kaiyo3 Are Tricyclics any safer than SSRIs, in terms of protracted withdrawal?

[kaiyo3]

I have been prescribed amitriptyline for chronic migraines and widespread neuralgia.. plus hoping it'll help for PTSD as well.

I'm very concerned about protracted withdrawal from antidepressants, as I've had a run in with benzos in the past and know how real it can be. 

 

I'm desperate for some relief though and have talked to a lot of people that have had great experiences with amitriptyline. 

My question is, in regard to the possibility of protracted withdrawals and overall disruption of nervous system stability, are tricyclic antidepressants such as amitriptyline any safer than the traditional, widely-prescribed SSRIs?

[Altostrata]

Welcome, @kaiyo3

 

The answer to your question is no, amitriptyline and other tricyclics do not carry a lower risk of severe withdrawal syndrome or protracted withdrawal syndrome. In fact, the earliest reports of antidepressant withdrawal syndrome are from the tricyclic era.

 

Any antidepressant taken regularly for a month or more carries a risk of withdrawal if you go off.

 

Please look around the Introductions forum for the experiences of others who have taken amitriptyline. Whatever promises you hear from the medical profession may not be borne out.

 

Otherwise, as this is a site for going off psychiatric drugs, please let us know if you want any assistance tapering.

[kaiyo3]

I have terrible PTSD and anxiety. I've heard and tried every recommendation - exercise, diet, meditation, mindfulness, etc. While they all help some, the trauma I've endured has left me with physical changes to my nervous system that have put me beyond the point of healing on my own. Thing is, sites like this, and my own experiences with medications, have left me absolutely TERRIFIED of medically treating my PTSD and anxiety. The constant state of physical stress is wreaking havoc on my body; I have developed fibromyalgia, migraines, chronic gastritis, etc. I know my body will keep getting worse if I don't do something. But I read the horror stories here and I'm just too scared to put my nervous system in further disarray. 

 

So my question is - what do you think is worse/more dangerous for me and my nervous system - going unmedicated for years with major PTSD and physical anxiety? Or taking the plunge and starting Zoloft to ease my symptoms and halt the toll that PTSD is taking on my body?

 

It's not the medication I'm scared of, of course. It's the inevitable future withdrawal process. I have gotten off antidepressants in the past without much trouble. But I cold turkey'd a benzodiazepine a few years ago and it made my now sensitive nervous system even more sensitive. I'm SOOO scared to do that again... 

 

But - this leads me to my other question - Does a well planned, super-slow taper effectively eliminate most/all of the most dangerous risks of getting off an SSRI? I mean, if I ever have to get off, will a slowwwww taper take away most of the severe dangers of protracted withdrawal? That's my worse fear. Protracted withdrawal. For those that have been in this circle for a long time, are there numerous cases of protracted withdrawal or post-withdrawal syndrome that happen even after proper tapers?

 

I had my tricyclic antidepressant compounded into 1mg pills and cut down once every month recently and it was pretty easy to taper off. Could I do this with Zoloft and basically eliminate the long-term risks? I need something major to put the brakes on this chronic state of stress and dysfunction. 

 

Very grateful for any responses or advice. 

[Onmyway]

Quote

I have terrible PTSD and anxiety. I've heard and tried every recommendation - exercise, diet, meditation, mindfulness, etc. While they all help some, the trauma I've endured has left me with physical changes to my nervous system that have put me beyond the point of healing on my own. Thing is, sites like this, and my own experiences with medications, have left me absolutely TERRIFIED of medically treating my PTSD and anxiety. The constant state of physical stress is wreaking havoc on my body; I have developed fibromyalgia, migraines, chronic gastritis, etc. I know my body will keep getting worse if I don't do something. But I read the horror stories here and I'm just too scared to put my nervous system in further disarray. 

 

Dear @kaiyo3, 

welcome back to SA. I have merged your new post into your thread - everyone gets one thread only so we can provide the best advice knowing your history. 

 

I am sorry you are suffering. It sounds like  a terrible place to be. You seem quite hopeless for your situation and convinced that your only option is drugs. You state that you have physical changes to your nervous system and that you are beyond healing. Have these physical changes been documented somehow? Or is it your own assessment colored by feeling hopeless. Based on my experience here I am convinced that with the right resources, our brains and psyches can heal - our brains are incredibly plastic but that plasticity is not usually achieved through medicine in my experience. SSRIs do not generally cause physical changes back as far as I am aware. But I may be biased given the amount of suffering I see here. 

 

Quote

So my question is - what do you think is worse/more dangerous for me and my nervous system - going unmedicated for years with major PTSD and physical anxiety? Or taking the plunge and starting Zoloft to ease my symptoms and halt the toll that PTSD is taking on my body?

 

None of us can answer that question. If I knew that the drugs would be helpful and wouldn't harm you any further I would say go for it. But my personal view of this field is that drugs are not very effective for trauma incl. PTSD even though there are two FDA approved drugs to use for PTSD. It is important to know that the FDA approves drugs for a specific indication as long as two clinical trials show that it is good for that indication even if 100 others show that it is not effective. 

 

Below I have found two randomized clinical trials (gold standard of clinical research) that show that sertraline (one of the FDA approved drugs) and prozac do not in fact improve PTSD symptoms more than placebo or psychotherapy such as EMDR. If I were in your shoes I would not touch these drugs because I am not convinced of their benefit. 

https://pubmed.ncbi.nlm.nih.gov/11910265/

https://pubmed.ncbi.nlm.nih.gov/17962673/

 

Quote

It's not the medication I'm scared of, of course. It's the inevitable future withdrawal process. I have gotten off antidepressants in the past without much trouble. But I cold turkey'd a benzodiazepine a few years ago and it made my now sensitive nervous system even more sensitive. I'm SOOO scared to do that again... 

 

It is possible that your current nervous system dysregulation is from the benzo withdrawal rather than the original PTSD. We have members who get CFS and fibromyalgia during withdrawal. Good news is that it gets better over time. For some of our members (but not most based on my observation) withdrawal creates its own PTSD. Your current heightened anxiety may be from cutting amitriptyline rather than from the original PTSD as well. Subsequent psych drugs or withdrawals can be worse. You haven't provided a signature for me to see hen you started and stopped your various drugs to assess if this could still be leftovers from benzo and tricyclic withdrawals. Withdrawal can go for many years - rarely over a decade. 

https://www.survivingantidepressants.org/topic/27800-hypersensitivity-and-kindling/

 

Quote

But - this leads me to my other question - Does a well planned, super-slow taper effectively eliminate most/all of the most dangerous risks of getting off an SSRI? I mean, if I ever have to get off, will a slowwwww taper take away most of the severe dangers of protracted withdrawal? That's my worse fear. Protracted withdrawal. For those that have been in this circle for a long time, are there numerous cases of protracted withdrawal or post-withdrawal syndrome that happen even after proper tapers?

We don't see many people here who do a slow taper without first having withdrawal symptoms so we can't speak to it. In my case once I held for a very long time and started a very very slow taper my symptoms have been generally better. 

 

Quote

I had my tricyclic antidepressant compounded into 1mg pills and cut down once every month recently and it was pretty easy to taper off. Could I do this with Zoloft and basically eliminate the long-term risks? I need something major to put the brakes on this chronic state of stress and dysfunction. 

Every withdrawal experience is different and it is not possible to predict how it will go. Some people do not feel much the first time they stop and then have more severe withdrawals with later medications and stopping. I suspect that you are still bearing some of your withdrawal from the benzos and amitriptyline. There do seem to be some people who do not have withdrawal symptoms or not severe enough to recognize and suffer from them. But there are also some who have withdrawals but attribute it to the return of their original symptoms. Generally, we see that the more times you start and stop medicines the worse the subsequent withdrawals. 

 

I suspect that you have read the book "The Body Keeps the Score" where Bassel van der Kolk reviews the current best treatments for PTSD. 

 

I am really sorry you are suffering so badly, anxiety and PTSD are horrible and I wouldn't wish them on my worst enemy. I know you must be at the end of your rope to consider another antidepressant. Hope you get some respite from your suffering soon. Sorry we can't provide better predictions for you. 

 

OMW

Edited January 26, 2023 by Onmyway