Estman: reducing Anafranil, withdrawal symptoms

[Estman]

Hi,

I have been using various antidepressants for 8-9 years
Of this 6 years cymbalta and then tried Amitriptyline 8 months, then Valdoxan 2 months, then Brintellix 4 months and now Anafranil 9 months.

In addition, tried last year Olanzapine and Levomepromazine (2019a, this year will not take,insomnia)

I have reduced from 75mg to 37.5mg since December

I want to wean Anafranil, it's hard

Does anyone have contact with this medicine and can help?

 

[Estman]

Hello,

I started reducing Anafranil in December, then the dose was 75mg
I am currently taking 37.5mg of Anafranil.
I have reduced 2.5mg at a time every 3 weeks
However, withdrawal symptoms are severe and usually last for 2.5 weeks.
Usually there is restlessness-anxiety, fatigue, insomnia, bad dreams, feeling unwell and nausea and general confusion and great depression.
Does anyone have experience reducing this medicine?
I don't know if I'm moving too fast?

 

 

 

 

 

Edited April 8, 2020 by manymoretodays
merged to main Introduction

[Gridley]

Welcome to SA, Estman.

 

I see from your other post that you are reducing by 2.5mg every three weeks and are suffering from withdrawal symptoms.  Please post only here in this thread; only one Introduction topic per member.

 

You are tapering too fast, which is causing the withdrawal symptoms you're experiencing.   You should hold where you are at 37.5mg for at least two months to let your system catch up.

 

What is withdrawal syndrome.

 

Glenmullen’s withdrawal symptom list.

 

We recommend tapering by no more than 10% of your current dose every four weeks.  It is better to taper by a percentage rather than by a straight dosage drop.  If you taper by a percentage, your reductions will be progressively smaller, which is what you want as you get lower in dose.  If you drop by dosage, as you've been doing, your reductions gets progressively larger, which is not a good idea.

 

Why taper by 10% of my dosage?

 

The following link is specifically about tapering Anafranil, including how to get the nonstandard smaller doses you'll need for tour 10% taper.

 

Tips for tapering off clomipramine (Anafranil)

 

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium and omega 3 (fish oil). Many people find these to be calming to the nervous system. 

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

Add in one at a time and at a low dose in case you do experience problems.

 

This is your Introduction topic, where you can ask your questions and connect with other members.  We're glad you found your way here.

 

Edited April 7, 2020 by Gridley

[manymoretodays]

Hi Estman, and welcome,  @Estman

I have got your posts all merged up now.

Welcome again, and this is your introduction page now, where you have introduced yourself to the community.  And a good place for you to post questions, and concerns, around your WD(withdrawal) and tapering.

Did you see Gridley's post above?

 

We do have many members who have experience with the type of medicine that you are tapering now, and lot's of information and support for you too.

 

L, P, H, and G,

mmt

Edited April 8, 2020 by manymoretodays

[Estman]

Hi,

Thank you very much for your answers!
I understand that I have moved too fast
I was hoping to wean this year, but it seems that it will not work
I never want to take these drugs again.
If my dose was 50mg then I reduced it to 2.5mg at a time
I noticed that in the first week there were rather physical withdrawal symptoms: on the third or fourth day I felt unwell, nausea, unexplained restlessness.
In the second week more psychic withdrawal symptoms: anxiety, unfounded fear, difficulty falling asleep, bad and distressing dreams, blood pressure - faster pulse and general confusion
Then, usually in the third week, the lymph nodes decreased
The last symptoms were compulsions and great depression

I last reduced it 26 days ago
This time, apathy and depression still exist
Also can't get to sleep lately before 3pm
I understand that I should stay at this dose for 2 months, will the symptoms of depression disappear by that time?
Can I reduce every 4 weeks in the future?
How should it feel to further reduce?

Is Anafranil the hardest to wean?

[Gridley]

1 hour ago, Estman said:

will the symptoms of depression disappear by that time?
Can I reduce every 4 weeks in the future?
How should it feel to further reduce?

Is Anafranil the hardest to wean?

It isn't possible to predict how soon symptoms will diminish or disappear.  Two months is a reasonable starting point.  You may need to hold longer.  Let's wait and see how you feel in two months.

 

Once you've stabilized, you could resume tapering by 10% of current dose every four weeks.

 

If you're tapering slowly enough (some people have to taper more slowly than 10% every four weeks), you will likely feel some symptoms for a portion of the our week hold period, but these should resolve by the time you're ready for another reduction.

 

Anafranil is not regarded as among the hardest of the antidepressants to taper..

[Estman]

302/5000

 

 

 

When I quit amitriptyline in January 2019, I developed severe insomnia
I couldn't sleep.
Is insomnia similar to Amitriptyline with Anafranil withdrawal?Do they have a difference?
How to overcome the fear of insomnia?
I've been asleep at 3 o'clock for the last few days and my sleep is intermittent and bad.
How does sleep recover?
 

[Gridley]

8 minutes ago, Estman said:

severe insomnia

 

Insomnia is one of the most common withdrawal symptoms, regardless of the type of antidepressant taken.

 

Sleep gradually improves over time. 

 

Regarding fear of insomnia, the following post by Apace, one of our moderators, has many helpful suggestions:

 

there is, unfortunately, no "silver bullet" to withdrawal or any of its symptoms, including insomnia.  If there were, SA would be a much smaller site than it is at this point.  Sadly, it continues to grow as more and more people get caught in the psychiatric medication "web."

 

As Gridley said and you by now clearly understand, insomnia and disordered sleeping is a hallmark of psychiatric medication withdrawal.  It starts earlier than that with many studies making it clear that SSRIs (and other psych meds) frequently suppress REM sleep for those who take the meds.  https://www.sleepio.com/articles/sleep-aids/antidepressants-and-sleep/  Given this as a backdrop, it should be no surprise that coming off the meds can wreak havoc on sleep.  The good news, however, is that the brain works hard to achieve homeostasis and, all other things being equal, the brain will return to a place where sleep becomes, as it should be, a matter of routine.  How long that takes for any one person is impossible to predict. 

 

So, what do you do?  In no particular order, some of the things to try:

 

• Don't place too much significance on sleep.  Rest should be the key and when your body absolutely needs to sleep it will.  The anxiety that comes with lying awake and saying "I must sleep" is far worse than the not sleeping.  It's hard but it can be done.
• Try a journaling practice before bed -- get out the things that are on your mind and add 3 things you are grateful for from the day
• Get a sleep ritual in place so that you do the same thing day after day and start to repair your circadian rhythms
• Take a warm bath with epsom salts few hours before bedtime and add in a cup of chamomile tea
• Use lavender essential oils in a diffuser at bedtime
• Exercise early in the day so that you aren't activated near bedtime
• Get outside and get some sunlight early in the day so that your rhythms are reestablished
• Make sure you have a consistent bedtime 
• Try not to be too activated in the couple of hours before bed and, of course, no caffeine
• Add a meditation practice
• Try yoga
• Go for walks in nature

Most insomnia is the result of the body being "hyperstimulated."  It is very hard to calm down an overstimulated body, especially when it is the result of chemical cascades that come as a result of medication use and withdrawal.  But, it can be done to a certain degree and the skills learned will provide valuable as your body improves over time.  

 

From my own perspective, my sleep is still not great, but it it better than it was.  I went through many stretches of 2 or 3 days with zero or an hour or two a night of sleep.  At this point, I have the occasional sleepless night, but most nights I'm good for at least 5 and usually closer to 6 hours.  By "normal" people standards that's not great, but it feels pretty good when compared to 0 or 2-3 hours a night.  As the saying goes, "in the land of the blind the one-eyed man is king!"

 

Try not to let it become the dominant factor in your life.  Over time, it will get better and you will heal.  Just do your best to continue to live your life what your brain is repairing itself.

 

                                                               --------------------------

The following links are also helpful:

 

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

 

Relaxation exercises, guided meditations, calming videos, sleep hypnosis

 

Trick and tips to fall asleep faster

http://articles.mercola.com/sites/articles/archive/2017/02/16/tips-tricks-fall-asleep-faster.aspx?utm_source=dnl&utm_medium=email&utm_content=art1&utm_campaign=20170216Z1&et_cid=DM133787&et_rid=1889748952

 

This link contains helpful information, including insomnia and also non-drug coping skills.  

 

 Important topics about symptoms, including sleep problems

 

Some members have found Melatonin helpful with insomnia.  

 

 Melatonin for sleep   

 

It's best to start at a very low dosage, such as .25mg, and gradually increase if needed to the lowest effective dose.  

 

[delsol]

Hey I just wanted to chime in and say anafranil was my initiation into the world of psych drugs... All the way back in the 1990s ... I remember it making me very labile, hungry, and sedated. If I recall, I switched to Prozac because the anafranil had kind of pooped out after a while... Pzac was even worse for me... As for anafranil though, as it is a tricyclic, it can have some different flavors to its withdrawal than SSRIs, such as Prozac/Zoloft, due to tricyclics acting on 3 neurotransmitters. Your other drug, amitriptyline, is also a tricyclic though.  I've come off both (a tricyclic and an SSRI). Both have had a different "feel" to them. The tricyclic, in my opinion, caused more akathisia, both on and off. The SSRI caused more sexual issues, both on it and during withdrawal.  All antidepressants can cause insomnia during withdrawal.

 

Anyway, I just wanted to let you know that yes, there are some other former anafranil users on here. And certainly users of other tricyclics as well. Good luck.

[Estman]

Hi,

Some nights you can sleep, another not
Sleep is somehow intermittent, I usually sleep for 2 hours and then wake up in the meantime
So many times during the night
Yes, it is better not to worry too much and things will improve again
For some reason I got tired very quickly
When I do some work or activity physically, sometimes I feel exhausted for several days
It's like physical and mental fatigue-exhaustion.
Fatigue is usually one of the first symptoms after each reduction
Hi, delsol!

How quickly and to what extent did you give up Anafranil?
Or did you switch to another medicine?

[Altostrata]

Welcome, Estman.

 

On 4/8/2020 at 7:02 AM, Estman said:

Also can't get to sleep lately before 3pm

 

Do you mean 3 a.m.? What is your sleep schedule?

 

It's very common when someone has withdrawal symptoms that they are unable to sleep. This can be intermittent in pattern.

 

Please see

 

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

 

Path to Better Sleep FREE online for everyone from the US Veterans Administration

 

Music for self-care: Calms hyperalertness, anxiety, aids relaxation and sleep

 

What is the sleep cycle?

 

Melatonin for sleep: Many people find it helpful

 

TV or computer use in evening can disrupt sleep: Bright light signals the brain that it's daytime

[Estman]

Hi,

 

It is usually the case that if you do not fall asleep before 23-24, you will only fall asleep at 3-4 at night
Otherwise the sleep routine is still the same
It seems to be that media consumption in the evening before going to bed is disturbing
Disruptive broadcasts or news should be avoided

[delsol]

On 4/10/2020 at 10:56 AM, Estman said:

Hi, delsol!

How quickly and to what extent did you give up Anafranil?
Or did you switch to another medicine?

 

I think I was on Anafranil for a little over a year, before switching to Prozac. Anafranil made me feel bad, but Prozac was even worse, and then more / different drugs were added and subtracted over the years (**many** years). The reason I started psych drugs in the first place was for OCD, not for panic or depression, etc. However, the drugs induced mood changes which then led me to be diagnosed with other problems. I got more depressed after taking the Anafranil and didn't know that could happen. Anafranil is not known as a potent antidepressant and is mainly prescribed for OCD, which is probably why doc later switched me to Prozac. 

 

A misnomer among psychiatrists, in my opinion, is that the "older" (MAOI or tricyclic) drugs are somehow "worse" or "not as good as" newer drugs. They are all bad, in my opinion. 

[Estman]

Hi,

Is fatigue-weakness related to Anafranil?
I'm tired quickly and it's relatively persistent
Is fatigue a side effect or a withdrawal symptom?

 

 

[delsol]

It's so frustrating to sort out side effect-vs.-withdrawal issues. In my experience with anafranil, it made me tired, but so does withdrawal. It could be either or both. 

[Estman]

How long did you manage to wean Anafranil?

[delsol]

Unfortunately it's been so long I don't remember. Wish I could help more...

[Estman]

Hi,

Be aware that the withdrawal symptoms of Anafranil begin with bad dreams, live and emotional
Also on 3-4 days of feeling unwell as if a little sick, have a moderate headache
These symptoms are when I reduce by 6% every four weeks

 

[Estman]

Hi,

 

After dose reduction to 2.5 mg, withdrawal symptoms began on day 4
At first I developed fatigue, a weakness that turned into a great anxiety.
Anxiety interfered with falling asleep and it only managed at 4 o'clock at night
On day 5 there was a great deal of restlessness and nausea
The restlessness was reminiscent of akathisia, and it was very disturbing.
Did it show too fast a withdrawal or too high a dose?

[Altostrata]

Hello, Estman. Did you reduce from 37.5mg Anafranil on April 7? You're now taking 35mg?

 

[Estman]

Hello,

 

I reduced the dose on April 13 by 2.5 mg,now the dose is 35mg

Please forgive me Gridley  and Altostrata.I believe you want the best for me
I'm very worried that detoxification is so hard

It is still difficult for me to understand that small doses such as milligrams have such a great effect

I was hoping that 4 weeks is enough time and 2.5mg is a small dose to reduce (then I kept the dose at 37.5mg for 30 days)

I reduced again when I felt relatively normal

But now in 4 days the problems of panic anxiety, feeling unwell and distressing dreams started again

2.5 mg of my dose was 6.7% (37.5 of the dose)

Are severe withdrawal symptoms due to excessive reduction?

What can be done to reduce it more tolerably?

 

[Estman]

Do the symptoms depend on the size of the reduction?
I mean, if 2.5mg or 6.7% caused severe symptoms
Then would 1.5mg or 3% be better?

[Altostrata]

1 hour ago, Estman said:

Do the symptoms depend on the size of the reduction?
I mean, if 2.5mg or 6.7% caused severe symptoms
Then would 1.5mg or 3% be better?

 

That is the theory. We also recommend intervals of 4 weeks, not 3 weeks.

 

If you developed withdrawal symptoms while you reduced from 75mg to 37.5mg, you are compounding them by continuing to reduce. You might hold at 37.5mg for several months.

 

Yes, small changes in dosage can have big effects. See Why taper? SERT transporter occupancy studies show importance of gradual change in plasma concentration

 

 

[Estman]

Hi Alto,

Please explain if the plasma concentration does not change in 3-4 weeks?
I understand that 4 months and moving from 75mg to 35 is too fast?
In the meantime, it seemed like it was normal to be
If I am now on a dose of 35mg longer then will the reduction be easier later?
  Do you often have symptoms such as panic, anxiety, nightmares, difficulty falling asleep?
How do you understand a study that says that 10mg of Clomipramine covers 80% of the receptors?
I need something that gives me hope that I can get rid of the drug

[Altostrata]

It appears you're having difficulty going off Anafranil because you have been tapering too fast, your nervous system needs more time to adjust to each decrease.

 

After a reduction, plasma concentration will gradually decrease as the drug is metabolized until it reaches a "washout" stage at a lower steady-state. Clomipramine has an active metabolite; with its metabolite, washout of the reduction is 6 x 77-hour half-life or about 20 days later.

 

You may not know the full effect of the decrease for nearly a month. This is why we recommend making a reduction at monthly intervals, so you can see what happens. If you get withdrawal symptoms, you probably will not want to reduce again until they go away.

 

 

[Estman]

Hi,Yes, my symptoms seem to have accumulated
The last few nights have been particularly anxious and I can't fall asleep
I'll go to bed maybe 3 o'clock at night
The fight or escape reaction is like being turned on
I measured my blood pressure at night and it was a 145/105 pulse 70
Can an increase in blood pressure also be a symptom of withdrawal?

[Estman]

I also noticed that it was very hot at night
There were hot flashes, I don't know either because of blood pressure or just withdrawal symptoms
Room temperature normal 18 degrees

[Altostrata]

It may take some weeks or months for your nervous system to settle down from reducing too fast. You've been at 37.5mg only 2 weeks.

 

If your symptoms get significantly worse over the next week, you may wish to updose slightly, to 40mg, see if that helps, and hold there for a while.

[Estman]

Hi,The last few days have been very anxious
Especially in the second half of the day and in the evening and at night
then there is a great feeling of pressure in the head
Last night was a great deal of anxiety and headache
I have tried to maintain the current dose so as not to increase it again
I have diazepam at home but I haven't used it
Can it be taken in such an extreme situation or not?

[Estman]

I take the drug three times a day
The last time I reduced (9 days ago) I reduced the dose at lunch
I have noticed that a few hours after taking the medicine I feel weak and especially unwell
Why such a reaction?
It should feel better
Has anyone noticed such a reaction?

[Altostrata]

What times of day (o'clock) do you take your drugs, with their dosages? Please keep daily notes of times of day you take your drugs, their dosages, and your symptoms throughout the day. Post 24 hours of notes at a time in this topic, in a simple list format with time of day on the left and notation (symptom or drug and dosage) on the right.

 

Please review adverse effects of Anafranil (and any other drugs you may take) at drugs.com

 

Quote

Levomepromazine 5mg  03.08.19-20.12.19

 

How did you go off levomepromazine? Do your increased symptoms date from late December?

[Estman]

I took Levomepromazine in the evening to be able to fall asleep
My insomnia was due to anxiety and fear of not being able to fall asleep
Although Levomepromazine helped me sleep and sleep better, it bothered me the next day
It caused apathy, fatigue and depression
In addition, he seemed confused and did not orient himself well
I reduced the drug for several weeks by taking half a tablet (2.5mg) and later 1/4 tablet
Unfortunately, it is not possible to distinguish its withdrawal symptoms accurately

At the same time, I started to reduce the daily dose of Anafranil (75mg)
I remember being terribly depressed and feeling sick at Christmas
Anxiety, of course, increased because Levomepromazine has a strong sedative effect

[Altostrata]

I need to see your daily symptom pattern: Please keep daily notes of times of day you take your drugs, their dosages, and your symptoms throughout the day. Post 24 hours of notes at a time in this topic, in a simple list format with time of day on the left and notation (symptom or drug and dosage) on the right.

[Estman]

Hi,

I'll send some notes

 

April 22 (10 days after drug reduction)
I slept well at night
At 8 o'clock I took 10mg of Anafranil
At 8-10 difficult to recover, severe drowsiness and confusion
After 10 o'clock more bad mood, moderate nausea and weakness
At 12 I took 5mg of Anafranil
14.00 was more anxiety
 15.00 I took 10mg of Anafranil
There was fatigue, I slept until 15-16.30
At 17.00 there was less anxiety but I felt unwell and apathy
At 21.00 I took 10 mg of Anafranil
18.30-23.00 Strong depression and very bad mood
There is also apathy and compulsive worry
23.00-3.00 was dominated by restlessness and could not sleep

 

April 23 (11 days after drug reduction)
I was able to sleep intermittently between 3.00 and 8.00
At 8:00 I took 10 mg of Anafranil
8.00-12.00 was restless
At 12.00 I took 5mg of Anafranil
13.00 less restlessness, mood swings, was better then worse
At 15.00 I took 10 mg of Anafranil
15.00-17.30 fatigue and weakness increase
17.30 severe diarrhea
17.30-22.00 great weakness and bad mood, anxiety
At 21.00 I took 10 mg of Anafranil
At 21.00 I fell asleep, the phone rang and I fell asleep
22.00-2.00 restlessness, sleep does not come

 

April 24 (12 days of drug reduction)
7.00 sleep went away, restlessness and weakness, bad mood
Great weakness and bad mood have continued throughout the day
Taking the drug at the same times
This weakness is very severe and occasionally causes nausea

Edited April 24, 2020 by Altostrata
added line breaks

[Altostrata]

Why are you taking Anafranil 4 times a day?

[Estman]

I have been taking the drug several times a day for a few months
I don't know if it's the best
I thought that if I take small doses and often then the side effects are smaller
Drug concentration or more uniform?