physical symptoms (inexplicable muscle tension and, in parallel, muscle weakness and pulling, a sensation as if someone was trying to push me down at the neck, pelvis and knees, weird sensations in the head, shivering, dizziness, burning sensation - up to a point where I started having trouble walking and maintaining normal body positions) got even worse. When I asked my doctor about possible serotonin toxicity (I am very sensitive to medications), she dismissed my question. I struggled for a third month – my muscles turned into a real mess (tightness, weakness, trouble walking and sitting in a normal position, vibration along my spine) - and then stopped (too abruptly).

Now I have to deal with the nightmarish consequences of the 'treatment' and withdrawal, including:
constant (non-stop 24/7) internal vibration in the entire body combined with high-frequency muscle contractions in the entire body (not so much sustained cramps or spasms but firing of nervous impulses affecting my muscles in the entire body) – my muscles seem to be constantly shortened by the high-frequency impulses making it very difficult to stand, move or even sit up without resting my elbow somewhere (While lying down I'm a vibrating and contracting mess...). It's constant and relentless making me home-bound and hardly able to take care of my needs. When I ingest something calming – say a cup of chamomile tea or a tiny dose of a tranquillizer, it makes my body a wobbly vibrating mass that I struggle to keep in an upright position, my torso and limbs feeling more relaxed but very heavy. The dysbalance of my body is really debilitating.

I had my blood tested, an MRI scan and neurological consultation – I have no underlying pathologies.

I wonder if there is anyone here or anyone here knows anyone who has experienced such symptoms or could come up with some ideas how to help my possibly overstimulated and oversensitized body. Are there any threads on this forum that might be of help in my situation? I find it hard to believe that my issues are unique, but I have found almost zero information by googling.

[clearday]

Welcome -

 

Sounds like an adverse reaction to those medications. 

 

I'm not sure if it was due to the Zoloft or the Mirtazapine.

 

There are reports on here of people having similar bad reactions to antidepressants after using them for a short time, and they continue to have the symptoms for quite a while after stopping the medication.

 

It seems you are still suffering from the adverse reaction to the medications, unclear whether your symptoms are due to withdrawal from them - although there is probably an element of that too.

 

Did your symptoms worsen after stopping the drugs; how long ago did you stop the drugs -

 

A moderator with more knowledge will be along to help you move forward and help you decide how to proceed from here.

 

Remember that you should largely heal from what these drugs have done to you, it often takes quite some time. 

[mammaP]

Hi Raspberry, welcome to SA. I am so sorry that you were treated so bady by someone who should have been caring for you. That doctor obviously didn't have a clue as you were having some major reactions to the drugs. They shouldn't have been prescribed together but often are and when patients complain they are given even more drugs. This is the report from the interactions checker at drugs.com.

 

Interactions between your selected drugs

sertraline ↔ mirtazapine

Applies to: Zoloft (sertraline), mirtazapine

Using sertraline together with mirtazapine can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should seek immediate medical attention if you experience these symptoms while taking the medications. Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

You mentioned a tranquiliser, can you tell us about that? It is important to include all drugs or supplements in your signature, even those taken only occasionally as they can affect withdrawal.  How long is it since you quit the drugs?  Clearday is right, this will get better but will take time for your body to heal. Your symptoms sound very much like our Wiggleit who also suffers terribly but is improving slowly. You can read Wiggleits story here...http://survivingantidepressants.org/index.php?/topic/7485-wiggleit-tardive-dyskinesia-from-tcas-and-benzo-rapid-tapers/?hl=wiggleit

You need to take care of yourself and allow your body to recover, eat good fresh food if it is at all possible, sleep and very gentle exercise to move your body, just getting up and moving every hour or so for a few minutes if that is all you can do. And sleep if you can.  Many people find  fish oil and magnesium helpful in withdrawal. 

http://survivingantidepressants.org/index.php?/topic/36-omega-3-fatty-acids-fish-oil/

http://survivingantidepressants.org/index.php?/topic/1300-magnesium-natures-calcium-channel-blocker/

When we have the answer to those 2 questions we may be able to offer more advice .

 

 

 

[Raspberry]

Thank you so much for your response and questions.

My symptoms did become worse after stopping the two medications, so I guess it is a combination of adverse reactions and withdrawal here. I initially stopped in early March (i.e. three months ago), but I reinstated the medications at a low dose in May for ten days to see if this was of any help. Unfortunately it was not and I decided to come off of them for good.

I take a low dose (0.25 or even less) of Xanax if things become really intolerable, otherwise I try to make do with chamomile tea and magnesium citrate drinks (started yesterday).

Any suggestions by anyone who reads this thread are more than welcome.

[Frustrated]

I do suffer with the vibration and muscle excitability that you describe.  I t involves my entire body but my calves see the worst of it.  It is like the muscles stay tight all the time and it is very uncomfortable.  Also all my muscles twitch endlessly throughout the day.  I am constantly rubbing myself to try to loosen them up to no avail.  The doctor's idea of help is to give me baclofen which is CNS acting so I never took it.  Too scared of making matters worse.  Sorry you are suffering this as well.  Truly horrible.

[Raspberry]

Thank you, Frustrated, for your response. In my case, it is my neck, upper back and upper arms that are affected the most, but the truth is that all my muscles feel vibrating, tight and wobbly and heavy at the same time.

[mammaP]

How often do you take the xanax Raspberry, and how long have you been taking them? Sometimes it is better to take a regular dose of benzos rather than occasional because they can cause interdose withdrawal. You take some to ease the symptoms, which helps. Then symptoms return and they are made worse because of withdrawal from xanax! I will ask one of the mods who are expert on benzos to have a look for you. If we can get you stable it will ease things a little for you. Do you think the tiny dose of mirtazapine is helping any? We recommend tiny doses when reinstating and they can help for some people, even just 1mg can help sometimes. If it is helping then holding at that dose for a few months to stabilise would be the best thing to do rather than trying to taper when your nervous system is so unstable. It will take time to get stable again but you will get there.  I really feel for you, we all do. 

[Altostrata]

Welcome, Raspberry.

 

Yes, it sounds like you have a combination of withdrawal syndrome and the aftereffects of adverse reactions.

 

Believe it or not, fish oil and magnesium supplements often reduce some of these symptoms, 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/

 

Also see What is withdrawal syndrome? and other topics in the Symptoms and Self-Care forum.

[Raspberry]

Thank you!

 

My history of taking Xanax is really short, I have taken about  four doses (once per two weeks or so). I'm sceptical about relying on any benzos, especially as their benefit has been quite limited in my case - i.e. they do help relax my muscles, but do not seem to have much effect on the vibration going on in my body leading to weakness. How often is it safe to take a low dose to avoid withdrawal?  Can a single dose lead to withdrawal? Can you suggest a safe pattern?

 

I'm likewise sceptical about the tiny dose of mirtazapine I still take to help my sleep, meaning that it does help me get a decent amount of sleep, but I'm not sure about its stabilizing effect in general. I would really like to try something else for sleep (a natural remedy) but I'm not sure what to try given my current overall hypersensitivity. Do you have any ideas?

[Hopefull]

Hi Raspberry,

 

There are so many natural supplements for sleep. It is hard to know what would work for you. Ad's can make you sensitive to supplements, you have to be careful what you take. I have been drinking rooibos tea, after reading it helps with nervous tension and insomnia.

 

I hope you find something that will help you sleep better.

Meditation helps.

[Petunia]

Hi Raspberry,

 

I'm confused whether you are still taking mirtazapine or not...

 

I reinstated the medications at a low dose in May for ten days to see if this was of any help. Unfortunately it was not and I decided to come off of them for good.

 

 

I'm likewise sceptical about the tiny dose of mirtazapine I still take to help my sleep, meaning that it does help me get a decent amount of sleep...

 

How much mirtazapine are you taking now? If you are still taking some mirtazapine its important to take the same amount at the same time every day in order to keep your nervous system stable. Once you are stable again, then you can start a slow, safe taper off that amount, which we will be able to help you with.

 

 

My history of taking Xanax is really short, I have taken about  four doses (once per two weeks or so)...... How often is it safe to take a low dose to avoid withdrawal?  Can a single dose lead to withdrawal? Can you suggest a safe pattern?

 

 

The way you have been taking xanax is unlikely to lead to dependence. In a stable nervous system taking it 2 - 3 times a week is generally considered to be safe, which means you are unlikely to become physically dependent on it. But once your nervous system becomes sensitive, taking it at all can cause paradoxical effects. It could increase anxiety, rather than reduce it. The other thing which can happen is you experience a kind of rebound anxiety as the drug is leaving your system and if you are already in a sensitized state, this can make you feel much worse.

 

If you are in withdrawal, or have an unstable nervous system, its better not to take any xanax at all, or only in an emergency. Its better if you can avoid the irregular use of any psychoactive substances as you recover, this includes alcohol and caffeine.

[Raspberry]

Thanks, Petunia!

I take about 3 mg of mirtazapine before going to bed.

Yes, benzos are tricky, especially in my condition, so I generally try to stay away from them. In fact, I try to stay away from anything stimulating, but as I have read, many 'safe' things can have paradoxical effects...

[Raspberry]

Also, I wonder if anyone would recommend GABA as a supplement or would it be too risky for me to try?

[Altostrata]

Please go to the Symptoms and Self-Care forum and use search to see our discussions about GABA.

[Raspberry]

Yes, I try to research the topics as much as can on my own.

Ironically, I sometimes think that if I only felt good, I would do a really-really thorough research, only to realize that if I felt good, I would probably rather engage in my numerous hobbies that I can only dream of at the moment. The truth is that I often run out of ideas about what to research since my condition seems to be so mysterious - I wish I knew a single keyword that would lead me closer to the truth or a single button that I could try to push to get some relief. As my mind is clear most of the time (no brain fog, confusion, etc, just the frustrating and crippling physical sensations), I feel like trapped in my body I would like to help, but I'm clueless how.

[Altostrata]

You might want to spend some time in the Symptoms and Self-Care forum -- we've got a topic from just about anything related to withdrawal syndrome. Your symptoms are not mysterious to us!

[AppleOfSodom]

Doctors prescribe SSRIs/SNRIs together with mirtazapine all the time even though the drug leaflet cautions against it. They even have a name for the combo Effexor-Mirtazapine: California Rocket Fuel. I **** you not. https://en.wikipedia.org/wiki/California_rocket_fuel

[AppleOfSodom]

My doctor prescribed me in my first appointment that combination immediately. Why not introduce just one of the AD's and wait to see? Probably I would have got better just with one of the drugs and I might not have PSSD today.

The only justification to do it is a completely ignorant oppinion on the safety of the drugs.

[clearday]

Doctors prescribe SSRIs/SNRIs together with mirtazapine all the time even though the drug leaflet cautions against it. They even have a name for the combo Effexor-Mirtazapine: California Rocket Fuel. I **** you not. https://en.wikipedia.org/wiki/California_rocket_fuel

 

Wow thanks for the link -

[KT38]

Hi Raspberry! Your story sounds a little like mine.  I tried 4 different antidepressants within a 2 month period and they just made me really bad.  I went on them because I had a few panic attacks.  I ended up in the hospital out of my mind and the psych there told me to come off cold turkey.  So, here I am almost 10 weeks off this stuff and not anywhere near normal. I have had a couple windows, usually in the evening when the sun goes down.  I have extreme anxiety/fear and the internal vibration you talk about.  You will probably go through an extreme rage/anger part, but that is normal. It will calm down.  My nervous system is so out of whack I can't drive or go shopping or be alone.

[Raspberry]

Yes, by now I have learned that doctors regard mirtazapine as a fairly safe add-on medication or a sleeping aid. In my case it was prescribed as a sleeping aid since my sleep was choppy and sertraline seemed to make it even choppier. At one point when I complained about my issues, my doctor even wanted to prescribe buproprion as another add-on medication and insisted that the other two drugs could not possibly have had a toxic effect since the doses were 'so low'.

 

Yes, KT38, I have been quite hard on myself (I tend to blame myself rather than doctors) and disillusioned about getting any individualized treatment and care.

[Altostrata]

If I were you, I would stay on the 3mg mirtazapine until the other symptoms resolve, since it helps you sleep.

 

Acupuncture might help you, please see our discussions in Symptoms and Self-Care.