Fightingawar: Withdrawals after having serotonin syndrome

[Fightingawar]

Or they are saying I can try Luvox? 

[JLex1981]

Hi Fightingawar,

 

I had terrible Zoloft withdrawal many years ago and they replaced with Lexapro... ALL withdrawal symptoms went away. 

 

JLex. 

[Altostrata]

JLex, you were taking an SSRI, Zoloft, and then another SSRI, Lexapro. Drugs from the same class are more likely substitutes.

 

Luvox is another SSRI. It is not related to Anafranil, a tricyclic.

 

Fightingawar, you did not answer the question about whether you might have eaten a food that conflicted with Anafranil, or something else that caused your metabolism to change. Did you take a benzo? Even cold medicine? This is an important question. If something happened, you can tell the doctors that a little Anafranil will be safe because your reaction was from a drug-drug conflict.

 

Imipramine (Tofranil) is a triicyclic relative of clomipramine. Amitriptyline is another tricyclic. If you cannot get a little clomipramine, you might ask for a little imipramine; failing that, amitriptyline.

 

However, I am hesitant to suggest anything, because as long as you are dealing with traditional psychiatrists, they will insist you take a much higher dose of any drug than is prudent for someone with withdrawal syndrome, and you may have a bad reaction. I strongly recommend you find the most open-minded among them, and work with that person.

 

Of course, once you get tablets or capsules, you can take a partial dose on your own.

 

[Altostrata]

I just found this, from https://www.uspharmacist.com/article/drug-induced-serotonin-syndrome

 

Quote

Clomipramine and imipramine have relatively high serotonergic activity compared with amitriptyline, which inhibits serotonin reuptake to a lesser degree.

 

Fighting, your doctors may be more amenable to prescribing amitryptyline, which is a gentler tricyclic.

[Fightingawar]

I didn’t take anything that I know of that would affect it other then my Ativan and my regular meds which I already checked in the drug interaction checker so I don’t know of anything else. I think they are just really scared that I might get it again which I am too but I also am not 100% sure they know what they are doing. It’s just scary because I’m supposed to take 2.5 mg of the Trintellix in the morning and I don’t know what to do it’s been almost 8 weeks do I keep putting it off and asking them to try a different medication. Has anyone ever heard of Benadryl helping withdrawals?

[Carmie]

Hi fightingawar,

 

I just saw on another thread that you were asking about ear acupuncture. 

 

A friend of mine used to have a little acupuncture clinic where she did acupuncture for withdrawal for alcoholics and drug addicts. She only charger $5. 

 

I wasn’t on any meds then and knew nothing about withdrawals  but I used to get it done because it was very relaxing. She put five needles in each ear.

 

I started going to an acupuncture clinic again last year but I don’t know how much it’s been helping me, though I haven’t asked the acupuncturist to do the five needles in each ear. He’s really nice and I’m sure he would do it. The acupuncture was really helping with my low blood pressure though. 

 

I havent been for months but I think I might go again, I should see if the five needles in each ear might help. 

 

Take care my fellow sufferer xx

 

 

 

 

[Fightingawar]

Does anyone get really bad anxiety and trembling for the the first hour when they get up in the mornings? Is this from increased cortisol, is there anything that can help with it?

[xyz]

exercise.

i go for a 40 min run first thing in the morning and it goes away.

mine is so bad, i have teeth chattering, heart palpitation, body vibration. after i run, i am good as new.

[NobodySpecial]

Hey @Fightingawar , I had a similar thing. XYZ has great advice, moving your body and doing something about it is super productive. Even getting my feet on grass is enough to down-regulate.

 

Do you have the opportunity in the morning to do something about it, or do you have work quite early?

[Fightingawar]

I don’t work but it’s so hard for me to get out the bed when I’m like that it’s just crazy. I didn’t have that before withdrawing I wonder why I have it now. I’m so ready to just feel so much better I’m so tired of being sick but I am thankful for the window I had last night.

[xyz]

1 hour ago, Fightingawar said:

I don’t work but it’s so hard for me to get out the bed when I’m like that it’s just crazy. I didn’t have that before withdrawing I wonder why I have it now. I’m so ready to just feel so much better I’m so tired of being sick but I am thankful for the window I had last night.

 

i was really hard for me too. i felt paralized and then my therapist told me to do it as if my life depends on it. and it took the cortisol surge away.

they say 25 min is all it takes. and they were so right.

 

i didn't have cortisol surge and insomnia until i was 6 months off of my first benzo withdrawal. it takes time for the nervous system to repair itself.

evenings are always better for me as well.

 

try to go for a run next time that happens to you. your body needs to burn the adrenaline.

 

[manymoretodays]

Here is the topic that we have going on this:

http://survivingantidepressants.org/topic/17471-waking-with-panic-or-anxiety-managing-cortisol-spikes/

 

It's up to 21 pages now but you might find something helpful.  I know that Alto often recommends the sleep mask and black out curtains or shades. 

 

I also found this one that talks about the trembling and others experiences with it:

http://survivingantidepressants.org/topic/2016-tremors-shaking-body-vibration-internal-trembling/

 

 

 

If, or as other W/D symptoms arise go to:

Our Home or Forum page > then to Symptoms and Self Care.  There is a whole indexed list in the last pinned topic at the top.  > Important topics about symptoms, including sleep problems. 

 

I found both of these.........what I linked you to........in the Symptoms and Self Care> Important topics about symptoms, including sleep problems.

Like xyz, I find exercise to be really helpful........for me it's not always first thing in the morning.  And also the nature stuff and connecting to it all, like Nobody mentions.

 

Love, peace, healing/inrecovery, and growth,

manymoretodays

[Kristine]

3 hours ago, Fightingawar said:

Kristine can you explain what this means? I was on Anafranil and had to pretty much cold turkey and I just ran across this. I wanted to reinstate my Anafranil at a very low dose but my psychiatrist will not let me because they think I had serotonin syndrome so I was looking into something else similar to reinstate and I seen Norpramine but that’s on this list too so I was wondering what this meant. They want to try a low dose of Trintellix but I’m to scared so even though that’s what they gave me I haven’t started it but I’m suffering so bad I have literally been trying to call psychiatrist all over the US trying to get one on the phone for someone to give me direction. I guess they don’t want to do the Anafranil because it has a higher rate of producing serotonin from what I understand.

 

1 hour ago, Kristine said:

Please don't concern yourself with this FAW. Some medications have a major drug interaction when taken together. I wanted to know why. Put very simply each medication is metabolised by a different liver enzyme. If taking more than one medication which is metabolised by the same liver enzyme...such as CYP2D6, there can be complications. This is why it is important to put all ones drugs into a drug interaction checker. I am unable to go into more detail at the moment due to chronic sleep deprivation.i just can't think properly. It would be a good idea to post this on your thread so you have a record and some get some advice. Much Love K xo

Hi FAW, regarding your questions on my thread. It occurred  to me that some individuals process medications differently due to inherited genetic traits. Due to your recent experience with Anafranil and serotonin syndrome, it may be worth discussing this with your doctor. There is a test available to determine how your body metabolises certain drugs. The following quote is from the following site...https://www.mayoclinic.org/tests-procedures/cyp450-test/about/pac-20393711

 

"Your doctor may use cytochrome P450 (CYP450) tests to help determine how your body processes (metabolizes) a drug. The human body contains P450 enzymes to process medications. Because of inherited (genetic) traits that cause variations in these enzymes, medications may affect each person differently" 

 

If I were you, I would have a read and discuss it with your doctor. 

Much Love. K xo

Edited April 30, 2018 by Kristine
Spelling

[DrugfreeProf]

Hi, FightingaWar, I can tell that you are very distressed and frightened about your symptoms. That is completely understandable, especially since your are early in withdrawal. I think the mods offered good sound advice and MammaP was right in saying you WILL feel better; it's just a matter of time.

Ironically, my (sort-of) daughter in law "tapered" off Zoloft (as per guidance by her doctor) in order to get pregnant.  Three months later she went into a total meltdown, and I was

able to explain why. I suggested she reinstate a small dose of Zoloft as per SA guidelines and to post here. But she was in a panic and ended up going back to her doctor, who put her on Trintellex.  I wish

she hadn't done it but you can only lead a horse to water. . .It took her several weeks but she did stabilize and then got pregnant shortly after. . .still taking the Trintellex which, of course,

the doctors assured her was "safe to take during pregnancy." 

Your acute symptoms sound exactly like those of the average person who posts here.

It really helps if you can read the success stories, of which there are many, and meanwhile do the small reinstatement recommended by the mods. Reinstatement is the best chance you have to avoid a protracted (long) withdrawal illness.

[Rosetta]

For cortisol causing anxiety every morning try magnesium.

 

http://survivingantidepressants.org/topic/15483-magnesium-natures-calcium-channel-blocker/

 

Exercise increases cortisol.  For some people exercise in the morning works anyway, but if you find that you have anxiety coming back in the day after you exercise you should try walking instead of jogging.

 

Im sorry you are suffering.  Try reading all the links Gridley gave you.  The more you know about WD the easier it is to make decisions.

 

Peace, Rosetta

[Fightingawar]

On 2/19/2018 at 10:45 PM, Kristine said:

Just to add ...http://www.ourmed.org/wiki/Dextroamphetamine_and_Amphetamine

 

A quote from this page:  this information is backed up by various journal articles...at this point I can't access them without paying for them...just the Abstract

• Antidepressant substrates of 2D6 such as amitriptyline (Elavil), amoxapine (Ascendin), clomipramine (Anafranil), desipramine (Norpramin), imipramine (Tofranil), or nortriptyline (Pamelor) may interact through competitive inhibition of Cytochrome p450 2D6
• Use special caution: Antidepressant blockers of 2D6 such as fluoxetine (Prozac), paroxetine (Paxil), will significantly block 2D6 over time and create accumulation of AMP with significant toxic implications

It is therefore my hypothesis, from what I have read so far, that since the introduction of dexamphetamine (20mg) December 2016 my body has slowly built up a level of dexamphetamine (amp)Toxicity due to the fluoxetine  being a substrate of 2D6...my plan is to taper the dexamphetamine more rapidly..perhaps 5% - 10% every 3 days (part of me is tempted to CT the remaining Dex) ..any thoughts are welcome. K 

 

15 hours ago, DrugfreeProf said:

Hi, FightingaWar, I can tell that you are very distressed and frightened about your symptoms. That is completely understandable, especially since your are early in withdrawal. I think the mods offered good sound advice and MammaP was right in saying you WILL feel better; it's just a matter of time.

Ironically, my (sort-of) daughter in law "tapered" off Zoloft (as per guidance by her doctor) in order to get pregnant.  Three months later she went into a total meltdown, and I was

able to explain why. I suggested she reinstate a small dose of Zoloft as per SA guidelines and to post here. But she was in a panic and ended up going back to her doctor, who put her on Trintellex.  I wish

she hadn't done it but you can only lead a horse to water. . .It took her several weeks but she did stabilize and then got pregnant shortly after. . .still taking the Trintellex which, of course,

the doctors assured her was "safe to take during pregnancy." 

Your acute symptoms sound exactly like those of the average person who posts here.

It really helps if you can read the success stories, of which there are many, and meanwhile do the small reinstatement recommended by the mods. Reinstatement is the best chance you have to avoid a protracted (long) withdrawal illness.

I did take the genesight test to show what medications work better I’m just so scared to try something since they think I had serotonin syndrome. Do you know people who have had that and are still able to take antidepressants? 

@DrugfreeProf how did she do on the Trintellix and what dosedid they start her on that is what they are wanting to start me on because the Anafranil what they took me off of is very high in increasing serotonin. 

When the doctor puts you on a medication for like reinstatement to help with the withdrawals are they supposed to increase or decrease it?

[DrugfreeProf]

FAW, I don't know how many milligrams they placed her on, maybe 10 if memory serves, or a "small" dose as they put it. She did not respond immediately but she did feel better in maybe a few weeks,  and eventually seemed to be back to normal. So somehow the Trintellex stabilized her, even though her former drug was Zoloft. I do not know about the serotonin syndrome problem; better ask a mod about that. If I had serotonin syndrome in the past, I too would be very, very hesitant to take an SSRI again. . .but the tiny dose that SA recommends may very well be fine. I suggest you follow their advice, as it's probably the best advice out there.

[manymoretodays]

How are you doing Fightingawar?  Updates?

 

Love, peace, healing, and growth,

mmt

[Altostrata]

Fightingawar, what is the health of your liver? Do you have a history of drinking alcohol or liver disease? Is there anything that happened recently that might compromise your liver function?

 

If your liver is healthy, it is unlikely you have suddenly developed an inability to metabolize drugs via cyp2D6 or any other liver enzyme. Something else must have interfered, such as another drug or an advancing liver condition.

 

If your liver function has not been checked recently, you should have your doctor do this immediately, before taking any other drugs.

 

On 4/27/2018 at 2:31 PM, Fightingawar said:

do I keep putting it off and asking them to try a different medication. Has anyone ever heard of Benadryl helping withdrawals?

 

If your liver is healthy, if I were you, I'd ask for amitryptyline, which is a tricyclic, rather than Trintellix, which is an expensive drug of another type.

 

Amitriptyline comes in a wider range of tablets, as well as a liquid, which makes it easier to titrate than Trintellix. 

 

You were on 125mg clomipramine, is that correct? I might try 5mg amitriptyline to reduce withdrawal symptoms. This is about a tenth of your clomipramine dosage, see the estimated drug equivalencies below.

 

https://www.sciencedirect.com/science/article/pii/S0165032715001512

 

Quote

 

We included 83 studies (14 131 participants). In the primary analysis, fluoxetine 40 mg/day was equivalent to paroxetine dosage of 34.0 mg/day, agomelatine 53.2 mg/day, amitriptyline, 122.3 mg/day, bupropion 348.5 mg/day, clomipramine 116.1 mg/day, desipramine 196.3 mg/day, dothiepin 154.8 mg/day, doxepin 140.1 mg/day, escitalopram 18.0 mg/day, fluvoxamine 143.3 mg/day, imipramine 137.2 mg/day, lofepramine 250.2 mg/day, maprotiline 118.0 mg/day, mianserin, 101.1 mg/day, mirtazapine 50.9 mg/day, moclobemide 575.2 mg/day, nefazodone 535.2 mg/day, nortriptyline 100.9 mg/day, reboxetine 11.5 mg/day, sertraline 98.5 mg/day, trazodone 401.4 mg/day, and venlafaxine 149.4 mg/day. Sensitivity analyses corroborated the results except for doxepin.

 

 

 

Since 5mg amitriptyline is a fraction of the clomipramine dosage that caused the problems, it is unlikely to trigger similar adverse reactions.

 

If you feel you want to try Trintellix, I would try a little piece of a 5mg tablet.

 

If you feel you need to switch to an SSRI, I would take 1mg Prozac, it's easier to taper than other SSRIs.

 

On 4/30/2018 at 7:23 PM, DrugfreeProf said:

 

FAW, I don't know how many milligrams they placed her on, maybe 10 if memory serves, or a "small" dose as they put it. She did not respond immediately but she did feel better in maybe a few weeks,  and eventually seemed to be back to normal. So somehow the Trintellex stabilized her, even though her former drug was Zoloft. I do not know about the serotonin syndrome problem; better ask a mod about that. If I had serotonin syndrome in the past, I too would be very, very hesitant to take an SSRI again. . .but the tiny dose that SA recommends may very well be fine. I suggest you follow their advice, as it's probably the best advice out there.

 

DrugFreeProf, Fightingwar was on a tricyclic antidepressant. Trintellix is not a tricyclic antidepressant. It may do a better job of substituting for Zoloft, an SSRI, than clomipramine, a powerful tricyclic. I explained this earlier in this topic. I am glad Trintellix worked for your daughter. Please be aware that recommending Trintellix to everyone might not be appropriate. (Or, it might be a miracle drug, but we don't know that at any degree of confidence.)

 

Fightingawar, please put drug dosages in your signature, this is very important.

[Fightingawar]

Does anyone else avoid taking a nap during the day because every time they drift off the jump back up in a panic? I know that in the mornings when you first get up and have bad bad anxiety that it’s your cortisol spiking but why when I try and take a nap I do that?

[manymoretodays]

Hi Fightingawar,

 

Here is your introduction topic:

http://survivingantidepressants.org/topic/17700-fightingawar-withdrawals-after-having-serotonin-syndrome/?tab=comments#comment-342098

 

 

When you sign in if you go to Activity>my activity you should be able to find your way back there.  I recently moved your Introduction back to Introductions and out of Symptoms and Self care.  I'm not certain how it got moved.

You can add updates about your progress to your Intro topic; it will be a kind of journal or history of your case.

There are some recent questions for you there, as well as suggestions.

 

Best,

mmt

 

Edited May 11, 2018 by manymoretodays

[DrugfreeProf]

Alto, just to be clear, I'd be the last person to recommend that someone take Trintellix or any other SSRI, drugs that I've come to hate. But since FAW brought up Trintellix (a relatively new SSRI--I call it "flavor of the month"), I thought I should report what I saw happen in my step-daughter's case, i.e., despite my recommendation that she follow SA's advice to go on a micro-dose of the Zoloft she had tapered off previously, her new psychiatrist put her on Trintellix--and miracle of miracles, she DID eventually stabilize on it, after a very hairy few-week period in which she was experiencing intolerable WD symptoms. 

[Altostrata]

Thanks, DrugFreeProf. Please be aware that FightingaWar is new here and might have misinterpreted your comment.

[Fightingawar]

So I got to thinking about something, I didn’t start really getting sick really sick until I was off my meds for about 3 weeks. Is that normal in withdrawal? My doctor keeps telling me they think something else cold be going on but I have all the withdrawal symptoms I just didn’t get really bad till 3 weeks in. So do you normally get worse before you get better? And if this is in the wrong place I’m sorry I get so confused on where to post stuff.

[coldturkmama]

Yep, kind of a delayed reaction. 

[Altostrata]

Fightingawar, please do not create any more new topics in the Introductions forum. There's only one Introductions topic per member. This topic is your Introductions topic.

 

Add to this topic when you have questions about your taper or your symptoms. If you want to see what other people have written about symptoms like yours, go to the Symptoms and Self-Care forum, use search, and add to existing topics before creating a new topic.

 

For example, see Important topics about symptoms, including sleep problems including

 

Waking with panic or anxiety -- managing cortisol spikes

 

Tips to help sleep -- so many of us have that awful withdrawal insomnia

 

You are creating many new topics when you should be adding to existing topics. This make unnecessary work for the moderators.

 

Also, be sure to read responses to your posts. Bookmark or follow this topic so you can find them. It's important that you answer my post from a week ago:

 

 

 

[Fightingawar]

Ok I’m sorry @Altostrata and I’m not sure the function of my liver I have blood work done a lot but they have never said anything was wrong. I do not drink alcohol although I used to but just on the weekends. I also talked to Dr. Ken Gilman who says I definitely didn’t have serotonin syndrome so now if I can find a doctor that believes me so I can reinstate a little of something before it’s to late I’m already at 10 weeks off.

[Altostrata]

Did your bad reaction to clomipramine coincide with a weekend of drinking? When did you last drink alcohol?

 

Have you ever had liver function tests done?

 

Any doctor can prescribe these drugs, it doesn't have to be a psychiatrist.

[Fightingawar]

No I haven’t drank alcohol in a very long time, I don’t think I have ever had that test. Dr. Gilman said I need to start back on the Clomprimine at a low dose so I will have to get a different set of doctors to do that because the ones I have now will not. Are you a doctor @Altostrata you sure know a lot about this stuff.

[Audrey88]

Hi, I know your pain going through this , I went through the no eating phase as well but it did get better. What helped me was making blended drinks like all veggies or oatmeal and fruit. It make it easier to get it down , but make sure what you do eat is all really healthy. 5 HTP has helped rebuild my serotonin and magnesium helps relax you. There is a brand of magnesium powder called " CALM by Natural Vitality" very relaxing. What helps me is distraction so house cleaning , walking around stores, a lot of jogging exercise Zumba even. It helps get your mind off of it for a little bit. Avoid all sugar, caffine and alcohol it will only make things a lot worse. If you can I would also suggest seeing a Naturopathic doctor in your area, I saw one yesterday and she gave me some great advice. I really hope you feel better soon. I'm here for you.

[Fightingawar]

Thank you @Audrey88 I’m actually looking on amazon now for a blender. How long have you been in withdrawals? I already take the calm powder and it does help some. I have been thinking about going to a Nautropathic doctor for a little while now she is expensive I just want to make sure she could really help me before I pay a lot of money because I have already done that with other things. How long did you have no appetite we’re you nauseous too? The hard part for me right now is the extreme anxiety which makes it hard to go anywhere and being able to excersise because my whole body hurts I just sit around all day really. I have lost 40 pounds in 10 weeks which is extreme I think but this has to be getting better soon right I meanin 2 weeks it will be 3 months off? I did go off without taper but some light should be showing soon shouldn’t it?

[Altostrata]

When did you last drink alcohol? Were you drinking when you had a bad reaction to clomipramine? If you don't answer my questions, I have no reason to respond to your posts.

 

If you have been drinking all your adult life, it's possible your liver function has been affected even if you are not drinking now. If I were you, I'd get liver function and kidney functions tests as soon as possible, and definitely before you take any additional drugs, particularly clomipramine.

 

I am not a doctor, however, I'm an expert in drug withdrawal syndrome, about which doctors generally know nothing. I've spent hours reading your posts. If you don't care to have my opinion, there are many other things I can do with my time.

[Fightingawar]

 

1 hour ago, Fightingawar said:

No I haven’t drank alcohol in a very long time, I don’t think I have ever had that test. Dr. Gilman said I need to start back on the Clomprimine at a low dose so I will have to get a different set of doctors to do that because the ones I have now will not. Are you a doctor @Altostrata you sure know a lot about this stuff.

 I already answered the question in the above post, no I wasn’t drinking when I was taking clomprimine I haven’t had alcohol in probably 5 years or more. And I do vaule your opinion very mush so or I wouldn’t ask questions I’m sorry if I offended you I just thought you might be a doctor since you are very knowledgeable. I’m sorry I’m still learning the ropes around here on how to reply to people and putting my stuff in the right place I have a lot of brain fog right now.

[Fightingawar]

Another question I have for everyone and I know everyone is different but how long in general does the severe part of withdrawal last? I know you can have symptoms for years but I’m talking about the part when your not hardly functioning? What have you seen to be average? 

[Altostrata]

Recovery time varies. What are your symptoms like now? How have they changed in the last week?

[Fightingawar]

I have nausea with sometimes actually getting sick, fatigue, high anxiety, body aches, no appetite. It seems like last week so better then this week and some days are better then others it’s really confusing. I know that’s the whole windows and wave thing but like can this severe part of it last longer then like 6 months? I call it severe because I’m really not functioning right now other then laying around it’s been almost 11 weeks I just want to be able to get out of bed and do at least a few things but I feel like I can’t do much because I’m so weak feeling.