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Hypersensitivity and Kindling What causes hypersensitivity? Some people may experience minor difficulty in stopping a psychiatric drug one time, but the next time they start and stop, the withdrawal symptoms are worse. For benzos, this can even include seizures due to a lowered seizure threshold (note: this is much more likely with a rapid or cold turkey benzo withdrawal). Stimulants and some antidepressants (such as Wellbutrin) also lower the seizure threshold. Repeated instances of going on and off drugs, adverse reactions, cold turkey, etc. seem to build neurological hypersensivity to drug and dosage changes, resulting in worsening adverse reactions, usually some form of activation. In Altostrata's post One Theory of Antidepressant Withdrawal, she writes: A benzo works by increasing GABA. Long-term exposure to benzos causes GABA receptor down-regulation and glutamate receptor up-regulation. A slow and careful taper makes it easier for the receptors to return to their pre-benzo state. But when there's a history of prior withdrawal, hypersensitivity may result in increased neuro-excitability, creating worsening withdrawal symptoms upon dosage reduction. If someone is dealing with antidepressant withdrawal in addition to benzo withdrawal, neurological hyper-reactivity may be even more intense. And with serotonin needed to release GABA and glutamate (see Serotonin as a Modulator of Glutamate- and GABA-Mediated Neurotransmission), the interplay of all of this neurotransmitter dysregulation can make hypersensitivity more likely. What is kindling? Kindling is a neurological reaction where repeated withdrawals cause hypersensitivity, then hyper-reaction when the same drug or a different drug is introduced. The kindling response is an exaggerated adverse reaction to the drug. You may be vulnerable to kindling if you have a history of repeated rapid taper or cold turkey withdrawal and / or a history of heavy or chronic alcohol use, especially binge drinking -- in effect, going on and off the drug, with hyper-reaction when the drug is taken again. Some short half-life benzos (such as Halcion) and z-drugs used for sleep may cause kindling because much of the drug is eliminated in between nightly doses. Over time, this traumatizes the nervous system with repeated exposure and withdrawal in between doses. The same may be true of the short half-life antidepressants, each successive drug dose causing a hyper-reaction. The same may also be true from skipping doses (for more, see How about taking my medication every other day to reduce my dosage?). While this phenomenon has been documented in the scientific literature for benzodiazepines for a long time, any drug that effects the nervous system and causes dependency can have a traumatic impact on the nervous system when changes are made often and abruptly. Research is now also pointing to kindling in antidepressant use. In the article Expertise from outside the Academy: tapering off antidepressants, Dr. Mark Horowitz cites a study by Dr. Giovanni Fava: While the exact mechanism of kindling is unknown, some of the details on kindling have been written about in papers on alcohol withdrawal, which like benzodiazepines, affects GABA (here is one such paper - Kindling in Alcohol Withdrawal). Here is an excellent explanation on the Benzodiazepine International Coalition website: Benzo Kindling. For a much more thorough description of GABA and glutamate during benzo withdrawal, see What is happening in your brain? Hopefully, more research will be published in the future regarding kindling in antidepressants, antipsychotics, drugs used as mood stabilizers, and drugs for pain. Kindling in antidepressants, for example, may involve the damage caused to the serotonin receptors by repeated on and off use of one or more of these types of drugs and the effect this has on the overall nervous system. A note on dopamine receptor supersensitivity: If you've been exposed to neuroleptics (antipsychotics), you can become hypersensitive to endogenous dopamine (the dopamine your body makes naturally) when the drug's dopamine blockage is removed. As opposed to benzo and antidepressant withdrawal caused by down-regulation of receptors, dopamine receptor supersensitivity is caused by up-regulation. However, dopamine receptor supersensitivity is not kindling - the symptoms of dopamine supersensitivity can occur without additional introduction or reinstatement of a drug or substance. You may experience dopamine receptor supersensitivity after coming off only one neuroleptic but not experience kindling. For more on dopamine receptor supersensitivity, see: Chouinard, 2017 Antipsychotic-Induced Dopamine Supersensitivity Psychosis: Pharmacology, Criteria, and Therapy While dopamine supersensitivity psychosis is specifically a neuroleptic withdrawal symptom, switching neuroleptics or making abrupt dose changes to the same neuroleptic can also lead to kindling. So it's important for people tapering neuroleptics to taper slowly to decrease the chances of both dopamine receptor supersensitivity and kindling. A note on limbic or psychological kindling: In this article on limbic (or psychological) kindling, the concept of being "hard-wired" for hypersensitivities is explored. If in addition to psychiatric drugs, you are also dealing with trauma, exposure to other drugs, pollutants, or chemicals, etc., you may already be in a state of chronic stress or what is also called the "flight or fight" state. Whether this directly translates to kindling is not clear - it may be related to learned responses, especially for those who have a history of trauma. Either way, learning how to self-soothe and calm the limbic system can be very helpful. See Non-drug techniques to cope with emotional symptoms. Steps to reduce the damage and mitigate hypersensitivity and kindling: Come off stimulating drugs first. Taking multiple psych drugs? Which drug to taper first? Consider a slow and mindful symptoms-based micro-taper. Micro-taper instead of 10% or 5% decrease The Brassmonkey Slide Method of Micro-tapering The slowness of slow tapers Allow withdrawal symptoms or adverse reactions to settle down before attempting another drug change. If you reinstate a drug or introduce a new drug, start at a very low dose. About reinstating and stabilizing to reduce withdrawal symptoms The Windows and Waves Pattern of Stabilization The rule of 3KIS: Keep it simple. Keep it slow. Keep it stable.
I've got some confusion going on about this. Don't know if it is "me", Celexa, post taper, or being sick with a couple of bacterial infections. Or all of the above????? About two weeks back, a friend (over brunch) told me not to talk about my imipramine taper, she said it was old and no one really wants to hear it. The truth is, I never told her about it while I was going thru it. I basically didn't really talk to anyone, except a few who have my back covered. I felt bad. Like I lost a friend. I know I did not innundate her with it. Post taper with the insomnia being so bad, I have stayed in on weekends to try and nap. This is Jupiter Florida. It is beautiful here and I haven't been enjoying the outdoors. I've been 'holed up.' I am findig that I have trouble returning calls. I haven't really been making calls either. I have had lots of issues lately, both physically/personally and don't want to be a broken record. I have also been wondering about having outgrown two friends. You know, reaching a saturation point. Maybe that is healthy. They are not. Other people are not responsible for my happiness. However I am going thru a spell here. I don't want to talk about being sick, I sound like Debbie Downer from SNK I don't feel well. I feel a complete lack of motivation. Everything is an effort, including emptying the dishwasher. Can we talk about this and your experiences, thoughts.....so glad I found you all
Hi everyone. I'm Liz and I need some counsel. First things first: I'm not a native english speaker, I'm german. So please excuse my poor language and mistakes, I'll try to express myself as clearly as I can. As you can see in my signature, I was put on Citalopram (it's Celexa in the US, right?) in 2007. I had developed quite a harsh anxiety disorder with massive panic attacks. At the point that I couldn't manage my everyday life anymore, I went to my GP and asked for help. He prescribed me 20mg Citalopram to "get back on track" and advised me to seek therapy, which I did immediately. While that therapy person wasn't the real deal, the pills worked well for a while. A year later I tried to quit them, but felt miserable. I went cold turkey because I didn't know any better. My GP sent me to a psychiatrist who put me on 30mg. This also worked for a while. Another year or so later (you can see a timeline in my signature) I tried to quit again. My psychiatrist told me to taper over the course of few weeks. It was basically another cold turkey, it failed, and I tried again and again. By the end of 2012 I managed to be completely off pills for 6 months, but then things got so bad that I went back on 20mg. As many of you may have experienced, my doctor told me I would need the meds and could take them forever and that there was no such thing as withdrawal. I changed the psychiatrist, but the second one told me the same. My GP told me the same. They basically labeled my withdrawal symptoms as hysterical. They all advised to stay on the meds. Which I did not want, because I missed my "human-ness" so much. Then I got pregnant, landed stable on 10mg somehow and stayed on that dose, it was the best I could. I'm really lucky my kid has not shown any signs of harm after her birth. She's developing perfectly normal, but I'm still feeling guilty because I couldn't fully quit the meds. I've been stable on 10mg for a long while, but as time went on, I desperately wanted to feel the "real me" again and began researching the topic of tapering and withdrawal. Turns out, withdrawal exists. For real. That gave me new hope. So. In the least years I've been tapering very slowly from 10mg. Things got bad from 7mg on, there was a full year of horrendous depression and anxiety and sheer terror. It took me another year to recover from this. Now I'm at 5.75mg, and I can't seem to go further. I tried a single reduction of 1% in May, some kind of microtapering plans in mind, and 3 weeks later I wanted to die. I reinstated and stabilized. Three weeks ago I dropped the dose about 0.5% and expected things to go mellow. Tiny dose, right? They didn't. I don't exactly want to die now, but 2 weeks after the reduction I developed severe anxiety with bizarre thoughts, vertigo, nausea and most of the other stuff I know so well. I reinstated two days ago and the bizzare thoughts are gone today, the nausea also. I really don't know what to do. With reductions of 0.5% every few months (because I can't bear it more often), I would not be able to come off meds in this lifetime. I'm 40 years old. Is this real? Is there a chance I'm really this sensitive? Or am I making things up in my mind? Is someone else here who can't do the tiniest of drops? And is there any way out of this hypersensitivity? It feels like symptoms are getting worse with every failed reduction. The citalopram itself doesn't exactly bother me at the given dose. I tolerate it quite well, I guess. Feeling no side effects (or I might be so used to them I can't feel them anyway). So, what's a girl gonna do when nothing works? (Short background info: I'm the main provider in my family and we have a toddler. My job is about creative thinking. So I have to function as a employee and a mum to some degree and I need a relatively clear mind to do my job. That's why I tried these tiny reductions, and of course because I don't want wanting to die, obviously). Thanks heaps for reading this. All the best Liz
Hi all, I'm new here and would like to thank everyone for sharing their experience and helping others. I wish every one of you success on your path to recovery! My story and symptoms: 2 years ago I tapered off citalopram/escitalopram, because after 6 years taking it I built tolerance to it, as well as some unbearable sinusitis-like side effects. I was prescribed this drug for GAD treatment (for details see my signature below) During the 5th year on citalopram I started to feel its antidepressant effects slowly vanish, and I also noticed I couldn't handle much stress anymore. Actually, my working name for this problem is "impatient stress" and it's one of the most unpleasant symptoms. I would describe the feeling as a mix of impatience and stress without any apparent stressor. I rush to finish whatever I'm doing, but my muscles are clenching and I'm feeling strong physical and emotional unease, sometimes to the extent it feels I'm going to faint or have a heart attack. Kind of stress over-reaction to even simple tasks like chores. My body and mind force me to stop, although there is no apparent stressor. 2 years after getting off meds, this poor stress tolerance doesn't seem to get better, in fact it seems to be worse these days. I try to help my body deal with this artificial stress by supplementing vitamin C and magnesium, but it doesn't seem to have much effect (although it probably does help a bit) Somehow related to this is perhaps my extreme sensitivity to stimulants (tea, coffee, even chocolate). Even small doses make me agitated and anxious next day. At the moment I seem to be even more sensitive than I was a few months after withdrawal. Maybe it's because now I tend to really avoid stimulants as much as I can, which is probably making me more sensitive to them... But is my body going to readjust if I never expose it to such substances? Or is it better to avoid all stimulants and wait if my brain heals from hypersensitivity over time? What's your experience? For example, last week I tried two adaptogenic herbs (ashwagandha, rhodiola) for just a few days, in very small doses. Although I only ingested one capsule of rhodiola (which is 1/2 of recommended daily dose) it made me feel like a new person for two days in row! I felt great and focused. The next morning I had an erotic dream (which I normally don't have) and just when the dream got too exciting, I woke up with a terrible spike of agitation, which pretty much resembled the stressed-out feeling, but much more intense and terrifying. It only lasted a second, but it felt like I was losing my mind, as if I'm going to faint or vomit. Extremely unpleasant feeling. (It wasn't a panic attack though, these are completely different. I'm also familiar with these morning cortisol surges, but this was more like a momentary shock.) I could feel my heart beating strong. I never experienced such a strange shock and I was quite scared. Perhaps the single small capsule of Rhodiola (which apparently is a MAOI) messed up neurotransmitter levels too much? I would love to know what's your experience with hypersensitivity to stimulants following SSRI withdrawal. Did stimulants also trigger anxiety for you? Did you register any change over time? For the last 4 months I seem to be having some kind of anxiety episode triggered by emotional stress and accidental ingestion of green tea. The anxiety is getting worse every day, my sleep is getting shorter and shorter, giving rise to more anxiety. Is there a way to escape this vicious circle? Sometimes I have pinkeye. Not sure if it's something to worry about, I guess it's linked to sleep problems. There's also this sharp "pulling" sensation which I get from time to time in my hands or legs. Feels like if my veins were being pulled into body, shortened. Anyone experienced this? Just recently I started to have occasional chin twitches, although very subtle, hardly noticeable. I hope they'll go away once I manage the anxiety and bodily tension. And the last problem is lower back pain which I have ever since I discontinued SSRI, which makes me think that the physical damage to my back was done probably much earlier, but the pain has been temporarily suppressed by SSRI. Is it possible? Or maybe my lower back isn't damaged that much, but the elevated stress hormones intensify pain signalling in the body. I came to this hypothesis because last week, when I was in better mood for two days, the back pain almost vanished. I've practiced daily meditation for 2 years since withdrawal, I underwent 6 week CBT course, tried fasting, self-help books, supplements, etc. Meditation and CBT provided some help and I'll definitely keep using them. But still... these days I feel so anxious, sensitive, unstable... scared. Since I cannot handle any work load, I had to leave my job. I moved to my family's house, and recently I applied for disability pension (I hope I'll need it just for a few years). Everything has turned upside down for me. I feel I'm doomed to suffer for the rest of my life. I'm worried every day that the taper was too fast (I was so stupid to rush it), and I'm afraid my brain will never recover from the dependency on SSRIs, which terrifies me so much! Can you please help? Any ideas what might be happening with me in regards to the poor stress tolerance? What is actually going on there? Your experiences regarding any of these symptoms will be much appreciated! Do you think the damage is permanent? It's been 2 years now. Thank you! PS: As I'm rereading this post, it all seems so negative... But there are positives also - I'm no longer depressed these days. The depression transformed into anxiety 4 months ago, and although that's not necessarily a great thing one would desire, at least I know something is going on and I can feel motivated again.