Alynna8: doctor gave me serotonin syndrome now I'm stuck in withdrawal

[Alynna8]

Hello to all. Thank you for this site. I'm sorry to all who are suffering through this. Back in August I was down to 112.5 mg of effexor from 187.5 when my doctor put me on 30 mg of prozac to help with my taper. Over a few weeks I developed seratonin syndrome and had to stop both at once on Sept 19th. I've been going through withdrawal ever since with it getting worse every morning. It is extreme in the mornings now. I found a fb group and started reintroducing effexor starting with 8 beads on Thursday Oct 15th. My main most disabling symptoms are extreme nausea,  vomiting, dry heaving, diarrhea,  and feeling extremely hot and prickly electric type shocks to my body. Any advice that anyone can offer would be greatly appreciated. I plan to hold at this dose for a week and then go up if not stable. 

Edited October 17, 2020 by Gridley

[Gridley]

Welcome to SA, Alynna8.  Thanks for completing your drug signature.  I'm sorry you're going through this.

 

The symptoms you describe are typical of withdrawal.

 

What is withdrawal syndrome.

 

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

 

Brain Remodelling 

 

It's good that you reinstated.  At less than a month since your last dose, you're well within the time frame, 3 months, that reinstatement most predictably works.  I don't know how many mg 8 beads is, but it sounds like a low dose, which is what we recommend.  Your system has been sensitized by the cold turkey, and too much of a reinstatement can overwhelm your system.  Please read:

 

About reinstating and stabilizing to reduce withdrawal symptoms. -- at least the first page of the topic

 

 We need to see how 8 beads affects you.  It takes about 4 days for a dose change to get to get to full state in the blood and a few days longer for it to register in the brain.  The effect should get stronger during that time.  I'd give the 8 bead reinstatement perhaps a couple more days than a week before upping your dose.  If 8 beads is enough it still may take some weeks or months for your nervous system to settle down. You probably will continue to have windows and waves (ups and downs)  but symptoms won't be as intense. Please keep in mind that the purpose of reinstatement isn't to eliminate all withdrawal symptoms (though it does for some) but rather to bring them down to tolerable levels.

 

If it seems you need a higher dose, it will be easy to very carefully increase, one bead at a time and giving that 1-bead increase time to work.   Once you found the dose that brings you relief, you will need to hold for several months to stabilize.  Then you can begin a slow 10% taper down to zero.  When that point comes we can help you with your taper of Effexor.

 

Why taper by 10% of my dosage?

 

It's a good idea to keep daily notes on paper to keep track of how your reinstatement is going. Please keep us updated.

 

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 way here.

 

 

 

 

 

 

 

 

 

 

 

[Alynna8]

Thank you so much! I actually am already taking omega 3s and magnesium and it has helped some.

[AJ716]

Hi Alynna8,

 

I am new to the site (been about 4 days) and believe my situation is similar to yours.  I was having debilitating daily episodes of panic and other symptoms for about 22 months and recently came to believe I've been suffering Serotonin Toxicity.  Every day starting when I woke up I'd become ill for hours and then slowly I'd start to get better. Next day, same thing.  The details are in my intro if you are interested.  The short of it is that I am taking a slower route and am not going cold turkey off of my medications like you are. I've noticed a difference and am doing better already.  It's brutal what you are enduring and I'm sorry you have to suffer so much.  My doctor is btw but I'll see mine in 12 days and let him know that to diagnose me he could have simply checked the interaction between the medications he has been prescribing for me. He's been testing me for cancer, etc and telling me I must just have anxiety/menopause. 

 

I've been reading a lot about different foods and meds that increase serotonin.  My doctor kept giving me different meds to try and relieve my symptoms and often they made me worse (anti nausea, etc).  That said, I wouldn't want to steer you wrong so I cannot suggest anything specific, but perhaps look into any kind of food/liquid or OTC med that increases Serotonin in low amounts .  That may lesson some of your suffering.  For example I learned that one of the few foods that can lower Serotonin is gelatin so I've been eating that and it has helped.  *Keep in mind that I'm currently in the opposite position of you so I am not suggesting you eat gelatin.  Hope you find some relief soon@!

[Alynna8]

I made a huge mistake! 😭After reinstating the effexor at 8 beads for 4 days my withdrawals were still severe so I decided to add 4 beads last night. This morning the withdrawal was much better but when I went to take my tiny piece of 2mg suboxone strip I felt mild seratonin syndrome symptoms return for about an hour.  Now I'm not sure if I should skip my dose for tonight. I know I need to lower it for sure. I was just so miserable that I made a huge mistake! Any advice would be greatly appreciated!

[Alynna8]

Hi AJ716 

 

I'm so sorry that you are going through this as well! I'm so glad you are doing better! I did read your intro. I hope you continue to improve!

[AJ716]

Hi Alynna,

 

Thanks!  It's been an up and down battle. I had a feeling the episodes would get worse again before regularly better and I was right. Just fighting through it and longing for when I believe I can safely make another reduction.

 

I read your other post about taking more beads and your leeriness regarding the Suboxone film.  You wrote it some time ago and no doubt you have made your decision.  How are you feeling? 

[Alynna8]

Hi AJ716,

 

I upped my beads from 8 to 12. That day when I took my tiny peice of suboxone I got the seratonin syndrome symptoms. So last night I didn't take anything. I'm feeling pretty rough. I plan to take 4-6 beads tonight but I'm torn as to which I should take.

[Gridley]

15 minutes ago, Alynna8 said:

,

 

I upped my beads from 8 to 12. That day when I took my tiny peice of suboxone I got the seratonin syndrome symptoms. So last night I didn't take anything. I'm feeling pretty rough. I plan to take 4-6 beads tonight but I'm torn as to which I should take.

It is extremely important to take the same number of beads every night and never to skip a dose.  Jumping around in doses, skipping doses, and increasing too much is very destabilizing to an already sensitized nervous system.  You need to give the reinstatement time to work.  It takes 4 days for the reinstatement dose to reach full strength in your blood stream and a few more days to register in the brain.

 

I suggest you go back to 8 beads.  Too much can overwhelm your nervous system.  Hold at 8 beads for over a week.  If you aren't feeling better, you can increase by one bead to 9 beads--no more.  Then give that a chance to work.

[AJ716]

Me too (rough) but even though it's very uncomfortable I do take some comfort in that it's no longer horrid.  Also I go through phases so I know what to expect and approximately how long it takes.  When unexpected discomfort occurs I get panicky and it spirals. 

 

I can sense your strength!!   I noticed you had to take a huge leap and can only imagine.  And I'm impressed at your accomplishment with your Suboxone taper!!  Have you looked into any foods like gelatin or collagen?  Jello helped me a little and it was comforting.  I'm also looking into Valerian root acid but was hesitant to change anything more.  Those are the only three OTC products I know of that are said to counter Serotonin (oddly there are dozens that increase it and many were unknowingly given to me by the doctor which made me worse).  I'm really rooting for you!

[Alynna8]

6 hours ago, Gridley said:

It is extremely important to take the same number of beads every night and never to skip a dose.  Jumping around in doses, skipping doses, and increasing too much is very destabilizing to an already sensitized nervous system.  You need to give the reinstatement time to work.  It takes 4 days for the reinstatement dose to reach full strength in your blood stream and a few more days to register in the brain.

 

I suggest you go back to 8 beads.  Too much can overwhelm your nervous system.  Hold at 8 beads for over a week.  If you aren't feeling better, you can increase by one bead to 9 beads--no more.  Then give that a chance to work.

I'm scared of the seratonin syndrome. Do you really think I should go back to 8 so soon?

[ChessieCat]

45 minutes ago, Alynna8 said:

I'm scared of the seratonin syndrome. Do you really think I should go back to 8 so soon?

 

Serotonin syndrome is generally caused either by taking 2 drugs which increase serotonin or taking too high a dose of 1 serotonin increasing drug.  It is dose related.  I had mild serotonin syndrome from taking only 1 drug, Pristiq, at 100mg.  As I reduced my dose the serotonin symptoms lessened and then completely went as my dose got lower.

 

You were taking Effexor 112.5mg + 30mg Prozac.  That was an extremely high dose of Prozac to add to that dose of Effexor.  Compared to what you were taking 8 beads of Effexor is a very tiny amount. 

 

When switching/bridging, the new drug should be started at a low dose and then the old drug decreased and the new drug increased at the same time and then repeated until you are only taking the new drug.  See this topic: 

 

the-prozac-switch-or-bridging-with-fluoxetine

 

Please read Post #1 of the reinstatement topic to help you understand the process. 

 

About reinstating and stabilizing to reduce withdrawal symptoms

[Alynna8]

Thank you from the bottom of my heart! Your reply was literally an answer to my prayers. I will reinstate at 8 beads tonight and hold for at least one week. I read the entire posts that you suggested. Again. thank you!💕

 

Edited October 21, 2020 by ChessieCat
removed quote

[ChessieCat]

You are very welcome.  I'm pleased that the information I provided has helped.

[Alynna8]

10 hours ago, ChessieCat said:

You are very welcome.  I'm pleased that the information I provided has helped.

I took the 8 beads last night and felt mild seratonin syndrome symptoms. Again today when I ate food that can increase seratonin I felt it again.  Should I lower my dose by 1 or 2 beads?

[Altostrata]

Hello, Alynna.

 

What do you mean by serotonin syndrome symptoms?

 

How long were you taking Effexor with Prozac?

 

What times of day do you take each of your drugs, with their dosages? Please put ALL your drugs in the Drug Interactions Checker https://www.drugs.com/drug_interactions.php
and copy and paste the results or a link to them in this topic.

[Alynna8]

5 minutes ago, Altostrata said:

Hello, Alynna.

 

What do you mean by serotonin syndrome symptoms?

 

How long were you taking Effexor with Prozac?

 

What times of day do you take each of your drugs, with their dosages? Please put ALL your drugs in the Drug Interactions Checker https://www.drugs.com/drug_interactions.php
and copy and paste the results or a link to them in this topic.

I was on the effexor for many years but for about a year this time. The prozac I started at the beginning of August. The symptoms are unmistakable as it happened right after I took my dose of 8 beads last night. The effexor is the only thing I am taking at this time but the prozac is very much still in my system. My heart rate shoots up along with my blood pressure and I feel very hot and nauseous with loose bowels. Only for a little while but still. I was taking a teeny tiny peice of a 2mg suboxone strip like 2 pieces of rice size but have since stopped.

[Altostrata]

You were on both Prozac and Effexor for about a month, August-September?

 

The Prozac is out of your system, but you are hypersensitive to drugs now. We see this a lot after people have mishaps with drugs.

 

Has the Effexor helped at all? If 8 beads is too much, you might reduce to 6 beads.

 

When did you stop Suboxone? Why were you taking it? Did you feel any new symptoms after you stopped it?

 

What about the Xyrem?

[Alynna8]

11 minutes ago, Altostrata said:

You were on both Prozac and Effexor for about a month, August-September?

 

The Prozac is out of your system, but you are hypersensitive to drugs now. We see this a lot after people have mishaps with drugs.

 

Has the Effexor helped at all? If 8 beads is too much, you might reduce to 6 beads.

 

When did you stop Suboxone? Why were you taking it? Did you feel any new symptoms after you stopped it?

 

What about the Xyrem?

I forgot about the xyrem. I will run the drug interactions. The last time I took the suboxone was on the 19th and no new symptoms yet. I had been on it for opioid dependency for many years bit tapered down to a tiny amount. I will try the 6 beads. It did seem to help some.

[Alynna8]

19 minutes ago, Altostrata said:

You were on both Prozac and Effexor for about a month, August-September?

 

The Prozac is out of your system, but you are hypersensitive to drugs now. We see this a lot after people have mishaps with drugs.

 

Has the Effexor helped at all? If 8 beads is too much, you might reduce to 6 beads.

 

When did you stop Suboxone? Why were you taking it? Did you feel any new symptoms after you stopped it?

 

What about the Xyrem?

Interactions between your drugs

Major

venlafaxine  sodium oxybate

Applies to: Effexor XR (venlafaxine), Xyrem (sodium oxybate)

Using sodium oxybate together with venlafaxine may increase side effects such as drowsiness, dizziness, lightheadedness, confusion, depression, low blood pressure, slow or shallow breathing, and impairment in thinking, judgment, and motor coordination. Occasionally, severe reactions may result in coma and even death. Talk to your doctor if you have any questions or concerns. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. You should avoid the use of alcohol while being treated with these medications. Also avoid driving, operating machinery, or engaging in potentially hazardous activities requiring mental alertness and motor coordination for at least six hours after taking sodium oxybate and until you know how the medications affect you, and use caution when getting up from a sitting or lying position. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

How to Prevent Deadly Drug Interactions

Some mixtures of medications can lead to serious and even fatal consequences.

Here are 9 ways to stay safe

Drug and food interactions

Major

sodium oxybate  food

Applies to: Xyrem (sodium oxybate)

Food may interfere with the absorption of sodium oxybate. You should wait at least 2 hours after eating before you take the first dose. Avoid alcohol during treatment, as it may add to the central nervous system effects of sodium oxybate and increase the risk of serious side effects such as respiratory depression, low blood pressure, fainting, coma, and even death. Do not drive, operate machinery, or perform other hazardous activities for at least six hours after taking sodium oxybate and until you know how the medication affects you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Moderate

venlafaxine  food

Applies to: Effexor XR (venlafaxine)

Alcohol can increase the nervous system side effects of venlafaxine such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with venlafaxine. Do not use more than the recommended dose of venlafaxine, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

Switch to professional interaction data

Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

[Altostrata]

What times of day do you take your drugs, with their dosages?

[Alynna8]

4 minutes ago, Altostrata said:

What times of day do you take your drugs, with their dosages?

8 beads effexor at 1030 last night and 3.75 g of xyrem at 11:30 and 2.5g at 3 am. I dont get drowsy from the effexor.

[Altostrata]

You might move the Effexor earlier by an hour each day until you are taking it at 6 p.m. Would that be convenient for you?

[Alynna8]

I try to take it so its highest in my system when I'm going through the withdrawal which is the same time every morning and is brutal. I think my liver may be having a hard time clearing the meds. I mistakenly told you August to September bit I was actually started on the prozac the beginning of July. I have asked my doctor to test my blood levels of the drugs but I doubt she will. 

[AJ716]

Hi Alynna,

 

I have been following your story since your first post because of your mention of SS in the title and I am experiencing similar.   I apologize for butting in however I've noticed something.

 

Although we are at different stages of discontinuation from our medications (you took the quick approach and I'm doing a slow taper),  we share a distinct similarity -  both suffering most in the "morning".  It has notoriously been a most horrid time of day for me too!   Like clockwork my symptoms start at night (but are less severe at that time) and continue through the morning when they peak for a couple of hours, before lessoning again.

 

Perhaps that's a clue?   I'm not 100% but I theorize that I endure sharp estrogen fluctuations at night and that it spikes Serotonin production (more predominant at night as well).  It's definitely cyclic (daily) but I have noticeable monthly variations as well.  *I went on HRT a year ago believing that would help but it actually made me worse.

[Alynna8]

42 minutes ago, AJ716 said:

Hi Alynna,

 

I have been following your story since your first post because of your mention of SS in the title and I am experiencing similar.   I apologize for butting in however I've noticed something.

 

Although we are at different stages of discontinuation from our medications (you took the quick approach and I'm doing a slow taper),  we share a distinct similarity -  both suffering most in the "morning".  It has notoriously been a most horrid time of day for me too!   Like clockwork my symptoms start at night (but are less severe at that time) and continue through the morning when they peak for a couple of hours, before lessoning again.

 

Perhaps that's a clue?   I'm not 100% but I theorize that I endure sharp estrogen fluctuations at night and that it spikes Serotonin production (more predominant at night as well).  It's definitely cyclic (daily) but I have noticeable monthly variations as well.  *I went on HRT a year ago believing that would help but it actually made me worse.

That is very interesting. I thought it was because that's when I used to take my meds was in the morning but yes mine is very similar. I loathe the morning as well. Mine starts about 3 am and peaks for a couple of hours in the morning before slowly getting better.  What time fo you take your effexor?

[Alynna8]

2 hours ago, Altostrata said:

You might move the Effexor earlier by an hour each day until you are taking it at 6 p.m. Would that be convenient for you?

What about taking it at 6 am as that's when I always took it before was in the morning? Also I think the symptoms I was having today was I was starting to experience withdrawal from the suboxone so I reinstated a teeny tiny peice and feel much better. I think maybe I will stick with the 8 beads for tonight and see what happens tomorrow. What do you think 8 or 6 beads?

[Alynna8]

Just now, Alynna8 said:

What about taking it at 6 am as that's when I always took it before was in the morning? Also I think the symptoms I was having today was I was starting to experience withdrawal from the suboxone so I reinstated a teeny tiny peice and feel much better. I think maybe I will stick with the 8 beads for tonight and see what happens tomorrow. What do you think 8 or 6 beads?

Also by 6 am the xyrem is out of my system and I'm wide awake.

[AJ716]

44 minutes ago, Alynna8 said:

That is very interesting. I thought it was because that's when I used to take my meds was in the morning but yes mine is very similar. I loathe the morning as well. Mine starts about 3 am and peaks for a couple of hours in the morning before slowly getting better.  What time fo you take your effexor?

 

I take Cymbalta (an SNRI like Effexor) and my Zoloft (SSRI) between 4 and 6 pm, although before the last few months I just took it whenever I remembered.  It never seemed to affect the timing of my symptoms (I make daily notations on a spreadsheet and am always watching for correlations). Note my schedule is probably different than yours. It's a mess.  I don't fall asleep until about 6-7 am and wake between 12-1 pm.  I've just referred to the time as "morning" because it's an easier translation, lol.

When my episodes started I thought it might be horrible case of peri-menopause but quickly determined that at minimum it must also be connected to something else.  Had loads of tests done but nothing startling came from them.  It's only recently that I considered Serotonin excess.  After reviewing my mountain of notes to SS research it all fell into place.  My doctor (that prescribes these meds) should have had SOME CLUE a LONG time ago..... but that's another story.  

[Alynna8]

4 hours ago, Altostrata said:

 

 

[Altostrata]

What do you mean by withdrawal in the morning?

 

Please clarify when you were taking Effexor and Prozac together, and how much you were taking of each.

[Alynna8]

31 minutes ago, Altostrata said:

What do you mean by withdrawal in the morning?

 

Please clarify when you were taking Effexor and Prozac together, and how much you were taking of each.

My withdrawal symptoms are mostly severe in the mornings like clockwork. I wake up between 530-630 with my heart racing and mild nausea. Around 730 the extreme nausea vomiting and diarrhea shocks and hot and cold kick in especially if I dont take bonine. Around 10AM it starts to slowly get better and between 1130 and 1230 I'm able to get out of bed and I feel very weak and no energy but am able to at least move to the living room. I continue to feel a bit better as the day wears on. I was on the effexor for about the last year this time and the prozac was started in the beginning of July and discontinued on the 19th of September. I really want to take my beads in the morning as that is when my symptoms are the most severe. Several have thought this would maybe help also. Thank you for your help and time very much! I was on 187.5 of effexor when the doctor started to taper me this time. When I got to 112.5 she started me on the prozac at 10mg and within 2 weeks I was taking 30 mg.

[Altostrata]

How long were you taking Effexor and Prozac at the same time?

 

When did these symptoms in the "morning" start? When did you start sleeping on this odd schedule?

 

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. This can show if your symptoms are adverse effects from one of your drugs.

 

 

 

[Alynna8]

3 minutes ago, Altostrata said:

How long were you taking Effexor and Prozac at the same time?

 

When did these symptoms in the "morning" start? When did you start sleeping on this odd schedule?

 

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. This can show if your symptoms are adverse effects from one of your drugs.

 

 

 

I was taking them together from the beginning of July until September 19th. 

 

I'm not sure what you mean by odd schedule for sleep. I have narcolepsy and I take my first dose of xyrem around 1130 to 12 a.m and my second dose at 230 ish am. I wake up around 530 to 630 am.

 

I was taking my meds first thing In the morning around the beginning of September and I at first was having the the seratonin syndrome in the morning. When I stopped the meds it turned into withdrawal In the morning at the same time as I was having the seratonin syndrome before. 

[Altostrata]

From what are you having withdrawal in the morning?

 

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. This can show if your symptoms are adverse effects from one of your drugs.