Jump to content

JimiJam: Discontinuing Elavil - still waiting on symptoms?


JimiJam

Recommended Posts

Hi! After an extensive search of the internet, it seems I've run across every useful bit of information to be found on the subject (not to mention countless sources of useless information), and this board seems both knowledgeable and friendly so I thought I'd try here.

 

I've a mind to discontinue use of amitriptyline, which I've taken for roughly 3 years at a dose of 50mg. I've seen this described as anything between a negligibly small dose to the beginnings of large dose territory; I've also seen people complain about getting off of 10mg doses as if it were more difficult than quitting 100mg. I know that everyone's experience is unique, but hopefully turning to a specific group of people, rather than random comments across the internet, might help narrow things down a bit. I've experienced discontinuation issues with several medications in the past (paxil, klonapin, geodon). By unfortunate happenstance it's been approximately 80 hours since my last dose of amitriptyline, and aside from a vague discomfort and slight sleep disturbance, I've not yet experienced anything worse. I've been considering getting off of it anyway, and as I sit here, largely symptom-free, I'm wondering if it might not be best to take advantage of the situation in which I find myself. I am, of course, aware that a gradual withdrawal is advisable, but if things don't get much worse, I don't see a point in dragging the process out over several more weeks.

 

I suppose the basic question here is: should I already be experiencing symptoms, or are they lying in wait along the course of the following week(s)? I haven't been able to find anything along the lines of a symptom schedule, in terms of onset of symptoms, peak symptomatic experience, etc. Any insights or shared experiences would be greatly appreciated.

 

(p.s. - should anything about my post run contrary to accepted etiquette in these forums, please let me know so I can make the necessary corrections)

Link to comment
  • Administrator

Hello, JimiJam, thanks for joining us and introducing yourself.

 

Withdrawal symptoms can take a while to show up. On the other hand, some people can quit cold turkey without a problem.

 

You don't know how bad withdrawal it will be until it happens, which is why we recommend gradual tapering.

 

If you get withdrawal symptoms, they indicate neurological instability that can last for a long time. It's best to keep the nervous system stable with gradual tapering and not risk severe, prolonged symptoms.

 

Do you have any Elavil left? You might want to take a half-dose and prepare to taper from there.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

Link to comment

Hi Alto, thanks for the welcome :) I definitely have some pills leftover--there's no way I'd attempt something like this without backup. By late evening last night, I began exhibiting the choline-related symptoms: runny nose, cough, watering eyes, etc. As an asthmatic, these were worrisome. I also got a bit crabby, so I decided to try your suggestion and halved a pill (more or less - they don't break very evenly). Today's been a good day. Woke feeling kind of subdued, but not nearly as zonked as I would have under the influence of a full dose. I think I'm going to see how 25mg per night goes for a week or so, and go from there.

Link to comment
  • Administrator

That's good, J. Cold turkey is high risk.

 

Consider staying at 25mg for at least a few weeks, your nervous system needs time to register and adjust to the 50% drop. Then you might tiptoe off at a more gradual rate.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

Link to comment

I feel surprisingly good, all things considered. I think it's more like I'm coming up to the 25mg level, after having gone those few days without. One thing that does surprise me is how inexpressive I feel; I'm accustomed to the occasional retreat into the mind, but these past few days I've become almost disturbingly taciturn. I figured I should at least return with an update, and a promise to flesh out the details when I find my mouth again :)

Link to comment
  • Moderator Emeritus

Welcome!

 

You might want to check this website for information on the half-life of the drug: http://en.wikipedia.org/wiki/Amitriptyline (see the sidebar). If you aren't familiar with the idea of half-life, it means half of the drug will be out of your system by the end of this period of time. It does, of course, vary a great deal with the particular person and their history. It looks like amitriptyline can take up to 100 hours to clear a person's system, so at the present time, you may still have more than 25 mg. working on you.

 

My withdrawal symptoms from Lexapro didn't start until I'd been off of it about a week. Thank God I found this forum or I would have thought I was going crazy. Over two months later, I'm still having problems. Today I woke up feeling sick to my stomach, quite lethargic, and yet irritable. The tinnitus is especially bad today, too. It is difficult to make plans when I never know if I'll be sick that day.

 

Let's hope you're one of the rare people who can get off of antidepressants easily.

Psychotropic drug history: Pristiq 50 mg. (mid-September 2010 through February 2011), Remeron (mid-September 2010 through January 2011), Lexapro 10 mg. (mid-February 2011 through mid-December 2011), Lorazepam (Ativan) 1 mg. as needed mid-September 2010 through early March 2012

"Never attribute to malice that which is adequately explained by stupidity." -Hanlon's Razor


Introduction: http://survivingantidepressants.org/index.php?/topic/1588-introducing-jemima/

 

Success Story: http://survivingantidepressants.org/index.php?/topic/6263-success-jemima-survives-lexapro-and-dr-dickhead-too/

Please note that I am not a medical professional and my advice is based on personal experience, reading, and anecdotal information posted by other sufferers.

 

Link to comment
  • Administrator

Excellent point, Jemima.

 

JimiJam started to feel withdrawal symptoms close to the end of the 100-hour half-life.

 

Now, half-life means, theoretically, 50% of the drug is out of your body. 50% still remains, but it is being metabolized at (perhaps, this is unknown) a similar rate.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

Link to comment

Hi Jemima :) I do indeed know about half-lives--I'm usually the one explaining them to others--but I hadn't found anything that listed the half-life for amitriptyline as more than 50 hours. Perhaps they're taking into account the half-life of the active metabolite? Factoring that in is new to me. I've done a lot of research in dealing with this sort of thing in the past, but only learned what pertained to the medications in question. I stepped down from 2mg of clonazepam by dropping the dose .25mg each week, and found out the hard way that a more gradual taper would have been prudent, to say the least. I wound up with a bp of about 180/120, went on a 6 month clonadine regimen that helped more than I can express. It's tragic that there are so few efficacious resources available on the subject of psychotropic discontinuation, but I've enjoyed the existential adventure of finding my way through research and reaching out to folks like you.

 

So far, the worst I can claim is an amount of fatigue, but not nearly so bad as I had been experiencing daily at the full dose. I think I'm a bit more emotional today, might define it as lability, but it's been easy enough to keep it in check. Part of the reason I want to discontinue use of this medication is a desire to experience my emotions fully. Thanks to over 4 years of CBT, I'm confident that I can manage them on my own.

Link to comment
  • Administrator

There are 2 active metabolites involved, see http://survivingantidepressants.org/index.php?/topic/1099-tips-for-tapering-off-amitriptyline

 

amitriptyline (10-26 hrs) ---> nortriptyline (18-44 hrs) ---> 10-hydroxynortriptyline (8-10 hrs)

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

Link to comment

This line "The overlapping metabolism of amitriptyline and the 2 active metabolites nortriptyline and 10-hydroxynortriptyline is probably why it's so difficult to estimate the half-life of this medication" was pretty much what I was thinking before I clicked on the link lol. It'd take making a complicated line graph for me to really grasp it. This just means more research, with links to more resources; huzzah! I know what I'm doing tomorrow lol.

 

Today went well. I found that the postures and positions that normally led to a small amount of parasthesia now lead to a more pronounced experience, and more quickly than usual, but otherwise feeling well. There's a slightly sickish feeling, but I find I enjoy it, reminds me of coming down from the illicit substances of my heyday, a sort of buzzing descent into normalcy.

 

Thanks again, though undoubtedly not for the last time, for the info and support. Would that I had known to find a place such as this when coming off the klonapin.

Link to comment
  • Administrator

When you find more info about amitriptyline metabolism, please post it in Tips for tapering off amitriptyline to enshrine your research pearls for posterity.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

Link to comment
  • Moderator Emeritus

Hi Jemima :) I do indeed know about half-lives--I'm usually the one explaining them to others--but I hadn't found anything that listed the half-life for amitriptyline as more than 50 hours.

I guess I didn't express that very well. The longest half-life for amitriptyline is 50 hours, theoretically, so that would mean it could stay in your system for 100 hours before completely clearing out. (Again, theoretically.) I'm not sure that shrinks or Big Pharma really know what they're doing with any of this.

Psychotropic drug history: Pristiq 50 mg. (mid-September 2010 through February 2011), Remeron (mid-September 2010 through January 2011), Lexapro 10 mg. (mid-February 2011 through mid-December 2011), Lorazepam (Ativan) 1 mg. as needed mid-September 2010 through early March 2012

"Never attribute to malice that which is adequately explained by stupidity." -Hanlon's Razor


Introduction: http://survivingantidepressants.org/index.php?/topic/1588-introducing-jemima/

 

Success Story: http://survivingantidepressants.org/index.php?/topic/6263-success-jemima-survives-lexapro-and-dr-dickhead-too/

Please note that I am not a medical professional and my advice is based on personal experience, reading, and anecdotal information posted by other sufferers.

 

Link to comment

With a half-life of 50 hours, it would take approximately 10 days for levels to reach 3.125% of the original concentration level. I've seen 5 days cited as the length of time it would take, however, and suspect 50 hours is indeed at the top of the half-life range. I'm having a heck of a time finding out how to calculate the half-life range of drugs with active metabolites. Thus far, it seems that most studies find the anti-cholinergic effects of 10-hydroxynortriptyline to be either negligible or non-existent. I'm not sure whether that negates consideration of 10-hydroxynortriptyline in regards to discontinuation of amitriptyline (or nortriptyline, for that matter). Interestingly, I have found somewhat less-recent studies that indicate an average half-life of only 21 hours for amitriptyline, and a half-life of 25 hours for nortriptyline; I'm beginning to wonder if the 50 hour figure isn't taking both the primary drug and its metabolite into account. I plan to ask my therapist for some assistance in gaining accesses to more useful resources than what I've been able to find online. There's a paywall blocking just about every professional study I've come across, which severely handicaps my ability to research the matter much further.

 

As far as my experience with decreased dosage is concerned, I'm happy to report that it's going extremely well. Yesterday was lackluster in terms of mood, and I've been sleeping less (though this was to be expected). However, despite sleeping fewer hours, I find I wake much more rested and refreshed, and have far less difficulty with fatigue throughout the day. The past few days, I've taken to busying myself about the apartment shortly after waking, where at the previous 50mg dose I was lucky to manage such activity by day's end, if at all. It is perhaps still too early to rule out the possibility of further symptoms of discontinuation syndrome, but I am becoming increasingly optimistic, and have been very happy with the decrease in basic side effects from the amitriptyline regimen.

Link to comment
  • Administrator

It sounds like you're stabilizing on 25mg?

 

You might write Sheldon Preskorn to elucidate the half-life of amitriptyline. He's a half-life expert.

 

His e-mail http://www2.kumc.edu/directory/basicsearch.aspx?Unit=preskorn

 

As a metabolite, 10-hydroxynortriptyline is produced in much higher volumes than its parent. (Weird but true about many active metabolites.) It may be weaker per mL but there's more of it.

 

While tricyclics are anti-cholinergic, this is not the reason for their antidepressant qualities -- it's why they may cause drowsiness -- and only partly why they cause withdrawal symptoms.

 

That was the assumption some time back but it's been disproven by withdrawal symptoms from SSRIs. Originally, it was assumed there would be no withdrawal problems with SSRIs because (except for Paxil) they were not anti-cholinergic like the TCAs, the anti-cholinergic properties of which were blamed for withdrawal symptoms. Now it is clear that screwing with brain chemistry is what causes withdrawal symptoms from TCAs, SSRIs, and every other psychiatric drug.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

Link to comment
  • 2 weeks later...

Hey all, sorry for not checking in sooner. Life has been ridiculously busy this past week. Alto, thanks for the link to Dr. Preskorn's page and contact info. Once I get a calm day in which I might pull things together well enough, I'll send a message and see what he says. I've also asked my therapist if she could look into the matter for me. If nothing else, I want to be able to use this experience to help others who have chosen this route.

 

As far as an update on my progress, it might still be too early to consider myself clear of the possibility of discontinuation symptoms, but for the time being I appear to be pretty well stabilized at the 25mg dose. Now that I've figured out how to cut the pills in half (I score them between the number and letter, then snap them) things are as routine as they were at the full 50mg dose. I'm sleeping relatively well, though not as heavily. I find myself waking a few hours after falling asleep, then sleeping another few hours, but as I've enjoyed dual-phase sleep in the past, this isn't much of a complaint. I've still got more energy during the day than I used to, and have been far more productive than I had been in recent months. My doctor ran some blood tests to make sure there's not anything else contributing to this complaint of fatigue, and I should get a call with results tomorrow. I don't expect anything out of the ordinary, but one never knows.

 

This week is so far looking to be less busy than last, so hopefully I'll be able to come back sooner.

Link to comment
  • Administrator

Good to hear 25mg seems to be working. Now to make a plan for more gradual tapering after a month of stability.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

Link to comment
  • 2 weeks later...

I think by this point I should be able to safely rule out any of the more egregious discontinuation symptoms. I've been having trouble sleeping the past few nights, though I honestly haven't been particularly tired. There's a confluence of life events, present and past, that would easily explain a distressed state. For the most part, I'm surprisingly calm, using external negatives as motivation to redouble efforts toward positive and lasting changes. It's somewhat remarkable to see that I still feel more and more myself as each day goes by. Beyond fatigue, I hadn't really noticed any side effects of the medication, a perspective which, in retrospect, appears a tad naive. The latest therapy session featured an intern who wished to observe the facility's most successful therapist working with a patient in the "maintenance phase" of therapy, and as such the discussion's focus was altered enough that I neglected to ask if my therapist had gained any insight as to the nature of of half-lives of active metabolites. Sorry that I don't have much more to report. To anyone attempting to discontinue an amitriptyline regimen, hopefully my success thus far is at least of some comfort, if not of more detailed use.

Link to comment
  • Administrator

Good to hear from you, JJ, and that you're doing well. Are you still taking 25mg? Did you tell your therapist about this?

 

What's your plan for tapering?

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

Link to comment

Still at the 25mg, thinking of keeping that up for at least one more week to make sure I'm stabilized. I'd like to wait until I'm feeling well rested and a bit more healthy (developing a cold today) before taking myself down a peg with a step down in dose. My therapist is completely on board with this decision, as is my GP. There's really not much that can be said for continuing, unless it turns out I really can't sleep any other way, but we're all fairly certain that a stable home life, healthy diet, and regular exercise should ensure I sleep well enough to forego further medical intervention.

 

As far as my plan, I'm not sure how best to proceed. I'm still scoring and breaking the 50mg pills in half, which seems to be working well enough. I think I'd like to step down a big more gradually than to drop straight to the 10mg pill. I don't know if my insurance will cover a 2 pill dose, though. Knowing the sometimes peculiar preferences of their bureaucratic approach, they might think the 25mg pill to be just as good as a 20mg dose, which wouldn't do me any favors here. I usually get good results when calling to discuss my care, so it might not be a major issue in the end. Additionally, I'm not slated to see my doctor for another month and a half, so I would either need to make the extra trip to discuss stepping down further, or simply wait until then to make the move down from 25mg.

 

I've thought about getting a scale, weighing the tablets, and calculating how much I would need to take off half a pill in order to arrive at a 20mg dose. I'm not sure if that seems extreme, naive, unwise, or any number of similarly discouraging adjectives lol. If anyone has any thoughts or experience with an idea like this, I'd be happy to hear from them.

Link to comment
  • Moderator Emeritus

The scale thing actually can work pretty well, if you can handle the math, which it sounds like you probably can.

 

Does amitriptyline come in a liquid form? If necessary you can probably get it compounded when you get down to where you need to make really small cuts.

 

I'm of the opinion that it might be a good idea to hang on to that 25 mg dose a bit longer before cutting again. Withdrawal symptoms can have a long lag time before they kick in, you do have a history of previous discontinuation problems, and 50% is a big chunk to cut. If it were me I'd wait a couple of months before cutting again.

Started on Prozac and Xanax in 1992 for PTSD after an assault. One drug led to more, the usual story. Got sicker and sicker, but believed I needed the drugs for my "underlying disease". Long story...lost everything. Life savings, home, physical and mental health, relationships, friendships, ability to work, everything. Amitryptiline, Prozac, bupropion, buspirone, flurazepam, diazepam, alprazolam, Paxil, citalopram, lamotrigine, gabapentin...probably more I've forgotten. 

Started multidrug taper in Feb 2010.  Doing a very slow microtaper, down to low doses now and feeling SO much better, getting my old personality and my brain back! Able to work full time, have a full social life, and cope with stress better than ever. Not perfect, but much better. After 23 lost years. Big Pharma has a lot to answer for. And "medicine for profit" is just not a great idea.

 

Feb 15 2010:  300 mg Neurontin  200 Lamictal   10 Celexa      0.65 Xanax   and 5 mg Ambien 

Feb 10 2014:   62 Lamictal    1.1 Celexa         0.135 Xanax    1.8 Valium

Feb 10 2015:   50 Lamictal      0.875 Celexa    0.11 Xanax      1.5 Valium

Feb 15 2016:   47.5 Lamictal   0.75 Celexa      0.0875 Xanax    1.42 Valium    

2/12/20             12                       0.045               0.007                   1 

May 2021            7                       0.01                  0.0037                1

Feb 2022            6                      0!!!                     0.00167               0.98                2.5 mg Ambien

Oct 2022       4.5 mg Lamictal    (off Celexa, off Xanax)   0.95 Valium    Ambien, 1/4 to 1/2 of a 5 mg tablet 

 

I'm not a doctor. Any advice I give is just my civilian opinion.

Link to comment

Just a brief update: It's been a brutal week, though the discontinuation is still going fine. Just been a lot of life circumstances piled atop a few tragic anniversaries, kind of typical for the third week of March, really. Looked into the type of scale I'd need, decided it's beyond the range of my budget; I'll wait until I see the doctor in 5 weeks to see if we can pull off a 40mg dose of 2 20mg tablets.

Link to comment
  • Administrator

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

Link to comment

Please sign in to comment

You will be able to leave a comment after signing in



Sign In Now
×
×
  • Create New...

Important Information

Terms of Use Privacy Policy