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PabloHoney825

PabloHoney825: withdrawal or Serotonin Syndrome, sensitization, reinstatement

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PabloHoney825

Hi,

 

I'm in a dire situation. I've been online all night (haven't slept) and came across this very informative forum and thought I'd link with others who are or who have gone through this hell. I can't reach out to my psych doc as he is away, and I don't want to the ER for a third time to have them tell me follow up with my specialists.

 

I started Mirtazapine for insomnia about a year ago. I never went above 15 mg and stayed mostly at 3.25. Recently I decided to get off as I felt it was losing it's potency (and noticed palpitations but not sure if it was the MIRT) and foolishly started to take it some nights and not others. I was supplementing with melatonin (5-20 mg) every night, and started to use an old script of low-dose Klonopin to help me sleep (.25-.5). 

 

The real trouble started about two weeks ago when I took tryptophan (1000 mg) at the same time as the Mirtazapine 3.25. The next day I felt really foggy and took my prescribed Vyvanse (60 mg) as usual. Within minutes I knew something was wrong. I had to pull over because of severe anxiety, palpitations, and racing heart. I took an "emergency" dose of Klonopin .5 and it helped calm me down and quiet the Vyvanse. I was able to go to work. Later that night, I went to sleep and took another Mirtazapine 3.25. About 20 minutes later I started to feel my muscles tensing and I began having tremors and shivering. My heart rate went up to 130 bpm and I could feel skipped beats. Ofcourse I freaked and it just made things worse. I'm not a hypochondriac and I haven't been to the ER in decades but I told my wife we had to go. On the way I downed another .5 of Klonopin. My heart rate eventually returned to normal but my blood pressure was elevated (160/95). I told them I thought I might have Seretonin Syndome but they didn't seem to know much about it and released me with a script for a beta blocker (Metrorpolol 50 mg) and told me to stay off the Mirtazapine. 

 

That weekend I took my other prescribed ADHD med, Desoxyn, which has less peripheral agitation, and was fine. I stayed away from the mirtazapine but replaced it with the beta blocker and the klonopin which helped me sleep. Several days later, I took a very low dose of my Desoxyn and I nearly jumped out of my skin. I t was like I had become sensitized to it, just like I had become sensitized to the Mirtazapine. Desoxyn has a interaction warning about Serotonin Syndome. I told myself I was down with these meds until I figured out what was going on. I had to sleep though so I took a Doxylamine (Unisom)- cut in half about 12.5 mg. Within 20 minutes, the same thing that happened with the Mirtazapine happened with the Doxylamine--racing heart, severe agitation,  high blood pressure. Off to the ER again. I took a .25 of Klonopin and by the time they took me in I was relaxed and everything was baseline. Doxylamine has anti-histamine activity just look low-dose Mirtazapine and when I brought this up, they again told me to follow up with a cardiologist. 

 

It's been three days and I've barely slept since. The next day I felt the same terror and agitation I felt when I took the Mirtazapine and the Doxylamine, but instead of going to the ER for a third time, I took another .5 mg of Klonopin and it subsided. I went to work but have had extreme anxiety, elevated blood pressure, chest and stomach tightness, no appetite, toe twitching, sweaty palms, palpitations, and severe agitation. The only thing that is keeping me sane is Klonopin (which I don't want to develop a tolerance to again, if I haven't already which I think I may have) and low-dose Metroprolol which keeps my hears under 100 but I can still tell it's fighting a ton of adrenaline surges every hour or so. I'm scared to death and wonder if I'm dealing with sensitization due to Serotonin Syndome or just taking Mirtazapine randomly different nights, withdrawal from the Mirtazapine since it's been about 1.5-2 weeks, withdrawal from the Klonopin...

 

In reading these forums, I am inclined to say I want to reinstate half of 3.25 Mirtazapine in order to kill the adrenaline surges and severe agitation. I feel that my heart is being overworked with a withdrawal, but since I seem to be sensitized to Mirtazapine (and other medications that work on serotonin or anti-cholergenic drugs) I don't know if that's a good idea. I'm appreciate of any feedback or wisdom here. I apologize if this post is rambling. I'm actually a writer but my lack of sleep over the last few nights has fried my executive functioning. 

 

BTW I do have an appointment with a cardiologist to get an event monitor, and my psychiatrist comes back in two weeks, but I'm afraid to wait that long if I should reinstate I understand timing is crucial. 

 

Thank you

 

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mammaP

Hello Pablohoney, welcome to SA. There have been a lot of changes in a very short space of time that have destabilised your nervous system.  

On 01/03/2018 at 12:57 PM, PabloHoney825 said:

I started Mirtazapine for insomnia about a year ago. I never went above 15 mg and stayed mostly at 3.25. Recently I decided to get off as I felt it was losing it's potency (and noticed palpitations but not sure if it was the MIRT) and foolishly started to take it some nights and not others. I was supplementing with melatonin (5-20 mg) every night, and started to use an old script of low-dose Klonopin to help me sleep (.25-.5). 

 

It sounds lime your mirtazepine dosing was very inconsistent with differing doses, much like you would with a painkiller, then tarted skipping doses. The feeling of losing potency would have been withdrawal.  

On 01/03/2018 at 12:57 PM, PabloHoney825 said:

I was supplementing with melatonin (5-20 mg) every night, and started to use an old script of low-dose Klonopin to help me sleep (.25-.5). 

 

When did you start using klonopin,  if you can remember it will help to have the dates and doses.  Because a dose of klonopin resolves your symptoms it could be interdose withdrawal. 

 

On 01/03/2018 at 12:57 PM, PabloHoney825 said:

The real trouble started about two weeks ago when I took tryptophan (1000 mg) at the same time as the Mirtazapine 3.25.

These 2  should never be taken together, because they can cause serotonin toxicity.  

 

ADHD drugs cause rapid heartbeat, we have other members who have problems with them.  

 

We need a full list of your drugs and doses, including the ADHD drugs.  You can list those in your signature,  we ask all members to do this.

And symptoms, you have given us a good description, and would be good if you can list them. ie  

Feb 12 8am vyvanse  10am palpitations 12.30 sweating  1.00 klonopin.........etc,  since the episode with tryptophan. 

 

There have been so many drugs and changes it is hard to pinpoint what is causing it all now, but the tryptophan would have toppled an already shaking nervous system.   When we have the information we can see better what is the best way forward for you.  Try not to panic, all these symptoms can be vary scary, I've had them too and my BP was spiking at 135/111!  

If you tag me I will be notified when you reply, I haven't done this before but I think it is this @mammaP hey I did it!  

 

How to fill in your signature......

http://survivingantidepressants.org/topic/12364-please-put-your-withdrawal-history-in-your-signature/

 

It is very late here and I have to log off now but will post some links for you tomorrow.

 

 

 

 

 

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ChessieCat

Hi Pablo and welcome from me too,

 

 This is the preferred format which makes it easier for us to see your drug history at a glance:

 

A request: Would you summarize your history in a signature - ALL drugs, doses, dates, and discontinuations & reinstatements, in the last 12-24 months particularly?

  • Please leave out symptoms and diagnoses.
  • A list is easier to understand than one or multiple paragraphs. 
  • Any drugs prior to 24 months ago can just be listed with start and stop years.
  • Please use actual dates or approximate dates (mid-June, Late October) rather than relative time frames (last week, 3 months ago)
  • Spell out months, e.g. "October" or "Oct."; 9/1/2016 can be interpreted as Jan. 9, 2016 or Sept. 1, 2016.
  • Link to Account Settings – Create or Edit a signature.

 

This gives an example of how to keep notes on paper.  This information can be very helpful for the mods:

 

Keep Notes on Paper

 

This is your own Intro topic where you can ask questions and journal your progress.  We suggest that members visit each others Intro topics so that can support and encourage each other.

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PabloHoney825

Hi mammaP and ChessieCat,

 

I appreciate the responses. I've updated my signature. I'm going to update my symptoms in chronological order below as I've cleaned it up a bit. I still feel agitated and have a ton of adrenaline. I hope to figure out what this is exactly. 

 

 

Leading up to these events I was sporadically taking .125 Klonopin about 2-3 times a week, desoxyn 15-20 mg 2-3 times a week, and recently went from using mirtazapine 3.75 mg 7 nights a week to 3-5 nights a week when I suspected PVCs were due to the mirtazapine. Melatonin 5-20 mg nightly with opther supplements like probiotics, magnesium, fish oil, multi-vitamin. Occasionally Valerian, Lemon Balm, Holy Basic etc for rough nights I couldn't sleep without the mirtazpine. 

 

 

2/12/18 10:00 pm: Took Mirtazapine 3.75, Tryptophan 1000 mg, Magnesium Threonate, Melatonin 10 mg, probiotics (66 billion).

 

2/13/18 7:00 am: Woke up feeling groggy. Took my ADHD med (Vyvanse 60 mg) before work and within minutes knew something was wrong. Way too overstimulating within minutes (high BP and rate- extreme agitation). Took a Klonopin .25 and was able to calm down and make it through the day

 

2/13/18 11:00 pm:  Started with meditation and binaural beats.  Took my usual dose of Mirtazapine 3.75, Magnesium Threonate, Melatonin 10 mg, probiotics (66 billion). Within minutes I noticed my legs cramping, then my back twitching. Soon I was pacing the bedroom shivering with a heart rate of 130 and could feel PVC arrhythmias every few beats. My wife took me to the ER. On the way I took a Klonopin again, a .125 mg.  They took my blood pressure upon arrival at 170/110. By the time the doctor came in to see me everything had calmed down to baseline. I had a normal EKG and he discharged me with a prescription for Metoprolol.

 

Immediately ceased taking Mirtazapine which I suspected may have caused Serotonin Syndrome when combined with Tryptophan. Started Metoprolol but 12.5 mg. Stopped taking Magnesium Threonate but continued with Melatonin and probiotics. Started to take Ambien to replace Mirtazapine but didn’t use every night.

 

2/24/18: Was able to take ADHD medicine again but at a lower dose. Desoxyn 10 mg.

 

2/25/18: Took 10 mg Desoxyn and immediately felt overstimulated. I usually take 20 mg. Blood pressure shot up even with the metoprolol and I feared unopposed alpha stimulation so I took a .25 Klonopin and everything returned to baseline.

 

2/26/18 10:00 pm: Took Doxylamine 12.5 mg, Melatonin 10 mg, and probiotic. Started meditating (yoga nidra) and binaural beats. Within minutes, the exact same thing happened that send me to the ER the first time.  Could feel my muscles seizing and started to shiver and tremble again. Heart skipping beats and went into full-blown panic. Took a Klonopin .125 and went to the ER when my heart started to feel tight in my chest.  I thought this was it. In the waiting room I drank some cold water and it seemed to make it worse. They brought me back and gave me an IV of electrolytes. Again, EKG was normal. Blood work came back normal. Within about an hour I felt relaxed and came back to baseline, which I attribute the Klonopin. Released and told to follow up with cardiologist, which I immediately did. I’m not on Atenolol 6 mg and have an event monitor on the way.  

 

The next few days were very uncomfortable to where I couldn’t even think. So much adrenaline. Still shaking and shivering, anxiety, weakness, out of breath, palpitations, tachycardia, and high blood pressure. The Atenolol took a couple days to kick in and when it did it took the edge of and lowered BP and adrenaline.

 

Possible explanations for what happened or this continued discomfort, hyperarousal, and agitation:

 

1)      Considered that all of this could be attributed to Klonopin withdrawal so I stabilized at .125 daily (it was sporadic before so could have been interdose withdrawal).  I’m much more comfortable but not nearly at baseline. I’m preparing to do a slow-taper off the Klonopin.

 

2)      Mirtazapine withdrawal since I also used it sporadically before first ER visit and then ceased after first ER visit

 

3)      Serotonin Sensitivity/Syndrome: Tryptophan and Mirtazapine will do this alone when combined. ADHD meds also increase serotonin. Melatonin also works on 5HT2 receptor as does magnesium. Doxylamine does too I think? Meditation also increases serotonin. If this is from serotonin toxicity, why do I still feel amped up weeks later though?

 

4)      Been taking high doses of melatonin for a couple years. From what I understand the pituitary produces ACTH which causes hyper-arousal. Perhaps when I stopped taking melatonin my this caused the pituitary to react in some sort of withdrawal or dysfunction and causing excess ACTH and this agitation I feel still.

 

5)      Mirtazapine, which I took the first time, at 3.75 works as an anti-histamine (sedating) and has     anticholinergic properties. This is very similar to Doxylamine (Unisom) which I took the second time. I swear that within minutes of taking each these symptoms started. The nervous system uses acetylcholine to calm down so perhaps I have a pre-existing condition that is causing sympathetic agitation (Klonopin withdrawal, mirtazapine withdrawal, Excess Serotonin, overactive thyroid etc.) and when I took these two medicines they suppressed the para-sympathetic system’s ability to compensate. Perhaps I am now flooded with histamine? I'm shooting in the dark now lol. 

 

I appreciate any insight you may be able to give. I understand this is complicated and we aren't doctors, but any direction as to where I can investigate further would be helpful. 

 

Best,

 

PabloHoney

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PabloHoney825

Hi everyone, 

 

I take Propranolol to lessen the agitation, hypertension, heart rate, and physical symptoms of mirtazapine withdrawal. I feel like I'm jumping out of my skin and my BP and HR skyrocket without the beta blocker. Anyway, I was doing some research and came across this...

 

In addition to its effects on the adrenergic system, there is evidence that indicates that propranolol may act as a weak antagonist of certain serotonin receptors, namely the 5-HT1A5-HT1B, and 5-HT2Breceptors.[59][60][46] The latter may be involved in the effectiveness of propranolol in the treatment of migraine at high doses.[46]

 

Does this potentially mean that while the Propranolol helps with much of the symptoms, if could be slowing or even impeding recovery of my serotonin receptors? Perhaps a solution to this would be to switch to Atenolol which doesn't affect the serotonin receptors but is also prescribed for anxiety off label. I asked my cardiologist and he was clueless. 

 

Thanks!

 

 

Edited by ChessieCat
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manymoretodays

Hi Pablohoney,

I got your post moved from Symptoms and Self Care back to your Introduction/Journal.  It is best to try and keep all your information in one place.

 

I don't really feel qualified to answer your question regarding the Propranolol that you are using.  As far as whether it is slowing the recovery of your serotonin receptors.   That's part of W/D and recovery from psychiatric/psychotropic medications.........it may not be the whole of it though.  We would recommend a careful tapering off of the Propranolol, if and when you might change that.   You may be okay with a switch to another betablocker but do check dose equivalencies before switching.  Here's a link I found on equivalencies:

https://sites.google.com/a/iconopsych.com/psychlopedia-com/Home/beta-blockers-equivalent-dosing

 

And am a bit confused as far as what you are taking daily.  And what you have C/Ted, and then what you restarted.    It looks like you have had a lot of starts and stops with your medications/drugs.  What dose of Propranolol have you tried?  Are you seeing a cardiologist regularly for cardiac irregularities?    In my own experience I found the solution was not in adding medications/drugs but in judiciously subtracting them. 

 

So, you feel you have stabilized now with Propranolol and Klonopin?

 

I think it is best if you could add the Propranolol to your signature.  As well as keep some notes on paper.  Once you have a couple of days done, share that here on your journal/introduction.   You'll find the links to help you do that(notes and signature) in the post from ChessieCat dated March 2nd.

 

Love, peace, healing/inrecovery, and growth,

manymoretodays

 

 

Edited by manymoretodays

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PabloHoney825

Hi manymoretodays, 

 

Thank you for your reply. I am stable now on Propranolol 15 mg and Klonopin .150 (I tapered from .188). I will continue to taper down each day. I do see a cardiologist and right now I am wearing a 7 day event monitor. I'll get some notes going. 

 

Best,

 

Pablohoney

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Carmie

Hi PabloHoney, 

 

Just checking in to see how you’re doing. Sending hugs🤗

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PabloHoney825

Hi Carmie,

 

Thanks for asking. I believe that I am over the worst part of the mirtazapine withdrawal. All of my symptoms are subdued and I manage to get between 5-7 hours of sleep a night, sometimes less. I am far from back to baseline, as I still struggle with paresthesia, anxiety, tinnitus, unease, some unpleasant physical stimulation that peaks in the late morning and late afternoon (cortisol?), weakness, and sometimes more uncomfortable side effects like inner tension and extreme nervousness, or primal physical fear (not rumination or worry, but a sense of danger or dread). Some days, things just dont feel "right"--possible DP/DR, but this mental symptom isn't often. Ofcourse, I am also tapering off of the Klonopin and I believe some, or all of this is because of that. I’m at .0165 mg Klonopin and plan to step off in a couple months. I feel worse after my evening dose of Klonopin (itching, stimulation, paresthesia) but I refuse to go fast getting off.

 

I’m also weaning off my Carvedilol. I know it’s ill-advised to wean off two “brakes” at once, but I swear that my heart-rate shoots up after taking this beta-blocker and I feel sick for a while after. Perhaps my body has developed a sensitivity to medicine after my mirtazapine withdrawal.

 

Thankfully, I’m able to work and help raise my 7-month old son. This has been the hardest trial in my life, and some days I’m simply trying to get through the day, but I remain hopeful that once I am off of everything, my body will heal and reset with time. I plan to post a victory post one day.

 

Pete

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Carmie

Hi PabloHoney, 

 

Nice to hear that some of your symptoms have subsided and that you feel you’re over the worst part of your withdrawal. It’s always great when some of our symptoms aren’t as intense anymore. You’re doing really well being able to work and take care of a baby. Wow! 

 

I’ll look forward to reading your success story as much as you will enjoy writing it once you eventually get there. Looking forward to writing mine too.😄 It’s still a long way off, but every day is one day closer to healing. 

 

Could you please update your signature, thanks a lot. 💚

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PabloHoney825

Thanks so much, Carmie. We will get there! Looking at your signature, you're kicking butt down to 7.5! If you can do that, you can push through the kick at the end of your race too!  Prayers going up for you today!

 

 

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Carmie

Thanks PabloHoney, 

 

Yes, I’ve certainly come a long way from the 300mg I was taking. It’s still going to take a long time to get off the 7.5mg as I can only taper by tiny doses. 

 

You made me smile the other day when you left a message for scottishpablo, one Pablo wondering how the other Pablo is going😂. Hope you’re doing okay, sending hugs🤗

 

 

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PabloHoney825

😂 I loled inside a little (after posting in concern first of course). Thanks for making me smile too. 

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Carmie
8 minutes ago, PabloHoney825 said:

😂 I loled inside a little (after posting in concern first of course). Thanks for making me smile too. 

 

Hi again PabloHoney, 

 

Yes, we certainly have to continue to find humour in things. I laugh at the oddest things, one thing I haven’t lost is my sense of humour. I’m glad you still have yours too. As they say, laughter is the best medicine.💚

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