Lumpy: Benzo taper finished. Help with Amitriptyline and Cipralex

[ChessieCat]

Q:  Have you taken any antibiotics?  If yes, what?  And when?

[Shep]

@LumpyDid you need to take any medication for Covid? If so, please list the name and doses and the start and stop date, if you're no longer taking it.

 

EDIT: Sorry, @ChessieCatjust saw your post on the next webpage. You already asked the "other meds" question.

Edited April 20, 2022 by Shep
added edit

[Lumpy]

Just now, Shep said:

@LumpyDid you need to take any medication for Covid? If so, please list the name and doses and the start and stop date, if you're no longer taking it.

Hi thank you for getting back to me. I didn’t take any medication when I got Covid. After about 2 months I tried taking a vitamin d supplement and had a bad reaction after one dose. It gave me severe panic and anxiety and akathisia/restless legs. I didn’t take any more and the extreme symptoms subsided. Two weeks ago I started fexofenadine antihistamine - lots of long covid people have found antihistamines helpful. It was prescribed by my doctor - 180mg daily. I have had a few better spells of a few hours while taking it but the last two days my anxiety and panic has rocketed again. It was only a two week trial and I have decided not to take it again after today. I had the issue with the amitriptyline before taking these medications. I know lots of people end up with mast cell activation in long covid which I do believe I have as I have a lot of allergy issues in the past. Mast cell activation can make taking any medication really hard. My system is so sensitive and always has been. It was a reaction to antidepressants that got me where I am today. However prior to Covid I was doing ok and amitriptyline has always helped me sleep. But now it’s the opposite.  Many thanks 

[Shep]

23 minutes ago, Lumpy said:

Two weeks ago I started fexofenadine antihistamine - lots of long covid people have found antihistamines helpful. It was prescribed by my doctor - 180mg daily. I have had a few better spells of a few hours while taking it but the last two days my anxiety and panic has rocketed again. It was only a two week trial and I have decided not to take it again after today. I had the issue with the amitriptyline before taking these medications

 

I placed your drugs in the drug interaction checker just to make sure there's no drug interaction  and below is the report. Please note you may need to register in order to view the report (it's free to do so).

 

Drug Interaction Report for fexofenadine, amitriptyline, and escitalopram (Cipralex)

 

We've already talked through the amitriptyline and Cipralex (escitalopram) interaction. Even though fexofenadine doesn't have a drug interaction with these other drugs, you may be getting a paradoxical reaction.

 

What time(s) of the day are you taking your drugs?

 

Please let us know how you feel tomorrow after not taking the fexofenadine.

 

 

[Lumpy]

On 4/20/2022 at 2:10 PM, Shep said:

 

I placed your drugs in the drug interaction checker just to make sure there's no drug interaction  and below is the report. Please note you may need to register in order to view the report (it's free to do so).

 

Drug Interaction Report for fexofenadine, amitriptyline, and escitalopram (Cipralex)

 

We've already talked through the amitriptyline and Cipralex (escitalopram) interaction. Even though fexofenadine doesn't have a drug interaction with these other drugs, you may be getting a paradoxical reaction.

 

What time(s) of the day are you taking your drugs?

 

Please let us know how you feel tomorrow after not taking the fexofenadine.

 

 

Hi, 

I take the fexofenadine in the morning.

I take the amitriptyline in the evening at around 8pm. 
I noticed again last night a reaction after taking the amitriptyline. 
I think Covid has made my body much more sensitive to medication or the excipients of the medication. 
I am hoping gradually over time  it will tone down the response.  
I slept well last night - so that is good. 
The dr wants me to continue on the antihistamine as she thinks it will help the long covid. I think she is probably right. 
I do think I would feel a lot better on a lower dose of amitriptyline as I have done coming down in the Cipralex. I felt better and better the lower I got. 
I just don’t want to upset my body any more than it has been from Covid. 
I would love your thoughts. I know covid is something that is new and unknown. 
I’m wondering whether to give myself another couple of weeks and see where I am. 
My anxiety is a little more manageable today, especially in the afternoon. Mornings are always hard and nights when my histamine levels rise. 
what do you think? 
Thank you in advance. I value your option as drs just don’t realise how sensitive we can be to small changes. 
 

[Shep]

19 hours ago, Lumpy said:

I take the fexofenadine in the morning.

I take the amitriptyline in the evening at around 8pm. 

 

What time do you take the Cipralex? 

 

19 hours ago, Lumpy said:

I slept well last night - so that is good. 

 

Yes, this is very good. 

 

19 hours ago, Lumpy said:

The dr wants me to continue on the antihistamine as she thinks it will help the long covid. I think she is probably right. 

 

I don't know much about long Covid, but if you're feeling better on this drug, than it may be something you'll want to continue on with. What symptoms is the antihistamine prescribed for? Did you have those symptoms as psychiatric drug withdrawal symptoms or did they just start when you got Covid? 

[Lumpy]

8 hours ago, Shep said:

 

What time do you take the Cipralex? 

 

 

Yes, this is very good. 

 

 

I don't know much about long Covid, but if you're feeling better on this drug, than it may be something you'll want to continue on with. What symptoms is the antihistamine prescribed for? Did you have those symptoms as psychiatric drug withdrawal symptoms or did they just start when you got Covid? 

My Dr is looking at whether long covid can cause mast cell activation syndrome. A lot of the symptoms can be common in long covid. Here is a link re: mast cell activation.https://www.psychologytoday.com/gb/blog/holistic-psychiatry/201907/mast-cell-activation-syndrome-alert-psychiatrists 

I have a history of histamine issues. Allergies and anaphylactic reactions to a past vaccine. So it is a route my dr would like to explore. A few long covid experts are talking about this. The problem I’m having is I’m so sensitive to any medication, supplements - I tried magnesium flakes in the bath last week and was covered in a rash. I find it hard to take any of the medication and I am now sensitive to the Amitriptyline which I was fine with before covid. If you are interested in reading further on MCAS there is a website called mastcell360 which has lots of info. 
I have decided to stick with the antihistamine for 2 more weeks plus a low histamine diet and see where I’m at. I’m not sure there is much I can really do about the amitriptyline and just hope I start to tolerate it again soon so it doesn’t have the reverse action. Thank you for your time. X

[Shep]

On 4/22/2022 at 3:10 PM, Lumpy said:

I find it hard to take any of the medication and I am now sensitive to the Amitriptyline which I was fine with before covid.

 

Did the sensitivity to amitriptyline start before or after you started taking fexofenadine? 

 

Please add the fexofenadine to your signature, along with the start date and the dose. A direct link is here:

 

Account Settings - Create or Update Your Signature

 

Do you feel that the covid symptoms are resolving? 

[Lumpy]

Hi Shep, 

I will add the fexofenadine to my signature. 
The reaction to amitriptyline started before I took fexofenadine. 
i had a bad panic attack last night and after reading some reviews on line about fexofenadine I have decided to stop it. I was on it for 2 weeks. Covid has definitely attacked my nervous system - I still feel like in acute symptoms. 
when I take the amitriptyline I notice after about an hour my anxiety and agitation definitely ramp up. I never had this before covid. Amitriptyline has always been good, the whole way through my benzo withdrawal. 
 

I have no idea what has caused this paradoxical reaction as I changed nothing when I caught Covid . I feel so stuck - should I reduce my amitriptyline a little or could I try taking my 2 x 25mg pills at different times before bed. It’s like my system no longer accepts this dose. 
I know covid is an unknown but right now I am so non functional. 
thank you

[Lumpy]

35 minutes ago, Lumpy said:

Hi Shep, 

I will add the fexofenadine to my signature. 
The reaction to amitriptyline started before I took fexofenadine. 
i had a bad panic attack last night and after reading some reviews on line about fexofenadine I have decided to stop it. I was on it for 2 weeks. Covid has definitely attacked my nervous system - I still feel like in acute symptoms. 
when I take the amitriptyline I notice after about an hour my anxiety and agitation definitely ramp up. I never had this before covid. Amitriptyline has always been good, the whole way through my benzo withdrawal. 
 

I have no idea what has caused this paradoxical reaction as I changed nothing when I caught Covid . I feel so stuck - should I reduce my amitriptyline a little or could I try taking my 2 x 25mg pills at different times before bed. It’s like my system no longer accepts this dose. 
I know covid is an unknown but right now I am so non functional. 
thank you

@Shep sorry me again. Just had a thought - do you think covid has completely revved up my nervous system so that anything that is sedating like my amitriptyline- my body just fights back. If this is the case waiting would be my best best until my nervous system calms itself naturally from Covid. Just trying to think it through 

[Shep]

23 minutes ago, Lumpy said:

Just had a thought - do you think covid has completely revved up my nervous system so that anything that is sedating like my amitriptyline- my body just fights back. If this is the case waiting would be my best best until my nervous system calms itself naturally from Covid. Just trying to think it through 

 

I don't know enough about Covid (and I'm not sure anyone does at this point) to make a prediction about what is best. I think you're doing an amazing job of thinking this through and analyzing your situation. 

 

1 hour ago, Lumpy said:

I feel so stuck - should I reduce my amitriptyline a little or could I try taking my 2 x 25mg pills at different times before bed.

 

You've brought up three ideas - wait it through, decrease the dose, or split your dose. 

 

What do you think about splitting your dose in half and moving it one hour a day? This will lower the peak plasma amount in your bloodstream and may help with the paradoxical reaction, as you've noted. It's less extreme a change than making a reduction and the gradual move will allow your nervous system to slowly adjust. Over the course of several days, you could move the split dose until you're taking one half in the early evening and one half before bedtime. 

 

Please post your thoughts. 

[Lumpy]

On 4/24/2022 at 2:44 PM, Shep said:

 

I don't know enough about Covid (and I'm not sure anyone does at this point) to make a prediction about what is best. I think you're doing an amazing job of thinking this through and analyzing your situation. 

 

 

You've brought up three ideas - wait it through, decrease the dose, or split your dose. 

 

What do you think about splitting your dose in half and moving it one hour a day? This will lower the peak plasma amount in your bloodstream and may help with the paradoxical reaction, as you've noted. It's less extreme a change than making a reduction and the gradual move will allow your nervous system to slowly adjust. Over the course of several days, you could move the split dose until you're taking one half in the early evening and one half before bedtime. 

 

Please post your thoughts. 

Hi Shep,

 

Thank you for your reply - so for the first 2 nights I moved my first dose to 8pm and the 3rd night to 7pm. It has definitely helped lower the paradoxical reaction. I am still not sleeping well and was up all night last night with burning arms but these are Covid symptoms. Never had this before Covid. I am finding my body is now so sensitive to everything - supplements, food, even smells and sunlight. Covid really is a beast for me - it has sent my nervous system crazy - it's all down to histamine and mast cells. I can't believe there isn't more being done to help long covid, but saying that I can't even take the medication I know would help. It's very similar to Benzo and AD withdrawal and can last a similar time. I think I am a bad case as I have allergy problems already. Anyway - thank you again and I'm going to continue with splitting my dose. Do you think I could move my first dose even earlier to 6pm / 5pm- anything I can do to not overload my system with medication at any one time. Thank you again for your help. I never thought this year I would be holding my taper on Cipralex, I imagined being at a low dose by the end of the year, eh oh - I just so desperately want to get back to work - never had a day off in my benzo withdrawal or Cipralex taper last year. Now I struggle to cook, clean and move from the sofa or couch. Sorry I'm venting.  

[Lumpy]

13 hours ago, Lumpy said:

Hi Shep,

 

Thank you for your reply - so for the first 2 nights I moved my first dose to 8pm and the 3rd night to 7pm. It has definitely helped lower the paradoxical reaction. I am still not sleeping well and was up all night last night with burning arms but these are Covid symptoms. Never had this before Covid. I am finding my body is now so sensitive to everything - supplements, food, even smells and sunlight. Covid really is a beast for me - it has sent my nervous system crazy - it's all down to histamine and mast cells. I can't believe there isn't more being done to help long covid, but saying that I can't even take the medication I know would help. It's very similar to Benzo and AD withdrawal and can last a similar time. I think I am a bad case as I have allergy problems already. Anyway - thank you again and I'm going to continue with splitting my dose. Do you think I could move my first dose even earlier to 6pm / 5pm- anything I can do to not overload my system with medication at any one time. Thank you again for your help. I never thought this year I would be holding my taper on Cipralex, I imagined being at a low dose by the end of the year, eh oh - I just so desperately want to get back to work - never had a day off in my benzo withdrawal or Cipralex taper last year. Now I struggle to cook, clean and move from the sofa or couch. Sorry I'm venting.  

Hi Shep, one more question. I would like to take vitamin c - I know lots of supplements can be stimulating. What are your thoughts on vitamin c? Thank you 

[ChessieCat]

There are many existing topics on SA.  You can use the site search function of use an internet search engine and add site:survivingantidepressants.org to the search term.

 

There is a topic for Vitamin C.

 

When trying anything new it is better to start with a low dose to see how react.  And only make one change at a time:

 

Keep it Simple, Slow and Stable

[Shep]

16 hours ago, Lumpy said:

Anyway - thank you again and I'm going to continue with splitting my dose. Do you think I could move my first dose even earlier to 6pm / 5pm- anything I can do to not overload my system with medication at any one time.

 

You could try that as your next step.

 

If your body is hyper-reacting to this drug (and it sounds like that's what's going on), you may want to make a small 2 - 3% reduction to test how you tolerate it if moving the drug isn't helping enough. 

 

2 hours ago, Lumpy said:

Hi Shep, one more question. I would like to take vitamin c - I know lots of supplements can be stimulating. What are your thoughts on vitamin c? Thank you 

 

I see ChessieCat linked to the "Keep it Simple" thread, which gives an excellent explanation of the "one change at a time" concept. Please note that moving your drug is considered a change, so you'll want to wait until you'e completely done with any of the drug changes before adding in a supplement. 

 

If you're able to eat foods high in vitamin C, you may want to try that first. 

[Lumpy]

On 4/28/2022 at 12:19 PM, Shep said:

 

You could try that as your next step.

 

If your body is hyper-reacting to this drug (and it sounds like that's what's going on), you may want to make a small 2 - 3% reduction to test how you tolerate it if moving the drug isn't helping enough. 

 

 

I see ChessieCat linked to the "Keep it Simple" thread, which gives an excellent explanation of the "one change at a time" concept. Please note that moving your drug is considered a change, so you'll want to wait until you'e completely done with any of the drug changes before adding in a supplement. 

 

If you're able to eat foods high in vitamin C, you may want to try that first. 

Hi, 

some more advice needed. 
So I am still in a very bad place after Covid, no improvement. My nervous system is shattered. High anxiety, agitation, foggy, dp, sweating, heat rushes, insomnia and more. I was stable on 3.6mg Cipralex before Covid. I have only just realised that my husband who was helping due to me being so unwell had been cutting my Cipralex as he thought I was still doing a gradual taper. It’s not much but from January to now he reduced down from 3.6 to 3.2mg over several weeks - it was gradual but definitely not something my nervous system needed. Tiny amount but maybe too much for my very delicate nervous symptom. I have updosed as of yesterday to 3.4. I am going to see if it helps and I see any benefit. I would welcome your thoughts. If I was to see any benefit how long would it normally take. I was not getting any better from what Covid did to my nervous symptom - no windows in the 4 months since I got it. I am hoping this tiny updose may help. I am not changing anything else - I did try antihistamines but they made me worse and gave me severe agitation and akathisia. No more trials of other medication. I think my body just has to do this on its own! Thank you. 

[ChessieCat]

It takes about 4 days for a dose change to get to a steady level in the blood and a bit longer for it to register in the brain so you will need to be patient and give it a chance to get to full effect.

[Lumpy]

4 hours ago, ChessieCat said:

It takes about 4 days for a dose change to get to a steady level in the blood and a bit longer for it to register in the brain so you will need to be patient and give it a chance to get to full effect.

Thank you for the advice. I have another question. A couple of weeks ago my GP thought it would be a good idea to try ketotifin (an antihistamine and mast cell stabiliser). Thinking in-line with Covid causing mast cell activation. I tried it and started at a very small dose 0.25 mg where the daily dose is 2mg. After a couple of days I went up to 0.5mg - after another 2 days I developed awful akathisia type continual rocking. I couldn’t keep still. I took a progesterone pill from my hrt that completely calmed the rocking and actually gave me a good window in the afternoon. I spoke to my dr today and said I wasn’t taking the ketotifin anymore and told her what had happened. She told me that it can’t be ketotifin that caused it and that because I am so nervous about taking medication my own adrenaline caused this reaction and that I should carry on taking it. She said drugs like this do not cause akathisia. I am in such a state now thinking all this agitation, anxiety insomnia brain fog and the rest are all in my head and I just have an anxiety disorder. I was doing so well before covid. Working full time, tapering nicely. Yes not perfect but 80%. Now I’m housebound and struggle to think beyond what’s wrong with me. I would love to hear your thoughts. Could ketotifin have caused heightened anxiety / agitation or is it my own fear. I was really happy to try the drug as right now I just want to be better and I thought it could really help. Thank you 

[Shep]

14 hours ago, Lumpy said:

I was stable on 3.6mg Cipralex before Covid. I have only just realised that my husband who was helping due to me being so unwell had been cutting my Cipralex as he thought I was still doing a gradual taper. It’s not much but from January to now he reduced down from 3.6 to 3.2mg over several weeks - it was gradual but definitely not something my nervous system needed. Tiny amount but maybe too much for my very delicate nervous symptom. I have updosed as of yesterday to 3.4. I am going to see if it helps and I see any benefit. I would welcome your thoughts. If I was to see any benefit how long would it normally take.

 

It will take a few days for your system to register the change and then it could take a week or more for your system to adjust to the change. Hopefully, you'll get some relief, but some of the symptoms may be more Covid than withdrawal. Either way, going into a long hold may be your best bet.

 

Try to do as much self care as you can.

[Shep]

9 hours ago, Lumpy said:

Could ketotifin have caused heightened anxiety / agitation or is it my own fear. I was really happy to try the drug as right now I just want to be better and I thought it could really help.

 

Here are a list of side effects:

 

Ketotifen ophthalmic Side Effects

 

With a hyper-active nervous system, your nervous system could be hyper-reacting to this drug.

[Lumpy]

I just want to share some good news. I slept without heat flashes, heart palpitations, sweating and panic attacks - the first time since I caught Covid 4 months ago. I am taking 25mg amitriptyline at 6pm now then the other 25mg at 10pm. I think this has really helped - as my nervous system was too hyped to have all that sedating amount in one go. I also did the little updose of Cipralex 5 days ago. Also off all  antihistamine meds dr wanted me to try. I felt the window close at 7am but I felt so happy when I woke up. I know this may just be a small window but it truly was amazing. X

[Lumpy]

17 minutes ago, Lumpy said:

I just want to share some good news. I slept without heat flashes, heart palpitations, sweating and panic attacks - the first time since I caught Covid 4 months ago. I am taking 25mg amitriptyline at 6pm now then the other 25mg at 10pm. I think this has really helped - as my nervous system was too hyped to have all that sedating amount in one go. I also did the little updose of Cipralex 5 days ago. Also off all  antihistamine meds dr wanted me to try. I felt the window close at 7am but I felt so happy when I woke up. I know this may just be a small window but it truly was amazing. X

Just to add too - I started using magnesium chloride flakes in my bath yesterday. A tiny amount compared to instructions - about 1/5 of the amount. There was a lot of talk on benzo websites when I came off (2 1/2 years ago) to avoid magnesium as it effects gaba receptors. I obviously don’t want to do that. Is it ok to use these flakes every day or should I use say 2 - 3 times a week? Thank you  

[Lumpy]

On 5/24/2022 at 8:47 AM, Lumpy said:

Just to add too - I started using magnesium chloride flakes in my bath yesterday. A tiny amount compared to instructions - about 1/5 of the amount. There was a lot of talk on benzo websites when I came off (2 1/2 years ago) to avoid magnesium as it effects gaba receptors. I obviously don’t want to do that. Is it ok to use these flakes every day or should I use say 2 - 3 times a week? Thank you  

@Altostrata I hope you don't mind me tagging you directly. I would really like your help with magnesium - I know my symptoms are from Covid and not reducing my antidepressant but the symptoms are identical. Covid has basically broken my nervous system - it was prob very fragile to begin with due to Benzo withdrawal and tapering Cipralex (which was going very well). Anyway the end result is the same - I feel like I have gone cold turkey off a drug. I need to heal my nervous system naturally. I have tried the medications offered by the GP and my system has reacted badly. So I have tried one bath with magnesium flakes - Ancient 750g Mineral Magnesium Bath Flakes - the recommendation was to use the whole bag in one bath, I used 50mg. I didn't notice any negative effect. In fact that evening I slept the best I have in the last 4 months - could just be coincidental. I don't want to jeopardise any thing at this stage so would really welcome your advice on how to proceed with the magnesium and how much and how often? It is difficult to tell any negative effects and I just feels so incredibly awful every day. I do seem to be getting evening windows this week which is so lovely. I go from debilitating anxiety, agitation, panic, depression and extreme exhaustion to feeling 60% normal in the evenings. I just wish I could re-instate / up dose like you would in a fast taper but I can't really up dose Covid. If you were treating this as a complete cold turkey, nervous system collapse what would be your advice for the magnesium. I really appreciate your advice and everything you guys do. Thank you

 

[Altostrata]

In my opinion, the concern about magnesium and post-benzo withdrawal is overblown. Magnesium is calming because it acts on the calcium channel in cell signaling, not GABA receptors. If you find it works, it works.