TaiLeiLe: tapered amitriptyline too fast 3 times - possible kindling?

[TaiLeiLe]

Hey everyone, I'll try to keep this concise.

 

Background: Currently early twenties student in university. In 2017, I was diagnosed with post-concussion syndrome (PCS). 40mg of Amitriptyline was prescribed by my neurologist to treat tension headaches.

 

My first experience with rapid tapering of amitriptyline was in August 2018, when my neurologist asked me to switch from amitriptyline to valproic acid for PCS, at a rate of 10mg Amitriptyline tapered each week until I was fully cold turkey. Unfortunately, I found out around the 10/20mg range I wasn't handling withdrawal too well and was forced to stop and reinstate. 

 

In February 2019, I read about the link between dementia and cholinergic medications and went cold turkey by my own choice. This lasted for two months of difficulty where I struggled through my hardest semester of college. I ended up reinstating in April after a discussion with my therapist.

 

Its important to note that at this point, for both aforementioned times I had attempted fast tapers I was not aware that withdrawal symptoms were a significant issue for antidepressants. Instead, I believed that once amitriptyline fully left my system I would be fine, and that all my symptoms were caused by PCS.

 

In July 2019, I was able to recover from PCS after two years. A month later in August, I spoke to my physician about getting off amitriptyline. He prescribed me a somewhat slower taper at 10mg a month and 7 weeks for the final 10 mg. Thus, I began my taper from 40mg to 30mg. You can probably guess what happened next. This taper put me through hell and lasted a total of a little over four months before I stabilized. In December 2019, I discovered this forum and decided to give slow tapering a shot using liquid titration (water, not ethanol). 

 

In January 2020, I tapered from 30mg to 27 mg. It took me about two months start to finish to stabilize. I was mildly symptomatic, but my symptoms were manageable.

 

In March, I tapered from 27 mg to 25 mg. This time, it took me nearly three months to stabilize. Even stranger, my I found that my symptoms were seemingly worse, even though the percentage tapered was still about 10%.

 

In June, I tapered from 25mg to 24mg, hoping that a tiny dose reduction would alleviate most of my issues with tapering. Flash forward to today. Nearly three months after I had began that taper I find that my symptoms, while very mild at first seemed to have gotten worse over time. Furthermore, a three month long time span for a 4% reduction seems very unusual. Now I that school is starting and I am actively interviewing for internships, I am considering reinstating back to 24.5 or 25 mg. 

 

I'm unsure about why my withdrawals seem to get worse even though I try to reduce my taper amount each time. I can think of a couple theories, those being:

1. Dissolving with water instead of ethanol causing issues somehow. I think this is unlikely because when I first was testing out a solution in water at my full dosage, I did not experience any withdrawal symptoms. Furthermore, when I switched to 1:10 ethanol:water solution for a couple nights while tapering, I did not experience any improvement in symptoms.
2. Withdrawals from previous tapers coming back to bite me in my ass. I'm aware of the whole waxing and waning thing and I'm wondering if it's possible that when I began my last taper, I hadn't actually completely stabilized and am now dealing with prolonged symptoms from previous tapers. Not sure how likely this is.
3. Kindling. This would make sense considering I have had three tried and failed fast tapers that each did a number on me. However, I'm struggling to find any sources regarding kindling in antidepressants to the point where I'm unsure if it's even possible.

 

My symptoms are mainly just hypersensitivity, disheveled sleep/insomnia, and exhaustion.

 

Thanks for reading this far.

 

 

[Gridley]

Welcome to SA, TaiLeiLe.  Sorry for the delay in response.

 

I thin your analysis of why your withdrawals are getting worse despite smaller reductions is correct.  Your system is highly sensitized from the failed tapers (your #3) and going up and down in dose. Whether you call it kindling or whatever, there's no doubt that repeated destabilizations leave the system increasingly sensitized.   It's also very possible that (your #2) you weren't stabilized and are now now dealing with symptoms from previous tapers.

 

It seems to me that a very long hold at current dose of 6 or more months is what's needed.  With the failed tapers in your past, it's impossible to tell what's causing what, but a very long hold would allow you to stabilize and for your system to catch up.

 

Once you've stabilized, and it may take longer than 6 months, you might want to look at taper methods more gentle than the 10% method.You may  want to switch to a micro-taper going forward. This is the gentlest way to come off these drugs. 

 

Micro-taper instead of 10% or 5% decreases

 

The Brassmonkey Slide is a way of making micro-taper reductions weekly, as opposed to a larger reduction once a month. This taper calls for four weeks 2 1/2% cuts with a two week hold, but you could reduce the to four 1% cuts.

 

The Brassmonkey Slide Method of Micro-tapering

 

So that you have a better idea of what you're experiencing, here is some information on withdrawal and the healing process.

 

What is withdrawal syndrome.

 

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

 

The Windows and Waves Pattern of Stabilization

 

When we take psychiatric medications, the CNS (central nervous system) responds by making changes over the months and years we take the drug(s). When the medication is discontinued, the CNS has to undo all the changes it made. Rebuilding the neurotransmitter production and reactivating the receptor and transporter cells takes time -- during that rebuilding process symptoms occur.  These explain the healing process really well:

 

Video:  Healing From Antidepressants - Patterns of Recovery

 

Brain Remodelling 

 

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 questions and connect with other members.  We're glad you found your wy here.

 

 

 

 

 

 

 

[Mia1]

Hi TaiLeiLe,

 I was reading your introduction and wanted to see how you are doing?

[TaiLeiLe]

Hi everyone, 

 

Quick update, I'm still hanging at 24mg. About 4 months after my last reduction, I still have very minor withdrawal symptoms but overall am doing well.

 

I plan on getting to 20mg at some point in the (perhaps far) future. What I plan to do after that, I'm not sure. To be honest, I will be graduating in the next year and don't want to spend my early career dealing with withdrawal illness, especially when I'm lucky enough to have very little side effects from amitriptyline. I don't really have a concrete plan yet though.

[Ripley]

Hi TaiLeiLe

 

I was wondering how you were getting along? Are you still holding or perhaps you've decided to taper again? I'm interested in how things are going for you as there are similarities in our situations (although different drugs). Hope it's going ok.

[TaiLeiLe]

Hi everyone,

 

I'm returning to this forum after a very long time to discuss something unusual that happened to me recently.

 

Per my last update, I began a 1mg dose reduction from 25mg amitriptyline to 24 mg in June 2020. Afterwards, I began a one and a half year period of PAWS, during which I displayed symptoms including significantly disturbed sleep, brain fog and cognitive issues, chronic exhaustion, heightened anxiety, and other interrelated physical and mental symptoms. However, I lacked symptoms of emotional dysregulation, i.e. mood swings, anhedonia, depression, etc. In attempts to obtain relief, I had attempted to reinstate my dosage by .1 mg several times but my symptoms would improve for at most a week or two. I found that NAC and zinc supplementation helped to mitigate these symptoms and increase my level of overall functionality. It seems that discussion of these supplements has been covered in other topics so I won't delve into my experience with them here, besides mentioning that I found them to be helpful. Regardless, given my slow rate of recovery from PAWS, I was expecting at minimum several more years of withdrawal symptoms. All in all, after my failed attempts at reinstatement I had increased my dosage to 24.8 mg by August 2021. 

 

In October 2021 I started to take creatine. Immediately after dosing for the first time, I noticed some... pretty significant changes. Within 24 hours, my physical symptoms had all but vanished- I slept the best I had in years and my brain fog had disappeared. This miraculous turn of events was counterweighted by the fact that I had started to experience mood swings, going from brief flashes of anger to sadness and then to anhedonia at different points in time, sometimes all during the same day. These mood swings lasted about a month and a half and were terrifying as they occurred, but after about a month and a half I had returned to functional normality- which was stunning, as I had been suffering from withdrawal symptoms since August 2018. 

 

Without being too pseudoscience-y,  I assumed that given the timetable and the nature of events creatine had somehow ended my PAWS and allowed my brain to adjust to the absence of antidepressants, leading a period of mood swings/anhedonia. To test my theory, I continued my creatine supplementation and began another dose reduction, from 24.8 mg to 24. That was one week ago. The next few days, there were certain spans that lasted a few hours where I felt slight discomfort and anxiety but now I appear to be fully asymptomatic again- a far cry from my previous attempts at dose reduction during which I developed moderate-to-severe withdrawal symptoms which lasted for a minimum of two months, even after smaller tapers of 10% or less of my total dosage. 

 

The only issue is... I can't find information anywhere that corroborates my experience, and I'm beginning to become worried that this was just a fluke of some sort. Creatine has nullified the withdrawal symptoms that I had been suffering from for over three years, but given that the sample size consists of solely myself, I'm not sure at how appropriate it would be to start broadcasting this discovery- hence why I posted under my own topic. I would really appreciate if anyone could follow up on this topic and give some guidance or share their own experience. 

 

 

[Future]

Hi TaiLieLe 

Thanks for your experience about creatine. I would like to hear how it works out in the future for you. I am also tapering Amitriptyline and are thankful for all information about whatever that can help in withdrawal, especially with the emotional symptoms.

Future