Butternubs: hi there, I have quit imipramine and have questions

[Butternubs]

I was on it for four (not entirely sure) years, 25-50mg. The first time I had to abruptly quit it was last year, 2020. I was in the hospital for 12 days and they would not give it to me there. That was when I was on 50mg.

 

Withdrawal effects from that year: I had to pee every couple hours at the most and every 15-30 minutes at the least and my oxygen levels dropped (normally they were 99-100 but then they were 92). I would wake up gasping for breath and generally feel very off.

 

This year: The imipramine quit working and was even making me feel worse, so I quit cold turkey from 25mg. Since then I have gotten a mysterious infection and was put on antibiotics, which I completed this morning. My primary doctor thinks I have an infection but could not find bacteria, just elevated white blood cells. I just had flu-like symptoms--headache, nausea, elevated temperature (about 100 degrees in the morning), fatigue, loss of appetite, weight loss, mild dizziness (which is improving) and visual hallucinations, which are not unusual because I also have schizophrenia. Doctor thinks COVID is unlikely, given lack of gastrointestinal issues and also lack of respiratory issues. Also I'm fully vaccinated and not very social.

 

Questions: Would it be a bad idea to take just a tiny bit of imipramine to see if this goes away? Or should I just press on?

 

Here is what I am more concerned about: I recently got a genetic test and do NOT have the MTHFR mutation (inability to process folic acid). But I will be taking Deplin, if insurance approves it, or generic methylfolate if it doesn't, starting with half of a 7.5mg--can it still help even if I don't have the mutation? I read that a lot of my health issues, like non-alcoholic fatty liver, poly-cystic ovary syndrome, depression, and schizophrenia can be helped with folate. I don't eat vegetables at all, and certainly no leafy greens, so is it possible I'm low in folate anyways?

 

I am not looking to change my diet at the time as I'm barely eating as is. Just the idea of eating makes me want to throw up most days. I know it would be good for me to eat better, but I just try and try and it feels like nothing changes. I do actually manage to eat in the afternoon when the nausea fades for a while and I get hungry. I've lost ten pounds in a few months and I'm at 139 now.

 

Thank you for reading!

[Altostrata]

Welcome, @Butternubs

 

Going off an antidepressant suddenly can cause odd symptoms, but elevated white blood cells indicate a physiological issue probably not related to withdrawal. One should have a test for bacterial infection before taking antibiotics, which can have their own adverse effects.

 

Other than elevated white blood cell count, what other symptoms do you have that occurred shortly after you went off imipramine this last time?

 

On 8/13/2021 at 10:21 AM, Butternubs said:

The imipramine quit working and was even making me feel worse

 

How did the imipramine make you feel worse?

 

Are you still getting an Abilify injection? Why are you being treated with this? Please list all the drugs you're taking currently, the times o'clock you take them each day, and their dosages, including Deplin and Abilify.

[Butternubs]

Thank you for your reply!

 

It's too late because I already finished the round of antibiotics... I was on the fence about taking them and it's hard to say if they helped or if it just went away with time, but I do feel somewhat better. My headache is better, and my temperature is low 99 instead of 100 in the morning. I'm feeling less fatigue too, but that's hard to gauge because I just got my monthly Abilify injection and it takes a week to kick in fully. When that shot wears off at the end of the month I can get more tired.

 

I'm mostly having the headache, some fatigue, loss of appetite, mild nausea, and I was hearing voices yesterday (usually when I'm stable like this I only have visual hallucinations). The worst of it is this "spaced out" feeling and the inability to feel awake/conscious. Hard to say if I can focus or not, I'm writing this just fine, but I don't feel present. The chills are going away too and so are the muscle aches, but my joints are acting up. I've never had any pain in my knees before this. I just turned 26. It's also hard to say how much of this is from not eating enough, too. I try, but there's no appetite and when I force myself to eat I get nauseous. I lose my appetite a couple times a year for a few months at a time, so it's not unusual.

 

When I quit imipramine, I think the first thing I noticed was feeling out of breath, then feeling the flu-like symptoms, but it didn't take off until the day after my second COVID shot. Then I had a fever of mid 101 degrees and all this popped up in full force. I think that's why I'm so confused--could it be the imipramine withdrawal, a reaction to the COVID shot, did I catch COVID, am I just not eating enough, or is it a bacterial infection? All of the above? I got that second vaccine on the 20th of July.

 

In other news, insurance didn't cover the Deplin so I got generic methylfolate, 7.5mg. I started taking that this morning. I'll be taking that every morning at nine AM.

 

Everything I take is in my signature, idk if anyone can see it yet, but I take propranolol 40mg once a day at night/anytime from 8-10pm (otherwise my tremors are so bad I can't even drink from a cup, and legs too shaky to drive sometimes) and I get the abilify maintena injection 400mg every four weeks, which treats some of my depression and nearly all of my schizophrenia (delusions, hallucinations, paranoia, disorganization, and it helps with some dissociation, and prevents self-harm.) I do not drink, don't smoke, no other drugs, and I don't drink coffee or caffeinated sodas except once every few weeks.

 

The imipramine was working great, some of the best years in my life, and then it just stopped working and I started getting more moody, depressed, and feeling like I might hurt myself, and when I quit it cold turkey most of that went away. In my experience, antidepressants I've taken work well for a while and then make things worse like this. Usually it causes the doctor to want to raise the dose, which only makes the depression worse.

 

Thank you for reading!

[Altostrata]

Thanks, @Butternubs

 

On 8/13/2021 at 10:21 AM, Butternubs said:

Doctor thinks COVID is unlikely, given lack of gastrointestinal issues and also lack of respiratory issues. Also I'm fully vaccinated and not very social.

 

Why did your doctor not order a covid-19 test? If I were you, I'd get a test for the antibodies. It may very well be you had mild covid and the antibiotics were unnecessary, the covid ran its course.

 

When did you last take imipramine? When did the headache start?

 

It is possible you had mild covid-19, the flu, or a cold AND you got imipramine withdrawal symptoms. Your doctor was remiss in not getting a test for bacterial infection and reflexively prescribing antibiotics, which can have lots of adverse effects on their own, particularly on the gut.

 

What is your current daily drug schedule (times o'clock), with dosages?

 

On 8/13/2021 at 10:21 AM, Butternubs said:

I don't eat vegetables at all, and certainly no leafy greens, so is it possible I'm low in folate anyways?

 

It's definitely possible. Fresh vegetables, particularly green leafies, are very, very good for humans and important to good neurological functioning. If I were you, I might titrate the 7.5mg methylfolate, a quarter-tablet to start, see if it has any effect over a week. Some people find B vitamin supplements make them nervous.

 

Deplin is a scam. Folate is not an antidepressant, though it may make you feel better overall. It is important for general body functioning and folate deficiency can be quite serious -- but your doctor was again remiss in not testing you for folate level.

 

On 8/13/2021 at 10:21 AM, Butternubs said:

The imipramine quit working and was even making me feel worse, so I quit cold turkey from 25mg.

 

What benefit did you feel from imipramine? How did imipramine make you feel worse? Did you ever accidentally forget or skip a dose? 

 

Why does your doctor want to prescribe another antidepressant? Is this your GP?

[Butternubs]

Thanks Altostrata! 

 

I'm not entirely sure why my primary doctor didn't test me for COVID. I think I might go back for a test... maybe my insurance doesn't cover it, which I doubt, but I just don't know until I ask.

 

That's a good question, I can't remember when I last took the imipramine. Looking through my journal, I see that I briefly switched over to amitriptyline 25mg when the imipramine stopped working. That was in mid June. Then I quit that as well because it wasn't helping the depression. I suppose I should have kept better records because my memory took a hit and I don't remember this. I wrote that I was feeling "fuzzy" and very out of it after quitting, but I don't have exact dates.

 

Yes, I think it might have been some sort of cold or minor COVID, I'm leaning towards minor COVID because I haven't ever had a cold last for weeks like that.

 

My daily drug schedule is Propranolol 40mg, at bedtime, usually nine PM. Then I get that monthly abilify maintena shot, but that's not like a pill I take every day. Then there's the methylfolate 7.5mg that I take with a huge glass of water when I wake up.

 

I'm feeling somewhat better since I started the methylfolate, but it's only been two or so days, and we'll see if it lasts or builds up. I have an iron-tough stomach (except with alcohol) so it doesn't cause any upset or anything. I haven't noticed anxiety. With the generic methylfolate I'm taking, they're capsules and I can't break them in half or I would have. I could open them and pour some of the powder out but then it would just go to waste.

 

Yes, I wish I could be tested for deficiencies but I've never heard of doctors doing anything like that where I live. I've asked for vitamin tests by name before, (I was on my period for two months and wanted my iron checked) but I just get a regular blood test/complete blood count. The primary care doctors (I just switched a month or two ago because my insurance changed) always tell me that if it's really important or serious, it'd be detected by a complete blood count, because it'd cause anemia. But I feel like there has to be more to it than that.

 

On 8/18/2021 at 4:30 PM, Altostrata said:

What benefit did you feel from imipramine? How did imipramine make you feel worse? Did you ever accidentally forget or skip a dose? 

 

 

I was in complete remission from my depression for a long time, sometimes I'd feel a little down but nothing severe, just normal sadness. When I get depressed it feels like my veins and heart are burning and that's when I know I'm really down. It didn't dull my emotions like SSRIs do, either. When it stopped working, I got more depressed and the burning feeling came back, and I'd sob at the smallest things. I never forgot doses, but near the end I skipped once or twice. I got the head zaps and they went away in a matter of days.

[Altostrata]

What are the symptoms you attribute to withdrawal?

 

3 hours ago, Butternubs said:

When I get depressed it feels like my veins and heart are burning

 

This sounds like a very, very unusual feeling of depression.

 

Please note, we don't treat depression here. We do, however, see a lot of drug adverse effects.

[Butternubs]

I think the biggest part of the withdrawal is feeling like I'm spaced out, or not in the zone. I feel dreamlike or fuzzy-headed often. There's the head zaps, which have fortunately passed. And then the frequent need to use the bathroom, which my primary doc thought was a bladder infection. And then I feel out of breath sometimes, but not as bad as when I first quit. 

 

I've heard that it's a very unusual symptom of depression, and I haven't encountered anyone else that feels the same way. But I do feel the burning feeling when I'm very depressed, and I know for certain that it's because of that. The pain gets so strong I can't get out of bed and barely breathe, and my heart might feel like it stops beating for a few seconds. If I feel for my pulse in my neck, there is nothing there in those moments. I wish there was someone who knew what this was. But that's besides the point. My heart tests every time I'm in the hospital are normal, but they've never tested me at the moment when the pain strikes. I know it all sounds outlandish, but it's always gone hand-in-hand with my depression.

 

Anyways. Is there anything to be done for the "out of it" and breathless feeling? Thank you again.

[Altostrata]

1 hour ago, Butternubs said:

I think the biggest part of the withdrawal is feeling like I'm spaced out, or not in the zone. I feel dreamlike or fuzzy-headed often. There's the head zaps, which have fortunately passed. And then the frequent need to use the bathroom, which my primary doc thought was a bladder infection. And then I feel out of breath sometimes, but not as bad as when I first quit. 

 

This is not a good feeling, but it is not depression.

 

2 hours ago, Butternubs said:

But I do feel the burning feeling when I'm very depressed, and I know for certain that it's because of that. The pain gets so strong I can't get out of bed and barely breathe, and my heart might feel like it stops beating for a few seconds.

 

How often does this happen? This also does not sound like depression, though you might feel depressed during or after one of these events.

 

In my opinion, it's unlikely any antidepressant is going to fix this, it sounds like it could be an adverse drug reaction, such as to propranolol. This sort of thing can occur when the drug reaches peak plasma, when it's wearing off (related to half-life), or if you take it off-schedule (withdrawal symptom).

 

Beta blockers are notorious for causing depression and they of course affect heart rate and breathing. It may very well be you get this odd symptom when a dose of propranolol reaches peak plasma 1 to 4 hours after a dose -- the drug at that point being too strong for you.

 

It's not unusual for an uninformed doctor to mistake an adverse drug effect or a withdrawal symptom for a psychiatric symptom and attempt to treat it with psychiatric drugs for many years.

 

We can help you taper off a psychiatric drug that's causing you trouble, but you'll have to identify the drug. 

 

To find out, you'd keep daily notes of times of day you take your drugs, their dosages, and your symptoms throughout the day. We need to know how you feel before and after taking each drug, and your symptoms in between. 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. They will show up in a regular pattern.

 

Why are you taking propranolol?

[Butternubs]

I'm on the Propranolol for severe tremors, and it also helps with anxiety and akathisia. I think it's very unlikely that it's causing any emotional issues--seeing that I had the burning feeling probably a decade before I even started the propranolol. When I was in the hospital once, they told me the same thing--that propranolol was causing my depression, but I didn't see any improvement when I was taken off it (I was mostly there for psychosis and restlessness). When I was pulled off it for a couple weeks I had horrible nightmares.

 

I can't get by without it either, because it's controlling my tremors so well. Before I was on it, I was having such bad tremors that I couldn't even drink from a cup without a lid and straw, and I had trouble driving. Now my hands are still as can be on my 40mg a night. I've tried lowering it to 20mg, but I think I did it too quickly and the tremors came back along with the nightmares.

 

I do have low blood pressure, however. I've been tracking it when I feel groggy and I've noticed that it has an impact on my dizziness and "out of it" feeling, but not a noticeable impact on my depression. I tend to hover a bit above 90/60 BP when I'm groggy and it goes up when I'm feeling more awake.

 

Can propranolol still cause low blood pressure even if my body is used to it, or does that effect go away with time the longer I'm on it? I might want to talk with my doctor about lowering to 30mg a day and see if that makes me feel any better, while still controlling my tremors. Is the 10% rule only for antidepressants or does it apply to this too?

 

Thank you again for your continued help!

[Butternubs]

Personality changes and confusion? Also sleepwalking

 

I've noticed after quitting nortriptyline (was on 50mg, then 25, then 10, then nothing), my most recent antidepressant, I've been feeling VERY different. It's as if my personality has changed!

 

I'm more pessimistic, always looking for the worst in people, cynical, and paranoid. Granted the paranoia might be my schizophrenia, but usually when I have it, I'm self-aware. This time, I'm NOT self-aware--just paranoid with a lack of insight. Which is very unlike me! When I step away from the situation, I'm still able to realize it, but when I'm around people, forget about it.

 

I also have a hard time typing which is unlike me--lots of typos I have to go back and fix. I'm a writer, so it's bothersome. My vocabulary feels like it's shrinking.

 

Also I have a hard time interpreting what I'm hearing and seeing. I walk into my bedroom and see my cat on the bed. Then I walk into the living room and see a blob on the cat tree and assume that's him. But afterwards I realize he can't be in two places at once. Or I'm driving and I see a mailbox and I think it's a person crouching by the side of the road. Or I hear running water and it sounds like someone whispering. And I see colorful blobs like floaters and generally feel "unreal."

 

I know these can all be due to the schizophrenia, but the personality shift is the most concerning and the overall fuzziness of my mind is VERY unusual for me. I've even started insulting people or using lots of curse words in my thoughts, which is extremely unlike me. I'm not irritable, but I am restless and I have a little akathisia. I bump into things and when I open the fridge I can't remember why. On top of that I can't seem to remember what day of the week it is, even if I constantly remind myself. I also sleepwalk sometimes, but I live alone so it's hard to tell how often. I've always been a sleepwalker as a kid, but I didn't do it for like 15 years.

 

With the nortriptyline, I was on 25mg and got very depressed, so it was raised to 50 and I was so much worse, so it was lowered to 25, and I was fine for a week, then got worse, and lowered it to 10, got better for a couple weeks, then felt horrible again. Then eliminated it entirely and felt so much better. Then a couple months, not entirely sure how long later, I'm dealing with this.

 

I am going through lots of stress in my personal life, but I don't think it's enough to do all of this.

 

Edited September 15, 2022 by ChessieCat
added topic title before merging with intro topic

[ChessieCat]

I've moved your post to your Introduction topic.

 

Please provide a list of what drugs you are currently taking, the dose, and the time you take it/them.

 

Q:  How is your sleep; ie how much sleep are you getting and what quality is it?

[Butternubs]

Thank you for moving this here.

 

My current drugs are just the propranolol 40mg daily at night, and the abilify maintena 400 injection monthly, as stated in my signature. I just got the shot on the seventh, so it's reached peak concentration for the month at this time.

 

I sleep 10-14 hours a day. I wouldn't say that I'm overly tired, because I can still function and I don't feel sleepy, but if I don't get this much sleep I start to hallucinate and dissociate.

 

I've noticed that I get the brain zaps when I'm trying to fall asleep at night, but they're subtle. I've tried vitamin B1 50mg (TTFD form) for these symptoms but haven't any luck and it seems to make the hallucinations worse (looked in the mirror and I had four eyes). I only took that for two or three days and my whole body smelled like garlic too. I don't know why.

[ChessieCat]

50 minutes ago, Butternubs said:

I am going through lots of stress in my personal life, but I don't think it's enough to do all of this.

 

I suggest you check out the following video.

 

Please note that I am not posting this with regards to detoxing but it is about how stress affects the body:

 

STRESS

 

Quote from the video:

 

any time that you have a stress response you're  going to decrease repair so basically you can  

defend yourself or you can repair stuff but you can't do both at the same time

 

This is a video about liver detox but the part that I would like to you to watch, and this is where the link begins, is the explanation about stress and the body:

 

Sten Ekberg:  #1 Absolute Best FATTY LIVER DETOX

[Butternubs]

Thank you for the video share. I watched the whole thing because I have non-alcoholic fatty liver.

 

I think it's possible that I had withdrawal but the stress made it a lot worse. I don't think the stress is going to go away for a few months though. Is it possible for withdrawal to appear over a month or two after quitting something? I've only heard of weeks, not months. Does it get worse before it gets better?

 

I would like to get to the root of this but I don't think I'm capable of thinking that deeply right now. I wonder if this is just my new personality.

[Altostrata]

1 hour ago, Butternubs said:

I've noticed after quitting nortriptyline (was on 50mg, then 25, then 10, then nothing), my most recent antidepressant, I've been feeling VERY different. It's as if my personality has changed!

 

Hello, @Butternubs Abilfy Maintena is not an antidepressant, it is a powerful antipsychotic. The "personality change" you've seen, disorientation, and fatigue are likely the usual effects of the drug you've been taking over the last year, NOT withdrawal from imipramine more than a year ago.

 

Suggest you talk to your prescriber and ask for a lower dose of Abilify Maintena. FYI here are Tips for tapering off aripiprazole (Abilify)

 

[Butternubs]

I've been on the abilify for four years and I haven't seen it do anything like this. If it is causing personality changes, it's a new thing. And very minimal compared to the personality change I have when I'm psychotic!

 

And quitting it has the risk of making my (currently mild) dyskinesia much worse and even make it permanent. Sometimes taking it causes dyskinesia, and sometimes quitting it does. It's not as simple as getting a lower dose. And when lowering it I am at risk of very severe self-harm like I have done in the past.

 

Besides all the risks, I have been thinking for a long time about lowering it but my doctor said it's not the time, especially with the stressful situation I'm in. I will ask again in a few months because I agree abilify is bad for me, just not for the reasons stated. I have muscle weakness, high cholesterol, tremors, among other things. I feel a little slowed down, but again I think that the bulk of it is due to the nortriptyline withdrawal.

 

And there seems to be a complete dearth of information on how to quit abilify injections without encountering TD, akathisia, psychosis, depression, fatigue, etc. besides "just go really slow" which with a prefilled syringe with no measurements on the side, doesn't seem that possible. There is a version in vials however, which may be more doable to measure. But then it's the problem of getting the nurse and doctor to go with it.

 

There is the 300 mg injection I could hop to, and then fill the gaps with pills. But the pills give me very severe akathisia, which the injection doesn't do. I think that complicates things.

 

I've noticed if I get the shot even a few days later than normal, it takes a month to recover. But I've always thought that was just "in my head."

 

Also I have started and quit the nortriptyline since taking the imipramine, which is my main concern at the moment. Sorry if I seem irritable, I'm just at my wit's end.

[Altostrata]

You've given absolutely zero details about your nortriptyline use in 2022.

 

If you get a movement disorder earlier in your Maintena injections, the dosage is too high.

 

14 minutes ago, Butternubs said:

I've noticed if I get the shot even a few days later than normal, it takes a month to recover. But I've always thought that was just "in my head."

 

This is interdose withdrawal from your Maintena injection as it wears off. You will have to work out with your doctor how to bridge this gap with perhaps partial tablets of Abilify.

 

You might read Tips for tapering off aripiprazole (Abilify)

 

I am sorry you have these symptoms, but we cannot help you with the adverse effects of a drug that you continue to take.

[Butternubs]

2 hours ago, Butternubs said:

With the nortriptyline, I was on 25mg and got very depressed, so it was raised to 50 and I was so much worse, so it was lowered to 25, and I was fine for a week, then got worse, and lowered it to 10, got better for a couple weeks, then felt horrible again. Then eliminated it entirely and felt so much better. Then a couple months, not entirely sure how long later, I'm dealing with this.

 

I put it right here but no one seems to be reading.

 

And these effects are NOT from the abilify. It has never done that to me and it wouldn't pop up right after quitting the nortriptyline. Not when the obvious answer would be that it's nortriptyline withdrawal. Like hearing hoofsteps and calling it a zebra instead of a horse.

 

The movement disorder isn't worse at the beginning of my monthly dose. I feel like no one here is reading my posts or caring about the situation. Would a little compassion hurt, especially when no one in my life understands? I thought someone here especially would understand but it doesn't seem like it.

 

Plus I said that I can't take the abilify pills because they cause unbearable akathisia, which the injection doesn't do. So linking to a post about tapering the pills does not help.