Estman: reducing Anafranil, withdrawal symptoms

[Altostrata]

It sounds like you're taking too much Anafranil each day. In a few weeks, I would start reducing the morning dose.

[Estman]

58 minutes ago, Altostrata said:

It sounds like you're taking too much Anafranil each day. In a few weeks, I would start reducing the morning dose.

Yes, I would already like to reduce.
But right now, you are definitely right to stay on the same dose for a few weeks
I expect it to stabilize enough in the meantime
I would like to add that I forgot to mention agitation
Never when I gave up Cymbalta was a great anxiety but don't remember that agitation
I first noticed this when I gave up Amitriptyline (January 2019)
I have had the same with Anafranil
If I reduce or make any changes,  are a big agitation
As for the moment, there can be no peace
This is usually within 2 weeks.
It seems to be very characteristic of a tricyclic drug

[Altostrata]

7 hours ago, Estman said:

I would like to add that I forgot to mention agitation

 

Is this what happened when you reduced the dose by 1mg recently?

 

Be sure to take the same dosages at the same times each day.

[Estman]

2 hours ago, Altostrata said:

 

Is this what happened when you reduced the dose by 1mg recently?

 

Be sure to take the same dosages at the same times each day.

 

Yes, agitation also occurred during the 1mm reduction
Started later than usual, with anxiety 7-8 days after reduction.
This is reflected in the fact that I am constantly trying to family
  describe my anxiety and restlessness
Today,I woke up in the morning with a lot of drowsiness.
For some reason it was also in the afternoon and I had to sleep for an hour
Later, after waking up and into the evening, there was apathy, lack of interest and depression (currently the most disturbing symptom).
Probably another wave that has not passed
There is still little will to do

Yes, I take doses at certain times

[Altostrata]

If your family doesn't understand, I'd stop asking them to understand.

 

As we've discussed before, it's best to keep drug changes to a minimum, make only one drug at a time. I had suggested you change the timing of your drugs. You decided to reduce Anafranil at the same time.

 

You'll have to be patient and hold on, not make any more changes (except to combine the 2 evening doses) until you stabilize. Please note you are still taking a dose of Anafranil in the morning. It has always been unnecessary to split the dosing. You may still feel effects from your morning dose. After you stabilize, from these recent changes, the intention is to reduce and perhaps eliminate your morning dose.

 

We don't have to see every up and down in your mood every day. That's normal. Please keep taking your doses on schedule and let us know if there are significant changes in your daily symptom pattern.

[Estman]

On 6/27/2020 at 9:57 PM, Altostrata said:

If your family doesn't understand, I'd stop asking them to understand.

 

As we've discussed before, it's best to keep drug changes to a minimum, make only one drug at a time. I had suggested you change the timing of your drugs. You decided to reduce Anafranil at the same time.

 

You'll have to be patient and hold on, not make any more changes (except to combine the 2 evening doses) until you stabilize. Please note you are still taking a dose of Anafranil in the morning. It has always been unnecessary to split the dosing. You may still feel effects from your morning dose. After you stabilize, from these recent changes, the intention is to reduce and perhaps eliminate your morning dose.

 

We don't have to see every up and down in your mood every day. That's normal. Please keep taking your doses on schedule and let us know if there are significant changes in your daily symptom pattern.

I have noticed that every day around 3 pm I feel tired and bad.
No matter how much I acted
I take 14mg in the morning at 8 and then 20mg in the evening
Other times it has been stable
Is it somehow related to drug metabolism, half-life?
Or is it the body's old habit of getting drug in the afternoon?
In general, Anafranil seems bad to me, there are many side effects after taking the dose and changes.

[Altostrata]

2 hours ago, Estman said:

Is it somehow related to drug metabolism, half-life?

 

Probably. This sounds like it goes away soon. Don't make any more changes, let the new schedule settle down.

[Estman]

On 6/30/2020 at 10:43 PM, Altostrata said:

 

Probably. This sounds like it goes away soon. Don't make any more changes, let the new schedule settle down.

In the meantime, things have been relatively stable.
The mood has been normal and there is less change.
I was hoping to reduce the dose again soon
However, the last four days have been weak and tired again
Especially in the second half of the day
It started on Monday after some work
I didn't overdo it, but I was active
Along with weakness, there is also anxiety and a bad mood
Anxiety only occurs with weakness, otherwise it does not
In addition, it seems as if all places are hurting
On a positive note, there was no need to sleep during the day
There has also been an initiative to act and no apathy.
I wonder if this causes any weakness or fatigue on Anafran itself?
It has also happened in the past that I do something strenuous and then there is a wave or recovery for a week
Dose reduction also often causes fatigue
But I haven't done it, I've been on the same dose for 47 days

[Altostrata]

You are having fewer adverse effects from the lower dose.

 

It's up to you if you want to reduce again. Please be aware our guideline is a reduction that is no more than 10% of your current dose of 35mg, or 3.5mg.

[Estman]

9 hours ago, Altostrata said:

You are having fewer adverse effects from the lower dose.

 

It's up to you if you want to reduce again. Please be aware our guideline is a reduction that is no more than 10% of your current dose of 35mg, or 3.5mg.

Yes, the drug itself probably causes harmful side effects
Thought to reduce 1.5-2mg
Should I wait another week?
If weakness-fatigue would decrease

[ChessieCat]

1 hour ago, Estman said:

Should I wait another week?

 

Alto has already said that it's up to you.

 

We understand that members can be impatient and want to get their dose lower quickly.  Unless you are experiencing an adverse reaction or really bad side effects it's generally better to hold for longer than to risk reducing too quickly.

 

If you are having fewer side effects and you are able to cope with the side effects that you are experiencing it might be better to wait for longer rather than risking withdrawal symptoms.  Withdrawal symptoms are a sign that your nervous system isn't happy.  Once you get withdrawal symptoms it may take some time to stabilise and some members find that they do stabilise a bit but don't get back to how they felt before.

 

Also, please do not rely on making a reduction and then updosing, because it may not work and it might actually make things worse.

 

So, it's up to you.  But knowing the above might help you to make an informed decision.

[Estman]

9 hours ago, ChessieCat said:

 

Alto has already said that it's up to you.

 

We understand that members can be impatient and want to get their dose lower quickly.  Unless you are experiencing an adverse reaction or really bad side effects it's generally better to hold for longer than to risk reducing too quickly.

 

If you are having fewer side effects and you are able to cope with the side effects that you are experiencing it might be better to wait for longer rather than risking withdrawal symptoms.  Withdrawal symptoms are a sign that your nervous system isn't happy.  Once you get withdrawal symptoms it may take some time to stabilise and some members find that they do stabilise a bit but don't get back to how they felt before.

 

Also, please do not rely on making a reduction and then updosing, because it may not work and it might actually make things worse.

 

So, it's up to you.  But knowing the above might help you to make an informed decision.

Yes, of course my decision.
However, the symptoms were caused by physical exertion and not by reducing the drug
The body does not seem to recover with this medicine
I don't want to rush too much, but this medicine is bad for me
It doesn't let me be active, play sports and work
I won't recover until I'm free

[ChessieCat]

10 hours ago, Estman said:

 

However, the symptoms were caused by physical exertion and not by reducing the drug

 

 

If the reduction and the physical exertion were done within a close time frame it is difficult to know what caused the increased symptoms.  It could be either or both, or it may have been coincidence and/or something else which you haven't thought about.

 

10 hours ago, Estman said:

 

I won't recover until I'm free

 

 

Recovery will be happening as you reduce your dose.

 

From the Are We There Yet? topic (link to topic below quote):

 

On 7/6/2020 at 5:35 AM, brassmonkey said:

 

There’s one very important point to bear in mind throughout this entire process:

 

Healing is happening all the time.

 

Even if you don’t feel it, from the very first dose reduction the body is sorting things out, making adjustments, reconnecting neural pathways.  There’s a tremendous amount of work for the body to do so at first it will seem that things are getting worse instead of better.  It’s all part of the healing process which is going on every minute of every day.

 

 

 

This topic has recently been updated and contains some excellent information gleaned from observations made over many years:

 

are-we-there-yet-how-long-is-withdrawal-going-to-take

 

 

Edited July 11, 2020 by ChessieCat
added quote

[Estman]

7 hours ago, ChessieCat said:

 

If the reduction and the physical exertion were done within a close time frame it is difficult to know what caused the increased symptoms.  It could be either or both, or it may have been coincidence and/or something else which you haven't thought about.

 

 

Recovery will be happening as you reduce your dose.

 

From the Are We There Yet? topic (link to topic below quote):

 

 

 

This topic has recently been updated and contains some excellent information gleaned from observations made over many years:

 

are-we-there-yet-how-long-is-withdrawal-going-to-take

 

 

Yes, it is good to know that healing happens with every reduction
It's hard to see when another wave comes
The current wave is 6 days and then began not with reduction but with physical exertion
There is constant depression and poor sleep
Dreams are confused and distressing
This then last 6 days so before that was more stable
It used to be better for several weeks
I will not reduce until stability is achieved again
I hope that this wave will pass as well

[Estman]

On 7/9/2020 at 9:35 PM, Altostrata said:

You are having fewer adverse effects from the lower dose.

 

It's up to you if you want to reduce again. Please be aware our guideline is a reduction that is no more than 10% of your current dose of 35mg, or 3.5mg.

I kept my previous dose for 53 days (34mg)

As it was stable, I wanted to reduce the dose Since the symptoms are severe, should I take Anafranil again?
Make a smaller reduction?
I felt good before the reduction and it was deceptive
I have 2mg doses that I can reduce
Then take either 32mg or 30mg (previously I took 34mg, now 30mg)again

I reduced 2mg on July 16th and another 2mg on July 19th

Withdrawal symptoms began on Sunday when I could not sleep at night (a few hours)

Other physical symptoms started yesterday

The first 4 days were normal, then everything changed

A bad mood added yesterday.

Higher heart rate and blood pressure

There is constant sweating and hot flashes

In addition, anxiety and nausea

Maybe the reduction was too big

I felt good then and a lot of will

It would be like sick and very bad right 

[Altostrata]

I cannot follow the chronology of whatever change you made.

 

15 hours ago, Estman said:

I reduced 2mg on July 16th and another 2mg on July 19th

 

This is far in excess of my recommendation PER MONTH. We've been around and around this barn before.

 

Do not ask me again to dig you out of a mistake you were warned about. I've said all I can say about it. You have the information to figure it out yourself.

[Estman]

I have been on the same dose for the last month
It has been generally stable and I planned to reduce the small dose
Last week I was feeling relatively good and I was actively working
There was stimulus and energy
By Friday I was a little tired but I was doing physically hard work
Again, in the evening a familiar weakness and bad mood arose
There was still a lot of weakness on Saturday and as if the body was not recovering
Could it be that Anafranil prevents or prolongs the recovery of strength?
By Sunday, still such a physically bad, a little nausea and powerless.In addition, there was great unrest-anxiety
Last night, the anxiety became panicky and it was difficult to fall asleep
There is still an unfounded fear this morning
Weakness is already less, but the body physically hurts
As if the withdrawal symptoms were there again, but I haven't changed the dose but kept it stable
I can't do sports or physical work, there is always such a reaction

there was no anxiety and fear for 1.5-2 weeks
Now again
Like a tsunami, constant waves

[Erell]

7 hours ago, Estman said:

Could it be that Anafranil prevents or prolongs the recovery of strength?

 

7 hours ago, Estman said:

 as if the body was not recovering

 

Your CNS went through a lot last 2 years with many drug changes : your CNS is probably doing a hard work to repair and adjust but need rest and good care.

And maybe some activities are just too much for the moment. 

This is actually quite common : a lot of folks report an uptick in symptoms after intense activities or work.

 

I know how frustrating this process can be, but we really need to treat our CNS like a baby while they are working hard to reach stability.

 

Question : accordin to your daily notes, have you noticed if this uptick in symptoms happens within the same timeframe after a drop ?

 

Question : Could this uptick in symptoms be related to things you eat/drink ? (for example : food that contains MSG, alcohol, cafeine, ....)

 

Question :  What are the percentages of your drops ?

 

Take care ☀️

 

 

Edited August 17, 2020 by Erell

[Estman]

1 hour ago, Erell said:

 

 

Your CNS went through a lot last 2 years with many drug changes : your CNS is probably doing a hard work to repair and adjust but need rest and good care.

And maybe some activities are just too much for the moment. 

This is actually quite common : a lot of folks report an uptick in symptoms after intense activities or work.

 

I know how frustrating this process can be, but we really need to treat our CNS like a baby while they are working hard to reach stability.

 

Question : accordin to your daily notes, have you noticed if this uptick in symptoms happens within the same timeframe after a drop ?

 

Question : Could this uptick in symptoms be related to things you eat/drink ? (for example : food that contains MSG, alcohol, cafeine, ....)

 

Question :  What are the percentages of your drops ?

 

Take care ☀️

 

 

I have noticed that most symptoms occur before taking a new dose.
If I take the tablet in the evening at 8 pm then the symptoms occur most the next day around 16-19. Obviously the level in the blood then the lowest

I did the physical work on Friday and I still have depression today
Sometimes it seems to stabilize only a week after physical exertion
The symptoms look the same as on reduction

I try to eat as healthy as possible
However, yesterday I tried a few pieces of chocolate and a few hours later I was particularly anxious
I have also eaten dairy products, but I do not know how cheese works

i don't drink coffee and alcohol

I currently take 3 tablets a day, a total of 30mg of Anafranil

 

193/5000

 

 

 

 

 

[Estman]

I am still plagued by great weakness
Last Friday I raised a bit of a difficult thing and since then the powerlessness is inside
4 days have passed, I have been able to sleep at night but my inner strength has not recovered
It's so strong that I want to cry.
It makes me afraid and anxious, I want to do something, but the constant weakness and hopelessness
There seems to be some mental weakness associated with the drug
However, it also feels physically, the feeling of feeling is generally constant
Sometimes there is nausea and cold sweat on the forehead
Nothing has been physically damaged.
How long does weakness usually last?
Have you experienced recovery?

[Estman]

I take Anafranil twice a day
I used to take 3 times a day
Since there was more lethargy and drowsiness during the day, I took the daily dose for the evening
At the moment I take 10mg when waking up in the morning and 20mg in the evening at 8pm
Unfortunately, the symptoms change during the day
In the afternoon, around 2 pm to 3 pm, there is sudden fatigue and weakness every day
As if the energy was off
My joints are also sore then
Often the heart rate is high which does not cause problems at other times
I don't know why at that time?
It lasts until evening and is very disturbing
I have kept the daily dose stable and taken it at certain times
Afternoon drowsiness is also back.
Is it due to fluctuations in the concentration of the medicine in the blood
Should I reduce my morning dose next?

[ChessieCat]

9 hours ago, Estman said:

In the afternoon, around 2 pm to 3 pm, there is sudden fatigue and weakness every day

 

It might be due to what Australians and New Zealanders call three thirtyitis:

 

"three thirtyitis Lapses in concentration that usually occur in the afternoon - typically 3.30pm. These lapse's in concentration typically occur because you are hungry. It is a very common and popular expression in New Zealand and Australia."

 

What time do you eat lunch?  I'm assuming that you eat breakfast and lunch.

 

You could try eating a small snack at about 1.30 pm and see if that makes a difference.  For example, a few nuts or a banana.

 

Sometimes during our taper we can get periods when we are more hungry and other times we might go through periods when we are less hungry.  I've noticed this myself.

 

Edited September 2, 2020 by ChessieCat

[Estman]

Yes, I usually eat lunch between 12.30 and 13-30
It is somehow related to concentration
I have no other health problems
And such wavy fatigue-weakness in a certain period is strange
It seems to me that Anafranil itself causes fatigue and weakness
I'm tired very quickly
When I do something physical I often find myself very powerless for several days
At the same time, there is unrest
Detoxification itself also seems to cause fatigue
I am often days tired, can't start much and have apathy
Also physically, the wrists of the hands, joints, back give a feeling

Will the fatigue go away and the strength will be restored after stopping the drug completely?
How is the experience with energy recovery?

Sleep is also very disturbed at the moment, I wake up repeatedly at night, sleep is confused and painful.

[ChessieCat]

2 hours ago, Estman said:

When I do something physical I often find myself very powerless for several days

 

Many members experience this.  exercise-do-more-do-less-do-nothing-what-worked-for-you

 

It's important that you do overdo physical exertion.

 

2 hours ago, Estman said:

Sleep is also very disturbed at the moment, I wake up repeatedly at night, sleep is confused and painful.

 

This also is common:  tips-to-help-sleep-so-many-of-us-have-that-awful-withdrawal-insomnia

 

2 hours ago, Estman said:

Detoxification itself also seems to cause fatigue

 

What do you mean by "detoxification"?

 

Are you using the word "detoxification" for reducing the drug?

 

Reducing the drug is called tapering.

 

Or are you using it as a way to cleanse the body of toxins (not related to the drug you are taking)?

 

On 6/16/2011 at 1:28 AM, Altostrata said:

 

My belief is that, our bodies and nervous systems being under so much stress from withdrawal, detoxing the liver or any other ritual of purification only adds further stress and doesn't do anything positive for proper withdrawal. (Liver detox was developed for serious, identifiable heavy metal poisoning.) Liver cleansing is one of those things naturopathic medicine routinely recommends for all kinds of ills, with very little evidence it helps any of them. I do not think it's appropriate for withdrawal syndrome.

 

 

[Estman]

4 hours ago, ChessieCat said:

 

Many members experience this.  exercise-do-more-do-less-do-nothing-what-worked-for-you

 

It's important that you do overdo physical exertion.

 

 

This also is common:  tips-to-help-sleep-so-many-of-us-have-that-awful-withdrawal-insomnia

 

 

What do you mean by "detoxification"?

 

Are you using the word "detoxification" for reducing the drug?

 

Reducing the drug is called tapering.

 

Or are you using it as a way to cleanse the body of toxins (not related to the drug you are taking)?

 

 

Yes, I was still thinking of reducing the drug, not detofication the body
Why does reducing the drug cause fatigue?
Logically, should there be more energy when Anafranil is removed?
Hopefully the energy and strength will recover
If I have weakness, then at the same time there is depression
The mood sinks very low and often so for a week
Probably a wave?

[Estman]

does physical exertion elevate cortisol high?
Two days ago, I felt normal
Yesterday I had to do physical work on the farm
I worked at an average load of 6-7 hours
As always in the evening, there was fatigue and anxiety
Yesterday all the muscles were sore, I felt particularly bad, there is also nausea, hot flushes
There is a particularly bad feeling, great depression and extreme anxiety
I sleep a lot and can't even get out of bed
It causes a lot of fear, the pulse is fast
Is it cortisol?
Can it be reduced?

[ChessieCat]

Physical exertion can increase withdrawal symptoms. 

 

exercise-do-more-do-less-do-nothing-what-worked-for-you

 

I suggest that you do a general internet search on:  does exercise increase cortisol

[Estman]

1 hour ago, ChessieCat said:

Physical exertion can increase withdrawal symptoms. 

 

exercise-do-more-do-less-do-nothing-what-worked-for-you

 

I suggest that you do a general internet search on:  does exercise increase cortisol

 

 

 

At the moment, anxiety is also extreme
Blood pressure is 153/100
I took a little blood pressure lowering
There is a huge feeling of stress in the head

[Estman]

Physical exertion seems to cause the same wave as drug reduction
Today is 7 days after it started
Some things have improved a little, a little less despair
There is a vague sense of fear
The mood is also depressing
There have been strong gases and indigestion in the last 3 days after taking the drug in the evening
The body seems to repel this substance a little
You can see how long the wave will last this time

[Estman]

I reduced my daily dose 8-9% 8 days ago
Now, a week later, there are very lively and confused dreams at night
They are very emotional, sometimes romantic, sometimes fight-escape with content
Is this the case with Anafranil or with other drugs?
There are also malaise with nausea every day. Is there any way to relieve the nausea?

[Estman]

Hi,

 

Is there a way to reduce the fight or escape reaction?
I am thinking of a state of fear and panic that lasts for several days
I do not use sedatives and it is very difficult to tolerate
It started 2 days ago with diarrhea and nausea
I forgot to take the drug at the right time and it shifted for an hour
Can sex trigger such symptoms afterwards?
is such a constant pre-panic anxiety with nausea
The last reduction was 10% and several weeks ago

Does it give something to do or does it go away on its own?

[ChessieCat]

sex-during-withdrawal-syndrome

 

Sex is physical exertion/exercise:

 

exercise-do-more-do-less-do-nothing-what-worked-for-you

 

Is there anything else that has happened leading up to the increase in your symptoms?  Missed a dose completely (ie not just taken it a bit late)?  Have you been sick?  Antibiotics?  Alcohol?  Caffeine (cola, energy, coffee)?  Relationship issues?  Financial or work stress?

[Estman]

8 hours ago, ChessieCat said:

sex-during-withdrawal-syndrome

 

Sex is physical exertion/exercise:

 

exercise-do-more-do-less-do-nothing-what-worked-for-you

 

Is there anything else that has happened leading up to the increase in your symptoms?  Missed a dose completely (ie not just taken it a bit late)?  Have you been sick?  Antibiotics?  Alcohol?  Caffeine (cola, energy, coffee)?  Relationship issues?  Financial or work stress?

Hi ChessieCat,

It's good to know that sex can also trigger symptoms!
I have known myself relatively accurately and I have not missed a dose
I don't drink coffee or alcohol
3 days ago when I first had diarrhea in the evening, I probably ate too much
I ate pizza, 2 fried eggs and tomatoes
An hour later, there were severe abdominal pain and total diarrhea with high anxiety and nausea
After the evening dose, there have been previous problems with digestive problems - gases and ailments
The next day there was a constant fight-escape reaction
It has lasted so far, great anxiety, stress and fear
I have no other illnesses, no financial or living problems
It must be related to this Anafranil
Yesterday was a year of great anxiety and constant fear
I fell asleep normally, maybe around 22-23
I woke up at 1 at night and then I felt better
There was no great fear and struggle or escape reaction
After that I fell asleep again and before waking up the sleep was restless
I woke up then with fear and anxiety
Is this a cortisol explosion?
It was more or less normal to be at night and anxiety again in the morning
This anxiety is expressed in a strong desire to escape
There is no reason for that
Does withdrawal symptoms increase cortisol levels?
 

[ChessieCat]

1 hour ago, Estman said:

Is this a cortisol explosion?

 

early-morning-waking-managing-the-morning-cortisol-spike

 

[Estman]

23 hours ago, ChessieCat said:

 

early-morning-waking-managing-the-morning-cortisol-spike

 

Last night there were severe stomach upsets and gas again
There were also general malaise and nausea.
I woke up several times during the night
When he woke up, there was a feeling of fear and anxiety
There was also a fast pulse and a feeling of cold
Usually I get better at night
It seems to be from excess cortisol
Is there any way to reduce cortisol?

[ChessieCat]

This post is on page 1 of the cortisol topic I linked previously. 

 

 

If trying anything new only make one change at a time and start with a small tester dose to see how you react.  Please also be aware that some members have tried something and it works for some time but then stops working or turns paradoxical.

 

There may be separate SA topics on the things listed in the above post.  Use a search engine and add site: survivingantidepressants.org to the search term to research them further.

 

the-rule-of-3kis-keep-it-simple-keep-it-slow-keep-it-stable

 

 

Edited October 17, 2020 by ChessieCat