neroli: is this benzo withdrawal, or other drugs interacting

[Tom37]

Hi Neroli,

 

Sorry to hear about your work situation. I went through a big restructure earlier in the year when was struggling quite a lot and it was not easy to go through. Whatever you do make sure you put yourself first and don’t worry about what they think about your situation. 

 

Just make sure you look after yourself and sometimes that means letting things go as the stress of fighting it can only make things worse and no job is worth that.

 

Not sure if you need to work for financial reasons but if you don’t then it could be an opportunity to take time out for yourself although that gas it drawbacks too. Typical of wd....sometimes you can’t win either way.

 

Take care.

[bubble]

Oh my, this sounds really tough but I love the way you are handling it: no catastrophising and lots of problem- solving and productivity. I think it is great that you are checking out the options with the help of the union and I believe you will come up with something that works out for you. Is there anything called reasonable accommodation and disability anti discrimination protection?

 

Unfortunately it doesn't seem like that manager will tolerate a different way of working but she might if that was a legal obligation to avoid discrimination. If not, finding a different position sounds good. Disability would be my third option. I just love your awareness of your needs and putting yourself first. I hope this resolves in a positive way and doesn't stress you too much.

 

It also seem that you continue to recover from the way.

[Rosetta]

Neroli,

I'm thinking about you and the situation with your work.  Very unfortunate timing.  I'm hoping that somehow this will all turn out to be a blessing.  I'm sure that if it does any signs of that possibility would be hard to see right now.  Thank goodness you have a union!  Being the only person left with institutional knowledge -- hmm.  Management there isn't very smart it seems.  

I'm rooting for you as always.  Give yourself permission to put it all out of your mind for several hours a day if you can.

Rosetta

[neroli]

Hello Tom

 

Thank you for your message.  It's not an easy situation and it ramps up my symptoms.

 

11 hours ago, Tom37 said:

Just make sure you look after yourself and sometimes that means letting things go as the stress of fighting it can only make things worse and no job is worth that.

 

Not sure if you need to work for financial reasons but if you don’t then it could be an opportunity to take time out for yourself although that gas it drawbacks too. Typical of wd....sometimes you can’t win either way.

 

I am trying to figure out what is the best for me.  I'm not rolling in money and I'd have to live on whatever benefit I could get from WINZ.  

 

I agree that fighting will be too stressful and even that carrying on working could be too.  Not working may bring some relief in terms of being able to not face major stress but it will also concern me that I am not able to get out and meet people and could find that I am have to deal with a lot of isolation.

 

As you say, sometimes there are no wins either way.

 

Hope your waves are passing or getting easier.

 

Neroli

 

[neroli]

Hello @bubble

 

Thank you for your kind words.  I am doing my best to contain my worry.  I'm afraid I cannot claim that I am not catatrophizing - it is bringing my symptoms on with more intensity.  

 

I will do my best to deal with it one step at a time and try to distract/use coping techniques.

 

Wishing you all the best

 

Neroli 💜

[neroli]

Hello Rosetta

 

Thank you for your lovely message and for rooting for me.

 

4 hours ago, Rosetta said:

I'm hoping that somehow this will all turn out to be a blessing.

 

Me too.  At the moment, as you say, I can't see that possibility clearly and I am so worried about the situation and how it is affecting me (more anxiety to cope with).

 

Am doing my best to take it one step at a time but finding it incredibly difficult not to have meltdowns.

 

Neroli 💜

[Tom37]

It’s a horrible situation to be in and I can understand the isolation part of your concerns. Whatever happens hopefully they treat you with the respect that you deserve. Maybe an agreement of voluntary  redundancy could be an option so you do get some money out of it if possible. 

 

I’ve been doing not too bad thanks and definitely better than first 4/5 months. Just hit a big wave though so dealing with that.

 

Look after yourself.

[neroli]

Thank you @Tom37

 

Well, we'll see how things develop over the next week or two.

 

Glad to hear that things have improved since the first 4/5 months - of course not so glad that you have hit a big wave.  You're hanging in though and you will come through.

 

Take care

 

Neroli 

[Carmie]

Hi Neroli, 

 

Thanks for dropping over to my thread. I’m sorry to read about your job situation. Hope you manage to work out what works best for you, sending hugs🤗

[Rabe]

Oh Neroli I am SO sad to hear this!  Is your old manager still there somewhere?  Would you be able to transfer to where she is?  Would you be able to talk to her for thoughts?  You sure did not need the extra stress as you are doing all that you can as it is.

Before you leave can you check on disability and all so that you have you job until you can get the other information re disability and all?  

Please let us know how it is going.  Know that I am holding you in my heart and thoughts!!!  Love you so my dear PF!!!💜

[neroli]

Hello dear @Rabe

 

Thank you for your message.  I am doing all that I can to get the relevant information.  I don't think talking to my old manager would a an appropriate thing to do - I am in negotiation with the new manager, the industrial relations manager and the Union - any communications outside of that could jeopardise negotiations.

 

Just doing things step by step.

 

Thank you for thinking of me.

 

Neroli 💜

[Rabe]

Hoping things have settled for you some Neroli.  I didnt realize this was so involved...with the new manager, IR manager, and the union.  SO hoping somehow things can be worked out in a way that will be ok for all.  I have been thinking about you and all this all week.  Love and hugs to you my dear PF! 

💜

[Kristine]

Dearest Neroli, I thought I would respond on your thread ☺️

16 minutes ago, neroli said:

Thank you so much, Kristine.  That's lovely of you to say that.

 

I've been a bit slack on SA recently.  

 

Work is no more, I have been medically retired, as of next week probably when the paper work is sorted.  They would not allow me to work from home all the time.  In part, it is a relief as it was getting very hard for me to put in the hours and keep up the focus on problem-solving and being in the loop.  I'm hoping this will mean I have more time to taper and take care of myself - despite some fears of not having my time taken up with something purposeful.  I have ideas of what I might do, as long as I'm not too symptomatic.  And of course I'll be living on a benefit - but then, I'm grateful that there is some state assistance.

 

Wish I could work out what is making my legs worse and worse - being on a particular drug, or the tapering off one (or any) of them.

 

Anyway, we do the best we can day by day.

 

with love

 

Neroli 💜

I am so sorry work is no more. I’m just hoping that this cascade of events has a silver lining and you will have more time and energy to focus on your wellbeing. I can, however, understand your fear associated with not having your “time taken up with something purposeful”....this is exactly how I felt when I had to resign from work 4 years ago. I’ve come to realise that I am working towards the most important and purposeful goal imaginable. Peace and freedom. 

 

When taking more than one psychotropic drug, It is so difficult to figure out what symptoms are caused by WD, side effects and/or drug interaction. My best guess would be that your leg trouble may be related to the major drug interaction between nortriptyline and Escitalopram...also the Benzo can make you feel wobbly. Two years ago when I was on high doses of three drugs with major drug interactions my legs would buckle underneath me. My leg muscles were like jelly. Therefore, you seem to be making the correct decision by tapering the nortriptyline. I wish we could all have some definitive answers to our questions. But as you said ..”we do the best we can day by day”....that’s really all we can do. 

 

lots of love, K xo

[Rosetta]

Neroli,

I'm very disappointed in your supervisor.  Rest assured this mistake will come back to haunt her.  I once worked with a company that did the same thing -- axed everyone who had institutional knowledge one by one until no one knew any history except one traveling salesman.  He didn't have time to repeat over and over what he knew to all the new people.  He couldn't do their jobs, and he didn't know the details of their jobs either.  Your supervisor will lose her job, too, and she will not get any medical retirement or any sort of softer landing.  She will be so shocked after doing everything upper management seemed to want her to do.  She's expendable to them, and she's going to become quite aware of that fact.  

 

I'm glad that you have a safety net of some sort.  Those are more and more rare these days.  My hope is that without the stress of a commute and a job with a company that is in turmoil you will heal faster.  My legs are still unpredictable.  Using escalatos is scary, and stairs are iffy.  But you are reducing your drugs the right way, and I did not.  Once you get past a certain point you will get your strength back.  Does medical retirement mean you have better access to physical therapy, etc, than before?  In the U.S. disability usually means a complete loss of health care except for the wealthy or those 65 or over.  A few states have a safety net for those unable to afford healthcare before 65 years of age.

 

Maybe you can find some clubs near your home?  I'll be thinking of you.  There a silver lining in this!  Somewhere!

 

All my love, Rosetta

[JackieDecides]

On 8/24/2019 at 7:03 AM, bubble said:

this sounds really tough but I love the way you are handling it: no catastrophising and lots of problem- solving and productivity.

 

On 8/24/2019 at 1:27 PM, neroli said:

I am doing my best to contain my worry.  I'm afraid I cannot claim that I am not catatrophizing - it is bringing my symptoms on with more intensity.  

 

 

at least you are self-aware. what a bad situation, I'm so sorry. 

 

the job I just relocated to a new state for - a state where I don't know anybody - is not giving me 40 hours a week.

 

 nothing to be done now as October first the entire way Medicare pays for therapy in nursing homes is replaced with a new system and after that we'll all just see who has jobs.

 

very scary. 😕

[Carmie]

Hi Neroli, 

 

Just wondering how you’re doing with the extra stress in your life? Thinking of you💚

[neroli]

Hello @Rosetta

 

Thank you for your kind message.

 

I think the department will be in a big mess with the way they have re-structured and made staff redundant.  In some ways, I am relieved that I will not be around to have to soak up some of the stress that is likely to ensue.  Organisations these days (some that I have been in anyway), don't give a jot about losing institutional knowledge and expertise.

 

I believe I will get some kind of state benefit, I don't see why I wouldn't but if I'm not eligible, then I'm up sh*t creek.  I will get on to researching this now that negotiations are in process for the Medical Retirement.

 

As I have been seeing a govt. health service physiotherapist, an application has been made for funding to allow me more home care.  I will need to be assessed to see what I am allowed.

 

Actually I CT'd off the drugs in 2014, after being brought to my knees by 4 changes in AD over the period of a year.  I didn't know about WD or long-term effects then and I went through significant symptoms for a few years before having a physical breakdown, accompanied by 24/7 suicidal "anxiety" in early 2017, which I could not live with, so I went back on drugs to see if that would ameliorate the symptoms (I knew it was risky, and I didn't really want to go back on and it took going onto 3 before I found any relief and I have hobbled my way through life and work since then).  I am probably still dealing with the protracted effects from the CT and then the re-drugging on top.

 

I'm sorry to hear you are still having issues with your legs - it's very debilitating.  But pleased to hear that you have made it to Spain - that is something enormous - I can barely get to my mail box.

 

I, too, hope that the removal of work stress will aid in my taper and recovery.

 

Wishing you all the best

 

love

 

Neroli 💜

[neroli]

Hello JD

 

On 9/6/2019 at 12:12 PM, JackieDecides said:

the job I just relocated to a new state for - a state where I don't know anybody - is not giving me 40 hours a week.

 

 nothing to be done now as October first the entire way Medicare pays for therapy in nursing homes is replaced with a new system and after that we'll all just see who has jobs.

 

very scary.

 

This does sound scary.  I hope that you will be able to retain employment at the number of hours you need.  Settling in to a new state is something that will take some time, maybe, and I think you are also looking for somewhere else to live.  I wish you the best for this and that you find your feet and some companionship in the new state.

 

You are a courageous person and coping with your situation well, given the uncertainty of it all.  My hat is off to you.

 

love

 

Neroli 💜

[neroli]

Hello @Carmie

 

Thank you for dropping in and for your thoughts.

 

I seem to have bad days and better days,  Better days are when I am more mobile and don't feel like my legs are going to seize up under me and when I don't have anxiety.  So it would depend on which day you asked the question as to how I would answer.  Today has been a better day, so I feel more motivated to write on my thread.  On a bad day, it would be barely mobile legs, anxiety, hungers and wees, fatigue up to the gills - oh you know the score.  And many, many tears and hopelessness.

 

I think I read that you have recovered somewhat from your wave and were preparing, or had recently taken, another drop.  I wish you all the best for that and as smooth a ride as possible through the reduction.

 

You're a veteran at distraction, which doesn't mean life is easy for you, but you make the best out of it that you can.  That is so brave of you.

 

love

 

Neroli 💜

[Rabe]

Hi Neroli.....oooohhhh I don't know what to say.  I am angry at the company...but seems etc be the way of the world these days which is a sad statement.  You have been SO devoted and conscientious in your job...they are the ones who have lost something and someone who is a great asset to the company.

I am sorry you are having to deal with this but also hope that not having that stress will ultimately be an unwrapped gift.  You will be  able to take better care of yourself I think and the less stress may alleviate some of your symptoms.  I so hope so.  Pleas let us know how you are doing.  I will be thinking about you more than usual!!!  Love and hugs to you my dear PF!!!  💜

[Carmie]

Hi Neroli, 

 

Just popping in again to see how you are today? You described your days as bad and better. I hope you’re having a better day. 

 

I’ve spent the majority of the day in bed, though I’ve gotten up to do some cooking and do a little bit of housework. It’s nearly 3pm here, I’m getting picked up for the movies around 5pm or so, so I must go and have a shower soon. It’s been too much effort so far. 

 

Sending hugs🤗

[neroli]

Thank you for dropping by @Carmie

 

I am astounded at how much you manage to do in spite of all your symptoms and the CFS - you must be made of steel.

 

I had a "bad" day today.  These legs are getting achier and stiffer and I had a wave this afternoon of anxiety and weak-feeling legs.  I've now got a walking frame, perching stool for the kitchen, and a frame round the toilet so I can lower myself and push myself up.  It frightens me if I think I'm losing all my independence - I need quite a bit of help now but so far have been able to look after myself in the house.  Haven't been out in ages.  And people are really kind and want to visit but I can't handle it.

 

I know we all heal - it's just the getting there that is the test.

 

I'm down to just knitting at the moment - somehow colouring isn't interesting me, I hope it comes back, though, as that was a soothing pastime.

 

I hope you get to enjoy some of the outings you have planned.  You just keep on keeping on.

 

Neroli 💜

[Carmie]

Hi Neroli, 

 

I’m sorry you had a bad day today. It must be awful to be in pain all the time. I’ve had severe chronic pain in the past, it’s no fun. I’m glad you got a few difference things to help you like the walker. I got hit by a car once and spent three months in hospital, I had to use a walker for a while too. 

 

I’m sorry too you haven’t been able to get out much. That’s lovely your friends are thinking of you even if you’re not up to having company at the moment. It’s nice to be thought of, especially when you’re sick. I hope your knitting is a good distraction for you. I used to crochet for years non stop to help me through withdrawals, but I had to stop this year because I got repetitive strain injury. When I say non stop, I pretty much started when I got up, I would do movie and tv series marathons and crochet while doing those. Crocheting really, really helped me through waves. I used to take it with me everywhere I went too.

 

No, I’m definitely not made of steel. If I added up all the hours I’ve spent in bed for the last twenty five years, I’ve done that more than doing anything else. The only way I can get out and about is if I spend the rest of the time pretty much in bed. If I do too much I end up not being able to move for days, or weeks sometimes. I’ve had periods where I was in bed for many months at a time, I could barely walk to the toilet. Going to the letter box would have been like climbing Mount Everest. I’ve learnt to pace myself so I can do the things I love.

 

When going out now I spend heaps of time sitting down, some days I’m too weak and faint to sit in a chair, so I sit on the floor or lie down. I went to the movies last night with friends, that was fine because you lie down in comfy chairs, but when my friends were standing around before and afterwards I was too weak and sat on the floor. My friends are used to me. 😁 The other day when I came back from the ballet with a friend and her son we were waiting in line for a bus, I couldn’t stand so I sat on the floor, my friend joined me. Her son was laughing.😂 I do what I have to do. 

 

Yes, I’ll keep on keeping on, you too. One day at a time, one hour at a time, one minute at a time does it. 💚

[Rosetta]

Neroli,

 

I'm thinking of you.  It's been a little while since you posted on your thread.  How are you?

 

Rosetta

[neroli]

Hello @Rosetta

 

Thank you for dropping in,  I'm not active on the SA forum at the moment.  I do PM people but I've been flagging as far as energy for keeping up with people on the forum is concerned.  And I think I got fed up with just posting that things were getting more difficult.

 

As you know, I lost my job and I have been in the transition to my "new" life since then.  First there was the medical retirement process from work to go through.  And now there are applications for benefits to be made, doctors visits to get certificates etc., as well as dealing with the health system to get some in-home care.  All in all it takes quite a bit of energy to do these things, and have to coordinate it all for myself (though friends have been helping with shopping and cooking and being able to talk to them about things).

 

Psychologically, I am still trying to adjust to not having the work to do (even though it was getting very tough to keep going) and am finding that my pastimes are not of interest to me, or I just feel too drained or on edge to do them.  The WD/iatrogenic damage symptoms do not help this.

 

The good news is that I have just received notice that I will get 10 hours a week in-home care - which I hope will take care of meal preparation and serving up, some washing and home cleaning and help with the shower in the morning.  I have yet to see how it will pan out.

 

The not so good news is that my condition has been deteriorating.  I no longer go outdoors, nor do I want to.  I have less mobility in my legs and more aches and stiffness.  Over the past few weeks this has meant that I have had to get to bed very early (varying between just after lunch to 4pm) because my legs are about to seize up and I get a lot of tremor, desperate fatigue, wooziness and at times high tension/anxiety (drizzled with a garnish of good old SI).  I prepare all my meals and snacks while I have energy in the morning and take them to bed with me if I have to abandon ship, so to speak.

 

I've caught a bit of your experience in Spain, you are so diligent keeping up your journal, and it seems like you are doing reasonably well (considering you are living a new life in a new place) and still coping with some significant symptoms.  I have to take my hat off to you that you are managing to do this.

 

I appreciate your kind thoughts, Rosetta, and hope that the end of your symptoms is just around the corner.

 

love

 

Neroli 💜

 

 

 

 

 

 

[Rosetta]

Oh, Neroli, I'm so sorry you are struggling right now.  Having someone to help you at home will be good for you.  I remember having worsening of symptoms in the evening at one time.  It's rare now, but does happen.  I am sure you are tired of hearing this, but everything is going to improve one day.  None of this is your fault.  I used to feel that if I were stronger I would not have been sick.  Looking back I realize just how bad it was, how far beyond absurd it was!  I could not wrap my brain around what was going on with my body and mind because it was outside of any experience I had had.  This time will end, Neroli, eventually.  Then, it will be clear that you were just along for the ride.  The body is going to react the way it will, and no amount of willpower will make your legs work differently right now.  I'm impressed that you can work around the challenges so well.  I might have nearly starved if I had had to prepare food.  Hold on.  Let time pass and you will get your life back.

Rosetta

[Rosetta]

Thinking of you.  All my love, Rosetta

[Altostrata]

On 9/20/2019 at 12:19 AM, neroli said:

Thank you for dropping by @Carmie

 

I am astounded at how much you manage to do in spite of all your symptoms and the CFS - you must be made of steel.

 

I had a "bad" day today.  These legs are getting achier and stiffer and I had a wave this afternoon of anxiety and weak-feeling legs.  I've now got a walking frame, perching stool for the kitchen, and a frame round the toilet so I can lower myself and push myself up.  It frightens me if I think I'm losing all my independence - I need quite a bit of help now but so far have been able to look after myself in the house.  Haven't been out in ages.  And people are really kind and want to visit but I can't handle it.

 

I know we all heal - it's just the getting there that is the test.

 

I'm down to just knitting at the moment - somehow colouring isn't interesting me, I hope it comes back, though, as that was a soothing pastime.

 

I hope you get to enjoy some of the outings you have planned.  You just keep on keeping on.

 

Neroli 💜

 

On 10/6/2019 at 9:13 PM, neroli said:

Hello @Rosetta

 

Thank you for dropping in,  I'm not active on the SA forum at the moment.  I do PM people but I've been flagging as far as energy for keeping up with people on the forum is concerned.  And I think I got fed up with just posting that things were getting more difficult.

 

As you know, I lost my job and I have been in the transition to my "new" life since then.  First there was the medical retirement process from work to go through.  And now there are applications for benefits to be made, doctors visits to get certificates etc., as well as dealing with the health system to get some in-home care.  All in all it takes quite a bit of energy to do these things, and have to coordinate it all for myself (though friends have been helping with shopping and cooking and being able to talk to them about things).

 

Psychologically, I am still trying to adjust to not having the work to do (even though it was getting very tough to keep going) and am finding that my pastimes are not of interest to me, or I just feel too drained or on edge to do them.  The WD/iatrogenic damage symptoms do not help this.

 

The good news is that I have just received notice that I will get 10 hours a week in-home care - which I hope will take care of meal preparation and serving up, some washing and home cleaning and help with the shower in the morning.  I have yet to see how it will pan out.

 

The not so good news is that my condition has been deteriorating.  I no longer go outdoors, nor do I want to.  I have less mobility in my legs and more aches and stiffness.  Over the past few weeks this has meant that I have had to get to bed very early (varying between just after lunch to 4pm) because my legs are about to seize up and I get a lot of tremor, desperate fatigue, wooziness and at times high tension/anxiety (drizzled with a garnish of good old SI).  I prepare all my meals and snacks while I have energy in the morning and take them to bed with me if I have to abandon ship, so to speak.

 

I've caught a bit of your experience in Spain, you are so diligent keeping up your journal, and it seems like you are doing reasonably well (considering you are living a new life in a new place) and still coping with some significant symptoms.  I have to take my hat off to you that you are managing to do this.

 

I appreciate your kind thoughts, Rosetta, and hope that the end of your symptoms is just around the corner.

 

love

 

Neroli 💜

 

 

The professional version of your drug interactions

Quote

 

Interactions between your drugs

Major

nortriptyline escitalopram

Applies to: nortriptyline, escitalopram

MONITOR CLOSELY: Concomitant use of agents with serotonergic activity including selective serotonin reuptake inhibitors, tricyclic antidepressants, and other antidepressants may potentiate the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A and 2A receptors. Symptoms of the serotonin syndrome may include mental status changes such as irritability, altered consciousness, confusion, hallucination, and coma; autonomic dysfunction such as tachycardia, hyperthermia, diaphoresis, shivering, blood pressure lability, and mydriasis; neuromuscular abnormalities such as hyperreflexia, myoclonus, tremor, rigidity, and ataxia; and gastrointestinal symptoms such as abdominal cramping, nausea, vomiting, and diarrhea.

MONITOR CLOSELY: Escitalopram can cause dose-dependent prolongation of the QT interval. Theoretically, coadministration with other agents that can prolong the QT interval including tricyclic antidepressants and other antidepressants (e.g., trazodone) may result in additive effects and increased risk of ventricular arrhythmias such as torsade de pointes and sudden death. In a double-blind, placebo-controlled ECG study consisting of 113 healthy subjects, the change from baseline in QTc (Fridericia-corrected) was 4.3 msec for escitalopram 10 mg/day and 10.7 msec for the supratherapeutic dosage of 30 mg/day. Based on the established exposure-response relationship, the predicted QTc change from placebo under the Cmax for 20 mg/day is 6.6 msec. Cases of QT interval prolongation and torsade de pointes have been reported during postmarketing use. In general, the risk of an individual agent or a combination of agents causing ventricular arrhythmia in association with QT prolongation is largely unpredictable but may be increased by certain underlying risk factors such as congenital long QT syndrome, cardiac disease, and electrolyte disturbances (e.g., hypokalemia, hypomagnesemia). Also, the extent of drug-induced QT prolongation is dependent on the particular drug(s) involved and dosage(s) of the drug(s).

MANAGEMENT: In general, the concomitant use of multiple serotonergic agents should be avoided if possible, or otherwise approached with caution if potential benefit is deemed to outweigh the risk. Patients should be closely monitored for symptoms of the serotonin syndrome during treatment. Particular caution is advised when increasing the dosages of these agents. If serotonin syndrome develops or is suspected during the course of therapy, all serotonergic agents should be discontinued immediately and supportive care rendered as necessary. Moderately ill patients may also benefit from the administration of a serotonin antagonist (e.g., cyproheptadine, chlorpromazine). Severe cases should be managed under consultation with a toxicologist and may require sedation, neuromuscular paralysis, intubation, and mechanical ventilation in addition to the other measures. Due to the potential for additive effects on the QT interval, ECG monitoring may also be appropriate when escitalopram is used with tricyclic antidepressants or other antidepressants like trazodone. Patients should be advised to seek prompt medical attention if they experience symptoms that could indicate the occurrence of torsade de pointes such as dizziness, lightheadedness, fainting, palpitation, irregular heart rhythm, shortness of breath, or syncope.

References

1. Insel TR, Roy BF, Cohen RM, Murphy DL "Possible development of the serotonin syndrome in man." Am J Psychiatry 139 (1982): 954-5
2. Harvey AT, Preskorn SH "Interactions of serotonin reuptake inhibitors with tricyclic antidepressants." Arch Gen Psychiatry 52 (1995): 783-4
3. Goldberg RJ, Huk M "Serotonin syndrome from trazodone and buspirone." Psychosomatics 33 (1992): 235-6

View all 35 references

Switch to consumer interaction data

Moderate

nortriptyline diazePAM

Applies to: nortriptyline, diazepam

MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients.

MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Cautious dosage titration may be required, particularly at treatment initiation. Ambulatory patients should be counseled to avoid hazardous activities requiring mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References

1. "Product Information. Belsomra (suvorexant)." Merck & Company Inc, Whitehouse Station, NJ.
2. Divoll M, Greenblatt DJ, Lacasse Y, Shader RI "Benzodiazepine overdosage: plasma concentrations and clinical outcome." Psychopharmacology (Berl) 73 (1981): 381-3
3. Plushner SL "Valerian: valeriana officinalis." Am J Health Syst Pharm 57 (2000): 328-35

View all 36 references

Switch to consumer interaction data

Moderate

diazePAM escitalopram

Applies to: diazepam, escitalopram

MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients.

MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Cautious dosage titration may be required, particularly at treatment initiation. Ambulatory patients should be counseled to avoid hazardous activities requiring mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References

1. "Product Information. Belsomra (suvorexant)." Merck & Company Inc, Whitehouse Station, NJ.
2. Divoll M, Greenblatt DJ, Lacasse Y, Shader RI "Benzodiazepine overdosage: plasma concentrations and clinical outcome." Psychopharmacology (Berl) 73 (1981): 381-3
3. Plushner SL "Valerian: valeriana officinalis." Am J Health Syst Pharm 57 (2000): 328-35

View all 36 references

 

 

These liver enzyme conflicts are not noted in the interactions report:

 

Substrates of p450 cyp 2C19 AND 3A457 diazepam, escilatopram

Substrates of p450 cyp 2D6 nortriptyline, escilatopram

Inhibitors of p450 cyp 2D6 escilatopram

 

Neroli: Diazepam and nortriptyline are competing with escilatopram for liver enzymes, plus escilatopram inhibits metabolism via the liver enzyme it shares with nortriptyline. The drug-drug interactions may push the blood levels of nortriptyline and escilatopram higher, giving the effect of higher dosages of both.  It is possible you have been suffering low-grade serotonin toxicity from the nortriptyline-escitalopram combination as long as you've been taking them.

 

This suggest you rather quickly need to get off escitalopram.

 

We know you've had trouble with this in the past, but the adverse effects of your cocktail have become so severe, the risk of withdrawal symptoms may be justified; they might not be any worse than what you're experiencing now. You will need to make this decision. If I were you, I'd make a cut of 25% in your escitalopram right away -- holding the other drug schedule constant. Please be prepared for bumps.

 

The prescribing physician is responsible for these drug conflicts. After you get through this, you should call for a review of your case.

 

Edited October 29, 2019 by Altostrata
removed code

[neroli]

Thank you Also

 

I will take this consideration to the new Dr. when I find one.

 

Neroli

[Altostrata]

neroli, you've been on the same drug cocktail, with the same drug-drug conflicts, since your first post here in January 2018. You've consulted doctors but made little progress in addressing the drug-drug conflicts, including the very well-known risk of serotonergic toxicity.

 

As you know, a diagnosis of FND is not useful, it means you have something going on but they don't know what and they don't know how to treat it.

 

Not sure who you're talking to, but my feeling is you need to take the possibility of serotonin toxicity seriously -- a condition that has not risen to the level of serotonin syndrome but has caused progressive neuromuscular abnormalities such as hyperreflexia, myoclonus, tremor, rigidity, and ataxia you are feeling in your lower body.

[neroli]

Thank you Alto

 

I did consult a Dr about possible serotonin toxicity - he did tests and said I didn't have it.

 

I am of course concerned and have planned to make reductions in the Escitalopram.  When I have managed to get a new Dr I will discuss this with him/her and ask about support for coming off the drug/s.  Each time I have tried reducing Esci. I have noticed a worsening in the legs, extreme fatigue and depression (even at small cuts) - I want to get some support in place before I embark on another attempt.

 

Neroli

[Altostrata]

There are no test for serotonin toxicity -- that's absurd. You can cross that doctor off your list.

 

I understand you would like physician support in helping you reduce your drug burden, but you've been looking for this since at least January 2018. Very few people here have found such support, they've had to make the hard decisions abut reducing drugs themselves.

 

Please let us know how you're doing.

[Rabe]

Thinking about you Neroli!!💜

[neroli]

Moderators:

 

I'd be interested if any of you have any opinion on what drug (or drugs) that I'm taking may be causing purple fingers with the fingertip ends being red, and deep purple toes, that go red at times (possibly when they are warmer) and in winter both fingers and toes get significant chilblains.  None of this happened before I was on the drugs.

[Rabe]

Hi Neroli,

I dont know if it is exactly the same but i find my extremities are often purple and it seems to be the Clonazepam.  I also notice the redness in my feet and toes.  I get hot and cold a lot.  I think the Clonazepam relaxes everything and then my muscles and blood vessels respond, and I think it relaxes the heart as well.  Just affects everything that has to contract or relax...and even things that dont HAVE to but DO because of the drug(s).  I also find it varies daily and thought out the day.  It has gotten better I think ? since drugs are lower?  

For what its worth....

Love and hugs my friend!!!💜

[neroli]

Help dear @Rabe

 

Thank you for that information - it's really useful to know.  I get very cold fingers and toes (even now the temperatures have lifted into spring). 

 

I really don't think we can know for sure what drug is doing what when we are poly-drugged but reducing should, I hope, lessen these symptoms.  I have found a government report for NZ that says there are about 12 reports of Nortriptyline causing a Reynaud's-type condition - so the more I can reduce these two drugs the better I feel.  I hope I can get them down far enough so that next winter it isn't as bad as it was this winter, the chilblains started to crack and blister and I do not want to have to deal with an infection from that!

 

Wishing you the very best, dear PF

 

Neroli 💜