bheb: akathisia without dose change

[bheb]

Unsure if I'm posting in the right place but this is somewhat of an introduction.

 

1.5 years ago I started on 20mg of Prozac for OCD. There was restlessness with starting but it went away. Gradually I tapered down to 10mg of Prozac which I was on for a full year. 2 months ago, I felt the sudden onset of a a very severely agitated feeling. It was very vague but I can pinpoint the exact moment I noticed it -- I was sitting, doing nothing remarkable, and unstressed. I had felt something like this before throughout my treatment but it was very very temporary and felt more like an agitated depression brought on by external circumstances.

 

When this feeling started I could not pinpoint anything else as the cause. Things were good in all parts of my life. I had not messed with the dosage of Prozac at all for a year. Is it still possible that the Prozac is causing this long term agitation/akathisia that I still experience today?

 

A month into the feeling I decided to taper off Prozac completely. I experienced very little withdrawal...just mild headaches and dizziness. The akathisia didn't get worse or better. But it is still quite bad. And the longer it continues the more hopeless I become and probably the more depressed as well because I can't see a life without this agitation anymore. Started on some Klonopin to treat the restlessness and help me sleep.

 

Has anyone else experienced akathisia without a dose change? And also only being on a low dose?

Edited May 27, 2017 by scallywag
tags

[KarenB]

Hello bheb, and welcome to SA,

 

I haven't had akathisia, but from reading here on SA for a long time now I do understand what a truly miserable symptom it is.  I'm so sorry you are having to deal with this.  It can occur as a w/d symptom and also as a side effect of the drug - which may explain why you have it.

 

How long were you on 20mg?  Can you give more detail as to how you tapered from 20mg to 10mg and then from 10mg to 0mg?  Has the klonopin changed anything?  Please put your withdrawal history in your signature – all drugs/dates/dosages etc - so we can see your situation easily whenever you post, and help you more accurately.  Thanks.

 

We recommend a gentle taper, reducing by no more than 10% of your current dose each month.  This allows your brain time to adjust as you go, and lessens any withdrawal.  If you did go faster than that your Central Nervous System will have become destabilised, creating better conditions for any withdrawal symptoms or side-effects to show up. 

 

For more detailed discussion of akathisia: 

http://survivingantidepressants.org/index.php?/topic/32-akathisia-vs-restlessness-anxiety-agitation/

http://survivingantidepressants.org/index.php?/topic/7029-blog-my-akathisia-experience-by-akathisiainfo/

http://survivingantidepressants.org/index.php?/topic/8452-freshs-fractured-fairytale-how-much-can-a-koala-bear/

 

Akathisia can be very slow to leave, but it does go away eventually.  In the mean time, you may find Fish oil and Magnesium useful - many people do, during withdrawal.   

 

Another thought:  Klonopin, as a benzo, is also a drug you don't want to get tangled up with. 

 

Anyway, have a read of those and then you can come back to this thread to discuss things further.  This can be your journal to record your tapering and healing progress, and to ask questions. 

 

Welcome to SA,

Karen

[bheb]

Thanks for the reply! 

 

I was on 20mg for 6 months. Then went to 15 for about 2 months and then continued on 10mg for 10 months. I started coming off completely 4 weeks ago and did 10mg every other day for a week then stopped. I have been off completely for 3 weeks. I'm afraid I didn't know about the gentle tapering method, but it's too late for that now. Luckily, however, I didn't experience a bad withdrawal. Akathisia didn't worsen and only head a headache that has since gone away.

 

I had bought Magnesium, B6, and Vitamin D (I'm slightly D deficient so I thought I'd finally address it to see if it helped the akathisia) supplements but will look into fish oil as well. The only thing I've started is B6, two days ago.

 

The Klonopin helps tremendously. I know people also get akathisia from it (mostly from its withdrawal) but I was too desperate to refuse. However, it doesn't address a subtler unsettled feeling. Keeps me from clawing at myself, but there is still some inner restlessness.  

[KarenB]

That B6 (and any B vitamins) can be activating during w/d - we generally suggest people don't use them.  When starting your other supplements, start one at a time and monitor each for a week or so to see how they affect you.  Also, start low and increase gently.

 

Thanks for your signature.  Just wanting to check if 'No prozac at all since January 5, 2016' and 'January 2016 Clonazepam .25mg morning and evening' should both read 2017?

 

You are right that the klonopin may be masking some w/d from the prozac.  Personally, I'd choose to carefully stop the klonopin, then reinstate a small dose of prozac in order to stabilise.  Once I'd achieved that, I'd taper down to 0 slowly, using the 10% monthly method.  Skipping doses every other day is a very destabilising way to taper, and has probably contributed to that 'inner restlessness' you are feeling.

 

However it is your decision.  Reinstatement is never guaranteed, but you are not far out from your last dose so it's probably worth a shot.  You can read discussion about it here:  http://survivingantidepressants.org/index.php?/topic/7562-about-reinstating-and-stabilizing-to-reduce-withdrawal-symptoms/

 

Please keep asking any questions if you have them - we really want to see you find your way out of this.

Karen

[bheb]

Yes, you're correct. I'll fix my signature. And thanks, I'll be careful with the supplements.

 

The problem is that the akathisia (agitation, inner and outer restlessness) developed while I was till on Prozac with no dose change. And it did not worsen when I stopped (even though, as you pointed out, I did not taper well). So I'm doubtful that reinstatement would do anything since the akathisia was not a withdrawal symptom but a side effect I experienced on my usual dose. But I will ask my doctor and maybe I will.

 

On the other hand, it could have been a withdrawal symptom that began a year after I first lowered my dose? Hard to tell. 

[Cipramillion]

My akathisia comes and goes, like the familiar "waves and windows" described by many members on these forums. Magnesium, caffeine, alcohol and sugar makes my symptoms much worse so thats a no go for me. I've had some sucsess with fresh self-made juice from spinach, avokado and reduced intake of carbs, to keep my bloodsugar stable. Fluctuations in bloodsugar trigger akathisia for me.

 

I guess this is a result of a hypersensitive nervous system and withdrawal. It will easily get overstimulated. I would recommend trying out som lifestyle changes in terms of stress reduction, diet and regular exercise. The symptoms will fade over time.

[Altostrata]

Welcome, bheb.

 

Is it possible you might have forgotten a dose of Prozac? Or taken it at inconsistent times of day? That can bring on the "withdrawal symptom" or neurological dysregulation that you've continued to experience.

 

What is your Klonopin schedule?

[LexAnger]

Hi bheb,

 

Just want to chime in with my experienc and thoughts.

 

My akathesia like symptoms started was caused by a few dose increased during tapering Lexapro. It always got better with each dose reduction, then flare back while I am holding. So I have been reducing wuite aggressively to control it.

 

Based on your description, it sounds to me not a WD symptom rather a side effect. I'm not sure how it eventually go for you WD wise ( great you don't have much Wd so far), but I doubt reinstate would do any good to the akathesia. Possibly it would make it even worse.

 

In my opinion, going back to Prozac only makes sense for the potential protracted withdrawal, which is unknown for now.

[bheb]

I'm so bad about finding my notifications on this website.

 

Thanks for the suggestions Cipramillion.

 

Altostrata, nope I did not miss a dose. I've read here on this website that prozac can be activating for some people? So that my body might react to it differently even way late in the game. I assume something like that happened.

 

Lexanger, yes I believe it is a side effect not a WD symptom too. I experienced it several times on prozac actually. But in the past the episodes were quite isolated -- brought on by stress/other drugs and only lasted a day to a week. Unfortunately it started up in late November and still hasn't changed at all. Even though I discontinued Prozac in January. 

 

Altostrata, as for my Klonopin schedule. I was taking 1mg divided day and night at my max dose (no longer than a week). I came down to .75mg divided day and night. Then about a month later I went down to .5mg divided day and night. Now I am actively trying to taper off it completely. Dropped to .375mg for three weeks and am starting (a much slower taper) with .3125 mg. 

 

General update: akathisia is no worse no better and no different. It is hard to tell whether the benzo taper (or lack thereof) is contributing because I do not notice a difference in my dose changes, but it may be maintaining the akathisia at least? 

[bheb]

I'm about 8 months from the beginning of akathisia and 7 months out from stopping Prozac. Really no better at all. I was taking an allergy med (zyrtec/cetirizine) and when I stopped it so did the physical urges and pacing. But I still feel very uncomfortable and agitated. I am finishing a taper from Clonazepam which I took for the akathisia symptoms.

 

It's really scaring me that I'm noticing no improvements aside from noticeable pacing (because that's not the worst of it for me). I'm wondering if this is tardive akathisia as a side effect? Still don't think I experienced withdrawal from Prozac (even though it was practically a ct) though I might be experiencing a withdrawal from Clonazepam that just manifests as the same akathisia?

[scallywag]

bheb -- I'm sorry that akathisia is still your annoying constant shadow.  I wish I could tell you how long your symptoms will last. Unfortunately, nobody can give you a decent prediction about that.

 

It's hard to say what the cause is and spending too much time trying to figure it out or to guess is a waste of your time, energy, and attention.

 

Can you shift to considering non-drug techniques that will help you cope?

Non-drug techniques to cope with emotional symptoms.

[bheb]

Thanks, scallywag. Just had a look through that thread and realized I already do many of those things, but will try the ones I haven't. When the akathisia is very intense there's really nothing that can touch it, unfortunately. But when it is less intense, some meditations help me sleep. 

 

Would there be any reason to consider reinstatement again? Perhaps it was a withdrawal symptom from the Prozac, just very delayed after the dose change. 

[scallywag]

It's possible that you started tapering clonazepam too soon after your last Prozac dose.  If I recall correctly, akathisia can be a symptom of a benzo taper. 

 

Have you been keeping track of your symptoms and doses?  Please keep notes on paper of your symptoms and the times of your dose(s). This post has a useful format for a daily log:

Take notes of doses and symptoms.

 

Post your notes each day for 3-4 days; we may be able to see a pattern that points to a next step.

[bheb]

Yes, akathisia can be a symptom of benzo withdrawal as well. 

 

And yes I've been keeping track. I just took my last dose of clonazepam yesterday at .03mg and haven't had Prozac since my cold turkey at 10mg in January. This is yesterday's diary (I'll post today's tomorrow):

 

1AM bad akathisia*. Can't sleep. 

 

11AM still bad. Hard to sit still while driving.

 

3PM back to average level of akathisia 

 

8:30PM some relief after a hot shower

 

9PM average akathisia is back 

 

10PM Clonazepam dose

 

*average level of akathisia for me = physically uncomfortable. Agitated. Slight urge to move around. 

 

*bad akathisia for me = increased intensity of agitation to the point that I start scratching myself, pacing, or thrashing around. Suicidal.

 

[bheb]

 update: I have been trying weekly acupuncture on mondays. And I finished my klonopin taper the day after the last post. Here were the following days:

 

 8/7 8am wake up feeling normal as always then the akathisia sets in after about ten minutes. Pretty bad 

 

10am walk the dog and then eat breakfast. Some relief 

 

5pm symptoms return full speed

 

8pm dinner and walked dog. Some relief 

 

8/8 2am consistent restlessness and tension 

 

1pm mostly restlessness in arms 

 

7pm feel very drowsy but not exactly relieved 

 

11pm consistent inner tension and uneasiness all over body 

 

8/9 11am bad headaches, ringing and ruffling in ears (possibly from dropping klonopin) 

 

2pm some relief from akathisia while sitting in sun, eating ice cream

 

11pm dinner and one glass of wine, relief 

 

now 8/25: the headaches and ear ringing are gone. Probably from stopping the klonopin. Akathisia feels about the same as ever except I have more of skin burning component to it now and a little more nervousness/icky feeling in my stomach 

[bheb]

Do people think it would be worth reinstating Prozac 8 months off?

[bheb]

I've had a stint with a prolonged UTI/kidney infection and some antibiotics with my first glimpse at waves and windows. I'm not sure why the akathisia is less just as I start to get sick. And my waves aren't related to the movement disorder...they are more a scary deep unsettled feeling that something is wrong. A terror. Maybe I was feeling it before but the akathisia was masking it or maybe illness/macrobid antibiotic triggered it

[ChessieCat]

On 26/08/2017 at 4:35 AM, bheb said:

11pm dinner and one glass of wine, relief 

 

If I were you I'd be cutting out the wine.  Alcohol and caffeine are 2 things which many members have to stop when in withdrawal.

[bheb]

Oh I haven't drunk since I posted that actually. No caffeine either.

[bheb]

Update: I got down to .03125mg of Klonopin in early August and hopped off. I experienced worsening head pressure between eyebrows, dizziness and skin burning. I reinstated .0625 3 weeks later and felt those symptoms go down a bit. A week after that I started experiencing windows for akathisia (my most distressing symptom caused by SSRI). As I experienced these windows I started getting inklings of this terror, unease, dysphoria, anxiety that I'm experiencing much more now. I've got this weird symptom of stomach fluttering much like you get when you are nervous or embarrassed except it lasts for a long time and happens randomly and many times a day. Still, it makes me think that I'm having anxiety and not akathisia now. Definitely not a type of anxiety I experienced before meds though. Anyone else experienced this kind of transition in symptoms?

[bheb]

Really not sure what changes to make. Having a surge in terror/dysphoria that is much worse than the physical restlessness I had before. I'm about to cut my Klonopin to see if it makes anything worse or better (I've been at my current dose fora month now )

[wantrelief]

I am so sorry you are experiencing such horrible symptoms, bheb.  So your current symptoms are worse than the akathisia you were experiencing before?  Maybe this is a delayed reaction of sorts to the K taper?  I wonder if it would be better to hold on changing anything at the moment.  Have you posted in the benzo section?I am hoping  a moderator will get back to you on what to suggest.  I just wanted to tell you that I am really sorry you are dealing with this.  You have been such a trooper with everything you have been experiencing this year.  I really hope this settles down for you soon.

 

   

[bheb]

1 hour ago, wantrelief said:

So your current symptoms are worse than the akathisia you were experiencing before?

I've been having a hard time comparing, but I think so. Constant dysphoria, but when that turns into terror it is much worse than previous physical agitation. Thanks for checking in...I hope to reach some sort of stability soon.

 

As for benzo section, no I haven't on here though I've been posting a bit on other benzo support groups. I might in a bit.

[wantrelief]

I am so sorry - the terror sounds awful.  I really hope you can reach some sort of stability soon as well.  I am curious what the benzo folks say?  Maybe an increase would help?

[bheb]

On 10/7/2017 at 6:42 PM, wantrelief said:

I am so sorry - the terror sounds awful.  I really hope you can reach some sort of stability soon as well.  I am curious what the benzo folks say?  Maybe an increase would help?

 

Thank you. Yes I'm a slight increase on my clonazepam to .07mg. 

 

Also asking again about whether I should reinstate. I know I have to hold the benzo for a while before I do anything, but do people think I should consider reinstating Prozac? The agitation and akathisia hasn't gotten better in about a year of getting it as a side effect. I'm not sure if my cold turkey is prolonging it. 

[Altostrata]

Hi, bheb. You've been off Prozac since January 2017, correct?

 

Given you've been changing your clonazepam dosage, it's hard to pin this on Prozac. Could be your nervous system was stressed from going off Prozac and going off clonazepam aggravated this.

 

Benzos are given as a treatment for akathisia. Has your symptom pattern gotten better or worse since you reinstated clonazepam in August? What is your current daily symptom pattern relative to the clonazepam dosing?

[bheb]

11 hours ago, Altostrata said:

Hi, bheb. You've been off Prozac since January 2017, correct?

 

Given you've been changing your clonazepam dosage, it's hard to pin this on Prozac. Could be your nervous system was stressed from going off Prozac and going off clonazepam aggravated this.

 

Benzos are given as a treatment for akathisia. Has your symptom pattern gotten better or worse since you reinstated clonazepam in August? What is your current daily symptom pattern relative to the clonazepam dosing?

 

Yes I've been off Prozac since January.

 

I didn't have much terror before reinstating clonazepam -- I reinstated to combat my less troubling physical symptoms like dizziness and head pressure. The reinstatement definitely helped those symptoms (but not akathisia), and then I developed full blown terror about 3 weeks after reinstating (I didn't change the reinstatement dose). However I did have inklings of terror a few days before reinstatement and in that period between reinstatement and the 3 week post-reinstatement full blown bout (which I'm still in).

 

Shep has been helping me over at the benzo section and thinks it may be delayed benzo wd. Definitely plausible.

 

The intense dysphoria, terror, and agitation is constant. All day long and does not improve after my clonazepam dose. Sometimes the akathisia and physical agitation is worse at night and wakes me up.

 

There's no doubt the clonazepam is worsening and complicating my adverse reaction to Prozac. I guess I'm just wondering if there's any use reinstating a small amount of Prozac in case I'm having a delayed reaction to my cold turkey as well.

[bheb]

Has anyone else had an adverse reaction while being on a medication for a long time?  I may now be suffering from withdrawal but I wasn't before -- I developed akathisia/agitation after being on Prozac for 1.5 years (and hadn't changed the dose within 6 months of the reactions). Just wondering if anyone else has experienced something similar, not necessarily the same symptoms. 

[Altostrata]

I don't know. Your guess is as good as anyone's. If you wish to try Prozac, if I were you, I might try 0.5mg.

[JenJen]

I have not but a very smart and helpful mod told me it can happen.  My withdrawal was going well.  She told me it can get awful at the end.  Our brains are restoring themselves and it isn't a smooth linear process.  I wish I could be more helpful but my understanding is limited.  

 

[bheb]

No worries, thanks for replying.

[bheb]

Okay, I might do that. 

 

After asking my doc more about my med history, it turns out I actually did increase my dose from 10 to 15mg in October. The reaction started in late November.

[bheb]

About the reinstatement, there's still some confusion about what doses i was on when. So I'm going to have another appt. to discuss that before I try the small reinstatement.

 

Just need to vent a little.

 

My heart breaks every time I have to convince a family member of my suffering. They underestimate the physical restlessness/agitation...think I can work out more and it will be gone, etc. At that point I have to really dig deep and expose the worst of it. Sometimes, it feels selfish to show them that. It feels selfish to make them hurt about how much I'm hurting. But there's really no other way to convince them that I have tried every common sense thing in the book, and this is beyond the scope of normal human experience. 

[bheb]

I will be trying reinstatement this weekend. If I feel no different at .5mg, how long do I wait to increase? And by how much?

 

I've read it takes 4 days for the change to register, so should I wait around 5?

[bheb]

Updosed to 1.6mg. Let me know if you have advice about my questions above 

[Shep]

On 11/16/2017 at 5:27 AM, bheb said:

I've read it takes 4 days for the change to register, so should I wait around 5?

 

Hi, Bheb.

 

Please see the below from About reinstating and stabilizing to reduce withdrawal symptoms:

 

On 10/8/2012 at 7:17 PM, Altostrata said:

How long should you give reinstatement?

• It takes at least 4 days for your body to fully register the addition of a neuroactive drug. Unless you have an immediate bad reaction, observe your symptom pattern for about a week to see if the reinstatement is helping. If you have an immediate bad reaction, reduce or stop taking the drug.
• After reinstatement, the amount of time needed to alleviate withdrawal symptoms (stabilizing) varies according to the individual. Relief can be felt immediately, after some weeks, or after some months.
• Once you feel withdrawal symptoms are reduced after reinstatement, give your nervous system time to stabilize before attempting dosage reduction. Think in terms of months, not days.
• Be patient after you reinstate. Reinstatement may not immediately eliminate all withdrawal symptoms. You may still experience waves of symptoms, which usually lessen as time goes on. Do not attempt to taper again until you feel symptom-free, or at least until your withdrawal symptoms are mild and tolerable.
• The dose needed for effective reinstatement varies according to the individual.

 

This is where it gets very tricky because you're dealing with a benzo as well as the recent AD reinstatement. Because these two drugs have almost identical withdrawal, it will be hard to weed out which symptoms you are having now are being caused by which drug. 

 

As you keep notes, pay close attention to symptoms you may recognize as specific to benzos and specific to the AD, if that's possible. This will help the AD mods as they give you advice. You may also want to think in terms of "overall stabilization" as opposed to zoning in on specific symptoms. 

 

I would give it a few more days unless you're seeing a bad reaction.