Jump to content
WilliamAtheling

WilliamAtheling Off ADs for first time in thirty years

Recommended Posts

Altostrata

Are these symptoms better or worse than before you reinstated 5mg amitriptyline?

Share this post


Link to post
WilliamAtheling
1 hour ago, Altostrata said:

Are these symptoms better or worse than before you reinstated 5mg amitriptyline?

Hi again

 

Thanks for your continued interest. $64 billion question. Truth is God knows. It may be the ongoing DS, rather than the marginal impact of the much reduced dose. I suppose I should judge again after a few more days. I wasn’t expecting miracles, just some stability and alleviation of symptoms.  

Share this post


Link to post
Rhiannon

If you can possibly hang on and give it a week or two, you may be able to get a clearer sense of how things are going. I think it usually takes at least four or five days to register.

 

It's tricky in your case, since you're in the early stages of withdrawal and it's hard to say how things would be with or without the 5 mg, since things are changing regardless at this point. (Pretty much as you just said.) 

 

If you can hang on and you aren't getting a clear strong negative reaction to the 5 mg, please hang on for a couple of weeks and see how it goes. We can look at how you're doing then and see what Alto thinks. It's possible you may do well with even a bit more, like 10 mg. Wait and see how this 5 mg treats you. Hang in there.

Share this post


Link to post
WilliamAtheling
3 minutes ago, Rhiannon said:

If you can possibly hang on and give it a week or two, you may be able to get a clearer sense of how things are going. I think it usually takes at least four or five days to register.

 

It's tricky in your case, since you're in the early stages of withdrawal and it's hard to say how things would be with or without the 5 mg, since things are changing regardless at this point. (Pretty much as you just said.) 

 

If you can hang on and you aren't getting a clear strong negative reaction to the 5 mg, please hang on for a couple of weeks and see how it goes. We can look at how you're doing then and see what Alto thinks. It's possible you may do well with even a bit more, like 10 mg. Wait and see how this 5 mg treats you. Hang in there.

Hi

 

Happy to be guided by you and others. My worry about increasing to 10mg would be the risk of the return to the unbearable symptoms experienced at 25mg ;appreciate the difference in dosage) If the choice is between felling garbage off med and equally garbage on, then but of a no brained??

 

Thanks

Share this post


Link to post
Altostrata

I would not increase to 10mg. I was thinking 2.5mg might be better -- but you have to see if your symptom pattern gets better or worse.

Share this post


Link to post
WilliamAtheling
8 minutes ago, Altostrata said:

I would not increase to 10mg. I was thinking 2.5mg might be better -- but you have to see if your symptom pattern gets better or worse.

Thanks. I don’t think I have the skill or patience needed to reduce 5mg to 2.5. Just about manage with pill cutter as it is)

Share this post


Link to post
Rhiannon

Right. 5 mg it is for now then. 🙂 (Said in a kind of really garbage English accent because I've been bingeing the Great British Baking Show.)

Share this post


Link to post
WilliamAtheling
3 minutes ago, Rhiannon said:

Right. 5 mg it is for now then. 🙂 (Said in a kind of really garbage English accent because I've been bingeing the Great British Baking Show.)

Update 

 

Took 4th 5mg tablet last night. Didn’t sleep a wink, gnawing feeling in solar plexus and digestive system grinding away all night. This is definitely worse than on zilch.  Previously I was waken at 4am by cortisol spike. Got up with severe shakes, pain and mental anguish. God knows what I do now??

Share this post


Link to post
Rhiannon

Might want to read in the tapering section about how to cut your tablets smaller, using a scale perhaps? Alto thinks you should try 2.5 mg, she's much more knowledgeable about reinstatement dosages than I am. @Altostrata do you think this is a reaction to the 5 mg? This is the fourth day of 5 mg. Let's see what Alto and the mods say, they're much more expert than I am with this dosage business.

Share this post


Link to post
WilliamAtheling

Ok. Thanks. Just managed to get to work, but going to leave shortly.  Apart from no sleep and shakes, the massive problem is mental anguish, tiredness and confusion. Really think I should have stayed off......,

Share this post


Link to post
WilliamAtheling

Excruciating physical pain now. Stabbing pains throughout arms and legs, painful muscular stiffness, loss of balance. Don’t know if my system is telling me:

 

5mg is  too much

5mg is nowhere near enough (despite ghastly 12 month journey on amitriptyline)

5mg is ok, but need to stabilise 

 

On a scale of 1-10, I’d say the symptoms are about 9.

 

Thanks

Share this post


Link to post
Rhiannon
22 hours ago, Altostrata said:

I would not increase to 10mg. I was thinking 2.5mg might be better -- but you have to see if your symptom pattern gets better or worse.

 

Maybe it's time to see if there's a way you can do the 2.5 mg. I'm so sorry for your suffering, I wish I knew an answer for you.

Share this post


Link to post
WilliamAtheling
28 minutes ago, Rhiannon said:

 

Maybe it's time to see if there's a way you can do the 2.5 mg. I'm so sorry for your suffering, I wish I knew an answer for you.

I was told 5mg would be a good start, Maybe I should wait a bit longer, before playing Russian Roulette again? I must confess I never dreamed it would make matters worse quite so soon!! If just inevitable intensification of DS, thought this strategy would mitigate?

 

Thank you

Share this post


Link to post
Rhiannon

From my limited understanding, nobody can predict exactly what is going to happen with a reinstatement. It's usually worth a try at a very small dose. 5 mg was suggested, but maybe that was too much. Maybe 2.5 mg would be better, I don't really know. Maybe, like you say, just staying where you are and not changing anything is the best bet. Only you know what you can tolerate.

 

I usually fall into the "don't change things" camp, but Alto is MUCH more experienced than I am with reinstatement and dosages, and she thought right from the start that 2.5 mg might be better for you. I generally follow her advice.

 

It would be wonderful if there were studies on this and doctors who were experienced and tests they could do and they could say "here is a solution that will work." That doesn't exist.  (yet.)

 

The thing about lower doses is that they are less likely to cause bad reactions and it seems to be generally less dangerous and destabilizing to start low and go up than to start too high and have to go down. But you said you don't want to have to deal with trying to cut or otherwise come up with a 2.5 mg dose. So there's that to factor in also.

 

I have to go to work now so I won't be around the site to reply further today.

 

I'm so sorry your situation doesn't seem to have an easy answer. 

 

 

Share this post


Link to post
Altostrata

If it makes your symptoms worse, 5mg is too much.

 

We don't subscribe to the idea that more is better when it comes to antidepressants. We're not trying to stomp out depression, we're trying to reduce withdrawal symptoms.

Share this post


Link to post
WilliamAtheling
6 hours ago, Altostrata said:

If it makes your symptoms worse, 5mg is too much.

 

We don't subscribe to the idea that more is better when it comes to antidepressants. We're not trying to stomp out depression, we're trying to reduce withdrawal symptoms.

I can’t be 100% sure that the 5mg is making me worse or the underlying pathology of the WD?

 

It’s just another example of Russian Roulette gone wrong again. I’m stuck now, as don’t have wherewithal or equipment to reduce from 5mg to 2.5. (Can use pill cutter but not accurate)

 

Thanks

 

Share this post


Link to post
Altostrata

What time are you taking amitriptyline at night? Are your symptoms worse in the hours after you take it? Overall, are you feeling better or worse than you were feeling before you started it 5 days ago?

Share this post


Link to post
WilliamAtheling
8 minutes ago, Altostrata said:

What time are you taking amitriptyline at night? Are your symptoms worse in the hours after you take it? Overall, are you feeling better or worse than you were feeling before you started it 5 days ago?

Hi again

 

Take it b4 bed. That was always the advice with amitriptyline due to soporific properties. The last two days I’ve felt palpably worse than b4 reinstatement (nerve pain and shakes mainly) I don’t know how pertinent that is, as symptoms have nosedived without reinstatement. (Wasn’t that consensus about inevitability of “coming storm” etc?)

 

I will have real issues reducing to 2.5mg. (Only have pill cutter and wife not persuaded by liquid conversion methods) She’s v supportive, but works for NHS in Ingerland. Some experience of dosage adaptions but with v different clientele. (Paediatric cardiology)

 

Thanks.

Meant “may have” nosedived.

Share this post


Link to post
Altostrata

Since your baseline symptoms are so variable, we don't know what the amitriptyline is doing after only 4 days. It takes about this long to get to steady-state in the bloodstream. We need a longer record of symptom pattern to see if it's helping.

 

This site exists because people can't find help from conventional medical sources such as NHS. Correct, the NHS doesn't know anything about tapering or modifying dosages to individual tolerance. If 5mg proves to be too high a dosage, you might thank your wife for her opinion and still split your tablet to take a dose lower than 2.5mg, or make a liquid from it as so many other people here have done. Your decision.

 

However, it doesn't make sense to worry about this now, because 5mg could be fine.

Share this post


Link to post
WilliamAtheling
21 minutes ago, Altostrata said:

Since your baseline symptoms are so variable, we don't know what the amitriptyline is doing after only 4 days. It takes about this long to get to steady-state in the bloodstream. We need a longer record of symptom pattern to see if it's helping.

 

This site exists because people can't find help from conventional medical sources such as NHS. Correct, the NHS doesn't know anything about tapering or modifying dosages to individual tolerance. If 5mg proves to be too high a dosage, you might thank your wife for her opinion and still split your tablet to take a dose lower than 2.5mg, or make a liquid from it as so many other people here have done. Your decision.

 

However, it doesn't make sense to worry about this now, because 5mg could be fine.

Thanks. Last year I had my own annus horribilis. I had become convinced that my condition was a major league neurological one. ;The neurologist I saw took about 5 mins to eliminate the usual suspects, MA, Parkinson’s etc.  I didn’t have the pain I’m now experiencing. Wouldn’t have affected diagnosis, just good to get his view on the neurotransmitter, transporter receptor status in long term AD usage. I asked him explicitly about this, but the discussion didn’t consider discontinuation issues.

Needless to say, he was v arrogant and unhelpful. “I only look for evidence” blah blah.  

 

I hear what you say. I can only tolerate this agony for another day or two.

 

Thanks

 

MS

Share this post


Link to post
Altostrata

Now I'm confused. What is your underlying health issue, aside from amitriptyline withdrawal?

Share this post


Link to post
WilliamAtheling
22 minutes ago, Altostrata said:

Now I'm confused. What is your underlying health issue, aside from amitriptyline withdrawal?

Depression and anxiety is underlying condition. (Thirty plus years) Visit to neurologist down to my species of symptoms convinced me there was a neurological basis to this. There wasn’t.

Share this post


Link to post
Altostrata

From your signature:

Quote

 

  • 22 Sept 11 Mirtazapine 30mg with venlafaxine
  • 2017 reduced Mirtazapine to 15mg?
  • 5 May 2017-came off Mirtazapine, but still on Venlafaxine
  • Oct  18- tapered off venlafaxine and replaced with amitriptyline 25, 50, 75, 100, 75, 50, 25, 0)
  • 10 Sept came off amitriptyline
  • 31 Oct reinstate 5mg amitriptyline

 

 

Have you had stiffness and pain since you were taking mirtazapine and venlafaxine together?

 

How did you feel went you came off venlafaxine and went on amitriptyline? How did you make the switch? Why did you make that change?

Share this post


Link to post
WilliamAtheling
1 minute ago, Altostrata said:

From your signature:

 

Have you had stiffness and pain since you were taking mirtazapine and venlafaxine together?

 

How did you feel went you came off venlafaxine and went on amitriptyline? How did you make the switch? Why did you make that change?

 

 

I don’t think I can provide precise responses to your questions.

 

1. I’ve only kept a detailed diary since I stopped the ven. However, the muscular stiffness has been a feature for many years. The pain I’ve previously experienced (b4 and after mirtazapine) was mainly a dull ache, numbness pins and needles, mainly legs. There were a few episodes of the more distressing pain now felt. (Last two weeks prior to the last two weeks prior to reinstatement, but much worse in last few days. (combination of pin pricks in arms and legs and more painful sensation down spine)

2.Ven-amitriptyline switch. Why? Had been referred to NHS neurologist. She advised switch. Think ostensibly because latter was allegedly good for pain management in addition to AD role. How change? Introduced 25mg A and dropped V from 175 to 112.5. Two weeks later maintained A at 25 and dropped V to 75mg. Two weeks later 50 A and 37.5 V. Two weeks later stop V and gradually titrating A as per signature. How feel? Shaking, stiffness, photo sensitivity, exhaustion, dizzy, awful mental debility and anguish.

 

I may not have articulated 100% correctly. This is v difficult.

 

Thanks

Share this post


Link to post
WilliamAtheling

Update

 

 6 days after reinstatement amitriptyline 5mg. 

 

Different symptoms to yesterday. None of the agonising nerve pain. However, head tremors ten times worse. Mental confusion and anxiety, when communicating and thinking.  

 

Not just waves and windows, v different waves.

Share this post


Link to post
Altostrata

What times of day do these head tremors occur, how long do they last? Please continue to monitor. This appears to be a small improvement. We expect symptoms to mutate.

Share this post


Link to post
WilliamAtheling
24 minutes ago, Altostrata said:

What times of day do these head tremors occur, how long do they last? Please continue to monitor. This appears to be a small improvement. We expect symptoms to mutate.

Hi again

 

Head tremors seem to be pretty permanent at the moment. Did you read my response to your questions about ven/amitriptyline cross taper and nerve pain?

Share this post


Link to post
Altostrata

My guess is you suffered those painful symptoms for years because you were taking venlafaxine with mirtazapine, which can cause serotonin toxicity, a low-grade form of serotonin syndrome.

 

Quote

 

Interactions between your drugs

Major

venlafaxine mirtazapine

Applies to: venlafaxine and mirtazapine

MONITOR CLOSELY: Concomitant use of agents with serotonergic activity such as serotonin reuptake inhibitors, monoamine oxidase inhibitors, tricyclic antidepressants, 5-HT1 receptor agonists, ergot alkaloids, cyclobenzaprine, lithium, St. John's wort, phenylpiperidine opioids, dextromethorphan, and tryptophan 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.

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....

 

 

When you substituted amitriptyline for venlafaxine, you got withdrawal symptoms from venlafaxine. It may be that coming off amitriptylilne caused further upset, as reinstatement seems to have relieved some symptoms.

 

It may take your nervous system some time to settle down from years of serotonergic overstimulation. I would be very careful about increasing serotonergics such as amitriptyline (which, fortunately, is a relatively mild antidepressant). Since you've already seen a little improvement, if I were you, I would hold on 5mg amitriptyline, be patient, let your nervous system settle down.

Share this post


Link to post
WilliamAtheling
19 minutes ago, Altostrata said:

My guess is you suffered those painful symptoms for years because you were taking venlafaxine with mirtazapine, which can cause serotonin toxicity, a low-grade form of serotonin syndrome.

 

 

When you substituted amitriptyline for venlafaxine, you got withdrawal symptoms from venlafaxine. It may be that coming off amitriptylilne caused further upset, as reinstatement seems to have relieved some symptoms.

 

It may take your nervous system some time to settle down from years of serotonergic overstimulation. I would be very careful about increasing serotonergics such as amitriptyline (which, fortunately, is a relatively mild antidepressant). Since you've already seen a little improvement, if I were you, I would hold on 5mg amitriptyline, be patient, let your nervous system settle down.

Thanks again. Strange about risks with “California Rocket fuel”, when the World and his Wife were extolling the virtues of this. I appreciate your expertise, but not sure about “reinstatement relieving some symptoms”. It’s v much day to dat, but the mental anguish and tremors now experienced are unlike anything I had in seven week period immediately after dropping 25mg amitriptyline.

 

Thank you

Share this post


Link to post
Altostrata

Being a skeptic is fine, there's no reason you should take advice from strangers on the Web. The sarcasm and mocking are not welcome.

 

Of course your symptom pattern changed, you've added a chemical. You claimed "agonizing pain" had been relieved in 5 days. If you think your doctors can effect faster progress, please consult them. I'm not going to argue with you about it.

Share this post


Link to post
WilliamAtheling
12 minutes ago, Altostrata said:

Being a skeptic is fine, there's no reason you should take advice from strangers on the Web. The sarcasm and mocking are not welcome.

 

Of course your symptom pattern changed, you've added a chemical. You claimed "agonizing pain" had been relieved in 5 days. If you think your doctors can effect faster progress, please consult them. I'm not going to argue with you about it.

Apologies. I’m not mocking, sceptical or being sarcastic. I’ve probably suffered longer than many, not all, so v empathetic to the suffering and different approaches proposed.

 

All I was stating was that the agonising pain had started on day five of reinstatement and had eased considerably on day six. 

 

I was aware that the process might not be effective on my case. That was no reason for me to ridicule, and certainly not my intention. Apologies if you feel that way.

Share this post


Link to post
Altostrata

What we see, which is explained in detail in About reinstating and stabilizing to reduce withdrawal symptoms  is that reinstatement of a low dose will GRADUALLY allow the nervous system to stabilize. The low dose is a crutch. We want the nervous system to do the major part of the work instead of clobbering it with a dosage that might cause kindling.

 

The reinstatement process is described hundreds of times in Introductions topics. When you've already seen improvement after 5 days, there is no reason to think GRADUAL improvement will not continue -- unless you are of an exceptionally pessimistic frame of mind, which will be produce exactly the bad outcome you expect. When it comes to psychological conditions, as Henry Ford said, 'Whether you think you can, or you think you can't--you're right."

 

EVERYBODY here who's older than 30 has had 30 years of depression.

Share this post


Link to post
WilliamAtheling
10 minutes ago, Altostrata said:

EVERYBODY here who's older than 30 has had 30 years of depression.

Ok. I guess I’m only down for 33 years then, as earliest experience was when I was 27.

Share this post


Link to post
Altostrata

Very convincing, you're the biggest sufferer of them all.

 

Not sure what's going in with the 5mg amitriptyline reinstatement. You are the only one who can judge whether you feel better or worse.

Share this post


Link to post
WilliamAtheling
27 minutes ago, Altostrata said:

Very convincing, you're the biggest sufferer of them all.

 

Not sure what's going in with the 5mg amitriptyline reinstatement. You are the only one who can judge whether you feel better or worse.

How long should I give it? It’s only been a week, but signs not good. 

Share this post


Link to post
Altostrata

I'd cut it in half to 2.5mg per day.

Share this post


Link to post
Guest
This topic is now closed to further replies.
×
×
  • Create New...

Important Information

Terms of Use Privacy Policy