Snorky: Reinstatement of amitriptyline

[sunnysideup69]

Hey @Snorky, you'll probably not get many responses posting in here. Better to do it on your thread  It does go quiet from time to time as mods are volunteers and also dealing with their own withdrawal...but you will get a response.

[Snorky]

20 minutes ago, sunnysideup69 said:

Hey @Snorky, you'll probably not get many responses posting in here. Better to do it on your thread  It does go quiet from time to time as mods are volunteers and also dealing with their own withdrawal...but you will get a response.

Thanks. Yes, I get that and appreciate how busy and selfless folk are. Ironically Inpisted here, as thought my main thread in the introduction section was bein overlooked. 

 

 

[Snorky]

Hi All

 

Was just wondering what mods and majority would suggest when:

 

Reinstatement at lower dose of original med failed.

 

While on CT, all symptoms deteriorating, particularly advent of new and v palpable depressive and helplessness feelings. 

 

Is this more suggestive of serotonin depletion linked to original diagnosis, rather than WD?

 

Thank you.

[Snorky]

Hi

 

Not sure if anyone read my query yesterday, but appreciate how busy people are, and also fighting their own battle. However, now have further update. Went to Doc today as deteriorating so fast. 

 

Recent bloods indicated low level of Vitamin D, so prescribed this. Also recommended mild sedative (not addictive) and just for a month to address dreadful insomnia. (Mainly used as antihistamine)

 

Have others been offered these? 

Have they been helpful?

 

Thank you

 

[Snorky]

Sedative is promethazine.

[Gridley]

21 hours ago, Snorky said:

 

Is this more suggestive of serotonin depletion linked to original diagnosis, rather than WD?

Snorky, I'm sorry you're still feeling so bad.

 

The "serotonin deficiency" or "chemical imbalance" theory is invalid and has been thoroughly debunked.  There's a huge amount of serotonin in your gut and if your brain needed some, your body would send some right up there.

Again, chemical imbalance is a myth. Stop the lies, please ...

57 minutes ago, Snorky said:

Sedative is promethazine.

 

Promethazine, which is an antihistamine, shouldn't be CT'd.  If you're only taking it once a day, it doesn't require much tapering.  When you decide to stop it, you might reduce it by 25% every few days.

 

I wish I had something more to suggest regarding your situation beyond what I said before.

 

[Snorky]

29 minutes ago, Gridley said:

Snorky, I'm sorry you're still feeling so bad.

 

The "serotonin deficiency" or "chemical imbalance" theory is invalid and has been thoroughly debunked.  There's a huge amount of serotonin in your gut and if your brain needed some, your body would send some right up there.

Again, chemical imbalance is a myth. Stop the lies, please ...

 

Promethazine, which is an antihistamine, shouldn't be CT'd.  If you're only taking it once a day, it doesn't require much tapering.  When you decide to stop it, you might reduce it by 25% every few days.

 

I wish I had something more to suggest regarding your situation beyond what I said before.

 

Hi G

 

Hope you’re “ok”. What I was getting at, was wondering whether the palpable depressive feeling was more linked to serotonin deficiency than the other symptoms of anxiety and depression. 

 

Thanks for  comments re sedative. 

[Snorky]

Hi “again again”

 

Also thought recent research found that although ADs didn’t increase overall amount of serotonin, they did maximise its active agent by blocking brain reabsorption? 

 

(Whether S deficiency responsible for depression is another issue. Maybe that has been effectively debunked??)

 

Thanks

[Freedom15]

Your pritty much where i was when i was first CT off the meds even down to when i was prescribed Promethazine.

 

I took it for few days it worked for 1 or 2 nights then the seditive side stopped working and i ended up with full visual hallucinations and

had to stop that as well.

 

I have not be well since the CT in 2014 and altho i am slowly improving i still have massive effects that are related to the inital CT and the damage that

gave to my CNS system.

 

I leanered vary quickly that the docotrs and services have not got any clue regarding WD and long term damaging effects of the meds they give out.

 

Are you getting any improvements at all even if they are vary small ??

 

 

[Snorky]

1 hour ago, Freedom15 said:

Your pritty much where i was when i was first CT off the meds even down to when i was prescribed Promethazine.

 

I took it for few days it worked for 1 or 2 nights then the seditive side stopped working and i ended up with full visual hallucinations and

had to stop that as well.

 

I have not be well since the CT in 2014 and altho i am slowly improving i still have massive effects that are related to the inital CT and the damage that

gave to my CNS system.

 

I leanered vary quickly that the docotrs and services have not got any clue regarding WD and long term damaging effects of the meds they give out.

 

Are you getting any improvements at all even if they are vary small ??

 

 

Hi

Thanks for cheering me up in promethazine. Just about to start tonight. My mental anguish is certainly only going one way, no respite or windows  there. The physical symptoms, other than the awful tremors, seem to wax and wane.

[Gridley]

On 12/16/2019 at 9:33 AM, Snorky said:

 

Also thought recent research found that although ADs didn’t increase overall amount of serotonin, they did maximise its active agent by blocking brain reabsorption? 

 

I don't know anything about AD's "maximizing [serotonin's] active ingredient" but they definitely block brain reabsorption.  That's how they work.

 

On 12/16/2019 at 9:33 AM, Snorky said:

 

(Whether S deficiency responsible for depression is another issue. Maybe that has been effectively debunked??)

Yes, serotonin deficiency as a cause of depression has been debunked, as described in the links I sent earlier.

[Gridley]

@Snorky

 

SA prefers that you post questions about tapering and withdrawal in your thread rather that via PM so that others mods may respond.  

 

You recently wrote about  "the specific emergence of v palpable depressive type symptoms during CT, and whether these were more likely to be relapse than withdrawal?"

 

Alto today wrote about relapse vs. withdrawal in katy398's thread: 

 

"If symptoms occur during or after a drug reduction, they are more likely to be withdrawal symptoms than "relapse." After taking the drugs for a while, your brain and nervous system and everything attached to them are altered by accommodation to the drug. This doesn't simply bounce back after the drug is removed, "relapsed" to the original state. You have a different nervous system etc. than you did before the drugs; at the very least, you're older.

 

If someone has "depression" or "anxiety" with other withdrawal symptoms after coming off a psychiatric drug, they are in withdrawal, not "relapse."  What's confusing is the overlap between "depression" and "anxiety" prior to drugs and "depression" and "anxiety" as withdrawal symptoms. While withdrawal "depression" and "anxiety" often have the same CONTENT as prior to taking the drug, they usually occur in the waves and windows pattern and progressively lessen in intensity. That is not the pattern of "relapse."

 

 

[Snorky]

25 minutes ago, Gridley said:

@Snorky

 

SA prefers that you post questions about tapering and withdrawal in your thread rather that via PM so that others mods may respond.  

 

You recently wrote about  "the specific emergence of v palpable depressive type symptoms during CT, and whether these were more likely to be relapse than withdrawal?"

 

Alto today wrote about relapse vs. withdrawal in katy398's thread: 

 

"If symptoms occur during or after a drug reduction, they are more likely to be withdrawal symptoms than "relapse." After taking the drugs for a while, your brain and nervous system and everything attached to them are altered by accommodation to the drug. This doesn't simply bounce back after the drug is removed, "relapsed" to the original state. You have a different nervous system etc. than you did before the drugs; at the very least, you're older.

 

If someone has "depression" or "anxiety" with other withdrawal symptoms after coming off a psychiatric drug, they are in withdrawal, not "relapse."  What's confusing is the overlap between "depression" and "anxiety" prior to drugs and "depression" and "anxiety" as withdrawal symptoms. While withdrawal "depression" and "anxiety" often have the same CONTENT as prior to taking the drug, they usually occur in the waves and windows pattern and progressively lessen in intensity. That is not the pattern of "relapse."

 

 

Many thanks for comparison of symptoms more associated with WD than relapse. My fear and evidence points to symptoms rapidly deteriorating, rather than the waves and windows pattern. I’ve stated this before, providing examples. I know I’m barely 3+ plus months in, but decline is v noticeable and worrying.

[Gridley]

@Snorky

 

I've gone back through your thread.  In response to Freedom's long list of symptoms, you responded

 

"I can relate to about 90% if your symptoms. The only other ones on the physical list are recent loss of appetite, a constant sort of gnawing feeling in duodenum area while in bed and short stabbing pains in arms and legs (could be your pin pricks?)"

 

These are typical withdrawal symptoms.  I know the mental anguish is the worst, but going by Alto's criterion--"If someone has "depression" or "anxiety" with other withdrawal symptoms after coming off a psychiatric drug, they are in withdrawal, not "relapse" --it seems like withdrawal to me.

I know this brings no relief to your anguish.  However, knowing that it's withdrawal brings with it the knowledge that it will pass.  

[Snorky]

13 minutes ago, Gridley said:

@Snorky

 

I've gone back through your thread.  In response to Freedom's long list of symptoms, you responded

 

"I can relate to about 90% if your symptoms. The only other ones on the physical list are recent loss of appetite, a constant sort of gnawing feeling in duodenum area while in bed and short stabbing pains in arms and legs (could be your pin pricks?)"

 

These are typical withdrawal symptoms.  I know the mental anguish is the worst, but going by Alto's criterion--"If someone has "depression" or "anxiety" with other withdrawal symptoms after coming off a psychiatric drug, they are in withdrawal, not "relapse" --it seems like withdrawal to me.

I know this brings no relief to your anguish.  However, knowing that it's withdrawal brings with it the knowledge that it will pass.  

Thanks. Patience is a virtue and I since hope there will be some alleviation. It’s so difficult, as probably changing all the time, but v marginally. The other “elephant in the room” in the ride it out approach is the length of time (years) and inability to work with all that this entails.

 

Thanks

[Snorky]

Hi All

 

Regular diatribe of doom and gloom. Symptoms only going one way, plummeting downwards. On a scale of 1-10:

 

Physical

 

Head tremors 15

Pain 9

Muscular stiffness 12

Photosensitivity 11

Hoarse throat 13

Insomnia 18

 

Mental

 

Confusion 15

Anxiety/Edge 29

Depression/Mood 28

 

(Just started Vit D and sedative)

 

Is it like this for others currently CTing? (Three months) 

 

Thank you

 

 

 

[Snorky]

Also forgot to mention been on sick leave for five weeks since failed reinstatement of amitriptyline.

[Altostrata]

Hello, Snorky.

 

You never felt right after swapping venlafaxine for amitriptyline, is that correct?

 

If so, it's likely you're suffering from venlafaxine withdrawal. Your doctor should have recognized this when you made the switch.

 

Your adverse reactions to amitriptyline have exacerbated your withdrawal syndrome.

 

In your case, amitriptyline did not work as a replacement for venlafaxine. There's a chance a very small amount, such as 0.5mg of fluoxetine or citalopram can work. They both come in a liquid form to take a very small amount of drug. I would even start at 0.25mg, as it seems you're quite sensitized. If it works, you can taper off later.

 

Please let us know how you're doing.

[Snorky]

12 minutes ago, Altostrata said:

Hello, Snorky.

 

You never felt right after swapping venlafaxine for amitriptyline, is that correct?

 

If so, it's likely you're suffering from venlafaxine withdrawal. Your doctor should have recognized this when you made the switch.

 

Your adverse reactions to amitriptyline have exacerbated your withdrawal syndrome.

 

In your case, amitriptyline did not work as a replacement for venlafaxine. There's a chance a very small amount, such as 0.5mg of fluoxetine or citalopram can work. They both come in a liquid form to take a very small amount of drug. I would even start at 0.25mg, as it seems you're quite sensitized. If it works, you can taper off later.

 

Please let us know how you're doing.

Hi A

 

Thats right. A has been an unmitigated disaster. However, looking back at my notes, I highlighted the following just as I was moving across from Ven to A. 

 

 

NEED TO REMEMBER THAT FEELING AWFUL BEFORE TRANSITION. GRIND, CONFUSION, DIZZY, STIFFNESS AND SHAKES.

 

Also trued Citalopram and Prozac many years ago. Both were unsuccessful, particularly Prozac which had to be discontinued after a few days. 

 

Don’t feel physically or emotionally able to carry on playing Russian Roulette. 

 

I saw a psychiatrist in the summer (b4 initial Amitriptyline CT) He suggested reintroducing Venlafaxine, as I had tolerated that for so long. At least able to function and work.

 

Thanks

 

 

 

[Altostrata]

I am confused. You were having adverse effects from venlafaxine before you switched to amitriptyline? Was this just after a dosage increase or other change? Did you accidentally forget to take any doses? Do you have any dosage history for venlafaxine?

 

What was your reaction to citalopram and Prozac, at what dosages?

[Snorky]

7 hours ago, Altostrata said:

I am confused. You were having adverse effects from venlafaxine before you switched to amitriptyline? Was this just after a dosage increase or other change? Did you accidentally forget to take any doses? Do you have any dosage history for venlafaxine?

 

What was your reaction to citalopram and Prozac, at what dosages?

Hi

 

1. Started ven 2008. Went from 75-150-225. Finally settled on 150 in 2011 as most tolerable dose. 

2. 150mg from 2011 to Oct 2018.

3. 150-75-37.5 and eventually 0 over 6 weeks Oct- Nov 18.

4. Just about functioning on ven. Many physical and mental symptoms. Never established whether this was side effects or adverse effects. 

5. Citalopram May 06-June 06. Don’t have record of dose or reaction, but came off after a month.

6. Prozac April 07-May 07. Ditto Citalopram comments.

 

Thanks

[Snorky]

I’ve just looked up various articles on serotonin deficiency. Seems to fit me perfectly.

[Snorky]

Hi

 

Politely bumping this. (Has provided info required by mid, then added supplementary)

 

Thank you

[Altostrata]

I am still confused.

 

On 12/19/2019 at 11:45 AM, Snorky said:

Hi A

 

Thats right. A has been an unmitigated disaster. However, looking back at my notes, I highlighted the following just as I was moving across from Ven to A. 

 

 

NEED TO REMEMBER THAT FEELING AWFUL BEFORE TRANSITION. GRIND, CONFUSION, DIZZY, STIFFNESS AND SHAKES.

 

Also trued Citalopram and Prozac many years ago. Both were unsuccessful, particularly Prozac which had to be discontinued after a few days. 

 

Don’t feel physically or emotionally able to carry on playing Russian Roulette. 

 

I saw a psychiatrist in the summer (b4 initial Amitriptyline CT) He suggested reintroducing Venlafaxine, as I had tolerated that for so long. At least able to function and work.

 

Thanks

 

 

 

 

What symptoms were you having WHILE you were taking venlafaxine?

 

How did your symptoms change after you went off venlafaxine started amitriptyline?

 

How were Prozac and citalopram "unsuccessful." What happened when you took Prozac?

 

 

There is no such thing as a serotonin deficiency. It makes sense to you because it was clever marketing by the pharmaceutical companies. Please read this again:

 

On 11/25/2019 at 5:01 AM, Gridley said:

 

The chemical imbalance concept, made up by the pharmaceutical companies, has been thoroughly debunked. 

Again, chemical imbalance is a myth. Stop the lies, please ...

 

[Snorky]

22 minutes ago, Altostrata said:

I am still confused.

 

 

What symptoms were you having WHILE you were taking venlafaxine?

 

How did your symptoms change after you went off venlafaxine started amitriptyline?

 

How were Prozac and citalopram "unsuccessful." What happened when you took Prozac?

 

 

There is no such thing as a serotonin deficiency. It makes sense to you because it was clever marketing by the pharmaceutical companies. Please read this again:

 

 

Hi

 

Siery you’re still confused. Not my intention here.

 

1. Ven mainly producing symptoms highlighted in upper case in previous post. Ie some tremors, muscular stiffness around face and neck, but mainly mental anguish. What I describe as “grind” (for want of a better word) Like brain hurt when trying to think and communicate.

 

2. All symptoms exacerbated.

 

3. V difficult recalling back to 2006 and 2007. My diary just records I came off both Cit and Prozac after a week or so. 

 

4. Serotonin deficiency-noted. I just wish there was some tiny evidence of progress towards homeostasis. I know I’m worse than when I started my sick leave on Nov 18. I also know with equal conviction that the slope is going downhill.

 

Thanks

[Altostrata]

I'm going to assume there were other drug switches before you went on venlafaxine, as your signature indicates prior Cymbalta and Lyrica. Do your odd symptoms date from a switch from Cymbalta to venlafaxine? How did you go off Lyrica?

 

18 hours ago, Snorky said:

tremors, muscular stiffness around face and neck, but mainly mental anguish. What I describe as “grind” (for want of a better word) Like brain hurt when trying to think and communicate.

 

You had this for 8 years while you were taking venlafaxine? What combination of drugs were you taking when these symptoms started? Did you skip any doses of venlafaxine prior to these symptoms coming on?

 

Did you ever feel okay while taking venlafaxine?

[Snorky]

52 minutes ago, Altostrata said:

I'm going to assume there were other drug switches before you went on venlafaxine, as your signature indicates prior Cymbalta and Lyrica. Do your odd symptoms date from a switch from Cymbalta to venlafaxine? How did you go off Lyrica?

 

You had this for 8 years while you were taking venlafaxine? What combination of drugs were you taking when these symptoms started? Did you skip any doses of venlafaxine prior to these symptoms coming on?

 

Did you ever feel okay while taking venlafaxine?

Hi again

 

Yes, there were many switches b4 venlafaxine.

 

When you say “odd symptoms”, do you mean the mental anguish/depressive thoughts and sensations?  

 

Looking st my notes, I didn’t switch from Cymbalta to Ven. I was on Cym from July 06-April 07. I then moved to Prozac, Sertraline and Citalopram briefly, prior to commencing on Ven in July 08. I can’t link my current symptoms to that era.

 

I was recommended Lyrica by a new Shrink in 2010. I stayed on this or six months b4 reverting to Ven. My notes just say I moved from 150mg Lyrica to 150mg Ven in March 2011. 

 

I can’t say I had the side effects the whole time I was on Ven.

 

I was mainly on 150mg ven, but added mirtazapine some time after. I stopped mirtazapine in 2017 but kept the Ven going. I was able to function the whole time with minimal time sick.

 

No skipping of doses of ven.

 

Thanks

 

 

[Altostrata]

20 hours ago, Snorky said:

tremors, muscular stiffness around face and neck, but mainly mental anguish. What I describe as “grind” (for want of a better word) Like brain hurt when trying to think and communicate.

 

If you were taking venlafaxine steadily and not having adverse reactions, what happened to your venlafaxine dosing to cause this? Did you increase dosage or add another drug?

 

I'm asking because it looks like your symptoms might be venlafaxine withdrawal, with amitriptyline an insufficient substitute. Since venlafaxine is difficult to taper, venlafaxine withdrawal often is treated by fluoxetine.

[Snorky]

18 minutes ago, Altostrata said:

 

If you were taking venlafaxine steadily and not having adverse reactions, what happened to your venlafaxine dosing to cause this? Did you increase dosage or add another drug?

 

I'm asking because it looks like your symptoms might be venlafaxine withdrawal, with amitriptyline an insufficient substitute. Since venlafaxine is difficult to taper, venlafaxine withdrawal often is treated by fluoxetine.

Hi

 

I mentioned I had mainly taken 150mg ven, I went up to 225 for a short while, but couldn’t tolerate that., I would say that in the whole time I was on Ven, it was 150mg, also took mirtazapine with it for muchos anos. I can’t honestly remember at what point the symptoms kicked in. I do know this though. Those symptoms were like a walk in the park compared to those currently experienced.

 

[Altostrata]

Is it possible that you were taking 150mg venlafaxine with xxmg mirtazapine (a combination known for potential adverse drug-drug interaction) and got this bad reaction when you increased venlafaxine to 225mg?

[Snorky]

1 hour ago, Altostrata said:

Is it possible that you were taking 150mg venlafaxine with xxmg mirtazapine (a combination known for potential adverse drug-drug interaction) and got this bad reaction when you increased venlafaxine to 225mg?

I’ve no idea really. I was only on 225mg for a v short time m, as couldn’t tolerate that anyway. So hard, pouring over this so long after the event and trying to analyse.

[Altostrata]

Well, you've got antidepressant withdrawal syndrome, probably from venlafaxine, and amitriptyline isn't helping. You might do better with a tiny amount of venlafaxine (perhaps a few beads out of a 75mg capsule) or 0.5mg fluoxetine. What would you like to do?

[Snorky]

8 hours ago, Altostrata said:

Well, you've got antidepressant withdrawal syndrome, probably from venlafaxine, and amitriptyline isn't helping. You might do better with a tiny amount of venlafaxine (perhaps a few beads out of a 75mg capsule) or 0.5mg fluoxetine. What would you like to do?

I've been off ven since Oct 18. I've also been off Am since Sept 19 if you exclude the failed four week reinstatement period. Last night I watched an old horror movie (bad idea). I suddenly became extremely depressed and went to bed like that. I then had the usual mental angst coupled with the terrifying black feeling all night. Finally, I wake up with all these feelings continuing and the usual Parkinson's head tremors. I feel completely overwhelmed, like I've done everything by the book and have zilch reward. Not a hint of a window or respite. Three months of ever increasing hell. Should there not be the odd green shoot of a wave, sign of return to homestasis. Isn't that what others are told?

 

No idea what I'm going to do. Just know I'm supposed to go back to work on Monday, when feeling like a nervous wreck and jibbering idiot. 

 

(I asking thought there was a big government health warning about going back on old meds, albeit small dose)

 

[Altostrata]

It probably will take a lot longer than 3 months to recover from withdrawal syndrome plus the adverse drug reactions. This is the dark side of psychiatric drug treatment, the part your doctor won't tell you about it (because he or she is not aware of it).

 

If you've gotten worse over the 3 months, you might consider a tiny reinstatement. If you've seen some improvement, you might want to wait it out. This will take patience and a lot of self-soothing, because ever-changing symptoms tend to come in waves, which can be discouraging. But as recovery progresses, the waves tend to be less intense and come less often.

 

How has your sleep pattern changed over 3 months?

 

A lot of people find fish oil and magnesium supplements helpful, see
https://survivingantidepressants.org/index.php?/topic/36-king-of-supplements-omega-3-fatty-acids-fish-oil/
https://survivingantidepressants.org/topic/15483-magnesium-natures-calcium-channel-blocker/

 

Try a little bit of one at a time to see how it affects you.

[Snorky]

35 minutes ago, Altostrata said:

It probably will take a lot longer than 3 months to recover from withdrawal syndrome plus the adverse drug reactions. This is the dark side of psychiatric drug treatment, the part your doctor won't tell you about it (because he or she is not aware of it).

 

If you've gotten worse over the 3 months, you might consider a tiny reinstatement. If you've seen some improvement, you might want to wait it out. This will take patience and a lot of self-soothing, because ever-changing symptoms tend to come in waves, which can be discouraging. But as recovery progresses, the waves tend to be less intense and come less often.

 

How has your sleep pattern changed over 3 months?

 

A lot of people find fish oil and magnesium supplements helpful, see
https://survivingantidepressants.org/index.php?/topic/36-king-of-supplements-omega-3-fatty-acids-fish-oil/
https://survivingantidepressants.org/topic/15483-magnesium-natures-calcium-channel-blocker/

 

Try a little bit of one at a time to see how it affects you.

Thanks again

 

 Think it’s inevitable that I’m going to have to “reinstate “, either  at low or more therapeutic level. (Aka Russian Roulette)

 

Sleep pattern- been deteriorating since first CT in Sept. Dic prescribed sedative (Promethazine) last week, along with Vit D. Sleep slightly better now, but a sort of sideshow compared to the depression, anger, agitation and anguish.

 

Happy to try those supplements. 

 

First priority is to get through holiday, then see Doc on Monday.

 

Will keep you posted.

 

Thank you.

[Altostrata]

We do not recommend "therapeutic" dosages. We want to reduce withdrawal symptoms, not clobber depression. Your nervous system might be sensitized by your drug misadventures and react badly to anything approaching a normal "therapeutic" dose. It's not likely your doctor will have any awareness of this or anything else related to withdrawal syndrome.

 

Perhaps your best bet would be to request 75mg Effexor XR in name-brand capsules, which contain tiny beads. You can titrate by opening the capsule and trying a few beads, which would be about 3mg. Or, if you can get regular Effexor, you can make a liquid from it to take a small amount.